1. IRSC Follow-up
Mr. Fred Senne, the guest speaker (Dentsply), kindly allowed us to give you his slides for
reference.
Please contact us if you have practice questions or would like to see certain topics presented
at IRSC.
We look forward to seeing you at the next IRSC meeting on May 9th. The topic is: The Fixed
Hybrid Denture Solution with 4-6 Implants Using the Straumann Dental Implant System
presented by Brad Cates of Straumann.
Chris Bishop and Savi Abey
Implant Restorative Study Club (IRSC)
Prosthodonticsin.com
2. Dentsply Contacts
Implant
Restorative
Mr. Fred Senne (Regional Manager, West –
Study Club
Laboratory Channel) 800-531-3481 x66285
fred.senne@dentsply.com
Clark Beal (Clinical Sales Rep) 440-7830
clark.beal@astratech.com
Alex Schaeffer (District Manager, Laboratory
Sales) 773-469-4979
alex.schaeffer@dentsply.com
4. The freedom of unlimited possibilities
– patient-specific CAD/CAM abutments for all major implant systems
5. Atlantis BioDesign Matrix™
Atlantis VAD™ (Virtual Abutment Design)
Designed from the final tooth shape
Natural Shape™
Shape and emergence profile are based on the
individual patient anatomy
Soft-tissue Adapt™
Optimal support soft tissue sculpturing and
adaptation to the finished crown
Custom Connect™
Strong and stable fit –customized connection
for all major implant systems
6. Atlantis VAD™ (Virtual Abutment Design)
– designed from the final tooth shape
Utilizing the unique Atlantis VAD™ software,
Atlantis™ Abutments are individually designed
from the final tooth shape. The result is an
optimized abutment solution that offers the
best possible function and esthetics.
7. Atlantis VAD™ (Virtual Abutment Design)
• Proprietary software system designs
abutments entirely in a virtual environment
• Utilizes optimized 3D scanning of casts
• Integrates technician’s specifications into
design
• Automatically detects multiple features/design
parameters
• Engineered designs ensure
highest level of precision
8. Designed from final tooth shape
The scanned model is When the desired tooth shapes The final design is checked for
transformed into a 3D image, are decided, the abutments are fit and occlusal clearance before
making it possible to create the designed the abutments are produced
final tooth shape.
9. Atlantis VAD™ is beyond CAD
• CAD abutment design is humans doing design aided by computers
• Atlantis VAD™ is computers doing design aided by humans
• Part of an integrated, highly optimized process
• Specialized to abutment design
– Creates an optimal design to begin with based on
• Anatomy
• Engineering
• Manufacturability
– Never permits an invalid design
10. Value of Atlantis VAD™
• Esthetics – based on the natural tooth shape
• Function – retention, anti-rotation, crown function/failure
• Mechanics – undercuts, fit, low-fracture
• Compensates for misalignments of the implant
– angulations, offset
• Open for cooperation and partnerships, such as 3Shape,
Dental Wings and 3M
11. Original design
Design based on ideal values:
Feature Original values
Shoulder 0.5 mm
Taper 2.5°
Path of insertion even
Original
Optimal goal
Result
- Thin distal core
12. Manual correction: Option 1
Feature Original values New values
Shoulder 0.5 mm 0.5 mm
Taper 2.5° 1.5°
Path of insertion even even
Original
Optimal goal
Result
- Reduced taper allows for tighter fit
- Optimal goal still not achieved
13. Manual correction: Option 2
Feature Original values New values
Shoulder 0.5 mm 0.5 mm
Taper 2.5° 2.5°
Path of insertion even 3° change
Original
Optimal goal
Result
- Increase mesial porcelain offset
- Possible conflict with path of insertion
- Optimal goal still not achieved
14. Manual correction: Option 3
Feature Original values New values
Shoulder 0.5 mm 0.3 mm
Taper 2.5° 2.5°
Path of insertion even even
Original
Optimal goal
Result
- Only 1.0 mm for porcelain
15. The optimized solution: Atlantis VAD™
Feature Original values New values
Shoulder 0.5 mm 0.31 mm
Taper 2.5° 2.12°
Path of insertion even change of 0.7°
