ceramic implants international No. 1, 2024

ceramic implants international No. 1, 2024

Cover / Editorial + content / Two-piece ceramic implant: Customised, fully digital solution for highly aesthetic results in the anterior region / Robotic facilitation of ceramic implants in compromised alveolar ridges / Reconstruction of a maxillary lateral incisor / Full-arch: Full rehabilitation of the upper jaw—Part 2 / Compromised patients, yet no peri-implantitis / Industry / Events / Manufacturer news / News / Imprint

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issn 1868-3207 Sondernummer · Vol. 8 · Issue 1/2024

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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!”

[2] =>

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editorial + content

CONTENT
03
editorial
Dr Sofia Karapataki

06
Two-piece ceramic implant
Dr Claudia Michl, M.Sc.

Dr Sofia Karapataki
Dr Sofia Karapataki |
Dentist, Periodontist,
Ceramic Implantologist.

Dr Sofia Karapataki

12
Robotic facilitation of ceramic
implants in compromised alveolar
ridges
Shepard DeLong DMD

A woman’s
look in ceramic
implantology
16

O

Reconstruction of a maxillary lateral
incisor

ur generation is so busy trying to prove that
women can do what men can do. Many times, us
women lose the unique qualities that make us
stand out. Women were not created to do what
a man can do—women were created to do what
a man cannot do. It is not a matter of competence but an equally
important and different addition. A lioness is not trying to be the
lion. She embraces her role as a lioness. She is strong, powerful,
and nurturing.
Women in dentistry are nowadays minimum as many as their male
colleagues. This is earned and not given after a long and difficult
struggle during the years. For all the ladies who enter now into this
field, there is no need of such a thing as competition. We are here
certainly because we are qualified. My advice to the young female
dentists: do not play the game of antagonism to the male col-

Dr Sofia Karapataki

22
Full-arch: Full rehabilitation
of the upper jaw—Part 2
Dr Dr Michael Rak, Norbert Wichnalek, Arbnor
Saraci & Lukas Wichnalek



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3

[4] =>

editorial + content



leagues, you don’t need to prove anything. Do your job the best
way you can and add your own perspective, your personal insight, your imagination, and way of thinking. The only person to
compete with is yourself and only in to improve yourself and
your skills. The only thing to balance is your inner self—to add
one more task within the multiple ones a woman needs to fulfil,
but this one here will be out of love and the most care for your
patients.

CONTENT
30
Compromised patients, yet no
peri-implantitis
Interview with Dr Sofia Karapataki

The importance, influence, and role of women in this world has
increased and will be much stronger as the years go by. The
world needs more kind, compassionate, humble, loyal, persistent, confident, fierce, bold, pure, and loving women. This
applies to every field and of course to oral implantology and to
be more specifically in ceramic implantology. An open mind and
flexibility as well as inner strength are the prerequisites in order
to follow the path of ceramic implantology. It is discipline and
vision at the same time. A clear look at ceramics with knowledge
and respect on the material’s nature together with the empathy
and natural care of women can make a perfect combination on
this field.

Sincerest regards,

“Ceramic implants—State of the Art”

Z-SYSTEMS—a 17-year follow-up

Sofia Karapataki

36
EACim presents work and shares
knowledge at DCIC—
Dubai Ceramic Implant Congress
Dr Philippe Duchatelard

40
European Society of Ceramic
Implantology (ESCI) presents
its satellite symposium

42
Long-awaited Digital Dentistry Show
to premiere in Berlin in June 2024

issn 1868-3207 Sondernummer · Vol. 8 · Issue 1/2024

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44
manufacturer news

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!”

48
news
Cover image courtesy of
Zircon Medical Management AG |
Patent™,
www.mypatent.com

50
events + imprint

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[5] =>

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[6] =>

case report

Two-piece ceramic implant:
Customised, fully digital solution for highly
aesthetic results in the anterior region
Dr Claudia Michl, M.Sc., Germany

01
Tooth 11 before
extraction.

02
X-ray of tooth 11
before extraction.

04
Tooth extraction
and cystectomy.

03
CBCT of pre-op
cyst.

Introduction
Implants made of high-performance zirconia have now also become an established solution for patients with special aesthetic
requirements. Replacing a front tooth with an implant places
very high professional demands on the dentist. It is therefore
particularly important to carry out precise planning in advance
of tooth extraction and implant placement to ensure an attractive result.
However, the use of ceramic implants not only offers aesthetic
benefits, but also provides patients with a metal-free restoration. In particular, patients with proven titanium intolerance
and an increased individual genetic predisposition to inflammation have a sixfold increased risk of primary or secondary loss of
the titanium implant.4 Furthermore, the risk of peri-implantitis is
significantly reduced due to the high biocompatibility of zirconia. Various studies have demonstrated a high implant survival
rate of over 94% after nine years,1 low BOP and stable gingival
conditions around the implant even many years later.

Clinical situation and treatment planning
Initial situation
The 38-year-old patient presented to my practice on 3/11/2020.
His main complaint was discomfort in tooth 11. He had undergone root canal treatment several years ago and had been experiencing discomfort for the past two years. This manifested as
permanent latent bite pain in tooth 11 and sometimes also pressure on the neighbouring tooth 21. In addition, pus and blood
sometimes appeared to be discharged from tooth 11.

Clinical examination
Tooth 11 had been restored with a metal-ceramic crown. The
gingiva around the crown showed clear signs of inflammation.
The BOP index on tooth 11 was positive, there was no plaque.
The crown margin on 11 was insufficient. Apical to the tooth
there was a prominent fistula, from which secretions and pus
were discharged under pressure. Tooth 11 was clearly sensitive

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[7] =>

The ONLY Two-Piece System
With Long-Term Studies
• Predictable Osseointegration1
• No Implant Fractures2
• No Peri-Implantitis2, 3

1. 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. 2022 Sep 14;8(1):37.
doi: 10.1186/s40729-022-00437-z. PMID: 36103094; PMCID: PMC9474793.
2. 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):1233–44. doi: 10.1111/clr.14005. PMID: 36184914.
3. Karapataki S, Vegh D, Payer M, Fahrenholz H, Antonoglou GN.
Clinical performance of two-piece zirconia dental implants after 5 and up to 12 years.
Int J Oral Maxillofac Implants 2023;38:1105–1114. doi: 10.11607/jomi.10284

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Independent long-term studies report
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[8] =>

case report

06
Implant in situ
four months after
bone augmentation.
07
Sealing with a
3 mm high
gingiva former.

08
Customised
abutment.

05
Socket preservation with Bio-Oss.

to percussion. The adjacent teeth were insensitive to percussion
and sensitive to cold stimuli. The periodontal screening index
was 2 in all sextants and oral hygiene was considered good. The
occlusion showed Class 1 interdigitation with many gaps in the
maxillary and mandibular anteriors. The vertical dimension was
low. The overbite was 4 mm, and the overjet was 1.5 mm. The
canines showed clear signs of wear. The Ahlers & Jakstat CMD
screening test gave no indication of the presence of arthrogenic
or myogenic dysfunction.
Radiological examination
The single-tooth image showed an endodontically treated
tooth 11 with a gutta-percha point inserted into the fistula. Bone
whitening was visible around the gutta-percha point which,
starting apically from tooth 11, clearly occupied the interradicular space between 11 and 21. Based on these radiological findings, a CBCT scan with a FOV of 80 x 90 mm was performed.
The CBCT showed a very extensive interradicular hypodensity in
the region 11, 21 starting from tooth 11. The dimension of the
interradicular area with low bone density measured from coronal
to apical is 19.4 mm and from mesial to distal is 10.9 mm. The
buccal bone lamella was extremely thin, and no bone could be
detected buccally in the area of root 11. A small hyperdense artefact, which can be interpreted as dispersed, overpressed root
filling material, was prominent cranial to the whitening. Diagnosis was inadequacy of crown 11 and radicular cyst originating
from tooth 11 with buccal fistula.
Procedure
Based on the findings and in consultation with the patient, the
following treatment steps were taken:

1. Removal of tooth 11 with simultaneous cystectomy, reconstruction of the bone defect and fabrication of a temporary
restoration (Erkodent aesthetic splint).
2. Placement of a two-piece ceramic implant (Zeramex XT,
CeramTec Schweiz) four months after augmentation.
3. Restoration of the implant with a crown.
As the patient had several allergies, a lymphocyte transformation test (LTT) and a basophil degranulation test (BDT) were carried out in advance to rule out type I or VI allergies to the bone
replacement material Bio-Oss (Geistlich Biomaterials). Blood
samples were taken at our practice and analysed by the IMD laboratory in Berlin. No type I or VI allergy to Bio-Oss was detected.
From five days preoperatively to five days postoperatively,
the patient was premedicated with amoxicillin-clavulanate
500 mg x 3 daily, prednisolone 60 mg as a single dose one hour
prior to surgery. For postoperative pain prophylaxis and antiinflammatory therapy, a procaine base infusion (4 ml 2% procaine, 100 ml 8.4% sodium bicarbonate and 100 ml physiological
saline solution) was administered during surgery and Ibuprofen
600 mg for four days postoperatively, as well as Pantoprazole
20 mg once daily to support the gastric mucosa.
Care was taken to ensure that the tooth removal and cystectomy
were as atraumatic as possible and there were no complications.
This resulted in a complete buccal fenestration, exposing a
three-wall bone defect. This was reconstructed using Bio-Oss
bone replacement material, which was biologised with autologous bone in a ratio of 2:1 and PRF (platelet-rich fibrin). In addition, metronidazole powder was added to the augmentation
material for antimicrobial prophylaxis. After augmentation, an
OSSIX Plus membrane (Regedent) and Plasmamatrix PRF, which

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[9] =>

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Newsletter
The ISMI newsletter keeps you up to date with the latest scientific trends, products,
and events on a regular basis. It also features user reports as well as a wide range
of information and tips on the subject of metal-free implantology.

