root-line 2 surgical procedure - camlog implant systems...dental implants and abutments should only...

CAMLOG® ROOT-LINE 2 implants

Planning of implant positions

Surgical procedure

Healing options

Impression-taking, bite registration, temporary restoration

root-line 2SUrGiCAl ProCeDUre

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CAMLOG® ROOT-LINE 2 IMPLANT

GenerAl SYSteM inForMAtion ABoUt tHe CAMloG® iMPlAnt SYSteM 2

CAMloG® root-line 2 iMPlAntS 3INTRODUCTION 3IMPLANT DIMENSIONS AND OVERVIEW 4INNER CONFIGURATION 5

iMPlAnt PoSition PlAnninG 7TEAM CONCEPT 7TREATMENT CONCEPTS 8SURGERY SET CAMLOG® ROOT-LINE 2 19OVERVIEW OF DRILLING SEQUENCES 22

SUrGiCAl ProCeDUreS 24INCISION LINE 24IMPLANT BED PREPARATION 25IMPLANTATION 35CAMLOG® HEALING CAPS 43HEALING OPTIONS 44

iMPreSSion-tAKinG 47OPEN IMPRESSION-TAKING METHOD 50CLOSED IMPRESSION-TAKING METHOD 53

Bite reGiStrAtion 55teMPorArY ABUtMent 60ArtiCle liSt CAMloG® root-line 2 iMPlAntS 64FUrtHer inForMAtion 68

tABle oF ContentS

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GenerAl SYSteM inForMAtion ABoUt tHe CAMloG® iMPlAnt SYSteM

tHe CAMloG® iMPlAnt SYSteMThe CAMLOG® Implant System has been developed on the basis of many years of clinical and laboratory experience. It is a user-friendly, consistently prosthetical-oriented implant system.

All CAMLOG® products are always manufactured with the most state-of-the-art technology. The CAMLOG® Implant System is continuously being developed by the company’s research and development team in collabora-tion with clinicians, universities and dental technicians and therefore stays abreast of the latest technology.

The CAMLOG® Implant System is very well-documented scientifically. Stud-ies support this with respect to a great many parameters including the im-plant surface, time of implantation and/or implant loading, primary stabil-ity, connection design or type of superstructure. The long-term results of the CAMLOG® Implant System are convincing.

iMPortAnt noteThe descriptions that follow are not adequate to permit immediate use of the CAMLOG® Implant System. Instruction by a surgeon experienced in using the CAMLOG® Implant System is strongly recommended. CAMLOG® dental implants and abutments should only be used by dentists, physi-cians, surgeons and dental technicians who have been trained in using the system. CAMLOG regularly offers relevant courses and training ses-sions. Methodical errors made during the treatment can result in loss of the implant and significant loss of the peri-implant bone.

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CAMloG® root-line 2 iMPlAntS

CAMLOG® ROOT-LINE 2 implants are endosseous implants available in var-ious lengths and diameters. The implants are surgically inserted in the bone of the maxilla and/or mandible and serve as an anchor for functional and esthetic oral restorations for partially and fully edentulous patients. The prosthetic restoration is performed with single crowns, bridges or full den-tures that are attached to the implants with the appropriate elements.

CAMLOG® ROOT-LINE 2 implants represent root-shaped screw implants in terms of their outer geometry. The outer surface of the implants is abrasive-blasted and acid-etched (Promote® surface structure). The implants are available with the Promote® plus surface. The implant shoulder is machined. The implant is easily inserted due to the self-centering geometry of the im-plant body.

Specific CAMLOG® ROOT-LINE 2 form drills and taps are used to prepare the implant bed for CAMLOG® ROOT-LINE 2 implants.

AreAS oF APPliCAtionCAMLOG® ROOT-LINE 2 implants can be employed as immediate or delayed immediate implants in the bone of the maxilla and mandible.

In the case of a one-stage surgical procedure, the implants can be loaded immediately if good primary stability has been achieved and functional loading is appropriate. CAMLOG® abutments are used for the prosthetic restoration with crowns, bridges and full prosthesis.

The following specific indications apply to CAMLOG® implants with a diameter of 3.3 mm:These are an alternative in cases where the alveolar ridge width is only 5–6 mm. Because of their lower mechanical strength compared with larger diameter implants, they should only be used under the follow-ing conditions:• As single implants, they should be used only to replace mandibular

incisors and/or maxillary lateral incisors.• An edentulous arch can only be restored with a bar retained super-

structure with at least four implants of 3.3 mm diameter without distal extensions.

• Implants of diameter 3.3 mm are suitable for a partially edentulous arch when combined with implants of larger diameter for splinted superstructures. However, the limited strength of the implants with diameter 3.3 mm must be taken into account.

• Avoid excessive mechanical stressing of the implants when using ball abutments in combination with diameter 3.3 mm implants.

The healing time for diameter 3.3 mm implants is at least 12 weeks.

Contraindications:CAMLOG® implants with a diameter of 3.3 mmThese implants are not suited as single-tooth restorations for central maxillary incisors, as well as canines, premolars and molars in the max-illa and mandible. Double crown restorations are not allowed on these implants. In case of an implant divergence greater than 10° per implant, the use of Locator® abutments is contraindicated.

CAMLOG® implants with a diameter of 3.8 mmThese implants are not to be used with angled abutments in the molar region.

CAMLOG® ROOT-LINE 2 Implant Promote® plus

INTRODUCTION

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CAMloG® root-line 2 iMPlAntS ProMote® PlUS Ø 3.3 MM Ø 3.8 MM Ø 4.3 MM Ø 5.0 MM Ø 6.0 MM

Length 9 mm K1032.3809 K1032.4309 K1032.5009 K1032.6009 Length 11 mm K1032.3311 K1032.3811 K1032.4311 K1032.5011 K1032.6011 Length 13 mm K1032.3313 K1032.3813 K1032.4313 K1032.5013 K1032.6013 Length 16 mm K1032.3316 K1032.3816 K1032.4316 K1032.5016 K1032.6016apical Ø 2.2 mm 2.3 mm 2.55 mm 2.9 mm 3.8 mm (mean value)Note: The implant length is the distance from the apical curve to the occlusal shoulder surface of the implant.


Machined implant shoulder surface

0.4 mm machined section of implant neck

Abrasiv blasted, acid-etched Promote® surface

ProMote® PlUS SUrFACeA lower coronal implant shoulder is especially worthwhile in esthetically demanding regions. In CAMLOG® ROOT-LINE 2 implants with Promote® plus surface, the machined section of the implant neck is only 0.4 mm. The implant is inserted into the bone up to this section.

The following clinical conditions should be given:• Normal to thick biotype• Gingival thickness of at least 3.0 mm• Minimum width of attached gingiva should be 1.0 mm• Minimum distance between the attached gingiva and the mimic musculature should be 2.0 mm.

IMPLANT DIMENSIONS AND OVERVIEW

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The implants are equipped with the proven Tube-in-Tube™ implant-abut-ment connection and feature three symmetrically arranged angular grooves in the cylindrical part of the implant neck. CAMLOG® abutments are extended apically in tubular shape (5.4 mm) and include three cams in the upper section that correspond to the three grooves in the implant.

CAMLOG® Abutment

Cams

Abutment guide in the implant

CAMLOG® Abutment screw

CAMLOG® Groove/cam design

Upper inner thread

Lower inner thread

CAMLOG® Implant

INNER CONFIGURATION

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CAMLOG® ROOT-LINE 2 implants are part of the CAMLOG® Implant System and assigned K article numbers. The CAMLOG® Implant System consists of surgical, prosthetic, laboratory components and instruments.

The CAMLOG® ROOT-LINE 2 implants are used with CAMLOG® compo-nents such as CAMLOG® cover screws, CAMLOG® healing caps, CAMLOG® impression posts as well as CAMLOG® prosthetic components, also for platform switching.

Only CAMLOG® components for the Tube-in-Tube™ inner configuration are compatible with CAMLOG® ROOT-LINE 2 implants!

oPtion PlAtForM SWitCHinGTo give CAMLOG users the option of platform switching, the grooves in the implant inner configuration of the CAMLOG® ROOT-LINE 2 implants are de-signed angular and shortened. The angular groove design enables restora-tion with prosthetic components suitable for platform switching, which have a tapered diameter in the apical section and do not fully cover the im-plant shoulder support. CAMLOG® healing caps PS, CAMLOG® impression posts PS (open and closed tray) and CAMLOG® abutments PS are compat-ible with CAMLOG® ROOT-LINE 2 implants.

CAMLOG® abutment with K article number

CAMLOG® ROOT-LINE 2 implant with K article number

CAMloG® tUBe-in-tUBe™ iMPlAnt-ABUtMent ConneCtion WitH SQUAre iMPlAnt GrooVeS AnD ABUtMent CAMS

If CAMLOG® healing caps PS are used for healing, then further pros-thetic restoration must be continued with CAMLOG® prosthetic compo-nents PS for platform switching to avoid tissue damage!

PS: Platform Switching

MAnUFACtUrinG PreCiSionThe inner and outer geometry of the CAMLOG® implants and abutments are rotary machined for the most part. The tolerances can therefore be keep very low. The result is excellent part precision without impacting the mate-rial structure. The CAMLOG® implant-abutment connection thus ensures a very precise, stable and rotation-resistant connection to the CAMLOG® prosthetic components.

MAteriAlSAll CAMLOG® implants are manufactured from pure titanium grade 4, the CAMLOG® abutments and abutment screws from titanium alloy Ti6Al4V ELI.


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iMPlAnt PoSition PlAnninG

tHe teAM

The patient must be educated about the options and limitations of pros-thetic implant restoration in his or her specific case. The expectations and desires of the patient should be clearly understood and documented.

The restorative dentist providing prosthetic treatment is usually the team leader. Examination, diagnostics, treatment planning and reaching a con-sensus for the treatment plan from the patient and possibly the surgeon (if applicable) and dental technician. He coordinates the prosthetic prepa-ration, while the surgeon plans and manages the treatment stages: surgi-cal intervention, wound healing, and exposure.

The surgeon conducts a separate patient information session. He utilizes the diagnostic records, templates, medical/dental history, and radiographic information provided by the restorative dentist and dental technician. He performs the implantation procedures requested by the restorative dentist.

The dental technician contributes his laboratory knowledge and experi-ence to the pre-operative planning of the implant-supported restoration. He prepares a set-up/ wax-up, evaluates esthetic and functional issues, and makes suggestions for the design of the final restoration and implant posi-tioning. His tasks include fabrication of the provisional and final restora-tions as well as provision of radiographic and drilling templates and he selects the implant abutments.

An important prerequisite for the long-term success of a dental implant is excellent oral hygiene. The dental hygienist/nurse/assistant explains correct oral hygiene to the patient and takes the preparatory steps to create an inflammation-free situation. She is also responsible for ensuring regular follow-up appointments.

