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IMPLANT TRIBUNE
The World’s Dental Implant Newspaper · U.S. Edition

November 2009

www.implant-tribune.com

Platelet-rich plasma

uPage

By Pankaj Singh, DDS, DICOI, DABOI, FAAID

With very advanced jawbone
resorption, there may not be enough
bone width or height for the more
common and routinely placed type
of implant: the root form implant.
This advanced, severe bone
resorption is due to long-standing
edentulism and the detrimental
forces from loading these jaws with
soft-tissue supported dentures.
One complication that arises from
this severe bone resorptive pattern
is ill-fitting dentures that even after
repeated relines aren’t stable during normal or even soft mastication
and the patients have to use massive
amounts of denture adhesive to just
keep them in place to speak.
Besides being a quality of life
issue, it becomes a health issue as
the lack of proper masticatory process results in inadequate nutrition,
which leads to a host of digestive
disorders including acid reflux and
esophageal blockage, and can even
contribute to metabolic disorders1.
Chronic excessive use of denture
cream containing zinc may result in
hypocupremia and serious neurologic disease.2-4
Another major complication is
pain from direct pressure on the
exposed inferior alveolar nerve a
g IT page 4

Implant system has many
options, a variety of pricing

Success rests on your
interaction with the patient

uPage

AAID covers it all
in New Orleans
By Sierra Rendon, Managing Editor

From implant design to emergency medicine to particulate grafting,
there was in-depth
information for everyPhoto
one to take home
with them from the
Gallery,
American Academy
Page 15
of Implant Dentistry
meeting, which was
held Nov. 11 to 14 in New Orleans.
The meeting offered three days of
education on new techniques on a
wide variety of subjects.
Here is a sampling of the meeting’s
topics:
* New implant design: Drs. Henry
Salama, Maurice Salama and David
Garber presented from the perspective that implant-supported restoration must cosmetically equal or surpass that of conventional restorative
dentistry.
They outlined the biological, clinical and biomechanical factors that
allow clinicians to reduce or eliminate the waiting period to implant
loading without sacrificing predictably successful osseointegration.
Emergency medicine: Dr. Stanley
Malamed presented a dynamic prog IT page 14

Dental Tribune America
213 West 35th Street
Suite #801
New York, NY 10001

The forgotten
implant:
subperiosteal

New implant products

Implant experiences

PRP therapy can accelerate
bone and tissue growth

Vol. 4, No. 11

Above, Dr. Eric Van Dooren speaks Nov. 12 on the main podium.
Below, Alex Miller, president of Meisinger, talks with AAID attendees
about products. (Photos/Sierra Rendon)

PRSRT STD
U.S. Postage
PAID
Permit # 306
Mechanicsburg, PA

[2] =>

News

Implant Tribune | November 2009

AAID: Platelet-rich plasma
enhances bone, tissue growth
An exciting treatment gaining
acceptance in orthopedics and sports
medicine, called platelet-rich plasma therapy (PRP), is showing strong
potential for accelerated healing of
dental implant procedures, according to a prominent dental researcher
speaking at the American Academy
of Implant Dentistry (AAID) annual
meeting.
James Rutkowski, DMD, PhD, editor of the Journal of Oral Implantology and a practicing implant dentist
in Pennsylvania, spoke at the AAID
convention and said that for dentalimplant patients, platelet-rich plasma
therapy can accelerate bone and tissue growth and wound healing and
help assure long-term success of
implant placements.
“What could be better than using
the body’s own regenerative powers
to grow bone and soft tissue safely and
quickly? For dental implant procedures, PRP treatments can jump start
bone growth and implant adherence
in just two weeks, which cuts down
the time between implant placement
and affixing the permanent crown,”
Rutkowski said.
Platelet-rich plasma is obtained

from a small sample of the patient’s
own blood. It is centrifuged to separate platelet growth factors from red
blood cells. The concentration of
platelets triggers rapid growth of new
bone and soft tissue.
“There is very little risk because we
are accelerating the natural process
in which the body heals itself,” Rutkowski said. “PRP speeds up the healing process at the cellular level, and
there is virtually no risk for allergic
reaction or rejection because we use
the patient’s own blood.”
Rutkowski noted that some orthopedic physicians have been using PRP
with success for painful and hard to
treat injuries like tennis elbow, tendonitis and ligament damage. An avid
Pittsburgh Steelers fan, Rutkowski
couldn’t resist mentioning that PRP
was used in 2009 pre-game Super
Bowl treatment for two Steeler players
(Heinz Ward and Troy Polamalo), and
both were instrumental in the team
winning its sixth Super Bowl.
For dental surgery applications,
Rutkowski explained that PRP is mixed
as a gel that can be applied directly in
tooth sockets and other sites.
It also is effective in cases when

bone grafts are required to foster
proper bone integration for implants.
Growth factors in PRP preparations
help the grafts bond faster with the
patient’s own bone. Rutkowski reported that in one of his studies there was
increased radiographic bone density
during the initial two weeks following
PRP treatment when compared to sites
that did not receive PRP treatment.
“Accelerated healing is a goal we’ve
been seeking in implant dentistry and
we now have treatment that activates
the natural healing process. It is a very
promising development for implant
dentistry,” explained Rutkowski.
He estimates that about 10 percent
of practicing implant dentists have
used PRP treatment and predicts it will
become more common as more studies are performed. IT

About AAID
AAID is based in Chicago and has
more than 3,500 members. It is the first
organization dedicated to maintaining the highest standards of implant
dentistry by supporting research and
education to advance comprehensive
implant knowledge For more information, see www.aaid.com.

