ceramic implants international No. 2, 2024

ceramic implants international No. 2, 2024

Cover / Editorial + Content / Single unit implant rehabilitation in the aesthetic area / Single unit implant rehabilitation in the aesthetic area / Impact of periodontitis on systemic health and on implants / Peri-implantitis prevention starts with the choice of a clean implant / From concept to patented innovation / European Society of Ceramic Implantology (ESCI) satellite symposium—“Ceramic Implantology” / EAO Congress 2024: Advancing excellence in implant dentistry / International experts define standards for edentulous maxilla treatment / Manufacturer news / Imprint

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Table of contents

issn 1868-3207 Sondernummer · Vol. 8 · Issue 2/2024

© gfx_nazim – stock.adobe.com

2/24

international magazine of ceramic implant technology
case report
Single unit implant rehabilitation
in the aesthetic area

research
Impact of periodontitis on systemic
health and on implants

events
ESCI satellite
symposium 2024

[2] =>

February 8, 2025

SOPIO & EACim
MEETING
Lisbon University

Portugal

Ceramic Implant
as an alternative
to Titanium
•
Immediacy in
Implant Dentistry
INTERNATIONALLY RENOWNED
LECTURERS WITH LONG EXPERIENCE
IN IMPLANTOLOGY

João Caramês / André Moreira / Helena Francisco / Paulo Carvalho / Luca Stavola
Juan Blanco / Giancarlo Bianca / Oliver Cheron / Amandine Para / Fabrice Baudot

Lectures in English
9h15 - 9h30 • Opening and presentation of the seminar
9h30 - 10h10 • Paulo Carvalho
10h10 - 10h50 • João Caramês
10h50 - 11h20 • Coffee Break
11h20 - 12h00 • Luca Stavola
12h00 - 12h40 • Juan Blanco
12h40 - 13h10 • Morning round table
13h10 - 14h20 • Lunch

INFORMATION & REGISTRATION

14h20 - 15h00 • Giancarlo Bianca
15h00 - 15h40 • Oliver Cheron
15h40 - 16h00 • Coffee Break
16h00 - 16h40 • Fabrice Baudot
16h40 - 17h20 • Amandine Para
17h20 - 17h50 • Evening round table
17h50 - 18h00 • Closing

eacim-ceramic-implantology.com

[3] =>

editorial + content

CONTENT
03
editorial
Timo Krause
Timo Krause
Germany
Editorial Manager

Timo Krause

Single unit implant rehabilitation in the aesthetic area
Dr Geninho Thomé, Carolina Accorsi Cartelli,

Dr Sérgio Rocha Bernardes, Dr Jean Uhlendorf

12
Single-tooth restoration
in the anterior maxilla

Don Quixote—
quitting is no
option

Dr João Pedro Almeida & António Korrodi Ritto

et’s begin with a brief history lesson: the earliest
attempts at dental prosthetics date back to the
5th millennium BCE. Archaeological illustrations
show how shell fragments were used to replace
extracted teeth. Remarkably, this material came
directly from nature—composed of calcium carbonate,
magnesium carbonate, silicates, clay minerals, and organic components.

Impact of periodontitis on systemic
health and on implants—Part 1
Prof. Curd Bollen, Prof. Paul Tipton, Dr Mishel
Kocharyan & Prof. Gagik Hakobyan

24
Peri-implantitis prevention starts
with the choice of a clean implant

Even in ancient times, dentures made of ivory or walrus
tusks were common. These “teeth” were secured with
gold bands and threads around neighbouring teeth.

Drs Dirk U. Duddeck and Dana Adyani-Fard

Then, in 1806, Giuseppangelo Fonzi may have invented
the first artificial ceramic tooth, designed to meet both
functional and aesthetic standards. This innovation was a
milestone, paving the way for further development in dental solutions.
Starting in the 1960s, the focused development of dental implants began. Early attempts were made with aluminium oxide to create a system that could be mass-



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[4] =>

editorial + content



produced. Although there were setbacks, the idea of a metalfree alternative to popular titanium implants stuck with many
pioneers. In the 1990s, they developed new solutions using
zirconia, a type of ceramic that was stronger and more resilient
than aluminium oxide. The benefits of this new material were
quickly recognised in the dental field.

CONTENT
30
From concept to patented
innovation

Where are we today? Zirconia implants have now shed their
niche status and established themselves in modern dentistry.
From a small group of enthusiasts, a global network of experts
has emerged. They regularly exchange ideas, bringing fresh perspectives to the industry, which in turn continuously refines
these materials.
And where will this lead? We don’t know for sure. But we do
know that ceramic implantology remains a niche for many and is
sometimes underestimated due to the material’s specific properties. However, zirconia implants, as stated by numerous studies and committees, now offer a competitive alternative to metal.
Although ceramic implantology is sometimes viewed with skepticism, many advanced concepts have developed around the implanting process itself, contributing significantly to successful
treatments.

32
European Society of Ceramic
Implantology (ESCI) satellite
symposium —“Ceramic
Implantology”

Ceramic implantology is neither magic nor a game; it is serious
business, and those specialising in this field deserve to be taken
seriously. With ceramic implants, we aim to provide all ceramic
implantology specialists with a platform and a voice.
So, let’s not give up—let’s break down the barriers standing in
our way together and let us continue to fight against the windmills of scepsis, harsh critic and laughter. Don Quixote 2.0.
Sincerely

Timo Krause

EAO Congress 2024: Advancing
excellence in implant dentistry

36
International experts define
standards for edentulous maxilla
treatment

issn 1868-3207 Sondernummer · Vol. 8 · Issue 2/2024

2/24

international magazine of ceramic implant technology
case report
Single unit implant rehabilitation
in the aesthetic area

research
Impact of periodontitis on systemic
health and on implants

events
ESCI satellite
symposium 2024

38
manufacturer news
Cover image courtesy
of Neodent—
A Straumann Group Brand
www.neodent.com

42
events + imprint

2/24

[5] =>

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Learn more about our implants at zsystems.com

[6] =>

case report

Single unit implant
rehabilitation in
the aesthetic area
Zi Ceramic Implant System in use with immediate
loading associated with Socket Shield technique
Dr Geninho Thomé, Carolina Accorsi Cartelli, Dr Sérgio Rocha Bernardes, Dr Jean Uhlendorf, Brazil

“The Socket Shield
prevents bone loss
and gingival recession
while enhancing
implant stability
and producing a
more natural-looking
outcome.”

01a

Introduction
01b
01a–c
Patient’s initial
situation:
patient’s smile,
occlusal view and
periapical X-ray
(tooth 11).

01c

6

To restore teeth to their natural appearance and function,
aesthetic rehabilitation in dentistry requires accuracy. The
selection of methods and materials is essential. Due to
their exceptional biocompatibility and attractive features,
two-piece injection-molded zirconia implants have gained
enormous attention.1,2
High biocompatibility of zirconia implants lowers the risk
of rejection and inflammation, among other benefits.3
Compared to standard titanium implants, their white hue
closely matches natural teeth, offering greater aesthetics.4
The injection molding technology in their production ensures perfect adaptation and long-term durability due to
its high accuracy and strength.5 Because of these qualities,
zirconia implants combine practical and aesthetic advantages, making them a promising alternative for dental restorations.6

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[7] =>

03
04

02–04
Steps of the surgery:
occlusal view after
dental section and
maintenance of the
buccal fragment.
Evidence of thread
formation in the dental
socket. Neodent ® Zi
4.3 x 13 mm implant
installed (45 Ncm).

The Socket Shield method preserves a portion of
the native tooth root after implant insertion, the alveolar bone and surrounding soft tissues are kept
intact. This prevents bone loss and gingival recession
while enhancing implant stability and producing a
more natural-looking outcome.7 Inject-molded zirconia implants combined with the Socket Shield
method are a significant break-through in cosmetic
dentistry that provides excellent aesthetic and functional outcomes.7,8
In addition to their visibility and aesthetic requirements, dental operations in the maxillary aesthetic
areas can be extremely difficult. To guarantee immediate loading, long-term functionality, and harmonious soft tissue aesthetics, these procedures require meticulous and customised planning.9
Considering the functional and aesthetic requirements of the clinical case, this study uses a twopiece ceramic implant with the Socket Shield technique to treat the right central incisor region.

General aspects and
health conditions
Female, 37 years old, with aesthetic complaints due
to the presence of diastema between the upper central incisors with a progressive increase in the space
between the teeth over time. (Figs. 1a & b). After the
clinical evaluation and periodontal probing, periodontal involvement of the right incisor was ob-

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[8] =>

case report

“Ceramic implants have been indicated more
frequently over the years, especially in cases of
rehabilitation in anterior regions (upper jaw) in
patients who have high aesthetic expectations.”
served: deep probing (more than 6 mm in 03 sites) and grade I
mobility. After carrying out imaging exams: panoramic, periapical radiographs and CBCT, crestal bone resorption and periapical lesion were observed (Fig. 1c). Considering this diagnostic,
the installation of a ceramic implant in the region of tooth 11 was
proposed for the patient, using the Socket Shield technique followed by upper lip frenectomy and immediate loading.

Surgical technique
Initially, an anaesthetic infiltration block was performed in the
anterior portion of the right superior alveolar nerve and complemented by palatal with subperiosteal infiltration. To preserve the
buccal bone wall and maintain the thickness of connective tissue
on the same face, it was decided to perform the Socket Shield
surgical technique, preserving the buccal fragment of the root
(infraosseous). Started with a dental section (Zeckria drill), remo-

tion of the palatal portion of the root and curettage of the periapical lesion, followed by grinding and finishing (conical diamond drill with rounded end) of the buccal root fragment (Fig. 2).
Then the drilling protocol was made according to the manufacturer’s instructions: Spear drill, conical drill Ø 2.0, Ø 3.5, Ø 4.3
and drill for threading (tapping) with Ø 4.3 respectively (Fig. 3).
The Neodent ® Zi 4.3 x 13 mm implant was installed in the region
reaching 45 Ncm of torque, allowing immediate load. The space
(gap) between the implant surface and the root portion was filled
with particulate bone (Cerabone Straumann®; Fig. 4).

