CONELOG White Paper: Facts and figures

Aim To provide important insights into the scientific documentation of the CONELOG implant system based on facts and figures. Introduction Only very few implant systems have been systematically and thoroughly documented in the literature. The CONELOG implant system belongs to these well documented systems because encouraging independent research is fundamental to the Camlog strategy. The well-established features of the system like the sandblasted and acid-etched Promote® surface, the platform switching, the outer geometry, and the internal conical implant-abutment connection are based on the scientific state-of-the-art and were evaluated in numerous mechanical, in-vitro, and clinical studies (Fig. 1). Fig. 1: The development of the CONELOG® implant system is based on a solid foundation of scientific research. Success built on progress with clinical evidence Promote surface (15) 1999 2006 2008 2010 2014 2019 2020 Platform switching (11, 12, 13, 14) Guide System (20, 21, 22) Clinical success 5+ year data (9, 10, 12) SCREW-LINE design (15) CONELOG connection (2, 3, 4, 6) PROGRESSIVELINE design (23) TAKE HOME MESSAGE: 1. Clinically well-established implant system 2. Superior precision of the implant-abutment connection 3. Excellent preservation of crestal bone level 4. Mastering modern treatment options CONELOG® Implant System – facts and figures at a glance Excellent results of the CONELOG® implant system Precision of fit and preservation of crestal bone

CONELOG® implant system - Summary Precision of the conical connection CONELOG implants offer a patented implantabutment connection with self-locking cone geometry and cams/grooves indexing. Several in-vitro tests have demonstrated the precision and stability of the implant-abutment connection attributable to geometrical design and high-precision manufacturing (1, 2, 3, 4). The reduced rotational freedom given by the indexing design and the ability to reposition the abutment without vertical displacement play a major role in the precision of the final prosthetic restoration. Mechanical studies with disassembly and reassembly of the implant-abutment complex showed excellent results for the CONELOG connection compared to other systems with conical connections (3, 4) (Fig. 2). 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. Microgaps are impossible to eliminate also in a conical connection (5, 6, 7, 8), but it is the good balance of the precision of a deep conical connection and CONELOG specific features which enable to support the clinician in achieving accurate restorations and easy workflow (Fig. 3). Excellent bone preservation with platform switching Preservation of the crestal bone is important for the peri-implant long-term stability. Studies with CONELOG implants with integrated platform switching showed very stable conditions (9, 10) and even slight bone gain 5-year postloading (11, 12). These data confirm the positive effect of platform switching found in various studies with Camlog implants (13, 14). Clinically proven success and patient satisfaction The Promote surface has proven to be effective in various preclinical and clinical studies over years (15). For the CONELOG SCREW-LINE implants several clinical studies documented very positive mid- and long-term treatment outcomes in different indications and loading modalities (9, 10, 16, 17, 18). High survival rate, excellent stability of hard and soft tissues as well as a patients’ satisfaction of 100% could be shown in a multicenter study in daily dental practice with follow-up controls up to 7 years (9). The short implants (7mm) are established as reliable and safe treatment option to avoid sinus augmentation procedures in the posterior maxilla (10) as well as with splinted and nonsplinted fixed dental prostheses in the posterior mandible (19). Guide system accuracy Template guided implant placement is a method to ensure the ideal implant position for immediate or delayed restoration. The difference between the virtually planned and the clinically achieved implant positions with the CONELOG Guide system was evaluated in several clinical trials (20, 21, 22). The accuracy was proven to be high leading to predictable prosthetic results independent of the implant