Dentsply Launch the Astra Tech EV implant system.

On Friday we were in London for the Official UK launch of the Astra EV implant system! 

This was completely new for most of those attending the exclusive event in London, but for almost a year now we have been secretly working with Dr Mark Willings and Dentsply in restoring the EV implants that he has been working with as part of the Ambassador program.

The design philosophy of ASTRA TECH Implant System^™ EV is based on the natural dentition utilizing a site-specific, crown-down approach supported by an intuitive surgical protocol and a simple prosthetic workflow.

The EV system is an evolution of the already very successful Astra implant system, and now incorporates new design features that improve upon an already class leading and clinically proven implant system.

From a laboratory point of view there is nothing tricky about switching to this system but there are some nice touches, such as a unique index system that will only allow custom made abutments to seat in one position. This is also obviously a huge benefit for the surgeon as they don't have to worry about them seating in one of several possible positions as we do with existing implant systems.

If anything Dentsply have managed to simply improve the user friendly appeal of the already successful Astra system, and build upon the strength and clinically proven results they already provide with the existing implant and restorative range.

It’s been really difficult for us to keep this under our hat as we have naturally been very excited and keen to share the work we have done with the EV implant system. The whole team are honoured to be included in the Ambassador phase of this implant system’s worldwide pre launch roll out and as today is the official launch, we can finally share it with you (although we're not going to share too many details on the systems specifics, we'll leave that to Dentsply)

Here are a few of the many cases we have restored under prescription and guidance of Dr Mark Willings, who was selected from a handful of surgeons worldwide to work with the EV implant system during the pre launch phase.

CASES

It’s obviously a huge honour to be trusted to work on a confidential project such as this one, especially as we have had early access to some of the nice touches that this system brings to the lab when restoring implants, but more importantly for us was the opportunity to feedback on the experience from the lab.

As you would expect we have only used the very best restorative solutions and avoided all potential compromise when dealing with these new EV cases. This has been the Atlantis system for single units and Atlantis ISUS system for multiple unit cases (which is our protocol on all Dentsply implant systems)

The requirement for these cases was that they should be screw retained crowns or bridges, although we do have 1 cement retained case and a couple that were screw retained using lateral fixing screws.

Here is a sneak preview of some selected shots that have been taken from the large variety of cases that Dr Willings presented at The Royal College of Physicians on Friday. We will also have the final fitted pictures to show after Mark has presented them at the launch today. For now we have the images of the lab work we produced on the new system.

Case 1 - 2 Atlantis abutments with a 3 unit bridge, retained with lateral fixing screws

First we designed 2 Atlantis abutments and then Lee tapped them both to accept Bredent Lateral Fixing Screws. Abutment design and framework by Lee Nichols

We then produced a framework which is secured into place with the screws. Ensuring we have a screw retained solution and avoid any issues with the access holes coming through the buccal of the restorations

The screws are slightly flush to the restoration so that after torquing into place the surgeon can trim them flush with the contoured surface of the back of the tooth.

Although this is still screw retained, we have managed to remove the access hole which would have been coming through in the aesthetic zone.

Case 2 - Screw retained molar crown

The final crown that was layered with e.max ceramics by Mark Ambridge

With this case the patient requested a screw retained zirconia crown abutment, so we used the Atlantis system to design a zirconia sub structure that we could layer the ceramic directly onto.

The final abutment was designed and adjusted by Steve Campbell using the Atlantis Web-order Editor interface

You can see from the image below that we used the Atlantis crown proposal to ensure we provided optimal support for the ceramic on the final crown

Case 3 - Full arch Atlantis ISUS milled chrome and ceramic layered bridge

This case was a full arch that was scanned and designed from an immediate denture made by Mark Price, which was later converted to an immediate fixed restoration during the patients transition from temporary denture and guide to our final restoration. An effective way of working back from great prosthetic planning, which perfectly matches the EV crown down philosophy.

