Dentsply Sirona Ankylos Balance C User manual

Ankylos®
Laboratory Manual

General prosthetic advice for Ankylos®
In order to obtain utmost benefit from the unique
restorative features of the Ankylos implant system,
please observe the following guidelines:
• Avoid occlusal overload, aim for initial infra-occlusion
to ensure clearance of contacts in function.
• If possible, use B-implants or larger for single
molar restorations.
• Use gingiva height 0.75 and 1.5 only if really
necessary, and in correspondence with thin gingiva.
• Minimize the functional occlusal surface in buccal-
lingual dimension to avoid lateral levers.
• Take adequate precautions to avoid occlusal
overload in correspondence to any prosthetic
cantilevers.
• Bear in mind the resilience of neighboring teeth
when planning for single tooth restorations. Establish
full contact on the implant crown only during
maximal clenching ensuring an even load distribution
on all teeth during maximum chewing force.
• Check for parafunctional habits. Consider changes
during recall appointments.
• In case of any changes to the occlusal scheme in
other areas, evaluate the consequences for the
implant restoration and, if required, take appropriate
measures.
• Advice for the dental laboratory: The abutment
design must not be manipulated at the areas of the
connection taper or adjacent to the sulcus.
Please read this manual carefully before using the system for the
first time and always observe the clinical indications, directions and
notes in the instructions for use of the system components and
instruments.
Furthermore, we recommend that all users attend a training course
specific to the system prior to first using a new implant system.
Some products may not be available in all countries.
Please contact your Dentsply Sirona Sirona Implants representative
to obtain up to date information on the product range and on
availability.
To improve readability for our customers, Dentsply Sirona Implants
does not use ® or ™ in body copy. However, Dentsply Sirona Implants
does not waive any right to the trademark and nothing herein shall
be interpreted to the contrary.

3
Treatment planning
Aspects of treatment planning 4
Conventional treatment planning 6
Computer-guided treatment planning 7
Prosthetic concept
The prosthetic principle of Ankylos 8
Ankylos prosthetics navigator 11
Solutions for single-tooth restoration 12
Solutions for larger tooth gaps 14
Solutions for the edentulous jaw 16
Basic guidelines for soft tissue management 18
Ankylos® Balance C/ or /X
Crowns and bridges on Ankylos Balance Anterior C/ or /X,
crowns on Ankylos Cercon Balance C/ 20
Ankylos® Regular C/ or /X
Crowns and bridges on Ankylos Regular C/ or /X 30
Ankylos® Balance Base Abutment C/
Bar-supported overdentures and bridges, also CAD/CAM-fabricated,
on Ankylos Balance Base Abutment C/ 42
Ankylos® SynCone® C/
Overdentures on Ankylos SynCone C/ 66
Ankylos® Snap Attachment® C/
Overdentures on Ankylos Snap Attachment C/ 80
Ankylos® Standard C/
Crowns, bridges and bar-supported dentures on Ankylos Standard C/ 84
CONTENTS
Ankylos®

4
Aspects of
treatment planning
Treatment planning
Precise planning for any implantological procedure
in close coordination between practitioners and
laboratory is the basic prerequisite for lasting
therapeutic success. All suitable measures and
alternatives that will fulfill the expectations of
the patient in terms of function and esthetics of
the implant prosthetic rehabilitation should be
stipulated in the planning.
Today, along with conventional treatment planning,
treatment can be planned using computer-guided
facilities for three-dimensional “crown down”
treatment with planning of the optimal implant
placement from the point of view of the desired
prosthetic restoration, both functionally and
esthetically.

5
The basis of treatment planning is always a thorough
discussion with the patient with a view towards
determining the wishes and perceptions of the
patient, excluding contraindications and clarifying
matters thoroughly with the patient. Next, a complete
general and specific medical history is taken and
an intraoral diagnostic assessment is made with an
analysis of the initial anatomical situation.
The following points should be taken into account:
• Medical history
• General diagnosis – elimination of contraindications
• Specialist consultation where there are risk factors
• Extensive intraoral diagnosis (PAR diagnosis,
functional examination, reasons for tooth loss,
assessment of the existing tooth replacement,
radiological examination)
After all the diagnostic details have been submitted
and evaluated, the treatment can be planned.
This comprises the following elements:
• Preprosthetic planning
• Surgical planning
• Schedule
• Cost projection

