implants international No. 1, 2022

Cover / Editorial / Content / Radicular transplantation - The use of dental roots in the treatment of bone insufficiency / Partial extraction therapy and implant treatment in the maxilla / Resolving severe bone atrophy with the cortical lamina technique and innovative materials / Type 4 implant placement with custom healing abutment - A completely digital prosthetic workflow / Maxillary molar replacement with an implant and immediate restoration / Periodontitis and peri-implantitis in implant dentistry / Laser protocol for peri-implantitis treatment / Manufacturer News / Industry / Events / News / Imprint

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issn 1868-3207 • Vol. 23 • Issue 1/2022

implants
international magazine of oral implantology

case report

Type 4 implant placement

interview

Periodontitis and peri-implantitis
in implant dentistry

events

Education across borders

1/22

[2] =>

BA SURFACE

AFI Avenir Park, Radlická 740/113c, 158 00, Prague 5, Czechia
T: +420 296 238 802
www.osstem.eu

[3] =>

editorial

Dr Georg Bach
President of the DGZI

Same procedure as every year?
Dear colleagues, when writing the editorial for this
first issue of our implants—international magazine of
oral implantology, the British cabaret sketch Dinner for One
came to mind. Each time the legendary butler James
asks the question “The same procedure as last year?”,
he is answered with the catchphrase “The same procedure as every year, James!” by the lady of the house.
Indeed, the situation in which we now find ourselves
at the beginning of 2022 is reminiscent of exactly one
year ago. In view of the agonising uncertainty, I too
have the fear that it could be the same again at the
beginning of 2023—the same procedure as...—because
the fact is that the pandemic will not let us out of its
clutches.

Do we have cause for resignation? There might be plenty of
reasons, but resignation does not befit the spirit of our profession. Dentists are creators, and this should and will remain so. Let us—despite the adverse conditions—approach
the new year positively and with vigour. The realisation that
we are allowed to practise one of the most beautiful professions of all and the joy of our special discipline, dental implantology, allow us to generously overlook a thing or two.

But what has happened in this past year, from editorial
to editorial? The pandemic has changed our everyday
lives and that of our practices for yet another year; it has
thoroughly shaken things up again. But fortunately, there
have also been beautiful moments, like the German
Association of Dental Implantology’s (DGZI’s) grandiose
birthday congress in Cologne last autumn, when the
DGZI family celebrated the 50 plus one anniversary with
many friends.

Warm and collegial greetings,

Let us look forward to an exciting year and to many personal interactions with the members of our large and
international DGZI family! I wish you well in your private
and professional lives, success, much joy and, above all,
the best of health.

Dr Georg Bach

1 2022

[4] =>

| content
editorial
Same procedure as every year?

03

Dr Georg Bach

case report
page 24

Radicular transplantation

06

Dr Renaud Girieud

Partial extraction therapy and implant treatment in the maxilla

12

Dr Snježana Pohl, Dr Mijo Golemac, Dr Daniela Grgi ć Miljani ć,
Dr Pantelis Petrakakis & Prof. Jelena Tomac

Resolving severe bone atrophy

18

Dr Roberto Rossi, Dr Giovanni Franzone & Stefano Giulini
page 32

Type 4 implant placement with custom healing abutment

24

Dr Pál Nagy

Maxillary molar replacement with an implant and immediate restoration 32
Dr Leandro Soeiro Nunes

interview
page 44

Periodontitis and peri-implantitis in implant dentistry

36

An interview with Dr Inga Boehncke

Laser protocol for peri-implantitis treatment

38

An interview with Dr Michał Nawrocki

news

Cover image courtesy of
bredent medical GmbH & Co. KG /
www.bredent-implants.com

manufacturer news

40

news

48

industry
Osstem Europe: New European headquarters in Prague

43

Henrik Eichler
issn 1868-3207 • Vol. 23 • Issue 1/2022

implants

1/22

events

international magazine of oral implantology

Education across borders

44

Janine Conzato

about the publisher

case report

Type 4 implant placement

interview

Periodontitis and peri-implantitis
in implant dentistry

imprint

events

Education across borders

04

1 2022

50

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[1] Wen et al. J. Periodont. 2019, 1, 734.
[2] Schmitt et al. Clin Oral Implants Res. 2013, 24, 576.
[3] Kloss et al. Clin Oral Implants Res. 2018, 29, 1163.
[4] Solakoglu et al. Clin Implant Dent Relat Res. 2019, 21, 1002-1016.
[5] Kloss et al. Clin Case Rep. 2020, 8, 5.
References available at: www.biohorizonscamlog.com/references_minerossa
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[6] =>

| case report

Radicular transplantation
The use of dental roots in the treatment
of bone insufficiency
Dr Renaud Girieud, France

Fig. 1: Extracted root for radicular graft. Fig. 2: Radicular grafts are polarised. Fig. 3: Space between the graft and ridge filled with a filling material.

Treating bone insufficiency is a familiar challenge for
all implant practitioners. Such insufficiency can compromise the placement of an implant, its long-term viability
and even the anticipated aesthetic outcome. In summary, where there is a bone defect, there are two broad
treatment types available to us. Firstly, there is guided
bone regeneration. This combines a membrane and a
biomaterial, of which there are several variants, depending on the type of membrane and the materials used.1
Secondly, we can use autogenous bone in block or
chip form as an onlay or supporting structure, according
to the technique developed by Prof. Fouad Khoury.2

Depending on the skill and experience of the surgeon,
these various techniques can necessitate several operations, and it can be months before an implant can be
placed into the arch.
However, there is a third way to treat bone insufficiency,
based on the principle of ankylosis and root resorption,
by block grafting the roots of the patient’s own teeth.
We will use the term “radicular graft” to refer to the root
fragments used. This technique was originally described
by the team working with Prof. Frank Schwartz, who
proposed the grafting of dental roots in pre-implant

Fig. 4: Serious risk of dehiscence. Fig. 5: Low residual bone thickness in the vestibular area of the implants. Fig. 6: The roots were shaped to fit the defect and
fixated at the insertion site using osteosynthesis screws.

1 2022

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| case report

Fig. 7: A #4/0 rapidly resorbed braided thread was used for the sutures. Fig. 8: Healing abutments were connected to the implants. Fig. 9: The osteosynthesis
screws were removed.

surgery in 2016.3 Through three clinical cases, we will
discuss the scope of application for radicular grafts as
we use them in our daily work in the dental surgery and
how this has changed in comparison with the technique
described by the team working with Prof. Schwartz.3
Our aim is to improve our patient’s surgical experience
and, whenever possible, to achieve bone augmentation
and implant placement concomitantly. We have deliberately restricted our application to transverse bone in
sufficiency.

Materials and method
First, the root must be extracted; this will be the future
radicular graft (Fig. 1). This is then prepared by polishing
it gently to clean it and remove calculus deposits. The
coronal section and any soft or decayed parts are removed.3 The root is cut into two using a disc. A diamond
drill is used to clean the canals, and any debris from fillings is removed.3 If necessary, the root is cut again to
shape it to match the defect, and holes are drilled into it
for the osteosynthesis screws.3 The graft is fixated at the
insertion site using osteosynthesis screws with the dentine in contact with the bone ridge and the cementum in
contact with the soft tissue.3 Radicular grafts are actually
polarised: the dentine must be in contact with the bone
ridge to allow ankylosis, while the cementum, in contact
with the soft tissue, acts as a barrier to prevent graft
resorption by the soft tissue (Fig. 2). If the graft is being

used as a biological membrane and is intended to form
a supporting structure, the space between the graft and
the ridge is filled with a filling material (Fig. 3).

Case 1
A 36-year-old patient with teeth #36 and 37 missing and
transverse bone insufficiency in the existing gap was
treated. It would have been possible to place implants,
but this would have left only a thin layer of vestibular bone
at the neck of the implants. There was a serious risk of
dehiscence, which can compromise the survival of the
implant in the arch (Fig. 4).
We had three alternative courses of action: a bone block
graft from the mandibular ramus,2 a segmental osteo
tomy4 or a radicular graft, knowing that tooth #46 could
not be saved. We chose the third option because it allowed for simultaneous implant placement and bone reconstruction. A large flap was elevated to assess the gap
in the bone and in anticipation of closing the flap on an
augmented ridge. Two implants were placed as normal
despite the low residual bone thickness in the vestibular
area of the planned positions for the implants (Fig. 5). The
roots of tooth #46 were extracted atraumatically (root
separation, use of piezo-surgery, etc.) and were then
prepared as described. The roots were shaped to fit the
defect and fixated at the insertion site using osteosynthesis
screws (Fig. 6).3 The flap was mobilised and stretched

Fig. 10: Transverse bone insufficiency on the ridge of tooth #22. Fig. 11: Full-thickness flap elevation and extraction of teeth #23 and 24. Fig. 12: Edges of
the radicular graft in contact with the alveolar bone.

1 2022

[9] =>

case report

Figs. 13 & 14: The osteosynthesis screws were not removed because they were not visible under the gingiva. Fig. 15: Radicular fracture at tooth #13 under
a crown and with a fistula opposite.

to achieve edge-to-edge closure without tension, and a
#4/0 rapidly resorbed braided thread was used for the
sutures (Fig. 7). Four months after the bone augmentation
and implant placement, healing abutments were connected to the implants and the osteosynthesis screws removed (Figs. 8 & 9). During the operation, time was taken
to perform a visual check that ankylosis of the radicular
grafts had been successful and that these were sound.
Finally, a CBCT assessment was performed. The prosthesis was fitted by our colleague a few weeks later, once
the soft tissue had healed.

Case 2
A 62-year-old patient with a bridge from tooth #21 to
tooth #27 requiring replacement, teeth #21, 23, 24 and 27
with abutments and the crown of #22, 25 and 26 missing,
was treated. The ridge of tooth #22 exhibited a transverse
bone insufficiency which would have allowed the placement of an implant, but the aesthetic outcome would
have been unsatisfactory (Fig. 10). First, the bridge of
tooth #24 was sectioned distally and the root of tooth #27
extracted. After a two-month healing period, the patient
was treated with simultaneous extraction, implantation
and aesthetic restoration. The bridge was sectioned distally at tooth #21, a full-thickness flap was elevated and
the teeth #23 and 24 were extracted, allowing the bone
defect at tooth #22 to be assessed (Fig. 11). Implants
were placed into sites #22, 24 and 27. The root of tooth
#23 allowed us to compensate for the bone defect and
achieve a satisfactory aesthetic result. The root was prepared as described. The radicular graft was fixated away

from the ridge, the edges of the graft in contact with the
alveolar bone (Fig. 12). The spaces between the ridge, the graft
and the alveoli were filled with a synthetic, hydroxyapatite-
based biomaterial, the flap was stretched and sutured
around the healing abutments, an impression was taken,
and a temporary prosthesis from implant #22 to 27 was
made during the day by the laboratory and fitted the same
evening. The stitches were removed on the tenth day and
the bridge after two months to check for the successful
osseointegration of the implants. The osteosynthesis
screws were not removed in this case because they
were not visible under the gingiva (Figs. 13 & 14).
A CBCT assessment was performed after six months
to check that the graft had taken successfully. Finally,
our colleague fitted the definitive prosthesis.

Case 3
A 55-year-old patient with a radicular fracture at tooth #13
under a crown and a fistula opposite was treated (Fig. 15).
The plan was to treat this patient with simultaneous extraction, implantation and aesthetic restoration. Unfortunately, as sometimes happens and despite the pre
cautions taken, a large part of the vestibular wall of the
alveolus was extracted with the root, creating a significant bone defect. A full-thickness flap was elevated and
the implant placed. The root was prepared and fixated
with an osteosynthesis screw to replace the lost wall
(Fig. 16). The space between the root and the implant was
filled with a hydroxyapatite-based biomaterial (Fig. 17).
This bone reconstruction was combined with a con
nective graft. The flap was stretched and sutured with a

Fig. 16: Preparation of the root and fixation with an osteosynthesis screw to replace the lost wall. Fig. 17: The space between the root and the implant was filled
with a hydroxyapatite-based biomaterial. Fig. 18: A #5/0 resorbable braided thread was used for the sutures.

1 2022

[10] =>

| case report

Figs. 19 & 20: The osteosynthesis screw was visible under the gingiva and was thus removed after six months. Fig. 21: Fitting of the definitive prosthesis.

#5/0 resorbable braided thread (Fig. 18). An impression
was taken and a temporary screw-retained prosthesis
was made during the day by the laboratory and fitted the
same evening. The sutures were removed on the tenth
day. The temporary prosthesis was removed after two
months to check that the implant had been successfully
integrated into the bone. The osteosynthesis screw was
visible under the gingiva and was removed after six
months (Figs. 19 & 20). A CBCT assessment was performed at the same time. The radicular graft had ankylosed perfectly and the ridge regenerated ad integrum.
The definitive prosthesis was fitted by our colleague
(Fig. 21).

