today EAO Annual Scientific Meeting Milan Oct. 24–26, 2024

today EAO Annual Scientific Meeting Milan Oct. 24–26, 2024

Details make perfection at EAO meeting in Milan / CleanImplant Foundation: The mission is at full throttle / “We should aim to minimise bone augmentation whenever possible” An interview with Dr Giovanni Zucchelli. / “It’s all about wound healing” Dr Otto Zuhr offers perspectives on the latest advancements in soft-tissue management. / “Moving away from money-driven implantology to patient-centred care” An interview with Dr Tiziano Testori about the shift towards a more conservative and ethical approach to implantology. / “We are really pushing the limits of what is possible” An interview with Profs. Rubens Spin-Neto and Donald Tyndall about dental dedicated magnetic resonance imaging. / Immediate loading protocols are supporting global expansion of dental implants: Rising popularity of immediate loading reflects growing demand for efficient approaches. A report by Hanieh Valipour & Dr Kamran Zamanian, iData Research / News: Impact of nicotine-containing products on peri-implant health / News: Implant planning made easier with 3D-printed shell complete dentures / News: Antibiotic use in implant dentistry: A call for standardised guidelines / News: Could citric acid save dental implants affected by peri-implantitis? / Unconventional applications of dental 3D printing: A novel two-piece 3D-printed screw-retained provisional implant restoration. by Dr Andrew Ip, Australia / Laser-assisted protocol for the treatment of peri-implantitis: A long-term retrospective case series. By Drs Gary M. Schwarz, David M. Harris & Gregori M. Kurtzman, US / News: Study reveals healing abutment reuse in residency programmes; Early results indicate robotic dental implant system is quite accurate / Industry news / What’s on in Milan, 24–26 October: Eight exciting things to do in the city this week. / Useful information for and networking opportunities at EAO 2024

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Interview
EAO speaker Dr Tiziano Testori from Italy talks
about the shift towards a more conservative
and ethical approach to implantology.

» page 10

© Noppasin Wongchum/Shutterstock.com

31 st EAO Annual Scientific Meeting • Milan • 24–26 October 2024
Market report

Dental products in focus

The rising popularity of immediate loading
reflects the growing demand for efficient and
patient-centred approaches.

The EAO meeting is an excellent o pportunity
to see the most up-to-date innovations in
implant dentistry.

» page 14

» page 26

Details make perfection at EAO meeting in Milan
Global experts converge to discuss advancements that push the boundaries of osseointegration.
n The annual scientific meeting
of the European Association for
Osseointegration (EAO) is one of
Europe’s premier platforms for
dental professionals to exchange
knowledge, network with peers and
discover the latest advancements
in implant dentistry, particularly
concerning osseointegration. With a
focus on both fundamental practices
and innovative future approaches,
the congress caters to a range of
attendees, from emerging professionals to seasoned experts. Themed
“Details make perfection”, this
year’s event provides a blend of
educational sessions, hands-on workshops and engaging debates aimed
at advancing knowledge in implant
dentistry.
In an interview with Dental Tribune
International ahead of the congress,

© Noppasin Wongchum/Shutterstock.com

renowned periodontist Dr Otto Zuhr
expressed his enthusiasm for the
event: “I am particularly excited
about the focus on peri-implantitis
treatment and the role of digital technologies. The live surgery demonstra-

tion on vertical hard-tissue defects
will be a highlight, offering practical
insights into a complex and increasingly relevant area of implant dentistry.” [Read the complete interview
on page 8]
The congress is being held
jointly by the EAO and two pres
tigious Italian organisations: the
Italian Academy of Osseointegration
(IAO) and the Italian Society of Periodontology and Implantology (SIdP).
Together, they are hosting sessions
combining their respective scientific perspectives to address pressing
clinical challenges.

A multifaceted scientific
programme

This year’s congress is structured around a core theme for each
of the three days: “The fundamentals”, “State of the art—certainties”
and “Beyond the limits”. These
themes reflect the evolving nature
of dental implantology, and the programme covers both the foundational
elements of the field and its future
potential.

5

Impressions from last year’s European Association for Osseointegration meeting in Berlin in
G ermany. (All images: © EAO)

Dr Giovanni Zucchelli, co-chair of
the scientific committee, highlighted
the significance of this year’s meeting: “The EAO congress is a tremendous opportunity not just for Italian
societies but for the entire global
dental community. With the theme
‘Beyond the limits’, we are looking
forward to exploring new horizons in
implant dentistry, particularly how
we can overcome current challenges
and limitations in osseointegration
treatment.” [Read the complete interview
on page 6]

The first day, dedicated to
“The fundamentals”, will include
in-depth discussions on essential
topics such as osseointegration,
implant surface characteristics and

treatment planning. Under the title
“My first implant”, a hands-on session
organised by the EAO Junior Committee
 page 2
AD

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news

About the EAO
The EAO was founded in the late
1980s subsequent to a meeting
in Munich in Germany organised
by Prof. Per-Ingvar Brånemark,
the father of modern implantology.
Concerned scientists, teachers
and clinicians gathered to address the growing influence of
commercial companies on osseo
integration and the lack of critical
academic scrutiny in the field.
They recognised the need for a
forum where innovative work on
reconstructive surgery and prosthetic rehabilitation could be presented with a scientific and clinical
focus. The EAO was established
to cover a wide range of medical
and dental disciplines, including
orthopaedics, periodontics and
maxillofacial reconstruction, and
held its first annual meeting in
Leuven in Belgium in 1992, attracting over 500 attendees from
26 countries.
Since its inception, the EAO has
grown significantly, its recent
congresses attracting more than
4,000 participants and membership expanding to over 2,000. In
1993, the association designated
Clinical Oral Implants Research
as its official journal, further
enhancing its scientific influence.
The EAO has maintained strict
independence from commercial
sponsors, ensuring high scientific
standards at its meetings. Although
its original focus included appli
cations beyond the mouth, over the
years, its annual meetings have
concentrated on clinical advancements in osseointegration. The
board meets regularly to strategise and engage with the growing
membership base, maintaining the
EAO’s reputation as a leading forum
for scientific and clinical excellence
in the field.

 page 1
will provide theoretical and prac
tical insights into successful implant placement and complication
management for newer practitioners.
Focused on “State of the art—
certainties”, the second day will
bring together experts to discuss
up-to-date, evidence-based practices.
Speakers will explore certainties
in implant dentistry, sharing techniques that can be immediately applied in clinical settings. Key topics
will include peri-implantitis treatment, digital workflows and guided
surgery techniques.
The final day, themed “Beyond
the limits”, will address the future
of implantology and its exciting
possibilities. Debates will focus on
overcoming current limitations in
osseointegration and exploring advancements in the use of artificial
intelligence in dental practices.
The official language of this
year’s EAO congress is English,

though interpretation into Italian
and other languages will be available for select sessions. A special
programme for dental hygienists
will take place on Saturday, 26 October,
and will be presented in Italian by
the IAO and SIdP.

A global line-up
of experts

The congress is renowned for
its international speaker line-up,
and this year is no exception.
More than 70 experts from across
the globe will share their research,
experience and predictions on the
future of implant dentistry. Notable
names include Prof. Daniel Buser
and Vincent Fehmer from Switzerland,
Prof. Mariano Sanz from Spain and
Dr Massimo Simion from Italy.
Their sessions will highlight the
latest scientific findings and clinical
innovations, providing attendees
with a well-rounded update in the
field.

Industry innovations
and hands-on opportunities

One of the highlights of the
congress is the exhibition, at which
industry leaders are showcasing

cutting-edge products and technologies aimed at advancing dental practice. Companies such as Straumann,
Nobel Biocare, Dentsply Sirona and
Geistlich Pharma will host industry
forums, offering insights into their
latest research and development initiatives. Attendees will have opportunities to participate in hands-on
workshops, where they will test
new materials and tools and learn
innovative techniques to improve
patient care.
The Young Generation Session,
scheduled for Thursday, 24 October, is another highly anticipated
feature. This session aims to inspire
the next wave of dental innovators,
and young professionals have been
invited to present their cases in
a competition setting. The focus of
this year’s challenge, “Simplification through innovation”, encourages participants to demonstrate
how innovative techniques can
simplify complex dental procedures.
For those looking to expand
their practical skills, hands-on workshops are being offered with support

31 st EAO Annual Scientific Meeting · Milan

from sponsors such as BioHorizons
Camlog, Osstem Implant and
HuFriedyGroup. These sessions are
designed to provide clinicians with
the tools they need to refine their
surgical techniques and improve
clinical outcomes. 7

In 2025, the congress will be
held in Monaco from 18 to
20 September.
More information about the congress can be found online at
congress.eao.org.

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today will appear at the 31st EAO Annual Scientific
Meeting in Milan, 24–26 October 2024. The n ewspaper
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industry

CleanImplant Foundation: The mission is at full throttle
Promoting awareness of clean implant surfaces.
5

F ig. 1: Dr Dirk U. Duddeck, the managing director and head of research at the CleanImplant
Foundation. Fig. 2: CleanImplant Certified Dentist
d isplay this year. Fig. 3a–c: Surface
contamination on sterile-packaged implants.

courses globally. Their valuable efforts
have illuminated factory-related contaminants on implant surfaces as a
critical risk factor in implant failure.
All dentists are encouraged to join the
initiative as members, contributing
to a unified and stronger voice in
advocating for independently tested
and reliable medical devices.

Contaminants
on implant surfaces
1

n The CleanImplant Foundation is
dedicated to improving the safety
and quality of dental implants. Independent studies have shown that
far too many implant samples are
contaminated by manufacturing processes, packaging procedures or the
packaging itself. The CleanImplant
Foundation’s mission is to raise

awareness about factory-related contaminants on implants.
The non-profit organisation conducts objective periodic quality assessments of implant systems in the
global marketplace. These comprehensive inspections, carried out every
two to three years, are independent of

any manufacturing influence. To date,
over 300 implant systems from leading
brands have been analysed, revealing
alarming findings: nearly one in three
samples contained residues from
manufacturing processes or packaging
contamination.
Dr Dirk U. Duddeck, the managing
director and head of research at the
CleanImplant Foundation, commented:
“We are committed to protecting practitioners and their patients from un
reliable medical devices, ensuring that
they benefit from high-quality dental
implant treatments. That is why we
will be present at the annual congress
of the European Association for Osseo
integration. Our booth (#D16) will be
the place to learn more about our history, research and passion for ethical
standards of care.”

The global mission

The CleanImplant Foundation is
proudly represented in North America
by Dr Ken Serota with an office in
New York. Recently, the company
opened an office in Seoul in South
Korea under the leadership of Dr Dana
Adyani-Fard. The company’s growing
community includes over 170,000 dental
professionals worldwide who engage
with it on social media to navigate
the complexities of the implant marketplace. “These dedicated colleagues
are laser-focused on ensuring the
safety of their practices and patients,”
stated Dr Duddeck.

The initiative has the backing
of over 50 international ambassadors
and numerous prominent key opinion leaders, who actively disseminate
current assessment results at congresses and continuing education
5

Using advanced scanning electron
microscopy and time-of-flight secondary
ion mass spectrometry, independent
studies have detected particles of
polysiloxane, thermoplastics and other
synthetic polymers, among others, on
implant surfaces. Additionally, analyses have identified thin film residues
of substances such as dodecylbenzenesulphonic acid (DBSA), an aggressive
and surface-active chemical cleaning
agent, and the quaternary ammonium
compound didecyldimethylammonium
chloride (DDAC), which is commonly
used as a biocide and pesticide. With
appropriate manufacturing controls
and packaging techniques, these substances should not be detectable on
sterile-packed implants.

Passion for ethical standards

The CleanImplant Foundation
acts as an intermediary, bridging the
legitimate expectations of patients
and providers with the quality assurance processes of medical device
manufacturers. Through its initiatives, it has frequently identified previously unrecognised deficiencies in
manufacturing and packaging, leading to significant and lasting improvements in production protocols. The
shared commitment to the fundamental medical ethics principle of primum non nocere (first, do no harm)
highlights the collaborative approach
the foundation takes in working with
its partners and manufacturers.
Moreover, understanding the implications of residues of pesticides such as
DDAC and of cytotoxic and hazardous surface-active agents such as
DBSA on sterile-packaged implants
intended for patient use is critical to
ensuring product safety and efficacy.

Awards and certifications

“Trusted Quality” mark: This award
guides dentists in selecting reliable
implant systems. The mark is awarded
to implant systems that meet the
CleanImplant quality seal criteria established by the consensus recommendation of the foundation’s scientific
advisory board in 2017. These criteria
are recognised as the de facto standard
for cleanliness in implantable devices.
Currently, 18 implant systems hold the
“Trusted Quality” mark.
“Certified Production Quality”:
This certificate demonstrates superior
quality management by contract manufacturers of implants.

Fig. 4: Officially accredited laboratory for scanning electron microscopy imaging. Fig. 5: CleanImplant
Ambassadors’ Summit 2023 in Berlin in Germany. (All images: © CleanImplant Foundation)

31 st EAO Annual Scientific Meeting · Milan

“Approved by CleanImplant” seal:
This seal indicates outstanding properties of medical devices, digital technology, software, implant care products
or technologies proved to support
successful clinical outcomes in dental
implantology. To date, the SDSBOX
(Swiss Dental Solutions), ACTILINK
(Plasmapp) and SDS AIM (Swiss Dental
Solutions) have received this seal.
“CleanImplant Certified Dentist”:
More than 500 dentists and dental
clinics worldwide are registered
as CleanImplant Certified Dentists,
reaping significant benefits from this
membership, including attracting
new patients. 7
Editorial note: More information can be found
at www.cleanimplant.org. EAO visitors have
the opportunity to learn more at the company’s
booth (#D16).

CleanImplant Foundation
at a glance
The CleanImplant Foundation is
a non-profit organisation founded
in 2016 by dentist and biologist
Dr Duddeck and headquartered in
Berlin in Germany.
The CleanImplant Foundation performs regular quality assessment
studies in collaboration with prominent universities, employing rigorous testing in specialised laboratories. Following a strict peer-review
process, implant systems that
meet the company’s standards
are awarded the “Trusted Quality”
mark, devices or technologies
with outstanding properties that
support successful clinical outcomes receive the “Approved by
CleanImplant” seal and dentists can
become members—CleanImplant
Certified Dentists.
The members of the CleanImplant
Foundation’s scientific advisory
board are Prof. Ann Wennerberg
(Sweden), Prof. Tomas Albrektsson
(Sweden), Dr Michael R. Norton (UK),
Prof. Hugo de Bruyn (Netherlands),
Prof. Florian Beuer (Germany),
Prof. Jaafar Mouhyi (Morocco),
Dr Luigi Canullo (Italy) and Dr Scott
D. Ganz (US).
Current “Trusted Quality” implant
systems are AnyRidge (MegaGen),
Astra Tech EV (Dentsply Sirona),
BLUEDIAMOND IMPLANT (MegaGen),
ICX-PREMIUM (medentis medical),
In-Kone (Global D), INVERTA (Southern
Implants), Kontact W (Biotech Dental),
(R)Evolution (Champions-Implants),
s-Clean SQ-SL (DENTIS), SDS1.2
and SDS2.2 (Swiss Dental Solutions),
Spiral SB/LA (Ritter Implants),
SuperLine (Dentium), T6 and T6
Torq (NucleOSS), UnicCa (BTI Biotechnology Institute), whiteSKY
(bredent medical) and ZENEX
(IZEN IMPLANT).

[5] =>

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interview

“We should aim to minimise bone augmentation whenever possible”
An interview with Dr Giovanni Zucchelli.
By Nathalie Schüller, Dental Tribune International
soft-tissue thickness and improving
the soft-tissue management, the clinician can usually avoid bone augmentation. Have things changed?
I think that many things have
changed in the last five years. There
has been a growing recognition of
the critical role soft-tissue management plays in implantology. While
bone augmentation remains important, soft-tissue augmentation often
achieves optimal outcomes without
the need for additional bone procedures. Managing soft tissue becomes
more complex when performing
bone augmentation, and for that
reason, we should aim to minimise
bone augmentation whenever pos
sible.

Dr Giovanni Zucchelli is the scientific committee co-chair of this year’s EAO congress.

n Ahead of EAO congress, Dr Giovanni
Zucchelli, who is a co-chair of the
scientific committee, spoke with

Dental Tribune International about

the major areas of discussion at this
year’s event. In this interview, he
talks about significant advancements
in the field of implantology and the
value of the event for attendees.
Dr Zucchelli as a past president of the
Italian Academy of Osseointegration
and as a co-chair of the EAO congress, what are your thoughts on the
significance of this year’s collaboration
with the EAO?
I think the EAO congress is a
great opportunity for Italian societies
as well. The Italian Society of Periodontology and Implantology and the
Italian Academy of Osseointegration
will be present both to join forces
and because the EAO is a very big

and important event. The most important speakers in the field are invited,
and the topics that will be covered
are not only exciting but also the
most relevant and challenging topics.
We also have a new theme, “Beyond
the limits”. The goal is to try to understand what we can do in the future to
overcome what have been considered
to be limitations of osseointegration
treatments to date—an important
compass for implant therapy.
Indeed, when we spoke five years
ago at the MASTERMINDS2 conference
in Athens in Greece, you mentioned
that implantologists tended to focus
on bone augmentation around the
implant and less on soft-tissue management, considering it a procedure
done only to improve on the outcome
achieved with bone augmentation.
You believe that, by increasing the

Historically, the focus was on
bone augmentation because it was
perceived as simpler to manage. However, especially in the aesthetic zone,
soft-tissue management is essential
and frequently provides excellent
results without requiring bone enhancement. Additionally, bone augmentation can sometimes damage
the surrounding soft tissue, further
complicating treatment.
Given these considerations, the
field of implantology has evolved.
No longer is the emphasis solely on
the relationship between the implant
and the bone; there is now a greater
appreciation of the crucial role of
soft tissue. A strong periodontics
background is essential for effective
soft-tissue management, which ultimately enhances overall implant
therapy outcomes.
Can you share some key topics or
themes that will be highlighted at
this year’s EAO congress and explain

“In terms of innovation, we must consider the digital impact
on implantology.”

