ceramic implants international No. 2, 2023
Cover
/ Editorial
/ Content
/ Integrative oral medicine meets aesthetic dentistry: Mission possible
/ Single-tooth restoration with a two-piece Patent™ Implant Immediate implant placement and loading in the aesthetic zone
/ Restoring anterior aesthetics with two-piece zirconia implants
/ Stability ensured - Advancing implant dentistry with Z-SYSTEMS bone level ceramic implants
/ CleanImplant Foundation Trusted Quality seal: More manufacturers prove the production quality of their implant systems
/ Advocating for the superiority of ceramic systems
/ Neodent, a Straumann Group brand - A global player in dental solutions that restore smiles and con dence
/ Events
/ Manufacturer news
/ Imprint
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[1] =>
issn 1868-3207 Sondernummer • Vol. 7 • Issue 2/2023
ceramic
2/23
implants
international magazine of ceramic implant technology
case report
Integrative oral medicine
meets aesthetic dentistry:
Mission possible
interview
Advocating for the superiority
of ceramic systems
events
Discover the EAO annual
scientific meeting in Berlin
[2] =>
www.witar.de
[3] =>
editorial
|
Fifty shades
of white?
The advantages of implants fabricated from zirconium dioxide, such as aesthetics and high corrosion resistance, make them an interesting therapeutic
alternative. Clinicians must realise, however, that just like implants made of
titanium and titanium alloys, not every ceramic implant successfully osseointegrates.
The etiology of complications in implant therapy is not always found in those
patients with pre-existing conditions, poor oral hygiene, or placement by
those physicians with inadequate training and experience. Some manufacturers assert that these factors are the root cause of failure to osseointegrate, conveniently omitting their role as a result of flaws in the manufacturing and packaging process.
Implant quality is a key factor for successful osseointegration. After unboxing, every implant must be free of foreign particles and contaminants resulting from deficits in the complex chain of production. Sterility does not equate
with a clean surface. Even though it is not rocket science, some manufacturers fail to strive for sufficient quality assurance. In particular, micron-sized
plastic residues on the implant surface are associated with unwanted biological effects ranging from bone loss to implant failure.
We reached a critical degree of research integrity if a manufacturer in a
renowned scientific journal portrays a level of implant cleanliness that technically does not exist—by showing manipulated and “cherry-picked” SEM
images of his ceramic implant system.
It is even less supportive in building trust among implantologists if the analysis of another ceramic implant system reveals a cell-toxic biocide on the implant surface in a quality assessment study. After this manufacturer was informed accordingly, the authors of the study were subject to intimidation
tactics and threats of legal action in the event of any publication of the scientific findings.
In this way, few manufacturers tarnish the success of the dental industry’s
pursuit of enhancing clinical safety in ceramic implantology. Fortunately,
there are responsible manufacturers who meet the quality expectations in
their products and deliver flawless dental implants.
Dr Dirk U. Duddeck, Germany
Founder and Head of Research
of the CleanImplant Foundation
Dr Dirk U. Duddeck
Ceramic implants deserve the trust of practitioners and patients, provided
they are as clean as promised. Trust is like paper. Once it’s crumpled it can
never be perfect again.
With respect,
Dr Dirk U. Duddeck
implants 2 2023
03
[4] =>
| content
editorial
Fifty shades of white?
03
Dr Dirk U. Duddeck
case report
page 14
Integrative oral medicine meets aesthetic dentistry:
Mission possible
06
Drs Fabian Schick, Johann Lechner & Florian Notter
Single-tooth restoration with a two-piece Patent™ Implant
14
Dr Harald Fahrenholz
Restoring anterior aesthetics with two-piece zirconia implants
18
Dr Saurabh Gupta
testimonial
page 22
Stability ensured
22
research
CleanImplant Foundation Trusted Quality seal:
24
More manufacturers prove the production quality of their implant systems
interview
page 34
Advocating for the superiority of ceramic systems
26
An interview with John Sheehy
industry
Neodent, a Straumann Group brand
28
events
ceramic
Discover the EAO annual scientific meeting in Berlin
32
“Ceramic Implants meets Aesthetics”: 7th Annual Meeting of
ISMI successful in Munich
34
manufacturer news
2/23
implants
international magazine of ceramic implant technology
case report
Integrative oral medicine
meets aesthetic dentistry:
Mission possible
interview
Advocating for the superiority
of ceramic systems
events
Discover the EAO annual
scientific meeting in Berlin
04
30
news
Cover image courtesy of
Z-SYSTEMS
www.zsystems.com
issn 1868-3207 Sondernummer • Vol. 7 • Issue 2/2023
Zirconia implant: An evolution or a revolution?
implants 2 2023
36
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| case report
Integrative oral medicine
meets aesthetic dentistry:
Mission possible
Practice
Drs Fabian Schick, Johann Lechner & Florian Notter, Germany
Introduction
Modern dental treatment concepts face a growing number of difficulties. Aesthetics, biocompatibility, and immunological release for the purpose of enhancing health are
all factors that are increasingly important in addition to
sustainability and functionality.
This article aims to demonstrate how bioinert materials and biological-functional regeneration-based integrative dental treatment concepts are progressively
becoming promising superior treatment options that
can even exceed the highest aesthetic demands.
Sustainable, functional, and immunologically ideal results
can all be accomplished simultaneously using minimally
invasive and defect-oriented surgical procedures and protocols to optimise healing and regeneration of oral hard
and soft tissues.
There is research on whether long-term immunological stress
and dysregulation can cause chronic fatigue.1 But it is not
always clear where this persistent dysregulation and immunological stress comes from. Hence, views that chronic diseases also have an oral origin are becoming more frequent:
1
“We now know that many chronic diseases originate in the
oral cavity,” says Prof. Zeltner, Chairman WHO, 2022.2
Question
This case study demonstrates that the aesthetic restoration of a patient with a high smile line and immunological release by removal of chronic inflammatory lesions in
the oral cavity are not at all incompatible.
Can immunologic stress occur in the oral cavity even
when there are no acute symptoms? Can a disorder with
2
Fig. 1: Diagnostic scheme Integrative Oral Medicine/Immunedentistry. Fig. 2: Preoperative orthopantomograph (OPG) transalveolar ultrasound sonography.
06
implants 2 2023
[7] =>
case report
|
an unknown etiology like chronic fatigue arise because of
this continuous stress and the dysregulation it causes?
Material and methods
A middle-aged patient with a prominent smile line and strong
aesthetic expectations comes to see us at the beginning
of 2021. She inquires about the clarification of chronic inflammatory lesions in the oral and maxillofacial region as
she suffers from chronic fatigue. We perform complete
oral imaging, toxicological, and immunological tests in
accordance with a standardised diagnostic system, after
which we develop an individual treatment plan. The primary goal is to identify osteoimmunological chronic inflammatory lesions in the oral and maxillofacial region.
Secondarily, we want to release and stabilise autologous
immunological regulation through the removal of chronic
stress. An overall health symptom such as chronic fatigue
is also to be achieved through immunological release and
the interdisciplinary connection can be brought up.
Oral imaging
3
4
Fig. 3: Preoperative transalveolar bone densitometry (TAU), numerical evaluation of TAU measurement of bone density in CTU. Fig. 4: Transalveolar bone
densitometry (TAU) for tooth region 11-21.
Prosthetically insufficiently restored teeth, metal-containing
crowns, endodontically treated teeth 11, 23, 26, missing
tooth 22. Possible apical osteolysis 21. No signs of other
acute or chronic inflammatory lesions.
logarithmic average value (Average [log]) of the absorption intensity and, therefore, of the recorded bone density
is computed by selecting the darkest sensor fields of the
analysed odonton (area 11, 21, 22, 23 in red; Fig. 4).
Transalveolar ultrasound sonography
A CTU of 0.51 for fatty degenerative osteolysis/osteonecrosis (FDOK/FDOJ) is shown in this instance at site 22.
In order to enable an excellent biologic-functional regeneration with high bone quality, it was necessary to
pay special attention to a complete removal of the osteolytic bone regions before implant drilling 22, extraction 23, and before implant insertion 22, 23. An implant osseointegration result that is sustainable and
inflammation-free can be achieved by inserting the implant in healthy bone.4
Areas of lower bone density (red) and higher bone density
(green) were visible using transalveolar bone densitometry and ultrasonography. Red areas surrounding roottreated teeth and in toothless bone areas indicate osteolytic degeneration of the bone, which is expected to have
increased RANTES/CCL5 cytokine expression.3 Hence,
red bone areas indicate immunologic stresses such as
unformed dental germs, endodontically treated teeth
with increased expression of toxins such as thioethers
and mercaptans, and improperly healed wounds. A
three-dimensional CBCT/DVT is then performed if it is
suspected that the relevant areas contain chronic inflammatory lesions.
For an overview of CTUs and their interpretation, see the
table below:
Anatomy/
suspicion
CTU Colour
Consistency
Numerical evaluation of TAU measurement
of bone density in CTU
0,24 Grey
Hollow Cavity Fault?