AAP supports foundation’s guidelines
on oral health for people with diabetes
New clinical guidelines released by
the International Diabetes Foundation
(IDF) emphasize the importance of
periodontal health for people with diabetes. Diabetes affects approximately
246 million people worldwide, and this
number is only expected to increase.
The IDF is an organization of 200
national diabetes associations from
160 countries.
The new IDF oral health clinical
guideline supports what research has
already suggested: that management
of periodontal disease — which affects
the gums and other supporting tissues
around the teeth — can help reduce
the risk of developing diabetes; and
can also help people with diabetes
control their blood sugar levels. Studies have suggested there is a twoway relationship between diabetes
and periodontal disease, and the IDF
guideline outlines helpful guidance for

health professionals who treat people
living with and at risk for diabetes.
The IDF guideline contains clinical recommendations on periodontal
care, written in collaboration with the
World Dental Federation (FDI), that
encourage health professionals to conduct annual inquiries for symptoms of
periodontal disease such as swollen
or red gums or bleeding during tooth
brushing, and to educate their patients
with diabetes about the implications of
the condition on oral health and especially periodontal health.
“Everyone should maintain healthy
teeth and gums to avoid periodontal disease, but people with diabetes should
pay extra attention,” said Samuel Low,
DDS, MS, associate dean and professor of periodontology at the University of Florida College of Dentistry, and
president of the American Academy of
Periodontology (AAP). “Periodontal dis-

ease triggers the body’s inflammatory
response which can affect insulin sensitivity and ultimately lead to unhealthy
blood sugar levels. Establishing routine
periodontal care is one way to help
keep diabetes under control.”
In recognition of American Diabetes Month, the American Academy of Periodontology commends the
International Diabetes Foundation on
the release of the Guideline on Oral
Health for People with Diabetes. IT

About AAP
The American Academy of Periodontology (AAP) is the professional
organization for periodontists — specialists in the prevention, diagnosis
and treatment of diseases affecting the
gums and supporting structures of the
teeth and in the placement of dental
implants. The AAP has 8,000 members
worldwide.

IMPLANT TRIBUNE
The World’s Newspaper of Implantology · U.S. Edition

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Managing Editor/Designer
Implant & Endo Tribunes
Sierra Rendon
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Managing Editor/Designer
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Published by
Dental Tribune America
© 2009, Dental Tribune International
GmbH. All rights reserved.

Dental Tribune makes every effort to
report clinical information and manufacturer’s product news accurately,
but cannot assume responsibility for
the validity of product claims, or for
typographical errors. The publishers
also do not assume responsibility for
product names or claims, or statements made by advertisers. Opinions expressed by authors are their
own and may not reflect those of
Dental Tribune International.

Editorial Advisory Board
Dr. Sascha Jovanovic, Editor in Chief

Dr. Bernard Touati
Dr. Jack T. Krauser
Dr. Andre Saadoun

Tell us
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Do you have general comments or criticism you
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Corrections

Implant Tribune strives to maintain
the utmost accuracy in its news and
clinical reports. If you find a factual
error or content that requires clarification, please report the details to
Managing Editor Sierra Rendon at
s.rendon@dental-tribune.com.

Dr. Gary Henkel
Dr. Doug Deporter
Dr. Michael Norton
Dr. Ken Serota
Dr. Axel Zoellner
Dr. Glen Liddelow
Dr. Marius Steigmann

[3] =>

Implant Tribune | September 2009

Folio 00

[4] =>

Clinical

Implant Tribune | November 2009

Fig. 1: Panoramic view of a severely resorbed mandible.

f IT page 1

result of dehissed inferior alveolar
canal and mental foramen by the
mandibular denture and resulting
Trigeminal neuralgia.5
In these cases the subperiosteal
implant can be of tremendous help.
By definition, a subperiosteal
implant is a framework specifically
fabricated to fit the supporting areas
of the mandible or maxilla with
permucosal extensions for support
and attachment of a prosthesis. The
framework consists of permucosal
extensions with or without connecting bars and struts. Struts are classified as peripheral, primary and secondary. The subperiosteal implant
can be constructed as a complete
arch, unilateral or universal, and is

loaded immediately.
Prior to the tremendous success
of the root form implants since Dr.
Brånemark introduced the concept
of osseointegration in 1981, the subperiosteal implant along with blade
and plate implants were routinely
used to support either a fixed, or
removable, complete or partial prosthesis. The subperiosteal implant
is custom made and designed to
fit and sit on top and around the
bone, but under the gums. There are
two methods for its fabrication and
installation.
The first and original technique
is the “dual surgery” method. Usually under sedation, the jawbone
is exposed and an impression of
the bone is made using a custom
impression tray and the impression
material of choice (not alginate).

Fig. 2a: Mandibular complete arch
subperiosteal implant with locator
attachments and countersunk screw
holes for bone screws.
Whenever possible, vertical
dimension in centric relation to the
alveolar ridge with the opposing
arch to provide inter-maxillary distance for determination of abutment
height of the subperiosteal framework and the height of the prosthesis is recorded while the bone was
still exposed. The gums are sutured
closed and the patient is dismissed
with a facemask-type compression
bandage.
This impression is poured with
plaster to fabricate a replica (model)
of the jawbone and the model is used
by the dental laboratory to custom
cast the implant with the suprastructure to fit the jaw along with the final
prosthesis that was prescribed. Six
to eight weeks after the first-stage
“impression acquisition” surgery, a
second procedure is then carried out

Fig. 2b: Maxillary subperiosteal
implant with recepticles with thread
pattern for locator abutments and
countersunk screw holes for rigid
fixation using bone screws.
where the jawbone is re-exposed
and the implant placed and secured
into place. The gums are closed with
stitches over the subperiosteal and
around the suprastructures and the
prosthesis is placed into place.
This type of protocol was very
common and predictable as it used
very familiar and commonly practiced prosthodontic techniques
for workup and fabrication of the
implant and the final prosthesis, but
was very unsatisfactory to the patient
and a big deterrant for undergoing
the therapy.
In the late 1980s and early 1990s
with CT and within the past decade
cone beam volumetric tomographic
(CBVT) scans becoming more common in dental/oral surgical diagg IT page 6
AD

AD
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9 1/4 x 6 3/4

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ICOI
Full Page
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6

Clinical

Implant Tribune | November 2009

Fig. 4a: Mandibular model with the
subperiosteal over it in place.

