BASIC INFORMATION ON THE

Straumann ® CARES ® Implant-­

borne prosthetic procedures
 Contents

1. Introduction 2

2. General information 3
2.1 Restorative options with the Straumann ® CARES ® Portfolio 4
2.2 Technical requirements 5
2.3 System overview 6
2.4 Compatibility chart for CADCAM systems 8

3. Preparation for CARES ® Visual 9

3.1 Fabrication of the master cast 9
3.2 Planning / Wax-up sleeves 10
3.2.1 Straumann ® CARES ® Wax-up kit 10
3.2.2 Step-by-step instructions for use 11
3.3 Straumann ® Scanbodies 14
3.3.1 Straumann ® CARES ® Mono Scanbody 14
3.3.2 Straumann ® Scanbody 15
3.4 Scanning with the desktop scanner 16

4. Restorations, designing and finishing 17

4.1 Restoration: CARES ® Abutment 17
4.1.1 Designing CARES Workflow
®
18
4.1.2 Finishing (Straumann ® CARES ® Abutments – Completion at the dental laboratory) 18
4.1.3 Insertion (dentist’s office) 19
4.2 Restoration: CARES ® Variobase™ Abutments 20
4.2.1 Designing CARES ® Workflow 21
4.2.2 Finishing 21
4.2.3 Insertion (dentist’s office) 24
4.3 Restoration: CARES ® Variobase™ coping 25
4.3.1 Designing CARES ® Workflow 26
4.3.2 Finishing (Straumann ® CARES ® Abutments – Completion at the dental laboratory) 26
4.4 Restoration: CARES Screw-retained bridges and bars (SRBB)
®
27
4.4.1 Straumann CARES ® Screw-retained bridge 29
4.4.2 CARES ® Bars 33

5. Auxiliaries and instruments 39

5.1 SCS Screwdriver 39
5.2 Ratchet 39
5.3 Polishing aids and analog holder 39
5.4 Auxiliaries for bar matrices 40
5.5 Wax-up kits 40

6. Appendix 41
6.1 Related documentation 41

7. Important guidelines 42
The ITI (International Team for Implantology) is academic partner of Institut Straumann AG
in the areas of research and education.

1
 1. Introduction 2. General information

Purpose of this guide Note CARES ® Prosthetics incorporating

This guide was created for dental technicians working with the pp Implant-borne superstructures require optimal oral hygiene on state-of-the-art technology
Straumann CARES Visual software for designing customized
® ®
the part of the patient. This must be considered by all involved The Straumann® CARES ® implant-borne prosthetics provide you
abutments, copings, bars and screw-retained bridges. parties when planning and designing the restoration. with customized solutions for single-tooth gaps, multiple-tooth
It provides complementary information regarding the conven- pp Consult the brochure Basic Information on the Surgical Proce- gaps and fully edentulous jaws.
tional working steps in the dental laboratory when working dures for information on indications and contraindications of Different materials and kinds of restorations are available to
with the Straumann CARES CADCAM system, e.g. the correct
® ®
Straumann Dental implants, such as the required minimum
®
give you flexibility in the way you restore the implants.
handling of the scanbodies, wax-up sleeves, etc. number of implants, implant type, diameter and loading pro-
tocols.
Additional brochures are Basic Information on Tooth-borne
Prosthetic Procedures, Straumann® CARES® Visual – Software
Manual and Straumann® CARES® System.

All of the described devices are CAD-derived and CAM-man-

ufactured. Straumann® CARES ® Visual supports you designing
the devices within indication-related conditions.

Instructions provided are insufficient to serve as the only means

for processing and placing Straumann ® CARES ® implant-borne
prosthetics related components. Only those dental profession-
als thoroughly trained in dental restorations should be pro-
cessing and placing these devices. Processing and placing
Straumann ® CARES ® implant-borne prosthetics and related
components without proper training may lead to failure of the
restoration. Restoration failure may lead to restoration removal
or other complications.

Failure to follow the procedures outlined in these instructions

may harm the patient and/or lead to any or all of the following
complications:

pp Aspiration or swallowing of a component

pp Breakage
pp Infection

2 3
 2.1 Restorative options with the Straumann ® CARES ® Portfolio 2.2 Technical requirements

Screw-retained Cement-retained There are many ways to a CARES ® restoration, which makes
different “combinations” of infrastructure possible. Those com-
binations are required for designing and ordering Straumann ®
CARES ® restorations:

1  2  3  4 Desktop scanner
1  2  3 es1-Scanner CARES ® Scan CS2
The patient situation can be taken with a conventional impres-
1 CARES Abutment, ZrO2
®
sion tray. The dental laboratory will scan the fabricated master
1 CARES® Abutment, ZrO2 2 CARES® Variobase™ Abutment
2 CARES® Variobase™ Abutment 3 CARES® Abutment, Ti model (preferably with removable segments) with a Straumann-
3 CARES® Variobase™ Coping 4 CARES® Variobase™ Coping approved desktop scanner (e.g. Straumann® CARES ® Scan
CS2).

Software
The restoration is designed with a Straumann-approved soft-
ware (e.g. Straumann® CARES ® Visual), which is engineered
1  2  3  4
to ensure that the restoration dimension complies with the
1 CARES® Abutment, ZrO2 ­Straumann manufacturing capabilities.
2 CARES® Variobase™ Abutment Straumann ® CARES ® Visual
3 CARES® Abutment, Ti
CARES® Screw-retained bridge 4 CARES® Variobase™ Coping Intraoral scanners
(incl. repositionable implant analogs)
The patient situation can be scanned with a Straumann-ap-
proved intraoral scanner (e.g. iTero™ or 3M™ Lava™ Chair-
Screw-retained For removable overdentures
side Oral Scanner C. O. S.). The data can be imported in the
Straumann-approved software (e.g. Straumann® CARES ® Visual
version 5.IO or higher).