0,23 Dark red
Dissolved/
liquid
Osteolysis
A quantitative and qualitative evaluation of the osteolytic
bone regions is required for individualised treatment planning. For this goal, the authors have created a method to
evaluate each odonton’s transalveolar ultrasound examination (TAU). The darker levels of each individual sensor field
are analysed and evaluated for this purpose; this grade
can, for example, support in the therapeutic decision of
immediate implantation after removal of the osteolytic areas
or delayed implantation. This prevents osteoimmunological
stress and results in a problem-free osseointegration. A
0,62 Light red
Soft/fatty
Osteonecrosis
1,18
Orange
Partially soft
Ostitis
1,68
Yelloworange
Increasingly
soft
Nerve
structure
Reduced
hardness
1,85 Light yellow
1,96 Light green
3,98 Green
Dense/solid
Ischemia
N. Infraalveolaris
Healthy
Spongiosa
Cortical bone/
linea obliqua
implants 2 2023
07
[8] =>
| case report
Three-dimensional radiographic imaging
The findings in ultrasound are validated by significant chronic inflammation apical to the endodontically treated teeth 11, 23, and 26 (postendodontic inflammation) and decreased Hounsfield values in bone
regions with previous extractions.
Toxicological examination
Increased local expression of the toxicologically active bacterial metabolite thioether/mercaptan, which originates from remaining bacteria in endodontically treated teeth and is detected locally on the
tooth using paper points that colours a particular test liquid more or
less intensely depending on its exposure time.5
5
Immunological examination
Following blood samples showed, that the protein metabolites thioether and mercaptan that are toxicologically active were immunologically sensitised. And therefore, the clinical necessity for the surgical
revision of the incompletely healed bone wounds with elevated cytokine expression (FDOK/FDOJ) and removal of the endodontically
treated teeth was given.
Clinical image/aesthetic planning
Special consideration was also necessary in this case because the
patient was also dissatisfied with her smile aesthetics. The aesthetic
reconstruction has to include the different length and shade relationships as well as the additional high smile line. Immediate ceramic
implants were designed for aesthetic purposes in addition to immunological benefits in order to reliably and sustainably avoid the appearance of metallic margins and to protect as much bone volume
as possible.6 In order to extend the clinical crowns aesthetically and
create a harmonious appearance, a minimally invasive gum lift was
also planned.
6
Surgical reconstruction
All chronic inflammatory lesions in the upper jaw were to be surgically removed using minimally invasive and defect-focused techniques especially in the aesthetically critical regions. The periapical
ostitides and the chronically inflamed teeth 11, 22, and 23 were carefully removed. Fatty degenerated osteolysis (FDOJ/FDOK) in surrounding bone regions was checked for and carefully removed. The
toothless jaw areas underwent the same process. Tissue samples
were collected to confirm increased RANTES/CCL5 cytokine expression. When compared to healthy bone tissue, cytokine expressions were found to be 14 times higher.7
7
8
9
Clinical Immunology
Reactivity Mercaptans/Thioether
INFg-stimulated
IL10-stimulated
< 0.1
66.6
pg/ml
pg/ml
< 0.2
< 10
Fig. 5: Periradicular osteolysis tooth 11. Fig. 6: Periradicular osteolysis tooth 23. Fig. 7: Periradicular osteolysis tooth 26. Fig. 8: Bone density (HU) measurement in region 18/19. Fig. 9: Immunological sensitisation to thioethers/mercaptans.
08
implants 2 2023
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| case report
10
11
12
13
14
15
16
17
Fig. 10: Initial clinical situation upper jaw front for aesthetic planning. Fig. 11: Aesthetic planning of ideal tooth proportions. Fig. 12: Postoperative quantification of RANTES/CCL5 from intraoperatively collected tissue sample and comparison with healthy bone tissue.7 Fig. 13: Bone density visualisation apical teeth
12-23 with ultrasound sonography TAU. Fig. 14: Intraoperative imaging after implantation 11, 22, 23, 26. Fig. 15: Postoperative control image (OPG). Fig. 16:
Intraoperative image after healing of the implants, removal of metal restorations and preparation for metal-free, ceramic restorations. Fig. 17: Metal-free,
ceramic restorations.
10
implants 2 2023
[11] =>
case report
Biological-functional regeneration
Ozone gas was used to properly clean the bone, which
was by this point healthy and free of inflammation.8 The
cavities created after curettage of the osteolytic areas
apical to the endodontically treated teeth were filled with
autologous blood concentrates (A-PRF), acting as “healing chambers” after disinfection and before implant
placement.
It was possible to insert immediate ceramic implants in
regions 11, 23, and 26 plus a late implant at site 22 following the removal of fatty degeneration (FDOK) in the
correct prosthetic and aesthetic positions. This method
enabled a one-stage treatment and preserving the soft
tissue and bone that are essential for aesthetic reasons.
In position 26, the aggressive, self-tapping thread was
compactly anchored in the opposite compacta, enabling
the primary stable insertion of the immediate ceramic implant. In order to create closed healing chambers, only
autologous blood concentrates (PRF) were put into the
gaps and the internal sinus lift.9–11 To ensure the best possible regeneration of healthy local bone without provoking further immunological foreign body reactions to various bone substitute materials, the flaps on the implant
are minimally invasively sutured in the sense of a tentpole
approach. After that, liquid blood concentrate (I-PRF)
was injected to all wound areas to deliver a significant
quantity and concentration of growth factors at the start
of the healing process.
|
Moreover, perioperative care was made to guarantee
sufficient vitamin D levels for ideal bone metabolism and
recovery.12
Prosthetic restoration
A stability check (periotest) was performed to evaluate
the osseointegration following a three-month healing period. In order to improve the aesthetic outcome prior to
the final prosthetic restoration, an electrosurgical gum lift
of 1 to 2 mm was also performed in the maxillary anterior
region. The inadequate metal-containing restorations were
taken out four weeks after, and the final full-ceramic crowns
were prepared. For the restorations, only full-ceramic
materials were used. To prevent any immunologicalallergological stress caused on by composite components, a conventional cement was used for cementation.
In to achieve bilateral stability, implants 22 and 23 were
connected to one another. Of course, there was no prosthetic connection between implants and teeth. Impressive features of the metal-free ceramic implants are their
excellent soft-tissue compatibility and bacterial-sealing
closure that creates inflammation-free soft tissues.
Immunological-health development
The patient’s chronic fatigue was improved by removing
immunological stress. Vitality has increased after the surgical and prosthetic intervention, and the patient is really
happy with the aesthetic outcome.
18
19
20
21
Fig. 18: Upper anterior after healing and preparations of the implants for metal-free, ceramic restorations. Fig. 19: All-ceramic prosthetic restoration. Fig. 20:
Aesthetic situation before treatment. Fig. 21: Aesthetic situation after treatment.
implants 2 2023
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[12] =>
| case report
22
Fig. 22: Control image after prosthetic restoration and complete healing of the ceramic implants.
Discussion
Summary
In order to achieve immunological release and stabilise
autologous immune regulation, integrative oral medicine
attempts to eliminate chronic stress and chronic inflammatory lesions from the body, even in subacute states.
When chronic stress can be seen as a root cause for chronic
diseases,1,13 the question arises whether this chronic stress
can also originate in the oral cavity. But, even in the absence of pain or other symptoms, how can chronic stress
in the oral and maxillary region be detected and identified? Can materials that are incompatible with the patient,
endodontically treated teeth, and fatty degenerative bone
regions (FDOJ/FDOK) cause immunological stress in the
oral and maxillary region? In a previous article, the authors attempted to clarify these relationships using a systematic diagnostic approach.14 Despite the use of advanced
techniques, endodontic treatments frequently result in
residual bacteria in the root canals.15–18
This case study demonstrates how to identify and treat
chronic stress in the oral cavity of a patient suffering from
chronic fatigue as well as how to recover and regenerate
the affected areas in an aesthetic and functional way.
By using minimally invasive techniques and biologicalfunctional regeneration, the patient’s condition could be
drastically improved on both an immunological and an
aesthetic level. Hence, integrative-complementary techniques can be con-sidered as a development and addition to well-established and efficient therapy methods in
immunological and aesthetic regeneration. Since chronic
stress is thought to be the root cause of chronic autoimmune diseases,1,13,14 the elimination of immunological
stress generating dysregulation from the oral and maxillofacial region may be related to chronic disorders.
An immunological sensitisation to bacterial metabolites
thioethers/mercaptans was detected and these were
also measured in increased concentrations locally on the
tooth. These toxic sulfur compounds might also block
ATP from being generated at the mitochondrial membrane.5 Furthermore, fatty degenerative osteolytic bone
areas (FDOJ/FDOK) were detected, which included
significant quantities of the proinflammatory cytokine
RANTES/CCL5, by transalveolar bone densitometry with
ultrasound (TAU). They are also hypothesised to be the
origin of systemic endogenous regulatory issues.7,14,19
Both, it has been able to improve the aesthetic problem
using a minimally invasive technique and a defectoriented approach.
As a conclusion, ceramic implants are highly recommended
in terms of aesthetic and integrative immunological treatment concepts. So, rather from being seen as in conflict
to established, well-researched therapy concepts, the
treatment concepts of integrative oral medicine as they
are presented here should be seen as a development and
further evolution of those philosophies.
12
implants 2 2023
Chronic fatigue in a patient has reportedly been remarkably improved by removing immunologic stress. To gather
evidence, additional large-scale research on chronic fatigue needs to be done with parameters that could be
consistently replicated. Hence, a suggestion for general
therapy for chronic fatigue should not be made here. Immunological considerations and prosthetic-aesthetic requirements should be more closely combined in this
context.
