Compendium 1 surgery by camlog

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1 Surgery The CAMLOG Compendium, consisting of manual 1 Surgery and manual 2 Prosthetics, describes (using more than 800 illustrations) the clinical and prosthetic procedures involved in the practice of implant dentistry. The CAMLOG Compendium is targeted at users in order to ensure the proper handling of the system. The prosthetically oriented CAMLOG® Implant System stands for interdisciplinary teamwork – combining the skills of dentist and dental technician to develop implant solutions that benefit the patient.

➤ The CAMLOG Compendium 1 Surgery addresses the insertion of the different

CAMLOG® implant configurations. It consists of a description of the prosthetic CAMLOG concept, general information about the system, and prosthetic planning up to surgical intervention.

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

ISBN 978-3-13-134351-2 +E219J800000271I

www.thieme.com

+$0000010150IJ

1 Surgery

The CAMLOG® Implant System is one of the most successful systems on the international implant market.

CAMLOG Compendium

1 Surgery

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CAMLOG Compendium | 1 Surgery

CAMLOG Compendium 1 Surgery All materials and dental procedures mentioned in this Compendium must be used and applied by qualified dentists and physicians only. The CAMLOG Compendium consists of two parts: 1 Surgery 2 Prosthetics Single pages must not be distributed.

Section Overview CAMLOG Compendium Part 1, Surgery: I. General system information II. CAMLOG concept Ill. Planning IV Surgery manual

CAMLOG Compendium Part 2, Prosthetics: V. Prosthetics Manual

CAMLOG Compendium | 1 Surgery

Bibliographic information of the German Library The German Library catalogs this publication in the German National Bibliography; detailed bibliographic information can be found on the Internet website: http://dnb.ddb.de. All rights, including reprinting, reproduction in any form and translation into other languages, are reserved by the copyright holder and publisher. The manual may not be reproduced in whole or in part by photomechanical means (photocopy, microfiche) or stored, exploited systematically or distributed with electronic or mechanical systems without written approval from CAMLOG Biotechnologies AG.

Important note: Like every field of science, medicine is undergoing continuous change. Research and clinical experience are continuously extending our knowledge, particularly of treatment and medicinal therapy. Where this publication refers to a dosage or administration, the reader can be assured that the authors, editor and publisher have taken great care to ensure that this information conforms to the state of the art at the time of publication.

Alexander Focke, Dieter Mozer, Alex SchĂ¤r, Bernd Wagner

However, the publisher cannot accept any liability for information on dosage instructions and forms of administration. Every user is urged to check carefully the information in the package inserts of the medications and if necessary consult a specialist to see if the recommended dosage and administration or the observance of contra-indications is different from the information given in this book. It is particularly important to check this in the case of rarely used medications or those that have just been introduced to the market. Every dosage or administration is the sole responsibility of the user. The authors and the publisher request all users to inform the publisher of any inaccuracies.

Manufacturer: ALTATEC GmbH Maybachstrasse 5 71299 Wimsheim, Germany

Protected brand names (trademarks) are not specially indicated. The absence of such indication does not mean that it is not a trademarked name.

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

Copyright ÂŠ 2007 CAMLOG Biotechnologies AG Art. No.: J8000.0027 web version Printed in Germany Cover design: CAMLOG Team, Thieme Verlagsgruppe Printing/binding: Grammlich, Pliezhausen ISBN: 978-3-13-134351-2

123456

The 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.

CAMLOG Compendium | 1 Surgery

Table of Contents

I. General System Information

II. CAMLOG Concept

1. Introduction . . . . . . . . . . . . . . . . . . . . . . . .

2. CAMLOG 速 system - description . . . . . . . . . .

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

. . . . . . . .

3 3 4 5 6 7 8 8

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

. . . . .

. 9 . 9 . 9 . 9 . 10

1. Team concept . . . . . . . . . . . . . . . . . . . . . . . 11 The team . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Team input . . . . . . . . . . . . . . . . . . . . . . . . . . 12 2. Treatment concepts . . . . . . . Introduction . . . . . . . . . . . . . . Leverage relations at the implant Esthetics . . . . . . . . . . . . . . . . Patient cooperation . . . . . . . . . Patient information . . . . . . . . . Fixed dentures . . . . . . . . . . . . . Single crowns . . . . . . . . . . . . . Splinted crowns . . . . . . . . . . . Implant-supported bridges . . . . . Removable dentures . . . . . . . . Telescopic crowns . . . . . . . . . . . Bar abutment . . . . . . . . . . . . . . Ball abutment . . . . . . . . . . . . .

III. Planning

. . . . . . . . . . . . . .

13 13 13 14 14 14 15 15 16 17 18 18 19 19

1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . 20 2. Anamnesis . . . . . . . . . . . . . . . . . . . . . . . . . 21 General . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Special (dental) . . . . . . . . . . . . . . . . . . . . . . . 21 3. Examinations Clinical . . . . Radiographic . Laboratory . . .

... .... .... ....

. . . .

21 21 22 22

CAMLOG Compendium | 1 Surgery

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

. . . .

24 24 25 26

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

27 27 27 27 27 28 28 29 29 29

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

IV. Surgery Manual

1. Preparation of the patient . . . . . . . . . . . . . 33 2. Drilling template . . . . . . . . . . . . . . . . . . . . 33 3. CAMLOG 速 surgical system . . . . . . . . . . . . . 33 Surgical sets . . . . . . . . . . . . . . . . . . . . . . . . . 34 Drilling system . . . . . . . . . . . . . . . . . . . . . . . 37 4. Healing options . . . . . . . . . . . . . . . . . . . . . 38 5. SCREW-LINE Implant . . . . Introduction . . . . . . . . . . . . Preparation of implant bed for SCREW-LINE Implants . . . . . Implant package . . . . . . . . . Implant insertion . . . . . . . . . 6. ROOT-LINE Implant . . . . . . Introduction . . . . . . . . . . . . . Preparation of implant bed for ROOT-LINE Implants . . . . . . . Implant package . . . . . . . . . Implant insertion . . . . . . . . .

. . . . . . . . . . . . . 39 . . . . . . . . . . . . . 39 . . . . . . . . . . . . . 44 . . . . . . . . . . . . . 54 . . . . . . . . . . . . . 56 . . . . . . . . . . . . . 65 . . . . . . . . . . . . . 65 . . . . . . . . . . . . . 70 . . . . . . . . . . . . . 80 . . . . . . . . . . . . . 82

CAMLOG Compendium | 1 Surgery

7. SCREW-CYLINDER-LINE Implant . . Introduction . . . . . . . . . . . . . . . . . . Preparation of implant bed for SCREWCYLINDER-LINE Implants . . . . . . . . . Implant package . . . . . . . . . . . . . . . Implant insertion . . . . . . . . . . . . . . .

. . . . . . . 91 . . . . . . . 91 . . . . . . . 96 . . . . . . .106 . . . . . . .108

8. CYLINDER-LINE Implant . . Introduction . . . . . . . . . . . . . Preparation of implant bed for CYLINDER-LINE Implants . . . . Implant package . . . . . . . . . . Implant insertion . . . . . . . . .

. . . . . . . . . . . . .117 . . . . . . . . . . . . .117

9. Healing caps . . . . . . . . . Introduction . . . . . . . . . . . Healing caps - cylindrical and Healing caps - bottleneck . . Tissue augmentation/support

. . . . .

.137 .137 .138 .138 .139

. . . .

.140 .140 .141 .144

........ ........ wide body ........ .......

10. Transfer system . . . . . . . . Introduction . . . . . . . . . . . . Closed tray impression method Open tray impression method

11. Bite registration

. . . . . . . . . . . . .122 . . . . . . . . . . . . .130 . . . . . . . . . . . . .132

. . . .

. . . . . . . . . . . . . . . . . . . .147

12. Provisional solution . . . . . . . . . . . . . . . . . .148 13. Torque wrench . . . . . . . . . . . . . . . . . . . . . .151 Introduction . . . . . . . . . . . . . . . . . . . . . . . . .151 Cleaning, sterilization, care . . . . . . . . . . . . . . .154 14. Information . . . . . . Cleaning, sterilization Information protocol Materials . . . . . . . . Certificates . . . . . . .

.. . .. .. ..

. . . . .

.155 .155 .157 .158 .159

General System Information Introduction

I. General System Information 1. Introduction Modern implant prosthetics is now an established component of dentistry. The expectations and demands of patients are steadily increasing. Therefore, the ultimate goal of modern implant-supported treatment concepts is for full esthetic, functional, phonetic, and psychosocial rehabilitation. This applies equally to replacements of lost single incisors associated with trauma and the complex rehabilitation of periodontally compromised remaining teeth or the treatment of an edentulous heavily atrophied maxilla and mandible.

This manual should help promote treatment success quickly, simply, and efficiently. The layout of this publication follows the logical sequence of planning and performance of a periodontal implant-supported prosthetic restoration. You get acquainted primarily with the configuration, mechanical, and biomechanical features of the implants, as well as with the innovative CAMLOG ® implant-to-abutment connection. Before presenting the prosthetic concepts, we give you an overview of the "backward planning" method and the team concept on which it is based, to ensure the best treatment result possible. The section Treatment Concepts provides an overview of the prosthetic options using the CAMLOG ® Implant System.

Warning The descriptions that follow are not adequate to permit use of the CAMLOG ® Implant System immediately. Instruction by an experienced operator in the management of the CAMLOG ® Implant System is strongly recommended. CAMLOG ® dental implants and abutments should be used only by dentists, physicians, surgeons and dental technicians trained in the system. Appropriate courses and training sessions are regularly offered by CAMLOG. Methodological errors in treatment can result in loss of the implant and significant loss of peri-implant bone substance.

The other sections follow the order of procedures suggested in the backward planning concept: • History, examination, diagnostics • Prosthetically oriented planning • Feasibility testing, adaptation, patient-oriented planning of the procedure sequence • Surgery • Prosthetics • Follow-up

General System Information CAMLOG ® System Description

2. CAMLOG ® System Description The CAMLOG ® Implant System The CAMLOG ® Implant System is based on many years' clinical and dental technological experience. It is a user-friendly, logically prosthetic-oriented implant system. All CAMLOG ® products are continuously manufactured according to state of the art. The CAMLOG ® Implant System was further developed progressively through inhouse research and development in collaboration with hospitals, universities, and dental technicians. Today, it represents the state of the art in implant dentistry. In the recent past, science has become more and more important at CAMLOG. Today, the CAMLOG ® Implant System is scientifically very well documented. The system has been confirmed by numerous studies investigating into different parameters, e.g., implant surfaces, time of implantation and/or implant loading, primary stability, design of implant-abutment connection or type of superstructure. Long-term results of up to seven years for the CAMLOG ® Implant System are convincing.

General System Information Implant Configuration

3. Implant Configuration Macroscopic Shapes All CAMLOG ® implants are equipped with the CAMLOG ® tube-in-tube implant-to-abutment connection. The four different external implant configurations have the same diameter-matched, internal configuration. This makes the use of different implant configurations in an arch possible without curtailment of the prosthesis (see also the recommended indications for the different implant types).

SCREW-LINE Implant, Promote ®

ROOT-LINE Implant, Promote ®

SCREW-LINE Implant, Promote ® plus

SCREW-CYLINDER-LINE Implant, Promote ®

CYLINDER-LINE Implant, TPS

General System Information Implant Configuration

External Configuration CAMLOG ® implants SCREW-LINE, ROOTLINE and SCREW-CYLINDER-LINE with the Promote ® surface have a cylindrical machined portion 1.6 mm high in the coronal area (1). A rough machined chamfer - the Bioseal Bevel (height 0.4 mm) - is attached to this apically (2). Below it is the self-tapping thread of the SCREW-LINE, ROOT-LINE or SCREWCYLINDER-LINE implants (3) with the Promote ® surface. In the case of the CYLINDER-LINE implants, a TPS (titanium plasma-sprayed) surface is provided. Internal Configuration Starting from the coronal implant edge (4), all implants have three symmetrical grooves (width 0.5 or 0.7 mm, depth 1.2 mm, 120° offset) in the upper cylindrical area (5). The abutment cams lock into these grooves. Beneath this area, an upper inner thread is found (6), on which the cover screw, healing caps, bar abutments, and male inserts of different prosthetic caps can be screwed. Apical to the thread is a short cylindrical part to which the abutment "tube" is attached (7). After another 60° offset, there follows apically a second inner thread (8) onto which the abutment screws M 1.6 or 2.0 are fastened.

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

4 1

6 7

General System Information Implant Configuration

Bioseal Bevel/Implant Shoulder Following the protocol-conformal insertion of the implant, the implant shoulder lies approx. 0.4 mm above the bone level. Drilling irregularities between the implant drill hole and implant are totally excluded by the chamfer (Bioseal Bevel) beneath the implant shoulder which matches the profile of the drill hole.

A biological width of approx. 2 mm remains (1 mm connective tissue adaptation and upon this an approx. 1-mm junction epithelial attachment) following protocol-conformal insertion of the implants with the Promote 速 surface and TPS coating, and following exposure and a minor bone adaptation of approx. 1 mm apically.

Promote 速 and TPS surface

SCREW-LINE Implants with Promote 速 plus surface are likewise inserted so as to leave a 0.4 mm projection above the bone level. During the insertion and exposure, the periosteum should be removed only in the implant penetration area.

Promote 速 plus surface

General System Information Implant Configuration

Surfaces Promote ® and Promote ® plus Surface Structure Promote ® and Promote ® plus have an identical micro-macro surface structure, differing only in the vertical position of the rough/smooth boundary. The CAMLOG ® implants SCREW-LINE, ROOTLINE and SCREW-CYLINDER-LINE are available with the Promote ® surface.

The CAMLOG ® SCREW-LINE implants are also available with the Promote ® plus surface, which has a machined part of only 0.4 mm in the coronal area. This sand-blasted, acid-etched surface has given excellent results in anchoring dental implants.

Research results from cell cultures, bone histology, and extraction tests support this. The results suggest that the Promote ® surface promotes rapid osseointegration of the CAMLOG ® implants.

Promote ® surface structure

Laser scan of Promote ® surface

Osteoblasts on a Promote ® surface

Titanium Plasma-Sprayed Surface Structure The CAMLOG ® CYLINDER-LINE Implants have a titanium plasma-sprayed (TPS) surface in their endosseous portion, which has proven in long-term studies to be exceedingly reliable.

Titanium plasma-sprayed surface structure

General System Information Implant Configuration

Tube-in-Tube Connection The long-term maintenance of periimplant soft and hard tissue health in implant-treated patients heavily depends on oral hygiene and pre-, intra-, and post-operative soft tissue management. The biomechanics of implant-supported restorations are controlled by the implant design and the components of the implant-abutment connection.

The design features of the patented CAMLOG connection result in improved results on statics strength and compression fatigue tests. To maintain these

levels and ensure long-term stability, the connection must never be modified for any reason!

Even if the number of implants is adequate and positioning is correct, a mechanically critical interface also exists between force application (through crown occlusion) and force absorption (by the ankylotic anchor in the bone) in the area of the implant-abutment connection. Numerous studies have shown that abutment screw loosening or fracture may occur here - even at submaximal load - depending on the implant-abutment connection used. Hence, the design of the implant-abutment connection is fundamentally important. Engineering science indicates the use of an connection with a diameter/insertion depth ratio greater than 1.4 for form-fit connection. The implant-abutment connection used in the CAMLOG 速 System is a form-fit connection in which the diameter/insertion depth ratio is 1.5 to 2.4 depending on the implant diameter.

