Camlog Compendium 2 Prosthetics

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CAMLOG Compendium

Prosthetics2The CAMLOG implant system is one of the most successful implant systems on theinternational market.

The CAMLOG Compendium, consisting of Part 1. Surgery and Part 2. Prosthetics,covers the whole spectrum of clinical and prosthetic practice from the practitioner'sviewpoint (using more than 800 graphics). The CAMLOG Compendium is targeted atusers in order to ensure the proper handling of the system. In prosthetics, CAMLOGstands for interdisciplinary teamwork - combining the skills of dentist and dentaltechnician to develop implant solutions that benefit the patient.

The first part of the manual, Surgery, addresses insertion of the different CAMLOGimplant geometries. It also contains a description of the CAMLOG concept in pros-thetics, general system information, and prosthetics planning up to surgical inter-vention.

The second part, Prosthetics, opens up the multiplicity of CAMLOG implant treat-ment options that the dentist and dental technician can apply. The patented implantabutment connection allows natural-looking, implant-based perioprosthetics to pro-vide both fixed and removable dentures.

➤

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ISBN 3-13-134361-3ISBN 978-3-13-134361-1

CAMLOG Compendium

Prosthetics2

ISBN 1-58890-473-3ISBN 978-1-58890-473-7

Rest of World The Americas

Camlog_Prothetik_engl_ok.qxd 23.10.2007 14:13 Seite 1

CAMLOG Compendium | 2 Prosthetics

CAMLOG® Compendium2 Prosthetics

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

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

Chapter Overview

CAMLOG Compendium1 Surgery:I. General system informationII. CAMLOG conceptIII. PlanningIV. Surgery manual

CAMLOG Compendium2 Prosthetics:V. Prosthetics Manual


Bibliographic informationof the German Library

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

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

Authors:Karl-Ludwig Ackermann, Axel Kirsch

Alexander Focke, Dieter Mozer,Rainer Nagel, Gerhard Neuendorff,Alex Schär, Bernd Wagner

Manufacturer:ALTATEC GmbHMaybachstrasse 571299 Wimsheim, Germany

Copyright © 2005 CAMLOG Biotechnologies AGPart no.: J8000.0028

Printed in Germany

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

Rest of World The AmericasISBN 3-13-134361-3 ISBN 1-58890-473-3ISBN 978-3-13-134361-1 ISBN 978-1-58890-473-7

Important note: Like every field of science, medicine is under-going continuous change. Research and clinical experience arecontinuously extending our knowledge, particularly of treat-ment and therapy with medications. Where this publicationrefers to a dosage or administration, the reader can be assuredthat the authors, editor and publisher have taken great care toensure that this information conforms to the state of knowl-edge at the time of publication.

However, the publisher cannot accept any liability for informa-tion on dosage instructions and forms of administration. Everyuser is urged to examine carefully and if necessary consult aphysician or specialist on whether the recommended dosageand administration or the information on contra-indications inthe package inserts of the preparations is different from theinformation given in this publication. It is particularly impor-tant to examine this in the case of preparations that are rarelyused or those that have just been introduced to the market.Every dosage or administration is entirely at the user's ownrisk and responsibility. The authors and the publisher requestall users to inform the publisher of any inaccuracies or discrep-ancies noticed.

Protected brand names, trademarks or proprietary names arenot specially indicated. The absence of such indication doesnot mean that it is not a trademarked or proprietary name.

This publication, including all parts thereof, is protected bycopyright. Any use, exploitation, or commercialization beyondthe limits set by copyright legislation without the approval ofCAMLOG Biotechnologies is not approved and subject to legalsanctions. This applies in particular to photostat reproduction,copying, mimeographing, preparation of microfilms, and elec-tronic data processing and storage.


Contents

V. Prosthetics Manual 1. General informationNotice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1Torque ratchet– Maintenance . . . . . . . . . . . . . . . . . . . . . . . . 2– Usage of the tools . . . . . . . . . . . . . . . . . . . . 2– Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

2. PlanningGeneral information . . . . . . . . . . . . . . . . . . . . 4Diagnostic cast . . . . . . . . . . . . . . . . . . . . . . . 8Planning template . . . . . . . . . . . . . . . . . . . . . 9Drill template . . . . . . . . . . . . . . . . . . . . . . . . . 10

3. Transfer systemIntroduction . . . . . . . . . . . . . . . . . . . . . . . . . . 11Impression methods . . . . . . . . . . . . . . . . . . . . 11Impression material . . . . . . . . . . . . . . . . . . . . 11Closed impression method . . . . . . . . . . . . . . . . 12Open impression method . . . . . . . . . . . . . . . . . 15Registration . . . . . . . . . . . . . . . . . . . . . . . . . . 18

4. Temporary restorationIntroduction . . . . . . . . . . . . . . . . . . . . . . . . . . 19Preparation of the temporary abutment . . . . . . . 19Temporary crown/bridge . . . . . . . . . . . . . . . . . 21Insertion . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

5. Preparation of workIntroduction . . . . . . . . . . . . . . . . . . . . . . . . . . 22Cast fabrication– Closed impression method . . . . . . . . . . . . . . 22– Open impression method . . . . . . . . . . . . . . . 23Cast conditioning . . . . . . . . . . . . . . . . . . . . . . 24Articulation . . . . . . . . . . . . . . . . . . . . . . . . . . 25Wax-up/set-up . . . . . . . . . . . . . . . . . . . . . . . . 26Silicone index . . . . . . . . . . . . . . . . . . . . . . . . 26

6. AbutmentsIntroduction . . . . . . . . . . . . . . . . . . . . . . . . . . 27Abutments . . . . . . . . . . . . . . . . . . . . . . . . . . . 27Abutment selection . . . . . . . . . . . . . . . . . . . . . 28Abutment selection aids . . . . . . . . . . . . . . . . . 29


7. Single-tooth crownIntroduction . . . . . . . . . . . . . . . . . . . . . . . . . . 30Abutment preparation– Ceramic abutment . . . . . . . . . . . . . . . . . . . . 31– Titanium abutment . . . . . . . . . . . . . . . . . . . . 34– Gold-plastic abutment . . . . . . . . . . . . . . . . . 37Crown fabrication . . . . . . . . . . . . . . . . . . . . . . 38– Casting . . . . . . . . . . . . . . . . . . . . . . . . . . . 38– Devestment . . . . . . . . . . . . . . . . . . . . . . . . 38– Cementable . . . . . . . . . . . . . . . . . . . . . . . . 39– Vertical screw-retention . . . . . . . . . . . . . . . . 40– Horizontal screw-retention . . . . . . . . . . . . . . 42– Splinted crowns/bridges . . . . . . . . . . . . . . . . 43Insertion . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46– Abutments . . . . . . . . . . . . . . . . . . . . . . . . . 47– Cementation . . . . . . . . . . . . . . . . . . . . . . . . 48– Screw-retention, vertical . . . . . . . . . . . . . . . . 49– Screw-retention, horizontal . . . . . . . . . . . . . . 49

8. Removable constructionsIntroduction . . . . . . . . . . . . . . . . . . . . . . . . . . 50Set-up/tooth arrangement . . . . . . . . . . . . . . . . 50

9. Telescopic techniqueIntroduction . . . . . . . . . . . . . . . . . . . . . . . . . . 52Transfer to the milling table . . . . . . . . . . . . . . . 52Cast fabrication for milling technique . . . . . . . . 52Abutment preparationUniversal/telescopic abutment . . . . . . . . . . . . . 54Gold-plastic abutment . . . . . . . . . . . . . . . . . . . 56Secondary coping . . . . . . . . . . . . . . . . . . . . . . 59Tertiary framework . . . . . . . . . . . . . . . . . . . . . 60Set-up and try-in . . . . . . . . . . . . . . . . . . . . . . 61Finishing and insertion . . . . . . . . . . . . . . . . . . 62


10. Bar techniqueIntroduction . . . . . . . . . . . . . . . . . . . . . . . . . . 63

Custom-milled barIntroduction . . . . . . . . . . . . . . . . . . . . . . . . . . 64System components and materials . . . . . . . . . . 64Abutment selection . . . . . . . . . . . . . . . . . . . . . 65Wax-up preparation . . . . . . . . . . . . . . . . . . . . 66Bar wax-up . . . . . . . . . . . . . . . . . . . . . . . . . . 67Casting and devestment . . . . . . . . . . . . . . . . . 68Trimming . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69Try-in . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70Bonding the titanium base . . . . . . . . . . . . . . . . 70Milling and finishing . . . . . . . . . . . . . . . . . . . . 72Electroformed secondary framework . . . . . . . . . 73Tertiary framework . . . . . . . . . . . . . . . . . . . . . 74Bonding the electroformed secondary framework . . . . . . . . . . . . . . . . . . . 75Bar finishing . . . . . . . . . . . . . . . . . . . . . . . . . 76Set-up and try-in . . . . . . . . . . . . . . . . . . . . . . 76Finishing . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76Insertion . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77

Prefabricated barIntroduction . . . . . . . . . . . . . . . . . . . . . . . . . . 78Fabrication types . . . . . . . . . . . . . . . . . . . . . . 78System components and materials . . . . . . . . . . 79Impression and abutment selection . . . . . . . . . . 80Cast fabrication . . . . . . . . . . . . . . . . . . . . . . . 81Base for bar abutment, solderable . . . . . . . . . . 82System components and materials . . . . . . . . . . 82Base for bar abutment, laser-weldable . . . . . . . . 84System components and materials . . . . . . . . . . 84Base for bar abutment, cast-on . . . . . . . . . . . . 85System components and materials . . . . . . . . . . 85Base for bar abutment, burn-out . . . . . . . . . . . . 87System components and materials . . . . . . . . . . 87Bar try-in . . . . . . . . . . . . . . . . . . . . . . . . . . . 89Tertiary framework . . . . . . . . . . . . . . . . . . . . . 89Set-up and try-in . . . . . . . . . . . . . . . . . . . . . . 89Finishing and insertion . . . . . . . . . . . . . . . . . . 89Integration into an existing denture . . . . . . . . . 89


11. Ball abutment (Dalbo system)Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . 90System components and materials . . . . . . . . . . 90Setting the retention force . . . . . . . . . . . . . . . . 91Placing the ball abutment . . . . . . . . . . . . . . . . 91Aligning the duplication components . . . . . . . . 92Duplicating the working cast . . . . . . . . . . . . . . 92Metal reinforcement . . . . . . . . . . . . . . . . . . . . 92Bonding the matrices . . . . . . . . . . . . . . . . . . . 93Set-up and try-in . . . . . . . . . . . . . . . . . . . . . . 93Finishing . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94Insertion . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94Integration into existing denture . . . . . . . . . . . . 95Indirect method (laboratory fabrication) . . . . . . . 96Relining . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98Recall procedure . . . . . . . . . . . . . . . . . . . . . . 99

InformationInformation on instrument preparation . . . . . . .100Notice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .101Materials . . . . . . . . . . . . . . . . . . . . . . . . . . . .102Certificates . . . . . . . . . . . . . . . . . . . . . . . . . .104

1

General informationNotice

FOR THE DENTISTAND DENTAL TECHNICIANV. Prosthetics Manual

1. General information

NoticeThe cooperation between the dentist anddental technician is greatly simplified ifthe important data of the geometry ofthe implant used, the gingiva height,and the desired prosthetic configurationare noted on an information worksheetin the dental office and the worksheetaccompanies the work. Because the formremains with the prosthetic work, everydental technician has the relevant infor-mation available immediately. Thisprevents time wasted answering obviousquestions.

Additional information is added to theworksheet in the laboratory andreturned to the dental office with thefinished work. This gives the dentist allthe important information for placement.

Because it is important that both thedentist and dental technician understandthe CAMLOG system, it is recommendedthat the entire Prosthetics Manual bereviewed by all members of the implantteam. For the convenience of the review-er, individual sections are identified as • FOR THE DENTIST

AND DENTAL TECHNICIAN• FOR THE DENTIST• FOR THE DENTAL TECHNICIAN.Pages identified as “FOR THE DENTISTAND DENTAL TECHNICIAN“ includeeither general information applicable toboth the dentist and dental technician orsubsections specific to both specialties.

Dental Office/Laboratory Information Worksheet

Patient

Dental Office

Date:

Name

Date

Last Name: ________________________________________ First Name(s): ________________________________ Date of Birth: ______________________

Alloy / Solder: _______________________________________________________ Technician: _______________________________________________________

Ceramic: _____________________________________________________________ Final check / date: _______________________________________________

Acrylic: ______________________________________________________________ Patient ID / Date: ________________________________________________

Tooth shade: ________________________________________________________

Dental Laboratory

Type of treatment

Buccal markers

Abutment

Implant diameter

Implant length

Type of implant

Type of implant

Implant length

Implant diameter

Abutment

Buccal markers

Type of treatment

1 2 3 4 5 6 7 8✼

18 17 16 15 14 13 12 11

48 47 46 45 44 43 42 41

32 31 30 29 28 27 26 25

31 32 33 34 35 36 37 38

24 23 22 21 20 19 18 17

9 10 11 12 13 14 15 16

21 22 23 24 25 26 27 28▲

▲

✼

Implant diameter: 3.3 / 3.8 / 4.3 / 5.0 / 6.0 mmImplant length: 9 / 11 / 13 / 16 mm, Type of treatment: ST* / bridge / telescopic / bar / ball abutmentImplant type: SL = Screw Line / RL = Root Line / CL = Cylinder Line / SCL = Screw-Cylinder Line

✼ USA numbering▲ European numbering

2

General informationTorque ratchet – maintenance

FOR THE DENTISTAND DENTAL TECHNICIAN

MaintenanceThe torque ratchet must be disassembledinto five separate components after use.Unscrew the torque adjustment screw (5)completely and pull spring (4) and han-dle (3) off. Pull the fastening pin backwith thumb and forefinger and removethe ratchet wheel (1) from the ratchethead (2). Preclean the parts with a small

plastic brush under running water, thenimmerse in desinfectant solution (immer-sion time as specified by the manufactur-er). Rinse thoroughly and dry.

Wet the parts indicated with the red ▲icon with contra-angle handpiece oil orspray and reassemble the torque ratchet.Insert the ratchet wheel (1) first: pull the

fastening pin back with thumb and fore-finger and insert the ratchet wheel (1) atIN with the narrow side towards theratchet head (2). Then slide the handle(3) on, push the spring (4) into the han-dle and turn the torque adjustment screw(5). Sterilize the ratchet in the autoclavebefore clinical use. (See “Cleaning andsterilization instructions”).

