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CAMLOG Compendium

Surgery1The CAMLOG® Implant System is one of the most successful systems on the inter-national implant market.

The CAMLOG Compendium, consisting of manual 1 Surgery and manual 2 Prosthetics,describes (using more than 800 illustrations) the clinical and prosthetic proceduresinvolved in the practice of implant dentistry. The CAMLOG Compendium is targetedat users in order to ensure the proper handling of the system. The prostheticallyoriented CAMLOG® Implant System stands for interdisciplinary teamwork – combi-ning the skills of dentist and dental technician to develop implant solutions thatbenefit the patient.

The CAMLOG Compendium 1 Surgery addresses the insertion of the differentCAMLOG® implant configurations. It consists of a description of the prostheticCAMLOG concept, general information about the system, and prosthetic planningup to surgical intervention.

The CAMLOG Compendium 2 Prosthetics presents the dentist and dental technicianwith an array of treatment options available in the CAMLOG® Implant System. Thepatented CAMLOG® implant-abutment connection allows natural-looking, implant-supported perioprosthetics for fixed and removable dentures.

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ISBN 978-3-13-134351-2

CAMLOG Compendium

Surgery1

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CAMLOG Compendium | 1 Surgery

CAMLOG Compendium1 Surgery

All materials and dental proceduresmentioned in this Compendium mustbe used and applied by qualifieddentists and physicians only.

The CAMLOG Compendium consists oftwo parts:1 Surgery2 ProstheticsSingle pages must not be distributed.

Section OverviewCAMLOG Compendium Part 1,Surgery:I. General system informationII. CAMLOG conceptIll. PlanningIV Surgery manual

CAMLOG Compendium Part 2,Prosthetics:V. Prosthetics Manual


Bibliographic informationof the German Library

The German Library catalogs this publication in the GermanNational Bibliography; detailed bibliographic information canbe found on the Internet website: http://dnb.ddb.de.

All rights, including reprinting, reproduction in any form andtranslation into other languages, are reserved by the copyrightholder and publisher. The manual may not be reproduced inwhole or in part by photomechanical means (photocopy,microfiche) or stored, exploited systematically or distributedwith electronic or mechanical systems without writtenapproval from CAMLOG Biotechnologies AG.

Authors:Axel Kirsch, Karl-Ludwig Ackermann,Rainer Nagel, Gerhard Neuendorff,

Alexander Focke, Dieter Mozer,Alex Schär, Bernd Wagner

Manufacturer:ALTATEC GmbHMaybachstrasse 571299 Wimsheim, Germany

Copyright © 2007 CAMLOG Biotechnologies AGArt. No.: J8000.0027 web version

Printed in Germany

Cover design: CAMLOG Team,Thieme VerlagsgruppePrinting/binding: Grammlich, Pliezhausen

ISBN: 978-3-13-134351-2 1 2 3 4 5 6

Important note: Like every field of science, medicine is under-going continuous change. Research and clinical experience arecontinuously extending our knowledge, particularly of treat-ment and medicinal therapy. Where this publication refers to adosage or administration, the reader can be assured that theauthors, editor and publisher have taken great care to ensurethat this information conforms to the state of the art at thetime of publication.

However, the publisher cannot accept any liability for informa-tion on dosage instructions and forms of administration. Everyuser is urged to check carefully the information in the packageinserts of the medications and if necessary consult a specialistto see if the recommended dosage and administration or theobservance of contra-indications is different from the informa-tion given in this book. It is particularly important to checkthis in the case of rarely used medications or those that havejust been introduced to the market. Every dosage or adminis-tration is the sole responsibility of the user. The authors andthe publisher request all users to inform the publisher of anyinaccuracies.

Protected brand names (trademarks) are not specially indicat-ed. The absence of such indication does not mean that it isnot a trademarked name.

The publication with all its parts is protected by copyright.Any exploitation beyond the narrow limits of the copyright Actis not permissible without the approval of CAMLOGBiotechnologies AG and is subject to legal sanctions.


Table of Contents

I. General System Information 1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . 1

2. CAMLOG® system - description . . . . . . . . . . 2

3. Implant configuration . . . . . . . . . . . . . . . . 3Macroscopic shapes . . . . . . . . . . . . . . . . . . . . 3Internal and external configuration . . . . . . . . . . 4Bioseal Bevel / implant shoulder . . . . . . . . . . . 5Surfaces . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Tube-in-tube connection . . . . . . . . . . . . . . . . . 7Production precision . . . . . . . . . . . . . . . . . . . 8Materials . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

4. Mechanics and biomechanics . . . . . . . . . . . 9Mechanical studies . . . . . . . . . . . . . . . . . . . . . 9Lateral loading . . . . . . . . . . . . . . . . . . . . . . . . 9Failure loading . . . . . . . . . . . . . . . . . . . . . . . . 9Torsion loading . . . . . . . . . . . . . . . . . . . . . . . 10

II. CAMLOG Concept 1. Team concept . . . . . . . . . . . . . . . . . . . . . . . 11The team . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Team input . . . . . . . . . . . . . . . . . . . . . . . . . . 12

2. Treatment concepts . . . . . . . . . . . . . . . . . . 13Introduction . . . . . . . . . . . . . . . . . . . . . . . . . 13Leverage relations at the implant . . . . . . . . . . . 13Esthetics . . . . . . . . . . . . . . . . . . . . . . . . . . . 14Patient cooperation . . . . . . . . . . . . . . . . . . . . 14Patient information . . . . . . . . . . . . . . . . . . . . 14Fixed dentures . . . . . . . . . . . . . . . . . . . . . . . . 15Single crowns . . . . . . . . . . . . . . . . . . . . . . . . 15Splinted crowns . . . . . . . . . . . . . . . . . . . . . . 16Implant-supported bridges . . . . . . . . . . . . . . . . 17Removable dentures . . . . . . . . . . . . . . . . . . . 18Telescopic crowns . . . . . . . . . . . . . . . . . . . . . . 18Bar abutment . . . . . . . . . . . . . . . . . . . . . . . . . 19Ball abutment . . . . . . . . . . . . . . . . . . . . . . . . 19

III. Planning 1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . 20

2. Anamnesis . . . . . . . . . . . . . . . . . . . . . . . . . 21General . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21Special (dental) . . . . . . . . . . . . . . . . . . . . . . . 21

3. Examinations . . . . . . . . . . . . . . . . . . . . . . . 21Clinical . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21Radiographic . . . . . . . . . . . . . . . . . . . . . . . . . 22Laboratory . . . . . . . . . . . . . . . . . . . . . . . . . . . 22


4. Preliminary prosthetic design . . . . . . . . . . . 24Wax-up / set-up . . . . . . . . . . . . . . . . . . . . . . . 24Planning template . . . . . . . . . . . . . . . . . . . . . 25Radiographic template . . . . . . . . . . . . . . . . . . 26

5. Implant position verification . . . . . . . . . . . 27Purpose . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27Clinical . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27Orthopantomography . . . . . . . . . . . . . . . . . . . 27Dental film . . . . . . . . . . . . . . . . . . . . . . . . . . 27Computer tomography with/without 3-D analysis 28Drilling template . . . . . . . . . . . . . . . . . . . . . . 28Final prosthetic design . . . . . . . . . . . . . . . . . . 29Customizing the prosthetic design . . . . . . . . . . 29Planning treatment procedures . . . . . . . . . . . . 29

6. Recommended indications for various configurations . . . . . . . . . . . . . . . . . . . . . . 30

IV. Surgery Manual 1. Preparation of the patient . . . . . . . . . . . . . 33

2. Drilling template . . . . . . . . . . . . . . . . . . . . 33

3. CAMLOG® surgical system . . . . . . . . . . . . . 33Surgical sets . . . . . . . . . . . . . . . . . . . . . . . . . 34Drilling system . . . . . . . . . . . . . . . . . . . . . . . 37

4. Healing options . . . . . . . . . . . . . . . . . . . . . 38

5. SCREW-LINE Implant . . . . . . . . . . . . . . . . . 39Introduction . . . . . . . . . . . . . . . . . . . . . . . . . 39Preparation of implant bed for SCREW-LINE Implants . . . . . . . . . . . . . . . . . . 44Implant package . . . . . . . . . . . . . . . . . . . . . . 54Implant insertion . . . . . . . . . . . . . . . . . . . . . . 56

6. ROOT-LINE Implant . . . . . . . . . . . . . . . . . . . 65Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . 65Preparation of implant bed for ROOT-LINE Implants . . . . . . . . . . . . . . . . . . . . 70Implant package . . . . . . . . . . . . . . . . . . . . . . 80Implant insertion . . . . . . . . . . . . . . . . . . . . . . 82

7. SCREW-CYLINDER-LINE Implant . . . . . . . . . 91Introduction . . . . . . . . . . . . . . . . . . . . . . . . . 91Preparation of implant bed for SCREW-CYLINDER-LINE Implants . . . . . . . . . . . . . . . . 96Implant package . . . . . . . . . . . . . . . . . . . . . .106Implant insertion . . . . . . . . . . . . . . . . . . . . . .108

8. CYLINDER-LINE Implant . . . . . . . . . . . . . . .117Introduction . . . . . . . . . . . . . . . . . . . . . . . . . .117Preparation of implant bed for CYLINDER-LINE Implants . . . . . . . . . . . . . . . . .122Implant package . . . . . . . . . . . . . . . . . . . . . . .130Implant insertion . . . . . . . . . . . . . . . . . . . . . .132

9. Healing caps . . . . . . . . . . . . . . . . . . . . . . .137Introduction . . . . . . . . . . . . . . . . . . . . . . . . .137Healing caps - cylindrical and wide body . . . . . .138Healing caps - bottleneck . . . . . . . . . . . . . . . .138Tissue augmentation/support . . . . . . . . . . . . .139

10. Transfer system . . . . . . . . . . . . . . . . . . . . .140Introduction . . . . . . . . . . . . . . . . . . . . . . . . .140Closed tray impression method . . . . . . . . . . . . .141Open tray impression method . . . . . . . . . . . . .144

11. Bite registration . . . . . . . . . . . . . . . . . . . .147

12. Provisional solution . . . . . . . . . . . . . . . . . .148

13. Torque wrench . . . . . . . . . . . . . . . . . . . . . .151Introduction . . . . . . . . . . . . . . . . . . . . . . . . .151Cleaning, sterilization, care . . . . . . . . . . . . . . .154

14. Information . . . . . . . . . . . . . . . . . . . . . . . . .155Cleaning, sterilization . . . . . . . . . . . . . . . . . .155Information protocol . . . . . . . . . . . . . . . . . . .157Materials . . . . . . . . . . . . . . . . . . . . . . . . . . .158Certificates . . . . . . . . . . . . . . . . . . . . . . . . . .159


General System InformationIntroduction

1

I. General System Information

1. Introduction

Modern implant prosthetics is now anestablished component of dentistry. Theexpectations and demands of patientsare steadily increasing. Therefore, theultimate goal of modern implant-sup-ported treatment concepts is for fullesthetic, functional, phonetic, and psy-chosocial rehabilitation. This appliesequally to replacements of lost singleincisors associated with trauma and thecomplex rehabilitation of periodontallycompromised remaining teeth or thetreatment of an edentulous heavily atro-phied maxilla and mandible.

This manual should help promote treat-ment success quickly, simply, and effi-ciently. The layout of this publication fol-lows the logical sequence of planningand performance of a periodontalimplant-supported prosthetic restoration.You get acquainted primarily with theconfiguration, mechanical, and biome-chanical features of the implants, as wellas with the innovative CAMLOG®

implant-to-abutment connection.Before presenting the prosthetic con-cepts, we give you an overview of the"backward planning" method and theteam concept on which it is based, toensure the best treatment result possi-ble. The section Treatment Concepts pro-vides an overview of the prostheticoptions using the CAMLOG® ImplantSystem.

The other sections follow the order ofprocedures suggested in the backwardplanning concept:• History, examination, diagnostics• Prosthetically oriented planning• Feasibility testing, adaptation,

patient-oriented planning of theprocedure sequence

• Surgery• Prosthetics• Follow-up

WarningThe descriptions that follow are not ade-quate to permit use of the CAMLOG®

Implant System immediately. Instructionby an experienced operator in the man-agement of the CAMLOG® ImplantSystem is strongly recommended.CAMLOG® dental implants and abut-ments should be used only by dentists,physicians, surgeons and dental techni-cians trained in the system. Appropriatecourses and training sessions are regu-larly offered by CAMLOG.Methodological errors in treatment canresult in loss of the implant and signifi-cant loss of peri-implant bone substance.

General System InformationCAMLOG® System Description

2

2. CAMLOG®

System Description

The CAMLOG® Implant SystemThe CAMLOG® Implant System is basedon many years' clinical and dental tech-nological experience. It is a user-friendly,logically prosthetic-oriented implantsystem. All CAMLOG® products arecontinuously manufactured according to state of the art.

The CAMLOG® Implant System was fur-ther developed progressively through in-house research and development in col-laboration with hospitals, universities,and dental technicians. Today, it repre-sents the state of the art in implantdentistry.

In the recent past, science has becomemore and more important at CAMLOG.Today, the CAMLOG® Implant System isscientifically very well documented. Thesystem has been confirmed by numerousstudies investigating into differentparameters, e.g., implant surfaces, timeof implantation and/or implant loading,primary stability, design of implant-abut-ment connection or type of superstruc-ture. Long-term results of up to sevenyears for the CAMLOG® Implant Systemare convincing.

General System InformationImplant Configuration

3

3. ImplantConfiguration

Macroscopic ShapesAll CAMLOG® implants are equippedwith the CAMLOG® tube-in-tubeimplant-to-abutment connection. Thefour different external implant configura-tions have the same diameter-matched,internal configuration. This makes theuse of different implant configurations inan arch possible without curtailment ofthe prosthesis (see also the recommend-ed indications for the different implanttypes).

SCREW-LINE Implant,Promote®

SCREW-LINE Implant,Promote® plus

ROOT-LINE Implant,Promote®

SCREW-CYLINDER-LINEImplant, Promote®

CYLINDER-LINEImplant, TPS


4

External ConfigurationCAMLOG® implants SCREW-LINE, ROOT-LINE and SCREW-CYLINDER-LINE withthe Promote® surface have a cylindricalmachined portion 1.6 mm high in thecoronal area (1). A rough machinedchamfer - the Bioseal Bevel (height 0.4mm) - is attached to this apically (2).Below it is the self-tapping thread of theSCREW-LINE, ROOT-LINE or SCREW-CYLINDER-LINE implants (3) with thePromote® surface. In the case of theCYLINDER-LINE implants, a TPS (titaniumplasma-sprayed) surface is provided.

Internal ConfigurationStarting from the coronal implant edge(4), all implants have three symmetricalgrooves (width 0.5 or 0.7 mm, depth 1.2mm, 120° offset) in the upper cylindricalarea (5). The abutment cams lock intothese grooves. Beneath this area, anupper inner thread is found (6), onwhich the cover screw, healing caps,bar abutments, and male inserts of dif-ferent prosthetic caps can be screwed.Apical to the thread is a short cylindricalpart to which the abutment "tube" isattached (7). After another 60° offset,there follows apically a second innerthread (8) onto which the abutmentscrews M 1.6 or 2.0 are fastened.

1

2

3

4

5

6

7

8

On the SCREW-LINE Implant with Promote® plussurface, the machined part measures 0.4 mm.


5

A biological width of approx. 2 mmremains (1 mm connective tissue adapta-tion and upon this an approx. 1-mmjunction epithelial attachment) followingprotocol-conformal insertion of theimplants with the Promote® surface andTPS coating, and following exposure anda minor bone adaptation of approx.1 mm apically.

Bioseal Bevel/Implant ShoulderFollowing the protocol-conformal inser-tion of the implant, the implant shoulderlies approx. 0.4 mm above the bone lev-el. Drilling irregularities between theimplant drill hole and implant are totallyexcluded by the chamfer (Bioseal Bevel)beneath the implant shoulder whichmatches the profile of the drill hole.

SCREW-LINE Implants with Promote®

plus surface are likewise inserted so asto leave a 0.4 mm projection above thebone level. During the insertion andexposure, the periosteum should beremoved only in the implant penetrationarea.

Promote® and TPS surface

Promote® plus surface

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Titanium Plasma-Sprayed Surface StructureThe CAMLOG® CYLINDER-LINE Implantshave a titanium plasma-sprayed (TPS)surface in their endosseous portion,which has proven in long-term studies tobe exceedingly reliable.

Surfaces

Promote® and Promote® plus Surface StructurePromote® and Promote® plus have anidentical micro-macro surface structure,differing only in the vertical position of the rough/smooth boundary. TheCAMLOG® implants SCREW-LINE, ROOT-LINE and SCREW-CYLINDER-LINE areavailable with the Promote® surface.

Promote® surface structure Laser scan of Promote® surface Osteoblasts on a Promote® surface

Titanium plasma-sprayed surface structure

The CAMLOG® SCREW-LINE implants arealso available with the Promote® plussurface, which has a machined part ofonly 0.4 mm in the coronal area.This sand-blasted, acid-etched surfacehas given excellent results in anchoringdental implants.

Research results from cell cultures, bonehistology, and extraction tests supportthis. The results suggest that thePromote® surface promotes rapidosseointegration of the CAMLOG®

implants.

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Tube-in-Tube ConnectionThe long-term maintenance of peri-implant soft and hard tissue health inimplant-treated patients heavily dependson oral hygiene and pre-, intra-, andpost-operative soft tissue management.The biomechanics of implant-supportedrestorations are controlled by theimplant design and the components ofthe implant-abutment connection.

Even if the number of implants is ade-quate and positioning is correct, amechanically critical interface also existsbetween force application (throughcrown occlusion) and force absorption(by the ankylotic anchor in the bone) inthe area of the implant-abutment con-nection.