Original
Optimal goal
Result
- Optimal retention and fit
- 1.3 mm available for porcelain
- Optimal goal achieved
16. What Atlantis VAD™ considers
Cusp and fossa positions Core angle limits Occlusal surface existence Margin width relative to implant Cusp angles
Core keep out zone Porcelain thickness Core completion Sulcus shape Tissue blanching Papilla positions
Occlusal undercut Screw exposure Papilla widths Base emergence angle smoothness Base undercut
Core wall thickness Crown emergence angle smoothness Margin depth from soft tissue Bevel heights adjustment
Ideal shoulders Emergence angle limit Core shank interference Margin follows soft tissue Path of insertion
Cingulum undercut Taper angle Cervical margin visibility Ideal base shape per tooth
Occlusal reduction Core height Interproximal reduction
Margin smoothness Blank limit Margin height from implant
Papilla undercut Core retention
…and more
Papilla smoothness
Margin to counterbore distance
17. Natural Shape™
– shape and emergence profile are based on
the individual patient anatomy
The unique anatomical shape and
emergence profile of the abutment nourish
long-term soft tissue management and
provide optimal support and retention for the
final restoration.
18. Teeth are not round
Atlantis™ Abutments are
designed from the final tooth
shape
Reference:
Wheeler´s Dental Anatomy, Physiology and Occlusion,
Major M. Ash, Stanley Nelson
20. Stock vs. Abutments
Atlantis™Atlantis™ abutment
- optimized function and esthetics
Atlantis™ patient-specific abutment Stock abutment
21. Soft-tissue Adapt™
– optimal support soft tissue sculpturing
and adaptation to the finished crown
The design of each Atlantis™ Abutment
takes biology, anatomy and engineering
principles into consideration, providing the
right conditions for soft tissue to heal and
adapt to the finished crown.
26. Custom Connect™
– strong and stable fit – customized
connection for all major implant systems
Atlantis™ Abutment connections and
abutment screws are specifically engineered
and tested for each implant interface for
optimal fit, stability and a successful result.
27. Atlantis™ patient-specific abutments for
all major implant systems
• Astra Tech
• BioHorizons
• Biomet 3i
• Dentsply Friadent
• Keystone Dental
• Nobel Biocare
• Straumann
• Sybron Implant Solutions
• Zimmer Dental
All trademarks are the property of their respective owners.
28. Atlantis™ interface design philosophy
All interfaces are designed within the constraints of the
particular implant and include:
• Insertion feature for simplified handling
• Seating surface necessary to maintain tight seal and stability
• Anti-rotation features that also allow the abutment to be
accurately indexed to the implant
• Each abutment screw is designed to work optimally with the
specific connection and to correspond to the manufacturer’s
torque driver
29. Implant interface connection types Seal
A
Seal
B C
Seal Insertion
Insertion
Anti-rotation
Insertion Anti-rotation
Anti-rotation
A) Deep conical seal B) Planar or shallow cone C) Planar seating surface
with indexing feature with internal connection with external connection
E.g. Astra Tech, NobelActive, Straumann E.g. Zimmer TSV, 3iCertain, E.g. Nobel Branemark, Straumann
BoneLevel NobelReplace, Keystone Prima Narrow Neck
All trademarks are the property of their respective owners.
30. Atlantis™ quality
• Atlantis™ abutments are required to pass the
same testing protocol for regulatory authority
clearance as implant OEM products
• Atlantis products are subjected to extensive
mechanical testing including extreme
geometries (maximum angle, maximum length)
in both static and fatigue loading conditions
31. Engineering analysis on Atlantis™
interface designs
• Finite Element Analysis (FEA) performed for
every interface design to optimize strength of
critical regions
• Validated by mechanical testing
• Various configurations tested
• Component designs optimized via FEA & testing
(wall thickness, radii, etc.)
