ICOI heats up spring in Vegas / Surgical predictability of vertical GBR in the posterior mandible / Implant position in the esthetic zone / Scenes from ICOI Spring Symposium / ICOI to host its World Congress XXX in Istanbul - Turkey
Array
(
[post_data] => WP_Post Object
(
[ID] => 60099
[post_author] => 0
[post_date] => 2013-06-25 15:15:14
[post_date_gmt] => 2013-06-25 15:15:14
[post_content] =>
[post_title] => Implant Tribune U.S. No. 6, 2013
[post_excerpt] =>
[post_status] => publish
[comment_status] => closed
[ping_status] => closed
[post_password] =>
[post_name] => implant-tribune-u-s-no-6-2013-0613
[to_ping] =>
[pinged] =>
[post_modified] => 2024-10-22 03:25:01
[post_modified_gmt] => 2024-10-22 03:25:01
[post_content_filtered] =>
[post_parent] => 0
[guid] => https://e.dental-tribune.com/epaper/itus0613/
[menu_order] => 0
[post_type] => epaper
[post_mime_type] =>
[comment_count] => 0
[filter] => raw
)
[id] => 60099
[id_hash] => c882875bcf8228ec1485aedd3df805c2aa4479bac71fed3daf9694611d709da9
[post_type] => epaper
[post_date] => 2013-06-25 15:15:14
[fields] => Array
(
[pdf] => Array
(
[ID] => 60100
[id] => 60100
[title] => ITUS0613.pdf
[filename] => ITUS0613.pdf
[filesize] => 0
[url] => https://e.dental-tribune.com/wp-content/uploads/ITUS0613.pdf
[link] => https://e.dental-tribune.com/epaper/implant-tribune-u-s-no-6-2013-0613/itus0613-pdf-2/
[alt] =>
[author] => 0
[description] =>
[caption] =>
[name] => itus0613-pdf-2
[status] => inherit
[uploaded_to] => 60099
[date] => 2024-10-22 03:24:55
[modified] => 2024-10-22 03:24:55
[menu_order] => 0
[mime_type] => application/pdf
[type] => application
[subtype] => pdf
[icon] => https://e.dental-tribune.com/wp-includes/images/media/document.png
)
[cf_issue_name] => Implant Tribune U.S. No. 6, 2013
[contents] => Array
(
[0] => Array
(
[from] => 01
[to] => 01
[title] => ICOI heats up spring in Vegas
[description] => ICOI heats up spring in Vegas
)
[1] => Array
(
[from] => 01
[to] => 05
[title] => Surgical predictability of vertical GBR in the posterior mandible
[description] => Surgical predictability of vertical GBR in the posterior mandible
)
[2] => Array
(
[from] => 08
[to] => 08
[title] => Implant position in the esthetic zone
[description] => Implant position in the esthetic zone
)
[3] => Array
(
[from] => 10
[to] => 11
[title] => Scenes from ICOI Spring Symposium
[description] => Scenes from ICOI Spring Symposium
)
[4] => Array
(
[from] => 12
[to] => 12
[title] => ICOI to host its World Congress XXX in Istanbul - Turkey
[description] => ICOI to host its World Congress XXX in Istanbul - Turkey
)
)
)
[permalink] => https://e.dental-tribune.com/epaper/implant-tribune-u-s-no-6-2013-0613/
[post_title] => Implant Tribune U.S. No. 6, 2013
[client] =>
[client_slug] =>
[pages_generated] =>
[pages] => Array
(
[1] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/60099-8e6dfda0/2000/page-0.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/60099-8e6dfda0/1000/page-0.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/60099-8e6dfda0/200/page-0.jpg
)
[key] => Array
(
[2000] => 60099-8e6dfda0/2000/page-0.jpg
[1000] => 60099-8e6dfda0/1000/page-0.jpg
[200] => 60099-8e6dfda0/200/page-0.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[2] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/60099-8e6dfda0/2000/page-1.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/60099-8e6dfda0/1000/page-1.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/60099-8e6dfda0/200/page-1.jpg
)
[key] => Array
(
[2000] => 60099-8e6dfda0/2000/page-1.jpg
[1000] => 60099-8e6dfda0/1000/page-1.jpg
[200] => 60099-8e6dfda0/200/page-1.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[3] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/60099-8e6dfda0/2000/page-2.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/60099-8e6dfda0/1000/page-2.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/60099-8e6dfda0/200/page-2.jpg
)
[key] => Array
(
[2000] => 60099-8e6dfda0/2000/page-2.jpg
[1000] => 60099-8e6dfda0/1000/page-2.jpg
[200] => 60099-8e6dfda0/200/page-2.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[4] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/60099-8e6dfda0/2000/page-3.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/60099-8e6dfda0/1000/page-3.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/60099-8e6dfda0/200/page-3.jpg
)
[key] => Array
(
[2000] => 60099-8e6dfda0/2000/page-3.jpg
[1000] => 60099-8e6dfda0/1000/page-3.jpg
[200] => 60099-8e6dfda0/200/page-3.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[5] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/60099-8e6dfda0/2000/page-4.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/60099-8e6dfda0/1000/page-4.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/60099-8e6dfda0/200/page-4.jpg
)
[key] => Array
(
[2000] => 60099-8e6dfda0/2000/page-4.jpg
[1000] => 60099-8e6dfda0/1000/page-4.jpg
