Implant Tribune U.S. No. 2, 2012
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[1] =>
ed
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AO
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IMPLANT TRIBUNE
The World’s Dental Implant Newspaper · U.S. Edition
february 2012 — Vol. 7, No. 2
www.dental-tribune.com
industry clinical
Zirconium
dioxide
implant
solutions
A metal-free option
By David DiGiallorenzo, DMD
The newly upgraded Phoenix Convention Center is the site of the Academy of Osseointegration’s annual meeting in February.
Photo/Provided by Academy of Osseointegration
‘Finally, AO meeting
comes to Phoenix’
Academy of Osseointegration
F
or the first time in the Academy
of Osseointegration’s 28-year
history, the AO Annual Meeting
will be held in downtown Phoenix, also known as “Valley of the Sun.”
Why haven’t the AO leaders previously
elected to hold the meeting in the largest
capital city in the United States (1,445,632
people, 2010 U.S. Census)? In a word, because until recently, Phoenix didn’t have
a convention center large enough to accommodate the academy’s expanding
meeting space needs.
Early settler and former Confederate
veteran Jack Swilling, who came west to
seek wealth in the 1850s, probably never
imagined the growth that was to come
to the city he founded and wanted to
call Pumpkinville because of the large
pumpkins that flourished in the area.
Now it attracts more than 13 million visitors each year. As you can imagine, Swilling didn’t get too much support for the
Pumpkinville name, so he decided to
call his new settlement “Stonewall,” after
General Stonewall Jackson. It wasn’t until
his good friend, Lord Darrell Duppa, sug-
Dental Tribune America
116 West 23rd St., Ste. 500
New York, NY 10011
By Kevin P. Smith, Executive Director
gested the name Phoenix to describe a
city born from the ruins of a former civilization, the Hohokam peoples, that the
name was finally accepted.
The leaders of the academy agreed Phoenix (located in the Sonoran Desert) would
be a perfect place to hold the AO 27th Annual Meeting, from March 1-3. Its newly expanded Phoenix Convention Center is specifically designed to exhibit the look and
feel of the Southwestern culture in a warm
winter climate, with daily winter temperatures in the mid-70s. It was agreed that
many of the Eastern and Midwestern AO
members would certainly appreciate meeting in this subtropical and arid climate, as a
relief from harsh winter climates.
A multi-phased $600 million expansion project, which nearly tripled the size
of the Phoenix Convention Center, makes
it possible to hold the academy’s 2012
meeting there. The design of the convention center features steel canopies that
extend over Third Street to create shade.
The large glass and stone atrium in the
West Building represents the unique angles and light of an Arizona canyon. More
than $3.2 million of fine art is on display
throughout the convention center. Also,
many restaurants are in the food court
for all attendees to enjoy.
The entire meeting takes place in the
” Continue on Page 2
Zirconia dioxide has a long history
of use in orthopedic and dental applications. Zirconium (Zr) is a metal; however, through a chemical reaction with
oxygen, zirconium is converted to
zirconia or zirconium dioxide (ZR02).
Currently, there are several manufacturers of zirconia dioxide dental implants.
Z-Systems, a Swiss-manufactured
single-piece dental implant, was FDA
approved more than four years ago
for use in tooth-replacement therapy.
Developed in 2001 by Dr. Ulrich Volz,
in collaboration with Metoxit, a world
leader in the production of ceramic
material, the new implants offered
a predictable way to produce strong,
dimensionally stable, metal-free implants using the isostatic process.
A key element of success in the process is the quality of the raw materials
and the technology of the production.
” Continue on Page 14
Fig. 1: The single-stage design eliminates the
effects of the microgap and micromotion on
the crestal interface of bone and soft tissue.
Photos/Provided by David DiGiallorenzo
PRSRT STD
U.S. Postage
PAID
San Antonio, TX.
PERMIT #1396
[2] =>
2
“ From Page 1
convention center, which is located just
across the street from the academy’s official meeting hotels, the Sheraton Phoenix Downtown Hotel and Hyatt Regency
Phoenix, both just four miles from the
Phoenix Sky Harbor International Airport. Airport shuttle transportation will
again be provided for all attendees by a
grant from Astra Tech.
There is lots to see and do while attending the meeting, with many museums
and attractions to enjoy for a uniquely
Southwestern experience. Stroll through
the Desert Botanical Garden to see desert plants, or visit the Heard Museum for
Native American art and culture. If it‘s
contemporary art you seek, the Phoenix
Art Museum and SMOCA are for you. If
you have kids, the Children’s Museum of
Phoenix and the Phoenix Zoo are mustdos.
Save the Arizona Science Museum for
the President’s Reception, open to all
registered AO meeting attendees. The
President’s Reception on Friday night at
the Science Center will include the Irene
Flinn Theater featuring IMAX technol-
News
ogy enabling outstanding films in 3-D.
The reception is sponsored by DENTSPLY
Tulsa Dental.
Also, we will have the new Dorrance
Planetarium reserved throughout the
evening, with special planetarium shows
designed just for AO attendees. The Science Center promises to be another AO
social event experience that you will not
want to miss.
The entire facility is open for the evening with convenient serving stations
located throughout the premises. A special, high-powered telescope exhibition
will be offered in the observatory area
just for AO guests. Who knows, you might
even see the remnants from the famous
“Phoenix Lights” UFO sightings that took
place exactly 12 years ago to the date of
our March meeting.
If you have some spare time from the
busy meeting sessions, explore the Phoenix area’s natural sights, as it is known for
its lush and colorful deserts and rugged
mountains.
For the more adventurous, you can partake in the area’s hiking and biking trails.