“There is now a greater appreciation
of the crucial role of soft tissue.”
why these are particularly relevant
to the current state of dental implantology?
The traditional topics will be
covered, but I strongly encourage
clinicians to attend the sessions of
the new theme, “Beyond the limits”.
These sessions will challenge participants to explore treatments that go
beyond what is currently considered
evidence-based. Going beyond the
limits means achieving clinical results that surpass what is currently
documented in evidence-based literature. While evidence-based practice
provides a foundation, today, we have
the opportunity to achieve outcomes
that, although not yet fully reported
on in the literature, are indeed pos
sible.
For example, the sessions will
explore innovative approaches to
treating and managing peri-implantitis,
including handling implant failures
with advanced soft-tissue management techniques and strategies for
dealing with implant extraction due
to peri-implantitis. It will be fascinating to learn how far we can go in
treating a failing implant, whether
through efforts to salvage it with
soft-tissue management and prosthetic adjustments or when extraction is necessary, requiring a
complete restart of the treatment
process.
From your perspective, what are
some of the most exciting advancements or innovations in the field of
implantology that will be discussed
at the congress?
In terms of innovation, we must
consider the digital impact on implantology, such as the enhancement of
implant placement with precise guidance using digital tools. This tech
nology allows for implant placement
even in areas with limited bone, reducing the need for extensive bone
augmentation by utilising the available bone more effectively. Additionally,
it enables a more minimally invasive
approach, as implants can now be
placed with less bone than was required in the past when such guidance
tools were not available.
Another significant advancement
involves new materials for both softand hard-tissue augmentation. These
materials help clinicians reduce the
invasiveness of surgical procedures,
promoting better patient outcomes
and faster recovery.
Having been deeply involved in the
field for many years, what do you
personally hope attendees will take
away from this congress?
When attending a major congress
like this, it’s important to focus on the

31 st EAO Annual Scientific Meeting · Milan

key innovations and future directions highlighted by the latest research. This is an opportunity to gain
insights into cutting-edge techniques,
technologies and materials that are
shaping the future of implantology.
By understanding these advancements, clinicians can enhance their
practice, improve patient outcomes
and stay ahead in a rapidly evolving
field. 7
Editorial note: Dr Giovanni Zucchelli will be
one of the chairs in the session titled “Beyond
the limits of hard- and soft-tissue augmentation:
the next level”, which will be held on Saturday,
26 October from 11:00 to 12:15.

Dr Giovanni Zucchelli
graduated in 1988 with a degree
in dentistry and was awarded a
PhD in medical biotechnology in
1999 from the University of Bologna in Italy. Since 2000, he has
been a full professor and dean of
the periodontics department at the
same university. He has received
many awards for clinical research
in periodontics in Europe and the
US. In 2006 and 2008, he was
awarded the American Academy of
Periodontology Foundation’s E. Bud
Tarrson Research Award in Oral
Plastic Surgery. He is an International Team for Implantology fellow
and was made an honorary member of the American Academy of
Periodontology in 2020. He has
developed several soft-tissue plastic
surgical techniques and has taught
theoretical and practical (with live
surgery) courses in many countries.
Dr Zucchelli is the author of
150 articles listed in PubMed,
co-author of two textbooks on periodontal
plastic surgery (Edizioni Martina)
and author of the book Mucogingival
Esthetic Surgery (Quintessence,
2013), published in 12 languages,
and of the book
Mucogingival
Esthetic Surgery Around Implants
(Quintessence, 2022). He is an
active member of the European
Academy of Esthetic Dentistry,
Italian Society of Periodontology
and Implantology and Italian Academy
of Osteointegration, as well as a
member of the European Federation
of Periodontology. Dr Zucchelli was
president of the Italian Academy
of Osteointegration from 2020 to
2022. He is an associate editor of
the International Journal of Esthetic
Dentistry, a member of the editorial
board of the International Journal
of Periodontics and
Restorative
Dentistry and a peer reviewer for
a number of ranked periodontics
journals.

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interview

“It’s all about wound healing”
Dr Otto Zuhr offers perspectives on the latest advancements in soft-tissue management.
By Nathalie Schüller, Dental Tribune International

5

Dr Otto Zuhr.

n In the field of periodontics and
implant dentistry, achieving optimal
soft-tissue healing is critical to the
success of surgical procedures.
Board-certified periodontist Dr Otto
Zuhr has spent decades researching
soft-tissue wound healing and re
construction. In this interview with
Dental Tribune International, Dr Zuhr
shares insights ahead of his lecture
at this year’s EAO congress, where he
will explore the key surgical factors
that clinicians can control to enhance
wound healing outcomes.
Dr Zuhr, your lecture at this year’s
EAO congress focuses on surgical
factors that can influence soft-tissue
healing. Could you please give a brief
overview of the key points you will
cover in your presentation?
First of all, attendees will learn
that there are various categories of
risk factors that influence soft-tissue
wound healing outcomes, but only
some of these factors can be controlled by clinicians. From there, we

will concentrate on the risk factors
that can be controlled, which are
primarily related to ensuring optimal
blood supply in the surgical field
and maintaining the best possible
stability of the wound after surgical
intervention.
Soft-tissue healing is a critical aspect
of periodontics and implant dentistry.
Why do you believe it’s essential for
clinicians to have a deeper understanding of the factors that influence
soft-tissue healing?
It’s all about wound healing.
Success or failure in reconstructive
periodontal and implant surgery is primarily determined by soft-tissue wound
healing outcomes. The ultimate goal,
most of the time, is to achieve healing
by primary intention. There are many
examples of this: periodontal regeneration, successful guided bone re
generation, and soft-tissue reconstruction
in areas of high aesthetic importance all rely on healing by primary
intention.

Your research focuses on soft-tissue
wound healing and reconstruction.
Could you share some of the latest
insights or findings in this area that
you think will have a significant
impact on clinical approaches in the
near future?
There are many exciting developments that come to mind. One is
the ability to measure volumetric
changes using digital measurement
technology. I am convinced that this
will bring significant changes to
the techniques we apply in treating
our patients. Additionally, on a more
foundational level, I believe that in
the future we will be able to use
laser technology to visualise tissue
beneath the mucosal surface in the
oral cavity—potentially identifying
true periodontal ligament fibres.
Another fascinating development
is Doppler ultrasonographic eval
uation for measuring blood flow
circulation, recently recommended
by Dr Lorenzo Tavelli’s group at
Harvard.1 There are indeed many
intriguing advancements occurring
right now.
The EAO congress is a prominent
event for professionals in implant
dentistry. What are some of the
emerging trends or developments
you have seen in periodontics and
implant surgery that you believe
will be highlighted at this year’s
meeting?
Looking through the programme,
I have seen many intriguing topics.
One key focus is the treatment
of peri-implantitis, addressing questions such as how to achieve re-
osseointegration and the fine line
between maintaining an implant or
opting for removal and replacement.
These are highly relevant subjects
for me. Innovations in digital tech
nologies are also always exciting.
A major highlight this year will be

“A major highlight this year
will be the live surgery showcasing
the challenging treatment
of vertical hard-tissue d efects.”
the live surgery showcasing the
challenging treatment of vertical
hard-tissue defects.
What advice would you give to
clinicians looking to enhance their
skills in soft-tissue management and
achieve better clinical outcomes?
Those who know me understand
that I’m not particularly fond of
cookbook approaches or rigid clinical
protocols. I believe in focusing on
three key areas for self-improvement.
Firstly, increasing one’s knowledge
by embracing lifelong learning is
essential. Secondly, improving one’s
decision-making skills by cultivating
critical thinking is crucial. Finally,
manual skills are incredibly important.

I think it’s essential to view manual
dexterity not as an innate talent but
as a motor skill that can be developed
and improved at any stage, regardless
of current ability. 7
Reference

1. T avelli L, Kripfgans OD, Chan HL, Vera
Rodriguez M, Sabri H, Mancini L, Wang HL,
Giannobile WV, Barootchi S. Doppler ultrasono
graphic evaluation of tissue revascularization
following connective tissue graft at implant
sites. J Clin Periodontol. 2023 Oct 20. doi:
10.1111/jcpe.13889. Epub ahead of print.

Editorial note: Dr Zuhr’s lecture, titled “Surgical
factors that can influence soft tissue healing”,
is part of the session “How can we influence
soft tissue healing?”, which will be held on
25 October from 11:00 to 12:15.

Dr Otto Zuhr
is a prominent expert in periodontics and implant dentistry. He
studied dentistry at RWTH Aachen
University in Germany from 1986
to 1992 and later specialised
and obtained board certification
through the German Society of
Periodontology. He operates a
private practice in Munich in Germany, along with Dr Markus Hürzeler,
focusing on periodontics and implant dentistry. Dr Zuhr is also an
associate professor in the department of periodontics at Goethe
University Frankfurt in Germany.
He has authored numerous scientific articles and co-authored
the highly regarded book Plastic-
Esthetic Periodontal and Implant
Surgery (Quintessence, 2012).
His research primarily centres on
soft-tissue wound healing and
reconstruction, and he lectures
internationally on these topics.

8

31 st EAO Annual Scientific Meeting · Milan

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interview

“Moving away from money-driven implantology to patient-centred care”
An interview with Dr Tiziano Testori about the shift towards a more conservative and ethical approach to implantology.
By Nathalie Schüller, Dental Tribune International
For more experienced clinicians,
one barrier to dynamic surgery is
that they’re accustomed to watching
their hands while working rather
than looking at a monitor. Both
approaches require learning and
practice, particularly in planning.
In dynamic surgery, however, the
preparation of surgical guides is not
necessary.
Given your extensive experience,
what trends are emerging in the field
of osseointegration and implan
tology that professionals should
prepare for?
A key trend is the integration
of artificial intelligence (AI), which is
becoming a reality in cutting-edge
facilities. AI assists in the diagnostic
phase and is being introduced into
routine procedural steps, including
automated surgical planning. Ad
vanced planning software today in
corporates AI, simplifying the pro
cess. More than the planning itself,

“There is no strong evidence suggesting
that static surgery is superior
to dynamic surgery or vice versa.”
from money-driven implantology to
patient-centred care. In the past,
we’ve seen cases where healthy teeth
were extracted to place implants.
Doing so is fundamentally wrong
and unethical. Patients are becoming
more aware of conservative treat
ment options and understand that
periodontal disease can be treated
and that implants are meant to
replace lost teeth.
Clinicians need to carefully eval
uate dental and periodontal para
meters before deciding to render a
patient edentulous. It’s also essential

the minimally invasive full-arch (MIFA)
protocol, which is currently in the
preliminary stages of an important
clinical study. 7
Editorial note: Dr Testori’s lecture, titled
“Minimally invasive full-arch protocol in fully
edentulous patients”, is part of the session
“Full-arch reconstructions: The surgical approach:
When is it time to keep the dentition?”, which
will be held on 25 October from 13:45 to 15:00.

References
1. T estori T, Robiony M, Parenti A, Luongo G,
Rosenfeld AL, Ganz SD, Mandelaris GA,
Del Fabbro M. Evaluation of accuracy and
precision of a new guided surgery system:
a multicenter clinical study. Int J Periodontics
Restorative Dent. 2014;34 Suppl 3:s59–69.
doi: 10.11607/prd.1279. PMID: 24956092.

“Clinicians need to carefully evaluate dental and periodontal
parameters before deciding to render a patient edentulous.”
5

Dr Tiziano Testori is a distinguished expert in dental implantology and on the roster of international
speakers at this year’s EAO congress.

n Dr Testori, your lecture at the EAO
congress focuses on full-arch guided
surgery. What are the key limitations
you will be addressing, and why should
dental professionals be aware of
them?
Guided surgery in implant den
tistry still presents some limitations
owing to inherent inaccuracies. For
example, a 2014 study showed posi
tioning discrepancies between the
virtually planned and actual implant
outcomes.1 Guided implant surgery
requires learning and practice,
and certain inaccuracies can arise
throughout the digital workflow,
from data acquisition to placement.
Even when the guide is properly pre
pared, it can still be positioned in
accurately. This highlights how the
practice of our profession involves
the consideration of small details

that, when combined, can make a
significant difference.
How do static and dynamic navi
gation techniques differ, and what
factors should influence the choice
between them?
The difference between static and
dynamic surgery in implantology is
not scientifically significant in clinical
terms. There is no strong evidence sug
gesting that static surgery is superior
to dynamic surgery or vice versa.
While the literature supports both ap
proaches, the choice typically depends
on the clinician’s preference. Static
surgery remains the most widely used
globally, whereas dynamic surgery re
quires more effort to learn. A clinician
needs patience and should ideally perform
at least 50 cases to become proficient
in dynamic surgery.

AI automates steps that previously
required manual input, such as
clicks, replacing them with voice
commands. As software becomes
more user-friendly, many clinicians
who did not grow up with digital tools
will find it easier to adopt these
technologies, leading to more accurate
implant placement.
Another significant trend is a
medical approach to patient evalua
tion. This involves assessing individ
ual risk factors to improve success
rates and prevent peri-implant dis
ease. For example, we systematically
evaluate vitamin D levels, give
patients vitamin C supplements to

promote tissue healing, and assess
oxidative stress. There’s increasing
scientific evidence supporting this
personalised holistic approach.
Our group published the first article
on the importance of vitamin D sup
plementation in implantology ten
years ago.2
Why is the decision to retain or
extract teeth critical in full-arch

restoration, and what advances

influence this choice?
This question has an ethical
aspect. In recent years, there’s been
a shift towards a more conservative
and ethical approach, moving away

to consider the patient’s individual
response to treatment. In 2016,
we published the longevity protocol,
which is a computerised assessment
to better profile the patient from an
implantology perspective.3
Another consideration is that,
while we have effective tools to treat
periodontal disease, we lack uni
versally agreed-upon treatments for
peri-implantitis. This makes it crucial
to evaluate the patient thoroughly
before deciding to extract teeth.
What can attendees expect to gain
from your lecture in terms of prac
tical applications for their clinical
practice?
I hope that attendees will take
away important concepts, starting
with a well-executed diagnostic
phase and a comprehensive patient
evaluation. I will also introduce tech
nologies that allow us to be less
invasive, which reduces postopera

tive recovery time. Minimally inva
sive procedures also involve design
ing prostheses that are easy for
patients to maintain with regular oral
hygiene routines. When an implant is
correctly placed, the prosthesis will
be more accurate and easier to main
tain, thereby reducing the risk of
peri-implantitis. We have developed

“A key trend is the integration of
artificial intelligence, which is becoming
a reality in cutting-edge facilities.”
10

31 st EAO Annual Scientific Meeting · Milan

2. Choukroun J, Khoury G, Khoury F, Russe P,
Testori T, Komiyama Y, Sammartino G, Palacci P,
Tunali M, Choukroun E. Two neglected
biologic risk factors in bone grafting and
implantology: high low-density lipoprotein
cholesterol and low serum vitamin D. J Oral
Implantol. 2014 Feb;40(1):110–4. doi: 10.1563/
aaid-joi-d-13-00062.
3. Testori T, Clauser C, Deflorian M, Capelli M,
Zuffetti F, Fabbro MD. A retrospective analysis
of the effectiveness of the longevity protocol for assessing the risk of implant failure.
Clin Implant Dent Relat Res. 2016 Dec;18(6):
1113–8. doi: 10.1111/cid.12428. PMID: 27271293.

Dr Tiziano Testori
Dr Testori received his MD in 1981
and his DDS in 1984 from the
University of Milan in Italy, where
he also completed a specialty in
orthodontics in 1986. He is currently an adjunct clinical associate
professor in the Department of
Periodontics and Oral Medicine at
the University of Michigan School
of Dentistry in the US and serves
as a visiting assistant professor in
the Department of Oral Medicine,
Infection and Immunity at Harvard
School of Dental Medicine in the US.
Additionally, Dr Testori is an adjunct professor at the University of
Milan’s dental school.
Dr Testori was president of the
Italian Academy of Osseointegration from 2017 to 2018. He is the
founder, CEO and scientific director of Lake Como Institute in Italy.
As a leading voice in implantology,
Dr Testori has authored three books,
contributed to 13 chapters in
international books and published
176 peer-reviewed articles.

[11] =>

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interview

“We are really pushing the limits of what is possible”
An interview with Profs. Rubens Spin-Neto and Donald Tyndall about dental dedicated magnetic resonance imaging.
By Jeremy Booth, Dental Tribune International
be met or answered by this technology,
as well as looking at fractures of the
tooth. It is difficult to see fractures,
particularly if a tooth has root canal
material in it, and we think that there
is a great possibility that MRI will be
able to see these as well.

