das camlog implantatsystem: chirurgisches handbuch

Table of Contents

1.2.3.4.5.6.7.8.9.9.10.11.12.13.14.15.16.

The CAMLOG® implant systemRehabilitation with CAMLOG® implantsPatient evaluationContraindicationsPre-implant prosthetic surgical measuresPre-operative planningPost-operative measuresThe CAMLOG® surgical systemPlacing CAMLOG® implants (1)Placing CAMLOG® implants (2) Placing 3,3mm implantsPlacing 3,8mm implantsPlacing 4,3mm implantsPlacing 5,0mm implantsPlacing 6,0mm implantsMaintenance of surgical instruments

The CAMLOG® transfer system

Note: All of the information and procedures contained in this manual are solely for the use of qualified personnel. This manual is a synthesis of concepts and should be considered in this entirety and not as individual treatment recommendations.

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The CAMLOG® Implant system 1

Implants Precision The Bioseal® Bevel The Surfaces The CAMLOG® Connection

Implants

External Geometry

The uppermost portion of all three implant geometries have a 1.5mm polished collar (- 1 -).Below the collar is a 0,5mm textured, machined 45° chamfer, the Bioseal® Bevel (-2-).Below this are either the blasted, etched self-tapping threads of the Screwcylinder and Root Lines(-3-)or the titanium plasma spray coating of the Cylinder Line (-4-).

Internal Geometry

In the uppermost cylindrical portion (-5-) of all three

implant geometries are three symmetrical notches (0.5mm or 0.7mm in diameter, 1.2mm deep, 120° apart) (-6-).These notches engage corresponding cams on the abutments. Below ore internal threads (-7-),which accept the Gingivaformers, the PDL Line abutments, and other prosthetic components. Further down inside the implant, within the I.D. of the upper thread, extends an odditional cylindrical part (-8-),engaging the apical tube extension of the abutments. After a 45° chamfer, a second internal thread (-9-)extends apically, accepting the abutment fixing screw.

Precision

All internal and external geometries of the implants, abutments, and other components are machined on lathes. This allows the tolerances to be kept very close. The result is a precise fit of all system components and guarantees absolute (0°) rotational stability. Such close tolerances are absolutely essential to the construction of ,inovable prostheses with double crowns, Dalbo attachments, etc.

Der Bioseal® Bevel

Preparation related discrepancies between receptor site and implant are mechanically sealed by the machined 45°chamfer below the polished collar. Connective tissue downgrowth is thereby inhibited. lf the implant is placed according to protocol (approx. 0.4mm above bone crest), after exposure and a physiological bone adoptation of up to 1 mm, there is available a biologic length of 2mm that remains stable over time (1 mm connective tissue and 1 mm junctional epithelium).

The Surfaces

TPS cooting of the Cylinder Line implants

Promote® surface of the screwcylinder Line and Root Line implants(Ra= 3,0 µm, Rmax= 20,5 µm)

The CAMLOG® Connection

The Iong term maintenance of soft and hard tissue health in the patient freoted with implants depends upon the patient's oral hygiene, the pre-, intro-, and postoperative soft tissue management, the biomechanics of the reconstruction, and the design of the implant hardware and components. As forces are transmitted and distributed during function and parafunction, the implant/abutment connection plays a central role.The tube-in-tube design of the CAMLOG connection is mechanically very stable and absolutely (0°) rotation free. The CAMLOG connection is a form-and force-based connection.The design features of the CAMLOG connection, when compared with FDA minimum requirements (ad modem Brånemark), demonstrate nearly 100% higher values in static compression tests (required: 54.5 lbs, achieved: 103.6 lbs) and over 60% higher values in compression fatigue tests (required: 20.0 lbs, achieved: 32.5 Ibs).

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Rehabilitation with CAMLOG® Implants 2

Team members The CAMLOG Team Concept

Team members

Patient

The long term health, expectations, ond wishes of the patient should be ascertained and clearly ocumented. The case specific possibilities and limitations of an implant-prosthetic rehabilitation must be clearly spelled out for the patient. The importance of a comfortable patient cannot be underestimated, especially if further measures are to be recommended.

Dentist

The restorative dentist is generally the team leader. Responsibilities include diagnosis treatment planning, communication of findings to the patient and reaching consensus os to the course of action with the patient, surgeon, and technician. The team leader coordinates the treatment throughout the various phases:surgery, healing, and rehabilitation. The restorative dentist should work closely with the technician cind surgeon for example, in the construction of the surgical template to optimize function and aesthetics. Supervision of communication, logistics and patient trust are the team leader's responsibilities.

Surgeon

The surgeon carries out the pre-implantation and implantation procedures as prescribed by the restorative dentist using the diagnostic and surgical templates created in advance by the technician and restorative dentist. The surgeon should explain the procedures to be performed to the patient and may request further radiologic and medical information.

Dental technician

The technicion adds his laboratory skills and experience to the preoperative planning phase. He creates a set-up and wax-up designed to optimize function and aesthetics, and make suggestions as to the design, of the definitive restoration. He constructs the provisional and final prostheses, the x-ray and surgical templates, and chooses the implant abutments.

Hygienist

The patient's oral hygiene is basic to the long term success of dental implant therapy. The hygienist plays a vital role in instructing and motivating the patient. The hygienist is involved throughout all phases of the treatment including heoling and, of course, the follow-up phase with continuous reinstruction and re-motivation to maintain a high level of oral hygiene.

Altatec

ALTATEC has made it's business directly supporting all members of the implant rehabilitation team through product development, production, and sharing of information. Production takes place under strictest protocols in order to achieve the highest possible quality control standards.ALTATEC can assist the restorative dentist in the selection and correct application of prosthetic components to achieve optimal function and aesthetic results. ALTATEC stands ready to assist both technician and dentist with case specific advice in planning and selection of components.

The CAMLOG Team Concept

The modern implant prosthetic reconstruction requires a high level of attention to detail and clinical experience from all involved, the dentist, the oral surgeon, the technician, as well as the dental assistants and auxiliaries. Emphasis an quality, quality assurance and specialization, dictates a multi-disciplinary opproach for a knowledgeable, experienced team. The CAMLOG team concept requires that the treatment plan is clearly structured, the separate phases of the treatment are the result of collaborative planning, and all team members are clearly informed of the logical course of the treatment.

