implants international No. 2, 2024
Cover
/ Editorial
/ Content
/ Laser-assisted protocol for the treatment of peri-implantitis: A long-term retrospective case series
/ Full-arch: Full rehabilitation of the upper jaw—Part 2
/ Straumann Pro Arch with BLT implants in a periodontal patient with hopeless dentition: A five-year follow-up
/ An interview with Prof. Arjan Vissink on the current state of big data in implant dentistry: Big data in implant dentistry— “We are standing at the beginning”
/ Industry
/ Events
/ Manufacturer news
/ Statement on the decision of the Berlin Regional Court regarding two-piece ceramic implants
/ Imprint
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[1] =>
issn 1868-3207 • Vol. 25 • Issue 2/2024
implants
2/24
© gfx_nazim – stock.adobe.com
international magazine of oral implantology
research
Laser-assisted
protocol for the
treatment of
peri-implantitis
case report
BLT implants in a periodontal
patient with hopeless dentition
interview
Big data in implant dentistry
[2] =>
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[3] =>
editorial
|
Dr Georg Bach
President of the DGZI
Before the court
and on the high
seas...
Dear colleagues!
“Before the court and on the high seas, you are in God’s
hands,” goes the oft-quoted adage. A recent verdict by
the Berlin Regional Court underscores the profound resonance of this proverb. Despite the assertions of the
court-appointed expert to the contrary, the ruling discounted the medical necessity of two-part ceramic implants due to purported lack of evidence. The remarkable
aspect lies not merely in the court’s dismissal of expert
testimony but in the consequential denial of reimbursement by various insurance companies for procedures involving two-part ceramic implants, citing this ruling.
The ensuing discourse has illuminated a persistent reality: ceramic implants remain a contentious topic in contemporary implantology, even years after their introduction. It falls upon each of us, esteemed colleagues, to
discern our stance on ceramic implants, be they onepiece or two-piece, and draw informed conclusions. However, one incontrovertible truth emerges: such a verdict
demands a response.
As the representative of the Implantology Consensus
Conference, the DGZI (German Association of Dental
Implantology) brought this issue to the forefront during
the latest meeting, known internally as the “KK”. The KK
issued a succinct yet cogent statement in response. Yet,
under the auspices of DGZI’s leadership, a cadre of experts convened to craft a comprehensive analysis and
further statement. I urge you to turn to pages 40 and 41
of this edition of implants for a detailed exposition. Rest
assured, DGZI remains vigilant in monitoring developments on this front and will keep you apprised accordingly.
In this vein, I extend my warm regards and encourage you
to delve into this issue of implants with zeal.
Yours sincerely
Dr Georg Bach
President of the German Association of
Dental Implantology
Dr Georg Bach
2 2024
03
[4] =>
| content
editorial
Before the court and on the high seas...
03
Dr Georg Bach
research
page 6
Laser-assisted protocol for the treatment of peri-implantitis:
A long-term retrospective case series
06
Drs Gary M. Schwartz, David M. Harris & Gregori M. Kurtzman
case report
Full-arch: Full rehabilitation of the upper jaw—Part 2
16
Dr Dr Michael Rak, Norbert Wichnalek, Arbnor Saraci &
Lukas Wichnalek
page 16
Straumann Pro Arch with BLT implants in a periodontal patient
with hopeless dentition: A five-year follow-up
24
Dr Amin Motamedi
30 years OEMUS MEDIA
31
interview
Big data in implant dentistry
32
An interview with Prof. Arjan Vissink
page 24
industry
Commitment to safety
34
Insights in modern dentistry
36
events
Patient-customised concepts: “Implantology 4.0”
in Düsseldorf this November
37
Long-awaited Digital Dentistry Show to premiere
in Berlin in June 2024
38
news
Cover image courtesy of Nobel Biocare,
www.nobelbiocare.com
issn 1868-3207 • Vol. 25 • Issue 2/2024
implants
2/24
© gfx_nazim – stock.adobe.com
international magazine of oral implantology
research
Laser-assisted
protocol for the
treatment of
peri-implantitis
case report
BLT implants in a periodontal
patient with hopeless dentition
interview
Big data in implant dentistry
04
2 2024
manufacturer news
39
Statement on the decision of the Berlin Regional Court regarding
two-piece ceramic implants
40
about the publisher
imprint
42
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| research
Laser-assisted protocol for the
treatment of peri-implantitis:
A long-term retrospective
case series
Drs Gary M. Schwarz, David M. Harris & Gregori M. Kurtzman, USA
Pulsed Nd:YAG dental lasers are surgical tools used to
obtain specific surgical objectives as defined in the LANAP
(laser-assisted new attachment procedure) for periodontitis and the LAPIP (laser-assisted peri-implantitis procedure) for peri-implantitis. The LANAP using the PerioLase
Nd:YAG laser (Millennium Dental Technologies) was introduced in 1998 as Laser ENAP,1 and in 2004, the LANAP
gained US Food and Drug Administration 510(k) clearance (No. K030290) for the claim “laser-assisted new attachment procedure (cementum-mediated periodontal
ligament new attachment to the root surface in the absence of long junctional epithelium)”. Subsequently, human histology studies2, 3 established that the LANAP resulted in “periodontal regeneration—true regeneration of
the attachment apparatus (new cementum, new periodontal ligament, and new alveolar bone) on a previously diseased root surface” (2016 510[k] clearance No. K151763).
of the clinical outcomes and a quantitative description of
changes in radiographic density two to five years after
undergoing a LAPIP in a private practice setting.
Dr Schwarz completed training in the LAPIP in September 2013. A retrospective analysis of the 222 sequential
patients with 437 failing dental implants that were treated
during the following three years was performed.7 That study
was focused on the short-term efficacy of the LAPIP. A statistically significant reduction of clinical signs of erythema,
bleeding and suppuration and reduced probing depth
(PD) at the first follow-up visit (median period: 7.6 months;
P < 0.001) was noted. The survival rate, the percentage
of intact implants, was 94% over the longest follow-up
period (median: 13.1 months) among those in the analysis.
The LAPIP emerged from the LANAP as a stand-alone
procedure.4–7 The indication for the LANAP is moderate
to advanced periodontitis, whereas the LAPIP is indicated for peri-implantitis treatment. The basic steps in the
two protocols are the same and have adjustments for the
whole mouth versus a single site, the responses to irradiation of root cementum versus implant titanium, and differences in surgical objectives.
A recent review of published studies of peri-implantitis laser
treatment concluded that laser treatment enhances bone
growth, but a quantitative analysis of bone-level changes
is limited.9 The authors called for greater relevance and
translation of the research findings to the clinician. This
report addresses those concerns with a detailed analysis
Fig. 1: Proportion of dental implants in each clinical treatment outcome category.
i Periodontitis: “Inflammation of the periodontal tissues resulting in clinical attachment loss, alveolar bone loss, and periodontal pocketing.”8
ii Peri-implantitis: “An inflammatory process around an implant which includes both soft-tissue inflammation and loss of supporting bone.”8 Clinical signs
include inflammation, bleeding on probing and suppuration. It progresses from peri-implant mucositis, which is confined to the soft tissue, to include PD > 4 mm
and evidence of bone loss. Peri-implantitis often leads to progressive loss of osseointegration and eventual loss of the implant.
06
2 2024
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| research
Long-term clinical and radiographic data are presented
from the same group of 222 patients. There was a continuum of responses, including long-term successes, partial responses with intact implants and implants lost after
two years of maintenance with multiple treatments, as
well as cases of successful treatments that relapsed after
one to two years. Analysis of radiographic data from a
sample of successfully treated implants provided a time
course for bone regeneration.
original analysis. Case report forms of additional followup visits were collected, uploaded and added to the original data set. This resulted in 155 patients with 299 implants who had sufficient baseline and follow-up data to
determine implant survival and clinical outcomes.
Methods
Collection and analysis were performed of retrospective
data, wherein patient records were sorted to find all patients in the practice who had undergone LAPIP treatment within the 37-month interval from the first treatment
(October 2013) until the date of institutional review board
approval (October 2016). A private institutional review
board (Quorum Review) granted a waiver of informed
consent and approved the retrospective data collection
and analysis protocol. Later, the institutional review board
approved the retrospective analysis of the long-term
follow-up data that is included in this report. The original
study was conducted according to standards established by the Declaration of Helsinki and Good Clinical
Laboratory Practice Guidelines. Research standards established in the original study were maintained in the current study.
The purpose of the original study was a precise statistical
analysis of the initial clinical outcome of a single treatment, seeking to determine whether there was improvement or a lack of improvement at the first follow-up visit.
A review was conducted of patients who received the
treatment in the three years after the LAPIP training. All
patients were included to eliminate selection bias. A staff
member went through the medical records of each LAPIP
patient and copied data into case report forms. Any identifying information was excluded, and the case report
forms were sent electronically to the statistician for data
entry and analysis. Data captured included laser settings,
demographics, medical history, implant information, adverse events, PD (mm; for six pockets) and the presence
of clinical signs (bleeding, erythema and/or suppuration).
Panoramic and/or periapical radiographs were available
for analysis. The statistician excluded patients with missing data from the various analyses. The original group
included 222 patients with 437 implants. That study
enrolment closed in October 2016. Exclusion of patients with incomplete data resulted in 116 patients with
224 implants available for analysis, including 47% men
and 53% women with a mean age of 65.8 years (range:
23–98 years).