Discussion
Radicular grafts as graft materials have many of the same
characteristics as autogenous bone, plus some of the advantages of biomaterials. Moreover, they are autogenous
materials consisting of a mineral fraction, an organic fraction (the patient’s own proteins) and water, in proportions
comparable to those found in alveolar bone.3 They are
thus identified as part of the patient’s body and do not
cause an inflammatory response as occurs with foreign
bodies. They are highly compatible with the soft tissue
that covers them if no sharp or cutting edges are left when
the wound is closed. They allow for remarkably highquality, fast healing. They can be used in two different ways,
either as a stand-alone block or as a biological membrane
in combination with a biomaterial.3, 5, 6 Initially, there is ankylosis of the root on the ridge, then centrifugal resorption
replaces this.3 The root is resorbed and replaced by bone,
as expected under the principle of root resorption. What
differs is that when the graft is fixated at a distance from
the ridge we also observe the formation of new bone
between the dentine and the graft. The material exhibits
osteoconductive and osteoinductive properties.3, 5, 6 The
grafts are easy to extract. There is no specific protocol
or storage period: during the operation, before they are
used, they can be left quite safely open to the air in the
operating theatre with no consequences. These solid
blocks are unaffected by muscle tension and are easy to
shape with a bur or a disc. They make it possible to restore the horizontal shape of the ridge. They have a certain plasticity, which means that they can be flexed slightly
to create curvature without breaking them.3, 5 Their slow

1 2022

resorption gives them great volumetric stability over time,
so the volume of the graft extracted always regrows.5, 7
The major downside is their availability. Whether from
roots extracted during a dental extraction or implantation,
third molars or condemned teeth, this substance is only
available in limited quantities.
In conclusion, as demonstrated in these three cases, this
technique has enabled us to combine implant placement
consistently and successfully with bone reconstruction
and even to fit temporary prostheses on the same day.
We have been able to achieve our surgical, mechanical
and aesthetic objectives while minimising the trauma of
surgery for our patients, since they only undergo one
operation. Given the characteristics and the many ad
vantages associated with these radicular grafts, this
technique is now our treatment of choice when condemned roots are available. In this first article, we have
chosen to present only simple cases to explain the technique. However, having now used it to treat several dozen
patients, we have been able to broaden the scope of
what we can accomplish with this technique. It has allowed us to treat complex aesthetic cases which would
previously have been impossible to treat with surgery in
a straightforward, predictable way. We intend expanding
on this subject in a second article.

about the author
Dr Renaud Girieud has a European
master’s degree in dental implantology, clinical surgery, prosthetics and
bone grafts from Goethe University in
Frankfurt am Main in Germany. He received
university diplomas in maxillofacial surgical
rehabilitation from Paris Diderot University and in clinical periodontics from
Aix-Marseille University, both in France.
Author details

contact
Dr Renaud Girieud
Eyguières, France
girieud.renaud@wanadoo.fr

Literature

[11] =>

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[12] =>

| case report

Partial extraction therapy and
implant treatment in the maxilla
Two years of follow-up
Dr Snježana Pohl, Dr Mijo Golemac, Dr Daniela Grgi ć Miljani ć, Dr Pantelis Petrakakis &
Prof. Jelena Tomac, Croatia & Germany

Introduction

Patient situation

Various techniques and methods based either on grafting of the fresh extraction socket (ridge preservation) with
different materials and delayed implant placement or on
immediate implantation with grafting of the gap between
implant and socket wall have been applied in order to prevent ridge alterations after tooth extraction. However, insights concerning superiority of the type of grafting technique or material are scarce.1, 2 Partial extraction therapy,
leaving either the whole root (root submergence therapy)
or the buccal part of the root (socket shield technique)
of hopeless teeth inside the extraction socket, may have
clinical significance as an alternative to conventional preservation procedures. These techniques are based on the
observation, made already 80 years ago, that resorption
of the bundle bone within the extraction socket may be
reduced by leaving the root or a root fragment inside
the socket, attached by a healthy periodontal ligament
to the buccal socket wall, providing good blood supply
to the hard and soft tissue.3–5 This procedure was forgotten until 2007, when Salama et al. published a case report showing an implant-supported bridge with perfectly
maintained hard and soft tissue by leaving a root submerged in the pontic area.6 Likewise, the socket shield
technique has been shown to be an efficient technique for
reducing the amount of post-extraction ridge resorption
as well.5 The present case report introduces ridge preservation with root submergence therapy and the socket
shield technique, as well as augmentation with particulate autologous dentine, in the course of an implant and
prosthetic rehabilitation in a partially edentulous maxilla.

The 58-year-old, non-smoking and systemically healthy
female patient was referred by her dentist to our dental clinic for implant treatment. The patient’s main complaints were poor aesthetics in the upper jaw, including
a high smile line and distinct tooth pattern anomalies in
the anterior maxilla (Figs. 1 & 2), as well as masticatory
discomfort. Teeth #17, 15 and 27 were missing and had
not undergone any prosthetic treatment, whereas the five
missing teeth in the premolar and molar areas on both
sides of the mandible had been replaced with a removable partial denture. All remaining teeth were affected by
Stage IV periodontitis according to the 2017 Classification
of Periodontal and Peri‐implant Diseases and Conditions,
displaying a mean periodontal pocket depth of 5.6 mm.7
Mean bleeding on probing and mean plaque index were
70% and 80%, respectively. With respect to periodontal
parameters, as well as to oral hygiene measures (visible
calculus and dental plaque), the patient’s oral hygiene
was graded as poor. The patient had been treated elsewhere with two implants in the posterior maxilla in order
to replace the right first premolar and first molar (Fig. 3).
She had a thick flat biotype, according to a definition
introduced in 1977.8, 9

1

2

Diagnostics and treatment planning
After obtaining informed consent from the patient, we
would start dental rehabilitation in the maxilla, and we
opted for a two-stage surgical approach after initial therapy.
Initial therapy would consist of systematic periodontal

Fig. 1: Patient’s initial situation, extra-oral aspect. Fig. 2: Patient’s initial situation, intra-oral aspect.

12

1 2022

[13] =>

case report

Fig. 3: Initial radiograph before treatment. Fig. 4: CBCT scan showing the bone condition of the maxillary teeth. Vertical resorption and reduced thickness of the
buccal bone plate of the right and left central incisors were evident. Fig. 5: Clinical situation after partial extraction of tooth #12, extraction of tooth #22, and root
submersion of teeth #11 and 21. Fig. 6: Clinical situation after extraction of teeth #24 and 25 and augmentation with autologous dentine. Fig. 7: Immediate implant
placement into the fresh extraction socket of tooth #22 after ridge grafting with autologous dentine. Fig. 8: Clinical situation after completion of first-stage surgery.

treatment and regular recalls with instructions and checks
for dental hygiene over a period of three months. The
first stage of rehabilitation of the maxilla would consist of
partial extraction therapy in conjunction with Type 1 implant placement in the regions of the teeth #12 and 22
according to the Proceedings of the Fourth ITI Consensus
Conference and ridge preservation in the region of teeth
#24 and 25 with particulate dentine, obtained and processed from the two extracted left maxillary premolar
teeth.10 Owing to increased tooth mobility and the obvious poor buccal bone volume, as displayed on the CBCT
scan (CRANEX 3D Ceph, Soredex, KaVo Kerr), regions
#11 and 21 were not suitable for the socket shield technique in conjunction with implant placement (Fig. 4). Both
central incisors were to be treated with the submerged
root technique instead, in order to prevent damage of the
buccal socket wall and volume loss of the alveolar ridge
after tooth extraction. With both roots in place, a physiological pontic site development for the definitive restoration
would be enabled. Based on periodontal re-evaluation
after the initial therapy, only the two maxillary canines
were considered worth preserving. The left first molar was
to be temporarily retained in order to serve, in conjunction
with the two canines, as an additional abutment tooth for
fixation of the temporary bridge during the healing period.
Crown preparation of the three remaining teeth would be

done before surgical treatment, in order to prefabricate
a temporary bridge for immediate fixed provisionalisation
after the first surgery. The second surgical stage would
consist of implant placement in region #24, performing
of the socket shield technique on the mesiobuccal root,
submersion of the distobuccal root and extraction of the
palatal root of tooth #26 before immediate implant placement. Definitive prosthetic treatment would be performed
after a transgingival implant healing period of at least three
months, applying a conventional implant loading protocol
with fixed bridges.11

Surgical intervention
Both surgical interventions were performed under local
anaesthesia, and antibiotic medication (a single dose of
2 g of amoxicillin) was administered 60 minutes before surgery. The first stage of rehabilitation of the maxilla involved
immediate implant placement in the post-extraction sockets of both lateral incisors in combination with the socket
shield technique for the right lateral incisor. Owing to an
increased tooth mobility of more than Grade II, the socket
shield technique was contra-indicated for the left lateral
incisor and both premolars. The clinical crowns of both
central incisors were decapitated, and the roots were carefully prepared with a round diamond bur under rinsing with

1 2022

[14] =>

| case report

13a

13b

Fig. 9: Radiograph after first-stage surgery. Fig. 10: Temporary bridge. Fig. 11: Clinical situation after a three-month healing period, displaying proper volume of
the alveolar ridge in the maxilla. Fig. 12: Clinical situation during second-stage surgery after flap elevation, displaying proper bone regeneration in the premolar
area after ridge preservation with autologous dentine. Figs. 13a & b: Histological images showing new bone formation in close contact with dentine particles.

sterile saline solution, until both cranial root edges reached
a distance of 3 mm from the gingival margin (Fig. 5). In the
right lateral incisor site, a socket shield was prepared as
described by Gluckman et al.12 The extracted premolars
were mechanically cleaned and then dried and processed
with the Smart Dentin Grinder (KometaBio) according to
the manufacturer’s recommendations.13 After implant site
preparation, particulate dentine was applied into the prepared left lateral incisor implant site, and both extraction
sockets of the left premolars (Fig. 6). Implant placement
was performed in the extraction sites of both lateral incisors with two BEGO Semados RSX implants (BEGO
Implant Systems) with a length of 13.00 mm and a diameter of 3.75 mm (Fig. 7). Peri-implant gaps were grafted with
particulate dentine autograft and sealed with platelet-rich
fibrin (PRF) membranes using the Poncho technique.14
After buccal and palatal tunnel preparation, the premolar
extraction sockets and submerged left central incisor root
were covered with PRF membranes, prepared according
to the Choukroun method (A-PRF, mectron) after centrifugation at 1,300 rpm for 13 minutes.15 The right central incisor was covered with a connective tissue graft harvested
from the palatal mucosa of the first quadrant. Covering
membranes and the connective tissue graft were introduced into the buccal and palatal tunnel preparations
and fixed with absorbable monofilament #5/0 suture
thread (Serafast, Serag Wiessner; Fig. 8). The postoperative radiograph showed adequate root submersion of the
central incisors, correct implant positioning in the lateral
incisor sites and proper filling of both premolar extraction
sockets (Fig. 9). The patient was provided with the fixed
provisional bridge (Fig. 10) and prescribed amoxicillin (1 g
three times a day for five days after surgical intervention).
Postoperative healing was uneventful.

1 2022

At the time of the second surgical intervention, three
months after the first surgery, no obvious volume loss
of the maxillary alveolar crest was noticed (Fig. 11).
Second-stage surgery was performed in the left posterior maxilla with an open flap approach. After elevation
of the mucoperiosteal flap, very good preservation of
bone volume was observed, indicating successful ridge
preservation by means of particulate dentine as the augmentation material (Fig. 12). Partial extraction therapy
was performed for the right first molar. After decapitation, socket shield therapy of the mesiobuccal root and
submersion of the distobuccal root was performed.
After extraction of the palatal root, the implant site was
prepared in the septum and the sinus membrane was
concomitantly lifted by the use of an osseodensification
protocol with Densah burs (Versah).15 After sinus grafting with Gen-Os (OsteoBiol), a particulate collagenated
corticocancellous bone mix of porcine origin, a BEGO
Semados RSX implant with a length of 13.0 mm and
a diameter of 4.5 mm was placed. Another BEGO
Semados RSX implant with a length of 13.0 mm and a
diameter of 4.1 mm was placed into the first premolar
region. In order to evaluate the remodelling process after ridge preservation with the dentine autograft histologically, a histological sample was harvested with a trephine bur from the first premolar region during implant
preparation. Histological analysis revealed new bone
formation in close contact with dentine particles and
no signs of inflammation or fibrous encapsulation of the
autologous augmentation material (Fig. 13). Immunohistochemistry was done in order to evaluate osteoblast
differentiation and bone formation. New bone formation was confirmed by osteoblasts, being marked by
antibodies against Osterix (Anti-Sp7/Osterix antibody,

[15] =>

case report

ChIP grade, ab22552; Abcam). All implants healed uneventfully during a period of four months.