Also, during the time of the AO meeting,
15 major league baseball teams will be
conducting spring training in the metro
Phoenix area in what is known as The
Cactus League. You can get up close and
personal with your favorite major league
stars.
We expect many attendees will consider staying a few extra days to visit the
Sedona Valley and/or the Grand Canyon,
only 90 minutes away. It’s no secret that
Phoenix and Scottsdale also boast some
of the world’s top-rated golf courses, so
don’t forget to pack your clubs and book
18 holes at one of more than 200 golf
courses in the area. Prospects are excellent for a pleasant day of golf, as Phoenix
boasts 310 days of sun throughout the
year.
How can you not plan to attend the
Academy of Osseointegration’s 27th Annual Meeting? You owe it to yourself,
your staff and family to join us, take
advantage of everything that Phoenix
has to offer, obtain C.E. credits and keep
up-to-date with the latest dental implant
technology. The annual meeting theme,
“Technology to Practice,“ has been carefully designed to provide stimulating
and evidence-based presentations that
offer something for everyone.
CAD/CAM innovation: a pathway to
better implant restorative dentistry
By Carl Drago, DDS, MS
Functionally and esthetically optimal
dental restorations traditionally have been
fabricated by restorative clinicians and dental laboratory technicians using impressions, casts and articulator mountings prior
to waxing and casting metal frameworks.
These procedures are labor-intensive, and
the accuracy of the casts depends on many
factors, including the water/powder ratio,
type of dental stone employed, and impression materials and techniques.
Each step introduces the potential for
human and/or material error. And yet the
success of implant prosthodontic treatment depends to a large extent on the accuracy of transferring implant positions
intraorally to master casts.
Moreover, the traditional impressionmaking process requires the placement
and removal of impression copings from
implant-restorative platforms. Minimizing the frequency of tissue disruption
could prove beneficial in maintaining both
peri-implant bone height and peri-implant
soft tissue adjacent to implant restorations.
The use of computer-aided design and
computer-aided manufacturing (CAD/
CAM) technology offers a pathway to
reduced tissue disruption and greater
framework accuracy. CAD/CAM tools for
diagnosis, treatment planning, surgery,
prosthetic treatment and laboratory procedures have become an intimate part of
implant dentistry.
CAD/CAM abutments and frameworks
are now routinely fabricated from commercially pure titanium, titanium alloy
and zirconia by various implant companies and milling centers. Such frameworks
have proven to be more accurate than traditional cast restorations.
Implant Tribune U.S. Edition | February 2012
Implant Tribune
Publisher & Chairman
Torsten Oemus t.oemus@dental-tribune.com
Chief Operating Officer
Eric Seid e.seid@dental-tribune.com
Group Editor
Robin Goodman r.goodman@dental-tribune.com
Editor in Chief IMPLANT Tribune
Sascha A. Jovanovic, DDS, MS
sascha@jovanoviconline.com
Managing Editor Implant Tribune
Sierra Rendon s.rendon@dental-tribune.com
Managing Editor Show Dailies
Kristine Colker k.colker@dental-tribune.com
Managing Editor
Fred Michmershuizen
f.michmershuizen@dental-tribune.com
Managing Editor
Robert Selleck, r.selleck@dental-tribune.com
Account Manager
Humberto Estrada h.estrada@dental-tribune.com
Marketing Manager
Anna Wlodarczyk-Kataoka
a.wlodarczyk@dental-tribune.com
Marketing & SALES Assistant
Lorrie Young l.young@dental-tribune.com
C.E. Manager
Christiane Ferret c.ferret@dtstudyclub.com
Dental Tribune America, LLC
116 West 23rd St., Suite 500
New York, N.Y. 10011
Phone (212) 244-7181
Fax (212) 244-7185
Published by Dental Tribune America
© 2012 Dental Tribune America, LLC
All rights reserved.
Dental Tribune America strives to maintain the utmost accuracy in its news and clinical reports. If you
find a factual error or content that requires clarification, please contact Managing Editor Sierra Rendon at
s.rendon@dental-tribune.com.
Dental Tribune America cannot assume responsibility for the validity of product claims or for typographical errors. The publisher also does not assume
responsibility for product names or statements made
by advertisers. Opinions expressed by authors are
their own and may not reflect those of Dental Tribune
America.
Editorial Board
Dr. Sascha Jovanovic, Editor in Chief
Dr. Bernard Touati
Dr. Jack T. Krauser
Dr. Andre Saadoun
Dr. Gary Henkel
Dr. Doug Deporter
Dr. Michael Norton
Dr. Ken Serota
Dr. Axel Zoellner
Dr. Glen Liddelow
Dr. Marius Steigmann
Dr. Pankaj Singh
Corrections
The Academy of Osseointegration‘s annual meeting will include a day-long program of
technical and scientific-based lectures for dental lab technicians. Photo/Provided bythe AO
Laser and tactile scanning are enabling
better and less invasive diagnostics, and
other CAD/CAM tools are making it possible to create restorations that fit more
precisely, take less time to fabricate and
may result in decreased costs.
An excellent opportunity for dental laboratory technicians to stay abreast of this
rapidly evolving technology will be at AO’s
upcoming annual meeting in Phoenix. It
will include a special day-long program of
technical and scientific-based lectures for
dental lab technicians.
The AO program will present protocols
and instrumentation for using scanned
images of the natural dentition (prepared
teeth) and implants. Scanning may be
acccomplished intraorally, thereby eliminating the errors associated with impressions and casts. Vertical gap measurements of scanned wax copings have been
reported to be significantly larger than
those noted in copings designed virtually
in a computer.
About the author
Dr. Carl Drago, clinical director of EON Clinics in
Waukesha, Wis., received his dental degree from
Ohio State University College of Dentistry in Columbus, Ohio, and a masters degree from the University
of Texas Graduate School of Biomedical Sciences at
San Antonio, Texas. A diplomate of the American
Board of Prosthodontics, he has published three
textbooks on dental implants.