[200] => 60099-8e6dfda0/200/page-4.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[6] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/60099-8e6dfda0/2000/page-5.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/60099-8e6dfda0/1000/page-5.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/60099-8e6dfda0/200/page-5.jpg
)
[key] => Array
(
[2000] => 60099-8e6dfda0/2000/page-5.jpg
[1000] => 60099-8e6dfda0/1000/page-5.jpg
[200] => 60099-8e6dfda0/200/page-5.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[7] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/60099-8e6dfda0/2000/page-6.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/60099-8e6dfda0/1000/page-6.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/60099-8e6dfda0/200/page-6.jpg
)
[key] => Array
(
[2000] => 60099-8e6dfda0/2000/page-6.jpg
[1000] => 60099-8e6dfda0/1000/page-6.jpg
[200] => 60099-8e6dfda0/200/page-6.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[8] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/60099-8e6dfda0/2000/page-7.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/60099-8e6dfda0/1000/page-7.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/60099-8e6dfda0/200/page-7.jpg
)
[key] => Array
(
[2000] => 60099-8e6dfda0/2000/page-7.jpg
[1000] => 60099-8e6dfda0/1000/page-7.jpg
[200] => 60099-8e6dfda0/200/page-7.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[9] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/60099-8e6dfda0/2000/page-8.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/60099-8e6dfda0/1000/page-8.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/60099-8e6dfda0/200/page-8.jpg
)
[key] => Array
(
[2000] => 60099-8e6dfda0/2000/page-8.jpg
[1000] => 60099-8e6dfda0/1000/page-8.jpg
[200] => 60099-8e6dfda0/200/page-8.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[10] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/60099-8e6dfda0/2000/page-9.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/60099-8e6dfda0/1000/page-9.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/60099-8e6dfda0/200/page-9.jpg
)
[key] => Array
(
[2000] => 60099-8e6dfda0/2000/page-9.jpg
[1000] => 60099-8e6dfda0/1000/page-9.jpg
[200] => 60099-8e6dfda0/200/page-9.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[11] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/60099-8e6dfda0/2000/page-10.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/60099-8e6dfda0/1000/page-10.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/60099-8e6dfda0/200/page-10.jpg
)
[key] => Array
(
[2000] => 60099-8e6dfda0/2000/page-10.jpg
[1000] => 60099-8e6dfda0/1000/page-10.jpg
[200] => 60099-8e6dfda0/200/page-10.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[12] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/60099-8e6dfda0/2000/page-11.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/60099-8e6dfda0/1000/page-11.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/60099-8e6dfda0/200/page-11.jpg
)
[key] => Array
(
[2000] => 60099-8e6dfda0/2000/page-11.jpg
[1000] => 60099-8e6dfda0/1000/page-11.jpg
[200] => 60099-8e6dfda0/200/page-11.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[13] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/60099-8e6dfda0/2000/page-12.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/60099-8e6dfda0/1000/page-12.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/60099-8e6dfda0/200/page-12.jpg
)
[key] => Array
(
[2000] => 60099-8e6dfda0/2000/page-12.jpg
[1000] => 60099-8e6dfda0/1000/page-12.jpg
[200] => 60099-8e6dfda0/200/page-12.jpg
)
[ads] => Array
(
[0] => Array
(
[post_data] => WP_Post Object
(
[ID] => 60101
[post_author] => 0
[post_date] => 2024-10-22 03:24:55
[post_date_gmt] => 2024-10-22 03:24:55
[post_content] =>
[post_title] => epaper-60099-page-13-ad-60101
[post_excerpt] =>
[post_status] => publish
[comment_status] => closed
[ping_status] => closed
[post_password] =>
[post_name] => epaper-60099-page-13-ad-60101
[to_ping] =>
[pinged] =>
[post_modified] => 2024-10-22 03:24:55
[post_modified_gmt] => 2024-10-22 03:24:55
[post_content_filtered] =>
[post_parent] => 0
[guid] => https://e.dental-tribune.com/ad/epaper-60099-page-13-ad/
[menu_order] => 0
[post_type] => ad
[post_mime_type] =>
[comment_count] => 0
[filter] => raw
)
[id] => 60101
[id_hash] => 7ad9f59f2be50ab0d9f4993aa80a70238e91c2456478b505cd135e3af7806dfe
[post_type] => ad
[post_date] => 2024-10-22 03:24:55
[fields] => Array
(
[url] => http://www.dental-tribune.com/companies/3752_dentsply_implants.html
[link] => URL
)
[permalink] => https://e.dental-tribune.com/ad/epaper-60099-page-13-ad-60101/
[post_title] => epaper-60099-page-13-ad-60101
[post_status] => publish
[position] => 3.11,3.55,91.86,95.63
[belongs_to_epaper] => 60099
[page] => 13
[cached] => false
)
)
[html_content] =>
)
[14] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/60099-8e6dfda0/2000/page-13.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/60099-8e6dfda0/1000/page-13.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/60099-8e6dfda0/200/page-13.jpg
)
[key] => Array
(