Pre-implantation and implantation procedures are corried out by the surgeon or surgically qualified restorative dentist. The CAMLOG surgical armamentarium is simple and thoughtfully assembled. lf the implantation is one-stage, a second surgery is not required. lf the implantation is two-stage (covered), a Gingiformer is used for soft tissue conditioning for approximately three weeks between exposure and impression taking. Using the transfer system, the dentist takes an impression with a material of choice (hydrocolloid, silicon, polyether, etc.) Apart from the transfer components, only a screwdriver is required. After the master model is produced, selection of abutments is accomplished in the lab from a trial abutment set. The required components are then ordered and delivered. There is no need for dentists or labs to maintain extensive and costly inventories. Due to the high precision of the components and the absolute rotational stability of the implant/abutment connection, time consuming intermediate try-in oppointments can generally be skipped. Since placing the abutments is quick and easy, dentist and technician can fully utilize the try-in appointment to concentrate on the aesthetic andhygienic aspects of the restoration. Single crowns, small bridges, bars constructed with the CAMLOG Passive Fit system, and telescoping overlay prostheses constructed with galvono-formed copings

fit with predictable accuracy. The CAMLOG implant system is extremely user-friendly and time saving.

Course of Treatment

Planning Team

Pre-treatment Dentist (Surgeon), Technicion, Hygienist

Implantation Dentist (Surgeon)

Exposure and Impressions Dentist (Surgeon)

Model work, Approval of the Plan and Abutment Selection

Technicion, Dentist

Prosthetic Crection Technicion

Bisque Bake- Dentist, Technician Esthetic Try-in

Dentist, Technicion

Finalization Technicion

Insertionof the Prosthesis Dentist

Maintenance Dentist, Hygienist



Patient evaluation 3

General Documentation Guidelines Anamnesis Recording findings

General Documentation Guidelines

A basic and thorough pre-operative plan is essential for the long-term success of the implant prosthetic restoration. The plan should be developed with input from the entire team influencing the treatment concept reducing problems and complications. All information from the anamnesis, findings, diagnostics and observations must be documented. A greater understanding comes from this thorough documentation and results in a better treatment plan and informed consent form.

Anamnesis

In the general, social and special anamneses, all aspects of medical contra-indications, such as disecises which inhibit microcirculation or surgical unsuitabilities relating to the planned implant prosthetic restoration must be examined. Risk factors like smoking, alcohol and drug abuse must be discussed and documented in a trust building fashion. The psychic and psycho-social situation of the patient indicates the level of expected compliance and influences treatment plan and prosthesis design.

General

In the general anamnesis, thorough medical history, especially the regular intake of medicines and pre-existing conditions that may negatively influence the success of an implant prosthetic rehabilitation should be evaluated. Of further importance are conditions which affect the patient's ability to cope with the treatment and later to maintain the restoration hygienically.

Special

In the special anomnesis the current state of the stomotognatic system is examined. Evidence of yet undiscovered systemic illness may be discovered. Evaluation of the bone quality will influence whether preimplant augmentation will be required.

Patient expectation

In planning the entire scope of the treatment, especially pre -implantation augmentative procedures, it is imperative to assess thepatient's willingness to accept the possible functional and aesthetic limitations. An optimal result requires optimal preparation. This must be made absolutely clear to the patient. The motivation for the treatment corresponds directly with the patient's actual decrease in quality of life and experience with previous attempts to solve dental problems.

It is important to ascertain the patient's willingness to comply with the level of maintenance required by the planned implant prosthetic restoration . The aesthetic and functional expectations of the patient frequently do not correspond with economic and practical feasibilities. The job of the team, from the very first appointment, is to explain a n d document these boundaries.

Recording findings

The extra- and intra orol findings should, when possible, be discussed with the technician. The current condition should be routinely documented in words and photographs. Upper and lower impressions and bite registration should be taken for subsequent evaluction of possible prosthetic schemes. Radiologic findings with intra-oral and panoramic x- rays generally round out the diagnostic spectrum. More indepth imaging techniques mey be required in some cases (see Preoperative planning: further radiologic diagnostic techniques).

extraoral

In addition to findings acquired in a routine extraoral exam (nerves, muscles, sensitivity), the patient's profile and the need to enhance the support of facial structures is critical to the design of the prosthesis, especially in the maxilla. If a great discrepancy exists between the desired labial position and the expected location of the implants, then, from a loading standpoint, a removable appliance is indicated (bar or double crown type).

intraoral

Next, the existing intra-oral condition of all structures is assessed and the prognosis for each tooth determined. Along with checking for soft tissue pathologies, the level of hygiene is evaluated. This is a primary indication of the patient's later motivation to cooperate. For implant prosthetic rehabilitation, occlusion, articulation, inter-alveolor space, and also eventual TMJ problems are important factors. TMJ problems should be corrected prior to implant therapy.All findings that would result in an increased loading of the masticatory system must be closely examined, documented and weighed in the prosthetic planning. The existing prosthesis should be evoluated for aesthetics, phonetics, and functionality. The existing prosthesis can be used to inquire about the patient's subjective problems ond perceptions.In edentulous areas, examine the condition of the soft tissue, especially the width of the attached gingiva. Resorbed or undercut areas are noteworthy in evaluating a possible implant site as augmentative procedures may be required.

radiologic

In addition to examining for pathologies, a panoramic x-roy gives first insight into the structure of the hard tissues (especially in edentulous areas), and the possible apical expansion of the implant site. In some cases, radiologic findings must be augmented with

special images.



Contraindications 4

Medical contraindications Anatomic contraindications

Medical contraindications

Contraindications must be actively looked for and corefully evoluoted. Commonly, they may be overcome through separate medical therapy. Without successful remedies or adequate patient cooperation, implant prosthetic treatment is ruled out.

Relative

Relative contraindications are patient health conditions that, with special care, can still receive implant prosthetic treatment. Patients with a history of heart attock, arterial sclerosis, und stroke should only be treated after consultation with their physician, und where oppropriate, proper medication. All conditions which influence bone regeneration, microcirculation, und the blood increase risk. These patients may only receive implant prosthetic treatment if their conditions are able to be controlled with medication. Implantation should not be done during pregnancy.

