Restorative Procedure

Impression and Transfer Technique
Components required:

  1. PerioSeal Metal Impression Post (PI0021)
  2. PerioSeal Implant Analog of the correct size

The PerioSeal system offers a convenient and simple method for preparing a laboratory model. The metal transfer impression post has a mechanical attachment identical to the collet lock on PerioSeal abutments. One impression posts fits all the PerioSeal implants; however it is extremely important to use the correct size PerioSeal Implant analog.

The metal impression post may be used with an open or closed tray method.

  1. Remove the healing cap or the tissue retraction abutment using the .050 hex with 1-2 turns counterclockwise (figure 1 in the next tab).
  2. The metal impression post is placed in the implant and tightened with a .050 hex driver (figure 2 in the next tab). Be certain the post is fully seated. It may be necessary to retract tissue from around the implant to visually verify proper seating or take a radiograph. Inject the impression material around the transfer pin and proceed with a routine impression (figure 3 in the next tab).
  3. Remove the recorded impression from the patient’s mouth and remove the post from the patient’s implants with the .050 hex driver. The impression material is of the clinician’s choice (figure 4 in the next tab).
  4. Replace the tissue retraction abutment in the patient’s implant or place a PerioSeal provisional abutment with a provisional restoration.
  5. Again, using the .050 hex drivers, lock the impression post into an implant analog corresponding to the size implant in the patient (figure 5 in the next tab).
  6. Insert the locked implant-analog assembly into the impression and send to the laboratory for processing (figure 6 in the next tab).
  7. Send the impression to the laboratory for fabrication of the working model.
    Note: The working model should always be a soft tissue model to allow accessibility to the prosthetic margin on the implant analog.

    Cementation Procedure
  8. After the fabrication of the prostheses, remove the healing cap or contour abutment from the patient’s implant (figure 7 in the next tab).
  9. Insert the prosthetic abutment from the laboratory in the patient’s implant and lock using the .050 hex driver (figure 8 in the next tab).
  10. After placing the prostheses, check occlusion and verify seating by using a radiograph. Cement the prostheses to the implant abutment. The cement of choice is the clinician’s personal preference. (figure 9 in the next tab).

Note: It is a good practice to always orient the flat side of the impression post to the facial if possible. This method makes it easier to place the post back into the impression correctly.

IMPRESSION TRANSFER PROCEDURE


Remove healing cap or tissue contour healing abutment from the patient's implant using the .050 hex wrench. Verify the locking nut is attached.

Insert metal impression post into implant and lock with hand pressure using the .050 hex wrench.

Inject impression material around the impression post and proceed with a routine impression.

Remove impression tray from patient. Remember to replace healing cap or tissue contour healing abutment back into the patient's implant.

Unlock impression post from the patient's implant and separate. Assemble the impression post to the corresponding implant analog and lock together with hand pressure.

Insert the locked implant-analog assembly into the impression and send to dental laboratory along with abutment of choice.

CEMENTATION PROCEDURE


Remove the healing cap or tissue contour healing abutment from the patient's implant using a 0.50 hex wrench.

Insert the prosthetic abutment fromthe laboratory in the patient's implant and lock with hand pressure using the 0.50 hex wrench.

Cement the prosthesis to the implant abutment. The cement of choice is the clinician's personal choice.

PROSTHETIC PROCEDURE


Items needed for impression phase.
Note: Implant analog must correspond with proper implant diameter.

Abutments for final prosthesis.
Note: Based on implant placement and aesthetic considerations, select straight, tapered, or tapered abutment as needed.