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.
Tell us what you think!
Do you have general comments or criticism
you would like to share? Is there a particular
topic you would like to see articles about in
Implant Tribune? Let us know by e-mailing
feedback@dentaltribune. com. We look
forward to hearing from you! If you would
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(name, address or to opt out) please send us
an e-mail at database@dental-tribune.com
and be sure to include which publication
you are referring to. Also, please note that
subscription changes can take up to six
weeks to process.
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Ace
[4] =>
Trinon
[5] =>
5
education
Implant Tribune U.S. Edition | February 2012
Trinon Collegium Practicum: practical
implantology courses for clinicians
Continuing education in dental implantology has traditionally focused on
theoretical aspects. However, since 2003,
the Trinon Collegium Practicum has organized practice-orientated dental implantology courses based on the model of
surgeon training in European hospitals,
enabling dentists to have a firmer grasp of
implantology.
Entering implantology can be difficult
for dentists to achieve successfully. It is
not a subject of university education, and
with international universities and courses being focused largely on theoretical
orientation, it proves a time-consuming
endeavor. Furthermore, in international
education and training programs, the
dentists almost never work on patients or
might work on phantom cases, classified
as hands-on.
This, according to Prof. Rainer Valentin,
board member of the German Society for
Dental Implantology (DGZI), led to education in implantology placing an increasing emphasis on theoretical training,
which then results in a neglect of practical experience and, most importantly, the
proof thereof.
This phenomenon is repeated globally
and results in dentists often lacking in
confidence and developing a fear of complicated cases, which essentially leads to
long pauses between individual implants
and a limited learning curve.
Learning by doing
The Q-Implant Marathon is one reaction to this situation in the continuouseducation sector. Started in 2003 in
Cuba, and since conducted more than
70 times in four countries worldwide,
the course is designed to be purely
hands-on with a real patient experience
under strict supervision from international surgeons and university hospitals. Participants with a strong theoretical foundation in implantology spend
five days assisting in and performing
surgery, placing approximately 30 implants within this short period.
“One only is confident doing what one
knows,” said Dr. Harald Glas from Vienna,
summarizing the positive effect of practical education. During the Q-Implant
Marathon, Glas worked with international peers and supervisors on several cases
a day. Every case is discussed beforehand
with the supervising tutor and assisting
surgeon; furthermore, even during the
surgery, questions about surgical treatments are addressed.
Patients are prepared and followed-up
by the resident team of the university
hospital and, in most cases, are immediately provided with long-term temporary
restorations so participants can see the result of the treatment and complete their
photographic documentation.
The phased approach of the Q-Implant
Marathon, which accounts for 45 dental CME points, divides participants in
three levels: Beginner, Advanced I and
Advanced II.
This gives dental practitioners an opportunity to learn the relevant practical
The Q-Implant Marathon team with participants in Santo Domingo. Photos/Provided by Trinon Collegium Practicum
knowledge they require at their home clinics.
Beginners’ courses are working on basic implant cases whereas surgeons with
considerable experience can venture into
more complicated cases with the knowledge and safety of having a supervisor to
discuss the case and assist during surgery.
The concept of hands-on courses has
been influenced by surgeon training in European hospitals where emphasis on practical surgical training of young doctors is at
the center from day one. The experienced
surgeon guides the hand of the assistant
physician and gives him the feeling for
working on patients while in a safe and
controlled environment.
“Learning by doing is the most successful way to gain experience in implantology
and that is why we do it that way,” said Dr.
Alfredo Valencia, the scientific director of
the Q-Implant Marathon program.
A focus on the United States
Today, the concept has been rolled out
throughout three permanent locations
worldwide with one in Dominican Republic and two courses in Asia. In the last
eight years, the Trinon Collegium Practicum has seen more than 2,000 dentists
participate in the Q-Implant Marathon
with more than 12,000 patients treated
and more than 30,000 implants placed.
The decision to conduct these handson courses in Dominican Republic stems
from the rising number of dental implantologists in the United States and its surrounding regions, a growing number of
patients demanding a high level of care
and the overall lack of practice-orientated
courses in close proximity to American
dentists. The course in Dominican Republic is based in Santo Domingo and has been
conducted more than 26 times. This course
collaborates with private clinics, where
the clinic equipment is comparable to U.S.
standards; similarly, the infrastructure is
more or less comparable to the situation in
the United States. All of the Trinon Collegium Practicum courses have ensured that
conditions under which surgeons work
have appropriate standards including surgical equipment, professional tooth scaling for patients, digital X-ray equipment
and modern dental treatment chairs.
The head instructor for the Q-Implant
Marathon in Santo Domingo is Valencia,
who studied human medicine at the Oviedo University in Spain and specialized in
stomatology, oral-maxillofacial surgery
and implantology over the years. Valencia
is supported by a team of assisting tutors,
whom he personally recruited. Most of
these tutors have learned implantology
from him.
“So I know them well and it is easy for me
to work with them,” Valencia said.
The atmosphere is harmonious: even
after 12 hours in the surgery room, the
groups still like to meet for an evening
Q-Implant Marathon participants in Santo
Domingo working in a team.
meal. Courses in Santo Domingo have developed even further over time with regard
to patient care and technical aspects of surgery. One of the most important improvements has been patient selection. The local
team is now able to assign patients to suit
the ability and the needs of participants.