Torque ratchet

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1

2 3 4 5

The tools click into the ratchet wheel; toremove them press the handle (8) of the toolwith a finger and remove from below. Do notuse pliers.

Inserting toolsScrewing in: IN is visible (6), unscrew-ing: OUT is visible (7).

For final insertion all abutment prosthe-tic screws and abutments must be tight-ened to the specified torque with thetorque ratchet.

Attention: Abutments must be retightenedto the same torque after five minutes to reachthe maximum retaining screw tension. Thisprevents screws from loosening.

6 7 8

▲ ▲ ▲ ▲

3

General InformationTorque ratchet – adjustment


Torque settings for CAMLOGcomponentsAbutments must not be screwed tightwith the torque ratchet in the laboratory.The following values are only relevantfor clinical use.

ATTENTION:Use new retaining screws for finalplacement to ensure optimum ini-tial tightness.

Setting for the torque ratchetImplant cover screw tightened by handGingiva former tightened by handImpression post tightened by hand

Abutment/prosthetic screws– Provisional abutment tightened by hand– Ceramic abutment 20 Ncm– Esthomic abutment 20 Ncm– Standard abutment 20 Ncm– Universal/telescopic abutment 20 Ncm– Gold-plastic abutment 20 Ncm– Horizontal screw tightened by hand– Prosthetic screw 15 Ncm

Abutments Ø 3.3 mm: Ø 3.8 – 6.0 mm:– Bar abutment 20 Ncm 30 Ncm– Ball abutment 20 Ncm 30 Ncm

Setting the torque limitationThe selected torque (newton-centime-tres) is set by screwing the torqueadjustment screw in or out (9). Thetorque ratchet clicks out when the speci-fied torque is reached (10). Do not con-tinue beyond this point!

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10

4

The following general information is illus-trated in Compendium 1 Surgery.

OverviewEvery planning process is divided intothe following sections:

• Actual situationSpecification and documentation of theactual situation by general medical his-tory, special (dental) history, intraoraland extraoral clinical diagnosis, func-tional diagnosis and radiological diagnosis.Altogether this information provides adescription of the initial status of theoral system.

• Initial prosthetic situationAn ultimate (maximum) treatment goalis defined from the diagnosis, therequirements, the desires of the patientfor esthetics and function and from thewax-up and set-up.

• Ultimate treatment goalA cost-benefit/work-benefit/risk-benefitanalysis of the various treatment optionsis made with the patient. The final resultwill be a treatment goal customized forthe desires and options of the patient.

• Individual treatment goalProsthetically oriented implant positionsare defined and verified clinically andradiologically with reference to the indi-vidual treatment goal. Finally, the treat-ment sequence is defined. It includes theplans for accompanying measures, graft-ing and any required preliminary treat-ment.

PlanningGeneral Information

FOR THE DENTIST AND DENTAL TECHNICIAN

Anamnesis

IntroductionThe medical history and diagnosis arenot different from the evaluation pro-cedures required for other dental surgeryor restorative treatments. For this reasononly the specific points for perio-implantprosthetic treatments are describedbelow.The general, social and special (dental)medical history considers all generalmedical contraindications and diseasesthat could affect the microcirculation orthe patient’s suitability for the proposedimplant-based restoration. Risk factorssuch as nicotine, alcohol and drug abuseare confidentially evaluated, discussedand documented. The patient’s psycho-logical and psychosocial situation givesan indication of the compliance that canbe expected and will influence the plan-ning of the treatment and the futureprosthesis design.

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

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

5



Diagnosis

ClinicalIn addition to all standard extraoralfindings, the soft-tissue profile or thesupport of the soft tissues (particularly inthe maxilla) is a significant factor indesigning the prosthesis. If a large dis-crepancy between the required labialtooth position and the expected positionof the implant is found, this may requiredelivery of a removable denture for load-ing reasons (bar, telescopic crown, ballabutment).The intraoral diagnosis includes assess-ment of all teeth for whether they areworth retaining. In addition to the exam-ination of the soft tissue for pathologicalfindings, the care of the teeth isassessed for information on the patient’spossible compliance during and aftertreatment.

The static and dynamic occlusion, inter-alveolar distance and jaw relations arechecked. Diseases of the jaw joints mustbe treated before starting dental treat-ment.All findings that could indicate excessloading on the masticatory system (e.g.bruxism) must be investigated, docu-mented and considered in the prostheticplanning.

The status of the soft tissue in edentu-lous jaw sections (width and thicknessof the attached gingiva) must bechecked and the extension of the alveo-lar ridge must be evaluated for suitabili-ty as a possible implant site.

Dental x-raysDental x-rays are sufficient for an initialassessment of the bone volume with sin-gle tooth gaps and small interdentalgaps. The periodontic situation of theremaining teeth must be closely exam-ined, because the implant site could beinfected by pathogenic organisms frominfected pockets.

Panoramic x-rayAn OPG is required to provide basicinformation. Depending on the situation,dental x-rays, remote x-ray side views orCAT scans provide additional informa-tion.

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

CAT scanThree-dimensional imaging divided intoindividual slices.

Cast analysisA diagnostic cast must be mounted in anadjustable articulator for assessment ofthe jaw relations. It is particularly impor-tant to check whether a change of theocclusal position is worthwhile orrequired. This should be done beforestarting the implant-prosthetic treatmentif at all possible. A change of the verticaldimension must be preceded by treat-ment with a long-term provisional.

Diagnostic castsThe diagnostic casts must clearly showthe occlusal surfaces, the vestibular foldand the retromolar regions.

ArticulationThe diagnostic cast is placed in anadjustable articulator with the aid of anarbitrary face-bow register and a centricregister as in perioprosthetics.

Vertical dimensionIf the vertical dimension requires correc-tion, it must be done by a guard or long-term provisional treatment before theimplant-based prosthetic restoration.

Jaw relationship (transversal)The jaw relationship affects the loaddirection and therefore the axial align-ment of the implants. This is particularlyimportant with cross-bite situations.

Jaw relationship (sagittal)The crowns cannot be placed preciselyover the implants in the case of anAngle class II dentition because the softtissues must be supported and the spacefor the tongue must not be reduced. Aremovable denture is indicated in thissituation.

Initial prosthetic situationThe initial prosthetic situation describesthe dental status and the jaw relation-ship, the anatomical status of the oralhard tissue, the intraoral and extraoralsoft tissue, the existing functional, pho-netic and esthetic restrictions of thepatient and the related influence on thepatient’s quality of life.

6



Preliminary prostheticdesign

IntroductionModern implant prosthetics is plannedby working back from the desired goalof the therapy; this is referred to as“backward planning”. This is particularlyimportant for pre-implant grafting meas-ures intended to restore sufficient bonestructures to allow placement of implantsin the optimum prosthetic position.Forward planning, which is only orientedto anatomical-surgical conditions, is nolonger used.Function, phonetics and hygiene capacityrequire prosthetically oriented implantpositioning and dimensioning, which thedental technician defines on the basis ofthe wax-up. The prosthetic design andthe required implant position(s) areplanned by the dentist and the dentaltechnician. This requires them to be fullyinformed of the treatment options.If an implant cannot be implemented fora fixed reconstruction for functional,esthetic or hygienic reasons, a removablesolution must be planned.

Wax-up/set-upThe wax-up or set-up is fabricated onthe patient cast in the dental laboratory.The optimum tooth position from anesthetic and functional point of view canbe planned in this way. The possible dis-crepancy between the atrophied jawbone and the prosthetically requiredcrown position allows a timely diagnosisof any required grafting measures.The ideal occlusion concept will be acuspid dominated occlusion or cuspiddisocclusion. Freedom in centric shouldbe possible.

Planning templateA planning template is fabricated to testthe planned implant positions in themouth. The template can be converted toa surgical drill template later.Radio-opaque markers may be includeddepending on the CAT scan evaluationprocedure (e.g. titanium, barium sulfate).

7



Verification of theimplant positions

GoalThe goal is to specify the possibleimplant positions. Now the final implantplanning is carried out according to theselected concept. The x-ray images mustshow calibrated measurement points toenable measurement of the bone volumeavailable for implant placement.

ClinicalThe wax-up or set-up must be tried in onthe patient. It allows esthetic aspects tobe included in the plan, such as thesmile line, tooth color, facial shape andgeneral presentation of the patient.

CAT scanwith/without 3D evaluationA precise three-dimensional evaluationof the bone contour is only possible witha CAT scan. Simulation programs can beused for computer-aided evaluation.Special findings such as septums orinfections in planned sinus-floor eleva-tions and critical vertical relationships inthe mandible can be recognized.Depending on the program the templateshould include radio-opaque positionmarkers (titanium balls, titanium tubes,barium sulfate coating).

Dental x-rayA metal ball with a known diameter(> 4 mm) can be included in the x-ray ofthe planned implant position to checkthe dimensions.

OrthopantomographX-ray foils in various scales are availablefor all implant geometries for checkingthe dimensions in the OPG. The magnifi-cations of the foils correspond to themagnification factors of most OPGs, butthey are only useful as approximationsfor implant dimensioning.

Final prosthesis designThe surgical feasibility of the treatmentsequence is checked with reference tothe clinical situation, the casts and thex-ray findings. Depending on the clinicalsituation, periodontic and grafting treat-ment is conducted before the implantsurgery or at the same time as theimplant placement.

Documentation for patient inter-view and informationThe results of the planning are discussedwith the patient. Casts, x-ray images andthe planning devices (wax-up and set-up) are helpful here. The following crite-ria are considered.

• Initial situation

• Desires and expectations regardingesthetics, function and comfort

• Cost/benefit ratio

• Costs

• Risk

• Duration of treatment

• Restrictions in comfort during treat-ment

Individual adaptationof the prosthesis designThe patient’s wishes regarding the scopeand cost of the implant-prostheticrestoration expressed in the patientinterview are incorporated into the indi-vidual prosthesis design. The number ofimplants, the requirement for grafts andpossible soft-tissue corrections aredetermined exclusively from the localfindings and the prosthetic design. Thisinterview must be documented in detailand the patient must sign a statement ofconsent before implementing the treat-ment process.

Planning the treatment sequenceWhen the prosthetic goal has beendefined, the required treatment steps arespecified in a backward planningprocess. This process must include alldetails that are likely to be found, par-ticularly in connection with grafting. Theplanning template can now be convertedinto a surgical template.

8

PlanningDiagnostic cast


2. Planning

Diagnostic castThe diagnostic casts for implant-pros-thetic planning should be fabricatedfrom superhard stone, similar to perio-prosthetics, and mounted in anadjustable articulator with an arbitraryface-bow and centric occlusion register.

The centric occlusion must be clearlyindexed to allow the casts to be mount-ed with correct axial alignment and cor-rect position.

The impression must reproduce the soft-tissue condition and any condition inhard and soft tissue defects to includethe vestibular fold, because this is wherethe first indications of a required inclina-tion of the implant or grafting can beidentified. As in perio-prosthetics, theretromolar regions must also be repro-duced to allow specification of the den-tal arch and assessment of the verticalvolume (see arrows).

The use of templates greatly simplifiesthe planning and implementation of aperi-implant prosthetic rehabilitation.

Planning templatePlanning the best possible restoration by wax-up/set-up requires an adjustablearticulator.Bone deficits should not be consideredat this stage. The template may be usedto fabricate a silicone index during fabri-cation of the prosthesis.

X-ray templateThe planning template developed fromthe ideal wax-up/set-up should includeCT tubes or other radio-opaque markerspositioned at the ideal implant site.

The CT information derived from the x-ray template can be used to determinethe bone volume and quality with theaid of a CT and a 3D evaluation. Thiswill determine the subsequent therapyprocedure (number of implants, implantposition, implant diameter and implantlength).The final prosthetic design and the hardand soft tissue grafting, if required, arediscussed with the patient on the basisof this information and approved.

Drill templateThe planned implant positions are triedin and compared with the x-ray informa-tion and adjusted if necessary. Theadjustments change the x-ray templateinto a drill template.

9

PlanningPlanning template


Planning templateThe dental technician fabricates a com-plete wax-up/set-up with all missingteeth in their ideal prosthetic position.In accordance with the “backward plan-ning” principle anatomical deficits arenot considered at this stage. The treat-ment goal determines the surgical andprosthetic procedure.

A silicone index is fabricated from thisset-up. After setting, the index is dividedorally along the central occlusion line toform a labial and an oral section similarto a denture plate.An acrylic template can be fabricatedwith the aid of the silicone index.

Alternatively the work can be done witha rigid vacuum form foil via a duplicatecast.

10

PlanningDrill template


To control the planned implant positionson x-rays, markers can be integrated intothe template if required. Titanium tubesfor CT-supported planning or otherradio-opaque positioning components(barium sulfate) are integrated, depend-ing on the software used for evaluation.If the tubes are placed directly at thesoft tissue level, its thickness can bedetected on the CT.For more information see the documen-tation for the systems.

Drill templateThe positions of the titanium tubes aremodified or specified in the template. Inconsultation with the surgeon the tem-plate is reduced to a framework toenable stable positioning during surgery.After preparation of the flap, stabilityrequires a dental or gingival base out-side the planned surgical region.

11

Transfer systemIntroduction


3. Transfer system

IntroductionThe parts of the transfer system are tita-nium and are manufactured by CNCmilling technology. This provides anextremely precise, rotationally stabletransfer system for closed and openimpression methods. The system compo-nents are color-coded according to theimplant diameter.Note that only implant and prostheticcomponents of one diameter (color-coded) may be used together.Components of different diameters mustnever be connected to one other.The system components must not bemodified.

Impression methodsThe closed or open impression methodmay be selected (1).The open impression method should beselected if the abutments axis are divert-ing or used in combination with a func-tional impression (2).Special impression posts, which aredescribed in the applicable chapter, areused with the prefabricated bar.

Impression materialHydrocolloids and silicone or polyethercan be used as impression materials forthe closed method.Silicone or polyether materials are rec-ommended for the open impressionmethod.

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

2

1

12

Transfer systemClosed impression method

FOR THE DENTIST

Overview of color-coded impression posts and impression aids

When the impression postis inserted, the retainingscrew extends about 2 mm.

When the screw is seated,it is flush with the top.(4 – 5 revolutions).

Bite registration cap

Transfer cap

Hex screwdriver, short,long

Impression postLab analogRetaining screw

Closed impression method

System componentsThe system components for the closedimpression method are all color-coded(10). The impression post (3) comeswith the retaining screw (4), impressionaid (6) and bite registration cap (5). Thetransfer impression cap and the bite reg-istration cap (5) are single-use articles.The hex screwdriver, short or long(1+2), is used. The retaining screw (4)is tightened manually in the implant andin the lab analog (7).