1
5

Fig. 1: Jeremy Booth of Dental Tribune International (left) in conversation with Prof. Rubens Spin-Neto of the Department of Dentistry and Oral Health at Aarhus University in Denmark (centre)
and Prof. Donald Tyndall of the Department of Diagnostic Sciences at the University of North Carolina at Chapel Hill Adams School of Dentistry in the US (right).

n Change is in the air. In June, Dental
Tribune International reported that
Dentsply Sirona and Siemens Healthineers
had unveiled plans for a dental dedicated magnetic resonance imaging
(ddMRI) device for dentistry. The
MAGNETOM Free.Max Dental Edition
has the potential to allow dentists
to visualise inflammation and soft
tissue in the mouth without exposing
patients to ionising radiation. In this
interview, the project’s leading re
searchers, Prof. Rubens Spin-Neto of
the Department of Dentistry and Oral
Health at Aarhus University in Denmark and Prof. Donald Tyndall of the
Department of Diagnostic Sciences
at the University of North Carolina at
Chapel Hill Adams School of Dentistry
in the US, speak about the new technology and its potential to trigger a
paradigm shift in oral care.
Profs. Spin-Neto and Tyndall, what
was the direction of the research that
preceded this launch?
Prof. Spin-Neto: From our perspective, the research was always focused

on making sure this technology was as
good as than what is already available
and attempting to highlight the potential added values. As researchers, we
approached it first and foremost as a
modality, asking: What is already avail-

tration (FDA) clearance before it can
be sold in the US (among others).
I have been involved in studies for
FDA clearance before, and it is very
important that any new system does
at least what the current systems do

“The question is, how are these
improvements going to have
an impact on treatment planning?”
—Prof. Rubens Spin-Neto
able to us now? Can this new modality
do the same things? What else can it do—
what comes on top? All of our main
research questions followed that north
star. Of course, where we are at now
has raised new questions.
Prof. Tyndall: Any new system needs
to have US Food and Drug Adminis

and also what the manufacture claims
it can do. What we have been waiting
for is the ability to see soft tissue, and
one of the expected major added values that we have seen—and we emphasise this—is the ability to see inflammation prior to clinical signs. People
are asking me what MRI does that
CBCT can’t do. A lot of that has to do

2
5

with being able to look at inflammation and define its boundaries, being
able to see periodontal disease before
it manifests visibly in the bone or in
CBCT scans of the bone. We have
clearly made the case for non-inferiority,
and the next step is clinical trials
investigating how much better ddMRI
is for highlighting pathological con
ditions compared to radiograph-based
modalities.
What types of dental problems could
be diagnosed more effectively using
the device?
Prof. Tyndall: We see potential for
any kind of inflammation, such as
periapical inflammation or inflammation in the bone itself. Of course, there
is always the differentiation of tumours from cysts, which MRI can
do much better than CBCT can. Then
there is the temporomandibular joint,
where MRI already is the standard of
care for temporomandibular disorder
problems―ddMRI would be able to
help with that. Almost any of the more
common dental diagnostic tasks could

Prof. Spin-Neto: And I think we will
be potentially able to anticipate when
you see some diseases, because currently we only see many diseases—
even clinically—when they are already
at an advanced stage. I think we will
not only be able to see them, but also
see them very early in the onset. So,
it could be easier, cheaper and faster
to treat these diseases. We always like
to talk about dentistry as a preventive
medicine, but right now we wait for
the problem to be there, and when
we see it, we treat it. Using modalities
like ddMRI, we can potentially see the
problems even before they progress to
serious disease. In cases of bone loss
around the tooth, for example, if we
can see oedema in the bone, that is
much easier to treat than bone loss.
I think we will be able to act much
faster and provide better care.
Prof. Tyndall: Early detection always
means better treatment; usually it
means fewer treatments, and it can
mean no surgery is required.
How do the imaging capabilities compare
with those of existing technologies,
and what about patient safety?
Prof. Tyndall: Dentists will want
to know how much more information
this system can provide, whether it
will be viable and helpful in their
practice, and whether it will help patients. What I tell them is that ddMRI
certainly provides more detail about
soft tissue. For example, we are starting to produce digital dentures at our
school, and the treatment begins with
an intra-oral scan, which is quite good
but takes a little bit longer. Some
colleagues have asked if we can do a
CBCT scan and make a digital denture
directly from that. Perhaps we could;
however, using MRI is something that
could be considered. It can provide us
with details of bone and soft-tissue
thickness and a much better definition
of where the muscles are. In the future,

Fig. 2: “We find ourselves at a very important point in the history of dentistry,” said Prof. Spin-Neto. F ig. 3: Profs. Tyndall and Spin-Neto spoke at the congress of the European Academy of Dentomaxillofacial Radiology in June.

31 st EAO Annual Scientific Meeting · Milan

[13] =>

interview

digital dentures may be another dental
MRI application.
Prof. Spin-Neto: MRI is already
much safer because we remove ionising
radiation from the equation. Currently,
with CBCT, we ask whether the patient will benefit from the risk of
receiving radiation in order to detect
disease. When this risk is removed,
we could say that using dental MRI
in a certain population is 100% safe.
It then becomes up to the dentist to
decide, asking: “Would I need to make
use of more resources on this case to
improve the treatment or treat the
patient in a different way?” In many
cases, radiation makes a difference.
For example, we would seldom consider follow-up CBCT images, even
though we would really like to see
bone healing in a patient. I cannot
invite a patient for a monthly CBCT—
although it would be nice for my
research. Some of our patients have
been coming in every two weeks for
one year to receive follow-up MRIs,
because it only takes some minutes of
their time and there is no risk. That is
going to teach us so many new things
that I feel it will be necessary to rewrite
parts of the reference books concerning tissue healing and best clinical
scenarios.
Prof. Tyndall: I think that one
of the biggest impacts is going to be
on the way we treat and manage
patients. What we are doing today is not
necessarily bad; however, we would
like to see this imaging technology not
only reveal new information, but also
perhaps even change our thinking
about how we are treating the patient.
Instead of doing it one way, we might
be doing it another way. I think that
is going to be one of the biggest ad
vantages of this research. Dentistry
changed with the introduction of CBCT,
and I think that change is going to
accelerate with ddMRI.

“Almost any of the more common
dental diagnostic tasks could be met
or answered by this technology.”
—Prof. Donald Tyndall

4
5

F ig. 4: The MAGNETOM Free.Max Dental Edition does not use ionising radiation and could
allow dentists to visualise inflammation and soft tissue in the mouth.

so we could already save a lot on
human resources, and we could also
optimise the key measure of time.
The patient will not need to change
clothes in a special dressing room or
talk to a nurse before the scan. These
cost-saving factors—calculated over, say,
a ten-year period—may bring just as
much economy as the machine itself.
I have operated the machine by myself

on many occasions. The patients come
in, and I speak with them, scan them
and report on the images. Previously,
that was unimaginable with MRI.
Prof. Tyndall: That’s a great point,
and one of the big promises of any
3D technology, where the images are
essentially constructed using computer
algorithms, is, of course, artificial

“Dentistry changed with the introduction
of CBCT, and I think that change
is going to accelerate with ddMRI.”—
Prof. Donald Tyndall

intelligence (AI). AI is going to get better, so I see a road map where there
is going to be continual improvement.
The question is, how are these improvements going to have an impact
on treatment planning? Remember, when
we first started with CBCT, we thought
it would be used for implants, and now
there are so many more uses.

what I did ten years ago would be
judged as wrong now, that I can see
more, and I know better.” And that is
how it should be; we should always be
able to do better and find mistakes
from the past. The fact remains that
we have not developed much in the
past ten years, and this technology is
going to change that.

How might dental MRI further develop
in the future?
Prof. Spin-Neto: We find ourselves
at a very important point in the history of dentistry. I would describe it
like this: Until now, we have been listening to music without all the channels on. Suddenly, as we hear these
new channels, we must learn what
to do with that extra information.
In my lecture during the congress
of the European Academy of Dentomaxillofacial Radiology, in June, I mentioned that research shows that dentists have been overtreating up to
some 40% of cases, depending on the
type of disease. What might that number be if I were to repeat that study
now with this new modality? Would
it go down to 20% or even 5%? Finding
out where we are and further refining
the modality is the next step. Of
course, we can look at the situation
from many different angles. Imagine
an insurance agency, for example,
wanting to judge whether a dentist
has treated the patient correctly.
I think we may even have to point
the finger at ourselves, saying: “Well,

Prof. Tyndall: It is going to be
similar to—in fact, greater than—the jump
from film to digital images was. Moving
to 3D images with the introduction
of CBCT was a big enough jump, and
this is even bigger. For the future,
I would envision a compact unit which
can be used on a seated patient, whose
whole body we do not need to cover;
the system images a certain area in and
around the oral cavity. Of course, these
units will be at universities, other major
institutions, military institutions and large
group dental practices. Being of a smaller
size will help to democratise the tech
nology. We are also going to see more
developments in the software.
Prof. Spin-Neto: If you ask the new
version of ChatGPT to create a picture
of a dental MRI unit, it can’t, because
it does not exist. This technology is
changing so many paradigms that
even AI cannot predict how it might
look or what the next step might be.
This shows us that we are really at the
limit of what we know. I believe that
is a good sign, that we are really pushing
the limits of what is possible. 7

What are the practical considerations
for integrating the unit into a dental
school or clinical setting?
Prof. Spin-Neto: The machine already has much lower requirements
than medical MRI units do. Medical
units require access to and backups
for cooling and water and access
to helium, which is expensive. The
MAGNETOM Free.Max is a closed system and does not depend on external
helium. In our school, we tracked how
much electricity and water are used
per patient, and these are lower compared with a typical MRI unit. The
cost per patient is much lower, the
footprint is smaller and the requirements for the building are less complicated, aligning with the global push
for green technologies.
What about staff required to operate
the unit?
Prof. Spin-Neto: Where it gets
costly with MRI generally is the need
to find personnel. Previously, if a dentist was to consider using an MRI unit,
he or she would need a neuroradiologist to help report and a nurse to deal
with the patients. Now, idea is that the
dentist can do everything alone, no
one needs to inject anything into the
patient and the technology does not
reveal image structures that dentists
cannot report on, because the machine will focus only on the mouth,

5
5

Fig. 5: Max Milz, group vice president of connected technology solutions at Dentsply Sirona unveiled the planned MAGNETOM Free.Max Dental Edition in Germany in June. (All images © Dentsply Sirona)

31 st EAO Annual Scientific Meeting · Milan

[14] =>

Immediate loading protocols are supporting
global expansion of dental implants
Rising popularity of immediate loading reflects growing demand for efficient approaches.
Hanieh Valipour & Dr Kamran Zamanian, Canada

“Immediate loading offers unparalleled
convenience for patients.”
protocols, and patients receiving
the treatment have increased confidence in the durability and longevity of their implant-supported
restorations.

Evolution of immediate loading procedure volume globally between 2020 and 2030. (Source: © iData Research)

n Immediate loading of dental implants, that is, placement of a restoration in occlusal function within
48 hours of implant placement, is becoming increasingly desired by patients.
The success of immediate loading depends on factors such as the quality
and quantity of bone, implant design,
patient’s oral health and surgical technique used. Clinical advancements
have supported a notable increase in
immediate loading protocols; however,
the soaring demand for efficient and
patient-centric approaches in implant
dentistry are expected to boost growth
even further by 2030.
Immediate loading protocols are
set to experience a greater and more

pronounced growth trajectory than
two-stage implant treatments over the
forecast period. Immediate loading offers
the following advantages:
R
educed treatment time: One of
the primary benefits of immediate
loading is the significant reduction in treatment time. Conventional loading protocols typically
involve a healing period of several
months between implant placement and provisional restoration.
In contrast, immediate loading
allows patients to receive a functional provisional restoration on
the same day or very shortly after
implant placement—and sometimes
a final restoration. This accelerated

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timeline is particularly advantageous
for patients seeking quick restoration of their smile and tooth
functionality.
 Improved patient satisfaction: Immediate loading provides faster
aesthetic and functional restoration,
and this can lead to higher levels
of patient satisfaction, owing to
swift improvements in quality of
life and overall well-being.
 Preservation of bone and soft tissue:
Immediate loading helps preserve
the surrounding bone and soft
tissue. Delayed loading protocols
may result in bone resorption
during the healing period. Immediate loading helps to minimise
this bone loss and maintain the
natural contours of the jawbone
and soft tissue. Preserving bone
and soft tissue integrity is crucial
for long-term implant success and
ensures a stable foundation for
the restoration.
 Convenience: Immediate loading
offers unparalleled convenience
for patients, who can avoid the inconvenience of wearing removable dentures or going without
teeth during the healing period.
Additionally, immediate loading
can reduce the time spent at the
dental office and the number of
appointments required.
 Predictable outcomes: Despite the
expedited timeline, immediate
loading has been shown to yield
predictable outcomes and high
success rates when performed by
experienced dental professionals.
Advances in implant technology,
surgical techniques and prosthetic
materials have contributed to the
reliability of immediate loading

However, immediate loading may
not be suitable for all patients and
clinical scenarios. Factors such as
bone quality, implant location and
patient-specific risk factors must be
carefully evaluated to determine the
feasibility and predictability of im
mediate loading. Additionally, meticulous treatment planning, surgical
precision and strict adherence to
postoperative protocols are essential
to mitigate potential risks and optimise
outcomes.
The global landscape of dental
implant procedures is influenced by
various factors, including improvements in oral healthcare and socio-
economic factors such as rising income levels and government policies
regarding healthcare reimbursement.
Adoption rates of implant-supported
restorations, particularly among older
adults facing financial constraints,
tend to be higher in countries where
government insurance partially covers dental implant costs. This underscores the importance of addressing
financial barriers to ensure equitable
access to advanced dental treatments
across diverse populations. However,
government oral health policies
can also reduce the need for tooth
replacement procedures, including
dental implants. In advanced economies, such as the US and Canada,
a focus on oral health education and
preventive measures emphasises
early intervention and regular dental
care and aims to preserve natural
teeth.
Overall, the rising popularity of
immediate loading reflects the growing
demand for efficient and patient-
centred approaches in implant dentistry. Dental research continues to
refine implant protocols and tech
nologies, and this is expected to fuel
the continued recognition of imme
diate loading as a viable option for
expedited and predictable implant
restoration. 7

“The rising popularity of immediate
loading reflects the growing demand
for efficient and patient-centred
approaches in implant dentistry.”

About the authors

Dr Kamran Zamanian is CEO and
founding partner of iData Research.
He has spent over 20 years working
in the market research industry
with a dedication to the study
of dental implants, dental bone
grafting substitutes, prosthetics, as
well as other dental devices used
in the health of patients all over
the globe.

Hanieh Valipour is CEO and founding partner of iData Research. He
has spent over 20 years working
in the market research industry
with a dedication to the study of
dental implants, dental bone grafting substitutes, prosthetics, as well
as other dental devices used in
the health of patients all over the
globe.

About iData Research
For over 15 years, iData Research
has been a strong advocate for
data-driven decision-making within
the global medical device, dental
and pharmaceutical industries. By
providing custom research and
consulting solutions, iData empowers
its clients to trust the source of
data and make important strategic decisions with confidence.
More information can be found at
idataresearch.com.

news

[15] =>

news

Impact of nicotine-containing products on peri-implant health
Study compares effect of electronic cigarettes, cigarettes, waterpipes and smokeless tobacco on dental implants.
By Dental Tribune International

“As a dental prosthodontic team, we
have daily experience of how smoking
affects peri-implant health and is
linked to peri-implant disease, which
is the leading cause of implant loss.
The use of alternative tobacco products
has increased dramatically over recent
years. Recent meta-analyses have investigated the effect of waterpipes and
e-cigarettes on periodontal and peri-
implant parameters. However, there
is a lack of comprehensive analysis
comparing the effects of more types of
nicotine-containing products with one
another. Based on the available literature,

we were able to include traditional
cigarettes, e-cigarettes, waterpipes and
smokeless tobacco in our analysis,”
lead author Dr Orsolya Vámos from
the Department of Prosthodontics at
Semmelweis University in Budapest told
Dental Tribune International.
According to Dr Vámos, some
nicotine-containing products, such as
waterpipes and smokeless tobacco,
are often incorrectly perceived as less
harmful than traditional cigarettes
and have thus grown in popularity
in recent years. To compare the effect
of nicotine-containing products on
peri-implant tissue, the researchers
conducted a systematic review of
the literature and then a network
meta-analysis of the eligible 32 studies.
They collected data on clinical, radiographic and immunological peri-
implant parameters such as marginal
bone loss, probing depth, plaque index,
bleeding on probing and peri-implant
sulcular fluid volume among smokers
and non-smokers.

c ompared with non-smokers.
In general, most nicotine-
containing product users
presented with worse peri-
implant parameters compared with non-smokers.
However, e-cigarette users
did not show significant differences from non-smokers
in many outcomes.

n Smokers have been shown to have
a higher chance of developing peri-
implant disease. However, there is a
lack of research comparing cigarettes
with popular alternative products that
contain nicotine in this regard. To fill
the gap, a recent study has compared
the effects of electronic cigarettes,
waterpipes, cigarettes and smokeless
tobacco on the peri-implant mucosa—
the first network meta-analysis to
do so. The researchers reported that
e-cigarettes caused the least harm to
the soft tissue around dental implants
compared with the other three nicotine-
containing products examined in the
study.