Prosthetic treatment
Definitive prosthetic treatment was performed after
completion of implant healing with three CAD/CAMfabricated monolithic zirconia bridges (DD cubeX2,
Dental Direkt). The bridges were screwed on to BEGO
titanium base abutments (Figs. 14–16). Good fit of the
prosthetic superstructures was displayed in the radiograph after placement (Fig. 17). The two-year follow-up
examination in July 2019 revealed excellent aesthetic
and clinical soft-tissue conditions (Figs. 18–20). No radiographic bone loss had occurred at the implant sites
(Fig. 21). Neither the submerged central incisors nor the
distobuccal molar root displayed any signs of periapical
inflammation, and the patient reported no complications. The patient’s oral hygiene had improved significantly during the follow-up period.

closure of submerged roots with connective tissue grafts
or fibrin membranes, seems to be a prerequisite for a
rapid healing process and for successful submersion of
root segments.19, 20
Hinze et al. demonstrated in a cohort study successful
preservation of alveolar width and height by applying
the socket shield technique in conjunction with immediate implant placement, producing no midfacial recession or increased probing depths.21 The main concerns
with the socket shield technique still lie in the limited
evidence, specifically the need for randomised controlled
studies, in order to enable more evidence-based insights.

Discussion
The key objective of the present treatment approach was
maintenance of maximal ridge volume for both aesthetic
and functional reasons as described in a recently published technical report.16 A staged approach using a few
teeth to support a provisional fixed restoration during the
healing process was applied for a number of reasons:
(1) immediate implant placement after the extraction of
hopeless teeth was contra-indicated in the premolar
area owing to the poor periodontal state; (2) a fixed provisional prosthesis would enable soft-tissue conditioning during healing;17 and (3) surgical burden, postoperative morbidity and additional costs could be reduced for
the patient through the application of partial extraction
therapy, an osseodensification protocol for bone expansion, compaction and crestal sinus elevation, and autologous dentine as augmentation material. Root submergence therapy of both central incisors was chosen
in our patient case as the procedure of choice in order
to avoid unfavourable buccal bone remodelling. Submerged root therapy is based on reports from the early
1940s that showed that fractured roots may be retained
in the extraction socket without any pathological clinical symptoms if they are protected by epithelial gingival
overgrowth.3, 4 Since the alveolar bundle bone and periodontal ligament are preserved, submerged root therapy
appears to be a promising technique for ridge preservation in conjunction with conventional prosthetic treatment. The presence of the periodontal ligament seems
to preserve a higher amount of surrounding hard and
soft tissue, compared with conventional socket preservation techniques.6, 18 Reduction of root heights in order
to maintain a sufficient soft-tissue thickness of 3 mm between submerged roots and the gingival margin and future pontic base, respectively, as well as dense primary

17
Fig. 14: Frontal aspect of the definitive prosthetic restorations, showing
good aesthetic conditions with no signs of soft-tissue complications after
insertion. Fig. 15: Right lateral aspect of the restorations. Fig. 16: Left lateral
aspect of the restorations. Fig. 17: Final radiograph with definitive prosthetic
superstructures in place.

1 2022

[16] =>

| case report
with growth factors like bone morphogenetic protein
(BMP-2) and fibroblast growth factors.22, 23 The present
histological and clinical findings after ridge preservation
with autologous dentine are in line with the insights of
clinical studies, including new bone formation, favourable
wound healing and good dimensional stability.24, 25 Clinical aspects in connection with re-entry in the left posterior maxilla showed very good ridge dimensions after
three months. The present clinical and histological results confirm suitability of particulate dentine autograft as
augmentation material for ridge preservation, retaining
adequate dimensional stability and holding osteoinductive
and osteoconductive capacity.

20
Fig. 18: Frontal aspect of the restorations after the two-year follow-up period.
Fig. 19: Right lateral aspect of the restorations after the two-year follow-up
period. Fig. 20: Left lateral aspect of the restorations after the two-year
follow-up period.

Autogenous particulate dentine has gained attention as
an alternative grafting material to autologous bone and
bone substitutes. Despite the fact that dentine is an
acellular matrix, bone and dentine are very similar in their
biochemical structure, comprising mainly Type I collagen

In our present case, implant site preparation of the molar
septum after partial extraction of the right maxillary first
molar, as well as the simultaneous trans-crestal sinus elevation, could be performed by using the osseodensification protocol with Densah burs.26 Osseodensification has
been shown to increase bone mineral density and bone
to implant contact and to enhance primary implant stability, compared with standard drilling.27, 28 Nonetheless, this
technique should be used with caution, because of a limited number of long-term studies.29, 12 The main concerns
with the socket shield technique still lie in the technique
sensitivity of this method and the need for randomised
controlled studies in order to enable evidence-based
insights and transfer of this technique into routine dental
practice.30 However, the present case report encourages
the application of different preservation procedures as
alternative clinical methods for successful ridge preservation. Corresponding patient cases are intended for
presentation in future publications.

about the author
Dr Snježana Pohl is a doctor of both
general medicine and dental medicine
and holds a specialisation in oral surgery, periodontics and implantology.
She is currently based in Rijeka in
Croatia, where she practises, teaches
and mentors. Since 2010, she has been
head of the department of oral surgery at Rident dental clinics in Croatia.
She also teaches as an assistant professor at the Department
of Oral Medicine and Periodontology of the Faculty of Dental
Medicine at the University of Rijeka.

contact
21
Fig. 21: Radiographic control after the two-year follow-up period, showing no
visible bone loss at the implant sites and no signs of periapical inflammation
at submerged roots.

1 2022

Dr Snježana Pohl
+385 51 648900
snjezana.pohl@rident.hr
www.snjezanapohl.com

Author details

Literature

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| case report

Resolving severe bone atrophy
with the cortical lamina technique and innovative materials
Dr Roberto Rossi, Dr Giovanni Franzone & Stefano Giulini, Italy

1a

1b

Fig. 1a: Initial situation. Figs. 1b & c: Initial CBCT scan.

Introduction
The 65-year-old female patient presented for treatment
of her bilateral posterior edentulism. She presented with
a negative medical history and the loss of her diathoric
teeth as a result of fractures after an old prosthesis
(Fig. 1a). The CBCT scan of the mandibular dental arch
showed a horizontally resorbed edentulous bone ridge with
an average thickness not exceeding 3 mm (Figs. 1b & c).
After a preventive oral hygiene session, bone regen
eration using the cortical plate technique was planned
(Fig. 2).

1c

18

1 2022

The objectives of the treatment plan designed for this
patient included in the first phase the insertion of implants
(Neodent, Straumann), two implants in the left of and four
in the right of the mandible, with subsequent augmen
tation of the bone volume and at the uncovering of the
implants the increase of the soft tissue, given the small
amount of attached gingiva.

Materials and methods
Local anaesthesia with articaine with 1:200,000 adrenaline was administered. An incision with a #12 blade was

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[20] =>

| case report

Fig. 2: Close-up of the edentulous area. Fig. 3: Exposure of the residual bone ridge. Fig. 4: Post-op radiograph. Fig. 5: Implants in position. Fig. 6: Bone grafting
material placed. Fig. 7: Lamina inserted.

made on the edentulous ridge, taking care to divide the
small amount of keratinised gingiva equally between the
vestibular and lingual flaps. The exposed ridge confirmed
what had been observed on the CBCT scan: the thickness in the ridge was 3 mm in the area distal to the canine
and thinned to 1 mm in the molar area (Fig. 3). Near site
#46, there was a residual root, which was removed, and
an implant of standard diameter (4 mm) was inserted in the
same position, whereas the implants placed in the premolar and second molar sites were of reduced diameter
(3.5 mm; Fig. 4).
The postoperative radiograph showed that the implant in site #46 was anchored to the bone only by its
apical portion. The clinical image showed an evident
vestibular dehiscence affecting all four implants, at least

five to six implant threads being exposed outside the
crest, and evident volume insufficiency horizontally
(Fig. 5).
For this specific clinical situation, a grafting material
(GTO, OsteoBiol) with special characteristics was selected. This sticky biomaterial is composed of collagenous porcine bone combined with a thermosensitive gel
(TSV Gel, O
steoBiol), allowing it to jellify and become solid
on contact with the moisture of the mouth. GTO can be
used to create and maintain volume even in an anatomically unfavourable situation. Its properties make it both
easy to mould to the defect and stable. Figure 6 shows
how this stability makes it possible to apply an adequate
amount of material to correct the defect in the ridge and
cover the exposed implant threads.

Fig. 8: Sutures. Figs. 9a & b: The ridge six months post-op. Fig. 10: Reintegration. Fig. 11: NovoMatrix (BioHorizons) in position. Fig. 12: The sutured flap.

1 2022

[21] =>

case report

14a

14b

Fig. 13: Occlusal view of the ridge. Figs. 14a & b: Fixed crowns in position.

The procedure was completed with the use of a fine
cortical lamina (Lamina, OsteoBiol) as a membrane. The
lamina was adequately modelled, cut out, hydrated with
a clot of blood from the patient and stabilised by the
stickiness of the graft, which it covered, helping it adhere
to the underlying bone (Fig. 7).
Sutures play a crucial role in this phase. One or two
horizontal mattress sutures with a PTFE thread aim
to compress the lamina horizontally and to produce

coronal tissue positioning. The flaps are then approximated using a continuous blocking suture to guarantee
airtight closure of the area (Fig. 8). This type of graft,
that is using a membrane made of bone, takes slightly
longer to heal. This being a large graft, it was decided to
re-explore the area after a six-month period of healing
(Figs. 9a & b).
Under local anaesthesia, an incision that left a modest part of the attached gingiva on the lingual side

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[22] =>

| case report

Fig. 15: Radiograph taken at six months after implant insertion. Fig. 16: Follow-up at 12 months post-op.

was made and a full-thickness vestibular flap was
raised, revealing excellent mineralisation of the lamina
and maintenance of the horizontal volume (Fig. 10).
It could also be seen how the bone had formed and
mineralised even above the screws covering the implants.
To remove the bone layer, it was necessary to use a diamond drill in order to unscrew the covering screws and
connect the healing screws. At the same time as the
implants were being uncovered, the planned vestibular
soft-tissue augmentation of the reconstructed area was
performed. Given the size of the area to be augmented
and the scarcity and quality of palatal tissue (as well as
the difficulty of access in a relatively small mouth), it was
decided to use a connective tissue substitute of the
same origin as the grafts (NovoMatrix, BioHorizons).
This biomaterial has a peculiarity that differentiates it
from similar products: it is pre-hydrated and reminiscent
of native connective tissue, has a thickness of 0.8 mm
and is available in different sizes. In this case, it can be
seen that with a 2.5 × 1.5 cm strip the entire previously
grafted area was substantially increased (Fig. 11). Given
the easy manageability and stability of this new type of
graft, it was not necessary to suture it to the underlying
tissue or implants, so it was simply inserted under the
vestibular flap and repositioned at the neck of the healing
screws (Fig. 12).
About eight weeks later, the integration of the grafts
(bone and soft tissue) and the significant difference in
the vestibular ridge volume could be observed (Fig. 13).
Three months after the implants had been uncovered
and the tissue had completely healed, impressions were
taken and definitive zirconia crowns placed (Figs. 14a & b).
The radiograph taken six months after prosthetic com
pletion (Fig. 15) showed the stability of the prosthesis–
implant complex and the complete reconstruction of the
bone defect surrounding the implants. Compared with
Figure 1a, Figure 16 shows how the initially concave edentulous area was restored to a convex shape to protect
the prosthetic restoration.

1 2022

Conclusion
The correct diagnosis and planning of complicated cases
are key factors for achieving a sustainable result. A fundamental component is knowledge of new biomaterials and
their correct application in complex situations. In the present
case, the use of this particular sticky grafting biomaterial in
an unfavourable anatomical situation helped to achieve rapid
healing without any complications. The decision in favour of
a fine lamina rather than a thick, rigid one facilitated the integration and the excellent mineralisation of the lamina itself.
The choice of a conical implant with an aggressive tip facilitated
primary stability (especially in the post-extraction site) even where
the anatomy was unfavourable. Grafting a biomaterial instead of
autologous connective material simplified the procedure and reduced morbidity to zero. For this reason, it is believed that knowledge of the best, new and innovative biomaterials is the way
forward to make even complex procedures simple in the future.

about the author
Dr Roberto Rossi graduated in dentistry and dental prosthetics (with
honours) from the University of Genoa
in Italy and obtained a specialist qualification in periodontics in 1991 and an
MSc in dentistry in periodontics from
the Boston University Henry M. Goldman
School of Dental Medicine in the US in
1992. Since 1993, he has been practising in his practices in Casale Monferrato and Genoa in Italy.
He has been a contract professor in several Italian universities
and since 2004 has been a contract professor in the master’s
degree in periodontics programme at the Sapienza University
of Rome in Italy.
Dr Roberto Rossi

contact
Dr Roberto Rossi
+39 010 5958853
drrossi@mac.com

Literature

[23] =>

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[24] =>

| case report

Type 4 implant placement
with custom healing abutment
A completely digital prosthetic workflow
Dr Pál Nagy, Hungary

1

2
Fig. 1: Pre-op dental panoramic tomogram showing missing maxillary right first premolar and cantilever bridge. Fig. 2: Digital planning with CBCT for implant size.