Fig. 3a: Panoramic.

f IT page 4

nosis and treatment planning, and
medical modeling companies getting
better and more accurate in computer modeling of anatomic structures,
the first stage surgery for the fabrication of an accurate impression of the
jaw was bypassed.
For the “single surgery” method,
a special CT/CBVT scan of the arch
being considered for rehabilitation
is ordered. A replica (radiographic
template) of the final prosthesis is
fabricated with the denture base
made with acrylic with 25 percent
barium sulfate, a radiopaque marker
that shows in the 3-D radiograph
outlining the soft tissue (gum) architecture (Fig. 3).
The radiographic template is
ADS

worn during the scan, and using the
scan data and advanced computer
modeling techniques, a model of the
jawbone and overlaying soft tissue is
constructed.
This stereoithographic model
(Fig. 4) of the alveolus and the overlaying gum (Fig. 5) is used by the
dental laboratory to fabricate the
custom subperiosteal implant and
process and finish the prosthesis for
immediate function.
A surgical procedure is then
carried out where the alveolus is
exposed and the implant placed
and secured to the jaw (with bone
screws) and any gaps between the
implant and the underlying bone
is filled with hard tissue graft of
the dentist’s liking and guided bone
regeneration technique is applied.
The gums are closed with stitches

Fig. 3b: Cross-section view of the
radiopaque radiographic guide;
notice the dehissed mental foramen.

and the prosthetic is put into place
for immediate function.
The patient is instructed in the
usual manner for postoperative
wound and prosthesis care and a
stretchable compression bandage is
applied.
This modern one-stage protocol is
more palatable for the patient who is
more likely to consider this form of
implant therapy versus undergoing
multiple augmentation procedures
to build the ridge to the appropriate dimentions (height and width)
in the certain areas for implantation of appropriately sized rootform
implants. Depending on the location
and type of materials used for augmentation, it could be six months to
up to two years or more before the
patient is rehabilitated with a final
prosthesis.
At times, the patient is not a good
candidate to undergo such significant augmentative procedures either
due to health or financial considerations.

Fig. 5b: Maxilla.

Fig. 4b: Maxilla, occlusal view.

Fig. 4b: Maxilla, anterior view.

Fig. 5a: Mandible.

Fig. 5c: Maxilla degloved.

[7] =>

Clinical

Implant Tribune | November 2009
Case report No. 1
A 61-year-old caucasian female presents with the chief complaint that
her lower denture doesn’t fit well
and every time she wore it, it caused
great pain and a burning sensation
in the lower jaw. She only wore it for
cosmetic reasons and never chewed
with them in and made excuses for
not eating in company of others.
She has been to several dentists,
including prosthodontists, who fail to
fabricate complete removable mandibular dentures she can wear comfortably.
She also has sought consultations
with several oral surgeons who would
only recommend multiple autogenous
onlay grafts in the intermental region
for an implant-supported soft-tissue
bourne overdenture with the possibility of still experiencing pain due to
the free end saddles pressing into the
exposed mental foramen and inferior
alveolar nerve when chewing.
Her past medical history was significant for post-menopausal osteoporosis for which she takes Boniva
(ibandronate sodium) once a month.
She also suffers from hypertension,
which is under control, and for which
she takes a combination of thiazide
diuretic and beta blocker. She also
suffers from panic disorder for which
she takes Zanax (alprazolam) on a
regular basis.
Social history is significant for her
becoming a widow eight years ago
and is socially active, and her only
son was to be married within three
months of consultation.
Her past dental history is significant for periodontal disease, which
was the reason for her losing all of
her teeth by the time she was in her
30s and now having severe atrophy of
both jaws.
Twenty years ago, she began
implant therapy for supporting her
complete mandibular dentures. During the years, the implants failed for
one reason or another and the last one
remaining is fractured with a piece
still integrated but not usable. Both
mental foramen and parts of the mandibular canal are exposed on the crest
of the alveolus with the nerves enveloped in the soft tissue over the crest.
Treatment plans were developed
after an initial panoramic view was
extracted from a CBVT.

Treatment plan No. 1
• Total treatment time: eight to 12
months.
• Anterior illiac crest to be used as a
donor site for block grafts to augment
the intermental region and posterior
mandible with bilateral relocation of
the mental foramen and mandibular
canal more apically and laterally.
• Surgery under general anesthesia.
• Insertion of a full maxillary
removable denture and immediate
insertion complete mandibular denture at the time of mandibular augmentaton.
• Healing time of six months and
then insert four implants to support
an implant-supported locator mandibular overdenture or eight implants
to support a fixed cemented prosthesis and, depending on the primary

Fig. 6: Duplicate cast of the stereolithographic model with the waxup of the
subperiosteal framework with locator
abutments.
stability of the implants, to either load
immediately or delay the load four
months.

Treatment plan No. 2
• Total treatment time: six to eight
weeks. (Patient elected to undergo

this option.)
• One-stage protocol mandibular
subperiosteal (bone contact side coated with hydroxyl appatite) placement
and rigid fixation with bone screws
and simultaneous bilateral relocation
of the mental foramen and mandibular canal more apically and laterally.
• Surgery under I.V. conscious
sedation and local anesthesia.
• Insertion of a full maxillary
removable denture and immediate
insertion of a functionaly loaded complete mandibular denture using four
locator abutments.
• Permanent reline of the lower
prosthesis in two months.

Case report No. 2
A 48-year-old caucasian female presents with the chief complaint that
her lower implant bar-retained over-

denture is extremely uncomfortable,
doesn’t fit well and is cosmetically
unacceptable. She is also unhappy
with the way her maxillary denture
fits and feels.
She has sought consultation from
several dentists including prosthodontists, periodontists and oral surgeons who recommended various
options, including removal of the
existing implants and placing new
ones in a more favorable angulation
and even changing the retention
mechanism from bar to individual
implant retention (o-rings, locators
and type).
For the maxillary denture, all recommended a new denture.
Her past medical history was insigg IT page 8

[8] =>

Clinical

Fig. 7a: Processed final restoration;
maxillary full denture.

Fig. 9: Soft tissue reline of the immediately loaded maxillary denture.

Implant Tribune | November 2009

Fig. 7b: Processed final restoration;
mandibular complete denture.

Fig. 8a: Subperiosteal over the maxillary ridge, held down with bone screws.

Fig. 8b: Bone screws and a mandibular
subperiosteal.

Fig. 10: Pre-op occlusal view of the
severely resorbed mandible.

Fig. 11: Reconstructed view of the mandible with the exposed inferior alveolar
canals highlighted in purple.

Fig. 12: Intraop view of the mandibular
subperiosteal with bone screws visible
on the buccal in the canine region.

Fig. 13: Two weeks postoperative view
of the transgingival locator abutments.
Fig. 14: Lateral Cephalometric view of
the installed mandibular full subperiosteal implant. Notice the intimate fit of
the framework to the underlying bone.

Fig. 15: Initial view of mandibular
denture adapted to the implant-supported bar. Note the angulation of the
implants, making the bar out too far
labially where the buccal flange could
not cover it, and a window cut out to
accommodate the seating of the denture.

Fig. 16: Preoperative panoramic view
outlining the mandibular canal in
purple.

