Aim To provide important insights into the scientific documentation of the CAMLOG implant system based on facts and figures. Introduction Only very few implant systems have been systematically and thoroughly documented in the literature. The CAMLOG implant system belongs to these well documented systems because encouraging independent research is fundamental to the Camlog strategy. For 25 years, the features of the system like the butt-joint Tube-in-Tube connection, the sandblasted and acid-etched Promote surface, the option of platform switching, the outer geometry etc. have been continuously improved based on the scientific state-ofthe-art and were evaluated in numerous mechanical, in-vitro, and clinical studies (Fig. 1). Fig. 1: The development of the CAMLOG implant system is based on a solid foundation of scientific research Promote® surface 1999 2002 1996 2006 2008 2013 2019 2020 Promote® plus surface Full digital workflow (DEDICAM®) Clinical success – proven a million times First SCREW-LINE design Tube-in-Tube® connection Option Platform switching PROGRESSIVE- LINE design TAKE HOME MESSAGE: 1. Clinically well-established implant system 2. Precision and stability of the implant-abutment connection 3. Long-term preservation of soft and hard tissues 4. Covering an extended number of treatment options CAMLOG® Implant System – facts and figures at a glance The CAMLOG® implant system – clinically and scientifically established Precision of fit and excellent long-term outcomes
CAMLOG® implant system - Summary Stability and fit of the Tube-in-Tube connection The implant-abutment connection design influences the rotational, vertical, and angular positioning accuracy of the abutment and longterm stability of the prosthetic restoration. The design of the well-proven Tube-in-Tube implant-abutment connection with the three symmetrically arranged interlocking grooves and cams was designed biomechanically based on complex finite element analyses (FEM) (Fig. 2). Several in-vitro tests have demonstrated the precision of fit and stability of the implant-abutment connection attributable to geometrical design and high-precision manufacturing (1, 2). The Tube-in-Tube connection also demonstrated favorable results regarding their load-bearing capacity (3) and a high fracture strength score after dynamic loading in a chewing simulation (4). The geometric design of the cam-groove connection was mathematically analyzed and evaluated with the highest positional accuracy (rotation) compared to other designs (5, 6, 7). This theoretical approach was confirmed by a mechanical study with disassembly and re- assembly of the implant-abutment complex showing the least rotational discrepancies for the CAMLOG connection compared to other systems. The vertical displacements were significantly less than in the other conical systems evaluated (8). Microgaps and its impact, i.e. micro-leakage or bacterial penetration, are the reason to aim for small manufacturing tolerances of all the components in two-piece implant systems but are impossible to eliminate independently of the connection design (e.g. conical, butt-joint) (9, 10, 11). The Tube-in-Tube connection seems to minimize micromovements and pumping effects under dynamic loading resulting in a late bacterial penetration (9). Clinically proven success and patient satisfaction The Promote surface has proven to be effective in various preclinical and clinical studies over years (12). A study investigating different implant systems including more than 6’000 Camlog implants in private practices over more than 10 years showed the highest probability of survival for implants with Promote surface (13). Very positive mid- and long-term treatment successes with CAMLOG implants have been documented in clinical trials for various implant lengths and diameters (13, 14, 15, 16), for various indications and various surgical and loading approaches (17, 18). A recent international multicenter study in daily dental practice reported a high survival rate, excellent stability of hard and soft tissues as well as patient reported