Cover / Editorial / Content / Minimally invasive implant dentistry with short or narrow implants / Periapical implant lesion and retrograde peri-implantitis / Implant retreatment / Measuring implant stability / Bringing a turnkey restoration solution to dentists / Manufacturer News / Events / News / Imprint
Cover
01 - 01 viewEditorial
03 - 03 viewContent
04 - 04 viewMinimally invasive implant dentistry with short or narrow implants
06 - 13 viewPeriapical implant lesion and retrograde peri-implantitis
14 - 20 viewImplant retreatment
21 - 29 viewMeasuring implant stability
30 - 32 viewBringing a turnkey restoration solution to dentists
34 - 35 viewManufacturer News
36 - 40 viewEvents
41 - 46 viewNews
48 - 49 viewImprint
50 - 50 viewArray
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[1] =>
issn 1868-3207 • Vol. 19 • Issue 3/2018
implants
international magazine of oral implantology
case report
Minimally invasive implant dentistry
industry
Implant retreatment
interview
Measuring implant stability
3/18
[2] =>
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editorial
|
Dr Rolf Vollmer
First Vice President and Treasurer of DGZI
We are inviting you to the future
Dear colleagues,
This year, the 48th DGZI International Annual Congress, being held on 28 and 29 September in Düsseldorf, Germany, will also be the 1st Future Congress in
Dental Implantology. In cooperation with the congress
organiser and publisher OEMUS MEDIA AG, we have
developed a diverse and future-oriented further training programme.
On Friday morning, the Future Podium “Visions in
Implantology” will kick off the event followed by two
live-streamed and moderated surgeries (CAMLOG,
Straumann). Table clinics will take place in the afternoon. Participants can attend up to three subsequent
table demonstrations, having a choice between 24 table
clinics covering diverse, practice-oriented topics. As the
number of participants is limited to eight per table, we
would like to ask you to inform us about your preferences as soon as possible.
their stand designs. Chat with colleagues, expand your
network and enjoy the evening, after the day’s events.
Saturday will be dedicated to scientific presentations of renowned national and international experts. All
presentations will be simultaneously interpreted into
English or German.
As you can see, we have organised a diversified and
informative educational event on modern and futureoriented dental implantology. In addition, a two-day programme (hygiene in dental practices, QMC) will run in
parallel for your practice team and is being offered at a
special team rate. Detailed programme information can
be found in the congress programme on pp. 41–43 and
at www.dgzi-jahreskongress.de.
Be part of it! We are looking forward to seeing you in
Düsseldorf!
Yours,
Hard work deserves time off too—after the table
sessions, you are thus invited to a casual and relaxed
get-together on Friday evening in the exhibition area,
where the industry sponsors have put special effort into
Dr Rolf Vollmer
3 2018
03
[4] =>
| content
editorial
We are inviting you to the future
03
Dr Rolf Vollmer
case report
Minimally invasive implant dentistry with short or narrow implants
page 06
06
Prof. Mauro Marincola, Dr Daniel Hernández-González,
Dr Jaime Guzmán-De Ávila & Dr Miguel Simancas-Pallares
Periapical implant lesion and retrograde peri-implantitis
14
Dr Nikolaos Papagiannoulis
industry
Implant retreatment
page 22
22
Dr Philippe Leclercq, Jean-François Martinez,
France & Michael Brüsh
interview
page 45
Measuring implant stability
30
Bringing a turnkey restoration solution to dentists
34
events
Best of EuroPerio9
44
Nobel Biocare announces new products and partnerships
45
Implantology & Modern Dentistry
46
news
Cover image courtesy of
Integration Diagnostics Sweden AB
www.penguinrfa.com
Original Background:
© Jan Martin Will/Shutterstock.com
issn 1868-3207 • Vol. 19 • Issue 3/2018
implants
3/18
36
news
48
about the publisher
imprint
international magazine of oral implantology
case report
Minimally invasive implant dentistry
industry
Implant retreatment
interview
Measuring implant stability
04
manufacturer news
3 2018
50
[5] =>
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[6] =>
| case report
Minimally invasive implant d entistry
with short or narrow implants
Ridge splitting and crestal and internal sinus lift
Prof. Mauro Marincola1, Dr Daniel Hernández-González1, Dr Jaime Guzmán-De Ávila1 &
Dr Miguel Simancas-Pallares1, Colombia
1
Dental Implant Unit, Faculty of Dentistry, University of Cartagena, Colombia
Introduction
Dental implants have been advocated as the treatment
of choice for missing teeth and tooth replacements. Scientific evidence demonstrates their high success rates
and therefore their clinical applicability. However, in
some circumstances due to premature posterior tooth
loss leading to severe sinus pneumatisation or a congenitally missed tooth causing alveolar bone collapse, implant placement can still remain challenging for clinicians.