Absolute

The general medical contraindications are uncontrollable conditions, for example, with hypertension, diabetes, etc. Implant prosthetic therapy should also be withheld in cases of immunosuppression und diseases of the rheumatic family, collagenosis, leukemia, hepatitis, and the condition after radiation treatment. Psychological and physical conditions that preclude the patient's cooperation or understanding during the therapy und maintenance phases are contraindications. Patients who cannot be motivated to good oral hygiene are not condidates for implont therapy. Unless nicotine abuse, alcohol abuse, or parafunction like bruxism, pencil chewing, etc. con be dealt with in the pre-treatment phase, implant treatment should be withheld.

Anatomic contraindications

Today's augmentative possibilities, und ongoing advances in membrane techniques, reduce the absolute anatomiccontraindications to only those situations where it is just not possible to create an adequate implant bed.



Pre-implant -prosthetic surgical measures 5

Time of operation Overview of procedure Healing phases

Time of operation

The choice of when to operate is greatly dependent upon the particular situation and the experience level of the surgeon. From two-stage procedures with adequate healing time, to onestage (simultaneous) procedures, to minimally invasive soft tissue manipulation at implant exposure, encomposses o broad spectrum of level of difficulty. If primary stability of the implant in conjunction with hard tissue augmentation is not achievable, then a two-stage procedure is required. Often a secondary soft-tissue manipulotion is avoidable if the hord-tissue correction is well done in the first place.

Overview of procedure

Hard-tissue

Where inadequate bone exists in the mandible, granular material should be used for lateral augmentation and bone blocks for vertical and/or lateral augmentations. In the maxilla, in most cases, an adequate zone of bone can be created through lateral augmentation with granular material, lateral and/or vertical augmentation with bone blocks, or sinus floor elevation and augmentation with granular material and/or bone blocks.

Soft-tissue

In correcting soft-tissue deficiencies, the guiding principal must be: "softtissue follows hard" meaning without adequate underlying hard-tissue structures, soft-tissue manipulations generally have a high risk of recidivism. Procedures like vestibuloplasty, lateral and coronal flap transposition, as well as mucosol/connective tissue transplant are possible options. Always ensure there is a zone of attached mucosa around the implant.

Healing phases

After hard-tissue augmentation procedures, a healing phase of four to six months should be expected. This period can be longer depending upon the particular case. Healing time for soft-tissues is not relevant to implantation.


Pre-operative planning 6

General guidelines Consent Form Evaluation of radiographs Further radiologic diagnostic techniques Model analysis Set-up, Wax-up Prosthetic design Indications for the various implant geometries Construction of a planning and drilling template

General guidelines

The best evidence that the patient understands the possible risks of a dental procedure, is a signed informed consent form, created by the dentist and an attorney, limiting liability. In order to gain the consent of the patient, the dentist must first explain the reasons for the treatment and the type of therapy indicated. The procedures to be performed should be explained in depth as well as the underlying reasons for each. Second, possible alternative treatments should be offered along with the dentist's reasons for having a preferred course of action. Third, the risks associated with the prescribed treatment must be explained, Risks which are commonly understood, or that the patient is familiar with from o previous treatment, need not be reiterated. The risks that the patient is unaware of, and necessary for the patient's informed decision must be made clear. The dentist presumably need not detail every associated risk, the exact language is a matter of judgment. All risks that occur with known probabilities must be explained. The informed consent form should also be signed by witnesses. The form then becomes a part of the patient's medical record. A copy of the agreement is given to the patient. Guidelines recommended by the International Congress of Oral Implantologists are an the following page. The form is intended os a reference. ALTATEC refrains from offering an opinion an the adequacy of this form. It is highly recommended that such an informed consent form be used. This form should advise the patient of the expected results and the risks associated with the surgical procedures. The patient should be informed that there is no guarantee of success, and a successful implantation may not last forever. The content ond manner of use of the consent

form varies from state to state and country to country. Consult an attorney in constructing your own form .

The informed consent agreement provides the patient with an explanation of the expectations for a dental procedure in easily understood language.To be included:1. why the treatment is necessory2. which alternative treatments exist;3. which risks are associated with the treatment:4. what would happen if the treatment were not completed.

*The available information comes from the U.S. department OF Health andhuman services, Public Health service Publication No. 81-1531, fromDecember 1980 with the title Dental Implants: Benefits and Risk: AtNIH Harvord consensus development Conference.

Consent Form

Click here, around Consent Form to display.

Evaluation of radiographs

Ridge form, size of the maxillary sinus, and the path of the mandibular canal influence the positioning of implants.In most cases, these anatomic constraints can be documented with radiographic film. For forensic reasons pre-and post-implantation x-rays should be taken.

Conventional x-rays

In cases of single implantation in an area of adequate bone and adequate distance from critical structures, a conventional x-ray (right-angle technique) may suffice. lf a measuring ball is included in the x-ray, the dimensions of the zone of available bone may be calculated.

Length (actual) = Length(image) x Ball

Diameter (actual) / Ball Diameter (image)

Aids

Include objects of known dimension in radiographs for evaluation. Use, for exemple metal balls cured in an acrylic base in the planned implant positions. Truly accurate metric analysis requires a CT scan (see further radiologic diagnosis). Use of small titanium tubes in a CT scan template produces no artifacts, and allows planning of implant axis as well.

Segment of a panoramic x-ray

Panoramic x-rays

A panoramic x-roy makes immediately clear whether a patient is a good condidate for implant therapy.Enlargement scales vary (25-40%). Use metal pins or balls in an acrylic base to verify enlargement. The enlargement factor may be calculated by comparing the actual length of the mecisuring pin with the x-ray. Ball bearings in an acrylic base are very suitable measurement aids.Panoramic x-rays should be used in conjunction with other radiologic techniques in assessing the height, width, and quality of bone, and position of vital structures like the inferior alveolor nerve, the mental foramen, maxillary sinus and floor of the nose. The image in a panoramic x-ray is locally distorted. The CAMLOG implant template allows for an average distortion factor of from 1:1.25 to 1:1.4. In cases of minimal clearance from critical structures, further radiologic diagnostic techniques should be employed.