The abutment locking feature is a sliding nut that moves when the screw in the abutment is loosened or tightened. It is important to make sure the screw is not tight (locked) prior to insertion of the abutment or it will not go into the implant.
If the abutment does not seat properly, loosen the nut 1/2 turn counterclockwise and reinsert.
Note: Do not loosen more than one turn or the nut may come off the abutment screw. In the event abutment nut remains in the implant, reinsert the abutment and tighten the abutment screw one turn and retract abutment. Verify the nut is attached.
PRINT VIEW

Prosthetic Tips for the Restorative Dentist

Custom Trays:
A custom tray is recommended for implant impressions to accommodate the extended length of the transfer components. A custom tray will also ensure room for adequate amounts of impression material, assuring a distortion-free impression.
Implant Model:
If uncertain about the type of abutment to for the restoration, record an impression of the implant(s) using the transfer technique. The impression can be poured with a soft tissue model material and the laboratory can assist with the selection of appropriate abutment design of the restoration. This model can also be used for fabrication of the restoration.
Abutment Seating:
After removing the healing abutment or healing cap, irrigate and inspect the implant interface for any bone or tissue fragments. Any small debris can preclude the required flush interface necessary for a secure seat. An abutment must be securely seated into the implant prior to any impression procedure. The abutment should be firmly seated with the appropriate tool. A radiograph can be helpful to confirm proper seating.
Radiographs:
A periapical radiograph may be taken prior to recording the impression to ascertain a flush interface between the abutment and implant or transfer assembly and implant. If these components are not fully seated, the impression will be inaccurate.
Removal of Broken Screws:
If an abutment screw fractures in the abutment or the abutment fractures in the implant, the remaining portion of the abutment can usually be removed with a suction tip or an explorer to work the broken segment out.
Materials:
All transfer impressions should be recorded with a firm impression material such as polyvinylsiloxane or polyether. Impression material should be expressed around transfer components as well as in the tray. Follow manufacturers’ recommendations regarding use of tray adhesives. Final impressions of modified Fixed Abutments can be recorded with conventional crown and bridge impression materials.
Inspection:
After removing the impression from the mouth, check the area in the impression around transfer component for impression material. If a flash of material is present, the transfer component was not properly seated. A new impression must be taken.
Abutment Modification:
Necessary modification of fixed abutments should be done on an analog model rather than intraorally. The heat generated by contouring the abutment is potentially detrimental to the health of the implant/bone interface. Small abutment adjustments with water irrigation may be made intraorally.
Framework Try In:
A try-in of the metal framework is advised prior to completion of the final restoration. Consideration should be given to casting large frameworks in sections, relating the sections intraorally with a light-cured resin and soldering the sections in the laboratory.
Fixed Cementation:
Provisional cement may be used for cementing crown and/or bridge restorations to Fixed Abutments. The provisional cement will maintain the ease of retrievability in the restoration and preclude moisture and bacteria from gathering between the restoration and abutment.
Combining Fixed Components
In multiple implant supported restorations, a situation may occur where it would be desirable to use multiple Fixed Abutments (cement-retained prosthetics).
Covering Abutment Screws:
Seat the restoration and tighten the abutment screw with the torque wrench. Place a thin covering of removable material over the head of the abutment screw (e.g., gutta percha, temporary filling material). Fill the remaining channel with a restorative composite material.

Prosthetic Tips for the Laboratory Technician

Abutment Modification:
When modifying fixed abutments, carborundum discs and carbide burs are most effective. It is not recommended to modify fixed abutments intraorally. All major modifications should be done on an implant analog or diagnostic model with implant analogs in place.
Waxing:
The waxing of the restoration should be done directly to the prosthetic abutment that is to be utilized as the final abutment in the patient’s implant.
Alloy Selection:
All implant restorations should be fabricated from a high noble alloy. Non-noble alloy materials should be avoided in implant prosthetics.
Die Material:
When pouring crown and/or bridge models of modified fixed abutments, a reinforced die stone, epoxy or resin material is suggested in the area of the abutments for additional strength.
Gold Alloy Abutments:
These components are machined from a high noble, non-oxidizing gold alloy. For ceramo-metal restorations, be certain that the wax covers the parent alloy in all areas that will receive porcelain. When casting to these components for a ceramo-metal restoration, an alloy with a similar thermal coefficient of expansion must be used. The wax is burned out and subsequently replaced with ceramic alloy. Care must be taken to ensure adequate thickness of the cast alloy to prevent cracking of the porcelain.
Plastic Components:
When placing the abutment screw into a plastic component, lightly tighten the screw just to stabilize the component. Excessive tightening can potentially distort the plastic component during the waxing phase.
Polishing:
When polishing the prostheses place some sort of protection over the soft tissue portion of the implant neck area to protect the surface during polishing procedures.

