ceramic implants international No. 1, 2022

ceramic implants international No. 1, 2022

Cover / Editorial / Content / Dental implants and bone marrow defects - Evaluation of bone quality by intra-oral ultrasonography / Ceramic dental implants in clinical use - Evaluation of the ESCI scientific survey / Ceramic implant placement in a medically compromised patient / Single-tooth replacement with ceramic implants / Biological and osseointegration capabilities of a zirconia implant / Rehabilitation of the maxilla with implant-supported zirconia bars / Ceramic implants account for 50% of implants we use / Industry / Manufacturer news / Events / News / Imprint

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issn 1868-3207 Sondernummer • Vol. 6 • Issue 1/2022

ceramic

1/22

implants

international magazine of ceramic implant technology

research

Dental implants and
bone marrow defects

case report

Ceramic implant placement
in a medically compromised patient

industry

Patent™—the proven master of zirconia implants

[2] =>

SICwhite
the individual approach

Metal free. Cement free. Two parts.
www.sic-invent.com

[3] =>

editorial

Janine Conzato
Managing editor

A new year, new faces and
new long-term data
Today, patients have significant access to information
and may come into the dental office with in-depth questions or recommendations regarding their treatment.
Responding to these may require dentists to learn more
about new procedures or technologies, looking at the
scientific evidence with a critical eye. Regarding dental
implantology, for example, there is market demand for
a broader range of indications and greater prosthetic
flexibility. Now new reliable long-term data on the clinical success of two-piece ceramic implants has made
a fundamental contribution to evidence-based implantology, heralding a paradigm shift in the scientific discussion about ceramic implant systems. Many readers
will be learning about this evidence for the first time in
this issue of ceramic implants.
Among the new generation of ceramics in dentistry,
zirconia presents outstanding aesthetic characteristics,
a low propensity for plaque adhesion around the
implant surface, excellent biocompatibility, and good
osseointegration, muco-integration and biomechanics.
In addition, zirconia implants have characteristics similar
to those of titanium implants, and zirconia is frequently
used in implant prostheses with pleasing results.
This issue of ceramic implants provides reports on
the advantages of ceramic implants and a scientific
update on the topic, including a worldwide survey by the
European Society for Ceramic Implantology, conducted
to gain a deeper insight into the daily use of ceramic
implants. The survey findings provide valuable information for the further development of ceramic implants
and make an important contribution to their reliable
use—ultimately for the safety of patients. It is clear that

the work being done in dental clinics and continuing
education regarding the use of ceramic implants are
contributing greatly to this development. This issue of
ceramic implants is good testimony to that: numerous
research articles, case reports, reviews and upcoming
events testify to an extraordinarily active community.
Over the past two years, continuing dental education
in the form of in-person events has practically come
to a standstill—not only in Europe but also beyond.
Many of the great events in the dental world, like the
International Society of Metal Free Implantology’s annual
conference, EuroPerio and the European Association
for Osseointegration’s annual scientific meeting, had to
be called off. In-person events are slowly resuming, and
the opportunity these offer for exchange among peers
and socialising is more appreciated than ever.
Like the title of this editorial implies, we have something
new to announce. There is a new dynamic duo in implant
dentistry publishing: Timo Krause, OEMUS MEDIA AG
product manager, and I are excited to have teamed
up to write articles for our magazine. These are aimed
at providing our readers with a comprehensive overview which reflects the diversity of ceramic implant
initiatives, and we hope to live up to this objective in
this new issue of ceramic implants.
Stay up to date with us by following us on LinkedIn.
Sincerely wishing you an enjoyable read,
Janine Conzato
Managing editor

implants 1 2022

[4] =>

| content
editorial
A new year, new faces and new long-term data

03

Janine Conzato

research
Dental implants and bone marrow defects

06

Dr Johann Lechner

Ceramic dental implants in clinical use

12

Dr Jens Tartsch

page 18

case report
Ceramic implant placement in a medically compromised patient

14

Dr Alexandr Bortsov

Single-tooth replacement with ceramic implants

18

Professors Curd Bollen & Paul Tipton

Biological and osseointegration capabilities of a zirconia implant

24

Dr Saurabh Gupta

Rehabilitation of the maxilla with implant-supported zirconia bars

28

Dr Witalij Kolbe
page 28

interview
Ceramic implants account for 50% of implants we use

30

Prof. Michael Gahlert & Dr Stefan Röhling

industry
Patent™ —the proven master of zirconia implants

34

Zircon Medical Management

Second-generation ceramic implant

36

bredent medical
page 34

events

46

news
Cover image courtesy of
Zircon Medical Management AG
www.zircon-medical.com
issn 1868-3207 Sondernummer • Vol. 6 • Issue 1/2022

ceramic

1/22

implants

international magazine of ceramic implant technology

research

Dental implants and
bone marrow defects

case report

Ceramic implant placement
in a medically compromised patient

industry

Patent™—the proven master of zirconia implants

04

implants 1 2022

manufacturer news

42

news

48

about the publisher
imprint

50

[5] =>

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Localized gingival augmentation to increase keratinized tissue (KT) around teeth and implants
Alveolar ridge reconstruction for prosthetic treatment
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Product features
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Before use, physicians should review all risk information, which can be found in the Instructions for Use attached to the packaging of each NovoMatix™
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[1] Wen et al. J. Periodont. 2019, 1, 734.
[2] Schmitt et al. Clin Oral Implants Res. 2013, 24, 576.
[3] Kloss et al. Clin Oral Implants Res. 2018, 29, 1163.
[4] Solakoglu et al. Clin Implant Dent Relat Res. 2019, 21, 1002-1016.
[5] Kloss et al. Clin Case Rep. 2020, 8, 5.
References available at: www.biohorizonscamlog.com/references_minerossa
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k%LR+RUL]RQV$OOULJKWVUHVHUYHG1RWDOOSURGXFWVDUHDYDLODEOHLQDOOFRXQWULHV

[6] =>

| research

Dental implants and bone
marrow defects
Evaluation of bone quality by intra-oral ultrasonography
Dr Johann Lechner, Germany

Introduction
In ceramic implants—international magazine of
ceramic implant technology issue 2/2021, I discussed

the objective validation of bone quality before implant placement in light of establishing whether the
level of mineralisation in the jawbone is sufficient to
osseointegrate an implant without any issues and
to keep it secure in a stable bone bed for a long time
or whether the implant is connected to a bone marrow
defect.1 In this current article, I would like to consider
two questions relevant to the situation after implant
insertion:
– Was the implant inserted into poorly healed bone?
– Is implant failure directly associated with incomplete
wound healing of the implant site and a bone marrow
defect around the implant?

How to forecast the success
of dental implants
1a

1b

Inflammatory cytokines/acute
TNF-α, IL-1β, IL-6, etc.

Long-term increase
in RANTES per implantation

Neuronal chemokine/
receptor expression

RANTES
overexpressed

Neurological
symptoms

Basal
RANTES
mirror in FDOJ
Phase 1
3–30 days
Implant placed
in the FDOJ area

Phase 2
30–? days

Triggering of RANTES
expression by TNF-α, IL-1β, IL-6, etc.

Successful
osseointegration

2
Figs. 1a & b: Radiograph of an implant. No sign of inflammation in the jawbone
(a). Fatty degenerative osteolysis directly attached to the implant and thus not
detectable by radiograph (b). Fig. 2: This figure shows schematically the sequence
of cytokine expression after wound setting by insertion of an implant into a bone
area that is already preloaded with chronic inflammation of fatty degenerative
bone marrow.

06

implants  1 2022

The measurement of the quantitative ultrasonic transmission velocity (UTV) has been established as an innovative, objective, valid and reliable method for repeated, non-invasive measurements of bone quality
before dental implantation.5 The intra-individual correlation of the UTV values of the maxillary and mandibular
lateral regions makes the data easy to interpret. The use
of a small UTV device in this study enabled the recording of intra-oral UTV values in a large and heterogeneous patient population. Assessment of alveolar ridge
UTV could provide a method for identifying critical bone
quality before implant insertion or for monitoring bone
healing (mineralisation) after augmentation procedures.6
The main advantages of ultrasonic measurement are
that it is non-ionising, non-invasive, tolerable and available at relatively low costs. Furthermore, the examination
is not a complicated process and can be easily performed by clinicians.7, 8 The new technology of trans-
alveolar ultrasonic (TAU) measurement by CaviTAU can
reliably identify regions of low mineralisation density in
bone marrow cavities with signs of bone marrow defects
and collateral chronic ischaemic inflammation.9, 10

[7] =>

research

Implant insertion and bone
marrow defects

High structure
density

There is no doubt that dental implantology has achieved
a very high reliability and success rate in recent years.
Despite this, there is increasing evidence that, in addition to the success of long-term stability, other medical
assessment criteria should also be part of the discussion. Further questions on implant insertion arise,
such as:

Dental crown
Implant
= straight
line to the
implant
Less bone
density

– Are good stability and loading capacity of an implant
the only assessment criteria for implant success?
– Is there also undetected silent inflammation arising
from fatty degenerative bone marrow defects (fatty
degenerative osteonecrosis of the jawbone; FDOJ)?

Direction of measurement
(from caudal to cranial)

A clinical case gives the answer to these questions:
the panoramic radiograph showed that the implant
had healed inconspicuously, hiding that it was directly
attached to fatty degenerative morphology (Fig. 1).
The overexpression of chemokine RANTES (CCL5) in
regions of reduced bone density surrounding implants,
as presented in the following case reports, has been
described in detail. These FDOJ areas persist as silent
or subclinical inflammation without the typical signs of
acute inflammation.
In bone resorption in periodontitis and peri-implantitis,
the acute cytokines tumour necrosis factor- (TNF-)
and interleukin-6 (IL-6) are central to the destructive
inflammatory process. A possible titanium intolerance
provokes further expression of TNF- and IL-1 via
released titanium particles and increased bone resorption.3
However, beyond this easily accessible therapeutic
level, there are other bone resorption processes in the
deeper layers of the bone marrow known as bone marrow defects or marrow oedema. This FDOJ morphologically shows bone softening, and TNF- and IL-6 are
far below the levels found in the healthy medullary cavity. In contrast, there is an up to 35-fold overexpression
of RANTES.11 With this chronic RANTES signal transduction, FDOJ appears to represent a unique pattern
of inflammation with osteolysis in the body.
Local periodontal production of inflammatory cytokines
such as TNF- and IL-1 or IL-6 dysregulates regulatory
and compensatory mechanisms that prevent the formation of implant-related FDOJ in the bone marrow.
Arising from an intramedullary overexpression of
RANTES, this phenomenon seems to be more widespread than originally thought. However, surgical removal of FDOJ areas can stop the induction of RANTES
signalling pathways and thus inhibit the progression of
associated symptoms.11

Nerve canal,
not very dense

Lower edge of
the cortex

Figs. 3a & b: Two ceramic implants in areas #46 and 47 in an unremarkable
radiograph (a). CaviTAU measurement in four vertical comparison steps (b).

An implant may be placed in an ischaemic area of
subclinical FDOJ because of the radiographically
inconspicuous FDOJ morphology and the lack of
alternative methods for measuring bone density.
Perala et al. demonstrated the induction of TNF-
in vitro after co-incubation of native implant material,
which ensures that immunogenic particles are released from the materials.12 With regard to cytokine
expression in the context of an implant and the associated phases of healing, analysis during different
stages of implantation reveals several new phases of
cytokine-triggered signalling pathways. Acute wounding

Figs. 4a–d: Radiograph showing implants in areas #24 and 25 and inconspicuous
bone around the implants (a). CaviTAU image clearly displaying the straight line
where the implant (in green) comes into contact with the obviously osteolytic
jawbone in red (b). The white columns show the implant, and the red columns
indicate the diminished bone density of the directly adjacent jawbone (c). In contrast to the radiograph, the measurement by CaviTAU of the bone density adjacent
to the implants displays diminished bone density in red (d).

implants 1 2022

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| research
CaviTAU detects focal inflammation areas
around implants that cannot
be identified by radiographs

Figs. 5a–d: Frontal and sagittal CBCT images of implant #16. No conspicuous
signs of inflammation (a & b). CaviTAU image of the apical part of the implant
in green (green = hard substance), surrounded by suspected osteolytic or osteo
necrotic areas in red (red = low bone density; c). CaviTAU image of the hard
substance of the implant in white, surrounded by suspected osteolytic or osteo
necrotic areas in red (d).

initiated by implant placement, which induces the
release of acute cytokines through surgical trauma,
provokes inflammatory cascades of TNF-, IL-6 and
IL-1 expression. TNF- expression provokes increased secretion of RANTES in the bone surrounding
the implant in the medium to long term (Fig. 2).13–16 The
apparent clinical stability of the implant and the radiographic inconspicuousness of the implant lead to
the misdiagnosis of an apparently inflammation-free
osseointegration.