Introduction

3

4
Fig. 3: Buccal soft-tissue defect. Fig. 4: Evaluation of biologic width based
on vertical soft-tissue thickness.

5

6

Implant therapy is a safe and reliable method for the re
placement of missing teeth. In the past few years, implant
dentistry has witnessed several advancements in bioma
terial science, treatment technique and even equipment.
Digitisation in implant dentistry is one such aspect. The
dentist can plan and predict the outcome before per
forming the surgery. This enables better communication
and improves treatment acceptance. Another aspect
of improving predictability is giving utmost importance
to the soft tissue during treatment planning. Longterm success of an implant restoration is correlated with

7

Fig. 5: Palatal roll flap. Fig. 6: bredent medical copaSKY 4x10 implant placement. Fig. 7: Subcrestal implant placement according to expected biologic width.

24

1 2022

[25] =>

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[26] =>

| case report

Fig. 8: Customised healing abutment on a titanium base showing a tulip-shaped emergence profile. Fig. 9a: Occlusal view of closure. Fig. 9b: Buccal view
of tension-free closure.

many factors, among others especially peri-implant health.
All efforts should be made to achieve a good peri-implant
seal. The following case report highlights the combination
of soft-tissue management and a completely digital pros
thetic workflow for a Type 4 implant placement.

Preoperative phase
A young patient presented with a fractured cantilever
prosthesis (Fig. 1). The missing first premolar was indi
cated for implant-supported restoration. A CBCT assess
ment with NNT Viewer (NewTom) was used for bone
evaluation, and a copaSKY 4 × 10 mm implant (bredent
medical) was planned (Fig. 2). Soft-tissue evaluation re
vealed a Seibert Class I ridge defect (Fig. 3).1 Hence, a
palatal roll flap technique was proposed with simultane
ous implant placement to compensate for the buccal
soft-tissue collapse. The vertical soft-tissue thickness
was measured and subcrestal implant placement was
planned to correlate with biological width establishment
during the transgingival healing period (Fig. 4).

Surgical phase
The procedure was done under local anaesthesia
(articaine hydrochloride 4% with 1:100,000 adrenaline).

A papilla-sparing U-shaped palatal incision was made,
and a full-thickness mucoperiosteal flap was raised and
rolled buccally (Fig. 5). De-epithelisation was done on the
buccally rolled part of the flap. This would compensate
for the buccal soft-tissue defect. Sequential osteotomy
was done and the bredent copaSKY 4x10 implant was
placed to a torque of 30 Ncm (Fig. 6). The implant
was placed 1 mm subcrestally to compensate for future
supracrestal soft-tissue widening (Fig. 7).
A customised healing abutment was fabricated by luting
composite on to a titanium base for soft-tissue condition
ing during the transgingival healing phase (Fig. 8). The
individualised healing abutment imitated a tulip shape to
create the preferred emergence profile. The soft tissue
was sutured with a tension-free closure using a #6/0
non-resorbable monofilament thread (Optilene, B. Braun
Deutschland; Figs. 9a & b). A postoperative radiograph
was taken, and it showed parallel placement with adja
cent teeth (Fig. 10). Postoperative instructions were
given to the patient for hygiene maintenance around the
implant site.
At the first follow-up visit one week later, the sutures
were removed and the site showed satisfactory healing
(Fig. 11). Delayed loading after four months was planned
according to the patient’s wish.

Prosthetic phase

11
Fig. 10: Immediate post-op radiograph. Fig. 11: Suture removal after one
week, showing satisfactory healing.

1 2022

A completely digital prosthetic workflow was executed on
exocad software (exocad) for the fabrication of a hybrid
screw-retained zirconia monolithic crown over a copaSKY
uni.fit titanium base (bredent medical). The implant site
showed adequate buccal soft tissue thickness and a fa
vourable gingival contour (Figs. 12a & b). After the removal
of the customised healing abutment, a healthy peri-implant
soft-tissue collar was observed (Figs. 13 & 14). Further
more, a preoperative intra-oral scan was immediately taken
for soft-tissue profile recording. This was followed by place
ment of the scan body, and a digital impression was

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| case report

12a

12b

transmitted to the dental laboratory. A PMMA try-in crown
was fabricated on the titanium base to check for proximal
and marginal fit as well as to harmonise the occlusion
(Figs. 16 & 17). A re-scan was carried out once all the
adjustments had been completed. The definitive hybrid
screw-retained full-contour zirconia crown over a tita
nium base was fabricated with a highly polished gingival
surface and torqued to 25 Ncm (Fig. 18). An excellent
shade match and clinical outcome was achieved
(Fig. 19). The occlusal opening was plugged with PTFE
and sealed with composite (Fig. 20). A postoperative con
trol radiograph was taken which showed proper seating
of the prosthesis (Fig. 21). At the six-month follow-up, an
enhanced soft-tissue profile and maintained crestal bone
levels were clearly visible (Figs. 22–24).

Discussion

14
Fig. 12a: Biologic width of 5 mm. Fig. 12b: Post-op occlusal view after four
months showing adequate buccal soft-tissue thickness. Fig. 13: Buccal
view after four months showing marginal zenith maintained. Fig. 14: Healthy
peri-implant soft tissue collar.

performed to record the implant position (Fig. 15). The
opposing arch and the bite were also recorded with the
same technique. The acquired STL files were digitally

One of the challenges of delayed implant placement
is compensation for post-extraction ridge atrophy. The
amount of horizontal and vertical ridge loss may reach
up to 60% within two years of tooth extraction, most
of it occurring within the first six months of tooth
extraction.2
The current case report demonstrates a predictable
soft-tissue management technique performed simulta
neously with implant placement. A modified palatal roll
flap technique was used to compensate for the buccal
defect and to achieve a better soft-tissue contour. Unlike
a free subepithelial connective tissue graft, this peduncu
lated approach not only augments the ridge deficiency
with better vascularity but also thickens the marginal

15
Fig. 15: Intra-oral scanning done sequentially to record the soft tissue, implant position with the scan body and to obtain a digital master cast.

1 2022

[29] =>

case report

gingiva around the uncovered implant. Biotransformation
to a thicker peri-implant mucosa may promote periimplant tissue stability.3 This approach is also preferable,
as there is no secondary donor site or raw area which
could cause additional pain and discomfort to the patient
during the healing phase. Since it is performed at the same
time as implant placement, a second surgery for softtissue enhancement is avoided. This improves patient com
fort and creates a positive dental experience. Subcrestal
implant placement was utilised to compensate for bio
logical width enlargement during transgingival healing.
Supracrestal soft-tissue thickness around implant resto
ration is very important, as it has a direct influence on the
peri-implant seal and ultimately the long-term success of
the therapy. Violation in this relation between the bone
and soft tissue around the implant may be one of the
causes of early crestal bone loss.4 Marginal bone loss
around implants can either affect the long-term aesthetic
outcome owing to gingival recession after bone loss or
be the initial causative factor of a later peri-implant infec
tion. A one-stage non-submerged protocol is more pre
dictable compared with the submerged technique owing
to advantages such as reduced chairside time and a
more matured soft-tissue healing, since no additional sur
gical procedure is required.5 When it comes to transgin
gival healing, a customised healing abutment is prefera
ble in order to achieve a favourable soft-tissue profile for
the definitive restoration. Hence, creating a surface with
similar dimensions to those of the lost tooth at the level of
the gingival margin, together with a narrowing transmu
cosal part towards the implant platform, help reach this
goal. The main advantage of the customised healing abut
ment is the preformed gingival contours to determine the
correct emergence profile of the future prosthetic compo
nents when immediate provisionalisation is not an option.6
To summarise, the soft-tissue considerations employed
in this case report include the following: pouch roll flap,
subcrestal placement to avoid biological width violation
and customised healing abutment. The implant system
used was selected for its unique osseo connect surface
(OCS) and because the neck of the implant supports

Fig. 16: Fabrication of provisional PMMA crown. Fig. 17: Adjustments on
PMMA crown. Note the minimal gap between the marginal gingiva and
PMMA pseudo-cementoenamel junction. This is because the soft tissue
had already shrunk between the time the healing abutment was removed
and the time the first scan was performed. This was easily corrected by the
technician through a minimal surface enlargement on the gingival surface
of the crown–abutment interface.

soft-tissue attachment for the prevention of bacterial infiltra
tion and protection of the implant. The sandblasted and
etched surface enhances rapid osseointegration. It has a
back taper design and double self-cutting compression
threads, which are important for the attainment of high
primary stability. In addition, the copaSKY implant system
employs platform switching to minimise crestal bone loss
because the minimisation of crestal bone loss is crucial for
the long-term success and stability of the implant. The
self-tapping double thread achieves faster insertion of the
implant with lower heat generation and bone condensation.7
Sandblasted and etched implants with a self-cutting thread
in a cylindrical and conical hybrid design show statistically
higher insertion and removal torque values compared with
machined implants, along with enhanced primary stability.8
A fully digital prosthetic protocol was followed for fabrica
tion of the definitive prosthesis. Intra-oral scanners are
devices used to capture direct optical impressions in
dentistry.9 A review of the current literature of intra-oral

Fig. 18: Definitive hybrid screw-retained monolithic zirconia crown over titanium base with polished gingival collar without glaze. Fig. 19: Buccal view of
definitive crown showing excellent shade match and contours.

1 2022

[30] =>

| case report
Monolithic crowns are fabricated with CAD/CAM technol
ogy and have high flexural strength and fracture toughness,
higher than those of alumina-based ceramic crowns.14

Conclusion

Fig. 20: Occlusal opening sealed with composite. Fig. 21: Post-op radio
visiograph after definitive crown placement.

scanners concluded that they are time-efficient, reduce
patient discomfort, eliminate the use of plaster models
and allow better communication with the dental labora
tory technician.10 A hybrid screw-retained prosthesis

The pursuit of precision and perfection has led to an
evolution in the field of implant dentistry. New-age tech
niques and materials, coupled with rapid digitalisation in
dentistry, have improved the patient experience through
improved comfort, shorter treatment time and more pre
dictable results. Digital workflows minimise manual and
technical errors not only by the dentist but also by the
dental laboratory technician. Hence, there being a pleth
ora of implant companies available, it is crucial to choose
a provider which enables completely digital workflow
options in implant dentistry for both the surgical and
prosthetic aspects. Holistic treatment planning with re
gard to well-laid down biologic principles for the periimplant soft and hard tissue yields superior aesthetic
results and leads to long-term success.

Fig. 22: Six-month follow-up showing excellent emergence profile. Fig. 23: Six-month follow-up showing enhanced soft-tissue thickness. Fig. 24: Six-month
follow-up radiovisiograph showing maintained crestal bone levels.

was planned and executed in this case. A comprehensive
review focused on clinical significance of screw-retained
versus cement-retained crowns for decision-making found
that a screw-retained restoration demonstrates fewer
biological complications and has the advantage of easy
retrievability without damage to the abutment and the
crown.11 The removal of a cement-retained crown is still
more challenging and less predictable compared with
a screw-retained restoration.11 Thus, a screw-retained
prosthesis simplifies case management if any complica
tion arises in the future. Cement extrusion and retention
in the peri-implant tissue can result in microbial coloni
sation and peri-implant tissue damage. With screwretained restorations, it is easier to evaluate oral hygiene
and maintenance procedures are easier to carry out.12
A polished full-contour zirconia crown was used for the
definitive prosthesis. In layered zirconia crowns, the ve
neering porcelain shows chipping or even delamination
after long-term wear, resulting in restoration failure.13

1 2022

about the author
Dr Pál Nagy, DMD, PhD, is a certified
clinical specialist in periodontics and
dental implantology. He started the
DifferENTAL dental clinic together with
his brother in Budapest, Hungary. Dr Nagy
would like to acknowledge the dental
technician and the dental technician’s lab:
Kapos Dentart Dental Lab – Tamas Cser.

contact
Dr Pál Nagy
Csalogány utca 26
1015 Budapest, Hungary
kardpali@gmail.com
+36 30 9605255

Author details

Literature

[31] =>

Tapered Body

Dual & Open Thread

Improving
Initial fixation force

Prevent bone loss

Vacuum cleaning machine

x 2,000

x 5,000

S.L.A. Surface
Excellent Osseo-Integration with
SLA surface

Quality Control
Clean implant with automatic
cleaning system

Double Thread
Smooth implant placement
and shorten surgery time

Wide Cutting Edge
Improved Self-tapping

Sharp shape of Apex
Superior initial placement

99, Seongseoseo-Ro, Dalseo-Gu, Daegu, Korea

[32] =>

| case report

Maxillary molar replacement with an
implant and immediate restoration
Dr Leandro Soeiro Nunes, Brazil

2
Figs. 1 & 2: The periodontal condition of the patient, showing the missing
maxillary right first molar. Fig. 3: Pre-op CBCT scan revealing sufficient
vertical and horizontal bone availability.