CAMloG supports all members of the implant treatment team by provid-ing high product quality, information, service, continuing education, and continuous research and development on the CAMLOG® Implant System.

teAM APProACH

Modern implant-supported restorations need a high level of attention to detail and clinical experience.

The CAMLOG team concept takes all of these demands into consideration. The sequence of treatment procedures is structured, and specific proce-dures are clearly assigned to specific team members once the joint planning phase is complete.

Pre-implantation surgical interventions and the implantation itself are carried out by the surgeon, or a surgically qualified restorative dentist. The surgical instrumentation is simply and thoughtfully organized. If a transgin-gival implantation (one-step) is to be performed, this eliminates a second intervention (implant exposure). In contrast, if a covered implantation is selected (two-step), a healing cap must be attached for soft-tissue condi-tioning for three weeks after the exposure and before taking the impression, depending on the indications. The dentist/surgeon takes the impression us-ing the transfer system and an impression material of choice (silicone, poly-ether). In addition to the impression components, only a screwdriver is required. The implant-abutment selection is made after the master cast has been fabricated in the laboratory.

Because of the high precision of the implant components incl. the rotational stability of the implant-to-abutment connection, time-consuming interme-diate try-ins can be skipped. Both dentist and dental technician can concen-trate on esthetics and the hygienic adaptability of the restoration because the insertion of the abutment is simple and quick. Crown and bridge struc-tures, as well as hybrid restorations can be fabricated to offer a perfect fit with CAMLOG® prosthetic components.

The CAMLOG® Implant System is therefore user-friendly and time-saving. The scope and value of pre-implantation diagnostics have changed. Today, pre-implantation diagnostics must be oriented to prosthetic needs (back-ward planning).

Since implant-supported treatment success is judged almost entirely in terms of esthetics and function, no prior compromises in these areas should ever be considered. The objective is to obtain a patient-oriented total reha-bilitation.

TEAM CONCEPT

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PreliMinArY reMArKSIt is known from general physiology that both non-loading and underload-ing of the bone induce degradation just as much as overloading (inactivity atrophy, pressure atrophy). The area between these two extremes is called normal loading. This consists in a balance between growth and degrada-tion. Working with bridge restorations in conventional prosthetics has led to identification of consistently high rates of bone degradation in non-loaded or underloaded teeth pillar (Misch/Frost 1990). W. Schulte recog-nized this in 1982 and proposed early (immediate, if possible) implantation to offset atrophy of the periodontal structures, which commences immedi-ately after tooth loss. The implant supports the alveolar bone and prevents the bony areas from being either overloaded or subjected to inactivity at-rophy (stress-shielding).

VertiCAl DiMenSion For oCClUSAl PlAneFor implantologist, the information on the length of the implant being used plays an important role in prosthetic planning and restoration. The loading of the implant-bone interface is determined by the leverage ratio from the osseointegration-related resistance to the prosthetic load arm (equal to the supracrestal implant length plus crown length from the im-plant shoulder). If IL is less than CL, measures must be taken to reduce loading (e.g. using prosthetic splints). The aspect ratio from the single crown to the implant should be at most CL 0.8:IL 1.

IL

CL

CL = Crown LengthIL = Implant Length


eStHetiCS

The use of therapeutic methods from an esthetic perspective is very depen-dent upon the initial situation and the visibility of the esthetic impairment. In the “esthetic zone” (anterior maxillary area), the smile line determines the extent of work that may be necessary. If prominent transversal or verti-cal hard- or soft-tissue deficits are present that affect the extraoral soft tissue profile, then lip and cheek support will have to be provided through suitable augmentative methods such as implant positioning or prosthesis design. These can restore the patient’s physiognomy to a large extent.

PAtient CoMPliAnCeThe greater the patient’s desire for a functional – and especially for an es-thetic – restoration and the more compromised the initial situation, the more extensively the patient must be educated. Temporary limitation of function and esthetics may result from the surgery and the patient might be required to wear a long-term provisional. The extent of pre-treatment and the particulars of the case will affect the overall duration of treatment.

In selecting a prosthetic restoration, make sure to take into account, in ad-dition to the functional and esthetic aspects of the case, any manual and visual impairments uncovered by the history that may affect the patient’s ability to manage oral hygiene and prosthesis care.

PAtient inForMAtionWhen the process of ruling out contraindications, collecting clinical and radiographic information, and making a diagnosis is complete, an informa-tional conference is held with the patient, using documents and models for demonstration. Risks of treatments and possible alternatives are fully dis-cussed and documented.

TREATMENT CONCEPTS

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FiXeD reStorAtionS

SinGle CroWnSSingle-crown treatment is a possible form of treatment under the aspect of a “Restitutio ad integrum”. It contains all the beneficial elements of peri-odontal prosthetic rehabilitation:

• Physiologically adequate biomechanical loading prevents further atrophy of the hard- and soft tissue• Good preconditions for natural-looking esthetics• Hygiene friendliness• Fabrication is technically straightforward• Readily extendable/alterable.

eStHetiCAllY CHAllenGinG reGionTo achieve an esthetically successful restoration, a number of important elements are required: a harmonious gingival line, optimal implant position-ing as well as vertical/orofacial and mesio-distal, a physiological crown shape, and the presence of interdental papillae. The indications for the hard-tissue configurations to be preserved and for soft-tissue management must be observed during planning.

Structure-preserving or structure-sparing procedures must be used during flap creation and implant placement. In addition, oral hygiene requirements must be kept in mind during planning.

Vertical implant position

Mesio-distal implant position at bone level

Distances at bone level

5 mm bone level up to the approximal contact point

3–4 mmimplant shoulder

up to the gingival margin

16 I 17

Behandlungskonzepte

> 3 mm

Øx

Øx

1.5–2 mm

1.5–2 mm 1.5–2 mm

Øx

16 I 17

Behandlungskonzepte

> 3 mm

Øx

Øx

1.5–2 mm

1.5–2 mm 1.5–2 mm

Øx

16 I 17

Behandlungskonzepte

> 3 mm

Øx

Øx

1.5–2 mm

1.5–2 mm 1.5–2 mm

Øx

1.5–2 mm 1.5–2 mm2–3 mm implant shoulder up to the cemento-enamel junction

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SPlinteD CroWnS

In the event of unfavorable leverage relations around the implant, a choice must be made between a longer implant or, if this is anatomically impossi-ble, splinting adjacent crowns. If splinting is required by reason of statics, then hygienic requirements must also be taken into account.

Development of a uniform insertion direction for the crown block must be part of the abutment preparation. The implant-abutment connection should not be altered.

Single-crown restoration

Crown-splinting

Examples of bridge positioning

iMPlAnt-SUPPorteD BriDGeS

Implant-supported bridges can be inserted wherever an implantation is impossible. Implant distribution should be structured in such a way that spanned segments are kept small.


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Initial situation

Abutments in lab analogs

Prepared abutments

Cement-retained bridge

Development of a uniform insertion direction for the crown block should be part of the abutment preparation. The implant-abutment connection should not be altered.

reMoVABle reStorAtionS

A hybrid denture may be implant-retained mucosa-supported, or implant-supported. The tension-free seat of a secondary (double crown) or primary (bar-) splinted structure on implants is called “passive fit”.

In the case of double crowns, this is obtained through intraoral bonding of the secondary crowns (preferably galvano crowns) onto the tertiary frame-work. In the case of bar structures, it involves the use of bar sleeves for a passive fit and intraoral bonding of the titanium bonding base. The idea is to create a fit that is free from stress or to minimize stress on the implants.

When planning a removable denture, the implants should be placed so that, if necessary, an extension to a fixed restoration is possible.

DoUBle CroWnSThe production precision of the CAMLOG connection is particularly neces-sary with double crowns restoration since the abutments can be fastened always in the same, exactly defined position on the implant. A precision fit for the removable superstructure is made simple and consistent in every case.

Indication: The double crown technique is suitable for jaw relations in A ngle Classes I and III.

PlAnninG

introDUCtionModern implant prosthetics is planned by working back from the desired therapy goal; this is referred to as “backward planning”. It applies particu-larly to pre-implantation augmentation procedures to restore sufficient bony structure to allow placement of implants in the optimal prosthetic position.

Esthetics, function, phonetics, and hygienic potential require prosthetically oriented implant positioning and dimensioning, which the dental technician defines on the basis of the wax-up. The prosthetic design and the required implant position(s) and axial alignment(s) are planned by the dentist and dental technician working closely together. This requires both to be fully in-formed of the treatment options.

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SPeCiFiC (DentAl)The special medical history must clarify the reasons for the current situation of the oral system. It may provide information on systemic diseases that may not have been detected, yet. If implants and/or grafts were previously placed, this may be important for assessment of the bone quality.

eXAMinAtion

CliniCAlIn addition to all standard extraoral examinations, the soft-tissue profile and support of the soft tissues (especially in the maxilla) are a critical factor in designing the prosthesis. If a large discrepancy exists between the required labial tooth position and the proposed implant position, the use of a remov-able denture may be necessary for loading reasons.

The results of the intraoral examinations determine which teeth can be saved. The standard of hygiene is evaluated and a check of the soft tissue for pathological conditions is performed for information on the patient’s possible compliance during and after treatment.

The static and dynamic occlusion, interalveolar distance, and centric rela-tions are checked. Temporomandibular joint disorders are addressed before the start of treatment.

All findings indicating elevated stress on the masticatory system (e.g., brux-ism) must be investigated, documented, and considered in the prosthetic planning.

The status of the soft tissue in edentulous arch segments (width and thick-ness of the attached gingiva) must be checked and the extension of the alveolar ridge must be evaluated for its suitability as a possible implant site.

rADioGrAPHiC eVAlUAtionDENTAL X-RAYSDental x-rays are sufficient for the initial assessment of bone supply with single tooth gaps or small interdental gaps. The periodontic situation of the remaining dentition must be closely examined, because the implant site may be colonized by pathogenic organisms from infected pockets.

ORTHOPANTOMOGRAMAn orthopantomograph can also be a critical instrument for gathering basic information. Additional data required by the specific situation may be obtained through dental x-rays, remote x-ray side views, or computer-to-mographic scans (CT).

If implant positions (implants approximating the former tooth positions) cannot be implemented for a fixed denture for whatever reason – functional (implant loading, crown length), esthetic (soft tissue support) or hygienic – a removable denture must be planned.

A. ACtUAl SitUAtion/ProStHetiC initiAl SitUAtionFind out and document the ACTUAL situation by taking a general and spe-cial (dental) history and performing intra- and extraoral clinical, functional and radiographic examinations. Together, these findings are the basis for a description of the initial situation of the oral-maxillofacial system.