Dr Barbara Kispélyi,
associate professor in the
Department of Prosthodontics
at Semmelweis University,
commented that, in light of
the traumatic stress and
high treatment costs of implant surgery, she believes
that dentists should determine whether it is advisable
to proceed with implant
placement or whether they
should recommend against
it owing to possible compli- 5 Dr Orsolya Vámos is the lead author of the study.
cations due to nicotine use,
in addition to health considerations.
them with appropriate oral health
Additionally, the researchers highmaintenance and cessation support.
They also recommended that further
The data showed that non-smokers
lighted the importance of educating
had the smallest marginal bone loss,
patients about the risks that any
studies should include heated tobacco
whereas the majority of nicotine- nicotine-containing product may pose
products and consider factors such as
to implants and about the benefits of
the participants’ smoking habits and
containing product users had signi
oral hygiene.
ficantly higher marginal bone loss
quitting smoking and of providing

“By providing accurate and
balanced information, dental
professionals can help patients
make informed choices about
nicotine use and its impact
on oral health. They should
emphasise that alternative
nicotine products are not completely risk-free and that nicotine itself remains addictive
and can negatively affect oral
and overall health. Periodontal
disease, dry mouth and oral
cancer are still associated with
other nicotine-containing products. They should encourage
patients to quit all forms of nicotine rather than switching
from one product to another.
Patients who continue to smoke
should be instructed on proper
at-home oral hygiene practices,
and there should be a focus
on regular dental check-ups,”
Dr Vámos concluded.

The study, titled “The effect of
n icotine-containing products on peri-
implant tissues: A systematic review
and network meta-analysis”, was
published online on 15 April 2024 in
Nicotine and Tobacco R
esearch, ahead
of inclusion in an issue. 7
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[16] =>

news

Implant planning made easier with 3D-printed shell complete dentures
New technique saves patients valuable time when undergoing implant treatment.
By Dental Tribune International
orientation, before proceeding to
implant placement. These dentures
serve as a diagnostic aid, enabling
clinicians to visualise, validate
and modify the prosthodontic
para
meters without altering the

theses. This
patient’s existing pros
approach is beneficial for identifying aesthetic and functional deficiencies and planning necessary
modifications to create ideal final
restorations.

These shell dentures guide the
planning of implant location and the
design of different types of provisional
prostheses. As diagnostic devices,
they support transfer of the intra-oral
relationships to a semi-adjustable artic-

ulator and determination of what
intra-oral adjustment is required before provisional prosthesis delivery.
By using existing prostheses
as a template, 3D printing simpli-

© Scharfsinn/Shutterstock.com

AD

n Where time can realistically and
safely be saved in dental and restorative treatments, so can both money
and patient chair time. A new case
series has documented the testing
and use of 3D-printed shell complete dentures as a diagnostic tool
in implant planning and provisional
restoration fabrication to expedite
full-arch restoration. The research
highlights the potential of this approach to simplify and streamline
the process and to save clinical and
laboratory time, offering enhanced
aesthetic outcomes and functional
results.
With technological advancements in implant design, imaging
and manufacturing, there is a shift
towards more efficient planning and
execution of implant-supported restorations. Digital technologies such
as CAD/CAM have introduced new
possibilities for creating precise
dental appliances, including surgical guides and prostheses. These
tools allow dental clinicians to overcome clinical challenges such as difficulty assessing the occlusal plane
and complex surgical interventions,
making digital workflows suitable
for full-arch restoration with implants.

November 3, 1995:
BioHorizons USA
registered

UK office
registered on
1st October 2005

Introduction of the
Maestro External
Implant System

Launch of Tapered Internal
Implant featuring Laser-Lok®
Relocation into new headquarters
Mem-Lok® launch

Biomaterials
distribution begins
with AlloDerm™ and
Grafton® DBM
BioHorizons
founded by
Dr. Carl Misch,
Martha Bidez and
COO Todd Strong

BioHorizons
first patent
granted

MinerOss® Blend and
the Internal Implant
launched
International
distribution begins

Introduction
of Laser-Lok®
3.0 Implant
and Laser-Lok®
abutments

BioHorizons Spanish
office opened

3D-printed shell
complete dentures

Conventional methods involve
creating radiographic templates
from duplicate dentures or desired
tooth set-ups to ensure ideal oc
clusion and aesthetic outcomes,
whereas 3D-printed shell complete
dentures are generated from the
scans of the patient’s existing
prostheses. They allow clinicians to
assess critical aesthetic and functional parameters, such as facial
support, lip position, vertical dimension of occlusion and occlusal plane

16

Dr. Axel Kirsch,
establishes
Altatec
Medizinische
Elemente GmbH

Launch of the
brand CAMLOG
Introduction of the
CAMLOG® Implant
System

CAMLOG®
Distributor starts
selling in NL

Established as
CAMLOG®
Foundation

Established CAMLOG
Biotechnologies GmbH
Headquarters, Basel/Switzerland
Start CAMLOG Vertriebs GmbH,
Wimsheim/Germany ALTATEC
GmbH, Wimsheim

KEY:

Henry Schein
Implantology
distributing
CAMLOG® System

[17] =>

news

The presented cases

The study presents a case series
involving three patients who underwent full-arch restoration using the
3D-printed shell denture protocol.
Each case illustrates the practical

application and advantages of this
technique.
The first patient presented with
a maxillary complete denture,
compromised mandibular teeth,
a decreased vertical dimension of
occlusion, an irregular occlusal
plane and an unstable occlusion.
Treatment involved provisional
maxillary and mandibular prostheses, followed by a final maxillary
complete denture and a mandibular
implant supported complete denture.

The use of 3D-printed shell dentures
allowed for accurate assessment
and enhancement of aesthetic
parameters.
The second patient presented
with a severely resorbed maxillary
arch, a partially edentulous mandible, a decreased vertical dimension
of occlusion and an irregular occlusal plane. The treatment involved
placement and immediate loading
of six implants with a provisional
complete denture, followed by a

© Oleggg/Shutterstock.com

fies the creation of provisional
restorations, saving time and resources. This efficiency is particularly valuable in cosmetic dentistry, where patient satisfaction
and reduced treatment time are
paramount.

AD

final maxillary complete denture
and implant-
supported restoration
of the edentulous site #46. The
3D-printed shell complete dentures
facilitated accurate implant placement and improved aesthetics.
The final patient presented with
a severely resorbed maxillary arch,
overerupted anterior mandibular
teeth, and maxillary and mandibular removable prostheses showing
excessive wear, irregular occlusion,
significant discoloration and multiple repairs, indicating anterior
hyperfunction syndrome. Treatment
involved four zygomatic implants
for the maxillary arch, restored
with a provisional maxillary complete denture, and a new mandib
ular removable partial denture
supported on two implants. The

3D-printed shell complete denture
approach allowed for effective management of the complex anatomical
changes and ensured satisfactory
aesthetics and function.

Key components
for success
Introduction of
Computer Guided
Surgery Kit

CONELOG® Progressive-Line
introduced to U.S.
TeethXpress full-arch solutions
launched

Tapered Short
introduced in U.S.

Formation of Vulcan Custom Dental
BioHorizons Italia subsidiary formed

Release of the Tapered Pro
Implant, 25-year
celebration

France became
BioHorizons Camlog

Spain became BioHorizons
Camlog

Introduction of
Pro Surgical Kit
(keyless guided
kit) in U.S.

Italy becomes BioHorizons
Camlog

Introduction of
Tapered Plus Implant
and Multi-unit
abutments

Introduction of
MinerOss® X
xenografts

Tapered Short
introduction in Europe

BioHorizons UK
& Ireland office
relocation

OD Secure and
MinerOss® XP
introduced in U.S.

Introduction
of CONELOG®
Implant System

BioHorizons UK &
Ireland: CAMLOG
distribution begins

Launch of iSy® Implant
System in Europe

Formation of the
Oral Reconstruction
Foundation

Henry Schein
purchases 100% of
BioHorizons; becomes
part of Global Oral
Reconstruction Group

Camlog Vertriebs
GmbH expands
facilities with the new
Camlog Sales Building
in Wimsheim

Benelux became
BioHorizons
Camlog

Mem-Lok® Amnio
and Striate+
introduced to U.S.

Progressive-Line:
Guide system &
FLEX kit launched

UK office relocates
to larger premises

Launch of Pro
Surgical System
& Striate+™

Launch of the
CERALOG® Ceramic
Implant System
Launch of the
expanded iSy®
Implant System in
the US

BioHorizons Camlog brand
launched in UK
Tapered Pro,
CONELOG® Progressive-Line
& IntraSpin® launch

The researchers emphasised
the importance of thorough data
collection and extra-oral and intra-
oral assessment in implant planning
from the beginning for full-arch
restoration. By providing a tangible
representation of the projected
treatment, the 3D-printed shell
dentures supported communication between the prosthodontist,
oral surgeon and patient and encouraged patient treatment acceptance.
The process reduces the need
for extensive occlusal adjustments
and e xpedites the creation of pro
visional restorations, offering a sig
nificant time-saving advantage over
traditional methods. Additionally,
the ability to customise prosthetic
appliances based on the patient’s
existing dentures ensures that aesthetic and functional para
meters
are tailored to individual needs.
The accuracy and precision of
3D-printed shell complete dentures
lead to better implant positioning,
improved aesthetic results and enhanced patient satisfaction, aligning
with the goals of cosmetic dentistry
and restorative practices.
The study, titled “3D-printed
shell complete dentures as a diagnostic aid for implant planning
and fabricating interim restorations
for complete arch rehabilitations:
A case series”, was p ublished online
on 22 July 2024 in the Journal of
Prosthodontics, ahead of inclusion
in an issue. 7

17

[18] =>

news

Antibiotic use in implant dentistry: A call for standardised guidelines
© Charité—Universitätsmedizin Berlin

Fig. 1: Dr Björn Klinge. Fig. 2: Dr Giulia Brunello. Fig. 3: Prof. Bodil Lund. Fig. 4: Prof. Kathrin Becker.

n There are conflicting opinions and
evidence on antibiotic use before
and after implant surgery and in
peri-implantitis treatment. Given that
inappropriate antibiotic prescription
plays a major role in antibiotic resistance in dentistry, a recent study
sought to investigate prescribing
practices in relation to implant treatment and awareness of antibiotic
resistance among dentists in Europe.
It found that, although the participants showed good understanding of
the topic, the antibiotic prescription
rate in implant dentistry was high.
To that end, the study pointed to a need
for the development of and adherence
to standardised European guidelines
to improve antibiotic stewardship in
dentistry.
According to the World Health
Organization, antimicrobial resistance
is among the most significant threats
to global public health and development. In 2019, bacterial antimicrobial resistance was estimated to be
the direct cause of 1.27 million
deaths worldwide and played a role
in 4.95 million deaths.
“Antibiotic resistance is a growing and alarming concern related to
the misuse and overuse of antibiotics
in various clinical settings and sit
uations,” co-author Dr Björn Klinge,
professor emeritus in the Faculty of
Odontology at Malmö University and
at the Department of Dental Medicine of Karolinska Institutet in Stockholm in Sweden, told Dental Tribune
International (DTI). After talking to
his peers about their routines for
antibiotic use in implant dentistry,
he understood that antibiotic prescription in this context varies considerably. He also noted that access to
and awareness of national guidelines
and recommendations for using antibiotics in implant dentistry seems to
vary between European countries.
“After discussing this with our research team, we agreed to investigate
antibiotic use and the availability
of guidelines more systematically,”
Dr Klinge explained.

researchers developed a questionnaire and sent it to 6,431 recipients
who had been members of the European Association for Osseointegration
at least once since 2018. The questionnaire contained 17 items, and
281 dentists from 33 European
countries completed the survey. The
questions gathered data on working
environment, years of experience,
number of implant placements and
surgical treatments of peri-implantitis
per year and the use of antibiotics for
these, attitudes towards antibiotic
prescription, adherence to national
guidelines for antibiotic prescription
and awareness of antibiotic resistance.
Data was collected from April to
May 2023.
According to senior author
Dr Giulia Brunello, a postdoctoral
research fellow in the Department
of Oral Surgery at the University
Hospital of Düsseldorf in Germany,
the survey yielded several interesting
outcomes. She told DTI that, although
current evidence does not support
using systemic antibiotics as an
adjunct in non-surgical and surgical
peri-implantitis therapy, more than
half of the study participants indicated that they use systemic anti
biotics to treat peri-implantitis. “This
highlights a significant discrepancy

between clinical practice and available
knowledge,” she commented.
The study found that almost 80%
of the respondents routinely prescribe antibiotics prophylactically
and after implant placement, especially in medically compromised

Additionally, the findings pointed
to a notable inconsistency in prescription practices among the respondents.
The researchers suggested that this
may be explained by the lack of or
difficulty accessing national guide-

“Antibiotic resistance is a growing and
alarming concern related to the misuse
and overuse of antibiotics in various
clinical settings and situations.”
—Dr Björn Klinge
patients or in cases requiring bone
grafting. As observed in other studies,
amoxicillin, alone or in combination
with clavulanic acid, was found to
be the most commonly prescribed
antibiotic among the participants.
Commenting on these findings,
Dr Brunello said: “Despite a significant
awareness of antibiotic resistance among
the respondents, their prescription
rate for dental implant procedures
remains high.”

Exploring dentists’ antibiotic
prescribing patterns

To better understand the prescribing patterns and attitudes of
dentists towards antibiotic use, the

Urgent need for national
guidelines in Europe

31 st EAO Annual Scientific Meeting · Milan

lines on antibiotic prescription in implant dentistry in some European
countries.
In light of the findings, co-author
Prof. Bodil Lund, head of the Department
of Dental Medicine of Karolinska
Institutet, said that the study indicates
potential for enhancing antibiotic prescribing practices in Europe. She told
DTI: “Although surgical placement of
dental implants is a common therapy,
© Creative Cat Studio/Shutterstock.com

Researchers find high antibiotic prescription rates in implant dentistry in Europe.
Iveta Ramonaite, Dental Tribune International

there are several European countries
that either lack national guidelines or
those available are not known to the
dental professionals. Both educational
efforts and guidelines are needed
to improve the use of antibiotics in
implant dentistry.”

Future perspectives
on antibiotic prescription
in implant dentistry

Discussing future perspectives
on antibiotic prescribing practices in
dentistry, lead author Prof. Kathrin
Becker, director of the Department of
Dentofacial Orthopedics and Orthodontics at Charité—Universitätsmedizin
Berlin in Germany, and co-author
Dr Katarzyna Gurzawska-Comis, an
associate professor and lead of maxillofacial surgery and pathology at
the Aarhus University in Denmark,
and a consultant and senior lecturer
in oral surgery at the University of
Liverpool in the UK, told DTI that
there is an urgent need for more judicious use of antibiotics in implant
dentistry to curb global antimicrobial
resistance. “Although we do not anti
cipate significant shifts in antibiotic
prescribing in relation to dental
implant placement, we envisage the
progressive replacement of prolonged
antibiotic therapies, aiming at minimising postoperative infections with
the adoption of single-dose antibiotic
prophylaxis in the near future,” they
noted.
Since current scientific data
lacks robust evidence to support
the use of antibiotic prophylaxis in
implant dentistry, the researchers
recommend conducting additional
randomised clinical trials to address
this research gap. They also emphasised
the importance of collaboration to
establish standards regarding quality
and uniformity in national guidelines
across European countries towards
consistent and evidence-based anti
biotic prescribing practices in implant
dentistry.
The study, titled “Patterns of
antibiotic prescription in implant

dentistry and antibiotic resistance
awareness among European dentists:
A questionnaire-based study”, was
published online on 24 May 2024
in
Clinical Oral Implants Research,
ahead of inclusion in an issue. 7

[19] =>

news

Could citric acid save dental implants affected by peri-implantitis?
New research suggests that citric acid could be an effective tool against peri-implantitis.
By Anisha Hall Hoppe, Dental Tribune International

Current peri-implantitis treatments
focus on decontaminating the implant
surface to inhibit biofilm formation
and encourage tissue regeneration.
Among these treatments, implantoplasty, which involves mechanically
smoothing the implant surface, is
commonly used. However, this process often reduces the surface roughness of the titanium, making it less
conducive to cell adhesion and tissue
growth. The researchers sought
therefore to investigate the effects
of citric acid-based decontamination

All treatments were found to be
cytocompatible, and no significant
cytotoxic effects were observed. This
suggests that such treatments could
be safely used in clinical applications
to aid in the recovery from peri-
implantitis and the maintenance of
implants.

solutions on titanium surfaces to
enhance cell viability and inhibit bacterial colonisation.
After subjecting 80 titanium discs
to an implantoplasty protocol, the researchers treated the discs with four
different solutions: 25% citric acid,
25% citric acid with 0.25 g/l collagen,
25% citric acid with 0.50 g/l collagen,
and 25% citric acid with 0.50 g/l collagen and 1% magnesium nitrate.
The surfaces were analysed for roughness, wettability, fibroblast adhesion,
osteoblast proliferation and bactericidal behaviour against the common
oral bacteria Streptococcus sanguinis,
Streptococcus gordonii and Pseudomonas
aeruginosa.
The researchers found that citric
acid increased the roughness of the
titanium surfaces slightly and made
them super-hydrophilic, significantly
reducing the contact angle from
78° to 13°. This change was deemed
beneficial for cell adhesion, as it
creates a better environment for cell
proliferation.
Additionally, fibroblast and osteoblast proliferation greatly improved

n New research provides compelling
evidence that citric acid-based treatments, particularly those combined
with collagen and magnesium, are
effective in enhancing the surface

properties of titanium dental implants after implantoplasty. These
treatments not only improve cell proliferation and tissue regeneration but
also offer significant antibacterial
benefits. The findings suggest that
such solutions could be developed
into practical applications, such as
mouthwashes, to support the longterm success of implants by promoting
tissue regeneration and preventing
bacterial recolonisation.

on surfaces treated with the citric
acid solution containing collagen and
magnesium. This solution showed
the highest cytocompatibility and
contributed to a rapid increase in cell
numbers within 24 hours, indicating
that it may support tissue regen
eration on the implant surface. The
presence of magnesium appeared to
further stimulate cell adhesion and
differentiation.