Numerous studies have shown thatabutment screw loosening or fracturemay occur here - even at submaximalload - depending on the implant-abut-ment connection used. Hence, the designof the implant-abutment connection isfundamentally important. Engineeringscience indicates the use of an connec-tion with a diameter/insertion depthratio greater than 1.4 for form-fit con-nection. The implant-abutment connec-tion used in the CAMLOG® System is aform-fit connection in which the diame-ter/insertion depth ratio is 1.5 to 2.4depending on the implant diameter.

The design features of the patentedCAMLOG connection result in improvedresults on statics strength and compres-sion fatigue tests. To maintain these

levels and ensure long-term stability, theconnection must never be modified forany reason!

CAMLOG® implant-abutment connection with abutment screw

General System InformationProduction Precision

8

Production PrecisionThe internal and external geometry of theimplants and abutments are machined,with the exception of the milled camsand grooves. This means that productiontolerances can be kept very tight, and aprecision fit with rotational stability(0.5°-1.0°) is ensured for all systemcomponents. This is an essential require-ment in the fabrication of prostheticrestorations, starting with the transfer ofthe implant position to the master castand continuing up to the final oral inser-tion.

MaterialsAll CAMLOG® implants are made ofpure grade 4 titanium. The abutments,caps, and abutment screws are made oftitanium alloy Ti6AI4V (ASTM F136) (seeInformation - "Materials").

CAMLOG® Implant

Implant-abutment connection with abutment screw

CAMLOG® Abutment

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General System InformationMechanics and Biomechanics

4. Mechanics andBiomechanics

Mechanical TestsFinite element models were preparedand the behaviors of different implant-abutment connections were comparedunder vertical-lateral and torsional load-ing. The simulation was conducted usingan FEM (finite element method) program(ASNSYS 3.3) at Offenbach TechnicalUniversity.

External hex connection CAMLOG tube-in-tube connection

Lateral LoadingThe vector L of a load applied at 30° isdivided into an axial force (Fa) and alateral force (Fq). The axial componentand lateral force must be compensatedby the screw retention force as a func-tion of the length of the lever from thefulcrum (D).

In the case of the form and force-basedCAMLOG connection, the lateral compo-nent (Fq) is almost completely compen-sated by the supporting forces (F1 andF2) provided by the tube-in-tube connec-tion. Because of the configuration of thetube-in-tube connection, the fulcrumlocation is practically on the midline ofthe implant. The lever length of the axialforce component (Fa) is thereby reducedtowards zero.

Form and force-based connectionForce-based connection

Finite element studies show that when avertical-lateral load is applied to theabutment, the forces are transmittedthrough the apical end of the tube tothe implant body. Loading of the abut-ment screw hardly occurs.

Failure LoadComparison of failure load (300 N at30°) in a 3.75 mm screw implant withan external hex connection clearlyshows that the CAMLOG® abutmentscrew is hardly stressed (blue = lowstrain, red = high strain).

In the case of a force-based external hexconnection, the Fa is ~5 Fq because ofthe lever ratio (the distance of the ful-crum from the middle of the axis is theimplant radius).

General System InformationMechanics and Biomechanics

10

Torsion LoadingIn the case of torque up to the momentthe cams make contact in the implant,only the production clearance is consid-ered, and therefore the repositioningaccuracy of the abutment in the implant.The strain on the implant-abutment con-nection is very small (blue = low strain,red = high strain). The smaller the angu-lar deflection, the more precise a posi-tion can be transfered.

Tors

ion

[Nm

m]

Torsion behavior of the CAMLOG connection

Angular deflection (°)

CAMLOG ConceptTeam Concept

11

II. CAMLOG Concept

1. Team Concept

The Team

PatientThe patient must be fully informed aboutthe options and limits of implant-sup-ported rehabilitation in his or her partic-ular case. The expectations and demandsof the patient should be clearly formu-lated and documented.

DentistThe restorative dentist providing pros-thetic treatment is usually the teamleader. His function is handling examina-tions, diagnostics, and treatment plan-ning, and reaching a consensus for thetreatment plan from the patient andpossibly the surgeon and dental techni-cian. He coordinates the prostheticpreparation while the surgeon plans andmanages the treatment stages: surgicalintervention, wound healing, and expo-sure.

SurgeonThe surgeon conducts a separate patientinformation session. He utilizes the diag-nostic records, templates, medical/dentalhistory, and radiographic informationprovided by the restorative dentist anddental technician. He performs theimplantation procedures requested bythe restorative dentist.

Dental TechnicianThe dental technician contributes hislaboratory knowledge and experience tothe preoperative planning of theimplant-supported restoration. He pre-pares a setup/ wax-up, evaluates esthet-ic and functional issues, and makes sug-gestions for the design of the finalrestoration and implant positioning. Histasks include fabrication of the provi-sional and final restorations as well asprovision of radiographic and drillingtemplates and he selects the implantabutments.

Dental Hygienist/Nurse/AssistantAn important prerequisite for the long-term success of a dental implant isexcellent oral hygiene. The dentalhygienist/nurse/assistant explains correctoral hygiene to the patient and takes thepreparatory steps to create an inflamma-tion-free oral situation. She is alsoresponsible for ensuring regular follow-up appointments.

CAMLOGCAMLOG supports all members of theimplant treatment team by providinghigh product quality, information,service, continuing education, andcontinuous research and development of the CAMLOG® Implant System.

CAMLOG ConceptTeam Concept

12

Team Input

Increasingly higher demands for qualityand specialization require a multidiscipli-nary team approach to combine themembers' acquired knowledge and expe-rience. Modern implant-supportedrestorations need a high level of atten-tion to detail and clinical experience.This is true equally for the restorativedentist, the surgeon, the dental techni-cian, and the dental office support staffsuch as the nurse, hygienist, and chairassistant. The CAMLOG team concepttakes all of these demands into consid-eration. The sequence of treatment pro-cedures is structured, and specific proce-dures are clearly assigned to specificteam members once the joint planningphase is complete. Pre-implantation sur-gical interventions and the implantationitself are carried out by the surgeon, ora surgically qualified restorative dentist.The surgical instrumentation should besimply and thoughtfully organized. If atransgingival implantation (one-step) isto be performed, this eliminates a sec-ond intervention (implant exposure). Incontrast, if a covered implantation isselected (two-step), a healing cap mustbe attached for soft tissue conditioningfor three weeks after the exposure andbefore taking the impression, dependingon the indications. The dentist/surgeontakes the impression using the transfersystem and an impression material ofchoice (silicone, polyether, etc.). In addi-tion to the impression components, onlya screwdriver is required.

The implant-abutment selection is madeafter the master cast has been fabricat-ed in the laboratory.

Because of the high precision of theimplant components and the rotationalstability of the implant-to-abutment con-nection, time-consuming intermediatetry-ins can be skipped. Both dentist anddental technician can concentrate onesthetics and the hygienic adaptabilityof the restoration because the insertionof the abutment is so simple and quick.Single-crown restorations, small bridges,bar abutments with the CAMLOG pas-sive-fit system, and telescopic crownscan be fabricated to offer a perfect fit.

The CAMLOG® Implant System is there-fore user-friendly and time-saving. Thescope and value of pre-implantationdiagnostics have changed. Today, pre-implantation diagnostics must be orient-ed exclusively to prosthetic needs (back-ward planning).

Since implant-supported treatment suc-cess is judged almost entirely in terms ofesthetics and function, no prior compro-mises in these areas should ever be con-sidered. The objective is to obtain apatient-oriented total rehabilitation.

Sequence of Treatment Procedures• Planning Team• Pre-treatment Dentist (surgeon, if needed)

dental support staff, hygienist• Implantation Dentist (surgeon, if needed)• Impression taking Dentist (surgeon, if needed)• Cast fabrication Dental technician• Plan review, abutment selection Dentist, dental technician• Prosthesis fabrication Dental technician• First bake (esthetics) try-in Dentist, dental technician• Finishing Dental technician• Prosthesis insertion Dentist• Maintenance/recall Dentist, support staff

CAMLOG ConceptTreatment Concept

13

2. Treatment Concept

IntroductionIt is known from general physiology thatboth non-loading and underloading ofthe bone induces degradation just asmuch as overloading (inactivity atrophy,pressure atrophy). The area betweenthese two extremes is called normalloading. This consists in a balancebetween growth and degradation.Working with bridge restorations in con-ventional prosthetics has led to identifi-cation of consistently high rates of bonedegradation in non-loaded or under-loaded abutment teeth (Misch/Frost1990).

W. Schulte recognized this in 1982 andproposed early (= immediate, if possible)implantation to offset atrophy of theperiodontal structures, which commencesimmediately after tooth loss. The implantsupports the alveolar bone and tooth-by-tooth implant-supported rehabilitationprevents the bony areas from beingeither overloaded or subjected to inac-tivity atrophy (stress-shielding).

Leverage Relations at the ImplantLoading of the implant-bone interface isa result of the leverage relation generat-ed by osseointegration-related resistanceto the prosthesis load arm (equivalent tothe supracrestal implant length plus theheight of the crown above the implantshoulder). If this (IL) is less than 1 (CL),then the load must be reduced (e.g.,through prosthetic splinting).

ReferencesFrost HM. Bone "mass" and the"mechanostat": a proposal. Anat Rec1987; 219:1-9

Misch CE. Contemporary implant den-tistry. St Louis. Mosby Inc. 1999;Ch.22:317-318

Schulte W. Das Tübinger Implantat.Schweiz Mschr Zahnmed 1985; 95:872-874


14

EstheticsThe use of therapeutic methods from anesthetic perspective is very dependentupon the initial situation and the visibili-ty of the esthetic impairment. In the"esthetic zone" (anterior maxillaryarea), the smile line (as described byKois) determines the extent of work thatmay be necessary. If prominent transver-sal or vertical hard or soft tissue deficitsare present that affect the extraoral softtissue profile, then lip and cheek supportwill have to be provided through suit-able augmentative methods such asimplant positioning or prosthesis design.These can restore the patient's physiog-nomy to a large extent.

Patient CooperationThe greater the patient's desire for afunctional - and especially for an esthet-ic - restoration and the more compro-mised the initial situation, the moreextensively the patient must be educat-ed.Temporary limitation of function andesthetics may result from the surgeryand the patient might be required towear a long-term provisional. The extentof pretreatment and the particulars ofthe case will affect the overall durationof treatment.In selecting a prosthetic restoration,make sure to take into account, in addi-tion to the functional and estheticaspects of the case, any manual andvisual impairments uncovered by the his-tory that may affect the patient's abilityto manage oral hygiene and prosthesiscare.

Patient InformationWhen the process of ruling out con-traindications, collecting clinical andradiographic information, and making adiagnosis is complete, an informationalconference is held with the patient,using documents and models for demon-stration. Risks and alternative treat-ments are fully discussed and docu-mented.

Low smile LineThe patient exhibits:<75% of the crown length

Application of the necessary therapy.

High smile LineThe patient exhibits:• the entire crown length• adjacent gingiva

Use of all therapeutic methods:• All-ceramic restorations• Papillae• Hide scars

15


Fixed Restorations

Single CrownsSingle crown treatment in the form oftooth-by-tooth restorations is the desir-able and ideal form of treatment for thepurpose of a complete oral makeover. Itcontains all the beneficial elements ofperiodontal prosthetic rehabilitation:• Physiologically adequate, biomechani-

cal loading prevents further atrophy ofthe hard and soft tissue.

• Good preconditions for natural-lookingesthetics are established.

• Oral hygiene is simple.• Fabrication is technically straightfor-

ward.• Readily extendable/alterable.• Maintenance is easy.• Economical for the patient in the mid-

dle and long term. In the event of fur-ther tooth loss, no new construction isnecessary, just extension.

Esthetically difficult AreasTo achieve an esthetically successfulrestoration, a number of important ele-ments are required: a harmonious gingi-val line, optimal implant positioning onboth vertical and horizontal planes, anatural-looking crown shape, and thepresence of interdental papillae. Theindications for the hard tissue configura-tions to be preserved and for soft tissuemanagement must be observed duringplanning. Structure-preserving or struc-ture-sparing procedures must be usedduring flap creation and implant place-ment. In addition, oral hygiene require-ments must be kept in mind during plan-ning.

ObjectiveSingle crowns (tooth-by-tooth treatment)provide the ideal restoration in terms ofbiomechanical, esthetics, hygiene,tongue comfort, and muscular balance.They prevent inactivity atrophy of thebone surrounding the implant throughphysiological loading.

Vertical implant position

Mesiodistal implant position at bone level Distance to bone level

16


Splinted CrownsIn the event of unfavorable leveragerelations around the implant, a choicemust be made between a longer implantor, if this is anatomically impossible,splinting adjacent crowns. If splinting isrequired by reason of statics, thenhygienic requirements must also betaken into account.

Development of a uniform insertiondirection for the crown block should bepart of the abutment preparation. Theimplant-to-abutment connection shouldnot be altered.

Single-crown restoration

Crown splinting

Single-crown restoration in the augmented maxillary posterior area

Crown splinting in the augmented maxillaryposterior area

Implant-Supported BridgesImplant-supported bridges can be insert-ed wherever an implantation is impossi-ble. Implant distribution should be struc-tured in such a way that spannedsegments are kept small.

Development of a uniform insertiondirection for the crown block should bepart of the abutment preparation. Theimplant-to-abutment connection shouldnot be altered.

17

Abutments in a lab analog

Prepared abutments Cemented bridge

Examples of bridge positioning


Initial situation

18


Removable Restorations

IntroductionA hybrid denture may be implant-retained, mucosa-supported, or implant-supported. The tension-free seat of asecondary (telescopic crown) or primary(bar) splinted structure on implants iscalled as "passive fit".

Telescopic CrownsThe production precision of the CAMLOGconnection is particularly necessary witha telescopic crown restoration since theabutments can be fastened always in thesame, exactly defined position on theimplant. A precision fit for the removablesuperstructure is made simple and con-sistent in every case.

Indication: The telescopic crown tech-nique is suitable for jaw relations inAngle Classes I and III.

In the case of telescopic crowns, this isobtained through intraoral bonding ofthe secondary crowns (preferably gal-vano crowns) onto the tertiary frame-work. In the case of bar structures, itinvolves the use of bar sleeves for a pas-sive fit and intraoral bonding of the tita-nium bonding base.

The idea is to create a fit that is freefrom stress or to minimize stress on theimplants. In the planning of a removabledenture the implants should be placedso that, if necessary, a tooth-by-toothrestoration or a fixed restoration is pos-sible.

Bar supported DenturesBars are suitable for jaw relations inAngle Class II and for large horizontaldeficits. It may be possible to fabricate abar structure with either prefabricated orindividualized components.

Ball AbutmentsThe ball abutment is suitable for simple,implant-retained prosthetic restorations.It is simply a retainer, but positional sta-bility can be created through addition ofan extension prosthesis.

19


20

1. Introduction

Modern implant prosthetics is plannedby working back from the desired thera-py goal; this is referred to as "backwardplanning." It applies particularly to pre-implantation augmentation proceduresto restore sufficient bony structure toallow placement of implants in the opti-mal prosthetic position.

PlanningGeneral Information

OverviewA planning project may be divided into the following modules:

Function, phonetics, and hygienic poten-tial require prosthetically orientedimplant positioning and dimensioning,which the dental technician defines onthe basis of the wax-up. The prostheticdesign and the required implant posi-tion(s) and axial alignment(s) areplanned by the dentist and dental tech-nician working closely together. Thisrequires both to be fully informed of thetreatment options.

If implant positions (implants approxi-mating the former tooth positions) can-not be implemented for a fixed denturefor whatever reason – functional(implant loading, crown length), esthetic(soft tissue support) or hygienic – aremovable denture must be planned.

• Actual situation / prostheticinitial situation

Find out and document the actual sit-uation by taking a general and special(dental) history and performing intra-and extraoral clinical, functional andradiographic examinations. Together,these findings are the basis for adescription of the initial situation ofthe oral-maxillofacial system.

• Ultimate treatment goalAn ultimate treatment goal is definedby integrating the diagnosis, needs,patient's wishes for esthetics andfunction, and findings from the wax-up/set-up.

• Individual treatment goalA full analysis is conducted with thepatient, including a cost/benefit,work/benefit, and risk/benefit analy-sis. The final result will be a treatmentgoal customized to the desires andoptions of the patient.

• Treatment sequenceWith the individualized treatmentgoal as guide, prosthetically orientedimplant positioning is defined andverified clinically and radiographically.Then, a treatment sequence is set up.It includes the planning of ancillaryprocedures, augmentation, and anyrequired pretreatment.

III. Planning

21


2. Anamnesis

IntroductionThe medical history and diagnosis arenot different from the evaluation proce-dures required for other dental surgeryor restorative treatments. For this reasononly the specific points for perio-implantprosthetic treatments are describedbelow.

The general, social and special (dental)medical history considers all generalmedical contraindications and diseasesthat could affect the microcirculation orthe patient's suitability for the proposedimplant-based restoration. Risk factorssuch as nicotine, alcohol and drug abuseare confidentially evaluated, discussedand documented.The patient's psycological and psychoso-cial situation gives an indication of thecompliance that can be expected andwill influence the planning of the treat-ment and the future prosthetic design.

GeneralThe general medical history shouldinclude not only the disease history butalso regular medication usage and thepossibility of general medical problemsthat could adversely affect an implant-based prosthetic treatment.

Special (dental)The special medical history must clarifythe reasons for the current situation ofthe oral system.It may provide information on systemicdiseases that may not have been detect-ed yet. If implants or grafts were previ-ously placed this may be important forassessment of the bone quality.