B. inDiViDUAl treAtMent GoAlA full analysis is conducted with the patient, including a cost/benefit, work/benefit, and risk/benefit analysis. The final result will be a treatment goal customized to the desires and options of the patient.

C. treAtMent SeQUenCe With the individualized treatment goal as guide, prosthetically oriented im-plant positioning is defined and verified clinically and radiographically. Then, a treatment sequence is set up. It includes the planning of accompa-nying measures, augmentation, and any required pre-treatment.

AnAMneSiS

introDUCtionThe medical history and diagnosis are not different from the evaluation procedures required for other dental surgery or restorative treatments. For this reason, only the specific points for perio-implant prosthetic treatments are described below.

The general, social and special (dental) medical history considers all general medical contraindications and diseases that could affect the microcircula-tion or the patient’s suitability for the proposed implant-based restoration. Risk factors such as nicotine, alcohol and drug abuse are confidentially evaluated,discussed and documented. The patient’s psychological and psychosocial situation gives an indication of the compliance that can be expected and influences the planning of the treatment and the future pros-thetic design.

GenerAlThe general medical history should include not only the disease history but also regular medication usage and the possibility of general medical prob-lems that could adversely affect an implant-based prosthetic treatment.


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REMOTE X-RAY SIDE VIEWUse for large sagittal differences and planned bone removal in the chin region.

COMPUTER-TOMOGRAPHIC SCAN/DIGITAL VOLUME TOMOGRAPHYThe CT/DVT is used for extensive radiological diagnostics and for generat-ing raw data for computer-based augmentation and implant planning. It enables a 3-D evaluation of the site from its anatomical structures and can provide information about the density of the existing bone (with DVT rela-tive only or via calibration).

Indications must be strictly adhered to due to the increased radiation expo-sure compared to purely two-dimensional procedures.

lABorAtorYCAST ANALYSESIt is essential to mount diagnostic casts in an adjustable articulator to assess jaw relations. Specifically, a check should be made whether a change of the occlusal position is worthwhile or required. If at all possible, it should be done before the actual implant-supported prosthetic treatment gets un-der way. In any case, a change in occlusal height must be preceded by treat-ment with a long-term provisional.

DIAGNOSTIC CASTSThe diagnostic casts must clearly show not only the occlusal surfaces but also the vestibular fold and retromolar areas.

The centric registration must be freely adjustable to enable the casts to be mounted in correct axial alignment and position.

The impression should reproduce the soft-tissue situation and any hard- or soft-tissue deficits as far as the vestibular fold, since it is here we detect the first indications to incline the implant or the necessity for bone augmenta-tion. Just as in perioprosthetics, the retromolar areas must be reproduced to allow specification of the dental arch and assessment of the vertical space available.

Planning and implementation of periodontal implant-supported rehabilita-tion is much simpler when templates are used.

ArtiCUlAtor Set-UPDiagnostic casts for implant planning are made of super-hard dental stone, just as in perioprosthetics, and mounted on an adjustable articulator with an arbitrary face bow and centrics registration.

oCClUSAl HeiGHtIf an occlusal height requires correction, this must be done with a splint therapy or long-term provisional before the implant-supported prosthetic restoration begins.

ArCH relAtionS (trAnSVerSAl)The arch relations control the load direction and therefore the axial align-ment of the implants. This is particularly important with cross-bite situa-tions.

ArCH relAtionS (SAGittAl)Crowns cannot be placed precisely over the implants in the presence of Angle Class II dentition because the soft tissues must be supported and the space for the tongue must not be reduced. A removable denture is indicated in this situation.

initiAl ProStHetiC SitUAtionThe initial prosthetic situation describes the dental status, arch relations, the anatomical status of the hard tissue, the intraoral and extraoral soft tissue. The presence of functional, phonetic and esthetic restrictions can have influence on the patient’s quality of life.

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WAX-UP/Set-UP

The wax-up or set-up is prepared on the diagnostic cast in the dental labo-ratory. This permits planning of optimal tooth positioning from both func-tional and esthetic perspectives. It also enables early recognition of the need for augmentation procedures if a discrepancy is detected between the atrophied crestal bone and the required position for a prosthetic crown.

The ideal articulation concept to aim at is a situation-adapted anterior- cuspid guidance with early disclusion of the posteriors (“freedom in centric” should be possible).

PlAnninG teMPlAteA planning template is fabricated to review the planned implant positions in the mouth. The template can be converted to a drilling template later.

The dental technician initially fabricates a complete wax-up/set-up with all missing teeth in their ideal prosthetic position for preliminary planning of the prosthetic reconstruction. In accordance with the “backward planning” principle, any anatomical deficits are not considered at this stage. The treat-ment goal specifies the surgical and prosthetic procedure.

A silicone index is fabricated from this set-up. After hardening, the index is divided along the central occlusion to form a vestibular and an oral section.

An acrylic template can be fabricated with the aid of the silicone index. Alternatively, the work can be done with a rigid vacuum foil via a duplicate cast. Depending on the x-ray methods, radio-opaque markers (e.g. titanium, steel, barium sulfate coating) are integrated.


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Planning template with CT-tubes for CT/DVT planning

Template without upper tube section for use as drilling template

X-ray template, outlined with tubes

X-ray template with radio-opaque teeth, pre-inserted tubes and reference element for computer-based implant planning

Ø 2.5 mm external diameter

10 mm

4 mm

Example:CT-tubes for CT planning for pilot drill Ø 2.0 mm

Drill for placement of CT-tubes

Ø 2.1 mm internal diameter

X-rAY/DrillinG teMPlAte WitH Ct-tUBeS For Ct PlAnninG

CT-tubes for the CT planning are integrated at the ideal implant positions in the planning templates created from the wax-up/set-up and are used as reference positions in the X-ray image. The CT-tubes have two parts, and the titanium material does not cause any scattering of rays in the CT/DVT. The lower section is polymerized into the template. The upper section is pluggable. The entire CT-tube is used for the radiological diagnostics; the upper section can be removed for surgery. Depending on the software used for the evaluation, titanium CT-tubes or other radio-opaque positioning elements (e.g. steel, barium sulfate) are integrated for the CT/DVT-sup-ported planning. Placing the CT-tubes directly on the mucosa makes it pos-sible to determine density in the CT/DVT. The documentation included with these systems contains more information on this topic.

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PLANNING WITH ORTHOPANTOMOGRAPH/DENTAL FILM

TARGETThe target is to specify the implant positions. Now, the final implant plan-ning is performed depending on the selected concept. The x-ray images must show calibrated measurement points to enable measurement of the bone volume available for the implantation.

CLINICALThe wax-up or set-up must be checked at the patient. This allows esthetics to be included in the plan, such as the smile line, tooth shade, facial shape and general presentation of the patient.

ORTHOPANTOMOGRAM

X-Ray planning foils are available in 1.25 : 1 and 1.4 : 1 scales for all implant types to check the dimensions on the orthopantomograph. The foil magni-fications match the delay factors for most orthopantomographs. However, they should be considered only as approximations in implant dimensioning.

The self-adhesive implant planning films (X-Ray Transfer pictures, scale 1.25:1) for the specific implant type can be attached to the proposed implant positions on the orthopantomograph film.

X-ray transfer pictures on the Orthopantomograph

+E219K530090121M

+$0000050300MO

X-ray planning foil

IMPLANT POSITION PLANNING

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CoMPUter toMoGrAPHiC SCAn/DiGitAl VolUMe toMoGrAPHY WitH/WitHoUt 3-D eVAlUAtion

Precise three-dimensional evaluation of the bone dimensions and subse-quent planning of the implant positions are only possible using the data from a CT scan or DVT and a computer-supported planning program. Special conditions such as septation or infections in planned sinus floor elevations and critical vertical relations in the mandible can be identified. An x-ray or planning template that the patient wears while the image is taken provides information about the optimal prosthetic alignment of the implants. Depending on the program, the template must have radio-opaque position markers (e.g. titanium ball, titanium sleeve, barium sulfate-coated markers).

With the aid of a CT scan/DVT and a 3-D evaluation, the medical informa-tion derived can be used to determine the bone quantity and quality (with

DVT, definable only relatively or via calibration). Together with the pros-thetic information from the geometry of the x-ray template, the number of implants, implant position, implant diameter and implant length are deter-mined.

The final prosthetic design and the hard- and soft-tissue augmentation, if required, are discussed and coordinated in the team with the patient on the basis of this information.

With the information derived, the planned implant positions are checked and adjusted if necessary.

View of the casts X-ray templates in situ Computer-supported 3-D planning of implant positions

View of the casts X-ray templates in situ Computer-supported 3-D planning of implant positions

18


FinAl ProStHeSiS DeSiGn

The surgical feasibility of the treatment sequence is checked with reference to the clinical situation, the casts, the x-ray findings and the computer-sup-ported planning. Depending on the clinical situation, periodontal or aug-mentation interventions are performed before implant surgery or at the time of the implant placement.

inDiViDUAliZAtion oF tHe ProStHetiC DeSiGn

The patient’s wishes regarding the scope and costs of the implant-sup-ported prosthetic restoration expressed in the patient interview are incor-porated into the individual prosthesis design. The number of implants, the requirement for augmentation measures and/or required soft-tissue correc-tions are determined exclusively by local conditions and the prosthetic design. This interview must be documented in detail and the patient must sign a statement of consent before implementing the treatment process.

PlAnninG tHe treAtMent SeQUenCe

Now that the prosthetic goal has been defined, the required treatment steps are specified in a backward planning process. This process must consider the required healing time, particularly in connection with augmen-tation measures.

DoCUMention oF PAtient interVieW/PAtient eXPlAnAtionThe results of the planning process are discussed with the patient. Casts, x-ray images and the planning devices (wax-up/set-up) as well as the pre-sentation of the completed computer-supported planning are helpful here.

The following criteria are considered:• Initial situation• Wishes and expectations regarding esthetics, function and comfort• Effort/benefit ratio• Costs• Risk• Duration of treatment• Restrictions on comfort during treatment.

FABriCAtinG tHe DrillinG teMPlAte

WitH Ct-tUBeS For Ct PlAnninGIf a planning or x-ray template with tubes for CT planning was created, it can be converted into a drilling template after adjusting the tube positions based on the implant planning. If required, the template is reduced to an outline after preparation of the flap to ensure it stays in position during sur-gery (dental or gingival base outside the surgical area).

Pilot DrillinG WitH Ct-tUBe For Ct PlAnninGThe pilot drill without coil with of 2.0 mm diameter is also available for use with the CT-tube for CT-planning with 2.1 mm internal diameter. There are ring markings the lower edges of which show drilling depths for 7, 9, 11, 13, 16, 18 and 20 mm each in the working area of the drill. The width of the ring markings is 0.4 mm. The 18 and 20 mm markings are not filled in and are used for orientation when using the 4 mm long CT-tube with 2.1 mm inter-nal diameter.

iMPortAnt noteOnly use CT-tubes for CT-planning with 2.1 mm internal diameter in conjunction with the pilot drill!