Prosthetic rehabilitation
After implant installation, the narrow PEEK CR abutment (4.0 x
1.5 mm) was selected (Fig. 5). A temporary cylinder was installed
to capture the acrylic resin crown, using resin cement, for subsequent installation of the screw-retained crown (torque of 32 Ncm,

05 + 06
Surgical step: CR
abutment installed
and insertion of the
bone graft (Cerabone
Straumann) into the
gap. Patient’s smile
after implant
installation and
immediate temporary
prosthesis.

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07
Follow-up
(five months)
showing the
healthy
appearance of
gingival tissue
after removing
the prothesis for
the scanning of
the final crown.

[9] =>

case report

08a–c
Follow-up
(two years of the
installation of the
implant): buccal
and occlusal
views, and X-ray.

08a

08b

08c

“Two-piece zirconia implants also avoid wound
healing problems and undesirable loading during
the healing period, which are disadvantages of
one-piece zirconia implants.”
Fig. 6). In the fifth month of postoperative follow-up, the provisional prosthesis
was unscrewed (Fig. 7), and the scanning was done to create the definitive prosthesis. The scan body was installed, and through intra-oral scanning, the definitive prosthesis was manufactured (Zirconia). Thus, using the printed model, the
crown was cemented onto the ZiBase (3.75 x 4.0 x 1.5) with resin cement and then
installed with 32 Ncm of torque.

Discussion and final considerations
Ceramic implants have been indicated more frequently over the years, especially in cases of rehabilitation in anterior regions (upper jaw) in patients who
have high aesthetic expectations. Clinical performance of two-piece zirconia
dental implants after five and up to 12 years.10 The literature about ceramic implants shows satisfactory results about the biological, mechanical, and aesthetic
properties.1,2,11
In this case, it was decided to use the surgical technique called Socket Shield
and the use of a Zi System implant (Neodent) to achieve a completely satisfactory result. Maintenance of the buccal root fragment provides anatomical preservation of periodontal structures and prevents long-term recession of the bone

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[10] =>

case report

and gingival tissue. During the drilling (sequence of drills) and
the installation of the implant, it is necessary to take much care
to avoid an excess of pressure at the remaining tooth and consequent displacement of them.11
Most of the clinical investigations describe the use of one-piece
zirconia implants instead of the employ of two-piece zirconia
implants to treat partial or total edentulous patients.12 In this
case report, the use of two-piece zirconia implants presents
several advantages, including the increase of prosthetic versatility due to the variability of abutments options. Two-piece zirconia implants also avoid wound healing problems and undesirable loading during the healing period, which are disadvantages
of one-piece zirconia implants.13

“Periodic clinical and radiographic monitoring is
essential for the control
of peri-implant tissues
and the success of the
rehabilitation.”

This case shows survival and success during two years of followup. Four systematic literature reviews14–17 cited a few clinical
cases about the use and survival of two-piece zirconia implants.
Haro Andanez et al.14 and Hashim et al.18 described the clinical
studies performed by Cionca et al. and Payer et al., which were
previously described. Haro Andanez et al. also described the
clinical studies from Becker et al.19 and Brüll et al.20 and performed a meta-analysis. Considering only the two-piece zirconia
implants the implant survival rate was 94% between one and
three years of follow-up.

Periodic clinical and radiographic monitoring is essential for the
control of peri-implant tissues and the success of the rehabilitation. The present case has 24 months of follow-up with great results. It was possible to observe clinical (Figs. 8a & b) and radiographic (Fig. 8c) images of the implant and prosthesis about
the following factors: complete osseointegration, maintenance
of the marginal bone level (no signs of peri-implantitis), excellent
aesthetics and soft-tissue function, reflecting the success of this
treatment. Further research is required to evaluate the long-term
outcomes.

Geninho Thomé
Dr Thomé holds a degree in Dentistry from
the Federal University of Santa Catarina, a specialisation in Periodontics and Implantology, and a
Master’s and Doctorate in Implantology. Dr Thomé is
currently the Scientific President of Neodent, Chairman of
the Board of Directors of Neodent, and General Director of
ILAPEO College.

Sérgio Rocha Bernardes
Dr Bernardes holds a degree in Dentistry from
the Federal University of Rio de Janeiro (1995–
1999), a specialisation in dental prosthetics from
APCD/Bauru (2000–2002), a specialisation in Implantology recognised by the CFO (2007), a master’s degree
in Dentistry (Oral Rehabilitation) from the Federal University
of Uberlândia (2003–2005) and a PhD in Dentistry (Oral Rehabilitation) from the School of Dentistry of Ribeirão Preto, University
of São Paulo, with research in collaboration with the Eastman
Dental Institute, London (2005–2008). Dr Bernardes holds a postgraduate degree and an MBA in Business Management from the
Getulio Vargas Foundation (2009–2011). Dr Bernardes is certified
by the Portuguese Dental Association for passing the equivalence
exam (2007). He is a member of the review board of the International Journal of Oral and Maxillofacial Implants and Editor-inChief of Prosthesis Laboratory in Science. He is currently a professor at the Latin American Institute of Dental Research and Education (ILAPEO) and Head of Global Research & Education at Neodent.

+55 41 3595-6000 · geninho.thome@neodent.com

Jean Uhlendorf
Dr Uhlendorf holds a degree in Dentistry (UP,
2001–2005), a specialisation (ILAPEO, 2008–2010)
and a master’s degree in Implantology (ILAPEO,
2011–2013).
+55 41 99898-5655 · jean.digital@yahoo.com

+55 41 98867-1272 · sergio.bernardes@neodent.com
Carolina Accorsi Cartelli
Carolina Cartelli is currently technical specialist at Neodent. She graduated in Dentistry
from the Federal University of Paraná (2012) and is
a specialist in Implantology. She holds a master’s degree in Dentistry with an area of concentration in Implantology from the Latin American Institute of Dental Research
and Education.

Literature

+55 41 99107-5340 · carolina.cartelli@neodent.com

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[11] =>

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[12] =>

case report

Single-tooth restoration
in the anterior maxilla
Dr João Pedro Almeida & António Korrodi Ritto, Portugal

Introduction
Replacing an unsalvageable tooth in the anterior maxilla with a
dental implant poses certain challenges clinicians must navigate.
Due to the high visibility of this area, using an implant system that
can facilitate optimum aesthetics by predictably preserving the
hard and soft tissue is crucial. In the clinical case described below, an implant system was used to restore a central incisor that
has been proven in independent long-term studies to precisely
achieve that.1, 2

01
01
Clinical situation
at the start of
orthodontic
treatment in 2011.

02a–d
CBCT images
showing marginal
bone loss around
tooth #21.

This two-piece tissue-level implant has a parallel-walled design
with a shallow thread and is inserted using moderate torques not
exceeding 30 Ncm to avoid compression of the surrounding tissue and thus to allow fast and predictable healing, which is a prerequisite for long-term stability and vitality of bone levels and
overall tissue health.
The implant treatment described in this case required a multidisciplinary approach and coordination with the orthodontist, as
orthodontic treatment had not been completed at the time of
implant placement, as the patient was still wearing retainers.

Initial situation

02a

The female patient, aged 30, was referred by her orthodontist
owing to the fractured root of tooth #21. She had started orthodontic treatment in 2011 (Fig. 1). After discoloration of the tooth
developed, a CBCT scan was taken (in 2021), and it showed marginal bone resorption and bone loss around the root of the endodontically treated tooth #21 (Figs. 2a–d).

02b

02c

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02d

[13] =>

case report

03
Removal of the
crown and failing
post-and-core
restoration.
04
Extraction of the
remaining root.
05
Extraction socket
filled with particulate xenograft
material.

04

05

03

06
Grafted site
covered with the
collagen
membrane.
07
Sutured site.

06

08
Clinical situation
after placement
of the provisional
restoration.

“A minimally invasive
implant placement with a
moderate insertion torque
of a maximum of 30 Ncm is
imperative to ensure minimal bone compression
to retain the vitality of
the bone after implant
insertion, allowing healing
to progress undisturbed.”

07

08

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13

[14] =>

case report

09a

09b

09c

09d

Treatment planning
The treatment would involve extraction of the failing tooth
and augmentation of the surrounding hard and soft tissue.
This would be followed by placement of a two-piece dental implant in this position after healing.

Surgical procedure
10

11a

The crown and failing post-and-core restoration were removed (Fig. 3), and the remaining root was extracted (Fig. 4).
The extraction socket was then carefully curetted to remove any fibrous tissue and filled with particulate xenograft material (Bio-Oss, Geistlich; Fig. 5). The site was covered with a collagen membrane (Bio-Gide, Geistlich; Fig. 6),
and a full-thickness palatal pedicle graft was rotated and
positioned to assure closure and augmented soft-tissue
volume. The site was then sutured (Fig. 7), and a provisional restoration (Maryland bridge) was bonded to the
adjacent teeth (Fig. 8).
After a healing period of 6.5 months (Fig. 9), the provisional restoration was removed (Fig. 10). The osteotomy
was prepared according to the surgical protocol of the
implant manufacturer and a two-piece dental implant
(Patent™ Dental Implant System, Zircon Medical Management; 4.5 mm in diameter and 11.0 mm in length) was
placed equigingival to an insertion torque of 30 Ncm. The
soft tissue was adapted around the implant on the labial
aspect as part of a minimally invasive grafting procedure
to increase the gingival volume (Figs. 11a & b). The connection of the implant was sealed with a PTFE strip and
flowable composite, and a new provisional restoration
(Maryland bridge) was bonded to the adjacent teeth, covering but not touching the implant (Fig. 12).

09a–d
CBCT images
after 6.5 months
of healing.

11b

14

10
Clinical situation
after removal of
the provisional
restoration.

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11a + b
Clinical situation
after implant
placement and
minimally invasive
grafting to
increase the
gingival volume.

[15] =>

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

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

international magazine of ceramic implant technology
events
“Ceramic implants—
State of the Art”

case report
Two-piece
ceramic implant

interview
“If this system performs well in these
patients, it will perform in every patient!”

[16] =>

case report

12
Clinical situation
after placement
of the new
provisional
restoration.

12

13a

13b

13c

15

14
14
Removal of
excess gingiva.