ATTENTION:Transfer caps and bite registrationcaps are single-use articles.Do not reuse these parts!

1

2

3

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5

6

7

8 9

10

13


FOR THE DENTIST

The retaining screw is tightened manually(15 – 17) with the hex screwdriver (ifnecessary use x-ray images to check thatthe impression post is correctly seated).

12

11

15

1413

1716

Placement of the impression postAfter removal of the gingiva former orthe temporary abutment, the impressionpost with the retaining screw is insertedinto the implant (12). Tactile engage-ment of the cams with the implantgrooves can be detected when the postis rotated (13).

ATTENTION:The retaining screw extends about 2 mm(15).The post is rotationally symmetrical,making a particular alignment unneces-sary.

14


FOR THE DENTIST

Impression The color-coded impression cap is placedon the impression post using the guidegrooves (16) until it passes a percepti-ble pressure point and the impressioncap is fixed in place (17). Three guidegrooves on the impression post (at 120°intervals) allow the impression cap to bepositioned without contacting adjacentimpression caps or teeth (18). Theextensions on the impression caps mustnot be removed.Check that the impression cap is correct-ly seated immediately before taking theimpression (19).

The impression caps remain in theimpression after removing the tray. Ifthis is not the case, the impression mustbe repeated.

TIP: We recommend sending the labanalog to the laboratory to enablefast fabrication of the cast. Theimplant diameters are noted on the worksheet. Send the impres-sion post screwed to the lab ana-log to prevent loss of the retainingscrew (19).

I

II

III

Three possible positions of the impression cap

16 17

18 19

15

Transfer systemOpen impression method

FOR THE DENTIST

ImpressionA customized impression tray is requiredfor the open impression method. The traymust be perforated at the extension ofthe implant axis for the retaining screwson the impression posts.

System componentsThe system components for the openimpression method are color-coded (5).The retaining screw is secured by an O-ring (2+3). The retaining screw ishand-tightened only in the implant andin the lab analog (1).

Before removing the impression (4) theloosened screw must be pulled back tothe stop (O-ring) (2), otherwise it maynot be possible to remove the impres-sion because of the off-axis inclinationof the implants or the impression maybe deformed by excessive compression.

Overview of color-coded impression posts

1

23

4

5

16


FOR THE DENTIST

Placement of the impression postThe gingiva former or the temporaryrestoration is removed. Before placementof the impression post the screw ispushed fully in apical direction to orientit in the direction of the implant axis(6+7).The impression post for the open impres-sion is placed in the implant and theretaining screw is screwed in lightly (9).

The impression post is rotationally sym-metrical, making a particular alignmentunnecessary. The post is pressed on tothe implant and rotated until the camsclick into the grooves of the implant(10).

ATTENTION:Height difference is only 0.4 mm(9).

The retaining screw is tightened manual-ly with the screwdriver.The correct seating of the impressionpost may be checked by x-ray (10+11).

67

8

9

10

11

12

17


FOR THE DENTIST

ImpressionAfter checking the perforations (13) andthe dimensions of the customizedimpression tray, the impression can betaken with elastomeric (silicone or poly-ether) material (14).

To remove the impression loosen theretaining screw, pull it back completelyand then remove the impression tray(15+16).

TIP: We recommend sending the labanalog to the laboratory to enablefast fabrication of the cast. Theimplant diameters are noted on theworksheet.

13 14

15 16

18

Transfer systemRegistration

FOR THE DENTIST

System componentsFor bite registration the impression postsfor closed impression are used (3+10)(see Closed Impression Method). Theappropriate color-coded bite registrationcaps (5) are placed on the impressionposts (8). The correct seating is indicat-ed by an audible click (9). The caps donot contain sharp edges. A registrationcan be made with the standard registra-tion materials. The bite caps must notadhere to the registration and are alsosent to the laboratory (11).

If the vertical dimensions are unsuitableand a bite registration is not taken,cylindrical 6 mm gingiva formers can beused as an alternative.

ATTENTION: Note the diameter,position and height of the gingivaformer in the worksheet and deliv-er a corresponding gingiva formerwith it.

Transfer caps and bite registrationcaps are single-use articles.To retain precision they must beused once only.

1

7

5

6

8 9

10 11

2

4

3

19

Temporary restorationPreparation of the temporary abutment


4. Temporaryrestoration

IntroductionThe PEEK temporary abutment (3)(PEEK = PolyEther Ether Ketone) isdesigned for esthetic immediate restora-tion or for long-term temporary restora-tion.

The advantage of immediate implantplacement with an esthetic, non-func-tional immediate restoration is that thestructures of the periodontal or peri-implant tissue are supported, particularlyin esthetically critical regions.After a sufficient healing phase (osseoin-tegration) for the implant and the peri-implant soft tissue, another impression istaken for the final restoration.

System componentsTemporary abutments PEEK (3) are avail-able for all implant diameters except3.3 mm. The abutment screw (5) isscrewed in manually with the hex screw-driver (1+2).The retaining screw (5) is supplied withthe abutment.

Preparation of the temporary abut-mentThe abutment is inserted into theimplant and rotated until the cams audi-bly click into the grooves (6+7). Thenthe retaining screw is inserted and tight-ened manually. The preparation marginis marked on the abutment correspon-ding to the gingiva line (8).

1

2

5

4

3

7

8

6

20

Temporary restorationPreparation of the temporary abutment


The temporary abutment is preparedoutside the mouth. It can be held withthe universal holder for preparing abut-ments or a lab analog for easier han-dling (10). A preparation is made as inperio-prosthetics following the marking(9) that corresponds to the gingival con-tour (10).

The most suitable preparation tools arehigh speed diamond burrs, withoutwater cooling and low pressure.The chamfer or crown margin should beplaced in a paragingival position for anesthetic immediate restoration and 1-1.5 mm subgingivally with delayedrestoration to achieve an anatomicalemergence profile of the peri-implant

tissue. A mark (13) is placed on thelabial side of the abutment for easierrecognition of the insertion position.

An impression is taken with the transfersystem immediately after placement oruncovery of the implant to facilitate atemporary restoration in the laboratory.After fabrication of the master cast theabutment is prepared in accordance withthe anatomical requirements and thetemporary crown is fabricated (12+13).Fabrication in the laboratory allows met-al reinforcement to be used if necessary(for long span bridges), similar to along-term temporary denture.

109

11 12

13

21

Temporary restorationTemporary crown/bridge


Temporary crown/bridgeA pre-fabricated crown or an existingcrown is adapted by lining it with acrylicand molded to the situation (14).The insertion direction of the crown,determined by the neighboring teeth,and the direction of the screw canal inthe implant rarely match. For this reasonthe abutment and the crown are fabri-cated in separate units. The trimming isdone outside the patient’s mouth. Allother procedures for fabrication of tem-porary restorations are also possible inthe same manner as crown and bridgeprosthetics.

Insertion of the temporary restora-tionThe prosthetic components must becleaned and desinfected before inser-tion. The implant is sprayed inside withwater to remove any residue and blowndry. The temporary abutment is insertedinto the implant and rotated until thecams audibly click into the grooves ofthe implant (15). After carefully hand-tightening the abutment screw, thescrew cavity is filled with soft acrylic(16). Do not use composite, because ithas to be drilled out to gain access tothe screw (17).The crown will only fit if the screw chan-nel is not overfilled. Remove any excesscement completely.

LiteratureSofortimplantation und Sofortbelastung.Das Einzelzahn-Sofortimplantat mit pro-visorischer Versorgung.Nagel, Rainer; Ackermann, Karl-Ludwig;Kirsch, AxelZMK 17, 1 – 2 / 2000

14

15 16

17

22

Preparation of workCast fabrication

FOR THE DENTAL TECHNICIAN

5. Preparation of work

IntroductionAll prosthetic components used in thelaboratory are hand-tightened. The abut-ments and abutment retaining screwsare made of Ti6Al14V alloy (for materialdata see appendix).WARNING: Do not modify the implant-abutment connection (tube, cam) underany circumstances.

Closed impression methodThe impression post (1) is screwed man-ually into the lab analog of the appro-priate diameter (2+3) (4–7). Afterchecking that it is seated correctly with-out a gap (7) it is carefully positioned inthe impression tray with the impressioncap (8). It is important to make surethat it fits into the grooves in theimpression cap (9). Do not use glue.

The master cast is fabricated (10) (11)by the standard procedure. When fillingthe impression with stone by vibrationmake sure that none of the impressionposts are loosened.Articulation immediately follows themodel fabrication. The color-coded capfor bite registration is pushed on until itaudibly clicks into place.

System componentsApart from the impression posts sup-plied by the dental office, only a hexscrewdriver (1) and the lab analogsmatching the diameter (2) are requiredfor cast fabrication. Information from thedental office is included on a completedworksheet.

Master castThe impression is first conditioned anddisinfected as specified by the manufac-turer of the material. If milling work isplanned (telescopic crowns, bars), twocasts may be required.

1 2

10 11

98

2

13

4 5 6 7

23

Preparation of workOpen impression method


Open impression methodThe impression post is hand-tightened tothe color-coded lab analog. Make surethat it is correctly seated with no gap(1 – 4).

Then the master cast is fabricated in thestandard procedure (5).To remove the impression the retainingscrew must be loosened and pulled backcompletely (6). The master model isbased in accordance with the system inuse (7).

ArticulationThe impression posts for the closedimpression method are mounted withthe bite registration cap or the corre-sponding gingiva former depending onthe selected method (8).The casts are articulated in the openimpression method by using standardregistration techniques.

1 2 3 4

765

8

24

Preparation of workCast conditioning


System componentsCast condition by smoothing the plastercast above the lab analog shoulder isrecommended for placement of the abut-ment (6) without interference. The pro-filer of the correct diameter is used towiden the plaster cast (1). The profiler iscentered by a guide pin (2).In its final position the profiler sits onthe guide pin. This prevents damage tothe lab analog.

After removal of the impression post (5)the color-coded guide pin (7) is screwedin hand-tight. Then the profiler with thematching diameter (1) mounted in theuniversal holder (3) is slid on to theguide pin (2) and rotated clockwise intothe cast (8+9). When the reamer is fullyinserted, it is in contact with the guidepin (10). The profile frees the lab analogshoulder to ensure a correct emergenceprofile and the abutment is seated with-out a gap (11).

1

2

34

2

1

5 6

7 8 9 10 11

25

Preparation of workCast conditioning


The plaster dust must be removed com-pletely before removing the guide pin(12).

A small notch can be cut into the lin-gual/palatal side of the model (14) for avisual check that the abutment fitsexactly into place (13).

ArticulationThe impression posts for the closedimpression method are mounted withthe cap for bite registration or the corre-sponding gingiva former depending onthe selected registration (15).The casts are articulated in the openimpression method by using standardregistration techniques.

12 13

14

15

26

Preparation of workWax-up/set-up


Wax-up/set-upA silicone index makes it much easier togain an overview of the space availablefor the prosthetics. It is fabricated froma wax-up/set-up without abutments(1+2).This procedure makes it quick and easyto check the dimensions of the restora-tion during subsequent stages of thework. It can be used for all restorativeoptions (4).

Silicone indexAfter try in of the shape, axis andesthetics on the patient, a silicone index(3) is fabricated based on the wax-up /set-up. The index must cover the dentalarches from oral to labial. After settingof the material the index is cut linguallyto the incisal or occlusal center line. Thisgives an overview of the shape of thecrown after removal of the set-up, i.e. aguide for the required preparation of theimplant abutment (4).

1 2

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27

AbutmentsIntroduction


6. Abutments

IntroductionThe high precision and stability of theCAMLOG implant/abutment connectionfacilitates standard crown and bridgelaboratory techniques. The dental techni-cian selects and prepares the implantabutment.

AbutmentsThe following abutments are available inthe CAMLOG system:

1 Ceramic abutment

2 Esthomic abutment with anatomicallyshaped shoulder, straight and angled(20°), gingiva height 1.5 and 4 mm

3 Standard abutment with straightshoulder, straight and angled (15°),gingiva height 1.5 and 4 mm

4 Universal/telescopic abutment

5 Inset abutment, gingiva height1.5 mm, with anatomically shapedshoulder. The shoulder diameter corre-sponds to the implant diameter.

6 Gold-plastic abutment, cast on

All abutments must be adapted tothe individual situation.

15º

15º

20º

20º

1 4 5 6

3

2

28

AbutmentsAbutment selection


Abutment selectionThe suitable abutment can be selectedwith the aid of an index. The followinginformation is important for the abut-ment selection:implant axis, gingiva height, cam posi-tion (for angled abutments), verticaldimension to the occlusal level.

1. Implant axis (1):Up to approx. 10° axial inclination canbe compensated with a straight abut-ment. If the axial inclination is greater,angled abutments or the gold-plasticabutment must be used.

2. Gingiva height (2):The selection criterion is the maximuminterproximal thickness of thegingiva/papilla. The specified gingivaheight corresponds to the height at thelowest labial point. Because the finalcrown margin must be 1 – 1.5 mm sub-gingival on the labial side and paragin-gival at the lingual/palatal side, an abut-ment with an appropriate gingiva heightmust be selected (3+4) to enable prepa-ration of an esthetic, hygienic crownmargin.

1

2

43

29

AbutmentsAbutment selection aids


3. Vertical dimension to the occlusionlevel (5):The implant lenght indicated on theworksheet determines the implant (IL)crown (CL) ratio. This indicates thenecessity for splinting the crowns. Theideal ratio is < 0.8.

4. The inset abutment (6) may be usedwhere space is particularly restricted.The special feature of this abutment isthat its maximum diameter is equal tothe implant diameter.A cast-on gold-plastic abutment is avail-able as an alternative to titanium abut-ments. The cast-on abutment can also beused for fabrication of a vertical(occlusal) screw-retained crown.

The color-coded abutment selection aids(7) simplify selection of the final abut-ments. They match the geometry of theEsthomic and standard abutments. Anabutment that fits the axial inclinationand gingiva margin is selected on themaster cast. The selection aids can beused more than once. They have onlyone cam and are completely colored todistinguish them from the clinical abut-ments. They must not be used in thepatient's mouth under any circum-stances.

5

6

7

30

Single-tooth crownAbutment preparation


7. Single-tooth crown

IntroductionThe components of the CAMLOG systemallow fabrication of single-tooth crownsaccording to standard perio-prostheticprotocols.