Fig. 20: Anterior view of the completed
dentures in place, attached to the locator abutments.

Fig. 17: Reconstructed 3-D view of the
severely atrophied mandible and the
maxilla with dehissed mandibular
canals.
f IT page 7

nificant and was categorized as an
ASA1 patient. Social history is significant for divorce five years ago, and she
is planning on remarrying in the near
future.
Her past dental history is significant
for becoming completely edentulous
at age 18 upon recommendation of
her dentist. Ten years ago, she had
four implants placed in the anterior
mandibular symphesis out of which
one failed. Her bar was preserved and
made usable with three implants.
Two years ago, she had new mandibular and maxillary dentures fabricated by a prosthodontist that was
recommended by the periodontist who
removed the failed implant.
Treatment plans were developed
after evaluation of the panoramic view
extracted from the initial CBVT.
Treatment plan the patient elected
to undergo: Total treatment time of
eight to 12 weeks.

Fig. 18: One month postoperative view
of the maxillary subperiosteal implant.
• Remove the mandibular anterior
bar and replace it with locator abutments and fabricate a new mandibular
implant-retained overdenture on the
remaining three implants.
• One-stage protocol maxillary subperiosteal (bone contact side coated
with hydroxyl appatite) placement
and rigid fixation with bone screws.
• Surgery under I.V. conscious sedation and local anesthesia.
• Insertion of an immediate insertion (locator attached) complete maxillary denture at the time of implant
placement.

Conclusion
Both patients and others like them
have undergone this type of rehabilitation using subperiosteal implants
without any untoward complications
and have reported satisfactory results
upon visits with the hygienist.
The author would like to acknowledge Dr. Jerome Kaufman, DDS,
(prosthodontist) of Arch Dental at
Le Visage Center for Cosmetic and

Fig. 19: Antero-posterior view of the
permucosal locator abutment’s part
of the maxillary subperiosteal and the
replacement of the mandibular bar for
retention of complete dentures.
Implant Dentistry for performing the
prosthetic workup and completion of
such challenging reconstructions, and
Ryan Dutton, CDT of Dutton Dental
Labratory, Ohio, for his exemplary
fabrication of such difficult and precise
frameworks..
For detailed step-by-step instructions on the protocol for a one- or
two-stage subperiosteal implant and
accompanying prosthetics, please
refer to Chapters 14, 15, 26 of the
“Atlas of Oral Implantology,” third edition.

References
1.www.articlesbase.com/healtharticles/do-you-use-tagamet-pepcidaxid-or-zantac-62586.html
2. M. Spinazzi and M. Armani, Neurol
ogy, July 7, 2009; 73(1):676.
3. Nations SP et al., Neurology 2008
Aug. 26; 71:639.
4. Schaumburg H and Herskovitz S.,
Neurology 2008 Aug. 26; 71:622.
5. L. R. Carney, Neurology, Dec. 1967;
17: 1143.

About the author

Dr. Pankaj Singh has authored the third
edition of the best-selling textbook on
dental implants, “The Atlas of Oral
Implantology,”
which will be
released
in
December.
Singh is an
attending faculty at the Department of Dental
Medicine and
Oral Surgery
at
LIJ-North
Shore University Hospital Medical Center in New York
and is a clinical instructor of advanced
dentistry at New York University College of Dentistry (subatical). He is
the founder and CEO of Arch Dental
Associates and Le Visage Cosmetic &
Implant Dentistry with offices in Manhattan, Huntington and Garden City,
NY. Singh has been in private practice
for more than 15 years, specializing in
implant, sedation, reconstructive dentistry and dental sleep medicine. He
is a graduate of New York University
College of Dentistry. He completed his
advanced training in dental implants at
Brookdale Hospital and NYU.

[9] =>

Implant Tribune | November 2009

Technology

Materialise Dental, Medical Modeling
establish partnership for surgery planning
Materialise Dental, which develops
3-D technology solutions for implant
practices, oral maxillofacial surgeons
and orthodontists, announced recently that it has established a partnership
with Medical Modeling.
The new partnership allows Medical Modeling to exclusively manufacture orthognathic CAD/CAM splints
for the United States market and
equally provide support for the SimPlant® OMS software.
Materialise Dental focuses on 3-D
digital dentistry, offering a range
of integrated solutions in computer
guided dentistry.
With SimPlant OMS, the company
provides an interactive 3-D system
for predictable diagnosis and treatment planning of orthognathic cases.
SimPlant OMS allows for accurate
3-D cephalometric analysis, surgical
simulation and prediction of soft tissue movements.
Based on the surgeon’s pre-operative treatment planning, Medical
Modeling then produces custommade intermediate and final splints
using the stereolithography (SLA)
process, an additive manufacturing
technique.
The splints provide a seamless link
between planning and actual surgery,
ensuring optimal jaw positioning during surgery without any time consuming model surgery.
Bart Swaelens, CEO of Materialise
Dental said: “Medical Modeling has
many years of experience in supporting development of an accurate and
predictable orthognathic surgical protocol. We value the company’s high
esteem for quality service toward its
customers and thus we trust they
will do an excellent job in managing
the SimPlant OMS software support.
Their know-how in orthognathic surgery and our industry expertise in 3-D
treatment planning software complement each other perfectly.”
Andy Christensen, president of
Medical Modeling, said: “We are
proud to partner with Materialise
Dental for the U.S. market, as they
are a fast-growing international company with a strong background in
the research and development of
computer-guided treatment planning
software and patient-specific medical devices. Thanks to our unique
strengths, we can offer surgeons performing orthognathic cases a combination of the best 3-D treatment planning tools and orthognathic CAD/
CAM splints available on the market
today.”
The partnership gives surgeons
the possibility to opt for all-round
assistance during the treatment planning process.
Engineers at Medical Modeling are
equipped to help provide hands-on
assistance for surgical planning using
the software. Additionally, SimPlant
OMS users will gain access to patented technology surrounding Medical
Modeling’s protocol including fidu-

About Materialise Dental

cial registration of occlusal anatomy.

About Medical Modeling
Medical Modeling Inc., based in
Golden, Colo., is a world leader in
production of custom anatomical models made using medical imaging data
combined with additive manufacturing technology. Every day around the

world surgeons count on the company’s
ClearView® and OsteoView® anatomical models to prepare for and guide
complex surgery spanning the fields
of orthopedic surgery, spine surgery,
cranio-maxillofacial surgery and neurosurgery. More information on Medical Modeling can be found at www.
medicalmodeling.com.