15
Cementation of
the glass fiber
post.

16
Clinical situation
after intra-oral
preparation of
the glass fiber
post.

16

16

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13a–c
Clinical situation
and CBCT images
after a further
healing period of
four months.

[17] =>

case report

17
Clinical situation
after placement
of another
provisional
restoration.

18a + b
Clinical situation
one month later,
after orthodontic
space closure.

19
Fabrication of the
final crown.

18a

18b

Prosthetic restoration
After a further healing period of four months, the patient
returned for prosthetic restoration, showing a successfully
osseointegrated implant with healthy soft tissue and a stable marginal bone level (Figs. 13a–c). Excess gingiva was
removed with an electrosurgical device to expose the margin of the implant (Fig. 14). The glass fibre post of the twopiece implant system used was then cemented into the
implant’s prosthetic connection using a dual-polymerising
dental cement (ACTIVA BioACTIVE-CEMENT, Pulpdent;
Fig. 15) and prepared using a diamond bur at high speed
under water irrigation (Fig. 16). The prepared post received a provisional crown (Fig. 17), and the patient was
sent to the referring orthodontist for space closure before
the placement of the final crown.

Discussion

One month later, the spaces on either side of tooth #21
had been closed (Figs. 18a & b), and a final digital impression was taken. The Matisse-protocol was used to match
the shade and achieve the proper colour. The scan files
were transferred to the dental laboratory (Dentalook),
where the final crown was fabricated (Fig. 19). The patient
then received a second provisional crown (Fig. 20). Three
months later, the patient received the final crown. The result, two weeks after placement of the final restoration,
was deemed highly satisfactory (Fig. 21). At a follow-up
eight months later, the soft tissue had matured and was
deemed healthy and stable (Figs. 22a & b).

The challenges of this clinical case included the lack of marginal
bone crest because of external root resorption and the absence
of an alveolar buccal wall, necessitating augmentation. Also,
since the procedure involved restoring the aesthetic zone, a
highly visible area, a dental implant was needed capable of
maintaining vital and stable hard and soft tissue. The Patent™
system has been demonstrated to have this capability in longterm studies.1, 2 These studies have reported healthy soft tissue,
an aesthetic increase in keratinised gingiva as well as minimal
marginal bone losses after nine years of function, and no periimplantitis even up to 12 years of function. These results reflect
the treatment outcome of the case discussed here, where the

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[18] =>

case report

patient presented with stable bone levels around her new implant at the follow-up over 17 months after implant placement, as well as healthy soft tissue (Figs. 22a & b).
A minimally invasive implant placement with a moderate insertion torque of a maximum of 30 Ncm is imperative to ensure minimal bone compression to retain the vitality of the
bone after implant insertion, allowing healing to progress undisturbed. This is crucial to maintaining long-term stability of
the surrounding tissue. We have found adopting such a low
torque strategy together with an atraumatic insertion protocol with this implant system to minimise marginal bone loss
and to maintain overall tissue stability in daily practice.

Conclusion

21
20
Clinical situation
after placement
of another
provisional
restoration.

22a

21
Satisfactory result
two weeks after
placement of the
final crown.

22a + b
Healthy and
stable soft tissue
eight months
later.

The implant system used in this clinical case represents a viable option for replacing teeth in the aesthetic zone. Owing
to the implant’s ability to maintain vital and stable hard and
soft tissue and to foster strong soft-tissue adhesion, highly
satisfactory aesthetic results are to be expected over the long
term, and the risk of bacteria-induced chronic tissue inflammation like peri-implantitis is minimised.1, 2 The healing of the
soft tissue in this case progressed rapidly with almost no inflammation.
Literature:
1
Brunello G, Rauch N, Becker K, Hakimi AR, Schwarz F, Becker J.
Two-piece zirconia implants in the posterior mandible and
maxilla: a cohort study with a follow-up period of 9 years. Clin
Oral Implants Res. 2022. december;33(12):1233–44. doi:
10.1111/clr.14005. PMID: 36184914.
2
Karapataki S, Vegh D, Payer M, Fahrenholz H, Antonoglou GN.
Clinical performance of two-piece zirconia dental implants after
5 and up to 12 years. Int J Oral Maxillofac Implants. 2023.
december 12.;38(6):1105–14. doi: 10.11607/jomi.10284. PMID:
38085741.

Dr João Pedro Almeida
Clínica Médica de Implantologia
R. Comissão de Iniciativa
Nº2 A, Piso 6
2410-098 Leiria
Portugal
+34 244 824436
www.clinicaimplantologia.pt

Dr João Pedro
Almeida

22b

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Literature

[19] =>

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ƐŝŶŐůĞͲƉŝĞĐĞĂŶĚŵƵůƟͲƉŝĞĐĞŽƉƟŽŶƐ͕ǁŝƚŚĚŝĂŵĞƚĞƌƐĨƌŽŵϯ͘ϱƚŽϭϭ͘ϱരŵŵ
ĂŶĚůĞŶŐƚŚƐĨƌŽŵϲƚŽϭϰരŵŵ͘

ZIRKONUS Implantatsysteme GmbH & Co. KG
Bahnhofstraße 18, 71034 Böblingen, Germany


+49 711 305329-14
info@zirkonus.de
www.zirkonus.de

0483

[20] =>

research

Impact of periodontitis on
systemic health and on implants
Prof. Curd Bollen & Prof. Paul Tipton, UK, Dr Mishel Kocharyan & Prof. Gagik Hakobyan, Armenia

Introduction

1. Cardiovascular disease

Mouth and health go hand in hand. After all, the mouth is the
entrance gate to our body. Food enters through there and our
teeth are the instruments to chew this food so that the food
components we need can also be effectively released. There is
a need for a healthy mouth, to keep a healthy body!

Cardiovascular disease (CVD) encompasses a range of heart and
blood vessel disorders, including coronary artery disease, hypertension, and stroke.

After all, infections in the mouth have an enormous impact on
the rest of our general health. Biting and chewing can continuously force oral bacteria into our bloodstream, where they move
through the body, and can cause damage in several organs (e.g.
kidneys, heart, lungs and brain).
Thousands of scientific articles have already been published
about this topic: on 1 August 2024, there were 3,966 hits combining both topics on PubMed! However, this phenomenon is
still insufficiently known to the public and even to many dentists
and physicians.1
Meanwhile, periodontitis, the severe gum infection that damages the soft tissue and destroys the tissues that support the
teeth, has been linked to several systemic diseases. This connection is largely due to the inflammatory nature of periodontitis
which is accompanied by large quantities of highly pathogenic
bacteria (eg. Porphyromonas gingivalis, Prevotella intermedia
and Fusobacterium nucleatum). These pathogens have farreaching effects beyond the oral cavity because they strongly
trigger the immune response.2
The local consequence is limited to tissue destruction: the inflammatory response leads to the destruction of gum tissue,
periodontal ligament and alveolar bone.3
The systemic impact of these focal infections is however often
neglected although the scientific literature is very clear: periodontitis undeniably causes or worsens several systemic health
problems.4
This first article in a series of two, will focus on six key points
about the relationship between periodontitis and systemic diseases. The second article will come up with six more associations
between periodontal disease and systemic diseases.

Periodontitis and cardiovascular disease are interconnected
through various mechanisms, involving systemic inflammation,
endothelial dysfunction, and shared risk factors.
The inflammation caused by periodontitis can contribute to the
buildup of plaques in arteries (atherosclerosis), leading to heart
attacks and other cardiovascular events. Moreover, periodontitis
increases the risk of a heart attack by two times.5 The risk of a
stroke or TIA is even three times higher when periodontitis is
present.6 Existing heart problems are also aggravated by the
presence of oral infections.
The four main connections between periodontitis and cardiovascular disease are:
1. Systemic inflammation: periodontitis can cause an increase in
systemic inflammatory markers like C-reactive protein (CRP),
which is also linked to atherosclerosis.
2. Endothelial dysfunction: bacteria and inflammatory mediators
from periodontal disease can enter the bloodstream, leading
to endothelial dysfunction, a precursor to atherosclerosis.
3. Bacterial translocation: oral bacteria from periodontitis can
enter the bloodstream, contributing directly to the formation
of arterial plaques.
4. Immune response: the immune response to periodontal infection can exacerbate inflammatory processes in the arteries—
chronic inflammation is a key factor in the development of atherosclerosis.
Cardiovascular disease and periodontitis have several major
shared risk factors: smoking, diabetes, age, genetics and diet.7
The obvious link between the two diseases invites patients
and practitioners to some clinical implications:
1. Early screening: regular dental check-ups and periodontal assessments help identify individuals at risk for CVD.
2. Structured preventive care: good oral hygiene and periodontal therapy reduces systemic inflammation, lowering the risk
of CVD.

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[21] =>

2. Diabetes
Diabetes is a chronic metabolic disorder characterised by high blood glucose levels due to either insufficient insulin production (Type 1 diabetes) or
insulin resistance (Type 2 diabetes).

22-23 November 2024 | Med Uni Graz

Anatomy course

There is a bidirectional relationship between periodontitis and diabetes. Not
only are people with diabetes more susceptible to periodontitis, but periodontitis can also make it more difficult to control blood sugar levels, thereby
exacerbating diabetes.8 More than 90% of periodontitis patients are at risk
of diabetes. In this bidirectional relationship, both conditions can influence
the onset and progression of the other.

Prof. Dr. Dr.
Michael Payer

Impact of diabetes on periodontitis:
1. Impaired immune response: hyperglycemia can impair the immune system, making it harder to fight off bacterial infections in the gums.
2. Increased inflammation: high blood sugar levels increase the inflammatory response, exacerbating gum disease.
3. Poor healing: diabetes can slow down the healing process of gum tissue,
worsening periodontitis.9

Prof. Dr. Dr.
Michael Stiller

Impact of periodontitis on diabetes:
1. Increased blood sugar levels: chronic inflammation from periodontitis can
increase insulin resistance, making blood sugar control more difficult.
2. Systemic inflammation: periodontitis can elevate systemic inflammatory
markers, which can negatively affect blood sugar regulation.
3. Complications management: poor oral health can complicate the management of diabetes, leading to a vicious cycle of worsening health.