CaviTAU solves the problem by providing reliable ultrasonic imaging of the circumscribed bone density. The
measurement is divided into four vertical comparison
steps, demonstrated here with reference to Figure 3:
– Step 1: The bottom right measurement shows caudal
visualisation of the lower cortical margin of the lower
jaw, as well as the less dense areas of the infraalveolar nerve canal in red and dark blue.
– Step 2: The measurement shows the dense implant
structure in green or light blue and white with a clearly
straight delimitation of the distally located red or dark
blue indicating reduced mineralisation density and
suspected osteolysis.
– Steps 3 & 4: In a cranial and vertical direction, the
scan shows dense structures in green or white and
areas of suspected minor osteolysis or peri-implantitis
in light blue.

Case reports on chronic inflammation
around implants and their visualisation
In the following case reports, the reduced bone den
sities shown by CaviTAU—where the practice procedures allowed—were confirmed with the postoperative
findings of RANTES/CCL5 expression measured by the
multiplex procedure and light microscopy. Generally
speaking, panoramic radiographs do not show findings
of reduced bone density and are not sufficient for diagnosis of osteolysis.17 The focus of these case reports
is the metrological evaluation of bone density with
CaviTAU used from a diagnostic and a preventive
perspective.

Case 1
6b
6a

6c
Figs. 6a–d: Radiograph of the ceramic implant placed about nine months
before. The radiograph did not give any indication of a possible cause of the
atypical facial pain since insertion (a). CaviTAU image indicating a relatively
high degree of bone loss around the implant in red (b). CaviTAU image of
the implant in white and the surrounding diminished bone density in red (c).
According to the CaviTAU measurement, the conspicuous areas with possible
osteolysis indicated in red are towards the apical area of implant #16 with clear
osteolysis (d).

implants 1 2022

The 35-year-old female patient came to our practice
with complaints of pressure in areas #24 and 25, into
which two titanium implants had been placed. Pre
viously, after several root canal therapies and unsuccessful apicectomies, the teeth had finally been extracted
and replaced with titanium implants. On the CBCT
scan, the implanting dentist could not see any abnormalities at implants #24 and 25 that could explain the
pressure complaints and pulling pain in the implant
area. As the patient did not wish to retain the two implants owing to this chronic feeling of pain, she came to
our clinic with the request for a more detailed ultrasonic
diagnosis of her bone situation in the region of implants
#24 and 25.
We performed a measurement of the bone density in
the region of implants #24 and 25 with CaviTAU. The

[9] =>

research

“The use of a small UTV
device in this study enabled
the recording of intra-oral
UTV values in a large
and heterogeneous patient
population.”

healthy neighbouring teeth, teeth #23 and 26, were also
measured, as recommended for a lateral comparison
measurement (Fig. 4). The measurement showed the
teeth #23 and 26 in green, indicating dense structure.
The extensive red area of osteolytic jawbone with clear
demarcation of the hard implant proved the patient’s
complaint pattern. Both implants had been placed in a
bone area that had not healed properly, and the remaining FDOJ had led to the patient’s neuralgic complaint
pattern after implantation.18 These FDOJ areas remain
as silent or subclinical inflammation without the typical
signs of an acute inflammation.19
This case demonstrates the importance of the question
of whether the implants have been inserted into healthy
bone. With modern digital radiographic technology,
we have a means of digital determination of the bone
quantity, that is, whether the bone volume is sufficient
for implantation, but no means of digital determination
of bone quality, that is, whether the bone is healthy
enough for implantation.

Figs. 7a–c: Radiograph showing inconspicuous bone tissue around implant #16 (a).
The CBCT scan should show the degree of mineralisation of the peri-implant bone
environment; however, the hardening artefacts caused by the implant prevented
this visualisation (b). CaviTAU image clearly showing red around the implant,
indicating an area of reduced mineralisation density (c).

The main problem in practice related to radiographic
imaging in implantology is that typical hardening artefacts occur in CBCT scans, caused by ceramic implants in particular but also by titanium implants. The
regions between the implants and the implant–bone
interface cannot be visually reconstructed correctly for
technical reasons (Figs. 5 & 6).4
Histology was performed of a 0.5 cm sample material
of the apical tissue around implant #16 with an older
scarring apical granuloma with foreign-body granulomas around partially birefringent foreign material. The
sample material consisted predominantly of fibrous
connective tissue with foreign-body giant cells partly
around birefringent foreign material. Only minimal
chronic inflammatory cell infiltration was found.

The implanting dentist had already tried antibiotics for
several weeks without success. Therefore, the only way
out was to remove the implants, debride the osteolytic
areas and build up healthy bone to enable further
implantation in the patient. The financial expenditure for
the preceding implantation was thus just as high as
the preceding root canal therapies and apicectomies.
A quick assessment of the bone density in areas #24
and 25 employing a low-cost ultrasonic measurement
with CaviTAU would have led to a considerable costsaving and a medically safe procedure.

Case 2
Nine months before, the 57-year-old female patient had
received a ceramic implant simultaneously with a sinus
lift immediately after extraction of her endodontically
treated tooth #16. With the implant fixed, she was not
sensitive to biting, but had suffered from chronic pain
in the right upper jaw with no apparent cause for the
last six months.

Figs. 8a–c: Post-op photograph of the bone situation around the implant clearly
showing the FDOJ tissue attached to the implant (a). Corresponding to this is
the 2D view of the hard implant shown in green in CaviTAU with a rectangular
outline of the implant and a visualisation of the osteolytic dissolved tissue around
the implant bed in red (b). 3D representation of the osteolytic dissolved tissue
around the implant bed in red with clear borderlines to the implant, shown in
white (c).

implants 1 2022

[10] =>

| research
RANTES
(pg/ml)
RANTES
(pg/ml)
4.000,00
4.000,00
3.500,00
3.500,00

3,475.0
3,475.0

3.000,00
3.000,00
2.500,00
2.500,00
2.000,00
2.000,00
1.500,00
1.500,00
1.000,00
1.000,00
500,00
500,00

149.9
149.9

0,000,00

FDOJFDOJ
implant
areaarea
16 16 Norm
jawbone
(n=19)
implant
Norm
jawbone
(n=19)

were altogether consistent with changes related to
FDOJ (Figs. 8 & 9).

Conclusion
Our case studies demonstrate the immunological relationship between implants and FDOJ. The extent to
which increased expression of RANTES derived from
FDOJ areas contributes to immune-mediated disease is
difficult to determine. Our cases provide evidence for the
possible interaction between implants, RANTES signalling and general health. A comprehensive understanding
of the complex networks described in our cases requires
further research. Removal of implants and surgical removal of surrounding FDOJ areas can reduce RANTES
overexpressed signalling pathways, potentially reducing
inflammatory input and associated symptoms.
Owing to the insufficient imaging of the mineralisation
levels in the bony implant environment in panoramic
radiographs and the unavoidable hardening artefacts in
CBCT scans, a considerable part of the bone marrow
in the jaw cannot be correctly immunologically assessed. These assessment criteria in implantology can
be measured by CaviTAU ultrasonography (Fig. 10).

10a

10b
Figs. 9a & b: Large areas of dissolved bone directly around the implant, as well
as fatty parts (a). Local overexpression of RANTES by around 30-fold compared with the standard value of the multiplex analysis (b). Figs. 10a & b: The
sender and receiver are in a fixed coplanar position (a bar connects the sender
and receiver). There are semi-solid gel pads between the sender and the cheek
on the outside of the mouth and between the receiver and the alveolar ridge in
the intra-oral position. A trans-alveolar ultrasonic impulse is sent from the sender
to the receiver (blue arrows; a). Positioning of the sender (outside) and receiver
(intra-oral) in the lower jaw (b).

The peri-implant tissue showed not only the typical
FDOJ softening but also the overexpression of
RANTES. This further validated the pathological imaging by CaviTAU. It appeared that further inflammatory
signalling cascades—primarily based on RANTES messenger substances—had been provoked by the insertion of the implant and the directly associated wound
healing (Fig. 6).

After extraction of implants and removal of surrounding
FDOJ areas, the silent inflammation may remain in the
jawbone in case of incomplete debridement and poor
bone healing might occur. This situation is then also
often responsible for failure of the subsequent implantation or even for immediate ceramic implantation. For
future successful implant surgery, prior measurement
of the bone density and thus a determination of the
metabolic situation in the jawbone is therefore essential
for overall immunological safety for the patient and the
treatment success for the dentist. For unexplained pain
as in our described case reports, the easy-to-use and
radiation-free CaviTAU is available to detect radiographically undetectable silent inflammation.

Author details

Literature

Case 3
The 57-year-old female patient had suffered from migraines, but only on the right side, and atypical facial
pain, in her upper right jaw only, since the implant
placement (Fig. 7).
Histology of a medullary tissue sample from region #16
found exclusively fatty marrow and necrobiotic changes
and areas of mucinous degeneration as well as small oil
cysts. It also found small areas of fibrosis. The findings

implants 1 2022

contact
Dr Johann Lechner
Praxisklinik Ganzheitliche ZahnMedizin
Grünwalder Straße 10
81547 München, Germany
drlechner@aol.com
www.dr-lechner.de

[11] =>

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[12] =>

Ceramic dental implants in clinical use
Evaluation of the ESCI scientific survey
Dr Jens Tartsch, Switzerland

Introduction

Method

In modern dental implantology, ceramic implants offer
a supplement to the treatment spectrum with titanium
implants. Increasing interest in ceramic implants owing
to their biological advantages can be observed not only
on the part of health-conscious patients but also in the
dental profession. Promising short- and medium-term
data on the successful use of ceramic implants is available. Nevertheless, the topic of ceramic implants is still
controversial in part because of the lack of long-term
data.

The survey questionnaire was designed by the ESCI
scientific advisory board in German and English and was
addressed to users of ceramic implants, users of titanium
implants and dental technicians. The results of the survey
were evaluated by the ESCI. The survey was not conducted
for commercial purposes, and no financial resources were
provided by partners or other third parties. The questionnaire was implemented in an online survey tool and sent as
an online link via e-mail to the members of the ESCI, among
others, published on the ESCI’s website, published via print
media of the dental press and distributed via various other
channels of the survey partners from April to November
2021. This included social media channels of and news
letters from collaborating professional societies and the
ESCI’s company partners. The ESCI would like to thank all
supporters for their efforts. These are the Austrian Society
of Implantology (ÖGI), European Association of Dental
Implantologists (BDIZ EDI), PEERS, the German Society
for Environmental Dentistry (DEGUZ), the “Zahngipfel”, as
well as the companies Institut Straumann AG, CAMLOG
Biotechnologies GmbH, Nobel Biocare Services AG,
Dentalpoint AG, Z-Systems GmbH, COHO Biomedical
Technology Co., LTD., CeramTec GmbH, Zircon Medical
Management AG and the Dental Campus Association, as
well as numerous media partners.

Even systematic reviews do not provide this, referring
mainly to specific experiences with individual systems.
Comprehensive findings on the general practical use
of ceramic implants and experience from daily dental
practice are still lacking.
To this end, the European Society for Ceramic Implan
tology (ESCI) conducted a global survey aiming to gain
deeper insight into the general daily handling of ceramic
implants and to answer questions concerning ceramic
implantology. This survey provides valuable information
for the further development of ceramic implants and
makes an important contribution to their reliable use—
ultimately for the safety of our patients.

implants 1 2022

[13] =>

research

Fig. 1: Distribution of responses from participants in 45 countries.

The survey was completed by 316 respondents from all
over the world (Fig. 1), demonstrating the importance of
the topic of ceramic implants. The size of this sample
allowed the ESCI to draw meaningful conclusions.
The questionnaire consisted of 42 questions in total, first
covering questions on general demographic information
and then posing questions in three separate sections
for each of the target groups: (1) general dentists, oral
surgeons and maxillofacial surgeons with experience in
ceramic implantology; (2) general dentists, oral surgeons
and maxillofacial surgeons without experience in ceramic
implantology; and (3) dental technicians. It also posed
questions on the further development and establishment
of ceramic implants to all three groups.