Two years later (September 2018), a second look at the
original group of patients was performed. Several patients had follow-up visits beyond the closing date of the
08
2 2024
Fig. 2: Example of a successful treatment (Case 1), showing changes in radiographic defect (mm2), probing depth (PD; mm) and clinical signs from baseline to 30 months later. Violet = cross-sectional area; MB = mesiobuccal PD;
B = buccal PD; DB = distobuccal PD; ML = mesiolingual PD; L = lingual PD;
DL = distolingual PD; R = redness; B = bleeding; P = suppuration; Tx1 = first
treatment.
Laser dosimetry
The dental laser was a 6 W pulsed Nd:YAG laser (PerioLase MVP-7, Millennium Dental Technology) utilising an
optical fibre that delivered high-energy pulses of light to
the tissue. For the LAPIP, the fibre tip is inserted into the
periodontal pocket. Parameters that are set on the control panel are energy per pulse up to 300 mJ; pulse duration, variable from 100 to 650 µs; and pulse repetition
rate from 10 to 100 Hz. The duration of exposure is controlled with a foot switch.
The LAPIP details have been published elsewhere4–7 and
are only summarised as follows for the protocol specifying surgical end points. Achieving those end points is
what determines the dosimetry. In Step 2 of the protocol,
the distal fibre tip is inserted into the periodontal pocket
and passed around the implant several times to initially
open the sulcus and then to remove the diseased pocket
epithelium and disinfect the tissue, constituting Pass 1
with the laser.10 In Step 4 of the protocol, the fibre tip is
inserted into the pooled blood within the sulcus and again
passed around the implant, heating and congealing the
blood and forming a fibrin clot, constituting Pass 2 with
the laser.11
Hence, real-time dosimetry is based on these clinical
conditions. With a constant laser power (output), the time
spent lasing within the sulcus determines the total energy
delivered. In other words, a prescribed laser dose does
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| research
software (ImageJ, National Institutes of Health freeware).
As the dimensions of the implant were known, the areas
were calibrated in square millimetres so that comparisons could be made over time and across cases. The
sum of the defect areas on both sides of the implant is
referred to as the cross-sectional area. Cross-sectional
areas at follow-up visits of successful cases were converted to baseline percentage to estimate the time course
of bone regeneration.
Results
Fig. 3: Example of a partial response to treatment (Case 2), showing changes
in radiographic defect (mm2), probing depth (PD; mm) and clinical signs from
baseline to 33 months later. Violet = cross-sectional area; MB = mesiobuccal PD;
B = buccal PD; DB = distobuccal PD; ML = mesiolingual PD; L = lingual PD;
DL = distolingual PD; R = redness; B = bleeding; P = suppuration; Tx1 = first
treatment; Tx2 = second treatment.
not determine the treatment end point; rather, achieving
the surgical end point determines the total joules. The
surgeon understands that clinical conditions determine
the precise laser parameters and the total energy delivered. However, exceeding the recommended dosimetry
increases the risk of possible adverse effects.
The hard copy printout of the laser dose for Pass 1 and
Pass 2 was available for 138 implants, and the mean total
energy per implant was 285.8 J. This was divided between the two laser steps. Pass 1 mean total energy was
181.8 J, and Pass 2 mean total energy was 104.0 J.
Energy was delivered according to the following formulas, and sizable case-to-case variance was required to
achieve the surgical end points:
· Pass 1 total joules delivered = 130 + (10 × aPD)
· Pass 2 total joules delivered = 85 + (4 × aPD)
The clinical outcome categories were defined as follows
(Fig. 1):
· Long-term success: return to healthy PD and an absence of clinical signs
· Short-term success: patients with successful outcomes
but without follow-up data beyond 12 months
· Partial response: failure to meet success criteria but
the implant was still intact and stable
· Relapse: initial success and then return of clinical signs
· Failed: implant lost or removed.
The long-term responses to treatment can thus be divided
into four general outcomes: successful response (Group 1),
partial response (Group 2), spontaneous relapse (Group 3)
and lost implant (Group 4). Summary statistics for each
of the four groups are presented in this section, followed
by one case from each group.
Group 1: Successful response
This was the most common response, 204 implants (68%)
meeting the success criteria of post-treatment PD ≤ 4 mm
and no clinical signs at follow-up visits. Most implants in
These two formulas are not a prescription; they merely
define the dosimetry used in this study. On average, Pass 1
required an initial 130 J for all implants, and Pass 2 required an initial 85 J. The formula specifies that the total
joules per pass is related to the average probing depth
(aPD; the average of six PD measurements). Consequently, to estimate the total energy, add ten times the
aPD in joules to the initial values for Pass 1 and four times
the aPD for Pass 2.
Radiographic analysis
Film radiographs were scanned and digitised and then
the digital radiographs were rotated, cropped and resized. Brightness and contrast were not adjusted. Images were arranged in chronological order to illustrate the
sequential changes in radiographic density for each case.
A technician skilled at reading dental radiographs outlined the radiographic defect and areas of change in subsequent images. The cross-sectional area of the defect
within the outlines was measured using public domain
10
2 2024
Fig. 4: Example of a successful single treatment that was without clinical
signs for over two years, and then the implant presented with signs of reinfection (Case 3), showing changes in radiographic defect (mm2), probing
depth (PD; mm) and clinical signs from baseline to 32 months later. Violet =
cross-sectional area; MB = mesiobuccal PD; B = buccal PD; DB = distobuccal PD; ML = mesiolingual PD; L = lingual PD; DL = distolingual PD; R =
redness; B = bleeding; P = suppuration; Tx1 = first treatment.
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this group (91%) achieved success after a single treatment. Others (7%) demonstrated a partial response and
then success after a second treatment, and 2% achieved
success after three treatments. The median follow-up
period in this group was 18.8 months, and one implant
was still successful at 63 months. At the time of the latest
analysis, 48% of all implants still showed long-term success
(12–63 months). The remaining 20% of successfully treated
implants had follow-up periods of less than 12 months,
so their long-term outcomes could not be determined.
Most of these patients did not return for their scheduled
hygiene visits.
Case 1 is an example from the group of successful treatments (Fig. 2). The patient was an 87-year-old man with
a cardiovascular condition and had implants in positions
#32 and 42 that supported a mandibular overdenture. He
presented with deep pockets (PD = 5.7 mm) accompanied by a large defect around implant #42. This had led
to acute symptoms, including pain, erythema, bleeding,
suppuration and swelling of the vestibule. At the pretreatment visit, the labial plate was mostly absent along the
buccal aspect of the implant becoming exposed. At six
months post-treatment, the clinical signs had resolved,
the PD had reduced to 3.8 mm and the area of radiolucency had reduced too. At 30 months, the PD was 2.8 mm,
and there was a complete absence of clinical signs.
Group 2: Partial response
Partial responders are implants that improved but still
showed some clinical signs, had a PD > 4 mm and never
achieved the success criteria. There were 47 implants
(16%) in this category. Most were treated a second time
at six or 12 months after the first treatment, and several
received a third treatment. They continued to exhibit clinical signs and had a PD > 4 mm. The median follow-up
period in this group was 22 months.
Case 2 is an example of a partial response to treatment
(Fig. 3). The patient was a 58-year-old man with Type 2
diabetes, hypertension and hyperlipidaemia and had had
an implant (Nobel Biocare Tapered) placed in position #46
in July 2014. The patient presented in December 2014 with
a PD of 9 mm around the implant, bleeding and suppuration and was treated with the LAPIP. At four months, there
was no bleeding, but the PD was still 9 mm, and a second
treatment was performed. At 15 months, the clinical signs
had improved, and PD was reduced to an aPD of 4.2 mm.
At 33 months, the implant was still intact; however, the PD
had increased to 5.3 mm, and there was some bleeding
on probing. The PD and clinical signs at follow-up visits did
not allow this implant to reach the success criteria. Even
though bone regeneration is unlikely with a defect this wide,
the PD and clinical signs improved and remained improved
for almost three years after the first LAPIP treatment, and the
implant remained in function at the time of last follow-up.
Group 3: Spontaneous relapse
There were 32 implants (11%) with initially successful outcomes that demonstrated relapse with the return of inflammatory markers along with deeper PD. The medium
time to relapse was 24 months (range: 11–43 months).
Case 3 is an example of a successful single treatment
that was without clinical signs for over two years and then
presented with signs of reinfection (Fig. 4). The 59-yearold female patient had had an implant (Nobel Biocare Tapered; 3.5 × 16.0 mm) immediately placed in position #11.
She had no risk factors for peri-implantitis, but four months
later, at her first follow-up visit, the implant showed signs
of redness and bleeding from 4 mm pockets. Subgingival
cement was noted on the periapical radiographs and
was removed. The first LAPIP treatment was performed
in September 2015. At follow-up visits at nine, 15 and
27 months after the first treatment, all inflammatory markers were absent, and the PD showed progressive improvement, good bone fill being noted in the periapical radiographs. The apical radiolucency was absent, but a new
defect had appeared coronally at 27 months. At 32 months,
she showed significant relapse with redness and bleeding from pockets that had deepened beyond the pretreatment levels. Radiography revealed that the new defect
had enlarged. The implant was subsequently retreated.
Group 4: Lost or removed implants
Fig. 5: Example of a lost implant (Case 4), showing changes in radiographic
defect (mm2), probing depth (PD; mm) and clinical signs from baseline to
30 months later. Violet = cross-sectional area; MB = mesiobuccal PD; B =
buccal PD; DB = distobuccal PD; ML = mesiolingual PD; L = lingual PD;
DL = distolingual PD; R = redness; B = bleeding; P = suppuration; Tx1 = first
treatment; Tx2 = second treatment; Tx3 = third treatment.
12
2 2024
There were 16 implants (5%) that failed during the followup period. The median time to failure after the initial LAPIP
treatment was five months (range: one week to 31 months).