In these processes there are three mechanisms of interaction. Both conditions increase the production of inflammatory cytokines such as TNF-α and
IL-6, which contribute to insulin resistance and tissue destruction. Furthermore, advanced glycation end-products (AGEs) which are elevated in diabetes, can accumulate in periodontal tissues, promoting inflammation and
tissue damage there.10 Finally, increased oxidative stress in both diabetes and
periodontitis can lead to further tissue damage and complications.
Due to this two-way relationship, similar clinical recommendations can be
highlighted as for CVD:
1. Screening and monitoring: for diabetics patients regular dental check-ups
are crucial to detect and manage periodontitis early. Whereas for periodontitis patients’ blood glucose monitoring can help identify undiagnosed diabetes or prediabetes.
2. Integrated care: dentists and other healthcare providers should work together to manage both conditions. Furthermore, educating patients on
the importance of oral hygiene and diabetes control is vital for overall
health.
3. Preventive and therapeutic strategies: regular brushing, flossing, and professional cleanings can help prevent periodontitis. Maintaining optimal
blood sugar levels through diet, exercise, and medication can reduce the
risk of periodontal disease. Medications and therapies to reduce inflammation can benefit both conditions.

Dr. Dr.
Thomas Mehnert

Program
1 full day of lectures & hands-on
exercises on human cadaver heads
for surgical implant procedures
using zirconia implants (with a
ratio of two delegates per cadaver
head for better training
experience)
Evidence based treatment planning
(e.g. sinus lift in maxilla & implant
placement in mandible)
Prevention and management of
complications
Also: Guided tour through the old
town of Graz & get-together

Participation fee
€ 1290 excl. VAT

3. Respiratory diseases
Respiratory diseases include a range of conditions affecting the lungs and
airways, such as chronic obstructive pulmonary disease (COPD), pneumonia,
and asthma. Chronic periodontitis has been linked to an increased risk of

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with

3. Promoting integrated care: serious collaboration between dental and
medical professionals improves overall patient health outcomes.

Registe
now

More info & registration
event@zeramex.com

www.zeramex.com

[22] =>

research

these respiratory conditions. The latter is thought to occur due
to the aspiration of bacteria from the mouth into the lungs. A
similar link has also been demonstrated with the severity of
COVID-19 infections.11
The relationship between respiratory disease and periodontitis
involves shared mechanisms such as inflammation and bacterial
infection.
The interconnection between both pathologies is based on:
1. Bacterial aspiration: bacteria from the oral cavity can be aspirated into the lower respiratory tract, leading to infections
such as pneumonia. This is particularly a risk in elderly patients
and those with weakened immune systems.12
2. Systemic inflammation: periodontitis can increase systemic
inflammatory markers (e.g. IL-6, TNF-α) into the bloodstream,
which can exacerbate chronic inflammatory conditions like
COPD and asthma.13
3. Immune response: the immune response to periodontal infection can weaken the body’s ability to fight off respiratory
pathogens.
4. Oral hygiene: poor oral hygiene associated with periodontitis can increase the risk of respiratory infections due to higher
levels of pathogenic bacteria in the mouth.
The same clinical recommendations as for periodontitis–diabetes/CVD are also applicable here: good oral hygiene, regular
dental check-ups, interprofessional dental–medical collaboration and early screening.
The therapy consists of anti-inflammatory treatments (managing
periodontal inflammation reduces systemic inflammation and
potentially improve respiratory health) and eventual antibiotic
therapy (when the bacterial infection is significant, targeted antibiotics may be necessary).

4. Pregnancy
Pregnancy is of course not a disease, but it involves significant
physiological changes that can influence oral health. Pregnant
women with periodontitis are at a higher risk of adverse pregnancy outcomes because inflammatory mediators from periodontitis may affect the fetal environment.

1. Pregnancy gingivitis: increased hormone levels can cause
gums to become more sensitive and prone to inflammation,
known as pregnancy gingivitis. If left untreated, it can progress
to periodontitis.16
2. Exacerbation of existing periodontitis: hormonal changes
during pregnancy can exacerbate existing periodontal disease due to increased blood flow to the gums and an altered
immune response.17
3. Altered oral hygiene: morning sickness and changes in diet
can lead to increased plaque accumulation, affecting periodontal health.18
The key aspects of these interactions include:
1. Hormonal changes: elevated levels of estrogen and progesterone. These hormones can enhance the inflammatory response in gum tissues.
2. Immune system alterations: modulated immune response to
accommodate fetal development. These changes in the immune system can alter the host response to periodontal
pathogens.
3. Inflammatory mediators increase: cytokines and prostaglandins produced during periodontal inflammation can affect
pregnancy outcomes.
4. Increased blood volume: enhances tissue sensitivity and
bleeding.
The clinical advice consists of: pre-conception care, regular dental visits, oral hygiene education, professional cleaning, good
oral hygiene practices, nutritional guidance and management of
morning sickness.

5. Rheumatoid arthritis
RA is an autoimmune disorder characterised by chronic inflammation of the joints, leading to pain, swelling, and eventual joint
destruction. There is evidence suggesting a link between periodontitis and rheumatoid arthritis. Both share several pathogenic mechanisms and risk factors. The more severe the periodontitis, the more severe the rheumatism. Specific oral bacteria
are responsible for this.
Emerging evidence suggests a bidirectional relationship between these diseases.

There are three main types of impact from periodontitis on
pregnancy:
1. Preterm birth: periodontitis has been linked to an increased
risk of preterm birth (delivery before 37 weeks). The inflammatory mediators produced in response to periodontal infection
can enter the bloodstream and potentially trigger premature
labor.14
2. Low birth weight: inflammatory cytokines and bacterial endotoxins from periodontitis can affect the placental function, potentially leading to low-birth-weight babies.15
3. Preeclampsia: periodontitis has been associated with an increased risk of preeclampsia, a pregnancy complication characterised by high blood pressure and damage to other organs, often the kidneys.

There are four shared mechanisms between rheumatoid arthritis and periodontitis:
1. Chronic inflammation: both conditions involve chronic inflammation driven by an overactive immune response.
2. Cytokine production: elevated levels of pro-inflammatory
cytokines like TNF-α, IL-1, and IL-6 are common in both RA
and periodontitis.
3. Genetic predisposition: certain genetic factors, such as shared
susceptibility loci, may predispose individuals to both conditions.
4. Autoimmunity: the presence of autoantibodies like rheumatoid factor (RF) and anti-citrullinated protein antibodies
(ACPAs) is common in RA and may be found in periodontitis
patients.

Furthermore, there are also three sorts of impact from pregnancy on periodontitis:

The impact of periodontitis on RA deals not only with increased
inflammation (periodontal infection can exacerbate systemic in-

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research

flammation, potentially worsening RA symptoms), but also with
bacterial translocation (oral bacteria, particularly P. gingivalis,
can enter the bloodstream and contribute to RA pathogenesis
through molecular mimicry and citrullination of proteins).19
Meanwhile, the impact of RA on periodontitis bears with an altered immune response (the dysregulated immune response in
RA can impair the body’s ability to control periodontal infections) and the effects of medication (immunosuppressive medications used to treat RA can affect oral health, either by increasing susceptibility to infections or causing dry mouth, which can
exacerbate periodontitis).20
Clinical implications comprise again: screening and diagnosis
(regular periodontal assessments for RA patients—individuals
with severe periodontitis should be evaluated for signs and
symptoms of RA), integrated care (rheumatologists and dentists
should collaborate) and preventive and therapeutic strategies
(oral hygiene, professional dental care and anti-inflammatory
treatments).

6. Chronic kidney disease
CKD is a progressive loss of kidney function over time, which can
eventually lead to kidney failure. It is often associated with other
comorbidities, such as cardiovascular disease and diabetes. Periodontitis has been associated with an increased risk of chronic
kidney disease. Inflammatory processes and bacterial infections
common to both conditions might play a role in this connection.
The combination of periodontitis and kidney disease leads to increased mortality due to the increase in the total inflammatory
burden.

1. Reduced immune function: CKD impairs the immune response, increasing susceptibility to periodontal infections.
2. Altered oral environment: CKD and its treatments can alter
the oral environment, making it more conducive to periodontal disease. For instance, reduced salivary flow can lead to increased plaque accumulation.
3. Medication side effects: medications for CKD, such as immunosuppressants and antihypertensives, can affect oral health
and increase the risk of periodontal disease.22
The clinical implications are similar as for the other systemic conditions: screening and diagnosis, integrated care and preventive
and therapeutic strategies.

Summary
The effect of periodontitis is not limited to the oral cavity.
Periodontitis is not only causing tooth loss, but it has also a
far-reaching impact on general health. Periodontopathogens
and their toxins are causing harm to different organs and systems in our body.
Therefore, dentists and all other medical practitioners are not
only responsible for their specific field of training/interest, but
they are all co-responsible for the overall health of their patients.
It is of utmost importance to not only make patients aware of
the dental–general health connection, but also to sensitise all
medical professionals for this link. Therefore, a holistic medical/
dental approach is highly advised.

Chronic kidney disease (CKD) and periodontitis are interconnected through shared risk factors, inflammatory mechanisms,
and potential bidirectional influences.

Literature

The shared mechanisms between these two diseases are based on:
1. Chronic inflammation: both CKD and periodontitis involve
chronic inflammatory responses. Periodontitis can contribute
to systemic inflammation, exacerbating CKD.
2. Immune dysregulation: CKD can impair the immune system,
making individuals more susceptible to infections, including
periodontal disease.
3. Common risk factors: conditions like diabetes and cardiovascular disease are risk factors for both CKD and periodontitis.
Periodontitis has a three-way influence on CKD:
1. Systemic inflammation: periodontal infection can increase
systemic inflammatory markers such as C-reactive protein
(CRP), which can worsen kidney function.
2. Bacterial translocation: oral bacteria and their by-products
can enter the bloodstream, potentially affecting the kidneys
and contributing to the progression of CKD.
3. Endothelial dysfunction: chronic inflammation from periodontitis can lead to endothelial dysfunction, a factor in the
progression of CKD.21

Prof. Curd Bollen
Tipton Training Academy
Manchester, UK
+31 6 19130754
curdbollen @me.com
Prof. Curd Bollen

In the other direction, CKD has a trilateral impact on periodontitis:

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research*

Peri-implantitis prevention
starts with the choice of a
clean implant
Two years ago, in implants 4/2022, we raised an important question: how clean must sterile-packaged implants
be to meet the high expectations of dental professionals who entrust these medical devices to their patients?
At that time, extensive quality assessments conducted by the CleanImplant Foundation revealed troubling
impurities on the surfaces of new, sterile-packaged implants, identified through independent laboratory
testing. It was reasonable to expect that the manufacturers involved would address these issues promptly and
ensure that their medical devices meet the highest standards of cleanliness. Regrettably, even after two years,
we cannot give the “all-clear”. Here’s an update to where things stand now.