[2000] => 60099-8e6dfda0/2000/page-13.jpg
[1000] => 60099-8e6dfda0/1000/page-13.jpg
[200] => 60099-8e6dfda0/200/page-13.jpg
)
[ads] => Array
(
)
[html_content] =>
)
)
[pdf_filetime] => 1729567495
[s3_key] => 60099-8e6dfda0
[pdf] => ITUS0613.pdf
[pdf_location_url] => https://e.dental-tribune.com/tmp/dental-tribune-com/60099/ITUS0613.pdf
[pdf_location_local] => /var/www/vhosts/e.dental-tribune.com/httpdocs/tmp/dental-tribune-com/60099/ITUS0613.pdf
[should_regen_pages] => 1
[pdf_url] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/60099-8e6dfda0/epaper.pdf
[pages_text] => Array
(
[1] =>
IMPLANT TRIBUNE
The World’s Dental Implant Newspaper · U.S. Edition
June 2013 — Vol. 8, No. 6
www.dental-tribune.com
Surgical predictability
of vertical GBR in the
posterior mandible
Flap design, management and passivation
of soft tissues as principal keys for success
By Drs. Marco Ronda
and Claudio Stacchi
T
he effectiveness of guided bone
regeneration (GBR), a technique
used to promote horizontal or
vertical bone regeneration, has
been well-documented since the early
1990s.1-4 The stability of the regenerated
bone and its positive response in time,
once functioning, has also been welldemonstrated.5-8
Vertical GBR is a technique with great
potential but one that requires both the
precise adherence to surgical protocols
and application by operators with the appropriate knowledge and manual skills
to ensure optimum management of soft
tissues. In addition to achieving primary
closure of the flaps, maintaining this
closure during the entire period necessary for the formation and maturation
of the new bone is a pre-requisite for the
avoidance of membrane exposure, which
inevitably leads not only to bacterial
contamination but, nearly always, to the
impairment of the surgical procedure of
regeneration.9,10
Numerous studies have described various clinical protocols regarding the management of soft tissues in both the upper
and lower arches.11-17
This retrospective analysis describes
the surgical technique of the management of soft tissues applied during GBR
with non-resorbable membranes in 127
cases of vertical defects of the posterior
mandible and evaluates the clinical results obtained.
Materials and techniques
Between 2000 and 2012, a total of 127
cases of vertical bone defects in edentulous posterior mandibles were treated
with the use of GBR with non-resorbable
membranes.
The technique was applied by following a surgical protocol, which has undergone few variations during the years.
From 2000 to 2008, expanded
polytetrafluoroethylene
(e-PTFE)
Fig. 1
ICOI heats
up spring
in Vegas
Group’s annual
symposium takes
over the Bellagio Hotel with
‘Maxilla’-focused sessions
By Sierra Rendon, Implant Tribune
More than 1,200 attendees, including 700 doctors and 250 auxiliaries,
laboratory technicians, students and
industry personnel, hit the Bellagio
Hotel on the Las Vegas Strip for this
year’s Spring Symposium.
This event included an in-depth,
challenging focus on “The Maxilla:
Single Tooth to Full Arch Reconstruction” and welcomed main podium
lecturers such as Dr. Jaime Lozada, Dr.
Giuseppe Cardaropoli, Dr. Joseph Kan
and Dr. Michael Sonick.
For implant doctors or team members who came looking to stock up
on supplies or to look for products to
bring home to the office, the exhibit
hall was brimming with new technology and other treats. More than 100
exhibitors brought the industry’s latest and greatest options for implantologists to use in their practices.
See pages B10 and B11 for more
scenes and stories from the ICOI’s
Spring Symposium.
Fig. 2
Photos/Provided by Drs. Ronda Marco and Claudio Stacchi
titanium-reinforced
non-resorbable
membranes (Gore-Tex TR9, W.L. Gore &
Associates, Flagstaff, Ariz.) were used as a
barrier device in 72 cases (Fig. 1).
From 2009 to 2012, high-density
polytetrafluoroethylene
(d-PTFE)
titanium-reinforced
non-resorbable
membranes
(Cytoplast
TI250XL,
Osteogenics
Biomedical,
Lubbock,
Texas) were used as a barrier device in 55
cases (Fig. 2).
All the membranes were fixed mesially and distally on the lingual side with
the use of titanium pins (Helmut Zepf
Medizintechnik, Seitingen, Germany)
or mini-screws (Pro-Fix, Osteogenics
” See GBR, page B2
Dr. Jaime Lozada provides the first main
podium lecture on the first day of the
ICOI’s Spring Symposium in Las Vegas.
Lozada’s session focused on ‘Extraction
Site Management’ and, more specifically,
the IDR technique. Photo/Sierra Rendon,
Managing Editor
[2] =>
clinical
B2
“ GBR, Page B1
Biomedical, Lubbock, Texas) (Fig. 3).
After positioning the graft material
around the implants, which were left
protruding from the crest (Fig. 4), the
membranes were also stabilized on the
buccal side with the same fixation devices (Fig. 5). Preparation of the implant
sites, for the most coronal portion of
the osteotomy, involved the use of twist
drills and, for the most apical portion,
near the mandibular nerve, a piezoelectric OT4 insert (Piezosurgery, Mectron,
Carasco, Italy) (Fig. 6).