Utilizing Locator® Abutments


Remove Perioseal™ healing caps or tissue contour healing abutments with the .050 hex wrench. The top of the implant should be above the gingival crest.

Insert Locator® Abutment into implant applying pressure until abutment is sealed. NOTE: The Locator® Abutment will not seat if in locked position.

Hand-tighten the Locator® Abutment with the Locator® driver. Do not torque. (.5mm, .2mm, .3mm, and .4mm height)

Place the impression copings on the Locator® Abutments for the impression.

Take the final impression and connect the analogs to the impression copings. Send the impression to laboratory for processing.

The hook-style Core Tool and processing package.

Remove the black processing cap from the finished full denture base delivered from laboratory with the core tool.

Insert the replacement retention cap of choice (clear, pink or blue) with the male seating tool.

Upon delievery of denture, check pressure spots and occlusion. Adjust as needed.

Locator® Abutment components

  1. After removal of the Perioseal™ healing cap or the tissue abutment with the .050 hex wrench, insert the Locator® abutment into the Perioseal™ implant using the abutment driver and tighten by hand. The abutment driver is the gold colored portion of the Locator® Core Tool as seen in figure 6. Do not torque.
  2. Place a Locator® Impression Coping onto each Locator® Implant Abutment. Inject a light body, vinyl impression material around each impression coping.
  3. Complete the impression using a firm body impression material. The Locator® Impression Coping is designed with minimum retention to be picked up with the completed impression.
  4. Snap a Locator® Abutment Analog into each impression coping making sure the analog is fully seated. The Locator® Abutment Analog is designed with a precise fit into the Locator® Impression Coping, allowing for an accurate transfer to the working model.
  5. The master cast is poured, incorporating the Perioseal™ abutment analogs. The abutment analog in the master cast replicates the exact position of the Locator® abutment in the patient's mouth, now in the acrylic model.
  6. Send the master cast to the laboratory for processing of the denture. The dental laboratory will process the metal denture caps (housing) into the overdenture.
  7. After receipt of overdenture from the laboratory, remove the black processing liner out of the metal cap in the denture with the male removal tool.
  8. Seat a nylon retention cap (clear, pink or blue) into the metal denture cap with the male seating tool.
  9. Deliver the overdenture to the patient and make tissue and occlusional adjustments as needed.
DOWNLOAD POWERPOINT PRESENTATION
PRINT VIEW

BALL RETAINED OVERDENTURE

Components Required:

Ball-Top Abutment Accessories Package PA0142 or PA0143
Note: All Accessories used with the ball-top abutment are included with the ball-abutment package

The PerioSeal Ball-Top abutment and accessories are used to retain dentures in either arch. The Snap-Cap for the ball-top is made up of two components:

1. The Titanium Snap-Cap Housing
2. The White Delrin Retention Snap-Cap.

The retention snap-cap is assembled into the housing by pressing with the end of the restorative ratchet or another flat object. If needed, the retention snap-cap can be removed for replacement by cutting out a slot and prying it out with an explorer. The top of the PerioSeal implant body should be flush with the gingival tissue, which will allow the implant-abutment junction not to be subgingival. There may be as few as two implants, or in most cases,four to six implants to retain the denture.

The Ball-Top Abutment system offers a more economical alternative to a bar supported denture. The ball top retention of the removal denture is equal to, or better than, the conventional bar supported denture and costs less. The ball-top abutment allows stable and secure attachment of the denture to the PerioSeal implants while still allowing easy removal by the patient. The ball top also provides for better oral hygiene procedures by the patient.