01a

Peri-implantitis is a pathological condition affecting the
bone surrounding dental implants, characterised by inflammation of the adjacent soft and hard tissues, leading
to progressive bone loss.1, 2 If not diagnosed and treated
promptly, this condition can result in the loss of the implant. Unfortunately, the clinical and histological factors
that contribute to the progression from peri-implant mucositis to peri-implantitis are still not completely understood.3 Clinically, sites affected by peri-implantitis often
exhibit more extensive inflammatory lesions compared to
periodontal sites around natural teeth.

01b

or decades, dental implants have been the gold
standard for replacing missing teeth, whether
it’s a single tooth or an entire dental arch. However, alongside this success, experts have noted
a rise in cases of peri-implantitis and the associated peri-implant bone loss.

Sterile yet contaminated implants
A vastly underestimated risk factor that needs to be better
understood has recently gained attention: the manufacturing and packaging processes of dental implants. These
largely overlooked factors can significantly impact the
short- and long-term success of implants placed intraorally. The cleanliness of the implant surface is crucial, particularly because it directly affects the surrounding bone
during placement and the early phases of osseointegration.4
It is imperative that every stage of the manufacturing process is meticulously controlled to ensure that the final

01a + b
SEM 500x (a) and
SEM 380x (b).
Significant
impurities
located at the
shoulders of two
sterile packaged
titanium implants.

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

Drs Dirk U. Duddeck and Dana Adyani-Fard, Germany

[25] =>

product is not only sterile but also free from any
surface contaminants that could provoke an immunological response. While the implant may be
sterile when it is removed from its packaging,
there is a possibility of thin film contaminants, as
well as plastic or metallic particles, remaining on
the surface—residuals of the complex and intricate manufacturing process.5

DIGITAL WORKFLOW

PLANNING

Contaminants, whether in the form of particles
or thin layers on the implant surface, can be accurately identified through a combination of advanced analysis techniques. In a particle-free
clean room environment, the precise location of
these impurities is determined using material
contrast imaging in a scanning electron microscope (SEM). To further characterise the impurities, energy-dispersive X-ray spectroscopy (EDS)
provides initial insights into their elemental composition. The exact chemical nature of these contaminants is then identified through time-offlight secondary ion mass spectrometry (ToFSIMS). The CleanImplant Foundation ensures that
all these analyses are conducted exclusively in
accredited testing laboratories, adhering to
the stringent standards of DIN EN ISO/IEC
17025:2018, guaranteeing precision and objectivity in every analysis.

Results
In quality assessment studies conducted by the
CleanImplant Foundation in collaboration with
Charité–Universitätsmedizin Berlin and the Sahlgrenska Academy in Gothenburg, Sweden, significant impurities were discovered on new, sterilepackaged dental implants. These impurities
affected both titanium and zirconia implants.5, 6
On average, one in three analysed implant systems exhibited notable factory-related contamination on the implant surface immediately after
removal from the packaging. The contaminants
identified included organic particles from the
manufacturing process, metallic particles—such
as iron-chromium compounds, nickel, or tungsten—resulting from milling or surface treatments, and plastic residues from handling and
packaging. The areas most frequently contaminated were the shoulder region of the implant
platform (Figs. 1a & b) and the implant threads
(Figs. 2a & b). In some instances, analyses revealed not only isolated impurities but also larger
areas of the implant surface that had either been
inadequately cleaned during production or contaminated during packaging.

CAD

CAM

GUIDED
IMPLANTOLOGY

IMMEDIATE
RESTORATION

EASY.SAFE. DIGITAL.
Irrtum und Änderungen
vorbehalten
Irrtum und Änderungen vorbehalten

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

Methods of analysis

At high magnification, SEM images showed carbonaceous particles as black spots, alongside
thermoplastic materials, synthetic
polymers,
bredent
medical GmbH &and
Co. KG · Weissenhorner Str. 2 · 89250 Senden · Germany · T: +49
bredent
7309 872-600
medical· GmbH
F: +49 7309
& Co. 872-635
KG · Weissenhorner
· www.bredent-medical.com
Str. 2 · 89250 Senden
· @: info-medical@bredent.com
· Germany · T: +49 7309 872-600 · F: +49 7309 872-635 · ww
bredent medical GmbH & Co. KG · Weissenhorner Str. 2 · 89250 Senden · Germany
T: +49 7309 872-600 · F: +49 7309 872-635
www.bredent-medical.com · @: info-medical@bredent.com

[26] =>

research*

02b

“As analyses by independent laboratories show,
cell-toxic impurities can be found not only in
some titanium implants but also in those made
of ceramic. This makes choosing the right system
even more important.”
Dr Dirk U. Duddeck, Founder & CEO of CleanImplant Foundation

polysiloxanes on sterile implant surfaces. Both titanium implants
(Figs. 1a–2b) and zirconia (ceramic) implants from various manufacturers were found to be affected by these contaminants.

ganic, organic, and plastic particles (Fig. 5). This demonstrates
that contamination is not only a significant concern but also one
that is technically preventable.

Certain ceramic implants were found to have significant deposits
of polysiloxane, which could be traced back to the packaging
material (Fig. 3). Another potential threat to successful healing
(osseointegration) after implantation comes from thin-layer residues of highly aggressive, cytotoxic cleaning agents, such as dodecylbenzene sulphonic acid (DBSA)7 or the pesticide didecyldimethylammonium chloride (DDAC-C10)8. This quaternary
ammonium compound was identified using ToF-SIMS on the surface of a sterile-packaged ceramic implant (Figs. 3 & 4).

Clinical effects

Alarmingly, all implants analysed and found to contain contaminants carried the CE mark or had received clearance from the US
Food and Drug Administration. This highlights a critical concern:
even sterile-packaged medical devices can pose risks to patients
if contaminated. Such contamination can lead to implant failure,
often associated with peri-implantitis, as a result of inflammatory
reactions triggered by these impurities.

Carbon-containing organic particles that persist on the implant’s
surface during manufacturing or plastics from packaging can
provoke an immune response in the form of a foreign body reaction (Fig. 6). During implant insertion, particles that detach
from the surface are engulfed by macrophages through phagocytosis. This process triggers a cascade of proinflammatory cytokines, including TNF-α, interleukin(IL)-1β, and IL-6. These cytokines promote the differentiation of osteoclast precursors into
mature osteoclasts, which can enhance osteoclastic activity and
result in peri-implant bone resorption.10

However, it is important to note that many implants examined
under SEM revealed flawless surfaces, completely free of inor-

Even at low concentrations, thin-film contaminants—such as
those containing DBSA or quaternary ammonium compounds—
are cytotoxic to cells and impede rather than facilitate implant
healing. DBSA, an aggressive surfactant, is categorised as a
“hazardous substance” by the EPA. Similarly, the biocide/pesticide DDAC-C10 disrupts intermolecular interactions and destroys cell membranes.9

2/24

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

02a

02a + b
Major carbon-based
contamination of
titanium implant
threads straight
after unpacking,
shown at SEM 500x.

[27] =>

research*

04
ToF-SIMS visualisation of
polysiloxane (red) and
the quaternary
ammonium compound
DDAC (C22H48 N+; green)
on the surface of the
ceramic implant shown in
Figure 3 (with permission
of Tascon GmbH,
Münster, Germany).

05
SEM mapping image
of the whole implant
after removal from
the manufacturer’s
packaging (top); SEM
magnification 500x
(left) and 2,500x
(right), demonstrating a clean surface
free of any organic or
metallic particles or
other debris.

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

03
SEM image at 1,000×
revealing significant
plastic material and
thin-film contamination
on a sterile-packaged
ceramic implant.

Particularly, foreign particles ranging from 0.2 to 7.2 µm in size
are known to be highly proinflammatory.11–13 The increased expression of Matrix Metalloproteinase-8 (MMP-8) exacerbates
soft-tissue damage and inflammation, which can progressively
affect the adjacent bone.10 Consequently, the rough implant
threads become exposed to the oral environment, leading to
bacterial colonisation, often described as the “beginning of a
bad ending” and accelerating peri-implant disease. This progression often culminates in further crestal bone loss and, potentially, implant failure.

Discussion
The immunological response to contaminants varies among patients. While some may exhibit minimal or no reactions, others
may experience severe responses. The growing recognition of
peri-implant disease, facilitated by advances in clinical understanding, indicates that contaminants can provoke immunological reactions in a significant number of patients.
Contaminants on an implant’s surface signify a compromised implant. Addressing this issue is not complex: manufacturers have
the capability to prevent such contamination, and it is their responsibility to do so. There is no justification for failing in this re-

gard; the well-being of patients and the integrity of scientific
standards demand the highest quality control. As dental implants become more widely used, it is imperative to monitor patients closely throughout the lifespan of their restorations. Early
detection and intervention for peri-implant mucositis are crucial
for preserving the surrounding bone, halting the progression of
peri-implantitis, and enhancing long-term clinical outcomes.
However, preventing undesirable foreign body reactions and
early-stage peri-implantitis begins with selecting an implant system that is rigorously proven to be clean. Sterility alone does not
ensure safety, as contaminants—regardless of being labelled as
“sterile dirt”—can still trigger immunological responses.

Conclusion
The quality of the implant surface and the cleanliness of the implant are crucial factors in peri-implant diseases, though they remain significantly underestimated. Whether the implants are
made of titanium or ceramic, it is essential that the implant’s surface is free from foreign particles after removal from sterile packaging. Particulate and thin-film contaminants are often invisible
to the naked eye, even under magnification with magnifying
glasses or microscopes.

