Lab Tribune Middle East & Africa No. 1, 2019
The many characteristics of a long-term hybrid abutment crown
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DTMEA_No.1. Vol.9_LT.indd
PUBLISHED IN DUBAI
January-February | No. 1, Vol. 9
www.dental-tribune.me
The many characteristics
of a long-term hybrid abutment crown
Viteo Base is the basis for the production of implant-supported single tooth restorations
By Marie Reinhardt, Liechtenstein
This article presents the new titanium bonding base Viteo Base for implant-supported single tooth restorations. The prefabricated prosthetic
component has been specially developed for use together with ceramic
restorative materials: Viteo Base has
various characteristics that simplify
the path to aesthetic, long-lasting
implant restorations. The prefabricated connecting surface geometries
are compatible with various implant
systems. Viteo Base can be processed
using the press technique (IPS e.max
Press) and, alternatively, with CAD/
CAM technology (Telio CAD, IPS
e.max CAD). In the present case, the
working steps involved in producing a pressed implant crown and the
advantages of the Viteo Base will be
shown.
Implant prosthetics is an ever growing segment. It is becoming more
and more popular to close single
tooth gaps with an implant and the
corresponding restoration in order
to preserve the surrounding tooth
substance. Modern prosthetic concepts and state-of-the-art materials
enable the fabrication of functional
and aesthetic restorations. Titanium
bonding bases unite the advantages
of a prefabricated component with
those of a custom-made abutment:
In a comparatively simple manner,
the natural oval shaped emergence
profile of the tooth is adapted to the
round emergence profile of the implant. The design of the restoration
and its connection to the underlying
titanium bonding base are ultimately the elements which are essential
for the success of the restoration.
Many characteristics,
specifically incorporated to enhance the restoration material
With the new Viteo Base, the dental
technician is provided with a titanium bonding base which ideally
compliments press and CAD ceramics (Fig. 1). This has numerous advantages, which will be discussed further
throughout this article. The special
soft edge design without sharp edges
and protrusions, the recessed rotation protection and the preconditioned bonding surface of the titanium bonding base are responsible
for these benefits. The connection
between the titanium bonding base
and the implant is certified and coordinated with the most commonly
used implant systems. Viteo Base is
available in two diameters: MD (Medium Design) and SD (Small Design).
The chosen implant system determines the diameter to be used. Infor-
mation on which implant system is
suitable for which Viteo Base; which
scan abutment is to be used; which
restoration material can be applied
and which Viteo Base components
are available, is provided in a special
combination table. This is available
on the Ivoclar Digital website.
Shortening from 6 to 4 mm
Depending on the prosthetic situation, the Viteo Base can be shortened
from 6 mm to 4 mm. This is carried
out easily using a separating disc. A
special tool, the Viteo Base Trimmer,
restores the soft edge design (rounded design for even force distribution)
after the shortening process. The following case study illustrates this procedure: A hybrid abutment crown is
produced using the press technique
in the usual manner. The crown is
created in wax on the titanium base
according to the respective clinical
situation, then converted into press
ceramic and cemented to the Viteo
Base before being screwed into the
patient’s mouth.
when it is cemented to the restoration material and it acts as a “guide”.
In addition, the minimum thickness
of the restorative can be maintained;
the cement gap is even throughout
the restoration. Stress can therefore
be avoided.
The space available in relation to the
antagonist tooth was ideal for the
full-ceramic crown supported by a
6-mm titanium bonding base (Fig. 3).
In other cases, it may be necessary to
reduce the height of the Viteo Base
to 4 mm with a separating disc. The
shaft height must be no less than
4 mm. This is laser-marked on the
abutment shaft.
The Viteo Base Press Sleeve, a modelling aid made from acrylic, is used
to support the wax crown. The adhesive surface of the titanium bonding
base is preconditioned, which means
it is too rough for the wax to be applied directly. This is where the Viteo
Base Press Sleeves come into play.