3. Examinations

ClinicalIn addition to all standard extraoralexaminations, the soft tissue profile andsupport of the soft tissues (especially inthe maxilla) are a critical factor indesigning the prosthesis. If a large dis-crepancy exists between the requiredlabial tooth position and the proposedimplant position, the use of a removabledenture (bar-structure, telescopic crown,ball abutment, Locator®) may be neces-sary for loading reasons.The results of the intraoral examinationsdetermine which teeth can be saved. Thestandard of hygiene is evaluated and acheck of the soft tissue for pathologicalconditions is performed for informationon the patient's possible complianceduring and after treatment.

The static and dynamic occlusion, inter-alveolar distance, and centric relationsare checked. Temporomandibular jointdisorders are addressed before the startof treatment.All findings indicating elevated stress onthe masticatory system (e.g., bruxism)must be investigated, documented, andconsidered in the prosthetic planning.

The status of the soft tissue in edentu-lous arch segments (width and thicknessof the attached gingiva) must bechecked and the extension of the alveo-lar ridge must be evaluated for its suit-ability as a possible implant site.

22


Radiographic Evaluation

Dental x-raysDental x-rays are sufficient for the initialassessment of bone supply with singletooth gaps or small interdental gaps. Theperiodontic situation of the remainingdentition must be closely examined,because the implant site may be colo-nized by pathogenic organisms frominfected pockets.

OrthopantomographAn OPG is a critical instrument for gath-ering basic information. Additional datarequired by the specific situation may beobtained through dental x-rays, remotex-ray side views, or computer-tomographicscans (CT).

Remote x-ray side ViewUse for large sagittal differences andplanned bone removal in the chinregion.

Computer-Tomographic ScanThe CT is an instrument to be used forextensive radiological diagnostics. Itenables a 3-D evaluation of the sitefrom its anatomical structures and theplanning of augmentations. Indicationsmust be strictly adhered to because ofthe level of radiation exposure involved.

Laboratory

Cast AnalysisIt is essential to mount a diagnostic castin an adjustable articulator to assess jawrelations. Specifically, a check should bemade whether a change of theocclusal position is worthwhile orrequired. If at all possible, it should bedone before the actual implant-support-ed prosthetic treatment gets under way.In any case, a change in occlusal heightmust be preceded by treatment with along-term provisional.

Diagnostic CastsThe diagnostic casts must clearly shownot only the occlusal surfaces but alsothe vestibular fold and retromolar areas(see arrows).Diagnostic casts for implant planning aremade of super-hard dental stone, just asin perioprosthetics, and mounted on anadjustable articulator with an arbitraryface bow and centrics registration. Thecentric registration must be freelyadjustable to enable the casts to bemounted in correct axial alignment andposition.

The impression should reproduce thesoft tissue situation and any hard or softtissue deficits as far as the vestibularfold, since it is here we detect the firstindications to incline the implant or thenecessity for bone augmentation. Just asin perioprosthetics, the retromolar areasmust be reproduced to allow specifica-tion of the dental arch and assessmentof the vertical space available (seearrows).Planning and implementation of peri-odontal implant-supported rehabilitationwill be considerably simplified if tem-plates are used.

23


Articulator Set-UpThe diagnostic casts are mounted in anadjustable articulator with the aid of anarbitrary face bow and centric registra-tion as in perioprosthetics.

Occlusal HeightIf an occlusal height requires correction,this must be done with a guard or long-term provisional before the implant-sup-ported prosthetic restoration begins.

Initial Prosthetic Situation The initial prosthetic situation describesthe dental status, arch relations, theanatomical status of the oral hard tissue,the intraoral and extraoral soft tissue,the presence of functional, phonetic andesthetic restrictions on the patient, andthe resulting influence on the patient'squality of life.

Arch Relations (transversal)The arch relations control the load direc-tion and therefore the axial alignment ofthe implants also. This is particularlyimportant with cross-bite situations.

Arch Relations (sagittal)Crowns cannot be placed precisely overthe implants in the presence of AngleClass II dentition because the soft tis-sues must be supported and the spacefor the tongue must not be reduced. Aremovable denture is indicated in thissituation.

24


4. PreliminaryProsthetic Design

Wax-Up/Set-UpThe wax-up or set-up is prepared on theworking cast in the dental laboratory.This permits planning of optimal toothpositioning from both functional andesthetic perspectives. It also enables ear-ly recognition of the need for augmenta-tion procedures if a discrepancy isdetected between the atrophied crestalbone and the required position for aprosthetic crown.

The ideal articulation pattern to aim atis a situation-adapted anterior-to-cuspidline with early disclusion of the posteri-ors ("freedom in centric" should be pos-sible).

Initial Situation

Wax-Up/Set-Up


Planning TemplateA planning template is fabricated toreview the planned implant positions inthe mouth. The template can be convert-ed to a drilling template later.

The dental technician initially fabricatesa complete wax-up/set-up with all miss-ing teeth in their ideal prosthetic posi-tion for preliminary planning of the pros-thetic design. In accordance with the"backward planning" principle, anyanatomical deficits are not considered atthis stage. The treatment goal specifiesthe surgical and prosthetic procedure.

A silicone index is fabricated from thisset-up. After hardening, the index isdivided orally along the central occlusionto form a labial and an oral section. Anacrylic template can be fabricated withthe aid of the silicone index.

Alternatively, the work can be done witha rigid vacuum foil via a duplicate cast.

Depending on the x-ray methods, radio-opaque markers (e.g., titanium, steel,barium sulfate) are integrated.

25

Silicone Index

Cast with Planning Template

26

X-Ray TemplateIn the planning template or base pro-duced from the wax-up/set-up, CT-plan-ning tubes or other radio-opaque mark-ers are integrated at the idealimplantation position and are used asreference positions in the x-ray image.The tubes consist of two parts: The tita-nium used leaves no scattering on CTscans. The lower part is polymerized inthe template and the upper part insertsinto this. The complete tube is used inradiologic diagnostics, and the upperpart can be removed during surgery.

Planning template with tubes for CT planning


CT-tubes for CT-planningfor drills Ø 2.0 mm:Inner Ø 2.1 mmOuter Ø 2.5 mm

Template without tube upper section for use asa drilling template

X-ray template with radio-opaque teeth andinstalled tubes

X-ray template, outlined with tubes

Titanium tubes for CT-planning or otherradio-opaque positioning components(steel, barium sulfate) are integrated,depending on the analysis software. Ifthe tubes are placed directly on themucous membrane, its thickness can bedetected on the CT scan. For more infor-mation, see the documentation for thesesystems.

Drill for CT-tubeplacement

27


5. Implant PositionVerification

GoalThe goal is to specify the possibleimplant positions. Now, the final implantplanning is performed depending on theselected concept. The x-ray images mustshow calibrated measurement points toenable measurement of the bone volumeavailable for the implantation.

ClinicalThe wax-up or set-up must be tried in onthe patient. This allows esthetics to beincluded in the plan, such as the smileline, tooth shade, facial shape and gen-eral presentation of the patient.

OrthopantomogramPlanning films are available in 1:1.25and 1:1.4 sizes for all implant types tocheck the dimensions on the OPG. Thefilm magnifications match the magnifica-tion factors for most OPGs. However,they should be considered only asapproximations in implant dimensioning.

Dental FilmTo check the dimensions on x-ray film,the self-adhesive implant planning films(x-ray transfer pictures) for the specificimplant type should be attached to theproposed implant positions on the film.

28


CT Scan with/without 3-DEvaluation A precise three-dimensional evaluationof the bone dimensions is possible onlywith a CT scan. Simulation programs canbe used for computer-supported evalua-tion. Special conditions such as septa-tion or infections in planned sinus-floorelevations and critical vertical relationsin the mandible can be recognized.Depending on the program, the templatemust include radio-opaque positionmarkers (titanium balls, titanium tubes,barium sulfate coating).

Drilling TemplateUsing this radiographic information, theplanned implant positions are checkedand adjusted if necessary. The x-ray tem-plate is thereby converted to a drillingtemplate. The positions of the titaniumtubes are modified or specified in thetemplate. In consultation with the sur-geon, the template is reduced to anoutline after preparation of the flap toensure it stays in position during surgery,i.e., stability requires a dental or gingi-val base outside the planned surgicalfield.

View of the cast positioning X-ray templates in situ 3-D planning of implant positions

View of the cast positioning X-ray templates in situ 3-D planning of implant positions

The medical information derived fromthe x-ray template can be used to deter-mine the bone volume and quality withthe aid of a CT scan and 3-D evaluationand this will define the subsequent ther-apy procedure (number of implants,implant position, implant diameter, andimplant length).The final prosthetic design and the hardand soft tissue augmentation, if required,are discussed with the patient on thebasis of this information and approved.

29


Final Prosthesis DesignThe surgical feasibility of the treatmentsequence is checked with reference tothe initial situation, the casts, and the x-ray findings. Depending on the clinicalsituation, periodontal or augmentationinterventions are performed beforeimplant surgery or at the time of theimplant placement.

Individualization of the ProstheticDesign The patient's wishes regarding the scopeand cost of the implant-supported pros-thetic restoration expressed in thepatient interview are incorporated intothe individual prosthesis design. Thenumber of implants, the requirement foraugmentation and possible soft-tissuecorrections are determined exclusively bylocal conditions and the prostheticdesign. This interview must be docu-mented in detail and the patient mustsign a statement of consent beforeimplementing the treatment process.

Planning the Treatment SequenceNow that the prosthetic goal has beendefined, the required treatment steps arespecified in a backward planningprocess. This process must include alldetails that are likely to be required,particularly in connection with augmen-tation. The planning template can nowbe converted into a drilling template.

Documentation of Patient Interview and ExplanationThe results of the planning process are discussed with the patient. Casts, x-rayimages, and the planning devices (wax-up and set-up) are helpful, here.The following criteria are considered:

• Initial situation• Desires and expectations regarding esthetics, function and comfort• Effort/benefit ratio• Costs• Risk• Duration of treatment• Restrictions in comfort during treatment

30

PlanningRecommended Indications

SCREW-LINE ImplantBoth Promote® and Promote® plusSCREW-LINE Implants are universallyapplicable.

ROOT-LINE ImplantThe ROOT-LINE Implant (with Promote®

surface) is a root-shaped, screw-typeimplant and is specifically indicated inconditions of apically reduced bone sup-ply (canine fossa, apically on the mylo-hyoid line). The root-shaped design isparticularly advantageous in the pres-ence of root convergence from adjacentteeth.

6. RecommendedIndications for theDifferent ImplantConfigurations

CAMLOG® implants are endosseousimplants, available in different lengthsand configurations. They are placed sur-gically in the maxillary and/or mandibu-lar bone and serve as anchors for func-tional and esthetic oral rehabilitations inpartial or fully edentulous patients.Prosthetic treatments include singlecrowns, bridges, partial or full denturesattached to CAMLOG® implants throughsuitable connection elements. Generallythere are no preferred sites for the useof the different implant geometrys.

An independent selection of implantsaccording to the surgical situation ispossible because the diameter-specificprosthetic platform is identical for allimplant configurations. Different implanttypes can be used in the same arche.

31

PlanningRecommended Indications

SCREW-CYLINDER-LINE ImplantThe SCREW-CYLINDER-LINE Implant(with Promote® surface) is particularlysuitable for restorations in structurallyweak sites on the posterior maxilla. Inconjunction with sinus floor elevationand augmentation, its segmentallythreaded configuration permits use ofthe residual crestal bone height (>5mm) to stabilize the implant. The cylin-drical apical segment preserves the sinusmucosa during insertion of the implant(no thread edges) and provides superioradaptation to the particular bone aug-mentation material used.

CYLINDER-LINE ImplantCYLINDER-LINE Implants (with TPS sur-face) are universally applicable. A partic-ular advantage of this implant type is itssimple, time-saving application proce-dure. In conjunction with sinus floor ele-vation and augmentation, the press-fitfrom the cylindrical configuration of theimplant allows it to be placed in a struc-turally weak site with a residual boneheight <5 mm.

CAMLOG Implants with 3.3 mmDiameterThese implants (SCREW-LINE /CYLINDER-LINE) provide an alternative in the pres-ence of reduced crestal bone width (5-6mm). But because of their lowermechanical strength compared with larg-er diameter implants, they should onlybe used under the following conditions:• As single implants, they should be

used only to replace mandibular inci-sors and/or maxillary lateral incisors.

• They may be used in conjunction withbar splinting of at least four implantsof 3.3 mm diameter, without distalextensions on an edentulous arch.

• On partly edentulous arches, implantswith 3.3 mm diameter can be splintedto implants of larger diameter in con-junction with a fixed suprastructure.

• Excessive mechanical loading of theimplants must be avoided when ballabutments are used in conjunctionwith implants with 3.3 mm diameter.

• The healing period for implants with3.3 mm diameter is a minimum of 12weeks.

• Telescopic crown structures onimplants with 3.3 mm diameter arenot allowed.

33

Surgery ManualIntroduction

IV. Surgery Manual

1. Preparation of the PatientThe patient is prepared according to thestandard routine for a surgical interven-tion. Depending on the indication,antibiotics and anti-inflammatories maybe administered before and/or after sur-gery. In addition, an oral or intravenoussedative may be indicated depending onthe patient's history and general healthstatus.

2. Drilling TemplateBefore using a drilling template, it isnecessary to check its outline for theplanned incision line and to disinfect thetemplate. The drilling template must alsobe reproducible after the flap prepara-tion by remaining stable in place, andmust adhere to the soft tissue withoutpressure.

3. CAMLOG® Surgery SystemAll the drills, drivers, and accessoriesrequired for the implantation of the par-ticular implant configuration are system-atically organized in the Surgery Set. Thesequence of use of the drills and instru-ments in compliance with the CAMLOGsurgical protocol is color-coded accord-ing to diameter. The following SurgerySets with their matching drills are avail-able:

• SCREW-LINE • ROOT-LINE• SCREW-CYLINDER-LINE/CYLINDER-

LINE

Color Coding

Ø 3.3 mm grey

Ø 3.8 mm yellow

Ø 4.3 mm red

Ø 5.0 mm blue

Ø 6.0 mm green

34

SCREW-LINE Surgery Set

Surgery ManualCAMLOG® Surgery System

SCREW-LINE

35


ROOT-LINE Surgery Set

ROOT-LINE

36


SCREW-CYLINDER-LINE/CYLINDER-LINE Surgery Set

SCREW-CYLINDER-LINE/CYLINDER-LINE

37

Surgery ManualDrilling System

Drilling System

Drilling SpeedThe drilling speed is diameter-depend-ent. The recommended speed is 800-300rpm depending on the drill type. Therecommended maximum drilling speedfor thread tapping is 15 rpm. The tapadapter for ratchet also permits manualtapping.

CoolingThe CAMLOG® drilling system forimplant bed preparation consists mostlyof internally irrigated drills for cooling.The cooling liquid is sterile saline solu-tion (prechilled to 5 °C/41 °F).Optimum cooling consists of a combinedinternal/external cooling at the angledhandpiece.

Drill lifeDrill longevity depends on bone qualityand drilling technique. The pilot drills,pre-drills, and form drills are good for10-20 drilling cycles. If excessive forcehas to be applied because of a dull drill,then change the drill immediately to pre-vent bone overheating.

Article Speed (rpm)Round bur 800Pilot drill 2.0 mm / depth stop 800Pre-drill Ø 1.7 / 2.8 mm 600Form drill Ø 3.3 mm / depth stop 550Cortical bone drill Ø 3.3 mm** 550Tap Ø 3.3 mm* max. 15Form drill Ø 3.8 mm / depth stop 500Cortical bone drill Ø 3.8 mm** 500Tap Ø 3.8 mm* max. 15Form drill Ø 4.3 mm / depth stop 400Cortical bone drill Ø 4.3 mm** 400Tap Ø 4.3 mm* max. 15Form drill Ø 5.0 mm / depth stop 350Cortical bone drill Ø 5.0 mm** 350Tap Ø 5.0 mm* max. 15Form drill Ø 6.0 mm / depth stop 300Cortical bone drill Ø 6.0 mm** 300Tap Ø 6.0 mm* max. 15

The lower edge of the depth mark is the reference for the implant length. The maximum apicalextension length is 0.6 mm.** Use of a tap is recommended for SCREW-LINE , ROOT-LINE, and SCREW-CYLINDER-LINE Implants if

the bone quality is D1 or D2.** The SCREW-LINE cortical bone drill reduces the torque for implant insertion into cortical bone (D1).

38

IntroductionDepending on the indication, healing ofthe CAMLOG® implants may be managedthrough the transgingival or submergedtechniques. Suitable components areavailable for the selected option.

One-step Healing(transgingival)

Esthetic Immediate Restoration

Healing caps in different configurationsand gingival heights are available forone-step, non-loaded healing (see thesection "Healing caps").

The PEEK Provisional Abutment canbe used for an esthetic immediaterestoration (see also the CAMLOGCompendium 2 Prosthetics section:"Temporary restoration").

Two-step Healing(submerged)

The cover screw remains in the implantfor the duration of the submerged heal-ing period.

Surgery ManualImplant Healing

4. Healing Options

39

Surgery ManualSCREW-LINE Insertion

Area of Use/Indication for theSCREW-LINE implants withPromote® plus SurfaceA smaller coronal implant shoulder isespecially beneficial in treating estheti-cally challenging areas. The machinedsegment of a SCREW-LINE Implant withPromote® plus surface measures only 0.4mm. The implant is inserted into thebone as far as this segment.The following clinical prerequisitesshould be present:• Normal to thick biotype• Gingival height of at least 3.0 mm• Minimum width of 1.0 mm of the

attached gingiva• Minimum distance of 2.0 mm between

the attached gingiva and the mimeticmusculature

• Removal of the periosteum at the timeof exposure to be performed at theimplant insertion area only.

Apart from these requirements, therange of indications and the implant bedpreparation for SCREW-LINE ImplantsPromote® and Promote® plus are identi-cal.