These circumstances could be present in one surgical
Fig. 1a
target area at the same time, thus increasing treatment
complexity. In such cases, available options such as
short implants, ridge splitting, and internal and crestal sinus lifts have been proposed to minimise treatment cost
and time, as well as co-morbidities but preserve treatment success rates.
In order to address clinical-related sinus pneumatisation issues, two main surgical approaches have been
suggested: internal and lateral sinus lift techniques. The
internal sinus lift approach is indicated whenever the re-
Fig. 1b
Fig. 1c
Fig. 1d
Fig. 1e
Figs. 1a–e: CT scan analysis of the targeted surgical area: a) Coronal view of the maxilla showing the limited width and b) panoramic view of the maxilla depicting the reduced
vertical bone height in the right quadrant. c–e) Sagittal views of the molar area with the diminished residual bone height as little as 1 mm.
06
3 2018
[7] =>
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Fig. 2a
Fig. 2b
Fig. 2e
Fig. 2c
Fig. 2f
Fig. 2d
Fig. 2g
Fig. 2a: Pre-op view of the targeted surgical area. Fig. 2b: Targeted surgical area once the full-thickness flap was obtained. Fig. 2c: Cortical perforations to
generate initial split. Fig. 2d: Crestal perforation in order to expose the sinus cortical bone and perform a sinus lift. Figs. 2e & f: Cortical deepening by use of a
diamond-covered disc under continuous irrigation. Fig. 2g: Surgical view of the split area in the premolar zone and the crestal perforation in the molar area.
08
sidual bone height (RBH) is 4 to 7 mm. First proposed by
Summers, it entails performing a cortical greenstick fracture using osteotomes, allowing the Schneiderian membrane to be easily lifted.1 This technique has the advantage of allowing immediate implant insertion. The lateral
sinus lift approach is suggested when the RBH is less
than 4 mm. With this skill-dependent technique, a bony
lateral window has to be created, exposing the cortical
bone. Once this has been achieved, membrane detachment with the use of curettes is performed, and an alloplastic material is injected as a bone graft. After a graft
healing period of five to six months, the implants can be
inserted. In order to address alveolar collapse issues,
ridge splitting was proposed as a surgical approach,
wherein the cortical plates are separated to allow the insertion of implants into the artificially created space.
cussed because of their increased use in recent years.
Historically, long implants (> 13 mm) in combination with
sinus lift procedures were recommended to restore function and aesthetics. Nowadays, improvement on implant
design and scientific evidence have shown high success/
survival rates of short implants, thus indicating them to
be among the most valuable approaches in modern
dentistry.
All these options are of high clinical value when facing
such scenarios. However, implant length is considered
one of the most important predictors in treatment efficacy when performing these techniques. Likewise, short
implants have been proposed, since they have marked
clinical advantages, such as minimising the amount of
sinus membrane to be lifted and grafting material to
be injected, thus introducing the concept of minimally
invasive implant dentistry. Short implants are widely dis-
A 52-year-old male patient consulted our practice owing to his desire for functional and aesthetic restoration.