11 mm13 mm

16 mm18 mm20 mm

Pilot drill, without coil, Ø 2.0 mm

CT-tube for CT planning, inner Ø 2.1 mm

9 mm 7 mm


19


Content

The surgery set CAMLOG® ROOT-LINE 2 contains the surgical instruments needed for preparing the implant bed (drill and tap for Ø 6.0 mm not included):

• Round bur• Pilot drill• Pre-drill• Paralleling pin• Depth stops• Form drill with mounted depth stops• Tap• Screwdriver• Driver with ISO shaft for angled hand piece• Drivers• Drill extension• Adapter ISO shaft torque wrench• Tap adapter• Torque wrench• Holding key for insertion post

The surgery set is autoclavable with the inserted instruments.

SeGMentAtion oF tHe Set Content in DiFFerent reGionSThe drills are arranged in the set according to the treatment sequence and are color coded/sorted by implant diameter. Color lines indicate the exact drilling sequence. The form drills are equipped with depth stops. The form drills cortical bone and taps with hexagon are provided for optional use by bone qualities 1 and 2 (Lekholm & Zarb, 1985).

Separate arrangement of depth stops for pilot and pre-drills and paralleling pins. The holding key for insertion posts is located in the covered storage compartment.

The region of the surgical-prosthetic instruments contains the torque wrench, tap adapters for tap, the drivers (short/long) for screw implants, the driver for screw implants with ISO shaft for angled hand piece, the adapter ISO shaft for angled hand piece pieces/torque wrench, the drill extension ISO shaft and the hex screwdrivers (short/long, manual/wrench and long ISO shaft).

Color CoDinG oF tHe SUrGiCAl AnD ProStHetiC CAMloG® ProDUCtS

Color Diameter

gray 3.3 mm

yellow 3.8 mm

red 4.3 mm

blue 5.0 mm

green 6.0 mm

SURGERY SET CAMLOG® ROOT-LINE 2

20


ArrAnGeMent oF tHe SUrGiCAl AnD ProStHetiC inStrUMentS

J5055.3311

J5055.3309

J5055.3313

J5055.3316

J5056.3309

J5051.2800

J5051.2000

J5050.2300

J5316.0501

J5316.0503

J5316.0502

J5300.0008

J5300.0007

J5300.0009

J5002.0005

J5002.0010

J5322.0010

J5322.0011

J5055.3809

J5055.3811

J5055.3813

J5055.3816

J5056.3809

J5055.4309

J5055.4311

J5055.4313

J5055.4316

J5056.4309

J5055.5009

J5055.5011

J5055.5013

J5055.5016

J5056.5009

J5015.0011

J5015.0013

J5015.0009

J5300.2028

J5320.1030

J5302.0010

J

J5

J5


21


DrillinG SPeeDS

The drill speed depends on the diameter. The recommended speed is 800–300 rpm depending on the drill type (handpiece angle reduction ratio 16:1–20:1).

The recommended maximum drilling speed for thread tapping is 15 rpm(handpiece angle reduction ratio 70:1–100:1). The tap adapter for the torque wrench also permits manual tapping.

CoolinG

The cooling occur through external irrigation on the angled hand piece with sterile saline solution (pre-chilled to 5°C/41°F).

Drill liFe

Drill longevity depends on bone quality and drilling technique. The pilot drills, pre-drills, and form drills are good for 10–20 drilling cycles. If exces-sive force has to be applied because of a dull drill, then change the drill immediately to prevent bone overheating.

The lower edge of the depth mark is the reference for the preparation depth.

CAUtionThe maximum apical extension length of the drill is 0.6 mm.

Article drilling speed (rpm) Round bur 800 Pilot drill Ø 2.0 mm with/without depth stop 800 Pre-drill Ø 1.7 / 2.8 mm 600 Form drill Ø 3.3 mm with/without depth stop 550 Tap Ø 3.3 mm* max. 15 Form drill Ø 3.8 mm with/without depth stop 500 Tap Ø 3.8 mm* max. 15 Form drill Ø 4.3 mm with/without depth stop 400 Tap Ø 4.3 mm* max. 15 Form drill Ø 5.0 mm with/without depth stop 350 Form drill Ø 6.0 mm with/without depth stop 300 Tap Ø 5.0 and 6.0 mm* max. 15* Using the taps is recommended for bone qualities 1 and 2 (Lekholm & Zarb, 1985)

22


iMPlAnt BeD PrePArAtion Overview:

• Punch/mark the desired implant position with the Ø 2.3 mm round bur• Deep drill along the implant axial line with the Ø 2.0 mm pilot drill• Check with the Ø 1.7–2.8/2.0 mm paralleling pin with depth marks• Pre-drill with the Ø 1.7–2.8 mm pre-drill• Check with the Ø 1.7–2.8/2.0 mm paralleling pin with depth marks• Shape with the form drill• Probe the implant bed hole for its bony end• Tap ROOT-LINE 2 (for bone qualities 1 and 2*)

We recommend using the tap for bone qualities 1* and 2*.

1.0 mm1.0 mm Pr

omot

e® p

lus

0.4 mm

OpTIOnAL fOr ALL dIAMeTers

Ø 3

.3 m

m

Roun

d bu

rØ

2.3

mm

rpm 800 800

16 mm

13 mm11 mm

Pilo

t dril

lØ

2.0

mm Depth stop

U/min 800 800

Ø 3

.8 m

m

Ø 4

.3 m

m

Ø 5

.0 m

m

Ø 6

.0 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

rpm 800 800

rpm 800 800

rpm

rpm

800

800

800

800

16 mm

13 mm11 mm

9 mm

Pilo

t dril

lØ

2.0

mm

16 mm

13 mm11 mm

9 mm

Pilo

t dril

lØ

2.0

mm

16 mm

16 mm

13 mm

13 mm

11 mm

11 mm

9 mm

9 mm

Pilo

t dril

lØ

2.0

mm

Pilo

t dril

lØ

2.0

mm

*Bone quality as documented in Lekholm & Zarb, 1985

Depth stop

9 mm

Para

llelin

g pi

nDe

pth

mea

sure

men

t

Para

llelin

g pi

nDe

pth

mea

sure

men

t

Para

llelin

g pi

nDe

pth

mea

sure

men

t

Para

llelin

g pi

nDe

pth

mea

sure

men

t

Para

llelin

g pi

nDe

pth

mea

sure

men

t

Depth stop

Depth stop

Depth stop


OVERVIEW OF DRILL SEQUENCES

23


Para

llelin

g p

in

16 mm

Pre-

drill

Ø 1

.7–

2.8

mm *

Prom

ote®

plu

s

600 550 15

Tap

Form

dril

lFo

rm d

rill

13 mm11 mm

Depth stop

600 550 500 15

Ø 3

.3 m

mØ

3.3

mm

Ø 3

.3 m

m

Ø 4

.3 m

mØ

4.3

mm

Ø 5

.0 m

m

Ø 6

.0 m

m

Ø 3

.3 m

m

Ø 3

.8 m

m

16 mm

13 mm11 mm

9 mm

Para

llelin

g p

inPa

ralle

ling

pin

Para

llelin

g p

inPa

ralle

ling

pin

Pre-

drill

Ø 1

.7–

2.8

mm

Pre-

drill

Ø 1

.7–

2.8

mm

Pre-

drill

Ø 1

.7–

2.8

mm

Pre-

drill

Ø 1

.7–

2.8

mm

Prom

ote®

plu

sPr

omot

e® p

lus

Prom

ote®

plu

sPr

omot

e® p

lus

600 550 500 15

600 550

550

400

400

15

600

600

350

300

15

15

*

Tap

*

Tap

*

*

Tap

Tap

16 mm

13 mm11 mm

9 mm

16 mm

16 mm

13 mm

13 mm

11 mm

11 mm

9 mm

9 mm

9 mm

Depth stop

Depth stop

Depth stop

Depth stop

Ø 3

.8 m

mØ

3.8

mm

500

500

Ø 3

.3 m

m

Ø 4

.3 m

m

Ø 5

.0 m

m

550 400 350

Ø 3

.8 m

m

500

Form

dril

l

Form

dril

l

Form

dril

l

Form

dril

l

Form

dril

l

Form

dril

l

Form

dril

l

Form

dril

l

Form

dril

l

Form

dril

l

Form

dril

l

Form

dril

l

Form

dril

l

24


The indication used as an example illustrates the insertion of a Ø 4.3/13 mm CAMLOG® ROOT-LINE 2 implant in the lateral mandible. The implantation technique is one-step transperiosteal. A split flap preparation is selected for the incision line. We recommend this procedure in cases in which there is sufficient bone width and no bone augmentation has to be performed. We recommend a split flap preparation only where the thickness of the mucosa is adequate. Otherwise a full mucoperiosteal flap preparation should be performed.

After performing a somewhat lingual, paracrestal mucosal incision, a pre-dominantly epiperiosteal flap is created on the vestibular aspect. The mus-cle is divided and the preparation is continued for approximately another 5 mm The mucosa is separated 2–3 mm lingually to simplify suturing later.

After marking the desired implant position (if necessary, with a drilling tem-plate), the periosteum is removed circularly only in the area around this site (with gingival punch or scalpel). Depending on the selected implant diam-eter and implant length, the implant bed is then shaped using the instru-ments designed for the CAMLOG® ROOT-LINE 2 implant.

Initial situation

Mucosal incision

Epiperiosteal split-flap preparation

Removal of the periosteum at the implantation site

SUrGiCAl ProCeDUre

INCISION LINE

25


Shaping the implant bed includes cortical bone marking, pilot drilling, pre-drilling, and form drilling.

The pilot- and pre-drill hole define the depth and axis of the implant bed and ensure conservative bone preparation by enlarging the diameter in small gradations.

Drill eXtenSion A drill extension is available to prevent resting of the angled handpiece on the remaining dentition during preparation of the implant bed adjacent to elon-gated teeth.

DePtH StoP The pilot drill SCREW-LINE*, reduced coil, and pre-drill SCREW-LINE* have a maximum working length of 16 mm. The drilling depths of 7, 9, 11, and 13 mm are laser-marked. Insertable depth stops limit the drilling depths to the selected depths of 9, 11, or 13 mm.

CAUtion!the pilot drills and pre-drills SCreW-line* have a reduced diameter at the drill coil. the depth stops SCreW-line* are compatible only with these drills.

Drill extension

Depth stop SCREW-LINE*

* also for ROOT-LINE 2

IMPLANT BED PREPARATION

26


PArAllelinG Pin SCreW-line* WitH DePtH MArKinGSAfter each pilot and pre-drilling, the depth and axial direction is checked using the paralleling pin with depth markings.