32. Atlantis™ interface design
• All dimensional features of an implant are first characterized in great
detail
• Detailed dimensional data are analyzed using statistical methods
• Interface design variables are analyzed and designed to match or
exceed functionality of the OEM connection for:
– Ease of insertion
– Anti-rotation
– Precision seal/seating surface
33. Atlantis™ Abutments
• Consistent quality of fit, independent of implant system (higher
precision of fit for some interface designs)
• Reliability of functionality equivalent to or better than OEM
• Confidence of FDA cleared product that’s backed by extensive
design analysis and mechanical testing
34. Atlantis BioDesign Matrix™
Atlantis VAD™ (Virtual Abutment Design)
Designed from the final tooth shape
Natural Shape™
Shape and emergence profile are based on the
individual patient anatomy
Soft-tissue Adapt™
Optimal support soft tissue sculpturing and
adaptation to the finished crown
Custom Connect™
Strong and stable fit –customized connection
for all major implant systems
Atlantis is comprised of a unique combination of four key features, which together, make the Atlantis BioDesign Matrix. These features work together to support soft tissue management for ideal functional and estheitc result. This is the true value of Atlantis for dental laboratories, clinicians and implant patients.
Atlantis VAD ™ (Virtual Abutment Design) is an expert system software that designs abutments entirely in a virtual environment. It ’s smart software that can take all of the information input and transform it into an initial abutment design. Atlantis VAD utilizes optimized 3D scanning of casts to create a virtual copy of your case. It then integrates your specifications into the initial engineered design. Engineered designs ensure highest level of precision no matter what the interface or material.
Atlantis VAD™ designs each abutment from the final tooth shape. It starts with the end in mind and then makes the abutment work for the restoration. With stock abutment restorations, the crown is adapted to suit the abutment – with Atlantis VAD – the abutment is adapted to fit the crown! This gives you the ability to follow traditional crown manufacturing techniques and creates a more esthetic and functional restorations.
When designing an abutment, there are some basic ideal values that one would look to achieve. In this example, what you see is an abutment that is designed to follow the parameters of these ideal values where there is a 0.5 mm shoulder width, a taper of 2.5 degrees, and the path of insertion is even in distance to the neighboring teeth on either side. However, the distal core (on the left) is thin and what we would like to achieve instead for this particular case, is an optimal goal (CLICK MOUSE TO BRING UP) of increasing the distal height of the abutment.
When working manually to redesign the abutment to reach the ideal goal, one option would be to leave the shoulder height value the same and adjust the degree of taper. When the degree of the taper is reduced the fit of the coping to the abutment may become too tight. In this example, you can also see how when decreasing the taper by one degree, you also decrease the space between the abutment and neighboring teeth and while this also increases the distal height of the abutment closer to the optimal goal, it still does not reach the desired goal.
In this second design change option, the original shoulder and taper values are left the same, while the path of insertion is offset by three degrees distally (left). While this change does bring us closer to the optimal goal, it is still not fully achieved. In addition, changing the path of insertion can sometime cause other conflicts with such things as parallelism needed. And in this particular case, the mesial (right) porcelain offset is increased too much as a result of the change.
Yet another possibility, is to adjust the distal (left) shoulder width. Here you see an example where the distal shoulder width is reduced by 0.2 mm in order to produce the optimal goal for the abutment design. Unfortunately, this change also creates a situation where there is only 1.0 mm of space on the distal side for the porcelain.