Specialist magazine
As a member of ISMI, your membership fee includes a subscription of the independently published English language magazine ceramic implants—international magazine of ceramic implant technology. Published three times per year, the magazine
offers specialist articles and event reports as well as industry- and science-related
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implants provides information about manufacturers and their latest products.

issn 1868-3207 Sondernummer • Vol. 7 • Issue 3/2023

ceramic

Digitally customised asymmetrical
zirconium dental implant

research
Contaminants on ceramic implants:
Do manufacturing deficits
compromise their value?

interview
Advancing technologies in ceramic
implantology—AI sets new
milestones in dental treatments

Become a
member of ISMI now!

implants

international magazine of ceramic implant technology

case report

ISMI e.V. Office Leipzig
Holbeinstraße 29 | 04229 Leipzig | Germany
Phone: +49 800 4764-000 | Fax: +49 800 4764-100
office@ismi.me | www.ismi.me

3/23

[10] =>

case report

09
Implant crown
after insertion.
10
X-ray image after
insertion of the
crown.

10
11
Region 11 after a
one-year follow-up.

is rich in growth factors, were applied. To ensure tension-free
primary wound closure, the periosteum of the buccal flap was
stretched using the ST-UP Soft Brushing Kit from Joseph
Choukroun.
Histological examination of the removed cyst tissue confirmed
the suspected diagnosis of a radicular cyst. After the wound had
healed without complications, the sutures were removed 14 days
after surgery. The further healing process was uneventful and
the CBCT image taken four months after surgery showed a wellconsolidated augmentation. Both buccal and crestal bone continuity was almost completely restored. It was therefore possible
to proceed with the placement of a two-piece ceramic implant
made of alumina-toughened zirconia (ATZ; Zeramex XT, 10 mm
RB, CeramTec Schweiz).
Prior to implantation, the patient was premedicated according
to the protocol of J. Choukroun. This is as follows: 1,000 mg
azithromycin on the eve of surgery, 60 mg prednisolone one
hour before surgery, and 600 mg Ibuprofen three times a day
and 20 mg Pantoprazole once a day for pain relief and antiinflammatory therapy up to four days after surgery.
The implant bed was prepared according to the surgical drilling protocol. The pilot hole was drilled in a fully navigated fashion using a digitally designed and 3D-printed drilling template.
The drilling template was designed based on a previous intraoral scan (TRIOS 3, 3Shape) and a CBCT image (PaX-i3D Green,
VATECH) by the Norbert Delly dental laboratory in Bad Aibling
using 3Shape’s Implant Studio. The implant bed was drilled to a
depth of 11.5 mm to accommodate a 10 mm implant. The implant biologised with PRF was placed at bone level with 30 Ncm.
A primary wound closure was performed. Healing was uneventful.

After a healing phase of four months, a slight crestal vertical
bone loss of approx. 0.6 mm was observed. This corresponds to
the expected bone remodelling effect.2 During exposure, the
implant was sealed with a 3 mm high gingiva former. This was
customised with flowable composite prior to placement to optimise the emergence profile. The implant impression was created
using a 3D scan (TRIOS 3). For aesthetic reasons and to optimise
the emergence profile, a restoration with a custom-made abutment was chosen and fixed to the implant with a VICARBO screw
(carbon fibre-reinforced PEEK screw).
The abutment was fabricated from TZP ceramic in shade A3. The
all-ceramic crown (made of zirconia ceramic), fabricated by the
Norbert Delly dental laboratory, vestibularly veneered with silicone disilicate ceramic using the cut-back technique, was placed
semi-permanently with TempBond (Kerr).

Clinical results
The result after insertion of the ceramic crown shows an
inflammation-free soft-tissue condition. At the one-year followup, there was no inflammation or problems with the implant or
the prosthetic restoration.

Discussion
The Zeramex XT implant system is designed for a wide range of
indications. The two-piece design offers the usual advantages
of titanium implants, such as unencumbered healing, primary
wound closure, single-stage augmentation procedures and maximum flexibility in various surgical and prosthetic applications. The
bolt-in-tube VICARBO screw connection (carbon fibre-reinforced
PEEK screw) also provides a stable, secure abutment–implant

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[11] =>

connection that optimally resists biomechanical forces. Low-risk soft-tissue
management, customised shaping of the emergence profile and simple
re-entry and repair options are also possible.
Strict adherence to biological principles as part of the pre- and postoperative protocol and the patient’s individual and current immunological status
(allergies, presence of chronic systemic diseases) play an important role in
the success of the treatment. Proactive testing using LTT tests, BDT tests or
effector cell typing to detect possible material incompatibilities is an important factor in the course of cases to be solved.
In this context, an optimal supply of micronutrients such as vitamins D3, C,
B6 and B12, boron, manganese, and melatonin, as well as an “anti-inflammatory
diet”, including a special form of intermittent fasting, should also be mentioned. Also helpful are locally effective additives, such as the use of
platelet-rich fibrin (PRF), which is rich in growth factors. Anti-inflammatory
and immunomodulatory measures, such as the administration of specific
antibiotics and anti-inflammatory drugs according to a fixed regimen, complete the holistic approach in dental implantology.1
All these measures ensure that the oxidative stress in the tissue is kept at a
low level, thus providing the best possible support for bone remodelling
during wound healing.

Literature
1 Brunello G, Rauch N, Becker K, Hakimi AR, Schwarz F, Becker J (2022).
Two‐piece zirconia implants in the posterior mandible and maxilla: A cohort
study with a follow‐up period of 9 years. Clinical Oral Implants Research,
33(12), 1233–44.
2 Choukroun E, Surmenian J, Simonpieri A, Choukroun J (2021). Oxidative stress
and osteoimmunology: The two missing pieces of the oral osseointegration
puzzle. Diabetes, 16, 17.
3 Fischer J; Rohr P. D. N.; Jensch Fischer, P. D. Vielleicht darf’s auch glatt sein
[Perhaps it can also be smooth]. Internet: https://dzw.de/osseointegration-bei-zirkonoxid-implantaten. Last accessed on 30/04/24.
4 Jacobi-Gresser E, Huesker K, Schütt S (2013). Genetic and immunological
markers predict titanium implant failure: a retrospective study. International
journal of oral and maxillofacial surgery, 42(4), 537–43.
Photos: © Dr Claudia Michl, M.Sc.

About the autor
Dr Claudia Michl, M.Sc. is an implantologist and biological dentist
specialising in preventive dentistry as well
as conservative, prosthetic and surgical rehabilitation, with a practice in Kolbermoor (Germany).
She is certified in general implantology (DGZI e.V.)
and in environmental dentistry (DEGUZ e.V.). She also
holds a Master’s degree in dental functional analysis and
functional therapy (University of Greifswald). She is a
member of the DGZI, DEGUZ and DGAST.

Dr Claudia Michl

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[12] =>

case report

Robotic facilitation of ceramic
implants in compromised
alveolar ridges
Demonstrating the benefit of haptic guidance in
ridge-splits and lateral sinus lifts
Clinicians are frequently presented with less-than-ideal bony or soft-tissue anatomy in patients desiring oral rehabilitation with
dental implants. This presents challenges to implantologists who perform ridge or sinus augmentation techniques for their
patients, or those who only do minor grafting at the time of placement and refer to colleagues or specialists. It can be harder for
the placing surgeon to make the most of another practitioners’ surgical outcomes. This report highlights how comprehensive
dental therapy, and the use of robotic assistance and haptic guidance can maximise the bone and soft-tissue present, even in
challenging ceramic implant cases.

Shepard DeLong DMD, USA

02
01

Case #1
A 79-year-old female patient with an unremarkable health history presented to Lotus Dental Wellness in Portland, OR, USA
desiring a complete oral rehabilitation. She had numerous failing
teeth and advanced periodontal disease in her lower molars and
throughout the maxilla. She underwent extraction of all hopeless
teeth and LANAP to re-establish health on a reduced periodontium. Her upper jaw is currently planned for an All-on-X type
prosthesis supported by six or more ceramic implants which will
be placed with haptic guidance. The lower dentition became
stable after the periodontal treatment. Tooth #36 was the only
tooth that had remaining advanced disease and was planned for
extraction. Sites #46 and #47 had previously been extracted and

01
Pre-op photo.

02
Tooth #36 periodontal
infection and bone loss.

03
Site #36 post-op
radiograph.

grafted with 50/50 cortico-cancellous allograft. When the patient presented for placement at these sites each presented their
own unique challenge.
Advanced bone loss and infection had to be mitigated on patient’s left, while a very thin alveolar ridge was present on the
right. Z5–BL (Z-SYSTEMS) were chosen for their proven clinical
history and the ability to place them at bone level, either buried
or loaded with a healing abutment. Local anaesthesia was administered, and an anterior Yomi-link was placed so that the robotic device could assist bilaterally in the posterior mandible
without hindrance. A CBCT scan was exposed on the Axeos
(Dentsply Sirona) with the link and fiducial array, to allow for
digital implant planning. Tooth #36 was extracted without

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[13] =>

case report

04
Sites #46, 47.
05
CBCT slice
showing narrow
alveolar ridge sites
46, 47.
06
Ridge split.

07
Sites #46, 47 post-op
radiograph.
08
Ridge split
post-op photo.
09
Full-arch post-op
photo.

trauma to adjacent soft tissue. The bone was thoroughly debrided of all infected tissue and there was no major dehiscence
or fenestration. The site was irrigated with ozonated water and
fumigated with ozone gas. A 5.0 x 10 mm implant was planned in
Yomi-plan and the procedure on the left was completed with
haptic guidance. The concentric osteotomy allowed for precision
and the implant successfully engaged buccal, lingual, and apical
bone. A large diameter healing cap was placed, and the site was
grafted and closed with PRF, cortico-cancellous allograft and
PTFE suture.
A full-thickness flap was laid on the right and the dimensions of
the narrow ridge were exposed. A piezosurgery unit with a narrow diamond osteotomy tip was used. The crestal corticotomy
was punctuated with pilot drill osteotomies in both the anterior
and posterior positions. Vertical cuts were also made. Versah®
drills were used sequentially to spread the cortices and accurately followed the initial drill path. The final drill was the 0.325 mm
diameter ceramic drill from Z-SYSTEMS. Two 4.0 x 10 mm bone
level ceramic implants were placed with cover screws. Additional
grafting on the buccal and crestal with allograft and PRF was performed before the site was closed with PTFE suture. This case
took approximately two hours to complete, and the patient remarked on the overall ease with which it was completed. This
case has integrated successfully and is now ready to restore.