Discussion
The comparison of the responses given by participants
with practical experience in ceramic implantology to
those with only theoretical knowledge of the subject
is quite interesting. The assessments coincide in some
areas but diverge in others.
The possible advantages of zirconia in terms of biocompatibility and a low tendency to inflammation were confirmed and are in line with the ESCI’s view. In particular,
a significantly lower tendency to peri-implantitis seems to
be observed in private practice. This should be confirmed
by corresponding clinical studies. The fear of the past regarding stability could at least be relativised for the newer
systems, since fractures were not in the foreground in the
survey findings on the reasons for loss.
The potential for osseointegration was rated equally for
both zirconia and titanium. Loss during the healing phase
was reported proportionally more often for zirconia,
giving cause for further evaluation. Since various factors,
such as overloading, incorrect loading, surface design

and bone degeneration caused by overheating, can play
a role in early loss, the causes of loss need to be differentiated in order to address these causes and reduce
failures.
All responses indicated a clear tendency towards twopart systems, which allow a broader range of indications
and offer more flexibility. There is a need for solutions
which simplify the application compared with titanium
implants. The full official statement on two-piece ceramic
implants can be read on the ESCI website.
The clearest requirement, however, runs like a thread
through the survey: users of ceramic implants should record their experiences and make them accessible to all
interested parties. There should be broad, scientifically
sound and objective information on the subject. The data
on ceramic implants must be improved and long-term
evidence-based studies initiated. Then ceramic implants
will increasingly establish themselves for a broad user
group in the interest of our patients. Implementing this
requirement is a clear call from the survey to all manufacturers and research institutes—and a core topic of
the ESCI.
For a detailed overview of all questions and results,
please visit www.esci-online.com or request the full data
summary from the ESCI.

contact
European Society for Ceramic Implantology
Dr Jens Tartsch
Kilchberg, Switzerland
+41 44 7154877
info@esci-online.com
www.esci-online.com

implants 1 2022

[14] =>

| case report

Ceramic implant placement in
a medically compromised patient
Dr Alexandr Bortsov, Russia

Introduction
While dental implants are becoming a standard treatment for tooth loss, there is emerging but steadily
growing patient demand for reliable, metal-free, natural-

looking ceramic implants. This demand is particularly
pronounced not only in patients with metal sensitivity
but also in those who would like to have highly aesthetic
restorations. I personally have experienced that the
latter group are patients who have had restorations
before, done extensive research about the topic online
and come to my practice specifically asking for ceramic
implants. The challenge I face is that those patients
would like to have a reliable ceramic implant and expect
successful treatment outcomes irrespective of their
age, lifestyle or medical history.
The following clinical case report describes a three-unit
bridge restoration on ceramic implants in a medically
compromised patient who came to my practice seeking
a natural-looking, metal-free restoration.

Initial situation

A 53-year-old diabetic patient who was a smoker and
had good hygiene and no parafunctional habits presented to the clinic for the replacement of the missing
premolars and molars in the left mandible (Fig. 1). The
patient had received metal–ceramic restorations in the
past and was dissatisfied with the experience, complaining about a grey metal margin that became visible
with time and had a non-aesthetic appearance. The patient was well informed about the subject and wanted
to have a natural-looking, metal-free restoration which
would nevertheless be strong and reliable. He also was
concerned about the surgery itself and had a strong
preference for a minimally invasive surgical procedure.
Further anamnesis and routine testing revealed elevated haemoglobin A1C at 9%.

Treatment planning

8
Fig. 1: Initial situation. Fig. 2: coDiagnostiX planning in the molar region. Fig. 3:
Guided surgery template. Fig. 4: Guided surgery template close up. Fig. 5:
Checking precision fit of the guided surgery template. Fig. 6: Drill for the fixation
pin preparation. Fig. 7: Fixation pin in place. The template was securely fixed.
Fig. 8: Tissue punch, the pilot instrument.

implants 1 2022

It was discussed with the patient and his endocrinologist that Straumann PURE monotype ceramic implants
(zirconia implants with the ZLA surface) restored with a
full-ceramic three-unit bridge would provide a metalfree, aesthetic and mechanically strong restorative
solution in this clinical case. It was also agreed to use
a fully guided surgery approach to avoid incisions and
minimise surgical trauma.

[15] =>

case report

Fig. 9: Milling cutter, to flatten the bone ridge. Fig. 10: Guided drilling with the use of a guided handle. Fig. 11: Guided tapping. Fig. 12: Vial containing the PURE monotype
implant. Fig. 13: Monotype implant with PURE transfer piece. Fig. 14: Fully guided implant insertion in the molar region. Fig. 15: Monotype implants right after insertion.
Fig. 16: Monotype implants in place after the template was removed. Fig. 17: Closed-tray impression copings. Fig. 18: Analogues inserted into the impression.
Fig. 19: Protective caps fixed. Fig. 20: Laboratory model with analogues.
Fig. 21: Finished three-unit bridge restoration on the laboratory model.

The patient was referred for a CBCT scan of the area,
and we performed a digital scan using an intra-oral
scanner (TRIOS 3, 3Shape). Upon receipt, the DICOM
data was imported into the implant planning software
(coDiagnostiX, Dental Wings), and the scan files were
imported into the laboratory software (Straumann
CARES Visual). Since the ceramic implants used are
mono-bodies in design and it is not recommended to
modify the abutment, our task was to plan the most
parallel placement of the implants relative to each other,
considering all anatomical formations (Fig. 2). Once
the planning had been completed, the guided surgery
template was 3D-printed (Figs. 3 & 4).

“Patients would like
to have a reliable ceramic
implant and expect successful
treatment outcomes
irrespective of their age,
lifestyle or medical history.”

Surgical procedure
At the first stage, the surgical template was applied, and
the precision of its fit was checked (Fig. 5). The fixation
pin drilling and insertion were then done after the topup of the infiltration anaesthesia (Figs. 6 & 7). The first
instrument used was a tissue punch to facilitate an
optimal soft-tissue cuff and reduce trauma (Fig. 8). The
design of the PURE ceramic implant is a combination of
tissue-level and bone-level implant—the implant neck
mirrors the Straumann tissue-level implant, and the implant body mimics the Straumann bone-level implant

implants 1 2022

[16] =>

| case report

Fig. 22: Healed sites five days post-op. Fig. 23: Healed sites before cementation and after removal of the protective caps. Fig. 24: Final restoration.

design. Thus, the surgical protocol for osteotomy
preparation for PURE is the same as for the corresponding bone-level implant. For this case, the osteotomy preparation guide was used according to the
protocol established for bone-level implants provided
by coDiagnostiX (Figs. 9–11).
The basic implant bed preparation was done using pilot
drills followed by twist drills: for the 3.3 mm diameter
implant, the final drill was 2.8 mm in diameter; for the
4.1 mm diameter implant, the final drill was 3.5 mm in
diameter. The fine implant bed preparation was done
using the respective profile drilling and tapping for the
3.3 mm and 4.1 mm diameter implants. The PURE implant comes with a separate transfer piece that locks
securely into place (Figs. 12 & 13).
Three points on the driver line up with the flat surface of
the implant abutment and indicate the distance to the
shoulder (1, 2 & 3 mm; Fig. 14). This design greatly facilitates implant placement and makes it very straight
forward. The implants were placed in the positions of
the first premolar (diameter: 3.3 mm; narrow diameter;
length: 12.0 mm; abutment height: 5.5 mm) and second
molar (diameter: 4.1 mm; regular diameter: 12.0 mm;
abutment height: 5.5 mm), respectively. The implants
were placed precisely in the planned positions regarding the insertion depth and relative to the centre of the
sleeve (Figs. 15 & 16).

mucosa appeared a healthy pink (Fig. 23). The abutment parts of the ceramic implants were cleaned and
prepared for cementation. Excess cement was removed. A follow-up visit seven days after cementation
was arranged. No further crown adjustments were required, and the patient was very comfortable with the
final restoration (Fig. 24).

Treatment outcomes
At the one-year follow-up, there were no biological
or technical complications. The treatment option of
ceramic implants and a zirconia restoration appears
to be a valid alternative to titanium implants in patients
requiring metal-free restoration, even in a diabetic patient.
The soft tissue around the implant remained stable over
time, indicating the excellent biocompatibility of the
ceramic. The tissue-level design of the implant places
the cementation line at or above the gingival margin to
facilitate hygiene maintenance. The tooth-like colour of
the body enables the achievement of high aesthetics.
The patient was satisfied with the functional and aesthetic outcomes.

about the author
Dr Alexandr Bortsov graduated with a
DDS from South Ural State University in
Chelyabinsk in Russia. As a surgeon, his
focus areas are implantology and guided
surgery, aesthetic dentistry and digital
dentistry. Dr Bortsov is the director of the
Dental Art clinic in Chelyabinsk and of
the International Team for Implantology
study club in Chelyabinsk.

Prosthetic procedure

Since good primary stability was achieved (about
45 Ncm), and there were no teeth in the maxilla, it was
decided to take a closed-tray impression right after
the surgery and fix the implant analogues in the clinic
(Figs. 17 & 18). Appropriate protective caps were placed
on the abutment portions of the implants (Fig. 19). The
impressions were transferred to the laboratory, and
within four working days, a one-piece anatomical bridge
of zirconia was made (Figs. 20 & 21).

contact

After five days, the patient came to the clinic for fixation
of the final restoration. At this appointment, plaque was
seen on the protective caps (Fig. 22), but the healed

Dr Alexandr Bortsov
+7 905 839850
89058398504@mail.ru

implants 1 2022

Author details

[17] =>

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[18] =>

| case report

Single-tooth replacement
with ceramic implants
A case series
Professors Curd Bollen & Paul Tipton, UK

1d
Figs. 1a–d: Pre-op situation in all four patients. Case 1 (a). Case 2 (b). Case 3 (c).
Case 4 (d).

Introduction
Dental implants have helped to improve quality of life for
our patients. The material of choice for implants remains
Type IV titanium, whose mechanical and biological proper-

ties have been proved.1 Yet, this material is not exempt
from complications. Firstly, these metallic implants show
aesthetic limitations when used in the anterior region,
especially in patients with a thin gingival biotype. Examples
are the possible appearance of a metallic margin in case
of gingival recession and a greyish discoloration due
to translucency of the peri-implant mucosa.2, 3 Secondly,
studies have reported immunological reactions to titanium
particles, leading to biological complications.4 Others have
demonstrated allergic reactions to titanium, reporting a
prevalence of 0.6%.5 Thirdly, it must be taken into account
that the number of patients demanding metal-free implants
has been increasing during recent years. For these reasons, non-metallic alternatives to titanium have emerged.
The first ceramic implants arrived on the market more than
40 years ago.6 They were made of alumina, a material
prone to fracture when loaded unfavourably, and so they
are no longer available on the market.7 More recently,
yttrium tetragonal zirconia polycrystal (Y-TZP) became the
material of choice for the manufacture of ceramic implants.
It is characterised by a high resistance to fracture, a low
modulus of elasticity, a low affinity to plaque and high biocompatibility.8, 9 In this series of four cases, the CERALOG
system (BioHorizons Camlog) was used. CERALOG implants
are manufactured from Y-TZP.10 The CERALOG system
provides all the necessary elements to permit retention of
any type of prosthesis upon these implants, ranging from
single crowns to a full-arch restoration. In this case series,
the treatment indication was single-tooth implants.

Table 1: Patients’ data.

Sex

Age (years)

Health status

Smoking status

Periodontal health

Diastema location

Case 1

Male

ASA I

Healthy

#35

Case 2

Male

ASA I

Healthy

#25 & 26

Case 3

Male

ASA I

Healthy

#16 & 26

Case 4

Male

ASA I

Healthy

#26

implants 1 2022

[19] =>

case report

|

Table 2: Implant specifications.

Case 1
Case 2

Case 3
Case 4

Position

Implant diameter

Implant length

L-PRF

Insertion torque

#35

4 mm

12 mm

No

35 Ncm

#25

4 mm

12 mm

No

30 Ncm

#26

4 mm

8 mm

No

25 Ncm

#16

4 mm

8 mm

Yes

25 Ncm

#26

4 mm

10 mm

Yes

30 Ncm

#26

4 mm

10 mm

Yes

30 Ncm

Case series report
Four patients were selected for this case series (Table 1).
All of them wanted or needed replacement of one or two
teeth with ceramic dental implants. All the patients were
in good general health.

stability (measured using the Periotest, Medizintechnik
Gulden) and were completely osseointegrated. Radiographic examination confirmed the latter findings.

Examination
In all cases, the tooth or teeth to be replaced had been
extracted at least one year before the dental implant surgery. In none of these cases was socket preservation or
ridge preservation performed at the time of extraction.
Moreover, all the patients had good oral hygiene. In all but
one patient, radiographic analysis was performed by
CBCT, supplemented with subsequent digital implant
positioning (SICAT and Sidexis, both Dentsply Sirona; Fig. 1).