6
Treatment planning
Conventional treatment planning
Preprosthetic planning
Preprosthetic planning with the dental technician
is the most important factor for the esthetic and
functional success of the implant procedure.
Surgical planning
During preoperative planning it is very important to
check that the height and width of the jawbone is
sucient for placement of the implant.
The target is the best possible, tooth-analog
placement of the implants. During the first planning
session with the patient situation impressions are
made to be used as the base for laboratory-fabricated
diagnostic aids.
A diagnostic wax-up of the planned prosthetic
restoration is made.
A thermoformed splint with radiographic balls that
can be accurately repositioned in the patient‘s mouth
is prepared. It can be subsequently modified to a
conventionally fabricated surgical template.
The width of the vestibular and oral lamellae should
be at least 1.5 mm after implant placement. The
position and direction of important anatomical
structures such as the mental foramen or maxillary
sinus must be determined by radiology.
Grafted regions must be confirmed to have completely
regenerated to a mechanically stable state before
preparation.
Planned prosthetic measures must be checked to
ensure that they can actually be implemented with
appropriate surgical procedures. All aspects of
preprosthetic and surgical planning interact directly
with one another. Every change in the preprosthetic
planning will aect the surgical planning and vice
versa. This will also include the number, diameter,
lengths, positions and alignment of the implants.
The available bone volume and important anatomical
structures are examined in an x-ray image, which
is prepared with the laboratory-fabricated x-ray
template with the radiographic balls in the patient‘s
mouth. The dimensions of the intraoral structures
can be calculated from the defined diameter of the
radiographic balls, taking the magnification factors
resulting from radiological processes into account.
The implant lengths are selected by placing the
transparent radiographic template on the OPG. If
desired, the x-ray analysis must consider a subcrestal
implant position (note magnification scale).

7
Treatment planning
Computer-guided treatment planning
Digital treatment planning based on three-dimensional
imaging procedures enables the therapy to be
planned with the highest accuracy and makes the
result of the treatment safe and predictable.
Dentsply Sirona Implants oers a complete solution
for digital treatment planning and full-guided implant
placement based on the world-renowned Simplant
software.
The advantages over conventional planning include:
• Safe three-dimensional planning in the sub-
millimeter range and with reference to the desired
restoration
• Automatic collision control, which displays too
narrow clearances between implants or to the nerve
• Information on peri-implant bone quality for
accurate conclusions on the expected primary
stability
An individual Simplant drill guide is fabricated using
stereolithography, based on the digital planning data.
Depending on the individual case scenario, the guide
is prepared tooth-supported, mucosa-supported
or bone-supported, thus enabling a complete and
accurate transfer to the patient‘s mouth.
The Sleeve-on-Drill drill system, drills with a guide
sleeve that can be attached to the instrument for
precise guidance in the template, has been especially
developed for template-guided implant placement in
order to facilitate accurate, straight-forward implant
placement with the added security of the drill stop.
These enable simpler and precisely fitting placement
of the implants with the reliability of the drill stop.
Simplant drill guides are also available with lateral
access for easier management of the instruments,
even with a restricted oral cavity.
Digital treatment
planning with
Simplant.
Patient-specific
Simplant guide.
Sleeve-on-drill
drill system and drill
guide with lateral
access.

10
Based on the friction-locked and keyed TissueCare
connection, the Ankylos system concept also facili-
tates high flexibility in placing the abutments in the
implant. The abutments with tapered connection
geometry (C/) can be freely turned in the implant and,
hence, can always be positioned at the optimal angle
for the respective prosthetic restoration.
Additional indexed prosthetic components (/X) may
facilitate positioning the abutments, provided that the
abutment is not required to be freely rotatable.
Indexing option
Regardless of which implant is placed, abutments
from the Ankylos Balance Anterior and Regular
prosthetics
ranges as well as the TitaniumBase, oer you the
choice between indexed and non-indexed prosthetic
restorations:
• Indexed components for precise, straightforward
placement of the abutments in a range of six
positions
• Non-indexed components for freely positionable
abutments
The tapered Ankylos TissueCare connection provides
both options with optimal stability and rotation
locking.
The placement of the prosthetic abutments can also
be simplified by using the positioning aid (index)
whenever this facilitates the prosthetic procedure. If
the index hampers the procedure, abutments fitted
with the tapered connection alone can be used.
All Ankylos prosthetic abutments are laser-marked
corresponding with your intended use:
• Components with the “C/” marking use only the
taper for the connection and are not indexed.
• Components with the “/X” marking are indexed.
These use the index for positioning the abutments in
six possible positions.
• Components with the “C/X” marking are used for
indexed or non-indexed prosthetics.
Prosthetic concept
The prosthetic principle of Ankylos®
All components marked C/X, C/ or /X will fit
Ankylos C/X. Restorations using Ankylos plus
implants are only possible using components
with the C/ marking.
C/ /X