Case #2
A long-time patient of the clinic returned desiring an implant in
the upper-right quadrant, tooth #16. She was fifty-five years old

and in good health. She had been treated by an oral surgeon
in her hometown for extraction and a lateral sinus lift which had
to be revised due to postoperative infection. Upon initial CBCT
the site was minimally viable with the planned placement of a
4.0 x 10 mm Zeramex XT (Ceramtec) likely still requiring additional grafting. The risk of failure or complication was discussed, and the patient consented to the following procedure.
She was sedated with oral triazolam and locally anaesthetised.
A Yomi-link, CT scan, and intraoperative digital planning was
completed. The site was opened and extended posteriorly for
retrieval of surgical screws. The osteotomy was performed, and
plan executed precisely following both the prompts in the
Yomi software and the manufacturer’s drilling sequence. The
implant was placed with good torque and a 3 mm healing abutment. A similar grafting protocol was followed. Five months of
healing time elapsed and the case was restored with a screwretained crown composed of LiSi (GC) and a stock 1mm straight
abutment from Zeramex. Occlusion was verified with shimstock
and articulating paper. The patient was pleased with the result.

Discussion
Ceramic implants of various shapes, sizes and concepts have
been used since the 1960s.1 Zirconia has emerged as a promising
biomaterial for many orthopaedic devices including dental implants.2 There is recently published evidence that its use in the
surgical and prosthetic replacement of infected natural teeth
may reduce inflammation and reduce chromosomal degradation
in humans.3

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[14] =>

case report

10
Post lateral sinus
lift radiograph.
11
Post lateral sinus
lift CBCT slice.
12
Post-op
radiograph #16.

Robotics have had a major impact on modern surgical procedures beginning with the use of the DaVinci robot, Intuitive
Surgical, for general surgery.4 This is the first robot to have
been used intra-orally for oral surgical procedures including
cancer resection.5 The Yomi robot from Neocis is the first robotic device designed for oral surgery. The X-guide from
X-NAV Technologies, and Navident from ClaroNav, are both
classified as semi-robotic systems of dynamic navigation. The
distinction lies in the “active” arm which provides physical assistance, haptic guidance, to the hand of the surgeon. These
devices provide accuracy comparable to static guides and
significantly better than freehand surgery.6,7 They also allow
for the modification of surgical plans in real-time, improved
ergonomics, and the separation, or connection between
doctor and patient by an intelligent machine.

Conclusion

This case report showcases the advantages of robotically assisted guided implant surgery for the placement of ceramic
dental implants in difficult surgical scenarios. Surgeons from
all specialties benefit from the advancement of both material
and technological means for performing procedures that
lead to better patient health outcomes. Compromise, challenge, and ideals, are all concepts that define healthcare providers’ daily and life-long work. As evidenced by the concepts presented here, doctors and medical industry
professionals will not leave well enough alone but will continue the evolution of their methods to provide modern patients the best health outcomes possible.

13
Post placement
healed site.
14
Final restoration
occlusal photo.

15
Final restoration
buccal photo.
16
Final restoration
radiograph.

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[15] =>

case report

References
1 Sandhaus S. Tecnica e strumentario dell’impianto C.B.S. (Cristalline Bone Screw) [Technic and instrumentation of the implant
C.B.S. (Cristalline Bone Screw)]. Inf Odontostomatol. 1968;
4(3):19–24.
2 Chen YW, Moussi J, Drury JL, Wataha JC. Zirconia in biomedical applications. Expert Rev Med Devices. 2016;13(10):945–63.
doi:10.1080/17434440.2016.1230017
3 Schnurr E, Volz KU, Mosetter K, Ghanaati S, Hueber R, Preussler
C. Interaction of Telomere Length and Inflammatory Biomarkers Following Zirconia Implant Placement: A Case Series. J Oral
Implantol. 2023;49(5):524–31. doi:10.1563/a-id-joi- D-22-00236
4 Probst P. A Review of the Role of Robotics in Surgery: To DaVinci
and Beyond!. Mo Med. 2023;120(5):389–96.
5 Nishikawa D, Beppu S, Suzuki H, Terada H, Sawabe M, Hanai N.
A novel technique in transoral robotic surgery: A case report of
rotating and switching technique. Int J Med Robot.
2023;19(4):e2520. doi:10.1002/rcs.2520
6 Block MS, Emery RW, Lank K, Ryan J. Implant Placement Accuracy Using Dynamic Navigation. Int J Oral Maxillofac Implants.
2017;32(1):92–9. doi:10.11607/jomi.5004
7
Neugarten JM. Accuracy and Precision of Haptic Robotic-
Guided Implant Surgery in a Large Consecutive Series. Int J
Oral Maxillofac Implants. 2024;39(1):99–106. doi:10.11607/
jomi.10468

17
Measuring ceramic drill for
robotic osteotomy.
18
Z-SYSTEMS implant mounted
on robotic handpiece ready
for insertion.

19
Robotic situational photo.

About the author
Shepard DeLong is a 3rd generation dentist in Portland, Oregon, USA.
He holds a BS from Portland State University, DMD from Oregon Health
and Sciences University and completed a General Practice Residency at The
Queen’s Medical Center in Honolulu, Hawaii. He is a member of AMED, IAOCI,
EACim, IAOMT, and has served as a mentor for CEREC-doctors. He was formerly an
associate at the first LEED certified, hi-tech, eco-friendly practice in the US. He is on
the forefront of digital evolution, and development of novel technological workflows in
dentistry. He has a part-time position at Pure Health Dentistry on the island of Maui, Hawaii
and owns Lotus Dental Wellness, in Lake Oswego, Oregon. He is a residency site director
for the MSc Implantology programme at the University of Jacksonville, and lectures on ceramic
implantology, robotics, lasers, and digital dentistry. His latest project has been sharing the
profound advantages of combinational technologies for the health of both doctor and patient. He can be reached at drdelong@lotusdentalwellness.com.

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Shepard DeLong

Lotus Dental
Wellness

[16] =>

case report

Reconstruction of a maxillary
lateral incisor
Using an individualised narrow-diameter
two-piece implant
Reconstructing a lateral incisor in the maxilla poses particular challenges to the treating clinician. These include
a lack of space and the high visibility of this area, necessitating the use of an implant system capable of delivering reliable long-term function even with a narrow diameter while providing excellent aesthetics characterised
by healthy and stable soft tissue. In this case report, the use of an individualised narrow-diameter two-piece
implant is detailed that addressed these challenges effectively.

Dr Sofia Karapataki, Greece

01 + 02
Initial situation.

03
Surgical guide in
situ.

Initial situation
The 40-year-old male patient presented with a
congenital absence of tooth #12 (Figs. 1 & 2). He
was a nonsmoker and presented with psoriasis
and cataracts in both eyes. Additionally, his immunoglobulin E levels were elevated for no profound reason. The patient had undergone six
months of clear aligner treatment (Invisalign,
Align Technology; performed by Athens orthodontist Dr Katerina Samantara) to widen the
space sufficiently for implant placement.

Implant planning

Clinical and radiographic diagnostics were conducted to determine the interdental space and
available bone quantity. Based on this information, the ideal implant dimensions were determined to restore this case. A narrow-diameter
two-piece implant of 3.5 mm in diameter and

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[18] =>

case report

04
Inserted implant:
radiographic
view.
05
Inserted implant:
clinical view.
06
Cemented and
prepared glass
fiber post.
07
After placement
of the provisional
crown.

11.0 mm in length (Patent™ Dental Implant System, Zircon
Medical Management) was individually designed using software
(ImplantDesigner, Zircon Medical Management). The implant
was then fabricated at the production plant of the manufacturer.
It was planned to be inserted utilising an open double-fixed surgical guide.

Surgical procedure
The surgical guide was placed in the mouth (Fig. 3), and a minimal semilunar incision was made to expose the bone crest.
Bone quality classification revealed D2 for region #12. The osteotomy was then prepared according to the surgical protocol of
the implant manufacturer for this specific bone class and under
water cooling. The implant was then inserted with the scalloped
finish line at the equigingival level and at a final torque of 15 Ncm
(Fig. 4). Thereafter, the 3C connection was sealed with an Asilicone (Fig. 5). Thanks to the minimally invasive, flapless approach employed, no sutures were needed to stabilise the tissue after implant insertion. No antibiotics were prescribed for
the postoperative period; however, the patient was instructed

to rinse with a hydrogen peroxide solution before implant placement and for a period of three weeks thereafter.

Healing
Healing progressed uneventfully. At the follow-up appointment
after four months, the soft-tissue condition was deemed healthy and
stable. No periodontal pockets were observed around the implant.

Prosthetic restoration
After four months, the glass fibre post, serving as the retentive
element of the implant system used, was cemented into the implant platform using a dual-polymerising cement (RelyX Unicem,
3M ESPE). Thereafter, it was prepared using high-speed diamond burs under water cooling (Fig. 6). The prepared post was
then isolated with Vaseline oil and a provisional PMMA crown
was cemented over it using temporary cement (Fig. 7). This
crown was purposefully designed to provide interdental spaces
to facilitate orthodontic refinement by the treating orthodontist.
This final orthodontic treatment lasted three months. After a to-

1/24

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[20] =>

case report

08 + 09
After placement
of the final crown.