Implants with a diameter of 3.3 mmshould be used as lower incisors orupper lateral incisors only.

If the ratio of the crown length to theimplant length (see worksheet forimplant information) is greater than 0.8,the implant crown must be connected tothe neighboring prosthetics.

The following abutments are available:

1 Ceramic abutment

2 Esthomic abutment

3 Standard abutment

4 Universal/telescopic abutment

5 Inset abutment

6 Gold-plastic abutment

The crowns can be fabricated for cementor screw-retention. The preparationinformation is included with the relevantabutment type.

1 2 3 4 5 6

31



Ceramic abutment

IntroductionThe ceramic abutment consists of a tita-nium base (1), a zirconium oxide sleeve(2) and an abutment screw (3).Zirconium oxide is an extremely strongand hard material.Its advantages are:1. Precisely milled titanium base withthe CAMLOG tube-in-tube connection.2. With the subsequent bonding of thetitanium base and separately customized

PreparationFor customization of the zirconium oxidesleeve (2) a universal handle (5) withtwo separate holders for grinding thesleeve (8–10), one for the diameters3.3 mm, 3.8 mm, 4.3 mm (6), one for5.0 mm and 6.0 mm (7) are available.

zirconium oxide sleeve the abutment canbe modified or colored with ceramiccompounds* without any thermal influ-ence on the implant/abutment connec-tion in the cervical area.3. Screw head seats in metal part.

* Use only ceramic compounds with asuitable Coefficient of ThermalExpansion (CTE) (10.5 – 11.0).

1

22

1

4

3

5

6

8 9 10

2

6 7

32



The titanium base is inserted into thelab analog in the model, the rotationlock points in the lingual/palatal direc-tion (11) (maximum wall thicknesstowards the labial side) and the base ishand-tightened with the abutment screw(12). Then the zirconium oxide sleeve ispositioned over the base and rotateduntil the rotation lock clicks into place(13).

The abutment height is marked on thezirconium oxide sleeve with the siliconeindex in place. The shoulder margin mustbe 1 – 1.5 mm subgingivally on the labi-al side and paragingivally on the oralside (15+16).

Preparation of the zirconium sleeveThe zirconium oxide sleeve is placed onthe holder of the appropriate diameter(6+7) for grinding of the zirconiumoxide sleeve and rotated until the rota-tion lock clicks into place. The zirconiumoxide sleeve is locked with the clampingscrew (10). Grinding is conducted withdiamonds with a geometry similar totooth preparation (17). Use standardgrain size and fine for finishing. Waterirrigation to prevent cracking/furrowingby local overheating is essential.The wall thickness must not be less than0.5 mm.The abutment should be prepared withan angle of approx. 3° and a shoulderwidth of 0.5 mm.

11 12 13

15

10

17

16

14

33



Bonding the zirconium sleeveto the titanium baseThe bonding surfaces of the zirconiumoxide sleeve and the titanium base aregrit-blasted with 50 µm aluminum oxideat max. 2.0 bar (psi). Then the bondingsurfaces are cleaned with alcohol orsteam (to remove dust and grease) (18).We recommend attaching the titaniumbase to a lab analog or polishing aid forease of handling during the bondingprocess. The hex head of the abutmentscrew must be covered with wax.

The bonding agent (such as PanaviaF 2.0) is mixed as specified by the man-ufacturer and applied on the titaniumbase (19). The prepared zirconium oxidesleeve is pushed on to the stop (20).Make sure that the rotation and positionlock clicks into place. Remove largecement residue immediately.

The air blocker (Oxygard) is used at theceramic/titanium transition area and inthe screw hole to harden the bond (21).The residue is removed with a rubberpolisher after bonding is complete(22+23).

The porcelain crown is fabricated follow-ing the manufacturer’s directions.

18

20

23

22

21

19

34



Titanium abutment

IntroductionA universal handle (1) with abutmentholders color-coded to match the diame-ters (2) is available to simplify prepara-tion of the titanium abutment (3). Theholder (2) is attached to the handle (1)with a clamping screw (hex) and theabutment is fixed in place with theretaining screw (4).

The following sequences show the preparation of the abutmentin the posterior mandible

An abutment is selected by checking the sizewith the silicone index (6 – 9).

and in the anterior maxilla.

8 9

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5

43

1

2

4

3

2

1

Clamping screw(hex)

35



PreparationThe desired contour of the preparationmargin (labially 1 – 1.5 mm subgingival,lingually: gingival level), the height andaxial alignment are marked (permanentmarker) with the assistance of the sili-cone index (10+11).

Do not overheat the titanium, oth-erwise the surface will hardenunevenly. This “alpha case” layergreatly reduces the options for fur-ther modification.

The abutment is fitted in the universalholder for easier handling.The coarse preparation can be madewith an emery paper roll or a carbidebur for titanum (coarse cut) (12+13).The maximum speed is 10,000 rpm.Work with low pressure to avoid over-heating the titanium. First the height

and axial inclination are adjusted, thenthe preparation is made the same wayas a standard chamfer preparation of atooth (preparation angle 2 – 4°(depending on length), crown margin1 – 1.5 mm subgingival labially, lin-gual/palatal at gingival level). The finepreparation and finishing of the chamfer

are made with titanium burs (fine cut)(14+15). Do not allow the material tooverheat. During preparation the abut-ment may be returned to the cast andevery phase of grinding can be checkedwith the silicone index.

10

12 13

11

14 15

36



Titanium abutment

The finished customized abutments aretried with the silicone index to ensurethat there is sufficient space for the sub-sequent crown and bridge restoration.Always use the maximum length for alarge retention area (20+21). The abut-ment surface must be conditioned inproportion to the retention area immedi-ately before final cementation.

TIP: The abutments are marked onthe labial side (flat trough[s]) toallow orientation during place-ment. The mark is recorded on theworksheet.

Insertion to the mouth is greatly simpli-fied by the labial side mark (22+23) onthe abutment. This is particularly helpfulwith multiple abutments. Note the typeof marks on the worksheet.

22 23

20 21

To make subsequent insertion of thecrown easier, the preparation cross-sec-tion (18+19) should not be completelycircular but preferably oval or triangular– similar to the root cross section of thenatural teeth (16+17) – and must havea milled tapered guide groove.

Mandible 16

18 19

Maxilla 17

7 6 5 4 3 2 1 1 2 3 4 5 6 7

37



Gold-plastic abutment

IntroductionThe gold-plastic abutment (1) consistsof a cast-on base (Cerunor) and a burn-out plastic sleeve. Unlike the titanium orceramic abutments, the anatomical formis achieved by wax-up and then casting.Note: The cast-on base (tube connection)must never be modified.

The gold-plastic abutment can be usedto fabricate transocclusal screw-retainedsingle-tooth crowns and primary crownsfor the telescopic technique.

The gold-plastic abutments are notcolor-coded.

PreparationThe abutment is fixed manually to thelab analog with the retaining screw(2+3). The plastic sleeve is shortenedand checked against the silicone index(4+5).

Then the desired shape is waxed-up(6+7). The metal abutment shouldermust not be completely covered withwax. The wax-metal transition must bechecked under magnification to makesure that it is gap-free.

1

2 3 4

5 6 7

38

Single-tooth crownCrown fabrication


CastingMake sure that the wax coping is cor-rectly positioned in the casting ring dur-ing investing (10). The metal tube mustnot be positioned too close to the ringwalls or floor, otherwise it will lose heat(cooling rib). If the tube cools too quick-ly the casting may be faulty.The preheat temperature of the castingring must be increased approx. 50 °C.

DevestmentThe prefabricated CAMLOG connectionof the gold-plastic abutment must notbe mechanically altered or damagedunder any circumstances. Residues of theinvestment compound can be cleaned offwith acid or steam.We recommend fixing the abutment to alab analog for finishing and polishing.

A metal margin approx. 0.3 mm widemust be left at the implant-abutmenttransition, which must be free fromgrease and wax (8+9). This will preventthe fused material (casting vapor) fromovershooting on to the base surface ofthe abutment. 8

10

11

9

39



Crown fabrication

CementedBefore building-up the wax/acrylic cop-ing, the building-up thread of theoptional horizontal screw-retention andthe screw canal are closed (1+2).

TIP: Apply a thin film of lubricantto the abutment to make it easierto lift the coping (Vaseline or simi-lar).

The crown framework is fabricated onthe prepared abutment similar to thestandard crown and bridge technique(3+4). This applies for function, esthet-ics and hygiene. A metal island shouldbe created, lingual/palatal, to allow forthe grip of a detachment instrument (5).To allow removal of the implant crownat a later time, a slight undercut is madesupragingivally in the framework islandto provide a grip for a crown remover(6+7).

Insertion to the mouth is greatly simpli-fied by a mark on the labial side of theabutment. This is particularly helpfulwith multiple abutments. Note the typeof mark on the worksheet.

1 2

43

5

6 7

40



Vertical screw-retentionA single-tooth crown withvertical/occlusal screw-retention can befabricated with cast-on gold-plasticabutments.

The gold-plastic abutment is fixed to thelab analog with the retaining screw (1)and the plastic sleeve is shortened to1.5 – 2 mm below the occlusion level(2) (check with silicone index).

The framework must be shaped identi-cally to the tooth, but smaller (3) toobtain an even ceramic layer. The mini-mum metal thickness of the cast-on

alloy in the cast area must be 0.3 mmafter trimming (4). Note the CTE ofCerunor (CTE: 12.5/20 °C – 500 °C) toprevent tension cracking.

1 2

3

4

41



The framework around the screw chan-nel must not be trimmed too thin or leftwith sharp edges.Complications may arise during ceramicveneering (cracking/scaling) (6+7).

6

7

After completion of the metal core (9)veneer it with standard ceramics (10).

9 10

42



If horizontal screw-retention is planned,the implant alignment (one groove fac-ing labially) must be aligned preciselyduring implant placement.The screw direction is defined by theimplant position and the abutmentselected from the Standard or Esthomicrange (6 – 8).The cast-on screw sleeve (4) can beintegrated into the wax-up for horizontalscrew retention.The screw (3) must be hand-tightenedonly. The screw must not be modified,otherwise the contact surface of the hexwill be lost. For all horizontal screwretentions note that the anatomicalshape of the crown in the oral regionmust not be negatively influenced by theposition of the screw (check with the sil-icone index) (1+2).

Customized horizontal screw retentioncan be done by using the universal tele-scopic abutment or the gold-plasticabutment. When defining the screw axis,make sure that the screw can be easilyinserted intraorally.

Horizontal screw-retention

Insertion to the mouth is greatly simpli-fied by a mark on the labial side of theabutment. This is particularly helpfulwith multiple abutments. Note the typeof mark on the worksheet.

Ø 1.4 mm:

0.030”

Esthomic line

Standard line

Screw position

Screw position

1

2

6

87

5

3

4

43



Splinted crowns/bridges

IntroductionIf the ratio of crown length (CL) toimplant length (IL) (1) (see worksheetfor implant information) is greater than1, the neighboring single-tooth crownsshould be splinted after consultationwith the dentist.Bridges are best fabricated in severalsmall units.A free-end cantilever is not permitted ona single-tooth crown.With splinted crowns or bridges a free-end cantilever must not exceed the sizeof a premolar.

The implant abutments must not beprimarily splinted.

Implants with a diameter of 3.3 mmmust be used as lower incisors orupper lateral incisors only.

The common insertion path (2) must bedone by grinding or wax-up of the abut-ments.The abutments are hand-tightened tothe lab analog with the retaining screw(3), the volume is appropriately reduced(check with silicone index). Then the gin-gival contour is marked to define thecrown margin.

The adjustable table is placed in the par-allelometer (milling unit) to set the com-mon insertion path of the splinted crownor bridge. The common insertion direc-tion can be prepared on the master cast,on the universal or on the customizedmilling table.

Preparation on the master castThe abutment is prepared in the univer-sal handle and the insertion direction ischecked on the master cast in the paral-lelometer (milling unit) (4). Note thecontour of the preparation margin (1.0 –1.5 mm subgingival).

1

2 3

4

The insertion path must not bechanged by modifying the implant-abutment connection (e.g. shorten-ing the tube).

44



Transfer to a customized millingtableAn additional set of lab analogs andimpression posts, open tray, is requiredfor preparation of the customized millingtable.

The impression posts for the open trayare mounted on the master cast (1). Theposts are connected in the retentive area(NOT to the retaining screw) with atransfer construction (2) (cold-cured pat-tern resin). After loosening the retainingscrews and retracting them completely,the connected transfer part with theimpression posts is removed from thecast (3).

The corresponding lab analogs arescrewed to the impression posts (4),then inserted into a milling table insuperhard stone (5).The common insertion direction previ-ously determined on the master cast isalso the milling axis (7).

1 2 3

4 5

6

7

45



The selected titanium abutments areprepared for the common insertion pathwith a suitable titanium milling instru-ment (8+9).

The splinted crowns/bridges are fabricat-ed with standard crown and bridge tech-niques (10 – 12).

The framework should be tried-in.The hygiene design is particularly impor-tant.

8 9

10 11

12

46

Single-tooth crownInsertion

FOR THE DENTIST

Delivery

IntroductionThe marking on the labial side of theabutment that is noted on the worksheetindicates the only possible position inthe implant and ensures a quick andsecure placement.The marking reduces the three possibili-ties of the abutment to one correct posi-tion, because it would have to be rotat-ed 120° to the next position.Therefore a laboratory-fabricated inser-tion index is not required to find thecorrect abutment position.

System componentsThe following instruments must be disin-fected and prepared for insertion of theabutment in the patient’s mouth (followhygiene procedures):

1 Hex screwdriver, short, long

2 Hex screwdriver, ISO shaft, short, long

3 Torque ratchet

(These components are included in theprosthetic set)

Preparation of the prosthetic com-ponentsThe prosthetic components must be dis-infected before insertion. The implant issprayed inside with water to remove anyresidue and blown dry.The peri-implant hard and soft tissue sit-uation must allow a gap-free insertionof the abutment.

2 1

3

4 5

47


FOR THE DENTIST

Abutment insertionFor insertion the abutment marking (6)is aligned labially and the abutmenttube is inserted into the implant (7).When the cam is felt to be seated on theimplant shoulder, the abutment is rotat-ed until the cam is felt to click into thegroove (8+9).The abutment moves 1.2 mm deeperinto the implant.

Use new retaining screws for final place-ment to ensure optimum initial tight-ness.

The abutment screw is tightened withthe torque ratchet to 20 Ncm (10).After about 5 minutes it must be retight-ened to 20 Ncm (see instructions fortorque ratchet).