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[28] =>

research*

In most cases of peri-implantitis or implant failure, clinicians may
attribute the issue solely to patient factors. However, the results
from quality assessments of sterile-packaged implants suggest
that the medical device itself should also be considered a potential source of inflammatory reactions and a possible trigger for
peri-implantitis during the placement process.5

Read the previous
article

The decision to award this quality mark is made by the renowned
scientists on the Foundation’s Scientific Advisory Board through
a rigorous peer review process. To uphold the Trusted Quality
seal, a random sample of five implants from each system undergoes comprehensive, independent analysis every two years.

For the past eight years, the CleanImplant Foundation has collaborated with an expanding network of industry partners to ensure particle-free implant production. It has established the
“Trusted Quality” seal as a mark of assurance for implants that
have been rigorously tested and deemed clean.
The 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, the foundation 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 nature of the Foundation’s work with its
partners and manufacturers. Moreover, understanding the implications of residual biocides, such as DDAC, and cytotoxic,
surface-active agents like DBSA on sterile-packaged implants
intended for patient use is critical to ensuring product safety and
efficacy.
Dentists interested in supporting the CleanImplant Foundation
can become members through the website. This non-profit organisation provides details on the benefits of membership and
showcases numerous implants that have received the prestigious seal of quality, the “Trusted Quality” mark, after thorough
testing. The criteria for ensuring that implants are largely free of
particles were established in a consensus paper published in
2017.14

Dr Dirk U. Duddeck
CleanImplant Foundation
Berlin, Germany
info@cleanimplant.org
www.cleanimplant.org
Dr Dana Adyani-Fard
Düsseldorf, Germany
info@cleanimplant.org
www.cleanimplant.org

Dr Dirk U.
Duddeck

2/24

Dr Dana
Adyani-Fard

Literature

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

06
Impurities detach
during implant
insertion from the
surface and
induce a storm of
pro-inflammatory
cytokines leading
to bone
resorption and
soft-tissue
degradation.

[29] =>

Are you a writer?
Do you have clinical cases and a profound knowledge about a special treatment method?
Then become part of ceramic implants—international magazine of ceramic implant technology. Share your experience and knowledge and benefit from a global reach and high level
of awareness.
We are always on the lookout for new faces to increase our clinical and scientific network.

Submission checklist
Send us a text with length of 10,000 to 15,000 characters. We do not want to limit you in terms of article length, so please use the word count as a general
guideline!

Numbered images in TIF or JPEG format, in a printable quality of at least 300 dpi.

Most important: we would like to introduce you/the
mind behind the article. So please send us also your
portrait photo with a short biography about your
professional career and your contact information.

OEMUS MEDIA AG

Your contact:
Timo Krause
Editorial Manager
t.krause@oemus-media.de
+49 341 48474-220

Holbeinstraße 29 · 04229 Leipzig · Germany · Phone: +49 341 48474-0 · info@oemus-media.de

[30] =>

interview*

From concept to patented
innovation

Dr Walther, the ZIRKONUS implant system is a metal-free, modular
system that comes in single- and multi-part versions. One of its
standout features is the patented coupling mechanism between
the implant, abutment, and crown in the multi-part system. The
design harmonises perfectly with the material properties of ceramic. What motivated you to develop a new type of connection?
The pivotal moment came when the manufacturer of the implant system I was using in my practice transitioned from a transgingival concept to a bone-level approach. Although I had been highly satisfied
with the previous system, the often-visible dark titanium beneath the
gum tissue was aesthetically unpleasing. I was also concerned about
the long-term health effects of metal oxide release. It became clear
to me that simply changing the material was not enough—the design
itself needed to be rethought. Instead of opting for a hybrid solution
with a steel screw or a shoulder support, I wanted to develop a truly
ceramic-appropriate design that maximised the material’s unique
properties.
Could you walk us through the development process?
In the beginning, I found myself sitting on my sofa, reflecting on the
best way to bring this concept to life. I started by sketching my ideas
on paper and discussing them with experts in the field. The actual development took off after I secured the patent for my system in 2007.

01
01
Dr Dr Walther,
oral surgeon and
practice owner,
discussing the
development of
the ZIRKONUS
implant system.

02
Connection between the
implant body and abutment
via a Renk connection. The
abutment rotates 60 degrees
to the right, lowering by
5 degrees into the final
position when screwed in.
Rotational stability is achieved
by securing the dental crown.

2/24

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

Implantology is shaped by constant development and innovation. Dr Dr Gerd Axel Walther, an oral surgeon
and practice owner from Germany, has had a remarkable journey, during which he developed a new implant
system that stands out for its patented design principles. In this interview with Timo Krause and Henrik Eichler
from OEMUS MEDIA AG, Dr Walther offers insights into the inspiration behind this innovation, the development process, and the unique attributes of his implant system.

[31] =>

interview*

03
Implant, custom
abutments, and
bridge on
non-axially
aligned implants.

One of the defining characteristics of the design is how the components
fit together like a three-dimensional puzzle, significantly reducing the hollow spaces typically found in screw-based connections. Later, patents
were also secured in the EU and the USA.

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

What were the main challenges you faced during the system’s introduction?
Finding the right industrial partner proved to be much more difficult than
I anticipated, especially when it came to meeting ISO standards and ensuring the material’s durability. After investing a considerable amount of
time and resources, I decided to take matters into my own hands and develop the implant system independently. Today, we can produce implants
with undercuts in various sizes, and I believe this capability is one of the
company’s most valuable assets.
Please explain the core principles behind the system.
The ZIRKONUS system stands out for its screwless design, made entirely
from ceramic material. Surgeons using this system must adjust to a new
approach, as its geometric structure is fundamentally different from metalbased systems.
The system features a patented “Renk connection” between the implant
and abutment. When the abutment is screwed in, it lowers by 5 degrees
into place. The anti-rotation mechanism is secured with the placement of
the dental crown. The abutment, made of zirconium dioxide, utilises a
PEEK sleeve for optimal force transmission to the implant walls. This eliminates the need for screw channels in both the abutment and superstructure, enabling more delicate abutments and frameworks. Additionally, the
design minimises hollow spaces, reducing bacterial reservoirs common in
metal-based systems. The system allows for easy replacement of secondary components, and the crown is cemented onto the implant–abutment
complex. To reverse the abutment, the crown must first be removed.
A colour-coded marking on the implant shoulder ensures precise placement and replacement of components.
The ZIRKONUS implant system is ideal for fixed prosthetics, whether for
single-tooth restorations or bridges of any size, and is also suitable for immediate implantation procedures.
We thank you for this enlightening conversation, Dr Walther, and wish
you continued success in your endeavours!

Dr Dr Gerd Axel Walther
ZIRKONUS Implantatsysteme GmbH & Co. KG
Böblingen, Germany
Tel.: +49 711 30532914
info@zirkonus.de
www.zirkonus.de

2/24

Dr Dr Gerd Axel
Walther

[32] =>

events

European Society of Ceramic
Implantology (ESCI) satellite
symposium—“Ceramic
Implantology”
The European Society of Ceramic Implantology (ESCI) proudly presented its satellite symposium, “Ceramic
Implantology,” at the 6th Swiss Implant Congress of the Implant Foundation Switzerland, held from 19 to 21
September 2024. The symposium, hosted at the renowned Kursaal Bern, marked a pivotal moment in the
advancement and recognition of ceramic implantology within the larger field of dental implants. As a featured
event on the afternoon of 19 September, ESCI’s symposium attracted attention from professionals eager to
explore ceramic implants’ growing role and their practical applications.

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

Dr Jens Tartsch

he symposium offered a dedicated platform to
delve into the latest innovations and research in ceramic implantology, fostering a community of experts and practitioners committed to advancing
the field. The symposium brought together leading voices in ceramic implantology to discuss the most current
trends, challenges, and emerging opportunities. This satellite
event served as an essential forum for participants to familiarise
themselves with the specific benefits of ceramic implants, including their clinical reliability, biological compatibility, and
potential as a viable alternative to traditional implants.
Structured into two key parts, the symposium opened with a series of scientific lectures presented by respected experts. Prof.
Ronald Jung and Dr Jens Tartsch, who led the welcome and
opening remarks, set the stage for a series of in-depth presentations. Dr Jens Tartsch discussed whether ceramic implants are
more than just a trend, followed by Dr Stefan Röhling’s assessment of their reliability in daily practice. Prof. Ralf Kohal addressed the durability of ceramic implants for clinical use, while
Dr Frank Maier provided insights into managing hard and soft
tissue around ceramic implants. Prof. André Chen rounded off
this segment by exploring digital workflows involving ceramic
implants. Together, these lectures emphasised the robust scientific foundation behind ceramic implants and presented the latest data-driven results that support their use in clinical settings.
The second part of the symposium focused on practical, casebased learning through a session titled “My approach with...,” a
unique feature organised in collaboration with ESCI’s company
partners. This session allowed seasoned clinicians to share their
preferred implant systems and personal insights from real-world

2/24

[33] =>

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

events

applications, offering a deep dive into individual approaches. Dr Jens Tartsch
shared his experiences with Zeramex XT and Nobel Pearl, while Prof. Sebastian Kühl presented his approach with Straumann Pure. Dr Frank Maier discussed CERALOG implants, and Dr Lars Börner presented on Z-SYSTEMS.
Each speaker shared their methodology, system-specific advantages, and
firsthand clinical observations, giving participants a thorough understanding
of the versatility of ceramic implant options.
This ESCI satellite symposium was a cornerstone event, providing a rare and
valuable opportunity for dentists, oral surgeons, researchers, and industry
professionals to gain practical insights and deepen their expertise in ceramic
implantology. It enabled them to explore the technical, scientific, and clinical
dimensions of ceramic implants and understand the latest applications that
can shape future practices. Attendees were encouraged to take advantage
of this gathering to expand their knowledge, network with industry leaders,
and directly contribute to the continued acceptance and development of ceramic implants within implantology.
The satellite symposium was strategically designed to complement the
larger 6th Swiss Implant Congress, where a broader range of implantology
topics and esteemed speakers—such as Prof. Bilal Al-Nawas, Prof. Tomas Albrektsson, Prof. Giovanni E. Salvi, and Prof. Hannes Wachtel—enhanced the
overall learning experience for all attendees.