10
Final radiograph.

“Only vital bone can facilitate swift and undelayed
healing, which is the foundation for successful
osseointegration and long-term hard and softtissue preservation.”
tal of seven months, the patient received a multilayer zirconia crown
as a definitive restoration (fabricated by Athens-based dental laboratory IPS Markoglou; Figs. 8–10).

Discussion
Implant insertion to a low to moderate torque (< 35 Ncm) is crucial
to minimise compression of the surrounding bone, which would
compromise its vitality and lead to remodelling. Only vital bone can
facilitate swift and undelayed healing, which is the foundation for
successful osseointegration and long-term hard and soft-tissue
preservation. Considering that the bone was quite hard in the present case, using a low insertion torque was especially crucial to avoid
risk of fracture during insertion.
The implant used has a special cylindrical shape rather than the
usual conical emergence profile of the standard implant shape to
fit narrow spaces. Also, the platform has a scalloped design differ-

ent from the usual flat one to follow the scallop of the softtissue to support the aesthetic outcome of the smile. A challenge lies in properly positioning this curved shape during
surgery at the buccal and palatal surfaces.
Treatment planning with the prosthetic outcome in mind is
crucial. The final crown position must always be determined
before any kind of surgical procedure is carried out, as the
crown position determines where the implant must be
placed. Additionally, particular attention must be paid to
the equigingival positioning of this implant, requiring that
it be placed such that its platform is level with the free gingival margin. Placing the implant deeper would stimulate
remodelling and subsequent bone loss. When placed correctly, however, this implant has been demonstrated in
long-term studies to maintain the health and stability of the
hard and soft tissue over a long period and to resist periimplantitis effectively.1, 2

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[21] =>

case report

Conclusion
Thanks to its narrow diameter, the individualised twopiece implant system used was able to address the
limited space in this case ideally. It promises to deliver
excellent aesthetics over the long term in the highly visible anterior region thanks to its natural shade, equigingival design and optimised surface topography, which
promotes healthy and stable soft tissue. Moreover, a
minimal risk of biological complications such as periimplantitis is expected with this implant system, as evidenced in independent long-term studies.
References
1 Karapataki S, Vegh D, Payer M, Fahrenholz H, Antonoglou GN. Clinical performance of two-piece zirconia
dental implants after 5 and up to 12 years. Int J Oral
Maxillofac Implants. 2023 Dec 12;38(6):1105–14. doi:
10.11607/jomi.10284. PMID: 38085741.
2 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):1233–44. doi: 10.1111/clr.14005. PMID:
36184914.

Dr Sofia Karapataki
Adrianeiou 42
11525 Athens, Greece
+30 210 671138-0
pataki1811@gmail.com
www.KarapatakiSofia.gr
Patent™ Dental Implant System
Churerstrasse 66
Dr Sofia Karapataki
8852 Altendorf, Switzerland
c/o Krähbühlstrasse 58
8044 Zurich, Switzerland
info@zircon-medical.com
www.mypatent.com

AD

[22] =>

case report

Full-arch: Full rehabilitation
of the upper jaw—Part 2
The complete rehabilitation of a compromised residual dentition represents a major challenge in terms of
implantology as well as function and aesthetics. There is a great desire for fixed dentures with a satisfactory
aesthetic and functional realisation. In addition, patients are increasingly interested in biocompatible dentures
and surgical concepts that take biological criteria into account. Biological dentistry with metal-free implants
and zirconium oxide dentures can meet this demand at a high level. In the first part of the article, the authors
dealt with the diagnosis and its special features, the preparation of the patient and the surgical procedure for
implant placement. In the second part, the dental technical procedure is now explained.

Dr Dr Michael Rak, Norbert Wichnalek, Arbnor Saraci & Lukas Wichnalek, Germany

s a reminder: the 41-year-old patient wanted a
biologically neutral and metal-free overall rehabilitation of his compromised residual dentition
in the upper jaw and caries treatment of his
lower teeth. In the maxilla, there was a residual
dentition in regions 15 and 17 as well as two root remnants in
regions 13 and 15 in situ, on which a partial denture from 12 to
21 was located. All four remaining teeth had already undergone
endodontic treatment and were no longer worth preserving. In
the lower jaw, teeth 37, 36, 45 and 47 showed carious lesions.
Tooth 46 was devitalised, decayed, and showed extensive apical whitening on radiographs. The remaining teeth in the mandible were vital. Moderate chronic periodontitis was found in
both the maxilla and mandible.

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[23] =>

[24] =>

case report

“Occlusion cannot be
understood by looking
at the morphology of
individual teeth, but
rather from the living
structure (cybernetics)
of the entire organism.”
Carl Hildebrand, the founder of VITA Zahnfabrik, in the 1930s.

Procedure

Prosthetic rehabilitation of the patient
The success of a restoration is highly dependent on careful planning in advance. There is a lively exchange of information between the dentist, patient, and dental technician. Everything revolves around the following questions: what are the expectations?
What is sensible and what is 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 questions have been clarified, we realise the planned work as a dummy (prototype) and
check everything again for “oral suitability”.

Our focus is always on the whole person. Therefore, their posture
and, above all, their “comfortable bite position” play a central
role for us. Particularly with such a compromised maxillary residual dentition, it is important not to lose sight of the fact that the
person may have become accustomed to an incorrect bite position over the years. We therefore check the posture and whether
we need to intervene therapeutically in advance with the help of
a splint treatment. We discuss the patient’s wishes and select the
desired tooth mold together. Based on all this information, we
create a dummy in our laboratory that corresponds to the final
restoration in terms of shape and design. This dummy is made
of acrylic with the aid of the scanned actual situation of the patient with and without the inserted prosthesis and a conventional, fully adjustable articulator. A virtual wax-up was first generated from this data, from which we also prepared the various
surgical aids—an orientation drilling template and various transparent control foils—as shown in the first part of the article. Practice shows us time and again that despite the immense technical,
instrumental, and computer-assisted effort involved, there is always a discrepancy between the appliance and the biomechanical system of hard and soft tissue. Despite precise mathematically calculated joint paths and eccentric excursions of a virtual
articulator, the measure of all things is still the patient’s mouth.
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 Gysie, Hanau and Thielemann recognised that a “biological system” cannot be implemented on a
mechanically, mathematically precise chewing simulator. Carl
Hildebrand, the founder of VITA Zahnfabrik, said in the 1930s:
“Occlusion cannot be understood by looking at the morphology
of individual teeth, but rather from the living structure (cybernet-

1/24

[25] =>

case report

ics) of the entire organism.”9 Following this guiding principle, we use our patient as the best articulator a dental
technician could wish for. During the healing phase of the
implants, the dummy used serves to memorise the eccentric movements. This grinding-in behaviour manifests itself
in patient-specific grinding facets, which we can then
transfer 1:1 to the final restoration. All we must do is scan
our dummy in situ again when the patient visits the practice for a check-up and aftercare anyway. The dental practice sends us the data obtained in this way to the laboratory so that we can transfer the ground facets directly to
the final restoration.

Follow-up appointment in the practice
The patient came back to our practice after a healing period of around three months. After scanning the dummy,
we were able to remove it. Underneath, we found a completely irritation-free gingiva with beautifully healed implants (Figs. 22 & 23). We now molded this situation using
silicone and placed the temporary restoration on the implants again (Figs. 24 & 25). We were then able to submit
the documents generated in this way—i.e. scan and silicone impression—to the laboratory for completion of the
final restorations.

The principle of cranial respiration
It used to be assumed that the skull was a kind of “bony
steel helmet” that only served to protect the underlying
parts of the brain. Today we know that the bony structures
of the skull are a vibrating element in the organism. The
skull itself is made up of a very complex structure of numerous cranial bones. These form a three-dimensional interlocking gear train, whereby each cranial bone moves in
all three levels in two directions (back and forth, forwards,
and backwards, from medial to lateral), i.e. in six directions. The cranial bones as a whole “oscillate” in a kind of
“breathing movement”—this is also referred to as “cranial
breathing”. That means that they move rhythmically, alter-

1/24

[26] =>

case report

nating between shortening, expanding, lengthening, and
narrowing over a certain period of time, without the volume
of the skull changing quantitatively. Not only can this rhythm
of movement be pathologically altered, i.e. increased or decreased, but individual cranial bones can also be jammed or
displaced in such a way that their mobility and thus that of
the entire system is restricted.10

Creation of final maxillary prosthesis
After we received the documents from the practice, we realised the fabrication of the final restorations in zirconia. We
have favoured monolithic restorations in our laboratory since
2005. We see this as the greatest possible benefit for the patient. One of the main advantages of ceramic implants made
of zirconia is their excellent biocompatibility. Compared to
conventional titanium implants, zirconia offers several advantages. Firstly, zirconia is considered hypoallergenic, making it an ideal choice for patients with metal sensitivities 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
ceramic implants have remarkable resistance to corrosion
and plaque build-up. This reduces the risk of peri-implantitis,
which is characterised by inflammation and infection around
dental implants. The non-porous surface of zirconia prevents
the adhesion of harmful bacteria, which leads to healthier
gums and increases the overall longevity of the implant.11 In
order not to compromise the advantages of the inserted zirconia implants, the entire team has decided to favour zirconia for the dental part as well.
The entire prosthetic was divided into three segments and
constructed as three bridges. In this way, we consider the
cranial breathing described above so that we do not exert
any pressure on the difficult masticatory and cranial bone
system. Using the silicone impression, we produced a plaster model according to the usual procedure (Fig. 26). We
scanned this and digitally created the desired constructions
(Figs. 27 & 28). It is part of our philosophy that we always design all basal surfaces that rest on the gingiva to be closed
from the outset. We then sent the data collected in this way
to our milling cutter and initially obtained the three bridges
from the raw material (Fig. 29). After the first burning, the
advantages of the zirconium oxide used (VITA YZ ST, VITA
Zahnfabrik) that we were aiming for were already evident in
the impressive aesthetics (Fig. 30). The shade characterisation of the bridges was then carried out using the VITA AKZENT Plus shades. For even better aesthetics, additional shade
individualisation was carried out with the VITA YZ EFFECT
LIQUID infiltration shades. After the finalising wettability
glaze firing, we polished all gingival areas to a high gloss as
standard for the aesthetically visible areas (Figs. 31 & 32). In
our opinion, this is the most gingiva-friendly version of dental
work. The resulting advantage is described in bionics as the