Here you see an abutment design that utilizes Atlantis VAD optimization. Atlantis VAD is a sophisticated technology that has all abutment design expertise, design considerations and parameters and manufacturing constraints and requirements built in. This allows Atlantis VAD to make small changes to all the parameters to achieve an optimal trade-off to create an optimal balance of all design considerations and constraint to develop a unique and optimized abutment design – consistently, every time and for every case. It allows for results that can be achieved by a human only if they had infinite time and computer-like patience.
One of the challenges to getting great implant restorative results stems from the fact that implants are round but teeth are not. You have to transition somehow, from round implant to tooth-shaped crown. If you use a round stock abutment as the foundation for your tooth-shaped crown, you cannot transition from round to tooth shape until you reach the restorative margin of the abutment. If you place the margin near the tissue to allow for easy cement removal, you get “potato-on-a-stick” restorations or “lollipop” restorations that don’t resemble real teeth – they look like implant crowns.
Another option is to set the margin very far sub-gingival in order to give the crown more room to make the transition. This results in a more natural looking restoration but can create a difficult situation for cement removal. As you know, cement left behind is one of the key reasons for implant failure post integration and can also cause fistulas and infections.
With patient-specific abutments, the anatomical abutment design allows for a natural looking restoration and cement removal is made easier because the abutment margin can be designed to be where you want it.
You have a lot of control in how your Atlantis Abutments are designed. The “Emergence Width” choice you make has the single largest impact on how the abutment is designed. Depending on what you select, the abutment can come back looking very different so it’s important to understand these choices and how they influence design. We’ll walk through each one in detail.
Full anatomical dimensions Largest diameter abutment provided with best emergence profile possible. A surgical incision for placement may be required. 2. Contour soft tissue Medium diameter anatomically shaped abutment up to 1.0 mm larger than sulcus of model of soft tissue provided. 3. Support soft tissue Anatomically shaped abutment will be up to 0.2 mm larger than sulcus of silicone model of soft tissue provided with desired emergence profile. “Easy” insertion. 4 . No tissue displacement Smallest diameter, non-anatomically shaped abutment with no soft issue support. The abutment will not touch the soft tissue.
Full anatomical dimensions Largest diameter abutment provided with best emergence profile possible. A surgical incision for placement may be required. 2. Contour soft tissue Medium diameter anatomically shaped abutment up to 1.0 mm larger than sulcus of model of soft tissue provided. 3. Support soft tissue Anatomically shaped abutment will be up to 0.2 mm larger than sulcus of silicone model of soft tissue provided with desired emergence profile. “Easy” insertion. 4 . No tissue displacement Smallest diameter, nonanatomically shaped abutment with no soft issue support. The abutment will not touch the soft tissue.
The result, is optimized and predictable adaptation of the soft-tissue.
When we created Atlantis™, our vision was to provide dental implant restorations as individual as every patient, every time and for every major implant system – unique originals for unique individuals.
In the development of all interfaces for Atlantis Abutments, the key functional aspects that impact product handling and performance are carefully evaluated, including ease of insertion, the presence of a tight abutment-to-implant seal, anti-rotation and an abutment screw designed to correspond to the implant manufacturer ’s torque driver and guidelines.
There are three basic categories or types by which abutment-to-implant connections can be described, as shown in this diagram. The connection type influences how the three key functional aspects of insertion, anti-rotation and seal is addressed.
For NA the regulatory authority is FDA.
An example of one way Atlantis™ Abutment interface designs are analyzed and optimized is through the use of a finite element analysis, which is a computer-based form of stress analysis that is performed to evaluate stress distribution as a result of load to ensure that all Atlantis Abutment interfaces are optimized for strength and reliability.
A consistent process is also followed in the development of Atlantis™ Abutment interfaces, which include (read bullets) .
The consistency of design and extensive quality testing and control processes allows us to provide our customers with (read bullets).
Only the unique combination of the four key features of the Atlantis BioDesign Matrix working together can ensure optimal soft tissue management for ideal functional and esthetic results. This is what differentiates Atlantis from your traditional stock components as well as other so-called “CAD/CAM” solutions.