Straumann® CARES ® Solution WS (working station) is a solution

iTero™
for customers who do not require scanning the physical master
cast and therefore do not have to invest in a desktop scanner.
For detailed information on intraoral scanning, refer to the bro-
chure: iTero™ Intra-Oral Scanner for Digital Impressions.
CARES® Screw-retained bridge CARES® Bar

Scan & Shape Service

If the dental laboratory does not have a Straumann-approved
desktop scanner but wishes to order a Straumann® CARES ®
Abutment, they can send in their master model or wax-up abut-
ment to Straumann® CARES ® Scan & Shape service*.

* CARES ® Scan & Shape service is not available in all countries, please check with your local sales representative for further i­nformation.
Additional i­nformation about the CARES ® Scan & Shape service can be found in the brochures “The Way To Straumann® CARES ®
­A butments” and “Straumann® CARES ® Scan & Shape Process Guide”.

4 5
 2.3 System overview

NN NNC RN WN NC RC

Transfer parts

048.167 048.067 048.087 048.168 048.068 048.088 048.169 048.069 048.089 025.2915 025.2905 025.2903 025.4915 025.4905 025.4903
048.087-04 048.088-04 048.089-04 025.2903-04 025.4903-04

048.173 048.137 048.087-04

048.137V4

048.132 048.130 048.129 048.108 048.124 048.172 048.171 025.2102 025.2101 025.4102 025.4101

Temporary
­r estorations 2)

                   

Titanium abutments / 
bridges (titanium grade
4 / cobalt chromium) 2)

  1) 1)  1)     1)       1)    

Ceramic restorations 2)

  1)  
  1)         1)            1)         

CARES ® Bars
(titanium grade 4 /
cobalt chromium) 2)

Accessories screws

048.354 048.356 048.356 025.2906 025.2900 025.2926 025.4906 025.4900 025.2926

048.353 049.177 048.313 ZrO2 SRBB3)/Ti/Variobase™ SRBB3)/Ti/Variobase™ ZrO2 Ti/Variobase™ SRBB3) ZrO2 Ti/Variobase™ SRBB3)

Bar matrices

MP-Clip ®
Retention elements:
– yellow, standard retention G: 200004363
– white, medium retention G: 200004365
– red, extra retention X: 200004365
Dolder ® Ackermann ® Round Bar Spacer with sleeve X: 200004367
Regular: 048.414 A female part E (posterior): 05050010 Female part E: 050527
Mini: 048.413 B female part E (anterior): 05050011 (spacer is included) Spacer 50×0.6 mm: 052082

Important: The Dolder ® Bar matrix is available Important: The following matrices are available only from your local Cendres +
through Straumann. Méteaux Representative: Ackermann ®, MP-Clip ®, Round Bar.

1)
Straumann® CARES ® abutments can be ordered via the Straumann® CARES ® Visual software or at http://cares.straumann.com
2)
Manufactured at the Straumann CADCAM production center.
3)
SRBB is the abbreviation for Screw-Retained Bridge & Bar.

6 7
 3. Preparation for CARES® Visual

2.4 Compatibility chart for CADCAM systems Pre-conditions

pp The tooth shade has been identified and noted (via color chart or digital m
­ easuring device).
pp Impression has been taken.

Both, shade information and impression have been sent to the dental lab.

es1 Scanner CARES ® Scan CS2 Intraoral scanners1 Scan & Shape 2

Software Version 5.0 5.IO 6.0 6.2 7.0 8.0 4.2 n/a
3.1 Fabrication of the master cast
Straumann ® CARES ® Mono Scanbody 1 1 1 n/a
Accessories

Straumann ® Scanbody 1 1 1 1 1 1 n/a

Fabricate the master cast using standard methods and type-4
Straumann ® Wax-up sleeves 1 1 1 1 1 n/a 1 dental stone (ISO 6873). To ensure high-quality restorations, the
following requirements must be considered:
CARES ® Abutments 1 1 1 1 1 1
CARES ® Variobase™ Copings 1 1 pp Only use new, undamaged and original Straumann ­
implant analogs.
CARES ® Variobase™ Abutments 1 pp The implant analogs must be embedded in the stone and
p Tissue Level 1 1 must not move in the model.
CARES ® SRBB 3

pp A gingival mask should always be used to ensure the emer-

p Bone Level 1
CARES ® Restorations

gence profile is optimally contoured.

p Bone Level / Tissue Level mix 1 pp For CARES® SRBB1 a large-range removable gingival mask
p Dolder ® Egg-shape (regular) 1 1 is necessary to enable Straumann to conduct a fit check.
pp Preferably use scannable material for the gingival mask.
p Dolder ® Egg-shape (mini) 1
CARES ® Bar

p Dolder ® U-shape (regular and mini) 1

p MP-Clip ® Bar 1
p Ackermann-Bar ® 1
p Round-Bar 1

Note
Ensure that the planning is executed with the corresponding
­ traumann® CARES ®
­software version. Be aware not to mix the S
Mono Scanbody and Straumann® Scanbody in the same scan-
ning process.

1
 “iTero™ Partner Lab Software 4.2”/3M™ Lava™ Chairside Oral Scanner
C. O. S. is in preparation
  CARES® Scan & Shape service is not available in all countries, please check
2 

with your local sales representative for further information.

3
  SRBB is the abbreviation for Screw-Retained Bridge & Bar. 1
  SRBB is the abbreviation for Screw-Retained Bridge & Bar.

8 9
 3.2 Planning / Wax-up sleeves 3.2.2 Step-by-step instructions for use

For optimal esthetic planning, especially in the labial region, design a fully anatomic
wax-up and confirm the size and position intraorally.
For CARES ® abutments the wax-up can be scanned with the wax-up sleeve holder
and ordered, as an alternative to designing it in CARES ® Visual. (see brochure Basic
Procedure Straumann® CARES® System for more information).

For CARES ® screw-retained bridges the wax-up can be scanned and used as reference
when designing the restoration in CARES ® Visual.
Insert a wax-up sleeve into the master cast.
Wax-up sleeves are used for waxing up the abutment.