The citric acid solutions displayed
a clear bactericidal effect, especially
against Gram-positive bacteria like
S. sanguinis and S. gordonii. The solution containing magnesium showed
the lowest levels of bacterial adhesion, indicating its superior ability
to resist bacterial colonisation. However, the bactericidal effect was less
obvious against the Gram-negative
strain P. aeruginosa.

The authors recommended that
the same study be carried out
in vivo with soft tissue to rule out
the risk of tissue irritability. Doing
so could also determine whether
bone tissue is able to regenerate
such that re-osseointegration can
occur. The researchers further
recommended culturing biofilm to
evaluate how well citric acid solutions cope with the full variety of
bacterial strains present in the oral
cavity. Such an assessment would
also be useful in determining necessary concentrations for an effective
mouthwash.
The study, titled “Surface decontamination of titanium dental implants
subjected to implantoplasty by treatment with citric acid solutions”, was
published online on 27 August 2024
in Coatings. 7

THE GLOBAL DENTAL CE COMMUNITY

www.dtstudyclub.com

DT Study Club – e-learning community

@DTStudyClub

Tribune Group is an ADA CERP Recognized Provider. ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA
CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry.This continuing education activity has been planned and implemented in
accordance with the standards of the ADA Continuing Education Recognition Program (ADA CERP) through joint efforts between Tribune Group and Dental Tribune Int. GmbH.

[20] =>

clinical

Unconventional applications of dental 3D printing
A novel two-piece 3D-printed screw-retained provisional implant restoration.
Dr Andrew Ip, Australia

Figs. 1 & 2: Pre-op situation, showing the maxillary right first premolar with a poor restorative prognosis. Fig. 3: Initial periapical radiograph. Fig. 4: Post-extraction site. Fig. 5: Surgical guide design on 3Shape Implant Studio.

n The digitisation of dentistry has
unlocked many potential applications
in modern clinical and technical
practice. 3D printing is becoming an
increasingly popular and effective
part of that equation. Gone are the
days where it seemed like you needed

a PhD to operate a 3D printer. Chairside dental 3D printing has become
extremely cost-effective and simple
to learn, and there are many dentistry-
specific systems known to be highly
consistent, accurate, precise and
reliable.

Dental technology has allowed
us to create excellent provisional
restorations, cost-effective dentures,
same-day or even same-appointment
night guards, and more! However,
the beauty of 3D printing is that
applications are only limited by

your imagination, restrictions in
design software and the materials
currently available on the market.
It gives the clinician and technician
the opportunity to let their creativity
run rampant, all while improving
the patient experience. In this case

report, I will share how CAD software and CAM hardware can create
a predictable and innovative pro
visional implant restoration which
satisfies not only the patient but also
the clinician and dental designer–
technician.



31 st EAO Annual Scientific Meeting · Milan

F ig. 6: Provisional restoration design on
3Shape Implant Studio. Fig. 7: Abutment
design on 3Shape Implant Studio. Fig. 8:
Printing the temporary abutments out of
KeySplint Hard on the MAX UV using the
UltraGLOSS material tray. Fig. 9: Veneer,
facial aspect. Fig. 10: Veneer, fitting surface.
Fig. 11: Veneers nested and supported on
Composer 2.0 (Asiga). Fig. 12: Abutments
printed. Fig. 13: Veneers printed. Fig. 14:
AI3D–Dentiq provisional restorations assembled
and fully processed.

[21] =>

clinical

Fig. 15: Surgical guide in situ. Fig. 16: Guided
osteotomy. Fig. 17: Provisional restoration in
place after implant placement. Fig. 18: Post-op
situation. Fig. 19: Post-op situation, occlusal
a spect. Fig. 20: Situation after four months
of healing. Fig. 21: Situation after removal of
the provisional restoration. Fig. 22: Zirconia
crowns in situ. Fig. 23: Zirconia crowns in situ,
occlusal aspect. Fig. 24: Final periapical radiograph, showing the good fit and no excess
cement. Figs. 25a–f: Situation at each step of
treatment.



Overall, 3D printing and software
can unlock numerous applications to
improve not only the patient outcomes
but also the operator experience. It will
be truly exciting to see the innovations
that lie ahead.

Acknowledgements
I would like to acknowledge Jeroen
Klijnsma of Dentiq Dental Services
for the implant planning and surgical
guide design. 7

References

1. S cherer U, Stoetzer M, Ruecker M, Gellrich NC,
von See C. Templateguided vs. non-guided
drilling in site preparation of dental implants.
Clin Oral Investig. 2015 Jul;19(6):1339–46. doi:
10.1007/s00784-014-1346-7.
2. Kühl S, Zürcher S, Mahid T, Müller-Gerbl M,
Filippi A, Cattin P. Accuracy of full guided vs.
half-guided implant surgery. Clin Oral Implants
Res. 2013 Jul;24(7):763–9. doi: 10.1111/j.16000501.2012.02484.x.

Editorial note: This article was published in
3D printing—international magazine of dental
printing technology vol. 4, issue 1/2024.

Dr Andrew Ip

25a

25b

Initial situation

A male patient presented in our
dental office with a severely broken
maxillary right first premolar (tooth #14)
that had been designated for extraction
a number of years before. The tooth
immediately distal (tooth #15) was also
in need of substantial dental treatment
(Figs. 1 & 2). The patient had hypertension
that was controlled with anti-hypertensive
medication, but was otherwise medically fit. He intended to have the colour
of his anterior teeth improved, but
wished to address the issues on his
maxillary right side first.
Tooth #14 was deemed unrestorable,
and so it was decided to extract the
tooth (Figs. 3 & 4), wait for bone healing
and replace it with an implant with
a provisional restoration. During the
healing process, endodontic therapy
would be performed on tooth #15. After
bone integration, implant #14 would be
restored with a screw-retained direct-toimplant zirconia crown, and tooth #15
would also be restored with a complete
zirconia crown. A deliberately lighter
shade would be chosen, factoring in the
patient’s long-term desire to improve
the colour of his teeth.

Implant planning

Two months after tooth #14 had
been extracted, a CBCT scan (GO,
NewTom) and intra-oral scan (Medit
i700 wireless) were performed, and the
two data sets were merged on 3Shape
Implant Studio in order to plan the

25c

p atient’s case (Fig. 5). The use of surgical
guides has been shown to enhance accuracy and precision for many users.1
A tissue-level matrix implant
(4.1 × 8.0 mm; TRI Dental Implants) was
digitally positioned in order to design
the surgical guide, based on parameters
already preloaded on the extensive
3Shape Implant Studio library. A pilot
guide was designed in this case, as it has
been shown to produce similarly accurate
results in comparison with fully guided
systems.2 The surgical guide was printed
out of V-Print SG (VOCO) on the MAX UV
(Asiga) in 50 μm layers and was autoclaved after complete processing.

Provisional restoration d esign

Based on the implant plan, a two-piece
provisional restoration was designed
using the same software (Figs. 6 & 7).
The abutment portion would be printed
in a clear splint material (KeySplint Hard,
Keystone Industries) and highly polished for optimum transparency. This
would allow for visibility of the healing
process. To reduce the amount of polishing required, the abutment would
be printed in 50 μm layers to diminish
the appearance of the layers and
using the UltraGLOSS material tray
(Asiga; Fig. 8).
A separate facial veneer would be
bonded to this abutment and would be
printed in a restorative resin (saremco
print CROWNTEC, SAREMCO Dental)
to satisfy the aesthetic concerns of the

25d

25e

25f

patient. Two retentive slots would be
incorporated into the abutment and
veneer to ensure proper fixation during
the bonding process (Figs. 9–11). Prior
to final polymerisation in the Otoflash
G171 (two 2,000 flashes; NK-Optik), the
two pieces would be bonded together
using the splint resin as a cementing
agent (Figs. 12–14).

provisional restoration revealed a
natural soft-tissue profile and an improved soft-tissue contour without the
need for additional soft- or hard-tissue
augmentation (Fig. 21).

Implant placement
and provisionalisation

Definitive restorations were designed on exocad and milled in-house
on CRAFT 5X (DOF) out of EVEREST
Multilayer AT zirconia (Shade A3;
UNC International). A deliberately lighter
shade was chosen by the patient, as
he intended to have the appearance
of his other maxillary teeth improved.
The implant crown was torqued in to
35 Ncm, and the crown was cemented
to tooth #15 using G-CEM ONE cement
(GC Dental; Figs. 22–24).

The fit of the surgical guide was
confirmed, and the patient was an
aesthetised locally (Fig. 15). A small
full-thickness flap was raised, and
a guided osteotomy was performed.
The implant was inserted to a 45 Ncm
torque. The prefabricated two-piece
provisional restoration was torqued in
to 15 Ncm and was confirmed to be out
of occlusion. Two 4/0 PROLENE sutures
(Ethicon) were used to close the flap
(Figs. 16–19).
Endodontic therapy was commenced
on tooth #15 in the meantime. The
sutures were removed 14 days later,
and the patient reported uneventful
postoperative healing at this stage.

Implant and tooth restoration

A waiting period of four months
allowed adequate osseointegration of
the implant (Fig. 20). The endodontic
treatment of tooth #15 had been completed in the meantime, and the tooth
had been prepared for a complete zirconia crown. Removal of the implant

Secondary impression was taken
digitally with an intra-oral scanner and
the relevant scan body.

Conclusion

Digital dentistry and novel techniques can help produce excellent
and effective results. Improvements in
the software and physical workflow
have meant that the clinician’s and
the technician’s work are not only
more streamlined and straightforward
but also enjoyable (Figs. 25a–f). A
more-than-satisfactory outcome was
achieved for the patient. What made
all this possible was the novel and
innovative tissue-level matrix implant
connection, which lacks any sharp
corners or edges, allowing for direct-toimplant milled and printed restorations.

holds a BDS and is a member in
general dental practice of the Royal
Australasian College of Dental Surgeons. He also possesses a graduate
diploma of orthodontics, an MSc in
implantology and dental surgery, and
a graduate diploma of digital dentistry. Dr Ip runs a private dental practice based in Sydney in Australia. He
has a special interest in 3D printing,
which originally started off as a hobby, but has now formed a major part
of his clinical work. Having owned a
number of 3D printers—11 at last
count—has given him experience in
the software and hardware of various
manufacturers. While he is a key opinion leader for several companies and
services operating in 3D printing, he
is not endorsed by any specific company, and all his knowledge is based
on his own experience, involving many
aspects, including the design of surgical guides, planning of in-house
clear aligner treatment and design of
a chairside 3D-printed crown.

contact
AI3D Dental, Unit 1-15 133 Fontenoy Rd
Macquarie Park, NSW 2113, Australia
ai3dorthoimplant@gmail.com

31 st EAO Annual Scientific Meeting · Milan

[22] =>

clinical

Laser-assisted protocol for the treatment of peri-implantitis:
A long-term retrospective case series
Drs Gary M. Schwarz, David M. Harris & Gregori M. Kurtzman, US
(October 2016). A private institutional
review board (Quorum Review) granted
a waiver of informed consent and approved the retrospective data collection and analysis protocol. Later, the
institutional review board approved the
retrospective analysis of the long-term
follow-up data that is included in this
report. The original study was conducted according to standards established by the Declaration of Helsinki
and Good Clinical Laboratory Practice
Guidelines. Research standards established in the original study were maintained in the current study.

1
5

Fig. 1: Proportion of dental implants in each clinical treatment outcome category.

Introduction

Pulsed Nd:YAG dental lasers are
surgical tools used to obtain specific
surgical objectives as defined in the
LANAP (laser-assisted new attachment
procedure) for periodontitis and the
LAPIP (laser-assisted peri-implantitis
procedure) for peri-
implantitis. The
LANAP using the PerioLase Nd:YAG
laser (Millennium Dental Technologies)
was introduced in 1998 as Laser ENAP,1
and in 2004, the L
ANAP gained
US Food and Drug Administration 510(k)
clearance (No. K030290) for the claim
“laser assisted new attachment pro
cedure (cementum-mediated periodontal ligament new attachment to the
root surface in the absence of long
junctional epithelium)”. Subsequently,
human histology studies2, 3 established
that the LANAP resulted in “periodontal
regeneration—true regeneration of the
attachment apparatus (new cementum, new periodontal ligament, and
new alveolar bone) on a previously
diseased root surface” (2016 510(k)
clearance No. K151763).
The LAPIP emerged from the LANAP as a stand-alone procedure.4–7
The indication for the LANAP is
moderate to advanced periodontitis,i
whereas the LAPIP is indicated for
peri-implantitis treatment.ii The basic
steps in the two protocols are the same
and have adjustments for the whole
mouth versus a single site, the responses to irradiation of root cementum
versus implant titanium, and differences
in surgical objectives.

i Periodontitis: “Inflammation of the periodontal tissues resulting in clinical attachment
loss, alveolar bone loss, and periodontal
pocketing.”8
ii
Peri-implantitis: “An inflammatory process
around an implant which includes both soft
tissue inflammation and loss of supporting
bone.”8 Clinical signs include inflammation, bleeding on probing and suppuration.
It progresses from peri-implant mucositis,
which is confined to the soft tissue, to include PD > 4 mm and evidence of bone loss.
Peri-implantitis often leads to progressive
loss of osseointegration and eventual loss of
the implant.

A recent review of published studies of peri-implantitis laser treatment
concluded that laser treatment enhances bone growth, but a quantitative
analysis of bone-level changes is limited.9
The authors called for greater relevance and translation of the research
findings to the clinician. This report addresses those concerns with a detailed
analysis of the clinical outcomes and
a quantitative description of changes
in radiographic density two to five years
after undergoing a LAPIP in a private
practice setting.
Dr Schwarz completed training in
the LAPIP in September 2013. A retrospective analysis of the 222 sequential
patients with 437 failing dental implants that were treated during the
following three years was performed.7
That study was focused on the shortterm efficacy of the LAPIP. A statistically significant reduction of clinical
signs of erythema, bleeding and suppuration and reduced probing depth (PD)
at the first follow-up visit (median period:
7.6 months; P < 0.001) was noted. The
survival rate, the percentage of intact
implants, was 94% over the longest
follow-up period (median: 13.1 months)
among those in the analysis.
Long-term clinical and radiographic
data are presented from the same
group of 222 patients. There was
a continuum of responses, including
long-term successes, partial responses
with intact implants and implants lost
after two years of maintenance with
multiple treatments, as well as cases
of successful treatments that relapsed
after one to two years. Analysis of
radiographic data from a sample of
successfully treated implants provided
a time course for bone regeneration.

Methods

Collection and analysis were performed of retrospective data, wherein
patient records were sorted to find
all patients in the practice who had
undergone LAPIP treatment within the
37-month interval from the first treatment (October 2013) until the date of
institutional review board approval

The purpose of the original study
was a precise statistical analysis of the
initial clinical outcome of a single treatment, seeking to determine whether
there was improvement or a lack of improvement at the first follow-up visit. A
review was conducted of patients who
received the treatment in the three
years after the LAPIP training. All patients were included to eliminate selection bias. A staff member went through
the medical records of each LAPIP patient and copied data into case report
forms. Any identifying information
was excluded, and the case report
forms were sent electronically to the
statistician for data entry and analysis.
Data captured included laser settings,
demographics, medical history, implant information, adverse events, PD
(mm; for six pockets) and the presence
of clinical signs (bleeding, erythema
and/or suppuration). Panoramic and/or
periapical radiographs were available
for analysis. The statistician excluded
patients with missing data from the
various analyses. The original group
included 222 patients with 437 implants. That study enrolment closed in
October 2016. Exclusion of patients
with incomplete data resulted in 116
patients with 224 implants available
for analysis, including 47% men and
53% women with a mean age of 65.8
years (range: 23–98 years).
Two years later (September 2018),
a second look at the original group of
patients was performed. Several patients had follow-up visits beyond the
closing date of the original analysis.
Case report forms of additional follow-up visits were collected, uploaded
and added to the original data set. This
resulted in 155 patients with 299 implants who had sufficient baseline and
follow-up data to determine implant
survival and clinical outcomes.
Laser dosimetry
The dental laser was a 6 W pulsed
Nd:YAG laser (PerioLase MVP-7) utilising an optical fibre that delivered
high-energy pulses of light to the tissue. For the LAPIP, the fibre tip is inserted into the periodontal pocket. Parameters that are set on the control
panel are energy per pulse up to
300 mJ; pulse duration, variable from
100 to 650 µs; and pulse repetition
rate from 10 to 100 Hz. The duration of
exposure is controlled with a foot
switch.