The final bridge that was layered with Creation ceramic by Jack Gleave

CAD design stages that show how we used a copy of the immediate restoration which was modified for a more natural tooth emergence by Iain Baldwin, because the immediate had a flange that the patient did not want on the final restoration. 

The patient wanted the overall appearance and function copying, so this became our guide. We have made the final guide transparent so that you can see the CAD framework design within.

Here is the CAD proposition of the final framework we received from Atlantis ISUS.

By using Atlantis ISUS we ensure we get a perfect framework to support our final frameworks, we prefer to offer a framework that is clinically proven to offer a superior level of fit which in turn leads to successful long term restorations.

You can see from this image that the new multi unit abutments have a wider diameter implant screw.

I know we've only shared a select few images and cases from all the work we have done here, but I wanted to keep this as brief as possible and just share the experiences and benefits we have had using the new EV system. However after the launch event we will get the final images from Mark and upload the full set and more detailed case write ups in a separate blog

SUMMARY FROM A LAB

Many of the modifications made in the EV system are just nice little adjustments that make the system very easy and predictable to work with and we found no issues at all in the cases we restored.

The biggest noticeable change is a completely new index system that moves from a hex to a spline and allows for easy seating and positive single position only engagement of all Atlantis CAD/CAM restorations, as shown in the image below

All the components are now colour coded, from pickups and analogues right through to screws, which makes it easy to quickly visually verify you are using the correct components for the EV implant system. Also all the screws have the same 25 Ncm torque value to keep the system simple and user friendly.

There are a wide range of restorative options for the lab, although we have always preferred to stick with the CAD/CAM custom solutions.

Pickup components

Why talk about pickup components in a lab view? Here's why.

One handed self guiding pickup component which will not screw down until correctly engaged

How many times have you cast a model, made a beautiful CAD abutment and crown only to be informed that they were unable to fit it? After casting a new model with a new fixture pickup and comparing with the old cast and impression we find that the rotation and height differ, telling us the initial pickup was not correctly seated.

We're not criticising the surgeons here, traditional implant pickup components are not as user friendly as the EV system and therefore allow for technical errors, especial when having to work in a limited space and with what may not be the most co operative patient.

The Astra Tech EV System has a unique new patented pickup system that means the pickup component is self guiding and will only allow engagement and screw down when it is in the correct position. No more inaccurate implant pickups!

Option for capturing the soft tissue architecture

Again initially this doesn't seem like such a big problem, but from much experience we know of several cases where the surgeon had developed a soft tissue site and the pickup component was so big that all we saw was a big round hole where the nice anatomical tissue site should have been. In effect we had a beautiful replication of a big round pickup cylinder and not the custom tissue site we wanted.

With the Astra Tech EV system they have pickup components that allow for the capture of the cost tissue architecture, and although these are slim when you look at the design of the body and all the facets it incorporates we see that they have actually managed to produce a very retentive surface with a large overall surface area to ensure stability within the impression.

As the vast majority of our abutments are CAD/CAM custom abutments it makes sense that we contour this exactly to the soft tissue architecture that the surgeons have worked so hard to develop, leading to a superior final result for us all.

As shown the reason we are a big fan of the healing abutments is that Dentsply have managed to address the issues that cause technical difficulty or lead to false information on some of the other implant systems.

Site specific healing abutments

This system has a wide range of different healing abutments that are ovoid, round and triangular, ensuring that the surgeon can develop the soft tissue site in a wider range of options that more naturally mimic tooth root shapes than just a standard round pickup.

The reason that we as a lab are so excited and have come to love this system so much is the simple fact that most of the improvements incorporated into this system are technically driven. Therefore designed to eliminate mistakes or mis information that can cause a case we've worked so hard on to either not be fitted or not have the result we would have wanted because the information in the impression was inaccurate in some way, either implant or soft tissue site.

Astra Tech stated that this was a crown down philosophy driven design change and they are absolutely good to their word. We've greatly enjoyed working with this system for a year and look forward to seeing many more come into the lab.