Note 3.2.2.A Shortening wax-up sleeves in general

The wax-up sleeves are designed for single use only. If the sleeves are used more than
once, an accurate reproduction of the abutment’s position with reference to the implant pp The section above the implant shoulder represents the mini- NNC NN RN WN NC RC

position cannot be guaranteed and the milling results may be inaccurate. mum body, and must not be ground (displayed red in the
graphic to the right).
pp Only in the upper section the wax-up sleeve can be
­shortened (displayed green in the graphic to the right).
3.2.1 Straumann CARES Wax-up kit® ®
pp Do not wax below the basal margin of the wax-up sleeve
(red arrow).
The Straumann CARES Wax-up kit includes all wax-up sleeve holders which are
® ®
pp Sharp-edged modeling must be avoided.
required for placing the wax-up sleeves in the desktop scanner. They are required for
correct scanning of the customized abutment.
3.2.2.B Shortening wax-up sleeves for
Article number ­Variobase™ Abutments
pp 019.0063 – Straumann CARES Wax-up kit (used for Straumann Abutments)
® ® ®

pp 019.0050 – Straumann® CARES® Wax-up kit for Camlog The wax-up abutment must have a minimal height due to the
(used for Variobase™ Copings for Camlog Abutments)
®
Variobase™ Abutment height. The section above the implant
pp 019.0051 – Straumann® CARES® Wax-up kit for NobelReplace™ shoulder represents the minimum body and must not be ground
(used for Variobase™ Copings for NobelReplace™ Abutments) (displayed red in the graphic to the left). Only in the upper sec-
tion the wax-up sleeve can be shortened (displayed green in
the graphic to the right). Do not wax below the basal margin of
the wax-up sleeve (red arrow).

NC RC WN RN NNC

10 11
 3.2.2.C Waxing up the abutment / screw-retained bridge Option A: Full anatomic design (Variobase™ Temporary abutment)

Use only scannable wax to ensure an accurate scan (e.g. CopyCAD Wax from
­Straumann). If no scannable wax is used, apply scan spray.

Note
To ensure stability, it is recommended to make a frame with modeling resin with low
shrinkage when waxing up bridges.

The projecting part of the wax-up sleeve must always be cut off before scanning, oth- A full anatomic wax-up should be prepared for optimal es-
erwise this section will also be scanned and therefore milled. thetic planning. Use the wax-up sleeve to model the shape of
the full anatomic temporary abutment.

3.2.2.D Maximum geometry for production of CARES ® Abutments

Option B: Reduced anatomic design (Variobase™ Temporary abutment,
Variobase™ Abutment, CARES ® Abutments, CARES ® Screw-retained bridges)
Implant Platform NC RC NN RN WN

Wax-up sleeve ­
025.2903 025.4903 048.087 048.088 048.089 1 2
article number

Zirconium dioxide (ZrO2) 8 mm

10 mm 6 mm
8 mm

14 mm 8 mm 12 mm
10 mm 12 mm

CARES ® ZrO2 Abutment

027.2650 027.4650 040.679 040.688
article number

8 mm 10 mm A full anatomic wax-up should be prepared for optimal esthetic Prepare a silicone key over the full wax-up to determine the
Titanium (Ti) 10 mm 12 mm
8 mm
planning. optimal shape of the restoration.
14 mm 14 mm 11 mm
10 mm 12 mm

3 4

CARES ® Ti Abutment
027.2620 027.4620 040.693 040.689 040.694
article number

Note
The angulation of the wax-up must not exceed 30°.

Use the wax-up sleeve to model the shape of the reduced ana- Check the wax-up with the silicone key.
tomic restoration.

12 13
 3.3 Straumann ® Scanbodies

Product description 3.3.1.B Step-by-step instructions for use

The Straumann Scanbodies represent the position and orientation of the respective
®

dental implant or analog in CADCAM scanning procedures. This helps the CADCAM
software to correctly align the subsequent CADCAM restorations. Assembling
Check proper fit of the scanbody in the analog and hand-
Product overview tighten the self-retaining screw (maximum 15 Ncm). Only use
Straumann offers two different types of scanbodies which differ in handling and scan- the Straumann® SCS Screwdriver to fix the post in the analog.
ner compatibility: Check again for proper fit and for any rotational or vertical
pp Straumann® CARES® Mono Scanbody looseness. If a single-tooth restoration is planned, orient the
pp Straumann® Scanbody angled surface of the scanbody buccally (not adjacent to the
approximal tooth).
Make sure to select the correct Straumann® Scanbody according to the software ver- Avoid any contact of the scanbody to the approximal teeth.
sion (see compatibility chart on page 8).

Note
The Straumann® Scanbodies and all components are intended for single use only. 3.3.2 Straumann ® Scanbody
Multiple use of a scanbody can lead to inaccurate results. Make sure the stability of
the dental implant is sufficient for supporting the screwing/unscrewing operations of 3.3.2.A Product properties and benefits IN BRIEF
the scanbodies. Scan spray is not required at any time.
Two-component scanbody
pp Contains scan post, scan cap and fixation screw
3.3.1 Straumann CARES Mono Scanbody
® ®

For single-tooth restorations

3.3.1.A Product properties and benefits IN BRIEF pp Scanbody geometry to meet requirements of scanner etkon™ es1 and iTero™

Improved handling Well-accepted material

pp Single component incl. self-retaining screw pp PEEK for excellent scanning results

Improved functionality
pp Optimized geometry for the Straumann® CARES® Scan CS2 scanner and iTero™ 3.3.2.B Step-by-step instruction for use
pp Optimized system configuration for multi-unit restorations
Assembling
Well-accepted material Before placing the scanbody in the master cast, ensure that all components are clean
pp PEEK for excellent scanning results and undamaged (neither scratches, deformations nor discolorations). Check proper fit
of the scan post in the analog, insert the fixation screw and hand-tighten (maximum
15 Ncm). Only use the SCS Screwdriver to fix the post in the analog. Check again for
proper fit to prevent any rotational or vertical looseness.
Place the scan cap on the scan post. Ensure that the flat parts in the connection area
of the scan cap and the scan post are aligned to one another. The flat parts are the
rotational security feature between scan cap and scan post. If correctly placed, the
cap clicks on the post. Slightly press down with your fingertip to avoid any gaps be-
tween cap and post.