The introduction of dental implants for the replacement
of missing teeth disrupted the era of dental prosthetic dentistry by providing the possibility of replacing a missing
tooth with a fixed restoration without affecting the adjacent
teeth to perform a tooth-supported restoration. During the

beginning of the era of implant dentistry, two-stage procedures were followed by a waiting period of three to six
months from the day of the surgery to the loading.1
The attempts to provide a better patient experience have
led to the development of improved manufacturing technology, innovative techniques and a better understanding
of biology through clinical and preclinical studies. The immediate loading of implants is today a reality, and these
protocols are frequently used in the anterior maxillary area.
However, the placement of dental implants simultaneously
with provisional restorations can also provide benefits in
the posterior area, including a reduction in time to recovery
of the masticatory function.1 For this, the estimation of the
risk of treatment and effective treatment planning are crucial. It is essential to perform an analysis of the medical
condition of the patient, the bone availability, the soft tissue
and the desired tooth shape and to take into consideration
the patient’s needs and expectations. The following case
report describes the replacement of a single maxillary molar with the new Straumann TLX implant into a fully healed
site (International Team for Implantology Type 4 implant
placement) and immediate provisional restoration.

Initial situation
A healthy, non-smoker, 40-year-old female patient presented to our clinic with a missing maxillary molar. Her
chief complaint was that her condition did not allow her to
eat properly and was affecting her quality of life, and she
desired to recover masticatory function as soon as possible. Her dental history revealed that the tooth was lost
owing to a vertical fracture several months before. This
incident happened during the COVID-19 lockdown; therefore, she had not been able to receive complete treatment
of the site. The intra-oral examination confirmed that
the maxillary right first molar was missing. The periodontal
condition of the patient was healthy, and her oral hygiene
was classified as good (Figs. 1 & 2). The preoperative
CBCT scan revealed sufficient vertical and horizontal bone
availability for implant placement in site #16 and no risk of
damage to surrounding anatomical structures (Fig. 3).

Treatment planning
For a prosthetically driven planning a close communication
between the patient, the prosthodontist and the dental
technician is essential. After discussing, she opted for im-

1 2022

[33] =>

case report

Fig. 4: Raising of the flap for exposure of the bone in the area of site #16. Fig. 5: Pilot drill (diameter: 2.2 mm) used to full implant length (10.0 mm). Fig. 6:
Use of the second drill (2.8 mm). Figs. 7 & 8: Placement of the alignment pin. Fig. 9: Use of the corresponding profile drill. Figs. 10–12: Placement of the
Straumann TLX implant to achieve optimal primary stability. Figs. 13–18: Straight provisional titanium abutment and preselected tooth based on the stone cast.

plant placement and provisional restoration in site #16. The
clinical and radiographic evaluation showed adequate conditions for implant placement in the healed site. Furthermore, the CBCT scan for diagnosis revealed no need for
bone augmentation procedures. Therefore, a Straumann
TLX Regular TorcFit (RT) Standard Plus Roxolid implant
(3.75 × 10.00 mm) with immediate provisionalisation, provided the desired primary stability was achieved, was
planned. The implant system used offers fully tapered
tissue-level implants that are designed for high primary
stability and immediate treatment procedures.

Materials and method
Local anaesthetic was infiltrated using articaine (4%) with adrenaline. Mid-crestal and intrasulcular incisions were performed
without vertical release. The flap was raised to expose the bone
around site #16 (Fig. 4). Following the manufacturer’s surgical

protocol, the implant was placed in a prosthetically driven position. A minimum distance of 1.5 mm from the implant shoulder
to the adjacent tooth was taken into consideration.
Owing to the self-cutting properties of the implant used,
the implant bed was lightly underprepared. The drills were
used in a clockwise drill rotation direction and with an
intermittent drilling technique and precooled (5 °C) sterile
saline solution. For this, first, the needle drill (diameter:
1.6 mm) was used to mark the implant site, and this was
then followed by the pilot drill (diameter: 2.2 mm) used to full
implant length (10.0 mm; Fig. 5). Then the bone density was
determined through a pilot hole, and the second drill (diameter: 2.8 mm) was used (Fig. 6). Afterwards, an alignment
pin was placed to check the 3D position of the osteotomy
and preparation depth (Figs. 7 & 8). Additionally, since the
placement of the implant was planned to be deeper than
the shoulder mark on the mesial site, the corresponding

1 2022

[34] =>

Fig. 19: Single sutures placed around the implant. Fig. 20: Occlusal view of the restoration. Figs. 21 & 22: Monotype scan body screwed into the implant.
Fig. 23: The metal-free restoration was to be cemented on top of the RT Variobase abutment (Straumann). Fig. 24: Restoration cemented on to the abutment.
Figs. 25 & 26: The restoration in situ. Fig. 27: Sealing of the screw access hole with composite material.

profile drill was used (Fig. 9). The implant was placed with
a surgical ratchet to a torque value of > 35 Ncm, and optimal primary stability was achieved (Figs. 10–12).

manufacturer’s recommendations, the restoration was screwed
in to a torque of 35 Ncm (Figs. 25 & 26). Finally, the screw
access hole was sealed with composite material (Fig. 27).

Treatment outcomes
Replacing one tooth in the posterior zone and loading it
immediately can represent many challenges. The key is to
know in whom we can perform this type of treatment, and
for this, the selection of the patient is crucial. In this case,
we obtained good and predictable results in a short period
as requested by the patient. The Straumann TLX implant
system allows immediate loading, which in our case brought
high satisfaction in terms of health, aesthetics and function.

Prosthetic procedure
Since optimal primary stability had been achieved, we could
proceed with the preparation of the provisional restoration
as requested initially by the patient. For the provisionalisation,
a straight provisional titanium abutment and a preselected
tooth based on the stone cast were used (Figs. 13–18).
The provisional titanium abutment was reduced with a carborundum disc to avoid occlusal contact with the antagonist.
The preselected tooth was prepared for adaptation to the
abutment and bonded with flowable composite. The final
contour and polishing were done chairside by Dr Cristiane
Juchem. Single sutures with a #5/0 nylon thread were
placed around the implant (Figs. 19 & 20). Analgesics were
prescribed postoperatively, and a control appointment and
the suture removal were planned for one week later.
The follow-up appointments were scheduled for 30 and
60 days postoperatively. After two months of healing, a
monotype scan body was screwed into the implant, and a
digital impression with the Virtuo Vivo intra-oral scanner
(Straumann) was taken (Figs. 21 & 22). The coDiagnostiX
software (Dental Wings) was used for CAD processing,
and a metal-free restoration (zirconia) was cemented
(RelyX U200, 3M) on the top of an RT Variobase abutment
(diameter: 5 mm, height: 6 mm; Straumann) for screwretained restoration. The height of the abutment was adjusted accordingly (Figs. 23 & 24). According to the implant

1 2022

Reference:
1. Davarpanah M, Szmukler-Moncler S. Immediate loading of dental implants:
theory and clinical practice. Paris: Quintessence International; 2008. 356 p.

about the author
Dr Leandro Soeiro Nunes, MD, DMD,
graduated from the Federal University
of Rio Grande do Sul in Porto Alegre in
Brazil and specialised in oral and maxillofacial surgery in 2006 at the Universidade Luterana do Brasil in Canoas in
Brazil. During his advanced studies, he
evaluated the behaviour of biomaterials
in sinus lift procedures and compared
the biological behaviour of several implant surfaces. He is an
International Team for Implantology fellow and study club director in
Porto Alegre and teaches implantology at the Associação Brasileira de Odontologia, seção Rio Grande do Sul (Rio Grande do Sul
section of the Brazilian association of dentistry). He also runs his
own private practice focused on oral surgery,
Dr Leandro Soeiro Nunes
implant therapy and bone regeneration.

contact
Dr Leandro Soeiro Nunes
contato@nunesodontologia.com

[35] =>

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2/21

[36] =>

| interview

Periodontitis and peri-implantitis
in implant dentistry
An interview with Dr Inga Boehncke, Germany

Is the periodontal situation stable? Does the patient smoke?
Does the patient have diabetes? In addition, it is important to establish and monitor the haemoglobin A1c level,
which should normally be determined every three months
and should not exceed a value of 6.5–7.0%.
Interleukin polymorphisms also need to be considered,
especially in combination with several of the aforementioned factors, as about 10% of patients are high responders, meaning that an inflammatory change can
be associated with a stronger to excessive reaction.
Ultimately, the compliance of patients plays a decisive
role regarding the removal of plaque at home and the willingness to undergo oral hygiene at short intervals in order
to determine individual biofilm management depending
on their risk profile.

Peri-implantitis continues to be one of the greatest challenges for dental professionals. According to studies, the
prevalence of the condition will continue to rise in the coming
years. implants—international magazine of oral implantology
spoke with implant specialist Dr Inga Boehncke, who has
been running her own practice in Bremen in Germany since
2009, about specific features of implant therapy in the case
of previous periodontal disease, surgical and non-surgical
treatment protocols for peri-implantitis and how the treatment of the condition will develop in the future.

If periodontal conditions are stable—free of bleeding and
with probing depths of no more than 5 mm after previous
periodontal disease—we apply a 0.2% chlorhexidine
rinse three times for 30 seconds before implantation. If a
film is visible on the tongue, it is removed with a tongue
scraper and a chlorhexidine spray is used if necessary.
Additionally, periodontally compromised patients are advised to undergo systematic plaque removal in the practice two to three days before the procedure. We also
administer vitamin C and vitamin K2 and determine the
vitamin D3 level, supplementing depending on the value.
During follow-up, we closely monitor, in particular, the adequate removal of plaque. Postoperatively, patients are
advised to rinse twice daily with a 0.2% chlorhexidine
rinse for one minute. Alternatively, a chlorhexidine gel can
be applied to the wound area. During subsequent followups, depending on the severity, risk profile and cooperation
of the patients, an individual schedule of short intervals of
monitoring involving biofilm removal and determination
of the bleeding on probing is indicated.

Dr Boehncke, what is especially challenging about
implant treatment for patients with previous periodontal disease?
First, a stable periodontal situation must be established
by determining and discussing the individual risk profile
of the patient. The type and extent of previous periodontal disease play an important role and several questions
need to be addressed. Have there been recurrences?

In addition, we work with the active matrix metalloproteinase-8
(aMMP-8) biomarker from Bioscientia, which determines
collagenase activity and thus represents a kind of destruction marker. Inflammatory tissue destruction can thus be
detected at an early stage before it becomes clinically
visible. A value of 0 for the patient is determined two
to four weeks after prosthetic restoration of the implant.
One year later, another aMMP-8 test is carried out.

Dr Inga Boehncke is a member of the German Association of Oral Implantology.