The ball-top abutment package comes complete with all accessory items needed for attachment to the denture. The accessories furnished with each ball top abutment package allow either laboratory or chair side processing of the denture. It is the choice of the clinician as to which method best accommodates a particular case. Both methods are outlined for consideration.

Ball Top Abutment Placement and Impression for Laboratory Processing
Remove the healing cap or tissue retraction abutment with the .050 hex driver using one or two turns counterclockwise and then pulling the cap out of the implant (figure 1). Make certain that the nut at the bottom of the cap or abutment does not remain in the implant. Insert the correct size ball-top abutment into the implant and rotate clockwise by hand to engage the the hex within the implant body.

Place the ball-top driver over the hex on the ball abutment and rotate clockwise while pushing into the implant until the ball abutment is tight (figure 2). This method insures the mechanism is locked. Use a torque wrench and tighten to 35 ncm. Visually verify the ball abutment is seated with the top of the implant.

The ball top plastic snap impression cap is placed on each abutment and the impression is recorded, being sure that each cap is firmly seated (figure 3). Inject impression material around each plastic impression cap and proceed with a routine impression (figure 4). Remove the impression tray from the patient. The plastic snap impression cap will remain within the impression material (figure 5).

The ball implant analog is placed in each plastic snap cap of the recorded impression (figure 5). A soft tissue model is poured in dental stone for laboratory processing (figure 6). The snap-caps are processed into the denture using the block out rings under the snap-caps. Transfer post may also be utilized to record the implant position for the laboratory. The patient’s temporary denture may be relined with a soft material while the final denture is being processed.

ILLUSTRATED IMPRESSION PROCEDURE

BALL-TOPPED DENTURE

Remove healing cap or tissue contour healing abutments with the .050 hex wrench.
Insert ball-top abutments using the ball abutment driver and ratchet. Note: the ball-topped abutment will not seat when it is in the locked position.
Snap impression cap into place with finger pressure.
Inject impression material and take a closed tray impression.
Insert ball-top analog, or send to lab along with snap cap and metal housing for dental fabrication.
Ball-top analogs in stone model, ready for laboratory processing. The block-out ring is utilized when performing a chair side re-line of the denture.
Completed Denture.
Insert the prosthetic abutment fromthe laboratory in the patient's implant and lock with hand pressure using the 0.50 hex wrench.
Picture of all ball-top components.

Ball-Top Impression Procedure

  1. Unscrew the healing cap or tissue contour healing abutment 1-2 turns counterclockwise with the 0.50 hex wrench. Remove the healing cap from the implant, being sure the locking nut is attached. (Figure1)
  2. Place the ball-top driver over the hex on the ball abutment and rotate clockwise while pushing into the implant, until the ball abutment is tight. NOTE: Do not torque. (Figure 2)
  3. The white plastic impression cap is placed on each ball abutment. Be sure each cap is firmly seated. (Figure 3)
  4. Inject impression material around each plastic cap and proceed with a closed tray impression. (Figure 4)
  5. The plastic impression caps will remain within the impression material. A ball top implant analog is placed in the opening of each plastic impression cap embedded in the recorded impression. (Figure 5)
  6. A soft tissue model is poured in dental stone for laboratory processing. (Figure 6)
  7. The block-out ring is utilized when performing a chair side re-line of the denture. (Figure 7)

Ball Attachment-Retained Overdenture Tips

With the ball overdenture, the implant ball abutment junction must remain supragingival to prevent microbial trauma to the hard and soft tissues.

The ball retained overdenture is an implant and tissue supported overdenture retained by ball attachments, which are locked directly into the implants.

