Individual Crown SystemGuidelines and Processing

Table of Contents:

Prior To Case Submission

Process Overview

Clinical Considerations for Case Submission

Tips for Taking an Accurate Impression

Creating a Screw-Retained Diagnostic Wax Up

After Recieving Case

Checklist to Verify Fit

Acrylic Venering of the Gingival Contours

Installation of AccuFrame IC Crowns or Framework

Removal of AccuFrame IC Crowns or Framework

What’s Inside This BookletThis brochure is intended to provide detailed guidance on the AccuFrame IC System from surgery to

delivery of the final prosthesis. One of the key benefits of the AccuFrame IC System is the underly-

ing process was designed to simplify the traditional individual crown and framwork solution, while

delivering a superior product with unique set of advanced features.

While the depth of explanation might seem be overkill for some, there are several key points of

reference that are critical for success. Please take care to, at the very least, seek out those tips and

abide by them.

As with any Cagenix product, we encourage you to contact us with any questions or concerns at

(866) 964-5736.

Table Of Contents • TC

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Process OverviewSTEP 1 :Take impressions and occlusal records to determine vertical dimension, occlusal scheme, phonetics and aesthetics.

STEP 2 :Create a diagnostic wax-up (denture tooth setup) on a mounted master cast, utilizing your denture teeth of choice, to replace the missing teeth and/or teeth to be extracted. Ensure appropriate vertical dimension (10mm) is provided.

STEP 3 :Try in of diagnostic wax-up (denture tooth setup) to check for phonetics, occlusion, mid-line, and aesthetics

STEP 4 :Adjust diagnostic wax-up (denture tooth setup) per pa-tient feedback

STEP 5 :CBCT/X-Rays performed for determining implant place-ment

STEP 6 :Surgical placement of implants

STEP 7 :Final impression to create a master cast (See “Tips for Taking an Accurate Impression” - Page 5)

STEP 8 :Verify the impression with a verification jig.

STEP 9 :Take post-osseo-integration inter-occlusal re-cords to determine vertical dimension & occlusion

STEP 10 :Create screw-retained diagnostic wax-up (denture tooth setup) with an acrylic base plate, utilizing your denture teeth of choice, on a mounted master cast to verify the occlusion, vertical dimension, phonetics and aesthetics (We strongly recommend a fixed diagnostic wax-up to a removable wax-up for accuracy)(See “Creating a Screw-Retained Diagnostic Wax Up” - Page 7)

Clinical Considerations • 2

VERY IMPORTANT!It is critical to accurately create the fixed diagnostic wax up. A poor relation of the diagnostic wax up can lead to an improp-er occlusal scheme of the crowns, poten-tially resulting in significant modifcation at the time of delivery. ALL DIAGNOSTIC WAX UPS SHOULD BE CHECKED FOR THE FOLLOWING:• Occlusal contacts of Denture Teeth • Mesial/Distal contacts of Denture Teeth • Proper position of midline • Appropriate vertical dimension (10mm)• Minimum of 2 mating cylinders

Process Overview (continued)

STEP 11 : Send master model, completed order form, and diag-nostic wax-up to Cagenix. Customers may also opt to submit articulator in cases where occlusion needs to be verified including, but not limited to, cases where por-celain will be stacked on cutback crowns. (See Figure A)

STEP 12 :Fabricated AccuFrame IC is returned to doctor / dental lab for completion.

STEP 13 :Mount Framework to master cast. At this point, you may opt to cement crowns to the framework that do not cover screw-access holes. In such a case, Cagenix rec-ommends using a permenant white cement inside the crown, taking care to not apply so much that it over-flows when the crown is placed on the support post.

STEP 14 :Define desired gingival contour for final prosthesis. For crowns covering screw access holes, be cautious to keep gingiva below the lingual contours to avoid trap-ping crowns after processing and facilitate ease of re-moval. Crowns covering screw access holes should be removed periodically to ensure the wax contours have not trapped the crown. The crown contours should also be reviewed for potential undercuts, where acrylic may trap the crown. (See Figure B)

STEP 15 :Reverify the occlusion, vertical dimension, phonetics and aesthetics by inserting the waxed-up AccuFrame IC in patient.

STEP 16 :Now it is time to Process the gingival contours to the framework. Please see the appropriate section for guid-ance on this process.