After tightening the abutment screw theopening is sealed to a concave channel(11+12). A convex excess must beavoided, otherwise a correct crown posi-tion cannot be guaranteed.

1211

10

8

9

7

6

48


FOR THE DENTIST

Cementation

AdvantagesCementing offers the following advan-tages during fabrication, insertion andrecall:

• Simple, similar to conventional crownand bridge technique

• Time-saving, economical

• Stable, large retention area

• Esthetic, anatomical crown shape

• Tight, between abutment and crown

• Easy to maintain, short recall time

TechniqueBefore cementation, the abutment andcrown are cleaned and dried by thestandard method. Permanent phosphateor carboxylate cements are recommend-ed for cementing.NOTE: It is important that the preciseabutment-crown fit provides only a smallcementation gap. Apply a thin coat ofcement to the cervical margin of thecrown only (approx. 1 mm) and positionit (3+4).

ATTENTION:Carefully remove excess cement andclean the sulcus with dental floss or aninterdental brush.

Bite control indexA bite control index can be fabricated tocheck that the crowns are correctly seat-ed. It is made of light-cured acrylic(1+2).

Full ceramic crownsFull ceramic crowns are conditioned andcemented or bonded as directed by themanufacturer of the ceramic material(5).

1 2

3 54

49


FOR THE DENTIST

Screw-retention

Vertical (1)The crown fabricated with the gold-plas-tic abutment is placed on the implant.Make sure that the cam locks into place.The retaining screw is inserted and handor machine tightened with the hexscrewdriver. The screw is then tightenedwith the torque ratchet to 20 Ncm.After about 5 minutes the retainingscrew must be retightened to 20 Ncm(see instructions for torque ratchet).After tightening the retaining screw thescrew channel is sealed.

Horizontal (2)After inserting the abutment the restora-tion is placed, the horizontal screw(s)is/are screwed in and hand-tightenedcarefully.Do not overtighten the screw.

Note: The hex 0.03” screwdriver isrequired for horizontal screw-retention.

1

2

50

Removable constructionsSet-up/tooth set-up


8. Removable construc-tions

IntroductionAt least six implants are required in themaxilla for removable superstructures, atleast four in the mandible.When using implants 3.3 mm in diame-ter the prosthesis must be designed toensure that extensions do not causeoverloading.Tension-free seating of a secondary (tel-escopic) or primary (bar) splinted con-struction on implants is referred to as“passive fit”.With telescopic constructions this isachieved by intraoral bonding of the sec-ondary copings (e.g. electroformed cop-ing) to a tertiary framework. With barconstructions this is achieved by usingcrown sleeves for passive fit and intrao-ral bonding of the titanium base to thebar.In each case the goal is to fit the con-struction without tension.

Set-up/tooth arrangementThe phonetic and esthetic anterior tootharrangement of the denture must bedone on the patient with the dentaltechnician present. This procedure takesthe individual situation and the patient'swishes into account at the earliest possi-ble stage and ensures that the subse-quent procedures are directed to thatgoal.

When planning a removable constructionthe implants should be placed to enablea fixed restoration to be added later, ifrequired.

Tip: Abutments or gingiva formersmay be used to support a tempo-rary denture base of cold-curedacrylic (1– 6).

21

43

65

51

Removable constructionsSet-up/tooth arrangement


The anterior teeth are set up first on thestabilized denture base as specified inthe planning stage (7+8).

After the phonetic and esthetic try-in onthe patient (together with the dentaltechnician), the posterior region is builtup with a wax mold for a new bite regis-tration (9+10).

After new articulation the set-up is com-pleted (11+12). A silicone matrix is fab-ricated on the master cast from the waxset-up (13+14).The teeth are fixed to the matrix withsticky wax in the region of the futureretaining elements (15).This makes it easy to check the availablespace and the maximum size of theabutment in every phase of fabrication.

7 8

9 10

11 12

14 1513

52

Telescopic techniqueCast fabrication for milling technique


9. Telescopic technique

IntroductionThe rotational stability of the CAMLOGconnection and the precision manufac-turing make the CAMLOG system ideallysuited for fabrication of telescopic pros-theses.Two different methods are used for fab-ricating the secondary copings:

1. Cast copings similar to the well-known telescopic crown technique withfriction retention.

2. Electroformed copings with adhesiveretention.The tension-free seating of the super-structure is very important for the long-term success of an implant-basedrestoration. All secondary copings mustbe bonded intraorally into the tertiaryframework.

Transfer to the milling tableThe impression posts for the open tray(2) are mounted on the master cast (1).The posts are connected in the retentivearea (NOT to the retaining screw) with atransfer construction (3+4) (cold-curedpattern resin).

Cast fabrication for milling techniqueThe prosthesis can be fabricated on a second cast, on the master cast with a millingtable or on the master cast with a removable gingiva mask. This decision must bemade when starting the fabrication. We recommend determining the correct insertiondirection for the patient under clinical conditions at this time. In some cases it will benecessary to incline the primary crowns in the labial direction.

Second cast• Cast two silicone/poly-

ether impressions• Two impressions are

required with hydrocol-loids

• Fabricate two casts• Specify insertion direc-

tion• Mill

Master castand milling table• Specify insertion direc-

tion• Transfer implant position

and insertion directionto the milling table

• Mill

Master cast withremovable gingiva mask• Immediate decision• Fabricate gingiva mask• Specify insertion direc-

tion• Mill

1 2

3 4

53

Telescopic techniqueCast fabrication for milling technique


After loosening (5) the retaining screwsand retracting them completely, thetransfer construction with the impressionposts is removed from the cast (6).

Lab analogs are screwed to the impres-sion posts (7+8) (do not use polishingaids because there is no rotation lock)and mounted into a milling table orient-ed 0° (9 – 10). Universal telescopicabutments or cast-on gold-plastic abut-ments are used as the primary compo-nents.

5 6

87

109

54

Telescopic techniqueAbutment preparation


Universal/telescopicabutment

PreparationThe universal abutments (1) are placedin the lab analogs (2) and hand tightendwith the abutment screws. The heightand the axial alignment (3) are markedusing the silicone index (4).

First the height is adjusted. To ensuresufficient retention the height of thefunctional area must not be less than5 mm circular.

After defining the insertion direction,fabrication is continued in accordancewith the previously selected fabricationprocedure:

• Milling on the master cast (3)• Milling on the milling table (5)

1

2 3

4 5

55



A taper angle of 2 – 4° is recommendedfor the electroplating technique, depend-ing on the number of abutments and theavailable functional surfaces (6) (longabutments: 4°). Cast secondary crownsare prepared similarly to the standardtelescopic crown technique.The butt-joint runs from supragingival tono greater than gingival level (7).The secondary coping is prevented fromrotation by precision grooves.A sandpaper roller can be used forcoarse preparation. It must be run at amaximal speed of 10,000 rpm and itshould be applied at a low pressure onlyto prevent overheating the titanium.

First the axial inclination is adjusted,then preparation is continued similar tothe standard chamfer preparation of atooth. Titanium burs are used for finepreparation and shaping the shoulder.Do not allow the material to overheat.

The surfaces must be homogenous (rub-ber polished) for fabrication of the sec-ondary coping – high luster polishing isnot required.

The space for the tertiary frameworkrequired to receive the secondary crownscan be tested at every phase of prepara-tion with the silicone index with thedenture teeth in position (8+9).

Do not overheat the titanium, oth-erwise the surface will hardenunevenly. This “alpha case” layergreatly reduces the options for fur-ther processing.

6 7

8 9

56



Gold-plastic abutment

Material dataThe gold-plastic abutment consists of acast-on gold alloy (Cerunor)* and apressed-on, burn-out plastic sleeve. Thegold-plastic abutments are not color-coded.

* Propertiessee Information Section

Composition:Au 60%Pt 19%Pd 20%Ir 1%

Metallic weight of basic parts:Ø 3.3 mm 0.57 gØ 3.8 mm 0.65 gØ 4.3 mm 0.83 gØ 5.0 mm 0.91 gØ 6.0 mm 0.99 g

Melting range:1400 – 1490 °C2552 – 2714 °F

PreparationThe gold-plastic abutments (2) areplaced on the cast into the lab analogsand hand tightend with the retainingscrews (3). The silicone index is used toassist with marking the required lengthon the plastic sleeve to which it must beshortened (4 – 6).To ensure sufficient retention the heightof the functional area must not be lessthan 5 mm circular.After defining the insertion direction (4)fabrication is continued in accordancewith the previously selected fabricationprocedure:

1 2

3 4

5 6 7

57



WaxingThe primary crowns are fabricated withthe gold-plastic abutment similarly tothe conventional telescopic crown tech-nique. For the wax-up (1) note that thecervical margin of the gold-plastic abut-ment must not be completely coveredwith wax (2). A metal margin approx.0.3 mm wide must be left on the gold-plastic abutment. It must be free ofgrease and wax. This will prevent cast-on metal from overflowing on to thebase area of the gold-plastic abutmentas a result of expansion of the invest-ment compound. The contour of theshoulder (1) should run from supragingi-val to gingival level. The minimum heightof the primary components must be5 mm circular.

Placing and investingThe metal tube of the gold-plastic abut-ment must be aligned towards the heatcenter (3), because if the metal tube iscooled too fast the casting may befaulty. Use only phosphate-based invest-ment compounds. Use only high preciousmetal alloys for cast-on procedure.

TIP: The preheat temperature of thecasting ring must be increased toapprox. 50 °C.

DevestmentAfter cooling to room temperature thecast object is devested without mechani-cal impact.The precise CAMLOG connection of thegold-plastic abutment must not bemechanically processed under any cir-cumstances. The investment compoundresidue on the cast object must beremoved with acid or steam only.

1

2

3

58



PreparationPreparation is continued by followingthe selected fabrication procedure(milling technique) (4 – 7).

The penetration area through the gingivais given a concave shape (8).

4 5

6 7

8

59

Telescopic techniqueSecondary coping


Secondary coping

IntroductionIt is very important for the superstruc-ture to be seated without tension toensure the long-term success of animplant-based restoration. Therefore, allsecondary copings should be bondedinto the tertiary framework intraorally.This also ensures that the denture is suf-ficiently stable.The minimum gap (5 µm) of the electro-formed coping provides capillary spacesfor the saliva and results in adhesion.The cast coping is retained by friction.

TIP: When removing the electro-formed coping from the abutmentfor the first time carefully grip thelab analog with pliers and tap onlightly with an instrument.

Titanium abutment

Precious alloy abutment

2

4

5 6 7

1

3

Electroformed copingsBefore electroforming the abutments arescrewed to a lab analog (1). The labanalogs can be placed in acrylic (2). Allparts that are not to be electroformedmust be isolated (green area) and cov-ered (2).Titanium surfaces can be directly electro-formed (1).The casted abutments (3) must be iso-lated initially (green area) and thencoated with conductive lacquer (bluearea) in the relevant area (4).The electroforming (5 – 7) is continuedas directed by the manufacturer. The lay-er must be 0.2 – 0.3 mm thick. The spe-cial feature of the low layer thickness ofthe electroformed components and theresulting low stability of the secondarycoping prevent direct polymerization inthe acrylic denture base and therefore atertiary framework is necessary.

Cast secondary copingThe wall thickness of the secondary cop-ing is guided by the minimum possiblethickness allowed by casting technology(0.3 – 0.5 mm).Fabrication is similar to standard crownand bridge technique.

Advantages:• Purity (24 carat)• Homogeneity• Best possible fit• Reproducible precision• Easy to repair

60

Telescopic techniqueTertiary framework


Tertiary framework

WaxingA metal framework is essential for stabi-lizing the acrylic base and securelyretaining the secondary coping. To fabri-cate the tertiary framework the workingcast is blocked out, the coping is waxedover (1) (0.3 mm for bonding gap) andthen duplicated (2).

The tertiary framework is built in wax onthe duplicate cast with the silicone indexas a control (3 – 5).

1 2

3 4

5

76

The cervical margin of the secondarycoping must be completely reproducedin metal (6+7). The tertiary frameworkcan be fabricated from titanium or nonprecious alloy. The subsequent steps forcomplete fixation of the secondary com-ponents are done in the patient’s mouth.

61

Telescopic techniqueSet-up and try-in

FOR THE DENTIST

Set-up and try-in

After the metal bonding material hasset, the framework can be removed fromthe mouth with the secondary copingbonded in without tension. The abut-ments are removed and sent to the den-tal laboratory for finishing the secondarycoping/abutment transition.If the bonded tertiary framework cannotbe replaced on the master cast withouttension, the interfering abutment isremoved from the master cast for furtherprocedures.

The bonded points are trimmed (removalof excess material), the construction iscoated with a denture-colored opaquelayer to improve the cosmetic appear-ance (optional) and the teeth are posi-tioned with the silicone index (5).The try-in is also used to check the pho-netics, chewing function and esthetics,as with standard prosthetic procedures.

Bonding of the secondary copingThe secondary coping is fixed to the ter-tiary framework intraorally with a suit-able metal bonding material.The abutments (primary crowns) pre-pared by the dental technician areplaced in the cleaned implants and theretaining screw is hand-tightened. Thesecondary coping is prepared with astone or diamond to improve the adhe-sion of the bonding agent and placed onthe abutments. Then the tertiary frame-work is placed and the fit is checked forthe secondary coping to ensure that it isseated securely and with an evencement gap (1).This ensures that the coping can bebonded later into the framework withouttension (passive fit) (2 – 4).After try-in, the bonding surfaces aregrit-blasted and cleaned. Undercuts canalso be made at this time. Follow themanufacturer’s instructions for bonding.

Tip: Spread a light coat of Vaselineon the abutments (primary crowns)before placing the electroformedsecondary copings; do not coat thecervical margin.

1 2

3 4

5

62

Telescopic techniqueFinishing and insertion


DENTAL TECHNICIAN:FinishingThe acrylic can be finished with heat-cured or cold-cured material.Occlusion and articulation are adjustedin accordance with the functionalrequirements for centric andanterior/canine guidance. The occlusionand articulation are oriented to fixedrestorations. The multipoint contact incentric occlusion and anterior/canineguidance guarantee long-term harmo-nization of the prostheses. The finishedwork can finally be inserted into thepatient’s mouth after polishing theacrylic components.