31 st EAO Annual Scientific Meeting · Milan

The LAPIP details have been published elsewhere4–7 and are only summarised as follows for the protocol
specifying surgical end points. Achieving those end points is what determines the dosimetry. In Step 2 of the
protocol, the distal fibre tip is inserted
into the periodontal pocket and passed
around the implant several times to
initially open the sulcus and then to
remove the diseased pocket epithelium
and disinfect the tissue, constituting
Pass 1 with the laser.10 In Step 4 of
the protocol, the fibre tip is inserted
into the pooled blood within the sulcus
and again passed around the implant,
heating and congealing the blood and
forming a fibrin clot, constituting
Pass 2 with the laser.11
Hence, real-time dosimetry is
based on these clinical conditions.
With a constant laser power (output),
the time spent lasing within the sulcus
determines the total energy delivered.
In other words, a prescribed laser dose
does not determine the treatment end
point; rather, achieving the surgical
end point determines the total joules.
The surgeon understands that clinical
conditions determine the precise laser
parameters and the total energy delivered.
However, exceeding the recommended
dosimetry increases the risk of possible
adverse effects.
The hard copy printout of the laser
dose for Pass 1 and Pass 2 was available for 138 implants, and the mean
total energy per implant was 285.8 J.
This was divided between the two laser steps. Pass 1 mean total energy
was 181.8 J, and Pass 2 mean total
energy was 104.0 J. Energy was delivered according to the following for
mulas, and sizable case-to-case variance
was required to achieve the surgical
end points:

change in subsequent images. The
cross-sectional area of the defect within
the outlines was measured using
public domain software (ImageJ, National
Institutes of Health freeware). As the
dimensions of the implant were known,
the areas were calibrated in square
millimetres so that comparisons could
be made over time and across cases.
The sum of the defect areas on both
sides of the implant is referred to as
the cross-sectional area. Cross-sectional
areas at follow-up visits of successful
cases were converted to baseline percentage to estimate the time course of
bone regeneration.

Results

The clinical outcome categories
were defined as follows (Fig. 1):
 Long-term success: return to
healthy PD and an absence of clinical signs
 Short-term success: patients with
successful outcomes but without
follow-up data beyond 12 months
 Partial response: failure to meet
success criteria but the implant
was still intact and stable
 Relapse: initial success and then return of clinical signs
 Failed: implant lost or removed.
The long-term responses to treatment can thus be divided into four
general outcomes: successful response
(Group 1), partial response (Group 2),
spontaneous relapse (Group 3) and
lost implant (Group 4). Summary
statistics for each of the four groups
are presented in this section, followed
by one case from each group.

Group 1: Successful response

These two formulas are not a prescription; they merely define the dosimetry used in this study. On average,
Pass 1 required an initial 130 J for
all implants, and Pass 2 required an
initial 85 J. The formula specifies that
the total joules per pass is related
to the average probing depth (aPD;
the average of six PD measurements).
Consequently, to estimate the total
energy, add ten times the aPD in joules
to the initial values for Pass 1 and four
times the aPD for Pass 2.

This was the most common response, 204 implants (68%) meeting
the success criteria of post-treatment
PD ≤ 4 mm and no clinical signs at
follow-up visits. Most implants in this
group (91%) achieved success after a
single treatment. Others (7%) demonstrated a partial response and then
success after a second treatment, and
2% achieved success after three treatments. The median follow-up period
in this group was 18.8 months, and
one implant was still successful at
63 months. At the time of the latest
analysis, 48% of all implants still showed
long-term success (12–63 months). The
remaining 20% of successfully treated
implants had follow-up periods of less
than 12 months, so their long-term
outcomes could not be determined.
Most of these patients did not return
for their scheduled hygiene visits.

Radiographic analysis
Film radiographs were scanned
and digitised and then the digital
radiographs were rotated, cropped and
resized. Brightness and contrast were
not adjusted. Images were arranged
in chronological order to illustrate the
sequential changes in radiographic density for each case. A technician skilled
at reading dental radiographs outlined
the radiographic defect and areas of

Case 1 is an example from the
group of successful treatments (Fig. 2).
The patient was an 87-year-old man
with a cardiovascular condition and
had implants in positions #32 and
42 that supported a mandibular over
denture. He presented with deep pockets
(PD = 5.7 mm) accompanied by a large
defect around implant #42. This had
led to acute symptoms, including pain,
erythema, bleeding, suppuration and

 Pass 1 total joules delivered =
130 + (10 × aPD)
 Pass 2 total joules delivered =
85 + (4 × aPD)

[23] =>

clinical

Group 2: Partial response

Partial responders are implants
that improved but still showed some
clinical signs, had a PD > 4 mm and
never achieved the success criteria.
There were 47 implants (16%) in this
category. Most were treated a second
time at six or 12 months after the
first treatment, and several received
a third treatment. They continued to
exhibit clinical signs and had a PD > 4 mm.
The median follow-up period in this
group was 22 months.
Case 2 is an example of a partial
response to treatment (Fig. 3). The patient was a 58-year-old man with Type
2 diabetes, hypertension and hyper
lipidaemia and had had an implant
(Nobel Biocare Tapered) placed in position #46 in July 2014. The patient presented in December 2014 with a PD
of 9 mm around the implant, bleeding
and suppuration and was treated with
the LAPIP. At four months, there was
no bleeding, but the PD was still 9 mm,
and a second treatment was performed.
At 15 months, the clinical signs had
improved, and PD was reduced to an
aPD of 4.2 mm. At 33 months, the implant was still intact; however, the PD
had increased to 5.3 mm, and there
was some bleeding on probing. The PD
and clinical signs at follow-up visits
did not allow this implant to reach the
success criteria. Even though bone regeneration is unlikely with a defect
this wide, the PD and clinical signs
improved and remained improved
for almost three years after the first
LAPIP treatment, and the implant
remained in function at the time of
last follow-up.

Group 3:
Spontaneous relapse

There were 32 implants (11%) with
initially successful outcomes that demonstrated relapse with the return of inflammatory markers along with deeper PD.
The medium time to relapse was 24 months
(range: 11–43 months).
Case 3 is an example of a successful single treatment that was without
clinical signs for over two years and
then presented with signs of reinfection (Fig. 4). The 59-year-old female patient had had an implant (Nobel Biocare
Tapered; 3.5 × 16.0 mm) immediately
placed in position #11. She had no risk
factors for peri-implantitis, but four
months later, at her first follow-up visit,
the implant showed signs of redness
and bleeding from 4 mm pockets.
Subgingival cement was noted on the
periapical radiographs and was removed. The first LAPIP treatment was
performed in September 2015. At follow-up visits at nine, 15 and 27 months
after the first treatment, all inflammatory markers were absent, and the PD
showed progressive improvement, good
bone fill being noted in the periapical
radiographs. The apical radiolucency
was absent, but a new defect had
appeared coronally at 27 months.

At 32 months, she showed significant
relapse with redness and bleeding from
pockets that had deepened beyond the
pretreatment levels. Radiography revealed that the new defect had enlarged.
The implant was subsequently retreated.

Group 4:
Lost or removed implants

There were 16 implants (5%) that
failed during the follow-up period.
The median time to failure after the
initial LAPIP treatment was five months
(range: one week to 31 months). Four
implants were lost within the first month,
six more by the first follow-up visit
(five months), two at nine months,
one at 18 months and three after
two years of maintenance. One of the
last was healthy but ordered extracted
by the patient’s physician.
Case 4 is among the lost implant
cases (Fig. 5). The patient was an
81-year-old immunocompromised man
with several medical conditions, in
cluding cardiovascular disease and
a drug-resistant systemic infection.
An implant (Nobel Biocare Tapered;
5 × 13 mm) had been placed in position
#46, and he was seen six months later
with an aPD of 6.8 mm, bleeding at
four sites, erythema and radiographic
evidence of bone loss. At the five-month
follow-up visit, bleeding had resolved,
and the aPD was reduced to 5.5 mm, but
there was still redness and suppuration.
By the 18-month visit, the condition had
deteriorated. The aPD had increased
to 8 mm, and there was bleeding and
suppuration. At that time, the patient
received a second LAPIP treatment.
At 30 months, one PD was 11 mm and
the rest were 12 mm, and there was an
increase in the radiographic size of the
defect. A third treatment was performed,
and the laser dose was increased to
305 J at Pass 1 and 180 J at Pass 2 for
that treatment. However, the implant
was finally removed 31 months after
the first treatment.

Change in radiographic density

Radiographs from all 299 implants
were reviewed to identify interproximal vertical defects at baseline indicating bone loss. Many patients had
panoramic radiographs of low resolution, and most bone loss was restricted
to the buccal plate, which is not visible
in transmission (periapical and panoramic) radiography. Only 21 cases
were identified, and of these, ten
provided measurable baseline and
follow-up radiographs. Radiographic
data reflected a similar proportion of
outcomes to the PD and clinical sign
data. Out of the ten cases, one was

from Group 3 (lost implant), two were
from Group 2 (partial response) and
seven were from Group 1 (successful
cases). The cross-sectional areas of the
seven successful cases were converted
to a percentage of the baseline areas,
and those values were plotted at
their respective follow-up times (Fig. 6).
The data fitted well to a decaying ex
ponential function, y = e–0.1x, which
suggested that regeneration approached
98% by 36 months.

Discussion

The LAPIP utilises the advantages
of laser sulcular debridement (e.g. selective tissue removal, bacterial reduction, haemostasis, minimally invasive
method) and embeds the laser components into a medically sound protocol
that also includes implant debridement,
occlusal adjustment, and detailed pretreatment and post-treatment procedures.
Because of these additional therapeutic measures, the outcomes reported here may not be directly com
parable with those of many controlled
laser studies.
PD and clinical signs were analysed.
Analysis of the short-term data from
116 patients with complete baseline
and follow-up data determined that
there was a statistically significant reduction in PD and clinical signs at the
first follow-up visit (median: 7.6 months)
after a single treatment. The aPD was
reduced by 2.0 mm (5.4 mm reduced
to 3.4 mm, P < 0.001), and clinical signs
of erythema, bleeding and suppuration
were reduced by 78%–85% (P < 0.001).
A recent prospective controlled trial of
ten patients who were treated with the
LAPIP found similar results: a 1.9 mm
PD reduction and decreased bleeding
and suppuration.12
Several patients had follow-up
visits after the short-term study had
concluded. By the time of this longterm analysis, there were 155 patients
with 299 implants available to determine long-term survival and response
to therapy. The initial survival rate was
94% at 13.1 months (15 were lost out
of the 264 implants). The long-term
survival rate matched and surpassed
the previous results, being 95% at
28.8 months (16 of the 299 implants
were lost). In the long term, PD remained
≤ 4 mm, and clinical signs remained
absent for 68% of the 299 implants.
An additional 11% were initially successful, but then presented with a relapse
at about two years post-treatment.
Sixteen per cent of the 299 implants
never achieved success, but remained
intact at 22 months.

6
5

Fig. 6: Change in cross-sectional area of the defect as a percentage of the baseline area for seven
implants from Group 1. Black circles = success.



F ig. 2: Example of a successful treatment
(Case 1), showing changes in radiographic
defect (mm2), probing depth (PD; mm) and
clinical signs from baseline to 30 months
later. Violet = cross-sectional area; MB = mesiobuccal PD; B = buccal PD; DB = distobuccal PD; ML = mesiolingual PD; L = lingual PD;
DL = distolingual PD; R = redness; B = bleeding; P = suppuration; Tx1 = first treatment.
Fig. 3: Example of a partial response to treatment (Case 2), showing changes in radiographic defect (mm2), probing depth (PD; mm)
and clinical signs from baseline to 33 months
later. Violet = cross-sectional area; MB = mesiobuccal PD; B = buccal PD; DB = distobuccal PD; ML = mesiolingual PD; L = lingual PD;
DL = distolingual PD; R = redness; B = bleeding; P = suppuration; Tx1 = first treatment;
Tx2 = second treatment. Fig. 4: Example of a
successful single treatment that was wit
hout clinical signs for over two years, and
then the implant presented with signs of
reinfection (Case 3), showing changes in radiographic defect (mm2), probing depth (PD; mm)
and clinical signs from baseline to 32 months
later. Violet = cross-sectional area; MB = mesiobuccal PD; B = buccal PD; DB = distobuccal PD; ML = mesiolingual PD; L = lingual PD;
DL = distolingual PD; R = redness; B = bleeding; P = suppuration; Tx1 = first treatment.
Fig. 5: Example of a lost implant (Case 4),
showing changes in radiographic defect
(mm2), probing depth (PD; mm) and clinical
signs from baseline to 30 months later.
Violet = cross-sectional area; MB = mesiobuccal PD; B = buccal PD; DB = distobuccal PD;
ML = mesiolingual PD; L = lingual PD;
DL = distolingual PD; R = redness; B = bleeding;
P = suppuration; Tx1 = first treatment;
Tx2 = second treatment; Tx3 = third treatment.

The clinical healing curve indicated by the average rate of increase
in radiographic density for successful
cases demonstrated that, on average,
bone fill is expected to be 25% complete by three months, 70% complete
at one year, 90% complete by two
years and 98% complete after three
years. It is important to note that this
study only sampled interproximal
defects, and the analysis may thus
not accurately reflect changes to labial
bone.

Conclusion

One of the greatest challenges has
been fighting a losing battle against
peri-implantitis. The impact of the
LAPIP on treatment of peri-implantitis
has been significant. Using other
methods over 30 years of practice in
the case of Dr Schwarz, achieving
bone fill and eliminating all signs of
inflammation have been challenging.
These results describe the final stage
of translation of an experimental protocol into clinical practice. An attempt
to present an unbiased analysis of the
real-world clinical outcomes, successful or not, has been accomplished. The
results demonstrated would be typical
for any clinician who has been properly trained and follows the protocol.
Even a partial responder is a clinical
success if the implant remains improved. Periodic retreatment of the
partial responders and the relapses is
a way to extend the time of functionality for the patient. The results of this
study indicate that the LAPIP offers
a minimally invasive, repeatable way
to regenerate bone and eliminate clinical
signs of disease in most patients
and to effectively manage the more
difficult cases.
Acknowledgements
We would like to thank Veronica
Serna, Jennie Richie, Molly Tuttle
and Ray Guajardo for technical assistance and acknowledge Burkart
Associates, which assisted with

statistical analyses. We appreciate
the review by and suggestions of
John Sulewski, Ray Yukna, Jon Suzuki
and Dawn Gregg. 7

Editorial note: Please scan this
QR code for the list of references.
This article was first published in Dental Tribune UK
& Ireland vol. 14, issue 1/2024.

About the authors
Dr Gary M. Schwarz works in private
practice at Valley Oral & Maxillofacial
Surgery in McAllen in Texas in the US.
Dr David M. Harris works at the
Department of Periodontics of Rutgers
School of Dental Medicine in Newark
in New Jersey in the US.
Dr Gregori M. Kurtzman works in
private practice in Silver Spring in
Maryland in the US.

contact

swelling of the vestibule. At the pretreatment visit, the labial plate was
mostly absent along the buccal aspect
of the implant becoming exposed. At
six months posttreatment, the clinical
signs had resolved, the PD had reduced
to 3.8 mm and the area of radiolucency
had reduced too. At 30 months, the PD
was 2.8 mm, and there was a complete
absence of clinical signs.

Dr Gregori M. Kurtzman
3801 International Dr Ste 102
Silver Spring MD 20906, US
drimplants@aol.com

31 st EAO Annual Scientific Meeting · Milan

[24] =>

news

Study reveals healing abutment reuse in residency programmes

Non-standard decontamination practices may risk patient safety.
By Dental Tribune International
and the risk of initiating inflammatory
responses in patients. The researchers
found that, although only a small number of programmes reuse HAs, the lack
of standardisation of decontamination
practices could put patients at risk of
exposure to biomaterials.
The researchers utilised a survey
distributed to programme directors of
57 accredited periodontics residency
programmes in the US. The survey included seven questions focused on the
reuse of HAs, the duration for which
they are left in situ and the decontamination techniques employed.

n Although manufacturers indicate
that healing abutments (HAs) are
single-use components, HAs are
sometimes reused in clinical practice.
Academic institutions being at the
forefront of evidence-based dentistry,

a study has looked into the prevalence
of reuse of HAs across American periodontics residency programmes and
their decontamination protocols, as
concerns have arisen about their reuse
owing to potential cross-contamination

Among the 14 programmes that
completed the survey, three reported
reusing HAs. The responses revealed
an almost even split between one-stage
and two-stage implant placement
protocols. The duration that HAs
remained in situ varied widely, from
four weeks to six months, depending
on the case specifics and the protocol
followed.

Decontamination techniques included manual cleaning, ultrasonic
cleaning, rinsing and heat sterilisation
in autoclaves. However, the lack of
standardisation in the methods used
raises concerns, given the results of
multiple studies cited in the paper that
demonstrated incomplete removal of
biomaterials from HA surfaces after
standard cleaning procedures and
autoclave sterilisation in clinical practice. This residual contamination poses
a risk of cross-patient contamination
and could lead to adverse biological
responses, such as inflammation,
which may compromise the success of
the implant.
Furthermore, the US Centers for
Disease Control and Prevention and
Food and Drug Administration imply
that HAs should be treated as single-
use devices and thus should not be
reused. Despite this, economic pressures in educational settings may
influence the decision to reuse these
components, potentially compromis-

ing patient safety. Additionally, the
ethical and legal implications of
reusing single-use devices, especially
without patient consent, are significant and could expose institutions to
litigation.
The findings of this study suggest
that the reuse of HAs is not widespread in periodontics residency
programmes. However, the authors
emphasised that further research is
needed to assess the true extent of HA
reuse in both educational and private
practice settings. Moreover, there is an
urgent need to establish standardised,
effective decontamination protocols
to ensure that reused HAs do not pose
a risk to patients.
The study, titled “Are healing abutments being reused in periodontics
residency programs in the United
States? A survey-based study”, was
published online on 4 July 2024 in the
Journal of Dental Education, ahead of
inclusion in an issue. 7

Early results indicate robotic dental implant system is quite accurate
Research from China indicates robots now perform precise autonomous implant procedures.
By Dental Tribune International

The accuracy of implant positioning heavily relies on the expertise and
manual skill of the clinician. Even
slight deviations during the placement
procedure could result in functional
or aesthetic problems, potentially leading to complications such as nerve
damage or implant failure. Deviations
result in implant failure rates of up
to 10% even for the most skilled
surgeons, according to studies cited
by the authors.
Although static and dynamic
computer-assisted implant surgeries
improve the precision of implant
placement compared with freehand
procedures, these methods have in
herent limitations. In static computer-
assisted surgery, for example, the
guide must first be produced preoperatively, and it cannot be adjusted intraoperatively. Dynamic systems, while
offering more flexibility, still require
the surgeon’s continuous attention to a
screen rather than direct observation,

n Autonomous dental implant robotic
systems (ADIRSs) represent an ex
citing and innovative advancement in
implant dentistry, offering significant
potential for enhancing the precision
and success rates of implant surgeries.
According to recent clinical research
by a team in China, the robotic system
it tested demonstrates superior accuracy in implant placement, particularly in controlling angular deviations
and axial errors. The results indicate
that the technology, which utilises
a 6D robotic arm, is potentially more
efficient and precise than freehand and
conventional computer-aided implant
placement methods, and enables minimally invasive surgeries.

potentially giving rise to error due to
fatigue or manual inaccuracies. This is
where ADIRS technology emerges as a
promising solution, offering real-time
navigation and automation to perform
implant surgeries with higher precision
and reduced complexity.
Conducted at Peking University
Third Hospital, the study enrolled
74 participants with partial edentulism.
The participants underwent preoperative CBCT scans, and the data was fed
into the ADIRS software for surgical
path planning. The surgeries were
performed by an ADIRS called the
FZ-DISAS-I and a dental implant machine from two Chinese manufacturers
(Sichuan Fengzhun Robot Technology
and Kavacol Dental Medical Devices).
During the surgeries, the robotic arm
autonomously prepared the osteotomies
and placed the implants.