As with the titanium bonding bases,
they are available in two sizes (SD,
MD). In this case the sleeve diameter
was size MD, to suit the selected Viteo Base (Fig. 4). The Viteo Base Press
Sleeve was then shortened with a
ÿPage B2
AD
Starting situation in
the laboratory
An osseointegrated implant in region 46 required a full ceramic
crown. The soft tissue was optimally
shaped during the healing phase
with a temporary restoration (Telio
CAD). This was the ideal preparation
method for an implant-supported
crown made from IPS e.max Press.
A screw-retained crown was selected
in order to avoid any risk of residual
cement. The master model was produced from the implant impression.
A gingival mask was created to allow
an exact assessment of the soft tissue
situation and the emergence profile.
The press technique was selected for
this case, which meant that the modelled tooth shape and the occlusion
could be transferred directly into the
ceramic. In order to benefit from a
high degree of material strength and
good aesthetics, a monolithic restoration was selected.
The
original
Preparation
The titanium bonding base Viteo
Base was chosen according to the implant system in size MD, then placed
on top of the laboratory implant and
screw-fixed with a torque of approx.
5 Ncm (Fig. 2). The recessed anti-rotation protection (vertical groove) was
positioned distally in the jaw for the
production of the restoration. The
Viteo Base can also be positioned in
a mesial direction. The recessed antirotation protection is located vertically throughout the entire length of
the shaft. It ensures that the titanium
bonding base is situated correctly
All ceramic,
all you need.
www.ivoclarvivadent.com
Ivoclar Vivadent AG
Bendererstr. 2 | 9494 Schaan | Liechtenstein | Tel. +423 235 35 35 | Fax +423 235 33 60
[2] =>
DTMEA_No.1. Vol.9_LT.indd
B2
LAB TRIBUNE
Dental Tribune Middle East & Africa Edition | 6/2018
◊Page B1
Fig. 1: The assortment: Viteo Screw Channel Pin,
Viteo Base Press Sleeve, Viteo Base, Viteo Screw, (from
the left),
Fig. 2: The Viteo Base MD screwed together with the
laboratory implant
Fig. 3: Starting situation with the titanium bonding
base on the model
Fig. 4: Viteo Base with the unshortened Viteo Base
Press Sleeve in place
Fig. 5: Shortening the Viteo Base Press Sleeve with
the separating disc
Fig. 6: Isolating the Viteo Screw Channel Pins to
lengthen the screw channel
Fig. 7: Carving of the crown in wax
Fig. 8: Checking the wax crown for shape and function on the model
Fig. 9: The wax crown lifted from the Viteo Base
Fig. 10: Spruing the crown in preparation for the
pressing procedure
Fig. 11a: Checking the position of the crown in the
ring base with the IPS Multi Sprue Guide.
Fig. 11b: IPS Multi Sprue Guide
Fig. 12: In preparation for pressing: IPS e.max Press Multi ingot, disposable plunger, aluminium oxide plunger
diamond separating disc (Fig. 5). The
fit of the press sleeves on the titanium base in the region of the screw
channel and margin was thoroughly
checked. In order to ensure that the
wax can be simply lifted off later on,
the titanium bonding base was first
isolated in the area of contact to the
Press Sleeve.
Waxing-up the crown
The crown in region 46 was waxedup according to the required shape,
morphology and function. For this
purpose, the screw channel had to
be lengthened in the occlusal area.
A special pin (Viteo Screw Channel
Pin) made of acrylic was inserted
directly into the screw channel.
This also protected the screw channel from contamination. After the
crown had been waxed-up, the pin
was simply removed. The detailed
occlusal surface was left undamaged.
The pin was isolated before being
inserted into the screw channel and
the crown was subsequently carved
in wax (Figs. 6 and 7).
The crown was waxed-up in the
conventional manner, taking both
dynamic function as well as static
occlusion into consideration (Fig. 8).
The wax crown was lifted easily from
the titanium base (Fig. 9). Time and
effort invested in this working step
proves worthwhile after the pressing
process: The more detailed the wax
pattern is, the less rework is necessary on the pressed restoration.