Four implants were lost within the first month, six more by
the first follow-up visit (five months), two at nine months,
one at 18 months and three after two years of maintenance. One of the last was healthy but ordered extracted
by the patient’s physician.
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[14] =>
| research
sponse) and seven were from Group 1 (successful cases).
The cross-sectional areas of the seven successful cases
were converted to a percentage of the baseline areas,
and those values were plotted at their respective followup times (Fig. 6). The data fitted well to a decaying exponential function, y=e –0.1x, which suggested that regeneration approached 98% by 36 months.
Discussion
Fig. 6: Change in cross-sectional area of the defect as a percentage of the
The LAPIP utilises the advantages of laser sulcular debridement (e.g. selective tissue removal, bacterial reduction, haemostasis, minimally invasive method) and embeds the laser components into a medically sound
protocol that also includes implant debridement, occlusal
adjustment, and detailed pretreatment and post-treatment
procedures. Because of these additional therapeutic
measures, the outcomes reported here may not be directly comparable with those of many controlled laser
studies.
baseline area for seven implants from Group 1. Black circles = success.
Case 4 is among the lost implant cases (Fig. 5). The patient was an 81-year-old immunocompromised man with
several medical conditions, including cardiovascular disease and a drug-resistant systemic infection. An implant
(Nobel Biocare Tapered; 5 × 13 mm) had been placed in
position #46, and he was seen six months later with an
aPD of 6.8 mm, bleeding at four sites, erythema and radiographic evidence of bone loss. At the five-month followup visit, bleeding had resolved, and the aPD was reduced
to 5.5 mm, but there was still redness and suppuration.
By the 18-month visit, the condition had deteriorated. The
aPD had increased to 8 mm, and there was bleeding and
suppuration. At that time, the patient received a second
LAPIP treatment. At 30 months, one PD was 11 mm and
the rest were 12 mm, and there was an increase in the radiographic size of the defect. A third treatment was performed, and the laser dose was increased to 305 J at
Pass 1 and 180 J at Pass 2 for that treatment. However,
the implant was finally removed 31 months after the first
treatment.
Change in radiographic density
Radiographs from all 299 implants were reviewed to
identify interproximal vertical defects at baseline indicating bone loss. Many patients had panoramic radiographs
of low resolution, and most bone loss was restricted to
the buccal plate, which is not visible in transmission (periapical and panoramic) radiography. Only 21 cases were
identified, and of these, ten provided measurable baseline and follow-up radiographs. Radiographic data reflected a similar proportion of outcomes to the PD and
clinical sign data. Out of the ten cases, one was from
Group 3 (lost implant), two were from Group 2 (partial re-
14
2 2024
PD and clinical signs were analysed. Analysis of the
short-term data from 116 patients with complete baseline
and follow-up data determined that there was a statistically significant reduction in PD and clinical signs at the
first follow-up visit (median: 7.6 months) after a single
treatment. The aPD was reduced by 2.0 mm (5.4 mm
reduced to 3.4 mm, P < 0.001), and clinical signs of
erythema, bleeding and suppuration were reduced by
78–85% (P < 0.001). A recent prospective controlled trial
of ten patients who were treated with the LAPIP found
similar results: a 1.9 mm PD reduction and decreased
bleeding and suppuration.12
Several patients had follow-up visits after the short-term
study had concluded. By the time of this long-term analysis, there were 155 patients with 299 implants available
to determine long-term survival and response to therapy.
The initial survival rate was 94% at 13.1 months (15 were
lost out of the 264 implants). The long-term survival rate
matched and surpassed the previous results, being 95%
at 28.8 months (16 of the 299 implants were lost). In the
long term, PD remained ≤ 4 mm, and clinical signs remained absent for 68% of the 299 implants. An additional
11% were initially successful, but then presented with a
relapse at about two years post-treatment. Sixteen per
cent of the 299 implants never achieved success but remained intact at 22 months.
The clinical healing curve indicated by the average rate of
increase in radiographic density for successful cases
demonstrated that, on average, bone fill is expected to be
25% complete by three months, 70% complete at one
year, 90% complete by two years and 98% complete after three years. It is important to note that this study only
sampled interproximal defects, and the analysis may thus
not accurately reflect changes to labial bone.
[15] =>
AD
Conclusion
One of the greatest challenges has been fighting a losing battle against peri-implantitis.
The impact of the LAPIP on treatment of peri-implantitis has been significant. Using
other methods over 30 years of practice in the case of Dr Schwarz, achieving bone
fill and eliminating all signs of inflammation have been challenging. These results
describe the final stage of translation of an experimental protocol into clinical practice. An attempt to present an unbiased analysis of the real-world clinical outcomes,
successful or not, has been accomplished. The results demonstrated would be typical for any clinician who has been properly trained and follows the protocol. Even
a partial responder is a clinical success if the implant remains improved. Periodic
retreatment of the partial responders and the relapses is a way to extend the time
of functionality for the patient. The results of this study indicate that the LAPIP offers a minimally invasive, repeatable way to regenerate bone and eliminate clinical
signs of disease in most patients and to effectively manage the more difficult cases.
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Acknowledgements
We would like to thank Veronica Serna, Jennie Richie, Molly Tuttle and Ray Guajardo for technical assistance and acknowledge Burkart Associates, which assisted
with statistical analyses. We appreciate the review by and suggestions of John
Sulewski, Ray Yukna, Jon Suzuki and Dawn Gregg.
Editorial note: This article was first published in Dental Tribune UK & Ireland, Vol. 14, Issue 1/2024.
Submission
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Dr Gary M. Schwarz works in private practice at Valley Oral & Maxillofacial Surgery in McAllen in Texas in the USA.
also your portrait photo with
a short biography about your
professional career and your
Dr David M. Harris works at the Department of Periodontics of Rutgers
School of Dental Medicine in Newark in New Jersey in the USA.
contact information.
Dr Gregori M. Kurtzman works in private practice in Silver Spring in
Maryland in the USA.
Dr Alina Ion
Editorial Manager
contact
Literature
Dr Gregori M. Kurtzman
3801 International Dr Ste 102
Silver Spring, MD 20906, USA
drimplants@aol.com
www.maryland-implants.com
Dr Gregori M. Kurtzman
a.ion@oemus-media.de
+49 341 48474-141
OEMUS MEDIA AG
Holbeinstraße 29 · 04229 Leipzig · Germany
Phone: +49 341 48474-0 · info@oemus-media.de
[16] =>
| case report
Full-arch: Full rehabilitation
of the upper jaw—Part 2
Literature
Dr Dr Michael Rak, Norbert Wichnalek, Arbnor Saraci & Lukas Wichnalek, Germany
The complete rehabilitation of a compromised residual
dentition represents a major challenge in terms of implant
treatment as well as function and aesthetics. In particular,
there is great demand for fixed restorations that both
achieve aesthetics and restore function. In addition, patients are increasingly interested in biocompatible restorations and surgical concepts that take biological criteria
into account. Biological dentistry employing metal-free
implants and zirconia dentures can meet this demand effectively. In the first part of this case report, we dealt with
the diagnosis of the patient and the case’s special features, the preparation of the patient for surgery and the
surgical procedures of tooth extraction and immediate
implant placement.1 In this second part, the prosthetic
restoration will be described.
From Part 1, recall that the 41-year-old patient wanted a
biologically neutral and metal-free comprehensive rehabilitation of his compromised residual maxillary dentition
and caries treatment of his mandibular teeth. In the maxilla, the patient retained tooth #17 and part of tooth #25,
as well as the roots of teeth #13 and 15, and had a bridge
replacing teeth #12 to 22. The remaining maxillary dentition had already undergone endodontic treatment and
was not worth preserving. In the mandible, teeth #47, 45,
36 and 37 had carious lesions, and tooth #46 was devitalised and decayed and showed extensive apical whitening radiographically. The remaining mandibular teeth were
vital. Moderate chronic periodontitis was diagnosed in
both the maxilla and mandible.
1
2
Prosthetic restoration
The success of restoration is highly dependent on careful planning, requiring the exchange of information between the dentist, patient and dental technician. Planning
revolves around the following questions: What are the
patient’s expectations? What is realistic and technically
feasible? It is extremely important to involve the patient
in the entire decision-making process; after all, it is the
patient who will have to live with the finished work. Once
all the important matters have been clarified, we first fabricate the planned prothesis as a prototype (temporary
restoration) and then have everything checked in the
mouth.
16
2 2024
3
Fig. 1: Prototype in situ after about three months of healing. Fig. 2: Completely irritation-free gingiva with beautifully healed implants after about three
months of healing. Fig. 3: Silicone impression of the situation with the temporary restoration removed.
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[18] =>
| case report
part of this article. Practice has shown us time and again
that, despite immense technical, instrumental and computerassisted effort, there is always a discrepancy between
the appliance and the biomechanical system of hard and
soft tissue. The true measure is in the patient’s mouth,
not in the precise, mathematically calculated condylar
paths and eccentric excursions of a virtual articulator.
4
Fig. 4: After replacement of the temporary restoration on the implants.
Our focus is always on the whole person. Therefore, the
patient’s posture and, most importantly, his or her comfortable occlusion are central role to our approach. Particularly with such a compromised residual maxillary dentition, it is important to consider that the patient may have
adapted to an incorrect occlusion over the years. We
therefore check posture to determine whether we need
to intervene therapeutically in advance with the help of
splint therapy. We then discuss the patient’s wishes and
select the desired tooth shape together.