CAMLOG 速 implant-abutment connection with abutment screw

General System Information Production Precision

Production Precision The internal and external geometry of the implants and abutments are machined, with the exception of the milled cams and grooves. This means that production tolerances can be kept very tight, and a precision fit with rotational stability (0.5°-1.0°) is ensured for all system components. This is an essential requirement in the fabrication of prosthetic restorations, starting with the transfer of the implant position to the master cast and continuing up to the final oral insertion.

CAMLOG ® Implant

Materials All CAMLOG ® implants are made of pure grade 4 titanium. The abutments, caps, and abutment screws are made of titanium alloy Ti6AI4V (ASTM F136) (see Information - "Materials"). Implant-abutment connection with abutment screw

CAMLOG ® Abutment

General System Information Mechanics and Biomechanics

4. Mechanics and Biomechanics Mechanical Tests Finite element models were prepared and the behaviors of different implantabutment connections were compared under vertical-lateral and torsional loading. The simulation was conducted using an FEM (finite element method) program (ASNSYS 3.3) at Offenbach Technical University.

In the case of a force-based external hex connection, the Fa is ~5 Fq because of the lever ratio (the distance of the fulcrum from the middle of the axis is the implant radius).

In the case of the form and force-based CAMLOG connection, the lateral component (Fq) is almost completely compensated by the supporting forces (F1 and F2) provided by the tube-in-tube connection. Because of the configuration of the tube-in-tube connection, the fulcrum location is practically on the midline of the implant. The lever length of the axial force component (Fa) is thereby reduced towards zero.

Force-based connection

Form and force-based connection

External hex connection

CAMLOG tube-in-tube connection

Lateral Loading The vector L of a load applied at 30° is divided into an axial force (Fa) and a lateral force (Fq). The axial component and lateral force must be compensated by the screw retention force as a function of the length of the lever from the fulcrum (D).

Finite element studies show that when a vertical-lateral load is applied to the abutment, the forces are transmitted through the apical end of the tube to the implant body. Loading of the abutment screw hardly occurs. Failure Load Comparison of failure load (300 N at 30°) in a 3.75 mm screw implant with an external hex connection clearly shows that the CAMLOG ® abutment screw is hardly stressed (blue = low strain, red = high strain).

General System Information Mechanics and Biomechanics

Torsion Loading In the case of torque up to the moment the cams make contact in the implant, only the production clearance is considered, and therefore the repositioning accuracy of the abutment in the implant. The strain on the implant-abutment connection is very small (blue = low strain, red = high strain). The smaller the angular deflection, the more precise a position can be transfered.

Torsion [Nmm]

Torsion behavior of the CAMLOG connection

Angular deflection (째)

CAMLOG Concept Team Concept

II. CAMLOG Concept 1. Team Concept The Team Patient The patient must be fully informed about the options and limits of implant-supported rehabilitation in his or her particular case. The expectations and demands of the patient should be clearly formulated and documented. Dentist The restorative dentist providing prosthetic treatment is usually the team leader. His function is handling examinations, diagnostics, and treatment planning, and reaching a consensus for the treatment plan from the patient and possibly the surgeon and dental technician. He coordinates the prosthetic preparation while the surgeon plans and manages the treatment stages: surgical intervention, wound healing, and exposure.

Dental Technician The dental technician contributes his laboratory knowledge and experience to the preoperative planning of the implant-supported restoration. He prepares a setup/ wax-up, evaluates esthetic and functional issues, and makes suggestions for the design of the final restoration and implant positioning. His tasks include fabrication of the provisional and final restorations as well as provision of radiographic and drilling templates and he selects the implant abutments.

CAMLOG CAMLOG supports all members of the implant treatment team by providing high product quality, information, service, continuing education, and continuous research and development of the CAMLOG 速 Implant System.

Dental Hygienist/Nurse/Assistant An important prerequisite for the longterm 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 oral situation. She is also responsible for ensuring regular followup appointments.

Surgeon 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.

CAMLOG Concept Team Concept

Team Input Increasingly higher demands for quality and specialization require a multidisciplinary team approach to combine the members' acquired knowledge and experience. Modern implant-supported restorations need a high level of attention to detail and clinical experience. This is true equally for the restorative dentist, the surgeon, the dental technician, and the dental office support staff such as the nurse, hygienist, and chair assistant. The CAMLOG team concept takes all of these demands into consideration. The sequence of treatment procedures is structured, and specific procedures 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 should be simply and thoughtfully organized. If a transgingival 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 conditioning for three weeks after the exposure and before taking the impression, depending on the indications. The dentist/surgeon takes the impression using the transfer system and an impression material of choice (silicone, polyether, etc.). 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 and the rotational stability of the implant-to-abutment connection, time-consuming intermediate try-ins can be skipped. Both dentist and dental technician can concentrate on esthetics and the hygienic adaptability of the restoration because the insertion of the abutment is so simple and quick. Single-crown restorations, small bridges, bar abutments with the CAMLOG passive-fit system, and telescopic crowns can be fabricated to offer a perfect fit.

Sequence of Treatment Procedures • Planning • Pre-treatment • • • • • • • • •

Implantation Impression taking Cast fabrication Plan review, abutment selection Prosthesis fabrication First bake (esthetics) try-in Finishing Prosthesis insertion Maintenance/recall

The CAMLOG ® Implant System is therefore user-friendly and time-saving. The scope and value of pre-implantation diagnostics have changed. Today, preimplantation diagnostics must be oriented exclusively to prosthetic needs (backward 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 rehabilitation.

Team Dentist (surgeon, if needed) dental support staff, hygienist Dentist (surgeon, if needed) Dentist (surgeon, if needed) Dental technician Dentist, dental technician Dental technician Dentist, dental technician Dental technician Dentist Dentist, support staff

CAMLOG Concept Treatment Concept

2. Treatment Concept Introduction It is known from general physiology that both non-loading and underloading of the bone induces 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 degradation. Working with bridge restorations in conventional prosthetics has led to identification of consistently high rates of bone degradation in non-loaded or underloaded abutment teeth (Misch/Frost 1990).

Leverage Relations at the Implant Loading of the implant-bone interface is a result of the leverage relation generated by osseointegration-related resistance to the prosthesis load arm (equivalent to the supracrestal implant length plus the height of the crown above the implant shoulder). If this (IL) is less than 1 (CL), then the load must be reduced (e.g., through prosthetic splinting).

W. Schulte recognized this in 1982 and proposed early (= immediate, if possible) implantation to offset atrophy of the periodontal structures, which commences immediately after tooth loss. The implant supports the alveolar bone and tooth-bytooth implant-supported rehabilitation prevents the bony areas from being either overloaded or subjected to inactivity atrophy (stress-shielding).

References Frost HM. Bone "mass" and the "mechanostat": a proposal. Anat Rec 1987; 219:1-9 Misch CE. Contemporary implant dentistry. St Louis. Mosby Inc. 1999; Ch.22:317-318 Schulte W. Das T端binger Implantat. Schweiz Mschr Zahnmed 1985; 95:872874 13

CAMLOG Concept Treatment Concept

Esthetics The use of therapeutic methods from an esthetic perspective is very dependent upon the initial situation and the visibility of the esthetic impairment. In the "esthetic zone" (anterior maxillary area), the smile line (as described by Kois) determines the extent of work that may be necessary. If prominent transversal or vertical 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.

Low smile Line The patient exhibits: <75% of the crown length Application of the necessary therapy.

High smile Line The patient exhibits: • the entire crown length • adjacent gingiva Use of all therapeutic methods: • All-ceramic restorations • Papillae • Hide scars

Patient Cooperation The greater the patient's desire for a functional - and especially for an esthetic - 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 pretreatment 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 addition 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 Information When the process of ruling out contraindications, collecting clinical and radiographic information, and making a diagnosis is complete, an informational conference is held with the patient, using documents and models for demonstration. Risks and alternative treatments are fully discussed and documented.

CAMLOG Concept Treatment Concept

Fixed Restorations Single Crowns Single crown treatment in the form of tooth-by-tooth restorations is the desirable and ideal form of treatment for the purpose of a complete oral makeover. It contains all the beneficial elements of periodontal prosthetic rehabilitation: • Physiologically adequate, biomechanical loading prevents further atrophy of the hard and soft tissue. • Good preconditions for natural-looking esthetics are established. • Oral hygiene is simple. • Fabrication is technically straightforward. • Readily extendable/alterable. • Maintenance is easy. • Economical for the patient in the middle and long term. In the event of further tooth loss, no new construction is necessary, just extension. Esthetically difficult Areas To achieve an esthetically successful restoration, a number of important elements are required: a harmonious gingival line, optimal implant positioning on both vertical and horizontal planes, a natural-looking 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

Mesiodistal implant position at bone level

Distance to bone level

Objective Single crowns (tooth-by-tooth treatment) provide the ideal restoration in terms of biomechanical, esthetics, hygiene, tongue comfort, and muscular balance. They prevent inactivity atrophy of the bone surrounding the implant through physiological loading.

CAMLOG Concept Treatment Concept

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 impossible, 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 should be part of the abutment preparation. The implant-to-abutment connection should not be altered.

Single-crown restoration

Crown splinting

Single-crown restoration in the augmented maxillary posterior area

Crown splinting in the augmented maxillary posterior area

CAMLOG Concept Treatment Concept

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.

Examples of bridge positioning

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

Initial situation

Abutments in a lab analog

Prepared abutments

Cemented bridge

CAMLOG Concept Treatment Concept

Removable Restorations

Introduction A hybrid denture may be implantretained, mucosa-supported, or implantsupported. The tension-free seat of a secondary (telescopic crown) or primary (bar) splinted structure on implants is called as "passive fit".

Telescopic Crowns The production precision of the CAMLOG connection is particularly necessary with a telescopic crown 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 telescopic crown technique is suitable for jaw relations in Angle Classes I and III.

In the case of telescopic crowns, this is obtained through intraoral bonding of the secondary crowns (preferably galvano crowns) onto the tertiary framework. 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. In the planning of a removable denture the implants should be placed so that, if necessary, a tooth-by-tooth restoration or a fixed restoration is possible.

CAMLOG Concept Treatment Concept

Bar supported Dentures Bars are suitable for jaw relations in Angle Class II and for large horizontal deficits. It may be possible to fabricate a bar structure with either prefabricated or individualized components.

Ball Abutments The ball abutment is suitable for simple, implant-retained prosthetic restorations. It is simply a retainer, but positional stability can be created through addition of an extension prosthesis.

Planning General Information

III. Planning 1. Introduction Modern implant prosthetics is planned by working back from the desired therapy goal; this is referred to as "backward planning." It applies particularly to preimplantation augmentation procedures to restore sufficient bony structure to allow placement of implants in the optimal prosthetic position.

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 informed of the treatment options.

Overview A planning project may be divided into the following modules:

• Actual situation / prosthetic initial situation Find out and document the actual situation by taking a general and special (dental) history and performing intraand extraoral clinical, functional and radiographic examinations. Together, these findings are the basis for a description of the initial situation of the oral-maxillofacial system.

• Ultimate treatment goal An ultimate treatment goal is defined by integrating the diagnosis, needs, patient's wishes for esthetics and function, and findings from the waxup/set-up.

• Individual treatment goal A 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.

• Treatment sequence With the individualized treatment goal as guide, prosthetically oriented implant positioning is defined and verified clinically and radiographically. Then, a treatment sequence is set up. It includes the planning of ancillary procedures, augmentation, and any required pretreatment.

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.

Planning General Information

2. Anamnesis

3. Examinations

Introduction The 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.

Clinical In 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 removable denture (bar-structure, telescopic crown, ball abutment, Locator 速) 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 general, social and special (dental) medical history considers all general medical contraindications and diseases that could affect the microcirculation 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 psycological and psychosocial situation gives an indication of the compliance that can be expected and will influence the planning of the treatment and the future prosthetic design. General The general medical history should include not only the disease history but also regular medication usage and the possibility of general medical problems that could adversely affect an implantbased prosthetic treatment. Special (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 or grafts were previously placed this may be important for assessment of the bone quality.

The static and dynamic occlusion, interalveolar distance, and centric relations are checked. Temporomandibular joint disorders are addressed before the start of treatment. All findings indicating elevated stress on the masticatory system (e.g., bruxism) must be investigated, documented, and considered in the prosthetic planning. The status of the soft tissue in edentulous arch segments (width and thickness 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.

Planning General Information

Radiographic Evaluation

Laboratory

Dental x-rays Dental 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.

Cast Analysis It is essential to mount a diagnostic cast 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 under way. In any case, a change in occlusal height must be preceded by treatment with a long-term provisional.

Orthopantomograph An OPG is 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-tomographic scans (CT). Remote x-ray side View Use for large sagittal differences and planned bone removal in the chin region. Computer-Tomographic Scan The CT is an instrument to be used for extensive radiological diagnostics. It enables a 3-D evaluation of the site from its anatomical structures and the planning of augmentations. Indications must be strictly adhered to because of the level of radiation exposure involved.

Diagnostic Casts The diagnostic casts must clearly show not only the occlusal surfaces but also the vestibular fold and retromolar areas (see arrows). Diagnostic 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. 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 augmentation. Just as in perioprosthetics, the retromolar areas must be reproduced to allow specification of the dental arch and assessment of the vertical space available (see arrows). Planning and implementation of periodontal implant-supported rehabilitation will be considerably simplified if templates are used.

Planning General Information

Articulator Set-Up The diagnostic casts are mounted in an adjustable articulator with the aid of an arbitrary face bow and centric registration as in perioprosthetics.

Occlusal Height If an occlusal height requires correction, this must be done with a guard or longterm provisional before the implant-supported prosthetic restoration begins.

Arch Relations (transversal) The arch relations control the load direction and therefore the axial alignment of the implants also. This is particularly important with cross-bite situations.

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 Situation The initial prosthetic situation describes the dental status, arch relations, the anatomical status of the oral hard tissue, the intraoral and extraoral soft tissue, the presence of functional, phonetic and esthetic restrictions on the patient, and the resulting influence on the patient's quality of life.

Planning General Information

4. Preliminary Prosthetic Design

Initial Situation

Wax-Up/Set-Up The wax-up or set-up is prepared on the working cast in the dental laboratory. This permits planning of optimal tooth positioning from both functional 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 pattern to aim at is a situation-adapted anterior-to-cuspid line with early disclusion of the posteriors ("freedom in centric" should be possible).

Wax-Up/Set-Up

Planning General Information

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

Silicone Index

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 design. In accordance with the "backward planning" principle, any anatomical deficits are not considered at this stage. The treatment goal specifies the surgical and prosthetic procedure. A silicone index is fabricated from this set-up. After hardening, the index is divided orally along the central occlusion to form a labial and an oral section. An acrylic template can be fabricated with the aid of the silicone index.

Cast with Planning Template

Alternatively, the work can be done with a rigid vacuum foil via a duplicate cast. Depending on the x-ray methods, radioopaque markers (e.g., titanium, steel, barium sulfate) are integrated.

Planning General Information

X-Ray Template In the planning template or base produced from the wax-up/set-up, CT-planning tubes or other radio-opaque markers are integrated at the ideal implantation position and are used as reference positions in the x-ray image. The tubes consist of two parts: The titanium used leaves no scattering on CT scans. The lower part is polymerized in the template and the upper part inserts into this. The complete tube is used in radiologic diagnostics, and the upper part can be removed during surgery. CT-tubes for CT-planning for drills Ă&#x2DC; 2.0 mm: Inner Ă&#x2DC; 2.1 mm Outer Ă&#x2DC; 2.5 mm

Drill for CT-tube placement

Planning template with tubes for CT planning

Template without tube upper section for use as a drilling template

X-ray template, outlined with tubes

X-ray template with radio-opaque teeth and installed tubes

Titanium tubes for CT-planning or other radio-opaque positioning components (steel, barium sulfate) are integrated, depending on the analysis software. If the tubes are placed directly on the mucous membrane, its thickness can be detected on the CT scan. For more information, see the documentation for these systems.