Materialise Dental focuses on 3-D digital dentistry by offering a range of products and services to support specialists
in the treatment of their patients. Materialise Dental continues to lead the
dental industry in medical image processing, surgery simulation and rapid
prototyping technology. The company
is represented worldwide by subsidiary
offices and authorized distributors and
is a trusted partner for many of the
largest clinics and research institutions. For more information, see www.
materialisedental.com. IT

[10] =>

[11] =>

Practice Management 11

Implant Tribune | November 2009

Enhance the experience for implant patients
By Roger P. Levin, DDS

The current economy has
changed the way we look at revenue and profitability.
Prior to the downturn, services
like implants were experiencing
tremendous growth. As the economy places a heavier burden on
your patients’ discretionary funds,
elective services, like implants,
are starting to feel the recession’s
impact.
Enhancing the patient experience can help ensure greater
implant success.

Motivate patients with
benefits

Implants should be treated as a
practice within a practice. You
cannot expect success if you run
your implant systems the same
way you run the systems for other
types of services. Because acceptance of implant treatment is
based on emotional decision-making, you must excite patients and
motivate them about the benefits
of implants.
Use the following suggestions to
boost the implant experience:
• Encourage referring practitioners to send all potential patients.
Every patient missing teeth is a
candidate for implant treatment.
Work closely with referring practitioners to showcase the benefits
of implants to all referred patients.
• Schedule implant patients
within seven days or less. The longer it takes to schedule an elective
appointment, the more likely that
the patient will not present.
• Appoint an Implant Treatment
Coordinator (ITC). An ITC is a
specially trained individual who
has the ability to close a high percentage of cases as well as manage financial arrangements.

Exceeding patient
expectations

Patients who receive dental
implants are generally pleased
with the result, especially when
they are given excellent and timely
communication during the treatment process from both the surgical and restorative practices. With
a clear understanding of the procedure and the timeline involved,
patients feel more connected and
assured.
In addition, because the majority of implants are still provided by
multiple practices, it is important
to put the least amount of responsibility on the patient. Levin Group
suggests that you map out every
step of the interdisciplinary process and determine how to communicate next steps, time frames
and all fees along the way.

Conclusion
The success of your implant practice rests on your interaction with
the patient. When a unique experience is created, patients are

pleased with the outcome from an
esthetic and functional perspective. Communicating the value of
treatment helps patients realize
the benefit of implants beyond the
money they are spending.
Trying to decide where to take
the implant side of your practice?
Implant Tribune readers are entitled
to receive a 50 percent courtesy on
a Levin Group Practice Potential
Analysis™ — a six-step, in-office evaluation designed to identify the true
potential of your practice. Call (888)
973-0000 and mention “Implant Tribune” or e-mail customerservice@
levingroup.com with “Implant Tribune” in the subject line. IT

About the author

Dr. Roger P. Levin is founder and chief
executive officer of Levin Group, a leading
implant practice management firm. Levin
Group provides Total Implant Success™,
the premier comprehensive consulting
solution for lifetime success to implant
clinicians in the United States and around
the world.
Levin Group
10 New Plant Court
Owings Mills, Md. 21117
(888) 973-0000 or (410) 654-1234
customerservice@levingroup.com
www.levingroupimplant.com

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implants. NobelProcera provides
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09-10-21 14.20.10

[12] =>

Implant Direct
Full Page
10 5/8 x 15

[13] =>

Implant Direct
Full Page
10 5/8 x 15

[14] =>

AAID Annual Meeting

f IT page 1

gram with high-quality videos and
helpful acronyms such as PABCD
and MONA. Malamed’s presentation
began with a startling video example
of what might happen if a patient or
family member had a heart attack in
the waiting room of an unprepared
dentist’s office. The dentist and staff
did not have a plan for this type of
event, and the victim in this video
died.
“It didn’t have to be like this,” Malamed said. “Are you prepared? Is your
entire office staff trained for an emergency situation?”
To the musical strains of “Stayin’ Alive,” the University of Southern California professor offered tips
and advice. His main point was “your
legal obligation is to keep the patient
alive,” which means following steps to
ensure the patient either gets better or
simply remains alive until emergency
professionals arrive on the scene.
Acronyms such as PABCD (positioning; airway; breathing; circulation;
definitive care) and MONA (morphine;
oxygen; nitroglycerin; aspirin) will
help practitioners remember what to
focus on during an emergency.
“Remember: Doing nothing means
the person is going to die,” he said.
He also recommended that everyone purchase automated external
defibrillators (AEDs) to use in the case
ADS

of an emergency.
“They’re simple to use, they’re
available over-the-counter, you cannot do it wrong, and you might save
a life.”
• Laser treatments: Dr. Edward
Kusek of Sioux Falls told his AAID
colleagues he has employed lasers
in most of the surgeries he has performed in the last five years, which
include implants and endodontic procedures. He said the lasers use low
levels of non-ionizing radiation and
actually generate less heat and discomfort than other devices commonly
used in dental surgery.
“Erbium and/or diode lasers can
accelerate healing in dental surgery
and are very effective for detoxifying an area to clear up infection,”
Kusek said. “In our practice and in
several studies we have conducted,
lasers have proven to stimulate better
tissue growth and height and also foster stronger bone growth and better
contact with the implant. As a result,
we have cut the cycle time for most
implant procedures from six to three
months.”
Kusek added that for most patients,
laser detoxification allows immediate
placement of the implant and securing
a temporary crown in one visit. “Being
able to send the patient home in one
day with an immediate load implant in
the smile zone helps socially because
the missing teeth aren’t noticeable,”