Further radiologic diagnostic techniques

For difficult anatomical situations , i. e. a severely atrophied region of a posterior mandible or maxilla, the Dental-CT scan is a helpful, if not indispensable aid. From a prosthetic standpoint, implant position and axis may be simultaneously planned, dictating the construction of a planning and drilling template an mounted casts. For the transfer of the planned implant positions, titanium tubes are embedded in the CT scan template (titanium generates no artifacts). Evaluation of the scans is either by direct measurement or with the use of specialized computer programs.

Model analysis

Mounted casts and a diagnostic wax-up are an important aid in planning and verifying implant position in edentulous or particilly edentulous ijws. The casts are to be mounted with a face-bow and in centric relation.

Set-up, Wax-up

The diagnostic wox-up is an important aid for the surgeon and restorative dentist in verification of the individual implant positions. The diagnostic wax-up is proctical for cemented or screw-retained bridges and vital in tooth-for-tooth restorations and can be used to construct the planning/drilling template.

Prosthetic design

For decades, Ante's rule has been the basis in planning conventional perio-prosthetic rehabilitation. Analogously, a tooth-for-tooth perio-implant-prosthetic concept is based an the principal that each tooth be replaced with an implant whose surface area is at least as great as the root surface area of that tooth. The relationship between crown length and osseointegrated implant length, and the angle between crown axis and implant axis directly influence the lever relationship and therefore the magnitude, the direction and the localization of the static and dynamic forces at the interface. Peak loads at the interface of implant and

bone, and the surrounding bone structure must be avoided. The forces should be directed over the largest surface area possible. The relationship between crown length and root length should correspond with: crown length (CL) to osseointegrated implant length (IL). lf the relationship between crown length (CL) and implant length (IL) > 0.8, then single crowns should be splinted for bio-mechanical reasons. A cuspid guidance occlusal scheme and the resulting posterior disclusion prevents the occurrence of para-functional forces.

Indications for the various implant geometries

The choice of implant geometry is not location specific. The self-tapping threads of the Screwcylinder Line and the Root Line may be used when the surgeon feels the need for greater primary stability. Preparing an implant receptor site in bone qualities D1 and D2 where the cortical bone is very dense may require pre-tapping.

Construction of a planning and drilling template

Since optimal implant placement improves lang term prognoses, the routine use of a drilling template is recommended. The technician can construct this from the diagnostic set-up/wax-up. lf necessory, three dimensional positioning may be accomplished with CT scan data and the oppropriate computer software (see also "further radiologic diagnostic techniques").Teeth are waxed up in the desired implant positions for the construction of the planning ond drilling template. In certain circumstances, this wax-up may be used to fabricate a long term provisional appliance.In this situation, a silicon matrix is used to transfer the exact position of the eventual implant crowns to the template. An acrylic template is fabricated with the aid of the silicon matrix. In centric position, titanium tubes are then placed through the planned implant crowns in their proper axes.

The oppropriateness of the planned implant placement axes in two dimensions can be checked with the panoramic x-ray. Three dimensional imaging requires a CT scan. the planning/drilling template may be used for this too.



Post-operative measures 7

General Instructions Patient preparation Provisional prostheses After surgery General prosthetic instructions Complications

General Instructions

Routine postoperative procedures apply to procedures as well. The surgerized area must be kept free of all mechanical influences. Cold is used to reduce swelling. Antibiotics may e prescribed as the case dictates. Always take a postoperative x- ray and advise the patient to contact the practice if anything that seems abnormal occurs.

Patient preparation

The patient is prepared as he would be for any other surgical procedure. As the case dictates, an antibiotic may be given before or after the procedure. Medical history and the patient's general health dictates the use of oral or intrcivenous sedation.

Provisional prostheses

The patient may only be treated with a provisional appliance to the extent that there is no force being applied to the implant or the sutures. This possibility should be made clear to the patient in the planning phase. In the extreme case, going without a prosthesis must be tolerated. Generally, a Iong term provisional supported by the remaining dentition is fabricated a head of time ond seated after the surgical procedure. Typical provisionals include Maryland bridges, metal reinforced acrylic temporaries, and free-end bridges with short distal extensions. In some cases the existing prosthesis can be modified. In all situations, no pressure is to be exerted on the implant or the stitches. Temporary bridge pontics and denture borders can prolong the healing phase.

After surgery

The patient should be examined the day after surgery and monitored for ci week. Pay close attention to the tightness of the sutures and indications of onset of infection. The sutures can typically be removed in seven to ten days.

General prosthetic instructions

Due to the high stability of the CAMLOG connection, the precision of the components and the transfer systern, tooth for tooth restorations are now possible. Contilevered pontics are not to be used on free standing implants. The occlusal scheme of choice is simultaneous cinterior/cuspid guidance with subsequent posterior disclusion. Upper lip support in cases of severely atrophied anterior maxillas should be accomplished with removable prostheses (baroverdenture or double crown) to avoid excess inclination of implant crowns.

Complications

Care must be exercised in the following situations to avoid complications. In general, the hand piece must not be allowed to rotate with the wrist and not kept parallel. This results in an eccentric implant receptor site and the implant is inclined toword the distal. In certain circumstances the root of an adjacent tooth con be damaged.

In the mandible:

The mandible narrows below the linea mylohyoid. lf the drill is placed too for lingually, a perforation can occur even if the re-operative x-ray indicated adequate bone mass. lf the apical aspect of the mandible is made level, the available bone height is reduced and the implant length must be carefully checked. Otherwise the possibility of damaging important structures (nerve) exists.

In the maxilla:

The transversal contour of the maxillary sinus can only be ascertained with 3D imaging techniques. Should the pilot drill perforate the sinus, the implantation must be aborted or augmentation procedures must be employed.



The CAMLOG® surgical system 8

Surgical instrumentation Screwcylinder/Cylinder Line surgical set Root Line surgical set Implants

Surgical instrumentation

Surgical sets

The content of the CAMLOG surgical set is organized to guid you step by step through the procedure. The set is identical for the Screwcylinder and Cylinder Lines. There is a separate set for the Root Line. Both sets are aoilable with either connon-shaped or five-bladed pre-drills. The sets are organized in autoclavable trays.