1/24

[27] =>

case report

lotus effect, which refers to the low wettability of a surface,
as can be observed in the lotus plant Nelumbo. Water rolls
off the leaves in droplets or slides off the leaves, taking all
dirt particles on the surface with it. This is due to the complex
micro- and nanoscopic architecture of the surface, which
minimises the adhesion of dirt particles.12 In principle, this
surface coating not only improves aesthetics, but also reduces plaque adhesion to the restoration, promotes longterm stability and reduces abrasion processes on the (natural) antagonist.13 This procedure enables us to completely
dispense with any plaster niches. We see this as an absolute
advantage, as constant interdental cleaning often only irritates the gingiva unnecessarily and we run the risk of it receding. Finally, the work was packed according to the standard plasma cleaning concept in the sense of “Highfield-
Clean-Prostethics“14, disinfected via plasma and handed
over to the practice for the placement appointment.

Insertion date in practice
As soon as the final prostheses have arrived in the practice
from the laboratory, the bridges are placed on the implants
(Figs. 33–38), firmly cemented and the fit is visually checked once
again. It is nice to see how harmoniously the overall situation
integrates into its natural environment. The optimised aesthetics of the front also comes into their own (Figs. 39– 44). Finally,
the situation was checked using an X-ray image (Fig. 45). The
patient was already delighted with the new appearance of his
temporary restoration. The fact that the final restoration
made of zirconia integrates so harmoniously into the overall
oral structure of the mouth and did not bother the patient
unpleasant for a second as a foreign body, was not least
because we had transferred his individual chewing behaviour
as a grinding pattern from the temporary directly into the
final restoration.

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[28] =>

case report

43a

43b

43c

Summary
For us, the patient case shown is a good example of the impressive results that are
possible when the dentist, dental technician, and patient work together perfectly
and all the tools available to us are used at the right time. We see disinfection via
plasma as a central point—whether in the dental part during implant placement or
as the final step in the fabrication of prosthetics. The cleaner the materials used,
the more biological and the lower the risk of contamination of the materials jeopardising the longevity of the entire implant prosthetics system.

References
9 Wichnalek N. Mundgesundheit und Stress,
GZM Netzwerkjournal, 2/2011, 16. Jg.,
S. 40–42.
10 https://dp-verlag.de/magazin/zahnmedizin/
11 https://zeramexusa.com/zirconia-is-not-ametal-dr-markus-blatz/
12 https://de.wikipedia.org/wiki/Lotoseffekt
13 https://eadt.de/zirkonoxid-kronen-glasieren-oder-polieren-einfluss-auf-stabilitaet-und-alterungsbestaendigkeit/
14 Wichnalek N, Rak M. Biological dentistry,
environmental dentistry and plasma—a
combination for health, ceramic implants,
3/22, S. 6–13.

Dr Dr Michael Rak

Arbnor Saraci

Norbert Wichnalek

Dr Dr Michael Rak
Practice for biological dentistry
environmental dentistry & ceramic
implantology
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

Lukas Wichnalek

+49 821 571212
info@wichnalek-dl.de
www.wichnalek-dl.de

1/24

[29] =>

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[30] =>

Congratulations on the publication of your long-term
study on two-piece Patent™ Implants in the International Journal of Oral and Maxillofacial Implants,
a renowned high-impact journal in implant dentistry.
What surprised you the most about the results?
Everyday dentistry can be very challenging. In my private dental clinic in Athens, I treat every patient who
walks through my practice doors. These patients in
need of tooth replacements often present with typical
risk factors for dental implant treatment—either local
ones such as periodontitis or general health conditions
such as osteoporosis or diabetes. These patients are
usually considered far from ideal dental implant candidates. Commonly, these patients are under medication, have poor oral hygiene or are heavy smokers.
Also, compliance—which is crucial for the longevity of
implants—among these patients is often not as high as
we would hope it to be.
Furthermore, even in “ideal” patients, we as practitioners cannot guarantee that their state of health will
remain the same in the future. For instance, I have had
patients who developed cancer and underwent intense medical treatments. These patients had dental
implants and the challenge was to follow them up appropriately. My long-term study included exactly these
sorts of patients that I treat daily in my practice. What
surprised me the most was that, even in these challenging cases, the two-piece Patent™ Implants investigated yielded remarkable results. The most remarkable was that, even after 12 years, no instances of
peri-implantitis and a very low number of cases of
peri-implant mucositis were found.
Why did you choose Patent™ as your implant system?
I was determined to find a tooth replacement solution
that works in the challenging cases I mentioned. It
was difficult to find a system supported by extensive

1/24

* The articles in this category are provided by the manufacturers or distributors and do not reflect the opinion of the editorial team.

Conducted in collaboration with the Medical University of Graz, a new independent study followed patients treated with the
two-piece Patent™ Dental Implant System for a minimum of five and up to 12 years and found no cases of peri-implantitis—
even in those with compromised health. The study was led by Athens-based implant specialist and researcher Dr Sofia Karapataki, and in this interview, she talks about the need for a reliable tooth replacement solution that works in challenging cases
too—and continues to perform well over the long term.

Interview with Dr Sofia Karapataki on
her new long-term study on Patent™ Implants

Compromised patients, yet no
peri-implantitis

interview*

[31] =>

research. To my surprise, I learned that fewer and fewer
implant systems today undergo comprehensive scientific
evaluation before they are introduced into the market.
This means less predictability and higher risk for patient
and surgeon alike. In contrast, Patent™ has been extensively investigated in scientific studies, including longterm clinical trials.

w h i t e

SKY

How can this be explained?
The key to success lies in the strong and intimate softtissue adhesion to the transmucosal surface of the Patent™
Implant, serving as an ideal defense barrier against bacteria. Additionally, fast healing has been observed around
Patent™ Dental Implants in studies, ensuring greater safety
in compromised patients, who typically show a pattern of
slower healing.

What is your conclusion based on these long-term results?
If Patent™ performs exceptionally well over the long term
in my pool of compromised patients, as both the study
findings and my clinical experience prove, then trust me:
The results will last everywhere! In my opinion, this system
is the best choice for every patient and dentist.

Aesthetic.
Functional.
Safe.
Reshaping clinical
and scientific success.

Dr Karapataki, thank you for the interview!

Patent

Irrtum und Änderungen vorbehalten

Why did you initiate this long-term study on two-piece
Patent™ Implants?
I found it remarkable how well this implant system performed in the patients encountered daily in my practice.
That is why I wanted to validate my clinical experiences and
analyse the performance of this tooth replacement solution
in a scientific setting. The study results speak for themselves: no peri-implantitis after up to 12 years, only 7.7% periimplant mucositis at the patient level, survival and success
rates of 100%, and no prosthetic complications.

Irrtum und Änderungen vorbehalten

* The articles in this category are provided by the manufacturers or distributors and do not reflect the opinion of the editorial team.

Following up on the Patent™ Implants you placed, what
did you observe?
I observed stable marginal bone levels and healthy softtissue completely free of inflammation during annual
recalls—even in patients with preexisting health conditions and poor oral hygiene. For instance, I observed
cases where the bone and soft-tissue around a Patent™
Implant remained unaffected by chronic tissue inflammation around both adjacent teeth, a sensational finding!

Dr Sofia Karapataki
Dr Sofia Karapataki
Adrianeiou 42
11525 Athens, Greece
+30 210 671138-0
bredent medical GmbH & Co. KG · Weissenhorner Str. 2 · 89250 Senden · Germany · T: +49
bredent
7309 872-600
medical· GmbH
F: +49 7309
& Co. 872-635
KG · Weissenhorner
· www.bredent-medical.com
Str. 2 · 89250 Senden
· @: info-medical@bredent.com
· Germany · T: +49 7309 872-600 · F: +49 7309 872-635 · w
pataki1811@gmail.com
bredent medical GmbH & Co. KG · Weissenhorner Str. 2 · 89250 Senden · Germany · T: +49 7309 872www.KarapatakiSofia.gr
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.
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

[32] =>

industry*

Z-SYSTEMS—a 17-year follow-up
Z-SYSTEMS

We aim to illustrate the outstanding long-term performance of Z-SYSTEMS’ zirconia implant through
two clinical cases. In both instances, a one-piece zirconia implant was utilised for a single-tooth restoration in the mandibular posterior region 17 years
ago. Following surgical insertion of the implant and
adaptation of the wound margin with single sutures,
the exposed implant abutment was shortened by
wearing off the outer hexagon. To protect the implant and its transgingival portion during the healing
phase, an impression of the situation was taken in
the same session to fabricate a protective temporary restoration. The
pro
tec
tive temporary restoration, made of non-precious metal, was designed
in the form of a double brace. It was manufactured
in the dental laboratory within 24 hours and bonded
to the adjacent teeth of the interdental gap on the
subsequent day. The temporary restoration was designed with a depression in the area of the implant
abutment to prevent external forces from acting on
the implant during the healing process.
Further aspects that need to be considered, parti
cularly in the mandible, are the biomechanical phenomena that occur in a unilateral loading situation
due to the protection of the surgical site. Implant
bed preparation primarily weakens the mandibular
segment in the region of the interdental gap and
subjects it to a greater torsional potential. This in
creased torsional potential in the affected area could
be detrimental to the osseointegration process of
the implant, representing a risk factor. By securely
bonding the protective temporary restoration to the
neighbouring teeth, it effectively splints and immobilises the mandibular segment that was weakened
by the implant placement, thereby counteracting
the torsional forces.