Contact information
The Q-Implant Marathon is conducted
six to eight times a year in the Dominican Republic and Asia. To find out more
about the Q-Implant Marathon, contact:
Optimum Solution Group, Mac Kubiak, call (877) 705-1002, e-mail info@
optimumsolutiongroup.com or see www.
implantologycourses.com
[6] =>
6
events
Implant Tribune U.S. Edition | February 2012
ICOI takes Spring Implant Symposium to Toronto
Toronto will be the site of the ICOI‘s Spring Implant Sympsium. Photo/www.sxc.hu
Ad
The ICOI will be holding its Spring Implant Symposium at the Sheraton Centre
in downtown Toronto, Canada, from April
27–29.
The Sheraton Centre hotel is located in
the heart of Toronto, cheek-by- jowl to the
financial and theater districts and sits on
top of Toronto’s famous massive underground shopping mall, the PATH.
The Sheraton is conveniently located
near museums and Toronto’s professional
sports arenas.
The scientific program was designed by
Dr. Natalie Wong with assistance by her
committee members, Drs. Blake Nicolucci
and Yvan Poitras. The full 2½-day program
is as follows:
Friday, April 27
“When Do We Use Digital Imaging to Enhance Implant Therapy?”
Session host: Dr. Blake Nicolucci
1 to 1:15 p.m.: Drs. Ken Judy, Carl Misch and
Blake Nicolucci, Opening Ceremony
1:15 to 2:15 p.m.: Dr. Michael Pikos, “Cone
Beam CT: The Value of Pre- and Post-Graft
Scanning for Implant Reconstruction”
2:15 to 3:15 p.m.: Dr. George Mandelaris,
“Clinical Myths and Realities of ComputerGuided Implant Therapy”
3:15 to 3:45 p.m.: Break with exhibitors
3:45 to 4:45 p.m.: Dr. Richard Nejat, “Computer-Guided Surgery and CAD/CAM
Technology: Computer Generated Surgical
Guides with Extractions and Immediate
Provisionalization”
4:45 to 5:45 p.m.: Dr. Natalie Wong, “Destination … Digital! From Plans, Scans and
Now Digital Impressions”
6 to 7:30 p.m.: Tabletop and Poster Presentations and Welcome Reception
Saturday, April 28: morning session
“What a Restorative Dentist Should Know
About Implant Surgery”
Session host: Dr. Scott Ganz
8:30 to 9:30 a.m.: Dr. Bach Le, “Avoiding
and Managing Esthetic Complications Associated with Implant Therapy”
9:30 to 10:30 a.m.: Dr. Avi Schetritt, “Implant Design: Healing Prosthetic Consequences”
10:30 to 11 a.m.: Break with exhibitors
11 a.m. to 12 p.m.: Dr. Carl Misch, “Sequence of Treatment for Esthetics in the
Pre-maxilla of Implant Prostheses”
12 to 1 p.m.: Lunch with exhibitors
Saturday, April 28: afternoon session
“What a Surgeon Should Know About Implant Prosthetics”
Session host: Dr. Natalie Wong
1 to 2 p.m. Dr. Scott Ganz: “The Impact of
Implant Placement on Abutment Design
for Screw-Retained and Cementable Restorations: Who Makes the Decisions?”
2 to 3 p.m.: Dr. Joseph Kan, “Prosthetic
Driven Esthetic Anterior Implant Surgery”
3 to 3:30 p.m.: Break with exhibitors
3:30 to 4:30 p.m.: Dr. Barry Goldenberg,
“The Ideal Partnership to Successful Implant Prosthodontics: Each One’s Role
from Diagnosis to Treatment through
Maintenance”
4:30 to 5:30 p.m.: Dr. Ken Hebel, “Effective Comprehensive Treatment Planning
and Consultation for Restorative and Implant Dentistry”
6 to 7 p.m.: Awards ceremony
Sunday, April 29: morning session
“Emerging Surgical Techniques to Enhance Treatment Outcomes”
Session host: Dr. Yvan Poitras
8:30 to 9:30 a.m.: Dr. Blake Nicolucci,
“Pre-implant Bone Manipulation”
9:30 to 10:30 a.m.: Dr. Yvan Poitras, “Alternate Treatment Plans and Their Prognosis in Implant Dentistry”
10:30 to 11 a.m.: Break with exhibitors
11 a.m. to 12 p.m.: Dr. Stephen Wallace,
“Changing Paradigms in Maxillary Sinus
Elevation”
12 to 1 p.m.: Lunch with exhibitors
Sunday, April 29: afternoon session
“Emerging Prosthetic Techniques/Procedures to Augment Implant Outcomes”
[7] =>
events
Implant Tribune U.S. Edition | February 2012
Session host: Dr. Dwayne Karateew
1 to 2 p.m.: Dr. Murray Arlin: “Surgical Risk
Factors and Complications — How to Treat
and How to Avoid Them”
2 to 3 p.m.: Dr. Jamie Lozada, “Benefits of
Provisional Restorations for Immediate
Loading Protocols”
3 to 3:30 p.m.: Break with exhibitors
3:30 to 4:30 p.m.: Dr. Dwayne Karateew,
“Prosthetic Strategies to Enhance Peri-Implant Soft Tissue Esthetics”
ADIA program
ICOI’s component society, the Association
of Dental Implant Auxiliaries (ADIA), will
be holding a 1½-day program for hygienists,
dental assistants and front office staff members. In addition to the Friday afternoon
program, the ADIA will on Saturday give certification courses for these three areas of the
dental practice. The program is as follows:
Friday, April 27
1 to 1:15 p.m.: Introductions
1:15 to 2:15 p.m.: Carla Fray, “Transforming
and Growing Your Dental Team”
2:15 to 3:15 p.m.: Gisèle Choquette: “Successful Lifelong Oral Hygiene with iTOP Technique”
3:15 to 3:45 p.m.: Break
3:45 to 4:45 p.m.: Yva Khalil, “Aesthetics Perceptions”
4:45 to 5:45 p.m.: Audree Beaudin, “Understanding Biomaterials”
Certification programs
Saturday, April 28
(Please choose one program.)