Based on all this information, we create a prototype in our
laboratory that corresponds to the final restoration in
terms of shape and design. The prototype in this case
was made of acrylic based on the intra-oral scan of the
patient with and without his existing bridge and a conventional fully adjustable articulator. From this data, we first
generated a virtual wax-up, from which we also prepared
the various surgical aids—the surgical guide and various
transparent verification templates—as shown in the first
5
An occlusal restoration is always a compromise. Occlusion is not something that can be measured. Occlusion
is something individual. Even at the beginning of articulation research, dental technology greats such as Dr Alfred
Gysi, Rudolph L. Hanau and Dr Rudolf Thielemann recognised that a biological system cannot be implemented
on a mechanically and mathematically precise mastication simulator. Carl Hildebrand, the founder of VITA Zahnfabrik, said in the 1930s: “Occlusion cannot be understood from observation of the morphology of individual
teeth but rather from the living structure (cybernetics) of
the entire organism.”2 Following this guiding principle, we
use our patient as the best articulator a dental technician
could wish for. During the osseointegration of the implants, the prototype serves to record the eccentric
movements manifesting in patient-specific wear facets,
which we can then transfer directly to the final restoration. The dental practice scans the prototype in situ
when the patient visits the practice for a check-up and
follow-up care and sends the data obtained in this way to
the laboratory for transfer of the wear facets directly to the
final restoration.
Follow-up appointment in the practice
The patient came back to the practice after a healing period of around three months. After scanning the prototype,
6
7
Fig. 5: Plaster model created based on the silicone impression. Fig. 6: Digitised model. Fig. 7: Design of the three bridges.
18
2 2024
[19] =>
case report
8
9
10
11
|
Fig. 8: Three milled bridges prior to processing. Fig. 9: Impressive aesthetics of the zirconia after the first firing. Fig. 10: Bridges after the final glaze firing and
polishing. Fig. 11: Bridges on the model after the final glaze firing and polishing.
we removed it and found a completely irritation-free gingiva
underneath with beautifully healed implants (Figs. 1 & 2).
We then took an impression of this situation using silicone
and then replaced the temporary restoration on the implants (Figs. 3 & 4). We thereafter submitted the scan and
silicone impression to the laboratory for completion of the
final restoration.
It used to be assumed that the skull was a kind of bony
steel helmet that only served to protect the underlying
brain. Today, we know that the bony structures of the skull
are a vibratory element within the organism. The skull is
made up of a very complex structure of cranial bones
which form a 3D interlocking mechanism. Each cranial
bone can move along all three planes, allowing movement in six directions (anterior to posterior, superior to inferior, medial to lateral). The cranial bones as a whole oscillate in a kind of breathing motion referred to as “cranial
respiration”. They move rhythmically, alternating between
shortening, expanding, lengthening and narrowing over a
period, without the volume of the skull changing quantitatively. Not only can this rhythm of movement be pathologically altered, that is, increased or decreased, but individual cranial bones can also become stuck or displaced
in such a way that their mobility and thus that of the entire
system is restricted.3
12
13
Principle of cranial respiration
Figs. 12 & 13: Situation before placement of the final restorations.
2 2024
19
[20] =>
| case report
Fabrication of the final maxillary restoration
We regard zirconia as a material with the greatest possible benefit for the patient. Compared with conventional
titanium implants, zirconia offers several advantages.
One of the main advantages of implants made of zirconia
is their excellent biocompatibility. Zirconia is considered
hypoallergenic, making it an ideal choice for patients with
metal sensitivity or allergies. Unlike titanium, zirconia does
not trigger any adverse reactions in the body, ensuring a
comfortable and stress-free dental implant experience. In
addition, zirconia implants have remarkable resistance to
corrosion and plaque build-up, reducing the risk of periimplantitis. The non-porous surface of zirconia prevents
the adhesion of bacteria, resulting in healthier gingivae
and greater longevity of the implant.4 In order to avoid
compromising the advantages of the zirconia implants
placed, the dental team jointly decided on zirconia for the
prosthetic restoration as well. Therefore, after receiving
the data from the practice, we fabricated the final restorations in zirconia. Our laboratory has preferred monolithic restorations since 2005.
The restoration was constructed as three bridges. This
approach takes into account cranial respiration, ensuring
that no pressure is exerted on the delicate masticatory
and cranial bone system. Based on the silicone impres-
After the first firing, the advantages of the zirconia chosen
(VITA YZ ST, VITA Zahnfabrik) were already evident from
the impressive aesthetics (Fig. 9). The shade characterisation of the bridges was then carried out using the VITA
AKZENT Plus stains. For even better aesthetics, additional individualisation was carried out with the VITA YZ
EFFECT LIQUID infiltration shades. After the final glaze
firing, we polished the aesthetically important areas and
all the areas that would be in contact with the gingiva to
a high gloss like we usually do (Figs. 10 & 11). In our opinion, this creates a restoration that is supportive of gingival
health, having the advantage of what is described in bionics as the lotus effect, which refers to the low wettability of a surface, as can be observed on the lotus plant.
Water gathers on the leaves in spherical droplets or slides
off the leaves, taking all dirt particles on the surface with
it.5 In principle, this surface not only improves aesthetics,
but also reduces plaque adhesion to the restoration, promotes long-term stability and reduces abrasion on the
14
15
16
17
Figs. 14–17: Final restorations in place.
20
sion, we produced a plaster model according to the usual
procedure (Fig. 5). We scanned this and digitally designed the desired bridges (Figs. 6 & 7). In our approach,
we always design all basal surfaces that rest on the gingiva to be fully sealed from the outset. We then sent the
data collected in this way to our milling centre, which sent
us the three unprocessed milled bridges (Fig. 8).
2 2024
[21] =>
case report
18
19
20
21
|
Figs. 18–21: Harmonious integration of the restorations into the oral and facial situation and pleasing aesthetics of the anterior teeth.
(natural) antagonist.6 Our procedure enables us to avoid
any cleaning niches. We regard this as a significant advantage, as constant interdental cleaning often irritates
the gingiva unnecessarily and poses a risk of recession.
Finally, the restorations were disinfected and packaged
according to the standard plasma cleaning protocol we
follow (Highfield Clean Prosthetics)7 and handed over to
the practice for the placement appointment.
Placement appointment
Once the final restorations have been received from the
laboratory, the bridges were placed on the implants and
22a
22b
firmly cemented in, and the fit was visually checked
(Figs. 12–17). It was gratifying to see how harmoniously
the restorations integrated into the patient’s mouth and
face, and the optimised aesthetics of the anterior teeth
were particularly notable (Figs. 18–23). Finally, the situation was checked radiographically (Fig. 24).
The patient had been delighted with the appearance of
his temporary restoration. Because we had transferred
his individual masticatory behaviour from the temporary
restoration directly to the final restoration, the final zirconia restorations blended harmoniously into the overall
oral structure and did not feel foreign to the patient.
22c
Figs. 22a–c: Visual summary of the workflow from the implants (a) via the digital design (b) to the integrated restoration (c).
2 2024
21
[22] =>
| case report
contact
Dr Dr Michael Rak
Practice for biological dentistry, environmental dentistry &
ceramic implantology
Dr Dr Michael Rak
Wettersteinstraße 9
82347 Bernried on Lake Starnberg
Germany
+49 8158 2656
info@praxis-dr-rak.de
www.praxis-dr-rak.de
Dental technology Norbert Wichnalek
Arbnor Saraci
Lukas Wichnalek
Hochfeldstraße 62, 86159 Augsburg, Germany
+49 821 571212
info@wichnalek-dl.de
www.highfield.design
23
Fig. 23: Patient delighted with the natural-looking aesthetics of the final restoration.
Norbert Wichnalek
Arbnor Saraci
Lukas Wichnalek
Conclusion
In our opinion, this case demonstrates the impressive results that are possible when the dentist, dental technician
and patient work together and all the tools available to us
are used at the appropriate time. We regard disinfection
using plasma as essential, whether during implant placement or in the fabrication of restorations. The cleaner the
materials used, the more healthy tissue is supported and
the lower the risk of contamination of the materials jeopardising the longevity of the entire implant–restoration
system.
24
Fig. 24: Final radiograph.
22
2 2024
about the authors
Dr Michael Rak qualified as a dentist from Heidelberg University in 2008 and then went on to study human medicine at LMU
Munich, both in Germany, and in 2014 gained his licence to practise medicine. While still studying human medicine, he completed
his dentistry residency at Dr Georg Hägler’s practice for oral and
[23] =>
AD
maxillofacial surgery and at Susanne Berthold’s practice for holistic
dentistry, both in Munich. Since 2014, he has continued his education
and training in biological dentistry with Dr Karl Ulrich Volz at the SWISS
BIOHEALTH CLINIC in Kreuzlingen in Switzerland. Between 2015 and
2019, he specialised in biological dentistry and ceramic implantology
at the SWISS BIOHEALTH EDUCATION CENTER. Dr Rak has also
studied environmental dentistry and dental hypnosis.
Norbert Wichnalek passed his journeyman’s examination in 1987
and then his master’s examination as a dental technician in Munich in
Germany in 1993. One year later, he opened his own dental laboratory.
From 1996 to 2014, Wichnalek taught specialist dental technology
practice at Berufsschule 2 in Augsburg in Germany. He has been a pioneer and developer in the use of plasma technology in dental technology since 2013 and a speaker on environmental dental technology for
the German society for environmental dentistry (Deutsche Gesellschaft
für Umwelt-ZahnMedizin) since 2012. Wichnalek is the author of more
than 100 specialist publications in Germany and abroad. His laboratory
focus is on dental restorations in harmony with the human body, metalfree dental restorations and plasma technology.