IntroductionThe SCREW-LINE Implant is a universallyindicated screw implant with the optionof either Promote® or Promote® plus sur-face. It is suitable for both late implan-tation and immediate/delayed immediateimplantation. The selected healing methodmay be either submerged or transgingival.The implant is easily insertable becausethe taper of the implant body (3°-9°depending on length and diameter)induces self-centering. The self-tappingthread provides a continuous grip on thebone and high primary stability. Themacro-configuration of the implant inconjunction with the Promote® plus sur-face leads to larger contact with thebone, compared with the Promote® sur-face. SCREW-LINE Implant

Promote®

SCREW-LINE ImplantPromote® plus

5. SCREW-LINE Implant

40


SCREW-LINE Implant with Promote®

SurfaceOverview of implant lengths anddiameters.

The machined segment on the implant neckmeasures 1.6 mm.

The machined segment on the implant neckmeasures 0.4 mm.

SCREW-LINE Implant with Promote®

plus SurfaceOverview of implant lengths anddiameters.

41


Removal of the periosteumat the implant site

Epiperiostealsplit-flap preparation

Mucosal incision

Initial situation

Incision line

The example indication shows the inser-tion of a 4.3 / 13 mm SCREW-LINEImplant in the posterior mandible. Theimplantation technique is one-steptransperiosteal. A split-flap preparationis selected for the incision line.

Following a somewhat lingual, paracre-stal mucosal incision, a predominantlyepiperiosteal flap is created on thevestibular aspect. The muscle is dividedand the preparation is continued forapprox. 5 mm further. The mucosa isseparated 2-3 mm lingually to facilitatelater suturing. Following marking of thedesired implant position (if necessarywith the aid of a drilling template), theperiosteum is removed circularly in thearea of this site alone (with a gingivalpunch or scalpel).

This is followed by shaping of theimplant bed to match the selectedimplant diameter and length with thecustomized instruments for the SCREW-LINE Implant.

42


Drilling Sequence

Ø3.

3 m

m

Ø3.

8 m

m

Ø4.

3 m

m

Ø5.

0 m

m

Ø6.

0 m

m

Para

llelin

g pi

n

* If the bone quality is D1 or D2, use of the tap (thread cutter) is recommended for SCREW-LINEImplants.

Implant Bed PreparationOverview of the implant bed prepara-tion.Note: implant bed preparation is identi-cal for SCREW-LINE Implants withPromote® and Promote® plus surfaces.

• Punch-mark the desired implant posi-tion with the internally irrigated Ø2.3 mm round bur.

• Deep drill along the implant axial linewith the internally irrigated Ø 2.0 mmpilot drill.

• Check with Ø 1.7-2.8 / 2.0 mm paral-leling pin with depth marks.

• Pre-drill with the internally irrigated Ø1.7-2.8 mm pre-drill.

• Check with the Ø 1.7-2.8 / 2.0 mmparalleling pin with depth marks.

• Shape with internally irrigated formdrill.

• Probe the implant bed hole for itsbony end.

• Cortical bone drilling (for bone qualityD1).

• Thread cutting with SCREW-LINE tap(for bone quality D1 and D2)

Depth Stop

16 mm

13 mm11 mm

9 mm

16 mm

13 mm11 mm

9 mm

16 mm

13 mm11 mm

9 mm

16 mm

13 mm11 mm

9 mm

16 mm

13 mm11 mm

9 mm

16 mm

13 mm11 mm

9 mm

Para

llelin

g pi

nDepth Stop

16 mm

13 mm11 mm

9 mm

Para

llelin

g pi

nDepth Stop

16 mm

13 mm11 mm

9 mm

Para

llelin

g pi

nDepth Stop

16 mm

13 mm11 mm

9 mm

Para

llelin

g pi

nDepth Stop

16 mm

13 mm11 mm

9 mm

Pre-

drill

Ø1.

7–

2.8

mm

Pre-

drill

Ø

1.7

–2.

8 m

m

Pre-

drill

Ø

1.7

–2.

8 m

m

Pre-

drill

Ø

1.7

–2.

8 m

m

Pre-

drill

Ø

1.7

–2.

8 m

m

Roun

d bu

rØ

2.3

mm

Roun

d bu

rØ

2.3

mm

Roun

d bu

rØ

2.3

mm

Roun

d bu

rØ

2.3

mm

Roun

d bu

rØ

2.3

mm

Pilo

t dril

lØ

2.0

mm

Pilo

t dril

lØ

2.0

mm

Pilo

t dril

lØ

2.0

mm

Pilo

t dril

lØ

2.0

mm

Pilo

t dril

lØ

2.0

mm

1.0 mm

Optional for alldiameters

0.4 mm

Prom

ote®

plus

Prom

ote®

rpm 800 800 600

rpm 800 800 600

rpm 800 800 600

rpm 800 800 600

rpm 800 800 600

0.4 mm

The indication range and implant bedpreparation of the SCREW-LINE Implantare identical for Promote® and Promote®

plus surfaces.

43

Para

llelin

g pi

n

Form drill

Form drill

Form drill

Form drill

Form drill

Ø3.

3Ø

3.3

Ø3.

3

Ø3.

8

Ø3.

3

Ø3.

8

Ø3.

3

Ø3.

8

Ø4.

3Ø

4.3

Ø5.

0

Ø4.

3

Ø5.

0

Ø6.

0

** The SCREW-LINE cortical bone drill reduces the torque for implant insertion into cortical bone (D1).

Ø3.

8

**

**

**

*

*

*

*

Tap

Tap

Corti

cal b

one

drill

Tap

Corti

cal b

one

drill

Tap

Corti

cal b

one

drill

0.4 mm

Para

llelin

g pi

nPa

ralle

ling

pin

Para

llelin

g pi

nPa

ralle

ling

pin

**

Corti

cal b

one

drill

**

Corti

cal b

one

drill

Depth Stop

13 mm11 mm

9 mm

Depth Stop

13 mm11 mm

9 mm

Depth Stop

13 mm11 mm

9 mm

Depth Stop

13 mm11 mm

9 mm

Depth Stop

13 mm11 mm

9 mm

Tap*

0.4 mm

0.4 mm

0.4 mm

0.4 mm

Prom

ote®

plus

Prom

ote®

Prom

ote®

plus

Prom

ote®

Prom

ote®

plus

Prom

ote®

Prom

ote®

plus

Prom

ote®

Prom

ote®

plus

Prom

ote®

550 550 15

550 500 500 15

550 500 400 400 15

550 500 400 350 350 15

550 500 400 350 300 300 15

44


SCREW-LINE Depth StopThe SCREW-LINE pilot drill, reduced coil,and the SCREW-LINE pre-drill have amaximum working length of 16 mm. Thedrilling depths of 9, 11, and 13 mm arelaser-marked. An insertable depth stoplimits the drilling depth to the selecteddepth of 9, 11, or 13 mm.Caution! The pilot drill and pre-drill have a reduced diameter atthe drill coil. The SCREW-LINEdepth stops are matched to thesedrills.

SCREW-LINE depth stop

Drill ExtensionA drill extension is available to preventresting of the angled handpiece on thedental crown during preparation of theimplant bed adjacent to elongated teeth.A longer irrigation tube is required forthe internal irrigation system.

Implant Bed Preparation for SCREW-LINE Implants

Shaping the implant bed includes Punch-marking the cortical bone, pilot drilling,pre-drilling, and form drilling.The pilot hole and pre-drill hole definethe depth and axis of the implant bedand ensure conservative bone prepara-tion by enlarging the diameter in smallgradations.

Drill extension

45


SCREW-LINE paralleling Pin withDepth MarksOn completion of pilot drilling and pre-drilling, the depth and axis orientationof the implant bed are checked with theparalleling pin with depth marks.The diameter combination 1.7-2.8/2.0mm permits consecutive use whilematching the drill diameter.

Short paralleling pins are available asaccessories to check the implant/antago-nist alignment.

SCREW-LINE paralleling pin

Paralleling pin, short

The depth marks and diameter grada-tions on the paralleling pins allow tocheck the drilling depth and axis at eachstage of pilot drilling and pre-drilling.

46


Round bur, Ø 2.3 mm

Pilot drill with reduced coil, Ø 2.0 mm

Punch-Marking the Cortical BoneThe Ø 2.3 mm internally irrigated roundbur is used for Punch-marking the corti-cal bone, which secures the use of thedrills to follow. The bur is inserted as faras the bur equator. Recommendeddrilling speed: 800 rpm.

Pilot DrillingThe depth and axis orientation are pre-pared with the internally cooled pilotdrill with reduced coil. The depth markson the drill correspond to the implantlengths: 9 / 11 / 13 mm. The maximumdrilling depth is 16 mm. For safety rea-sons, a depth stop matching the pro-posed implant length should be used.Recommended drilling speed: 800 rpm.

Punch-marking the cortical bone Pilot drilling

max. 800 rpm

max. 800 rpm

Depth measurement after pilot drilling


If a drilling template is used, the depthstops may be placed on the pilot drillafter the positions have been marked.Once drilling is complete, the depth andaxis of the implant bed are checked withthe paralleling pin. If several implantsare to be placed, a paralleling pin isinserted in the first hole to align thesubsequent implant axes.

The pilot drill is aligned parallel to theparalleling pin and visually checked ontwo planes (sagittal and transversal).

47


SCREW-LINE pre-drill Ø 1.7–2.8 mm

Pre-drilling

Pre-DrillingA tapered SCREW-LINE pre-drill with a2.8 mm coronal and 1.7 mm apicaldiameter is available for the SCREW-LINE configuration. The recommendeddrilling speed is 600 rpm.The depth marks on the drill match theimplant lengths (9, 11, and 13 mm). Themaximum drilling depth is 16 mm. Forsafety reasons, a depth stop matchingthe proposed implant length should beused. Further drilling is performed withthe form drills.

max. 600 rpm

Checking the axis orientation after pre-drilling Ø 1.7 – 2.8 mm

Depth measurement after pre-drilling


48


Form Drilling

Diameter and Lengths

Diameter- and length-calibrated formdrills with reduced coil are available foreach implant size. The internally irrigatedform drills are color-coded and laser-marked.

The form drills included in the surgerysets are supplied with a color-codedremovable depth stop. This should beused with the SCREW-LINE form drill,only. Depending on the specified drillingdepth (implant length), the hole diame-ter is expanded progressively with theseries of form drills until the plannedimplant diameter is reached.

Recommended drilling speeds:Ø 3.3 mm 550 rpmØ 3.8 mm 500 rpmØ 4.3 mm 400 rpmØ 5.0 mm 350 rpmØ 6.0 mm 300 rpm

The protocol-specified insertion depthwith depth stops in place for SCREW-LINE Implants is the implant length (9 / 11 / 13 / 16 mm) minus 0.4 mmwith the circular stop at the bone level,so that the implant shoulder extends 0.4 mm above the ridge.

If a greater insertion depth is desirable,the depth stop can be removed and thepreparation will then be guided by thedepth marks (black). The distancesbetween marks are 1.0 mm, while themark width is 0.4 mm.

Ø 3.3 mm Ø 3.8 mm Ø 4.3 mm Ø 5.0 mm Ø 6.0 mm

9 mm 11 mm 13 mm 16 mmLength

SCREW-LINE form drills

49


Form drill with depth stop Form drill without depth stop

Promote® Promote® plus

The bottom edge of the first depth mark corresponds to the implant lengthwith the depth stop in position.

Caution!Because of the cutting angle on thedrill tip of the form drill, thelength exceeds the implant by upto 0.6 mm.

Depth StopDuring implant bed preparation, thedepth stop rests on the highest point ofthe crest and thereby limits the insertiondepth. Since the circular bony ridge maybe irregular, the form drills are equippedwith a removable depth stop. If a deeperinsertion is required for esthetic or func-tional reasons, the depth stop can beremoved and form drilling can be contin-ued for a further 2 mm at most (watchfor anatomic structures!). The reusabledepth stop can be used on replacementform drills (delivered without depthstops).

The depth stop must be removed beforecleaning the drill. The cleaned depthstop must be placed back on the drillbefore sterilization (see "PreparationInstructions for the CAMLOG® ImplantSystem," Art. No. J8000.0032). Depthstops may be reordered individually.

50


Adjusting the depth by 1 mm

Example:Ø 4.3 mm form drilling

Checking the implant bed

Adjusting the depth by 2 mm

Form DrillingOnce pre-drilling is complete, form drillsin increasing diameters are used for fin-ishing the final implant bed. Tissue-conservative preparation of the bone isensured by the small gradations indiameter size.

Checking the Implant BedResults of probing tests for the absenceof soft tissue in the implant bed must befiled in the patient chart. If the probedetects soft tissue, this indicates a fen-estration into the adjacent tissue by thedrill.

51


Cortical Bone DrillingIf the bone quality is D1, the corticalbone drill enables reduced-torqueimplant insertion through controlled cir-cular expansion of the implant bed inthe apical area. The flattened drill tipserves as a depth stop. A color-coded,laser-marked cortical bone drill is avail-able for each implant diameter.The cortical bone drills are internallycooled. The maximum drilling speedshould not exceed 300 rpm.

Ø 4.3 mm cortical bone drill for implant length 13 mm

max. 300 rpm


SCREW-LINE Cortical Bone form drills

52


SCREW-LINE Tap

Introduction

All SCREW-LINE Implants come with aself-tapping thread with sand-blasted,etched surface (Promote®, Promote®

plus). Use of a tap is recommended forbone qualities D1 or D2.The taps are internally cooled. The maxi-mum drilling speed should not exceed15 rpm during power-assisted tapping.We recommend manual tapping.

max. 15 rpm


SCREW-LINE tap with hexagon

53


Manual tapping is performed with thetap adapter for SCREW-LINE taps andthe locked torque wrench. Make surethat the implant bed axis orientation ismaintained during insertion and removalof the tap. The limit for insertion of thetap is the upper edge of the cuttingblade. See also the instructions for thetorque wrench on page 151.

Caution!The SCREW-LINE taps must not be used for ROOT-LINE or SCREW-CYLINDER-LINE Implants.

Locked torque wrench

Tap Adapter, short / long

54

Implant Package

All CAMLOG® implants are double-sterilepackaged. The primary package (blister)of SCREW-LINE implants contains theimplant with pre-installed insertion postand mounted handle.


Outer package with label Primary package (sterile) with label (blister pack)

Peel-back pouch (sterile)

Primary package withvisible implant

Cover screw located in the handleOpened primary package withimplant and mounted handle

System information on the label

55


Implant Positioning

Protocol-compliant implant positioning(form drilling with depth stop) isachieved when the cylindrical machinedimplant shoulder extends 0.4 mm abovethe crestal bone and one of the 3groove marks indicates the specifiedprosthetic position.

If it was decided to set preparationdepths for the implants individually byremoving the depth stop during formdrilling, this should be kept in mind dur-ing implant insertion. It is possible toindividually position implants with the1.6 mm implant shoulder and Promote®

surface, or the 0.4 mm implant shoulderand Promote® plus surface, vertically tomatch the drilling depth.It should be made sure, however, toposition the Bioseal Bevel circularly inthe cortical bone.

Vestibular orientation of the groove

Groove Positioning

Marks are inscribed on the drivers forthe SCREW-LINE Implants that matchthe three grooves on the CAMLOGconnection. These permit to check thegroove positions during the insertionand their orientation as required for theprosthesis. If the dental technician hasnot indicated the groove position, avestibular orientation is advantageous inmost cases since the abutment angleoriginates at a groove.

Note: Keep in mind during positioning ofthe grooves that turning to the nextgroove position (120°) will cause thescrew implant to be inserted about 0.2mm deeper.

Driver

Insertion post

Implant

Mark

Cam

Groove

56


Inserting the implant

Implant Insertion

The implant is removed from the primarypackage (blister) by the sterile handle.Contamination from non-sterile partsmust be avoided.

Caution!The silicone plug and cover screwmust be removed from the bluehandle prior to implant insertion.

Taking the implant by the handle, insertit into the implant bed. Make sure tofollow the orientation of the implant bedaxis. If the hole has been pre-threaded,the position of the thread dog point inthe cortical bone must match with thaton the implant.

Tip:Screw the implant carefully to theleft until the thread dog point canbe felt.Then, using the handle, screw theimplant to the right until it obtainssufficient grip to allow withdrawalof the handle.

Optional AccessoryCAMLOG® PickUp InstrumentIf the intraoral space is insufficient toallow insertion of the implant with thehandle, the implant can be removedfrom the handle with the PickUp instru-ment. Slide the PickUp instrumentbetween the implant and the handleonto the insertion post and lift off thehandle. For the insertion procedure,place the selected driver on the insertionpost. The implant is then inserted intothe bone and the PickUp instrument isremoved.

57


Locked-on PickUpPlacing the PickUp on the insertion post

Removing the handle Inserting the implant Mounting the driver and removing the PickUp

58


You have three options for the finalinsertion of the implant:- Power-assisted insertion (A)- Manual insertion with the torque

wrench and driver (B)- Manual insertion with the cardanic

driver (C)During insertion make sure to use theexternal mark for the groove position inthe implant.

B CA

A. Power-assisted insertion with thedriver for screw implants, ISO shaft(max. 15 rpm).

B. Manual insertion with the lockedtorque wrench and driver (short/long) for screw implants.

C. Manual insertion with the cardanicdriver.

If the bone quality is D1 or D2 at theimplant insertion site, the implant mustbe externally cooled (saline solution,5 °C/41 °F) during the insertion.

59


Next, unscrew the retention screw of theinsertion post with the screwdriver andremove the insertion post (Caution!Danger of aspiration). If the implant sitehas a weak bone structure, a holding keyfor insertion post is available (as anaccessory) to lock the insertion post andprevent implant movement whenunscrewing the retention screw.