Fig. 13: Cooling the ring down after pressing
Transferring the wax crown
into ceramic
Lithium-disilicate glass ceramic
IPS e.max Press is well proven for
good press results in ceramic. High
strength of 470 MPa, exceptional
esthetics and excellent light-optical
properties ensure a life-like restoration. The polychromatic press ingot
IPS e.max Press Multi, with lifelike
graduating colour and translucency
from the dentin structure to the incisal edge, gives monolithic restorations the desired aesthetic appearance. In general, after pressing, the
restoration only requires glazing or
it can be customized with the IPS
Ivocolor stains.
The versatile Press Multi ingot
The IPS e.max Press Multi ingot
has significantly more chroma in
the lower region than in the upper
third. A special spruing technique is
used in order to ensure that the ingot’s colour layers are in the correct
position on the crown after pressing. For this purpose, the waxed
crown was connected to the side of
the ring base. Instead of wax rods, a
prefabricated precision wax pattern
(IPS e.max Press Multi Wax Pattern)
was used. The wax crown was positioned vertically centred to the wax
pattern and attached at the mesiobuccal side, so that an optimal colour
graduation could be achieved in the
visible area (Fig. 10). The crown was
sprued onto the 200-g IPS Multi ring
base. The occlusal surface of the wax
crown was pointed towards the bottom of the ring base. The sprue position was checked with the IPS Multi
Sprue Guide 200 g (a type of template) (Fig. 11).
New investment material used
The object was invested using a new
investment material: IPS PressVest
Premium. After mixing, investing
and setting, the ring was placed in a
preheating furnace (850 °C) for 60
minutes. The press ingot (IPS e.max
Press Multi, shade A 3.5), the disposable plunger and the aluminium
oxide plunger (IPS e.max Press Multi One Way Plunger and IPS Alox
Plunger) were then placed into the
preheated furnace (Fig 12). The ingot
and the plungers were not preheated. After placing the assembled press
ring into the preheated press furnace
(Programat EP 5010), the pressing
program was started.
After pressing, the ring was removed
from the furnace and allowed to cool
slowly (Fig. 13). Using glass blasting
beads, the ring was first divested
roughly (4 bar pressure) and then
finely (2 bar pressure).
The fit of the pressed crown on the
Viteo Base was checked. In this case,
the crown was a little too tight; it
was adjusted with a diamond grinding bur (Fig. 14). The crown was then
screwed onto the master model together with the titanium bonding
Fig. 14: Fitting the ceramic crown on the Viteo Base
base. The proximal contact points were checked,
along with the static and
dynamic occlusion. Any
interfering contacts were
removed before the try-in
in the mouth.
Fig. 15: For better handling, the Viteo Base, screwed
onto the laboratory implant, was attached to the
Viteo Holder and then silicone was applied for the
first clinical try-in.
Trying-in the hybrid
abutment crown in
the mouth
Before the ceramic crown was permanently cemented with the Viteo
Base, there was a clinical try-in. The
two parts were temporarily attached
to each other with a thin flowing impression silicone (Virtual Extra Light
Body Fast Set). The titanium bonding
base was screwed to the laboratory
implant. In this case, the Viteo Holder made handling easier.
The ceramic structure was then
placed correctly on the Viteo Base
and the position was marked with
a water-resistant pen. The two parts
were then separated from one another and cleaned with the steam jet.
Then the screw channel of the Viteo
Base was closed with the Viteo Screw
Channel Pin. The silicone (Virtual Extra Light Body Fast Set) was applied
to the adhesive surfaces of the Viteo
Base and the pressed ceramic structure. Both objects were then reconnected into the correct, previously
marked position (Figs 15 to 17). Excess
material was carefully removed with
an instrument after the silicone had
set (Fig. 17).