Along with our work with Dr Willings were some great presentations by some of the surgeons that were involved in the ambassador program. Dr willings showed a detailed walkthrough of the cases and final fitted pictures of all the work we had produced together.

Dr Mark Willings presents his EV cases

Dr Michael Norton who was heavily involved in the design changes for the new system, so it was great to hear from him first hand all the new design considerations and technical reasons for the improvements. 

He stressed that the BioManagement complex that had made the existing OsseoSpeed such a success had not been changes, all the modifications were technical ones to ensure improved restorative procedure and predictability. Which was obvious from our experienced with the system

Dr Michael Norton displays the unique new EV index system

We then had a very interesting and detailed talk by Dr Kia Rezavandi on the simplified drilling procedure and surgical kit of the EV system. You can hear his thoughts (among others) on the system in the testimonial video at the bottom of the EV site http://www.jointheev.com

DR Kia Rezavandi Demonstrates the EV surgical tray concept

After a break we were then presented with some cement lovely retained restorations of Atlantis abutments by Dr Stephen Jacobs, who also went into great detail regarding the pickup components and various implant sizes, including the benefits of a more flexible site specific approach that the EV system brings. As you'd expect this presentation was very detailed, showing some lovely work which well received by those attending.

Dr Steven Jacobs shared his cases and also gave a great presentation on EVolution 

and why we must always strive to improve.

Thank you to the whole lab team who have kept this quiet for so long and worked so hard on all stages of the many cases we have restored over the last year. There were many more ceramic cases by Marc Tocher and Rachelle Webb that we have not shown, along with James Kelly, Ollie Ambridge & Andrew McAuley who were involved in all the CAD and preparation stages for these cases. The whole team behind the scenes that makes it possible for us to take the time to work on and catalogue all the images for a big projects like this, it truly is a team effort. 

Finally we'd also like to thank Dr Willings and Dentsply for choosing us to work with them on a project this big and exciting and also to everyone attending the event who were so complimentary regarding the quality of the cases we were showing.

From Left to right - Dr Mark Willings - Mark Ambridge - Chris Orpin - Steve Campbell

We recently realised that five years ago we were at Altitude in London for the official launch of the Astra Atlantis system, which has gone on to revolutionise and dominate the CAD/CAM restorative market on all the major implant systems. Another great EVolution was launched here, and maybe this will go on to do the same for the surgical implant side?

There's more news to come

I’m not about to let the cat out of the bag just yet, but we do have a few more very exciting market leading projects still ongoing. Watch this space!

Want to know more about Astra Tech EV? Here is a link to the pdf

For more information on this or any restorative solution at all from us please contact

sean@ambridgeceramics.com

or visit our site for full contact details

http://www.ambridgeceramics.co.uk/contact/

Aesthetic Dentistry Awards 2014

It's been almost a year since we won an award at The Aesthetic Dentistry Awards 2013, and thanks to a nomination by Dr Andy Denny we're going to the awards again and hoping to make it 2 years running!

Back in 2013 we were surprised and delighted to be nominated by Andy, and overjoyed when we won, as you can see from the picture below.

(Mark Ambridge - Centre, Andy Denny - Right)

And here was the case

So what are we up for this year?

The categories we are nominated in for 2014 are:

Restorative case – single arch

Andy Denny
Mark Ambridge (technician) 

Conservative Ceramic – Smile Makeover

Andy Denny
Mark Ambridge (technician) 

We think these awards are a welcome recognition of the hard work and beautiful smiles that are created by the surgical and laboratory team working closely to ensure the best restorative outcome and care for the patient.

This year, just as last we will be flying the British Bite Mark Flag. The British Bite Mark shows that a lab is using skilled General Dental Council (GDC) registered professionals to produce world class dental restorations which are produced in a laboratory that fully complies with strict MHRA and MDD regulation.

The work is anonymously assessed by a well respected panel of judges, each of whom is recognised for their skill and contribution to great dentistry, so the recognition of our work in 2013 was very much appreciated by the whole team.