1 2022

[37] =>

interview

In addition, patients with implants should be enrolled in
special oral health programmes that include regular systematic removal of the microbial biofilm and early inflammatory diagnostics.
Recent studies have found that mesially and distally splinted
implants, as well as implants with an over-contoured restoration, pose an increased risk of peri-implantitis. The
more difficult plaque removal for patients and the resulting
accumulation of plaque plays a central role in this.
The design of the implant superstructure in terms of facilitation of cleaning and adequate attachment of the soft tissue should be given high priority from the outset to guarantee patients easy and pain-free plaque removal at home.
An unattached and thin mucosa often leads to discomfort
during cleaning as well as to faster pocket formation
and thus plaque accumulation. We often use CAMLOG’s
NovoMatrix to thicken and secure the peri-implant tissue.
Peri-implantitis can be treated both surgically and
non-surgically or with a combination of both methods.
However, there is no standardised surgical protocol yet.
How can dentists guarantee good care for their patients?
The decision of whether to treat peri-implantitis surgically
or non-surgically depends mainly on the severity and
the implant surface. It must be clarified whether a rough
surface or even already exposed contaminated threads
are present. The first step is to eliminate mechanical risk
factors such as overhangs that have contributed to
plaque formation. The superstructures should be removed. For both surgical and non-surgical cases, the
main focus lies on decontamination. Removal of the microbial biofilm and thus reduction of bacterial colonisation is achieved with hand instruments, ultrasonic tips
and powder-blasting devices that use glycine powder. In

addition, we use multiple 3% hydrogen peroxide rinses
and chlorhexidine rinses applied directly and alternately.
Local antibiotics can also be administered as a supportive measure. We use Ligosan Slow Release from Kulzer
with the aim of keeping the tissue free of bleeding and
reducing pocket depths.
In the case of defect morphologies that limit access or
already advanced bone resorption, we apply a surgical
therapy that involves flap elevation, analogous to open
periodontal therapy, to achieve better visibility over the
contaminated parts and thus better accessibility. For this
purpose, we use fine nickel–titanium brushes for decontamination, as well as glycine powder and repeated 3%
hydrogen peroxide and chlorhexidine rinses.
Furthermore, regenerative work can be carried out, and
the success of this is directly related to the morphology of
the defect. If a small bowl-shaped intraosseous defect is
present, it is easier to regenerate with augmentation than
are already developed supra-crestal defects which show
screw threads that are above bone level. If this occurs, the
threads are removed and the protruding implant surface
is smoothed as far as possible to eliminate roughness,
with the aim of preventing plaque colonisation anew.
There are also combined defects for which both procedures
can be used. We use autogenous bone chips and a bone
substitute material covered with a collagen membrane for
regeneration. The main aim is to support the soft tissue, and
in many cases thickening owing to scarring is observed.
How do you think the prevention and treatment of
peri-implantitis will develop in the future?
Particular attention should be paid to postoperative care
at short intervals in order to be able to intervene as early
as possible. Immunomodulatory therapies are currently
under discussion. Through the anti-inflammatory effect
of natural cranberry extract on the tissue-destroying
macrophages, topical application should directly intervene in the intensity of the inflammatory reaction.
Furthermore, I could imagine that new carrier materials
for local antibiotics or natural extracts—as already mentioned—will be developed. Modified implant surfaces,
possibly with anti-infection or plaque-inhibiting properties, are also conceivable. However, I think it is most important to raise patients’ awareness and motivate them
to have regular and thorough follow-up care and to
remove plaque at home, irrespective of the therapeutic
approach. After all, prevention is better than cure.

contact

Nowadays, dental implants have a high survival rate,
but peri-implant infections are among the most common complications. In the 2019 Delphi study of the
European Association for Osseointegration, experts
agree that the prevalence of peri-implantitis will increase in the coming years. How can dentistry meet
this challenge?
The prevalence of peri-implant mucositis, which is roughly
comparable to gingivitis and is initially limited to the inflammatory change in the soft tissue, is currently approximately 43%. Peri-implantitis, which is associated with inflammatory bone resorption that has already occurred,
meaning it is comparable to periodontitis, affects approximately 22% of patients. In my opinion, early detection of
inflammatory signs and timely intervention are the pillars
of postoperative care. Regular bleeding on probing assessment is a key diagnostic tool to detect inflammatory
changes at an early stage. As already mentioned, destruction markers can also be used. These are helpful in
explaining the therapy to the patient.

Dr Inga Boehncke

Dr Inga Boehncke, MSc
Bremen, Germany
+49 421 232722, info@zahnarzt-boehncke.de
www.instagram.com/doc.bremen

1 2022

[38] =>

| interview

Laser protocol for
peri-implantitis treatment
An interview with Dr Michał Nawrocki, Poland

Laser is becoming essential for every modern dental
practice. Moreover, from an educational standpoint, there
are many benefits in terms of the personal and professional
development of the practitioner. In this interview with
implants—international magazine of oral implantology,
Dr Michał Nawrocki explains how laser dentistry has
helped to advance his practice and career and why dental
laser, especially Fotona’s LightWalker, has become an
essential part of his daily practice.

What procedures do you perform with laser?
Laser can be used in all fields of dentistry; however, I am
mainly focused on implantology and surgery, as well as
prosthodontics. In prosthodontics, it can be used for sulcus conditioning, preparation for veneers and removal of
complete ceramic crowns, as well as during more challenging procedures like crown lengthening before tooth
preparation. We can use it in gingivectomy (Nd:YAG laser)
and bone recontouring (Er:YAG laser).

Dr Nawrocki, you’ve been using laser since 2016.
Looking back at your journey as a laser dentist, how
has LightWalker impacted your everyday practice?
I started my great adventure with Fotona’s LightWalker in
2016. Before that I had used a diode laser, but it was insufficient for me, and to be honest my knowledge of lasers,
physics, indications and procedures was incomplete at the
time. Then in January 2016, I invited Dr Ilay Maden to my
clinic to conduct a course and teach my colleagues and me
about various Er:YAG and Nd:YAG procedures with the
LightWalker laser. A few months later, I decided to extend
my knowledge about lasers by attending the Master of
Science in Lasers in Dentistry presented by Prof. Norbert
Gutknecht in Aachen. Now, I cannot imagine continuing my
daily practice and treatments without having LightWalker.
Sometimes, I use it as an additional tool during certain
procedures, but very often it’s a crucial and necessary tool
for me to use to conduct a particular procedure.

All my surgery cases are finished with photo-biomodulation
using the Nd:YAG Genova handpiece. I have observed that
wound healing is much faster and better in such cases
owing to pain reduction, disinfection, reduction of oedema
and the laser’s analgesic function. Sometimes, I have to
conduct an endodontic treatment during the procedure
(which is quite rare and normally done by my colleagues),
in which case I really appreciate the deep disinfection with
Nd:YAG, which offers the highest bacterial reduction
in comparison with other wavelengths, and the Er:YAG
SWEEPS [shock wave enhanced emission photoacoustic
streaming] procedure, which provides the most effective
cleaning and disinfection. With surgical treatments, I use
both wavelengths in almost all cases. Even when performing an easy and fast tooth extraction, I can use Er:YAG for
granulation tissue removal, followed by Nd:YAG for disinfection, clot stabilisation and finally photo-biomodulation.
Of course, I use laser before implant insertion, as well as
when complications appear.

Use of the Er:YAG laser Varian tip for granulation tissue removal, implant
surface decontamination and surface ablation of infected bone.

1 2022

In your opinion, what are the main benefits of choosing
a laser system that includes two complementary wavelengths, such as Er:YAG and Nd:YAG, especially in the
field of oral surgery?
Very often, we combine these two wavelengths to conduct
treatment in a fast, safe and predictable way. For me, it’s
crucial to use these two complementary wavelengths—
the interaction between the tissue and laser beam is quite
different, and owing to these differences in absorption,
transmission and scattering, we obtain different actions.
For example, during root apicectomy, after flap elevation,
I remove granulation soft tissue with the Er:YAG laser using
the H14 handpiece with a cylindrical tip (or when I want to
be more precise—a Varian tip) and the apicectomy is done
with the H02 non-contact handpiece. As the next step,
I conduct deep disinfection with the Nd:YAG laser (trans-

[39] =>

interview

mission in hydroxyapatite and absorption in pigmented
bacteria) before bone augmentation. Finally, I finish the
treatment with photo-biomodulation using the Nd:YAG laser.
As you can see from this example, I need both of these
two complementary wavelengths to achieve final success
with fast healing and proper bone regeneration.
Photo-biomodulation with the Nd:YAG laser.

Of course, we can also use the Er:YAG laser for more
common and “easy” procedures—like implant uncovering
(Er:YAG). The healing is faster and we avoid suturing, but of
course, even with the thin chisel tip, some amount of soft
tissue is vapourised—so it cannot be conducted in all cases.
In 2018, you defended your master’s thesis at RWTH
Aachen University titled Comparison of Two Methods of
Peri-implantitis Treatment with the Use of Nd:YAG and
Er:YAG Laser. Can you tell us more about that research?
Owing to the increasing number of implants being placed,
the development of peri-implantitis is a growing concern
and one of the primary challenges in present-day dentistry.
In cases of inflammation, it is necessary to implement treatment, or risk implant loss. However, until now, no uniform
protocol or procedure has been defined which could be
considered the best and the most effective solution. Different methods of treatment of tissue inflammation around the
implant are used, depending on the extent of inflammation,
method availability, type of defect, and skills and experience of the dental surgeon.
We know that laser can be used for the treatment of inflammation in soft and hard tissue around implants, such as
mucositis and peri-implantitis. I wanted to investigate what
kind of procedure would be the most effective and minimally invasive—so the question was whether we could use
a minimally invasive, flapless procedure for proper treatment and solve the problem of inflammation.

The procedures were conducted with Er:YAG and Nd:YAG
lasers. In the first group of patients, a mucoperiosteal flap
was elevated in order to gain better access to the operative
area, while the second group of patients was treated using a
more minimally invasive procedure without the flap method.
The assessment of treatment effectiveness involved clinical
and radiographic examination before the surgical procedures
and three months after the laser procedures. After conducting the intra-oral examination and defining plaque, probing
depth and bleeding on probing indices, photographic documentation of a given area was performed, bitewing and
occlusal surface radiographs were taken, and professional
scaling and root planing were subsequently carried out.
Based on my research, we know that non-surgical treatment of
peri-implantitis is effective and very often reduces inflammation.
Of course, when we have severe defects, it’s impossible to
avoid a surgical procedure to elevate
Unexpected ending?
a flap to get proper access to the
defect. In such cases too, we should
Read the
use a non-surgical procedure as a
complete interview
first step to decrease the inflammation and, after two to three weeks,
perform the flap procedure. („...“)

online

about the author
Dr Michał Nawrocki is an experienced implantologist. In 2009, he obtained a dental implantology certificate
from Goethe University in Frankfurt am
Main in Germany. In 2015 and 2016,
he participated in the Implant Prosthodontics Program at the Mediterranean
Prosthodontic Institute in Castellon in
Spain. Dr Nawrocki also obtained an
implantology certificate from the University of North Carolina at
Chapel Hill in the US in 2016 and earned an MSc in lasers in
dentistry from RWTH Aachen University in Germany in 2018.
He is a member of the Polska Akademia Stomatologii Estetycznej (Polish academy of aesthetic dentistry), Polish Society for
Laser Dentistry and International Society for Laser Dentistry.
Dr Nawrocki runs a private practice in Gdańsk in Poland.
Dr Michał Nawrocki

contact
Nawrocki Clinic
Ul. Czarny Dwór 10/34, 80–365 Gdańsk, Poland
+48 501 143042, rejestracja@nawrockiclinic.com

1 2022

One of your main fields of specialisation is implantology.
Where does the laser fit in this field?
We can use LightWalker for all implantology cases. Sometimes, it’s only needed for better and faster wound healing
(photo-biomodulation with the Nd:YAG laser), but very often it is necessary to conduct the treatment. For me, it’s the
most important device during immediate implantation with
immediate loading, especially when the bone must be very
precisely cleaned of granulation soft tissue and disinfected.
In the meantime, we can also provoke bleeding of the bone
using the Er:YAG laser for superficial bone ablation. I also
really appreciate the use of laser during bone grafting with
the Khoury method. Sometimes, I combine this technique
with immediate implantation, especially in the aesthetic
zone. Then, after bone shield fixation, I can use the laser for
bone recontouring. With the Er:YAG laser, it’s done very
precisely—I remove sharp edges and create an emergence
profile for the crown—and most importantly, everything is
safe for the shield (almost no vibration, so we don’t lose
stability) and the implant (no thermal effect).

[40] =>

| manufacturer news
bredent medical

The alternative to standard
dental implants
German dental implants company bredent medical has introduced
the copaSKY ultrashort implant system which offers an alternative to
standard dental implants which not only reduces costs—as a result
of eradicating the need to build up the bone through augmentation
or sinus lift procedures—but
also offers a less invasive
route to restoration. With a
length of only 5.2 mm and a
diameter of 4.0, 4.5, 5.0 or 6.0,
the copaSKY ultrashort implant makes it possible to utilise the available native bone
optimally. It creates a stable
basis for implant-supported
restoration, even under the most challenging of conditions. Award
winning Dr Marcus Gambroudes has placed over 4.000 implants
and trains and mentors other dentists about complex implant cases.
He comments “I am impressed by the clinical applications of the
copaSKY implant range. I use it for the versatility of the implant for
placement in areas of limited bone height, as well as immediate
placement in extraction sockets and full arch immediate load.”

The SQ implant is an integrated outcome of implant technology and
clinical knowledge. It has been verified by clinical studies for over
16 years. It is becoming an exemplary product for fast and convenient
implantation and is currently in the spotlight as an essential item for
dental clinics. We will thoroughly explore the SQ that is further expanding the base of clinical studies with a perfect SQ implant solution that
covers smooth implantation, osseointegration, as well as aesthetics.

bredent medical GmbH & Co. KG, Germany
+49 7309 872-600
www.bredent-implants.com

DENTIS, South Korea
+82 53 5832804
www.dentisimplant.co.kr/eng

DENTIS

Easy placement and optimal
osseointegration

SQ, launched as the new implant brand of DENTIS in 2018 based
on decades of implant technology and expertise, stands for
Submerged and Qualified System and for “Submerged Type, Depth
Control.” As the name implies, it is an easy-to-install, bone-level
implant that maximises placement, depth control, and fixation
power, solving many challenges of implant surgery.