2a

2b

2c

2d

3a

3b

4a

4b

Surgery
Two-stage surgery was performed for all six implants.
All surgeries were performed without sedation or preoperative systemic antibiotics. In two of the four cases, leucocyte- and platelet-rich fibrin (L-PRF) was used during
the intervention (IntraSpin, BioHorizons; Table 2). In all
cases, the exact CERALOG pre-tapping (maximum:
15 rpm) and drilling protocols (maximum drilling speed:
550–800 rpm) were used. All the implants were placed
manually to a maximum torque of 35 Ncm. After the insertion of the implant, a PEEK cover screw was inserted
into the implant (Fig. 2). The soft tissue was sutured tightly
with an atraumatic resorbable suture material. No postoperative complications were reported. The patients
were asked to rinse with chlorhexidine twice a day for
one week postoperatively (PERIO-AID, 0.05%, DENTAID).
A healing time of three months in the lower jaw and five
months in the upper jaw was respected.
After three months (Case 1) and five months (Cases 2,
3 & 4), the second-stage surgery was performed under
local anaesthesia. Healing abutments (PEEK material
with titanium screw) were placed to a maximum force
of 15 Ncm (Figs. 3–6). All the implants showed excellent

Figs. 2a–d: PEEK cover screws inserted into the implants. Case 1 (a). Case 2 (b).
Case 3 (c). Case 4 (d). Figs. 3a & b: Radiograph after three months (a) and
healing abutment in place (b; Case 1). Figs. 4a & b: Radiograph after five months
(a) and healing abutments in place (b; Case 2).

implants  1 2022

19

[20] =>

| case report

5a

5b

5c

6a

6b

Figs. 5a–c: Radiograph after five months (a) and healing abutments in place (b & c; Case 3). Figs. 6a & b: Radiograph after five months (a) and healing abutment
in place (b; Case 4).

Digital intra-oral scanning
One week after the second-stage surgery, the intra-oral
scanning was performed using a Medit i500 scanner
(Medit) following the scanning protocol prescribed by
the company (Fig. 7). After the removal of the healing
abutments, CERALOG scan bodies (PEEK–titanium alloy
screw) were inserted into the implants. After the scanning procedure, the original healing abutments were
re
inserted. Shade determination was digitally carried
out with a Rayplicker (Borea). For the planning of the

prosthetic restoration, polyphenylsulphone selection
abutments were used. All the crowns were ordered digitally from the same dental laboratory. For all the crowns,
a ceramic material was selected.

Crown installation
On average, two weeks after the scanning procedure, the
crowns were available for placement. PEKK abutments
were used. All the crowns were prepared as screwretained superstructures. Since the four patients strictly

7a

7b

7c

7d

Figs. 7a–d: Digital intra-oral scans after the second-stage surgery. Case 1 (a). Case 2 (b). Case 3 (c). Case 4 (d).

20

implants  1 2022

[21] =>

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[22] =>

| case report

10a

10b

10c

Figs. 8a & b: Final control radiograph of the implant position (a) and final intra-oral situation for Case 1 (b). Figs. 9a & b: Final control radiograph of the implant
position (a) and final intra-oral situation for Case 2 (b). Figs. 10a–c: Final control radiograph of the implant position (a) and final intra-oral situation for Case 3 (b & c).

wished for a bio-holistic approach, the six titanium abutment screws were replaced with six gold abutment
screws (Holisticor screws). These gold screws were tightened to a maximum torque of 15 Ncm. When titanium
abutment screws are used, a maximum toque of 25 Ncm
should be applied. As recommended by the company,

with occluding paper). Oral hygiene instructions were
given, focused on interdental cleaning with interdental
brushes. A final control radiograph was taken. The PEKK
abutment is not radiopaque, and therefore the distance
between the implant and crown can easily be determined
in the radiograph: the abutment is correctly positioned in
the implant when the gap between the implant shoulder
surface and the lower edge of the crown measures
0.55 mm in the radiograph (Figs. 8–11).

Conclusion

11a

11b
Figs. 11a & b: Final control radiograph of the implant position (a) and final
intra-oral s ituation for Case 4 (b).

all the screws were retightened to the corresponding
torque (15 Ncm) after at least 5 minutes. The screws were
protected with PTFE tape, and the remaining screw
openings were filled with a composite material of the
same colour as the zirconia crown. The occlusion was
checked and adjusted where necessary (occlusal concepts included no guidance on the implant-retained restorations and very light intercuspal contact as verified

implants 1 2022

All the patients were happy with the results of the therapy:
the functional and aesthetic outcome was satisfying.
The only remark was the long duration of the complete
therapy for the upper jaw cases. Owing to the extended
osseointegration period of five months, the complete
therapy took more than six months. From the practitioner’s point of view, there was no major difference in
comparison with the use of titanium implants, besides the
following of the strict guidelines from the manufacturer.
CERALOG implants seem to be an adequate and stable
alternative to titanium implants in the replacement of
lateral teeth in the upper and lower jaws.

Author details

contact
Prof. Curd M.L. Bollen
+44 121 3459847
curdbollen@me.com

Literature

[23] =>

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[24] =>

| case report

Biological and osseointegration
capabilities of a zirconia implant
Dr Saurabh Gupta BDS MDS, India

1

2

Introduction

follow up period.1 However, the rising demand for usage
of dental implants is associated with a growing need for
long term and predictable results, and despite having
excellent success rates, complications/failures may occur
because of biomechanical and biological complications.
Peri-implantitis is a biological complication and is still
a topic of concern.

Extraction of tooth is carried out for numerous reasons,
including caries, fractures, periodontal problems, prosthetic purposes, orthodontic, and widespread external or
internal root resorption. Root resorption (pathological)
has a multifactorial etiology, although many aspects remain unclear, and can lead to loss of tooth structure. The
use of dental implants is a reliable treatment option for
replacing missing or hopeless teeth, and the satisfactory
and predictable outcomes reported by several implant
research studies have supported the huge development
and standardisation of oral implantology.

24

According to the available data, the current success
rate of dental implants is around 94–95% in the maxillary
area and 97–98% in the mandibular area after a ten-year

Peri-implantitis is a pathological condition that occurs in
the tissues around dental implants and is characterised
by inflammation of the peri-implant connective tissue and
progressive loss of the supporting bone. In clinical situ
ation, peri-implantitis sites exhibit signs of inflammation
and, in particular, increased probing depths and/or recession of the mucosal margin, bleeding on probing and/
or suppuration, and radiographic bone loss. According
to Jan Derks, the prevalence of peri-implant mucositis

3

4

implants  1 2022

[25] =>

case report

and peri-implantitis ranged from 19 to 65% and from 1 to
47%, respectively. Meta analyses estimated weighted
mean prevalence of peri-implant mucositis and periimplantitis of 43% and 22%, respectively.2 The problem
with this pathology remains the lack of information on
etiological factors and standardisation of the utilised
diagnostic criteria.

characteristics, a low propensity of plaque adhesion
around the implant surface, excellent biocompatibility,
and good osseointegration, muco-integration and biomechanics. In addition, zirconia ceramics have characteristics similar to those of titanium implants and are
frequently used in implant prosthetics.11–14 This case report
describes how a failed titanium implant in the maxillary
posterior was successfully replaced with a zirconia
implant that became biologically integrated.

Titanium implants after interacting with intra-oral conditions, undergo tribocorrosion and release titanium particles into the surrounding gingivae. This release of ions
can contribute to the subsequent inflammation around
titanium dental implants. The degradation products in
the form of microparticles or ions may infiltrate the periimplant tissue and peri-implant bacterial plaque and trigger
an inflammatory response, resulting in bone resorption,
suggesting a possible pathogenesis of peri-implantitis.3–7
Furthermore, the studies have shown that allergic responses and hypersensitivity to metal are not uncommon
findings; in fact, delayed onset T cell mediated metal
hypersensitivity is reported in 12–17% of the general
population.8–10

Case presentation
A 40-year-old male patient presented to us after having
received a titanium dental implant at another private
practice ten months before presenting to our office.
He presented with a loose titanium implant (position #16)
in the maxilla.

The increasing incidence of peri-implant mucositis and
peri-implantitis affects both the short- and long-term
survival rates of titanium implants and their success.
Therefore, using an alternative material, zirconium dioxide, has been increasingly popular and successful.
Among the new generation of ceramics in the dentistry
field, zirconia ceramics presents outstanding aesthetic

The patient reported no history of tobacco smoking or
alcoholism. The last dental check-up visit had taken
place about six months before. No previous history of
periodontitis was detected. At clinical evaluation, the
peri-implant mucosa appeared swollen and red, and
probing revealed bleeding and a probing depth of
4 mm buccally and 4 mm lingually. There was slight
mobility. The radiographic image showed radiolucency
around the cervical region around the implant with
a diameter of 4.25 mm (Fig. 1). A diagnosis of periimplantitis was supposed, and after discussion with
the patient, the implant was removed (Figs. 2 & 3)

implants 1 2022

[26] =>

| case report

and the socket was debrided using diode laser
therapy.

latter releases corrosion products around the implant
site. The characteristics of their enhanced biocompatibility,
along with good osseointegration and success rates,
make zirconia implants clear candidates for use in clinical
implant dentistry. However, further investigations on titanium release and its connections with peri-implantitis,
hypersensitivity and bone resorption are recommended.

After 12 weeks, a one-piece zirconia implant (ZiBone,
COHO Biomedical Technology) was inserted following
the company’s protocol (Figs. 4–7). A zirconia implant
was chosen for better biological integration. Furthermore, the patient had requested a metal-free option,
since there was a possibility of a metal allergy.
The fixture was loaded with a metal-free zirconia crown
after 16 weeks (Figs. 8 & 9). During the follow-up period,
the patient did not report any symptoms of peri-implantitis
or other problems, and the clinical and radiographic
examination showed the success of the metal-free implant prosthetic restoration. In particular, the peri-implant
tissue appeared healthy (Figs. 10 & 11), and the radiograph confirmed the absence of marginal bone loss
around the implant and no sign of bone resorption
(Fig. 12).

Discussion
In the above case, the zirconia dental implant seemed
to have integrated well without any signs of marginal
bone loss and established excellent soft tissue healing.
A ceramic dental implant has some benefits over titanium:
although the survival and success rates of zirconia and
titanium dental implants are quite comparable, some research studies have stated that a zirconia dental implant
is more biocompatible compared with titanium, as the

implants 1 2022

about the author
Dr Saurabh Gupta graduated from
Manipal College of Dental Sciences in
India with a BDS and holds a master’s
degree in oral and maxillofacial surgery
from Rajiv Gandhi University of Health
Sciences in Bangalore in India. He is an
international and national lecturer and
a board member and Education Director
of the International Academy of Ceramic
Implantology. He is a member of the Zirconia Implant Research Group,
which aims to orient and lead research in the field of metal-free
implantology. He founded and directs WhiteZ Dental in Bangalore.

contact
Author details

Dr Saurabh Gupta BDS MDS
Oral & Maxillofacial Surgeon
Bangalore, India
+91 9916 203455
whitezdental.com

Literature

[27] =>

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[28] =>

| case report

Rehabilitation of the maxilla with
implant-supported zirconia bars
Dr Witalij Kolbe, Germany

Fig. 1: Pre-op radiograph revealing severely pronounced atrophy in the maxilla. Fig. 2: Six zirconia implants were placed in the patient’s maxilla.

The use of zirconia as a material for dental implants and
prostheses, in conjunction with newly developed materials and CAD/CAM technology, undoubtedly represents
a fascinating opportunity to restore the teeth of our patients. As with any new technology, increasingly precise
manufacturing techniques are bringing about a change
in indications. Today, it is possible to realise customfabricated CAD/CAM zirconia bars on zirconia implants.
The use of the material zirconia for abutments, implants
and bars is certainly recommended from a biological stance.
Based on the vast number of past successful clinical restorations, one can be confident in choosing restoration
with bar-supported hybrid prostheses. In the recent past,
the employment of zirconia as a material for implants,
abutments and bars in the context of surgery and hybrid
prostheses has proved to be both a successful combination method and a successful stand-alone approach in
clinical practice. In the following, a clinical case report is
described which illustrates how even the smallest details

matter when it comes to determining the optimal use of
zirconia implants, abutments and bars in clinical practice.

Clinical case
Owing to severely advanced atrophy in the maxilla, not
only missing tooth structure but also missing jawbone
and soft tissue had to be replaced in the patient (Fig. 1).
Six zirconia implants (AWI, WITAR) were placed in the
patient’s maxilla (Fig. 2). A complete denture was fabricated
for the healing phase and the base lined with a soft lining
material. Six months later, after the surgical phase had
been completed, the prosthetic restoration was carried
out. The therapeutic decision was made in favour of a
removable palate-free combination restoration.
In order to meet the aesthetic demands, it is imperative
to perform an overall wax try-in before designing the bar
so that the bar can be designed according to the tooth

3a
Figs. 3a & b: The implant shoulders and zirconia abutments were positioned transgingivally.

implants 1 2022

[29] =>

case report

Figs. 4a–c: The definitive bars were placed on the abutments and cemented.

position and not vice versa. The varying thickness of the
mucosa was compensated for by the transgingival preparation of the implant shoulders and the zirconia abutments
(AWI, WITAR; Fig. 3). Thereafter, a primary impression
was taken over the abutments, and the secondary impression was taken in a silicone-based impression material (A-silicone, DMG Dental). The bar constructions were
then milled from zirconia in a CAD/CAM procedure and
clinically checked for a tension-free fit.