We are in great company at this years awards, a full list of surgeons and technicians that have been nominated this year is available to download as a pdf here

We look forward to seeing all the nominees for a great night at the awards on the 21st March.

Atlantis titanium screw retained crowns now available

There's nothing worse than having a secret you cannot talk about! Due to a number of Beta programs we are currently running with our partners that we find ourselves with lots of secrets to keep.

Which is why it's a great relief to finally be able to talk about the Atlantis titanium crown abutments that we have been working on in the lab in Beta trials with Atlantis abutments and Dentsply implants.

For many years there has been a struggle to get a good aesthetic result and stable bond to titanium which is why most labs have tended to stay with the bonding alloys or chrome which we know well and avoid the potential for aesthetic issues that early titanium bonding systems could produce.

However, when it comes to implants there is undoubtedly an advantage to using titanium as the substructure materials for our bonded crowns and, during our in house testing we have been getting fantastic results with the Duceram Kiss porcelain which has been specially developed for fusing to titanium which ensures beautiful aesthetics and a strong stable bond.

Atlantis abutments, which are supplied by Dentsply implants have up until now only been available as a crown abutment (meaning a nucleus design that is intended to have ceramic layered and fired directly onto it, rather than a cement retained crown) in zirconia material, which although a good materials is not what we might want in certain restorative situations.

Kiss ceramic was not the only system we were trialling on on these cases (although the results with this have been very impressive) we also have another system as we want to really test these new abutments and see if we can generate any problems. We will share more on the other ceramic systems on the many implant cases that our surgeons are now restoring using the titanium crown abutment.

Maximum strength & biocompatibility

For us this is a very exciting day, we now are able to offer our surgeons the opportunity to use the most biocompatible material available when restoring their implants, with the confidence of a great aesthetic result and bond strength as our tests have so far shown no negative outcomes.

This is how the new atlantis titanium crown abutment comes back to the lab.

You can see on the case that this is indeed a milled Atlantis titanium crown abutment.

We used the 3D editor in the Atlantis WebOrder to ensure we had the support and design we wanted for the final crown, which you can see in the images below.

Cost efficient

The other great news is that we can offer the new titanium bonded screw retained crowns at the same cost as our screw retained chrome units, which on average also save the surgeon £80 compared to traditional cast gold screw retained crowns, and even more when compared to cement retained implant solutions.

No compromise

Once again we are managing to utilise CAD/CAM to deliver a restoration that is of a higher quality and biocompatibility than the traditional cast gold options, and also offer a significant cost saving purely on the efficiency and consistency that CAD/CAM technology offers us. This new option to our clients ties in perfectly with our belief in delivering the widest range of excellent restorative solutions and doing all we can to eliminate compromise.

No Cement to clear at fit

As the ceramic is fired directly to the abutment you have a one piece implant crown solution where you screw down the crown and then fill the access hole with composite, which also makes it easier to retrieve the crown or get to the screw should you ever need to.

Final result

This solutions is still not widely available so if you would like to offer Titanium bonded implant restorations to your patients then get in touch with Sean on 01765 607347  or email sean@ambridgeceramics.com and he will get all the details to you

Making the most of new materials and technology

We're very proud of the fact that we have worked with many pro active surgeons, which has allowed us to become known as a cutting edge CAD/CAM dental laboratory, with all the benefits this brings to our surgeons and their patients.

Over the years we have been involved in many Beta trials with some of the worlds biggest dental companies, which has given us a great insight into some of the benefits and potential weak points in some of the current materials and systems available today. The companies that we work on the Beta testing with are looking to overcome any potential weak points they see and improve the restorative options by heavily investing in research, and testing using the latest materials and technology.

For us as a laboratory one of the biggest leaps forward was definitely the use of CAD/CAM systems such as Atlantis and Isus to produce our titanium, chrome and zirconia sub structures (and even whole crowns in some case) as this allowed us to move away from some of the inconsistency, inaccuracy and wasted expense that the old traditional wax and cast or manual milling methods had.