14 15
 4. Restorations, designing
and finishing

3.4 Scanning with the desktop scanner 4.1 Restoration: CARES ® Abutment

Intended use
pp Cement-retained crowns
pp Cement-retained bridges via mesostructure
pp Screw-retained, directly veneerable crowns (CARES ® abutments, ZrO2 only)
BASIC PROCEDURE
STRAUMANN ® CARES ® SYSTEM Material
pp Titanium grade 4
pp Zirconium dioxide

Contraindication
pp Allergies to materials used, which may include any or all of the following: zirco-
nium dioxide (ZrO2), yttrium oxide Y2O2, aluminum oxide Al2O3, hafnium dioxide
HfO2, titanium (Ti), titanium alloy (Ti6Al7Nb titanium, niobium, aluminum or TAN).

Characteristics
pp CARES® abutment ZrO2 is the abutment of choice in the anterior region and for
patients with thin gingiva
pp Anatomic emergence profile
pp A patient-specific emergence profile supports soft tissue management and an es-
thetic outcome
pp Straumann Guarantee for Straumann® CARES® abutments

Please refer to the brochure Basic Procedure Straumann®

CARES® System for detailed information regarding the scanning
process of the wax-up sleeves and the master model.

16 17
 4.1.1 Designing CARES ® Workflow 4.1.3 Insertion (dentist’s office)

Step 1 – PREPARATION for CARES ® Visual 1 Straumann ® CARES ® abutment – Prosthetic procedure
Follow the preparation requirements according to chapter 3.
The final restoration is fixed on the master cast before it is delivered to the doctor’s
Step 2 – DESIGNING with CARES ® Visual office.
Design the restoration according the Straumann CARES Visual – Software Manual or
® ®

watch the CARES ® Tutorial videos online for further guidance. www.straumann-cares- Step 1 – Preparation
digital-solutions.com > my StraumannCARESDesktop > Products & Service > Education pp Remove the healing cap or temporary restoration.
pp Remove the superstructure from the master cast and unscrew the abutment from the
analog.
4.1.2 Finishing (Straumann ® CARES ® Abutments – pp Clean and dry the interior of the implant and the abutment thoroughly.
Completion at the dental laboratory)
2A Note
Option A: Screw-retained crown Use transfer aids if the model contains more than one abutment. Never use cement
when the abutment is inserted into the implant. Straumann® CARES® abutments made
Straumann CARES Ceramic Abutment
® ®
from zirconium dioxide are not autoclavable and must not be cleaned by steam blasting.
pp Fabricate a screw-retained crown with a ceramic that
is synchronized to the thermal e
­ xpansion coefficient of Step 2 – Final insertion Straumann ® CARES ® ­c eramic abutment
­zirconium dioxide.
pp Straumann® CARES® Ceramic Abutments made of zirconium Option A: Screw-retained crown
dioxide have a ­thermal expansion coefficient of pp Position the cleaned Straumann® CARES® Ceramic Abutment in the implant. Tighten
10.5 × 10 −6/K (25 °C – 500 °C, 77 °F – 932 °F). the screw to 35 Ncm using the SCS Screwdriver along with the ratchet and the
torque control device.
Note pp Close the SCS configuration of the screw with cotton and sealing compound (e.g.
Particular attention must be given to an even layer thickness of gutta-percha). This allows a later removal of the customized abutment in case a
the porcelain veneered on the abutment. crown replacement is required.

Option B: Cement-retained crown Option B: Cement-retained crown

2B pp Position the cleaned Straumann® CARES® Ceramic Abutment in the implant. Tighten
pp Mount the Straumann® CARES® Ceramic Abutment on the the screw to 35 Ncm using the SCS Screwdriver along with the ratchet and the
implant analog. torque control device.
pp Use a standard procedure to fabricate the cement-retained pp Close the SCS configuration of the screw with cotton and sealing compound (e.g.
single crown. gutta-percha). This allows a later removal of the customized abutment in case a
pp Veneer the structure. crown replacement is required.
pp Cement the superstructure to the abutment.
pp Remove superfluous cement.

Note
Use only the special basal screws provided for the Straumann ® CARES ® Ceramic
Abutment.

18 19
 4.2 Restoration: CARES ® Variobase™ Abutments 4.2.1 Designing CARES ® Workflow

Step 1 – PREPARATION for CARES ® Visual

Intended use Follow the preparation requirements according to chapter 3.
pp Screw-retained or cement-retained crowns
pp Cement-retained bridges via mesostructure Step 2 – DESIGNING with CARES ® Visual
Design the restoration according to the Straumann® CARES® Visual – Software Manual
Material or watch the CARES ® ­Tutorial videos online for further guidance. www.straumann-cares-
pp zerion (zirconium dioxide)
®
digital-solutions.com > myStraumannCARESDesktop > Products & Service > Education
pp polycon® ae (PMMA)

Contraindication 4.2.2 Finishing

pp Allergies or hypersensitivity to chemical ingredients of the zirconium dioxide
­material (zirconium dioxide (ZrO2), yttrium oxide (Y2O3), hafnium dioxide (HfO2), After reception, unpack the Straumann®
aluminum oxide (Al2O3)),titanium alloy (Ti6Al7Nb, titanium, aluminum, niobium or CARES ® Vario­b ase™ abutment.
TAN) or PMMA (polymethyl methacrylate).

Characteristics
pp Customized shape and emergence profile, and ideal for the
replacement of big teeth
pp Straumann logo indicating that it is an original component
pp zerion® and polycon® ae are available in various tooth shades
pp polycon® ae copings are intended for a usage of up to 180 days
pp Straumann Guarantee for Straumann® CARES® abutments

Step 1 – Fabrication of the crown

Option A: Screw-retained final restoration

Fabricate a screw-retained crown with a ceramic that is synchro-
nized to the thermal expansion coefficient of zirconium dioxide.

Note
pp CARES® Variobase™ copings must not be sandblasted or
ground.
pp All commercially available veneering ceramics that are
intended for veneering of this material and that are suitable
for a CTE value of 10x10 -6/K can be used.