outcome measures (PROMs) showing over 99% of satisfaction at 5-year follow-up controls (19) (Fig. 3). Excellent bone preservation Preservation of the crestal bone is important for the peri-implant long-term stability. CAMLOG implants showed clinically stable conditions with both platform matching and platform switching abutments (19, 20). However, a positive effect of platform switching could be found in clinical studies with CAMLOG implants. In a prospective randomized clinical study comparing the restoration with platform switching vs platform matching abutment Messias et al. could even identify a slight bone gain with platform-switching of 0.2 ± 0.5 mm 5-year post-loading and a significant mean difference to platform matching restorations. (20). Beschnidt et al. reported in a large prospective study excellent conditions with both platforms together with excellent PROMs (19). Guide system accuracy Template-guided implant placement is a method to ensure an ideal and predictable implant position for immediate or delayed restoration. Clinically, a comparison of the virtually planned and the achieved implant positions using the CAMLOG Guide system showed a high degree of accuracy (21, 22, 23) leading to predictable prosthetic results independent of the residual dentition and the surgical procedure (21). A success and survival rate of 100% was reported with template-guided inserted and immediately loaded implants (24). Modern treatment option – PROGRESSIVE-LINE CAMLOG implants are available with two different outer macro-designs: SCREW-LINE and PROGRESSIVE-LINE. The PROGRESSIVELINE implants have a conically shaped apical area and buttress threads to develop high initial stability. In the coronal area, a crestal anchoring thread gives support for optimal hold with limited bone height, e.g. in sinus lift procedures. The implants showed excellent stability based on insertion torque and ISQ measurements and thus enable modern treatment concepts such as immediate implantation or immediate loading even in soft bone (25). Conclusion The solid documentation of the CAMLOG implant system is based on scientific evidence. This is an important contribution to Camlog’s success story. The long-term data of the Promote surface, the use of either platform switching or platform matching, the positioning, and the stability of the implant-abutment connection are key factors contributing to the excellent performance and predictable success of CAMLOG implants in clinical practice. Continuous developments of the system satisfying modern treatment options are going hand in hand with clinical evidence. Fig. 3: Stable clinical situation of a SCREW-LINE implant 5-year post-loading in regio 36 (courtesy of Dr. S-M. Beschnidt) Fig. 2: a) Sectional view of the Tube-in-Tube connection b) FEM: Mises tension at a load with 200N (ISO14801)
M-0185-WPR-EN-GLO-BHCL-00-122020 Headquarters CAMLOG Biotechnologies GmbH | Margarethenstr. 38 | 4053 Basel | Switzerland Phone +41 61 565 41 00 | Fax +41 61 565 41 01 | info@camlog.com | www.camlog.com Manufacturer of CAMLOG® products: ALTATEC GmbH | Maybachstr. 5 | 71299 Wimsheim | Germany References (1) Edinger D, Kahler E, Hilgers R. Untersuchung der Rotationspassgenauigkeit. BDIZ EDI konkret. 2007(2):68-71. (2) Reinert M, Geis-Gerstorfer J. Vergleichende Untersuchung zur Passgenauigkeit von prothetisch-zahntechnischen Komponenten verschiedener Implantatsysteme / Comparison of the accuracy of the fit of abutments on implants. Dtsch Zahnarztl Z. 2007;62:668-74. (3) Dittmer S, Dittmer MP, Kohorst P, Jendras M, Borchers L, Stiesch M. Effect of implant-abutment connection design on load bearing capacity and failure mode of implants. J Prosthodont. 2011;20(7):510-6. (4) Steinebrunner L, Wolfart S, Ludwig K, Kern M. Implant-abutment interface design affects fatigue and fracture strength of implants. Clin Oral Implants Res. 2008;19(12):1276-84. (5) Semper W, Kraft S, Krüger T, Nelson K. Theoretical considerations: implant positional index design. J Dent Res. 2009;88(8):725-30. (6) Semper W, Kraft S, Krüger T, Nelson K. Theoretical optimum of implant positional index design. J Dent Res. 2009;88(8):731-5. (7) Semper W, Kraft S, Mehrhof J, Nelson K. Impact of abutment rotation and angulation on marginal fit: theoretical considerations. Int J Oral Maxillofac Implants. 