Outcome
Eighteen months after placement, the treating clinician
and the patient were still satisfied not only with the overall
aesthetic result of the restoration (Figs. 6a & b) but also with
a stable implant-supported superstructure, which was
installed without complications and which offers significant advantages from both a biological and technical
point of view (Fig. 7).

Figs. 5a & b: The prosthesis for the mandible was fabricated with IPS e.max pressed ceramics. Figs. 6a & b: Eighteen months after placement, the restoration was
considered satisfactory. Fig. 7: The prosthesis produced in the WITAR laboratory.

The superstructure, a sliding construction over the bars, was
fabricated from solid PEEK material. The finishing was done
with autopolymerising PMMA denture acrylic (Palapress
vario, Kulzer) and fabricated denture teeth (Genios,
Dentsply Sirona). During the fabrication of the combination
prosthesis, aesthetic, phonetic and functional aspects
were taken into consideration with a particular view to the
acrylic material used. The try-in of the completed bars went
smoothly and without complications. The definitive bars
were placed on the abutments and cemented with glass
ionomer cement (CX-Plus, SHOFU Dental) in a tension-free
way (Fig. 4). The prosthetic restoration in the mandible was
fabricated in a second step with lithium disilicate pressed
ceramics (IPS e.max Press, Ivoclar Vivadent; Fig. 5).

Acknowledgement
The author wishes to thank dental technician Artur Wolf
for the prostheses, which were produced in his WITAR
laboratory.

contact
Author details

Dr Witalij Kolbe
Cologne, Germany
+49 2233 201099
info@witar.de
www.witar.de

implants 1 2022

[30] =>

| interview

Ceramic implants account for
50% of implants we use
An interview with Prof. Michael Gahlert & Dr Stefan Röhling, Germany

Dr Stefan Röhling (left) and Prof. Michael Gahlert are experts in two-piece ceramic implants.

Experts in the field of two-piece ceramic implants,
Prof. Michael Gahlert and Dr Stefan Röhling together run an
oral surgery practice in Munich. In this interview with ceramic
implants, they discuss the advantages of ceramic implants
and provide a scientific update on the topic. In addition,
the implantologists, being pioneers in the field of modern
ceramic implants, share their experience of zirconia implants and consider the significance for clinicians of the
statement by the European Society for Ceramic Implantology on the clinical application of two-piece zirconia implants and what the future holds for ceramic implantology.
Dr Röhling, together with Prof. Gahlert and other
colleagues, you received the 2020 André Schroeder
Prize for Preclinical Research for your study titled
“Ligature-induced peri-implant bone loss around

implants 1 2022

loaded zirconia and titanium implants”. What exactly
did you investigate in that research?
Dr Röhling: In this experimental study, we investigated
for the very first time the occurrence and onset of
ligature-induced peri-implantitis around ceramic implants
in direct comparison with titanium implants. In the joint
project with Prof. David Cochran of the University of
Texas Health Science Center at San Antonio School of
Dentistry in the US, we were able to show that during active and spontaneous progression of inflammation there
was significantly less bone loss around ceramic implants
than around titanium implants.
There is clinical evidence that ceramic implants offer
superior biocompatibility. Does this have an impact
on the lower tendency to develop peri-implantitis?

[31] =>

[32] =>

| interview
Dr Röhling: The development of peri-implantitis depends on multiple factors. However, the accumulation of
bacteria on the implant surface in the form of biofilm can
clearly be observed to be one of the main causes of the
development of peri-implant inflammation. This formation
of biofilm depends not only on the physical (surface
roughness) and chemical (surface energy and surface
tension) properties of the surface but also on the type
of biomaterial used (titanium versus ceramic). Scientific
studies have shown that less biofilm accumulates on
ceramic than on titanium for implants with similar surface

“There is now sufficient
scientific data to support
reliable clinical use of
ceramic implants of zirconia.”
topography. The results of our experimental study are
even more concrete. Based on the currently available
data, it can certainly be assumed that the biocompatibility has an impact on the development of peri-implantitis.
However, whether ceramic implants truly have a lower
tendency to develop peri-implant infections over the
long term is very difficult to say based on the current data.
The research data obtained to date is very promising
nonetheless.
Prof. Gahlert, you are currently working on a retrospective follow-up study of Zeramex two-piece ceramic
implants. Do you already have initial results to share?
Prof. Gahlert: We conducted a retrospective follow-up
examination of 21 patients with one of our doctoral
students and the University of Basel. This involved
re-examination of 36 two-piece ceramic implants of
the type Zeramex XT. In addition to measuring clinical
parameters, the study considered abutment–implant
connection by means of a carbon screw, which did not
lead to complaints in any of the cases we re-examined.
The average loading phase of the ceramic implants
was 2.1 years, and the survival and success rates were
the same as for comparable and established titanium
implants.
Of the implants placed in your practice, what percentage are ceramic implants?
Prof. Gahlert: Looking back at the last ten years, the proportion of ceramic implants placed at our practice has
risen continuously alongside the use of titanium implants.
Today, especially at our practice, I would put the share
of ordinary ceramic implants at 50%.

implants 1 2022

There are hardly any one-piece titanium implants.
What role do one-piece ceramic implants play in
clinical practice?
Dr Röhling: One-piece ceramic implants are definitely
a niche product that is only routinely used by a few practitioners. Many clinicians are sceptical about the surgical
and prosthetic handling as well as the fact that the superstructures can only be cemented. The two-piece ceramic
implant designs are closer to what the majority of dental
surgeons would like to use, since the clinical handling is
comparable with that of titanium implants. At our practice, however, one-piece ceramic implants are an important factor in everyday clinical work because excellent
results can be achieved with regard to the red–white
aesthetics, especially in the aesthetically critical area of
the anterior teeth.
In which cases do you prefer two-piece, screw-
retained ceramic implants?
Prof. Gahlert: For larger prosthetic restorations, the twopiece implants offer greater prosthetic flexibility. Plus, as
implantologists, we prefer it when the implants heal subgingivally or epigingivally because this poses a lower risk
of early or improper loading caused by projecting implant
stumps. This problem remains with one-piece implants,
especially if patients wear removable temporary dentures
during the healing phase.
The current trend in titanium implants is bonelevel design. Does this also apply to ceramic implants?
Dr Röhling: Looking at the international market for
titanium implants, we see more bone-level designs in
use than tissue-level designs. This development can
definitely be attributed to increased prosthetic flexibility.
To further establish ceramic implants on the market and
make them of interest to more clinicians, it is absolutely
essential for reversible, screw-retained, two-piece bonelevel ceramic implant designs to be available to permit
the creation of individual abutments. The discussion
surrounding bone-level versus tissue-level designs,
however, should not be limited to the factor of prosthetic
flexibility. The underlying biological principles should be
considered as well. This makes it clear that there certainly
still are justifications for a tissue-level design in regular
clinical practice today.
Is the interest in ceramic implants reflected in your
patients?
Prof. Gahlert: We are repeatedly amazed at the range
of information which new patients looking for implant
restoration have when they arrive at our practice. The
Internet has a wealth of information to offer on this topic.
Many patients also come because ceramic implants
have now opened up new options for them that would
not be achievable with titanium from the patient’s perspective.

[33] =>

AD

Not all dentists use ceramic implants
yet. What do you think keeps them
from doing so?
Dr Röhling: Unfortunately, many prac
titioners still don’t trust the products
that are available. This can be attributed
to a lack of knowledge and marketing
communication deficits with regard to
the material properties and reliability.
Another factor is prejudice against ceramic implants. Negative reports from
the past involving ceramic implants of
alumina often play a role here. However,
it must be considered that modern ceramic implants are made of zirconia and
have significantly better biomechanical
properties than ceramic implants of
alumina, which have not been available
on the market since the mid-1990s.
This makes such prejudices outdated:
there is now sufficient scientific data to
support reliable clinical use of ceramic
implants of zirconia.
What would you advise your peers
working in private practice with regard to the advantages of ceramic
implants?
Dr Röhling: Ceramic implants expand
the treatment spectrum of a practice
and offer patients a dependable alter
native to titanium. This fact is all the more
important given that the demand for
ceramic implants by patients has con
tinued to increase. In a study conducted
by our research group, we showed that
tooth-coloured ceramic implants are
more attractive to patients than are grey
implants of titanium. In addition, ceramic

Prof. Michael Gahlert

Dr Stefan Röhling

interview

|

implants offer advantages for challenging aesthetic indications and compromised
soft-tissue conditions. In many clinical
cases over the last decade, we have
observed a rapid and stable adaptation
of the peri-implant mucosa without
irritation.
Are there any specific cases in which
you prefer ceramic implants, such as
for anterior teeth?
Prof. Gahlert: In addition to the highly
aesthetic restoration options of ceramic
implants in the maxillary anterior area,
as a periodontist I am particularly drawn
to using ceramic implants in patients
with past periodontal disease resulting
from genetic causes. Because ceramic
implants have lower bacterial affinity
than do titanium implants, they are my
first choice for tooth replacement in
these special cases.
How do you see the future of ceramic
implants compared with titanium
implants?
Prof. Gahlert: One of the most important
aspects will be greater recognition of
ceramic implants than is currently the case.
Although a robust movement in favour of
ceramic implants is taking shape around
the world, there are still too many gaps
in the data. My prediction is that in five
years, after scientific confirmation of ten
years of serious long-term data from a
variety of study groups and continued
positive clinical performance, ceramic
implants will have found a permanent
place alongside titanium ones.

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Dr Stefan Röhling
+49 89 2366800
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welcome@oralchirurgie-t1.de

CONTACT:
office@cavitau.de
MORE INFORMATION:
www.cavitau.de

implants  1 2022

33

[34] =>

| industry

Patent —the proven master
of zirconia implants
™

Supported by first ever long-term studies
Zircon Medical Management, Switzerland

© Zircon Medical Management AG

The first ever nine-year study
on ceramic implants

Fig. 1: At the 2022 Academy of Osseointegration annual meeting in February, the first
ever nine-year prospective study on two-piece ceramic implants was presented.

The prospective nine-year study presented at the recent
AO annual meeting investigated patients with average
health profiles who had received two-piece Patent™
Implants in single-tooth posterior restorations at Heinrich
Heine University Düsseldorf between 2011 and 2012.1
Extremely high survival rates for the implants (95.8%)
were documented after nine years of wear—rates comparable to those of titanium implants. Also, stable bone
and soft-tissue levels with mucosal recession of less than
1 mm were documented in all the implants after the nineyear period. Furthermore, the researchers observed no
bleeding on probing in more than half of the implants
after this period. In light of the convincing results, lead
researcher Prof. Jürgen Becker emphasised that predictable, safe and long-term reliable restorations can be
achieved in average implant patients with the two-piece
Patent™ Implants.

Revolutionary prosthetic concept
In response to the desire for a broader range of indications and greater prosthetic flexibility, two-piece ceramic
implant systems are increasingly finding their way on to the
market. In the past, however, numerous two-piece ceramic
implant systems have come to the market that presented
major drawbacks regarding failing osseointegration or
high fracture rates. With the Patent™ Dental Implant System,
Zircon Medical Management has adopted a revolutionary,
20-year-old technology that promises to eliminate these
drawbacks of conventional ceramic implant systems.
Making good on this ambitious claim, a team of researchers at Heinrich Heine University Düsseldorf in Germany
has now presented the first reliable long-term data of
its kind on the clinical success of two-piece ceramic implants at the recent 2022 Academy of Osseointegration
(AO) annual meeting in San Diego in the US, heralding
a paradigm shift in the scientific debate surrounding
dental implants. The fact that long-term successful
treatments can be realised with the two-piece Patent™
Dental Implant System has now been scientifically
proved.

34

implants 1 2022

The excellent long-term performance of the two-piece
Patent™ Dental Implant System documented in the prospective study can be attributed to a number of special
design factors implemented with the aim of eliminating
the drawbacks of conventional ceramic implants once
and for all. Unlike some other ceramic implants, the
Patent™ implant design was not merely copied from
titanium implants, but was purposefully engineered
with the specific material properties of zirconia in mind.
While other systems rely on metal screws for the internal connection or employ an unfavourable ceramic–
ceramic screw connection, the Patent™ Dental Implant
System has developed a revolutionary prosthetic concept: the prosthetic connection is realised via a hightech glass fibre post, which has dentine-like properties
and, being flexible, dampens the masticatory forces
transferred from the definitive restoration to the implant.
The result is a metal-free and extremely stable construction without a bacteria-prone micro-gap at the
subgingival level.