20 21
 Particular attention must be given to an even layer thickness of the porcelain veneered Step 3 – Product completion at the dental
on the abutment. ­l aboratory

Possible veneering ceramics: Option A: Screw-retained final restoration

pp VITA VM 9
®
Directly proceed to Step 4 – The use of transfer aids.
pp GC® Initial Zr
pp VINTAGE® Zr

The processing instructions of the veneering material manufacturers apply!

Option B: Cement-retained final restoration

pp Mount the Straumann® CARES® Variobase™ abutment on
Option B: Cement-retained final restoration the implant analog.
Directly proceed to Step 2 – Bonding process, described below. pp Use standard procedure to fabricate the cement-retained
restoration.
Step 2 – Bonding pp Veneer the structure.
Fix the Variobase™ abutment to the implant analog with a screw (hand-tight). Seal the
screw channel with wax.

Note
It is not necessary to sandblast the Variobase™ abutment.
Step 4 – The use of transfer aids
To ensure correct transfer of the abutment position from the mas-
ter cast to the patient, an individual index can be fabricated on
Apply self-adhesive dental cement on the Variobase™ abutment. Follow the cement the master cast using acrylic. The index is secured with support
manufacturer’s instructions. Bond the coping to the Variobase™ abutment. from the adjacent teeth.

Note Note
Immediately remove excess cement from the abutment and polish the lower margin of The occlusal screw opening must not be covered with acrylic.
the coping after the cement has dried. Ensure that no acrylic gets into the interior of the abutment,
pp Always use a polishing aid to protect the abutment’s prosthetic connection. otherwise it might not be possible to loosen the basal screw.
pp Do not fire the abutment after bonding.

22 23
 4.2.3 Insertion (dentist’s office) 4.3 Restoration: CARES ® Variobase™ coping

The final restoration is fixed on the master cast before it is deliv-

ered to the doctor’s office. Intended use
pp Screw-retained or cement-retained crowns on competitor abutments
Step 1 – Preparation pp Cement-retained bridges (via mesostructure) on competitor abutments
pp Remove the healing cap or temporary restoration.
pp Remove the superstructure from the master cast and u­ nscrew Material
the abutment from the analog. pp zerion® (zirconium dioxide)
pp Clean and dry the interior of the implant and the pp polycon® ae (PMMA)
abutment thoroughly.
Contraindication
Note pp Allergies or hypersensitivity to chemical ingredients of the zirconium dioxide
pp Always ensure that surfaces of threads and screw heads are ­material (zirconium dioxide (ZrO2), yttrium oxide (Y2O3), hafnium dioxide (HfO2),
clean and that a new screw is used for the final restoration. aluminum oxide (Al2O3), titanium alloy (Ti6Al7Nb titanium, aluminum, niobium or
pp Straumann CARES Variobase™ abutments, zerion can
® ® ®
TAN) or PMMA (polymethyl methacrylate).
be sterilized with moist heat (134°C/273°F, 5 min).
Characteristics
pp zerion® and polycon® ae are available in various tooth shades
Step 2 – Final insertion pp Customized shape and emergence profile
pp Straumann precision fit of coping to bonding base
Option A: Screw-retained final restoration
pp Position the sterilized Straumann® CARES® Variobase™ Polycon® ae copings are intended for a usage of up to 180 days.
abutment in the implant. Tighten the screw to 35 Ncm using
the SCS Screwdriver along with the ratchet and the torque
control device.
pp Close the SCS screw channel with cotton and ­sealing
­compound (i.e. gutta-percha). This allows for later removal
of the Straumann® CARES ® Variobase™ ­abutment in case a
crown replacement is required.

Option B: Cement-retained final restoration

pp Position the sterilized Straumann® CARES® Variobase™
abutment in the implant. Tighten the screw to 35 Ncm using
the SCS Screwdriver along with the ratchet and the torque
control device.
pp Close the SCS screw channel with cotton and ­sealing
­compound (i.e. gutta-percha). This allows for later removal
of the Straumann® CARES ® Variobase™ ­abutment in case a
crown replacement is required.
pp Cement the superstructure to the abutment.
pp Remove excess cement.

24 25
 4.3.1 Designing CARES ® Workflow 4.4 Restoration: CARES ® Screw-retained bridges and bars (SRBB1)

Step 1 – PREPARATION for CARES ® Visual

Follow the preparation requirements according to chapter 3. Intended use
Straumann® CARES ® SRBB are prosthetic mesostructures directly screwed to the endos-
Only use bonding bases or abutments of original implant system manufacturers and seous dental implant intended as an aid in prosthetic rehabilitations for multiple tooth
follow the corresponding instructions for use. Protect the abutment connection with a replacement or fully edentulous patients.
polishing aid during sandblasting. Use scan spray or sandblast the abutment surface
with aluminum oxide (50 µm with max. 2  b ar) to ensure proper digitization of the Material
bonding base. pp Titanium grade 4
pp Cobalt-chromium alloy (coron®)
Step 2 – DESIGNING with CARES ® Visual
Register the wax-up sleeve holder in the CARES ® Visual software and then design Contraindication
the restoration according to the Straumann CARES Visual – Software Manual. Or you
® ®
Allergies or hypersensitivity to chemical ingredients of the following materials used:
can also watch the CARES® Tutorial videos online for further guidance. www.straumann- coron® (cobalt-chromium alloy): cobalt (Co), chromium (Cr), tungsten (W), silicon (Si),
cares-digital-solutions.com > myStraumannCARESDesktop > Products & Service > manganese (Mn), niobium (Nb), commercially pure titanium grade 4 (Ti)TAN (titanium
Education alloy Ti-6Al-7Nb): titanium (Ti), aluminum (Al), niobium (Nb).

Note
Screw hole diameters for Straumann® Variobase™ Abutments are:
NNC = 2.2 mm, RN = 2.75 mm, WN = 2.75 mm, NC = 2.2 mm, RC = 2.3 mm

4.3.2 Finishing (Straumann ® CARES ® Abutments –

Completion at the dental laboratory)

Please follow steps described in chapter 4.2.2.