Planning General Information

5. Implant Position Verification Goal The goal is to specify the possible implant positions. Now, the final implant planning 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.

Clinical The wax-up or set-up must be tried in on 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 Planning films are available in 1:1.25 and 1:1.4 sizes for all implant types to check the dimensions on the OPG. The film magnifications match the magnification factors for most OPGs. However, they should be considered only as approximations in implant dimensioning.

Dental Film To check the dimensions on x-ray film, the self-adhesive implant planning films (x-ray transfer pictures) for the specific implant type should be attached to the proposed implant positions on the film. 27

Planning General Information

CT Scan with/without 3-D Evaluation A precise three-dimensional evaluation of the bone dimensions is possible only with a CT scan. Simulation programs can be used for computer-supported evaluation. Special conditions such as septation or infections in planned sinus-floor elevations and critical vertical relations in the mandible can be recognized. Depending on the program, the template must include radio-opaque position markers (titanium balls, titanium tubes, barium sulfate coating).

The medical information derived from the x-ray template can be used to determine the bone volume and quality with the aid of a CT scan and 3-D evaluation and this will define the subsequent therapy procedure (number of implants, implant position, implant diameter, and implant length). The final prosthetic design and the hard and soft tissue augmentation, if required, are discussed with the patient on the basis of this information and approved.

Drilling Template Using this radiographic information, the planned implant positions are checked and adjusted if necessary. The x-ray template is thereby converted to a drilling template. The positions of the titanium tubes are modified or specified in the template. In consultation with the surgeon, the template is reduced to an outline after preparation of the flap to ensure it stays in position during surgery, i.e., stability requires a dental or gingival base outside the planned surgical field.

View of the cast positioning

X-ray templates in situ

3-D planning of implant positions

View of the cast positioning

X-ray templates in situ

3-D planning of implant positions

Planning General Information

Final Prosthesis Design The surgical feasibility of the treatment sequence is checked with reference to the initial situation, the casts, and the x-ray findings. Depending on the clinical situation, periodontal or augmentation interventions are performed before implant surgery or at the time of the implant placement.

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 include all details that are likely to be required, particularly in connection with augmentation. The planning template can now be converted into a drilling template.

Individualization of the Prosthetic Design The patient's wishes regarding the scope and cost of the implant-supported prosthetic restoration expressed in the patient interview are incorporated into the individual prosthesis design. The number of implants, the requirement for augmentation and possible soft-tissue corrections 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.

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

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

Planning Recommended Indications

6. Recommended Indications for the Different Implant Configurations CAMLOG ® implants are endosseous implants, available in different lengths and configurations. They are placed surgically in the maxillary and/or mandibular bone and serve as anchors for functional and esthetic oral rehabilitations in partial or fully edentulous patients. Prosthetic treatments include single crowns, bridges, partial or full dentures attached to CAMLOG ® implants through suitable connection elements. Generally there are no preferred sites for the use of the different implant geometrys. An independent selection of implants according to the surgical situation is possible because the diameter-specific prosthetic platform is identical for all implant configurations. Different implant types can be used in the same arche.

SCREW-LINE Implant Both Promote ® and Promote ® plus SCREW-LINE Implants are universally applicable.

ROOT-LINE Implant The ROOT-LINE Implant (with Promote ® surface) is a root-shaped, screw-type implant and is specifically indicated in conditions of apically reduced bone supply (canine fossa, apically on the mylohyoid line). The root-shaped design is particularly advantageous in the presence of root convergence from adjacent teeth.

Planning Recommended Indications

SCREW-CYLINDER-LINE Implant The SCREW-CYLINDER-LINE Implant (with Promote ® surface) is particularly suitable for restorations in structurally weak sites on the posterior maxilla. In conjunction with sinus floor elevation and augmentation, its segmentally threaded configuration permits use of the residual crestal bone height (>5 mm) to stabilize the implant. The cylindrical apical segment preserves the sinus mucosa during insertion of the implant (no thread edges) and provides superior adaptation to the particular bone augmentation material used.

CYLINDER-LINE Implant CYLINDER-LINE Implants (with TPS surface) are universally applicable. A particular advantage of this implant type is its simple, time-saving application procedure. In conjunction with sinus floor elevation and augmentation, the press-fit from the cylindrical configuration of the implant allows it to be placed in a structurally weak site with a residual bone height <5 mm.

CAMLOG Implants with 3.3 mm Diameter These implants (SCREW-LINE /CYLINDERLINE) provide an alternative in the presence of reduced crestal bone width (5-6 mm). But because of their lower mechanical strength compared with larger diameter implants, they should only be used under the following conditions: • As single implants, they should be used only to replace mandibular incisors and/or maxillary lateral incisors. • They may be used in conjunction with bar splinting of at least four implants of 3.3 mm diameter, without distal extensions on an edentulous arch. • On partly edentulous arches, implants with 3.3 mm diameter can be splinted to implants of larger diameter in conjunction with a fixed suprastructure. • Excessive mechanical loading of the implants must be avoided when ball abutments are used in conjunction with implants with 3.3 mm diameter. • The healing period for implants with 3.3 mm diameter is a minimum of 12 weeks. • Telescopic crown structures on implants with 3.3 mm diameter are not allowed.

Surgery Manual Introduction

IV. Surgery Manual

1. Preparation of the Patient The patient is prepared according to the standard routine for a surgical intervention. Depending on the indication, antibiotics and anti-inflammatories may be administered before and/or after surgery. In addition, an oral or intravenous sedative may be indicated depending on the patient's history and general health status.

2. Drilling Template Before using a drilling template, it is necessary to check its outline for the planned incision line and to disinfect the template. The drilling template must also be reproducible after the flap preparation by remaining stable in place, and must adhere to the soft tissue without pressure.

3. CAMLOG ® Surgery System All the drills, drivers, and accessories required for the implantation of the particular implant configuration are systematically organized in the Surgery Set. The sequence of use of the drills and instruments in compliance with the CAMLOG surgical protocol is color-coded according to diameter. The following Surgery Sets with their matching drills are available:

Color Coding

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

Ø 3.3 mm

grey

Ø 3.8 mm

yellow

Ø 4.3 mm

red

Ø 5.0 mm

blue

Ø 6.0 mm

green

Surgery Manual CAMLOG 速 Surgery System

SCREW-LINE Surgery Set

SCREW-LINE

Surgery Manual CAMLOG 速 Surgery System

ROOT-LINE Surgery Set

ROOT-LINE

Surgery Manual CAMLOG 速 Surgery System

SCREW-CYLINDER-LINE/CYLINDER-LINE Surgery Set

SCREW-CYLINDER-LINE/CYLINDER-LINE

Surgery Manual Drilling System

Drilling System

Cooling The CAMLOG ® drilling system for implant bed preparation consists mostly of internally irrigated drills for cooling. The cooling liquid is sterile saline solution (prechilled to 5 °C/41 °F). Optimum cooling consists of a combined internal/external cooling at the angled handpiece.

Drilling Speed The drilling speed is diameter-dependent. The recommended speed is 800-300 rpm depending on the drill type. The recommended maximum drilling speed for thread tapping is 15 rpm. The tap adapter for ratchet also permits manual tapping.

Article Round bur Pilot drill 2.0 mm / depth stop Pre-drill Ø 1.7 / 2.8 mm Form drill Ø 3.3 mm / depth stop Cortical bone drill Ø 3.3 mm** Tap Ø 3.3 mm* Form drill Ø 3.8 mm / depth stop Cortical bone drill Ø 3.8 mm** Tap Ø 3.8 mm* Form drill Ø 4.3 mm / depth stop Cortical bone drill Ø 4.3 mm** Tap Ø 4.3 mm* Form drill Ø 5.0 mm / depth stop Cortical bone drill Ø 5.0 mm** Tap Ø 5.0 mm* Form drill Ø 6.0 mm / depth stop Cortical bone drill Ø 6.0 mm** Tap Ø 6.0 mm*

Speed (rpm) 800 800 600 550 550 max. 15 500 500 max. 15 400 400 max. 15 350 350 max. 15 300 300 max. 15

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 excessive 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 implant length. The maximum apical extension length is 0.6 mm. ** Use of a tap is recommended for SCREW-LINE , ROOT-LINE, and SCREW-CYLINDER-LINE Implants if the bone quality is D1 or D2. ** The SCREW-LINE cortical bone drill reduces the torque for implant insertion into cortical bone (D1).

Surgery Manual Implant Healing

4. Healing Options Introduction Depending on the indication, healing of the CAMLOG 速 implants may be managed through the transgingival or submerged techniques. Suitable components are available for the selected option.

One-step Healing (transgingival)

Two-step Healing (submerged)

Healing caps in different configurations and gingival heights are available for one-step, non-loaded healing (see the section "Healing caps").

The cover screw remains in the implant for the duration of the submerged healing period.

Esthetic Immediate Restoration

The PEEK Provisional Abutment can be used for an esthetic immediate restoration (see also the CAMLOG Compendium 2 Prosthetics section: "Temporary restoration"). 38

Surgery Manual SCREW-LINE Insertion

5. SCREW-LINE Implant Introduction The SCREW-LINE Implant is a universally indicated screw implant with the option of either Promote ® or Promote ® plus surface. It is suitable for both late implantation and immediate/delayed immediate implantation. The selected healing method may be either submerged or transgingival. The implant is easily insertable because the taper of the implant body (3°-9° depending on length and diameter) induces self-centering. The self-tapping thread provides a continuous grip on the bone and high primary stability. The macro-configuration of the implant in conjunction with the Promote ® plus surface leads to larger contact with the bone, compared with the Promote ® surface.

Area of Use/Indication for the SCREW-LINE implants with Promote ® plus Surface A smaller coronal implant shoulder is especially beneficial in treating esthetically challenging areas. The machined segment of a SCREW-LINE Implant with Promote ® plus surface measures only 0.4 mm. The implant is inserted into the bone as far as this segment. The following clinical prerequisites should be present: • Normal to thick biotype • Gingival height of at least 3.0 mm • Minimum width of 1.0 mm of the attached gingiva • Minimum distance of 2.0 mm between the attached gingiva and the mimetic musculature • Removal of the periosteum at the time of exposure to be performed at the implant insertion area only.

Apart from these requirements, the range of indications and the implant bed preparation for SCREW-LINE Implants Promote ® and Promote ® plus are identical.

SCREW-LINE Implant Promote ® plus

SCREW-LINE Implant Promote ®

Surgery Manual SCREW-LINE Insertion

SCREW-LINE Implant with Promote 速 plus Surface Overview of implant lengths and diameters.

The machined segment on the implant neck measures 0.4 mm.

SCREW-LINE Implant with Promote 速 Surface Overview of implant lengths and diameters.

The machined segment on the implant neck measures 1.6 mm.

Surgery Manual SCREW-LINE Insertion

Incision line The example indication shows the insertion of a 4.3 / 13 mm SCREW-LINE Implant in the posterior mandible. The implantation technique is one-step transperiosteal. A split-flap preparation is selected for the incision line. Initial situation

Following a somewhat lingual, paracrestal mucosal incision, a predominantly epiperiosteal flap is created on the vestibular aspect. The muscle is divided and the preparation is continued for approx. 5 mm further. The mucosa is separated 2-3 mm lingually to facilitate later suturing. Following marking of the desired implant position (if necessary with the aid of a drilling template), the periosteum is removed circularly in the area of this site alone (with a gingival punch or scalpel).

Mucosal incision

This is followed by shaping of the implant bed to match the selected implant diameter and length with the customized instruments for the SCREWLINE Implant.

Epiperiosteal split-flap preparation

Removal of the periosteum at the implant site

Surgery Manual SCREW-LINE Insertion

Pre-drill Ø 1.7 – 2.8 mm

Paralleling pin

Pilot drill Ø 2.0 mm

Pre-drill Ø 1.7 – 2.8 mm

Depth Stop

Paralleling pin

Pilot drill Ø 2.0 mm

600

16 mm 13 mm 11 mm 9 mm

Depth Stop

16 mm 13 mm 11 mm 9 mm

800

600

Depth Stop

16 mm 13 mm 11 mm 9 mm

Pre-drill Ø 1.7 – 2.8 mm

800

Pre-drill Ø 1.7 – 2.8 mm

600

Paralleling pin

Pilot drill Ø 2.0 mm

800

Paralleling pin

Round bur Ø 2.3 mm Round bur Ø 2.3 mm 800

Pilot drill Ø 2.0 mm

Ø 5.0 mm

16 mm 13 mm 11 mm 9 mm

800

16 mm 13 mm 11 mm 9 mm

0.4 mm

rpm

16 mm 13 mm 11 mm 9 mm

800

600

Depth Stop

Pre-drill Ø 1.7 – 2.8 mm

800

Paralleling pin

800

Pilot drill Ø 2.0 mm

The indication range and implant bed preparation of the SCREW-LINE Implant are identical for Promote ® and Promote ® plus surfaces.

rpm

Round bur Ø 2.3 mm

0.4 mm

Ø 6.0 mm

1.0 mm

Promote®

Optional for all diameters

Promote® plus

rpm

800

Round bur Ø 2.3 mm

rpm

Depth Stop

16 mm 13 mm 11 mm 9 mm

Round bur Ø 2.3 mm

Ø 3.3 mm rpm

Ø 3.8 mm

• Punch-mark the desired implant position with the internally irrigated Ø 2.3 mm round bur. • Deep drill along the implant axial line with the internally irrigated Ø 2.0 mm pilot drill. • Check with Ø 1.7-2.8 / 2.0 mm paralleling pin with depth marks. • Pre-drill with the internally irrigated 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 internally irrigated form drill. • Probe the implant bed hole for its bony end. • Cortical bone drilling (for bone quality D1). • Thread cutting with SCREW-LINE tap (for bone quality D1 and D2)

Drilling Sequence

Ø 4.3 mm

Implant Bed Preparation Overview of the implant bed preparation. Note: implant bed preparation is identical for SCREW-LINE Implants with Promote ® and Promote ® plus surfaces.

16 mm 13 mm 11 mm 9 mm

800

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

600

500

400

350

Promote® Promote®

Promote® plus

Promote® Promote®

Tap

Cortical bone drill

0.4 mm

Promote®

Promote® plus

Cortical bone drill

Tap

Ø 6.0

Promote® plus

300

Promote® plus

350

13 mm 11 mm 9 mm

Form drill 550

0.4 mm

350

Ø 5.0

400

Ø 4.3

Ø 3.8

Ø 3.3

Paralleling pin

Depth Stop

500

400

Ø 5.0

400

Ø 4.3

Ø 3.8

Ø 3.3

Paralleling pin

500

Tap

Cortical bone drill

13 mm 11 mm 9 mm

Form drill 550

Tap

Cortical bone drill

Ø 4.3

500

13 mm 11 mm 9 mm

Depth Stop

0.4 mm

500

Ø 3.8

Ø 3.3

Paralleling pin

Form drill 550

13 mm 11 mm 9 mm

Form drill 550

0.4 mm

550

Ø 3.8

Ø 3.3

Paralleling pin

Form drill 550

Depth Stop

Tap

Cortical bone drill

13 mm 11 mm 9 mm

Depth Stop

Promote® plus

Ø 3.3

Paralleling pin

Depth Stop

0.4 mm

300

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

Surgery Manual SCREW-LINE Insertion

Implant Bed Preparation for SCREW-LINE Implants Shaping the implant bed includes Punchmarking the cortical bone, pilot drilling, pre-drilling, and form drilling. The pilot hole 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 dental crown during preparation of the implant bed adjacent to elongated teeth. A longer irrigation tube is required for the internal irrigation system.