The patient did not report any medical background of
dental interest. He also signed informed consent prior to
the start of treatment and was classified as ASA I physical
status. After radiographic (Figs. 1a–e) and clinical (Fig. 2a)
examination, it was found that the patient required dental implantation in the right posterior maxilla owing to the
missing first and second premolars and first molar.
3 2018
Having all these concepts in mind, the objective of this
case report was to demonstrate the use of short implants
in combination with ridge splitting and internal and crestal
sinus lift in the same surgical area, thus applying a minimally invasive dentistry approach.
Case presentation
[9] =>
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[10] =>
| case report
Surgical technique
Infiltrative anaesthesia was performed during the entire procedure. Initially, a non-adrenaline anaesthetic
was used (PRICANEST 4 %, Ropsohn Therapeutics)
in order to collect blood to mix with a grafting material
(50–500 μm SynthoGraft, Bicon Dental Implants). Then,
2 % Xylocaine (Dentsply Pharmaceutical) was used to
complete the surgical treatment.
Fig. 3
Fig. 3: Residual bone height analysis in the targeted surgical area showed
12.40 mm in the first premolar area, 6.46 mm in the second premolar area
and 0.40 mm in the molar area.
Amoxicillin (500 mg every 8 hours) was prescribed two
days before the surgical procedure in order to avoid infections. An experienced clinician then performed the
surgical treatment as follows:
1. First premolar: ridge splitting with simultaneous insertion of a narrow implant.
2. Second premolar: ridge splitting, internal sinus lift with
simultaneous insertion of a narrow implant.
3. First molar: crestal sinus lift with simultaneous insertion
of a short implant.
Using a #15 blade in a Bard-Parker scalpel, we performed an intrasulcular incision. A full-thickness flap was
obtained in the area and then using the blade edges and
surgical mallet, cortical perforations were performed covering the premolar area (Figs. 2b & c). Using a carbide
round-edge bur (Sinus Lift Bur, Bicon Dental Implants) on
a low-speed handpiece, we created a crestal—but not
lateral—window until the sinus cortical bone was clearly
exposed (Fig. 2d). Then, using a diamond-covered disc
(Frios MicroSaw Diamond Discs, Dentsply Sirona) on a
low-speed handpiece, we achieved a deeper cortical
split in the premolar area (Figs. 2e–g).
A digital radiograph (Dr Suni, Suni Medical Imaging)
with a surgical chisel inserted was performed to control
Fig. 4a
Fig. 4b
Fig. 4c
Fig. 4d
Fig. 4e
Fig. 4f
Fig. 4g
Fig. 4h
Fig. 4a: Use of surgical chisels to create the artificial space (split) for implant insertion. Fig. 4b: Split area with hand reamers and paralleling pin.
Figs. 4c & d: Split area with hand reamers. Fig. 4e: Prepared space to receive implant insertion. Fig. 4f: Schneiderian membrane lift using surgical
curettes. Figs. 4g & h: Lifted membrane and grafted space.
10
3 2018
[11] =>
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Astra Tech Implant System®
Our world is not flat
Neither is the anatomy of your implant patients
Your world is already full of clinical challenges so why work harder because of
conventional thinking? Instead of augmenting sloped ridges to accommodate flat-top
implants, it’s time to discover a simpler solution by using an implant that follows the
bone. Because sloped-ridge situations call for anatomically designed sloped implants.
OsseoSpeed® Profile EV – It’s time to challenge conventional thinking
www.profiledentalimplants.com
Conventional vs
innovative approach
[12] =>
| case report
Fig. 5a
Fig. 5d
Fig. 5b
Fig. 5e
Fig. 5f
Fig. 5c
Fig. 6
Fig. 5a: Periapical radiograph showing the hand reamers in the premolar area and the grafting material in the molar area. Fig. 5b: Insertion of narrow implant
in the first premolar space. Fig. 5c: Inserted narrow implants in the split premolar area. Fig. 5d: Insertion of a short implant with a sinus lift abutment in the
molar area. Fig. 5e: Two narrow implants (premolar area) and the short implant (molar area) inserted in the targeted surgical area. Fig. 5f: Sutured wound
using the continuous technique. Fig. 6: Immediate post-op radiograph.