Literature
contact
Dr Fabian Schick
Specialist for Biological Dentistry and
Ceramic Implants (ISMI/IAOCI)
drfabischick@outlook.de
www.dr-lechner.de
Dr Fabian Schick
[13] =>
[14] =>
| case report
Single-tooth restoration with
a two-piece Patent™ Implant
Immediate implant placement and loading
in the aesthetic zone
Dr Harald Fahrenholz, Austria
Introduction
Today, practitioners have to meet growing patient demand for aesthetic tooth replacements that remain healthy
in the long term, often involving immediate implant placement and loading. In the following article, a case is presented in which the patient’s aesthetic zone was restored
using a two-piece zirconia implant system which has
been an integral part of the author’s clinical armamentarium for over fifteen years. In clinical studies, this implant
system has shown high survival rates, stable marginal
bone levels and a favourable soft-tissue reaction.1,2 Additionally, in an independent nine-year study—the first longterm study on two-piece zirconia implants—it demonstrated healthy and stable hard and soft tissue, excellent
aesthetics with a visible increase in keratinised gingiva
volume around all implants investigated, no fractures, and
no peri-implantitis.3 It is therefore ideally suited for the indication described.
1a
Initial situation
The 41-year-old female patient presented to the author’s
practice in October 2021. Owing to a failing post and core
restoration of an endodontically treated tooth #11, she expressed the desire for a fixed tooth replacement solution
(Figs. 1a & b). The radiographic evaluation by means of
CBCT revealed that there was sufficient bone volume in
the site for the planned implant placement (Fig. 1c).
1b
Treatment planning
As part of the surgical procedure, it was planned to remove the failing restoration, extract the remaining tooth
root and immediately insert a two-piece zirconia implant
(Patent™ Dental Implant System, Zircon Medical Management) into the extraction socket. Furthermore, it was
planned to prepare the glass fiber post and core assembly, which serves as the prosthetic build-up of the implant
system used, chairside in the same treatment session, to
14
implants 2 2023
1c
Fig. 1: Frontal (a), occlusal (b) and radiographic (c) views of the initial situation.
[15] =>
case report
2
3
4
5
|
Fig. 2: Root extraction. Fig. 3: Thorough curettage of the extraction socket. Fig. 4: Osteotomy preparation according to the drilling protocol of the manufacturer.
Fig. 5: Ozone therapy of the implant bed.
adhesively cement it on to the implant and to restore it
with a provisional crown so that the patient could leave
the dental practice after surgery without a missing tooth.
facturer (Fig. 7), up to a maximum torque of 35 Ncm. High
primary stability of the inserted implant was achieved
(Fig. 8).
Surgical procedure
Prosthetic restoration and healing
After local anaesthesia had been administered, a labial
incision was made in the region of tooth #11 to facilitate the
removal of the failing tooth. After the old restoration had
been removed (Fig. 2), the underlying tooth root was extracted, and the extraction socket was carefully curetted to
completely remove any fibrous tissue (Fig. 3). The osteotomy was prepared according to the drilling protocol of the
implant manufacturer and under water cooling (Fig. 4).
Once prepared, the osteotomy was treated with ozone to
disinfect and sterilise the implant bed (Fig. 5). Thereafter,
the two-piece zirconia implant with a diameter of 4.5 mm
and a length of 13.0 mm was removed from the implant
sleeve using an insertion tool and inserted into the osteotomy (Fig. 6). The implant was screwed into the bone
using the torque wrench provided by the implant manu-
Immediately after implant insertion, the prefabricated
glass fiber post was prepared extra-orally using a diamond bur and fitted into the 3C platform of the placed
implant for try-in. The final preparation of the post was
carried out intra-orally (Fig. 9a). After try-in of the provisional crown, which was fitted on to the prepared glass
fiber post, both the post and provisional crown were removed again. The 3C platform of the implant was filled
with a dual-polymerising cement (RelyX Unicem 2, 3M
ESPE), and the prepared glass fiber post was inserted
into it. Excess cement was removed and the glass fiber
post was light-polymerised (Fig. 9b). The glass fiber post
was isolated with Vaseline oil, and the provisional crown
was subsequently cemented using a temporary cement
mixture (Figs. 10a & b).
implants 2 2023
15
[16] =>
| case report
One week after surgery, the patient presented to the author’s dental office for a follow-up appointment. Already
at this time, an extremely beneficial and healthy softtissue reaction around the neck of the inserted implant
was evident. After successful osseointegration and an
uneventful healing period of three months, the definitive
crown was delivered (Figs. 11a & b). At the 12-month
follow-up, the soft-tissue conditions were considered
healthy and stable, and the treatment result was deemed
satisfactory from an aesthetic point of view (Fig. 12).
Discussion
6
The two-piece zirconia implant system used for the clinical case described is routinely and almost exclusively
used in the author’s practice. Thanks to its very rough
endosteal surface, reliable bone healing is to be expected.4 One of the main challenges in cases of immediate implant placement in the anterior region, like that described here, is the preservation of the alveolar bone (and
the buccal plate in particular) during extraction. Also, correct positioning of the planned implant and the direction
of insertion are of great importance to prevent the implant
from penetrating the buccal bone. For this reason, it is
necessary to drill slightly more palatally from the alveolar direction. Also, having a soft-tissue-level design, the
implant used is placed at the equigingival level, which
means that its crown margin is clearly visible and accessible during the entirety of the prosthetic procedure. For
the same reason, excess cement can be easily and completely removed after cementation of the glass fiber post.
As a result, the risk of cementitis due to subgingival cement
remnants is virtually nonexistent.
7
Moreover, as a result of implant positioning equigingivally,
and to the proper depth, too high a compression on the
cortical bone is avoided, which would otherwise adversely
impact marginal bone stability.5 Furthermore, the glass
fiber post used for the core build-up of the two-piece im8
9a
9b
Fig. 6: Insertion of the implant into the osteotomy. Fig. 7: Insertion of the implant using the torque wrench of the manufacturer. Fig. 8: Inserted implant after
achieving high primary stability. Fig. 9: Intra-oral preparation of the glass fiber post after try-in (a) and light polymerisation of the cement (b).
16
implants 2 2023
[17] =>
case report
10a
|
10b
11a
11b
12
Fig. 10: Frontal (a) and occlusal (b) views of the clinical situation after delivery of the provisional restoration. Fig. 11: Frontal (a) and radiographic (b) views
of the clinical situation after delivery of the definitive restoration after three months of healing. Fig. 12: Frontal clinical view of the final result after 12 months.
plant system used, offers added value regarding stability:
Having a dentine-like modulus of elasticity, the glass fiber
post attenuates masticatory forces transferred from the
superstructure to the implant, minimising the fracture risk
of the implant components as a result. Post preparation by
means of a diamond bur is done in the same way a natural tooth or a post and core in endodontic dentistry would
be prepared.
Conclusion
With the two-piece zirconia implant system used in the
clinical case described, aesthetic restorations in the anterior area can be realised thanks to its natural-looking
shade and its beneficial soft-tissue response. Also, thanks
to its soft-tissue level design, which avoids a microgap at
bone level, and the tissue-friendly and plaque-resistant
implant material, zirconia, long-term successful treatment
outcomes with minimal risk of biological late-term complications like peri-implantitis can be expected. The author has not experienced a single case of peri-implantitis
in the more than fifteen years for which he has been using
this implant system.
Literature
about the author
Born in Königssee, Bavaria, dental implant specialist Dr Harald Fahrenholz
graduated from the Paul-Gerhardt-Gymnasium in Laubach in Germany before
studying dentistry at the Johannes
Gutenberg University in Mainz. In 1974,
Dr Fahrenholz was granted his license
to practice dentistry. He worked as an
assistant dentist in Neumarkt-Sankt
Veit and Munich between 1974 and 1978. Between 1978 and
2005, Dr Fahrenholz led his own practice in Grünwald near Munich. From 2001 to 2007, he served as deputy director of the
CMF Institute in Vienna. In 2001 he obtained the certification
“Tätigkeitsschwerpunkt Implantologie” of the BDIZ. Since June
2007, Dr Fahrenholz has headed the Vienna Center for Dental
Aesthetics and since January 2017 the practices Zahnästhetik
am Kohlmarkt in Vienna and Zahnästhetik in Stetten.
contact
Dr Harald Fahrenholz
Zahnästhetik am Kohlmarkt
Kohlmarkt 7/1/4/34
1010 Vienna, Austria
+43 1 8905947
www.zahnaesthetik-wien.at
Dr Harald Fahrenholz
implants 2 2023
17
[18] =>
| case report
Restoring anterior aesthetics with
two-piece zirconia implants
Dr Saurabh Gupta, India
Zirconia implants are one of the newest and most exciting developments in dental implantology. Multiple studies have proved that zirconia implants induce little to no
peri-implant tissue inflammation and allow for high levels
of epithelial attachment. Additionally, these implants look
more natural; hence, they provide improved aesthetics.
Furthermore, they do not have metal components, which
makes them ideal for people with metal sensitivities and
patients who would prefer their implants to be metalfree.1–3
Aesthetics around natural teeth can be challenging under normal circumstances. When teeth are to be replaced with implants, especially in the aesthetic zone,
gingival tissue can complicate the desired results. In a
patient with a thin gingival biotype, the grey of a titanium
implant will show through, leading to a darker gingiva
overlying that area and decreasing the aesthetics of the
patient’s smile. A patient who has had a missing anterior
tooth for a period, resulting in resorption of the facial
plate even with a thicker gingival biotype, will have less
bone over the implant on the facial aspect of the ridge.