Unscrewing the retention screw Removing the insertion post

Screwdriver,extra short / short / long

Holding key for insertion post

60


Inserting the cover screw

Inserting the healing cap

Implant with cover screw

Implant with healing cap Wound closure

Wound closure

Submerged HealingOnce the silicone plug has been removed from the handle, the cover screw is liftedwith the screwdriver and screwed into the implant manually (Caution! Danger of aspi-ration). The cover screw must be tightened by hand only, using the screwdriver.

Open/Transgingival HealingIn this example, a cylindrical healing cap is picked up with the screwdriver and screwed into the implant manually (Caution! Danger of aspiration). The healing cap should be tightened by hand only, using the screwdriver.

61


Accessories

Adapter for Screw Implants, long,for narrow GapsA special reduced-diameter adapter forscrew implants, long, is available forimplant diameters 3.3 and 3.8 mm toassist manual insertion into small gaps.The setup must be performed under ster-ile conditions. After removal from theprimary package (blister) the color-codedholding sleeve with correct diameter isinserted over the endosseous part of theimplant to guide the adapter for screwimplants, long, into the screw implant.The holding sleeve is squeezed togetherlike a collet at the level of the implantshoulder and the handle is removed.Next, the insertion post is unscrewedwith the screwdriver and removed.

Setting up the holding sleeve Withdrawing the handle Unscrewing the retentionscrew

Removing the insertionpost

Adapter for screw implants,long, Ø 3.3 / 3.8 mm

Holding sleeve for implants to guide theadapter for screw implants, long, into the screwimplant, Ø 3.3 mm and Ø 3.8 mm

62


Inserting implant

Placing adapter forscrew implants,long

Tightening retentionscrew

Removing holdingsleeve

Implant attached to adapterfor screw implants

Placing torque wrench Turning implant into final position

Accessories

Following unscrewing and removal ofthe insertion post, slide the diameter-matched adapter for screw implants,long, into the implant until the camsengage the notches. To fasten, manuallytighten the retention screw on the inser-tion guide.

After removal of the holding sleeve, theimplant can be inserted.

For the insertion, place the lockedtorque wrench over the hex of theadapter for screw implants, long, andscrew the implant to its final position,making sure to line it up with thenotched mark.

63


Unscrewing the retention screw Inserting the cover screw

Implant with cover screw Wound closure

Removing the adapter for screwimplants

Accessories

Once the retention screw is unscrewed,detach the adapter for screw implants,long, from the implant. Remove the sili-cone plug from the prefastened handleof the implant, then pick up the coverscrew with the screwdriver and insert itin the implant manually (Caution!Danger of aspiration).The cover screw must not be powertightened. A healing cap should be usedfor transgingival healing method (seepage 137).

65

Surgery ManualROOT-LINE Insertion

The self-tapping thread ensures high pri-mary stability in the cylindrical area. Theroot-shaped macro-configuration in con-junction with the Promote® surface pro-duces greater contact with the bone sur-face. The CAMLOG connection enablesthe use of every type of prostheticrestoration.

Available diameters are 3.8 mm, 4.3mm, 5.0 mm, and 6.0 mm, in lengths of9 mm, 11 mm, 13 mm, and 16 mm.

6. ROOT-LINE Implant

IntroductionThe ROOT-LINE Implant is a root-shapedscrew implant. It is suitable for delayedimplantation and especially for immedi-ate or delayed immediate implantation.The healing method may be either sub-merged or transgingival. It can be usedin a space-limited apical bony sitebecause of its apical taper combinedwith a cylindrical body. Fenestrations canbe avoided through appropriate selec-tion of the prosthetic diameter and axialorientation.

ROOT-LINE Implant withPromote®

66


The machined segment on the implant neck measures 1.6 mm

ROOT-LINE Implant with Promote®

SurfaceOverview of implant lengths and diame-ters.

67


Removal of the periosteumat the implant position


Mucosal incision

Initial situation

Incision Line

The sample indication shows the inser-tion of a 4.3 mm-diameter, 13 mm-length ROOT-LINE Implant in the lateralmandible. The implantation technique isone-step transperiosteal. A split-flappreparation is selected for the incisionline.

Following a somewhat lingual paracre-stal mucosal incision, a predominantlyepiperiosteal flap is created on thevestibular aspect. The muscle is dividedand the preparation is continued forapprox. 5 mm further. The mucosa isprepared 2-3 mm lingually to facilitatelater suturing. Following marking of thedesired implant position (if necessarywith the aid of a drilling template), theperiosteum is removed circularly in thearea of this site alone (with gingivalpunch or scalpel).

This is followed by preparing of theimplant bed with the ROOT-LINEImplant-specific instruments until thedesired implant diameter and length areobtained.

68


Drilling Sequence

Ø3.

8 m

mØ

4.3

mm

Ø5.

0 m

mØ

6.0

mm

16 mm

13 mm11 mm

9 mm

The height of the depth stop for the form drill is 2 mm.* If the bone quality is D1 or D2, use of the tap (thread cutter) is recommended

for ROOT-LINE Implants.

Depth stop

rpm 800 800 600

rpm 800 800 600

rpm 800 800 600

rpm 800 800 600

Roun

d bu

r Ø3.

5 m

m

Para

llelin

g pi

nØ

2.0/

3.3

mm

Pre-

drill

Ø2.

8 m

m

16 mm

13 mm11 mm

9 mm

Depth stop

16 mm

13 mm11 mm

9 mm

Depth stop

16 mm

13 mm11 mm

9 mm

Depth stop

Implant Bed PreparationOverview of the implant bed prepara-tion.

• Punch mark the desired implant posi-tion with the internally irrigated Ø 3.5 mm round bur.


• Check with the Ø 2.0 / 3.3 mm paral-leling pin with depth marks.

• Pre-drill with the internally irrigated Ø 2.8 mm pre-drill.

• Check with Ø 2.8 / 3.6 mm parallel-ing pin with depth marks.



• Use ROOT-LINE/SCREW-CYLINDER-LINE tap (for bone qualities D1 andD2).

Roun

d bu

r Ø3.

5 m

mRo

und

bur Ø

3.5

mm

Roun

d bu

r Ø3.

5 m

m

Pilo

t dril

lØ2.

0 m

mPi

lot d

rillØ

2.0

mm

Pilo

t dril

lØ2.

0 m

mPi

lot d

rillØ

2.0

mm

Para

llelin

g pi

nØ

2.0/

3.3

mm

Pre-

drill

Ø2.

8 m

m

Para

llelin

g pi

nØ

2.0/

3.3

mm

Pre-

drill

Ø2.

8 m

m

Para

llelin

g pi

nØ

2.0/

3.3

mm

Pre-

drill

Ø2.

8 m

m

69


Ø 3

.8Ø

3.8

Ø 3

.8

Ø 4

.3Ø

4.3

Ø 5

.0

Ø 4

.3

Ø 5

.0

Ø 6

.0

500 15

500 400 15

500 400 350 15

500 400 350 300 15

Ø 3

.8Depth stop *

0.4 mm

Para

llelin

g pi

nØ

2.8/

3.6

mm

Depth stop

Para

llelin

g pi

nØ

2.8/

3.6

mm

Depth stop

Para

llelin

g pi

nØ

2.8/

3.6

mm

Depth stop

Para

llelin

g pi

nØ

2.8/

3.6

mm

Tap

*

Tap

*

Tap

*

Tap

Form drill

Form drill

Form drill

Form drill

13 mm11 mm

9 mm

13 mm11 mm

9 mm

13 mm11 mm

9 mm

13 mm11 mm

9 mm

0.4 mm

0.4 mm

0.4 mm

70


Depth stop for pilot drills andpre-drills

Pilot Drill and Pre-Drill Depth StopThe pilot drill and pre-drill have a maxi-mum working length of 16 mm. Thedrilling depths of 9, 11, and 13 mm arelaser-marked. An insertable depth stoplimits the drilling depth to the selecteddepth of 9, 11, or 13 mm.

Caution! The depth stops, pilot drills, andpre-drills shown here should beused only for implant bed shapingof ROOT-LINE, SCREW-CYLINDER-LINE, and CYLINDER-LINE Implants.These instruments are closelymatched to one another.


Implant Bed Preparation for ROOT-LINE Implants

Preparation of the implant bed includespunch-marking the cortical bone, pilotdrilling, pre-drilling, and profile drilling.The pilot drilling and pre-drilling definethe depth and axis of the implant bedand ensure a tissue-conservative bonepreparation by enlarging the diameter insmall gradations.

Drill extension

71


Paralleling Pin with Depth MarksOn completion of pilot drilling and pre-drilling, the depth and axis orientationare checked with the paralleling pin withdepth marks.The diameter combinations 2.0 / 3.3 mmand 2.8 / 3.6 mm permit consecutive usematching the pre-drill diameter.

Paralleling pins, long, withdepth marks


Paralleling pins, short


72


Depth / axis check after pilotdrilling Ø 2.0 mm

Round bur, Ø 3.5 mm Pilot drill, Ø 2.0 mm

Punch-Marking the Cortical BoneThe Ø 3.5 mm internally irrigated roundbur is used for punch-marking the corti-cal bone, which secures the use of thedrills to follow. The bur is inserted asfar as the bur equator. Recommendeddrilling speed: 800 rpm.

Pilot DrillingThe depth and axis orientation of theimplant bed are prepared with the inter-nally irrigated pilot drill. The depthmarks on the drill correspond to theimplant lengths of 9 / 11 / 13 mm. Themaximum drilling depth is 16 mm. Forsafety reasons, a depth stop matchingthe proposed implant length should beused.Recommended drilling speed: 800 rpm.


max. 800 rpm max. 800 rpm

If a drilling template is used, the depthstops may be placed on the pilot drillsafter the positions are marked. Oncedrilling is complete, the depth and axisof the implant bed are checked with theparalleling pin.If several implants are to be placed, aparalleling pin is inserted in the firsthole to align the subsequent implantaxes.


Paralleling pin, long,with depth marks Ø 2.0 / 3.3 mm

Paralleling pin, short Ø 2.0 / 3.3 mm

73


Pre-drilling Checking the drilling depth after pre-drilling Ø 2.8 mm

Pre-drill, five bladed cutter, Ø 2.8 mm

max. 600 rpm

Pre-DrillingAn internally irrigated, pre-drill fivebladed cutter, with a 2.8 mm diameter isavailable for the ROOT-LINE configura-tion.The depth marks on the drill match theimplant lengths. For safety reasons, adepth stop matching the proposedimplant length should be used. Furtherdrilling is performed with the form drills.The recommended drilling speed is 600 rpm.


Paralleling pin, long, with depth marks Ø 2.8 / 3.6 mm

74


Form Drilling


Diameter- and length-calibrated formdrills are available for each implant size.The internally irrigated form drills arecolor-coded and laser-marked.The form drills included in the surgerysets are supplied with a color-codedremovable depth stop (height 2 mm).Depending on the defined drilling depth(implant length), the hole diameter isexpanded progressively with the seriesof form drills until the planned implantdiameter is reached.

Recommended drilling speeds:Ø 3.8 mm 500 rpmØ 4.3 mm 400 rpmØ 5.0 mm 350 rpmØ 6.0 mm 300 rpm

Ø 3.8 mm Ø 4.3 mm Ø 5.0 mm Ø 6.0 mm

9 mm 11 mm 13 mm 16 mmLength

ROOT-LINE form drills

The protocol-compliant insertion depthfor ROOT-LINE Implants with depth stopin place is the implant length (9 / 11 /13 mm) minus 0.4 mm with the circularstop at the crestal bone level so that theimplant shoulder extends 0.4 mm abovethe bone level.

If a greater insertion depth is desirable,the depth stop can be removed and thepreparation will then be guided by thedepth mark.

75


Depth StopDuring form drilling the depth stop restson the highest point of the crest andthereby limits the insertion depth. Sincethe circular bone level may be irregular,the form drills are equipped with aremovable depth stop. If a greater inser-tion depth is required for esthetic orfunctional reasons, the depth stop canbe removed and form drilling can becontinued for a further 2 mm at most(watch for anatomic structures!). Thereusable depth stop can be used onreplacement drills (delivered withoutdepth stops).

Depth stops must be removed beforecleaning the drills. The cleaned depthstops must be placed back on the drillbefore sterilization (see "PreparationInstructions for the CAMLOG® ImplantSystem," Art. No. J8000.0032).

Form drilling with depth stop Form drilling without depth stop

The lower depth mark corresponds to the implant length with the depth stop inplace according to the protocol. The two depth marks are situated 1 mm apart.

76


Adjusting the depth by 1 mm Adjusting the depth by 2 mm

77


Example:Ø 4.3 mm form drill


Form DrillingOnce pre-drilling is completed, formdrills in increasing diameters are usedfor finishing the final implant bed.Tissue-conservative preparation of thebone is ensured by the small gradationsin diameter size.

Checking the Implant BedResults of probing tests for the absenceof soft tissue in the implant bed must befiled in the patient chart. If the probedetects soft tissue, this indicates afenestration into the adjacent tissue bythe drill.

78

ROOT-LINE Tap

IntroductionAll ROOT-LINE Implants come with a self-tapping thread with sand-blasted, etchedsurface (Promote®). Use of a tap is recom-mended with bone qualities D1 or D2.

The taps are internally irrigated. The max-imum drilling speed should not exceed 15rpm during power-assisted tapping. Werecommend manual tapping.


Ø 3.8 mm Ø 4.3 mm

max. 15 rpm

Ø 5.0 mm Ø 6.0 mm

ROOT-LINE, SCREW-CYLINDER-LINE tap

79


Manual thread tapping is performedwith the adapter with ISO shaft and thelocked torque wrench. Make sure thatthe implant bed axis orientation is main-tained during insertion and removal ofthe tap. The limit for insertion of the tapis the upper edge of the cutting blade.See also the instructions for the torquewrench on page 151.

Caution! The ROOT-LINE taps mustnot be used with SCREW-LINEImplants.

Adapter, ISO shaft


80

Implant Package

All CAMLOG® implants are double-sterilepackaged. The primary package (blister)of ROOT-LINE Implants contains theimplant with pre-installed insertion postand mounted handle.


Outer package with label Primary package (sterile) withlabel (blister pack)


Primary package with visible implant

Cover screw located in the handleOpened primary package withimplant and mounted handle


81


Implant Positioning

The protocol-compliant implant position(form drilling with depth stop) isachieved when the cylindrical machinedimplant shoulder protrudes 0.4 mmabove the crestal bone and one of the 3groove marks indicates the specifiedprosthetic position.

If it was decided to set the drilling depthfor the implants individually by removingthe depth stop during form drilling, thisshould be kept in mind during implantinsertion. It is possible to individuallyposition the 1.6 mm implant shouldervertically. You should make sure, how-ever, to position the Bioseal Bevel circu-larly in the cortical bone.


Groove Positioning

Marks are inscribed on the drivers forthe ROOT-LINE Implants that match thethree grooves on the CAMLOG connec-tion. These permit you to check thegroove positions during the insertionand their orientation as required for theprosthesis. If the dental technician hasnot indicated the groove position, avestibular orientation is advantageous in most cases since the abutment angleoriginates at a groove.

Note: Keep in mind during positioning of the grooves that turning to the nextgroove position (120°) will cause thescrew implant to be inserted about 0.2 mm deeper.

Driver

Insertion post

Implant

Mark

Cam

Groove

82


Implant insertion

Optional AccessoryCAMLOG® PickUp InstrumentIf the intraoral space is insufficient toallow insertion of the implant with thehandle, the implant can be separatedfrom the handle with the PickUp instru-ment. Slide the PickUp instrumentbetween the implant and the handleonto the insertion post and lift off thehandle. For the insertion procedure,place the selected driver on the insertionpost. Then insert the implant into thebone and remove the PickUp instrument.

Implant Insertion



Taking the implant by the handle, insertit into the implant bed. Make sure toobserve the orientation of the implantbed axis. If the hole has been prethread-ed, the position of the thread dog pointin the cortical bone must align with thaton the implant.


83


Removing the handle

Locked-on PickUp

Placing the PickUp on the insertion post

Inserting the implant Mounting the driver and removing the PickUp

84


B CA






driver (C)During insertion, make sure to use theexternal mark for the groove position inthe implant.

If the bone quality is D1 or D2 at theimplant insertion site, the implant mustbe externally cooled (saline solution,5°C/41°F) during the insertion.

85

Next, extract the retention screw of theinsertion post with the screwdriver andremove the insertion post (Caution!Danger of aspiration). If the implant sitehas a weak bone structure, a holding keyfor insertion post is available (as anaccessory) to lock the insertion post and prevent implant movement whenloosening the retention screw.


Loosening the retention screw Removing the insertion post



86


Inserting the cover screw Implant with cover screw Wound closure

Inserting the healing cap Implant with healing cap Wound closure

Submerged HealingOnce the silicone plug has been removed from the handle, the cover screw is liftedwith the screwdriver and screwed into the implant manually (Caution! Danger of aspi-ration). The cover screw must be hand-tightened only with the screwdriver.

Open/Transgingival HealingIn this example, a cylindrical healing cap is picked up with the screwdriver and screwed into the implant manually (Caution! Danger of aspiration). The healing cap should be hand-tightened only, using the screwdriver.

87


Accessories

Adapter for Screw Implants, long,for narrow GapsA special reduced-diameter adapter forscrew implants, long, is available forimplant diameter 3.8 mm to assist man-ual insertion into small gaps. The set-upmust be performed under sterile condi-tions. After removal from the primarypackage (blister) the color-coded holdingsleeve with correct diameter is insertedover the endosseous part of the implantto guide the adapter for screw implants,long, into the screw implant. The holdingsleeve is squeezed together like a colletat the level of the implant shoulder andthe handle is removed. Next, the inser-tion post is unscrewed with the screw-driver and removed.