[35] =>

industry

The proven high survival rates of Patent™ Implants can also
be attributed to the special implant surface created in a
proprietary manufacturing process. The endosteal implant
surface is hydrophilic, osteoconductive and significantly
rougher than the surfaces of conventional ceramic implants,
having a roughness value of 6 µm. Within minutes after insertion, a fibrin network forms on it, promoting extremely
successful bone healing through contact osteogenesis and
optimising the early phase of healing. The superior bone
healing of Patent™ Implants was impressively demonstrated
in an animal model study by Drs Roland Glauser and Peter
Schüpbach (in publication), in which the researchers found that
Patent™ Implants achieve bone–implant contact of over 70%
after only four weeks of healing. Such results demonstrate
that the Patent™ Dental Implant System outperforms all other
implants examined in comparable studies to date. Moreover,
thanks to the biomimetic implant design, which was modelled after a natural tooth, the Patent™ Dental Implant System
permits a particularly high degree of soft-tissue adaptation.
This soft-tissue seal prevents pathogenic bacteria from infiltrating the underlying tissue and causing marginal bone loss,
peri-implant inflammation and systemic complications.

Patent users and experts share
their experiences
™

Dr Sammy Noumbissi, president of the US expert society
International Academy of Ceramic Implantology, stressed:
“I’ve had the opportunity to look at the Patent™ Dental Implant
System very closely many times, and I have colleagues and
friends who are using them extensively now. The Patent™ Dental
Implant System is the first ceramic implant with a decade of
research behind it. This is unique, especially in the ceramic
implant world. In the past, many ceramic implant systems
with comparatively little scientific evidence have come to the
market. The Patent™ Dental Implant System has been used,

Fast and predictable osseointegration

Fig. 2: The two-piece Patent™ Dental Implant System is metal-free. The prosthetic
connection is realised via a high-tech glass fibre post, which is inserted into the
patented 3C connection of the implant and cemented. It is then ground and restored
just like a natural tooth. The glass fibre post has dentine-like properties and offers
great flexibility, immense strength and a wide variety of prosthetic possibilities.

tested and evaluated since 2006. In ceramic implantology,
I have never seen a product that has been so extensively
researched before being commercially marketed.”
Commenting on the unique nine-year study at Heinrich
Heine University Düsseldorf, Dr Paul Lee, founder of the
Luxembourg-based INTEGRA biohealth clinic, said: “This
long-term study confirms what I have been observing for
ten years now in clinical practice with the Patent™ Implants
I have placed.” Dr Glauser, who is a Swiss implantologist,
confirmed: “Thanks to the special, highly rough surface,
even better results in terms of bone healing can be achieved
with Patent™ Implants than with all other ceramic implants on
the market.” Among the many Patent™ users is also Dr Marcel
Wainwright, who said of the healing success of the Patent™
Dental Implant System: “The rougher the surface, the easier
it is for the cells to attach to it and form a fibrin network.
I don’t know of any other implant system that has a higher
roughness.” In addition, Dr Wainwright values the easy
handling of the Patent™ Implant: “The switch to Patent™ is by
no means dramatic—the few things that need to be learned
can be explained in one afternoon.”
Reference
1. Rauch NJ, Brunello G, Becker K, Schwarz F, John G, Becker J. Two-piece
zirconia implants in posterior regions: a prospective cohort study with
a follow-up period of nine years. Paper presented at: Academy of Osseointegration annual meeting; 2022 Feb 24–26; San Diego, Calif., US.

contact

Fig. 3: With a roughness value of 6 µm, the surface of the Patent™ Dental Implant
System is significantly rougher than the surfaces of conventional ceramic implants,
ensuring fast and predictable osseointegration (scanning electron microscopy
10,000× magnification).

Zircon Medical Management AG
Churerstrasse 66
8852 Altendorf
Switzerland
+41 78 8597333
www.mypatent.com

Company details

implants 1 2022

[36] =>

| industry

Second-generation ceramic implant
Successional whiteSKY zirconia implant from bredent medical
bredent medical, Germany

1

2
Fig. 1: The zirconia used for whiteSKY implants has a tetragonal structure. This structure only occurs in nature at temperatures between 1,173 °C and 2,370 °C. Yttria
is added to stabilise the structure at room temperature.7 Fig. 2: Unground zirconia has a strength triple that of titanium and double that of alumina. Industrial grinding
increases its strength even further, meaning that a strength of approximately 2,000 N can be achieved in implants.

The contemporary zirconia implant is truly com
parable to titanium and has no treatment limitations.
This makes it a reliable alternative for patients with metal
allergies, those wishing to lead a metal-free lifestyle and
those needing implants in the aesthetic zone to ensure
that dark shading does not affect the aesthetic out
come of the restoration. Zirconia is perfectly suited for
implants, since its strength is three times higher than
that of titanium and it exhibits ideal elasticity and long-

“Zirconia is perfectly 
suited for implants,
since its strength is three
times higher than that
of titanium and it exhibits
ideal elasticity and long-term
resistance to fracture.”

36

implants  1 2022

term resistance to fracture. Scientific studies have
shown that zirconia features the same characteristics
as comparable titanium surfaces regarding osseo
integration.1, 2
The whiteSKY zirconia implant system developed by
bredent medical has been proved to be safe and dura
ble, demonstrating excellent long-term results since its
introduction in 2006.1, 2 The company has now built on
this success with the launch of a second generation of
the system. The new whiteSKY Tissue Line and Alveo
Line ceramic implants incorporate all the features of
the classic whiteSKY implant in an improved, con
temporary design and new shape which has been
scientifically and clinically proved.
For the first generation of whiteSKY implants, clinical
and scientific evaluations have been carried out from
the very beginning, and histological investigations have
confirmed the implant’s excellent osseointegration
and verified its long-term clinical outcomes. Research
shows that its survival rate is on par with that of titanium
implants and that bone levels remain stable in the long
term, and the red–white aesthetics have been shown

[37] =>

industry

3

|

4

Fig. 3: Histology demonstrates excellent muco-integration of the whiteSKY zirconia implants, which is the basis of the long-term success.1 Fig. 4: Retaining proven
properties and developing these successes further was the goal of the development of the second generation of whiteSKY. The same highly stable material has been
used in the same production process and improvements have been made to the neck design, which is now available in two forms. The improvements in the superstructure
design ease the integration of both temporary and definitive prosthetic restoration and optimise the digital workflow.

to be outstanding.1, 2 Furthermore, studies have demon
strated that ceramic dental implants exhibit good
biocompatibility, good epithelial attachment and low
plaque accumulation.3–6

For the newly launched second generation, several
additional, customer-requested improvements have
been introduced and the following proven success
factors have been retained: the complex manufacturing
AD

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1/22

issn 1868-3207 Sondernummer • Vol. 6 • Issue 1/2022

ceramic

implants

issn 1868-3207 Sondernummer • Vol. 5 • Issue 2/2021

ceramic

international magazine of ceramic implant technology

implants

ceramic

international magazine of ceramic implant technology

Your benefits:
• author profile on ZWP online
• offprints

2/21

ceramic implant technology

• specimen copies
• speaking engagement*

Please contact Mrs Janine Conzato:
j.conzato@oemus-media.de
Phone: +49 341 48474-147

Creating natural emergence profiles in the

research

Dental implants and
bone marrow defects

case report

We look forward to receiving your manuscripts!

1/21

implants

Ceramic implant placement
in a medically compromised patient

research

Room for improvement

case report

Restoring aesthetics in the mandible

events

First JCCI held with great success

industry

Patent™—the proven master of zirconia implants

* according to the required profile

OEMUS MEDIA AG

Holbeinstraße 29 · 04229 Leipzig · Germany · Phone: +49 341 48474-201 · s.schmehl@oemus-media.de

[38] =>

| industry
whiteSKY Alveo Line with its wide platform
for the closure of the alveolus is ideal for
customisation according to the anatomical
situation of the patient to achieve maximum
in aesthetics in any case—then it is used
in the analogue and digital workflow like a
natural tooth.
whiteSKY Alveo Line and Tissue Line have
the reduced abutment height with a 15°
bevel at the tip which facilitates the resto
ration of tilted implants in the maxillary ante
rior region. The horizontal groove ensures
easy insertion of temporary restorations
and facilitate temporary and permanent
cementation.
The one-piece whiteSKY Tissue Line and
Alveo Line are versatile and suitable for a
wide range of indications, from single resto
rations in the aesthetic zone as well as the
posterior zone to short-span bridges in the
premolar–molar region and even in free-end
situations. Depending on the competence
6
of the dental team, the new generation
Fig. 5: Placed whiteSKY Tissue Line implant. Fig. 6: Placed whiteSKY Alveo Line. Ideal for immediate whiteSKY can be used also for very chal
implantation.
lenging cases of full arch restorations.
There is also no limitation in terms of improcess involving hot isostatic pressed zirconia; the
plant placement timing—all options are possible from
surface treatment; the one-piece design, which ensures
immediate implant placement to late implant placement
micro-gaps do not occur and therefore guarantees
for both systems.
the long-term survival of the implant; and the opti
mised design and bone-oriented surgical protocol,
In all cases, the manufacturer recommends the imme
which have been shown to achieve excellent primary
diate restoration of the whiteSKY implants because of
stability. This is a prerequisite for immediate resto
the proven improved osseointegration and patients’ wish
ration, which is highly recommended, as clinical re
for speedy but safe restoration.
search indicates that it can increase bone–implant
contact by 50%.3 The tooth-coloured whiteSKY
This year, bredent medical celebrates 15 years of the
zirconia implant meets patients’ high aesthetic de
whiteSKY implant system in various European cities.
mands—no dark shades will affect the beauty of the
At various international events you can find out more
restoration.
about the new whiteSKY implant system.

The implant can be used in cases of low gingival height.
Its one-piece design makes it ideal for immediate
loading. It has the same requirements as for an imme
diately loaded titanium implant, such as sufficient bone
volume, adequate primary stability and connection to
adjacent teeth or to other whiteSKY implants.

Literature

bredent

Two designs one goal—aesthetics
The second generation of whiteSKY is available in two
designs for the different user philosophies. whiteSKY
Tissue Line with the slim and scalloped sulcus design
offers the maximum space for the soft tissue and limits
the need for customisation—therefore, it is ideal for the
standardised analogue and digital workflows.

implants 1 2022

contact
bredent medical
Germany
+49 7309 872-600
www.bredent-medical.com

[39] =>

Workshop

October 15, 2022

EACim 2022

BRUSSELS Hôtel Le Plaza

Ceramic Implants, Piezosurgery and muco-gingival contributions
Pr Marcel WAINWRIGHT & Dr Norbert CIONCA (EACim Ambassadors)
A one-day training on Piezosurgery, muco-gingival surgery and hands-on
with Ceramic Implants:
• Piezosurgery, minimally invasive surgery
• Biological approach in ceramic implantology
• Hands-on ultra sonic surgery: minimally invasive extraction, crest splitting atraumatic, intra-lift transcrestal hydrodynamic ultrasonic sinuslift
• Surgical techniques for recession coverage around teeth and implants; including coronally advanced ﬂaps and tunneling
techniques
• Connective tissue grafts and soft-tissue substitutes
• Workshop: Recession coverage and graft harvesting techniques
• Hands-on ceramic implants on model with the EACim partners
INFO AND REGISTRATION: info@cosyn.eu
Phone: + 32 9 222 7117
Mobile: + 32 477 413298

https://eacim-ceramic-implantology.com/

[40] =>

ceramic
is ONLINE!

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[41] =>

implants
The magazine has established itself in the community with great success.
Now onto the next step: ceramic-implants.info is online.
Check out the website and follow us on LinkedIn!

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

[42] =>

| manufacturer news
bredent medical

Zirconia implant as alternative to titanium

2
Fig. 1: Clinical case with the whiteSKY Tissue Line by Dr Gallizia, France.
Fig. 2: The new whiteSKY Tissue Line zirconia implant-reshaping scientific success.