1
  SRBB is the abbreviation for Screw-Retained Bridge & Bar.

26 27
 Characteristics 4.4.1 Straumann CARES ® Screw-retained bridge

Straumann® CARES ® SRBB conditions

Implant divergence compensation

between any two implants
CARES ® SRBB are available on Screws for ­S traumann ®
following Straumann ® Implants CARES ® SRBB
Only TL Only BL Mixed TL and BL

Regular Neck (RN)

Straumann ® Soft synOcta ® Basal screw
36° –
Tissue Level implants 048.356
Wide Neck (WN)
24°
Regular CrossFit ® (RC)
Straumann Bone
®
NC / RC SRBB BL screw
– 24°
Level implants 025.2926
Narrow CrossFit (NC)
®

Note
pp The Straumann® Repositionable Implant Analogs are not intended to be used for
Straumann® CARES ® SRBB. Please consider the model preparation instructions
described in chapter 3.1. Straumann may return the order if the requirements are
not fulfilled.
pp The screws delivered together with the CARES® SRBB are meant for use in the pa- Intended use
tient’s mouth. For additional screws in case of loss or for use in the lab, only use Straumann® CARES ® screw-retained bridge is a framework which is intended for direct
the screws listed in the chart above. veneering with appropriate techniques in dental technology or for wrapping with acryl-
ics in combination with pre-fabricated teeth, to treat partially or fully edentulous cases.

Characteristics
pp 2 to 16 units
pp Placement on 2 to 16 implants
–– Straumann Soft Tissue Level (RN, WN),
Bone Level (NC, RC) and BL / TL mixed implant platforms
pp Maximum number of anterior pontics: 4
(only possible between the canines)
pp Maximum number of posterior pontics: 3
pp Maximum number of free-ends: 1 per end
pp Straumann Guarantee for Straumann® CARES® ­screw-retained
bridges and bars

Note
For 4 pontic span bridges more than two NC implants are required.

28 29
 4.4.1.1 Designing: CARES ® Workflow 4.4.1.2 Finishing

Step 1 – PREPARATION for CARES ® Visual Step 1 1

Follow the preparation requirements according to chapter 3. Delivery of the bridge and screws for use in the patient’s mouth
from ­Straumann: Use the included patient label for patient re-
Note cords in the laboratory. The bridge can be directly placed on
For optimal esthetic planning, especially in the labial region, model a fully anatomic the implant analogs and implants, no additional processing,
wax-up and confirm the size and position intraorally. The wax-up can be scanned and grinding or adjustments is needed.
used as reference when designing the restoration in CARES Visual.
®

Step 2
Step 2 – DESIGNING with CARES Visual ®
Check the tension-free fit on the master cast (e.g. Sheffield test)
Design the restoration according to the Straumann® CARES® Visual – Software Manual or and also check the occlusal situation with an antagonist model.
watch the CARES Tutorial videos online for further guidance.
® 2

www.straumann-cares-digital-solutions.com > myStraumannCARESDesktop > Products Step 3 (optional)

& Service > Education To further check the fit, send the bridge to the dentist for an ad-
ditional try-on in the patient’s mouth. Make sure the screws used
Step 3 – ORDER PROCESS for CARES ® SRBB are not damaged. Insert the screws with the SCS Screwdriver.
Order the restoration according to the process described in the brochure Straumann ®
The friction fit secures the screws to the instrument during inser-
CARES® Screw-retained Bridge and CARES® Bar – Service and Process. tion and ensures safe handling.

Step 4
Prepare and process the bridge according to the instructions
from the manufacturer of the veneering material. 3

Step 5
Use appropriate veneering techniques of dental technology to
veneer the framework. Be sure to follow the instructions for use
of the veneering material of your choice, which must be appro-
priate for the framework material.

Note
Consider anatomical guidelines when veneering. The “freedom
in centric” concept should be used for the occlusion. 5

Step 6
Send the master cast, the bridge together with
new screws, the IFU leaflet and patient labels to the restorative
dentist.

Note
The IFU must be sent together with the restoration to the dentist.

30 31
 4.4.1.3 Insertion (dentist’s office) 4.4.2 CARES ® Bars

The final restoration is fixed on the master cast before it is de-

livered to the dentist’s office together with new screws, IFU and
patient labels.

Step 1
Remove the healing abutment or temporary restoration.

Step 2
Clean and dry the interior of the implants. Ensure that the screws
and the bridgework are cleaned thoroughly before insertion
(cleaning, disinfection and sterilization according to the bro-
chure Guideline for Cleaning, Disinfection and Sterilization.

Step 3
Check the fit of the bridge before fixing it in the patient’s mouth.
Do not attach the bridge if the fit appears to be unsatisfactory
(e.g. when performing a Sheffield test).
Intended use
Step 4 Straumann® CARES ® bars are retentive elements to be combined with an overdenture
Position the cleaned bridge on the implants and insert the to treat edentulous cases.
screws. Tighten the screws to 35 Ncm using the SCS Screw-
driver with the ratchet and the torque control device. Characteristics
pp Placement on 2 to 10 implants
Note –– Straumann Soft Tissue Level (RN, WN),
The friction fit secures the screws to the instrument during inser- Bone Level (NC, RC) and BL / TL mixed implant
tion and ensures a safe handling. pp Free-end extensions possible
pp Large bar design variety:
Step 5 –– Dolder ® U-shape (regular and mini)
Close the screw channels with cotton and sealing compound –– Dolder ® egg-shape (regular and mini)
(e.g. gutta-percha or composite). This allows a later removal of –– Dolder ® mix (e.g. egg-shaped anterior,
the bridge if maintenance is needed. U-shaped free-end extensions)
–– MP-Clip ® Bar
Step 6 –– Ackermann-Bar ®
Polish the filling material. –– Round Bar
pp Straumann Guarantee for Straumann® CARES® ­screw-retained bridges and bars
Note
If additional screws are needed, consult the table “CARES ®
SRBB conditions” in chapter 4.4 for the corresponding article
numbers.