Implants (Spline Twist and Tapered
Screw-Vent, Zimmer Dental, Carlsbad,
Calif.) were inserted leaving their most
coronal portion protruding from the
crest for a length equivalent to the vertical bone regeneration planned. In certain
cases — those in which it was not possible to obtain adequate primary stability
in low quantities of residual bone — the
AD
Implant Tribune U.S. Edition | June 2013
IMPLANT TRIBUNE
Publisher & Chairman
Torsten Oemus t.oemus@dental-tribune.com
President/Chief executive Officer
Eric Seid e.seid@dental-tribune.com
Fig. 3
Fig. 4
Group Editor
Kristine Colker k.colker@dental-tribune.com
Managing Editor Implant Tribune
Sierra Rendon s.rendon@dental-tribune.com
Managing Editor
Fred Michmershuizen
f.michmershuizen@dental-tribune.com
Managing Editor
Robert Selleck, r.selleck@dental-tribune.com
Product/Account Manager
Humberto Estrada h.estrada@dental-tribune.com
Fig. 5
” See GBR, page B4
Product/Account Manager
Jan Agostaro j.agostaro@dental-tribune.com
Fig. 6
Product/Account Manager
Will Kenyon w.kenyon@dental-tribune.com
Marketing director
Anna Wlodarczyk-Kataoka
a.wlodarczyk@dental-tribune.com
Education Director
Christiane Ferret c.ferret@dtstudyclub.com
Tribune America, LLC
116 West 23rd Street, Suite 500
New York, NY 10011
Phone (212) 244-7181
Fax (212) 244-7185
Published by Tribune America
© 2013 Tribune America, LLC
All rights reserved.
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.
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 Tribune America.
Editorial Board
Dr. Pankaj Singh
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
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.
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
like to make any change to your subscription
(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.
[3] =>
[4] =>
clinical
B4
Implant Tribune U.S. Edition | June 2013
“ GBR, Page B2
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
vertical bone regeneration preceded the
positioning of the implants (Figs. 7, 8).
Multiple cortical perforations, which
created openings for osteopromotion,
were then made with a piezoelectric OP5
insert (Piezosurgery, Mectron, Carasco,
Italy) in order to stimulate blood and cell
migration from the bone marrow spaces
to the regeneration area.18,19
During the period of time analyzed,
various graft materials, alone or combined, were used together with the
membranes: autologous bone; tricalcium phosphate; DBM (Dynagraft, Keystone Dental, Burlington, Mass.); MFDBA
(Puros, Zimmer Dental, Carlsbad, Calif.
); or combinations of mineralized and
demineralized allograft bone (MFDBA
& DFDBA, enCore, Osteogenics Biomedical).
Surgical management of soft tissue
AD
educate | inspire | connect
April 30 - May 3, 2014
30th Annual AACD Scientific Session
Visit www.AACDconference.com
All surgeries as well as postoperative
care are carried out by a single operator.
For each patient, treatment includes the
analysis of a diagnostic wax-up and CT
or CBCT scan performed with a template.
The objective is not only to position the
implants where the quantity of residual
bone allows but to position their platforms on the ideal line situated approximately 2 mm under the cement-enamel
junction of the adjacent teeth.
After performing local anesthesia,
(articaine hydrochloride 4 percent with
epinephrine 1:100.000, Septanest, Ogna,
Muggiò, Italy), a horizontal, mid-crestal,
full thickness incision is performed in
keratinized tissue. The incision extends
from the distal margin of the last tooth
adjacent to the treatment area to the ramus of the mandible, ending with a releasing incision on its buccal surface.
In the second molar area, to preserve
the integrity of the lingual nerve, the
scalpel should be inclined at an approximately 45 degree angle with the
tip in vestibular direction, and the blade
should touch the external oblique line
while the incision is made in distal and
buccal direction.
In the proximal vestibular zone, the incision continues intrasulcularly involving the last two teeth adjacent to the area
to be treated and concludes with a vertical hockey stick releasing incision.
Lingually, the incision continues intrasulcularly until the gingival zenith of the
last tooth and continues along the crest
of the ridge for approximately 1 cm in the
thickness of the keratinized gingiva. Full
thickness flaps is then elevated and the
mental nerve is isolated. The mobilization and release of the buccal flap is obtained with a horizontal periosteal incision performed with a new blade for the
entire length of the flap, from the distal
to the mesial release.
This longitudinal incision is performed
approximately 5 mm apically from the
crestal incision and should only affect
the periosteal fibers. The passivation of
the vestibular flap, thus obtained, allows
for a mean coronal elevation of the flap
of approximately 20 mm: this is the sum
of the amount of tissue present above the
periosteal line of incision (5 mm) and the
stretching of the flap following the periosteal incision (15 mm) (Figs. 9, 10).
The lingual flap is also full thickness
elevated until the mylohyoid line is
reached. This maneuver allows for the
obtaining of a mean coronal elevation
[5] =>
of approximately 15 mm (Fig. 11). At this
point, following the technique previously described by Ronda and Stacchi17, the
mylohyoid muscle insertion on the inner
surface of the lingual flap is identified,
approximately 5 mm apically from the
crestal line of incision.