Adapter for screw implants,long, Ø 3.8 mm

Holding sleeve for implants to guide theadapter for screw implants, long, into the screw implant, Ø 3.8 mm

Setting up the holdingsleeve

Withdrawing the handle

Unscrewing the retention screw

Removing the insertion post

Inserting implant Placing torque wrench Turning implant into final position

88


Accessories

Following unscrewing and removal ofthe insertion post, slide the diameter-matched adapter for screw implants,long, into the implant until the camsengage the notches. To fasten, manuallytighten the retention screw on the inser-tion guide.

After removal of the holding sleeve, theimplant can be inserted.

Placing adapter forscrew implants, long

Tightening retentionscrew

Removing holdingsleeve

Implant attached toadapter for screwimplants

For the insertion, place the lockedtorque wrench over the hex of theadapter for screw implants, long, andscrew the implant to its final position,making sure to align it with the notchedmark.

89


Unscrewing the retention screw


Removing the adapter for screwimplants

Accessories

Once the retention screw is unscrewed,detach the adapter for screw implants,long, from the implant. Remove the sili-cone plug from the prefastened handleof the implant, then pick up the coverscrew with the screwdriver and insert itin the implant manually (Caution!Danger of aspiration). The cover screwmust not be power tightened. A healingcap should be used for the transgingivalhealing method (see page 137).


91

Surgery ManualSCREW-CYLINDER-LINE Insertion

The cylindrical apical segment preservesthe sinus mucosa during insertion of theimplant (no thread edges) and providessuperior adaptation to the particularbone augmentation material used.

The CAMLOG connection enables theuse of every type of prosthetic restora-tion.

Available diameters are 3.8 mm, 4.3mm, 5.0 mm, and 6.0 mm, in lengths of9 mm, 11 mm, 13 mm, and 16 mm.

7. SCREW-CYLINDER-LINE Implant

IntroductionThe SCREW-CYLINDER-LINE Implant(with Promote® surface) is particularlysuitable for restorations in structurallyweak sites in the posterior maxilla. Inconjunction with sinus floor elevationand augmentation, its special configu-ration permits the use of the residualcrestal bone height (>5 mm) for primarystabilization of the implant through itsthreaded segment.

SCREW-CYLINDER-LINEImplant with Promote®

92


The machined segment on the implant neck measures 1.6 mm.

SCREW-CYLINDER-LINE Implantwith Promote® SurfaceOverview of implant lengths and diame-ters.

93


Sinus floor elevation with partialmedial augmentation

Full flap preparation withperiosteal slit

Mucoperiosteal incisionInitial situation

Incision Line and SinusFloor Elevation/Augmentation

The example indication shows the inser-tion of a 4.3 / 13 mm SCREW-CYLIN-DER-LINE Implant in the posterior maxil-la with simultaneous sinus floor elevationand augmentation. The implantationtechnique is two-stage. A full flap prepa-ration is selected for the incision line. Aresidual crestal bone height of at least 5 mm is required for use of a SCREW-CYLINDER-LINE Implant.

Following a somewhat palatal, paracre-stal mucosal incision, a full flap is pre-pared on the vestibular aspect as far asthe required height to outline the sinuswindow. A periosteal slit is performed atthe superior margin of the flap to ensuretension-free wound closure later. Thedesign of the window and sinus floorelevation are performed following stan-dard surgical practice. Make sure toleave sufficient distance between thelower edge of the window and the alve-olar ridge. Augmentation material isapplied medially prior to preparation ofthe implant site, because this area is dif-ficult to access after implantation. Inaddition, it helps to retain the elevatedmucosa cranially.

This is followed by preparing of theimplant bed to match the selectedimplant diameter with the customizedinstruments for the SCREW-CYLINDER-LINE Implant.

94


Implant Bed PreparationOverview of the implant bed prepara-tion.• Punch-mark the desired implant

position with the internally irrigatedØ 3.5 mm round bur.



• If desired, use of the planisher to levelcrestal bone irregularities.









• Thread cutting with ROOT-LINE/SCREW-CYLINDER-LINE tap (for bonequalities D1 and D2).

Drilling Sequence

Ø3.

8 m

mØ

4.3

mm

Ø5.

0 m

mØ

6.0

mm

16 mm

13 mm11 mm

9 mm

The height of the depth stop for the form drill is 2 mm.* If the bone quality is D1 or D2, use of the tap (thread cutter) is recommended for

SCREW-CYLINDER-LINE Implants.

Depth stop

Roun

d bu

r Ø3.

5 m

m

Para

llelin

g pi

n Ø

2.0/

3.3

mm

rpm 800 800

rpm 800 800

rpm 800 800

rpm 800 800

Pilo

t dril

lØ2.

0 m

m

16 mm

13 mm11 mm

9 mm

Depth stop

Roun

d bu

r Ø3.

5 m

m

Para

llelin

g pi

n Ø

2.0/

3.3

mm

Pilo

t dril

lØ2.

0 m

m

16 mm

13 mm11 mm

9 mm

Depth stop

Roun

d bu

r Ø3.

5 m

m

Para

llelin

g pi

n Ø

2.0/

3.3

mm

Pilo

t dril

lØ2.

0 m

m

16 mm

13 mm11 mm

9 mm

Depth stop

Roun

d bu

r Ø3.

5 m

m

Para

llelin

g pi

n Ø

2.0/

3.3

mm

Pilo

t dril

lØ2.

0 m

m

95


Form

dril

l Ø3.

8 m

m

Pre-

drill

Ø2.

8 m

m

Pre-

drill

Ø3.

3 m

m

600 550 500 15

600 550 500 400 15

600 550 500 350 15

600 550 500 300 15

Depth stop

Para

llelin

g pi

n Ø

2.0/

3.3

mm

13 mm11 mm

9 mm

Form

dril

l Ø4.

3 m

m

Pre-

drill

Ø2.

8 m

m

Pre-

drill

Ø3.

3 m

m

Pre-

drill

Ø3.

6 m

m

Depth stop

Para

llelin

g pi

n Ø

2.8/

3.6

mm

13 mm11 mm

9 mm

Form

dril

l Ø5.

0 m

m

*Pre-

drill

Ø2.

8 m

m

Pre-

drill

Ø3.

3 m

m

Pre-

drill

Ø3.

6 m

m

Tap

*

Tap

*

Tap

*

Tap

Depth stop

Para

llelin

g pi

n Ø

2.8/

3.6

mm

13 mm11 mm

9 mm

Form

dril

l Ø6.

0 m

m

Pre-

drill

Ø2.

8 m

m

Pre-

drill

Ø3.

3 m

m

Pre-

drill

Ø3.

6 m

m

Depth stop

Para

llelin

g pi

n Ø

2.8/

3.6

mm

13 mm11 mm

9 mm

0.4 mm

0.4 mm

0.4 mm

0.4 mm

96


Implant Bed Preparation for SCREW-CYLINDER-LINE Implants


Caution! The depth stops for pilot drills, and pre-drills five bladed cutter, shownhere should be used only forimplant bed preparation of ROOT-LINE, SCREW-CYLINDER-LINE, andCYLINDER-LINE Implants. Theseinstruments are closely matched toone another.



Preparation of the implant bed includespunch-marking the cortical bone, pilotdrilling, pre-drilling, and form drilling.The pilot drilling and pre-drilling definethe depth and axis of the implant bedand ensure tissue-conservative bonepreparation by enlarging the diameter insmall gradations.

Drill extension



97




The depth marks and diameter grada-tions on the paralleling pins allow youto check the drilling depth and axis ateach stage of pilot drilling and pre-drilling.

98


Paralleling pin, long, withdepth marks Ø 2.0 / 3.3 mm


Parallelism/axis check after pilot drilling Ø 2.0 mm

Round bur Ø 3.5 mm Pilot drill, Ø 2.0 mm

Punch-Marking the Cortical BoneThe Ø 3.5 mm internally irrigated roundbur is used for punch-marking the corti-cal bone, which secures application ofthe drills to follow. The bur is inserted asfar as the bur equator. Recommendeddrilling speed: 800 rpm.

Pilot DrillingThe depth and axis of the implant bedare set with the internally irrigated pilotdrill. The depth marks on the drill corre-spond to the implant lengths of 9 / 11 /13 mm. The maximum drilling depth is16 mm. For safety reasons, a depth stopmatching the proposed implant lengthshould be used.


max. 800 rpm

max. 800 rpm

If a drilling template is used, the depthstops may be installed on the pilot drillsafter the positions are marked. Oncedrilling is complete, the depth and axisof the implant bed are checked with theparalleling pin.If several implants are to be placed, aparalleling pin is inserted in the firsthole to align the subsequent implantaxes.


Recommended drilling speed: 800 rpm.

Depth/axis check after pilot drilling Ø 2.0 mm

99

Pre-DrillingInternally irrigated pre-drills, five bladedcutter, are available for the SCREW-CYLINDER-LINE Implants; the availablediameters are 2.8 mm / 3.3 mm / 3.6 mm. The recommended drilling speedis 600 rpm.The depth marks on the drill match theimplant lengths. For safety reasons, adepth stop matching the proposedimplant length should be used.



Drilling depth check after pre-drilling Ø 2.8 mm

Ø 2.8 mm Ø 3.3 mm Ø 3.6 mm

Pre-Drill, five bladed Cutter

Sequence for SCREW-CYLINDER-LINE Implants

Pre-drill

Ø 2.8 mm

For implantØ 3.8 mm

Form drillØ 3.8 mm


Form drillØ 4.3 mm


Form drillØ 5.0 mm


Form drillØ 6.0 mm

Pre-drill

Ø 3.3 mm

Pre-drill

Ø 3.6 mm

Caution! The Ø 3.6 mm pre-drill must not be used for implant diameter 3.8 mm.

Pre-drill, five bladed cutter, max 600 rpm

Ø 2.8 mm pre-drilling

Parallelism/axis check after pre-drilling Ø 2.8 mm

The implant bed preparation is per-formed with pre-drills, five bladed cut-ter, in increasing size with reference tothe selected implant diameter andinsertion depth. Then, the implant bedis finished to the final size with a formdrill of appropriate length.

Paralleling pin, long,with depth mark Ø 2.8 / 3.6 mm

100


Pre-drilling Ø 3.3 mm

Pre-drilling Ø 3.6 mm

Note

If a simultaneous implantation into theaugmented sinus is to be performed,pre-drilling continues only until penetra-tion of the sinus cortical bone is felt.The use of a 9-mm depth stop is fordemonstration purposes only since thisconfiguration is also universally applica-ble. During final form drilling, the short-est possible form drill must be used toshape the Bioseal Bevel as far as thedepth stop.

Drilling depth checkafter pre-drilling Ø 3.3 mm

Parallelism/axis check afterpre-drilling Ø 3.3 mm

Drilling depth checkafter pre-drilling Ø 3.6 mm


101


Form Drilling


Diameter- and length-calibrated formdrills are available for the SCREW-CYLINDER-LINE Implants. The internallyirrigated form drills are color-coded andlaser-marked.The form drills included in the surgerysets are supplied with a color-codedremovable depth stop (height 2 mm).The implant bed is shaped to its finalsize with the form drill matching theselected implant size.For bone qualities D1 or D2, the use ofincreasing diameter form drills is recom-mended.

Recommended drilling speeds:Ø 3.8 mm 500 rpmØ 4.3 mm 400 rpmØ 5.0 mm 350 rpmØ 6.0 mm 300 rpm

Ø 3.8 mm

9 mm

Length

11 mm 13 mm 16 mm

Ø 4.3 mm Ø 5.0 mm Ø 6.0 mm

SCREW-CYLINDER-LINE form drills

The protocol-compliant insertion depthfor SCREW-CYLINDER-LINE Implantswith depth stop in place is the implantlength (9 / 11 / 13 / 16 mm) minus 0.4mm with the circular stop at the crestalbone level, so that the implant shoulderextends 0.4 mm above the bone level.If a greater insertion depth is desirable,the depth stop can be removed and thepreparation will then be guided by thedepth mark.

102


Depth StopDuring form drilling the depth stop restson the highest point of the crest andthereby limits the insertion depth. Sincethe circular bone level may be irregular,the form drills are equipped with aremovable depth stop. If a greater inser-tion depth is required for esthetic orfunctional reasons, the depth stop canbe removed and form drilling can becontinued for a further 2 mm at most(watch for anatomic structures!). Thereusable depth stop can be used onreplacement drills (delivered withoutdepth stops).


The lower depth mark corresponds to theimplant length with the depth stop in placeaccording to the protocol. The two depth marksare situated 1 mm apart.


103


Ø 4.3 mm form drilling


104


SCREW-CYLINDER-LINETap

Introduction

All SCREW-CYLINDER-LINE Implantscome with a self-tapping thread withsand-blasted, etched surface (Promote®).Use of a tap is recommended with bonequalities D1 or D2.

The taps are internally irrigated. Themaximum drilling speed should notexceed 15 rpm during power-assistedtapping. We recommend manual tapp-ing.

max. 15 rpm

Ø 3.8 mm Ø 4.3 mm Ø 5.0 mm Ø 6.0 mm

ROOT-LINE, SCREW-CYLINDER-LINE taps

105


Manual tapping is performed with theadapter with ISO shaft and the lockedtorque wrench. Make sure that theimplant bed axis orientation is main-tained during insertion and removal ofthe tap. The limit for insertion of the tapis the upper edge of the cutting blade.See also the instructions for the torquewrench on page 151.

Caution! The SCREW-CYLINDER-LINEtaps must not be used with SCREW-LINE Implants.

NoteSince no tapping is required in themaxilla for bone qualities D3 orD4, we show a situation in themandible for demonstration pur-poses.


Adapter, ISO shaft

106


Implant Package

All CAMLOG® implants are double-sterilepackaged. The primary package (blister)of SCREW-CYLINDER-LINE Implants con-tains the implant with pre-installedinsertion post and mounted handle.




Cover screw located in the handleOpened primary package with implant and mounted handle


Implant Positioning

The protocol-compliant implant position(form drilling with depth stop) isachieved when the cylindrical machinedimplant shoulder extends 0.4 mm abovethe crestal bone and one of the 3groove marks indicates the specifiedprosthetic position.

If it was decided to set the drilling depthfor the implants individually by removingthe depth stop during form drilling, thisshould be kept in mind during implantinsertion. It is possible to individuallyposition the 1.6 mm implant shouldervertically to match the drill hole. Youshould make sure, however, to positionthe Bioseal Bevel circularly in the corti-cal bone.


Groove Positioning

Marks are inscribed on the drivers forthe SCREW-CYLINDER-LINE Implantsthat match the three grooves on theCAMLOG connection. These permit youto check the groove positions during theinsertion and their orientation asrequired for the prosthesis. If the dentaltechnician has not indicated the grooveposition, a vestibular orientation isadvantageous in most cases since theabutment angle originates at a groove.

Note: keep in mind during positioning ofthe grooves that turning to the nextgroove position (120°) will cause thescrew implant to be inserted about 0.2mm deeper.

Driver

Insertion post

Implant

Mark

Cam

Groove

107


108


Implant Insertion



Taking the implant by the handle, insertit into the implant bed. Make sure tofollow the orientation of the implant bedaxis. If the hole has been prethreaded,the position of the thread dog point inthe cortical bone must mate with thaton the implant.


Inserting the implant

Optional AccessoryCAMLOG® PickUp InstrumentIf the intraoral space is insufficient toallow insertion of the implant with thehandle, the implant can be separatedfrom the handle with the PickUp instru-ment. Slide the PickUp instrumentbetween the implant and the handleonto the insertion post and lift off thehandle. For the insertion procedure,place the selected driver on the insertionpost. The implant is then inserted intothe bone and the PickUp instrument iswithdrawn.

109


Locked-on PickUpInstall the PickUp on the insertion post

Removing the handle Inserting the implant Mounting the driver and removing the PickUp

110




driver (C)During insertion, make sure to use theexternal mark for the groove position inthe implant.

B CA




If the bone quality is D1 or D2 at theimplant insertion site, the implant mustbe externally cooled (saline solution,5 °C/41°F) during the insertion.

111



Next, loosen the retention screw of theinsertion post with the screwdriver andremove the insertion post (Caution!Danger of aspiration). If the implant sitehas a weak bone structure, a holding keyfor insertion post is available (as anaccessory) to lock the insertion post andprevent implant movement when loosen-ing the retention screw.

Loosening the retention screw Removing the insertion post


112


Implant with cover screw If the periosteum is not intact, werecommend use of a membrane

Suture line Wound closure


Once the silicone plug has been removedfrom the handle, the cover screw is liftedwith the screwdriver and screwed intothe implant manually (Caution! Dangerof aspiration).The cover screw must be tightened byhand only, using the screwdriver.A healing cap should be used for thetransgingival healing method (see page137).

113

Accessories

Adapter for Screw Implants, long,for narrow GapsA special reduced-diameter adapter forscrew implants, long, is available forimplant diameter 3.8 mm to assist man-ual insertion into small gaps. The set-upmust be performed under sterile condi-tions. After removal from the primarypackage (blister) the color-coded holdingsleeve for implants with correct diameteris inserted over the endosseous part ofthe implant to guide the adapter forscrew implants, long, onto the screwimplant. The holding sleeve is squeezedtogether like a collet at the level of theimplant shoulder and the handle isremoved.Next, the insertion post is unscrewedwith the screwdriver and removed.

Adapter for screwimplants, long,Ø 3.8 mm

Holding sleeve for implants toguide the adapter for screwimplants, long, onto the screwimplant, Ø 3.8 mm

Setting up the holdingsleeve

Withdrawing the handle Unscrewing the retentionscrew

Removing the insertionpost


114


Inserting implant Turning implant into final position

Accessories

Following loosening and removal of the insertion post, slide the diameter-matched adapter for screw implantsonto the implant until the cams engagethe notches. To fasten, hand-tighten theretention screw on the adapter for screwimplants.