2/24

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

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

[34] =>

events

EAO Congress 2024:
Advancing excellence
in implant dentistry

© OEMUS MEDIA AG

O

ver 4,600 attendees from more than
70 countries gathered in Milan from
24 to 26 October for an exceptional
EAO Congress, themed “Details
Make Perfection”. This year’s programme, thoughtfully curated by the scientific committee, was designed to both inspire and challenge
participants, with each day focusing on a specific
theme: The Fundamentals, State of the Art—Certainties, and Beyond the Limits. Sessions featured the latest evidence-based practices, delivering practical
techniques that dentists can readily implement in their
practices.

© OEMUS MEDIA AG

The congress, as always, provided a unique opportunity to learn from leading experts in the field. Continuing its tradition of collaboration with prominent local

© OEMUS MEDIA AG

© OEMUS MEDIA AG

34

2/24

[35] =>

associations, the EAO partnered with the Italian Academy of Osseointegration (IAO) and the Italian Society
of Periodontology (SIdP). Their invaluable contributions
enriched the programme, presenting a comprehensive
perspective on the latest advancements in implant
dentistry.
Among the many highlights, distinguished specialists
shared insights on the challenges and innovations in
implant care, covering topics such as sustainable treatment models, digital advancements, and optimised
protocols for complex cases. Workshops offered participants hands-on experience with the latest techniques, equipping them with practical skills for immediate application.

events

Attendees enjoyed cutting-edge presentations, connected with esteemed colleagues from around the
world, and experienced the dynamic ambiance of one
of Europe’s most iconic cities. Meanwhile, an extensive
industry exhibition featuring leading companies in the
field fostered the exchange of the latest materials,
techniques, and technologies.
© OEMUS MEDIA AG

This congress marked the EAO’s second event in Italy
in the past decade, following the successful congress
in Rome in 2014. Milan, with its vibrant culture and cosmopolitan energy, served as an inspiring setting for this
global gathering.
For those who could not attend all sessions, a selection
of conference recordings is available on the congress
platform starting 5 November free of charge.

EAO European Association of
Osseointegration
Paris, France
+33 1 42366220
info@eao.org
eao.org

2/24

[36] =>

events

International experts define
standards for edentulous
maxilla treatment

D

uring a press conference at the Annual Meeting of the European
Association for Osseointegration (EAO) in Milan, the Global
Consensus for Clinical Guidelines (GCCG) was announced. For
this pioneering initiative, the EAO, the International Team for
Implantology (ITI), and the Osteology Foundation have joined
forces with the aim of establishing clinical guidelines for the treatment of the
edentulous maxilla. Contributors from around the world and professional organisations have been invited to ensure global relevance. The GCCG uniquely
integrates feedback from international clinicians, researchers, patients, and
stakeholders, with the goal of enhancing patient outcomes.

01

“The GCCG represents an innovative, evidence-based approach to consensusbuilding in implant dentistry,” explained the scientific leaders and co-initiators,
Frank Schwarz and Hom-Lay Wang. Engaging a broad spectrum of international
experts, patients, and stakeholders, this initiative contrasts traditional consensus conferences by aiming to create straightforward, practical clinical workflows
that improve outcomes for clinicians and patients alike.

Enhancing treatment through evidence-based guidelines
This first GCCG focuses on the rehabilitation of the edentulous maxilla, which
significantly affects patients’ quality of life. Therefore, by focusing on real-world
application, the GCCG seeks to equip clinicians with actionable, evidence-driven
guidelines to improve treatment outcomes for these patients.
Frank Schwarz emphasised the importance of integrating patient and clinician
perspectives in the GCCG: “Our guidelines aim to be clinically effective and reflective of patient needs, ensuring that our recommendations enhance treatments and ultimately improve patients’ lives.”

02

“Therefore, at the core of the GCCG’s methodology are Patient Reported Outcome Measures (PROMs) and Clinician Reported Outcome Measures (CROMs),
evaluated through systematic reviews,” he explained. “What also makes the
GCCG unique is that comprehensive feedback is gathered via tailored Delphi
surveys that have been distributed to a substantial number of clinicians, patients, and public stakeholders. We have undertaken these extensive efforts to
incorporate a wide range of perspectives. The results from these reviews, surveys, and associated meta-analysis then form the basis for formulating the actual clinical guidelines, ensuring their clinical relevance and practicality.”

A global collaborative effort

03

The GCCG draws expertise from around the world, making the guidelines applicable in various cultural and clinical contexts. “This is not just about developing another set of guidelines; this is about reshaping how we approach clinical
practice in implantology,” explained Hom-Lay Wang and continued: “By bringing together voices from all over the world and including both clinicians and pa-

01
The GCCG
involves
contributors and
associations from
around the world.

36

2/24

02
Press conference
during the EAO
Annual Meeting
in Milan.

03
Signing of the
Memorandum of
Understanding.

[37] =>

AD

“Our guidelines aim to be clinically effective and reflective of
patient needs, ensuring that
our recommendations enhance
treatments and ultimately
improve patients’ lives.”
tients, we are creating a global framework that will have a lasting impact on the
way we care for patients.”
Many traditional consensus conferences had only regional impact and did not
achieve global recognition and clinical relevance. The GCCG wants to overcome this by involving contributors and associations from around the world.

WE
LOVE
WHAT
WE
DO

The efforts will culminate in a consensus conference in Boston in June 2025,
where over 120 international experts will discuss and formulate the first global
guidelines for the treatment of the edentulous maxilla.

Joining forces to advance clinical practice
Representatives of the three core organisations that have teamed up to jointly
organise the GCCG were also present at the press conference.
Ronald Jung, President of the EAO and a co-initiator of the GCCG, underlined
the collaborative strength of the GCCG, noting, “The strength of the GCCG lies
in its ability to unite experts from around the world and create guidelines that
will benefit clinicians and patients alike. We are striving to make sure that these
guidelines will be useful across different clinical environments, ensuring better
treatment outcomes for patients facing the challenges of edentulism.”
Charlotte Stilwell, President of the ITI, supported this sentiment, adding, “The
ITI is proud to support the GCCG because it aligns with our mission of promoting the highest standards of clinical practice. We believe that by integrating
patient feedback and focusing on evidence-based solutions, the GCCG will deliver guidelines that have a tangible impact on improving patient care.”
Frank Schwarz, commented on behalf of Christer Dahlin, President of the Osteology Foundation, who could not attend. He also emphasised the alignment
with their goals: “The GCCG aligns perfectly with the Osteology Foundation’s
focus on oral regeneration and its mission to ultimately improve patient care.
Our joint aim in this collaboration is to create clinical guidelines that directly
translate into better treatments for patients.”
With these statements, the leaders highlighted the powerful collaboration in
developing globally applicable clinical guidelines. Concluding the press conference with a strong message of unity and a forward-looking vision, they added
that this alliance might be a starting point for further collaborative efforts and
could serve as a stepping stone for additional activities. “Discussions are already ongoing,” they said.

We publish dental for the
past three decades.
YOU CAN RELY ON US.
WWW.OEMUS.COM

We are g
tin
celebra

eart psower.
30 lY
marke

a
of dent

.
oin us

J

welovewhatwedo.org

Holbeinstraße 29 · 04229 Leipzig · Germany
Phone: +49 341 48474-0 · info@oemus-media.de

Source: Global Consensus for Clinical Guidelines

2/24

oemus media ag

[38] =>

manufacturer news*

COHO Biomedical Technology Company: Delivering
excellence in zirconia implants and medical devices

Expertise and innovation
in zirconia technology
Zirconia has emerged as a revolutionary material in the medical field,
especially in dental implants. Known for its exceptional biocompatibility, strength, and aesthetic appeal, zirconia offers a superior alternative to traditional materials like titanium. COHO Biomedical has
harnessed the full potential of this advanced material through rigorous research and development, ensuring that our products not only
meet but exceed industry expectations.
The ZIBONE Zirconia Implant is the culmination of years of research
and development. Our team of experts has meticulously designed
and tested this implant to ensure it delivers unparalleled performance
in terms of strength, durability, and patient comfort. The implant’s
unique design allows for optimal osseointegration, ensuring a secure
and long-lasting bond with the surrounding bone tissue. This results
in improved patient outcomes and a higher success rate in implant
procedures.

Commitment to quality and safety
At COHO Biomedical, quality and safety are not just priorities—they
are the foundation of everything we do. We understand that medical

devices, especially those implanted in patients, must adhere to the
most stringent safety standards. That’s why our ZIBONE Zirconia Implant and other zirconia medical devices undergo rigorous testing at
every stage of production. From raw material selection to final product
inspection, we implement comprehensive quality control measures to
ensure that our products are free from defects and safe for use.
Our commitment to quality extends beyond our products to the services we provide. We work closely with healthcare professionals to
ensure that they have the necessary training and support to use our
products effectively. Our technical support team is always on hand to
provide assistance, whether it’s answering questions about product
specifications or offering guidance on best practices for implant procedures.

Aesthetic and functional advantages
One of the standout features of zirconia as a material is its aesthetic
appeal. Unlike metal implants, zirconia implants are naturally white,
making them an ideal choice for patients seeking a more naturallooking solution. The ZIBONE Zirconia Implant is designed with aesthetics in mind, ensuring that it blends seamlessly with the patient’s
natural teeth. This makes it particularly suitable for use in the anterior
region, where the appearance of the implant is crucial to the overall
success of the procedure.
In addition to its aesthetic benefits, zirconia also offers functional
advantages. It is highly resistant to corrosion and does not conduct
heat or electricity, reducing the risk of adverse reactions in patients.
Furthermore, zirconia’s non-metallic nature means it does not interfere with medical imaging techniques, allowing for clearer and more
accurate diagnostic results.

Comprehensive product portfolio
While the ZIBONE Zirconia Implant is our flagship product, COHO
Biomedical offers a comprehensive range of zirconia-based medical devices to meet the diverse needs
of healthcare providers. Our product
portfolio includes everything from
dental crowns and bridges to surgical
instruments and orthopaedic implants,
all made from the highest quality zirconia. Each product is designed with the same
attention to detail and commitment to excellence that has become the hallmark of our
company.