This insertion, with the use of a blunt
instrument, is first isolated (Fig. 12), and
then separated from the flap by applying
light tensile force. This maneuver allows
for the near doubling of the lingual flap
passivation and brings the coronal elevation from approximately 15 mm to approximately 30 mm (Figs. 13, 14).
The flaps thus passivated can be sutured covering the membrane without
tension, using two different suture lines:
one horizontal mattress suture with 3-0
PTFE approximately 5 mm apically from
the crestal line of incision (Cytoplast Suture, Osteogenics Biomedical) and a series of interrupted sutures with 4-0 PTFE
to complete the flap closure. The releasing incisions are closed with resorbable
sutures (6-0, 7-0) (Serafit, Serag Wiessner,
Naila, Germany).
The sutures are removed after approximately 12-15 days and, during this period,
the patient uses a chlorhexidine 0.2 percent mouthrinse twice a day for one minute. In addition, antibiotics (amoxicillin/
clavulanic acid 875+125mg) and NSAIDs
(ibuprofen 600 mg) are prescribed for
one week.
After a period of approximately six
months, during which new bone formation is obtained and completed, the patient undergoes a second procedure for
the removal of the membrane and fixation system, completing soft-tissue management (Figs. 15, 16).
Results
The goal of this study was to describe the
results and complications that occurred
both during and after surgery in 127
cases of vertical GBR with non-resorbable
membranes, until their removal. Certain
complications in a considerable percentage of cases can lead to the failure of the
entire regenerative procedure. In order to
list and analyze them, the classification
proposed by Fontana et al. (2011)20 was
used.
Beyond the normal sequelae associated
with surgery (edema, blood extravasation and hematoma), neurological complications (B, Fontana 2011) occurred in
three cases (2.4 percent). Paresthesia is
believed to have been related to the release and elevation of the vestibular flap,
which most likely caused the stretching
of mental nerve fibers. In all three cases,
the symptoms of paresthesia subsided
one month after the surgery.
During the healing period, no membrane exposure occurred in any of the
cases (no Class I, II or III complications,
Fontana 2011). In nine cases (7.1 percent),
graft sepsis occurred in the absence of
membrane exposure (Class IV, Fontana
2011). All Class IV complications occurred
during the first month after the regenerative procedure.
B5
Clinical
XXXXX
Implant Tribune U.S. Edition | June 2013
About the authors
Fig. 13
Fig. 14
Dr. Marco Ronda graduated with a degree in
medicine from the University of Verona. A oneyear course in advanced surgery, taught by Dr.
Massimo Simion, and a Masters course in Regenerative Surgical Techniques at the University of
Pennsylvania are among the many specialization
Fig. 15
Fig. 16
courses he has attended. Ronda periodically gives
lectures and provides practical training courses in
implantology and bone-regeneration techniques
Discussion
The objective of this retrospective analysis is to focus on the complications associated with the surgical technique of vertical regeneration with non-resorbable
membranes in order to evaluate the level
of surgical predictability associated with
this procedure in view of the complexity
and difficulty in augmenting the posterior ridge.
From the analysis of the results described, the general percentage of failure
was 7.1 percent.
However, it is evident that with the
application of conventional passivation
techniques, and the introduction of the
new lingual flap management technique,
the extent of coronal displacement of
the flaps guarantees the specialist a sufficient quantity of tissue to perform a
tension-free suture above the regeneration area.
This is confirmed by the fact that no
membrane exposure occurred in the
127 cases analyzed. The primary cause of
failure of this technique, from the analysis of our data, is the bacterial contamination of the graft-membrane-implant
complex in its entirety.
Contamination can already occur during surgery (inappropriate handling of
surgical instruments, graft contamination as a result of bacteria present in saliva) or during the postoperative phase
(failed primary closure of the flaps or early exposure of the membrane). As seen,
the appropriate management of soft
tissue allows for an entirely passive and
hermetic primary closure of the flaps, as
well as its maintenance, for the entire duration of the healing period.
The problem yet unresolved is that of
the cases in which graft sepsis occurs, despite flap closure being perfectly maintained.
In this situation, which always mani-
at his practice in Genoa. He is also invited to
fests itself during the first month after
the procedure, intra-operative graft
contamination plays a fundamental
role. Given the difficulty in keeping the
surgical area completely isolated from
salivary contamination during the GBR
procedure (above all, in the posterior
mandible), the reduction of surgical time
is one of the keys for minimizing the risk
of infection.
In this regard, it could be useful to harvest autologous bone from a donor site,
which is not from the actual area of regeneration, prior to the GBR procedure
(with an inevitable increase in morbidity), or the use of commercial bone grafts
alone, with the objective of entirely eliminating both autologous bone harvesting
and the risk of infection associated with
prolonged operating times.21
speak at many national and international meetings and cooperates with several Italian universities including Milan, Trieste, Modena, Genoa and
Pisa, and he is an adjunct professor at Bologna
University.
The International Journal of Periodontics & Restorative Dentistry has published his study regarding a new surgical technique of lingual flap
management that has been proven to increase
bone volume in all cases. He is also the author of
an article that was published in the Clinical Oral
Implants Research journal that compares expanded PTFE and dense PTFE in guided bone regeneration. He may be contacted at mronda@
panet.it.