The diameter combination 1.7–2.8/2.0 mm permits consecutive use while matching the drill diameter.

The depth marks and diameter graduations on the paralleling pin allow in-spection of the drilling depth and axis at each stage of pilot and pre-drilling.

16 mm

13 mm11 mm 9 mm 7 mm

0

Paralleling pin SCREW-LINE*

16 mm

13 mm

11 mm 9 mm 7 mm

0

2.0 mm

2.8 mm

1.7 mm


SUrGiCAl ProCeDUre

27


PUnCH-MArKinG tHe CortiCAl BoneThe round bur Ø 2.3 mm is used for punch-marking the cortical bone, which simplifies the use of the drills to follow. The bur is inserted up to the bur equator. Recommended drilling speed: 800 rpm.

Pilot DrillinGThe pilot drill with reduced coil determines the depth and axis of the implant site. The depth marks on the drill correspond to the implant lengths 7, 9, 11 and 13 mm. The maximum drilling depth is 16 mm. For safety reasons, a depth stop matching the proposed implant length should be used.Recommended drilling speed: 800 rpm.

max. 800 rpm

Pilot drill, reduced coil, Ø 2.0 mmRound bur Ø 2.3 mm

max. 800 rpm

If no drilling template is used, the depth stops may be placed to the pilot drill after the markings have been drilled. Once drilling is complete, the depth and axis of the implant bed is checked using the paralleling pins. If several implants are placed, a paralleling pin is inserted into the first drill hole to then align the other implant axes.

The pilot drill is aligned parallel to the paralleling pin and visually checked from two planes (sagittal and transversal).

Punch-marking the Cortical Bone Pilot drilling Depth measurement after pilot drilling


16 mm

13 mm11 mm 9 mm 7 mm

0


28


Pre-DrillinGA tapered pre-drill SCREW-LINE* with a coronal diameter of 2.8 mm and apical diameter of 1.7 mm is available for the ROOT-LINE 2 configuration.Recommended drilling speed: 600 rpm. The depth marks on the drill correspond to the implant lengths 7, 9, 11 and 13 mm. The maximum drilling depth is 16 mm. For safety reasons, a depth stop matching the proposed implant length should be used. Further drilling is performed with the form drills.

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

Pre-drill SCREW-LINE*: Ø 1.7–2.8 mm

2.0 mm

2.8 mm

1.7 mm

max. 600 rpm

2.8 mm

1.7 mm



SUrGiCAl ProCeDUre

29


ForM DrillinGDiameters and lengths

Diameter- and length-calibrated form drills with reduced drill coil are avail-able for each implant size. The form drills are color-coded and laser-marked.

The form drills included in the surgery sets are supplied with a color-coded, removable depth stop. This must only be used with form drills ROOT-LINE 2. Depending on the specified drilling depth (implant length), the hole diam-eter is expanded progressively with the series of form drills until the intended implant diameter is achieved.

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 depth for ROOT-LINE 2 implants, with depth stops in place, is the implant length (9, 11, 13, 16 mm) minus 0.4 mm with the circular stop at the bone level, so that the implant shoulder extends 0.4 mm above the ridge.

The preparation is performed using the laser marks (black) as guides. The marks are spaced 1.0 mm apart. The mark widths are 0.4 mm.

Form drill ROOT-LINE 2

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 mm

Length

1 mm

1 mm

1 mm

0.4 mm

0.4 mm

0.4 mm

30


DePtH StoPDuring form drilling, the depth stop rests on the highest point of the crest and thereby limits the insertion depth. Since the circular bony ridge may be irregular, the form drills are equipped with a removable depth stop. If a deeper insertion is required for esthetic or functional reasons, the depth stop can be removed and form drilling can be continued for a further 2 mm at most (watch for anatomic structures!). The reusable depth stop can be used on replacement form drills (delivered without depth stops).

The depth stops must be removed before cleaning the drill. The cleaned depth stops must be reattached before sterilization (see also “Preparation instructions for the CAMLOG®/CONELOG® Implant System”, Art. No. J8000.0032). The depth stops can be reordered individually.

CAUtion!Because of the cutting angle on the drill tip of the form drill, the length exceeds the implant by up to 0.6 mm.

The lower edge of the first depth mark corresponds to the drill length with the depth stop in place.

Form drilling with depth stop

Form drilling without depth stop

Form drilling without depth stop for deeper insertion

Submersion depth of implant shoulder at bone level

oPtion: Vertical position of the implant shoulder on bone level

0.4 mm

Promote® plus

1 mm

1 mm

1 mm0.4 mm

SUrGiCAl ProCeDUre

31


ForM DrillinGAfter pre-drilling is complete, form drills are used in increasing diameters for final preparation of the implant bed. The small graduations in diam-eter ensure a gentle preparation of the bone.

Example: Form drilling Ø 4.3 mm

Checking the implant bed

CHeCKinG tHe iMPlAnt BeDResults of probing tests for the absence of soft tissue in the implant hole must be documented in the patient file. If the probe detects soft tissue, this indicates fenestration into the adjacent tissue by the drill.

tAPPinGAll CAMLOG® ROOT-LINE 2 implants come with a self-tapping thread with abrasive-blasted, acid-etched surface (Promote®). Use of a tap is recom-mended for bone quality categories 1 and 2 (Lekholm & Zarb, 1985).

The maximum speed must not exceed 15 rpm when performing power- assisted tapping. We recommend manual tapping.

Tap ROOT-LINE 2, with hexagon, max. 15 rpm

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

32


Locked torque wrench

Manual tapping is performed with tap adapters for the taps ROOT-LINE 2 and the locked torque wrench. Make sure to pay attention to the axial direction of the implant bed when inserting and removing the tap. The limit for insertion of the tap is the upper edge of the cutting blade.

Tap adapter, short, long

SUrGiCAl ProCeDUre

33


The CAMLOG® implant packaging consists of three components:• Outer packaging (cardboard) with label• Transparent peel-back pouch• Transparent primary package (blister, sterile) with label

CAMLOG® ROOT-LINE 2 implants are double-sterile packaged. The primary package (blister) contains the implant with pre-installed CAMLOG® inser-tion post and mounted blue handle.

iMPlAnt PACKAGinG

System information on the label

34


iMPlAnt PoSitioninGProtocol-compliant insertion depth of CAMLOG® ROOT-LINE 2 implants with attached depth stop is achieved when the machined plane surface of the implant extends 0.4 mm above the crestal bone level and one of the three groove marks indicates the specified prosthetic position.

If it was decided to set preparation depths for the implants individually by removing the depth stop during form drilling, this must be kept in mind when inserting the implant. It is possible to individually position implants vertically to match the drilling depth.

GrooVe PoSitioninGCorresponding to the three grooves of the CAMLOG implant-abutment connection, marks are inscribed on the drivers for the CAMLOG Implants. These permit a check of the groove positions during the insertion and their orientation as required for the prosthesis. If the dental technician has not indicated the groove position, a vestibular orientation is advantageous in most cases since the angle of angulated abutments originates at a groove.

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

Driver

CAMLOG® insertion post

CAMLOG® ROOT-LINE 2implant

Groove marking

Cam

Groove

0.4 mm

Vestibular orientation of the groove

SUrGiCAl ProCeDUre

35


Inserting the implant

iMPlAnt inSertionThe CAMLOG® ROOT-LINE 2 implant is taken by the sterile handle and removed from the primary package (blister). Contamination from nonster-ile parts must be avoided.

CAUtionBefore inserting the implant, the silicone plug and the CAMLOG® cover screw must be removed from the handle.

Taking the implant by the handle, insert it into the implant bed. Make sure to observe the axial orientation of the implant bed. If a hole has been pre-tapped, the positions of the thread dog point in the cortical bone must match that on the implant.

tiP: Carefully screw the implant to the left until you can feel the thread dog point. Then, using the handle, screw the implant to the right until it obtains sufficient grip to allow withdrawal of the handle.

oPtionAl ACCeSSorieS:PiCKUP inStrUMentIf the intraoral space is insufficient to allow insertion of the implant with the handle, the implant can be removed from the handle using the PickUp instrument. Slide the PickUp instrument between the implant and handle onto the CAMLOG® insertion post and lift off the handle. For the insertion procedure, place the selected driver on the CAMLOG® insertion post. The implant is inserted into the bone, and the PickUp instrument is removed.

iMPortAnt noteThe instruments used in the CAMLOG® Implant System are supplied non-sterile unless they are explicitly marked as sterile. They must be cleaned, disinfected and sterilized before first use and every use.

IMPLANTATION

36


Placing the PickUp on the CAMLOG® insertion post

Locked-on PickUp

Inserting the implant Mounting the driver and removing the PickUp

Removing the handle

SUrGiCAl ProCeDUre

37


DriVerSThere are three options for the final inserting of the CAMLOG® implant:• Power-assisted insertion (A)• Manual insertion with torque wrench and driver (B)• Manual insertion with the cardanic driver (C).

During insertion, make sure to use the mark on the driver for the groove position in the implant (also see page 34, Implant positioning).

Driver for screw implants with ISO shaft

Driver, cardanic

Driver, short, long

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

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

C Manual insertion with cardanic driver.

38


Next, unscrew the retention screw of the CAMLOG® insertion post with the screwdriver, hex, and remove the insertion post (Danger of aspiration!). If the implant site has a weak bone structure, a holding key for insertion post (as an accessory) is available to lock the insertion post and prevent im-plant movement when unscrewing the retention screw.

Screwdriver, hex, extra short, short, long

Unscrewing the fixing screw Removing the CAMLOG® insertion post

Holding key for insertion post

SUrGiCAl ProCeDUre

39


SUBMerGeD HeAlinGUsing the screwdriver, hex, pick up the CAMLOG® cover screw you removed from the handle and manually screw it into the CAMLOG® ROOT-LINE 2 implant (Danger of aspiration!). The cover screw must only be tight-ened manually using the hex screwdriver.

oPen/trAnSGinGiVAl HeAlinGIn this example, a cylindrical CAMLOG® healing cap is picked up with the screwdriver, hex, and manually screwed into the CAMLOG® ROOT-LINE 2 implant (Danger of aspiration!). The CAMLOG® healing cap must be tightened only by hand with the screwdriver, hex.