The result, like with a thin gingival biotype, will be a
shadow over the underlying implant that hampers the
aesthetic result and does not blend with the adjacent
tissue around the natural teeth.4–7 In the following, a clinical case is described to demonstrate the use of twopiece ceramic implants in the anterior aesthetic zone to
avoid this difficulty.
Case presentation
A 44-year-old male patient presented to our office to
learn about options for replacement of his failing maxillary central incisors after undergoing partial root canal
therapy. He also complained of greyish gingiva around
the endodontically treated teeth and desired a metal-free
solution (Figs. 1 & 2). Photographs of his teeth when smiling were taken to assess the overall aesthetic risk of the
case. Treatment options were then discussed with the
patient. After reviewing the options, the patient chose to
have the endodontically treated teeth extracted and replaced with two-piece zirconia implants and metal-free
crowns.
1
Surgical procedure
The guidelines for zirconia implant placement in the anterior zone and the drilling protocol specified by the
manufacturer (Zeramex XT, Dentalpoint) were followed. It
is important to note that implant sites must be prepared
adequately to prevent excessive implant insertion torque
and that the use of a bone tap is necessary. Both the
2
18
Fig. 1: Initial situation. Fig. 2: Initial radiograph.
implants 2 2023
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member of ISMI now!
[20] =>
| case report
3
4
5
Fig. 3: After atraumatic extraction of teeth #11 and 21. Fig. 4: Immediate placement of Zeramex XT implants. Fig. 5: PMMA temporary crowns placed one
week after surgery.
vertical and transverse insertion depth of the zirconia implant are important for prosthetic success. The implant
can be placed between 1.6 and 0.6 mm supra-crestally
because the neck section (0.6 mm) is smooth. The insertion depth is determined by the height of the gingiva and
the existing bone around the adjacent teeth.
After a four-month healing period, the second-stage surgery was performed with a 940 nm diode laser, the cover
screws were removed and healing abutments were
placed for a period of two weeks. Reduced inflammation
of the peri-implant soft tissue was noted, demonstrating
excellent biocompatibility and host response (Fig. 6).
After atraumatic extractions and laser curettage, twopiece zirconia implants (4.2 × 12.0 mm) were placed in
sites #11 and 21 under local anaesthesia, cover screws
were placed and the sites closed to allow for healing
(Figs. 3 & 4). After 72 hours, the PMMA temporary crowns
were inserted (Fig. 5).
Angulated abutments (15°), also made of alumina-toughened zirconia like the implants, were placed on the implants with Zeramex XT VICARBO screws (Figs. 7–9). This
screw, which is made of longitudinal carbon fibre strands
and moulded slightly larger than the internal aspect of
the implant, allows absorption of the forces of mastica-
8
9
10
11
Fig. 8: Angulated zirconia abutments in position. Fig. 9: Four-month post-op radiograph. Fig. 10: Zirconia crowns in situ, lateral view. Fig. 11: Zirconia crowns
in situ, frontal view.
20
implants 2 2023
[21] =>
AD
Specialist in
Integrative
Oral Medicine
6
7
Fig. 6: Healing after four months. Fig. 7: Example of a Zeramex XT implant, abutment and VICARBO screw
(metal-free solution).
tion and provides a hermetically sealed
connection. A digital impression was
taken for the fabrication of the final crowns
(Fig. 10). Zirconia crowns were cemented
to the abutment heads with glass ionomer cement to provide natural aesthetics.
Instructions were given for maintenance
and periodic recall (Figs. 10–12).
Discussion
Owing to rising complications observed
in some clinical situations involving the
use of titanium dental implants and the
growing incidence of peri-implant mucositis and peri-implantitis affecting both
the short- and long-term survival rates of
titanium dental implants, the develop-
ment of alternative materials to address
these has been pursued. Zirconia has
been shown to have similar osseointegration success to titanium, offer a softtissue response that is superior to that
of titanium and have less of an affinity
for plaque collection compared with titanium surfaces.
Also, the peri-implant soft tissue around
titanium and zirconia abutments has
been shown to have colour differences
compared with the soft tissue around
natural teeth, and the peri-implant soft
tissue around zirconia has been demonstrated to have a better colour match
to the soft tissue than titanium. This can
be extrapolated to the aesthetics of the
colour of the implant itself. Zirconia implants can be used in aesthetic situations, the white shade of the implant
eliminating any potential for darkening of
the gingival tissue and providing a more
natural final aesthetic result than is possible with titanium implants. Long-term
studies are necessary to continue to
evaluate the effectiveness and success
rates of two-piece zirconia implants.
Fig. 12: Radiograph of implants and final crowns.
Dr Saurabh Gupta
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More information:
www.icosim.de
[22] =>
| testimonial
Stability ensured
Advancing implant dentistry with Z-SYSTEMS
bone level ceramic implants
In an interesting case performed by Dr Paul S. Petrungaro, Z-SYSTEMS bone level ceramic implants showcased their exceptional capabilities in a challenging scenario. The case involved a 100% fully-ceramic dental
implant reconstruction utilising Z-SYSTEMS’ bone level
implants within an All-on-X fully digital workflow technique. The patient, a survivor of throat and tongue cancer, presented unique challenges that demanded a sophisticated approach, and Z-SYSTEMS’ innovative ceramic
implants proved their efficacy.
Patient background and challenge
The patient’s history of throat and tongue cancer presented complexities that required a comprehensive strategy. The use of radiation and chemotherapy treatments
for cancer patients create a high risk for wound healing
complications. Selecting the appropriate implant material
was crucial. Z-SYSTEMS’ bone level ceramic implants
emerged as the preferred solution due to their exceptional biocompatibility and tissue-friendly nature, which
were paramount for patients with compromised healing
abilities.
2
Fig. 2: Immediate postoperative CT scan panoramic view.
22
implants 2 2023
1
Fig. 1: Pre-treatment smile.
[23] =>
testimonial
|
3
Fig. 3: Case complete milled monolithic zirconia All-on-X upper and lower
definitive prosthesis.
The preferred choice
Dr Petrungaro highlighted, “In intricate cases such as this,
where optimal healing and patient well-being are paramount, choosing an implant solution that ensures stability and promotes healthy tissue integration is crucial.
Z-SYSTEMS’ bone level ceramic implants proved to be
the natural choice. Their biocompatibility, absence of
metallic ions, and tissue-friendly properties significantly
mitigate the risks associated with compromised healing,
making them the ideal option for our patient’s complex
needs.”
Z-SYSTEMS’ bone level ceramic implants offer a host of
unparalleled benefits, particularly in challenging cases:
– Optimal biocompatibility: The absence of metallic ions
in Z-SYSTEMS’ ceramic implants ensures reduced complications, enhancing the healing process, and safeguarding patient well-being.
– Tissue-friendly properties: Z-SYSTEMS’ bone level implants promote superior tissue integration, crucial for
high-risk patients with compromised healing abilities.
– Structural integrity: The screw-retained conical connection and ceramic composition provides robust stability and strength, ensuring the long-term success of
the dental reconstruction.
– Aesthetic excellence: The natural appearance of ceramic
implants ensures a seamless blend with the patient’s
natural dentition, enhancing aesthetics and selfconfidence.
Dr Paul S. Petrungaro’s case exemplifies the transformative potential of ZSYSTEMS’ bone level ceramic implants in intricate and high-risk scenarios.
4
Fig. 4: Case complete smile.
This testimonial is a tribute to Z-SYSTEMS’ pioneering
approach to advancing implant dentistry, catering to
unique patient requirements, and ensuring their oral health
and satisfaction.
Dr Paul S. Petrungaro is a committed user of
the Z-SYSTEMS’ implants.
contact
Z-SYSTEMS
www.zsystems.com
implants 2 2023
23
[24] =>
| research
CleanImplant Foundation Trusted Quality
seal: More manufacturers prove the
production quality of their implant systems
CleanImplant Foundation provides dentists and patients with
guidance for clean dental implant systems of titanium and zirconia
After the “Astra Tech EV” by Dentsply Sirona was awarded
this March, the coveted seal for Trusted Quality has now
been given to two other implant systems: The renowned
implants, “SuperLine” by Dentium and “INVERTA” by
Southern Implants are now welcomed into the family of
certified clean implants. The scientifically based seal of
quality, which underlines the first-class surface purity of
dental implants, is only awarded by the CleanImplant
Foundation’s Scientific Advisory Board after a rigorous
peer-reviewed analysis and testing process.
1
“This award is an objectively transparent proof that colleagues are using a residue-free medical device for their
patients by manufacturers who implemented the highest
quality standards,” explains Dr Dirk U. Duddeck, Founder
and Head of Research at CleanImplant. To obtain this
valid, objective proof, a so-called “five step approach”
was established in cooperation with the eight-member
Scientific Advisory Board:
CleanImplant Trusted Quality seal | Five step approach
STEP 1
Neutral sampling of
five implants
Batch-spanning random sampling: Three implants are
ordered ex-factory, and two implants of the same type
are provided via mystery shopping from practices.
STEP 2
Unpacking and
scanning under clean
room conditions
All five collected samples are carefully unboxed, mounted,
and scanned in a clean room environment according to
Class 100 US Fed. 209, Class 5 DIN EN ISO 14644-1.