Implant Tribune | November 2009

Dr. Stanley Malamed explains why all practitioners need to be prepared
for an emergency in their dental office.
he said. “Three months later, the permanent crown can be affixed.”
In his presentation, Kusek covered
the case of a young woman whose root
canal failed because the root cracked
and the area was badly infected. The
tooth was extracted and the laser was
used to clear up the infection. “Once
the socket and surrounding area were
detoxified by the laser treatment, the
implant was inserted and a temporary
crown attached. The patient went
home with her smile looking great
and the final outcome in three months
was excellent,” said Kusek. “Given
the degree of infection, she would
not have received an immediate-load
implant in the same visit without the
laser treatment.”
Kusek said about 7 percent of
dentists have some type of lasers in
their offices and many are evaluating the cost benefits. “In my experience, nothing matches laser applications for overall implant procedure
outcomes in infection management,
bone regeneration, osseointegration,
tissue-growth enhancement and overall esthetic success,” he said.
• Esthetic zone: Dr. Eric Van Dooren, who maintains a private practice in Belgium, provided a lecture
focusing on less invasive procedures
that allow for preserving soft-tissue
quality.
“It’s all about soft-tissue stability,”
Van Dooren said.
He offered surgical and prosthetic
concepts for five different cases and
explained what sort of intuition he
used to determine which techniques
to use in each case.
Some techniques Van Dooren dis-

cussed included modified socket seal
surgery, flapless surgery, both delayed
and immediate implant placement,
connective tissue grafting with BioOss, and hybrid techniques.
• Accessible treatment: In a candid address, noted dental researcher,
author and lecturer Gordon Christensen, DDS, PhD, urged more dentists to add implants to their practices,
but said the procedure must become
simpler and less costly to achieve optimal public and professional acceptance.
“I strongly encourage more dentists to add implants to their practices
and make this treatment accessible
and affordable for their patients,”
Christensen said. “The statistics on
missing teeth in the U.S are staggering and, frankly, embarrassing for
the dental profession. We can make a
major contribution to improving the
nation’s oral health by further utilization of dental implants, but we must
get serious about reducing the cost
of the procedure. Ultimately, costly
implant placements don’t serve the
public or the profession, even though
dental implants are the best treatment available for replacing missing
teeth.”
Impressive advances in technology
have made implant procedures safer
and more predictable with 95 percentplus success rates, Christensen noted.
“However, we need more innovative and simpler implant designs
— short, wide, narrow, hollow, nonround — and simpler and more reliable methods for evaluating bone
quality, quantity and osseointegration.” IT

[15] =>

Implant Tribune | November 2009

AAID Annual Meeting 15
Clark Barousse of
BioHorizons offers
information about the
company’s implant
technology.

A Southern Implants official shows
off the wide variety of implants
available through the company.

Scenes from AAID
Implant Direct President
Gerald Niznick talks to
AAID attendees about
his company’s varied
implant offerings.

Sabine Nahme, director of dental
CT sales and business development for PreXion, shows off the
company’s scanner.

Impladent has exhibited
at the AAID for more
than 20 years.

Piezosurgery’s Caleb Hill
shows an AAID attendee
how easy it is to use the
technology with the use
of a fresh egg.

Matt Tedrow of Materialise
Dental walks a customer
through the basics.

Joseph Jung, DDS, asks questions about ACE Surgical
technology to Tim Ritchey.

[16] =>

16

Events

Implant Tribune | November 2009

AAOMS offers implant conference
The American Asssociation of
Oral and Maxillofacial Surgeons
will host Dental Implant Conference
ADS

2009 from Dec. 3–6 at the Sheraton
Chicago Hotel and Towers in Chicago.

The meeting will focus on topics
such as immediate loading partialand full-arch restorations; custom
vs. CAD/CAM vs. stock ceramics
abutments; advances in treatment
planning; advances in delivery of
care for the implant patient; and
short- and long-term effects of
implant restorations compared to
traditional dental restorations.
Speakers include Drs. Maurice
A. Salama; Joseph Y. Kan; Sonia
Leziy; Jaime L. Lozada; Lars Sennerby; Steven J. LoCascio; Jonathan
Ferencz; Ira D. Cheifetz; and many
more.
For more information, see
www.aaoms.org/implant_
conference/2009/. IT

IT

[17] =>

Events 17

Implant Tribune | November 2009

NYU, ICOI
to host
20th event
New York University College
of Dentistry, Ashman Department of Implant Dentistry, and
the ICOI will co-host their 20th
Annual Implant Symposium at
NYU this winter.
The theme for this symposium is “Advances, Challenges
and Innovations in Successful
Implant Therapy” and will feature an impressive list of international speakers. Main podium
lecturers will be Drs. Alan Herford (USA), Lars Sennerby (Sweden), Stefan Fickl (Germany),
George Zarb (Canada), Giulio
Preti (Italy), Edwin McGlumphy
(USA), Kevin Murphy (USA), Jay
Malmquist (USA), Scott Ganz
(USA), John Cavallaro, Jr. (USA),
William Giannobile (USA), Istvan Urban (USA) and Hom-Lay
Wang (USA).
For more information or to
register for this meeting contact
the ICOI at the following:
E-mail: icoi@dentalimplants.com
Phone: (973) 783-6300
In addition to the two-day
doctors’ program, the Association of Dental Implant Auxiliaries (ADIA), will conduct a
full-day Implant Certification
Program for dental auxiliary
staff members on Saturday,
Dec. 12.
This event will be presented
by Lynn Mortilla, RDH. The program, open to all staff members, will address all aspects of
dental implantology including
treatment planning, surgical,
prosthethic and maintenance
procedures, case presentation,
financial arrangements, insurance issues and more.
Interested auxiliary staff
should contact NYU at:
E-mail: dentalcde@nyu.edu
Phone: (212) 998-9757

AO to offer new approaches,
unexpected complications
Different approaches to implant
therapy and solutions to unexpected
complications are among the highlights
of the Academy of
Osseointegration’s
25th anniversary
annual meeting
from March 4–6
at the Walt Disney
World Dolphin
Resort.
“Treatment
Approaches:
Controversies
in Implant Den- Dr. Stuart
tistry,” held Fri- Froum
day, March 5, and
Saturday’s “Unexpected Complications:
Complications and Solutions,” are key
pillars of the meeting’s overall theme,
“The Formula for Predictable Implant
Success.”
“The 2010 meeting will serve as
a celebration of everything we have
learned in the past 25 years, and how
that knowledge is applied for the benefit of our patients today,” Annual
Meeting Committee Chair Dr. Stuart
Froum, New York, NY, explains. “Our
focus is on exploring how the exciting
treatment innovations we’ve witnessed
over the last quarter century enable us
to increase predictability and optimize
outcomes in an age where esthetics
have never been more valued.”