Inserting the CAMLOG® healing cap CAMLOG® ROOT-LINE 2 implant with healing cap

Wound closure

Inserting the CAMLOG® cover screw CAMLOG® ROOT-LINE 2 implant with cover screw

Wound closure

40


CAMloG® ADAPter For SCreW iMPlAntS For nArroW GAPS AnD HolDinG SleeVe to GUiDe tHe ADAPter into tHe iMPlAntDiameter-reduced CAMLOG® adapters, long, are available for the CAMLOG® ROOT-LINE 2 implant diameters Ø 3.3, 3.8 mm and 4.3 mm for manual insertion into small gaps. Three lateral marks match the cams on the adapter and provide a buccal orientation for one of the CAMLOG® ROOT-LINE 2 Implant grooves. After removal from the primary package (blister) the color-coded holding sleeve with correct diameter is inserted over the endosseous part of the implant to guide the adapter into the im-plant. The sleeve is squeezed together like a collet at the level of the implant shoulder and the handle is removed.

noteIn order to be able to hold the implant tightly and securely in the sleeve, we recommend clamping the sleeve using an hemostatic clip. Then, the handle can be removed, the fixing screw of the insertion post can be unscrewed using a screwdriver, hex, and the insertion post can be re-moved.

iMPortAnt noteThe hemostatic clip, the CAMLOG® adapter and the sleeve must be sterilized prior to use.

ACCeSSorieS

Setting up the sleeve Clamp the sleeve in an hemostatic clip and remove the handle

Unscrewing the fixing screw

Removing the CAMLOG® insertion post

CAMLOG® adapter for screw implants, long, Ø 3.3 mm, Ø 3.8 mm and Ø 4.3 mm

Holding sleeve for screw implants to guide the adapter into the screw implant, Ø 3.3 mm, Ø 3.8 mm and Ø 4.3 mm

SUrGiCAl ProCeDUre

41


Following unscrewing and removal of the CAMLOG® insertion post, slide the diameter-matching CAMLOG® adapter into the implant until the cams engage the grooves. To fasten, manually tighten the retention screw of the

For the insertion, place the locked torque wrench over the hexagon of the CAMLOG® adapter and screw the implant to its final position, making sure to line it up with the groove marking.

adapter. After removal of the sleeve, the CAMLOG® ROOT-LINE 2 implant can be inserted.

Inserting the implant Placing the torque wrench Tightening the implant in final position

Placing the CAMLOG® adapter Tightening the retention screw Opening the hemostatic clip and removing the sleeve

CAMLOG® ROOT-LINE 2 implant screw retained with the CAMLOG® adapter

42


Once the retention screw is unscrewed, detach the CAMLOG® adapter from the CAMLOG® ROOT-LINE 2 implant. Pick up the CAMLOG® cover screw with the screwdriver, hex, and insert it into the implant manually (Danger of aspiration!).

The CAMLOG® cover screw must not be power-tightened. A CAMLOG® healing cap should be used for the transgingival healing method (see pages 43–46).

Unscrewing the retention screw Removing the CAMLOG® adapter

CAMLOG® ROOT-LINE 2 implant with CAMLOG® cover screw

Wound closure

Inserting the CAMLOG® cover screw

SUrGiCAl ProCeDUre

43


Use of the CAMLOG® healing cap supports the development of peri-implant soft tissue. CAMLOG® healing caps are available in three different geome-tries:

• cylindrical• wide body• bottleneck

CAMLOG® healing caps are color-coded to match the implant diameter.

CAMloG® HeAlinG CAPS PS For PlAtForM SWitCHinGThe CAMLOG® healing caps PS (cylindrical, wide body, bottleneck) are tapered in diameter on the apical end and enable the adaptation of soft tissue over the implant shoulder.

CAMloG® HeAlinG CAP 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

CAMloG® HeAlinG CAPS PS CYlinDriCAl WiDe BoDY BottleneCK

DiAMeter GinGiVA HeiGHt (GH) GinGiVA HeiGHt (GH) GinGiVA HeiGHt (GH) 3.8 mm 2.0/4.0 /6.0 mm 4.0/6.0 mm 4.0/6.0 mm 4.3 mm 2.0/4.0 /6.0 mm 4.0/6.0 mm 4.0/6.0 mm 5.0 mm 2.0/4.0 /6.0 mm 4.0/6.0 mm 4.0/6.0 mm 6.0 mm 2.0/4.0 /6.0 mm 4.0/6.0 mm 4.0/6.0 mm

iMPortAnt note!if CAMloG® healing caps PS are used for healing, the later prosthetic restoration, including the CAMloG® impression taking, must use CAMloG® prosthetic components PS for platform switching to prevent tissue injury!

PS: Platform switching

CAMLOG® HEALING CAP

44


HeAlinG oPtionS WitH CAMloG® HeAlinG CAPS AnD CAMloG® HeAlinG CAPS PS

CAMloG® HeAlinG CAPS, CYlinDriCAl, AnD WiDe BoDYThe cylindrical and wide body CAMLOG® healing caps are for standard use. After removal of the CAMLOG® cover screw, a diameter-matching CAMLOG® healing cap is screwed in manually with a screwdriver, hex. A gingival height ensuring that the healing cap sits 1–1.5 mm supragingi-vally should be selected. The CAMLOG® impression is taken once the peri-implant soft tissue has been stabilized.

CAMloG® HeAlinG CAPS PS, CYlinDriCAl, AnD WiDe BoDY CAMLOG® ROOT-LINE 2 implants with Promote® plus surfaces are suitable for the platform switching option. Because the surface is brought further upward, more bone is available in coronal direction. The shift in the hori-zontal shoulder towards the implant axis at the implant shoulder level ensures more space for soft-tissue management.

CAMLOG® healing cap, cylindrical CAMLOG® healing cap, wide body

CAMLOG® healing cap PS, cylindrical, height 2 mm, for submerged healing

CAMLOG® healing cap PS, cylindrical CAMLOG® healing cap PS, wide body

SUrGiCAl ProCeDUre

HEALING OPTIONS

45


CAMloG® HeAlinG CAP, BottleneCKIn esthetically challenging areas, the treatment outcome can be optimized by using CAMLOG® healing caps, bottleneck. The coronally tapered cross-cut enables soft-tissue generation during healing.

After 3–4 weeks (and before the final organization of the elastic fibers) a CAMLOG® healing cap cylindrical is screwed in. No tissue should be excised. The tissue is coronally suppressed and thereby forms a papilla-like structure. The impression is taken after stabilization of the peri-implant soft tissue.

Healing stage Soft-tissue generation Coronal suppression of the soft tissue by substitution with a CAMLOG® healing cap cylindrical

WArninGto prevent soft tissue injury, CAMloG® healing caps PS should only be replaced by CAMloG® healing caps PS!

Healing phase with a CAMLOG® healing cap PS bottleneck

Soft-tissue generation with a CAMLOG® healing cap PS bottleneck

Coronal suppression of the soft tissue by substitution with a CAMLOG® healing cap PS cylindrical

CAMloG® HeAlinG CAP PS, BottleneCK

46


tiSSUe GenerAtion/tiSSUe SUPPort

One-step use (transgingival)

Two-step use (submerged)

BottleneckTissue generation–step 1

Wide bodyTissue support

CylindricalTissue generation–step 2

Temporary restoration– CAMLOG® PEEK abutment

Final restoration– abutment with suprastructure

optio

nal

SUrGiCAl ProCeDUre

47


iMPreSSion tAKinG oF CAMloG® iMPlAntS

introDUCtionThe CAMLOG® impression-taking system provides a highly precise, rota-tion-resistant transfer system for both closed and open tray methods. All system components are color-coded by implant diameter. It must be made sure that only implants and impression-taking components of the same diameter (by color-coding) are used with each other. No components of different diameters should be attached to one another. The system compo-nents must not be modified.

iMPreSSion-tAKinG MetHoDSThe open or closed tray method may be selected for impression-taking. If heavily divergent implant axes are present, or combination with a func-tional impression-taking is desired, the open impression-taking method should be used. For the use of the Logfit® prosthetic system, the ball abut-ments and Locator® abutments, or a prefabricated bar, special matching impression posts are available.

iMPreSSion-tAKinG MAteriAlSilicone or polyether materials can be used as impression-taking materials for the open and closed impression-taking methods.

All impression posts with K article numbers are compatible with all CAMLOG® implant lines.

iMPreSSion PoStS, oPen trAYART. NO. K2121.3300 K2121.3800 K2121.4300 K2121.5000 K2121.6000Impression post, open tray, incl. fixing screw

FOR IMPLANT Ø 3.3 MM 3.8 MM 4.3 MM 5.0 MM 6.0 MM

iMPreSSion PoStS, CloSeD trAYART. NO. K2110.3300 K2110.3800 K2110.4300 K2110.5000 K2110.6000Impression post, closed tray, incl. impression cap, bite registration cap and fixing screwFOR IMPLANT Ø 3.3 MM 3.8 MM 4.3 MM 5.0 MM 6.0 MM

iMPreSSion CAPART. NO. J2111.3300 J2111.3800 J2111.4300 J2111.5000 J2111.6000Impression cap for impression post, closed tray (5 units)

FOR IMPLANT Ø 3.3 MM 3.8 MM 4.3 MM 5.0 MM 6.0 MM

iMPreSSion tAKinG

48


PreSSion tAKinG

iMPreSSion PoStS PS For PlAtForM SWitCHinG

iMPreSSion PoSt PS, oPen trAYART. NO. K2119.3800 K2119.4300 K2119.5000 K2119.6000Impression post PS, open tray, incl. fixing screw

FOR IMPLANT Ø 3.8 MM 4.3 MM 5.0 MM 6.0 MM

iMPreSSion PoStS PS, CloSeD trAYART. NO. K2109.3800 K2109.4300 K2109.5000 K2109.6000Impression post PS, closed tray, incl. impression cap, bite registration cap and fixing screw


iMPreSSion CAPART. NO. J2111.3800 J2111.4300 J2111.5000 J2111.6000Impression cap for impression post, closed tray (5 units)


oPtion iMPreSSion tAKinG For PlAtForM SWitCHinG

The platform switching option is possible with ROOT-LINE 2 implants. To make appropriate soft-tissue management possible for platform switching, healing caps PS are used for healing. This requires the subsequent use of impression posts PS for platform switching. Like the healing caps PS, these are also tapered in the apical area making it possible to adapt soft tissue over the im-plant shoulder.

iMPortAnt note• To avoid soft-tissue injury while taking impressions, only impression posts PS for platform switching should be used in conjunction with healing caps PS!

Apical tapering ROOT-LINE 2 implant

49


noteImpression-taking of CAMLOG® Implants with the existing impression posts, open and closed tray, is identical to the impression posts PS, open and closed tray, for platform switching.

important instrumnets / lab analogs:

CAMLOG® lab analog, Ø 3.3/3.8/4.3/5.0/6.0 mm

iMPortAnt noteAll components for impression-taking on CAMLOG® Implants are for single use only and must not be modified.