2010;25(4):752-8. (8) Semper W, Heberer S, Mehrhof J, Schink T, Nelson K. Effects of repeated manual disassembly and reassembly on the positional stability of various implant-abutment complexes: an experimental study. Int J Oral Maxillofac Implants. 2010;25(1):86-94. (9) Steinebrunner L, Wolfart S, Bossmann K, Kern M. In vitro evaluation of bacterial leakage along the implant-abutment interface of different implant systems. Int J Oral Maxillofac Implants. 2005;20(6):875-81. (10) Harder S, Quabius ES, Ossenkop L, Kern M. Assessment of lipopolysaccharide microleakage at conical implant-abutment connections. Clin Oral Investig. 2012;16(5):1377-84. (11) Angermair J, Wiest W, Rack A, Zabler S, Fretwurst T, Nelson K. Synchrotron-based Radiography of Conical- vs. Butt-joint Implant Abutment Connections. J Oral Implantol. 2020;Jan 27. Online ahead of print. (12) Camlog. CAMLOG and Science. 2013;XJ6164.11/2013:22-32. (13) Knöfler W, Barth T, Graul R, Krampe D, Schmenger K. Beobachtung an 10.000 Implantaten über 20 Jahre - Eine retrospektive Studie. Implantologie. 2017;25(4):413-21. (14) Krennmair G, Seemann R, Schmidinger S, Ewers R, Piehslinger E. Clinical outcome of root-shaped dental implants of various diameters: 5-year results. Int J Oral Maxillofac Implants. 2010;25(2):357-66. (15) Strietzel FP, Reichart PA. Oral rehabilitation using Camlog screw-cylinder implants with a particle-blasted and acid-etched microstructured surface. Results from a prospective study with special consideration of short implants. Clin Oral Implants Res. 2007;18(5):591-600. (16) Seemann R, Jirku A, Wagner F, Wutzl A. What do sales data tell us about implant survival? PLoS One. 2017;12(2):e0171128. (17) De Lange GL, Randelzhofer P, Sipos P, de Bruin M, Both CJ. Survival and risks of immediate placed anterior implants. 19th Annual Scientific Meeting of the EAO; October 6-9; Glasgow 2010. Poster 115. (18) Nelson K, Semper W, Hildebrand D, Ozyuvaci H. A retrospective analysis of sandblasted, acid-etched implants with reduced healing times with an observation period of up to 5 years. Int J Oral Maxillofac Implants. 2008;23(4):726-32. (19) Beschnidt SM, Cacaci C, Dedeoglu K, Hildebrand D, Hulla H, Iglhaut G, et al. Implant success and survival rates in daily dental practice: 5-year results of a non-interventional study using CAMLOG SCREW-LINE implants with or without platform-switching abutments. Int J Implant Dent. 2018;4(1):33 (20) Messias A, Rocha S, Wagner W, Wiltfang J, Moergel M, Behrens E, et al. Peri-implant marginal bone loss reduction with platform-switching components: 5-Year post-loading results of an equivalence randomized clinical trial. J Clin Periodontol. 2019;46(6):678-87. (21) Schnutenhaus S, Edelmann C, Rudolph H, Dreyhaupt J, Luthardt RG. 3D accuracy of implant positions in template-guided implant placement as a function of the remaining teeth and the surgical procedure: a retrospective study. Clin Oral Investig. 2018;22(6):2363-72. (22) Schnutenhaus S, Edelmann C, Rudolph H, Luthardt RG. Retrospective study to determine the accuracy of template-guided implant placement using a novel nonradiologic evaluation method. Oral surgery, oral medicine, oral pathology and oral radiology. 2016;121(4):e72-9. (23) Beretta M, Poli PP, Maiorana C. Accuracy of computer-aided templateguided oral implant placement: a prospective clinical study. J Periodontal Implant Sci. 2014;44(4):184-93. (24) Baruffaldi A, Poli PP, Baruffaldi A, Giberti L, Pigozzo M, Maiorana C. Computer-aided flapless implant surgery and immediate loading. A technical note. Oral Maxillofac Surg. 2016;20(3):313-9. (25) Hermann F. Perfekt in allen Knochenqualitäten. In: Barfuss A, editor. Dental Magazin. 2019. p. 64-6. The CAMLOG®, DEDICAM®, Promote® and Tube-in-Tube® trademarks are not registered in all markets.
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