The two cases of single-tooth restoration using one-piece zirconia
implants are presented in the following:

Case 1

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* The articles in this category are provided by the manufacturers or distributors and do not reflect the opinion of the editorial team.

ian Dilmaghani, MSc Impl., established
his dental practice, namely Schifflände
GmbH, in 2005 in Basel, Switzerland and
was one of the first users of the zirconia
implant developed by Z-SYSTEMS.
He has extensive training in treating functional
disorders of the masticatory apparatus and the
musculoskeletal system. The focus of his pro
fessional expertise is the holistic approach to dental
care, a pivotal factor in his preference for zirconia.
Meanwhile, zirconia has solidified its position as
a widely accepted and trusted choice in implant
dentistry.

[33] =>

industry*

Case 2

* The articles in this category are provided by the manufacturers or distributors and do not reflect the opinion of the editorial team.

Conclusion
These two clinical cases demonstrate that long-term success
was achieved due to the surface quality and implant geometry
of Z-SYSTEM implants. Despite suboptimal implant placement, vestibular bone supply and prosthetic restoration, both
implants have maintained functionality for a period of 17 years!
In patient No. 1, the implant site in region 46 exhibited a vestibular bone deficit. While efforts were made to augment the
defect using autologous bone obtained during site preparation, which was covered with a mucoperiosteal flap, the primary complete wound closure was not possible due to the
transgingival portion of the implant. A comparable procedure with a titanium implant would be inconceivable. Additionally, the vertical position of the implant was suboptimal as
it could have been placed 1.5 mm lower.
In contrast to patient No. 1, the implant in patient No. 2 was
positioned approximately 1.5 mm under the recommended
margin. Consequently, the transition from the implant crown
to the implant shoulder was lower than the optimal biological

width of the adjacent teeth. Exposure of the implant shoulder by
lasering is not recommended, as this provokes unnecessary
mucosal scarring and reduces moisture penetration.
This underscores the exceptional biocompatibility of Z-SYSTEMS’
zirconia implants, which demonstrate remarkable resilience,
even in cases where suboptimal conditions were inadvertently
created. Indeed, this is a positive indication of the long-term stability of the implant site.

Kian Dilmaghani
MSc Implantology
Dental Practice Schifflände GmbH
Tanzgässlein 2
4051 Basel
Switzerland

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Kian Dilmaghani

[34] =>

events

“Ceramic implants—
State of the Art”

ISMI website

Annual congresses of ISMI successfully being
held in Hamburg
After the great success of the last year’s concept, this year the International Society of Metal-Free Implantology
(ISMI) once again joint forces with the German Society for Cosmetic Dentistry (DGKZ). On 3 and 4 May 2024
both societies invited to meet at EMPIRE RIVERSIDE Hotel in Hamburg, Germany. With a diverse and top-class
programme, the organisers were once again able to inspire numerous participants about the topics of ceramic
implants and aesthetic concepts.

U

nder the scientific direction of Dr
Karl Ulrich Volz, Kreuzlingen, Switzerland and Dr Dominik Nischwitz,
Tübingen, Germany for the ISMI
and Prof. Dr M
 artin Jörgens, Düsseldorf, Germany at the DGKZ, both congresses
offered participants an extremely complex, varied, and top-class programme that offered plenty
opportunities for an interdisciplinary exchange.
On Friday, the joint podium was moderated by
all three scientific leaders—Volz, Nischwitz and
Jörgens. The participants had the opportunity
to follow exciting lectures and to actively participate in the discussions. Afterwards ISMI and
DGKZ highlighted their core topics in individual
lecture blocks until the afternoon.

34

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[35] =>

events

At the ISMI pre-congress symposium, Dr Volz lectured on the topic
of “Modern ceramic implants in direct comparison”. Dr Niels Hoffmann, Leipzig, Germany presented his concept “Smile Makeover in
the digital workflow” in the DGKZ panel that took place at the
same time. Prof. Dr Thorsten M. Auschill, Marburg, Germany spoke
on the topic “Dark teeth, fluorosis, white spots and co.—How do
we treat these professionally today?”.
During the break between the first block and the following table
clinic sessions, the attendees of ISMI and DGKZ congress had the
opportunity to visit the accompanying industrial exhibition—collegial discussions and interdisciplinary exchange included.
In the second part of the day the participants could attend the
table clinic sessions. Here, proven experts in the field of ceramic implantology and aesthetic dentistry shared and discussed their special knowledge and experience with the participating colleagues.

blood concentrates, hyaluronic acid and the like do to
the periodontium?” A topic that was worth discussing,
and many participants brought up their questions and
own opinions in the subsequent discussion. The lectures by Prof. Dr Dr Dr Shahram Ghanaati, Frankfurt am
Main and Univ.-Prof. Dr Dr Ralf Smeets, Hamburg, both
Germany were very well received. Both caught up on
the topics of “Biologisation in Regenerative Dentistry”
and on “Comparison of the use of PRF, PRP, PRP with
hyaluronic acid, PRGF or hyaluronic acid alone—what
makes sense and when?”.
The second congress day continued with further lectures in two separated podiums. For ISMI, Dr Tobias
Wilck, Hamburg, Dr Robert Bauder, M.Sc., M.Sc., Kitzbühel, Austria, Dr Dr Michael Rak, Bernried, Germany
and DT Norbert Wichnalek, Augsburg, Germany shared
their knowledge and in the DGKZ podium Prof. Dr
Christian Gernhardt, Halle (Saale), Germany, Prof. Dr
Thomas Weischer, Essen, Germany, Prof. Dr Thorsten
M. Auschill, Dr Natalie Pütz, Halle (Saale), Germany and
Dr Antje Diederich, Halle (Saale), Germany were holding their highly interesting lectures.
Next year, both ISMI and DGKZ will again hold their
annual conferences together. The participants will then
meet on 9 and 10 May 2025 in Dorint Kurfürstendamm
in Berlin, Germany. Anyone interested should note the
date in their calendar now and can register for the pro
gramme at event@oemus-media.de.

The first day of the congress came to a successful conclusion with the
get-together in the industrial exhibition, where everyone involved was
able to end the evening in a relaxed manner with wine, music and of
course lively discussions between speakers, exhibitors, and participants.
The Saturday’s session of ISMI and DGKZ congress was all about
science in their corresponding fields, and was again presented in an
exciting joint podium from both associations. One of the highlights of
the morning was the lecture by Prof. Dr Nicole B. Arweiler, Marburg,
Germany who spoke about “Biologisation in periodontology—what can

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International Society of Metal
Free Implantology—ISMI
Bücklestraße 5 a
78467 Konstanz
Germany
info@ismi.me
www.ismi.me

[36] =>

events

EACim presents work and
shares knowledge at DCIC—
Dubai Ceramic Implant
Congress
A delegation of the EACim went to the “DCIC 2.0” conference organised by the IAOCI, chaired by Dr Sammy
Noumbissi from the USA, at Sheraton Dubai Creek Hotel & Towers on 25 April 2024. The EACim was represented by Prof. Andrea Enrique Borgonovo (Italy), Dr Olivier Henry-Savajol (France), Dr Philippe Duchatelard
(France), and President of EACim, Dr Giancarlo Bianca (France).

Dr Philippe Duchatelard

n his opening speech, Dr Noumbissi gave a wonderful travel
through the years of IAOCI, which was founded in 2010. He
spoke about the past conferences, the IAOCI research groups,
the +100 publications throughout the years, and about the impact of the pandemic which resulted in cancelling the congress
planned in New Orleans in March 2020 but also about the initiation
of the first virtual IAOCI congress in December of 2020. He mentioned the partnerships with the ACS (American Ceramic Society)
for its 11th World Congress in May 2022 in Washington, DC, his city
of heart and work, together with our EACim Academy, and the
brand new Japanese academy JAOCI (Japan Association Of Ceramic Implants) represented by Dr Masanobu Saito (Japan).
The choice of “2.0” in the title of these conference days in Dubai
indicates the significant evolution of ceramic implantology in 2024
with the increase of the available products by a larger number of
manufacturers, and the development of implant designs which join
the titanium implants, “Tissue Level”, “Bone Level” while preserving the one-piece.
Dr Saurabh Gupta (India) who is a reference in ceramic implantology
and digital flow, directly addressed the clinical issue with the title
of his lecture: “Are Ceramic Implants the revolutionary solution to
the ongoing challenges in Implant Dentistry?” After discussing on
peri-implantitis and the role of metal particles, he documented the
very favourable response of the soft tissues in contact with zirconia;
he showed the evolution of ceramic implant surfaces, especially the
roughness, at the nanometric scale, one of the key factors for success in his opinion. He will be part of our speakers on this topic at
our congress in Madrid.
Dr Vladimir Kokovic (UAE) spoke about: “Two-piece ceramic dental
implants in daily practice: 10 years experience”; he related his ex-

01
01
Dr Saurabh Gupta,
Dr Giancarlo Bianca,
Dr Philippe Duchatelard (from left).

perience with Straumann’s ceramic implant Pure Tissue Level
compared to the titanium homologue. He exposed his beautiful study published on the continuous increase of primary
stability assessed using ISQ for this implant. “A new generation of ceramic one-piece implants based on long-term evidence” was the topic of the lecture of Prof. Borgonovo. He
showed the design evolution of one-piece implants in the
range of products of his use (bredent medical) with a clinical
experience of more than ten years, and the opportunity of
having reliable two-part options for the molars. He concluded
that this choice was realistic, not just imaginative! Dr HenrySavajol joined his partner and friend of the Loma Linda University (California), Sammy Noumbissi. After recalling this

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[37] =>

events

02
02
Discussion
between
colleagues.

