Nobel Biocare custom abutments for Camlog not fitting

[Brett Hansen CDT]

We have a doctor who recently started using Camlog implants. He has sent us about 4 cases so far using those implants. The first one I did with Atlantis and it had no problems. The second one I did with a stock Camlog abutment with no issues. The third was 2, 3.8mm platform Camlogs restoring 2 bicuspids. I used our Nobel Biocare Procera Forte to fabricate custom abutments for this case. The case came back because the doctor discovered that he didn't get the impression copings fully seated. The second model I poured up from the new impression confirmed this because the implant analogs were more subgingival. I modified the custom abutments and we remade the crowns.

At the same time this case was being remade, we had another implant case come back from the doctor. He was unable to get the custom abutment I fabricated to seat in the patient's mouth. The implant analog in our model is right at tissue level so it should have been very easy for him to seat the abutment. He was unable to seat it so he sent the case back. This was a 3.8 Camlog again.

I called the sales rep from Camlog. Of course he told me that the Nobel Biocare abutments were the problem. I asked him if that was the case, then why did the custom abutments fit into the implant analogs with no problems. He could not answer that question. I ordered a stock Camlog abutment to redo the this case so we could eliminate the Nobel Biocare abutment variable.

I talked to the doctor this morning. He opened up a Camlog implant that was the same as the one in the patient's mouth where we were restoring the 2 bicuspids. He said the abutments do not fit into the implant. He also called up the sales rep and asked him why these abutments fit into the analogs but not the implant. He didn't get an answer to that question either. I told him we were sending back the other remake case tomorrow and that I wanted him to take the stock abutment I used for that case and try it in the implant he opened up. Maybe that will give us some answers.

Has anyone else experienced this with the Camlog abutments? Any ideas on what could be going wrong?

 

[2thm8kr]

I've only used cam-log twice, but tons of nobel tri-lobes. Nobel Tri lobe interface is different than cam-log.

 

[JohnWilson]

Not sure if I read it right, how did you fabricate the PROCERA custom abutments with camlog?

 

[Brett Hansen CDT]

Sorry if I wasn't clear. The abutment is made by ordering a waxing sleeve From Nobel for the Camlog 3.8mm implant. Then you wax the abutment up and then insert it into the abutment jig for the Camlog 3.8mm implant. Then the jig is placed in the Procera scanner and the probe scans it. My Procera Forte can make custom abutments for Camlog, Braenemark, Octa, Replace, and a couple of other implants.

 

[Gru]

You probably checked, but...

Any chance the implant itself is damaged?
Any chance the implant is not what the doc thinks it is?

Oh, and John, you can have Procera custom abutments made for Camlog. Check order item #33565.

 

[Brett Hansen CDT]

Gru, I am having the doc send me the implant that he opened up that is the same as the implants that he has placed that the abutments won't fit into. I should have it tomorrow.

 

[CoolHandLuke]

brett you say you did the first Camlog with Atlantis? if i may ask, how? we have the FLO kit here in this lab and it suggests using FLO#N-02 but i do not have that in my kit, it only goes up to L.

did you send the models to atlantis and have them scan and design or did you scan the models yourself?

if Atlantis did the scan and design then i would think Atlantis should do it again because as you say it was done properly once.

 

[Brett Hansen CDT]

I had to send it in Luke. The last 2 times the sales rep has been in, he said he would make sure I got the FLO's for the Camlogs ASAP. I still don't have them, but I don't really need them because I should be able to make custom abutments on the Forte for much cheaper. Ever since Dentsply bought Astratech, Atlantis' support hasn't been as top notch as it used to be.

 

[JohnWilson]

Oh, and John, you can have Procera custom abutments made for Camlog. Check order item #33565.

I had forgotten they had a wax up kit for CAMLOG, what is so strange is that you can't do them via a scan locator with the optical scanner. I have a call into my rep to ask why the hell you can't do them this way. If they are milling the interface it should make no difference in how the case becomes digitized. We have been doing custom Zirconia abutments via a camlog TI base for some time.

Brett were the custom abutments from nobel Zi or Ti? If Zi was it a cementable ti base like straumann from procera?

 

[Brett Hansen CDT]

These were all Ti abutments.

 

[Gru]

Hey John, how do you like the cementable zirconia to Ti base? What do you advise docs to use? Thanks

 

[JohnWilson]

We cement with RelyX in the lab, its not my first choice but it seems to work, I just lay in bed sometimes worrying about what ifs.

 

[Brett Hansen CDT]

John, should I be cementing the Ti inserts for the Zir abutments I am getting back from Nobel for the custom abutments I am making with my Forte?

 

[Gru]

John, should I be cementing the Ti inserts for the Zir abutments I am getting back from Nobel for the custom abutments I am making with my Forte?

Ditto Brett. Currently I'm just having the doc do it at seating. Should I do it? And have you any opinion on Multilink Implant?

 

[JohnWilson]

I do it as I have seen too many clients botch the cement job by slightly rotating the abutment, ( there is a small bit of rotational tolerance to leave room fpr cement. ) You can imagine a very precise fitting crown only now its rotated 1* and then the dr adjust contacts and so on and so on. On top of that it is generally deep in the sulcus and having them try and do it in a wet sulcus is counter productive to a good clean cementation. Much easier on the model and its just one less thing I need to worry about.

Who do you think will be redoing the entire restoration if they cement the interface wrong?

Just my thoughts...

 

[martintay]

I`m Sure you know , but when ordering bewhere of camlog/ conelog !!

 

[JohnWilson]

Ditto Brett. Currently I'm just having the doc do it at seating. Should I do it? And have you any opinion on Multilink Implant?

If its a specific cement for luting crowns to implant abutments I would not use it for interfaces. Implant cement was developed to allow some retrievable in the event of an abutment coming loose to the fixture. Before these special cements were out I knew several clients that would cut their permanent cement with neosporin to dilute the strength. As it relates to an abutment to abutment base interface I want the strongest most potent stuff there is out there. I think RelyX fits the bill.

 

[Jo Chen]

I'll second martintay. Also ask the Dr. to send x-rays of the seated impression copings with the fixture level impressions. Sending x-rays along with the impressions is like buying insurance.

 

[martintay]

Sorry i should have been more specific . Beware if you haven`t realised camlog also make another implant/abutment range called conelog. Our clients send a case calling it camlog when they mean conelog !! It is confusing and well worth checking if you haven`t already. Hope this may help you and others.

 

[Brett Hansen CDT]

The doctor sent in an implant he opened up today along with the 2 custom abutments I made that don't fit. The cams on the abutments are longer than the slots they should go into on the implant he sent me so these abutments won't seat. I went online to downloaded Camlog's newest prosthetic manual. It seems there are 2 very similar Camlog implants, a J series and a K series. The K series is newer and the slots for the cams are shorter than the J series. So, this solves the problem of why my abutments weren't fitting. The only information I was given about the implant was that it was a Camlog 3.8mm. What i still didn't understand was why my abutments fit into the implant analogs that I was given to make the model, but not into the implant. I called the company and found out that they use the same lab analogs and same impression copings for both K and J series.

This is garabage. These are the first Camlog implant cases I have ever seen. This situation I am positive has happened before to other labs. In the first section of the prosthetic manual it has a warning about this incompatibility. The sales rep for Camlog who sold these implants to my doctor should have warned him and us about this issue. At the very least he should have figured out what the problem was when I talked to him about the abutments not fitting. I have never seen anything like this in the other implant lines I have worked with. From now on, I will make sure that I have the latest prosthetic manuals on any implant cases that I am unfamiliar with.

Now I gotta figure out how I can salvage some of the money we have burned on these cases.