Conclusions
The current flap passivation techniques
available to the specialist have significantly reduced the percentage of failure
associated with early exposure of the
membrane.
Therefore, we can surmise that vertical GBR is a realistically feasible solution
in regard to surgical success (treatment
results’ stability over time has already
been extensively demonstrated), despite
the technique being considered highly
“operator-sensitive.”
The fact that vertical GBR is a difficult
procedure is not, by any means, to be
underestimated. It requires extensive
knowledge and should be carried out
after appropriate training, which must
enable the specialist to acquire a complete theoretical and practical knowledge
both in the fields of periodontology and
implant dentistry.
Dr. Claudio Stacchi graduated in dentistry
(DDS) and specialized in oral surgery (MSc) at the
University of Trieste (Italy). He is contract professor in oral implantology since 2007 at the School
of Dentistry and at the Master Program in Oral
Surgery at the University of Trieste. He is an active founding member of the International Piezosurgery Academy, active member of the Academy of Osseointegration, member of the
International Team for Implantology (ITI), member of the Italian Society of Osseointegrated Implantology (SIO) and member of the Italian Soci-
References are available upon request
from the publisher.
ety of Oral Surgery and Implantology (SICOI).
Stacchi is a reviewer of the International Journal
of Periodontics and Restorative Dentistry and of
‘The current flap passivation techniques available to the
specialist have significantly reduced the percentage of failure
associated with early exposure of the membrane.’
the Journal of Oral Implantology. He is also author
of several publications on indexed journals and a
speaker at national and international congresses
on oral surgery and implantology topics. His professional practice is limited to periodontology and
implantology at the Dental Clinic of the University of Trieste and at his private office in Gorizia.
[6] =>
[7] =>
Implant Tribune U.S. Edition | April 2013
industry
B5
[8] =>
industry
B8
Implant Tribune U.S. Edition | June 2013
Implant position
in the esthetic zone
Establishing a treatment plan is paramount
By Siamak Abai, DDS, MMedSc
Since the advent of modern root form
osseointegrated implant dentistry in
1952, clinicians have strived for improvements in implant positioning in the esthetic zone to achieve predictable restorative and esthetic results.
Years of clinical experience in congruence with controlled clinical studies have helped establish parameters as
a guide for these results. Establishing a
treatment plan and clinical protocol prior to implant placement is paramount.
Treatment planning traditionally begins with comprehensive medical and
dental evaluations, articulated diagnostic casts, radiographs, cone-beam computed tomography (CBCT) scans and
a diagnostic wax-up. Patient demands
must be taken into consideration prior to
surgery, and pre-surgical mockups may
be necessary to convey the information
to the patient.
The advancement of CBCT technology
has led dentistry into a new realm of
dimensional accuracy. In combination
with the use of a surgical or guided stent,
proper 3-D positioning of an implant has
led to more accurate clinical results.
The importance of the implant position can be manifested in the four
dimensionally sensitive positioning
criteria: mesiodistal, labiolingual and
apico-coronal location, as well as implant angulation.1 The ultimate goal is
not only to avoid sensitive structures,
but to respect the established biological
principles to achieve esthetic results.
Mesiodistal criteria
Correct implant position in a mesiodistal
orientation allows the clinician to avoid
damaging adjacent critical structures. A
minimum distance of 1.5 mm between
implant and existing dentition prevents
damage to the adjacent teeth and provides proper osseointegration and gingival contours2–4 (Fig. 1a).
Distances of less than 3 mm between
two adjacent implants leads to increased
bone loss and can reduce the height of
the inter-implant bone crest. A distance
of more than 3 mm between two adjacent implants preserves the bone, giving
a better chance of proper interproximal
papillary height (Fig. 1b).
Labiolingual criteria
An implant placed too far labially can
cause bone dehiscence and gingival recession while an implant placed too far
lingually can cause prosthetic difficulties. A thickness of 1.8 mm of labial bone
is critical in maintaining an implant
soft-tissue profile5 (Fig. 2).
Labially oriented implants compromise the subgingival emergence profile
development, creating long crowns and
misalignment of the collar with respect
to the adjacent teeth.6
Apico-coronal criteria
Peri-implant crestal bone stability plays
a critical role in the presence of interdental papilla.7 Implants placed too shallow
may reveal the metal collar of the implant through the gingiva. Countersinking implants below the level of the crestal bone may give prosthetic advantages
but can lead to crestal bone loss.
The ideal solution would be the placement of an implant equicrestal or subcrestal to the ridge. However, the existing
microgap at the implant abutment junction leads to bone resorption because of
peri-implant inflammation.8 It is suggested an implant collar be located 2 mm
apical to the CEJ of an adjacent tooth if no
gingival recession is present9 (Fig. 3).
Fig. 1a: Minimum distance of 1.5 mm
between implant and existing dentition.
Photos/Provided by Glidewell Laboratories
Fig. 5a: Inclusive Tapered Implant
at placement.
Fig. 1b: Minimum distance of 3 mm between
two adjacent implants.
Fig. 5b: Inclusive custom healing abutment
in place.