STEP 3
Externally audited
process of analysis
SEM imaging and elemental analysis (EDS) are
performed according to DIN EN ISO/IEC 17025
accreditation process (competence of testing and
calibration laboratories) with external audits and
multi-annual re-assessments.
STEP 4
Full-size and
high-resolution SEM
images
A special full-size, high-resolution SEM image—
digitally composed of more than 360 single SEM
images in a magnification of 500x—always shows
the implant surface from shoulder to apex.
STEP 5
Peer-review process
24
implants 2 2023
Two members of the Scientific Advisory Board
independently review the comprehensive report of
analysis and sufficient clinical documentation or
multi-annual PMCF studies (Post-Marketing Clinical
Follow-Up) of the analysed implant type showing
survival rates of more than 95% for the device or
device family.
2
Fig. 1: SEM image SuperLine implant—Dentium. Fig. 2: SEM image INVERTA
implant—Southern Implants.
Every quality certification is valid only for two years and
has to be renewed after this period. Other titanium-made
implant systems that have been awarded the Trusted
Quality seal are: Kontact S (Biotech Dental), UnicCa (BTI
Biotechnology Institute), (R)evolution (Champions-Implants),
In-Kone (Global D), ICX-Premium (medentis medical),
AnyRidge and BLUEDIAMOND (MegaGen), T6 (NucleOSS),
Prama (Sweden & Martina). Other testing and analysis
results are pending.
Selected ceramic implant systems also carry the “Trusted
Quality” seal such as whiteSKY (bredent group), Patent/
BioWin! (Champions-Implants), and SDS 1.2 and SDS 2.2
(Swiss Dental Solutions). Moreover, CleanImplant “Certifi ed Production Quality” awards were received by the
CeramTec Group and Komet Custom Made as contract
manufacturers of ceramic implants.
[25] =>
AD
© CleanImplant Foundation
3
Fig. 3: Dr Dirk U. Duddeck placing an implant on the sample holder of the scanning electron microscope.
After five consecutive quality assessment studies on dental implants, the Foundation
has SEM data and test results of more than 300 different implant types on file. All
tests have been performed exclusively by officially accredited testing laboratories.
Dentists can request reliable information on the cleanliness of their preferred dental
implant system. With 150,000 subscriptions from dental professionals, the CleanImplant Foundation has become a grassroots movement on social media. More and
more dentists are actively supporting the CleanImplant Foundation. Certified as
“CleanImplant Certified Dentists”, they pass on the trust they gained in the products
to their patients and referring dentists.
Zeramex XT
The two-piece allceramic implant system
Get to know the proven allceramic implant system with
the unique metal-free carbonfiber reinforced Vicarbo® screw
that counteracts tensile and
bending forces.
Made in Switzerland - since 2005
The independent CleanImplant Foundation was founded as a non-profit organisation in Berlin in 2016. In cooperation with renowned universities, the
foundation regularly coordinates worldwide quality assessment studies of
dental implants and awards the “Trusted Quality” seal to particularly clean implant types following a strict peer-review process to generate independent
and meaningful data concerning the cleanliness/contamination of implant
surfaces of sterile-packaged implants. All samples are tested exclusively in
specialised testing laboratories officially accredited according to DIN EN ISO/
IEC 17025:2018. CleanImplant also certifies implantologists as well as dental
centers, thus increasing the confidence of referring clinicians, dentists and
patients. More information: www.cleanimplant.org
Dentium has provided best products to dentists for 22 years since its establishment, operated a production plant in the United States for the first time in
the domestic industry in 2004, and has obtained the certificate by MFDS
of major overseas countries, including the US FDA. Based on world-class
technology and reliable products, it is Korea’s representative implant that is
exported to more than 70 countries around the world. More information:
www.dentium.co.kr
Southern Implants is a leading provider of innovative oral reconstruction
products. The company focuses on providing site-specific, dental implant
treatment solutions to advanced professional users who want more choices.
Southern’s expertise in research, development and precision manufacturing
positions it to efficiently commercialise innovative treatment solutions that reduce treatment times and improve patient outcomes. Established in 1987 and
privately owned, Southern Implants is headquartered in South Africa with a
global distribution network. More information: https://southernimplants.com
life
time
contact
CleanImplant Foundation
Berlin, Germany
+49 30 200030190 · info@cleanimplant.org · www.cleanimplant.org
Implants
10
years
Secondary parts
Vicarbo screw
www.zeramex.com
© Wlad74/Shutterstock.com
[26] =>
| interview
Advocating for the superiority of
ceramic systems
An interview with John Sheehy, President of Z-SYSTEMS USA, director of global sales of Z-SYSTEMS
ceramic implants, USA
Since Z-SYSTEMS was founded in 2004, tens of thousands of its implants have been successfully placed
worldwide. This attests to the company’s reputation as a
pioneer with technical expertise, high product quality and
ongoing development. The company’s newest release is
the first two-piece bone level implant made of ceramic.
OEMUS MEDIA’s Dr Alina Ion spoke with John Sheehy,
President of Z-SYSTEMS USA and director of global sales
of Z-SYSTEMS ceramic implants, about how the company established itself, its recent products and the future
of the company.
Z-SYSTEMS is a world leader in metal-free zirconia
implants. What path did the company follow to achieve
this?
The global team at Z-SYSTEMS is understandably very
proud of our history in pioneering the use of zirconia for
dental implantology. We were one of the original manufacturers of ceramic implants for commercial sale, and we
achieved this independently, from sourcing the zirconia
material, then engineering the design of the implants to
manufacturing the products in our own factory in Switzerland. Today, we still manufacture entirely ourselves and
never outsource.
We also never compromised on convenience or quality
when faced with challenges that could have more quickly
or cheaply been solved with metal or plastic components,
as some other ceramic brands have done. Instead, we continued innovating—from our heritage one- and two-piece
implants to our most recent developments, the bone level
and tissue level implants. We continue to drive the industry forward by holding firm to that high standard of quality.
The dental implant market, especially the ceramic implant market, is highly competitive. How have you
maintained your position as a world leader?
Our success has come from three focus areas. Firstly, we
offer the most versatile, highest-quality products in the market, free of plastic and metal, produced using the strongest ceramic material on the market.
Secondly, our pace of innovation is set not only by our
own engineering but also by responding to our custom-
26
implants 2 2023
[27] =>
ers, including many of the world’s leading practitioners of
ceramic implantology. Our new product lines are constantly
evolving to provide the broadest range of restorative solutions. We were the first to offer a one-piece tapered implant and are the only brand to offer a conical connection.
Thirdly, we seek to provide our customers with the best
training, education and ongoing practitioner support. We
have full-time in-house technical assistance as well as a
global network of industry leaders whom we retain to
guide customers in the adoption and use of ceramic implants in their practice. We have also built up a comprehensive suite of resources, such as our online courses
and continuing education modules developed with our
media partner, Dentanext Media, which ensure customer
success.
What are the most recent innovations introduced by
Z-SYSTEMS?
Our newest offerings are the two-piece bone level and
tissue level implants with a conical connection—the first
of their kind in the world! These are truly revolutionary
products that advance implantology.
What is the focus of the company’s development?
On the product side, we are focused on expanding the
adoption of the bone level and tissue level line and will
soon release our next product launch, Tapered NEO.
Much of our energy is focused on successful adoption of
ceramic implants, expanding their use in implantology. The
key to this is educating practitioners.
Z-SYSTEMS has a new website. How does this serve
the company’s mission better?
We will always be a Swiss company, and the stringent
standards for quality that our heritage conveys are core
to our identity and an attribute that we are always quite
proud of. We also want to communicate our continued
commitment to technological innovation. Our new website
more fully foregrounds our dedication to educating and
supporting our customers, through our live events and
training, our educational modules, our technical support
teams and our industry leader network. You can visit our
newest landing page at www.zsystems.com/ceramicdental-implants.
You also offer webinars. How have these been received?
The webinar series, which was launched about five years
ago with Dentanext Media, has been extremely well received, and we continue to expand these offerings as
much as we can. This accelerated during the pandemic,
when continuing education was still required of practitioners but travel and in-person contact was limited. While
live training and in-person education are always preferable, our webinars and other online training modules offer
our customers convenience and a quick, easy reference
for optimum adoption of and success with our ceramic
implant system.
What does the future of Z-SYSTEMS look like?
Every day, our global team applies itself to maintaining the
momentum of our successes. We are actively seeking to
refine our technology to invent useful products and to bring
our customers along with us in the adoption of ceramic
implant options. We have aligned our success with theirs,
by not merely engaging in a sale transaction, but offering
customers and their practices ample support for each case
and education to maintain and improve their skills in working with ceramic implants. We continue to focus on the
work of advocating for the superiority of ceramic implant
systems over conventional metal implants and bringing
that message to new markets.
about the interviewee
For over two decades, John Sheehy has
been a leader in the world of biomedical
sales and marketing and, in the last ten
years, has been a significant ambassador
for the ceramic dental implant industry,
pioneering the adoption of ceramic implants in the US, Europe, the Middle East
and elsewhere around the globe. He joined
Z-SYSTEMS in 2014 and became President of the brand’s US division in 2017. Sheehy is also the founder
and President of Dentanext Media (www.dentanextmedia.com), a
premier media platform for advanced dentistry education and
livestreaming of events.
implants 2 2023
27
[28] =>
| industry
Neodent, a Straumann Group brand
A global player in dental solutions that
restore smiles and confidence
Neodent is ready to celebrate what it does best: creating new smiles every day. This year marks the 30th anniversary of the brand, which has been providing immediate treatment protocols and changing lives of patients
with millions of smiles worldwide since 1993. Founded by
a dentist, for dentists, Neodent is now present in 90 countries, thanks to its commitment to maximising predictability and enabling long-lasting results through its unique
features designed based on key biological principles. To
celebrate this milestone, Neodent is hosting the 30 Year
World Tour in the five regions where it has a presence.