Programs are conducted simultaneously
in three different rooms. (10 a.m. to 10:30 a.m
break; 12:30 to 2:30 p.m lunch; and 3:30 to 4
p.m. break)
8 a.m. to 6 p.m.: Audree Beaudin and Yva
Kha, “Dental Hygiene Implant Certification
Program” (DHICP)
Includes: rationale for dental implants;
classification and definitions of dental implants; contraindications; implant/tissue
interfaces; assessment, diagnosis and treatment planning; implant surgical and prosthodontic procedures; maintenance and evaluation procedures; management of implant
complications and failures.
8 a.m. to 6 p.m.: Vavi Bohbot and Carla Frey,
“Dental Assisting Implant Certification Program“ (DAICP)
Includes: classification and definitions of
dental implants; indications and contraindications; biomechanics and biomaterials;
client evaluation, assessment and selection;
treatment planning, site selection and implant selection; implant complications and
failures; surgical templates and stents; pharmacology and sedation; surgical preparation
and infection control; surgical procedures;
sinus lifts, bone grafts, tissue regeneration;
prosthetic procedures; provisional prostheses and fabrication of temporaries; and laboratory considerations.
8 a.m. to 6 p.m.: Karen Young, “Practice
Management Implant Certification Program” (PMICP)
Includes: terminology and definitions;
case presentation and handling objections;
commonly asked questions and appropriate
responses; fee presentation; financial options and arrangements; risk management,
documentation and record keeping; practice
plans and marketing; referrals; intra/interoffice communications.
C.E. credits will be given to both the doctors
and auxiliary attendees.
On Friday morning, April 27, Nobel Biocare and the Misch Institute will give presymposium workshops. Details of these two
workshops appear below.
Nobel Biocare course
Time/day: 8 a.m. to noon Friday
Course fee: Free
Attendance is limited. First come, first
served.
Dr. Anastasia Cholakis: “Delayed Implant
Treatment Complications — Prevention
and Treatment”
This seminar will review some delayed
implant treatment complications such as
hard- and soft-tissue loss. Peri-implant mucositis, soft tissue recession or dehiscences
and peri-implantitis will be discussed as
well as preventive measures and treatment
modalities. An in-office implant maintenance protocol will be outlined to assist in
the monitoring of the peri-implant tissues.
At the end of this seminar the participant
should be able to :
• Identify soft- and hard-tissue complications
• Adopt preventive strategies
• Have an understanding of some current
treatment modalities
• Implement an in-office peri-implant
maintenance program
Misch Implant Institute course
Time/day: 9 a.m. to noon Friday
Course fee: $395
Attendance is limited. First come, first
served.
Dr. Carl E. Misch: “Key Implant Position
and Implant Number for Fixed Prostheses”
In every treatment plan for missing multiple teeth there are key implant positions,
which are more important, related to biomechanics. There are four guidelines to determine these positions:
• No cantelivers
• No 3-adjacent pontics
7
• The canine and first molar rules
• Arch dynamics
Cantilevers are force magnifiers. Three
adjacent pontics not only overload the adjacent abutment, the flexure of the metal is
27 times the flexure of a 1-pontic prosthesis.
The canine and first molar are key positions for an arch and, whenever missing,
should be replaced with an implant (rather
than a pontic). Arch dynamics (especially
for a maxilla) require the structure to be
considered as a 5-sided open pentagon.
At least one implant in each section is required for each edentulous segment.
Once these key positions are determined,
the additional implants required to restore
the patient are considered based upon patient force factors and the bone density in
the edentulous sites.
Delegates to this symposium should take
advantage of these pre-symposium courses for additional C.E. credits.
AD
[8] =>
8
Industry
Implant Tribune U.S. Edition | February 2012
Osteogenics to host
2012 Global Bone
Grafting Symposium
World-renowned speakers showcase the latest
in bone-grafting techniques, materials, research
Osteogenics Biomedical‘s annual Global Bone Grafting Symposium will be held at The Westin
La Cantera Resort in San Antonio, Texas. Photos/Provided by Osteogenics Biomedical.
Ad
Osteogenics Biomedical announces its
2012 Global Bone Grafting Symposium,
unique for its focus on dental bone grafting and treatment planning, will be held
April 19–21 at The Westin La Cantera Resort in San Antonio, Texas.
The symposium will feature presenta-
tions by world-renowned speakers, interactive treatment-planning sessions with
an expert panel and optional hands-on
workshops. Speakers include Dr. Stephen
Caldwell, Dr. Sascha Jovanovic, Dr. Bradley McAllister, Dr. Alvaro Ordonez, Dr.
Michael Pikos, Dr. Istvan Urban, Dr. HomLay Wang and Dr. Thomas Wilson.
“After 30 years of attending a wide variety of C.E. courses, this symposium is
at the top of my list,” said Dr. Catherine
Hebert about the 2011 symposium. “Fabulous speakers sharing an in-depth knowledge of the art and science of bone grafting … I will be back for more like this!”
On April 20 and 21, the symposium
will feature 90-minute main podium
lectures, question-and-answer sessions
and interactive treatment planning sessions. Optional hands-on workshops will
be offered the afternoon of Thursday,
April 19. Workshop topics include: vertical and horizontal ridge augmentation
techniques, ridge sculpting using tenting screws and acellular membranes and
socket augmentation techniques to minimize buccal bone resorption and improve
implant esthetics.