32 33
 Straumann ® CARES ® Bars Portfolio Bar Positioning
To ensure optimal force distribution, position the bar in parallel to the occlusal plane
Dolder ® U-shape Bar Dolder ® Egg-shape Bar and place it physiologically optimal over the alveolar ridge. Consider the path of inser-
tion of the coverdenture when designing the bar. To avoid horizontal forces, design the
bar in parallel to the occlusal plane. (Wirz, 1994)1

pp U-shaped cross section

pp Egg-shaped cross section
pp Rigid and stable combination
pp Vertical translation and rotation possible
of bar and matrix

Ackermann-Bar ® Round Bar MP-Clip ® Bar

4.4.2.1 Designing: CARES ® Workflow

Step 1 – PREPARATION for CARES ® Visual

Follow the preparation requirements according to chapter 3.
pp Economical alternative to prefabricated
pp Round-section bar metal matrixes
pp Round-section bar Note
pp 2 rider concepts for space saving mounting pp Retention intensity can easily be adjusted by
pp Bar diameter 1.9 mm For optimal esthetic planning of the bar, make a setup of the overdenture in wax and
pp Bar diameter 1.8 mm exchanging the retention inserts
pp Bar diameter 1.8 mm check its fit intraorally. The setup can be scanned and used as reference when design-
ing the bar in CARES ® Visual.

Step 2 – DESIGNING with CARES ® Visual

Design the restoration according to the Straumann® CARES® Visual – Software Manual
or watch the CARES ® Tutorial videos online for further guidance.
www.straumann-cares-digital-solutions.com > myStraumannCARESDesktop > Products
& Service > Education

Step 3 – ORDER PROCESS for CARES ® SRBB

Order the restoration according to the process described in the brochure Straumann®
CARES® Screw-retained Bridge and CARES® Bar – Service and Process.

1
 Jager, K., Wirz J. Unterkiefer-Hybridprothesen mir vier Implantaten. Eine In-vitro-Spannungs-
analyse. Schweiz. Monatsschr. Zahnmed., 104, 1489-1494 (1994).

34 35
 4.4.2.2 Finishing

Step 1
Delivery of the bridge and screws for use in the patient’s mouth MP-CLIP ® BAR
from ­Straumann: Use the included patient label for patient re- pp Attach the spacer with the sleeve on the bar and make sure that it fits perfectly.
cords in the laboratory. The bar can be directly placed on the pp Cut the sleeve back according to the height of the bar and block out the space
implant analogs and implants, no additional processing, grind- between the sleeve and gingiva as well as the implant caps with wax.
ing or adjustments is needed. pp Finalize the denture according to the standard dental technique. Remove the bar
from the denture and strip the spacer from the sleeve. Use the insert positioner to
Note place the retention insert in the metal sleeve.
Be advised that changing the shape or the cross section of the
bar might have a negative impact on the fit of the matrices on Ackermann ®, Dolder ® and Round Bar matrix
the bars. Do not alter/weaken the connection interface be- Ackermann®: Use the Ackermann® Bar Matrix A in the posterior and Matrix B in the 1
tween bar and bar copings. anterior region.
Dolder ® Bar: Shorten the matrix according to the length of the bar. To ensure a secure
Step 2 fixation in the denture, the matrix should be at least 5 mm long.
Check the tension-free fit on the master cast (e.g. Sheffield test). Ackermann®, Dolder ® and Round Bar: Place the matrix on the bar. Place the accord-
ing spacer between the bar and the matrix during polymerization.
Step 3 (optional) Ackermann® and Round Bar: To prevent the matrices from premature wear and to
To further check the tension-free fit, send the bar to the dentist achieve a consistent insertion axis of the denture, position the matrices in parallel to
for an additional try-on in the patient’s mouth. Make sure the each other (Fig. 1). Block out the space between matrix /bar and gingiva as well as
 

1
screws used are not damaged. Insert the screws with the SCS the implant caps with wax (Fig. 2). Ensure that the lamellae of the matrix is blocked out
Screwdriver. The friction fit secures the screws to the instrument adequately to enable deflection when the denture is inserted or removed.
during insertion and ensures safe handling. Dolder ® Bar: Block out half of the height of the Dolder ® Matrix (Fig. 3).
Ackermann®, Dolder ® and Round Bar: Finalize the denture according to the standard
Step 4 dental technique.
Fabricate the final prosthesis and fixate the matrices according
to the instructions on the following page. For optimal fit and best Note
performance of the Straumann CARES bar, it is recommended
® ®
To avoid unwanted loading of the implants during chewing, always use the according 2
to combine the device only with the corresponding original spacer between the bar and the matrix when polymerizing. This also ensures the verti-
matrices of the CARES ® System. cal translation of the prosthesis to the bar.

Varying the retention force of the bar matrix

Only the appropriate activator/deactivator may be used for activating/deactivating
the bar matrix.
pp To activate the matrix, press its walls together with the a­ ctivator.
pp To deactivate the matrix, push its walls apart with the d­ eactivator. 3

Step 5
Send the master cast, the bar, the prosthesis, new screws, the IFU and the patient labels
to the restorative dentist.

Note
The IFU must be sent together with the restoration to the dentist.

36 37
 5. Auxiliaries and instruments

4.4.2.3 Insertion (dentist’s office) 5.1 SCS Screwdrivers

The final restoration is fixed on the master cast before it is de-

Art. No. Article Dimensions Material
livered to the dentist’s office together with new screws, IFU and
patient labels. SCS Screwdriver
046.400 Length 15 mm Cronidur ® 30
for ratchet, extra short

Step 1 SCS Screwdriver

046.401 Length 21 mm Cronidur ® 30
Remove the temporary restoration. for ratchet, short

SCS Screwdriver
046.402 Length 27 mm Cronidur ® 30
Step 2 for ratchet, long

Clean and dry the interior of the implants. Ensure that the screws
and the bar are cleaned thoroughly before insertion (cleaning,
disinfection and sterilization according the brochure Guideline
for Cleaning, Disinfection and Sterilization. 5.2 Ratchet

Step 3
Art. No. Article Dimensions Material
Check the fit of the bar before fixing it in the patient’s mouth.
Do not attach the bar if the fit appears to be unsatisfactory (e.g. Ratchet
046.119 Length 84 mm Stainless steel
includes service instrument
when performing a Sheffield test).