Arbnor Saraci began training as a dental technician in 2014 after
completing an internship at the Wichnalek dental laboratory in Augsburg in Germany and attending Zirkonzahn’s Military School beginners’ training programme in Mühlen in Taufers in Italy. After passing
his journeyman’s examination in 2016, he attended Zirkonzahn’s advanced training programme. In 2017, he completed intensive training
at the Novadent international training centre in Manila in the Philippines under Shoji Sasaki from the Osaka Ceramic Training Center in
Japan. In 2018, he completed the curriculum of the German society
for environmental dentistry (Deutsche Gesellschaft für Umwelt-ZahnMedizin) to become an environmental dental technician and then advanced training at the Novadent centre in Manila. Saraci continues to
pursue his education at home and abroad on dental technology topics
and dental photography. In 2018, he took joint first place with Lukas
Wichnalek in Zirkonzahn’s 10 Years of Prettau Zirconia competition
and published his first article. In addition, he serves on the editorial
board of a journal for young dental technicians.
WE
LOVE
WHAT
WE
DO.
Lukas Wichnalek started his training as a dental technician in 2014
and attended Zirkonzahn’s Military School beginners’ training programme in Mühlen in Taufers in Italy in 2015 and Zirkonzahn’s Ranger
School in Bruneck in Italy one year later. This was followed in 2017
by intensive training at the Novadent international training centre in
Manila in the Philippines under Shoji Sasaki from the Osaka Ceramic
Training Center in Japan. He sat for his journeyman’s examination in
2018, then completed the curriculum of the German society for environmental dentistry (Deutsche Gesellschaft für Umwelt-ZahnMedizin) to
become an environmental dental technician and thereafter undertook
further intensive training at the Novadent centre in Manila. Wichnalek
regularly attends continuing education courses at home and abroad
on dental technology topics and dental photography. In 2017, he won
first place in the Kuraray Noritake Award’s Level 2 CAD category, and
in 2018, he took joint first place with Arbnor Saraci in Zirkonzahn’s
10 Years of Prettau Zirconia competition. He has been publishing articles in professional journals since 2018 and serves on the editorial
board of a journal for young dental technicians.
We are g
tin
celebra
rs er.
a
e
Y
0
3 arket pow
lm
a
of dent
.
s
u
n
i
Jo
oemus media ag
Holbeinstraße 29 · 04229 Leipzig · Germany
Phone.: +49 341 48474-0 · info@oemus-media.de
[24] =>
| case report
Straumann Pro Arch with BLT
implants in a periodontal patient
with hopeless dentition:
A five-year follow-up
Dr Amin Motamedi, Iran
Nowadays, patients are not merely concerned with the
functionality of their dentition, but aspire for natural aesthetics and predictable results. Consequently, the comprehensive rehabilitation of edentulous patients has
emerged as a critical challenge, needing a fusion of diverse dental specialties, advanced technologies, and
innovative treatment modalities.
Full-arch fixed dental prostheses present high survival
and success rates. In recent years, several clinical studies and systematic reviews have demonstrated that the
early and immediate functional loading of dental implants
can be as effective as conventional loading protocols.1, 2
Immediate loading of dental implants offers various advantages, including time-savings, enhanced aesthetic
and occlusal function, elimination of the need for provisional removable prostheses, avoidance of secondary
surgical procedures and preservation of the residual alveolar ridge.3
The following case report demonstrates the successful
management of a patient with a hopeless dentition and
the desire for a long-term fixed solution. Through periodontal and orthodontic treatment and implant-supported
rehabilitation with four Straumann Tissue Level implants
in the maxilla and six Straumann Bone Level Tapered
(BLT) implants in the mandible, we fulfilled her expectations. The interdisciplinary approach employed in this
clinical scenario reflects the collaborative synergy between dental professionals, each contributing their expertise to create a customised treatment plan that renewed not only the patient’s smile but also her confidence
and quality of life.
1
Initial situation
2
Fig. 1: Initial intra-oral situation. Fig. 2: Mandibular occlusal view after scaling
and root planing.
24
2 2024
A 67-year-old female patient without any relevant medical
history came to the clinic seeking a solution for her oral
health concerns. She stated that for as long as she could
remember she had been experiencing feelings of embarrassment about her mouth. Her ongoing struggles with
bleeding gingivae and mobile teeth had significantly hindered her ability to eat and smile confidently. She expressed her desire for fixed rehabilitation of her failing
dentition and emphasised her inability to tolerate traditional removable complete dentures at any treatment
step.
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[26] =>
| case report
3
4
Fig. 3: Panoramic view: severe bone loss in the anterior mandible. Fig. 4: Right side 3D CBCT view: severe bone loss in the anterior mandible and posterior
maxilla.
The intra-oral examination revealed inadequately
treated teeth and dentition with a mostly poor
prognosis in terms of preservation and prosthetic restoration. In the maxilla, she presented
with two metal–ceramic bridges from tooth #16
to tooth #14 and from tooth #24 to tooth #27, and
the abutment teeth presented with mobility and
cervical caries. The mandible presented with deep
periodontal pockets, active infection, mobility,
suppuration and bleeding on probing, especially
regarding tooth #42, and only the root of tooth #36
remained (Figs. 1 & 2).
5
Fig. 5: ITI SAC classification tool indicates high surgical and medium prosthetic complexity.
The radiographic assessment showed moderate bone resorption around the maxillary anterior
teeth and bone loss around the abutment teeth.
In the lower jaw, severe alveolar bone resorption
was observed, particularly in the anterior around
tooth #42 (Figs. 3 & 4). According to the International Team for Implantology’s SAC classification, the patient case was categorised as complex in terms of the surgical classification and
advanced in terms of the prosthodontic classification (Fig. 5).
Treatment planning
6
Fig. 6: Periodontal therapy in the maxilla including root planing, GTR, and soft-tissue
grafting.
26
2 2024
Through a comprehensive discussion of the
available treatment options with the patient, it
was determined that a comprehensive periodontal treatment would be carried out in the
upper jaw, and all the mandibular teeth would
be extracted. Immediately thereafter, BLT implants using the Straumann Pro Arch system
would be placed.
[27] =>
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[28] =>
| case report
The treatment workflow included:
1. full-mouth scaling and root planing and oral
hygiene instructions;
2. periodontal surgery and soft-tissue grafting of
the maxillary anterior teeth;
3. orthodontic treatment of the maxillary anterior
teeth;
4. implant placement in the posterior maxilla;
5. extraction of the mandibular teeth;
6. prosthetic and aesthetic analysis;
7. preparation of a provisional mandibular full-arch
prosthesis;
8. preparation of an analogue implant insertion
guide;
9. immediate implant placement and bone augmentation in the mandible;
10. immediate loading of the mandibular implants;
11. placement of the final monolithic zirconia screwretained prostheses; and
12. supportive periodontal therapy (every three to
four months).
7
Surgical procedure
Initially, the patient was scheduled to undergo a
comprehensive periodontal treatment regimen that
included oral hygiene instructions, scaling and root
planing, and regular follow-up evaluations. Clinically, significant improvements were noted in oral
hygiene, gingival health and periodontal pocket
depths. Subsequently, periodontal therapy was
performed in the maxilla, including root planing,
guided tissue regeneration and soft-tissue grafting
(Fig. 6). As the patient also expressed a desire for
enhanced aesthetic outcomes, it was decided to
improve the alignment of the maxillary teeth through
orthodontic treatment before implant placement in
the maxilla.
8
9
10
Fig. 7: Bone reduction due to severe alveolar bone destruction. Fig. 8: Placement of
six Straumann® BLT implants with optimum anterior posterior distribution to ensure an
optimal force distribution. Fig. 9: A minimum of 2 mm buccal bone thickness to create
stable long-term bone around implants. Fig. 10: Tension-free softtissue closure by
periosteal releasing and apical mattress sutures.
28
2 2024
In the maxillary arch, two 4.1 × 12.0 mm Straumann
Tissue Level implants and two 4.8 × 10.0 mm
Straumann Tissue Level implants were surgically
positioned in regions #16, 14, 24 and 26. After this,
under local anaesthesia, a mucoperiosteal flap
was elevated, and an atraumatic extraction technique was employed to remove all the mandibular
teeth with the aim of preserving the soft and hard
tissue and minimising any potential trauma. Furthermore, reduction of the crestal alveolar bone
was carried out using a straight surgical handpiece
with copious sterile saline irrigation to address the
significant bone deficiency, thereby augmenting
the available bone volume to optimise the placement of dental implants (Fig. 7). The same day, a
thorough prosthetic and aesthetic analysis was
conducted for the fabrication of the immediately
loaded fixed mandibular full-arch prosthesis, along
[29] =>
case report
|
with the preparation of an analogue implant insertion guide.
The drilling sequences for the BLT implants were
performed in accordance with the manufacturer’s
instructions. Six BLT implants (SLActive, Roxolid;
3.3 × 12.0 mm, 4.1 × 12.0 mm, 4.1 × 10.0 mm) were then
strategically positioned with an anterior–posterior
distribution, carefully planned to ensure the most
effective distribution of forces (Fig. 8). The implants
were placed utilising the Pro Arch guide. The insertion torque was between 35 and 55 Ncm, measured
using a torque wrench. The decision was made to
use Straumann BLT implants owing to their design,
which facilitates primary stability, allows for immediate loading and can be seamlessly integrated with
Straumann Pro Arch for the creation of implantsupported fixed full-arch prostheses, ensuring predictable outcomes.
