Columbus Birdge Protocol © 2011

                          All the “ColumbusBridgeProtocol”custom products are available on line on the Biomet 3i catalogue.








Surgery


Surgical Probe

This custom-made probe has a round tip that gives the possibility to sound the anterior wall of the maxillary sinus avoiding the risk of damaging the  Schneider membrane. In this way it is possible to choose the emergency and the angulations  of the distal implants.

Extra-oral prosthesis screwdriver

With this instrument it is possible to tighten or to unscrew the prosthetic components without inserting the hands in the mouth of the patient. This feature becomes important for  the prosthetic procedures during the surgery.

Abutment repositioning cylinders

Abutment Repositioning Cylinders have been manufactured with cervical bevels that permit removal of abutment screws when the positions of pre-angled Low Profile Conical Abutments have to be modified.

The authors have found that modification of pre-angled abutments is sometimes necessary during prosthetic re-evaluations, before placement of definitive restorations.


Tissue conditioning cylinders

These components have been designed to work with post-surgical silicone dressings. These components are manufactured without sharp line angles.  This design facilitates retention of the silicone dressing to the restorative components intra-orally, and does not traumatize intra-oral soft tissues such as the tongue, lips, or cheeks.


Advantages of silicone dressing are:

- Better control of post-surgical bleeding and swelling

- Maintenance of optimal soft tissue profiles

- Increased/improved patient comfort (patients generally do not perceive sutures while wearing the dressing)

- Maintenance of jaw relationships

- Silicone dressings may also function as occlusal night guards, and may prevent implant overload associated with para-functional habits often seen in bruxism patients

- Improved time efficiencies as the peri-implant soft tissues heal in such a fashion as to allow complete access to the intra-oral abutments without interference from collapsed soft tissues post-removal of the Tissue Conditioning Cylinders

- Reduction in patient discomfort during insertion of the provisional full fixed denture

- Decreased expenses as there will be no laboratory charges involved with these procedures

Impression Material

The impression technique of the ColumbusBridgeProtocol is studied to reach the highest stability and precision during the transmission of informations from the clinician to the dental laboratory. For this reason an open-tray technique with a stone impression material (BF-Plaster, Dental Torino) is adopted.

The stone impression material is recognized to be the elective material in the impression of the edentulous patient. The design of the abutment pick-up impression copings features increases retention within  impressions. Increased retention within impressions is related to four broad dovetail joints, present in each impression coping that result in a cross-shaped design. The use of these pick-up abutment impression copings, in conjunction with impression plaster results in rigid, definitive impressions and precise, accurate master casts, without discrepancies.

Highly Retentive Abutment Pick-up Impression Copings have been designed in two different lengths. The longer vertical portions permit completely supra-gingival positions of the cross-retention features in clinical situations where patients present with different mucosal thicknesses.

Another important feature with these impression copings is the design of the screw head: this design allows the use of both hexagonal and slotted screwdrivers.

The use of slotted screwdrivers in posterior situations is particularly advantageous where space is limited; hexagonal screwdrivers allow for better control of the screws in anterior quadrants.

Laboratory


Technique for developing passive, accurate prosthesis fit (luting technique)

The laboratory components for this technique include specific components that enable dental laboratory technicians to achieve passive fit between prostheses and abutments on the master cast and clinically.  The authors have termed this technique “the luting technique”.

The main components for this technique are titanium cylinders with double grooves that include castable caps with two opposing longitudinal areas of relief. When the cylinders and castable caps are connected, a calibrated circumferential gap of 0.2 mm exists between the caps and cylinders.  At the end of the prosthesis construction, these areas will be completed filled with cement avoiding misfit.


The luting technique has the following advantages:

- Accurate, passive fits between prostheses and intra-oral abutments can be predictably obtained

- The technique is relatively simple and may be accomplished quickly, especially when compared to other techniques used to obtain passive fit between frameworks and clinical components

- The possibility to perform the technique simultaneously or one by one for each cylinders; this permits to overcome non-parallel cylinders situations

- This procedure can be used for construction of definitive full fixed dentures or partial ones

- Prostheses constructed with this technique have demonstrated long-term stability

- This technique, takes advantage of the use of a luting cement to avoid misfit, maintaining all the benefits of the screw-retained restorations at the same time

- This technique is relatively inexpensive

Prosthesis

Utilities

Low profile conical abutment healing caps (Jaw relation records)

Accurate jaw relation records may be made by using Low Profile Abutment Healing Caps.  These healing caps are available in three different heights and are selected according to the heights of the peri-implant soft tissues.

Based on the Columbus Bridge Protocol, the various lengths of the healing caps enables clinicians to select healing caps that are supra-gingival, and yet will still allow for adequate thickness of the centric jaw relation wax records. The authors have found this feature permits better control of the vertical dimensions associated with jaw relation records.

After the clinical jaw relation records have been made, clinicians must inform dental technicians the specific lengths of each healing cap used intra-orally so that duplicate healing caps can be placed onto the Low Profile Conical Abutment lab analogs prior to mounting the casts into an articulator.

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