Step 4
Position the cleaned bar on the implants and insert the patient
screws. Tighten the screws to 35 Ncm using the SCS Screw- 5.3 Polishing aids and analog holder
driver with the ratchet and the torque control device.

Art. No. Article Dimensions Material

Note
The friction fit secures the screws to the instrument during inser- Polishing protector
046.245 for RN synOcta ® Copings, Length 15 mm Stainless steel
tion and ensure safe handling. If additional screws are needed,
transocclusal screw-retained
consult the table “Straumann® CARES ® SRBB conditions” in
025.2920
chapter 4.4 for the according article numbers. 025.2920-04
NC Polishing aid Length 16 mm Stainless steel

025.4920
Step 5 RC Polishing aid Length 16 mm Stainless steel
025.4920-04
Attach the final prosthesis.
046.239 Analog holder Length 105 mm Al/Steel

38 39
 6. Appendix

5.4 Auxiliaries for bar matrices 6.1 Related documentation

Art. No. Article Dimensions Material

pp Basic Procedure Straumann® CARES® System
Activator set pp Instructions for use Straumann® CARES® Mono Scanbody
046.150 for all bar matrices, Length 50 mm Stainless steel pp Instructions for use for Straumann® Scanbody
three-part
pp Basic Informationon Straumann® CARES® Tooth-borne Prosthetic Procedures
Deactivator pp Basic Information on the Surgical Procedures – Straumann® Dental Implant System
046.151 for Dolder ® Bar matrices, Length 66 mm Grilon BS/Brass
mini
pp Guideline for Cleaning, Disinfection and Sterilization
pp Straumann® CARES® System
Deactivator
pp Basic Procedure Straumann® CARES® System
046.152 for Dolder ® Bar matrices, Length 66 mm Grilon BS/Brass
regular pp Straumann® CARES® Visual Software Manual
pp Straumann® CARES® Screw-retained Bridge and CARES ® Bar – Service and Process
pp The Way to Straumann® CARES® Abutments
pp Straumann® CARES® Scan & Shape Process Guide
pp iTero™ Intra-Oral Scanner for Digital Impressions
5.5 Wax-up kits pp www.straumann-cares-digital-solutions.com > myStraumannCARESDesktop > Products & Service > Education

Art. No. Article Dimensions Material

Straumann ® CARES ®
­Wax-up kit contains wax-up
019.0063 sleeve holders for Strau-
mann ® Dental restorations
on Straumann ® Implant

Straumann ® CARES ®
­Wax-up kit for Camlog ®
contains wax-up sleeve­
019.0050
­h olders for Straumann ®
Dental restorations on
Camlog ® Implants

Straumann ® ­C ARES ®
­Wax-up kit for
­N obelReplace™
019.0051 contains wax-up sleeve
holders for Straumann ®
Dental ­restorations on
­N obelReplace™ Implants

40 41
 7. Important guidelines Notes
IMPorTAnT GUIDELInES

Please note Explanation of the symbols on labels and instruction leaflets

Practitioners must have appropriate knowledge and instruction in the
handling of the Straumann CADCAM products or other Straumann Batch code
products (“Straumann Products”) for using the Straumann Products
safely and properly in accordance with the instructions for use.
Catalogue number

The Straumann Product must be used in accordance with the

instructions for use provided by the manufacturer. It is the practitioner’s Sterilized using irradiation
responsibility to use the device in accordance with these instructions
for use and to determine, if the device fits to the individual patient
situation.
Lower limit of temperature
…min.
The Straumann Products are part of an overall concept and must be
used only in conjunction with the corresponding original components
and instruments distributed by Institut Straumann AG, its ultimate …max.

parent company and all affiliates or subsidiaries of such parent

company (“Straumann”), except if stated otherwise in this document Upper limit of temperature
or in the instructions for use for the respective Straumann Product.
If use of products made by third parties is not recommended by
Straumann in this document or in the respective instructions for use,
…max.
any such use will void any warranty or other obligation, express or
implied, of Straumann. Temperature limitation
…min.

Availability
Some of the Straumann Products listed in this document may not be
available in all countries. Caution: Federal law restricts this device
to sale by or on the order of a dental
Caution professional.
In addition to the caution notes in this document, our products must
be secured against aspiration when used intraorally.
Do not re-use
Validity
Upon publication of this document, all previous versions are
superseded.
non-sterile
Documentation
For detailed instructions on the Straumann Products contact your
Straumann representative. Caution, consult accompanying documents

Copyright and trademarks

Straumann® documents may not be reprinted or published, in whole
Use by
or in part, without the written authorization of Straumann.
Straumann® and/or other trademarks and logos from Straumann®
mentioned herein are the trademarks or registered trademarks of
Straumann Holding AG and/or its affiliates. Keep away from sunlight

BAR Trademarks C+M:

Dolder ® is a registered trademark from Prof. Eugen Dolder, former Straumann Products with the CE mark fulfill
director, School of Dentistry of Zürich the requirements of the Medical Devices
Directive 93/42 EEC
Ackermann-Bar ® is a registered trademark of Cendres+Métaux Hold-
ing SA, Switzerland. 0123

MP-Clip is a registered trademark of Cendres+Métaux Holding SA,

®

Switzerland.
Consult instructions for use

42 43
 w w w.straumann.com
Straumann products are CE marked    02/13  152.822/en    B00313

International Headquarters
Institut Straumann AG
Peter Merian-Weg 12
CH-4002 Basel, Switzerland
Phone +41 (0)61 965 11 11
Fax +41 (0)61 965 11 01

Dolder ® is a registered trademark from Prof. Eugen Dolder, former director, School of Dentistry of Zürich
Ackermann-Bar ® is a registered trademark of Cendres + Métaux Holding SA, Switzerland.
MP-Clip ® is a registered trademark of Cendres + Métaux Holding SA, Switzerland.
© Institut Straumann AG, 2013. All rights reserved.
Straumann ® and/or other trademarks and logos from Straumann ® mentioned herein are the trademarks or registered trademarks of Straumann Holding AG
and/or its affiliates. All rights reserved.