Drill extension

SCREW-LINE Depth Stop The SCREW-LINE pilot drill, reduced coil, and the SCREW-LINE pre-drill have a maximum working length of 16 mm. The drilling depths of 9, 11, and 13 mm are laser-marked. An insertable depth stop limits the drilling depth to the selected depth of 9, 11, or 13 mm. Caution! The pilot drill and predrill have a reduced diameter at the drill coil. The SCREW-LINE depth stops are matched to these drills.

SCREW-LINE depth stop

Surgery Manual SCREW-LINE Insertion

SCREW-LINE paralleling Pin with Depth Marks On completion of pilot drilling and predrilling, the depth and axis orientation of the implant bed are checked with the paralleling pin with depth marks. The diameter combination 1.7-2.8/2.0 mm permits consecutive use while matching the drill diameter.

Short paralleling pins are available as accessories to check the implant/antagonist alignment.

Paralleling pin, short

SCREW-LINE paralleling pin

The depth marks and diameter gradations on the paralleling pins allow to check the drilling depth and axis at each stage of pilot drilling and pre-drilling.

Surgery Manual SCREW-LINE Insertion

Punch-Marking the Cortical Bone The Ă&#x2DC; 2.3 mm internally irrigated round bur is used for Punch-marking the cortical bone, which secures the use of the drills to follow. The bur is inserted as far as the bur equator. Recommended drilling speed: 800 rpm.

Pilot Drilling The depth and axis orientation are prepared with the internally cooled pilot drill with reduced coil. The depth marks on the drill correspond to the implant lengths: 9 / 11 / 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.

If a drilling template is used, the depth stops may be placed on the pilot drill after the positions have been marked. Once drilling is complete, the depth and axis of the implant bed are checked with the paralleling pin. If several implants are to be placed, a paralleling pin is inserted in the first hole to align the subsequent implant axes. The pilot drill is aligned parallel to the paralleling pin and visually checked on two planes (sagittal and transversal).

max. 800 rpm

max. 800 rpm Round bur, Ă&#x2DC; 2.3 mm

Punch-marking the cortical bone

Pilot drill with reduced coil, Ă&#x2DC; 2.0 mm

SCREW-LINE paralleling pin

Pilot drilling

Depth measurement after pilot drilling

Surgery Manual SCREW-LINE Insertion

Pre-Drilling A tapered SCREW-LINE pre-drill with a 2.8 mm coronal and 1.7 mm apical diameter is available for the SCREWLINE configuration. The recommended drilling speed is 600 rpm. The depth marks on the drill match the implant lengths (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.

max. 600 rpm

SCREW-LINE pre-drill Ø 1.7–2.8 mm

SCREW-LINE paralleling pin

Pre-drilling

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

Depth measurement after pre-drilling

Surgery Manual SCREW-LINE Insertion

Form Drilling Diameter and Lengths Diameter- and length-calibrated form drills with reduced coil are available for each implant size. The internally irrigated form drills are color-coded and lasermarked. The form drills included in the surgery sets are supplied with a color-coded removable depth stop. This should be used with the SCREW-LINE form drill, only. Depending on the specified drilling depth (implant length), the hole diameter is expanded progressively with the series of form drills until the planned implant diameter is reached.

Ø 3.3 mm Ø 3.8 mm SCREW-LINE form drills

Ø 4.3 mm

Ø 5.0 mm

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

Length 9 mm

The protocol-specified insertion depth with depth stops in place for SCREWLINE Implants 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. If a greater insertion depth is desirable, the depth stop can be removed and the preparation will then be guided by the depth marks (black). The distances between marks are 1.0 mm, while the mark width is 0.4 mm.

11 mm

13 mm

16 mm

Ø 6.0 mm

Surgery Manual SCREW-LINE Insertion

Depth Stop During implant bed preparation, 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).

Form drill with depth stop

The depth stop must be removed before cleaning the drill. The cleaned depth stop must be placed back on the drill before sterilization (see "Preparation Instructions for the CAMLOG 速 Implant System," Art. No. J8000.0032). Depth stops may be reordered individually.

Promote 速

Form drill without depth stop

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.

Promote 速 plus

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

Surgery Manual SCREW-LINE Insertion

Adjusting the depth by 1 mm

Adjusting the depth by 2 mm

Form Drilling Once pre-drilling is complete, form drills in increasing diameters are used for finishing the final implant bed. Tissueconservative preparation of the bone is ensured by the small gradations in diameter size.

Checking the Implant Bed Results of probing tests for the absence of soft tissue in the implant bed must be filed in the patient chart. If the probe detects soft tissue, this indicates a fenestration into the adjacent tissue by the drill.

Example: Ă&#x2DC; 4.3 mm form drilling

Checking the implant bed

Surgery Manual SCREW-LINE Insertion

Cortical Bone Drilling If the bone quality is D1, the cortical bone drill enables reduced-torque implant insertion through controlled circular expansion of the implant bed in the apical area. The flattened drill tip serves as a depth stop. A color-coded, laser-marked cortical bone drill is available for each implant diameter. The cortical bone drills are internally cooled. The maximum drilling speed should not exceed 300 rpm.

Ø 3.3 mm

Ø 3.8 mm

Ø 4.3 mm

Ø 5.0 mm

Ø 6.0 mm

max. 300 rpm SCREW-LINE Cortical Bone form drills

Ø 4.3 mm cortical bone drill for implant length 13 mm

Surgery Manual SCREW-LINE Insertion

SCREW-LINE Tap Introduction All SCREW-LINE Implants come with a self-tapping thread with sand-blasted, etched surface (Promote ®, Promote ® plus). Use of a tap is recommended for bone qualities D1 or D2. The taps are internally cooled. The maximum drilling speed should not exceed 15 rpm during power-assisted tapping. We recommend manual tapping.

SCREW-LINE tap with hexagon

Ø 3.3 mm

Ø 3.8 mm

Ø 4.3 mm max. 15 rpm

Ø 5.0 mm

Ø 6.0 mm

Surgery Manual SCREW-LINE Insertion

Manual tapping is performed with the tap adapter for SCREW-LINE taps and the locked torque wrench. Make sure that the implant bed axis orientation is maintained during insertion and removal of the tap. The limit for insertion of the tap is the upper edge of the cutting blade. See also the instructions for the torque wrench on page 151.

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

Locked torque wrench

Tap Adapter, short / long

Surgery Manual SCREW-LINE Insertion

Implant Package All CAMLOG 速 implants are double-sterile packaged. The primary package (blister) of SCREW-LINE implants contains the implant with pre-installed insertion post and mounted handle.

Outer package with label

Peel-back pouch (sterile)

Primary package (sterile) with label (blister pack)

Primary package with visible implant

Opened primary package with implant and mounted handle

Cover screw located in the handle

System information on the label

Surgery Manual SCREW-LINE Insertion

Implant Positioning Protocol-compliant implant positioning (form drilling with depth stop) is achieved when the cylindrical machined implant shoulder extends 0.4 mm above the crestal bone and one of the 3 groove marks indicates the specified prosthetic position.

Driver

If it was decided to set preparation depths for the implants individually by removing the depth stop during form drilling, this should be kept in mind during implant insertion. It is possible to individually position implants with the 1.6 mm implant shoulder and Promote ÂŽ surface, or the 0.4 mm implant shoulder and Promote ÂŽ plus surface, vertically to match the drilling depth. It should be made sure, however, to position the Bioseal Bevel circularly in the cortical bone.

Insertion post

Implant

Mark

Groove Positioning

Groove

Marks are inscribed on the drivers for the SCREW-LINE Implants that match the three grooves on the CAMLOG connection. These permit to check 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 abutment angle originates at a groove.

Vestibular orientation of the groove

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

Cam

Surgery Manual SCREW-LINE Insertion

Implant Insertion The implant is removed from the primary package (blister) by the sterile handle. Contamination from non-sterile parts must be avoided. Caution! The silicone plug and cover screw must be removed from the blue handle prior to implant insertion. Taking the implant by the handle, insert it into the implant bed. Make sure to follow the orientation of the implant bed axis. If the hole has been pre-threaded, the position of the thread dog point in the cortical bone must match with that on the implant. Tip: Screw the implant carefully to the left until the thread dog point can be felt. Then, using the handle, screw the implant to the right until it obtains sufficient grip to allow withdrawal of the handle.

Inserting the implant

Optional Accessory CAMLOG 速 PickUp Instrument If the intraoral space is insufficient to allow insertion of the implant with the handle, the implant can be removed from the handle with the PickUp instrument. Slide the PickUp instrument between the implant and the handle onto the insertion post and lift off the handle. For the insertion procedure, place the selected driver on the insertion post. The implant is then inserted into the bone and the PickUp instrument is removed.

Surgery Manual SCREW-LINE Insertion

Locked-on PickUp

Placing the PickUp on the insertion post

Removing the handle

Inserting the implant

Mounting the driver and removing the PickUp

Surgery Manual SCREW-LINE Insertion

You have three options for the final insertion of the implant: - Power-assisted insertion (A) - Manual insertion with the torque wrench and driver (B) - Manual insertion with the cardanic driver (C) During insertion make sure to use the external mark for the groove position in the implant.

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

If the bone quality is D1 or D2 at the implant insertion site, the implant must be externally cooled (saline solution, 5 째C/41 째F) during the insertion.

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

C. Manual insertion with the cardanic driver.

Surgery Manual SCREW-LINE Insertion

Next, unscrew the retention screw of the insertion post with the screwdriver and remove the insertion post (Caution! Danger of aspiration). If the implant site has a weak bone structure, a holding key for insertion post is available (as an accessory) to lock the insertion post and prevent implant movement when unscrewing the retention screw. Screwdriver, extra short / short / long

Unscrewing the retention screw

Holding key for insertion post

Removing the insertion post

Surgery Manual SCREW-LINE Insertion

Submerged Healing Once the silicone plug has been removed from the handle, the cover screw is lifted with the screwdriver and screwed into the implant manually (Caution! Danger of aspiration). The cover screw must be tightened by hand only, using the screwdriver.

Inserting the cover screw

Implant with cover screw

Wound closure

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

Inserting the healing cap

Implant with healing cap

Wound closure

Surgery Manual SCREW-LINE Insertion

Accessories Adapter for Screw Implants, long, for narrow Gaps A special reduced-diameter adapter for screw implants, long, is available for implant diameters 3.3 and 3.8 mm to assist manual insertion into small gaps. The setup must be performed under sterile conditions. 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 for screw implants, long, into the screw implant. The holding sleeve is squeezed together like a collet at the level of the implant shoulder and the handle is removed. Next, the insertion post is unscrewed with the screwdriver and removed.

Setting up the holding sleeve

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

Withdrawing the handle

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

Unscrewing the retention screw

Removing the insertion post

Surgery Manual SCREW-LINE Insertion

Accessories Following unscrewing and removal of the insertion post, slide the diametermatched adapter for screw implants, long, into the implant until the cams engage the notches. To fasten, manually tighten the retention screw on the insertion guide. After removal of the holding sleeve, the implant can be inserted.

Placing adapter for screw implants, long

Tightening retention screw

Removing holding sleeve

Implant attached to adapter for screw implants

For the insertion, place the locked torque wrench over the hex of the adapter for screw implants, long, and screw the implant to its final position, making sure to line it up with the notched mark.

Inserting implant

Placing torque wrench

Turning implant into final position

Surgery Manual SCREW-LINE Insertion

Accessories Once the retention screw is unscrewed, detach the adapter for screw implants, long, from the implant. Remove the silicone plug from the prefastened handle of the implant, then pick up the cover screw with the screwdriver and insert it in the implant manually (Caution! Danger of aspiration). The cover screw must not be power tightened. A healing cap should be used for transgingival healing method (see page 137).

Unscrewing the retention screw

Removing the adapter for screw implants

Implant with cover screw

Wound closure

Inserting the cover screw

Surgery Manual ROOT-LINE Insertion

6. ROOT-LINE Implant Introduction The ROOT-LINE Implant is a root-shaped screw implant. It is suitable for delayed implantation and especially for immediate or delayed immediate implantation. The healing method may be either submerged or transgingival. It can be used in a space-limited apical bony site because of its apical taper combined with a cylindrical body. Fenestrations can be avoided through appropriate selection of the prosthetic diameter and axial orientation.

The self-tapping thread ensures high primary stability in the cylindrical area. The root-shaped macro-configuration in conjunction with the Promote 速 surface produces greater contact with the bone surface. The CAMLOG connection enables the use of every type of prosthetic restoration. Available diameters are 3.8 mm, 4.3 mm, 5.0 mm, and 6.0 mm, in lengths of 9 mm, 11 mm, 13 mm, and 16 mm.

ROOT-LINE Implant with Promote 速

Surgery Manual ROOT-LINE Insertion

ROOT-LINE Implant with Promote 速 Surface Overview of implant lengths and diameters.

The machined segment on the implant neck measures 1.6 mm

Surgery Manual ROOT-LINE Insertion

Incision Line The sample indication shows the insertion of a 4.3 mm-diameter, 13 mmlength ROOT-LINE Implant in the lateral mandible. The implantation technique is one-step transperiosteal. A split-flap preparation is selected for the incision line. Following a somewhat lingual paracrestal mucosal incision, a predominantly epiperiosteal flap is created on the vestibular aspect. The muscle is divided and the preparation is continued for approx. 5 mm further. The mucosa is prepared 2-3 mm lingually to facilitate later suturing. Following marking of the desired implant position (if necessary with the aid of a drilling template), the periosteum is removed circularly in the area of this site alone (with gingival punch or scalpel).

Initial situation

Mucosal incision

This is followed by preparing of the implant bed with the ROOT-LINE Implant-specific instruments until the desired implant diameter and length are obtained.

Epiperiosteal split-flap preparation

Removal of the periosteum at the implant position

Surgery Manual ROOT-LINE Insertion

rpm

Pre-drill Ø 2.8 mm

Paralleling pin Ø 2.0/3.3 mm

Pilot drill Ø 2.0 mm

16 mm

Depth stop

Pre-drill Ø 2.8 mm

600

Paralleling pin Ø 2.0/3.3 mm

800

13 mm 11 mm 9 mm

16 mm

Depth stop

Pre-drill Ø 2.8 mm

600

Paralleling pin Ø 2.0/3.3 mm

800

13 mm 11 mm 9 mm

800

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

Pre-drill Ø 2.8 mm

Depth stop

Paralleling pin Ø 2.0/3.3 mm

600

13 mm 11 mm 9 mm

800

Pilot drill Ø 2.0 mm

16 mm

Pilot drill Ø 2.0 mm

Round bur Ø 3.5 mm Round bur Ø 3.5 mm

800

Pilot drill Ø 2.0 mm

Ø 6.0 mm

rpm

Depth stop

13 mm 11 mm 9 mm

800

Round bur Ø 3.5 mm

rpm

16 mm

800

Round bur Ø 3.5 mm

Ø 3.8 mm rpm

Ø 5.0 mm

• Punch mark the desired implant position with the internally irrigated Ø 3.5 mm round bur. • Deep drill along the implant axial line with the internally irrigated Ø 2.0 mm pilot drill. • Check with the Ø 2.0 / 3.3 mm paralleling pin with depth marks. • Pre-drill with the internally irrigated Ø 2.8 mm pre-drill. • Check with Ø 2.8 / 3.6 mm paralleling pin with depth marks. • Shape with internally irrigated form drill. • Probe the implant bed hole for its bony end. • Use ROOT-LINE/SCREW-CYLINDERLINE tap (for bone qualities D1 and D2).

Drilling Sequence

Ø 4.3 mm

Implant Bed Preparation Overview of the implant bed preparation.