White 3,3 mmYellow 3,8 mmRed 4,3 mmBlue 5,0 mm

Green 6,0 mm

Color coding

All diameter specific components of the CAMLOG implant system are color coded. This color coding of the individual elements simplifies the selection of instruments, implants, and related accessories and greatly reduces the chance of mix-up. Drills for a certain implant diameter are the same color as the implant and its packaging.

Screwcylinder / Cylinder Line surgical set

Best.-Nr. J5300.0001 with cannon drillsBest.-Nr. J5300.0003 with 5-bladed drills

Root Line surgical set

Best.-Nr. J5300.0002 with cannon drillsBest.-Nr. J5300.0004 with 5-bladed drills

Implants

All Screwylinder Line implants have a Promote® surface.

Orderl-No. Diameter Length

J1022.3809J1022.3811J1022.3813J1022.3816

3,8 mm3,8 mm3,8 mm3,8 mm

09 mm11 mm13 mm16 mm

J1022.4309J1022.4311J1022.4313J1022.4316

4,3 mm4,3 mm4,3 mm4,3 mm


J1022.5009J1022.5011J1022.5013J1022.5016

5,0 mm5,0 mm5,0 mm5,0 mm


J1022.6009J1022.6011J1022.6013J1022.6016

6,0 mm6,0 mm6,0 mm6,0 mm


All Cylinder Line implants have a titanium plasma spray coating (TPS).

Order-No. Diameter Length

J1011.3311J1011.3313J1011.3316

3,3 mm3,3 mm3,3 mm

11 mm13 mm16 mm

J1011.3809J1011.3811J1011.3813J1011.3816

3,8 mm3,8 mm3,8 mm3,8 mm


J1011.4309J1011.4311J1011.4313J1011.4316

4,3 mm4,3 mm4,3 mm4,3 mm


J1011.5009J1011.5011J1011.5013J1011.5016

5,0 mm5,0 mm5,0 mm5,0 mm


J1011.6009J1011.6011J1011.6013J1011.6016

6,0 mm6,0 mm6,0 mm6,0 mm


All Root Line implants have a Promote® surface.

Order-No. Diameter Length

J1032.3809J1032.3811J1032.3813J1032.3816

3,8 mm3,8 mm3,8 mm3,8 mm


J1032.4309J1032.4311J1032.4313J1032.4316

4,3 mm4,3 mm4,3 mm4,3 mm


J1032.5009J1032.5011J1032.5013J1032.5016

5,0 mm5,0 mm5,0 mm5,0 mm


J1032.6009J1032.6011J1032.6013J1032.6016

6,0 mm6,0 mm6,0 mm6,0 mm




Placing CAMLOG® implants (1) 9

Incision Implantation modalities Gingiformers Implantation modalities Temporary abutments Suture closure Drilling system Aids

Incision

Choice of incision placement is based on the planned course of treatment. The crestal incision is the easiest, but due to the possibility of post-operative complications such as suture dehiscence, not recommended. In order to achieve a tension free suture closure with adequate flap length to be leak free, the vestibular incision is recommended in all cases. Additionally, the sutures should not rest atop the implant.

Vestibular incision

Crestal incision

Implantation modalities

The placement of the different implants can, according to the indication, be a one-phase transgingival, or a two-phase covered procedure. Immediate loading is possible whether placernent is at time of extraction or delayed. Prerequisites for immediate loading are optimal primary stability and simultaneous overload protection. The system contains specific components for virtually every implantation modality. Whether the implant is immediately loaded, or already integrated, impression taking procedure remains the same.

Covered healing is the standard method for the CAMLOG system in all indications.

In special circumstances in which maintenance of soft tissue structure is desired as in cases of simultaneous extraction with implant placement, open healing can take place around a Gingiformer.

Gingiformers

The use of the Gingiformer promotes and supports the creation of a papilla around the implant, optimizing the aesthetic result. When the bottleneck shaped Gingiformer in inserted, a correspondingly shaped tissue form is created which, when compressed by the restorative crown, is papilla-like in appearance. The bottleneck Gingiformer is available in both titanium and plastic (PEEK) in all diameters and in 4 mm and 6 mm protrusion lengths.

Order Number Diameter Protrusion

Length J2012.3340 3,3 mm 4 mmJ2012.3360 3,3 mm 6 mmJ2012.3840 3,8 mm 4 mmJ2012.3860 3,8 mm 6 mmJ2012.4340 4,3 mm 4 mmJ2012.4360 4,3 mm 6 mmJ2012.5040 5,0 mm 4 mmJ2012.5060 5,0 mm 6 mmJ2012.6040 6,0 mm 4 mmJ2012.6060 6,0 mm 6 mm

Order Number Diameter Protrusion

LengthJ2010.3340 3,3 mm 4 mmJ2010.3360 3,3 mm 6 mmJ2010.3840 3,8 mm 4 mmJ2010.3860 3,8 mm 6 mmJ2010.4340 4,3 mm 4 mmJ2010.4360 4,3 mm 6 mmJ2010.5040 5,0 mm 4 mmJ2010.5060 5,0 mm 6 mmJ2010.6040 6,0 mm 4 mmJ2010.6060 6,0 mm 6 mm

Implantation modalities

In cases of absolute primary stability in a recession free receptor site, where the relation of implant length to crown length is greater than 1 : 1 , a temporary may be placed on a plastic (PFEK) provisional abutment. The crown must be adjusted out of occlusion.

Temporary abutments

The temporary abutments of the CAMLOG system are made of plastic (PEEK) and can, where operating parameters permit, be used to support a lang term provisional restoration. After implantation, the provisional abutment is fixed in the implant and the form of the surrounding gingiva is marked on the abutment. The abutment is then modified accordingly and polished in the Iaboratory (Not in the mouth!). After re-insertion in the mouth, the screw is covered with wax and a prefabricated temporary crown is relined to fit, or a chairside temporary is made. The crown is

placed with temporary cement.

Order Number DiameterJ2240.3800 3,8 mmJ2240.4300 4,3 mmJ2240.5000 5,0 mmJ2240.6000 6,0 mm

Suture closure

Vestibular incision

The vestibular incision makes possible in all cases a tension-free flap adaptation. This method has distinct advantages, especially in cases of small simultaneous augmentations like recessions and perforations. lf a membrane is used, closure must be absolutely leak-free.

with membrane

Crestal incision

Closure is made with single button stitches. lf there is a blood clot directly below the incision, the risk of dehiscence increases. A deep mattress stitch may be used to reduce the tension. The crestal incision is not recommended.