The whiteSKY Tissue Line and Alveo Line ceramic implants incorporate all the features of the “classic” whiteSKY implant in an
improved, contemporary design and new shape which has been
scientifically and clinically proven. The zirconia implant is truly
comparable to titanium and has no treatment limitations. This
makes it a reliable alternative for patients with metal allergies,
those who want to lead a metal-free lifestyle and those needing
implants in the aesthetic-zone to ensure that dark shading does
not affect the aesthetic outcome of the restoration. Zirconia is
also perfectly suited for implants since its strength is comparable
to that of titanium and exhibits ideal elasticity and long-term resistance to fracture.
Dr Claude Gallizia from France stated titanium equates to bio
tolerance whilst zirconia offers total bio compatibility. “In practical
terms, I am pleased to say that with whiteSKY, we get minimal
post-operative pain, achieve beautiful osseointegration and get a
phenomenal reaction from bone and gingival tissues.”
bredent medical GmbH & Co. KG · Germany
+49 7309 87222 · info@bredent.com

SIC invent

Innovative dentistry, one hundred per cent metal-free

Dr Pasc Marquardt
al

Ceramics is an alternative to titanium for specific indications. The two-part, metal-free SICwhite implant lets the attending dentist,
working closely with the patient, decide which treatment philosophy and which technology is the right one for a given indication.
In Dentalpoint AG –Zeramex, we have found the ideal partner for technological joint ventures in ceramics. With more than 15 years
of experience, they are one of the innovation leaders in ceramic implants.
Dr Pascal Marquardt, a specialist in prosthodontics and oral implantology and a dedicated
member of the Schilli Implantology Circle explains: “In 2016 I discovered
this new option of the VICARBO® screw. The combination of highstrength PEEK thermoplastic polymer and specially aligned carbon fibres in the abutment screw and the most stable ceramic
material on the market in the implant itself—finally successfully rivalled the common components of titanium implants in
terms of strength and long-term clinical success.” Compared to
titanium implants, so the experienced implantologist, the low
plaque adhesion and the lower peri-implantitis rates that have
emerged in recent reports make ceramic implants a particularly
interesting option in patients with periodontal disease or who have
issues with proper oral hygiene. The favourable soft-tissue reaction makes
for uncomplicated handling in the aesthetic zone. Dr Marquardt also emphasises the complex manufacturing
process of the SICwhite, in which both the implant and the abutment are milled from particularly strong,
fully sintered ATZ ceramics providing maximum safety in terms of the fracture strength of these ceramic
implants. It is true that not all cases are suitable for ceramic implants today. But given the developments over
the last few years, we have good reason to expect that a growing range of indications and an increasing
variety of implant types will eliminate many of today’s restrictions in the future.

SIC invent AG · Birmannsgasse 3 · 4055 Basel · Switzerland · www.sic-invent.com

implants 1 2022

[43] =>

manufacturer news

Zircon Medical Management

Master of zirconia: The PatentTM Dental Implant System
While other ceramic implant manufacturers struggle with early
osseointegration failure and high fracture rates, Zircon Medical
Management, the manufacturer of the Patent™ Dental Implant
System, together with leading scientists and a team of highly
experienced material experts, has succeeded in mastering the
complex process of manufacturing zirconia implants in a unique
way—employing a process that has been protected by 14 patents. All surface-machining steps are carried out prior to sintering. Through the proprietary manufacturing process, a surface
roughness is achieved (6 µm) that is up to five times rougher than
conventional zirconia implant surfaces. In the subsequent sintering stage, potential process-related microcracks are eliminated.
Moreover, the design of the Patent™ Dental Implant System does
not merely mimic the design of titanium implants. Rather, its
design was purposefully engineered to perfectly complement
the material characteristics of zirconia. The result is a true tissuelevel zirconia implant that is unparalleled in terms of fracture
resistance, osseointegration and long-term stability. In addition,
the entire manufacturing process—from raw material assembly
to milling and final packaging—takes place exclusively at two
proprietary production sites in Germany. Therefore, Zircon Medical
Management is able to guarantee Patent™ users absolute quality
control. Choose long-term stability. Choose reliable osseointegration. Choose Patent™ Implants from Zircon Medical
Management, the master of zirconia.

The two-piece Patent™ Dental Implant System is entirely metal-free. It
consists of the implant itself and an incredibly strong yet flexible glass fibre
abutment, which, having dentine-like properties, attenuates the masticatory
forces within the context of definitive restoration.

Zircon Medical Management AG
+41 78 8597333
www.mypatent.com

CaviTAU

New insight into an underrecognised entity
Why do implants fail?
Why do more and more
people become chronically ill? Is an undetected
disease “silent inflammation of the jawbone”
behind it? Many questions, one modern answer: the digital-quality
determination of bone
density through ultrasound
sonography—CaviTAU ®.
Such, the dentist localises chronic and pathogenetic inflammation CaviTAU® application with LED gel pad and schematic representation of transalveolar sonography.
patterns, cleans them up
in surgical “Jawbone Detox steps” and thus turns from a dentist
over 200 literature citations through all the science behind
into a systemic-immunologically oriented and integrative Oral
CaviTAU®. The book can be ordered online at the website
Physician.
www.icosim.de.
With the newest version of the english book Cavitational
osteonecrosis in jawbone by Dr Johann Lechner, you will
be guided in over 390 pages, with 120 illustrations and
CaviTAU · Germany · +49 89 244154460 · www.cavitau.de

implants 1 2022

[44] =>

| manufacturer news
ZiBone

A wide range of zirconia products
Zirconia is a well-known highly biocompatible material. Given
more than 30 years of manufacture and research experience,
COHO has produced orthopaedic, dental implants and surgical
instruments for many years. Furthermore, COHO has cooperated
with several world-famous dental experts and research units
from National Taiwan University for launching various zirconia
products, expanding application of zirconia, and last but not the
least, the advancing surface treatment research to reduce the
evitable risks during surgery and implantation by using metal
materials in order to reach our terminal goal of enhancing the safety
and convenience during surgical procedure. Currently Zibone
has a series of zirconia products in the market, such as: zirconia
implant drill, pilot drill, tissue punch, tissue trimmer, scalpel, elevator, etc. Now, COHO and doctors are working closely and hopefully not far from the future to introduce Zircasso, IZI and tissue
level implant system in the market. Therefore, we are so pleased
to see doctors’ trust and allow us to manufacture the tools as
needed and lead to the ideal working environment as you wish.

COHO Biomedical Technology Co., LTD. · Taiwan
+886 3 3112203 · www.zibone.com

Straumann

Changing lives by giving smiles back: SmileAward 2022
Submission requirements
The required documentation includes all relevant diagnostics and
step-by-step illustrations. It is also required to submit a 4-minute
video that combines high-definition clinical images with the testimonial of the patient. All cases fulfilling the criteria will go through to a
public vote. A jury composed of key opinion leaders in dentistry will
select the final winners, who will be announced at EuroPerio10.
Timeline
– Submission of cases: by 20 July
– Public voting: 1 Aug–29 Aug
– Selection of winners by jury: 1 Sept–14 Sept
– Announcement of winners: EAO Congress, Geneva (29 Sept–1 Oct)

Every day, around the globe, we know dental professionals rely on
Straumann to give patients the confidence to smile again, to laugh,
to show off their smiles, to eat the foods they love. Thousands of
dental professionals use our products and solutions to rebuild the
quality of life for patients and to unlock the potential of people’s lives.
While Immediacy Protocols stood in the focus in 2021, the
SmileAward 2022, welcomed dental professionals to show us
how they are changing the lives of their patients through full-arch
rehabilitation or clear aligner therapy. They are invited to submit
their best patient stories and share with the world the many ways
that dentistry can restore confidence and improve our well-being.
The 2022 SmileAward aspires to be the most inspiring, most
uplifting clinical case competition.

implants 1 2022

Great prizes
All finalists in both categories will be awarded a prize so that they
can continue changing lives together with Straumann. The top three
winners in both contest categories will be #GivingSmilesBack
with the materials needed to complete one or more pro bono
cases, and our top winner in each category will also get their
patient video story edited professionally, and it will be seen with
worldwide visibility across Straumann channels and platforms.
Our winners can also opt for a #ChangingLives prize, a donation to a philanthropic organisation in their honour—or for a
#BoostingYourPractice prize in which the top winner in each
category will take home a TRIOS intra-oral scanner.
Institut Straumann AG · Peter-Merian-Weg 12 · 4052 Basel
Switzerland · www.straumann.com/smileaward

[45] =>

manufacturer news

Zeramex

Dr Rouven Wagner on his experience with 2ingis guided
surgery for Zeramex implants
Nowadays, digital workflows are an integral part of the daily routine of an
implantology dental practice. In addition, optical impressions and CAD/
CAM workflows are already covered during studies at almost every university in order to learn about different digital tools and their advantages.
“I studied in Leipzig, where Prof. Ludwig Graf and Dr Wolfram Knöfler
dealt with titanium implant alternatives very early on”, explains Dr Rouven
Wagner. “That’s how I got into the world of ceramic implants. I also looked
into the subject during my oral surgery training and my master’s degree
at the IMC under the supervision of Prof. Ulrich Joos. Finally, I wrote my
master’s thesis on ceramic implants.” Dr Rouven Wagner started working
with Zeramex because he was convinced by the metal-free implant with
the carbon fibre-reinforced VICARBO® screw and its prosthetic flexibility.
With the Zeramex implant, the usual workflow can be maintained.
“I tested several surgical guides. Unfortunately, some of them were
partly inflexible and not open. That’s why I chose 2ingis, an open-source
system that gives me a lot of flexibility. I have the full field of vision and
can decide whether a punch is enough or whether I should open up. The
water cooling is also excellently solved,” says the implantologist.
Especially in the anterior region, it is safe to work with a 3.5 mm
Zeramex implant in narrow gaps in the lower jaw. With an analogue impression, one could damage the orthodontic appliance or
change it much too much. Great results could also be achieved with
treatments in combination with orthodontic restorations. Surgical
guides make it possible to place an implant in a pre-planned location and determine the exact position of it. This has the advantage
that the implantation is easier and the treatment time is shorter.
The surgical procedure can be performed in a way that is gentler

Dr Rouven Wagner

on the tissue and more comfortable and safer for the patient, as
few or no soft tissue incisions are required.
Dentalpoint AG · +41 44 3883636 · info@zeramex.com

CAMLOG Biotechnologies

Digital workflow with the CERALOG® Implant System
The demand for highly aesthetic, natural-looking restorations is
continually increasing—so is the demand for efficient workflows.
The well-established CERALOG® Implant System will shortly be
complemented with a bonding base, allowing to efficiently plan

and manufacture the restorations for CERALOG® twopiece implants.
The CERALOG® bonding base CAD/CAM PS as well as
all other new components will be platform switched—
opening the pathway for more efficient workflows and
improved aesthetic outcomes. With these new prosthetic components CAMLOG confirms its commitment for
a ceramic system which is easy to use, with lean instrumentation, and clearly structured surgical procedures.
CAMLOG Biotechnologies GmbH · +41 61 5654141
www.biohorizonscamlog.com

Fig. 1: CERALOG® bonding base CAD/CAM PS. Combining the
benefits of platform switching with efficient digital workflows. Fig. 2:
Hexalobe—abutment connection for ceramic implants. The torque
is transmitted tangentially to the implant, which allows a much higher
torque compared to hexagonal connections, and more rotational stability.

implants 1 2022

[46] =>

| events
EuroPerio10

Congress programme with over 130 top speakers
30 countries in the main programme. The
scientific programme features a wide variety
of innovative formats, including live mucogingival and bone-regeneration surgeries, interactive sessions, so-called nightmare sessions (worst-case scenarios), video sessions,
debates, interviews, symposia, and more.
Considerable attention will be also given to the
EFP’s S3-level clinical guidelines on the treatment of periodontitis—the newest guideline,
on stage IV periodontitis, will be presented
at the congress.
“The scientific programme addresses the
interests of every member of the dental community and provides them with an updated
snapshot of what perio is today,” explains
David Herrera, scientific chair of EuroPerio10.
“We have a great faculty, complete and diverse,
addressing the main challenges of our profession with the most engaging session formats.
David Herrera and Phoebus Madianos are looking forward to the EuroPerio10 taking place in June.
So, we are proud to have prepared an exciting
congress up to the task of bringing dental professionals up to date in terms of knowledge, skills, trends and
The tenth edition of EuroPerio returns in 2022 after having been
postponed from last year because of the Covid-19 pandemic.
solutions, but also in terms of personal interaction and networking
Organised by the European Federation of Periodontology (EFP),
with colleagues,” says Phoebus Madianos, chair of EuroPerio10.
Registration for EuroPerio10 is possible at the EFP website and
EuroPerio10 will take place on 15–18 June in Copenhagen,
has been open to all professionals since August last year.
Denmark. It features a top-level scientific programme packed
with sessions covering all the latest trends and topics for oralhealthcare professionals, with 135 well-known speakers from over
EuroPerio10 · www.efp.org/europerio · europerio@mondial-congress.com

EAO Congress 2022 in Geneva

Uniting nations through innovations
The European Association for Osseointegration is
the daily live programme, the digital evening
th
pleased to announce details of its 29 congress,
event will feature additional content, available to
which will take place in Geneva from 29 Septema global online audience. Anyone attending in
ber to 1 October with a digital programme for
person will be able to participate in both parts
of the programme, experiencing two educational
those who cannot attend in person. Geneva is
UNITING NATIONS
THROUGH INNOVATIONS
events at the same time. The congress is being
home to many international organisations including the United Nations, the World Health Organiheld in partnership with the Swiss Society of
sation and the Red Cross. Reflecting their goals
Oral Implantology (SGI), the Swiss Society of
of global collaboration, the theme of the EAO
Periodontology (SSP), the Swiss Society for
Oral Surgery and Stomatology (SSOS) and the
congress will be uniting nations through innovations. It will focus on the role of new technology
Swiss Society of Reconstructive Dentistry (SSRD).
in disrupting the way we communicate, work
Geneva 2022 will be a unique opportunity to learn
and learn. The programme will feature renowned
from the best. We hope that you can join us—
speakers who will share their knowledge on
either in person or virtually—for what will be
ONSITE
& ONLINE
a ground-breaking programme focused on the
the application of digital technologies across all
aspects of implant dentistry. Sessions will comevolving role of technology in implant dentistry.
pare current digital techniques with conventional techniques and will
provide clinically relevant take-home recommendations. As well as
EAO Office · eao.org · eaocongress@eao.org · +33 1 42366220
FIRST ANNOUNCEMENT

29 Sept. - 1 Oct. 2022
Chair: Irena Sailer
congress.eao.org

implants 1 2022

[47] =>

The innovative specialist society for modern metal-free implantology

Become a member now!
Benefits
Effective public relations
Beneﬁt from a strong community that elevates the marketing of your practice
through effective public relations strategies.