600

Surgery Manual ROOT-LINE Insertion

13 mm 11 mm 9 mm

Ø 3.8

Tap

Depth stop

Paralleling pin Ø 2.8/3.6 mm

Form drill

0.4 mm

500

13 mm 11 mm 9 mm

Ø 4.3

Ø 3.8

Tap

Depth stop

Paralleling pin Ø 2.8/3.6 mm

Form drill

0.4 mm

500

400

13 mm 11 mm 9 mm

Ø 5.0

Tap

Ø 4.3

Ø 3.8

Depth stop

Paralleling pin Ø 2.8/3.6 mm

Form drill

0.4 mm

500

400

350

13 mm 11 mm 9 mm

Ø 6.0

Tap

Ø 5.0

Ø 4.3

Ø 3.8

Depth stop

Paralleling pin Ø 2.8/3.6 mm

Form drill

0.4 mm

500

400

350

300

Surgery Manual ROOT-LINE Insertion

Implant Bed Preparation for ROOT-LINE Implants Preparation of the implant bed includes punch-marking the cortical bone, pilot drilling, pre-drilling, and profile drilling. The pilot drilling and pre-drilling define the depth and axis of the implant bed and ensure a tissue-conservative bone preparation by enlarging the diameter in small gradations.

Drill extension

Pilot Drill and Pre-Drill Depth Stop The pilot drill and pre-drill have a maximum working length of 16 mm. The drilling depths of 9, 11, and 13 mm are laser-marked. An insertable depth stop limits the drilling depth to the selected depth of 9, 11, or 13 mm. Caution! The depth stops, pilot drills, and pre-drills shown here should be used only for implant bed shaping of ROOT-LINE, SCREW-CYLINDERLINE, and CYLINDER-LINE Implants. These instruments are closely matched to one another.

Depth stop for pilot drills and pre-drills

Surgery Manual ROOT-LINE Insertion

Paralleling Pin with Depth Marks On completion of pilot drilling and predrilling, the depth and axis orientation are checked with the paralleling pin with depth marks. The diameter combinations 2.0 / 3.3 mm and 2.8 / 3.6 mm permit consecutive use matching the pre-drill diameter.

Paralleling pins, long, with depth marks

Short paralleling pins are available as accessories to check the implant/antagonist alignment.

Paralleling pins, short

The depth marks and diameter gradations on the paralleling pins allow to check the drilling depth and axis at each stage of pilot drilling and pre-drilling.

Surgery Manual ROOT-LINE Insertion

Punch-Marking the Cortical Bone The Ø 3.5 mm internally irrigated round bur is used for punch-marking the cortical bone, which secures the use of the drills to follow. The bur is inserted as far as the bur equator. Recommended drilling speed: 800 rpm.

Pilot Drilling The depth and axis orientation of the implant bed are prepared with the internally irrigated pilot drill. The depth marks on the drill correspond to the implant lengths of 9 / 11 / 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.

If a drilling template is used, the depth stops may be placed on the pilot drills after the positions are marked. Once drilling is complete, the depth and axis of the implant bed are checked with the paralleling pin. If several implants are to be placed, a paralleling pin is inserted in the first hole to align the subsequent implant axes. The pilot drill is aligned parallel to the paralleling pin and visually checked on two planes (sagittal and transversal).

max. 800 rpm

Round bur, Ø 3.5 mm

Pilot drill, Ø 2.0 mm

Punch-marking the cortical bone

Pilot drilling

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

Paralleling pin, short Ø 2.0 / 3.3 mm

Depth / axis check after pilot drilling Ø 2.0 mm

Surgery Manual ROOT-LINE Insertion

Pre-Drilling An internally irrigated, pre-drill five bladed cutter, with a 2.8 mm diameter is available for the ROOT-LINE configuration. The depth marks on the drill match the implant lengths. For safety reasons, a depth stop matching the proposed implant length should be used. Further drilling is performed with the form drills. The recommended drilling speed is 600 rpm.

max. 600 rpm

Pre-drill, five bladed cutter, Ø 2.8 mm

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

Pre-drilling

Checking the drilling depth after pre-drilling Ø 2.8 mm

Paralleling pin, short Ø 2.8 / 3.6 mm

Surgery Manual ROOT-LINE Insertion

Form Drilling Diameter and Lengths Diameter- and length-calibrated form drills are available for each implant size. The internally irrigated 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 (height 2 mm). Depending on the defined drilling depth (implant length), the hole diameter is expanded progressively with the series of form drills until the planned implant diameter is reached.

Ø 3.8 mm

Ø 4.3 mm

Ø 5.0 mm

Ø 6.0 mm

Length 13 mm

16 mm

ROOT-LINE form drills

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

9 mm

The protocol-compliant insertion depth for ROOT-LINE Implants with depth stop in place is the implant length (9 / 11 / 13 mm) minus 0.4 mm with the circular stop at the crestal bone level so that the implant shoulder extends 0.4 mm above the bone level. If a greater insertion depth is desirable, the depth stop can be removed and the preparation will then be guided by the depth mark.

11 mm

Surgery Manual ROOT-LINE Insertion

Depth Stop During form drilling the depth stop rests on the highest point of the crest and thereby limits the insertion depth. Since the circular bone level may be irregular, the form drills are equipped with a removable depth stop. If a greater insertion depth 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 drills (delivered without depth stops). Form drilling with depth stop

Form drilling without depth stop

Depth stops must be removed before cleaning the drills. The cleaned depth stops must be placed back on the drill before sterilization (see "Preparation Instructions for the CAMLOG 速 Implant System," Art. No. J8000.0032).

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

Surgery Manual ROOT-LINE Insertion

Adjusting the depth by 1 mm

Adjusting the depth by 2 mm

Surgery Manual ROOT-LINE Insertion

Form Drilling Once pre-drilling is completed, form drills in increasing diameters are used for finishing the final implant bed. Tissue-conservative preparation of the bone is ensured by the small gradations in diameter size.

Example: Ă&#x2DC; 4.3 mm form drill

Checking the implant bed

Surgery Manual ROOT-LINE Insertion

ROOT-LINE Tap Introduction All ROOT-LINE Implants come with a selftapping thread with sand-blasted, etched surface (Promote ®). Use of a tap is recommended with bone qualities D1 or D2. The taps are internally irrigated. The maximum drilling speed should not exceed 15 rpm during power-assisted tapping. We recommend manual tapping.

ROOT-LINE, SCREW-CYLINDER-LINE tap

Ø 3.8 mm

Ø 4.3 mm

Ø 5.0 mm

max. 15 rpm

Ø 6.0 mm

Surgery Manual ROOT-LINE Insertion

Manual thread tapping is performed with the adapter with ISO shaft and the locked torque wrench. Make sure that the implant bed axis orientation is maintained during insertion and removal of the tap. The limit for insertion of the tap is the upper edge of the cutting blade. See also the instructions for the torque wrench on page 151.

Locked torque wrench

Adapter, ISO shaft

Caution! The ROOT-LINE taps must not be used with SCREW-LINE Implants.

Surgery Manual ROOT-LINE Insertion

Implant Package All CAMLOG 速 implants are double-sterile packaged. The primary package (blister) of ROOT-LINE Implants contains the implant with pre-installed insertion post and mounted handle.

Outer package with label

Peel-back pouch (sterile)

Primary package (sterile) with label (blister pack)

Primary package with visible implant

Opened primary package with implant and mounted handle

Cover screw located in the handle

System information on the label

Surgery Manual ROOT-LINE Insertion

Implant Positioning Driver

The protocol-compliant implant position (form drilling with depth stop) is achieved when the cylindrical machined implant shoulder protrudes 0.4 mm above the crestal bone and one of the 3 groove marks indicates the specified prosthetic position. If it was decided to set the drilling depth for the implants individually by removing the depth stop during form drilling, this should be kept in mind during implant insertion. It is possible to individually position the 1.6 mm implant shoulder vertically. You should make sure, however, to position the Bioseal Bevel circularly in the cortical bone.

Insertion post

Implant

Mark

Groove Positioning

Cam

Groove

Vestibular orientation of the groove

Marks are inscribed on the drivers for the ROOT-LINE Implants that match the three grooves on the CAMLOG connection. These permit you to check 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 abutment angle originates at a groove. Note: Keep in mind during positioning of the grooves that turning to the next groove position (120째) will cause the screw implant to be inserted about 0.2 mm deeper. 81

Surgery Manual ROOT-LINE Insertion

Implant Insertion The implant is removed from the primary package (blister) by the sterile handle. Contamination from non-sterile parts must be avoided. Caution! The silicone plug and cover screw must be removed from the blue handle prior to implant insertion. Taking the implant by the handle, insert it into the implant bed. Make sure to observe the orientation of the implant bed axis. If the hole has been prethreaded, the position of the thread dog point in the cortical bone must align with that on the implant. Tip: Screw the implant carefully to the left until the thread dog point can be felt. Then, using the handle, screw the implant to the right until it obtains sufficient grip to allow withdrawal of the handle.

Implant insertion

Optional Accessory CAMLOG 速 PickUp Instrument If the intraoral space is insufficient to allow insertion of the implant with the handle, the implant can be separated from the handle with the PickUp instrument. Slide the PickUp instrument between the implant and the handle onto the insertion post and lift off the handle. For the insertion procedure, place the selected driver on the insertion post. Then insert the implant into the bone and remove the PickUp instrument.

Surgery Manual ROOT-LINE Insertion

Placing the PickUp on the insertion post Locked-on PickUp

Removing the handle

Inserting the implant

Mounting the driver and removing the PickUp

Surgery Manual ROOT-LINE Insertion

You have three options for the final insertion of the implant: - Power-assisted insertion (A) - Manual insertion with the torque wrench and driver (B) - Manual insertion with the cardanic driver (C) During insertion, make sure to use the external mark for the groove position in the implant.

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

If the bone quality is D1 or D2 at the implant insertion site, the implant must be externally cooled (saline solution, 5째C/41째F) during the insertion.

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

C. Manual insertion with the cardanic driver.

Surgery Manual ROOT-LINE Insertion

Next, extract the retention screw of the insertion post with the screwdriver and remove the insertion post (Caution! Danger of aspiration). If the implant site has a weak bone structure, a holding key for insertion post is available (as an accessory) to lock the insertion post and prevent implant movement when loosening the retention screw. Screwdriver, extra short / short / long

Loosening the retention screw

Holding key for insertion post

Removing the insertion post

Surgery Manual ROOT-LINE Insertion

Inserting the cover screw

Implant with cover screw

Wound closure

Inserting the healing cap

Implant with healing cap

Wound closure

Surgery Manual ROOT-LINE Insertion

Accessories Adapter for Screw Implants, long, for narrow Gaps A special reduced-diameter adapter for screw implants, long, is available for implant diameter 3.8 mm to assist manual insertion into small gaps. The set-up must be performed under sterile conditions. 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 for screw implants, long, into the screw implant. The holding sleeve is squeezed together like a collet at the level of the implant shoulder and the handle is removed. Next, the insertion post is unscrewed with the screwdriver and removed.

Setting up the holding sleeve

Adapter for screw implants, long, Ă&#x2DC; 3.8 mm

Withdrawing the handle

Holding sleeve for implants to guide the adapter for screw implants, long, into the screw implant, Ă&#x2DC; 3.8 mm

Unscrewing the retention screw

Removing the insertion post

Surgery Manual ROOT-LINE Insertion

Placing adapter for screw implants, long

Tightening retention screw

Removing holding sleeve

Implant attached to adapter for screw implants

For the insertion, place the locked torque wrench over the hex of the adapter for screw implants, long, and screw the implant to its final position, making sure to align it with the notched mark.

Inserting implant

Placing torque wrench

Turning implant into final position

Surgery Manual ROOT-LINE Insertion

Unscrewing the retention screw

Removing the adapter for screw implants

Implant with cover screw

Wound closure

Inserting the cover screw

Surgery Manual SCREW-CYLINDER-LINE Insertion

7. SCREW-CYLINDERLINE Implant Introduction The SCREW-CYLINDER-LINE Implant (with Promote 速 surface) is particularly suitable for restorations in structurally weak sites in the posterior maxilla. In conjunction with sinus floor elevation and augmentation, its special configuration permits the use of the residual crestal bone height (>5 mm) for primary stabilization of the implant through its threaded segment.

The cylindrical apical segment preserves the sinus mucosa during insertion of the implant (no thread edges) and provides superior adaptation to the particular bone augmentation material used. The CAMLOG connection enables the use of every type of prosthetic restoration. Available diameters are 3.8 mm, 4.3 mm, 5.0 mm, and 6.0 mm, in lengths of 9 mm, 11 mm, 13 mm, and 16 mm.

SCREW-CYLINDER-LINE Implant with Promote 速

Surgery Manual SCREW-CYLINDER-LINE Insertion

SCREW-CYLINDER-LINE Implant with Promote 速 Surface Overview of implant lengths and diameters.

The machined segment on the implant neck measures 1.6 mm.

Surgery Manual SCREW-CYLINDER-LINE Insertion

Incision Line and Sinus Floor Elevation/ Augmentation The example indication shows the insertion of a 4.3 / 13 mm SCREW-CYLINDER-LINE Implant in the posterior maxilla with simultaneous sinus floor elevation and augmentation. The implantation technique is two-stage. A full flap preparation is selected for the incision line. A residual crestal bone height of at least 5 mm is required for use of a SCREWCYLINDER-LINE Implant. Following a somewhat palatal, paracrestal mucosal incision, a full flap is prepared on the vestibular aspect as far as the required height to outline the sinus window. A periosteal slit is performed at the superior margin of the flap to ensure tension-free wound closure later. The design of the window and sinus floor elevation are performed following standard surgical practice. Make sure to leave sufficient distance between the lower edge of the window and the alveolar ridge. Augmentation material is applied medially prior to preparation of the implant site, because this area is difficult to access after implantation. In addition, it helps to retain the elevated mucosa cranially.

Initial situation

Mucoperiosteal incision

Full flap preparation with periosteal slit

Sinus floor elevation with partial medial augmentation

This is followed by preparing of the implant bed to match the selected implant diameter with the customized instruments for the SCREW-CYLINDERLINE Implant.

Surgery Manual SCREW-CYLINDER-LINE Insertion

rpm

Paralleling pin Ø 2.0/3.3 mm

Pilot drill Ø 2.0 mm

16 mm

Depth stop

Paralleling pin Ø 2.0/3.3 mm

800

13 mm 11 mm 9 mm

800

16 mm

Depth stop

13 mm 11 mm 9 mm

800

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

Paralleling pin Ø 2.0/3.3 mm

Depth stop

13 mm 11 mm 9 mm

800

Pilot drill Ø 2.0 mm

16 mm

Pilot drill Ø 2.0 mm

Round bur Ø 3.5 mm Round bur Ø 3.5 mm

800

Paralleling pin Ø 2.0/3.3 mm

Ø 6.0 mm

rpm

Depth stop

13 mm 11 mm 9 mm

Pilot drill Ø 2.0 mm

rpm

16 mm

800

Round bur Ø 3.5 mm

Ø 4.3 mm

rpm

Round bur Ø 3.5 mm

Ø 3.8 mm

Drilling Sequence

Ø 5.0 mm

Implant Bed Preparation Overview of the implant bed preparation. • Punch-mark the desired implant position with the internally irrigated Ø 3.5 mm round bur. • Deep drill along the implant axial line with the internally irrigated Ø 2.0 mm pilot drill. • Check with the Ø 2.0 / 3.3 mm paralleling pin with depth marks. • If desired, use of the planisher to level crestal bone irregularities. • Pre-drill with the internally irrigated Ø 2.8 mm pre-drill. • Check with Ø 2.8 / 3.6 mm paralleling pin with depth marks. • Pre-drill with the internally irrigated Ø 3.3 mm pre-drill. • Check with the Ø 2.0 / 3.3 mm paralleling pin with depth marks. • Pre-drill with the internally irrigated Ø 3.6 mm pre-drill. • Check with Ø 2.8 / 3.6 mm paralleling pin with depth marks. • Shape with internally irrigated form drill. • Probe the implant bed hole for its bony end. • Thread cutting with ROOT-LINE/ SCREW-CYLINDER-LINE tap (for bone qualities D1 and D2).