DENTIST:InsertionThe abutment marking is aligned labiallyand the abutment tube is inserted intothe implant. When the cam is felt to beseated on the implant shoulder, theabutment is rotated until the cam is feltto click into the groove of the implant.The abutment will move 1.2 mm deeperinto the implant.The retaining screw is inserted and tigh-tend manually or mechanically with thehex screwdriver. The screw is then tight-ened to 20 Ncm with the torque ratchet(1). After about 5 minutes it must beretightened to 20 Ncm (see instructions

LiteratureThe Dental Cripple – oder Die wiederge-wonnene Lebensqualität. Neuendorff G,Ackermann KL, Kirsch A, Hahn, C; dentalspectrum, V, 2/2000,91 – 114

1

2 3

for torque ratchet). After tightening theabutment screw, the screw channel issealed.Use new abutment screws for finalplacement to ensure optimum initialtightness. Then the prosthesis is inserted(2+3).

Tip: When sealing the screw chan-nel in the abutments (primary com-ponents) ensure that the final sur-face is concave. All acrylic residuemust be removed to ensure thatthe prosthesis is perfectly seated(3).

63

Bar techniqueIntroduction


10. Bar technique

IntroductionCopings are available for fabrication ofcustom-milled or prefabricated bar con-structions.

Passive fitApplication of the passive-fit techniquerequires use of the burn-out bar sleevefor passive fit. Intraoral bonding of thetitanium bonding bases (2) into the cus-tomized bar compensates for any impre-cision (1) that could cause tension.

Custom-milled bar (3)Features:• Customized, hygiene-compatible shape• Parallel milled• One-piece cast• Passive fit

Prefabricated bar (4)Features:• Time-saving and economical with pre-

fabricated components• Bar profile can be selected• Bar clip can be selected

1

2

3

4

64

Bar techniqueCustom-milled bar


Diameters and gingiva heightsBar abutments are available in diametersof 3.3 mm, 3.8 mm, 4.3 mm, 5.0 mmund 6.0 mm (12).The gingiva height is the distance fromthe shoulder of the implant to the high-est point of the surrounding gingiva. Thebar abutment plateau should be about0.5 mm supragingival. Abutments areavailable in heights of 0.5 mm, 2.0 mmand 4.0 mm (13).

1 23

4

5

6

11

7 8 9 10

10 a

10 b

13

System components and materials1 Implant driver 3.3 – 4.3 mm2 Implant driver 5.0 and 6.0 mm3 Screwdriver, 0.05 hex, short4 Screwdriver, 0.05 hex, long5 Ring wrench6 Torque ratchet

Custom-milled bar

IntroductionPrefabricated bar components are avail-able for bar technique with a custom-modeled, milled bar. This makes it possi-ble to adjust the bar position to theclinical situation as desired (below the

denture teeth) from a hygienic, function-al and esthetic viewpoint. Special barcomponents for passive fit techniqueallow the bar to be adjusted withouttension with no soldering or laser-weld-ing.

12

7 Bar abutment Ti6Al4V8 Base for bar abutment, burn-out Polyoxymethylene9 Base for bar abutment, cast-on CERUNOR 10 a Bar sleeve for titanium bonding

base, burn-out Polyoxymethylene10 b Titanium bonding base for bar abutment Ti6Al4V11 Prosthetic screw

65



Abutment selectionIn the standard method the dental tech-nician selects the bar abutmentsdepending on the gingiva height on thebasis of the diagnostic model (16). Thebar must be 0.5 mm from the gingiva(20). The bar abutments of appropriatediameter are screwed manually into theprepared master cast (16) with theimplant driver (14, 15, 18).

These parts are original compo-nents and must not be modified.

14 15 16

17 18

19 20

21

66



Wax-up preparationThe burn-out (24+27) or cast-on(23+26) base for a bar when using thedirect technique is fixed to a bar abut-ment in a center position on the cast.The base acts as a reference point and isdesigned so that it can be placed direct-ly on the bar abutment after casting.Titanium bonding bases and burn-outbar sleeves are fixed to the remainingbar abutments with the prostheticscrews (22+25) (tighten lightly only)(28).They are securely centered in positionover the inner plastic fixation edge withthe prosthetic screws (25).

The burn-out bar sleeves are shortenedto match the available space. The sili-cone index with the mounted teeth isused as a reference. (28 – 30).

22 23 24

28 29

25 26 27

30

67



Bar wax-upThe bar should be integrated below theprosthetic teeth (38).Pay attention to hygiene aspects duringwax-up. The shape of the bar dependson the type of the secondary component.If cast by the conventional method, thebar must have a linear shape (expansionand contraction during casting). Whenusing electroforming technique (37), atrough-shaped curve is waxed in toenhance the stability of the electro-formed secondary structure.The implant distribution and implantdimensions must be taken into accountwhen developing the dimensions andshape of the bar.As an option, prefabricated bar maleparts may be integrated.

The silicone matrix with the mountedprosthetic teeth is used to check the bardimension and position. The additionalvolume of the tertiary structure and theretaining elements must also be consid-ered. A labial/lingual check of the avail-able volume must also be made(35+36). This is the only way to ensurethat there is sufficient room for thetongue. A second silicone matrix posi-tioned lingually makes this possible. Afinal occlusal check in the articulatorwith the waxed-up bar guarantees thatthe bar can be further processed(31–38).

31 32

33 34

35 36

37 38

68



CastingAfter sprueing all retaining screws arecarefully removed, the bar is lifted offwithout distortion and the titaniumbonding bases are removed from the barsleeves (Attention: never cast them withthe other components). The bar is invest-ed in a sufficiently large crucible (39).The investment compound must be phos-phate-based.When using castable bar bases as a ref-erence, the preheat temperature of thecrucible must be increased by about50 °C for precise casting. The holdingtime of the preheat temperature must bemaintained in accordance with the cru-cible size. To simplify the casting processand to ensure a homogenous castobject, we recommend waxing coolingvents to the object.

DevestmentThe castable bar base is devested withacid or steam (40 – 42).

39

40

41 42

69



TrimmingAfter devestment and cleaning of thecast, the internal fixation edges (waxingaid) are removed from the bar sleeveswith a round bur (Ø 2.4 mm) (43+44).The prosthetic screw must slide throughthe bar sleeve without contact (44).The final screw seat is on the titaniumbonding base (45).

When using a burn-out bar base as areference base, check that it fits perfect-ly on the bar abutment. The screw seathas to be checked carefully.Reamers for casting residues are avail-able for reworking the screw seat andthe shoulder contact area (46 – 49).

The fit of the cast-on bar basemust not be reworked.

M 1.6Ø 3.3–4.3

M 2.0Ø 5.0–6.0

Ø 3.3–4.3 Ø 5.0+6.0

43

47

45

44

46

48 49

70



Try-inFirst check that the titanium bondingbase fits into the sleeve without contactand make sure that the cement gap iseven. The bar framework is inserted bythe reference of the burn-out/cast-onbase and fixed in the correct positionwith the prosthetic screw (52+53).The parallel-walled extension of the barsleeve must be shortened or ground. Thetitanium bonding bases are replaced onthe bar abutments and fixed with theprosthetic screws for an additional checkof the fit (51).The titanium bonding bases show acement gap between them and the burn-out bar sleeves. Interfering contacts mustbe removed. Coloration or matt blastingmake it easier to identify interfering con-tacts. Checking it under a microscopeincreases the precision (53).

Bonding the titanium bonding baseThe criteria of the Sheffield test must bemet to check that the seat is free of ten-sion (passive fit). When the bar fits in themouth without tension, this determinesthe subsequent procedure (54 – 57). Ifdifferences between the oral and cast sit-uation occure, the faulty bar abutment isremoved from the working cast for fur-ther milling. This ensures that the barposition is identical on the master castand in the mouth.

50 51

52 53

54 55

56 57

71



To bond the bar sleeves to the titaniumbonding bases in the mouth, the contactareas must be conditioned as specifiedby the cement manufacturer (58).Additional retention elements (grooves)must be cut into the titanium bondingbase and the cast sleeves for mechanicalretention of the bonding agent. The con-ditioned titanium bonding bases arefixed to the bar abutments with theprosthetic screws, the internal hex iscovered with wax.

Attention! Do not place wax on theconditioned surface.

The cement is mixed as specified by themanufacturer and applied to the internalsurface of the sleeve and the outer sur-face of the titanium bonding base (58).The cast bar construction is positionedon the bar abutments and fixed via thereference base with the prosthetic screw(59+60).

Pay attention to the setting time ofthe cement.Use refrigerated bonding material.

The accessibility of the prosthetic screwrequires quick removal of the cementresidue from the screw hole during theplastic phase. After the bond has setcompletely, the bar is removed byremoving all prosthetic screws from thebar abutments. Cement residues at thebase can be carefully removed.

58 59

60

72



Milling and finishingThe bar is parallel-milled on the mastercast or the milling table (62). Avoidsharp edges; occlusal chamfering makesthe insertion of the secondary structureeasier. Parallel milling is conducted withcoarse cut hard-metal milling tools (62),depending on the alloy used. The barposition is checked on the master cast(silicone index) with the bar matrices inposition (63).

The base section of the bar is trimmedand polished at a later time.

When using a cast titanium alloy itmust not be overheated, becausethis may cause differential harden-ing of the surface.This “alpha case” layer greatlyreduces the options for further pro-cessing.

61 62

63 64

73



Electroformed second-ary framework

FabricationThe finished bar is lifted off the barabutments. The screw channels and theinside of the titanium bonding bases arecompletely filled with acrylic.Soldering aids are screwed into two orthree titanium bonding bases (65+66)to make it easier to separate the electro-formed framework from the bar later. Allsections not to be electroformed arecovered with masking lacquer (67).Silver conductive lacquer must be appliedover the screw channels to ensure aclosed electroformed framework (68).A completely grease-free titanium sur-face can be directly galvanized. All otherdental alloys must be coated with a con-ductive lacquer before galvanizing.

Electroforming is conducted as specifiedby the manufacturer. The thicknessshould be 0.2 – 0.3 mm (69).

After removal of the masking lacquer thebase margins of the electroformedframework are carefully smoothed withrubber wheels.

The two soldering aids (abutment) in thetitanium bonding bases allow the elec-troformed framework to be lifted evenlyfrom the bar (70). The acrylic can beremoved from the titanium bondingbases.Residues of conductive lacquer areremoved from the inner surface of theelectroformed framework with 53%nitric acid (use standard precautionswhen working with acids).The bar and electroformed frameworkare replaced on the master cast forfurther processing (71).

65 66

67 68

69 70

71

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The wax-up with retentions is checkedwith the silicone index with the teethmounted (75). The cervical margin of theelectroformed framework must be incontact with the cast to ensure a mini-mum cement gap.

After casting (77) the tertiary structureis trimmed to allow it to be placed onthe bar or electroformed frameworkwithout pressure or tension to ensure aneven cement gap (79 – 81).

72

73 74

75 76

77

78 79

80 81

Tertiary framework

The tertiary structure is for stabilizingthe electroformed framework and rein-forcing the prosthetic base. A duplicatecast is required for this technique.All undercut areas on the master cast areblocked out (72+73). The electroformedframework is coated with a layer of waxof 0.2 to 0.3 mm to create an evencement space. Duplication and fabrica-tion of an investment model are per-formed in line with the standard rules ofcasting technology (74). The referenceretentions of the silicone index fabricat-ed from the set-up must also be dupli-cated.

Bonding the electroformed second-ary frameworkThe electroformed framework is bondedinto the tertiary structure on the mastercast. The tertiary framework must beperforated to ensure the out-flow of thebonding material cement.Before bonding, all internal areasbetween bar and cast must be blockedout with colorless wax (cement discol-oration) (83+84).

Bar and abutments are isolated by a thincoat of Vaseline before positioning theelectroformed framework. This allows thebonded construction to be lifted offlater.

75



Advantages of electroforming• Purity (24 carat)• Homogeneity• Best possible fit• Reproducible precision• Easy to repair

82

83

84

85 86 87

88

When bonding the electroformed frame-work to the tertiary framework all bond-ing surfaces must be conditioned asspecified by the manufacturer. The metalbond is applied in a thin coat to theelectroformed framework, (85) the terti-ary framework is carefully positioned

(86 – 88). The bonding points arecleaned once the bond has set and theconstruction is removed.The basal transition margins from theelectroformed framework to the tertiaryframework must be completely free ofbonding residues (plaque retention).

76



DENTAL TECHNICIAN:Bar finishingThe base area of the bar is given a con-vex shape and a high polished surface toensure that it is easy to maintainhygiene. The base contour and the pene-tration region of the abutments (89) areshaped so that an interdental brush canbe inserted with light pressure (checkduring try-in).

DENTIST/DENTAL TECHNICIAN:FinishingAfter try-in, finishing is continued withheat-cured or cold-cured polymerizationtechnique. High polishing and the convexshape of the basal bar components mini-

mize plaque retention. The dentist checksthe cleanability of the restoration.The individual components must be pre-cise and gap-free to prevent retention ofplaque and food residue in these areas.

DENTIST:Set-up and try-inThe teeth are positioned using the sili-cone index (90+91).

For the patient try-in (92+93) the barabutments are removed from the mastercast, cleaned, disinfected, and screwedmanually into the implants with theimplant driver of the appropriate diame-ter.The bar is positioned and fixed with theprosthetic screws.The tension-free seating (passive fit) ischecked again. The set-up prosthesis isinserted and checked for esthetics, func-tion, phonetics and soft-tissue supportas in the standard prosthetic procedure.

89

90 91

92

93

77


FOR THE DENTIST

InsertionFor long-term success, it is important toensure that the superstructure can beeasily inserted and removed, hygiene canbe maintained without problems andthat it functions correctly. A carefulshort-term re-call is essential after finalinsertion.

Screwing in the bar abutments andthe barAfter removing the gingiva former andcleaning the implant, the bar abutmentsare screwed in with the implant driverand finally tightened with the torqueratchet (94+95).

Torques:Ø 3.3 mm 20 NcmØ 3.8 – 6.0 mm 30 Ncm

Use new prosthetic screws for finalplacement to ensure optimum initialtightness of the bar (96+97).The prosthetic screws are tightened to15 Ncm.

The screws must be tightenedagain after five minutes.

In addition to the final clinical check(occlusion, articulation, esthetics, etc.),an x-ray examination is required tocheck the congruent position of thesuprastructure on the implants(98 – 100).