Screwdriver, hex, extra short, short, long

Color-CoDinG oF tHe SUrGiCAl AnD ProStHetiCAl CAMloG® ProDUCtS

color diameter

gray 3.3 mm

yellow 3.8 mm

red 4.3 mm

blue 5.0 mm

green 6.0 mm

50


The impression posts, open tray, are color-coded, equipped with an inter-nal fixing screw, and can be used with the platform switching method.

For the open impression-taking method, an individually fabricated impres-sion tray to be perforated on the extension of the implant axis to allow release of the fixing screw is required.

The fixing screw is secured in the impression post with an O-ring and must be hand-tightened using the screwdriver only, both in the implant and in the lab analog.

The fixing screw is equipped with a break-off point. If space limitations are encountered, it can be shortened by 3.0 mm by breaking it off with a screw-driver, hex.Caution: Shorten extra-orally, only!

Impression posts, open tray

Impression post

10.0 mm

Lab analog

Impression posts PS, open tray, for platform switching

O-ring

noteBefore removing the impression, loosen the screw and pull it back until the stop (O-ring) is felt. Otherwise, removal of the impression will be im-possible due to axial divergence of the implants, or the impression itself will be deformed through excessive compression.

3.0 mm

iMPreSSion tAKinG

OPEN IMPRESSION-TAKING METHOD

O-ring

51


iMPreSSion PoSt inSertionRemove the healing cap or temporary abutment. To ensure orientation in the direction of the implant axis, insert the screw fully in the apical direction before inserting the impression post.

Place the impression post for open impression-taking on the implant and tighten the fixing screw slightly. The impression post is rotationally symmet-rical; no special orientation is required. Carefully rotate the impression post onto the implant until the cams engage with the implant grooves.

The fixing screw must be hand-tightened with the screwdriver, hex. For tight and thick gingiva in particular, we recommend a radiographic check of the correct seating of the impression post prior to taking the impression.

Caution! if the cams have not engaged, the height difference is about 0.4 mm.

52


iMPreSSion-tAKinGBefore taking the impression, check the tray for a precision fit. The fixing screws protruding from the perforations must not touch the tray. Then use a silicone or polyether impression-taking material to take the impression.

To remove the impression, loosen the fixing screw, pull it back and then lift off the impression.

Tip: To simplify the procedure, we recommend also sending the matching lab analog to the laboratory.

iMPreSSion tAKinG

53


The impression posts, closed tray, are color-coded, equipped with an inter-nal fixing screw, and can be used with the platform switching method. They are supplied with an impression cap and a bite registration cap.

A prefabricated impression tray is used for the closed impression-taking method.

A screwdriver, hex, extra short, short, or long is required. The fixing screw must be hand-tightened both in the implant and in the lab analog.

iMPreSSion PoSt inSertionFollowing removal of the healing cap or the temporary abutment, insert the impression post (with its attached fixing screw) into the implant. Rotate until engagement of the cams with the grooves is felt.

Impression posts, closed tray

Impression posts PS, closed tray, for platform switching

The fixing screw extendsabout 2 mm above theinserted impression post.

2.0 mm

After tightening the fixing screw,it sits flush with the upper edge of the impression post (4–5 turns).

Lab analog

Impression post

Impression cap

CLOSED IMPRESSION-TAKING METHOD

54


note: tHe FiXinG SCreW ProtrUDeS ABoUt 2 MM FroM tHe PoSt AFter tHe iMPreSSion PoSt enGAGeS AnD BeFore tiGHteninG.

The fixing screw must be hand-tightened with the screwdriver, hex. For tight and thick gingiva in particular, we recommend a radiographic check of the correct seating of the impression post prior to taking the impression.

iMPreSSion-tAKinGThe color-coded impression cap is now installed, using the guide grooves on the impression post, until a detectable pressure point is reached and the impression cap is definitely fastened. Three guide grooves on the impres-sion post (placed at 120° intervals) facilitate contact-free placement rela-tive to adjacent impression caps or teeth. The impression cap extensions must not be removed.

Correct seating of the impression caps should be checked again before the impression is taken.

The impression caps should remain in the impression after the impression tray is lifted. If this is not the case, repeat the impression-taking.

Tip: To simplify the procedure, we recommend also sending the matching lab analog to the laboratory.

To prevent loss of the fixing screw, the impression post must be shipped attached to the lab analog.

Three guide grooves make three positioning options possible for the impression cap

1

3

2

iMPreSSion tAKinG

55


Bite reGiStrAtion

oPtion A Bite reGiStrAtion WitH Bite reGiStrAtion PoSt

Color-coded bite registration posts are available for all CAMLOG implant diameters for accurate implant-supported measurement of jaw relations and their transfer to the cast situations. The posts include a bite registration cap and an integrated fixing screw.

PoSSiBle MetHoDS For Bite reGiStrAtion:1. Bite registration with mounted bite registration caps2. Bite registration with splinted bite register without caps

The bite registration posts have a prosthetic height of 8.1 mm and are suit-able for limited occlusal space conditions. A shortened post/implant connection in comparison to the Tube-in-Tube™ abutment connection and the impression posts make the use of splinted bite registration posts with implant abutment divergences of up to 20° possible.

The bite registration posts are tapered apically in area of the shoulder sup-port and are therefore suitable for the platform switching option (not for implant diameter 3.3 mm).

Prosthetic height 8.1 mm

Apical tapering

CAMLOG® bite registration post

PH: Prosthetic height*Note: The bite registration posts with diameter 3.8/4.3/5.0/6.0 mm can also be

used for the platform switching option.

Shortened post/implant connection

rePlACeMent Bite reGiStrAtion CAPART. NO. J2112.3300 J2112.3800 J2112.4300 J2112.5000 J2112.6000

For implant Ø 3.3 mm 3.8 mm 4.3 mm 5.0 mm 6.0 mm

Bite registration cap (5 units)

iMPortAnt noteAll components for implant-supported bite registration on CAMLOG® implants are for single use only and must not be modified.

Bite reGiStrAtion PoStS inCl. Bite reGiStrAtion CAPART. NO. J2140.3300 J2140.3800* J2140.4300* J2140.5000* J2140.6000*

For implant Ø 3.3 mm 3.8 mm 4.3 mm 5.0 mm 6.0 mmPH 8.1 mm 8.1 mm 8.1 mm 8.1 mm 8.1 mm

Bite registration posts incl. fixing screw and bite registration cap

56


APPliCAtion

Implant-supported measurement of the jaw relations and there transfer to the cast situation may be carried out using bite registration posts with mounted bite registration caps or splinted bite registration posts as a one-piece bite register.

1. Bite reGiStrAtion WitH MoUnteD Bite reGiStrAtion CAPSThe bite registration posts are placed in the previously cleaned implants and a screwdriver (hex) is used to hand-tighten the fixing screws.

The bite registration caps are placed on the bite registration posts based on the color code and the occlusion is checked. Correct seating is indicated by a perceptible locking feel.

Registration of the habitual jaw relations requires only standard materials. The caps should not be allowed to bond to the register.

Bite reGiStrAtion

57


2. Bite reGiStrAtion WitH SPlinteD Bite reGiSterAfter taking the impression and fabricating the cast, fix the bite registration posts in the lab analogs and fabricate a bite register splinted with the posts on the working cast. Wrap and combine the bite registration posts in a suit-able plastic. Do not cover the fixing screws.

tiP: To correct distortion stress with larger restorations (edentulous jaw, large gaps), we recommend disconnecting the register between the implant pillars and then reconnecting in the mouth with suitable plastic after atta-ching to the implants.

Remove the bite register, bite registration caps and bite registration posts (by loosening the fixing screws) and give to the dental laboratory. Screw in the bite registration posts in the color-coded lab analogs in the cast and mount the bite registration caps in the final position. Place the bite regis-tration on the caps. Connect the bite registration to the opposing jaw cast and mount the casts in an articulator.

58


Fixing screw extracted to the stop position

Once the register has been created, it is inserted in the mouth, a screwdriver (hex) used to hand-tighten the fixing screw and the occlusion checked.

Registration of the habitual jaw relations requires only standard materials.

Loosen the fixing screws after curing. To safely remove the bite register, ex-tract the screws from the posts to the stop position. Remove the bite register with the integrated bite registration posts and give to the dental laboratory.

Mount the bite register with integrated bite registration posts on the lab analogs in the cast and screw on. Connect the bite registration to the opposing jaw cast and mount the casts in an articulator.

tiP: If bite registration posts cannot be used due to limited space condi-tions (to prevent bite elevation), a 6.0 mm healing cap cylindrical may be used. Record the diameter, position, and height of the healing cap on the information work sheet and deliver it with the corresponding healing cap to the dental laboratory.

Bite reGiStrAtion

59


oPtion BBite reGiStrAtion WitH iMPreSSion PoStS, CloSeD trAY

The impression posts, closed tray (both versions), are inserted into the previously cleaned implants and the fixing screws hand-tightened with a screwdriver, hex.

The bite registration caps are placed on the impression posts based on the color code and the occlusion is checked. Correct seating is indicated by a perceptible locking feel.

Registration of the habitual arch relations requires only standard materials. The caps should not be allowed to bond to the register.

Remove the bite registration, bite registration caps, and impression posts (by loosening the fixing screws) and give them to the dental laboratory. Screw in the impression posts in the color-coded lab analogs in the cast and mount the bite registration caps in the final position. Place the bite regis-tration on the caps. Connect the bite registration to the opposing jaw cast and mount the casts in an articulator.

Prosthetic height 10.7 mm

60


teMPorArY ABUtMent For CAMloG® iMPlAntS

introDUCtionThe temporary abutment, PEEK (PEEK=polyether ether keton), is designed for use in immediate restorations in esthetically significant regions. It can also be used for long-term provisionals up to 6 months as needed. The ben-efits of immediate implantation with an esthetic, non-functional immediate restoration consist in preservation of the structures of the periodontal or peri-implant tissue in esthetically critical zones. Once an adequate healing (osseointegration) period for the implant has elapsed and the peri-implant soft tissue has matured, a new impression for the final restoration can be taken.

teMPorArY ABUtMentART. NO. K2241.3800 K2241.4300 K2241.5000 K2241.6000CAMLOG® temporary abutment, preparable, incl. abutment screw


12.0 mm

The temporary abutment has a prosthetic height of 12.0 mm. Use the screw-driver to hand-tighten the abutment screw.

teMPorArY ABUtMentS PS For oPtion PlAtForM SWitCHinG

The platform switching option is possible with CAMLOG® ROOT-LINE 2 im-plants. To make appropriate soft-tissue management possible for platform switching, healing caps PS are used for healing. This requires the subsequent use of the temporary abutment PS for platform switching. Like the healing caps PS, these are also tapered in the apical area making it possible to adapt soft tissue over the implant shoulder.