Postoperative CBCT scans were
used to measure deviations between
the planned and actual implant positions. The mean global coronal deviation was found to be 0.61 ± 0.20 mm,
the global apical deviation was
0.79 ± 0.32 mm and the angular de
viation was 2.56 ± 1.10°. These results
reflect a high level of accuracy, comparable or superior to other computer-
assisted methods. Notably, the study
found that factors such as the implant
region (premolar or molar), jaw, implant length and surgeon did not
significantly affect the placement
accuracy.
Beyond improved accuracy, further benefits of using an ADIRS in
implant surgery include minimal need
for human intervention and reduced
potential for human error, operator
fatigue and visual obstructions, which

31 st EAO Annual Scientific Meeting · Milan

are common challenges in freehand
and computer-assisted surgeries. The
need for larger incisions or extensive
soft-tissue manipulation is also reduced during an ADIRS procedure,
promoting faster healing times and
causing less postoperative discomfort
for patients.
The robot operates according
to a preprogrammed surgical plan.
Unlike manual methods or dynamic
computer-assisted surgery, which
can require extensive experience
to achieve a high level of precision,
an ADIRS simplifies the process,
enabling less-experienced surgeons
to perform implant surgeries with
expert-level accuracy under proper
supervision.
Despite its advantages, the use of
ADIRSs in clinical settings is not without

challenges, and the technology is still
in the early stages. The hardware
alone requires a considerable amount
of space and additional personnel to
operate efficiently, and these requirements may pose logistical issues in
smaller clinics or surgical settings.
Additionally, the high cost of the
equipment may lead to increased
expenses for patients, potentially limiting
its accessibility.
The researchers additionally
noted the potential for errors if the
positioning markers used during the
surgery become loose. These markers
are crucial for the real-time tracking
and navigation capabilities of the
robotic system. Loosening of these

markers during surgery can lead to
deviations from the planned implant
position. Therefore, careful monitoring and verification of marker sta
bility throughout the procedure are
essential.
Furthermore, while the study
demonstrated high accuracy in
straightforward cases of partial edentulism, the authors indicated that
more research is needed on more
complex clinical scenarios, such as
patients with severe bone defects and
placement into extraction sockets.
Future research will likely focus
on expanding the applicability of
ADIRSs to a wider range of clinical
situations.
The study, titled “Accuracy of
an autonomous dental implant robotic
system in dental implant surgery”,
was published online on 13 August 2024
in the Journal of Prosthetic Dentistry,
ahead of inclusion in an issue. 7

[25] =>

dental-tribune.com

dtstudyclub.com

E-newsletter

For 20 years,, Dental Tribune
International has been at the
forefront of dental media, education,
and events, shaping the global
landscape of dental knowledge
dissemination. With a presence
in over 90 countries,
countries Dental
Tribune International stands as
the world’s largest dental
network, connecting profesThe global voice in essential dental media
sionals and industry representatives across the globe. Our
commitment to providing
essential information to the dental
community is unwavering. Since our
inception in Leipzig, Germany, in
2003, Dental Tribune International
has flourished into a powerhouse.
Our integrated approach merges print,
digital, and educational media,
offering a myriad of marketing
channels to engage with the vast
dental community
worldwide. As we celebrate this
milestone, we proudly
merge our anniversary with our esteemed German forerunner
company, OEMUS MEDIA. With roots dating back to 1994, OEMUS
MEDIA has evolved into a pivotal player and trusted partner in the dental
landscape, setting trends and standards in the German-speaking markets.
Together, Dental Tribune International and OEMUS MEDIA bring forth over
50 years of collective industry expertise, reflecting our commitment to
14
15
innovation, quality, and service excellence.

Celebrating 20 years of

16

Interview
Prof. Phoebus
Madianos disclose
s what attendees can look
forward to at
this year’s
EuroPerio.

News
The European
Federat
has made sustaina ion of Periodontology
bility a central
EuroPerio10.
focus of

» page 4

EFP welcome
s attendees
to EuroPerio1
0 in Copenhag
More than 130
en
speakers from
to present
over 30
on advances in

© Marina Datsenko/Shu

tterstock.com

© d.ee_angelo/

» page 6

Shutterstock.com

Products
EuroPerio offers
the opportunity
to see and
try out the most
current innovat
ions in periodontics and implant
dentistry.

» pages 17–2

“We aim to ins
pire excellenc
e
during this ye
ar’s EuroPeri
An interview with
Holger Essig, chief
o”
marketing officer

countries
periodontics and
implant dentis
try

of BioHorizons

THE GLOBAL DENTAL CE COMMUNITY

 Organised by
the European
Periodontolog
 As dental profess
y (EFP), EuroPe Federation of
dontics and implan
ionals around
rio10 is being
held from 15
up for EuroPe
t dentistry and
to 18
nection with
rio10, Dental Tribunethe world gear
their conhagen in Denma June at Bella Center Copen
other dental
reached out to
International
and medical
rk. EuroPerio,
plines.
Holger Essig,
discithe leading congress in period
chief marketing
ficer of BioHor
ontics and implan
ofizons Camlog
With its wide
is usually held
and
t dentistry,
Henry Schein’
triennially, but
EuroPerio10 has range of scientific format
s Global Oral Recons a member of
had to be postponed last year
s,
educational opport
to discuss the
truction Group,
becaus e of the
general dentist
company’s particip
unities for
What sorts of
EuroPerio10
s, periodontists
pande mic.
event and its latest
produc
ation at the
has an impres
,
orthod
oral
surgeons,
initiatives.
tendees of EuroPe ts and activities can atontists, prosth
sive speaker
up of more than
linerio10 look forwar
130 experts from
ists, dental nurses odontists, dental hygien
BioHorizons Camlog
d to at the
tries who will
over
,
Mr
30
other
Essig, in 2018,
counbooth?
dental and medica
cover the latest
CAMLOG’s theme
We are offerin
trends in periol
was “Perio-friendly
for EuroPerio
g an Expert
gramme, and
and
Lounge proefficient
with CAMLOG”.
throug
` page 2
Does BioHorizons restorations
renowned expert hout Thursday and Friday,
congress theme
Camlog have a
s are holding
for this year’s
live presentashow? Which
are
` page 2

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Dental Tribune International

[26] =>

industry

“PREVENTION IS OFTEN UNDERREPRESENTED AT DENTAL SHOWS”
An interview with Curaden’s Dr Ana Bokuchava on transforming oral health.
to change the narrative around preven
tion with our iTOP method, which
focuses on perfect individual prophy
laxis. We train dentists and hygienists
to become real leaders in prevention
who can coach their patients to perfect
oral health in turn.
Earlier this year, Curaden also
presented The Gentle Guide to Oral
Health and Human Happiness,
which shows how we are uniting
thousands of dental professionals
who share our mission to transform
oral healthcare through prevention.
In the guide, 40 global experts share
their insights on prioritizing pre
vention, supported by the latest
research and World Health Organi
zation policies.

Dr Ana Bokuchava is an experienced professional in the dental industry.

n Dr Ana Bokuchava is a dentist and
the international marketing manager
for Swiss prevention pioneer Curaden.
In this interview, she shares the com
pany’s vision on advancing oral health
at 2024 EAO congress in Milan and
how prioritising prevention remains a
challenge in modern dentistry.

Dr Bokuchava, is it still a challenge
to grab people’s attention with prevention?
The problem with prevention is
that it seems too easy. Prevention is the
most important element of maintaining
good oral health but also the one that
seems most basic. At Curaden, we aim

What can visitors expect at the
Curaden booth?
Prevention is often underrepre
sented at dental shows. At the
EAO congress, we will therefore offer
a comprehensive blend of sorely
needed preventive education and
the products that go along with that.
What dental professionals increas
ingly need are the tools and knowl
edge to promote health and happi
ness and maintain a healthy mouth.
Our products are designed around
four key pillars: being attractive,
accepted, effective and safe.
At the Curaden booth, visitors
will find our typically vibrant,

Perio plus zero is he latest addition to the Curaprox Perio plus line of mouthwashes.

colourful displays, as well as our
latest innovation in the Perio plus
line: Perio plus zero, an innovative
mouthwash is set to revolutionize
the industry with its completely
different formula, offering a ground
breaking approach to oral health.
We’ll also be showcasing the
Hydrosonic pro toothbrush, offer
ing a free travel set and providing
educational insights on our prod
ucts. I’ll be there to present and
share details about the Perio plus
zero and more.

as a practising dentist. I remember
its yellow handle with blue bristles
and how its 5,460 soft filaments felt
on my gums. It was a game-changer.
Over the years, I’ve discovered many
fantastic products, like our interden
tal brushes and unique calibration
system. Today, the Aligner Foam and
Prio plus zero too have a special
place in my heart. It’s hard to choose
just one favourite, as each product
contributes uniquely to our mission
of improving oral health. 7

What is your favourite product?
My favourite product is
Curaprox’s CS 5460 toothbrush, a
nostalgic choice from my early days

Curaden, Switzerland
https://curaprox.ch
Booth C79

BIOHORIZONS CAMLOG PRESENTS BIOMATERIALS CAMPAIGN AND MARKS MILESTONE ANNIVERSARIES AT EAO
aging peri-implant defects, which
pose a significant challenge for
dentists involved in implant place
ment. Participants will be trained
to use a newly introduced scaffold
matrix regenerative therapy pro
cess collagen membrane, which
preserves the collagen structure
without cross-linking or chemical
modification. The hands-on exercises
will be performed on customised
models.

n BioHorizons Camlog is showcas
ing its regenerative biomaterials
portfolio through the “The Art of
Regeneration” campaign and intro
duces the Tapered Pro Conical, the
company’s latest dental implant to
the European market. Attendees can
look forward to insightful workshops
and sessions providing information
on regenerative techniques and first
steps with implants.
The company is celebrating two
significant achievements this year.
Alongside BioHorizons’ 30th anniversary,
Camlog marks 25 years of serving
dental professionals with ongoing in
novation, expertise and commitment
in the field of implant dentistry.
“We are proud to celebrate this
milestone and extend our heartfelt
thanks to our highly committed
team, valued customers and long-
standing partners across the globe,”
stated Bianka Wilson, co-CEO of
BioHorizons Camlog. “Each one is
a testament to the hard work,
passion and advancements that
have guided BioHorizons Camlog
on this remarkable journey,” she
continued.

the biomaterials portfolio in a very
aesthetic way. The campaign illus
trates how these innovative bioma
terials are transforming the process
of regeneration into a form of art,
serving clinicians who act as artists
crafting new smiles every day. In
Austria, Germany and Switzerland,
this campaign will be launched
in 2025.

The company’s “The Art of
Regeneration” campaign features

In line with the campaign,
BioHorizons Camlog will hold two

workshops at the event. These will
focus on regeneration. On 24 October,
Dr Luca de Stavola from Italy will
speak about regenerative tech
niques with hard- and soft-tissue
solutions from 15:15 to 17:30 in
Room Amber 1. The workshop aims
to define hard- and soft-tissue aug
mentation strategies and will also
consider the value of hard- and
soft-tissue substitute material in
many clinical applications. The
instructive hands-on exercises will

31 st EAO Annual Scientific Meeting · Milan

involve soft-tissue augmentation
around teeth and implants on animal
jaws and vertical bone augmentation
on customised models.
On 25 October from 9:00 to
11:30, Prof. Hom-Lay Wang from
the US will talk about the re
generation of peri-implantitis intra
osseous defects via a submerged
guided bone regeneration approach.
This workshop will take place in
Room Amber 3 and focus on man

“In addition, BioHorizons Camlog
will host the “My First Implant”
session on 24 October from 8:30
to 13:30 in Rooms Amber 3
and 4. In this hands-on session,
Dr Joao Pitta and Michael Knackmuss
will cover the basics of implant
placement and restoration with
a focus on practical skills and
patient management. Attendees
will have the opportunity to learn
from
experienced clinicians and
gain hands-on experience in a
supportive and educational envi
ronment. 7

BioHorizons Camlog,
Switzerland
www.biohorizonscamlog.com
Booth F55

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[28] =>

industry

OSSTEM IMPLANT ENVISIONS FUTURE OF DENTISTRY WITH INNOVATIVE PATIENT-CENTRED TECHNOLOGY
metal sleeves, chairside time can
be significantly reduced. This approach can also produce excellent
results, even in cases involving
narrow spaces or where superior
aesthetics are required, such as in
the anterior region,” Dr Tallarico
said.

n A diamond sponsor of this year’s
EAO congress, Osstem Implant will
support the “My first implant” session on 24 October from 8:30 to
13:00, organised by the EAO Junior
Committee. This programme will
combine theoretical lectures with
hands-on training and is expected
to attract approximately 60 young
dentists. The hands-on sessions
will be conducted at 20-minute
intervals, accommodating groups
of ten participants in each session,
and will take place six times
throughout the day. Dentist and
EAO adviser Dr Marianzela Alexopoulou will impart her expertise
on utilising Osstem’s 122 Taper Kit,
which allows dental professionals
to treat any clinical case regardless
of its complexity and the bone
condition.
On 25 October, Osstem will
host an industry forum titled
“Latest advancements to boost
osseointegration and achieve modern
patient-centered outcomes” from
12:30 to 13:30 in Room Garda,
which has a capacity of up to 350
attendees. The session will be
chaired by biomaterials expert
Dr Marco Esposito from Italy.
Prof. Darko Božić from Croatia,
Dr Leonardo Muzzi and Dr Fulvio Gatti,
both from Italy, will join as speakers
and address methods to enhance
osseointegration.

Lee Jin-Moo added: “Osstem
Implant, which has participated
in EAO annually since 2004, was
elevated to the status of diamond
sponsor last year. As a sponsor, we
have organised an enriching and
comprehensive on-site lecture series this year. In addition to the
implant, OneGuide and guided bone
regeneration exhibition zones, we
have arranged a digital exhibition
area showcasing our T2 CBCT unit,
making its debut at the EAO meeting
this year.”

From left: OneCAS KIT, OneGuide KIT, and 122 Taper KIT, all of which have received certification under the EU Medical Device Regulation (MDR).

“Providing patients with comfortable and aesthetically pleasing
treatment outcomes is the primary
objective of the modern implantology community,” said Lee Jin-Moo,
executive director and head of
Osstem Implant Europe. “At the

industry forum, Osstem Implant,

alongside esteemed lecturers with
extensive clinical experience, will
confidently showcase its latest patient-

centred technologies, including the
OneGuide system and the next-
generation surface technology SOI
both designed to enhance osseo
integration, facilitate rapid recovery
and promote healthy smiles,” he
continued.
On 26 October, Dr Marco Tallarico
from Italy will hold a hands-on
industry session from 9:00 to

11:30 in Room Amber 4. He will
discuss the implant placement
and prosthetic workflow using the
OneGuide system for addressing
complex clinical cases, such as
aesthetic treatments and full-arch
restorations, with high precision.
“By utilising Osstem Implant’s
OneGuide template, which is
3D-printed and allows for guided
surgery without the need for

EAO attendees who receive
consultations at the booths or join
the Osstem hands-on courses or
industry forum will receive gifts,
such as toothpaste, toothbrushes,
surgical bandanas, mugs and plush
dolls. 7

Osstem Implant,
Czech Republic
en.osstem.com
Booth E31

JDENTALCARE OFFERS A COMPREHENSIVE PROGRAMME AT EAO MEETING
n At this year’s EAO congress,
JDentalCare, a dental implant manufacturer from Italy with a network
of distributors across five continents, is presenting its 12 implant
lines, which offer effective and
simplified solutions for dental professionals worldwide. In addition,
JDentalCare is showcasing its sur
gical kits, instruments and tools
designed to enhance the daily

practice of clinicians.
The focus of JDentalCare’s participation this year is on the advantages of its innovative Maxilla-For-All
treatment concept. This approach
combines pterygoid, trans-sinus and
zygomatic implants, enabling the
rehabilitation of all cases involving
severe maxillary atrophy. At the
JDentalCare booth, EAO visitors can
also discover new and innovative
tools developed for computer-guided
surgery. One example is the
Scanbody Full Arch Tracer, a device
that serves as an anatomical landmark during intra-oral scanning,
facilitating pre- and post-surgery

scan alignment for full-arch cases.
Another innovative product is the
Z-GO Guide, a patented solution for
fully guided zygomatic implant surgery that supports clinicians during
complex cases involving zygomatic
implants.