These inperson events will
bring together customers
and experts to strengthen
relationships.
solutions that bring innovative and reliable solutions to the
community.
Zi ceramic implant system
In 2022, Neodent launched its first ceramic implant system, Zi, which uses advanced technology and ceramic
material for a more natural and aesthetically pleasing
look. The solution was developed in response to the demands of dentists and new market trends. The global
launch was guided by the latest technology and featured,
in a digital symposium, global experts and
a live surgery performed by Dr Thomé.
The Zi Virtual Symposium was attended
by viewers from 92 countries and was
presented in five languages, providing
an interactive online experience that immersed the audience in the world of Zi.
The event featured presentations by in-
“In 2015 […] we
started to spread
our philosophy around
the world and the
gratitude to see
Neodent present
in 90 countries
with great results
makes me happy and
excited for the next
30 years.”
The 30 Year World Tour is
featuring Neodent founder
Dr Geninho Thomé and
CEO Matthias Schupp, who
are celebrating the brand’s
history and philosophy and
promote its innovative portfolio. “I am proud to see how
much we have grown over
time since our foundation,
in 1993, until our first ceramic implant system, in 2022.
I just see reasons to smile.
In 2015, with the full acquisition by the Straumann
Group, we started to spread
our philosophy around the
world and the gratitude to
see Neodent present in
90 countries with great results makes me happy and excited for the next 30 years. I would like to thank everybody who has been part of our history until now and I invite you to celebrate with us the evolution of implantology,
technology, the dentistry market, aesthetics, patients and
Neodent,” said Dr Thomé on Neodent’s momentous
achievement.
Throughout its 30-year history, Neodent has learned that
celebrating is a choice, and as long as it exists, it will
choose to bring smiles to people’s lives. The manufacturer provides direct, progressive and affordable dental
28
implants 2 2023
Fig. 1: Dr Geninho Thomé, founder of Neodent.
[29] =>
industry
|
Fig. 2: In 2022, Neodent launched its first ceramic implant system, Zi, which uses advanced technology and ceramic material for a more natural and aesthetically pleasing look.
ternational guest speakers, who shared the latest consumer trends and their impact on the industry, among
other topics. Prominent physicians also shared their experiences with the Zi ceramic implant system.
“Over six years ago, we started dreaming: we decided
to create not just a new ceramic implant; we decided to
do something innovative and completely different,” said
Schupp at the opening of the event.
Zi combines flexibility, stability and aesthetics. The twopiece solution provides flexibility with a longer screw that
ensures a reliable fit between the implant and the ceramic
abutment. This also optimises the performance of the
ceramic and distributes force along the ZiLock connection. The connection has six lobes and six points, allowing the precise positioning of the abutment and protecting against rotation. Stability is enabled by the naturally
tapered implant design, engineered for predictable immediacy in all bone types.
Zi implants are available in diameters of 3.75 and 4.30 mm
and in lengths of 10.0, 11.5 and 13.0 mm. The prosthetic
portfolio, also made of ceramic, provides both cement-
retained and screw-retained solutions for single-unit
cases. Zi offers options for conventional and digital workflows. Digital treatment planning for Zi cases supports
more efficient and precise treatment for better clinical
outcomes.
With a strong focus on research and development,
Neodent is constantly pushing the boundaries of what is
possible in dental technology. Its products are backed by
rigorous clinical testing and real-world results, and the
company has a proven track record of success in helping
dental professionals deliver high-quality, affordable dental care. With its commitment to innovation, quality and
customer satisfaction, Neodent pursues the best possible care for patients. The company’s mission is simple: to
improve lives through better oral health. Join Neodent’s
mission to change the world, one smile at a time.
Neodent
contact
Neodent (Straumann Group brand)
+55 800 7072526
www.straumann.com/neodent
implants 2 2023
29
[30] =>
Zirconia implant: An evolution or
a revolution?
3rd EACim CONGRESS in Paris
© eyetronic – stock.adobe.com
| events
On 10 June 2023, the European Academy of Ceramic
Implantology successfully held its annual congress at Les
Salons Hoche in Paris, France. This prestigious event
brought together more than 200 healthcare professionals
and experts in the field of integrative and complementary
medicine from ten countries around the world. During this
exciting day, fifteen partners from the industry were also
able to present their latest developments.
© EACim
The aim of the congress was to promote dialogue, collaboration, and knowledge exchange, thereby advancing
the field of ceramic implantology. Through lectures and
panel discussions, the attendees had the opportunity to
learn about the latest research findings, emerging trends,
and innovative practices in this field.
In addition to the educational sessions, the congress also
offered participants the opportunity to exchange ideas
with like-minded professionals, make new contacts and
discover potential partnerships. The event also featured
an exhibition area where companies and organisations
could showcase their products, services, and innovations in the field of ceramic implantology.
© EACim
The 3rd EACim CONGRESS was an enriching and inspiring experience for expert practitioners, researchers, students or simply those interested in ceramic implant
dentistry, providing valuable insights and networking opportunities.
EACim cordially invites to its 4th annual congress which
will take place in 2025 in Spain. The congress topic will
be “Evolution through ceramic thinking”. For more information about the congress, the programme, speakers,
and registration, please visit the EACim website.
© EACim
contact
EACim website
European Academy of
Ceramic Implantology (EACim)
+33 4 91530105
contact@eacim-ceramic-implantology.com
www.eacim-ceramic-implantology.com
© EACim
30
implants 2 2023
[31] =>
Are you a writer?
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Share your experience and knowledge and benefit from a global reach and high level of awareness.
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Phone: +49 341 48474-0 · info@oemus-media.de
[32] =>
What are the unique features of the 2023 EAO-DGI
joint meeting?
Florian Beuer (FB): One of the things that’s unique about
this year’s congress is that we’ve planned it twice, as it
was originally supposed to take place in 2020. That’s why
we’ve called it “Berlin reloaded”. It’s a joint meeting with
the DGI, so it will bring together Europe’s biggest implant
dentistry organisation and biggest national association.
Henning Schliephake (HS): A new feature this year is the
table clinics, which means speakers and the audience
around the table can interact directly. We’ve also refined
the Battle of Concepts session to make it even more impactful.
What are the main focuses of the congress this year?
HS: The first focus is advances in digital technology,
which is something that’s being talked about more and
more. AI is creeping into many areas of medicine, particularly diagnostics. The second topic is the frail patient.
Patients are getting older and older, with comorbidities
and their associated risk factors. We have to be aware of
that and identify frail patients early on so we can respond
with appropriate planning.
© EAO
Ceramic Implants caught up with Prof. Florian Beuer
and Prof. Henning Schliephake, co-chairs of the EAO’s
forthcoming congress in Berlin, to find out what’s in store
for delegates at the event.
© EAO
Discover the EAO annual scientific
meeting in Berlin
FB: The third focus of this year’s congress is peri-implantitis,
which is a topic we still don’t know enough about. There
are many treatment approaches and associated questions. Exciting new discoveries are emerging that should
help identify patients who are at risk in the future.
What should delegates expect from this year’s Battle
of Concepts?
HS: The Battle of Concepts will explore the three approaches to treating peri-implantitis: non-surgical treatment, the resective approach, and the regenerative approach. All three have their indications, along with pros,
cons and limitations. These will be discussed alongside
footage of three surgical procedures.
FB: Delegates can really expect to hear some different
thoughts about peri-implantitis during this session, which
will look at the role of the immune response in periimplantitis, plus associated factors caused by the shape
of the prosthesis and the material it’s made from.
© EAO
We’re hearing a lot about big data and AI at the moment. How is this relevant to dentistry?
HS: As with many advanced technologies, you probably
won’t be using big data or AI in your office immediately,
but it’s coming and will be a reality soon. One of the
speakers taking part in the plenary on big data and AI will
be looking at data protection and some of the other issues we need to consider when talking about personalised medical data.
32
implants 2 2023
FB: This part of the programme will provide some really
interesting insights into how AI works and how it will be
used in the future. We’re very proud to have some of the
leading experts in the field on the programme and to be
© André Biesecker – stock.adobe.com
| events
[33] =>
|
© EAO
© EAO
events
If you want to, you can go to the German sessions and
hear them in a completely different language, such as
Mandarin. So as well as visiting a city that’s as exciting
and historic as Berlin, almost all our delegates should be
able to enjoy hearing the sessions in their language of
choice.
Many thanks for the interview.
kicking off the congress by discussing this important
topic.
Are the congress sessions available in alternative
languages?
HS: This year we’re excited to be piloting live translation
using AI, which will mean delegates can experience the
congress live in 26 languages. Breaking down language
barriers and helping people who aren’t fluent in English
to participate is very important.
More details and information about the EAO congress in
Berlin as well as application information are to find at
EAO’s website www.congress.eao.org.