Apical tapering ROOT-LINE 2 implant

teMPorArY ABUtMent

61


iMPortAnt note• To avoid soft-tissue injury with temporary restorations, only temporary

abutments PS for platform switching may be used in conjunction with healing caps PS!

teMPorArY ABUtMent PS For PlAtForM SWitCHinGART. NO. K2208.3800 K2208.4300 K2208.5000 K2208.6000Temporary abutment PS, preparable, incl. abutment screw


12.0 mm

The temporary abutment PS has a prosthetic height of 12.0 mm.Use the screwdriver, hex, to hand-tighten the abutment screw.

noteFabrication of the temporary superstructures on CAMLOG® ROOT-LINE 2 implants with the existing temporary abutment and temporary abutment PS for platform switching is identical.

important instruments/lab analogs/lab screws:

Lab screw, thread M 1.6 for implant Ø 3.8/4.3 mm

Lab screw, thread M 2.0 for implant Ø 5.0/6.0 mm

CAMLOG® lab analog, Ø 3.3/3.8/4.3/5.0/6.0 mmScrewdriver, hex, extra short, short, long

62


Perform any required grinding of the temporary abutment extra-orally to prevent contamination of the surrounding tissues.

For better handling, the abutment can be mounted on a lab analog or abut-ment pick-up for the universal holder.

To protect the abutment screw, we recommend using a lab screw with the corresponding diameter.

Depending on the marks, the preparation resembles conventional perio-prosthetics. A good solution is obtained with a diamond bur at high drilling speed, without water irrigation, and using little pressure. The chamfer or crown margin must lie paragingivally in immediate restorations in estheti-cally critical regions and approx. 1.0–1.5 mm subgingivally for later resto-rations to achieve an anatomically favorable emergence profile in the peri-implant tissue. A mark is placed on the vestibular aspect to facilitate detection of the insertion position of the abutment.

FABriCAtion oF A teMPorArY reStorAtion

ProCeSSinG tHe teMPorArY ABUtMentInsert the temporary abutment into the implant and rotate until the cams engage with the grooves. Insert the abutment screw into the abutment and use a screwdriver, hex, to hand-tighten.

Mark the vestibular midpoint and the preparation margins on the abutment following the gingival line.

Temporary abutment insertion Vestibular mark

Trimming the abutment on the lab analog

teMPorArY ABUtMent

63


teMPorArY CroWn/BriDGe, CHAir-SiDeThe temporary abutment is mounted to the implant and acrylic material se-cures the temporary crown/bridge (strip crown) to the temporary abutment. To prevent acrylic material from flowing into the screw channel, the chan-nel can be sealed with wax in advance.

teMPorArY CroWn/BriDGe, lAB-SiDeThe temporary restoration can also be fabricated in the dental laboratory on the working cast based on the procedure for fabricating temporary so-lutions similar to those used in conventional crown and bridge restorations.

inSertinG tHe teMPorArY ABUtMentThoroughly clean and dry the inner configuration of the implant prior to in-serting the temporary abutment. Insert the temporary abutment into the implant and rotate it until the cams engage with the implant grooves. After hand-tightening the abutment screw with a screwdriver, hex, seal the screw channel with an easily removable material. Do not use composite since drill-ing it out would be required in order to remove the screw. Make sure that the screw channel is not overfilled; the surface should be concave.

The temporary crown or bridge is mounted to the customized temporary abutment using temporary cement. All cement residues must be removed.

noteThe insertion directions of the abutments, indicated by the implant axial direction, rarely match. For this reason, bridge structures should not be fabricated in one piece (firmly attached) with the temporary abutment. The temporary abutments are first screwed on the implants, then the temporary bridge is mounted (passive fit).

Customized temporary abutment on the working cast

ART. NO.J5050.2300

J5051.2000

J5051.2800

J5015.0009

J5015.0011

J5015.0013

J5300.2028

ARTICLEround burresterilizablepilot drill sCreW-LIne*reduced coil, resterilizablepre-drill sCreW-LIne*resterilizabledepth stop sCreW-LIne*for pilot drill (J5051.2000) and pre-drill (J5051.2800), resterilizable

paralleling pin sCreW-LIne*with depth marks

Ø IN MM2.3

2.0

1.7–2.8

1.7–2.8/2.0

LENGTH

9

11

13

MATERIALStainless steel

Stainless steel

Titanium alloy

64


ArtiCle liSt CAMloG® root-line 2 iMPlAntS

ART. NO. ARTICLE Ø IN MM LENGTH MATERIALK1032.3311 3.3 11 Titanium K1032.3313 13 grade 4K1032.3316 16 K1032.3809 3.8 9 K1032.3811 11 K1032.3813 13 K1032.3816 16 K1032.4309 4.3 9 K1032.4311 11 K1032.4313 13 K1032.4316 16 K1032.5009 5.0 9 K1032.5011 11 K1032.5013 13 K1032.5016 16 K1032.6009 6.0 9 K1032.6011 11 K1032.6013 13 K1032.6016 16 Surface: Promote®


SUrGiCAl inStrUMentS For CAMloG® root-line 2 iMPlAntSART. NO. ARTICLEJ5300.0059 sUrGerY seT CAMLOG® rOOT-LIne 2

contains all necessary color-code sorted surgical instruments, incl. torque wrench and holding key for insertion post

J5300.8915 sUrGerY TrAY CAMLOG® rOOT-LIne 2 without content

* Can also be used for the preparation of the implant bed for CAMLOG® ROOT-LINE 2 implants

CAMLOG® rOOT-LIne 2 IMpLAnT, promote® plusincl. insertion post and cover screw, sterile

65


SUrGiCAl inStrUMentS For CAMloG® root-line 2 iMPlAntSART. NO.J5055.3309J5055.3311J5055.3313J5055.3316J5055.3809J5055.3811J5055.3813J5055.3816J5055.4309J5055.4311J5055.4313J5055.4316J5055.5009J5055.5011J5055.5013J5055.5016J5055.6009J5055.6011J5055.6013J5055.6016J5015.3300

J5015.3800

J5015.4300

J5015.5000

J5015.6000

J5056.3309

J5056.3809

J5056.4309

J5056.5009

J5056.6009

ARTICLEform drill rOOT-LIne 2with reduced coil, resterilizable

depth stop for form drills sCreW-LIne and rOOT-LIne 2with reduced coil, resterilizable

Tap rOOT-LIne 2with hexagon, resterilizable

Ø IN MM3.3

3.8

4.3

5.0

6.0

3.3

3.8

4.3

5.0

6.0

3.3

3.8

4.3

5.0

6.0

LENGHT 9 11 13 16 9 11 13 16 9 11 13 16 9 11 13 16 9 11 13 16

MATERIALStainless steel

Titanium alloy

Stainlesssteel

66


ART. NO.J5002.0005

J5322.0010

J5322.0011

J5300.0007

J5300.0008

J5300.0009

J5300.0010

J5300.0030

J5002.0010

J5302.0010

K5302.3310K5302.3810K5302.4310J5302.3300J5302.3800J5302.4300

ART. NO.J5316.0510

J5316.0501

J5316.0502

J5316.0504

J5316.0503

J5320.1030

ARTICLEdrill extension ISO shaftTap adapter, shortfor tap ROOT-LINE 2Tap adapter, longfor tap ROOT-LINE 2driver for screw implantswith ISO shaft for angled hand piecedriver, shortfor screw implants, manual/wrench with bore hole for screwdriver, hex, longdriver, longfor screw implants, manual/wrenchdriver, cardanic (30°)for all screw implants, adjustable lengthpickUp instrumentholder for carrying implantsAdapterISO shaft for angled hand pieceHolding key for insertion post

Adapter for screw implants, longfor CAMLOG® ROOT-LINE 2 implants

Holding sleeve for screw implants color-coded

ARTICLEscrewdriver, hex extra short, manual/wrenchscrewdriver, hexshort, manual/wrenchscrewdriver, hexlong, manual/wrenchscrewdriver, hexshort, ISO shaftscrewdriver, hexlong, ISO shaftTorque wrenchwith continuous torque adjustment until max. 30 Ncm

Ø IN MM

3.33.84.33.33.84.3

Ø IN MM

LENGTH26.6

18.0

23.0

27.5

18.0

27.0

21.0

LENGTH14.5

22.5

30.3

18.0

26.0

MATERIALStainlesssteel

Stainlesssteel

Titanium alloy

MATERIALStainlesssteel

SUrGiCAl-ProStHetiC inStrUMentS

SUrGiCAl inStrUMentS

67

CAMLOG® ROOT-LINE 2 IMPLANTAT

ARTIKEL-NR.K1039.3813

K1039.4313

K8010.1011

ARTIKEL-NR.K5300.9012

K5300.9013

ARTIKEL-NR. K5300.9070 K5300.9071 K5300.9072 K5300.9073 K5300.9074X-Ray Transfer pictures 1.25:1 CAMLOG® ROOT-LINE 2 Implant, Planungsfolien, selbstklebend, 25% Vergrösserung

Ø IN MM3.3 3.8 4.3 5.0 6.0

ARTIKELCAMLOG® ROOT-LINE 2 Übungsimplantat,inkl. Einbringpfosten und Verschlussschraube, gelb anodisiertCAMLOG® ROOT-LINE 2 Übungsimplantat,inkl. Einbringpfosten und Verschlussschraube, rot anodisiertCAMLOG® ROOT-LINE 2 Makromodell,Massstab 3:1

ARTIKELX-Ray Planning Foil 1.25:1 CAMLOG® ROOT-LINE 2 Implant, 25% Vergrösserung

X-Ray Planning Foil 1.4:1 CAMLOG® ROOT-LINE 2 Implant, 40% Vergrösserung

Ø IN MM3.8

4.3

LÄNGE13

13

MATERIALTitanlegierung

Kunststoff/Stahl rostfrei

ZUSATZARTIKEL

X-RAY PLANUNGSFOLIEN UND TRANSFER PICTURES

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FUrtHer DoCUMentAtion

Further information on the CAMLOG® products can be found in the follow-ing documents:

• CAMLOG® product catalog• CAMLOG® working instructions• Preparation instructions• CAMLOG® instruction manuals (included in the package of CAMLOG® products)• www.camlog.com


trADeMArKS AnD CoPYriGHtProtected brand names (trademarks) are not specially indicated. The ab-sence of such indication does not mean that it is not a trademarked name. This publication with all its parts is protected by copyright. Any exploitation beyond the narrow limits of the copyright act is not permissible without the approval of CAMLOG Biotechnologies AG and is subject to legal sanctions.

HeADQUArterSCAMLOG Biotechnologies AG | Margarethenstrasse 38 | CH-4053 Basel Tel +41 61 565 41 00 | Fax +41 61 565 41 01 | [email protected] | www.camlog.com

Manufacturer of CAMLOG®/CONELOG® products: ALTATEC GmbH, Maybachstraße 5, D-71299 Wimsheim, Germany

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