Drilling system

Speed

The recommended top speed for drills is 2,000 RPM. The top speed for thread cutting is 50 RPM. Please make sure your surgical drill is properly limited.

Cooling

With the exception of the round burs and thread cutters, the drills of the CAMLOG system are internally cooled. Sterile saline solution should be used for cooling. The internally cooled drills require special attention be paid to ensure the irrigation ports are not clogged with bone chips. When using the pilot drills, pre-drills and form-drills, a pumping motion should be employed. In this way the bone is drilled for two to three seconds and then the drill is retracted without stopping the handpiece motor. This allows the irrigation system to clear the bone debris. Proceed in this fashion until the desired depth is reached. Should the irrigation port become clogged, take the drill out of the handpiece and clear the blockage with the cleaning needle. Do not drill if no irrigation solution is flowing!

Service life of the drills

How long the drills remain sharp is greatly dependent on drilling technique and bone quality. The pilot-, pre-, and form drills normally last through 10 to 20 uses. This number can vary greatly. lf a great amount of force is required, replace the drill immediately to avoid overheating the bone. Remember that each

sterilization cycle compromises the cutting efficiency of the drill.

Aids

Depth stop

All CAMLOG pilot- and pre-drills can be fitted with depth stops to avoid creating too deep a receptor site. Without depth stop the drill is for 16 mm long implants. With the appropriate stop installed the bore is limited to 9, 11, or 13 mm respectively. The stops are intended for the spiral drills the connon drills, and the five-bladed drills.

Order Number LengthJ5016.0009 09 mmJ5016.0011 11 mmJ5016.0013 13 mm

Depth and axis control

After pilot boring, depth and axis may be checked by inserting the parallel pin/depth gauge. The pins are supplied in all pre-drill diameters.

Order Number DiameterJ5300.2033 2,0/3,3 mmJ5300.2836 2,8/3,6 mm

Roundbur

The round bur has a diameter of 3.1 mm and is used to make an indentation in the compact bone, to facilitate the subsequent insertion of the cannon drill or five-bladed cutter. It is used with external irrigation as this is a minimally invasive step. In certain indications, the round bur is used prior to the spiral drill as well. The round bur is used to make a slight depression in the alveolor ridge (half the depth of the bur), in which the tip of the next drill seats. The round bur may also be used to remove sharp edges and other irregularities on the crest of the ridge. This should be done with ample external irrigation.

Order NumberJ5005.3100

Pilot drill

With the 2 mm pilot drill, the depth and orientation of the bore is finalized. The marks cut in the tool represent the implant lengths 9, 11 , and 13 mm. The overall tool length is for 16 mm implants. We generally recommend the use of the depth stops corresponding to the planned implant lengths. lf a drilling template is used, the stops can be put on after the holes have been marked. After drilling, the depth and orientation of the receptor sites are checked with the 2 mm paralleling pins. lf more than one implant is to be placed, it is advisable to place a paralleling pin in the first hole as a visual guide for the subsequent bores. This technique is, of course, not applicable when a drilling template has been prepared that indicates the desired axes.

Order NumberJ5005.2000

Planisher

In select instances, it can make sense to planish the alveolar crexxx in order to create a regular bone surface around the implant. The choice of diameter of planisher corresponds to the planned implant diameter (see illustration). The planisher is used following the pilot drill. The tip of the planisher is placed in the pilot hole. Pay special attention to the speed of the motor, and proceed slowly and carefully so the planisher doesn't chatter. After planishing, the depth of available bone must be rechecked, paying special attention to critical anatomical structures! (alternatively a shorter implant must be selected).

Order Number DiameterJ5006.5200 5,2 mmJ5006.6200 6,2 mmJ5006.7200 7,2 mm



Placing CAMLOG® implants (2) 9

Pre-drills Form drills Receptor site preparation sequence Placement instruments Removing the implants from the packaging Orientation of the implant Screwcylinder Line/ Root Line Cylinder Line

Pre-drills

Screwcylinder/Cylinder Line

Pre-drills for the Screwcylinder and Cylinder Lines are 2.8 mm, 3.3 mm, and 3.6 mm in either cannon or five-bladed geometries. Marks on the tools correspond to the various implant lengths analogous to the pilot drills. Use of depth stops is recommended for safety. Use the xxxll chart in selecting the proper diameter drills for the various implant sizes.

Order Number Diameter

J5018.2800 2,8 mmJ5018.3300 3,3 mmJ5018.3600 3,6 mm

Root Line

For the root line, only the 2.8 mm pre-drill in cannon or five-bladed form is used. Use of depth stops is recommended. For the further enlargement of the receptor site, form-drills in increasing diameters are used sequentially. Refer to the drill chart for the appropriate implant diameter.

Order Number DiameterJ5020.2800 2,8 mmJ5020.3300 3,3 mmJ5020.3600 3,6 mm

Form drills

Screwcylinder/Cylinder Line

The form-drills of the Screwcylinder and Cylinder Lines have depth stops. The depth stops are designed to leave the implant 0.4 mm supro crestal. These colorcoded metal rings sleeve over the drill and engage in a groove. In situations where the alveolar ridge is uneven, it can be difficult to achieve the desired depth. First, prepare the receptor site with the drill stop in place, then, when the drill stop is removed, on additional 2 mm of drill is available (Exercise caution near critical structures!) to achieve the required depth.

Root Line

The form-drills of the Root Line have depth stops. These color-coded metal rings sleeve over the drill and engage in a groove. In situations where the alveolar ridge is uneven, it can be difficult to achieve the desired depth. First, prepare the receptor site with the drill stop in place, then, when the drill stop is removed, an additional 2 mm of drill is available (Exercise caution near critical structures!) to achieve the required depth.

Thread cutters

All CAMLOG implants in the Screwcylinder and Root Lines have self tapping threads. lf required by special indications, thread cutters are available for each of the implant diameters. Do not operate the thread cutters above 50 RPM to avoid overheating. The axis of the receptor must be carefully observed. The thread cutters are only inserted as for as the cutting part of the tool extends.