RBH (Fig. 3). Surgical chisels were employed to increase
length and width in the split area (Fig. 4a). Figures 4b–e
show the subsequent use of hand reamers to create the
implant space. Besides the ridge split procedure, in the
area of the second premolar, a previously published protocol was followed in order to simultaneously perform the
sinus lift.2
For the molar area, surgical curettes were used to
carefully lift the Schneiderian membrane (Fig. 4f). A synthetic and bacteriostatic grafting material (SynthoGraft;
beta-tricalcium phosphate, size 50–500 μm) was mixed
with the collected blood to a putty consistency—no liquid was evident in the mixture. Then, a 4 mm bone graft
syringe was used to place a bone graft material into the
apical portion of the osteotomy. Once resistance against
the Schneiderian membrane was detected, the syringe was slowly retracted while continuously injecting
(Figs. 4g & h). A new digital periapical radiograph was
taken to control the grafted space and premolar osteotomies (Fig. 5a). In the first and second premolar areas,
one 3.0 x 8.0 mm implant and one 3.5 x 8.0 mm implant
(Bicon Dental Implants) were inserted, respectively, with
the use of seating tips (Figs. 5b & c).
12
3 2018
After bone grafting material had been injected, a
4.5 x 6.0 mm implant (Bicon Dental Implants) was inserted into the lifted sinus using an implant inserter-retriever mounted in a straight handle at first and then gently tapping with a seating tip. Owing to the limited RBH
in the area (Fig. 3), a sinus lift abutment (Bicon Dental
Implants) was used in conjunction with the implant in order to avoid implant displacement into the lifted grafted
space (Figs. 5d & e).
Finally, a continuous suture with polyglycolic acid was
used to close the incisions (ACE Surgical Supply, Fig. 5f).
After implant insertion, an immediate postoperative radiograph was taken (Fig. 6). The patient received postoperative and home care instructions. An antibiotic (amoxicillin) and analgesic (ibuprofen) were prescribed in order
to avoid infection, pain or swelling.
Discussion
Several research results have shown the successful
outcomes of using surgical procedures such as ridge
splitting and sinus lifts in combination with or without
dental implants. Brizuela et al. evaluated 36 threaded im-
[13] =>
AD
EXCEED
plants in 36 patients placed using internal sinus lift without grafting material and
showed after 24 months that the implant
success rate was 91.6 per cent.3 Further,
Nedir et al. showed that atrophic posterior maxillae could be predictably rehabilitated using osteotomes with simultaneous implant placement.4 The new
bone formed around implants after one
year was stable after five years, irrespective of the presence or the absence of
a graft.4 Grafting was unnecessary to
achieve an average bone augmentation
of 3.8 mm, but more bone was gained
with grafting.4 Deliberador et al. successfully demonstrated the use of the
ridge split technique with simultaneous
implant insertion.5
Despite all of these results, there is little in the scientific literature on a combination of procedures, for example sinus
lift and ridge splitting, and implant insertion, as shown in this case report. In this
patient, the second premolar area was
effectively regained using the ridge split
and internal sinus lift techniques in the
same surgery.
The literature is conclusive that internal sinus lift should be performed when
the available RBH is between 4 mm and
7 mm and lateral sinus lift whenever an
RBH of less than 4 mm is present. This
case report successfully describes the
use of an innovative surgical approach
(crestal sinus lift) too via the bone crest
lift of the maxillary sinus when the available RBH was less than 1 mm. This approach represents less morbidity and
greater time saving and allows implant
placement in the same surgery thus decreasing overall treatment time.