Curaden

Rinsing against SARS-CoV-2—one mouthwash reduces infection risk
In a study that is the first of its kind, researchers from
Claude Bernard Lyon 1 University in France have
shown that Curaprox’s Perio plus regenerate mouthwash reduces the risk of transmitting SARS-CoV-2.
A single rinse with the mouthwash lowers the viral
load in the mouth by 71%, aiding the immune system
in controlling the start of infection.
An important breakthrough
The Curaprox Perio plus mouthwash protects against
viral infections and has protective and regenerative
properties, thanks to the hyaluronic acid it contains.
The result is an oral mucosa that is in optimal health
and minimally susceptible to viral infection. Rinsing
and gargling with Perio plus regenerate is an excellent barrier
measure against the spread of SARS-CoV-2. The discovery has
interesting implications for fighting the COVID-19 pandemic, as well
as for future antiviral preventive measures. Be it for personal or
clinical use, antiviral mouthwashes could play an important role in
reducing the general risk of contamination.

1 2022

The study, titled “Use of an antiviral mouthwash as
a barrier measure in the SARS-CoV-2 transmission
in adults with asymptomatic to mild COVID-19:
A multicentre, randomized, double-blind controlled
trial”, was published in the October 2021 issue of
Clinical Microbiology and Infection.
Curaden, Switzerland
www.perioplus.com

[41] =>

Dentsply Sirona

Discover the joy of efficient
handling
The DS PrimeTaper Implant System delivers seamless workflow
integration, enviable aesthetics, lasting bone care and efficient
handling. The unique, progressive thread is designed to let clinicians install the implant quickly and shorten the procedure.
The implant has three distinct thread shapes. On the top part of
the implant is the conserving
MicroThread shape that provides long-term marginal bone
maintenance. In the middle,
there’s the condensing crestal
squared thread shape, and at
the bottom of the implant the
cutting apical pointed thread
shape. Together, these variable thread shapes with
the pronounced flute design
contribute to initial stability
and cutting efficiency, linear
torque build-up throughout the
implant installation for predictable implant placement,
and immediate installation
stability for all implant cases.
Dentsply Sirona
Sweden
+46 31 3763000
www.dentsplysirona.com/primetaper

Fotona

Dual wavelength power for
effective treatments
Peri-implantitis is a well-known inflammatory process affecting
the soft and hard tissues surrounding dental implants. Fotona’s
award-winning SkyPulse and LightWalker dental lasers offer one of
the most effective methods of peri-implantitis treatment, proven
to successfully control infection and halt disease progression.
The dual-wavelength procedure harnesses the bactericidal effect of
the Er:YAG wavelength for decontaminating the implant surface and
removing granulomatous tissue without chemicals, while the sub
sequent Nd:YAG or diode treatment step promotes disinfection and
faster healing by biostimulating the tissue with photo-biomodulation
(PBM) to help dilate blood vessels and improve blood circulation while
also accelerating tissue regeneration. Fotona’s unique MarcCo handpiece line features a special ergonomic design that is engineered to
enable fast and simple non-invasive PBM treatments for peri-implantitis,
ensuring faster healing with reduced pain and inﬂammation.
Fotona d.o.o., Slovenia
+386 1 5009100
www.fotona.com

Straumann

Iconic Tissue Level meets Immediacy
The science of tissue-level implants has been taken to the next
level. Straumann® has built on and perfected its well established
Straumann® TL system.
The Straumann® TLX system combines a neck design mimicking
the natural anatomy and respecting the biological distance in all
dimensions with latest innovative endosteal design, optimised for
primary stability. The new system is designed to significantly
reduce the risk of inflammation and bone resorption as the
implant-abutment interface is moved away from the bone. The
Straumann® TLX system has been developed for optimal primary
stability and immediate protocols in all bone types and lets you
increase efficiency with a one-stage, straightforward workflow.
It forms the perfect complement to the Straumann® BLX system
for bone-level implants. Both systems use one common drill set
and TorcFit™ connection for maximum compatibility with minimum
investment.

Institut Straumann AG, Switzerland
+41 61 9651111, www.straumann.com

1 2022

[42] =>

| manufacturer news
Argon Medical

A combination of main healing
aspects and desirable aesthetics
The successful K3Pro implant line from Argon Medical has
been enlarged last year by an additional innovation, namely
The Compress Implant. The dire need of discerning implantologists to provide their patients with stable provisionals immediately after implantological operations, requires an implant
with exceptionally high primary stability—especially in the
case of soft bone. For immediate implantations, however, it is
often necessary that self-tapping thread flanks secure the
implant with the alveolar wall. Also and of much importance
is a generous free space for healing through blood coagulation.
The new Compress Implants fulfil both aspects mentioned
above without neglecting the classic virtues of optimisation
for subcrestal insertion for outstanding aesthetics. Furthermore, the anti-bacterial seal, as well as the micromovement-free
connection for sustained tissue preservation is also given in this
well-rounded idea of the Stable Tissue Concept. The compressive and
progressive self-tapping thread for easy and precise insertion in soft
bone has a plateau design and offers added primary stability for immediate loading. The implant diameter is measured according to the
width of the thread flank, whereas the implant body remains similarly slim.
Therefore, the choice of diameter regulates the degree of primary stability.
Argon Medical, Germany
+49 6721 3096-0, www.argon-medical.com

Neoss

Three-day conference to celebrate
20 years of Intelligent Simplicity
This summer, Neoss is celebrating 20 years of Intelligent Simplicity
and is inviting the dental community from around the globe to attend an exceptional scientific programme. Happening in Gothenburg,
Sweden, the home of modern implantology and Prof. Per-Ingvar
Brånemark, from 9 to 11 June. This three-day conference chaired
by Prof. Christer Dahlin, will invite renowned speakers to the stage
to discuss topics and techniques such as prosthetic simplicity
without compromise, simplicity in practice, managing risk factors,
digital flexibility for you and your patient, and accurate simplicity in
intra-oral scanning. Included, will be various break-out sessions for
the whole dental team. The programme lectures and break-out sessions
will showcase how you can bring efficient workflows into your
daily practice. And that’s not all! Each day, scheduled around the
conference will be social activities and excursions which will delight
all, from the more energetic morning running, boat trips and ex
citing dinners, to the more relaxed sunrise yoga and health and
wellbeing sessions. All to celebrate the valued community Neoss
has created over its 20 years of innovation.
Neoss Ltd., UK
www.neossintegrate.com

BioHorizons Camlog

New regenerative materials for biomaterials portfolio
BioHorizons Camlog is expanding its portfolio of dental implant products to include innovative regenerative materials that cover almost all
conceivable material and application preferences. These biomaterials
include MinerOss® A, SynMax®, PermaPro®, Argonaut® and C eraOss®.
The new products are manufactured by botiss biomaterials GmbH,
whilst being distributed by BioHorizons Camlog under their own brand
names. In the case of hard and soft tissue deficiencies, the choice
of suitable bone graft substitute materials is of crucial importance
to achieve the desired clinical result in functional, structural and
aesthetic terms. MinerOss® A particles are allograft bone substitute
from human donor bone, processed by the Cells+Tissuebank Austria,
and available in cancellous and corticocancellous form. SynMax® is
a fully synthetic, safe, and biocompatible material that, when brought
into an osseous environment, serves as an osteoconductive scaffold

1 2022

to support the ingrowth and fusion of adjacent, vital bone. PermaPro®
is an exceptionally thin, non-resorbable and biocompatible membrane.
Argonaut® membrane is a completely resorbable collagen membrane
produced from porcine pericardium used to support guided tissue and
bone regeneration. CeraOss® is a one hundred per cent pure bone
mineral of bovine origin, which provides an appropriate scaffold for
the adherence and migration of osteogenic and blood vessel-forming
cells, which in turn promotes bone regeneration.
Argonaut®, CeraOss®, PermaPro® and SynMax® are registered trademarks of
Camlog Biotechnologies GmbH. MinerOss® is a registered trademark of BioHorizons.

Camlog Biotechnologies GmbH, Switzerland
+41 61 5654100
www.biohorizonscamlog.com/biomaterial-news

[43] =>

industry

Osstem Europe:
New European
headquarters in Prague
Fig. 1: JM Lee, Executive Managing Director of Osstem Europe.

Henrik Eichler, Germany
As one of the fastest growing implant manufacturers
in the world, the South Korean company Osstem Implant
provides dental implants and related products to patients
in more than 70 countries. Now the company opened the
doors to its new headquarters in Prague. In an interview
with implants, JM Lee, Executive Managing Director of
Osstem Europe, talks about the company’s motivation and
their plans for the European market.
Osstem Implant was founded in South Korea in 1997.
Why did you choose Prague as the location of your
new European headquarters?
There were several reasons for choosing the Czech capital.
It is geographically in the centre of Europe, and we wanted
to be able to support our 41 partners across the continent
even better and use the multi-cultural environment and thus
this great pool of talents for our organisation. The expansion
of our infrastructure and the ability to offer a wider portfolio
of products and provide a total solution was another reason
for Prague. Now we have a service centre, a training centre,
and a logistics service. And of course, we wanted to be able
to strengthen our presence in the German market and have
the space for our direct sales in Germany.
What significance does the European market have for
Osstem?
The European market has always been significant for us,
but at the same time we have been recognising it as the
most conservative and difficult market. Strategically, as
an initial step of our globalisation, we targeted the Asian &
Pacific Region, where we successfully grew into one of the
market leaders. Thanks to our strong presence in those
markets, we were able to achieve our market position as
the fourth biggest dental implant manufacturer worldwide,
accounting for 8% of the global market share.

What makes Osstem Europe special compared to
other major competitors?
I would say our various solutions and unbeatable valuefor-money ratio. We have a range of special surgery kits
that other companies do not offer. For example, the CAS
Kit for sinus surgery, the ESSET Kit for narrow ridge and
the ESR Kit maintenance kit. These special kits can serve
as an entry product for our new customers. Furthermore,
we offer high-quality products at a reasonable price.
Since the foundation of our company, we have been continuously investing 7% of our annual sales on R&D and
recently we have even increased this share up to 11%. We
pursue the philosophy of our founder: “Provide the best
value to the dentist and patient.” Once the practitioners
experience our products, they will realise what I mean.
What are your plans for the future of Osstem Europe,
and what developments can your customers perhaps
look forward to this year?
We have plans of launching new products such as a
new implant system, new implant surface treatments,
GBR and of expanding our impression materials line-up.
Additionally, continuous online and offline education
courses will take place; for instance, Osstem OnDemand
and Osstem OnSite. And finally, our annual event “The
Osstem-Hiossen Meeting” in Rome will be held on 28 and
29 October 2022.

contact

Interview video excerpt

Osstem Europe
Prague, Czech Republic
+420 296 238801
www.osstem.eu

Fig. 2: Dr Mukesh Soni, Course Director of Practical Implantology, UK (second from left), JM Lee, Executive Managing Director of Osstem Europe (third from left), Ben Nahab, CEO of
Dental Direct UK (third from right) and Prof. Marco Tallarico, President of AIC Italy (second from right). Fig. 3: Prof. Marco Tallarico giving the first lecture in the new training centre.

1 2022

[44] =>

| events

Education across borders
Maximise your potential with DGZI’s continuing
education on an international level
Janine Conzato, Germany

and science-based implant dentistry and has set standards in oral implantology in Germany. Its activities are
focused on the continuing education and training of implantologists in Germany and abroad. The goal of these
activities is to improve quality and quality assurance, as
well as the safety of therapies, in the interest of patients.
Globalisation in dentistry has for years been setting new
standards in the demand for internationally active implantologists and for German dental clinics that cater to international patients. A large number of German dentists work
abroad, have partners all over the world and are very successfully engaged on an international level. Many implantologists have also adapted to this situation and are successfully treating patients from abroad. Especially patients
from the Arab region, African countries and countries of
the Commonwealth of Independent States appreciate
the quality and knowledge of German dentistry and visit
Germany for extensive dental treatment.
1
Fig. 1: DGZI vice president Dr Vollmer (center) with the DGZI representatives from Sudan.