Order Number DiameterJ5030.3855 3,8 mmJ5030.4355 4,3 mmJ5030.5055 5,0 mmJ5030.6055 6,0 mm

Receptor site preparation sequence

Overview of receptor site preparation

- Roughening of the alveolor ridge in the desired implant placement area (optional)- Marking of the implant position with the 2mm twist drill- Depth drilling and axis determination- Verification with depth gauge/paralleling pin- Planishing of the alveolar ridge (optional)- Re-verification (optional)- Pre-drilling according to the drill chart- Form drilling- Thread cutting (optional)

Placement instruments

Screwcylinder/Root Line

All the required instruments are included in the set. The torque ratchet can adjusted 90° by turning the handle. The wrench will not work past the selected torque. The torque can be varied between 10 and 30 Ncm by turning the adjustment screw in the end of the handle in or out to the appropriate mark.

Description Order Number A Drive Mandrell J5300.0007 B Cardanic Driver J5300.0010

C Torque Wrench J5300.1030 D Ratchet Adapter J5002.0010

Cylinder Line

Description Order NumberSeating instrument J5300.0005

Removing the implant from the packaging

Contents of the Smart Pac®

The Smart Pacs for the Screwcylinder and Root Lines contain the implant and the mounted placement head in a hand grip. The implant sealing screw in under a foil closure in the hand grip. The Smart Pacs for the Cylinder Line contain the implant with sealing screw in place and a mounted, breck-away placement head in a hand grip.

Orientation of the implant

All CAMLOG implants are conceived so that when the drill system is properly used, the coronal aspect of the implant lies approximately 0.4 mm above the bone. In excepted cases, removal of the depth stop on the form drill facilitates another 2 mm of depth.

Corresponding to the cams of the CAMLOG connection are clearly visible (1 mm diameter) marks machined into the outer surface of the implants of the Cylinder Line. One of these marks is oriented toward the vestibule at implantation. The corresponding cam is therefore also oriented toward the vestibule.

Corresponding to the cams of the CAMLOG connection are marks machined into the placement instruments for the Screwcylinder and Root Line implants. These marks must be orienied toward the vestibule at implantation.

Warning: Don't confuse these marks with dimples holding instrument tips on!

Screwcylinder Line/Root Line

The implant is sterile when removed from the inner packaging and therefore should only be grasped by the hand grip. The implant is placed by hand in the receptor site, and finger tightened. The hand grip is then removed.

For the tightening of the implant, three options are available.-mechanical tightening with the mandrel-manual tightening with the ratchet -manual tightening with the cordanicdriverThe final positioning is always done manually to avoid overtightening the external threads of the implant in the bone. The correct implant position is reached when the upper edge of the implant is cipproximotely 0.4 mm above the bone and one of the cam marks is oriented toward the buccal.

Once the desired position is reached, the fixing screw is unscrewed and the insertion head is removed. After cleaning the threads, the accompanying sealing screw is installed. The sealing screw is in a foil covered compartment in the hand grip.

Warning: Take precautions to avoid swallowing or aspiration of the parts.

Cylinder Line

The implant is sterile when removed from the inner packaging and therefore should only be grasped by the hand grip. The implant, with one of the marks oriented buccally, is pressed into place as far as it will go by hand, making sure not to remove the breakaway placement head. Slide, rather than snap, the hand grip off the placement head!

Next, place the seating instrument an the placement head and tap into place with the surgical hammer. The final position is recognized by a "satisfying" hollow sound. At this point the placement head is broken away from the implant. The placement head stays in the seating instrument because of its silicon o-ring. The tightness of the sealing screw is checked with a hand screwdriver.

Warning: Take precautions to avoid swallowing or aspiration of the parts.



Placing 3,3mm implants 10

Placing Cylinder Line implants

Placing Cylinder Line implants

Drilling sequence

Order Number Description UsageJ5005.2000 Pilot drill 2,0 mm

J5016.00xx Depth stop According to planned implant length

xx=LengthJ5300.2033 Parallel/Depth pinJ5006.5200 Planisher 5,2 mm OptionalJ5020.2800 Pre-drill 2,8 mm Or J5018.2800 Cannon

drillJ5021.33xx Form drill 3,3 mm According to planned

implant length xx=Length



Placing Screwcylinder/Cylinder Line implants Placing Root Line implants

Placing Screwcylinder/Cylinder Line implants

Drilling sequence

Order Number Description UsageJ5005.2000 Pilot drill 2,0 mmJ5016.00xx Depth stop According to

planned implant length

xx=LengthJ5300.2033 Parallel/Depth pinJ5006.5200 Planisher 5,2 mm OptionalJ5020.2800 Pre-drill 2,8 mm Or J5018.2800

Cannon drillJ5020.3300 Pre-drill 3,3 mm Or J5018.3300

Cannon drill

J5021.33xx Form drill 3,3 mm According to planned implant lengthxx=Length

J5030.3855 Thread cutter Optional

Placing Root Line implants

Drilling sequence




Cannon drillJ5022.38xx Form drill 3,8mm According to

planned implant lengthxx=Length

J5030.3855 Thread cutter Optional






Drilling sequence





Cannon drill

J5020.3600 Form drill 3,6 mm Or J5018.3600 Cannon drill

J5021.43xx Thread cutter 4,3 mm

According to planned implant length

xx=LengthJ5030.4355 Gewindeschneider Optional


Drill sequence

Order Number Description UsageJ5005.2000 Pilot drill2,0 mmJ5016.00xx Depth stop According to



Cannon drillJ5022.38xx Form drill 3,8 mm According to


xx=LengthJ5022.43xx Form drill 4,3 mm According to


xx=LengthJ5030.4355 Thread cutter Optional






Drill sequence





Cannon drill

J5020.3600 Pre-drill 3,6 mm Or J5018.3600 Cannon drill

J5021.50xx Form drill 5,0 mm According to planned implant length



Drill sequence




Cannon drill

J5022.38xx Form drillr 3,8 mm According to planned implant length











Drill sequence





Cannon drill

J5020.3600 Pre-drill 3,6 mm Or J5018.3600 Cannon drill

J5021.60xx Form drill 6,0 mm According to planned implant length



Drill sequence




Cannon drillJ5022.38xx Form drill 3,8 mm According to



Maintenance of surgical instruments 15

Instrumentation

Instrumentation

1. After every surgical procedure, all the surgical drills, hand instruments, and accessories should be cleaned with a soft brush and an appropriate surgical instrument cleaning solution.