EAO website
© EAO
FB: This is a great opportunity for people from all over the
world to hear the presentations in their native language.
implants 2 2023
33
[34] =>
| events
Photo gallery
“Ceramic Implants meets
th
Aesthetics”: 7 Annual Meeting
of ISMI successful in Munich
With a multi-faceted and high-calibre programme, the
congress in sunny Munich was once again able to inspire
numerous participants for the trendy topic of ceramic implants.
© OEMUS MEDIA AG
The 7th Annual Meeting of the International Society of Metal
Free Implantology (ISMI) took place in Munich on 5 and 6 May
2023 under the guiding theme “Ceramic Implants meets
Aesthetics”. Under the scientific direction of Dr Karl Ulrich
Volz/Kreuzlingen (CH) and Dr Dominik Nischwitz/Tübingen
(DE), the congress offered participants an enormously
multi-layered, varied and top-class programme on the topic
of ceramic implants and also highlighted biological aspects
of metal-free implantology. For the first time ever, the ISMI
Annual Meeting was held as a joint venture with the Ger-
34
implants 2 2023
man Society for Cosmetic Dentistry (DGKZ) and thus offered ample opportunity for interdisciplinary exchange.
The first day of the congress was opened under the
motto “Zirconium dioxide in general dentistry and implantology—where do we stand and what are the prospects?”
by ISMI President Dr Volz, Vice President Dr Nischwitz
and DGKZ Board Member Dr Martin Jörgens/Düsseldorf
(DE). After Dr Alessandro Alan Porporati/Plochingen (DE)
presented the basics, material and technology of zirconium vs metal-ceramics in his lecture, Priv.-Doz. Dr Kristian Kniha/Munich (DE) vividly explained the aesthetic
potential of ceramic implants. Dr Johann Lechner/Munich (DE) then spoke about osteo-immunology and implant success with ceramics in comparison with titanium.
[35] =>
© OEMUS MEDIA AG
© OEMUS MEDIA AG
After the lunch break, which was used extensively for a
visit to the accompanying industrial exhibition and collegial discussions, the pre-congress symposium including
a surgical tutorial continued directly. Dr Volz explained in
detail how the error rate in the use of ceramic implants
can be reduced and gave an overview of what ceramics
can do, where the limits lie and what good complication
management looks like.
(From left:) Dr Dominik Nischwitz (Vice President), Dr Karl Ulrich Volz (President) and Dr Tobias Wilck (Member of the Board of Directors).
Afterwards, the participants had ample opportunity to
discuss various special topics in implantology and aesthetic dentistry with proven experts and to look beyond
their own horizons at the popular Table Clinics. At the
same time, a workshop on the collection and preparation of autologous blood concentrates with Prof. Dr Dr Dr
Shahram Ghanaati/Frankfurt am Main (DE) offered dental
practice teams the opportunity to get fit for this increasingly important topic and to gain practical experience in
the hands-on part.
The first day of the congress was brought to a successful close with a get-together in the industrial exhibition,
where all participants were able to end the evening in a
relaxed atmosphere with wine, music and, of course, lively
discussions.
More interesting lectures on Saturday
Prof. Ghanaati opened the main congress on Saturday
with his lecture on biologisation in implantology and oral
surgery and gave an overview of the current state of affairs. “1-piece versus 2-piece ceramic implants—which to
choose?”—this question was addressed by Prof. Dr Curd
Bollen/Roosteren (NL) and he explained their differences
as well as advantages and disadvantages. Dr Alexander
Sobiegalla/Hemsbach (DE) then showed how to design
the digital workflow with both systems. The following lectures of the high-calibre podium with Prof. Dr Dr Ralf
Smeets/Hamburg (DE), Dr Ralf Masur/Bad Wörishofen
(DE) and Dr Tobias Wilck/Hamburg (DE) also dealt with various aspects of metal-free implantology and at the same
time raised critical questions about the topic. In addition,
ISMI Vice President Dr Nischwitz also spoke about the fusion of high-tech dentistry with functional medicine and
health optimisation as “Biological Dentistry 2.0”. Basically,
according to the tenor of Dr Wilck’s closing lecture, ceramic implants are an important building block for health
optimisation in the case of tooth loss.
The 7th Annual Meeting of ISMI ended with a final discussion and sent the numerous enthusiastic participants off
into the sunny Saturday afternoon. Once again, the professional society underlined its relevance in the world of
implantology despite its comparatively young age.
After the congress is before the congress: The 8th Annual
Meeting of ISMI will take place in Hamburg on 4 and
5 May 2024. Interested parties should already note the
date in their calendars and can pre-register for the programme at event@oemus-media.de.
contact
OEMUS MEDIA AG
Holbeinstraße 29 · 04229 Leipzig · Germany
+49 341 48474-308
Fax: +49 341 48474-290
event@oemus-media.de
www.oemus.com
www.ismi-meeting.com
implants 2 2023
35
[36] =>
| manufacturer news
Zircon Medical | Patent™
The only two-piece zirconia implant with long-term studies
Minimum risk of fracture and predictable osseointegration—
the Patent™ Dental Implant System has solved the challenges
of conventional zirconia implants. Only its patented production process creates the surface roughness needed for fast
and predictable osseointegration. In the last step of this revolutionary manufacturing method, process-induced microcracks are eliminated, maximising the Patent™ implant’s
overall strength and hardness. That the Patent™ approach
works is substantiated by scientific research: In a preclinical
study, Patent™ implants achieved bone–implant contact
(BIC) of over 70% after just four weeks of healing, outperforming all other dental implants investigated in similar studies. An independent long-term study over nine years found
no implant fractures for any of the two-piece Patent™ implants investigated, as well as healthy and aesthetic soft
tissue, stable marginal bone levels and no peri-implantitis.
Patent™ proves that long-term implant success is a reality.
Learn more at www.mypatent.com.
Zircon Medical Management AG
Switzerland
+41 44 5528454
www.mypatent.com
bredent medical
High primary stability and aesthetic appearance
The whiteSKY implant system from bredent is among the bestdocumented zirconia implant systems worldwide. It has not only
demonstrated excellent osseointegration and longevity in numerous studies but has also proven its efficacy in practice. In fact, the
longevity of whiteSKY implants is comparable to that of titanium
implants. The whiteSKY implant system offers two different implant types: the whiteSKY Tissue Line and the whiteSKY Alveo
Line. The narrow whiteSKY Tissue Line implant provides sufficient
space for both the hard and soft tissue and ensures an aesthetically pleasing appearance with its slightly tapered shape in the
sulcus area, transitioning from the gingiva to the implant crown.
The whiteSKY Alveo Line, on the other hand, is ideal for immediate
loading as it fills the extraction socket. At the same time, it provides the treating doctor with the possibility to individualise the
implant according to the specific requirements of the clinical case.
Optimal conditions for soft-tissue attachment and high mechanical stability
Both the Alveo and Tissue Line implants of the whiteSKY system
offer optimal conditions for soft-tissue attachment due to their
specially designed sulcus surface. The whiteSKY implants are
made of hardened zirconia and are one-piece, which gives them
particularly high mechanical stability. Thanks to the improved
thread design and bone-quality-oriented surgical protocol, the
whiteSKY implants achieve high primary stability, making them
ideal for immediate loading. Studies have shown that immediate
implant placement can improve the bone–implant contact by
more than 50 per cent.
36
implants 2 2023
bredent medical GmbH & Co. KG, Germany
info@bredent.com · www.bredent-implants.com
[37] =>
52
ND
INTERNATIONAL
ANNUAL CONGRESS
OF DGZI
IMPLANTOLOGY
IN TEAM
IMPLANTOLOGY IS TEAM
6 TH/7 TH OCTOBER 2023
HAMBURG
REGISTER
NOW!
www.dgzijahreskongre
ss.de/en
[38] =>
| manufacturer news
WITAR
Ideal solution for all indications
AWI ceramic implants from WITAR offer superior aesthetics, stability, accuracy and healthy osseointegration. A sophisticated design combined with modern
materials make for an ideal solution for all bone classes
and indications. Made of zirconium dioxide, AWI dental
implants are metal-free and thus fully biocompatible.
The cemented zirconia abutment allows an individual
design. The transgingival shoulder has an ideal surface
for interacting with soft tissue for any type of indication.
The conical micro-thread allows great primary stability
and axial loading. Studies have shown that the thread
roughness of 1.7 μm leads to optimal osseointegration.
Also, the surface is coated with a bioactive BIOVERIT I
nano-coating. This surface-thread combination enables
superior osseointegration for all bone classes. The selftapping implant tip provides space for bone chips and
low-compression insertion. AWI ceramic implants are now
available in gingiva colour too, which leads to even better
aesthetics and optimised risk areas.
WITAR Consulting GmbH, Germany
www.witar.de
Z-SYSTEMS
Breakthrough technology in dental implantology
Z-SYSTEMS ceramic implants, a pioneer and leading innovator
in dental implant technology, proudly announces the official
relaunch of its highly anticipated bone level and tissue level
100% ceramic, screw-retained conical connection implants.
Leveraging over 15 years of research, development, and clinical expertise, Z-SYSTEMS has revolutionised the field of implant dentistry with this groundbreaking solution.