Indications:

  • Provides denture stability
  • May be used as a transitional prosthesis
  • Severe posterior bone loss that prevents implant placement
  • Financially compromised patient
  • Implants too posterior to connect with a bar

Advantages:

  • Minimum of two implants required
  • Can retrofit existing prosthesis
  • Hygienic for home care

Advantages:

  • Lateral load and attachments need servicing
  • Implants must be parallel within 10-15 degrees

PRINT VIEW

BAR RETAINED OVERDENTURE

Components Required:
Cone-Top Abutment (PA0221 or PA0222)
Note: Accessories are not included with the abutment.

The PerioSeal Cone Top Abutment provides the components of a Cast Gold Alloy or Welded Titanium Bar for denture retention. There are two procedures for restoration using the cone top abutment. It is the choice of the clinician as to which method best accommodates a particular case. Both methods are outlined for consideration.

In the first method, an impression of the implants is recorded and a soft tissue model is fabricated with implant analogs. In the second method, the cone top abutments are placed at the second stage surgery and the model is fabricated with cone top implant analogs.

Restoration using Implant Analogs:
The implants are uncovered after appropriate healing of the tissues and a tissue contour abutment is placed to flare the soft tissue. A soft tissue working model is fabricated using implant analogs.

  1. An impression is recorded of the implants. (See impression and transfer technique)
  2. A model is fabricated and sent to the lab with the appropriate cone top abutments.
  3. A cast bar is fabricated by placing a cone top abutment into each implant analog and attaching a gold alloy coping with a plastic sleeve (PA3012) using a cone top screw (PH0018). The bar is formed by waxing between the copings. The bar is then cast using normal laboratory procedures.
  4. The lab then delivers the bar and the cone top abutments.
  5. The healing abutments are removed from the patient by loosening the screw with the .050 hex driver 1 or 2 turns and pulling the abutments out. Note: It is important to verify that the expansion nuts are on the healing abutments and not remaining in the implant in the patient.
  6. The cone top abutment is placed into the implant and the cone top abutment hex is aligned with the hex in the implant. A cone top hex driver is placed over the abutment and loosened 1 or 2 turns while gently pressing the abutment into the implant. When the abutment advances into the implant, the implant is tightened to 35 ncm.
  7. The bar is evaluated for passive fit in the patient. After verification of a passive fit, the bar is attached using the cone top screw (PI0018) tightened to 30ncm. Note: It is recommended that all screws be inserted and tightened hand tight before final tightening.

Restoration using Cone Top Abutments at Second Stage Surgery:
The appropriate size cone top abutment may be placed in the implant at the time of second stage surgery. An impression is taken of the abutment using a cone top impression post (PI0025) and a working model is fabricated using the cone top implant analog (PI0232) to make a working model.

  1. The healing cap is removed from the implant by loosening the screw 1 or 2 turns and pulling the cap out. It is important to verify the retention nut is on the healing cap. The appropriate size cone top abutment is placed into the implant by locating the hex in the implant and aligning it with the hex on the abutment. The abutment is loosened 1 or 2 turns while applying gentleforce to push it into the implant. The abutment is then tightened to 35 ncm.
  2. A cone top impression post (PI0225) is installed on the abutments with a retaining screw (PI0018). The impression is then recorded.
  3. The impression posts are removed from the abutments in the patient and attached to cone top implant analogs. The impression posts are then reinserted into the impression for fabrication of a working model.
  4. A cast bar is fabricated on the working model. A gold alloy coping with a plastic sleeve (PA0018)is fastened to each cone top implant analog using a cone top screw (PH0018). The bar is formed by waxing between the copings. The bar is then cast using normal laboratory procedures.
  5. The bar is evaluated for passive fit in the patient. After verification of a passive fit, the bar is attached using the cone top screw(PI0018) tightened to 30ncm.

Note: it is recommended that all screws be inserted and tightened hand tight before final tightening.Welded Titanium Bar

Components required for the Titanium Bar Coping
A welded titanium bar may be fabricated using a titanium bar coping. This service is offered by some dental labs. The procedures outlined above are the same for a welded titanium bar with the substitution of the titanium coping for the gold coping.