03
03
Dr Philippe
Duchatelard,
Dr Giancarlo Bianca
and Prof. Andrea
Enrique Borgonovo
(from left) meet at
DCIC 2.0.

04
Dr Sammy
Noumbissi and
colleagues in
discussion.

04
05
Dr Sammy
Noumbissi
holding his
lecture.
06
Dr Saurabh
Gupta.
07
Prof. Andrea
Enrique
Borgonovo.

05

06

07

08

09

08
Dr Olivier
Henry-Savajol.
09
Attendees of
DCIC 2.0.

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37

[38] =>

events

10
Dr Adina
Landschoof.
11
Dr Regeane
Kaniak.

period, and actually in charge of the EACim’s international relationships, he presented our academy to the attending participants. His
topic, “Full-arch immediate loading on ceramic implants”, showed
the use of bone-level (Z-SYSTEMS) ceramic implants for a full-arch
rehabilitation using fixed ceramic prostheses on eight implants in
the maxilla, with three years of follow-up, and after sharing his experience with titanium implants for this type of prosthesis.
The next session was moderated by Dr David Roze (UAE), and
opened the stage to two strong ladies in ceramic implantology. At
first, Dr Adina Landschoof (Germany) exposed her everyday practice using zirconia implants, and showed the quality of the contacting soft tissues during her lecture: “The beauty of soft tissue around
white implants”. The calligraphic style of her titles, the quality of the
iconography revealed her keen sense of aesthetics, and a feminin
approach to the topic. Dr Regeane Kaniak (Brazil) was holding her
lecture basing on a highly sensitive issue on osteoimmunolgy (Arron and Choi): “Osteoimmunology and bone metabolism are important factors to avoid osseointegration failures”. She managed to
captivate the audience with her enthusiasm, and shared her vast
knowledge on those current topics: the oxidative stress and osteonecrosing cavitations, BMDJ (bone marrow defects in the jawbone),
FDOJ (fatty degenerative osteonecrosis in the jawbone) with
RANTES (regulated on activation, normal T cell expressed and secreted), and other cytokines CCL5 (chemokine with chemotaxis effect and immune activation). She concluded that titanium particles

13
12
The congress
attendees.

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13
Dr Vladimir
Kokovic (left) and
Dr David Roze.

[39] =>

events

are immunogenic, not allergic. She is the Portuguese translator
of Dr Johann Lechner’s book Cavitational osteonecrosis in jawbone, also translated into French by Dr Joseph Choukroun
and Dr Jérôme Surmenian.
The last lecture was held by Dr Iyad Abou-Rabii (France) and
titled: “Beyond metal: exploring the effectiveness of ceramic
dental implants”. After a synthetic recall on the mechanical,
physicochemical, and biological properties of zirconia, he shared
his clinical experience illustrated by several single- or multi-unit
implants with high confidence in the strength of the one-piece
implants which he uses. After all lectures, a Q&A session with
the audience allowed to share on various issues (problems) of
this practice, such as, the maximum insertion torque for ceramic
implants.
Dr Noumbissi concluded the day by expressing the wish of a
greater cooperation between the American and European ceramic implant academies for promoting research and the development of this practice. We join this wish, and greatly thank him
and his team for all the work performed to organise this symposium, and for his kind invitation to participate, as well as for promoting ceramic implantology.
A pleasant and friendly evening organised by Dr Kokovic in the
form of a mini cruise in the Marina of Jumeirah allowed us to ap-

preciate the overwhelming architectural dynamism of Dubai and
its incredible all lit up “sky line” of sky-scrapers…
Dr Philippe Duchatelard Past President and Ambassador for
France

EACim website

European Academy of
Ceramic Implantology (EACim)
65, avenue du Prado
13006 Marseille
France
+33 491 530105
secretairegeneral@eacim-ceramic-implantology.com
www.eacim-ceramic-implantology.com

AD

www.zwp-online.info

#innovative
#creative
#unique
Holbeinstraße 29 · 04229 Leipzig · Germany
Phone: +49 341 48474-0 · info@oemus-media.de
© LanaSham – stock.adobe.com

[40] =>

events*

European Society of Ceramic
Implantology (ESCI) presents
its satellite symposium
“Ceramic Implantology” at the 6th Implant Congress
of the Implant Foundation Switzerland

rom 19 to 21 September 2024, the 6th Swiss Implant Congress of the
Implant Foundation Switzerland will take place at Kursaal Bern, Switzerland, on the topic of implant health. With 600 to 800 participants expected, this is the largest implant congress in Switzerland. It is organised
and held jointly with the four Swiss universities in Switzerland and the
societies of SGI, SSOS, SSP and SSRD. The congress takes place every three years
and includes a practice-oriented programme with many applications for everyday
life as well as an industry exhibition.
The European Society of Ceramic Implantology—ESCI is delighted to have been
invited to present its satellite symposium “Ceramic Implants” in the afternoon of
Thursday, 19 September 2024. Ceramic implantology is thus taking another important step towards general recognition as an important component of dental implantology. The ESCI symposium will provide an extended platform to present the latest
developments and groundbreaking research results in the field of ceramic implantology. Participants will also be able to familiarise themselves with the various implant systems through clinical case presentations.
The symposium brings together leading experts in ceramic implantology to provide
insights into the current trends, challenges, and opportunities in this emerging field.

Symposium

SCIENTIFIC LECTURES

Part 1

About ESCI:
The European Society of Ceramic
Implantology—ESCI is a leading international professional society dedicated to promoting research, education, and innovation in the field of
ceramic implantology. Through collaboration with experts from various
disciplines, ESCI strives to improve
patient care and further raise standards in ceramic implantology.

In the first part of the symposium, evidence-based backgrounds, and the latest study results
of ceramic implantology will be presented in detail in exciting scientific presentations. The
focus will be on the scientific underpinning of clinical applications in practice.

Prof. Ronald Jung
Dr Jens Tartsch

Welcome, Opening Symposium

Dr Jens Tartsch

Ceramic implants—just a trend?

Dr Stefan Röhling

Ceramic implants—a reliable alternative in everyday practice?

Prof. Ralf Kohal

Ceramic implants—stable enough for clinical use?

Dr Frank Maier, M.Sc.

Hard and soft-tissue management around ceramic implants

Prof. Andrè Chen

Digital Workflow with ceramic dental implants (en)

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* The articles in this category are provided by the manufacturers or distributors and do not reflect the opinion of the editorial team.

Dr Jens Tartsch

[41] =>

events*

The second part is a special feature in collaboration with the ESCI company partners:
In the session “my approach with...”, long-standing users will present “their” implant systems and
share their personal experiences with the auditorium—based on clinical cases. Participants will receive a comprehensive overview of the current ceramic implants and their possible applications.

Symposium

* The articles in this category are provided by the manufacturers or distributors and do not reflect the opinion of the editorial team.

CLINICAL LECTURES

Part 2

Dr Jens Tartsch

my clinical approach with ... Zeramex XT and Nobel Pearl

Prof. Sebastian Kühl

my clinical approach with ... Straumann Pure

Dr Frank Maier, M.Sc.

my clinical approach with … CERALOG

Dr Lars Börner

my clinical approach with ... Z-SYSTEMS
my clinical approach with … Patent

The ESCI Satellite Symposium thus offers a unique opportunity for dentists,
oral surgeons, researchers, and industry partners to gain an in-depth insight
into the world of ceramic implants, expand their implantological expertise,
their network and help shaping the future of ceramic implantology. The
Symposium will also help to further increase the successful use and acceptance of ceramic implants.
Take advantage of this unique opportunity to combine the ESCI Satellite
Symposium and the Swiss Implant Congress, which will present further
top-class speakers such as Prof. Bilal Al-Nawas, Prof. Tomas Albrektsson,
Prof. Giovanni E. Salvi, Prof. Hannes Wachtel and others! Register today!

For the Symposium the number of participants is limited, an early registration is recommended. Registration for the ESCI Satellite Symposium is possible with or without
the registration for the 6th Swiss Implant
Congress. The symposium is free of charge
for ESCI members. The congress language
is German.

Dr Frank Maier
M.Sc., Dr Stefan
Röhling,
Dr Jens Tartsch,
Prof. André Chen,
Prof. Ralf Kohal
(from left).

Registration

European Society of Ceramic
Implantology—ESCI
Kreuzstraße 2
8802 Kilchberg, Switzerland
+41 44 7154877
info@esci-online.com
www.esci-online.com

Further information on the programme and registration can be
found on the official website of the 6th Implant Congress of the
Swiss Implant Foundation www.implantatstiftung.ch/kongress
or the ESCI website www.esci-online.ch.
We look forward to an exciting afternoon with you!

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[42] =>

events*

Long-awaited Digital
Dentistry Show to premiere
in Berlin in June 2024

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 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

02
Located in Berlin’s
Alt-Treptow inner-
city district, the
6,500 m2 Arena
Halle offers
high-quality
professional
infrastructure.

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!

1/24

* The articles in this category are provided by the
manufacturers or distributors and do not reflect
the opinion of the editorial team.

ow 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.

[43] =>

events*
01
The 2024 Digital
Dentistry Show will offer
cutting-edge knowledge
and skills that will help
dental professionals
better navigate technological advancements
in the field.

* The articles in this category are provided by the manufacturers or distributors and do not reflect the opinion of the editorial team.

01

03
The Badeschiff
is a picturesque
floating public
swimming pool
area overlooking
the Spree river.

03

04

04
The Escobar is an
extension of the
Badeschiff
that includes a
covered bar area.
05
Attendees will
also have access
to the Sonnendeck of the
Escobar, where
they will be able
to enjoy delicious
food and drinks.