Designed to provide unparalleled aesthetics, durability, and
biocompatibility, Z-SYSTEMS’ bone level and tissue level
ceramic implants offer a transformative alternative to traditional metal implants. These state-of-the-art implants
combine the advantages of zirconia ceramics with an innovative two-piece conical connection, resulting in outstanding stability and long-term success rates.
Key features and benefits of Z-SYSTEMS bone
level and tissue level ceramic implants include:
– Two-piece, screw-retained conical connection: This
design ensures a micro-gap-free fit and eliminates
the risk of a pump effect, delivering optimal longterm performance.
– Superior aesthetics: The tooth-coloured zirconia material closely resembles natural teeth, creating seamless
and lifelike restorations.
38
implants 2 2023
– Enhanced biocompatibility: Z-SYSTEMS’ zirconia
implants biocompatible material with excellent
tissue acceptance, ensuring healthy osseointegration and long-term success of the implant.
– Outstanding durability: Zirconia’s exceptional
strength and fracture resistance make Z-SYSTEMS’
implants as durable as it and suitable for a wide
range of clinical cases.
To celebrate the relaunch, Z-SYSTEMS will be hosting live
surgical training sessions and other educational courses
for dental professionals worldwide through the end of this
year and throughout 2024. The comprehensive training programme will equip practitioners with the necessary knowledge and skills to integrate Z-SYSTEMS’ ceramic implants
into their practice successfully. Z-SYSTEMS will kick off the
series of live surgical training courses hosted in Chicago,
Los Angeles, New York City and abroad, with their first training session in November 2024. Interested participants can
e-mail sales@zsystems.com for details.
Z-SYSTEMS AG
Switzerland
www.zsystems.com
[39] =>
manufacturer news
|
CaviTAU
Unknown cause of chronic diseases discovered!
Why do more and more people suffer
from chronic diseases? Is the cause
due to an undiagnosed disease? Is a
“silent inflammation of the jaw bone”
possibly responsible? Many questions,
one modern answer: the digital quality
determination of bone density through
ultrasound sonography-diagnosis. In
this way, the dentist localises chronic
and pathogenic inflammatory patterns,
cleanses them in “Jawbone detox
steps” and thus turns from a dentist
into a systemic-immunologically oriented and integrative oral medicine
specialist.
With the newest version of the english CaviTAU® application with LED gel pad and schematic representation of transalveolar sonography.
book Cavitational osteonecrosis in jawbone by Dr Johann Lechner, you will be guided in over 390 pages, with 120 illustrations and over 200 literature citations through all the
science behind ultrasound sonography-diagnosis. The book can be ordered online at the website www.icosim.de.
CaviTAU
+49 89 244154460 · www.cavitau.de
AD
Aesthetic.
Functional.
Safe.
SKY
Mistake and subject to change reserved
Experience our workshops
live at EAO/DGI:
Irrtum und Änderungen vorbehalten
ALVEO LINE
TISSUE LINE
Reshaping clinical
and scientific success
w h i t e
bredent medical GmbH & Co. KG · Weissenhorner Str. 2 · 89250 Senden · Germany · T: +49 7309 872-600 · F: +49 7309 872-635 · www.bredent-medical.com · @: info-medical@bredent.com
[40] =>
| manufacturer news
Dentalpoint
Zeramex XT—Two years follow-up proves success
of the two-piece system
Zirconia, the dental material of the future, the two-piece design of
the implant, the unique carbon fiber reinforced implant–abutment
connection, the conventional and digital workflow as well as the
outstanding clinical results are the pillars of success of the Swiss
ceramic implant system Zeramex XT.
The heart of the implant–abutment connection is the VICARBO
screw made of carbon re-inforced high-performance PEEK. The
principle: the implant made of zirconium dioxide absorbs the compressive forces, while the VICARBO screw counteracts tensile and
bending forces. The design of the external thread ensures high
primary stability and the microrough and hydrophilic Zerafil surface demonstrates convincing osseointegration with a success
rate of 98%.
“…Astounding bone structure after remodel revealing hard cortical bone with absolutely no bone loss from around the implant
(Zeramex XT 3.5 mm placed in the anterior region) … The gum
response was amazing…,” points out Dr. Joseph Sarkissian who
has been using Zeramex XT for several years.
Studies confirm that two-piece zirconia implants show a similar
bone integration compared to the titanium implants or demonstrate a significantly reduced inflammation and bone loss compared to the titanium implants.
Dentalpoint AG, Switzerland
www.zeramex.com
ZiBone
ZiBone zirconia medical device: revolutionising dental implants
for straight smiles
With our state-of-the-art products, we aim to equip dentists with
the tools they need to create beautiful, natural-looking smiles for
their patients. We will delve into the key features and benefits of
our products, and how they can enhance your practice and
patient outcomes.
ZiBone zirconia implants represent the
pinnacle of dental implant technology.
Crafted with precision and passion, our
implants boast superior biocompatibility, promoting seamless integration
with the jawbone. The aesthetic appeal
of zirconia perfectly complements the
natural dentition, creating a lifelike
appearance that leaves patients with
renewed confidence in their
smiles. ZiBone zirconia
implants are engineered to offer
outstanding mechanical properties, ensuring last-
40
implants 2 2023
ing durability and stability, setting new standards for implant
success rates.
– Biocompatibility: Zirconia’s biocompatibility reduces the risk of
allergic reactions and inflammation, fostering a healthy healing
process.
– Optimal osseointegration: The advanced design of ZiBone zirconia implants with Ra 0.6 μm surface treatment, facilitates reliable osseointegration, promoting stable and successful implant
placements.
– Versatility: Our products cater to a wide range of dental cases,
enabling you to provide personalised solutions for each patient’s
unique needs. Implant dimension 3.6/4.0/5.0 with different
length 8/10/11.5/13/14.5.
Join us in revolutionising dental implantology—together, we create smiles that inspire confidence!
COHO BIOMEDICAL TECHNOLOGY CO., LTD.
Taiwan
+886 3311 2203
info@zibone.com
www.zibone.com
[41] =>
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Read the following topics
in our latest issue:
2/23
issn 1868-3207 Sondernummer • Vol. 7 • Issue 2/2023
ceramic
case report
Integrative oral medicine
meets aesthetic dentistry:
Mission possible
implants
international magazine of ceramic implant technology
interview
Advocating for the superiority of
ceramic systems
events
Discover the EAO annual scientific
meeting in Berlin
3/23
issn 1868-3207 • Vol. 24 • Issue 3/2023
implants
international magazine of oral implantology
case report
Integrative oral medicine
meets aesthetic dentistry:
Mission possible
interview
Advocating for the superiority
of ceramic systems
case report
events
research
Non-invasive measurement
of the height and thickness
of the peri-implant soft tissue
Discover the EAO annual
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Immune sustainability
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interview
Digital dentistry—
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[42] =>
| about the publisher
Congresses, courses
and symposia
6–7 October 2023
Hamburg, Germany
dgzi-jahreskongress.de/en
3rd JOINT CONGRESS for
CERAMIC IMPLANTOLOGY
13–14 October 2023
Kreuzlingen, Switzerland
joint-congress.com
ITI World Symposium
2024
9–11 May 2024
Singapore
worldsymposium.iti.org
42
implants 2 2023
© vongomthenen – stock.adobe.com
52nd International Annual
Meeting of DGZI
© Pyc Assaut – stock.adobe.com
28–30 September 2023
Berlin, Germany
congress.eao.org
© andreykr – stock.adobe.com
30th EAO annual scientific
meeting | 37th DGI annual
congress
© REMINDFILMS – stock.adobe.com
Imprint
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Copyright Regulations
ceramic implants international magazine of ceramic implant technology is issued three times
a year and is a special edition of implants international magazine of oral implantology — the
first issue was published in October 2017. The magazine and all articles and illustrations therein are
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legal venue is Leipzig, Germany.
[43] =>
Being Natural
Being Beautiful
IMPLANT
SYSTEM
www.zibone.com
[44] =>
The ONLY two-piece zirconia
implant with long-term studies
Independent 9-year study (University of Düsseldorf)1
Only we achieve this
• No peri-implantitis1
• No implant fractures1
• Predictable osseointegration2
(Over 70% BIC after 4 weeks)
1
Brunello G, Rauch N, Becker K, Hakimi AR, Schwarz F, Becker J. Two-piece zirconia implants in the
posterior mandible and maxilla: A cohort study with a follow-up period of 9 years. Clin Oral Implants
Res. 2022 Dec;33(12):1233-1244. doi: 10.1111/clr.14005. Epub 2022 Oct 31. PMID: 36184914.
2 Glauser, R., Schupbach, P. Early bone formation around immediately placed two-piece tissue-level
zirconia implants with a modified surface: an experimental study in the miniature pig mandible.
Int J Implant Dent 8, 37 (2022). https://doi.org/10.1186/s40729-022-00437-z
The New Standard
Long-term oral health: Patent™ redefines
success in the first long-term study
on two-piece zirconia implants. Learn more:
www.mypatent.com/scientific-studies
MDR
CERTIFIED
Zircon Medical Management AG | Switzerland | +41 44 552 84 54
9
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[page] => 28
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/ Restoring anterior aesthetics with two-piece zirconia implants
/ Stability ensured - Advancing implant dentistry with Z-SYSTEMS bone level ceramic implants
/ CleanImplant Foundation Trusted Quality seal: More manufacturers prove the production quality of their implant systems
/ Advocating for the superiority of ceramic systems
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