The try-in confirmed
the good fit
In the clinical try-in, the dentist
checked the emergence profile, the
proximal contacts and the occlusion of the crown. The try-in in the
patient’s mouth confirmed the good
fit of the restoration. Note: The lightoptical properties cannot be assessed
during the try-in. Firstly, the ceramic
is still matt at this time as it is still unfinished. Secondly, the permanent
luting composite (Multilink Hybrid
Abutment) has different degrees of
translucency, through which the
Viteo Base visually “disappears”. Regardless of these limitations, it was
apparent that IPS Ivocolor stains
would be needed to optimally adjust
the shade of the crown’s occlusal surfaces to adapt to and harmonize with
the surrounding teeth.
ÿPage B3
[3] =>
DTMEA_No.1. Vol.9_LT.indd
B3
LAB TRIBUNE
Dental Tribune Middle East & Africa Edition | 6/2018
◊Page B2
Fig. 17: Removing the excess silicone after setting
Figs 18 to 19: Characterization of the ceramic crown with the universal stain and glaze assortment of IPS
Ivocolor
Fig. 20: These instruments are required for luting the
Viteo Base together with the ceramic object.
Fig. 21: Conditioning the surface of the titanium bonding base
Fig. 22: Etching the bonding surface of the ceramic object.
Fig. 23: Applying the luting composite
Fig. 24: Removing the excess material during the setting phase
Fig. 25: Carefully polishing the joint
Fig. 26: Polishing the crown after insertion
Finishing the crown/individualization
The pressed IPS e.max crown was
stained with the universal stain and
glaze range of IPS Ivocolor (Fig. 18). A
warm colour was applied to the central fissure to give the impression of
depth. The cusp tips were accentuated with white (Fig. 19). A wash of blue
stain was gently added to the incisal
area to intensify the translucency of
the crown. After the stains had been
fired, the IPS Ivocolor Glaze Paste was
applied to the crown and Glaze firing
was carried out. The contacts were
then checked again in the articulator.
Permanent cementation of
the prosthetic implant restoration (Fig. 20)
The cementation process of a ceramic crown and titanium bonding
base is a delicate working step, which
requires high precision. Since the
Viteo Base is already preconditioned,
it does not have to be sandblasted
before cementation. This saves one
working step and therefore saves
time. Nevertheless, this does not apply if the abutment was shortened.
The shortened surfaces have to be
re-sandblasted in order to achieve an
ideal bond and a good marginal seal.
In this case, however, the Viteo Base
was used with a 6-mm shaft height
and was not shortened. The titanium bonding base was immediately
cleaned in the ultrasonic bath and
then additionally steam cleaned. In
doing so, all wax residues and other
impurities could be removed thoroughly prior to the bonding procedure. A uniform matt surface colour
showed that the drying and conditioning process was successful.
As with the temporary placement
procedure, the titanium bonding
base was cemented on the laboratory implant and placed in the Viteo
Holder for easy handling. The ceramic object had been previously
marked with a water-resistant pen
for correct positioning and subsequent bonding with the Viteo Base.
The universal primer Monobond
Plus ensures optimal bonding to the
metal. It was applied to the bonding surface of the Viteo Base and allowed to act for 60 seconds (Fig. 21).
Any excess was dried with oil-free
compressed air. Etching gel was applied to the bonding surface of the
ceramic object (IPS Ceramic Etching Gel) (Fig. 22), then the area was
thoroughly rinsed and dried. Next,
Monobond Plus was applied to the
ceramic surface and allowed to act
for 60 seconds. Any excess was
blown away. Alternatively, the innovative single-component primer
Monobond Etch & Prime can be used
here: It etches and silanizes the glassceramic surfaces in one working
step. Before cementation, the screw
channel had to be closed in order to
prevent composite residues from
falling into it. The Viteo Screw Channel Pin was used for this purpose. For
easier handling, this was shortened
and then inserted into the Viteo Base
screw channel.
The IPS e.max Press ceramic structure was bonded to the Viteo Base
using the Multilink Hybrid Abutment self-curing luting composite,
which is specially developed for the
permanent cementation of ceramic
structures to titanium/titanium alloy bases. It is available in two levels
of translucency. In this case we used
the version with a higher degree of
opacity (HO 0) (Fig. 23). The Multilink
Hybrid Abutment composite was
applied to the bonding surface of the
Viteo Base and to the inner surfaces
of the ceramic object. Thanks to the
previously applied pen mark, both
components could be easily placed
in the correct end position. The ro-
tation protection, which runs along
the entire length of the shaft, acted
as a guide.