Personal online member proﬁle
ISMI provides a personal proﬁle of all active members on their website—free
of charge. In addition, the ISMI patient platform provides important information for
patients and features a search tool with which patients can ﬁnd their perfect dentist.

CERAMIC IMPLANTS

Come and join us! Attend the Annual Meeting of ISMI in Berlin on 24 and 25 June 2022
and beneﬁt from ﬁrst-rate continuing education. ISMI members receive a special discount on the participation fee.

STATE OF THE ART

Discount on congress fees

Online archive for specialists
6 TH ANNUAL MEETING OF

24./25.Juni 2022
Berlin

Get exclusive access to ISMI’s extensive online archive. Discuss all relevant questions regarding metal-free implantology with experts and colleagues from around
the world and enjoy free access to the online archive where you will ﬁnd informative training videos and clinical case reports.

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

Specialist magazine
As a member of ISMI, your membership fee includes a subscription of the independently published English language magazine ceramic implants—international
magazine of ceramic implant technology. Published twice a 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. 5 • Issue 2/2021

ceramic

Room for improvement

interview
Towards healthier rehabilitations

events
A look back at the first JCCI

Become a
member of ISMI now!

implants

international magazine of ceramic implant technology

research

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

2/21

[48] =>

| news

GC International participates in awards ceremony

GC Brazil, represented by José Geraldo Lopes Neves on the right, joined
a hybrid ceremony held in honour of Prof. Maria Fidela de Lima Navarro,
among other academics, during which she was awarded the title of professor
emeritus by the University of São Paulo. (Image: © GC South America)

The faculty of dentistry on the University of São Paulo’s
Bauru campus bestowed the honour of professor emeritus including Prof. Maria Fidela de Lima Navarro. The
honour is awarded to retired professors who have distinguished themselves through teaching, research and other
contributions to the university.
The hybrid two-day awards ceremony took place on 7 and
8 March and was broadcast live on YouTube. GC Brazil,
represented by José Geraldo Lopes Neves, attended

Prof. Maria Fidela de Lima Navarro
honoured at University of São Paulo
the ceremony in recognition of the contributions that
Prof. Navarro has made to dentistry research in Brazil.
“Many actions have led us to share knowledge and continue to learn. We are here in this solemn moment, and it
gives me immense joy and a feeling of accomplishment
with the professional and personal goals that were
achieved, as a group,” Prof. Navarro said in her acceptance speech. “We reaffirm our confidence in being able
to always share a new path, towards the highest peaks
that certainly still need to be climbed. This is because,
despite the paths we have taken so far, many other fields
still need to be explored, and a journey of new discoveries
is just beginning,” she continued.
Prof. Navarro has contributed and continues to contribute to
research related to glass ionomers and glass hybrids as well
as their properties and applications in several clinical cases.
Source: GC International AG

Eklund Foundation

Applications for odontological research and education are welcome

Researchers within dentistry will soon be able to apply
for grants of up to €250,000, which is the total sum allocated by the Eklund Foundation in 2022. The application
portal will be open during May for the seventh year running, welcoming applicants from all parts of the world in
all fields of dentistry. Both experimental and clinical studies
within all fields of dentistry are accepted, but the foun-

dation will prioritise projects that can be related to periodontology, implantology, or cariology. Researchers may
apply for funding for a project in its entirety or for part
of a project. The Board will announce the successful
projects in September.
Information in short
– Allocated sum: €250,000
– Application period: 1–31 May 2022
– Announcement of grants: September 2022
– Applications from any location or university are accepted
– Read more and apply at www.eklundfoundation.org
Background
The Eklund family, owners of TePe Oral Hygiene Products,
created the Eklund Foundation in celebration of their
long-standing relationship with the professional dental
community. Since 2016, the foundation has distributed
€140,000–240,000 annually, supporting odontological
research worldwide. More information about the grants,
published studies, and interviews with previous recipients
are available on the website. The Eklund Foundation was
established in 2015 to support research and education
in the odontological field.

Eklund Foundation is established to support research within odontology.

implants 1 2022

Source: TePe Oral Hygiene Products AB

[49] =>

news

Komet Custom Made receives
the prestigious CleanImplant
Certified Production Quality award
Globally recognised as a testing authority for uncompromising implant quality, the CleanImplant Foundation has
awarded its seal of excellence to German contract manufacturer of ceramic implants Komet Custom Made. The
CleanImplant Foundation has long been an established
authority among implantologists for independent evaluations, ratings and information on the quality and cleanliness
of implant surfaces. In March, the non-profit foundation
granted the Certified Production Quality seal to Komet
Custom Made, a division of Gebr. Brasseler, for its excellent
production quality of ceramic implants. Scanning electron
microscopy (SEM) analyses of more than 100 different
commercially available implant systems show that this
deserves recognition. “More than half of all analysed
implants show significant impurities under SEM,” said
Dr Dirk U. Duddeck, managing director and head of
research at CleanImplant. “These contaminants on new,
sterile-packaged implants, which are entirely preventable
on the manufacturer’s side, unfortunately, have clinical
consequences and harm both practitioners and patients.
It is our responsibility to inform dentists accordingly and
provide a stage for quality manufacturers,” he added.

Significant milestone in implant production
quality management

Klaus Rübesamen (right), CEO Gebr. Brasseler, and Carsten Cieslik (left),
General Manager Komet Custom Made with Dr. Dirk Duddeck, Managing
Director and Head of Research at the CleanImplant Foundation.

Quality assurance by accredited testing laboratories
After an extensive testing process, carried out in an accredited testing laboratory, the CleanImplant Foundation
awards the Certified Production Quality seal to contract
manufacturers producing implants for various trade labels
according to regulations based on the CleanImplant consensus guideline on the cleanliness of dental implants,
which has been established for many years.
“The certification by the CleanImplant Foundation for
ceramic implants confirms the process reliability of the
quality assurance measures in place at the company, including validated final cleaning and subsequent packaging in the
cleanroom, and represents a further milestone in ensuring
overall ceramic competence of Komet Custom Made,” said
Carsten Cieslik, general manager of Komet Custom Made.
Source: CleanImplant Foundation

European Federation of Periodontology

Prof. Andreas Stavropoulos is new president and launches
campaign for Ukraine

On 26 March, the European Federation of Periodontology
called for the society’s members to work together despite
(EFP) was able to hold an in-person meeting for the first time
any differences, writing, “What we have in common is much
since 2019. The EFP’s annual general asgreater than what separates us.”
sembly took place in the Austrian capital of
The general consensus among attendees of the
Vienna, where a new president, Prof. Andreas
EFP’s general assembly was that an in-person
meeting was much needed after the predomiStavropoulos, was welcomed and a camnantly online nature of meetings over the past
paign launched to provide financial aid for
two years. “I am so pleased that this year we
Ukraine. The “Help Ukraine” campaign is
planning to assist the Ukrainian people and
returned to a face-to-face general assembly
refugees who have fled the country by calling
meeting and could greet everyone in person,”
said EFP Secretary General Prof. Nicola West.
on the EFP’s 37 affiliated national societies of
periodontics to raise at least €30,000 in donaShe continued: “While online meetings have
tions. The campaign was organised in coltheir place in our sustainability strategy, faceto-face meetings are essential for our business
laboration with the World Health Organizationaffiliated WHO Foundation.
to operate, creating energy, warmth and friendProf. Stavropoulos took over as president of
ship, which cannot be underestimated.”
the EFP from Prof. Lior Shapira. In his first mes- Prof. Andreas Stavropoulos, the new
sage since assuming the role, Prof. Stavropoulos president of the EFP.
Source: Dental Tribune International

implants 1 2022

[50] =>

| about the publisher

Congresses, courses
and symposia
Imprint

11th IAOCI World Congress
19–22 May 2022
Washington DC, USA
https://www.iaoci.com

Publisher
Torsten R. Oemus
oemus@oemus-media.de

Art Director
Alexander Jahn
a.jahn@oemus-media.de

CEO
Ingolf Döbbecke
doebbecke@oemus-media.de

Designer
Franziska Schmid
f.schmid@oemus-media.de

Member of the Board
Lutz V. Hiller
hiller@oemus-media.de

Customer Service
Marius Mezger
m.mezger@oemus-media.de

Chairman Science & BD
Jürgen Isbaner
isbaner@oemus-media.de

Published by
OEMUS MEDIA AG
Holbeinstraße 29
04229 Leipzig, Germany
Tel.: +49 341 48474-0
Fax: +49 341 48474-290
kontakt@oemus-media.de

Editorial Council
Dr Michael Gahlert (Germany)
Dr Sofia Karapataki (Greece)
Dr Franz-Jochen Mellinghoff (Germany)

CER AMIC IMPLANTS

STATE OF THE ART

Editorial Management
Janine Conzato
j.conzato@oemus-media.de

6 Annual Meeting of ISMI

Executive Producer
Gernot Meyer
meyer@oemus-media.de

24–25 June 2022
Berlin, Germany
ismi-meeting.com

Product Manager
Timo Krause
t.krause@oemus-media.de

6 TH ANNUAL MEETING

24./25. Juni 2022
Berlin

Printed by
Silber Druck oHG
Otto-Hahn-Straße 25
34253 Lohfelden, Germany

www.oemus.com

Bioceramics 32
32nd Symposium and
Annual Meeting of ISCM
20–23 September 2022
Venice, Italy
bioceramics32.org

2nd European Congress
of Ceramic
Implant Dentistry
20–22 October 2022
Zurich, Switzerland
www.esci-online.com

implants 1 2022

Copyright Regulations
ceramic implants international magazine of ceramic implant technology is issued three times
a year and is a special edition of implants international magazine of oral implantology — the
first issue was published in October 2017. The magazine and all articles and illustrations therein are
protected by copyright. Any utilisation without the prior consent of editor and publisher is inadmissible and
liable to prosecution. This applies in particular to duplicate copies, translations, microfilms, and storage
and processing in electronic systems.
Reproductions, including extracts, may only be made with the permission of the publisher. Given no
statement to the contrary, any submissions to the editorial department are understood to be in agreement
with a full or partial publishing of said submission. The editorial department reserves the right to check all
submitted articles for formal errors and factual authority, and to make amendments if necessary. No responsibility shall be taken for unsolicited books and manuscripts. Articles bearing symbols other than that
of the editorial department, or which are distinguished by the name of the author, represent the opinion
of the aforementioned, and do not have to comply with the views of OEMUS MEDIA AG. Responsibility for
such articles shall be borne by the author. Responsibility for advertisements and other specially labelled
items shall not be borne by the editorial department. Likewise, no responsibility shall be assumed for information published about associations, companies and commercial markets. All cases of consequential
liability arising from inaccurate or faulty representation are excluded. General terms and conditions apply,
legal venue is Leipzig, Germany.

[51] =>

COHO BIOMEDICAL TECHNOLOGY CO.,LTD.

www.zibone.com

[52] =>

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) [page_count] => 52 [pdf_ping_data] => Array ( [page_count] => 52 [format] => PDF [width] => 595 [height] => 842 [colorspace] => COLORSPACE_UNDEFINED ) [linked_companies] => Array ( [ids] => Array ( ) ) [cover_url] => [cover_three] =>

[cover] => ceramic implants international No. 1, 2022

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Table of contents

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