International exchange
on implantological standard

The medical market, particularly the dental market, is becoming increasingly global, and promoting medical progress in the field of implantology has always been a priority
of the German Association of Dental Implantology (DGZI).
DGZI, established and registered in 1970, is the oldest
dental implantology association in Germany and represents in its more than 50-year history practice-oriented

In addition to the focus on established practices, international networking is a cornerstone of DGZI’s philosophy.
When it comes to global education, DGZI has also been a
pioneer. Dr Rolf Vollmer, DGZI vice president and treasurer,
is responsible for the society’s successful foreign policy.
In order to disseminate the implantological standard internationally, the German Board of Oral Implantology (GBOI)

“I have been in close cooperation with DGZI/GBOI since
2010 as a speaker in the GBOI programmes all over
the Middle East and as a programme director of the
Comprehensive Dental Implant Certificate Program,
which is accredited by DGZI/GBOI.
The feedback I have received from students and
attendees has always been encouraging and
appreciative. The certificates offered by DGZI/GBOI are
also well recognised and distinguished, encouraging
more practitioners to join the renowned body.”—
Prof. Mohamed Moataz Khamis, University of Alexandria, Egypt

1 2022

[45] =>

events

“After my completion of the DGZI/GBOI international education
programme in Jordan in 2008, we have started cooperating with
DGZI in Sudan. From that time until now, six groups have graduated
from this one-year pure scientific programme with strong
clinical requirements. Most of our candidates are satisfied with their
work development and attribute their success to our GBOI novel
programme and the great DGZI team. Although many international
education programmes of implantology are running in Sudan,
DGZI/GBOI is the most preferred and reliable.”—
Dr Ahmed Fadl, DGZI representative in Sudan
was launched and certified by DGZI. In 2002, a postgraduate
programme offered through cooperation with universities,
certified visiting professors and opinion leaders was created. Its mission is to elevate the standard of and to
advance the science and art of dental implantology by
encouraging its study and improving its practice. Besides
providing training opportunities for dental experts from all
over the world, the programme allows for professionals to
acquire internationally recognised certificates such as the
DGZI Expert in Oral Implantology certificate and DGZI
Specialist in Oral Implantology certificate. These certificates are simultaneous proof of qualified subject-specific
English knowledge. In fulfilling its purpose and objectives,
the GBOI follows the guidelines and regulations set by
the respective associations in Germany, such as the

Bundeszahnärztekammer (German dental association)
and Deutsche Gesellschaft für Zahn-, Mund- und Kieferheilkunde (German association of oral and maxillofacial
dentistry). It provides international examination procedures
to evaluate the profound knowledge, expert skills and special talent required for practitioners to provide comprehensive, safe and effective oral implant therapy solutions for
patients. The curriculum of the one-year programme covers
surgical anatomy, imaging techniques and preoperative
preparation, as well as provides detailed information on
at-risk patients, anaesthesia and sedation, odontogenic
infections and complications. Furthermore, the programme
includes training on surgical basics and traumatology of
the teeth and jaws. Also, practical training, patient surgery
and e-learning modules are part of the curriculum.

2
Fig. 2: Congratulations to the examinees from Sudan from the DGZI board members Dr Rolf Vollmer (left) and Dr Rainer Valentin (second from right).

1 2022

[46] =>

| events
Why choose the GBOI c urriculum?
The structural education and
suitable training promote participants’ success in implant
treatment and promote the
dental practice too by the
dentist having earned
the international boardcertified qualification
and having the certi
ficate on display. The
GBOI certificate is a
professional qualification awarded by the
GBOI and is accredited
in all Arab and Gulf
countries. Also, it is a step
towards obtaining a master’s
degree in oral implantology
from the University for Continuing
Education Krems in Austria.

eral medicine recorded 1,634 cases and
thus ranked second.

DGZI Curriculum 2.0

Fig. 3

Learning to perform exact planning avoids mistakes
that lead to failures and subsequent medicolegal problems.
In Germany, dentistry is ranked fourth regarding cases of
suspected malpractice. Of the 14,042 cases of suspected
medical errors reported in 2020, 1,198 concerned dentistry
and 422 of these could be verified. With 4,337 cases, the
disciplines of orthopaedics and trauma surgery had the
greatest number of reported allegations. Internal and gen-

In 2019, DGZI introduced
its online campus, a
modern, innovative and,
above all, convenient
solution for participants. After the
launch of the German
campus, the English
version for international DGZI members
followed in 2020. Especially in times when faceto-face training has been
almost impossible, online offerings are playing an increasingly important role in the education and training of dentists. Initially
developed only for curricular training at
home and abroad, the online campus was opened to
all interested dentists, offering this continuing education
opportunity to a wider audience. The structure and content
of DGZI’s successful implantology curriculum was revised
in 2019. In addition, all course participants receive access
to the ITI Academy, through which young dentists and
those with little experience in implantology can learn the
fundamentals of dental implantology (Fig. 3)

4
Fig. 4: Group of participants in the GBOI programme in Sudan around Dr Ahmed Fadl.

1 2022

[47] =>

events

5
Fig. 5: GBOI graduation ceremony in Cairo, Al Jazira Sofitel Hotel.

The new DGZI Online Campus has been completely redesigned and enables e-learning from all devices and
from anywhere with Internet access. Well-prepared content, intermediate examinations and a final examination
provide the participant with constant feedback on the
level of knowledge he or she has achieved and thus

In conclusion, it can be stated that, with regard to the international implantological standard of the future, DGZI/GBOI
will continue to work actively on this topic with the aim of
mediating between science and clinical practice around
the world and continue to validate the relevance of this
professional society.

“The scientific and educational cooperation between the
Faculty of Dentistry of the Cairo University and DGZI
has started officially in the year 2006, when the first
GBOI programme in Egypt was launched. I had the pleasure
of being responsible for that programme ever since that
time and until now. We proudly helped more than
300 graduated dentists, living in Egypt but
from different countries to get decent basic and
advanced theoretical and practical dental implantology
education and international certification.”—
Prof. Amr Abdel Azim, University of Cairo, Egypt
prepare him or her for the practical modules in the curriculum. Each block ends with a learning success check.
The practical modules, however, can be practised as
often as desired in advance of examinations. Since not
only theoretical basics are necessary for curricular training, participants also start with practical modules in the
face-to-face further training after completing the theoretical training online. Special implant prosthetics, hard- and
soft-tissue management, and an anatomy course with
work on human specimens form the foundation of the
practical modules, which are then supplemented by
two further elective modules with freely selectable topics
of dental work.

On this behalf the DGZI invites its international guests
again this year to the 51st International Annual Congress,
which will take place on 30 September and 1 October 2022
at the Hotel Berlin Central District in Berlin.

contact

Association details

DGZI e.V.
+49 211 1697077
sekretariat@dgzi-info.de
www.dgzi.de

1 2022

[48] =>

| news
Plant-derived composite developed by MIT researchers

New material could pave the way for sustainable plastics
Researchers at the Massachusetts Institute of Technology (MIT) have
developed a potential 3D-printing material and conventional casting
within dentistry. They have engineered a composite made mostly from
cellulose nanocrystals, which are chains of organic polymers arranged
in crystal patterns mixed with a bit of synthetic polymer. The researchers found the cellulose-based composite is stronger and tougher than
some types of bone, and harder than typical aluminium alloys.
The team hit on a recipe for the CNC-based composite that they
could fabricate using both 3D printing and conventional casting.
They printed and cast the composite into penny-sized pieces of
film that they used to test the material’s strength and hardness.
They also machined the composite into the shape of a tooth to show
that the material might one day be used to make cellulose-based
dental implants — and for that matter, any plastic products — that
are stronger, tougher, and more sustainable. “By creating composites with CNCs at high loading, we can give polymer-based materials
mechanical properties they never had before,” says A. John Hart,
professor of mechanical engineering. “If we can replace some
petroleum-based plastic with naturally-derived cellulose, that’s
arguably better for the planet as well.”

Researchers at Massachusetts Institute of Technology have developed a new
composite material that could one day be used to make implants.

The study, titled “Printable, castable, nanocrystalline celluloseepoxy composites exhibiting hierarchical nacre-like toughening”,
was published online on 10 February 2022 in Cellulose.
Source: MIT

OR Foundation meets in Rome

Inauguration of new board of trustees and new executive director
On 29 November 2021 the Oral Reconstruction (OR) Foundation has
announced that Prof. Mariano Sanz from Spain, Dr Luca Cordaro

from Italy and Prof. Irena Sailer from Switzerland were elected to
its board of trustees during the board meeting in Rome. Prof. Sanz
was also officially inaugurated as president of the foundation.
In addition, Dr Martin Schuler, who has a strong background in the
field of medical devices and dental implants, was appointed executive director of the foundation, taking over responsibilities from
Dr Alex Schär, who is retiring after 16 years as board member and
five years as the foundation’s CEO. Dr Schuler assumed full responsibility for the foundation on 1 January 2022. Dr Schär will support
the transition of projects until the end of March 2022.

From left: Dr Martin Schuler, who has held various management positions
at Straumann in the past; Prof. Irena Sailer, head of the Division of Fixed
Prosthodontics and Biomaterials at the University of Geneva in Switzerland;
Prof. Mariano Sanz who has published more than 350 scientific articles and
book chapters about periodontics, implant dentistry and dental education;
and Dr Luca Cordaro who is head of the Department of Periodontology
and Prosthodontics at the Eastman Dental Hospital in Rome in Italy.
(Image: © Oral Reconstruction Foundation)

1 2022

During his presidency, Prof. Sanz intends to focus on supporting
young and upcoming scholars and on fostering clinical research
and efficient treatment approaches for the benefit of the patient.
Many educational events are scheduled for 2022, including
symposia in France, Germany, Japan, Spain and the US, and the
foundation will offer an excellent platform for the exchange of
expertise between universities and dental practitioners worldwide
throughout the year.
More information about the foundation can be found online at
orfoundation.org.

Source: Dental Tribune International

[49] =>

[50] =>

| about the publisher

Congresses, courses
and symposia

implants
Imprint

EuroPerio10
15–18 June 2022
Copenhagen, Denmark
www.efp.org/europerio

Publisher
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hiller@oemus-media.de

AAID Annual Conference
21–24 September 2022
Dallas, TX, USA
www.aaid.com/annual_conference

Chairman Science & BD
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Chief Editorial Manager
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(V. i. S. d. P.)
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info.vollmer@t-online.de
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29 annual scientific
meeting of EAO
th

29 September–1 October 2022
Geneva, Switzerland
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implants

international magazine of oral
implantology is published in cooperation

with the German Association of Dental
Implantology (DGZI).
DGZI
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1 2022

implants international magazine of oral implantology is published by OEMUS MEDIA AG
and will appear with one issue every quarter in 2022. The magazine and all articles and illustrations
therein are protected by copyright. Any utilisation without the prior consent of editor and publisher
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[51] =>

EXCELLENCE IN IMMEDIACY

Straumann® BLX

Confidence beyond Immediacy.

DYNAMIC BONE
MANAGEMENT

ESTHETIC EASE
CONCEPT

REAL
CONFIDENCE

Intelligent implant
concept supporting
immediate protocols
in all bone types.

One connection
and under-contoured
prosthetics to deliver
esthetics with ease.

Backed by long-term
scientific evidence for the
technologies Roxolid®
material and SLActive®
surface.

BLX unifies progressive functional design with our high-performance
Roxolid® material and the clinically proven SLActive® surface, designed
to provide you with confidence for all clinical situations. Innovations like
the VeloDrill™ System, Straumann® Dynamic Bone Management and
our Esthetic Ease Concept are aimed to significantly improve surgical
and restorative workflows.
Contact your local Straumann representative or scan QR-Code

A0016/en/B/01-IIM

02/22

[52] =>

Regist

JUNE 9-11
GOTHENBURG
SWEDEN

neossintegrate.com

Integrate. Educate. Celebrate.
Neoss® celebrates 20 years of Intelligent Simplicity
Join us and our community from around the globe for an exceptional
scientiﬁc program across three days. It will be an action-packed
conference with endless opportunities for continuing education
and to integrate with your peers.

Scientiﬁc Chair – Prof. Christer Dahlin
Meet our speakers
Dr. Emilie Abraham, United Kingdom
Dr. Michael Braian, Sweden
Dr. Pierluigi Coli, United Kingdom
Dr. Marcus Dagnelid, Sweden
Dr. Fabia
abia Flensberg,
Flensberg Germany
Dr. Scott Froum, United States
Dr. David González, Spain
Dr. Nicolas Haßfurther, Germany
Dr. Norbert Haßfurther, Germany
Dr. John Hodges, United States
Prof. Torsten Jemt, Sweden
Dr. Nermin Kamal, Egypt

Dr. Sreenivas Koka, United
ed States
S
Dr. Nico Laube, Germany
Germ
Dr. Giuseppe
eppe Luongo,
L
Italy
Dr. Hazem
Dr
H
Mourad, Egypt
Dr. Rishi Patel, United K
Mr. Steven Pigliace
Prof. Raoul Polan
Dr. Richard R
Dr. Rob Rit
Dr. Isab
Dr. C
D

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

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Table of contents

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