But recently we have seen a very exciting shift away from focussing on the machining of the custom component parts and sub structures, and a focus on the materials which we use to deliver the final prosthesis to our patients.

What's wrong with what we have?

Realistically with many cases there's absolutely nothing wrong with the Porcelain, composite or acrylics we have successfully used for many years to restore our implant cases, but if we have an implant restoration on a posterior tooth where the patient has shown a history of destroying restorations then maybe we can look to the new hybrid materials that are now available? These mix the higher aesthetics we want from ceramics with the qualities that we would ideally want on an implant restoration such as shock absorbency and chip resistance.

Shock absorbency

One of the main characteristics of new Hybrid ceramics like Vita Enamic or 3M ultimate is the fact that they actually absorb shock from the opposing dentition.

Chip resistance

Due to the fact that these materials are produced using CAD/CAM technology, they are a monolithic structure which greatly reduces the risk of delamination, further more these new engineered materials have been specifically designed to prevent crack propagation as shown in this pdf

What does this mean for us?

Thanks to our knowledge of CAD/CAM and depth of experience in using this with the new materials such as Visio.lign (which we use on full arch cases) and Vita Enamic we have been able to produce a screw retained CAD/CAM Hybrid Ceramic crown that offers the benefits mentioned above.

Below is a Vita enamic screw retained crown which has been milled and is awaiting final staining.

Further to being an ideal posterior restoration, this crown is also vastly more cost effective than a traditional screw retained ceramic layered implant crown (although if you do prefer ceramic for the very best aesthetics, we can now produce ceramic bonded to titanium implant crowns for maximum biocompatibility)

Thanks to our partnership with Atlantis we are also able to offer a restoration that has a custom titanium contour against the tissue and then transitions to these new Hybrid Ceramics in the rest of the screw retained crown restoration, think of it as a custom link abutment +

This is not a one size fits all solution, in fact we still produce many porcelain bonded screw retained units where aesthetics are absolutely critical, but it's always great to have another solution that we can mix and match into our restorative toolkit when we are looking at the needs of our patients.

We have used monolithic crowns on cement retained restorations for many years, starting initially with full zirconia and then moving on to the new Hybrid Ceramics such as Vita Enamic purely because of the improvements in aesthetics and functionality they offer.

No patient you see is exactly the same, which is why we want to ensure we have the widest range of restorative solutions available to match their specific restorative requirements.

These materials can be used for cement retained, screw retained or even angle corrected screw retained implant cases. We have more information on both of these over on our website

Atlantis CAD/CAM abutment article re published in the USA

The article we created along with Dr Tim Doswell on the Atlantis duplicate technique (which was originally published in the EDI Journal and Implant Dentistry Today) is being re published online and in print in the USA.

Well done Tim!

In the article (which was originally printed in Implant Dentistry Today, and the the European EDI Journal) Tim and the team from the lab showed how you can use the unique benefits of the advanced Atlantis CAD/CAM milling service to create an exact duplicate of the final abutment.

By having this exact duplicate (milled from titanium also, which means  either abutment can be fitted in the mouth) you can choose to design your abutment from an impresssion taken immediately at implant placement, and design the optimal soft tissue contour you wish to have.

So when the implant is ready to uncover, instead of fitting a healing abutment you place the Atlantis CAD/CAM abutment with a temp crown that has been designed to be very light in occlusion.

You then keep the original model and simply tell the lab to proceed to making the final crown (without having to take any more implant impressions) once you have reviewed the soft tissue healing weeks later.

The lab simply uses the original model and the duplicate abutment to make the crown, and because Atlantis CAD/CAM abutments are milled to such an exacting high standard the crown you made will transfer over to the abutment in the crown perfectly!

There's obviously many more steps and images to show the technique, but they are in the article and too deatailed to cover here.

You can contact Tim about his technique or article here

http://www.timdoswelldentalimplants.co.uk/

Or contact us at the lab and we will send you over a pdf copy of it to read.

sean@ambridgeceramics.com