LiteratureHerstellung einer implantatgetragenen,stegretinierten UK-TotalprotheseNeuendorff G, Ackermann KL, Kirsch A,Hahn Cdental spectrum, V, 2/2000, 91–114

94 95

96 97

98 99

100

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7

8

78

System components and materials1 Driver for bar abutment

Ø 3,3 – 4.3 mm2 Driver for bar abutment

Ø 5.0 + 6.0 mm3 Driver for impression post

and healing cap for bar abutment Ø 3.3 – 4.3 mm

4 Driver for impression post and healing cap for bar abutment Ø 5.0 + 6.0 mm

5 Screwdriver, 0.05 hex, short6 Screwdriver, 0.05 hex, long7 Universal ring wrench8 Torque ratchet

Bar techniquePrefabricated bar


IntroductionPrefabricated bar components are avail-able for the prefabricated bar. In addi-tion to prosthetic restoration afterosseointegration, there is the option ofimplementing functional early loadingwith a bar-supported restoration in themandible with sufficient primary stabilityon at least four implants. The dentistalone makes this decision.The bar must be seated on the implantswithout tension. Various types of fabri-cation are available.

Fabrication types• Gold base for bar abutment, solder-

able (ELUNOR WP) with prefabricatedbar profile of precious alloy

• Titanum base for bar abutment, laser-weldable (Ti6Al4V) with prefabricatedbar profile (Titanium Grade 4)

• Gold base for bar abutment, cast-on(CERUNOR) with prefabricated barprofile of plastic/wax

• Plastic base for bar abutment, burn-out (Polyoxymethylene (POM)) withprefabricated bar profile (plastic)

11. Prefabricated bar

79

Diameters and gingiva heightsBar abutments are available in diametersof 3.3 mm, 3.8 mm, 4.3 mm, 5.0 mmand 6.0 mm (16+17). The gingivaheight is the distance from the shoulderof the implant to the highest point ofthe surrounding gingiva. The bar abut-ment plateau should be about 0.5 mmsupragingival. Abutments are availablein heights of 0.5 mm, 2.0 mm and 4.0 mm (18).

The bar abutments with diameter 3.3 mm to 4.3 mm have a uniformplateau diameter of 4.3 mm. The 5.0 mmand 6.0 mm bar abutments have a uni-form plateau diameter of 6.0 mm.



9 10 11 12 13

14 15

16

18

17

System components and materials9 Bar abutment Ø 4.3 mm and prosthetic screw, M 1.6 Ti6Al4V10 Base for bar abutment, laser-weldable Titanium Grade 411 Base for bar abutment, solderable ELUNOR WP12 Base for bar abutment, cast-on CERUNOR13 Base for bar abutment, burn-out Polyoxymethylene14 Impression post for bar abutment Ti6Al4V15 Healing cap for bar abutment Ti6Al4V

80



The impression post for bar abutments isscrewed onto the bar abutments withthe driver to take an impression(7 – 11).

6

8 9 107

Impression and abutment selectionWith the standard method the impres-sion is taken at implant level (open orclosed impression). After fabrication ofthe cast the dental technician selects thebar abutments depending on the gingivaheight.The bar must be 0.5 mm from the gingi-va (5). The bar abutments with appropri-ate diameter are manually screwed tothe prepared master cast with the driver(1 – 3). The original components must notbe modified.There is also the option of taking a directimpression from the bar abutments in themouth.The dentist selects the bar abutmentschairside according to the above criteria.The bar abutments are screwed manuallyin with the driver (3) and finally tight-ened with the torque ratchet (4):

Ø 3.3 mm 20 NcmØ 3.8 – 6.0 mm 30 Ncm

After about five minutes the bar abut-ment must be retightened to the speci-fied torque.

4 5

31 2

11

81

12 13

14 15 16

1817 19

22 23 24

DENTIST:The impression is taken with a closedtray (12). After removal of the impres-sion (13) the impression posts areunscrewed from the bar abutment (14)and sent to the dental laboratory.The bar abutments remain in the mouth.The healing caps (Ø 4.3 mm or 6.0 mm)are screwed onto the bar abutmentsmanually with the hex screw driver. Theytake over the function of the gingiva for-mer (15+16).

21



DENTAL TECHNICIAN:Cast fabricationIn the dental laboratory the impressionposts for bar abutments are screwed tothe bar lab analog selecting the corre-sponding diameter (Ø 4.3 mm/6.0 mm)(17 – 19) and repositioned in theimpression (21+22). The cast is fabricat-ed by standard procedure (23+24).

82



Base for bar abutment,solderable

System components and materials1 Soldering aid/bar lab analog Stainless steel2 Base for bar abutment, solderable ELUNOR WP

Ø 3.3 – 4.3 mmØ 5.0 – 6.0 mm

3 Prosthetic screws for bar abutment Ti6Al4VØ 3.3 – 4.3 mm, M 1.6Ø 5.0 – 6.0 mm, M 2.0

4 Retaining screws Stainless steelØ 3.3 – 4.3 mm, M 1.6Ø 5.0 – 6.0 mm, M 2.0

Bar fabricationThe gold bases for solderable bar abut-ments of appropriate diameter arescrewed to the bar lab analogs/solderingaids in the cast with the supplied pros-thetic screws (5+6). The bar profile ofprecious alloy is fitted between thebases (7) and fixed with pattern resinthat burns out without leaving a residue(8).

The distance of the bar profile to thegingiva at the base must be selected sothat an interdental brush can be insertedwith light pressure.The fixed bar profile must be transferredto a soldering model. The bases for sol-derable bar abutments bonded to thebar profile are released and carefullyremoved from the master cast (9+10).

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2 3 4

5 6

7 8

9 10

83



TrimmingAfter soldering, the bar is placed on themaster cast and finished (14 +15). Theseat must be checked to ensure that it isfree of tension. The contact areas of thebases for solderable bar abutments mustnot be touched. The maintenance ofhygiene is important, particularly in thearea of the implants.The sleeves and riders are attached tothe existing or new denture as specifiedby the manufacturer.

Bar lab analogs/soldering aids are fixedto the bases with retaining screws(Stainless steel). A soldering model isfabricated (11 – 14). It protects thescrew seats and contact areas on thebase and the prefabricated precisionquality is retained.

1112

13 14

1615

1

2 3

Base for bar abutment,laser-weldable

System components and materials1 Bar lab analog Stainless steel2 Base for bar abutment, laser-weldable Titanium Grade 4

Ø 3,3 – 4.3 mmØ 5.0 – 6.0 mm


• Prefabricated bar profile of titanium

84



Bar fabricationThe titanium bases for laser-weldablebar abutments of appropriate diameterare screwed to the bar lab analogs onthe cast with the prosthetic screws forbar abutments (4+5). The bar profile oftitanium is fitted between the bases (6)and fixed with pattern resin (7).

The distance of the bar profile to thegingiva at the base must be selected sothat an interdental brush can be insertedwith light pressure.The titanium bar profile can be laser-welded to the base on the master cast(8).

TrimmingAfter laser welding, the bar is finishedon the master cast.The seat must be checked to ensure thatit is free of tension. The contact areas ofthe bases for laser-weldable bar abut-ments must not be touched. The mainte-nance of hygiene is important, particu-larly in the area of the implants.The sleeves and riders are attached tothe existing or new denture as specifiedby the manufacturer.

4 5

6 7

8

85



Bar fabricationThe gold bases for cast-on bar abut-ments of appropriate diameter arescrewed to the bar lab analogs on themaster cast with the prosthetic screwsfor bar abutments (4+5) and shortenedusing the silicone index (6+7).The bar profile (wax or plastic) is fittedbetween the bases and waxed-up (8+9).

The distance of the bar profile to thegingiva at the base must be selected sothat an interdental brush can be insertedwith light pressure.

1

2 3

4 5

6 7

8 9

Base for bar abutment,cast-on

System components and materials1 Bar lab analog Stainless steel2 Base for bar abutment, cast-on CERUNOR

Ø 3.3 – 4.3 mmØ 5.0 – 6.0 mm


• Prefabricated bar profile of plastic

86



TrimmingAfter devestment the bar is fitted andfinished on the master cast. The seatmust be checked to ensure that it is freeof tension (12). The contact areas of thebases for the cast-on bar abutment mustnot be touched. The maintenance ofhygiene is important, particularly in theregion of the implants.The sleeves and riders are attached tothe existing or new denture as specifiedby the manufacturer.

After sprueing, all prosthetic screws areremoved and the bar can carefully belifted off without distortion (10). The baris invested in a sufficiently large castingring (11).The investment compound must be phos-phate-based.For precise casting the preheat tempera-ture of the casting ring must beincreased approx. 50 °C. The holdingtime of the preheat temperature must bemaintained in accordance with the cast-ing ring size. Cooling vents should bewaxed on to simplify the casting processand to ensure that the cast object ishomogeneous.

After casting the residual investmentcompound must be removed with acid orsteam.

ATTENTION:The prefabricated base for barabutments must never be touchedor modified.

10 11

12 13

87



Bar fabricationThe plastic bases for burn-out bar abut-ments of appropriate diameter arescrewed to the bar lab analogs on themaster cast with the prosthetic screwsfor bar abutments (4+5) and shortenedusing the silicone index (6+7).The bar profile (wax/plastic) is fittedbetween the bases and connected.

The distance of the bar profile to thegingiva at the base must be selected sothat an interdental brush can be insertedwith light pressure (8+9).

1

2 3

4 5

6 7

8 9

Base for bar abutment,burn-out

System components and materials1 Bar lab analog Stainless steel2 Base for bar abutment, burn-out POM

Ø 3.3 – 4.3 mmØ 5.0 – 6.0 mm


• Stock bar profile of plastic

88



TrimmingAfter devestment the bar is fitted andfinished on the master cast (16). Theseat must be checked to ensure that it isfree of tension. The maintenance ofhygiene (17) is important, particularly inthe area of the implants.The sleeves and riders are attached tothe existing or new denture as specifiedby the manufacturer.

After sprueing, all prosthetic screws areremoved and the bar can carefully belifted off without distortion (10). The baris invested in a sufficiently large castingring (11). The investment compoundmust be phosphate-based. The holdingtime of the preheat temperature must bemaintained in accordance with the ringsize. Cooling vents should be waxed onto simplify the casting process and toensure that the cast object is homoge-neous.After casting, the residual investmentcompound must be removed with acid orsteam.Reamers are available to smoothen thescrew seat and the contact area at thebase of the bar coping (12 – 15).

10 11

16 17

Ø 3.3–4.3 Ø 5.0–6.0 Ø 3.3–4.3 Ø 5.0+6.0

13

12 14

15

89



DENTIST:Bar try-in The bar is placed in the mouth and fixedwith the prosthetic screws. The exact fiton the bar abutments can now bechecked. The criteria of the Sheffield testmust be met to ensure that the seat istension-free (passive fit). When the barfits in the mouth without tension, thesubsequent procedure is decided. Ifthere are differences between the mouthand cast situation the bar is separatedand reconnected intraorally.

DENTAL TECHNICIAN:Tertiary frameworkThe tertiary framework reinforces thedenture base. A duplicate cast isrequired for this technique.All undercut areas on the master castare blocked out. Duplication and invest-ment model fabrication are performed inaccordance with the standard rules ofcasting technology. The reference reten-tions of the silicone index fabricatedfrom the set-up must also be duplicated.

The wax-up with retentions and grips forthe sleeves and riders is checked againstthe silicone index with mounted teeth.After casting, the tertiary framework isfinished to allow it to be placed on thebar framework without pressure andtension.The sleeves and riders are fitted andbonded to the finished bar in accordancewith the systems used.

DENTIST/DENTAL TECHNICIAN:Set-up and try-inThe silicone index with the mountedteeth is placed on the master cast. Thewax try-in can be made after waxing-upon to the tertiary framework.The try-in in the patient’s mouth is alsoused to check the phonetics, chewingfunction and esthetics, as in standardprosthetic procedures.

DENTAL TECHNICIAN:FinishingAfter the try-in, finishing is continuedwith heat-cured or cold-cured polymer-ization. Polishing and the convex shapeof the basal bar components minimizeplaque retention. The dentist checks thecleanability.

DENTIST:InsertionAfter removal of the gingiva former orhealing caps and cleaning of theimplant, the bar abutments are insertedwith the implant driver. The bar abut-ments are finally tightened with thetorque ratchet.Torques:Ø 3.3 mm 20 NcmØ 3.8 mm – 6.0 mm 30 Ncm

Use new prosthetic screws for finalplacement to ensure optimum ini-tial tightness of the prostheticscrew.

The bar is placed and the prostheticscrews are tightened to 15 Ncm with thetorque ratchet. After about five minutesthe screws are tightened again.

In addition to the final check (occlusion,articulation, esthetics, etc.), an x-ray canbe made to check the precision of thesuperstructure on the implants. The barabutments are documented on the work-sheet.

DENTIST/DENTAL TECHNICIAN:Integration into an existing den-tureThe sleeves and riders are fitted to thefinished bar in accordance with the sys-tems used. The riders and sleeves can beintegrated or polymerized on the mastercast or in the mouth. The processinginstructions of the manufacturer must beobserved.

For long-term success it is important toensure that the superstructure can beeasily inserted and removed, hygiene canbe maintained without problems andthat it functions correctly.

90

Ball abutment (Dalbo system)Introduction


11. Ball abutment(Dalbo system)

IntroductionThe ball abutment technique is used onfour to six implants in the maxilla or onfour implants in the mandible. It is animplant-retained denture soft tissuesupported which requires a regular recallof the site.The ball abutment must not be modified.The implant axial divergence must notexceed 10°.

TorquesHand-tightening on the master cast isrequired. The following settings apply totightening with the torque ratchet in themouth:Ø 3.3 mm 20 NcmØ 3.8 – 5.0 mm 30 Ncm

Diameters and gingiva heightsBall abutments are available in diame-ters of 3.3 mm, 3.8 mm, 4.3 mm and5.0 mm (10). The gingiva height is thedistance from the shoulder of theimplant to the ball abutment plateau(11). The ball abutment plateau shouldbe about 1 mm supragingival.Abutments are available in heights of1.5 mm, 3.0 mm and 4.5 mm. The balldiameter is 2.25 mm for all abutments.

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2

3

4 5

6

7

8

9

10 11

System componentsand materials1 Torque ratchet2 Driver for ball abut-

ment3 Screwdriver, activator

for ball abutmentmatrix

4 Ball abutment (Male)5 Model analog (Brass)6 Matrices7 Duplication aid8 Stabilizing ring9 Lamella retention insert

91

Ball abutment (Dalbo system)Setting the retention force


Setting the retention forceWith the lamella retention insert at max-imum the retention force is approximate-ly 1200 g. The force is approximately200 g on delivery. The force can be regu-lated by screwing the activator (3) inand out (1+2).