2. Clean the inside of the drills with the help of a dull needle and syringe.

3. Clean all components in an ultrasonic in an appropriate surgical instrument cleaning solution. After ultrasonic cleaning, scrub the drills thoroughly.

4. Clean in ultrasonic with distilled water.

5. Use a dull needle and syringe to rinse internal parts with distilled water.

6. Dry all components and reassemble the set. Place the cleaned drills in the holder with the tips up. Return the hand instruments to

the holder and close the lid.

7. The complete surgical set is now ready for sterilization. Sterilize in a steam autoclave for one hour at 121° C. Do not exceed 160° C. Do not place the set directly an the metal of the autoclave, use a towel or tray holder.

Use only appropriate disinfection and cleaning products.


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The CAMLOG transfer system 16

Closed tray impression taking Open tray impression taking Registration

The transfer of the oral situation to the moster working model is accomplished with great precision with the CAMLOG Transfer System. The absolute rotational stability of the impression posts is the basis for the trouble-free, adjustment-free, and time saving insertion of the prosthesis. The impression may be taken with a closed or open tray as desired. There are impression posts optimized for both modalities. Impression caps are used on the impression posts for closed impression taking. All components are color coded.

Closed tray impression taking

After cleaning the implant threads, the impression post is placed in the implant. With light rotation, the cams positively engage in the notches in the implant. It does not matter which cam engages which notch. The fixing screw is then placed in the impression post and tightened. Next, the impression cap is snapped atop the impression post. Make sure the cap is seated in the notches of the impression post. Any accurate impression material may be used. The impression caps remain in the impression. The impression posts are removed and given to the Iaboratory with the impression. Do not modify the impression posts!

Order Number DiameterJ2110.3300 3,3 mmJ2110.3800 3,8 mmJ2110.4300 4,3 mmJ2110.5000 5,0 mmJ2110.6000 6,0 mm

Open tray impression taking

After cleaning the implant threads, the impression post is placed in the implant. With light rotation, the cams positively engage in the notches in the implant. lt does not matter which cam engages which notch. The fixing screw, captive in the impression post, is tightened. Any accurote impression material may be used. When the impression material has set, the fixing screws are loosened and the impression removed. The impression posts remain in the impression. Do not modify the impression posts!


Registration

For the bite registration, use the closed tray type impression posts. The registration caps are color coded according to implant diameter. Do not modify the modify the registration caps! The registration caps make for repositioningcaps make for articulation easy. Due to the rounded geometry of the registration caps, the master model with impression posts in place can be fitted to the bite without modificcition.

After cleaning the implant threads, the impression post is placed in the implant. With light rotation, the cams positively engage in the notches in the implant. lt does not matter which cam engages which notch. The fixing screw is then placed in the impression post and tightened. Next, the registration cap is seated atop the impression post. Any accurate registration material may be used. The registration caps should not stay in the registration. They may be easily repositioned in the laboratory. Do not modify the registration caps!


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INFORMATION AND CONSENT FORM FOR THE IMPLANT PATIENT

1. I have been informed and I understand the purpose and the nature of the implant surgery procedure. I understand what is necessory to accomplish the placement of the implant under the gum or in the bone.

2. My doctor has corefully examined my mouth. Alternatives to this treatment hove been explained. I have tried or considered these methods, but I desire an implant to help secure the replaced missing teeth.

3. I have further informed of the possible risks involved with surgery, drugs, and anesthesia. Such complications include pain, swelling, infection and discoloration. Numbness of the lip, tongue chin, cheek, or teeth may occur. The exact duration may not be determinable and may be irreversible. Also possible cre inflammation of a vein, injury to the teeth present, bone fractures, sinus penetration, delayed healing, allergic reactions to drugs or medications used etc.

4. I understand that if nothing is done, any of the following could occur: bone disease, loss of bone, gum tissue inflammation, infection, sensitivity, looseness of teeth, followed by the necessity of extraction. Also possible are temporomandibular joint (jaw) problems, headaches, referred pains to the back of the neck and facial muscles, and tired muscles when chewing.

5. My doctor has explained that there is no method to accurately predict the gum and the bone healing capabilities in each patient following the placement of the implant.

6. It has been expleined that in some instances implants fail and must be removed. I have been informed and understand that the practice of dentistry is not an exact science; no guarantees or assurance os to the outcome of results of treatment or surgery can be made.

7. I understand that excessive smoking, alcohol, or sugar may affect gum healing and may limit the success of the implant. I agree to follow my doctor's home care instructions. I agree to report to my doctor for regular examinations

as instructed.

8. I agree to the type of anesthesia, depending on the choice of the doctor. I agree not to operate a motor vehicle or hazordous device for at least 24 hours or more until fully recovered from the effects of the anesthesia or drugs given for my care.

9.To my knowledge I have given an accurate report of my physical and mental health history. I have also reported anyprior allegic or unusual reactions to drugs, food, insect bites, anesthetic, pollens, dust, blood or body disease, gum or skin reactions, abnormal bleeding or ony other conditions related to my health.

10. I consent to photogrAphy, filming, recording, and x-rays of the procedure to be performed for the advoncement of implant dentistry, provided my identity is not revealed.

11. I request and authorize medical/dental services for me, including implants and other surgery. I fully understand that during and following the contemplated procedure, surgery, or treatment, conditions may become apparent which warrant, in the judgment of the doctor, additional or alternative treatment pertinent to the success of comprehensive treetment. I also approve any modification in design, material, or core, if it is felt this is for my best interest.

_____________________ _____________________Signature of the Dentist Signature of the Patient

lf the patient is unable to sign er is a minor, then signiture of parent er legal guardion

_____________________Witness

___________ _____________________Date Relationship to Patient

That internationally Congress OF orally Implantologists is responsiblea non-profit international educational organization and not for theinterpretation, presentation or final results of the procedures whichare above.

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