Implant angulation
Implant angulation is particularly important in treatment planning for screwretained restorations. Implants angled too
far labially compromise the placement
of the restorative screw while implants
angled too far lingually can result in unhygienic and unesthetic prosthetic design.
For every millimeter of lingual inclination, the implant should be placed an additional millimeter apically to create an
optimal emergence profile.10 In general,
implant angulation should mimic angulation of adjacent teeth (Fig. 4). Furthermore, maxillary anterior regions require
a subtle palatal angulation to increase
labial soft-tissue bulk.11
Inclusive Tooth Replacement
Solution
Fig. 2: Proper labiolingual placement with
1.8 mm thickness of labial bone.
Fig. 3: Lateral view of implant placed with
the collar at the level of crestal bone with
adjacent teeth CEJ 2 mm coronal to the collar
of the implant.
The Inclusive® Tooth Replacement Solution was developed by Glidewell Laboratories as a complete, prosthetically
driven method of restoring missing
dentition. The solution is composed of
treatment planning, implant placement,
patient-specific temporization and the
definitive restoration (Figs. 5a–5f).
When utilizing the comprehensive
range of Inclusive Digital Treatment
Planning services, the clinician has absolute and precise control of each step.
The clinician has control of the four dimensions of implant placement in the
esthetic zone, creating a consistently predictable result.
To read the full article, go to www.
inclusivemagazine.com. References are
available from the publisher.
Fig. 5c: Contoured soft-tissue sulcus after
healing.
Fig. 5d: Screw-retained IPS e.max® crown
(Ivoclar Vivadent; Amherst, N.Y.) in place.
Fig. 5e: PA to verify seating of crown.
Fig. 4: Proper implant angulation with screw
access in the cingulum area.
Fig. 5f: Buccal view of final restoration at
delivery.
[9] =>
Glidewell
[10] =>
B10
industry
Implant Tribune U.S. Edition | June 2013
Scenes from ICOI Spring Symposium
Helping practices create more smiles are Springstone Patient Financing team members, from
left, Brian Pinkham, Maria Siannas and Anne Haines.
ICOI’s co-chairman Dr. Kenneth W.M. Judy provides the main podium’s opening comments on
the first day of the Spring Symposium.
Photos by
Sierra Rendon,
Managing Editor
Eric Townsend, i-CAT director of sales in
California, shows off the company’s i-CAT
FLX cone-beam 3-D system.
Rob Rhees, Tina Rodgers-Dobies and Joe
Spehar introduce Intra-Lock’s products to
ICOI attendees.
Kevin Downs, left, and Anthony Fiumani at
DENTSPLY Implants’ booth.
ZEST Anchors teaches ICOI attendees all about
its narrow-diameter overdenture implants
By ZEST Anchors staff
The latest technology in narrowdiameter implants was the highlight of
the ZEST Anchors Pre-Symposium program at the ICOI Spring Symposium.
The sold-out program held on May 16
at the Bellagio Hotel in Las Vegas was
the ideal gathering place for clinicians
wanting to learn more about treating
the large overdenture patient population with the latest technology in
narrow-diameter implants.
The four-hour program, titled “Utilizing The Next Generation of NarrowDiameter Overdenture Implants to
Expand Your Practice Revenue Opportunities,” was presented by Drs. Ara
Nazarian and Paresh Patel.
It reviewed the demographics of the
quickly expanding aging edentulous
population, as well as products and
techniques that clinicians can incorporate into their practices to help gain
patient acceptance for the implant-retained overdenture treatment option.
Of particular interest to attendees
was learning how the new LOCATOR®
Hands-on materials at the ZEST Anchors
pre-symposium program.
The sold-out ZEST Anchors pre-symposium program held May 16 at the ICOI Spring
Symposium in Las Vegas. Photos/Provided by ZEST Anchors
Overdenture Implant System, incorporating narrow-diameter dental implants and a world-leading overdenture
attachment — LOCATOR, culminates
into a complete system offering new
options for patients with limited fi-
nances or those who decline bone
grafting.
“When patients don’t accept an implant-retained treatment option, they
are rejecting a better treatment in the
long-run,” said Steve Schiess, president
and CEO of ZEST Anchors. “We believe
the LOCATOR Overdenture Implant
System serves both the patient and
practice by offering an effective, economical technique to secure patient’s
dentures, ultimately resulting in increased treatment acceptance and increased practice revenue growth.”
The program concluded with a
question-and-answer session with the
presenters, as well as an optional opportunity to utilize LOCATOR Overdenture Implant system instrumentation
to place the LOCATOR Overdenture Implant in sawbone mandibles.
[11] =>
ICOI review
Implant Tribune U.S. Edition | June 2013
B11
Scenes from ICOI Spring Symposium
PhotoMed’s Rex Koskela, left, and Tony Aguilar help ICOI attendees
find all the best digital cameras for their dental needs.
Glidewell’s Jaclyn Belida, RDA, and Diana
Ruelas introduce attendees to the company’s clinical and laboratory products.
Impladent staff teach ICOI attendees about the company’s products,
such as OsteoGen, OsteoTape, CollaForm and OsteoMend XTD
Achilles Tendon Collagen.
Implant Direct Sybron International had a
team ready to help answer questions and fill
orders at the company’s booth.