Bone augmentation was performed to establish a
stable buccal bone thickness of at least 2 mm for
the implant placement (Fig. 9). Straight screwretained abutments (Narrow CrossFit 3.5 × 4.0 mm,
Regular CrossFit 4.6 x 4.0 mm and Regular CrossFit
4.6 x 2.5 mm) were chosen based on soft-tissue
thickness. Healing caps were then screwed in
place. The soft tissue was closed without tension
through periosteal releasing and apical mattress
sutures (Fig. 10).
Impression copings were seated and splinted to
guarantee an immediate, precise and passive fit of
the prosthesis (Fig. 11). An impression was taken
using polyvinylsiloxane material, and it was sent to
the laboratory for the production of a full-arch provisional prosthesis. The provisional prosthesis was
delivered on the same day and was inserted to a
torque of 15 Ncm. The occlusal contacts were carefully adjusted to align with centric relation to prevent
excessive stress on the implants during the healing
period (Fig. 12).
11
12
13
Prosthetic procedure
At the three-month follow-up after implant placement, osseointegration of all the implants had been
achieved. It was also noted that there was sufficient
buccal keratinised tissue, which plays a crucial role
in ensuring the long-term stability of the soft tissue
and facilitating proper oral hygiene maintenance
(Fig. 13). The screw-retained definitive prostheses
made of monolithic zirconia were then placed (Fig. 14).
The patient received oral hygiene instructions, and
the occlusion was checked. She was scheduled for
supportive periodontal therapy sessions at intervals
of three to four months.
14
Fig. 11: Impression copings are splinted to ensure immediate passive fit of the prosthesis. Fig. 12: Occlusal contacts in centric relation to avoid implant overloading
during the healing period. Fig. 13: Adequate buccal keratinised tissue guarantees
long term soft-tissue stability and proper oral hygiene. Fig. 14: Monolithic zirconia
final restoration.
2 2024
29
[30] =>
| case report
15
16
Fig. 15: Three years follow-up panoramic view demonstrates stable periodontal and peri-implant bone. Fig. 16: Three years follow-up shows healthy, stabIe
soft tissue and prosthesis.
At the three-year follow-up, the periodontal and periimplant bone was stable, demonstrating the long-term
success of the initial treatment (Figs. 15 & 16). After five
years, clinical and radiographic examination of the implant rehabilitation were carried out and demonstrated
the continued long-term success of the initial treatment
(Fig. 17).
for any practice. The Straumann Pro Arch workflow offers
a more predictable and simplified approach with a proper
anterior–posterior distribution that provides optimum force distribution and
Literature
also, for your patients, reliability, comfort and compliance for an excellent
long-term result.”
Treatment outcomes
Utilisation of BLT implants following the Straumann Pro
Arch concept in a patient with compromised periodontal
health delivered exceptional results, including the health
of both soft and hard tissue, functional improvement and
enhanced aesthetics. This system allowed for immediate
implant loading and successful osseointegration. The patient was satisfied with the results.
Author’s testimonial
“Full-arch immediate implant restorations in patients with
advanced periodontal deterioration can be challenging
about the author
Dr Amin Motamedi holds a DDS and
an MSc in periodontics from Shahid Beheshti University of Medical Sciences in
Tehran in Iran and completed the fellowship in laser therapy in dentistry at the
Aachen Dental Laser Center in Germany
and the master clinician programme in
implant dentistry at the Global Institute
for Dental Education in Los Angeles in
the US. He is a fellow of the International Team for Implantology
and served as the chair of and postgraduate programme director
in the periodontics department at the dental school of Kerman
University of Medical Sciences in Iran. He runs his own specialist
practice in Kerman.
contact
Dr Amin Motamedi
17
Fig. 17: Stable periodontal and peri-implant bone at five years follow-up panoramic view.
30
2 2024
Dr Amin Motamedi
Dental and Implant Clinic
Kerman, Iran
+98 34 32470628
www.motamediclinic.com
[31] =>
30 years OEMUS MEDIA
oemus
YE
A
|
RS
lebrates three
OEMUS MEDIA AG ce
in the dental market.
decades of influence
e, the upcoming
To mark this mileston
24 will feature
issues of implants 20
ories on our team.
shor t background st
WE
LOVE
WHAT
WE
DO.
ORG
WE PUBLISH DENTAL
Introducing the implants team
Aniko Holzer
Aniko Holzer has been a member of the OEMUS team
since 2022. As a talented graphic designer, she oversees
several publications in our publishing house and is responsible for the conceptual design management of these
projects. With her creative talent, she consistently creates
impressive layouts for our magazine that always inspire our
readers. Throughout her career, she has acquired extensive knowledge in marketing and web design, further
enhancing her expertise. Her professional experience
enriches our team in many ways. Outside of her professional activities, Aniko shares a great passion for
football with her son. Together, they enthusiastically
cheer on their team, RB Leipzig, at every game.
Additionally, Aniko is an enthusiastic “hobby
sewer”, dedicating her free time to sewing
clothes and bags.
implants
ceramic
implants
EDI Journal
2 2024
welovewhatwedo.org
Graphic designer
31
[32] =>
| interview
© Sittipol – stock.adobe.com
Big data in
implant dentistry—
“We are standing
at the beginning”
An interview with Prof. Arjan Vissink on the current state of
big data in implant dentistry
Big data and artificial intelligence in implant dentistry
have become significant topics in contemporary discussions. In this interview, Prof. Arjan Vissink, a renowed oral
and maxillofacial surgeon from the Faculty of Medical
Sciences of the University of Groningen in the Netherlands, provides an insightful exploration of this subject.
He delves into the current state of big data in implant
dentistry, its future uses and its challenges.
Prof. Vissink, what possibilities does
big data offer in dentistry right now,
and what does the future hold?
Very few studies have used big data in implant dentistry. We are standing at the beginning. Not much can be said yet of the
impact of observations from big data in
implant dentistry with regard to diagnostics, risk profiles and prognosis. So far,
there has only been cursory study done in
this area. Some aspects explored include
implant type and diameter used (irrespective of the brand), indication and application, for example immediate or delayed
loading, and whether bone augmentation
was needed, in addition to general health
perspectives, such as smoking, diabetes,
immunological diseases, radiotherapy in
the head and neck region, and bisphosphonates, with regard to overall implant survival. It has
also been investigated whether an oral surgeon or periodontist has a better implant outcome, but the indications
for implant placement were not assessed. Whether implants are good solutions in elderly patients has also
been studied, specifically for supporting prosthetic restorations and how underlying diseases could compromise
32
2 2024
the outcome in this situation. The data reported so far is
not sufficiently robust to guide decision-making.
Technical innovations are being developed faster than
ever before. When will big data be more commonly
used in dental practice?
At the moment, there is no direct use of the results of big
data studies in implant dentistry for daily dental practice. Only very rough overall data
is available, and it is not tailored to
the individual patient. There is no
data available on immediate or delayed placement, immediate or delayed loading, one- or two-stage
procedures, or when an implant
site should be considered compromised, etc. We should first begin to better record implant procedures, restorations, procedures
used in the upper and lower jaw,
situations that necessitate bone
regeneration, the implant platform
used and more. From such data,
better general conclusions could
be drawn, and eventually, better
recommendations for the individual patient could be made. Although innovations are evolving
rapidly, it will be quite some time before the dental practice and the individual patient in particular will benefit from
these achievements.
Can you share some tips for dental professionals
who want to get more involved with artificial intelligence and the use of big data?
[33] =>
interview
|
all implant-specific data could be added to that database.
An example of big data documentation is the case of the
database used for patients with Sjögren’s syndrome, a
rare autoimmune disease affecting, among other things,
the eye (keratoconjunctivitis sicca) and the mouth (hyposalivation, xerostomia). More than 15,000 well-classified
Sjögren’s patients are anonymously registered in a very
valuable database documenting their disease. Those responsible for using the data and writing arising research
reports have no access to the patient files. When data is
missing or incomplete, the treating clinician is asked to
provide the missing data where possible. Financially,
there is barely any support.
What are the three most vital things about big data’s
role in implant dentistry to remember?
Big data in implant dentistry is just getting started. There
is no generally approved protocol as to what parameters
to evaluate and how to score. First, the content of the
questions through which data will be gathered must be
arranged, in addition to determining how those responses
will be reported.
Dentists should first start with a uniform description of
procedures, such as a standardised questionnaire for
the initial data collection for as many patients as possible.
Better conclusions could be formulated from such data
even if they are not yet tailored for the individual and
apply just at a group level. It will take much longer before
the conclusions drawn from big data research will have a
direct impact on individual patient care.
What challenges does the use of big data in dental
practice entail?
Big data in implant dentistry is in its infancy. First, a standardised database should be designed in which all details of implant placement and restoration can be recorded in a standardised manner. Standardisation of the
data entries will be a starting point for many future studies. Next, dentists who place implants and/or make the
prostheses for these implants should take the time to create a record in the database for every patient they treat.
Time spent on building the database is time that cannot
be used for patient treatment, but it will bring implant
dentistry further in the long run. Once the data entry process becomes routine for the dentist, the time requirement will become minimal.
The use of modern technologies also raises concerns regarding data protection. How can this issue
be addressed? And are there any other issues that
need to be considered when handling personal
medical data?
All data can be collected in an anonymised way. We must
ensure that insurance companies or organisations who
could gain financially cannot access this data. For example, all patient data could be coded in the database using
a code only known by the treating physician. Thereafter,
Thus far, only very general trends have been reported
with regard to implant dentistry.
We have to agree on the creation of a standardised database in which all results related to implant treatment will
be recorded.