2/24

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

At COHO Biomedical Technology Company, we pride ourselves on
being at the forefront of innovation and quality in the healthcare industry. Our commitment to excellence is evident in the specialised
services we provide, particularly in the realm of zirconia implants and
medical devices. Through our flagship product line, the ZIBONE
Zirconia Implant, and other cutting-edge zirconia-based medical
solutions, we have established ourselves as leaders in providing safe,
effective, and durable products that meet the highest standards of
patient care.

[39] =>

manufacturer news*

on the skill and knowledge of the practitioner, which is why we invest
heavily in training and education.
Our comprehensive training programmes cover everything from product installation and maintenance to advanced surgical techniques. We
also offer ongoing support to our clients, ensuring that they have
access to the latest information and best practices. Whether it’s
through in-person workshops, online training modules, or one-onone consultations, we are committed to helping our clients achieve
the best possible outcomes for their patients.

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

Our extensive product range allows us to offer complete solutions to
our clients, ensuring that they have access to the best possible tools
and materials for their practice. Whether it’s a single dental implant or
a full set of zirconia prosthetics, COHO Biomedical has the expertise
and resources to deliver products that meet the highest standards of
performance and patient satisfaction.

COHO Biomedical Technology Company is dedicated to advancing
healthcare through innovative zirconia implants and medical devices.
Our ZIBONE Zirconia Implant is a testament to our commitment to
quality, safety, and patient satisfaction. By combining cutting-edge
technology with professional support and training, we are helping
healthcare providers around the world achieve better outcomes for
their patients.

Professional support and training

COHO Biomedical remains focused on our core mission: to provide
the highest quality medical devices that enhance patient care and improve lives. Whether you are a healthcare provider looking for the best
in zirconia implants or a patient seeking a safe and effective solution,
COHO Biomedical is your trusted partner in healthcare innovation.

At COHO Biomedical, we believe that providing exceptional products is only part of the equation. Equally important is the support and
training we offer to the healthcare professionals who use our products. We understand that the success of any medical device depends

COHO BIOMEDICAL TECHNOLOGY CO., LTD.
info@zibone.com
www.zibone.com

Z-SYSTEMS reaches 20-year milestone in advanced
dentistry, pioneering zirconia implants
Z-SYSTEMS Ceramic Implants is proud to celebrate the continued
the
success of our bone-level and tissue-level ceramic implants—the
world’s first and only 100 per cent ceramic dental implants with a
screw-retained conical connection. These groundbreaking implants
have set a new standard in implantology, offering unmatched
strength, biocompatibility, and aesthetic excellence.

3. Two-piece conical connection: This unique connection ensures
a precise fit and stability while minimising the risk of bacterial
penetration, contributing to lasting implant success.
4. Outstanding durability: Zirconia’s exceptional strength and
fracture resistance make our implants highly durable and suitable for a wide range of clinical cases.

With 20 years of dedicated research and clinical expertise,
Z-SYSTEMS has revolutionised the field of implants and their
commitment to innovation has propelled the company to the
forefront of dental implant technology. The advanced design of
the 100 per cent ceramic implants provides patients with a metalfree solution that promotes optimal long-term outcomes, ensuring stability, natural appearance, and improved oral health.

Join us as we celebrate 20 years of pioneering excellence, as the
world leader in zirconia implants, and discover how Z-SYSTEMS’
bone-level and tissue-level implants can grow your practice
and improve patient outcomes. For more information, visit
www.zsystems.com.
Z-SYSTEMS Ceramic Implants is a leading dental implant
manufacturer specialising in advanced ceramic implant solutions. With a focus on innovation, precision, and patientcentric outcomes, Z-SYSTEMS has set a new standard in implant dentistry. The company’s commitment to excellence is
rooted in a passion for enhancing smiles and improving the
lives of patients worldwide.

Key features and benefits:
1. Superior aesthetics: The tooth-coloured zirconia material
closely resembles natural teeth, allowing for seamless and
lifelike restorations.
2. Enhanced biocompatibility: Our zirconia implants feature
biocompatible materials with excellent tissue acceptance,
promoting healthy osseointegration and long-term implant success.

Z-SYSTEMS AG
www.zsystems.com

2/24

[40] =>

manufacturer news*

Secure your spot and discover ZIRKONUS’
patented implant system!

ZIRKONUS Implantatsysteme GmbH & Co. KG
+49 711 30532914
info@zirkonus.de
www.zirkonus.de

Zeramex anatomy course in Graz
CeramTec Switzerland has prepared an exciting training course:
Dentists working in implantology can now attend an anatomy course.
The Zeramex course, which is certified with continuing medical education points, will take place under the direction of Prof. Dr Dr Michael
Payer on 22 and 23 November 2024 at the Medical University of Graz
(AT). The programme includes lectures by Prof. Dr Dr Michael Stiller
and Dr Dr Thomas Mehnert on the topics of anatomy & ceramic implants as well as practical work on human specimens.

Friday will begin with a guided tour through the old town of Graz and
a get-together from 7 p.m. Lectures and practical work are planned
for Saturday.

Course fee and registration
Registration is via e-mail event@zeramex.com or via the attached QR
code. The number of places is limited.

CeramTec Schweiz GmbH
www.zeramex.com

2/24

CeramTec Schweiz
GmbH

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

At this year’s DGZI congress, the popular table clinics provide an
ideal platform for showcasing this innovative system. These interactive sessions allow participants to engage with leading experts on
a variety of specialised implantology topics, expanding their knowledge and gaining valuable cross-disciplinary insights.

At the 53rd International Annual Congress of the DGZI, held on
8 and 9 November in Düsseldorf, Germany ZIRKONUS will present
its groundbreaking implant solution. This innovative, multi-part, all-ceramic system introduces
a cutting-edge coupling geometry that
seamlessly connects the implant body,
abutment, and crown. The abutment
rotates 60 degrees before settling into
its final position without the need for
adhesive, allowing it to be replaced
as often as needed when the crown is
removed. Additionally, the absence of
a screw channel enables very delicate
superstructures. Another unique feature
of ZIRKONUS is the availability of implants
with diameters ranging from 3.5 to 11.5 mm,
catering to a variety of clinical needs.

[41] =>

manufacturer news*

“BAYERNS BEST 50”—bredent receives an
award for best performance

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

“The award is a confirmation of our continuous corporate development and our commitment to our employees and the region,” explains Peter Brehm, founder and owner of bredent. “With our innovative approach and a strong focus on quality and training, we have
not only created jobs, but also actively contributed to the creation of
a high standard of living in Bavaria.”
The “BAYERNS BEST 50” award recognises companies that have
achieved superior growth in recent years. Important selection criteria
are the economic success of the company and the active role of the
company management in the business.

bredent GmbH & Co. KG was honored by the Bavarian State Ministry
of Economic Affairs, Regional Development and Energy as one of
the fastest-growing medium-sized companies
in Bavaria. As part of the “BAYERNS BEST 50”
event, the company and 49 other winners received the award, which stands for outstanding
entrepreneurial growth, employee growth and
sales growth. The award was handed over by Hubert Aiwanger, Bavarian State Minister for Economic Affairs, Regional Development
and Energy.

bredent medical GmbH & Co. KG
www.bredent-medical.com
bredent medical
GmbH & Co. KG

Neodent® Zi Ceramic Implant System:
performance with outstanding aesthetic result
The Neodent® Zi Ceramic Implant System combines the notions of
aesthetic, stability, and flexibility. This solution allows clinicians to immediately treat patients due to the modern naturally-tapered design
and wide prosthetic portfolio, achieving high-end aesthetic results.

Treatment flexibility
Designed to provide several treatment solutions and a wide
range of prosthetic possibilities through a two-piece connection, Zi offers solutions from conventional to digital workflow,
able to treat bone types I to IV.

ceramic abutment. This design improves the performance by optimising the force distribution along the internal connection.

Ceramic prosthetic portfolio
The Ceramic prosthetic portfolio allows conventional or immediate
protocols. In addition, both conventional and digital workflows can
be applied, resulting in a natural-looking restoration.
Neodent—
A Straumann Group Brand
www.neodent.com

Tapered design and connection
for stability
The Ceramic Implant System exhibits a modern
tapered geometry designed for predictable
immediate load. This feature is designed to
mimic the tapered shape of a natural tooth
root, achieving high primary stability.
Additionally, Zi has the exclusive ZiLock® internal
ceramic connection, a user-friendly system designed with a longer screw which provides a secure
engagement between the ceramic implant and the

2/24

[42] =>

about the publisher

Events

Imprint
Copyright Regulations

Publisher

ceramic implants international magazine of

Torsten R. Oemus

ceramic implant technology is issued three

oemus@oemus-media.de

French Dental Association
Annual Meeting
26–30 November 2024
Paris, France
adfcongres.com/en

© orpheus26 – stock.adobe.com

times a year and is a special edition of implants international magazine of oral implan-

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[43] =>

SAVE T

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DATE!

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BIOLOGISATION IN REGENERATIVE DENTISTRY
25‒26 SEPTEMBER 2025
RADISSON BLU HOTEL FRANKFURT AM MAIN

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[44] =>

DO YOU TRULY KNOW
YOUR IMPLANT SYSTEM?
sterile + clean
(R)Evolution – CHAMPIONS IMPLANTS
SDS 1.2 – SWISS DENTAL SOLUTIONS
SDS 2.2 – SWISS DENTAL SOLUTIONS

sterile + dirty

ICX-Premium – MEDENTIS MEDICAL
Astra Tech EV – DENTSPLY SIRONA
Spiral SB/LA – RITTER IMPLANTS
Inverta – SOUTHERN IMPLANTS
whiteSKY – BREDENT MEDICAL
Kontact W – BIOTECH DENTAL
BlueDiamond – MEGAGEN

s- Clean SQ-SL – DENTIS
ZENEX – IZEN IMPLANT
AnyRidge – MEGAGEN
SuperLine – DENTIUM
T6 torQ – NUCLEOSS
In-Kone – GLOBAL D
T6 – NUCLEOSS
UnicCa – BTI

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

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

࡛Join in as a CleanImplant Certified Dentist.
࡛Gain access to exclusive membership benefits.
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More information about this non-profit initiative:
www.cleanimplant.com/dentists

The independent dental implant quality assessment.

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[cover] => ceramic implants international No. 2, 2024

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Table of contents

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