“This symposium is unique in that it offers a broad scope in treatment perspectives and protocols from several of the
more prominent clinicians and researchers in our field,” said Dr. Philip Bird. “I
would recommend it to anyone treating
patients in the field of implant and regenerative dentistry.”
The Westin La Cantera Resort is an ideal
” Continue on Page 10
The Westin La Cantera in San Antonio, Texas,
the site of Osteogenics 2012 Global Bone
Grafting Symposium, features 36 holes of
championship golf and views of Texas Hill
Country. Photo/The Westin La Cantera
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[10] =>
10
events
More than 350 clinicians from nine different countries attended Osteogenics’ 2011 Global
Bone Grafting Symposium in Scottsdale, Ariz.
Implant Tribune U.S. Edition | February 2012
Dr. Sascha
Jovanovic
Dr. Bradley
McAllister
Dr. Alvaro
Ordonez
Dr. Michael
Pikos
Dr. Istvan
Urban
Dr. Hom-Lay
Wang
Dr. Thomas
Wilson
Dr. Stephen
Caldwell
AD
“ From Page 8
location because of San Antonio’s pleasant weather and national attractions.
The resort features 36 holes of championship golf, a world-class spa, six swimming pools and nature trails. The resort
offers complimentary shuttle service
to The Shops at La Cantera, an upscale
shopping
experience with a
variety of dining options and
Six Flags Fiesta
Texas.
Perched
on
top of 300
acres, the resort has views
of the Texas
Hill
Country.
Within driving
distance are a
number of top
entertainment
attractions including the San
Antonio Riverwalk, The Alamo and SeaWorld.
Tuition for the main symposium on
April 20 and April 21 is $795, offering up
to 14 C.E. credits. Assistants and office
personnel are welcome for $350. Clinicians can participate in one hands-on
workshop of their choice on April 19 and
earn four C.E. credits for an additional
$695.
For more information on Osteogenics’
2012 Global Bone Grafting Symposium,
visit www.osteogenics.com/courses, or
call Laura Wood at (806) 796-1923.
‘I would
recommend
it to anyone
treating
patients in the
field
of implant and
regenerative
dentistry.’
About Osteogenics Biomedical
Headquartered in Lubbock, Texas, Osteogenics Biomedical is a leader in the
development of innovative dental bone
grafting products serving periodontists, oral and maxillofacial surgeons
and clinicians involved in regenerative
and implant dentistry throughout the
world. Osteogenics offers a complete
line of bone grafting products including enCore™ Combination and Mineralized Allografts, Cytoplast PTFE™ membranes, Cytoplast™ collagen membranes,
Vitala™ porcine collagen membranes,
Cytoplast PTFE suture and the Profix™ Precision Fixation System.
[11] =>
Osstell
[12] =>
Implant Direct
[13] =>
Implant Direct
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Industry clinical
14
“ From Page 1
Not all zirconia is created equal. Currently, worldwide it is estimated that 3
percent of patients may be sensitive to
titanium.1-7
In addition, the systemic toxicity associated with titanium nanotechnology is
still unknown.8 However, it does appear
there is peripheral organ accumulation of
metal ions in certain clinical situations.9-10
How this affects overall health is still
unknown. With increasing frequency, patients are requesting metal-free biologic
implants and restorative solutions. Many
holistic and esthetically oriented doctors
and patients are looking for a metal-free
esthetic option in tooth replacement therapy.
Zirconia biocompatibility has been successfully documented in animal studies and human studies. These studies
have found zirconia to be biologically
Ad
compatible with osseointegration. Specifically, they have reported cellular responsessimilartotitanium,similarbone-toimplant contact, similar healing times,
similar biomechanical strength and similar soft-tissue biologic width, and similar
removal torque values.11-25
Additionally, several studies have
shown less inflammatory infiltrate at the
implant abutment junction and less bacterial colonization in this region, which
may have clinical significance regarding
short- and long-term biofilm accumulation and susceptibility.26-30
The only human clinical retrospective
study to date in the literature on human
success rates of zirconia reported a 92 percent success for smooth surface zirconia
and 97 percent for rough surface zirconia
over five years and 831 subjects.31
The implant
The Z-look Evo is a single-stage threaded
Implant Tribune U.S. Edition | February 2012
istics. However, a new dual-processed
sand-blasted and laser-etched surface will
be on the market by April 2012.
The single-stage design eliminates the
effects of the microgap and micromotion
on the crestal interface of bone and soft
tissue (Fig. 1). The current diameters range
from 3.3 to 5.5 mm and from 8.5 to 15 mm
length (Fig 2).
Fig. 2: The current diameters range from 3.3
to 5.5 mm and from 8.5 to 15 mm length.
implant with a prep-able abutment. It is
imperative to use the 49 micron zirconia
prep bur for reduction to reduce microcrack propagation. Preparation can be
completed at placement. There is no risk
of heating of the implant body because
of the low thermal conductivity of the
material.32 The apical thread pattern is
self-tapping. The current surface is sandblasted to improve surface character-
Diagnosis and treatment planning
The author has been selectively placing zirconium Implants during the last
three years. The following considerations
should be strictly adhered to when considering diagnosis and placement. Consider guided surgery for optimal alignment from a top(crown)-down approach.
The abutment can be prepped up to 20
degrees. Any misalignment beyond 20 degrees will cause restorative complications.
Snap Caps and Analogs are available for
impressions and lab processes (Figs. 3-5).
Only place the implant in healthy patients with no systemic and local risk factors such as smoking, diabetes, poor bone
quality and metabolic deficiencies. Type
1-2 host bone is ideal for successful integration.
Zirconia tends to lag four weeks behind
in cellular biologic fixation, according to
animal studies. In sites with native bone,
I will allow implants to remain undisturbed for four months on the lower and
six months on the upper.