Editorial note: This interview was conducted by Franziska Beier, Dental
Tribune International, and first published in today EAO Berlin 2023.
about the interviewee
Prof. Arjan Vissink is a renowned expert in oral medicine at
the University Medical Centre Groningen in the Netherlands. His
extensive expertise in implantology and reconstructive surgery
has led to significant contributions in these fields. Globally recognised, he is frequently invited to speak at international conferences and has authored numerous publications.
contact
Prof. Arjan Vissink
Department of Oral and
Maxillofacial Surgery
University Medical Center
Groningen, The Netherlands
+31 50 3611025
a.vissink@umcg.nl
Prof. Arjan Vissink
2 2024
33
[34] =>
| industry*
Commitment to safety
Celebrating extended and new Trusted Quality
seals awarded by the CleanImplant Foundation
More and more implant manufacturers recognise the
value that the CleanImplant award brings to practitioners
and their patients.
The plethora of implants available from an increasing
number of companies brings into question whether a universal standard of quality in production and packaging
exists for surface cleanliness. This presents as a conundrum for dentists worldwide regarding their choice of fixture to provide optimal patient care. The increased incidence of peri-implantitis warrants a revisiting of critical
thinking as to its source. The presence of surface contaminants is recognised as a contributing factor of the
sequelae of biological complications that can occur.
Receipt of the Trusted Quality seal awarded by the
CleanImplant Foundation after rigorous peer-reviewed
analysis and testing reflects a manufacturers’
commitment to ensuring surface cleanliness, a possible X factor in failed
34
2 2024
osseointegration. The Trusted Quality seal remains in
place for a two-year cycle after which the implant must
be retested to re-establish its surface cleanliness status
determined within the framework of the CleanImplant
consensus-based guideline. “After rigorous and extensive testing, we are pleased to extend the CleanImplant
Quality seal for an additional two years to the products
from Swiss Dental Solution from Switzerland and German manufacturer medentis medical, BTI from Spain and
the Korean producer MegaGen”, Dr Dirk U. Duddeck,
Founder and Head of Research at CleanImplant pointed
out. “The implant UnicCa from BTI and MegaGen’s
AnyRidge System went through a fourth re-evaluation
process for which they were awarded the special
CleanImplant award for “LongTerm Proven Excellence”
* The articles in this category are provided by the manufacturers or distributors and do not reflect the opinion of the editorial team.
© CleanImplant Foundation
[35] =>
AD
recognising companies’ continued pursuit of perfection
in quality for their client base.”
SUBSCRIBE NOW
implants—international magazine of
oral implantology
issn 1868-3207 Sondernummer · Vol. 8 · Issue 1/2024
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implants
2/24
international magazine of ceramic implant technology
events
“Ceramic implants—
State of the Art”
case report
Two-piece
ceramic implant
interview
“If this system performs well in these
patients, it will perform in every patient!”
international magazine of oral implantology
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Companies establish trust for their end users by following
through on their professional commitments, by working
to amend deficits in production standards, and by making changes where needed. The continuously updated
CleanImplant Foundation website and the quarterly newsletters advise their subscribers and members whether
that confidence is being earned. Dirk U. Duddeck concludes: “A duty of care must be sacrosanct for all, that is
both mandate and responsibility for those in the industry
and the profession.”
BESTELLUNG AUCH
ONLINE MÖGLICH
research
Laser-assisted
protocol for the
treatment of
peri-implantitis
case report
BLT implants in a periodontal
patient with hopeless dentition
interview
Big data in implant dentistry
www.oemus-shop.de
© CleanImplant Foundation
* The articles in this category are provided by the manufacturers or distributors and do not reflect the opinion of the editorial team.
As well, the Foundation wishes to congratulate Ritter
(Spiral SB/LA) and Dentis (s-Clean SQ-SL) who earlier
this year received the Trusted Quality award. The presence of the CleanImplant team at the Academy of Osseointegration annual meeting in Charlotte, North Carolina,
afforded the opportunity to present the seal in person to
representatives of the companies.
Fax: +49 341 48474-290
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Implant systems currently carrying the “Trusted Quality”
award are: AnyRidge (MegaGen), Astra Tech EV (Dentsply
Sirona), BlueDiamond (MegaGen), ICX-Premium (medentis
medical), In-Kone (Global D), Inverta (Southern Implants),
Kontact S (Biotech Dental), (R)evolution (ChampionsImplants), s-Clean SQ-SL (Dentis), SDS1.2 (Swiss Dental
Solutions), SDS2.2 (Swiss Dental Solutions), Spiral SB/LA
(Ritter Implants), SuperLine (Dentium), T6 (NucleOSS),
T6 Torq (NucleOSS), UnicCa (BTI Biotechnology Institute),
whiteSKY (bredent medical).
Terms & Conditions: The subscription may be cancelled in written form without due justification within 14 days of
order by contacting OEMUS MEDIA AG, Holbeinstraße 29, 04229 Leipzig, Germany. Dispatching notification in good time
will suffice. The subscription is automatically extended by another 12 months if it is not cancelled in written form 6 weeks
prior to the end of the reference period.
Last Name, First Name
Company
Street, ZIP, City, Country
contact
CleanImplant
CleanImplant Foundation
Berlin, Germany
+49 30 200030190
info@cleanimplant.org
www.cleanimplant.org
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Phone.: +49 341 48474-200 · j.panke@oemus-media.de
[36] =>
| industry*
Insights in modern dentistry
Making implantology simple with the MIS digital
workflow
MIS digital workflow for conical connection implants.
MIS has been investing in digital solutions for many years,
and the company has watched with enthusiasm as its
digital workflow has been adopted by clinicians around
the world. The workflow incorporates digital imaging,
intra-oral scanning, guided surgery and CAD/CAM technologies designed to enhance every step of the treatment
process. According to Orit Kario, digital solutions product manager at MIS, the aim is to simplify treatment for
clinicians, laboratories and patients through seamless
communication and data transition.
MIS offers workflows for single-tooth, partial-arch and
full-arch procedures that are tailored to general dentists
and specialists and the setting, whether chairside or laboratory. They include implant-level and tissue-level solutions and enable implant-to-crown procedures.
For example, the company’s workflow for conical connection implants begins with a Primescan intra-oral scan
and efficient prosthetically driven MSOFT planning, assisted by the MCENTER team, which provides comprehensive digital dentistry services and detailed surgical
plans. In the surgical step, bone augmentation is done
with the use of OSSIX biomaterials, and clinicians benefit
from the advantages of the unique MGUIDE surgical
guides. The C1 implant and MIS CONNECT stay-in abutment provide primary and long-term stability and offer
the ability to maximise tissue-level restoration, and the
36
2 2024
use of a computer-guided approach contributes to the
reduction of patient visits, treatment steps and corrections. For final restoration, MIS customers are offered a
wide range of implant-level and tissue-level digital prosthetic solutions, all implemented in leading CAD software.
Kario said that being a Dentsply Sirona company allows
MIS to offer clinicians significant advantages. She explained: “MIS can offer its customers a complete digital
workflow that incorporates the MIS guided surgery
system, the unique implant connections and the comprehensive digital prosthetic line, in combination with
Dentsply Sirona equipment and materials, all under one
roof. We believe that providing tools of this quality
strengthens the brand and contributes to customer trust.”
What can clinicians and laboratories gain from adopting
the digital workflow? Kario emphasised: “Digital workflows address procedural challenges that impact clinical
efficiency, may improve profit potential and drive actual
practice growth.”
To learn more, visit www.mis-implants.com/products/
digital-workflow.
contact
MIS Implants Technologies
P.O. Box 7
Bar Lev Industrial Park
2015600 Israel
info@mis-implants.com
www.mis-implants.com
* The articles in this category are provided by the manufacturers or distributors and do not reflect the opinion of the editorial team.
Digital workflows connect the dots in modern dentistry
by merging several connected procedures into one complete treatment. The harnessing of digital tools facilitates
accurate diagnosis and treatment planning, significantly
improving patient outcomes and clinical efficiency. Being
part of Dentsply Sirona, MIS Implants Technologies is
uniquely positioned to offer its customers comprehensive
digital workflows, combining MIS solutions with the latest
Dentsply Sirona equipment and materials.
[37] =>
events*
Patient-customised concepts:
“Implantology 4.0” in Düsseldorf
this November
On 8 and 9 November 2024, the 53rd International Annual Congress of the German Association of Dental Implantology (DGZI) will be held in Düsseldorf, centered on the theme
“Implantology 4.0—on the way to patient-specific concepts.” This congress promises to
be an enlightening event, guiding the future of dental implantology, fostering insightful discussions, and unveiling innovative approaches through the dynamic interaction between
participants, speakers, and the industry.
* The articles in this category are provided by the manufacturers or distributors and do not reflect the opinion of the editorial team.
For decades, dental practitioners have relied on standardised, evidence-based implantological treatments applicable to all patients. However, recent studies indicate a pressing
need to reassess this one-size-fits-all methodology. What ensures success in one patient
might not yield the same result in another. Hence, the focus is shifting towards patientindividualised concepts.
At the forefront of this transformation, the congress will showcase the latest scientific and
practical findings. Renowned speakers will engage with participants to explore the full
spectrum of dental implantology, fostering a collaborative environment where future advancements can take root. Traditionally, the congress kicks off with a forward-looking
perspective, featuring presentations from the emerging generation of DGZI professionals who will share their current research and projects in a dedicated forum.
This year’s DGZI Annual Congress will also include two in-depth tutorials: one on digital impressions in implantology and the other on immediate implantation and immediate loading. These sessions are designed to provide practical insights and hands-on
experience. Additionally, the ever-popular table clinics return, offering participants the
chance to discuss specialised topics with distinguished experts, thereby expanding
their knowledge beyond their usual practice.