position and the implant dimensions used (20). Modern treatment option – PROGRESSIVE-LINE CONELOG implants are available with two different outer macro-designs: SCREW-LINE and PROGRESSIVE-LINE. The PROGRESSIVE-LINE 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 (Fig. 4). In extraction sockets, these implants showed excellent stability based on insertion torque and ISQ measurements (23) and thus enable modern treatment concepts such as immediate implantation or immediate loading even in soft bone. Conclusion The solid documentation of the CONELOG 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 platform switching, the positioning, and the stability of the implantabutment connection are key factors contributing to the excellent performance of CONELOG implants in clinical practice. Continuous developments of the system satisfying modern treatment options are going hand in hand with clinical evidence. Fig. 3: “Vertical fit feature”: the impression post is not in contact with the cone during impression taking. The vertical discrepancies – inherent to all conical connections – are reduced by this concept. Fig. 4: PROGRESSIVE-LINE implant placed in posterior maxilla with simultaneous sinus lift (picture courtesy of Dr. R. Polsbroek) Fig. 2: Precision of different conical connections: see White paper X.J7777.09/2020. Semper Hogg et al. (2015) compared the CONELOG implant-abutment connection to other systems with conical connections, i.e. Nobel Active, Ankylos C/X, Astra Tech, Straumann Bone Level, and Straumann Tissue Level. The abutments were torque tightened according to each manufacturer’s recommendations. CONELOG showed the best results in terms of rotational displacement (Fig. 1) and canting moment range (Fig. 2) and very good results in terms of vertical displacement range (Fig. 3). Importance of the results: The precision of the implant-abutment connection is of major importance for the fabrication and later fit of the prosthetic restorations and their accuracy from the model to the patient’s mouth. Stability of the implantabutment connection is strongly influenced by the precision of fit, the connection design (incl. positional index design) and the manufacturing precision. The CONELOG implant-abutment connection showed evidences of high-precision manufacturing and superior positional stability when compared with other conical connections. Fig. 1: Rotational displacement of 6 implant systems. (Graphic depicted from Semper Hogg et al. 2015) 7 6 5 4 3 2 1 0 Rotation in ° CONELOG Nobel Active Ankylos C/X Astra Tech Straumann Straumann Bone Level Tissue Level TAKE HOME MESSAGE: 1. Superior precision of the implant- abutment connection for CAMLOG®and CONELOG®Implant Systems 2. Advantages of a good precision: a. Positional stability of supraconstruction b. Better passive fit c. Less abutment screw failure d. Time saving (e.g. less adjustment) 3.Beneficial for the patient, the dentist, and the dental technician Fig. 2: Canting moments of 6 implant systems. (Graphic depicted from Semper Hogg et al. 2015) 5,0 4.5 4,0 3.5 3,0 2.5 2,0 1.5 1,0 0.5 0 Canting moments in ° CONELOG Nobel Active Ankylos C/X Astra Tech Straumann Straumann Bone Level Tissue Level Fig. 3: Vertical displacement of 6 implant systems. (Graphic depicted from Semper Hogg et al. 2015) 160 140 120 100 80 60 40 20 0 Vertical displacement in µm CONELOG Nobel Active Ankylos C/X Astra Tech Straumann Straumann Bone Level Tissue Level High precision of the CONELOG implant-abutment connection As for the CAMLOG® Implant System, precision testings have confirmed the high precision of the CONELOG® implant-abutment connection, this to the benefit of the patient, the dentist, and the dental technician.(1,2)