600

550

550 Depth stop

13 mm 11 mm 9 mm

500

Depth stop

13 mm 11 mm 9 mm

500

300 Tap

500

Tap

13 mm 11 mm 9 mm

Tap

Form drill Ø 4.3 mm

Paralleling pin Ø 2.8/3.6 mm

550

Form drill Ø 5.0 mm

550 Depth stop

Paralleling pin Ø 2.8/3.6 mm

Pre-drill Ø 3.6 mm

Pre-drill Ø 3.3 mm

Pre-drill Ø 2.8 mm

Pre-drill Ø 3.3 mm

Pre-drill Ø 2.8 mm

Tap

Form drill Ø 3.8 mm

Paralleling pin Ø 2.0/3.3 mm

13 mm 11 mm 9 mm

Form drill Ø 6.0 mm

600 Depth stop

Paralleling pin Ø 2.8/3.6 mm

600

Pre-drill Ø 3.6 mm

Pre-drill Ø 3.3 mm

Pre-drill Ø 2.8 mm 600

Pre-drill Ø 3.6 mm

Pre-drill Ø 3.3 mm

Pre-drill Ø 2.8 mm

Surgery Manual SCREW-CYLINDER-LINE Insertion

500

400

350

0.4 mm

* 0.4 mm

0.4 mm

Surgery Manual SCREW-CYLINDER-LINE Insertion

Implant Bed Preparation for SCREW-CYLINDER-LINE Implants Preparation of the implant bed includes punch-marking the cortical bone, pilot drilling, pre-drilling, and form drilling. The pilot drilling and pre-drilling define the depth and axis of the implant bed and ensure tissue-conservative bone preparation by enlarging the diameter in small gradations.

Drill extension

Pilot Drill and Pre-Drill Depth Stop The pilot drill and pre-drill have a maximum working length of 16 mm. The drilling depths of 9, 11, and 13 mm are laser-marked. An insertable depth stop limits the drilling depth to the selected depth of 9, 11, or 13 mm. Caution! The depth stops for pilot drills, and pre-drills five bladed cutter, shown here should be used only for implant bed preparation of ROOTLINE, SCREW-CYLINDER-LINE, and CYLINDER-LINE Implants. These instruments are closely matched to one another. 96

Depth stop for pilot drills and pre-drills

Surgery Manual SCREW-CYLINDER-LINE Insertion

Paralleling pins, long, with depth marks

Short paralleling pins are available as accessories to check the implant/antagonist alignment.

Paralleling pins, short

The depth marks and diameter gradations on the paralleling pins allow you to check the drilling depth and axis at each stage of pilot drilling and predrilling.

Surgery Manual SCREW-CYLINDER-LINE Insertion

Punch-Marking the Cortical Bone The Ø 3.5 mm internally irrigated round bur is used for punch-marking the cortical bone, which secures application of the drills to follow. The bur is inserted as far as the bur equator. Recommended drilling speed: 800 rpm.

Pilot Drilling The depth and axis of the implant bed are set with the internally irrigated pilot drill. The depth marks on the drill correspond to the implant lengths of 9 / 11 / 13 mm. The maximum drilling depth is 16 mm. For safety reasons, a depth stop matching the proposed implant length should be used.

If a drilling template is used, the depth stops may be installed on the pilot drills after the positions are marked. Once drilling is complete, the depth and axis of the implant bed are checked with the paralleling pin. If several implants are to be placed, a paralleling pin is inserted in the first hole to align the subsequent implant axes. The pilot drill is aligned parallel to the paralleling pin and visually checked on two planes (sagittal and transversal). Recommended drilling speed: 800 rpm.

max. 800 rpm max. 800 rpm

Round bur Ø 3.5 mm

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

Pilot drill, Ø 2.0 mm

Depth/axis check after pilot drilling Ø 2.0 mm Punch-marking the cortical bone

Pilot drilling

Paralleling pin, short Ø 2.0 / 3.3 mm

Parallelism/axis check after pilot drilling Ø 2.0 mm

Surgery Manual SCREW-CYLINDER-LINE Insertion

Pre-Drilling Internally irrigated pre-drills, five bladed cutter, are available for the SCREWCYLINDER-LINE Implants; the available diameters are 2.8 mm / 3.3 mm / 3.6 mm. The recommended drilling speed is 600 rpm. The depth marks on the drill match the implant lengths. For safety reasons, a depth stop matching the proposed implant length should be used.

The implant bed preparation is performed with pre-drills, five bladed cutter, in increasing size with reference to the selected implant diameter and insertion depth. Then, the implant bed is finished to the final size with a form drill of appropriate length.

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

Paralleling pin, short Ø 2.8 / 3.6 mm

Pre-Drill, five bladed Cutter Sequence for SCREW-CYLINDER-LINE Implants For implant Ø 3.8 mm

For implant Ø 4.3 mm

Pre-drill

Ø 2.8 mm

Ø 3.3 mm

Ø 3.6 mm

Form drill Ø 3.8 mm

Form drill Ø 4.3 mm

For implant Ø 5.0 mm

For implant Ø 6.0 mm

Form drill Ø 5.0 mm

Form drill Ø 6.0 mm

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

Pre-drill, five bladed cutter, max 600 rpm Ø 2.8 mm

Ø 3.3 mm

Ø 3.6 mm Ø 2.8 mm pre-drilling

Drilling depth check after pre-drilling Ø 2.8 mm

Parallelism/axis check after pre-drilling Ø 2.8 mm

Surgery Manual SCREW-CYLINDER-LINE Insertion

Note If a simultaneous implantation into the augmented sinus is to be performed, pre-drilling continues only until penetration of the sinus cortical bone is felt. The use of a 9-mm depth stop is for demonstration purposes only since this configuration is also universally applicable. During final form drilling, the shortest possible form drill must be used to shape the Bioseal Bevel as far as the depth stop.

Pre-drilling Ø 3.3 mm

Drilling depth check after pre-drilling Ø 3.3 mm

Parallelism/axis check after pre-drilling Ø 3.3 mm

Pre-drilling Ø 3.6 mm

Drilling depth check after pre-drilling Ø 3.6 mm

Parallelism/axis check after pre-drilling Ø 3.6 mm

100

Surgery Manual SCREW-CYLINDER-LINE Insertion

Form Drilling Diameter and Lengths Diameter- and length-calibrated form drills are available for the SCREWCYLINDER-LINE Implants. The internally irrigated 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 (height 2 mm). The implant bed is shaped to its final size with the form drill matching the selected implant size. For bone qualities D1 or D2, the use of increasing diameter form drills is recommended.

SCREW-CYLINDER-LINE form drills Ø 3.8 mm

Ø 4.3 mm

Ø 5.0 mm

Ø 6.0 mm

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

Length 9 mm

11 mm

13 mm

16 mm

The protocol-compliant insertion depth for SCREW-CYLINDER-LINE Implants with depth stop in place is the implant length (9 / 11 / 13 / 16 mm) minus 0.4 mm with the circular stop at the crestal bone level, so that the implant shoulder extends 0.4 mm above the bone level. If a greater insertion depth is desirable, the depth stop can be removed and the preparation will then be guided by the depth mark.

101

Surgery Manual SCREW-CYLINDER-LINE Insertion

Form drilling with depth stop

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

102

Form drilling without depth stop

Surgery Manual SCREW-CYLINDER-LINE Insertion

Adjusting the depth by 1 mm

Adjusting the depth by 2 mm

Ă&#x2DC; 4.3 mm form drilling

103

Surgery Manual SCREW-CYLINDER-LINE Insertion

SCREW-CYLINDER-LINE Tap Introduction All SCREW-CYLINDER-LINE Implants come with a self-tapping thread with sand-blasted, etched surface (Promote ®). Use of a tap is recommended with bone qualities D1 or D2. The taps are internally irrigated. The maximum drilling speed should not exceed 15 rpm during power-assisted tapping. We recommend manual tapping.

ROOT-LINE, SCREW-CYLINDER-LINE taps

Ø 3.8 mm

Ø 4.3 mm

Ø 5.0 mm

max. 15 rpm

104

Ø 6.0 mm

Surgery Manual SCREW-CYLINDER-LINE Insertion

Manual tapping is performed with the adapter with ISO shaft and the locked torque wrench. Make sure that the implant bed axis orientation is maintained during insertion and removal of the tap. The limit for insertion of the tap is the upper edge of the cutting blade. See also the instructions for the torque wrench on page 151.

Locked torque wrench

Adapter, ISO shaft

Caution! The SCREW-CYLINDER-LINE taps must not be used with SCREWLINE Implants. Note Since no tapping is required in the maxilla for bone qualities D3 or D4, we show a situation in the mandible for demonstration purposes.

105

Surgery Manual SCREW-CYLINDER-LINE Insertion

Implant Package All CAMLOG 速 implants are double-sterile packaged. The primary package (blister) of SCREW-CYLINDER-LINE Implants contains the implant with pre-installed insertion post and mounted handle.

Outer package with label

Peel-back pouch (sterile)

Primary package (sterile) with label (blister pack)

Primary package with visible implant

Opened primary package with implant and mounted handle

Cover screw located in the handle

System information on the label

106

Surgery Manual SCREW-CYLINDER-LINE Insertion

Implant Positioning Driver

The protocol-compliant implant position (form drilling with depth stop) is achieved when the cylindrical machined implant shoulder extends 0.4 mm above the crestal bone and one of the 3 groove marks indicates the specified prosthetic position. If it was decided to set the drilling depth for the implants individually by removing the depth stop during form drilling, this should be kept in mind during implant insertion. It is possible to individually position the 1.6 mm implant shoulder vertically to match the drill hole. You should make sure, however, to position the Bioseal Bevel circularly in the cortical bone.

Insertion post

Implant

Mark

Cam

Groove Positioning Marks are inscribed on the drivers for the SCREW-CYLINDER-LINE Implants that match the three grooves on the CAMLOG connection. These permit you to check 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 abutment angle originates at a groove.

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

107

Surgery Manual SCREW-CYLINDER-LINE Insertion

Implant Insertion The implant is removed from the primary package (blister) by the sterile handle. Contamination from non-sterile parts must be avoided. Caution! The silicone plug and cover screw must be removed from the blue handle prior to implant insertion. Taking the implant by the handle, insert it into the implant bed. Make sure to follow the orientation of the implant bed axis. If the hole has been prethreaded, the position of the thread dog point in the cortical bone must mate with that on the implant. Tip: Screw the implant carefully to the left until the thread dog point can be felt. Then, using the handle, screw the implant to the right until it obtains sufficient grip to allow withdrawal of the handle.

Inserting the implant

108

Optional Accessory CAMLOG 速 PickUp Instrument If the intraoral space is insufficient to allow insertion of the implant with the handle, the implant can be separated from the handle with the PickUp instrument. Slide the PickUp instrument between the implant and the handle onto the insertion post and lift off the handle. For the insertion procedure, place the selected driver on the insertion post. The implant is then inserted into the bone and the PickUp instrument is withdrawn.

Surgery Manual SCREW-CYLINDER-LINE Insertion

Install the PickUp on the insertion post

Removing the handle

Locked-on PickUp

Inserting the implant

Mounting the driver and removing the PickUp

109

Surgery Manual SCREW-CYLINDER-LINE Insertion

You have three options for the final insertion of the implant: - Power-assisted insertion (A) - Manual insertion with the torque wrench and driver (B) - Manual insertion with the cardanic driver (C) During insertion, make sure to use the external mark for the groove position in the implant.

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

110

If the bone quality is D1 or D2 at the implant insertion site, the implant must be externally cooled (saline solution, 5 째C/41째F) during the insertion.

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

C. Manual insertion with the cardanic driver.

Surgery Manual SCREW-CYLINDER-LINE Insertion

Next, loosen the retention screw of the insertion post with the screwdriver and remove the insertion post (Caution! Danger of aspiration). If the implant site has a weak bone structure, a holding key for insertion post is available (as an accessory) to lock the insertion post and prevent implant movement when loosening the retention screw.

Holding key for insertion post Screwdriver, extra short / short / long

Loosening the retention screw

Removing the insertion post

111

Surgery Manual SCREW-CYLINDER-LINE Insertion

Once the silicone plug has been removed from the handle, the cover screw is lifted with the screwdriver and screwed into the implant manually (Caution! Danger of aspiration). The cover screw must be tightened by hand only, using the screwdriver. A healing cap should be used for the transgingival healing method (see page 137).

Implant with cover screw

If the periosteum is not intact, we recommend use of a membrane

Suture line

Wound closure

Inserting the cover screw

112

Surgery Manual SCREW-CYLINDER-LINE Insertion

Accessories Adapter for Screw Implants, long, for narrow Gaps A special reduced-diameter adapter for screw implants, long, is available for implant diameter 3.8 mm to assist manual insertion into small gaps. The set-up must be performed under sterile conditions. After removal from the primary package (blister) the color-coded holding sleeve for implants with correct diameter is inserted over the endosseous part of the implant to guide the adapter for screw implants, long, onto the screw implant. The holding sleeve is squeezed together like a collet at the level of the implant shoulder and the handle is removed. Next, the insertion post is unscrewed with the screwdriver and removed.

Setting up the holding sleeve

Adapter for screw implants, long, Ă&#x2DC; 3.8 mm

Withdrawing the handle

Holding sleeve for implants to guide the adapter for screw implants, long, onto the screw implant, Ă&#x2DC; 3.8 mm

Unscrewing the retention screw

Removing the insertion post

113

Surgery Manual SCREW-CYLINDER-LINE Insertion

Accessories Following loosening and removal of the insertion post, slide the diametermatched adapter for screw implants onto the implant until the cams engage the notches. To fasten, hand-tighten the retention screw on the adapter for screw implants. Following removal of the holding sleeve, the implant can be inserted.

Placing adapter for screw implants, long

Tightening retention screw

Removing holding sleeve

Implant attached to adapter for screw implants

For the insertion, place the locked torque wrench over the hex of the adapter for screw implants, long, and screw the implant into its final position, making sure to align it with the notched mark.

Inserting implant

114

Placing torque wrench

Turning implant into final position

Surgery Manual SCREW-CYLINDER-LINE Insertion

Accessories Once the retention screw is loosened, detach the adapter for screw implants, long, from the implant. Remove the silicone plug from the prefastened handle of the implant, then pick up the cover screw with the screwdriver and insert it into the implant manually (Caution! Danger of aspiration). The cover screw must not be power tightened. A healing cap should be used for the transgingival healing method (see page 137).

Loosening the retention screw

Removing the adapter for screw implants

Implant with cover screw

Wound closure

Inserting the cover screw

115

116

Surgery Manual CYLINDER-LINE Insertion

8. CYLINDER-LINE Implant Introduction CYLINDER-LINE Implants with TPS surface are universally applicable. The advantage of this implant type is its simple, time-saving application procedure.

Available diameters are 3.3 mm, 3.8 mm, 4.3 mm, 5.0 mm, and 6.0 mm, in lengths of 9 mm, 11 mm, 13 mm, and 16 mm (for Ă&#x2DC; 3.3 mm diameters, the lengths are 11 mm, 13 mm, and 16 mm).