Limiting any micromotion at the bone” Continue on Page 16
Fig. 3
Fig. 4
Fig. 5
Figs. 3-5: Snap
Caps and
Analogs are
available for
impressions and
lab processes.
[15] =>
Z Systems
[16] =>
Industry clinical
16
Implant Tribune U.S. Edition | February 2012
“ From Page 14
to implant interface is crucial. An essex
appliance is recommended during healing. Because grafted sites still contain
areas of devitalized bone, longer healing
times are important.
The following healing times are suggested for grafted sites. Allow grafted bone in
extraction sockets on the maxillary arch
to heal a minimum of six months, even
when using bioactive modifiers; sinus
grafts a minimum of eight months; and
lateral ridge augmentations on the upper
and lower arch eight months prior to implant placement.
Consider undersizing the osteotomy to
develop optimal primary stability. Progressive long-term loading in provisionals
is highly recommended to begin the accommodative physiologic bone response
at the cellular level. There is no replacement for experience, and the success of
zirconia implant therapy is directly related to the operators’ surgical and prosthetic skills and experience.
The biology
The primary means of surface modification to enhance surface microtexture on
zirconia include acid etching, laser etching and sandblasting. These processes
will enhance the hosts’ cellular response
and secondary fixation. However, remember zirconia’s secondary fixation occurs
about four weeks slower than titanium.
Therefore, not only is protected healing
required, but longer healing times are
Ad
Fig. 7: Soft-tissue response is remarkable with
crestal creeping soft-tissue attachment over
time.
Fig. 6: As a result of the implant design,
2 mm of bone loss will occur upon placement
to provide room for biologic width.
beneficial.
Crestal biologic bone response will always include accommodative bone resorption to the first thread. As a result of
the implant design, 2 mm of bone loss will
occur upon placement to provide room
for biologic width (Fig, 6).
A two-piece design with a medialized
offset will eventually provide the opportunity to preserve crestal bone, while
providing optimal restorative interface
options. Immediate loading and implants
” Continue on Page 18
Fig. 8: The bone to implant contact and
removal torque analysis for zirconium and
titanium is the same.
Fig. 9: The esthetic benefits of zirconia
prevent the grey show-through associated
with many titanium implants, particularly in
the thin biotypes.
Fig. 10: A 55-year-old man with remarkable
health had lost #8 five years prior. The area
was never grafted. Zirconia success is
optimal in host bone.
Fig. 11: A 4.0 by 13 Z–Look was secured under
50 ncm of torque.
Fig. 12: An essex appliance was placed for the
duration of the four-month healing interval.
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osteogenics biomedical
no. 1
[18] =>
Industry clinical
18
Implant Tribune U.S. Edition | February 2012
“ From Page 16
placed into extraction sockets is not recommended at this time, as there is not
enough clinical information or literature
to support this approach.
Soft-tissue response is remarkable with
crestal creeping soft-tissue attachment
over time (Fig. 7). It has been shown fibroblasts migrate extremely well on zirconia
surfaces.35-36 As well, biofilm development
is retarding as result of the surface biodynamics.37
To date, I have not reported any biomechanical failures including fracture, nor
have any been reported in the literature.
It appears from the literature that at the
12-week point in animal studies, the bone
to implant contact and removal torque
analysis for zirconium and titanium is the
same (Fig 8).
Stress distribution for zirconia and titanium is the same. The esthetic benefits of
zirconia prevent the grey show-through
Fig. 13: A provisional was placed at four
months and progressively loaded during the
next two months.
associated with many titanium implants,
particularly in the thin biotypes (Fig. 9).
A case study
Figs. 14-15: A final all-zirconium crown was
placed at six months.
A 55-year-old man with remarkable health
had lost #8 five years prior. The area was
never grafted. Zirconia success is optimal
in host bone (Fig. 10).
A 4.0 by 13 Z–Look was secured under
Ad
Figs. 16-17: X-ray and cone beam at one-year
mark reveal crestal bone loss to the first
thread; however, they also show excellent
tissue stability and esthetics.
50 ncm of torque (Fig. 11). An essex appliance was placed for the duration of the
four-month healing interval (Fig. 12). A
four-week post-op revealed dynamic softtissue health and composition.
A provisional was placed at four months
and progressively loaded over the next
two months (Fig. 13).
A final all-zirconium crown was placed
at six months. X-ray and cone beam at the
one-year mark reveal crestal bone loss to
the first thread. However, they also show
excellent tissue stability and esthetics
(Figs. 14-18).
Editor‘s note: References are available
upon request from the publisher.
About the author
David
DiGiallorenzo,
DMD, received his
training at the
University of
Pennsylvania in the
department of
periodontics and
periodontal
prosthesis in the
early 1990s. His
training included
prosthodontics,
orthodontics,
periodontics and
advanced oral
reconstructive
techniques including oral implantology. He is
currently in private practice in two locations in
Pennsylvania, focused on laser esthetic and
reconstructive periodontics, dental implantology,
advanced reconstructive case management,
advanced teeth-in-a-day and TMJ. DiGiallorenzo
works with more than 60 referring doctors in the
country and treats patients from every state. He is a
past clinical instructor at the University of
Pennsylvania, Department of Periodontics. He
lectures both nationally and internationally at local
and national meetings. He is a key opinion leader
and consultant for DENTSPLY, Synthase, Keystone,
Z-Look (Zirconium Metal Free Implants) and
Orapharma. DiGiallorenzo runs a holistic wellness
center attached to his practice offering acupuncture,
facial plastics, relexology, cranial sacral therapy,
laser therapy, medical detoxification for heavy metal
overload, infrared sauna therapy and nutrition.