Both components were firmly
pressed together for five seconds.
Any excess composite – a gel-like
consistency – was removed with
an instrument during the setting
phase (Fig. 24). The application of
Liquid Strip glycerine gel on the joint
prevented an inhibition layer from
forming during setting. After seven
minutes, the glycerine gel was rinsed
off with water and the Viteo Screw
Channel Pin was removed from the
screw channel. Finally, the joint was
carefully smoothed over with a fine
rubber polisher at low speed (<5000
rpm) and gentle pressure. In order to
leave the connection to the implant
as untouched as possible, it is advisable to leave the Viteo Base in the
Viteo Holder, or at least screw it onto
a laboratory implant. The restoration
was polished with goat hair brushes
and universal polishing paste (Fig.
25). A smooth and homogeneous
surface is important, so that the gingiva can adapt properly to the restoration.
Inserting the prosthetic
implant restoration
The assembled and cleaned hybrid
abutment crown was prepared for
insertion in the mouth. It is advisable
to autoclave the hybrid abutment
crown prior to intraoral insertion.
The temporary Telio CAD restoration in region 46 was removed by
the dentist, the implant lumen was
flushed (Cervitec Liquid) and the
peri-implant tissue (emergence profile) was examined. The crown was
screwed to the implant using the
originally packed Viteo Screw. It was
tightened according to the torque
specified by the manufacturer. By
screwing the crown in place instead
of cementing it, the risk of cement
residues in the peri-implant area
could be excluded. The screw channel in the occlusal area was sealed
with the light-curing esthetic composite IPS Empress Direct.
The restoration adapted harmoniously to the surroundings in the
mouth in terms of its shape, shade
and function. The emergence from
the soft tissue corresponded to that
of the natural dentition thanks to the
prepared emergence profile and the
individual design of the structure
(basal).
Conclusion
Ideally coordinated with
ceramic materials
The Viteo Base is ideally suited for
use with ceramic materials: It helps
to avoid chipping problems, the
lack of or weakness of a bond or inadequate force distribution. One of
the advantages of the Viteo Base is
the special soft edge design without
sharp edges and protrusions, which
on one hand strengthens the restoration material and on the other hand
provides optimal force distribution
under pressure.
The preconditioned, in other words
sandblasted surface saves an additional working step and therefore
saves time. In combination with
the appropriate composite system,
it ensures a secure connection of
the titanium base and the restoration material. This is a key factor
for the longevity of the restoration
and its integration into the oral environment. Due to the industrial
preconditioning the surface of the
Viteo Base is very uniform. Together
with the appropriate composite (e.g.
Multilink Hybrid Abutment), it ensures a permanent marginal seal.
The recessed rotation protection
means the cement gap is very even.
Compressive or tensile stresses are
avoided. The restoration material is
strengthened.
In addition, the Viteo Base’s shaft
height can be easily adjusted to suit
the prosthetic restoration: It can be
shortened from 6 mm to 4 mm. As
a result, optimal support of the restoration material is achieved by the
titanium bonding base. The restorative material and the Viteo Base together form a coordinated unit and
are the basis for clinical success.
In the production of an implantsupported single-tooth restoration,
the Viteo Base components enable a
smooth manufacturing process. In
this present case, a hybrid abutment
crown was produced in IPS e.max
Press using the press technique. The
ceramic crown, produced in the conventional manner, was cemented to
the Viteo Base. The recessed rotation
protection acted as a guide. An ideal
bond was achieved with the appropriate materials for conditioning and
placement. The hybrid abutment
crown was screwed in place in the
mouth. It fits harmoniously into the
overall appearance of the mouth.
Marie Reinhardt, DT
Schaan/Liechtenstein
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