The CAMLOG connection enables the use of every type of prosthetic restoration. CYLINDER-LINE Implant, TPS

117

Surgery Manual CYLINDER-LINE Insertion

CYLINDER-LINE Implant with TPS Surface Overview of implant lengths and diameters.

The machined segment on the implant neck measures 1.6 mm (on the Ă&#x2DC; 3.3 mm implant, the machined segment is 2.0 mm).

118

Surgery Manual CYLINDER-LINE Insertion

Incision line The example indication shows the insertion of a CYLINDER-LINE Implant with 4.3 mm diameter and 13 mm length in the lateral mandible. The implantation technique is single-stage transperiosteal. A split-flap preparation is selected for the incision line. Following a somewhat lingual, paracrestal mucosal incision, a predominantly epiperiosteal flap is created on the vestibular aspect. The muscle is divided and the preparation is continued for approx. 5 mm further. The mucosa is prepared 2-3 mm lingually to facilitate later suturing. Following marking of the desired implant position (if necessary with the aid of a drilling template), the periosteum is removed circularly in the area of this site alone (with a gingival punch or scalpel).

Initial situation

Mucosal incision

This is followed by preparation of the implant bed to match the selected implant diameter and length with the customized instruments for the CYLINDER-LINE Implant.

Epiperiosteal split-flap preparation

Removal of the periosteum at the implant site

119

Surgery Manual CYLINDER-LINE Insertion

rpm

120

13 mm 11 mm 9 mm

Depth stop

Paralleling pin Ø 2.0/3.3 mm

Depth stop

Paralleling pin Ø 2.0/3.3 mm

800

Pilot drill Ø 2.0 mm

Round bur Ø 3.5 mm

800

Paralleling pin Ø 2.0/3.3 mm

Pilot drill Ø 2.0 mm

Depth stop

16 mm

Depth stop

16 mm 13 mm 11 mm 9 mm

800

Pilot drill Ø 2.0 mm

800

16 mm 13 mm 11 mm 9 mm

800

16 mm 13 mm 11 mm 9 mm

800

Paralleling pin Ø 2.0/3.3 mm

Pilot drill Ø 2.0 mm

Round bur Ø 3.5 mm Round bur Ø 3.5 mm

800

Paralleling pin Ø 2.0/3.3 mm

Ø 6.0 mm

rpm

800

Pilot drill Ø 2.0 mm

rpm

13 mm 11 mm 9 mm

Round bur Ø 3.5 mm

rpm

Depth stop

16 mm

Round bur Ø 3.5 mm

Ø 3.3 mm Ø 3.8 mm

rpm

Ø 5.0 mm

• Punch-mark the desired implant position with the internally irrigated Ø 3.5 mm round bur. • Deep drill along the implant axial line with the internally irrigated Ø 2.0 mm pilot drill. • Check with the Ø 2.0 / 3.3 mm paralleling pin with depth marks. • If desired, use of the planisher to level crestal bone irregularities. • Pre-drill with the internally irrigated Ø 2.8 mm pre-drill. • Check with Ø 2.8 / 3.6 mm paralleling pin with depth marks. • Pre-drill with the internally irrigated Ø 3.3 mm pre-drill. • Check with the Ø 2.0 / 3.3 mm paralleling pin with depth marks. • Pre-drill with the internally irrigated Ø 3.6 mm pre-drill. • Check with Ø 2.8 / 3.6 mm paralleling pin with depth marks. • Shape with internally irrigated form drill. • Probe the implant bed hole for its bony end.

Drilling Sequence

Ø 4.3 mm

Implant Bed Preparation Overview of the implant bed preparation.

800

13 mm 11 mm 9 mm

TPS TPS TPS

Ø 4.3 mm

TPS

Ø 5.0 mm

0.4 mm

TPS

Paralleling pin Ø 2.8/3.6 mm

Ø 3.6 mm

13 mm 11 mm 9 mm

Ø 6.0 mm

Form drill 350

500

Depth stop Ø 3.3 mm

Ø 2.8 mm

Paralleling pin Ø 2.8/3.6 mm

Ø 3.6 mm

Ø 3.3 mm

Ø 2.8 mm

13 mm 11 mm 9 mm

500

0.4 mm

Form drill 400

500

Depth stop

Pre-drill, five bladed cutter 600 550

Paralleling pin Ø 2.8/3.6 mm

Ø 3.6 mm

13 mm 11 mm 9 mm

Pre-drill, five bladed cutter 600 550

0.4 mm

Form drill 500

Depth stop Ø 3.3 mm

Ø 2.8 mm

Pre-drill, five bladed cutter 600 550

Ø 3.8 mm

Paralleling pin Ø 2.0/3.3 mm

Depth stop

Pre-drill, five bladed cutter 600 550

0.4 mm

Form drill 550

Ø 3.3 mm

Ø 2.8 mm

Pre-drill, five bladed cutter 600

Ø 3.3 mm

Ø 2.8 mm

Depth stop

Paralleling pin Ø 2.8/3.6 mm

Chirurgie-Manual CYLINDER-LINE Insertion

0.4 mm

Form drill 300

121

Surgery Manual CYLINDER-LINE Insertion

Implant Bed Preparation for CYLINDER-LINE Implants Preparation of the implant bed includes punch-marking the cortical bone, pilot drilling, pre-drilling, and form drilling. The pilot drilling and pre-drilling define the depth and axis of the implant bed and ensure tissue-conservative bone preparation by enlarging the diameter in small gradations.

Drill extension

Pilot Drill and Pre-Drill Depth Stop The pilot drill and pre-drill have a maximum working length of 16 mm. The drilling depths of 9, 11, and 13 mm are laser-marked. An insertable depth stop limits the drilling depth to the selected depth of 9, 11, or 13 mm. Caution! The depth stops for pilot drills, and pre-drills five bladed cutter, shown here should be used only for implant bed shaping of ROOT-LINE, SCREW-CYLINDER-LINE, and CYLINDER-LINE Implants. These instruments are closely matched to one another.

122

Depth stop for pilot drills and pre-drills

Surgery Manual CYLINDER-LINE Insertion

Paralleling pins, long, with depth marks

Short paralleling pins are available as accessories to check the implant/antagonist alignment.

Paralleling pins, short

The depth marks and diameter gradations on the paralleling pins allow to check the drilling depth and axis at each stage of pilot drilling and pre-drilling.

123

Surgery Manual CYLINDER-LINE Insertion

max. 800 rpm

Round bur, Ø 3.5 mm

Paralleling pin, short Ø 2.0 / 3.3 mm

Pilot drill, Ø 2.0 mm

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

Punch-marking the cortical bone

124

Pilot drilling

Depth/axis check after pilot drilling Ø 2.0 mm

Parallelism/axis check after pilot drilling

Surgery Manual CYLINDER-LINE Insertion

Pre-Drilling An internally irrigated pre-drill five bladed cutter is available for CYLINDER-LINE Implants; the available diameters are 2.8 mm / 3.3 mm / 3.6 mm. The recommended drilling speed is 600 rpm. The depth marks on the drill match the implant lengths. For safety reasons, a depth stop matching the proposed implant length should be used.

The implant bed preparation is performed with pre-drills five bladed cutter in increasing size with reference to the selected implant diameter and insertion depth. Then the implant bed is finished to the final size with a form drill of appropriate length.

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

Pre-Drill, five bladed Cutter Sequence für CYLINDER-LINE Implants for Implant Ø 3.3 mm

for Implant Ø 3.8 mm

for Implant Ø 4.3 mm

Pre-drill

Ø 2.8 mm

Ø 3.3 mm

Ø 3.6 mm

Form drill Ø 3.3 mm

Form drill Ø 3.8 mm

Form drill Ø 4.3 mm

for Implant Ø 5.0 mm

for Implant Ø 6.0 mm

Form drill Ø 5.0 mm

Form drill Ø 6.0 mm

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

max. 600 rpm Ø 2.8 mm

Ø 3.3 mm

Pre-drill, five bladed cutter

Ø 3.6 mm

Ø 2.8 mm pre-drill

Drilling depth check after pre-drilling Ø 2.8 mm

Parallelism/axis check after pre-drilling Ø 2.8 mm

125

Surgery Manual CYLINDER-LINE Insertion

Pre-drilling Ø 3.3 mm

Drilling depth check after pre-drilling Ø 3.3 mm

Parallelism/axis check after pre-drilling Ø 3.3 mm

Pre-drilling Ø 3.6 mm

Drilling depth check after pre-drilling Ø 3.6 mm

Parallelism/axis check after pre-drilling Ø 3.6 mm

126

Surgery Manual CYLINDER-LINE Insertion

Form drilling Diameters and Lengths Diameter- and length-calibrated form drills are available for the CYLINDERLINE implants. The internally irrigated form drills are color-coded and lasermarked. The form drills included in the surgery sets are supplied with a color-coded removable depth stop (height 2 mm). The implant bed is shaped to its final size with the form drill matching the selected implant size. For bone qualities D1 or D2, the use of increasing diameter form drills is recommended.

Ø 3.3 mm

Ø 3.8 mm

Ø 4.3 mm

Ø 5.0 mm

Ø 6.0 mm

CYLINDER-LINE form drills

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

Length 9 mm

11 mm

13 mm

16 mm

The protocol-compliant insertion depth for CYLINDER-LINE Implants with depth stop in place is the implant length (9 / 11 / 13 / 16 mm) minus 0.4 mm with the circular stop at the crestal bone level, so that the implant shoulder extends 0.4 mm above the bone level. If a greater insertion depth is desirable, the depth stop can be removed and the preparation will then be guided by the depth mark.

127

Surgery Manual CYLINDER-LINE Insertion

Depth Stop During form drilling, the depth stop rests on the highest point of the crest and thereby limits the insertion depth. Since the circular bone level may be irregular, the form drills are equipped with a removable depth stop. If a greater insertion depth 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 drills (delivered without depth stops). Form drilling with depth stop

Implant length with the depth stop in place according to the protocol. The two depth marks are situated 1 mm apart.

128

Form drilling without depth stop

Surgery Manual CYLINDER-LINE Insertion

Adjusting the depth by 1 mm

Adjusting the depth by 2 mm

Form Drilling With bone qualities D1 or D2, form drills in increasing diameters are used. Tissueconservative preparation of the bone is ensured by the small gradations in diameter size.

Ă&#x2DC; 4.3 mm form drilling

Checking the implant bed

129

Surgery Manual CYLINDER-LINE Insertion

Implant Package All CAMLOG 速 implants are double-sterile packaged. The primary package (blister) of CYLINDER-LINE Implants contains the implant with the cover screw already mounted and attached tilt-off placement head in the handle.

Outer package with label

Peel-back pouch (sterile)

Primary package (sterile) with label (blister pack)

Primary package with visible implant

Opened primary package with implant and mounted handle

CYLINDER-LINE Implant with cover screw already mounted and attached tilt-off placement head

System information on the label

130

Surgery Manual CYLINDER-LINE Insertion

Implant Positioning The protocol-compliant implant position (form drilling with depth stop) is achieved when the cylindrical machined implant shoulder extends 0.4 mm above the crestal bone.

Seating instrument

If it was decided to set the drilling depth for the implants individually by removing the depth stop during form drilling, this should be kept in mind during implant insertion. It is possible to individually position the 1.6 mm implant shoulder vertically to match the drill hole. You should make sure, however, to position the Bioseal Bevel circularly in the cortical bone. Tilt-off placement head Cover screw

Implant

Groove Positioning

Groove

The CYLINDER-LINE Implants have three marks beneath the Bioseal Bevel on the implant body that match the groove position on the CAMLOG connection. Before insertion, align the implant with one of the groove marks at the specified position for the prosthesis. If the dental technician has not indicated the groove position, a vestibular orientation is advantageous in most cases.

Mark

Vestibular orientation of the groove

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Surgery Manual CYLINDER-LINE Insertion

Implant Insertion The implant is removed from the primary package (blister) by the sterile handle. Contamination from non-sterile parts must be avoided.

Taking the implant by the handle, insert it into the implant bed. Make sure to follow the orientation of the implant bed axis. Then press the implant in until it has sufficient grip to permit withdrawal of the handle. Take care that the tilt-off placement head is not bent too soon.

WARNING! Prior to insertion in the implant bed, the implant must be carefully aligned to the correct groove position with the aid of the external marks on the implant body. Changes cannot be made later!

Pressing the handle into the implant bed

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Lifting off the handle

Optional Accessory CAMLOG 速 PickUp Instrument If the intraoral space is insufficient to allow insertion of the implant with the handle, the implant can be separated from the handle with the PickUp instrument. Slide the PickUp instrument between the implant and the handle onto the tilt-off placement head and lift off the handle. The implant is then inserted into the bone and the PickUp instrument is withdrawn.

Surgery Manual CYLINDER-LINE Insertion

Installing the PickUp on the tilt-off placement head

Lifting off the handle

Locked-on PickUp

Transferring the implant into the implant bed

Installing the seating instrument and removing the PickUp instrument

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Surgery Manual CYLINDER-LINE Insertion

Following axial withdrawal of the handle (respectively after insertion of the implant into the bone with the PickUp instrument), the seating instrument is placed on the tilt-off placement head and the implant is tapped to its final position using the surgery mallet. The jaw requiring treatment should be appropriately supported by the dentist's assistant while this is being done.

The tilt-off placement head is removed by sideways bending of the seating instrument. The tilt-off placement head holds inside the seating instrument with in the aid of the silicone ring. Next, the fit of the cover screw must be checked with the screwdriver by hand. It must not be power-tightened. If a vertical correction of the seat depth is required, the tilt-off placement head lodged in the seating instrument can be re-inserted into the hex socket of the cover screw. Caution! Safety measures must be taken to prevent swallowing or aspiration of the components.

Seating instrument

Installing the seating instrument

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Tapping the implant to its final position

Surgery mallet

Removing the tilt-off placement head

Surgery Manual CYLINDER-LINE Insertion

Submerged Healing The example shows submerged healing with the cover screw in place.

Checking the cover screw

Wound closure

Open/Transgingival Healing The cover screw must be removed with the screwdriver before installation of a healing cap. Next, as shown in the diagram, a healing cap cylindrical is picked up with the screwdriver and inserted in the implant manually (Caution! Danger of aspiration).

The healing cap must be hand-tightened only with the screwdriver.

Removing the cover screw

Inserting the healing cap cylindrical

Wound closure

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136

Surgery Manual Healing Cap

9. Healing Cap Introduction Use of a healing cap supports the development of peri-implant soft tissue. Healing caps are available in different geometrys: • cylindrical • wide body • bottleneck The healing caps are color-coded by implant diameter.

Healing Caps

cylindrical

wide body

bottleneck

Diameter

Gingiva height (GH)

3.3 mm

2.0/4.0 mm

4.0 mm

3.8 mm

2.0/4.0/6.0 mm

4.0/6.0 mm

4.3 mm

2.0/4.0/6.0 mm

4.0/6.0 mm

5.0 mm

2.0/4.0/6.0 mm

4.0/6.0 mm

6.0 mm

2.0/4.0/6.0 mm

4.0/6.0 mm

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Surgery Manual Healing Cap

Healing Caps cylindrical and wide body For standard use, the most common healing caps are the cylindrical and wide body types. Once the cover screw has been removed, a diameter-matched healing cap is manually inserted with use of a screwdriver. When selecting the gingival height, make sure that the healing cap extends 1 - 1.5 mm above the gingiva. When the peri-implant soft tissue has stabilized, an impression is taken. Healing cap, cylindrical

Healing cap, wide body

Healing Cap bottleneck In esthetically challenging areas, the treatment result will be enhanced through the use of a healing cap bottleneck.

The coronally rejuvenated cross-section promotes soft tissue growth during the healing period.