Clinical Considerations • 3

Figure A

Figure B

Clinical Considerations for Case SubmissionThe screw retained diagnostic set-up of the denture teeth is critical for assurance of adequate restorative space, confirmation of the occlusion, aesthetics and phonetics for the patient. All of these parameters must be checked intra-orally prior to submission of a case to Cagenix. The screw retained diagnostic set-up must seat passively on the master cast. It is Cagenix responsibility to reproduce these same dimensions of the diagnostic set-up in the final IC Accuframe prosthesis.

EVALUATING CASE SUITABLITY STEP 1 : Examine existing prosthesis (denture, partial, etc.) or dentition and evaluate occlusal relationship, vertical dimension and position of teeth. If insufficient space is present, it may be necessary to remove osseous tissue. A diagnostic wax up of the missing teeth is recommended for this evaluation.

STEP 2 :Verify recommended restorative space. 10mm or greater restorative space is preferable. (See Figure C)

STEP 3 :Verify sufficient bone height & volume. A CT Scan is recommended to evaluate bone contours/quality/quan-tity.

STEP 4 :Review appropriate placement of implants to support the framework, especially in conjunction with distal ex-tensions. Distal extensions should be limited to 2 teeth or less. (See Figure D)

Clinical Considerations • 4

Figure C

Figure D

Tips For Taking an Accurate ImpressionCagenix AccuFrame IC technology is based on an ac-curate master cast. If an inaccurate impression is made, then the master cast will be inaccurate as well. Follow-ing a methodology to assure an accurate impression is critical to the accuracy of the final framework.

Preface:Cagenix recommends that you verify the master cast ac-curacy with a verification jig.

In an effort to simplify the verification of the implant position a recommended method would be to make a verification jig intra-orally and impress the tissue con-tours and the jig at the same time. It is recommended that you use a light body impression material to capture the tissue contours and a heavy body impression mate-rial to secure the verification jig within the impression material. This impression method requires that you use an open tray to make the impression.

STEP 1 : A custom tray can be made or a Miratray® for implants made by Hager Werken can be used to make the im-pression.

STEP 2 : Open tray implant or abutment transfers are placed on the implants or abutments. (See Figure E) STEP 3 : Transfers are linked together with Triad TruTray custom tray material or other light cured composite material. An auto-polymerizing acrylic can also be used to link together the transfers. This linking together of the trans-fers will act as the verification jig. After the transfers are linked, it’s imperative that the passivity of fit is checked for distortion during the curing process. Sectioning and re-luting the index can relieve any stresses that occur. It’s critical the verification jig be passively fitting before the impression is taken. (See Figures F & G)

Taking An Accurate Impression • 5

Figure E

Figure G

Figure F

Tips For Taking an AccurateImpression (continued)

STEP 4 :Light body impression material is syringed around the implants and base of the jig. Heavy body impression material is placed in the impression tray and placed over the transfers with the screw heads projecting thru the tray so they can be easily unscrewed. (See Figures H & I)

STEP 5 :After complete setting of the impression material the tray is removed by first unscrewing the transfer screws then removing the tray from the mouth.

STEP 6 :The impression is checked for voids and complete en-casement of the jig within the impression material.

STEP 7 :Analogs are placed on the transfers and a gingival mask material is placed around the transfers and analogs.

STEP 8 :The impression is poured up in the stone of choice to make the master cast. (See Figure J)

STEP 9 : A verification jig can be made on the stone to double check the accuracy of the master stone against the patient’s implant placement. This step double checks and helps assure that an accurate master stone is being utilized.

Taking An Accurate Impression • 6

Figure H

Figure I

Figure J

Creating a Screw-Retained Diagnostic Wax UpIt is critical that the diagnostic wax-up of the denture teeth be secured to prevent movement during the try-in and the scanning of the wax-up. Therefore, a screw retained diagnostic wax-up of the denture teeth is needed. It assures an accurate transfer of the occlusal, aesthetic and phonetic relationships acquired intra-orally to be transferred to the master cast. Cagenix will reproduce these in the IC Accuframe prosthesis.

STEP 1 : All undercut on the master cast are waxed out to allow removal of the screw retained occlusal tray.

STEP 2 : Two or more screw-retained copings are placed on the analogs. Check for any interference that may prevent complete seating of the copings on the master cast. (See Figure K)

STEP 3 :Lubricate the master cast.

STEP 4 : A light cured or auto-polymerizing tray material can be applied to the master cast engaging the retention slots of the copings. (See Figure L)

STEP 5 :Remove the tray after it is cured to check for a passive fit of the tray on the master cast. If movement is noted, the tray should be sectioned and reattached with new tray material. Recheck the tray for a passive fit.