Following removal of the holding sleeve,the implant can be inserted.

Placing adapter forscrew implants, long

Tightening reten-tion screw

Removing hold-ing sleeve

Implant attached toadapter for screwimplants

Placing torque wrench

For the insertion, place the lockedtorque wrench over the hex of theadapter for screw implants, long, andscrew the implant into its final position,making sure to align it with the notchedmark.

115


Removing the adapter for screw implants Inserting the cover screw


Loosening the retention screw

Accessories

Once the retention screw is loosened,detach the adapter for screw implants,long, from the implant. Remove the sili-cone plug from the prefastened handleof the implant, then pick up the coverscrew with the screwdriver and insert itinto the implant manually (Caution!Danger of aspiration).The cover screw must not be powertightened. A healing cap should be usedfor the transgingival healing method(see page 137).

117

Surgery ManualCYLINDER-LINE Insertion

Available diameters are 3.3 mm, 3.8mm, 4.3 mm, 5.0 mm, and 6.0 mm, inlengths of 9 mm, 11 mm, 13 mm, and16 mm (for Ø 3.3 mm diameters, thelengths are 11 mm, 13 mm, and 16mm).

8. CYLINDER-LINEImplant

IntroductionCYLINDER-LINE Implants with TPS sur-face are universally applicable. Theadvantage of this implant type is its sim-ple, time-saving application procedure.

The CAMLOG connection enables theuse of every type of prosthetic restora-tion.

CYLINDER-LINE Implant, TPS

118


The machined segment on the implant neck measures 1.6 mm (on the Ø 3.3 mm implant, the machinedsegment is 2.0 mm).

CYLINDER-LINE Implant with TPSSurfaceOverview of implant lengths and diame-ters.

119


Removal of the periosteumat the implant site


Mucosal incision

Initial situation

Incision line

The example indication shows the inser-tion of a CYLINDER-LINE Implant with4.3 mm diameter and 13 mm length inthe lateral mandible. The implantationtechnique is single-stage transperiosteal.A split-flap preparation is selected forthe incision line.

Following a somewhat lingual, paracre-stal mucosal incision, a predominantlyepiperiosteal flap is created on thevestibular aspect. The muscle is dividedand the preparation is continued forapprox. 5 mm further. The mucosa isprepared 2-3 mm lingually to facilitatelater suturing.Following marking of the desired implantposition (if necessary with the aid of adrilling template), the periosteum isremoved circularly in the area of this sitealone (with a gingival punch or scalpel).

This is followed by preparation of theimplant bed to match the selectedimplant diameter and length with thecustomized instruments for theCYLINDER-LINE Implant.

120


Implant Bed PreparationOverview of the implant bed prepara-tion.

• Punch-mark the desired implantposition with the internally irrigatedØ 3.5 mm round bur.



• If desired, use of the planisher to levelcrestal bone irregularities.









Drilling Sequence

Ø3.

8 m

m

Ø4.

3 m

m

Ø5.

0 m

m

Ø6.

0 m

m

Roun

d bu

rØ

3.5

mm

Roun

d bu

rØ

3.5

mm

Roun

d bu

rØ

3.5

mm

Roun

d bu

rØ

3.5

mm

Roun

d bu

rØ

3.5

mm

Para

llelin

g pi

nØ

2.0/

3.3

mm

Ø3.

3 m

m

Para

llelin

g pi

nØ

2.0/

3.3

mm

Para

llelin

g pi

nØ

2.0/

3.3

mm

Para

llelin

g pi

nØ

2.0/

3.3

mm

Para

llelin

g pi

nØ

2.0/

3.3

mm

16 mm

13 mm11 mm

9 mm

Depth stop

Pilo

t dril

lØ

2.0

mm

16 mm

13 mm11 mm

9 mm

Depth stop

Pilo

t dril

lØ

2.0

mm

16 mm

13 mm11 mm

9 mm

Depth stop

Pilo

t dril

lØ

2.0

mm

16 mm

13 mm11 mm

9 mm

Depth stop

Pilo

t dril

lØ

2.0

mm

16 mm

13 mm11 mm

9 mm

Depth stop

Pilo

t dril

lØ

2.0

mm

rpm 800 800

rpm 800 800

rpm 800 800

rpm 800 800

rpm 800 800

121

Chirurgie-ManualCYLINDER-LINE Insertion

0.4 mm

0.4 mm

0.4 mm

0.4 mm

TPS

TPS

TPS

TPS

Ø2.

8 m

m

Ø3.

3 m

m

TPS

0.4 mm

Form drill

Ø2.

8 m

m

Ø3.

3 m

m

Ø3.

8 m

m

Form drill

Ø2.

8 m

m

Ø3.

3 m

m

Ø3.

6 m

m

Ø4.

3 m

m

Form drill

Ø2.

8 m

m

Ø3.

3 m

m

Ø3.

6 m

m

Ø5.

0 m

m

Form drill

Ø2.

8 m

m

Ø3.

3 m

m

Ø3.

6 m

m

Ø6.

0 m

m

Form drill

Depth stop

Para

llelin

g pi

nØ

2.8/

3.6

mm

13 mm11 mm

9 mm

Depth stop

Para

llelin

g pi

nØ

2.0/

3.3

mm

13 mm11 mm

9 mm

Depth stop

Para

llelin

g pi

nØ

2.8/

3.6

mm

13 mm11 mm

9 mm

Depth stop

Para

llelin

g pi

nØ

2.8/

3.6

mm

13 mm11 mm

9 mm

Depth stop

Para

llelin

g pi

nØ

2.8/

3.6

mm

13 mm11 mm

9 mm

Pre-drill, five bladed cutter





600 550

600 550 500

600 550 500 400

600 550 500 350

600 550 500 300

122


Implant Bed Preparation for CYLINDER-LINE Implants


Caution! The depth stops for pilotdrills, and pre-drills five bladedcutter, shown here should be usedonly for implant bed shaping ofROOT-LINE, SCREW-CYLINDER-LINE,and CYLINDER-LINE Implants. Theseinstruments are closely matched toone another.



Preparation of the implant bed includespunch-marking the cortical bone, pilotdrilling, pre-drilling, and form drilling.The pilot drilling and pre-drilling definethe depth and axis of the implant bedand ensure tissue-conservative bonepreparation by enlarging the diameter insmall gradations.

Drill extension

123







124


Paralleling pin, long,with depth marks Ø 2.0 / 3.3 mm

Depth/axis check after pilot drillingØ 2.0 mm


Parallelism/axis check after pilot drilling

Round bur, Ø 3.5 mm Pilot drill, Ø 2.0 mm

Punch-Marking the Cortical BoneThe Ø 3.5 mm internally irrigated roundbur is used for punch-marking the corti-cal bone, which secures application ofthe drills to follow. The bur is inserted asfar as the bur equator. Recommendeddrilling speed: 800 rpm.

Pilot DrillingThe depth and axis of the implant bedare set with the internally irrigated pilotdrill. The depth marks on the drill corre-spond to the implant lengths of 9 / 11 /13 mm. The maximum drilling depth is16 mm. For safety reasons, a depth stopmatching the proposed implant lengthshould be used.


max. 800 rpm max. 800 rpm

If a drilling template is used, the depthstops may be installed on the pilot drillsafter the positions are marked. Oncedrilling is complete, the depth and axisof the implant bed are checked with theparalleling pin.If several implants are to be placed, aparalleling pin is inserted in the firsthole to align the subsequent implantaxes.

The pilot drill is aligned parallel to theparalleling pin and visually checked ontwo planes (sagittal and transversal).Recommended drilling speed: 800 rpm.

for ImplantØ 3.3 mm

Form drillØ 3.3 mm

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Paralleling pin, long,with depth marks, Ø 2.8 / 3.6 mm

Paralleling pin, short,Ø 2.8 / 3.6 mm

Drilling depth check after pre-drilling Ø 2.8 mm

Pre-DrillingAn internally irrigated pre-drill five blad-ed cutter is available for CYLINDER-LINEImplants; the available diameters are 2.8mm / 3.3 mm / 3.6 mm.The recommended drilling speed is 600rpm.The depth marks on the drill match theimplant lengths. For safety reasons, adepth stop matching the proposedimplant length should be used.

Ø 2.8 mm pre-drillPre-drill, five bladed cutter

Ø 2.8 mm Ø 3.3 mm

max. 600 rpm

Ø 3.6 mm

Pre-Drill, five bladed Cutter

Sequence für CYLINDER-LINE Implants

Pre-drill

Ø 2.8 mm


Form drillØ 3.8 mm


Form drillØ 4.3 mm


Form drillØ 5.0 mm


Form drillØ 6.0 mm

Pre-drill

Ø 3.3 mm

Pre-drill

Ø 3.6 mm

Caution! The Ø 3.3 mm pre-drill must not be used for implant diameter 3.3 mm.The Ø 3.6 mm pre-drill must not be used for implant diameter 3.8 mm.

The implant bed preparation is per-formed with pre-drills five bladed cutterin increasing size with reference to theselected implant diameter and insertiondepth. Then the implant bed is finishedto the final size with a form drill ofappropriate length.

126


Pre-drilling Ø 3.3 mm Drilling depth checkafter pre-drilling Ø 3.3 mm


Pre-drilling Ø 3.6 mm Drilling depth checkafter pre-drilling Ø 3.6 mm


127


Ø 3.3 mm

9 mm

Length

11 mm 13 mm 16 mm

Ø 3.8 mm Ø 4.3 mm Ø 5.0 mm Ø 6.0 mm

CYLINDER-LINE form drills

Form drilling

Diameters and Lengths

Diameter- and length-calibrated formdrills are available for the CYLINDER-LINE implants. The internally irrigatedform drills are color-coded and laser-marked.The form drills included in the surgerysets are supplied with a color-codedremovable depth stop (height 2 mm).The implant bed is shaped to its finalsize with the form drill matching theselected implant size.For bone qualities D1 or D2, the use ofincreasing diameter form drills is recom-mended.

Recommended drilling speeds:Ø 3.3 mm 550 rpmØ 3.8 mm 500 rpmØ 4.3 mm 400 rpmØ 5.0 mm 350 rpmØ 6.0 mm 300 rpm

The protocol-compliant insertion depthfor CYLINDER-LINE Implants with depthstop in place is the implant length (9 /11 / 13 / 16 mm) minus 0.4 mm withthe circular stop at the crestal bone lev-el, so that the implant shoulder extends0.4 mm above the bone level.

If a greater insertion depth is desirable,the depth stop can be removed and thepreparation will then be guided by thedepth mark.

128



Implant length with the depth stop in placeaccording to the protocol. The two depth marksare situated 1 mm apart.

Depth StopDuring form drilling, the depth stop restson the highest point of the crest andthereby limits the insertion depth. Sincethe circular bone level may be irregular,the form drills are equipped with aremovable depth stop. If a greater inser-tion depth is required for esthetic orfunctional reasons, the depth stop canbe removed and form drilling can becontinued for a further 2 mm at most(watch for anatomic structures!). Thereusable depth stop can be used onreplacement drills (delivered withoutdepth stops).


129


Ø 4.3 mm form drilling



Form DrillingWith bone qualities D1 or D2, form drillsin increasing diameters are used. Tissue-conservative preparation of the bone isensured by the small gradations in diam-eter size.

Checking the Implant BedResults of probing tests for the absenceof soft tissue in the implant bed must befiled in the patient chart. If the probedetects soft tissue, this indicates a fen-estration into the adjacent tissue by thedrill.

130


Implant Package

All CAMLOG® implants are double-sterilepackaged. The primary package (blister)of CYLINDER-LINE Implants contains theimplant with the cover screw alreadymounted and attached tilt-off placementhead in the handle.




CYLINDER-LINE Implant with coverscrew already mounted and attached tilt-offplacement head

Opened primary package withimplant and mounted handle


131



Groove Positioning

The CYLINDER-LINE Implants have threemarks beneath the Bioseal Bevel on theimplant body that match the grooveposition on the CAMLOG connection.Before insertion, align the implant withone of the groove marks at the specifiedposition for the prosthesis.If the dental technician has not indicat-ed the groove position, a vestibular ori-entation is advantageous in most cases.

Implant Positioning

The protocol-compliant implant position(form drilling with depth stop) isachieved when the cylindrical machinedimplant shoulder extends 0.4 mm abovethe crestal bone.

If it was decided to set the drilling depthfor the implants individually by removingthe depth stop during form drilling, thisshould be kept in mind during implantinsertion. It is possible to individuallyposition the 1.6 mm implant shouldervertically to match the drill hole. Youshould make sure, however, to positionthe Bioseal Bevel circularly in the corti-cal bone.

Seating instrument

Tilt-off placement head

Cover screw

Implant

Groove

Mark

132


Pressing the handle into theimplant bed

Lifting off the handle

Implant Insertion


WARNING!Prior to insertion in the implantbed, the implant must be carefullyaligned to the correct groove posi-tion with the aid of the externalmarks on the implant body.Changes cannot be made later!

Optional AccessoryCAMLOG® PickUp InstrumentIf the intraoral space is insufficient toallow insertion of the implant with thehandle, the implant can be separatedfrom the handle with the PickUp instru-ment. Slide the PickUp instrumentbetween the implant and the handleonto the tilt-off placement head and liftoff the handle. The implant is theninserted into the bone and the PickUpinstrument is withdrawn.

Taking the implant by the handle, insertit into the implant bed. Make sure tofollow the orientation of the implant bedaxis. Then press the implant in until ithas sufficient grip to permit withdrawalof the handle. Take care that the tilt-offplacement head is not bent too soon.

133


Locked-on PickUpInstalling the PickUp on the tilt-off placement head

Lifting off the handle Transferring the implantinto the implant bed

Installing the seating instrumentand removing the PickUp instrument

134


The tilt-off placement head is removedby sideways bending of the seatinginstrument. The tilt-off placement headholds inside the seating instrument within the aid of the silicone ring.

Next, the fit of the cover screw must bechecked with the screwdriver by hand.It must not be power-tightened. If avertical correction of the seat depth isrequired, the tilt-off placement headlodged in the seating instrument can bere-inserted into the hex socket of thecover screw.

Caution! Safety measures must betaken to prevent swallowing oraspiration of the components.

Removing the tilt-off placementhead

Seating instrument Surgery mallet

Installing the seating instrument Tapping the implant to its final position

Following axial withdrawal of the handle(respectively after insertion of theimplant into the bone with the PickUpinstrument), the seating instrument isplaced on the tilt-off placement headand the implant is tapped to its finalposition using the surgery mallet. Thejaw requiring treatment should beappropriately supported by the dentist'sassistant while this is being done.

135


Removing the cover screw

Checking the cover screw Wound closure

Submerged HealingThe example shows submerged healingwith the cover screw in place.

Inserting the healing cap cylindrical

Wound closure

Open/Transgingival HealingThe cover screw must be removed withthe screwdriver before installation of ahealing cap. Next, as shown in the dia-gram, a healing cap cylindrical is pickedup with the screwdriver and inserted inthe implant manually (Caution! Dangerof aspiration).

The healing cap must be hand-tightenedonly with the screwdriver.

137

Surgery ManualHealing Cap

9. Healing Cap

IntroductionUse of a healing cap supports the devel-opment of peri-implant soft tissue.Healing caps are available in differentgeometrys:• cylindrical• wide body• bottleneckThe healing caps are color-coded byimplant diameter.

Healing Caps cylindrical wide body bottleneck

Diameter Gingiva height (GH) Gingiva height (GH) Gingiva height (GH)

3.3 mm 2.0/4.0 mm 2.0/4.0 mm 4.0 mm

3.8 mm 2.0/4.0/6.0 mm 2.0/4.0/6.0 mm 4.0/6.0 mm

4.3 mm 2.0/4.0/6.0 mm 2.0/4.0/6.0 mm 4.0/6.0 mm

5.0 mm 2.0/4.0/6.0 mm 2.0/4.0/6.0 mm 4.0/6.0 mm

6.0 mm 2.0/4.0/6.0 mm 2.0/4.0/6.0 mm 4.0/6.0 mm

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Healing phase

Healing cap, cylindrical

Coronal displacement of thesoft tissue through replacementwith a healing cap cylindrical

Soft tissue growth

Healing Caps -cylindrical and wide bodyFor standard use, the most commonhealing caps are the cylindrical and widebody types. Once the cover screw hasbeen removed, a diameter-matched heal-ing cap is manually inserted with use ofa screwdriver. When selecting the gingi-val height, make sure that the healingcap extends 1 - 1.5 mm above the gingi-va. When the peri-implant soft tissue hasstabilized, an impression is taken.


Healing Cap -bottleneckIn esthetically challenging areas, thetreatment result will be enhancedthrough the use of a healing capbottleneck.

The coronally rejuvenated cross-sectionpromotes soft tissue growth during thehealing period.

After 3-4 weeks (before final structuringof the elastic fibers) a healing cap cylin-drical is inserted. No tissue should beexcised during this procedure. The tissueis suppressed coronally and therebyforms a papilla-like structure. Once theperiimplant soft tissue has stabilized, animpression can be taken.

Healing cap, wide body

139


OPT

ION

AL

One-stage method(transgingival)

bottlenecktissue growth - step 1

cylindricaltissue growth - step 2

Provisional restoration

PEEK abutment

Final restoration -abutment with

supraconstruction

wide bodytissue support

Two-stage method(covered)

Tissue Growth/Tissue Support

140

10. Transfer System

IntroductionThe transfer system provides a highlyprecise, rotation-resistant impressionsystem for both closed and open impres-sion tray methods. The system compo-nents are color-coded by implant diame-ter.

You should make sure to mix and matchonly implants and prosthetic componentsof the same diameter (by color-coding).No components of different diametersshould be attached to one another. Thesystem components must not be modi-fied.