Meisinger USA President Alex Miller, right,
and his brother Matt Miller celebrate
Meisinger’s 125th birthday at the symposium.
Keystone Dental’s Todd Luger, left, and Marc
Sabelli help attendees find immediate molar
implants at the company’s booth.
The Dentis staff at the company’s booth.
AD
[12] =>
future events
B12
Implant Tribune U.S. Edition | June 2013
ICOI to host its World Congress
XXX in Istanbul, Turkey
Topics will include
immediate loading,
bone grafting, 3-D
imaging, guided
surgical applications,
occlusion and more
AD
By Craig Johnson
ICOI Executive Director
T
he International Congress of
Oral Implantologists (ICOI) will
convene its World Congress XXX
in Istanbul, Turkey. The dates
for this three-day event are Oct. 3-5. The
venue for the congress will be the Istanbul Lutfi Kirdar International Convention
and Exhibition Centre (ICEC) located in
the heart of the European side of this exciting dual-continent city.
Situated on one of the world’s busiest waterways, Istanbul is flanked by the
Black and Marmara Seas and separated by
the famous Bosphorus, or Istanbul, Strait.
Two-thirds of Istanbul’s 12 million
people live on the European side of town,
while one-third resides on the Asian side.
ICOI’s World Congress will be held at the
perfect time of year in Istanbul, and attendees are assured of favorable weather.
An endless array of tourist opportunities awaits the delegates to the congress.
Istanbul is home to the famous Blue
Mosque, the Hagia Sophia Museum, the
Topkapi Palace, the Grand Bazaar and the
Egyptian Spice Market, among other attractions.
The theme for ICOI’s 30th World Congress is “International Innovation and
Perspectives for Implant Reconstruction,” and the meeting features a worldclass international faculty. The scientific
program was designed by Dr. Scott Ganz
from Fort Lee, N.J., and Dr. Ady Palti,
Baden-Baden, Germany.
The Scientific Committee, in concert
with the co-hosts for this World Congress,
the Turkish Society of Oral Implantology
and the Meffert Implant Institute, has
put together a lineup of speakers who
will present on innovative topics that
include immediate loading, bone grafting, three-dimensional imaging, guided
surgical applications, occlusion and
much more.
Main podium lecturers include Drs.
Shinichi Abe from Japan, Volkan Arisan
from Turkey, Nabil Barakat from Lebanon, Georg Bayer from Germany, Fred
Bergman from Germany, David Garber
from the United States, Aslan Gokbuget
from Turkey, Cuneyt Karabuda from
Turkey, Christian Makary from Lebanon, Stavros Pelekanos from Greece,
Marco Rinaldi from Italy, Nigel Saynor
from the United Kingdom, Georgios
Romanos from the United States, Avi
Schetritt from the United States, Deborah Schwartz-Arad from Israel, Gerard
Scortecci from France, Marius Steigmann from Germany, Jon Suzuki from
the United States, Istvan Urban from
Hungary and Gerlig Widmann from
Austria.
The congress will convene at 1:30 p.m.
on Thursday, Oct. 3. However, on Thursday morning, delegates will get the opportunity to attend several pre-congress
courses given by our sponsors.
Scientific table clinics and poster
presentations will also be a part of the
program. Those interested in presenting either a poster or table clinic should
visit the ICOI web site, www.icoi.org, for
guidelines and application forms or email Dr. Avi Schetritt at dravi@perio.org.
The social event of the World Congress
will be held at the exciting, slightly
naughty, but oh so much fun, Palas Cahid. This popular night spot (we will be
taking over the entire club) is located
near the ICEC, but buses will take guests
there, leaving from the ICEC at 7:45 p.m.
on Friday, Oct. 4.
Cocktails will be served starting at 8
p.m. followed by dinner … and then the
fun begins. A stage show will entertain
the guests until midnight.
For complete information on ICOI’s
World Congress XXX, visit the website at
www.icoi.org.
[13] =>
DENTSPLY
[14] =>
Zest
)
[page_count] => 14
[pdf_ping_data] => Array
(
[page_count] => 14
[format] => PDF
[width] => 765
[height] => 1080
[colorspace] => COLORSPACE_UNDEFINED
)
[linked_companies] => Array
(
[ids] => Array
(
)
)
[cover_url] =>
[cover_three] =>
[cover] => ![Implant Tribune U.S. No. 6, 2013]()
[toc] => Array
(
[0] => Array
(
[title] => ICOI heats up spring in Vegas
[page] => 01
)
[1] => Array
(
[title] => Surgical predictability of vertical GBR in the posterior mandible
[page] => 01
)
[2] => Array
(
[title] => Implant position in the esthetic zone
[page] => 08
)
[3] => Array
(
[title] => Scenes from ICOI Spring Symposium
[page] => 10
)
[4] => Array
(
[title] => ICOI to host its World Congress XXX in Istanbul - Turkey
[page] => 12
)
)
[toc_html] =>
Table of contents
[toc_titles] => ICOI heats up spring in Vegas
/ Surgical predictability of vertical GBR in the posterior mandible
/ Implant position in the esthetic zone
/ Scenes from ICOI Spring Symposium
/ ICOI to host its World Congress XXX in Istanbul - Turkey
[cached] => true
)