STEP 6 :Begin the wax set-up of the denture teeth and festoon the gingival contours. (See Figure M)

STEP 7 : Check the diagnostic set-up tray for a passive fit on cast. STEP 8 :Smooth the wax for an intraoral try-in.

Creating a Screw Retained Diagnostic Wax Up • 7

Figure K

Figure L

Figure M

Checklist upon receipt of AccuFrame IC Case from Cagenix

1) Place framework back on master cast to verify fit

2) Place crowns on framework

3) Place back on articulator to check occlusion (If occlusion is off, Go to “In event of articulator misfit” below)

4) If occlusion is acceptable, proceed with waxing up gingival contours for try-in

6) Try in waxed-up framework & crowns in patient

7) Verify fit via XRay

8) Check occlusion in patient and adjust as necessary

9) If occlusion is off in patient, re try-in diagnostic waxup to recheck occlusion

10) If Diagnostic Wax Up and AccuFrame IC are both off, take new centric relation record andremount the master cast to articulator in the lab and review occlusal schemes. If occlusal scheme re-quires significant adjustment, contact Cagenix.

11) If Diagnostic Wax Up and AccuFrame IC differ, contact Cagenix.

In event of articulator misfit:

1) Determine if slight, moderate or severe

2) If slight or moderate, adjust occlusion manually

3) If moderate to severe, replace fixed diagnostic wax-up back onto master cast and re-check occlusion of the Diagnostic Wax-up.

4) After performing review, contact Cagenix.

Checklist upon receipt of AccuFrame IC case • 8

Acrylic Veneering of the Gingival Contours This section provides guidance in veneering gingival contours to the framework using an injection process-ing system like the Ivobase Injector. Other methods for processing the gingiva include light-cured layered composite, and cold-cure pour processing.

1) Securing AnalogsProsthetic screws are used to attach the analogs to the waxed framework & crowns. If necessary, crowns are removed from waxup to expose screw holes.

2) Refinement of Wax Contours All the analogs are attached to the framework. Crowns covering screw access holes are replaced. Wax-up is refined and ready for processing. Wax thickness should be sufficient to fully cover the framework to prevent any potential show through. If additional wax can’t be applied, an opaque can be added to prevent show through. (See Figure 1)

3) Flask the Prosthesis A new stone cast can be poured around the analogs and prosthesis to represent the master cast. It is then invested in the lower half of the processing flask in the same manner as a denture. (See Figure 2)

4) Apply SeparatorOnce the stone is set, apply separator or vaseline to the stone. (See Figure 3)

5) Apply Wax SpruesThe sprue former is attached to the lower flask and injection and air sprues are added. (See Figure 4)

6) Covering CrownsCrowns and wax-up are covered with silicone-based material leaving incisal edges and cusp tips slightly exposed. This allows the crowns to engage the upper stone flask and prevent potential movement.

Acrylic Veneering of Gingival Contours • 9

Figure 1

Figure 3

Figure 2

Figure 4

Acrylic Veneering (continued)

7) FlaskingUpper flask member is placed over the lower and the side clamps are used to lock the flask halves together. Stone is applied around the silicone material and lubri-cated lower half of the flask. Allow stone to fully set.

IMPORTANT : SCREW ACCESS OPTIONS Milled Screw Access Holes: If screw access holes have been milled into the crowns, you may elect to secure all the crowns to the framework using your choice of permanent cement. Use a small enough amount to prevent overflow onto the framework.

Covering Screw Access Holes: Any crowns covering screw access holes will be cemented upong delivery using a temporary cement. All crowns not covering access holes may be cemented using your choice of permanent cement.

8) Boil OutThe flask is placed in a heated bath to soften the wax, and all wax is removed. The framework should also be steamed and immediately blown dry to remove re-sidual wax, and return the AccuFrame Plus finish to its original brilliant pink color.

9) Reapply SeparatorApply separator to both halves of the flask. Any crowns not being cemented should be appropriately placed in the silicon of the upper flask. Next, 2 thin coats of sep-arator (Rubber Sep®) are applied to all exposed areas (inside & outside) to allow for easy retrieval of crowns after processing. The framework is not lubricated.

10) Injecting AcrylicThe upper and lower sections of the flask are care-fully closed and injection tube is attached to the flask. Flasking unit is placed in the IvoBase Injector. See the manufacturer for recommended acrylic for covering metal substructure. Opaque powders can be added to the acrylic prior to injection for added masking.