M-0156-WPR-EN-INT-BHCL-01-122020 Headquarters CAMLOG Biotechnologies GmbH | Margarethenstr. 38 | 4053 Basel | Switzerland Phone +41 61 565 41 00 | Fax +41 61 565 41 01 | | Manufacturer of CAMLOG® and CONELOG® products: ALTATEC GmbH | Maybachstr. 5 | 71299 Wimsheim | Germany References (1) 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. (2) Semper-Hogg W, Kraft S, Stiller S, Mehrhof J, Nelson K. Analytical and experimental position stability of the abutment in different dental implant systems with a conical implant-abutment connection. Clin Oral Investig. 2013;17(3):1017-23. (3) Semper-Hogg W, Zulauf K, Mehrhof J, Nelson K. The Influence of Torque Tightening on the Position Stability of the Abutment in Conical Implant-Abutment Connections. Int J Prosthodont. 2015;28(5):538-41. (4) Nelson K, Zabler S, Wiest W, Schmelzeisen R, Semper-Hogg W. Die Implantat-Abutment Verbindung. Implantologie. 2013;21(4):355-63. (5) Harder S, Dimaczek B, Acil Y, Terheyden H, Freitag-Wolf S, Kern M. Molecular leakage at implant-abutment connection--in vitro investigation of tightness of internal conical implant-abutment connections against endotoxin penetration. Clin Oral Investig. 2010;14(4):427-32. (6) 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. (7) 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 (online ahead of print). (8) Rack T, Zabler S, Rack A, Riesemeier H, Nelson K. An in vitro pilot study of abutment stability during loading in new and fatigue-loaded conical dental implants using synchrotron-based radiography. Int J Oral Maxillofac Implants. 2013;28(1):44-50. (9) Ackermann K-L, Barth T, Cacaci C, Kistler S, Schlee M, Stiller M. Clinical and patient-reported outcome of implant restorations with internal conical connection in daily dental practices: prospective observational multicenter trial with up to 7-year follow-up. Int J Implant Dent. 2020;6(1):14. (10) Lorenz J, Blume M, Korzinskas T, Ghanaati S, Sader RA. Short implants in the posterior maxilla to avoid sinus augmentation procedure: 5-year results from a retrospective cohort study. Int J Implant Dent. 2019;5(1):3. (11) Moergel M, Rocha S, Messias A, Nicolau P, Guerra F, Wagner W. Radiographic evaluation of conical tapered platform-switched implants in the posterior mandible: 1-year results of a two-center prospective study. Clin Oral Implants Res. 2016;27(6):686-93. (12) Moergel M, Nicolau P, Rocha S, Messias A, Guerra F, Wagner W. Clinical outcomes with CONELOG SCREW-LINE implants in the posterior mandible -final 5-year results of a prospective two-center study. Int Poster J Dent Oral Med. 2018;20(ORGS):Supplement, Poster 1213. (13) 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. (14) Schwarz F, Alcoforado G, Nelson K, Schaer A, Taylor T, Beuer F, et al. Impact of implant-abutment connection, positioning of the machined collar/ microgap, and platform switching on crestal bone level changes. Camlog Foundation Consensus Report. Clin Oral Implants Res. 2014;25(11):1301-3. (15) Camlog. CAMLOG and Science. 2013;XJ6164.11/2013:22-32. (16) Cacaci C, Ackermann KL, Barth T, Kistler S, Stiller M, Schlee M. A non-interventional multicenter study to document the implants success and survival rates in daily dental practices of the CONELOG screw-line implant. Clin Oral Investig. 2019;23(6):2609-16. (17) Molina A, Sanz-Sanchez I, Martin C, Blanco J, Sanz M. The effect of one-time abutment placement on interproximal bone levels and peri-implant soft tissues: a prospective randomized clinical trial. Clin Oral Implants Res. 2017;28(4):443-52. (18) Fierravanti L, Ambrosio N, Molina A, Sanz I, Martin C, Blanco J, et al. The effect of one-time abutment placement on marginal bone levels and periimplant soft tissues: 3 years results from a prospective randomized clinical trial. Int Poster J Dent Oral Med. 2018;20(ORGS):Supplement, Poster 1211. (19) Al-Sawaf O, Tuna T, Rittich A, Kern T, Wolfart S. Randomized clinical trial evaluating the effect of splinting crowns on short implants in the mandible 3 years after loading. Clin Oral Implants Res. 2020;00:1-11. (20) Schnutenhaus S, Brunken L, Edelmann C, Dreyhaupt J, Rudolph H, Luthardt RG. Alveolar ridge preservation and primary stability as influencing factors on the transfer accuracy of static guided implant placement: a prospective clinical trial. BMC Oral Health. 2020;20(1):178. (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, Gröller S, Luthardt RG, Rudolph H. Accuracy of the match between cone beam computed tomography and model scan data in template-guided implant planning: A prospective controlled clinical study. Clin Implant Dent Relat Res. 2018;20(4):541-9. (23) Conserva E. Initial stability after placement of a new buttress-threaded implant. A case series study. implants. 2019(3):24-8. The CAMLOG® and CONELOG® trademarks are not registered in all markets.