Treatment approaches,
controversies

Friday’s implant therapy program
gathers an international roster of
experts to review the latest treatments and materials through an evidence-based approach.
Topics and presenters for “Treatment Approaches: Controversies in
Implant Dentistry,” include:
The Esthetic Zone — Do We Build
the Ridge or Build the Bridge? Dr.
Peter K. Moy, Los Angeles, Calif., will
discuss methods of classification for
both hard and soft tissues, correlating surgical procedures that aid the
surgeon in achieving success and predictable results with augmentation
procedures.
Decision-Making Process for the
Prosthetic Approach: Hybrid Versus Pink Porcelain. Dr. Axel Kirsch,
Filderstadt, Germany, will present a
proposal for a clinical classification of
alveolar hard- and soft-tissue deficits.
Based on this classification, Kirsch
will discuss selected solutions with
hybrid or pink porcelain cases according to the “backward planning concept,” or restorative-driven planning.
Is Zirconium the Ideal Material for
Implant Frameworks? Drs. Stephen
J. Chu, New York, N.Y., and Joerg
R. Strub, Freiburg, Germany, will
present differing perspectives on the
effectiveness of zirconium in implant
abutments and crowns. Attendees will
learn the various applications of zirconium for implant frameworks.
Timing of Implant Placement —

Advantages of Early Placement. Dr.
Daniel Buser, Bern, Switzerland, will
examine the effectiveness of implant
placement after four to eight weeks of
soft-tissue healing.
Timing of Implant Placement —
The Immediate Approach: Indications,
Contradictions and Coordinated Therapy. Dr. Barry D. Wagenberg, Livingston, N.J., will discuss a study of
1,925 immediate implant cases that
includes the effects of modifiers such
as gender, smoking, medications and
diseases.
The Advantages of the Root Submergence Technique (RST) for Pontic Site
Enhancement. Dr. Maurice A. Salama,
Atlanta, Ga., will detail the RST strategy and why it can more predictably
provide esthetic implant results for
multiple tooth replacement cases.
Managing Esthetics with Two
Adjacent Implants. The challenges
of placing side-by-side implants are
well documented. Dr. Nigel A. Saynor,
Stockport, U.K., will examine the limits and set parameters that influence
where implants can be placed side-byside with successful esthetic outcome.

Implant complications, solutions
The meeting’s closing symposium,
“Unexpected Complications: Complications and Solutions,” held Saturday,
March 6, will address common problems that clinicians are encountering
with greater frequency.
“The increasing number of implant
complications is something we did
not envision 25 years ago. Back then,
we measured success by whether an
implant worked or didn’t work,” Dr.
Froum recalls. “Complications are a
growing part of our everyday practices, due in part to the sheer number
of implants being placed.
Saturday’s session on complications
will explore why problems occur, how
to treat them and what we can do to
prevent them.”
Topics include:
Risk Factors: Dr. Myron Nevins,
Swampscott, Mass.;
Treatment Planning Failures: Dr.
Nicholas Elian, Englewood Cliffs, N.J.;
Soft-Tissue Esthetic Failures: Dr.
Bobby L. Butler, Seattle, Wash.;
Hard-Tissue Failure: Dr. Donald S.
Clem, III, Fullerton, Calif.;
Restorative Failures: Dr. Michael R.
Norton, London, U.K.;
Esthetic Failures Caused by Implant
Malpositions: Dr. Daniel Buser, Bern,
Switzerland.
The 25th anniversary annual meeting will kick off Thursday, March
4, with the opening symposium, “A
Quarter Century of Experience: The
Formula for Predictable Implant Success in the Esthetic Zone.” Moderated
by Dr. William R. Laney, the program
will address risk evaluation factors,
clinical application of computer-guided surgery for implant placement,
techniques to optimize provisional-

ization in the esthetic zone and final
prosthesis.
Program speakers include Drs.
Ueli Grunder, Zurich, Switzerland;
William C. Martin, Gainesville, Fla.;
Konrad H. Meyenberg, Zurich, Switzerland; Louis F. Rose, Philadelphia,
Pa.; Alan L. Rosenfeld, Park Ridge, Ill.;
Clark M. Stanford, Iowa City, Iowa;
and Dennis P. Tarnow, New York, N.Y.
Other annual meeting highlights
will include:
Hands-On Workshop — This premeeting, daylong series of sessions
will explore how 3-D imaging and
navigation technology helps providers
fabricate surgical templates, generate
final prosthesis and place implants
more effectively as part of the “team
approach” concept. The Hands-On
Workshop Committee has secured
the support of Astra, BioHorizons,
BIOMET 3i, Keystone Dental and
Nobel Biocare to provide equipment,
supplies and speakers for each session. (Wednesday, March 3)
AO Corporate Forum — AO’s 2010
Corporate Forum features 36 manufacturer-hosted educational sessions
that showcase the latest research,
products, techniques and developments. (Thursday, March 4)
“Two-Track” Scientific Program —
The Surgical Track will explore “Surgical Procedures to Enhance Implant
Success in the Esthetic Zone.” The
Restorative Track, “Where, When,
Why and How,” will cover prosthetic
considerations for restoring angled
or tilted implants; endodontics vs.
implants; and early predictors for biological and technical complications.
(Saturday, March 6)
Round Table Clinics — Twelve
separate sessions offer attendees
the opportunity to discuss diverse
implant dentistry topics — everything
from immediate placement of widediameter implants and image-guided
surgery to implant complications in
small, informal settings with presenters. (Friday, March 5)
Limited Attendance Lectures —
These lectures increase interaction
between annual meeting attendees
and world-class clinicians on a range
of topics, including strategies and
techniques for maxillary sinus elevation, the sandwich osteotomy and
immediate loading for the edentulous
patient. (Friday, March 5)
Allied Staff Program — The annual
meeting’s Allied Staff Program, scheduled for Saturday, March 6, offers concurrent sessions designed for dental
lab technicians and hygienists. The
daylong series of programs includes
technical and scientific-based lectures
that tie in with the meeting’s overall
theme.
The AO will distribute complete
program and registration information
in December. Additional information
on the 2010 annual meeting is available online at the Academy’s Web site
at www.osseo.org. IT