After 3-4 weeks (before final structuring of the elastic fibers) a healing cap cylindrical is inserted. No tissue should be excised during this procedure. The tissue is suppressed coronally and thereby forms a papilla-like structure. Once the periimplant soft tissue has stabilized, an impression can be taken.

Healing phase

Soft tissue growth

Coronal displacement of the soft tissue through replacement with a healing cap cylindrical

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Surgery Manual Healing Cap

Tissue Growth/Tissue Support One-stage method (transgingival)

Two-stage method (covered)

bottleneck tissue growth - step 1

OPTIONAL

wide body tissue support

cylindrical tissue growth - step 2

Provisional restoration PEEK abutment

Final restoration abutment with supraconstruction

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Transfer System Introduction

10. Transfer System Introduction The transfer system provides a highly precise, rotation-resistant impression system for both closed and open impression tray methods. The system components are color-coded by implant diameter. You should make sure to mix and match only implants and prosthetic components of the same diameter (by color-coding). No components of different diameters should be attached to one another. The system components must not be modified.

Impression Methods The impression method may optionally be either for closed or open tray. If heavily divergent implant axes are present or combination with a functional impression is desired, the open impression method should be used. Special impression posts must be used along with ball abutments, Locator ® abutments, or bar abutments.

Color-Coding

Ø 3.3 mm

gray

Ø 3.8 mm

yellow

Ø 4.3 mm

red

Ø 5.0 mm

blue

Ø 6.0 mm

green

Impression posts, closed tray

Impression posts, open tray

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Impression Material Silicone or polyether materials can be used as impression materials in both closed and open methods.

Transfer System Closed Impression Method

Closed Impression Method System Components The system components for the closed impression method are consistently color-coded. A fixing screw for impression post, impression cap, and bite registration cap are supplied along with the impression post. A screwdriver - extra short, short, long - is required. The screw must be hand-tightened both in the implant and in the lab analog. All transfer system and bite registration components are single-use items! For precision reasons, they may not be reused.

Bite registration cap

Impression cap

Screwdrivers, extra short, short, long

Impression post, Lab analog, Fixing screw for impression post

The fixing screw extends about 2 mm above the inserted impression post.

After fasten the screw, it sits flush with the upper edge (4-5 turns)

Overview of color-coded impression posts and impression caps

141

Transfer System Closed Impression Method

Impression Post Insertion Following removal of the gingiva former 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. Caution! The fixing screw will extend about 2 mm from the post after it engages with the grooves. The post is rotationally symmetrical; no special orientation is required.

The fixing screw must be hand-tightened with the screwdriver. We recommend a radiographic check of the correct seating of the impression post prior to taking the impression.

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Transfer System Closed Impression Method

Impression Taking The 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 impression post (placed at 120 째 intervals) facilitate contact-free placement relative 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. Tip: To shorten the procedure time, we recommend sending the matching lab analog also to the laboratory. To prevent loss of the fixing screw, the impression post must be shipped attached to the lab analog.

III

Three possible positions for the impression cap

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Transfer System Open Impression Method

Impression post

Open Impression Method An individually fabricated impression tray is required for the open impression method. On the extension of the implant axis, the individual impression tray must be perforated to allow release of the fixing screw of the impression post.

Lab analog

Screwdrivers, extra-short, short, long

System Components The system components for the open impression method are color-coded. The fixing screw is secured with an O-ring. The fixing screw must be hand-tightened only, both in the implant and in the lab analog.

Overview of color-coded impression posts

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

The fixing screw is equipped with a break-off point and it can be shortened by 3.0 mm by breaking it off with a screwdriver if space limitations are encountered. Caution! Shorten extra-orally only.

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O-ring

Transfer System Open Impression Method

Impression Post Insertion Remove the gingiva former 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 the open impression on the implant and tighten the fixing screw slightly. The impression post is rotationally symmetrical; no special orientation is required. Rotate it onto the implant until the cams engage with the implant grooves. Caution! If the cams have not engaged, the height difference will be about 0.4 mm.

The fixing screw must be hand-tightened with the screwdriver. We recommend a radiographic check of the correct seating of the impression post prior to taking the impression

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Transfer System Open Impression Method

Impression Taking Once a check of the perforations and the extension of the individual impression tray is complete, the impression can be taken with silicone or polyether material.

To remove the impression, loosen the fixing screw, pull it back and then lift off the impression. Tip: To shorten the procedure time, we recommend sending the matching lab analog also to the laboratory.

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Transfer System Bite Registration

Bite registration cap

11. Bite Registration System Components The impression posts for the closed impression method are used for the bite registration (see "Closed impression method", page 141). The diametermatched, color-coded bite registration caps are installed on the impression posts. Correct seating is indicated by a perceptible locking feel. Sharp edges in the register are prevented by the caps. Registration requires only standard materials. The caps should not be allowed to bond to the register and are delivered to the laboratory along with the impression posts. Alternatively, under limited space conditions and to prevent bite elevation, a 6.0 mm healing cap cylindrical may be used.

Impression post Fixing screw for impression post

Lab analog

Screwdrivers, extra-short, short, long

Impression posts, closed tray

Caution! 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. All transfer system and bite registration components are single-use items! For precision reasons, they may not be reused.

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Provisional Solution Introduction

12. Provisional Solution Abutment screw

Introduction The PEEK (polyether ether ketone) temporary abutment was designed for use in esthetic immediate restorations. It can also be used for long-term provisionals (max. 6 months). The benefits of immediate implantation with an esthetic, non-functional immediate restoration consist in preservation of the structures of the periodontal or periimplant 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 abutment

Screwdrivers, extra-short, short, long Lab analog

System Components The temporary abutment (PEEK) has a height of 12.0 mm and is available in diameters 3.8 mm â&#x20AC;&#x201C; 6.0 mm. The abutment screw must be hand-tightened only, using the screwdriver. An abutment screw is supplied along with the abutment.

Preparing the Temporary Abutment Insert the abutment into the implant and rotate until the cams engage with the grooves. Then insert the abutment screw and hand-tighten it. Mark the vestibular midpoint and the preparation margins on the abutment following the gingival line.

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Provisional Solution Preparing the Temporary Abutment

Perform any required grinding of the temporary abutment extra-orally to prevent contamination of the surrounding tissue. This procedure can best be managed by screwing the abutment into the universal holder for abutment grinding or into a lab analog. Depending on the marks, the preparation resembles conventional perioprosthetics. The best solution is obtained with a diamond bur at high drilling speed, without water irrigation and using little pressure. The chamfer or crown margins must lie paragingivally for esthetic immediate restorations, and approx. 1 mm â&#x20AC;&#x201C; 1.5 mm subgingivally for late restorations to achieve an anatomic 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.

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Provisional Solution Preparing the Temporary Abutment

Provisional Crown/Bridge A prefabricated crown or a previously prepared crown can be adapted to the situation by lining it with acrylic. The insertion direction of the crown, indicated by the adjacent teeth, rarely matches the orientation of the implant tube. Because of this, bridge structures should not be fabricated in one piece with the temporary abutment. Work on this must be performed extra-orally. All other procedures in the fabrication of temporary solutions are similar to those used in crown and bridge restoration.

Inserting the Temporary Abutment Disinfect and sterilize the prosthetic components prior to insertion. Clean the inside of the implant with water spray, check for residues, and allow to dry. Insert the temporary abutment into the implant and rotate it until the cams engage with the implant grooves. Handtighten the abutment screw and seal the screw channel with easily removable material. Do not use composite since drilling 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. Remove all cement residues.

Reference Sofortimplantation und Sofortbelastung. Das Einzelzahn-Sofortimplantat mit provisorischer Versorgung. Nagel, Rainer; Ackermann, Karl-Ludwig; Kirsch, Axel ZMK 17, 1-2/2000 150

General Information Torque Wrench

13. Torque Wrench Introduction The CAMLOG ® torque wrench is a stainless steel multi-component instrument to accomodate screwdrivers, drivers, adapters, and adapter for screw implants, long. The torque wrench is used for manual thread tapping, manual tightening of CAMLOG ® implants to their final position in the bone, and fastening of CAMLOG ® abutment screws and abutments at a torque specified in Ncm.

The torque wrench is supplied with a dual direction wrench mechanism (for turning in and out). When the selected torque value is reached – a choice of 10, 20, or 30 Ncm – the torque wrench bends down. This prevents use of an undefined torque value. The torque wrench is dismountable into five components for cleaning and care.

Instrument Installation The instruments lock in when inserted into the wrench wheel. • For the insertion function: "IN" is visible on the wrench head. • For the removal function: "OUT" is visible on the wrench head. • To remove, press on the instrument button with the finger and remove downward. Do not use pliers!

Insertion function "IN"

Removal function "OUT"

Remove the instrument downward

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General Information Torque Wrench

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

10 Ncm

20 Ncm

30 Ncm

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

Torque setscrew

For final installation in the implant, all abutment and prosthetic screws as well as abutments must be tightened to the preset torque with the torque wrench.

Setting the tightening torque for the torque wrench Implant cover screw hand tighten only with screwdriver Healing caps hand tighten only with screwdriver Impression post hand tighten only with screwdriver Abutment-/prosthetic screw: - Temporary abutment - Ceramic abutment - Esthomic ® abutment - Telescope abutment - Universal abutment - Gold-plastic abutment - Logfit TM abutment - Prosthetic screw for bar abutment

hand tighten only with screwdriver 20 Ncm 20 Ncm 20 Ncm 20 Ncm 20 Ncm 20 Ncm 15 Ncm

Abutments: Ø 3.3 mm - Bar abutment 20 Ncm - Ball abutment 20 Ncm - Locator ® abutment 20 Ncm NOTE: In the laboratory, abutments should not be tightened with The named values are relevant only for the clinical setting.

152

Caution! To reach maximum pre-tension on the screws, abutments should be retightened with the same torque after approx. 5 minutes. This will prevent loosening of the screws.

Ø 3.8–6.0 mm 30 Ncm 30 Ncm 30 Ncm the torque wrench!

Caution! To ensure optimal pre-tension, new abutment and prosthetic screws should be used for the final attachment of the abutment.

General Information Torque Wrench

Manual Thread Tapping and Implant Insertion Lock the wrench during this function, following the instructions below:

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

2. Slide back the handle.

3. Rotate handle 90째.

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

Torque function locked

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

153

General Information Torque Wrench

Cleaning, Sterilization, Maintenance Disassembly The torque wrench should be disassembled after use into its five components: • To do this, completely unscrew the torque setscrew (anti-clockwise) and pull out the spring and handle. • Pull back the fastening pin with your thumb and forefinger and remove the wrench wheel from the wrench head. • Clean the individual parts with a small plastic brush under running water, and place them in a disinfectant-cleaning liquid (for the duration, see the manufacturer's instructions). • Dry all parts. • Wet the drop-marked places ( ) with angled handpiece oil or spray and reassemble the torque wrench.

Wrench head

Push rod

Handle

Spring

Torque setscrew

Fastening pin

Wrench wheel

Fastening pin

Assembly • First install the wrench wheel: with your thumb and forefinger, pull back the fastening pin on both sides and insert the wrench wheel narrow side in the wrench head ("IN" must show). • Slide handle back on, insert spring in handle, insert and tighten torque setscrew (clockwise). • Sterilize the torque wrench in the autoclave prior to clinical use (see "Preparation Instructions for the CAMLOG ® Implant System," Art. No. J8000.0032).

Wrench wheel, narrow side

154

Information Information on Preparation Instruction

14. Information Cleaning and Sterilization 1. Instruments The CAMLOG 速 Implant System instruments are not supplied in sterile form unless specifically labeled as sterile. They must be cleaned, disinfected, and sterilized before first use and before every further use on the patient.

2. Prosthetic Components The prosthetic components of the CAMLOG 速 Implant System are not supplied in sterile form unless specifically labeled as sterile. They must be used only once. They must be cleaned, disinfected, and sterilized before use on the patient.

Detailed information on the preparation of instruments and prosthetic components can be found in the "Preparation Instructions for the CAMLOG 速 Implant System," Art. No. J8000.0032.

Exceptions: The impression cap and bite registration cap must not be sterilized.

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Dental Office/Laboratory Information Worksheet Date:

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

Dental Office

Dental Laboratory Name Date

Type of treatment Buccal marks Abutment Implant diameter Implant length Type of implant ✼ 1 ▲ 18 ▲ 48 ✼ 32

2 17

3 16

4 15

5 14

6 13

7 12

8 11

9 21

10 22

11 23

12 24

13 25

14 26

15 27

16 28

47 31

46 30

45 29

44 28

43 27

42 26

41 25

31 24

32 23

33 22

34 21

35 20

36 19

37 18

38 17

Type of implant Implant length Implant diameter Abutment Buccal marks Type of treatment Implant diameter: 3.3 / 3.8 / 4.3 / 5.0 / 6.0 mm Implant length: 9 / 11 / 13 / 16 mm, Type of treatment: SC / bridge / telescopic / bar / ball abutment / Locator ® Implant type: SL= SCREW-LINE / RL = ROOT-LINE / CL = CYLINDER-LINE / SCL = SCREW-CYLINDER-LINE

Alloy / Solder: ______________________________________________________

Technician: __________________________________________________________

Ceramic: ____________________________________________________________

Final check / date: _________________________________________________

Acrylic: ______________________________________________________________

Patient ID / Date: __________________________________________________

Tooth shade: _______________________________________________________ ✼ USA numbering ▲ European numbering

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Informations Materials

Titanium Grade 4

Properties: Chemical analysis (in %):

Mechanical properties:

Titanium alloy Ti6AI4V

Mechanical properties:

AI V Fe C N H Ti Strength Elongation

5.5 – 6.75 max. 3.5 – 4.5 max. 0.3 max. 0.08 max. 0.05 max. 0.015 max. ~ 90 860 MPa min. 10 %

Properties: Mechanical properties:

158

0.4 max. 0.3 max. 0.1 max. 0.05 max. 0.0125 max. > 99.0 680 MPa min. 10 %

Properties: Chemical analysis (in %):

PEEK (polyether ether keton)

O Fe C N H Ti Strength Elongation

Density Elongation at break Bending strength Melting point

1,38 g/cm3 >25 % 160 MPa 343 °C

Information Certificate

Quality for Users and Patients

ALTATEC GmbH is in all stages of its activities subject to the provisions set out by the Quality Protection System according to EN ISO 13485:2003. This European Standard defines in detail the criteria that have to be met by full quality protection of a company in all its processes in order for this company to be certified. Medical products have to adhere to standards that are parti-cularly demanding.They are defined in the European Standard ISO 13485,which we are also able to satisfy. We thereby ensure that the quality of our products and services meets the expectations of our customers,namely in a manner that is at all times monitored and retraceable.Our products fulfil the requirements for medical products in terms of product performance and patient safety,as they have been defined by the European Laws and Standards.Thus,all our legally controlled products carry the CE label. The products are in accordance with the strict requirements of the European Medical Device Directive 93/42/EEC for medical products and the Standards EN ISO 13485:2003.

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160

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Headquarters: CAMLOG Biotechnologies AG Margarethenstrasse 38 CH-4053 Basel Tel: +41 (0) 61/565 41 00 Fax: +41 (0) 61/565 41 01 info@camlog.com www.camlog.com

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➤ The CAMLOG Compendium 1 Surgery addresses the insertion of the different

CAMLOG® implant configurations. It consists of a description of the prosthetic CAMLOG concept, general information about the system, and prosthetic planning up to surgical intervention.

ISBN 978-3-13-134351-2

www.thieme.com

1 Surgery

The CAMLOG® Implant System is one of the most successful systems on the international implant market.

CAMLOG Compendium

1 Surgery