The lamella retention insert mustnever extend out of the housing,otherwise it may come loose andthe matrix will be lifted (4).

The special thread of the slotted lamellaretention set is slightly tapered to pre-vent accidental misadjustment.

DENTAL TECHNICIAN:Placing the ball abutmentThe dental technician selects the appro-priate ball abutment for the diameter onthe master cast in the required gingivaheight and screws it manually into thelab analog with the driver (1–3).

Different abutment heights can beselected to compensate for differencesin levels in the gingival margin andimplants. The ball heads should be at auniform level for the best possible reten-tion effect. The ball abutment plateaushould be about 1 mm supragingival (4).

1 2 3

4

2

3 4

1

DENTIST:ImpressionThe open impression method should beselected, because it can be combinedwith a functional impression for fabrica-tion of an extension denture.

92

Ball abutment (Dalbo system)Aligning the duplication components


Aligning the duplication compo-nentsThe included stabilizing rings (white) areplaced over the ball abutments and thered duplication aid components areclipped on (5). The duplication aid com-ponents are aligned parallel to theimplant axis (6). If the implant axesdiverge, the stabilizing rings are NOTused.The implant axial divergence must notexceed 10°.The removal and insertion path of thedenture is important for smooth “lock-ing” of the matrices and smooth activa-tion of the lamella retention inserts.The duplication aid components areplaced parallel on the ball abutments inthe common insertion path and stabilizedwith wax. Alternatively the matrix may beused instead of the duplication aid(5+6).

Metal reinforcementA metal reinforcement is waxed similarlyto a telescopic frame work (10). Themodel is checked using the siliconeindex. A perforation is provided forexcess cement (11). Soft tissue contactsare integrated in the free-end area andbetween the implants (11).

Duplicating the working castAfter the alignment (parallel) of theduplications components, undercut sec-tions are blocked out with wax.When using the matrix, it must be cov-ered with a thin coat of wax (0.3 mm)before duplication (bonding space)(7 – 9).

5

6

8

7

9

10 11

12

93

Ball abutment (Dalbo system)Bonding the matrices


The matrices can be bonded to the framework (15 +16). The lamella retentioninsert must be deactivated and isolatedbefore bonding. When deactivated, thelamella retention insert must not extendabove the margin of the matrix, other-wise the matrix will lift up from the ball.The matrices are clipped to the ballabutments and aligned to the positionset during fabrication of the duplicatecast. Bonding is performed with a metalattachment bond material as specifiedby the manufacturer (17).

Set-up and try-inThe teeth are set up with the siliconeindex on the metal framework (18). Thedenture is completely waxed and pre-pared for try-in (19). The try-in is con-ducted with deactivated matrices. Thevertical height, occlusion, articulation,tension-free seating and esthetics arechecked during this process.

13 14

15 16

18

17

19

Bonding the matricesAfter casting (12), finishing and testingon the master cast (silicone index check)(13+15), the bonding surfaces are con-ditioned. The manufacturer’s bondingdirections must be observed.

94

Ball abutment (Dalbo system)Finishing


DENTIST:InsertionAfter removal of the gingiva former andcleaning the implant, the ball abutmentsare screwed manually into the implantswith the implant driver (21) and thentightened with the torque ratchet (22).

Ø 3.3 mm 20 NcmØ 3.8 – 5.0 mm 30 Ncm

Apply vertical pressure on the driver dur-ing insertion to prevent the ball abut-ment from slipping off. The specifiedretention force of the lamella is set withthe activator and the denture is insertedinto the patient’s mouth (23+24).

ATTENTION! Do not place the stabi-lizing ring in the mouth.

The clinical insertion is completed with acheck of the occlusion and articulation.

21

2423

22

DENTAL TECHNICIAN:FinishingAfter the try-in, finishing is continuedwith heat- or cold-cured polymerization(20). The framework can be coated withpink opaquer beforehand.The matrix housing must be sealed toprevent entry of acrylic (wax, silicone,etc.).The denture must be easy to clean andmust function correctly to ensure long-term success.

20

95

Integration into an existing den-tureThe matrices can be integrated into anexisting denture, but this will weakenthe prosthesis. Because it is known thatthe chewing force increases withimplant-retained dentures, the denturecan fracture if not reinforced. This proce-dure can only be considered as a tempo-rary solution.

Abutment selectionThe ball abutments with the requiredgingiva height are selected by the den-tist to match the diameter and screwedto the implants with the driver and thetorque ratchet (1 – 3). Different abut-ment heights can be selected to com-pensate for differences in levels of thegingival margin and implants.The ball heads should be at a uniformlevel for the best possible retentioneffect. The ball abutment plateau shouldbe about 1 mm supragingival (4).The ball abutments remain in the mouth.

Torque valuesThe following settings apply to tighten-ing with the torque ratchet in themouth:Ø 3.3 mm 20 NcmØ 3.8 – 5.0 mm 30 NcmThe abutment must be tightened againafter about five minutes.

Ball abutment (Dalbo system)Finishing

FOR THE DENTIST

1

2 3

4

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Ball abutment (Dalbo system)Indirect method


Indirect method (labo-ratory fabrication)

DENTIST:Taking an impression of the ballabutmentsThe white stabilizing rings must not beused with this method.Silicone or polyether may be used as theimpression material of choice. Theimpression material is syringed aroundthe ball abutments before placement ofthe impression tray (1).

After the impression material has set,the tray is removed from the mouth (2).

DENTAL TECHNICIAN:Model analogs (Brass) without stabiliz-ing rings are placed in the impression tofabricate the master cast (3+4).The guide areas of the circular plateauensure that the implant axis is trans-ferred precisely to the master cast (5).The cast is fabricated with superhardstone in the standard method (6).

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3

4

5

6

97

Ball abutment (Dalbo system)Indirect method


DENTAL TECHNICIAN:Integrating the matricesThe lamella retention insert is isolatedwith Vaseline. The matrices (7) are posi-tioned and aligned by the same proce-dure as for a new fabrication. The den-ture base is carefully prepared (8) andperforated above the matrices (to allowacrylic to escape and as a check).

The matrix housing may be coated withpink opaquer after surface conditioning.Then undercut areas are blocked out (9).

The matrix housing is fixed with cold-cured acrylic (dough consistency) similarto direct relining (10+11). After setting,the denture can be lifted with the fixedmatrix and unfilled areas can be correct-ed.

DENTIST:After finishing and polishing, the lamellaretention inserts are activated and thedenture is inserted (12+13).

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98

Ball abutment (Dalbo system)Relining

FOR THE DENTIST

Relining

IntroductionThe denture site must be checked at reg-ular intervals and if necessary adjustedby relining to ensure that the ball-retained, soft tissue-supported dentureretains its long term function.

ImpressionThe denture base is prepared in accor-dance with the procedures for a reliningimpression (3). For easy removal of theimpression the matrices (2) (lamellainsert) must be deactivated with theactivator before taking the impression.The lamella insert must not extendabove the matrix housing (see “Settingthe retention force”).

The impression is taken without the sta-bilizing rings (4+5).

After taking the impression, removeimpression material from the basal areaof the matrix with a circular motion of ascalpel.The laboratory requires the diameters ofthe implants for correct selection of themodel analogs.The impression and the model analogs(Brass) are sent to the laboratory.

Cast fabricationTo fabricate the master cast, the modelanalogs (Brass) of appropriate diameterare repositioned in the matrices withstabilizing rings in place (6).After fabrication of the master cast theprocedure is continued as normal as forrelining a denture (7 – 9).

TIP: We recommend isolating thelamella retention inserts withVaseline before polymerization.

1

2

3 4 5

6 7 8

9

System componentsModel analogs (Brass) (1) of appropriatediameter are required for fabricating thecast.

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Ball abutment (Dalbo system)Recall procedure

FOR THE DENTIST

Recall procedure

CleaningIf plaque or calculus deposits are foundon components of the ball abutments,they must be cleaned immediately. Useplastic instruments only.

Never scratch the ball abutmentswith metal instruments.

Replacing the lamella retentioninsertThe retention force of the lamella reten-tion insert may be reduced by stress orwear.To replace it, unscrew it counter-clock-wise from the matrix housing. Screw inthe new lamella retention insert E clock-wise into the matrix housing. Make surethat it is placed axially.For a controlled adjustment of the reten-tion force the lamella insert E is firstscrewed in completely and thenunscrewed one complete turn. This setsthe retention force to about 200 g (basicsetting).The total retention force can be individu-ally adjusted at time of insertion of thedenture.

Functional checkThe denture site must be checked at reg-ular intervals and if necessary adjustedby relining to ensure that the ball-retained, soft tissue-supported dentureretains long term function.

LiteratureNeue Wege in der ImplantatprothetikKirsch A, Ackermann KL, Neuendorff G,Nagel RInterdiszipl J Proth Zahnheilk;3, 1/2000, 8–39

Activator for ball abutment matrix

InformationInformation on instrument preparation

100

1. InstrumentsThe instruments of the CAMLOG implantsystem are not supplied in sterile form,unless they are specifically labeled assterile. They must be cleaned, disinfectedand sterilized before first time use andprior to every use on the patient.

2. Prosthetic componentsThe prosthetic components of the CAM-LOG implant system are not supplied insterile form, unless they are specificallylabeled as sterile. They must be usedonly once.They must be cleaned, disinfected andsterilized before use on the patient.Exceptions: The transfer cap andthe cap for bite registration mustnot be sterilized.

Follow the instructions when preparingthe instruments and prosthetic compo-nents of the CAMLOG implant system.The instructions can be found atwww.camlog.com in the user informa-tion section.

101

Dental Office/Laboratory Information Worksheet

Patient

Dental Office

Date:

Name

Date

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

Alloy / Solder: ______________________________________________________ Technician: __________________________________________________________

Ceramic: ____________________________________________________________ Final check / date: _________________________________________________

Acrylic: ______________________________________________________________ Patient ID / Date: __________________________________________________

Tooth shade: _______________________________________________________

Dental Laboratory

Type of treatment

Buccal markers

Abutment

Implant diameter

Implant length

Type of implant

Type of implant

Implant length

Implant diameter

Abutment

Buccal markers

Type of treatment

1 2 3 4 5 6 7 8✼

18 17 16 15 14 13 12 11

48 47 46 45 44 43 42 41

32 31 30 29 28 27 26 25

31 32 33 34 35 36 37 38

24 23 22 21 20 19 18 17

9 10 11 12 13 14 15 16

21 22 23 24 25 26 27 28▲

▲

✼

Implant diameter: 3.3 / 3.8 / 4.3 / 5.0 / 6.0 mmImplant length: 9 / 11 / 13 / 16 mm, Type of treatment: ST* / bridge / telescopic / bar / ball abutmentImplant type: SL = Screw Line / RL = Root Line / CL = Cylinder Line / SCL = Screw-Cylinder Line

✼ USA numbering▲ European numbering

102

InformationMaterials


Titanium Grade 4 Properties:

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

Mechanical properties: Strength 680 MPa min.Elongation 10%

CERUNOR gold alloy Properties:

Chemical composition (%): Au 60Pt 19Pd 20Ir 1

Mechanical properties: Density 17.5 g/cm3

Color whiteLiquidus 1490 °CSolidus 1400 °C

Coefficient of 12.5 / 20 – 500 °Cthermal expansion 12.6 / 20 – 600 °C

E-module 136,000 Nmm2

hardened700 °C / 30 min.

Hardness HV5 2400.2% proof stress 610

Elongation at break 17Tensile strength N/mm2 770

Properties:

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

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

Mechanical properties: Strength 860 MPa min.Elongation 10%

Titanium alloy Ti6AI4V

103

InformationMaterials


ELUNOR WP gold alloy Properties:

Chemical composition (%): Au 70.00Pt 8.50

Ag 13.40Pd –Cu 7.50Zn 0.50Ir 0.10

Rh –Ru –

Mechanical properties: Color yellowMelting range 895 – 1010 °C

Hardnessannealed HV5 170hardened HV5 295

self-hardened HV5 280

Zirconium oxide Properties:

Chemical composition (%): ZrO2 + HfO2 + Y2O3 > 99.0Y2O2 4.5 – 5.4HfO2 < 5

AI2O3 < 0.5other oxides < 0.5

Mechanical properties: Density > 6.0 g/cm3

Porosity, open 0.00%

Microstructure:mean linear intercept size < 0.6 µm

3-point flexural strength ≥ 800 MPa

104

InformationCertificates

ALTATEC GmbH as the manufacturer of the CAMLOG products issubject to the regulations of the quality assurance system asspecified by EN ISO 13485:2003 at all stages of production.This standard lists in detail the criteria that must be met in thequality assurance system for company processes to be accredited.Particularly high requirements are placed on medical devices.This guarantees that the quality of our products and services willmeet the expectations of our customers and that they can betraced at all stages. Our products meet the basic requirements formedical devices regarding product performance and patient safe-ty specified in European laws and directives. Therefore, all ourproducts under these regulation carry the CE mark.The products of ALTATEC GmbH comply with the rigid require-ments of the European Directive 93/42/EEC for medical devicesand the standard EN ISO 13485:2003.

Quality for users and patients

For further information and support pleasecontact your local distributor.Contact details can be found at www.camlog.com

Headquarters:

CAMLOG Biotechnologies AGSteinengraben 22CH-4051 [email protected]


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www.thieme.com

CAMLOG Compendium

Prosthetics2The CAMLOG implant system is one of the most successful implant systems on theinternational market.

The CAMLOG Compendium, consisting of Part 1. Surgery and Part 2. Prosthetics,covers the whole spectrum of clinical and prosthetic practice from the practitioner'sviewpoint (using more than 800 graphics). The CAMLOG Compendium is targeted atusers in order to ensure the proper handling of the system. In prosthetics, CAMLOGstands for interdisciplinary teamwork - combining the skills of dentist and dentaltechnician to develop implant solutions that benefit the patient.

The first part of the manual, Surgery, addresses insertion of the different CAMLOGimplant geometries. It also contains a description of the CAMLOG concept in pros-thetics, general system information, and prosthetics planning up to surgical inter-vention.

The second part, Prosthetics, opens up the multiplicity of CAMLOG implant treat-ment options that the dentist and dental technician can apply. The patented implantabutment connection allows natural-looking, implant-based perioprosthetics to pro-vide both fixed and removable dentures.

➤

➤

ISBN 3-13-134361-3ISBN 978-3-13-134361-1

CAMLOG Compendium

Prosthetics2

ISBN 1-58890-473-3ISBN 978-1-58890-473-7

Rest of World The Americas


Documents

Camlog Compendium 2 Prosthetics