31 st EAO Annual Scientific Meeting · Milan

A cornerstone of JDentalCare’s
portfolio is its training courses,
which help dentists try out and
learn about the company’s products
while mastering the latest surgical
techniques to improve their daily
practice.
Today and tomorrow, implantology
expert Dr Ruggero Leoncavallo
will explain the benefits of the
Maxilla-For-All treatment protocol
and other JDentalCare products.

Dates and times:

2
4 October: 10:30–12:00 and
14:30–16:00
 25 October: 10:30–12:00 and
14:30–16:00
Throughout the meeting, visitors will have the opportunity
to receive exclusive discounts on
JDentalCare’s courses. 7

Editorial note: Please scan the
QR code for more information.

JDentalCare,
Italy
www.jdentalcare.com
Booth C74

[29] =>

industry

GBT: Oral hygiene at home as part of oral prophylaxis
By Dr Neha Dixit, Switzerland
such as poor diet, smoking and stress,
good oral hygiene makes a decisive
contribution to preventing a transition
to dysbiosis. The guidelines on gingivitis
prevention (currently undergoing
revision) recommend manual or
electric toothbrushes supplemented
by aids for mechanical interdental
cleaning and rinsing solutions.3, 4
These are tailored to the patient’s
individual risk, personal needs and
manual dexterity.

n Oral disease prevention consists
of two pillars: individual home care
and professional prophylaxis. For good
long-term oral health, both components
need to be respected. The evidence-
based Guided Biofilm Therapy (GBT)
protocol by EMS has adapted Axelsson and Lindhe’s systematic prophylaxis approach to today’s scientific
advances and technological progress.1 As the most common oral diseases are associated with the presence of dysbiotic biofilms,2 the
continued removal of these biofilms

through appropriate home care and
professional measures is essential to
maintain oral health. For long-term
oral health, patients need a customised
care package covering professional
biofilm and calculus management,
as well as individual education and
instruction in oral hygiene.

Risk factors and oral hygiene

Regular mechanical removal of
biofilm usually helps keep the biofilm in balance—in a symbiotic state.
In addition to avoiding risk factors

Toothbrushes are unable to reach
interdental spaces. Such areas thus
offer ideal local conditions for biofilm
to become established and mature.
Interproximal biofilm remains after
brushing, particularly in the pre
molar and molar regions.5 To prevent
this, interdental brushes are highly
recommended, alongside dental floss
for crowded teeth. Professional instruction on how to use both correctly is
essential.

Is there such a thing as
perfect oral hygiene?

Like other important aspects of
life, the key to good oral hygiene is
regular training. Disclosing tablets
can be part of a plan for effective
personal biofilm control. Regular use
helps patients learn to identify areas
where better cleaning is needed and
how best to go about this cleaning.

The clinical protocol of GBT includes
biofilm disclosure and patient motivation (Steps 2 and 3) as key to changing
behaviour on a lasting basis.
Serving also as clinical quality
control, this disclosure step is an
essential part of professional biofilm
management. Only biofilm that is visible—
disclosed—is removed in Step 4 of GBT
with AIR-FLOWING, employing the
AIRFLOW Prophylaxis Master with
the AIRFLOW MAX handpiece—which
boasts the patented Laminar Flow
Technology—and AIRFLOW PLUS powder.
Any remaining calculus is removed
with the original PIEZON NO PAIN PS
or PI MAX instrument (Step 6).6

Conclusion

The cornerstones of continued prevention of oral disease are good oral hygiene and the professional management
of biofilm and calculus. Both are supported by the best possible control of
risk factors as part of systematic pro
fessional prophylaxis through GBT.7
Individual advice, instruction and encouragement from the practice team
help patients become experts in their
own daily oral hygiene and thus achieve
optimal oral health in the long term. 7

Dr Neha Dixit

global lead of clinical affairs and
professional education at the
Swiss Dental Academy (SDA),
has been an integral member of
the SDA and EMS since 2009.
A periodontist by training, she
is a passionate and enthusiastic
clinician who believes in providing
education to clinicians globally that
is backed by scientific evidence.
Dr Dixit has received specialty
training in non-surgical periodontics and has been a staunch advocate of adopting a non-invasive
clinical approach right from her
graduation days, even before she
joined EMS.

Editorial Note: Please scan the QR
code to view the list of references.

Empowering women in dentistry
An interview with Jutta Roberts about Nobel Biocare’s upcoming annual education meeting.
By Nobel Biocare
© Lukas Pitsch

However, beyond the technical
skills, the event offers a chance to
connect with peers, mentors and
leaders in the dental industry. Building a strong professional network
is essential for personal and career
growth, and this meeting is designed to foster those connections.
In a profession where women are
still under-represented in senior
roles, this event is a unique oppor
tunity to learn, connect and be
part of a growing community that
champions female empowerment in
dentistry.

n On 29 and 30 November, female
dental professionals from around the
world will gather in Zurich in Switzerland for the 18th annual education
meeting of the Professionals in
Dentistry (PiD) Esthetic Group. Hosted
by Nobel Biocare, this two-day event
promises expert hands-on training
as well as a livestreamed surgery
from the renowned MALO CLINIC.
Additionally, the event will feature
a keynote speech by Prof. Tomas
Albrektsson, a pioneering figure in
implantology for almost 60 years.
In this interview, Jutta Roberts, the
group’s founder, shares more about

the initiative’s mission and highlights
of the upcoming event.
Ms Roberts, could you tell us more
about the PiD Esthetic Group for
women in dentistry?
It all began in 2006 when I joined
Nobel Biocare in Sweden. I noticed
a distinct need for female dentists,
students and technicians to have more
tailored opportunities for growth.
Women were entering the dental profession in increasing numbers, but
research showed that they were less
likely to adopt advanced surgical techniques or market their skills compared

with their male counterparts. This led
to the creation of the PiD Esthetic Group,
a global network dedicated to supporting the professional development of
female dental professionals.

MALO CLINIC. Every year, we also award
the Nobel Biocare Woman of the Year
prize to a female professional who has
demonstrated outstanding dedication
to aesthetic dentistry.

What kinds of activities does the
group offer?
Our activities are diverse and
cater to the varied needs of our
members. We organise hands-on
workshops, lectures and mentorship
programmes across the globe. Last
year, we held our annual educational
days in Lisbon in Portugal, where
members attended a course at the

Why should women join your event in
Zurich?
This year’s meeting is set to be one
of our most exciting yet. With a live surgery, a number of hands-on workshops
and Prof. Tomas Albrektsson as a keynote speaker, attendees will have the
opportunity to learn cutting-edge techniques and be updated on the latest
advancements in implant dentistry.

What have you learned from working
with the PiD Esthetic Group?
It has shown me the incredible
power of community. I’ve seen firsthand how mentorship and support
can transform a professional’s confidence and skills. One of our members, Dr Mathilda Qvarnström, told
me that she wouldn’t have pursued
implant surgery without the network’s support. Stories like hers
remind me of why we started this
group: to give women the confidence to take on advanced roles
in dentistry and ensure that they
have the support they need along
the way. 7
Editorial note: Dental professionals who register
for the event by 28 October will receive a
20% discount with the promotional code “EAO2024”.
More information about the programme and
registration is available at nobelbiocare.com/
education.

31 st EAO Annual Scientific Meeting · Milan

[30] =>

travel

What’s on in Milan, 24–26 October
Eight exciting things to do in the city this week.
Milan Cathedral

Galleria Vittorio Emanuele II

Milan’s iconic cathedral, the Duomo
di Milano, is a must-see attraction in
the city. A masterpiece of Gothic architecture, the cathedral contains over
3,000 statues and is replete with intricate spires that tower over the Piazza del
Duomo. Inside, visitors can explore more

Milan does haute couture like
no other, and the city’s most famous shopping arcade is packed
with luxury retailers, jewellers and
art dealers. Happily, it is also an
important meeting place for locals,
and its relaxed dining rooms and
cafes have lent it the welcoming

 Address: Via Carlo Maria Martini, 1
 Opening times: 9:00–19:00 daily
 More information:
www.duomomilano.it

 Address: Piazza del Duomo
 Opening times:
10:00–19:00 daily

Teatro alla Scala

 Address: Via Filodrammatici, 2
 Opening times: Hours vary in accordance
with performances and rehearsals
 More information: www.teatroallascala.org
The third jewel situated around
Milan’s Piazza del Duomo is the enormous,
lavish La Scala opera house, where visitors can soak up over two centuries
of world-class operatic, theatrical and
balletic culture. Join a tour to discover
hidden highlights of the vast gallery,
including the royal box, or visit the
on-site museum, which contains an entire room dedicated to famed composer
Giuseppe Verdi, and a copy of Plautus’
comedies printed in 1511.

Leonardo da Vinci, a human torpedo and
an IBM 704 computer (1954) in a single
museum visit. Milan’s science and technology museum—the largest in Italy—
appeals to those with a love of gadgetry
and all things technical. Housed in a former monastery founded in the sixteenth
century, the collection focuses on the
thematic areas of materials, transport,
energy and communication, as well as
new frontiers and science for younger
visitors. A major attraction for many is
the collection of models based on drawings
of machines conceived by Da Vinci. Did
you know that the renaissance polymath
designed a tank, a hydraulic saw and
a flying machine? Set aside an afternoon
in Milan to see them for yourself.

Primè, for fine dining

 Address: Viale Francesco Crispi, 2
 Dinner service: Monday to Friday:
19:00 to 23:00 | Saturday: 19:00 to
23:30
 More information: ristoranteprime.it
Located near the Garibaldi metro
station, Primè is one of a number of
excellent seafood restaurants in Milan.
The menu offers a contemporary twist
on local seafood dishes—such as
roasted octopus with lime hummus
and yellow rice chips, and salmon
with a pistachio crust and grapefruit
cream—and also caters to those who
prefer dishes of the mammalian variety.
Buon appetito!

Parco Sempione

After a busy day at the congress,
why not unwind in one of Milan’s most
beautiful parks? The eighteenth-century
Parco Sempione covers 38 hectares, and
its boundaries are marked by some of
the city’s most-visited landmarks, including Castello Sforzesco (Sforza Castle).
Those who wander the green expanses
will find several kiosks providing snacks
and refreshments, as well as a multi
coloured water fountain featuring sculptures designed by Giorgio de Chirico.
Look out for Locanda alla Mano, a popular cafe which is run by people with disabilities and located near the castle.
moniker il salotto di Milano—Milan’s
drawing room. A masterpiece of
nineteenth-
century Italian architecture, the iron and glass domed
roof creates an unforgettable spatial
effect. Those looking for a luxury
gift or souvenir may wish to visit
Borsalino, Italy’s oldest hat manufacturer, located in the northern
passage.

 Address: Via San Vittore, 21
 Opening times: Tuesday–Friday:
9:30–17:00 | Saturday and Sunday:
9:30–18:30
 Ticket price: €10 for regular entry
 More information: www.museoscienza.org
It is not every day that one can
see models of machines designed by

than six centuries of Roman Catholic
history, peruse the underground archaeological area and access rooftop terraces
with breathtaking views of the city.
Reserve a ticket online or beat the crowds
with a guided tour. Keep an eye out for
the Madonnina, a gilded statue of the
Virgin Mary that sits atop the church’s
highest spire and is said to represent the
heart and soul of Milan.

Leonardo da Vinci Museum
of Science and Technology

31 st EAO Annual Scientific Meeting · Milan

 Location: Piazza Sempione
 Opening times: 6:30–21:00 daily

JAZZMI jazz festival

Navigli night life district

An annual exploration of the forms,
history and sounds of jazz music, JAZZMI
celebrates Milan’s rich jazz tradition and
invites music fans to challenge their perceptions of the genre. Italian artist Alsogood
will perform at Piazza del Liberty on Thursday,
24 October, blending jazz with hip-hop and
electronica. The female percussion ensemble groove& will play at the San Fedele
Auditorium on Friday, 25 October, and the
UK composer, poet and activist Alabaster
DePlume will bring his fascinating mix of
spoken word and spiritual jazz to the Santeria
Toscana 31 venue on Saturday, 26 October.
Remember your dancing shoes!

Milan has a vibrant night life,
and the Navigli district is popular
with locals and tourists alike, owing
to the many bars, clubs and restaurants that line its historic canals and
laneways. A short walk south from
the Darsena docklands will bring you
to Ripa di Porta Ticinese, a street that
leaves revellers spoilt for choice.
Local favourites include Zog, Rita
Tiki Room and Iter for cocktails and
snacks and Bobino Milano, a welcoming nightclub with a terrace and live
music. 7

 Dates: 17 October to 13 November
 Venues: Theatres, clubs, bars and
alternative spaces throughout Milan
 More information: jazzmi.it/en/ |
@jazzmimilano on Instagram

 Suggested starting point:
Darsena docklands,
Viale Gorizia, 24
 Best time to visit:
Wednesday to Saturday,
from 20:00

[31] =>

travel

Useful information for and networking opportunities at EAO 2024
Exclusive events at some of Milan’s finest venues.

 European Association for Osseo
integration, Italian Academy of
Osseointegration and Italian Society
of Periodontology and Implantology

Venue

 Allianz MiCo			
Address: Piazzale Carlo Magno, 1,
20149 Milan

Opening hours

Conference hall:
 Thursday: 8:30–17:00
 Friday and Saturday: 9:00–17:00
Exhibition:
 Thursday, Friday and Saturday:
9:00–17:00

Money

ATMs are located in the south
wing on Level 1 and in the north
wing registration area.

Food

Catering services can be found in
the south wing on the ground floor
and on the balcony of Hall 3 (Level 1).

Useful information
about Milan

Currency: The euro (€) is the cur
rency of Italy. At the time of publishing,

€1.00 was equivalent to US$1.10,
£0.84, CNY 7.83, CHF 0.93 and
JPY 161.47.
Time zone: Italy will still be
observing Central European Summer
Time (UTC/GMT+2) at the time of
the meeting.
Emergency numbers: Dial “112”
(no prefix required) free of charge.
An operator will connect callers to
the required service.
Credit card acceptance: Debit
and credit cards are widely accepted
in Milan and other major Italian
cities. Smaller businesses may prefer
cash.
Taxis: Milan taxi drivers seldom
stop when hailed. Catch a ride from
a designated taxi stand instead or
by booking a ride in advance. The
FREENOW mobile app is popular in
the city for booking licensed taxis,
as well as e-scooters and bikes. Visit
the App Store or Google Play to down
load the app.
Tourist information: Visit the official
tourism website www.yesmilano.it/en
for traveller information and an over
view of things to do in the city.

First-time attendees’ lunch

Participants will have the oppor
tunity to learn how to make the most
of their first congress experience
through a presentation by committee
members. Following the presenta
tion, a lunch will be provided, offer
ing a chance to meet other first-time
attendees.
 When: 24 October, 12:30–13:30
 Where: Milan Convention Centre
 Availability: Free for all partici
pants

Get-together party

Participants will have the chance
to reconnect with colleagues and
meet new peers at this event.
 When: 24 October, 19:00–20:00
 Where: Milan Convention Centre
 Availability: Free for all partici
pants

Members and faculty dinner

© Matej Kastelic/Shutterstock.com

Organisers

 Availability: Reserved for EAO, IAO, and
SIdP members. €100 per person. Please
note that places are limited and will be
allocated on a first-come, first-served basis.

Club party

The dinner will be hosted at
La Pelota, a unique venue located in
Milan’s artistic Brera district, offering
attendees a memorable experience.

Free drink vouchers will be dis
tributed in the welcome area of the
congress for use at this event.

 When: 24 October, 20:30–22:30
 Where: La Pelota, Via Palermo, 10,
20121 Milan

 When: 24 October, from 22:30
 Where: Gate Milano, Via Giuseppe
Piazzi, 4, 20159 Milan

 Availability: Free and open to all
participants

Happy hour

Members will have the opportunity
to enjoy drinks and snacks at this
popular Milanese venue.
 When: 25 October, 19:00–21:00
 Where: The Sanctuary, Via Valenza, 2,
20144 Milan
 Availability: Free exclusive access for
EAO, IAO, and SIdP members. 7
AD

[32] =>

A global partner in total dental solutions

TS Implant System:
One of the world‘s leading dental implant systems
- Loved Globally
Versatile
Our dental implants adapt seamlessly to diverse clinical cases, offering
unmatched flexibility in treatment options.

User-friendly
Intuitive placement systems ensure ease of use, allowing even complex
cases to be handled with confidence and precision.

Reliable
Globally proven reliability ensures predictable outcomes, giving both
dentists and patients peace of mind with every procedure.

Find out more about the entire portfolio of Osstem at booth E31
Welcome to Osstem – your partner for outstanding implant solutions. As one of the preferred partners in the dental
implantology market, Osstem offers high-quality products and also a comprehensive service tailored to your individual needs.

Implants

Prosthetics

Surgical Kits

Equipment

Biomaterials

Instruments

Dental Education

Osstem World Meeting
22. - 23. Nov. 2024
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18. - 19. Apr. 2025
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[cover] => today EAO Annual Scientific Meeting Milan Oct. 24–26, 2024

Table of contents

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