Dr. Thomas Laux developed the TSA (The Biomechanical Abutment) to address issues with rigid implant abutments. The TSA abutment allows for micro-movement to absorb forces from chewing in a way that mimics natural tooth mobility. Clinical studies show the TSA abutment prevents overloading of implants and reduces the risk of complications. The multi-component TSA system provides varying levels of friction to suit different clinical situations.

1. TSA – The Biomechanical Abutment
Dr. Thomas Laux
1984-1989 Studied dentistry at the University of the Olympic city of Sarajevo
1990-1998 Dentist at implant clinic in Hamburg focusing biomechanics.
From 1999 Practicing dentistry in Augsburg. Management of the IMPLANT Diagnostic Centre in Augsburg.
Three patents granted in the field of oral implantology. Inventor of the BoneCare ™ titanium shock absorbers.

2. The natural chewing function is a dynamic process: anatomical structures such as mucosa, muscles, periodontal
ligament and even the lower jaw have a certain elasticity which absorbs and transfers the forces related to chewing.
When, with implants, the natural ligament is not present (ankylosis), physiological mobility (max.2 micron) is no longer
possible. In that case, mechanical overloading is the logical consequence. This entails an increased risk of fracture of
the implant, the abutment, the screw as well as the restoration. This overloading is also considered to be an aetiological
cofactor for the development of periimplantitis.

3. TSA – Abutment: Movement
BRIDGE WORK
► 20 micron vertical movement
► 45 micron horizontal movement
OVERDENTURE
► 150 micron vertical movement
► 45 micron horizontal movement
Special adhesive technology

4. The TSA abutment, with its unique resilience, will prevent these problems. The abutment is completely sealed off
from the environment of the mouth, and its mobility provides the underlying soft tissue with a micro-massage.

5. 10x TSA in a Chewing Simulator University of Munich

6. 2001
2012
Implant-Tooth-Connection
TSA
Biomechanical Abutment

7. Implant-Tooth-Connection
Christiaan Berghmans,

8. TSA abutment
FEM - Model
FEM - Modelridged abutment

9. TSA curve
Using the resonance frequency analysis of Osstell, changes in stiffness
and stability of the implant / bone interface can be monitored and
measured. Data collected since mid-2003 of the multi-center study
shows, that approximate the initially different implant stability Quozienten
(ISQ) for immediate loading and immediate restoration with the BoneCare
® titanium shock absorber, are increasing. Moreover, since that time, no
prosthesis is broken. Non of the 82 implants was lost. The controll group of
the multi-centre-study is the study of Roland Glauser et al. (Zurich). He
made the study on ridged abutments. He lost 11 of 82 implants.
Multi-Centre-Study

10. TSA – Friction Sleeve System
EXTRA LOW LOW MIDDLE HIGH SECUNDARY CAP CONE

11. TSA – Friction Sleeve System
CONE

13. Abutment level impression: fixation in the mouth
After making an impression, remove healing abutments and
determine the correct height of the TSA abutment.
The basic principle here is that the shoulder of the abutment must
come to the same level as the highest point of the surrounding
mucosal tissues. If, when using the TSA abutment, as opposed to other
anchoring systems, there is insufficient space, the shoulder of the
abutment can be placed 1 mm lower. The functioning of this
abutment allows the secondary cap to be partially positioned under
the mucosal tissue.
Definitive positioning of the abutments and tightening with a force of
25 Ncm.

14. Positioning of the spacer caps.
Functional impression with individual tray and conventional
impression materials. Ensure that there are enough recesses for the
spacer caps in the tray. Be careful for air bubbles around the caps.

15. Remove impression. Do not reposition the spacer caps in the
impression. Remove the spacer caps that remain in the impression.
Cast the definitive model. Bite plate and fitting in wax according to
the conventional method.

16. Before moulding the prosthesis ensure that only the undercuts under
the stumps (spacer) are blocked out. The spacer ensures that
sufficient space is created so that the prosthesis can be positioned
without friction and unambiguously over the secondary caps in the
mouth. The space needed to apply the fixation material is also
uniform, resulting in optimal fixation. The roughening of the recesses
for the application of the adhesive strengthens the bond between the
gel and the prosthesis.
As standard procedure, screw a metal-coloured sleeve using the tool
in the secondary cap. Be careful to ensure that the friction sleeve is
completely seated on the secondary cap.

17. Then mount the rubber dam under the sealing edge of the secondary
cap. Press the secondary cap over the abutment until a clear 'click'
(circle snap) is audible. Repeat this procedure for the remaining caps.
Finally, ensure that the rubber dam tightly fits against the mucosal
tissue. Then check whether the prosthesis is positioned properly on the
mucosal tissue before checking the occlusion. Remove any pressure
points. Blow the secondary caps dry before applying the etching
material; e.g., Metal Primer from GC (see manufacturer's instruction for
use). Etching ensures optimal fixation.
Roughen the inside of the recesses with a spherical bur, fill with an
adhesive and allow to dry briefly. The adhesive provides for the
optimal bonding between the plastic of the prosthesis and the
composite. The fixation of the secondary cap in the mouth is
achieved using, e.g. Quick Up from Voco or a similar product. It is
supplied in a cartridge and with an adhesive. The advantage of the
gel is that it does not harden too quickly, and due to uniform dosing, it
always has the same strength. With the aid of a dispenser, a small
amount of gel is applied to the recess. Be sure not to completely fill
the recess; filling it one-third is the recommended amount.

18. Place the prosthesis in the mouth and have the patient set the teeth in
a position of central occlusion. It is important that no force is exerted
by the patient during the hardening. After hardening, check occlusion
and articulation.
Click out the prosthesis and then remove the rubber dam and the
excess material. Reposition the prosthesis and check the friction.

19. Replace the extra low friction sleeves with sleeves of the suitable
friction level.

20. Coverdenture without metal frame

21. Coverdenture without metal frame

22. Removable Bridgework

23. Removable Bridgework

24. TSA-MAX single tooth

26. Thank you for your attention!