Impression MethodsThe impression method may optionallybe either for closed or open tray.If heavily divergent implant axes arepresent or combination with a functionalimpression is desired, the open impres-sion method should be used. Specialimpression posts must be used alongwith ball abutments, Locator® abut-ments, or bar abutments.

Impression MaterialSilicone or polyether materials can beused as impression materials in bothclosed and open methods.

Color-Coding

Ø 3.3 mm gray

Ø 3.8 mm yellow

Ø 4.3 mm red

Ø 5.0 mm blue

Ø 6.0 mm green

Impression posts, open tray

Impression posts, closed tray

Transfer SystemIntroduction

141

Transfer SystemClosed Impression Method

Overview of color-coded impression posts and impression caps

The fixing screw extendsabout 2 mm above theinserted impression post.

After fasten the screw, itsits flush with the upperedge (4-5 turns)

Bite registration cap

Impression cap

Screwdrivers,extra short, short, long

Impression post,Lab analog,Fixing screw forimpression post

Closed ImpressionMethod

System ComponentsThe system components for the closedimpression method are consistentlycolor-coded. A fixing screw for impres-sion post, impression cap, and bite regis-tration cap are supplied along with theimpression post. A screwdriver - extrashort, short, long - is required. The screwmust be hand-tightened both in theimplant and in the lab analog.

All transfer system and bite regis-tration components are single-useitems!For precision reasons, they may notbe reused.

142

The fixing screw must be hand-tightenedwith the screwdriver. We recommend aradiographic check of the correct seatingof the impression post prior to takingthe impression.

Impression Post InsertionFollowing removal of the gingiva formeror the temporary abutment, insert theimpression post with its attached fixingscrew into the implant. Rotate untilengagement of the cams with thegrooves is felt.

Caution!The fixing screw will extend about2 mm from the post after itengages with the grooves.The post is rotationally symmetri-cal; no special orientation isrequired.


143


Impression TakingThe color-coded impression cap is nowinstalled, using the guide grooves on theimpression post, until a detectable pres-sure point is reached and the impressioncap is definitely fastened. Three guidegrooves on the impression post (placedat 120 ° intervals) facilitate contact-freeplacement relative to adjacent impres-sion caps or teeth. The impression capextensions must not be removed.Correct seating of the impression capsshould be checked again before theimpression is taken.

The impression caps should remain inthe impression after the impression trayis lifted. If this is not the case, repeatthe impression.

Tip: To shorten the procedure time,we recommend sending the match-ing lab analog also to the laborato-ry. To prevent loss of the fixingscrew, the impression post must beshipped attached to the lab analog.

I

II

III

Three possible positions for the impression cap

144

Open ImpressionMethod

An individually fabricated impressiontray is required for the open impressionmethod. On the extension of the implantaxis, the individual impression tray mustbe perforated to allow release of the fix-ing screw of the impression post.

System ComponentsThe system components for the openimpression method are color-coded. Thefixing screw is secured with an O-ring.The fixing screw must be hand-tightenedonly, both in the implant and in the labanalog.

Before removing the impression, loosenthe screw and pull it back until the stop(O-ring) is felt. Otherwise, removal ofthe impression will be impossible due toaxial divergence of the implants, or theimpression itself will be deformedthrough excessive compression.

The fixing screw is equipped with abreak-off point and it can be shortenedby 3.0 mm by breaking it off with ascrewdriver if space limitations areencountered.Caution! Shorten extra-orally only.

Transfer SystemOpen Impression Method

Screwdrivers,extra-short, short, long

Impression post

Lab analog

O-ring O-ring

Overview of color-coded impression posts

145


Impression Post InsertionRemove the gingiva former or temporaryabutment. To ensure orientation in thedirection of the implant axis, insert thescrew fully in the apical direction beforeinserting the impression post.Place the impression post for the openimpression on the implant and tightenthe fixing screw slightly.

The impression post is rotationally sym-metrical; no special orientation isrequired. Rotate it onto the implant untilthe cams engage with the implantgrooves.

Caution! If the cams have not engaged, theheight difference will be about 0.4 mm.

The fixing screw must be hand-tightenedwith the screwdriver. We recommend aradiographic check of the correct seatingof the impression post prior to takingthe impression

146

Impression TakingOnce a check of the perforations and theextension of the individual impressiontray is complete, the impression can betaken with silicone or polyether material.

To remove the impression, loosen thefixing screw, pull it back and then lift offthe impression.

Tip: To shorten the procedure time,we recommend sending the match-ing lab analog also to the laborato-ry.


147

Transfer SystemBite Registration

11. Bite Registration

System ComponentsThe impression posts for the closedimpression method are used for the biteregistration (see "Closed impressionmethod", page 141). The diameter-matched, color-coded bite registrationcaps are installed on the impressionposts. Correct seating is indicated by aperceptible locking feel. Sharp edges inthe register are prevented by the caps.Registration requires only standardmaterials. The caps should not beallowed to bond to the register and aredelivered to the laboratory along withthe impression posts.

Alternatively, under limited space condi-tions and to prevent bite elevation, a6.0 mm healing cap cylindrical may beused.

Caution! Record the diameter, posi-tion, and height of the healing capon the information work sheet anddeliver it with the correspondinghealing cap to the dental laborato-ry.

All transfer system and bite regis-tration components are single-useitems!For precision reasons, they may notbe reused.


Impression posts, closed tray

Bite registra-tion cap

Fixing screw forimpression post

Impression post

Lab analog

148

12. Provisional Solution

IntroductionThe PEEK (polyether ether ketone) tem-porary abutment was designed for use inesthetic immediate restorations. It canalso be used for long-term provisionals(max. 6 months).

The benefits of immediate implantationwith an esthetic, non-functional immedi-ate restoration consist in preservation ofthe structures of the periodontal or peri-implant tissue in esthetically criticalzones.Once an adequate healing (osseointegra-tion) period for the implant has elapsedand the peri-implant soft tissue hasmatured, a new impression for the finalrestoration can be taken.

System ComponentsThe temporary abutment (PEEK) has aheight of 12.0 mm and is available indiameters 3.8 mm – 6.0 mm. The abut-ment screw must be hand-tightenedonly, using the screwdriver.An abutment screw is supplied alongwith the abutment.

Preparing the Temporary AbutmentInsert the abutment into the implant androtate until the cams engage with thegrooves. Then insert the abutment screwand hand-tighten it. Mark the vestibularmidpoint and the preparation marginson the abutment following the gingivalline.

Provisional SolutionIntroduction


Abutment screw

Temporary abutment

Lab analog

149

Provisional SolutionPreparing the Temporary Abutment

Perform any required grinding of thetemporary abutment extra-orally to pre-vent contamination of the surroundingtissue. This procedure can best be man-aged by screwing the abutment into theuniversal holder for abutment grindingor into a lab analog. Depending on themarks, the preparation resembles con-ventional perioprosthetics.

The best solution is obtained with a dia-mond bur at high drilling speed, withoutwater irrigation and using little pressure.The chamfer or crown margins must lieparagingivally for esthetic immediaterestorations, and approx. 1 mm – 1.5mm subgingivally for late restorations toachieve an anatomic emergence profilein the peri-implant tissue. A mark isplaced on the vestibular aspect to facili-tate detection of the insertion positionof the abutment.

150

Provisional Crown/BridgeA prefabricated crown or a previouslyprepared crown can be adapted to thesituation by lining it with acrylic.The insertion direction of the crown,indicated by the adjacent teeth, rarelymatches the orientation of the implanttube. Because of this, bridge structuresshould not be fabricated in one piecewith the temporary abutment. Work onthis must be performed extra-orally. Allother procedures in the fabrication oftemporary solutions are similar to thoseused in crown and bridge restoration.

Inserting the Temporary AbutmentDisinfect and sterilize the prostheticcomponents prior to insertion. Clean theinside of the implant with water spray,check for residues, and allow to dry.Insert the temporary abutment into theimplant and rotate it until the camsengage with the implant grooves. Hand-tighten the abutment screw and seal thescrew channel with easily removablematerial. Do not use composite sincedrilling it out would be required in orderto remove the screw. Make sure that thescrew channel is not overfilled; the sur-face should be concave. Remove allcement residues.

ReferenceSofortimplantation und Sofortbelastung.Das Einzelzahn-Sofortimplantat mitprovisorischer Versorgung.Nagel, Rainer; Ackermann, Karl-Ludwig;Kirsch, AxelZMK 17, 1-2/2000

Provisional SolutionPreparing the Temporary Abutment

151

General InformationTorque Wrench

13. Torque WrenchIntroductionThe CAMLOG® torque wrench is a stain-less steel multi-component instrument toaccomodate screwdrivers, drivers,adapters, and adapter for screw implants,long. The torque wrench is used formanual thread tapping, manual tighten-ing of CAMLOG® implants to their finalposition in the bone, and fastening ofCAMLOG® abutment screws and abut-ments at a torque specified in Ncm.

Remove the instrument downward

Removal function "OUT"Insertion function "IN"

The torque wrench is supplied with adual direction wrench mechanism (forturning in and out). When the selectedtorque value is reached – a choice of10, 20, or 30 Ncm – the torque wrenchbends down. This prevents use of anundefined torque value.The torque wrench is dismountable intofive components for cleaning and care.

Instrument InstallationThe instruments lock in when insertedinto the wrench wheel.• For the insertion function: "IN" is visi-

ble on the wrench head.• For the removal function: "OUT" is

visible on the wrench head.• To remove, press on the instrument

button with the finger and removedownward. Do not use pliers!

152


Setting Torque LimitsThe release torque (10, 20 and 30 Ncm) is set by screwing in or screwing back the torque setscrew.

The torque wrench bends down when the release torque is reached. After that, do not tighten further!

For final installation in the implant, allabutment and prosthetic screws as wellas abutments must be tightened to thepreset torque with the torque wrench.

10 Ncm 20 Ncm 30 Ncm

Torque setscrew

Caution!To reach maximum pre-tension onthe screws, abutments should beretightened with the same torqueafter approx. 5 minutes. This willprevent loosening of the screws.

Setting the tightening torque for the torque wrenchImplant cover screw hand tighten only with screwdriverHealing caps hand tighten only with screwdriverImpression post hand tighten only with screwdriver

Abutment-/prosthetic screw:- Temporary abutment hand tighten only with screwdriver- Ceramic abutment 20 Ncm- Esthomic® abutment 20 Ncm- Telescope abutment 20 Ncm- Universal abutment 20 Ncm- Gold-plastic abutment 20 Ncm- LogfitTM abutment 20 Ncm- Prosthetic screw for bar abutment 15 Ncm

Abutments: Ø 3.3 mm Ø 3.8–6.0 mm- Bar abutment 20 Ncm 30 Ncm- Ball abutment 20 Ncm 30 Ncm- Locator® abutment 20 Ncm 30 NcmNOTE: In the laboratory, abutments should not be tightened with the torque wrench!The named values are relevant only for the clinical setting.

Caution! To ensure optimal pre-ten-sion, new abutment and prostheticscrews should be used for the finalattachment of the abutment.

153


Manual Thread Tapping and ImplantInsertionLock the wrench during this function,following the instructions below:

1.Loosen the torque wrench setscrew(anti-clockwise).

2. Slide back the handle.

3. Rotate handle 90°.

4. Slide handle forward to the locking position in the wrench head.

5. Fasten handle with the torque setscrew (clockwise).The torque function is now locked.

Torque function locked

154


Cleaning, Sterilization, Maintenance

DisassemblyThe torque wrench should be disassembled after use into its five components:

• To do this, completely unscrew the torque setscrew (anti-clockwise) and pull out the spring and handle.• Pull back the fastening pin with your thumb and forefinger and remove the wrench wheel from the wrench head.• Clean the individual parts with a small plastic brush under running water, and place them in a disinfectant-cleaning liquid (for the

duration, see the manufacturer's instructions).• Dry all parts.• Wet the drop-marked places ( ) with angled handpiece oil or spray and reassemble the torque wrench.

Assembly• First install the wrench wheel: with your thumb and forefinger, pull back the fasten-

ing pin on both sides and insert the wrench wheel narrow side in the wrench head("IN" must show).

• Slide handle back on, insert spring in handle, insert and tighten torque setscrew(clockwise).

• Sterilize the torque wrench in the autoclave prior to clinical use (see "PreparationInstructions for the CAMLOG® Implant System," Art. No. J8000.0032).

Wrench head Push rod Handle

Fastening pin

Fastening pin

Wrench wheel

Wrench wheel,narrow side

Spring Torque setscrew

�

�

155

InformationInformation on Preparation Instruction

14. Information

Cleaning andSterilization

1. InstrumentsThe CAMLOG® Implant System instru-ments are not supplied in sterile formunless specifically labeled as sterile. Theymust be cleaned, disinfected, and steril-ized before first use and before everyfurther use on the patient.

2. Prosthetic ComponentsThe prosthetic components of theCAMLOG® Implant System are not sup-plied in sterile form unless specificallylabeled as sterile. They must be usedonly once.They must be cleaned, disinfected, andsterilized before use on the patient.

Exceptions: The impression cap andbite registration cap must not besterilized.

Detailed information on the preparationof instruments and prosthetic compo-nents can be found in the "PreparationInstructions for the CAMLOG® ImplantSystem," Art. No. J8000.0032.

157

Dental Office/Laboratory Information Worksheet

Patient

Dental Office

Date:

Name

Date

Last Name: _________________________________________ First Name(s): _______________________________ Date of Birth: _______________________

Alloy / Solder: ______________________________________________________ Technician: __________________________________________________________

Ceramic: ____________________________________________________________ Final check / date: _________________________________________________

Acrylic: ______________________________________________________________ Patient ID / Date: __________________________________________________

Tooth shade: _______________________________________________________

Dental Laboratory

Type of treatment

Buccal marks

Abutment

Implant diameter

Implant length

Type of implant

Type of implant

Implant length

Implant diameter

Abutment

Buccal marks

Type of treatment

1 2 3 4 5 6 7 8✼

18 17 16 15 14 13 12 11

48 47 46 45 44 43 42 41

32 31 30 29 28 27 26 25

31 32 33 34 35 36 37 38

24 23 22 21 20 19 18 17

9 10 11 12 13 14 15 16

21 22 23 24 25 26 27 28▲

▲

✼

Implant diameter: 3.3 / 3.8 / 4.3 / 5.0 / 6.0 mmImplant length: 9 / 11 / 13 / 16 mm, Type of treatment: SC / bridge / telescopic / bar / ball abutment / Locator®

Implant type: SL= SCREW-LINE / RL = ROOT-LINE / CL = CYLINDER-LINE / SCL = SCREW-CYLINDER-LINE

✼ USA numbering▲ European numbering

158

PEEK (polyether ether keton)

InformationsMaterials

Titanium Grade 4 Properties:

Chemical analysis (in %): O 0.4 max.Fe 0.3 max.C 0.1 max.N 0.05 max.H 0.0125 max.Ti > 99.0

Mechanical properties: Strength 680 MPa min.Elongation 10 %

Properties:

Chemical analysis (in %): AI 5.5 – 6.75 max.V 3.5 – 4.5 max.

Fe 0.3 max.C 0.08 max.N 0.05 max.H 0.015 max.Ti ~ 90

Mechanical properties: Strength 860 MPa min.Elongation 10 %

Properties:

Mechanical properties: Density 1,38 g/cm3

Elongation at break >25 %Bending strength 160 MPa

Melting point 343 °C

Titanium alloy Ti6AI4V

159

InformationCertificate

ALTATEC GmbH is in all stages of its activities subject to theprovisions set out by the Quality Protection System according toEN ISO 13485:2003.

This European Standard defines in detail the criteria that have tobe met by full quality protection of a company in all its processesin order for this company to be certified. Medical products haveto adhere to standards that are parti-cularly demanding.They aredefined in the European Standard ISO 13485,which we are alsoable to satisfy.

We thereby ensure that the quality of our products and servicesmeets the expectations of our customers,namely in a manner thatis at all times monitored and retraceable.Our products fulfil therequirements for medical products in terms of product perform-ance and patient safety,as they have been defined by theEuropean Laws and Standards.Thus,all our legally controlledproducts carry the CE label.

The products are in accordance with the strict requirements ofthe European Medical Device Directive 93/42/EEC for medicalproducts and the Standards EN ISO 13485:2003.

Quality for Users and Patients

Headquarters:

CAMLOG Biotechnologies AGMargarethenstrasse 38CH-4053 BaselTel: +41 (0) 61/565 41 00Fax: +41 (0) 61/565 41 [email protected]


CA

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www.thieme.com

CAMLOG Compendium

Surgery1The CAMLOG® Implant System is one of the most successful systems on the inter-national implant market.

The CAMLOG Compendium, consisting of manual 1 Surgery and manual 2 Prosthetics,describes (using more than 800 illustrations) the clinical and prosthetic proceduresinvolved in the practice of implant dentistry. The CAMLOG Compendium is targetedat users in order to ensure the proper handling of the system. The prostheticallyoriented CAMLOG® Implant System stands for interdisciplinary teamwork – combi-ning the skills of dentist and dental technician to develop implant solutions thatbenefit the patient.

The CAMLOG Compendium 1 Surgery addresses the insertion of the differentCAMLOG® implant configurations. It consists of a description of the prostheticCAMLOG concept, general information about the system, and prosthetic planningup to surgical intervention.

The CAMLOG Compendium 2 Prosthetics presents the dentist and dental technicianwith an array of treatment options available in the CAMLOG® Implant System. Thepatented CAMLOG® implant-abutment connection allows natural-looking, implant-supported perioprosthetics for fixed and removable dentures.

➤

➤

ISBN 978-3-13-134351-2

CAMLOG Compendium

Surgery1


compendium 1 surgery

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