Acrylic Veneering of Gingival Contours • 10

Figure 5

Figure 7

Figure 6

Figure 8

Acrylic Veneering of the Gingival Contours 11) Deflasking and Polishing AcrylicThe flask is separated and the prosthesis is deflasked. Uncemented crowns are removed from the prosthesis and examined for acrylic flash and voids. Remove any flash that may be present. The crowns should be re-placed, and master cast remounted to check occlusion via an articulator.

12) Contouring & Polishing The bulk of the acrylic can be contoured utilizing your preferred carbide burs. For the acrylic adjacent to ce-mented crowns, utilize a Burlew Knife Edge Wheel (Pa-cific Abrasives) to remove any acrylic flashing from the face of the crowns or to contour the acrylic papillas. For polishing we recommend utilizing cloth and brush wheels with a handpiece and a polishing compound such as Acryl Marvel (Dental Ventures of America) for providing a high shine.

13) Installing AccuFrame IC Restoration We recommend the prosthesis be inserted in the pa-tient and a new centric relation record be taken. This intraoral check allows for a correction of processing errors with occlusion, or relief of any pressure on the tissue side of the prosthesis. Any final adjustments can be performed in the laboratory.

Insert the prosthesis in the patient and recheck oc-clusion as well as tissue side clearance for cleaning. Torque the screws in place and cement the remaining crowns. Temporary cement may be preferable for future removal of crowns.

Acrylic Veneering of Gingival Contours • 11

Figure 9

Figure 11

Figure 10

Installation of AccuFrame IC Crowns or framework

These are abbreviated instructions for removal and installation of the AccuFrame IC System in the patient’s mouth. One of the main benefits of the IC Accuframe prosthesis is the ease in repair and removal for cleaning of the prosthesis. The IC Accuframe crowns are designed with a lingual slot to aid in the removal of the crowns. It is recommended that you use a crown remover to pro-tect the crown and the prosthesis.

STEP ONE :After processing, remount the master cast with the Ac-cuFrame IC on the articulator and correct any occlusal processing errors

STEP TWO :Insert the AccuFrame IC in the patient to check occlu-sion and tissue impingement

STEP THREE :Place a cotton pellet or other type of stopping mate-rial into the screw access hole to prevent cement from flowing into the screw head. Check crown for complete seating prior to cementation.

STEP FOUR :Screw access hole crowns are cemented with a tem-porary/permenant cement and sealed with a flowable composite. (Temporary cement is preferred for future retrieval of crowns) Place the cement only within the crown and not on the seating area to the acrylic. If excess cement is used, it will discolor the pink gingival color. Seal the acrylic margin to the crown with a tooth color flowable composite sealant of your choice.

Abridged AccuFrame IC Installation • 12

Removal of AccuFrame IC Crowns or framework

STEP ONE :Expose Lingual Notches on the crowns with bur of choice.

STEP TWO :Engage the lingual notch with the tool of your choice to break the cement bond and free the crown.

STEP THREE :If a crown needs to be replaced, call Cagenix to have a replacement crown manufactured and sent to you. A temporary crown can be placed until the new crown is returned to you.

STEP FOUR :If needed, the framework can be removed for cleaning or repairs.

STEP FIVE :Follow installation guidelines for re-cementation and insertion.

Abridged AccuFrame IC Removal • 13

Capture final tooth position, mid-line, and desired occlusion*

       Seat wax up on screw retained acrylic baseplate

       Include at least 2 screw-retained mating cyclinders

Case Submission & Order Form Instructions

Accurate Screw-RetainedDiagnostic Wax-Up x2

IMPRORTANT:  It is critical to accurately create the fixed diagnostic wax up as itwill be replicated. Failure to do so WILL lead to an improper occlusal scheme ofthe crowns, potentially resulting in significant modifcation at the time of delivery.

AccuFrame IC Order Form:      Denture Tooth Mold (attach tooth card(s) to order form)

        Desired Tooth Shade

       Crown Material (Zirconia or eMax)

       Restoration Type (Crown, Cutback or Coping)

Your Articulator       Include articulator* (Stratos or SAM® brand articulators exempt)

*Cagenix uses Stratos & SAM articulators in-house, no need to submit them with cases

Please review guidelines carefully to ensure cases meet all criteria.Failure to do so could result in delays in your case. Please do NOT send screws.

For More information please visit http://cagenix.com or call (866) 964-5736 

Verified Master Model       Include appropriate analogs for restorative height

(Inclusion of soft tissue model is recommended)

What To Send With Your AccuFrame IC Case:

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