[18] =>

AO
Full Page
10 5/8 x 15

[19] =>

Industry 19

Implant Tribune | November 2009

Zimmer launches Hex-Lock short abutment
Zimmer Dental Inc., a leading
provider of dental oral rehabilitation products and a subsidiary of
Zimmer Holdings, Inc., is pleased
to announce the availability of the
Hex-Lock® Short Abutment and
Restorative System in the United
States.
Created to minimize the challenges faced by clinicians and labs,
this new, all-inclusive system promotes simple, immediate and convenient posterior restorations.
The Hex-Lock Short Abutment
and Restorative System includes
the new titanium Hex-Lock Short
Abutment and corresponding Short
Restorative Components, innovatively designed to address a myriad
of challenges presented to clinicians and labs during the posterior
restoration process, including limited interocclusal space, reduced
visibility and time-consuming prep
work.
With the Hex-Lock Short Abutment’s reduced cone height, predetermined margins and off-the-shelf
convenience, chair and preparation
times can be significantly reduced.
The all-inclusive Restorative System provides snap-on caps for easier abutment level impression tak-

The Hex-Lock
Short Abutment
by Zimmer.

ing, and prefabricated copings for
immediate provisionalization and
final crown preparation — all in the
name of optimum efficiency.
Because the restorative protocol
is the same as Zimmer Dental’s
Hex-Lock Contour Abutment System, no additional learning curve is
required, and with color-coding to
match the emergence profiles, customers have a system that is simple,
immediate and convenient.
The Hex-Lock Short Abutment
and Restorative System is ideal for
single- and two-stage protocols, and
is designed to work seamlessly with
the popular Tapered Screw-Vent®
and Screw-Vent® Implant Systems.
Contact a Zimmer Dental Sales
Consultant or Customer Service at

The Hex-Lock
Short Abutment
and Restorative
System includes
the new titanium
Hex-Lock Short
Abutment and
corresponding
Short Restorative
Components

(800) 854-7019, (760) 929-4300 (for
outside the United States), or visit

www.zimmerdental.com for more
information. IT
ADS

[20] =>

Industry

Implant Tribune | November 2009

RIEMSER launches CollaGuide membrane
RIEMSER, Inc., a leading supplier of bone regeneration products, announces the launch of CollaGuide™, a new collagen membrane
designed for ease of handling, based
on its resiliency, and ease of placement, based on its translucency and
adherence to surrounding tissue.
CollaGuide is approved for guided
tissue regeneration (GTR) and guided bone regeneration (GBR) indications.
Derived to ensure the highest
purity, CollaGuide membrane,
developed and manufactured by
Kensey Nash Corporation (NASDAQ:
KNSY), contains no chemical crosslinking. Unlike many other collagen
membranes, CollaGuide is transAD

lucent and non-friable with a morphology of dense fibers that gives it
mechanical strength. In addition,
its fibrous structure creates porosity
that retards epithelial down growth
and prevents gingival connective
cell migration into the wound site.
CollaGuide is available in three
sizes: 15 mm x 20 mm, 20 mm x
30 mm, and 30 mm x 40 mm.
“Because of interest from dental practitioners, we wanted to add
an easy-to-use collagen membrane
to our product line for the busy
implant office,” said Rick Patton,
RIEMSER vice president. “Based on
its combination of transparency, pliability and dual-sided application
— i.e., the doctor can place it either
side up — CollaGuide will simplify
procedures, particularly because it
can be sutured into place using
absorbable sutures or affixed with
resorbable tacks.”
RIEMSER Inc., based in Research
Triangle Park, N.C., has a product portfolio that also includes
Cerasorb® M grafting material,
EpiGuide® membrane, REVOIS®
implant products, and the Bacterin
family of products, including OsteoSponge® Block, OsteoSponge® Filler,
OsteoWrap® and D-Block. IT

PaX-REVE3D
by eWoo
available
PaX-REVE3D is the new flagship three-in-one dental CBCT from
VATECH and E-WOO. The combined X-ray modalities of digital
pano, ceph and dental CBCT provide
the ultimate versatility of a single
X-ray system and increase the system utilization rate to one that was
never available before.
PaX-REVE3D offers the field-ofview (FOV) size of 15-by-15 cm,
which provides the anatomical information of the maxillofacial region,
including a condyle on both sides,
with a single scan.
The size of the FOV is customizable, based on an individual treatment
need to avoid radiographic information and X-ray exposure in places
other than at the region of interest. It
is equipped with a flat-panel, cephlometric X-ray detector (FPXD) that produces a radiographic image quality
comparable to a digital picture.
The new FPXD from VATECH
and E-WOO captures a radiographic
image in less than a half second,
which means no image distortion
from patient movement. IT
VATECH and E-WOO
256 North Sam Houston Pkwy. N,
No. 115
Houston, Texas 77060
(888) EWOOUSA (396-6872)
www.ewoousa.com

[21] =>

Implant Tribune | October 2009

Folio 21

[22] =>

Products

Implant Tribune | November 2009
Salvin OraPLUG & OraMEM

Salvin OraPLUG
The Salvin OraPLUG® is an absorbable collagen sponge with the follow-

ing features:
• Controls bleeding and stabilizes
• Excellent for extraction and blood clots
biopsy sites
• Protects wound bed
• Protects matrix for tissue ingrowth
• Absorbed in 10–14 days

ADS

Salvin OraMEM
The Salvin OraMEM® is an absorbable collagen membrane with the following features:
• For use in guided tissue regeneration procedures
• Excellent handling properties
• Bioabsorbable and biocompatible
• Provides wound stabiliztation
• Ideal for space creation
OraMEM absorbs in four to eight
weeks while OraMEM-Sustained®
absorbs in 18 weeks.

Salvin Dental Specialties
(800) 535-6566
www.salvin.com

Implant Direct’s
Legacy 1, 2 and 3
Systems

Twenty-three years after Dr.
Gerald Niznick introduced the
first conical connection with
an internal hex, Implant Direct
announces the launch of the Legacy™ 1, 2 and 3 Systems, expanding the surgical and prosthetic
options with the most copied
platform in the implant industry (Niznick U.S. Pat. #4,960,381
expired Oct. 2007).
All three systems share the
same surgical protocol, colorcoded prosthetic platform and
surface options of SBM or HA
($25 extra).
Dentists make selection based
on cost, which varies based on
a choice of fixture-mounts. All
three implants provide doublelead body threads for faster
insertion and quadruple lead
mini-threads near the top for
increased stability and reduced
stress concentration in the critical crestal area.
All Legacy Implants are packaged with a surgical cover screw
and an extender for use as a
2 mm healing collar.
Implant Direct
27030 Malibu Hills Road
Calabasas Hills, Calif. 91301
(888) 649-6425
www.implantdirect.com

[23] =>

[24] =>

00

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Implant Tribune | September 2009

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[cover] => Implant Tribune U.S.

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