[19] =>
MIS
[20] =>
Industry
20
Implant Tribune U.S. Edition | February 2012
Photos courtesy Dr. Paul Petrungaro
AD
To provide more treatment options to
patients without enough space for larger implants, Dentatus USA has created
a unique narrow body implant called
ANEW.
The titanium alloy narrow-body implants are specifically designed to fit
where others can’t while being strong and
safe for long-term use.
The ANEW system is available in 1.8,
2.2 and 2.4 mm diameters. ANEW is
the only narrow-body implant with a
screw-retained prosthetic system, and
it has more than 10 years of clinical research to support the safe, reliable, long-
term use for single-tooth replacement.
The advantages of the ANEW narrow
body implants are several.
First and foremost, the ANEW implants
expand the patient population that is
eligible for this treatment. Narrow body
implants make it much easier to maintain adequate buccal-lingual bone dimensions and proper implant spacing
without the need for ridge augmentation.
The narrow body allows a thicker buccal
bone because less bone is consumed for
the osteotomy. Finally, the implants are
designed to allow immediate loading.
The screw-retained prosthesis provides
more flexibility for longterm maintenance.
The restoration is
retrievable
and
allows for repair or recoloring of the crown
without causing micromovement that occurs with tapping off
of
cement-retained
crowns.
The ANEW tapered onepiece implant design
eliminates the microgap,
which is related to crestal
bone loss, facilitates onestage surgery, provides
immediate restoration
and is more conducive to
a flapless implant placement.
Additionally, utilizing
a minimally invasive
flapless procedure with
an immediate restoration eliminates many postoperative
challenges as well as reduces total treatment time.
ANEW narrow diameter implants have
been tested with university-based research from the around the world; the
first results were published in 2004.
In 2007, Dr. Stuart Froum and his colleagues from the New York University
Department of Implant Dentistry published a study in the IJPRD stating “40
Anew Implants in patients for 1 to 5 years
postloading. No implant failures were
reported, yielding a 100 percent survival
rating.”
In 2005, JOMI published Dr. Michael
Rohrer’s histology study on Dentatus
implants. Rohrer determined that the
percentage of bone in contact with the
body of Dentatus implants is in “the
same range and sometimes higher than
what is usually seen with conventional
implants.”
These results support well-known
literature about implant design and materials in the following ways: ANEW narrow body dental implants are composed
of grade V, titanium alloy; the threaded
portion of the implant is mechanically
roughened to increase surface area and
maximize the bone-implant interface;
and the tapered design better facilitates
implant placement, promotes initial
implant stability and better distributes
occlusal loads along the body of the implant.
Dentatus’ ANEW implant system is a
proven technology that provides clinicians and their patients with access to an
implant treatment option where others
can’t. ANEW Implants were introduced
by Dentatus in 2001, in conjunction with
research by the NYU Department of Implant Dentistry, developing a specific
protocol to help patients with limited
inter-dental spaces. In 2004, the FDA
approved ANEW Implants for long-term
use.
For more information on ANEW Implants, contact Dentatus at (800) 323-3136
or visit www.dentatus.com.
Photo/Provided by Dentatus
ANEW implants provide more patients
with gold-standard treatment options
[21] =>
Osteogenics No. 2
[22] =>
22
products
Implant Tribune U.S. Edition | February 2012
NovaBone
NovaBone® is the only dental bone
graft putty that is completely synthetic
and has excellent and reliable bone formation characteristics.
It is indicated primarily for implant related surgeries including but not limited
to sinus elevation surgeries, extraction
sockets, ridge augmentations, etc. Putty
does not require mixing as it is dispensed
in a pre-mixed state ready for implantation.
NovaBone Dental Putty is available in
multiple delivery mechanisms including
syringes and clam shells to suit various
clinical applications. The “Cartridge” de-
livery system is unique and an industry
first.
NovaBone Dental Putty is the only
graft material in the world that is available in disposable unidose cartridges that
will significantly simplify the delivery of
graft to the defect site following minimally invasive surgical techniques that
will reduce morbidity and enhance healing at the defect site.
For more product information and
promotional discounts, call ACE Surgical
Supply at (800) 441-3100 or visit
www.acesurgical.com.
Photo/Provided by Exactech
Photo/Provided by Ace Surgical Supply
AD
Oralife Plus
Combination
Allograft
Oralife® Plus Combination allograft
is a cost-effective alternative to completely engineered grafting materials.
It is a mixture of demineralized bone
matrix (DBM) with mineral-retained
cortical and cancellous chips, processed in a manner to retain natural
growth factors (BMP) and a conductive
lattice — all in one product.1,2 Oralife
Plus Combination is available in DBM
plus .25-1 mm chips and DBM plus 1-2
mm chips.
In addition to the Plus Combination,
the Oralife product line includes DBM,
cancellous particulate, cortical particulate and a 50:50 cortical/cancellous
mix. Oralife allografts may be used in
clinical situations such as periodontal
defects and sinus-grafting procedures,
extraction sockets and intrabony defects and inconjunction with implant
placement.3 All Oralife products are
single-donor grafts recovered and processed under AATB standards as well as
state and federal regulations (FDA and
the states of Florida, California, Maryland and New York), using Allowash®
Technology.
For more information, contact
Exactech Dental Biologics at oral.dental@
exac.com or visit www.exac.com/dental.
1. Blum B, Moseley J, Miller L, Richelsoph K, Haggard W. Measurement of bone morphogenetic proteins and other growth factors in
demineralized bone matrix. Orthopedics.
2004 Jan;27(1 Suppl):s161-5.
2. Data on file at LifeLink Tissue Bank. Allowash
Brochure.
3. McAllister BS, Hagnignat K. Bone augmentation techniques. J Periodontal. 2007 Mar;
78(3):377-96.
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