More information on registration and
the scientific programme can be found
at www.dds.berlin. Admission to the
event is free of charge.
Fotos: © Markus Nass

05

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43

[44] =>

CleanImplant Foundation:

Celebrating extended and new “TRUSTED
QUALITY” awards for oral implants from dedicated
implant manufacturers. More and more implant
manufacturers recognise the value that the
CleanImplant award brings to practitioners
and their patients.

T

he 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 peerreviewed analysis and testing reflects a manufacturers’ commitment to ensuring surface
cleanliness, a possible X factor in failed osseointegration. The Trusted
Quality seal remains in place for a two-year cycle after which

44

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* The articles in this category are provided by the manufacturers or distributors and do not reflect the opinion of the editorial team.

manufacturer news*

[45] =>

AD

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 “Long-Term Proven Excellence” recognising
companies’ continued pursuit of perfection in quality for their client base.”
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.

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.

* The articles in this category are provided by the manufacturers or distributors and do not reflect the opinion of the editorial team.

Made in Switzerland - since 2005

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.”
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 (Champions-Implants),
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).

life
time

Barbara Sonntag
CleanImplant Foundation
Corporate Media Relations
Sonntag@CleanImplant.org
+49 30 200030190

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Implants

10
years
Secondary parts
Vicarbo screw

www.zeramex.com

[46] =>

manufacturer news*

New design and layout of ceramic implants
magazine—a new standard for dental publications
impact. Large, high-resolution images draw the reader’s eye, while
smaller, supporting photos provide additional context, making the
content both informative and captivating.
The new cover design offers unprecedented flexibility, allowing for
personalised and thematic covers for each issue. The cover’s soft
and smooth texture, achieved through special paper and finishing
techniques, provides a tactile experience that is as pleasing to touch
as it is to see. This attention to material choice enhances the magazine’s premium feel, reflecting the sophistication and quality of
ceramic implants.
The magazine’s new layout aligns with the
overall refreshed look of OEMUS
MEDIA AG publications,
reinforcing the brand’s commitment to high standards
in both content and presentation. The redesigned ceramic implants is a testament
to OEMUS MEDIA AG’s dedication to innovation, ensuring
that readers receive the most
relevant, up-to-date information in a format that is both
engaging and educational. This
new design marks a significant
step forward, promising a richer
© Sde
coretM
ockup
reading experience for dental
– s to c
k.ado
b e.co
professionals worldwide.
m

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

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* The articles in this category are provided by the manufacturers or distributors and do not reflect the opinion of the editorial team.

The latest edition of ceramic implants features a fresh, innovative
design that sets new standards for dental publications. This redesign is more than just a visual update; it includes functional improvements that enhance the reader’s experience.
A standout feature is the dynamic use of different photo sizes in case
displays. This approach creates an engaging and visually appealing
presentation of clinical cases, highlighting details with clarity and

[47] =>

manufacturer news*

* The articles in this category are provided by the manufacturers or distributors and do not reflect the opinion of the editorial team.

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 lasting 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!

Zibone Zirconia Medical Device service team
COHO BIOMEDICAL TECHNOLOGY CO., LTD.
Taiwan
+886 3311 2203
info@zibone.com
www.zibone.com

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.

bredent medical GmbH & Co. KG, Germany
info@bredent.com
www.bredent-implants.com

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.

1/24

[48] =>

news*

Guideline on
Ceramic Implants:
The German Association of Oral Implantology
presents internationally the first guideline on this
topic

itanium implants as dental prostheses have been
scientifically recognised in Germany since 1982
and have become an established option for patients following tooth loss. Extensive prospective
long-term studies and experience have made
them the gold standard in oral implantology. Nevertheless,
many patients desire alternative treatment concepts with ceramic implants. Today, zirconia is the standard material for
these implants.
Important: The manufacturer’s competence. Unlike titanium implants, the essential properties of ceramic implants depend on
the individual production processes of the manufacturers and
the type and number of chemical additives used. Zirconium dioxide stabilised with the chemical element yttrium is now the
most commonly used variant due to its special mechanical
properties. The latest generation of ceramic implants also contains small amounts of aluminium oxide to increase flexural
strength. However, the manufacturing process is equally important. “The manufacturer’s expertise plays a significant role
in ceramic implants,” emphasise the experts.
The problem: lack of long-term data. The biggest issue when
experts want to assess the quality and stability of ceramic implants is the lack of long-term data from studies. Advanced production methods, successor models with altered material compositions, and the discontinuation of implant types used in
studies delay the acquisition of knowledge.
Research continues. “Despite promising material properties,
the development of even more powerful ceramics does not
seem to be complete,” write the authors of the guideline. Optimised manufacturing processes and methods to provide implants with microrough surfaces, for example, appear to have a

crucial impact on their long-term stability. Challenging conditions for guideline development. As positive as the continuous
development of implant systems is, it poses problems for guideline work. The first statement of the experts in the new guideline
states: “The long-term stability of zirconium dioxide-based
ceramic implants beyond five years cannot be conclusively assessed due to the lack of clinical prospective long-term study
data yet.”
The second statement provides the rationale: the material composition, like the respective workpiece quality, is manufacturerdependent and thus multivariate. Dynamic material modernisations and design changes often lead to replaced product
innovations, reducing the value of existing study data.
The good news in Statement 3, a setback in Statement 4: Preclinical and clinical studies point to a similar behaviour in the osseointegration of ceramic and titanium implants (Statement 3).
However, due to the current scientific evidence, an evidence-
based statement regarding plaque accumulation and periimplantitis risk in treatment with ceramic implants is not possible (Statement 4).
Ceramic implants can be recommended as an alternative therapy option. Despite all the difficulties, the experts emphasise in
their first of two recommendations that commercially available
monolithic ceramic implants based on zirconium dioxide, with
success and survival rates positively evaluated in scientific studies, are a valid and mature therapy method and can be recommended as an alternative therapy option.
No final judgement on two-piece ceramic implants. Regarding
the still “young” two-piece ceramic implants, the experts have
formulated their second recommendation: “Commercially avail-

1/24

* The articles in this category are provided by the manufacturers or distributors and do not reflect the opinion of the editorial team.

“One-piece ceramic dental implants based on zirconium dioxide, whose success and survival rates have been
positively evaluated in scientific studies, are a valid and mature therapy method and can be recommended as
an alternative therapy option.” This is recommendation number one from experts from 18 scientific societies
and organisations under the leadership of the German Association of Oral Implantology (Deutsche Gesellschaft
für Implantologie—DGI e.V.), who have developed the world’s first guideline on ceramic implants.

[49] =>

news*

02
Ceramics also play a role in
a new DGI guideline, which
was developed in 2024 and
coordinated by Prof. Stefan
Wolfart, Aachen, Germany.
However, this is about the
choice of material for fixed
implant-supported
restorations.

* The articles in this category are provided by the manufacturers
or distributors and do not reflect the opinion of the editorial team.

01
DGI guideline conference 2021:
Prof. Dr Dr Knut A. Grötz,
Wiesbaden, Germany (right),
coordinates the development
of the guideline on ceramic
implants, assisted by Prof.
Dr Christian Walter, Mainz,
Germany.

03
More than 50 delegates from
18 scientific medical and dental
associations take part in the
DGI’s guideline conferences—
as here in 2021.

03
04
After discussing
a guideline, the
delegates vote.

able two-piece ceramic implants based on zirconium dioxide appear to be a therapy option for
replacing missing teeth. However, a final assessment is not possible due to the low level of evidence from clinical studies.”
Special clarification required. Therefore, the experts
emphasise that a special clarification is necessary
when discussing with patients, where the therapy
with two-piece ceramic implants—compared to that
with titanium implants—is explained and highlighting the issue of the lack of long-term data so far.

Prof. Dr Dr
Knut A. Grötz

Coordinator:
Prof. Dr Dr Knut A. Grötz
Lead author: Dr Dr Daniel Thiem
Dr Dr Daniel Thiem

DGI e.V.
Rischkamp 37 F
30659 Hanover
Germany
www.dginet.de/web/dgi/leitlinien

1/24

[50] =>

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[52] =>

WE FIGHT DIRTY.
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BlueDiamond – MEGAGEN
s-Clean SQ-SL – DENTIS
AnyRidge – MEGAGEN
SuperLine – DENTIUM
T6 torQ – NUCLEOSS
In-Kone – GLOBAL D
T6 – NUCLEOSS
UnicCa – BTI

Scanning electron microscope images (BSE mode) of new implants after unboxing – Both implants were sterile packaged, FDA labeled and ready for clinical use.

Sterile does not mean clean. Far too many implant systems have
concerning residual surface contaminants.

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[cover] => ceramic implants international No. 1, 2024

[toc] => Array ( [0] => Array ( [title] => Cover [page] => 1 ) [1] => Array ( [title] => Editorial + content [page] => 3 ) [2] => Array ( [title] => Two-piece ceramic implant: Customised, fully digital solution for highly aesthetic results in the anterior region [page] => 6 ) [3] => Array ( [title] => Robotic facilitation of ceramic implants in compromised alveolar ridges [page] => 12 ) [4] => Array ( [title] => Reconstruction of a maxillary lateral incisor [page] => 16 ) [5] => Array ( [title] => Full-arch: Full rehabilitation of the upper jaw—Part 2 [page] => 22 ) [6] => Array ( [title] => Compromised patients, yet no peri-implantitis [page] => 30 ) [7] => Array ( [title] => Industry [page] => 32 ) [8] => Array ( [title] => Events [page] => 34 ) [9] => Array ( [title] => Manufacturer news [page] => 44 ) [10] => Array ( [title] => News [page] => 48 ) [11] => Array ( [title] => Imprint [page] => 50 ) ) [toc_html] =>

Table of contents

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