Complementing the scientific sessions, a separate congress for implantological assistants will take place, ensuring that the entire practice team benefits from comprehensive training and education.
Set against the backdrop of Düsseldorf, a city renowned for its vibrant culture and
dynamic atmosphere, the congress offers more than just professional development.
It promises an enriching and holistic experience that combines cutting-edge knowledge with the charm of one of Germany’s most fascinating cities. The DGZI Annual
Congress is a must-attend event for anyone involved in dental implantology, offering unparalleled opportunities for learning, networking, and professional growth.
contact
DGZI e.V.
DGZI e.V.
Paulusstraße 1, 40237 Düsseldorf, Germany
+49 211 1697077
sekretariat@dgzi-info.de
www.dgzi.de
|
[38] =>
| events*
Now is an exciting time for dentistry. Technological innovations lie at the heart of the profession and are significantly advancing personalised dental care. To provide a
platform to celebrate digital innovations in the field and
educate the dental team, DDS.Berlin has collaborated
with the Digital Dentistry Society, and they are bringing a
highly immersive experience to the capital of Germany—
the Digital Dentistry Show. Scheduled for 28 and 29 June
2024 at the Arena Berlin, the event promises to deliver
engaging educational and social opportunities with a
special focus on digital products and the digital workflow
in dentistry.
Through live product presentations, workshops, discussion sessions and an exhibition, the 2024 Digital Dentistry
Show seeks to provide attendees with first-hand knowledge of digital dental products and services and to offer
space for personalised advice and face-to-face interactions with industry leaders. With the focus on robust research evidence, the scientific programme will feature
Fig. 2: The Escobar is an extension of the
Badeschiff that includes a covered bar area.
presentations by prominent opinion leaders, including
Drs Henriette Lerner, Alessandro Cucchi, Raquel Zita
Gomes, Paul Schuh and Marcus Engelschalk, and cover
a wide range of topics, such as artificial intelligence, the
digital workflow in maxillofacial surgery and full-arch rehabilitation, and digital bone surgery. Attendees will have
the opportunity to earn up to 16 continuing education
credits.
Besides a strong educational aspect, the 2024 Digital
Dentistry Show will serve as a social hub for dental experts, professional organisations, manufacturers and
publishers who are looking to form or expand their network of like-minded, future-oriented individuals. To be
hosted at one of Berlin’s industrial pearls, the unique
event location offers a rich history and a distinctive modern feel. The adjacent Escobar and the Badeschiff spaces
will enhance the relaxed and jovial atmosphere, underlining the informal and engaging nature of the show.
The 2024 Digital Dentistry Show is expected to attract
over 2,000 eminent dental professionals from around the
world. You are invited to be one of them!
© Markus Nass
More information on registration and the scientific programme can be found at www.dds.berlin. Admission to
the event is free of charge.
Fig. 3: Attendees will also have access to the Sonnendeck of the Escobar,
where they will be able to enjoy delicious food and drinks.
38
2 2024
contact
DDS.Berlin Event
info@dds.berlin
www.dds.berlin
* The articles in this category are provided by the manufacturers or distributors and do not reflect the opinion of the editorial team.
Fig. 1: The Badeschiff is a picturesque floating public
swimming pool area overlooking the Spree river.
© Markus Nass
© Markus Nass
Long-awaited Digital Dentistry Show
to premiere in Berlin in June 2024
[39] =>
manufacturer news*
|
Nobel Biocare
The swiss company launches Zygoma academy
be
lB
io
ca
re
Visit the academy
website for more
information
* The articles in this category are provided by the manufacturers or distributors and do not reflect the opinion of the editorial team.
Personalised learning experiences
Zygomatic implants are primarily for the severely resorbed maxilla,
and they provide a faster and more comfortable alternative to sinus
lift or other types of bone grafting. To support clinicians’ skill in
providing such advanced treatments, the Zygoma Academy programme offers several levels of mentorship and training to meet
various needs:
• ZYGOMA 1 on 1: individualised mentorship and expert guidance
in specific areas of interest or concern
• ZYGOMA 1 on 2: small-group discussions for case reviews and
problem-solving, providing a platform for sharing experiences
• ZYGOMA 1 on 3: in-person courses with hands-on training that
enables participants to develop practical skills and confidence.
In addition, one of the standout features of Zygoma Academy is its
over-the-shoulder offering, which provides a rare opportunity for
clinicians to observe mentors in action.
A new era for the zygomatic implant community
The academy boasts an impressive roster of mentors and trainers,
including Drs Rubén Davó, Paulo Maló, Enrico Agliardi and Chantal
Malevez. These experts, hailing from more than ten countries,
bring with them diverse perspectives and a wealth of knowledge
for the next generation of best-in-class surgeons.
©
No
At the recent Envista Summit in Barcelona in Spain, Nobel Biocare
announced its latest advancement in professional development:
Zygoma Academy. This community-driven initiative includes oneto-one mentorship sessions with international experts and will
enable more clinicians to provide immediate full-arch restorations
in highly complex cases.
Zygomatic implants provide a faster
and more comfortable alternative to
sinus lift or other types of bone grafting
and Nobel Biocare’s new Zygoma Academy will
enable more clinicians to provide immediate full-arch
restorations in highly complex cases.
Commitment to excellence
Zygoma Academy represents Nobel Biocare’s ongoing commitment to advancing dental education and practice. By creating a
supportive, collaborative environment, the academy will not only
enhance individual skills but also contribute to the advancement of
the dental community and delivery of oral care. For clinicians seeking to master this complex area of practice, Zygoma Academy offers a new opportunity to learn, grow and excel.
Nobel Biocare
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2 2024
39
[40] =>
| news
Statement on the decision of the
Berlin Regional Court regarding
two-piece ceramic implants
In its ruling dated 6 June 2023 (case reference: 24 O
184/21), the Berlin Regional Court (LG) made a determination that diverged from the expert opinion procured,
refusing to acknowledge the medical necessity of treatment involving two-piece ceramic implants. Conversely,
the Ulm Regional Court, in its judgement of 28 July 2023
(Ref.: 3 O 75/22), affirmed the medical necessity based
on the expert testimony presented.
A task force convened by the DGZI, comprising Dr Elisabeth Jacobi-Gresser, board member and continuing
education officer, along with Assoc. Prof. Dr Stefan Röhling, board member, and including specialist lawyer for
medical law and certified compliance officer Anja Mehling
and Dr Alexander Raff, dentist and editor of the dental fee
commentary Liebold/Raff/Wissing, unequivocally asserts
its position on this matter.
In response to the Berlin Regional Court’s decision of
6 June 2023, the Implantology Consensus Conference
(KK) issues the following joint statement: “Two-piece
ceramic implants fulfil the criteria of a medically necessary treatment modality provided that the same standards applied to titanium implants are adhered to during
implant planning and indication determination.”
Evidence supporting two-piece ceramic
implants
Two-piece ceramic implants have emerged as a viable
alternative to titanium implants, demonstrating equivalency in restoration while offering superior biocompatibility. Notably, they exhibit reduced bacterial adhesion
1
2
3
Fig. 1: Dr Elisabeth Jacobi-Gresser, Member of the Board
and advanced training officer of the DGZI.
Fig. 2: Assoc. Prof. Dr Stefan Röhling, Member of the Board
of the DGZI.
Fig. 3: Anja Mehling, specialist lawyer for medical law and
certified compliance officer.
40
2 2024
[41] =>
news
and heightened corrosion resistance compared to titanium counterparts. These advantageous material properties render them particularly suitable for patients prone
|
Expert experience, including long-term studies, has been
amassed and recognised, even within academic settings.
© adata – stock.adobe.com
“Two-piece ceramic implants fulfil the criteria of a medically
necessary treatment modality provided that the same
standards applied to titanium implants are adhered to
during implant planning and indication determination.”
to inflammation due to genetic predisposition, as evidenced
by defined laboratory measurement parameters.
Moreover, patients with biotype 1, especially in aesthetically sensitive areas, stand to benefit from two-piece
ceramic implants. Over the past 15 years, the utilisation
of two-piece systems has facilitated more flexible prosthetic treatment options compared to one-piece systems.
Further advancements and enhancements in implant–
abutment coupling have been integrated into various systems over several years. The culmination of these positive
strides is reflected in an S3 guideline endorsing the utilisation of two-part ceramic implants as an alternative
therapy following informed patient consent.
Material selection and health insurance
coverage
The undersigned individuals emphasise the imperative
that reimbursement authorities should not dictate the
utilisation of two-piece ceramic implants in patient treatment. This determination should squarely rest upon patients and their attending dentists, contingent upon a
robust and substantiated body of evidence.
Adhering to the tenets of the Berlin judgement would
precipitate a significant impediment to medical treatment
involving novel therapeutic methodologies lacking S3level guideline endorsements. This would, in effect, impose substantial limitations on the adoption of emerging
medical interventions.
contact
4
Fig. 4: Dr Alexander Raff, dentist and editor of the dental
tariff guide Liebold/Raff/Wissing.
DGZI e.V.
Paulusstraße 1
40237 Düsseldorf
Germany
+49 211 1697077
sekretariat@dgzi-info.de
www.dgzi.de
DGZI e.V.
2 2024
41
[42] =>
| about the publisher
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implants
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implants—
international magazine of oral
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Copyright Regulations
implants—international magazine of oral implantology is published by OEMUS MEDIA AG
French Dental Association
Annual Meeting
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Paris, France
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42
2 2024
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[43] =>
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[44] =>
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