Schiegnitz et al. found that evaluation
of oral health-related quality of life after
sinus augmentation showed significant
improvement, indicating a remarkable
benefit of this procedure for patients.6
Nevertheless, we need additional studies, such as randomised controlled trials, to properly demonstrate effectiveness of these innovative techniques.
Tallarico et al. described a crestal approach to sinus lift, showing that sinus
floor augmentation can be successfully
accomplished with a transcrestal ap-
proach using a dedicated implant system.7 However, in this study, the mean
initial RBH was 4.64 ± 0.86 mm, which is
more consistent with the internal sinus
lift and not the crestal sinus lift surgical
indications.
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same patient constitutes a minimally invasive implant dentistry approach, since
they are less time-consuming procedures and produce a minimum rate of
complications that represents a less
traumatic surgical approach.
Editorial note: The authors disclosed that
they have no conflict of interest and that
they received no funding for this article.
Author details
Literature
contact
Dr Miguel Simancas-Pallares
Dental Research Department
Faculty of Dentistry
University of Cartagena
Avenida Del Consulado 48–152
Cartagena 130014, Bolívar, Colombia
Phone: +57 5 6698172-110
msimancasp@unicartagena.edu.co
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[14] =>
| case report
Periapical implant lesion and
retrograde peri-implantitis
Two conditions supported by little research
Dr Nikolaos Papagiannoulis, Germany
Introduction
Dental implants are established as a standard treatment in dentistry. More implants are placed every year
and dentists are encountering new findings, often pathological, that are little described and researched in the literature. The more implants placed, the greater the variety of novel clinical and radiographic findings for which no
treatment protocols exist. The association of peri-implantitis, implant failure and other pathologies with numerous
unknown factors is steadily increasing.
Definition of terms
In general, the term “periapical implant lesion” (PIL) describes radiographic findings around the apex of an implant. It refers to a variety of occurrences with no association with the rest of peri-implant tissue or adjacent teeth.
Clinical examination or patient complaints may not always
indicate pathological findings, and if they do, the definition
of the term overlaps with that of “retrograde peri-implantitis” (RPI). RPI has a similar definition, but is accompanied
by complaints and usually clinical findings (Figs. 1–3).
Diagnosis
RPI is manifested through radiographic findings and
various clinical ones. In the case of RPI there is retrograde
infiltration of pathological microorganisms that nest at the
apex of the implant. Often this infiltration comes from an
adjacent tooth; it is, however, not the only reason for RPI.
Other reasons relate to the operation protocol, prostheses and implant planning. In most cases, a combination
of more than one factor leads to this diagnosis. Lateral
defects, implant mobility or postoperative inflammation
regarding the rest of the implant body or peri-implant tissue are excluded from this definition.
Both PIL and RPI are often incidental radiographic findings made, after implant placement until years after prosthetic restoration. If accompanied by clinical findings like
positive percussion, occlusion complaints or pain syndromes, we distinguish two points of time: (a) during the
first six weeks after insertion; and (b) four to eight weeks
after loading. Pain complaints long after loading are in
most cases an indication of cross-contamination from
the adjacent teeth.
The reasons for RPI can easily be established. The
reasons for PIL are various and a combination of more
than one, and often no clear reason can be determined.
In cases of PIL we search for the reason through the
exclusion principle. The differential diagnosis is in both
cases difficult and often lacks evidence. Since there is no
protocol for diagnosis, we rely on empirical observation.
Reasons for periapical implant lesion and
retrograde peri-implantitis
We can distinguish between established and potential
reasons for such lesions.
Fig. 1
Fig. 2
Fig. 3
Figs. 1–3: Radiographs depicting cases of retrograde peri-implantitis.
14
3 2018
Established reasons are the following:
1. Contamination of the implant surface;
2. overheating of the bone during operation;
3. apical perforation of the buccal plate;
4. existing apical perforation of the buccal plate;
5. apical fracture of the bone (after external sinus, block
augmentation, two stages of guided bone regeneration);
6. endodontic pathology of the adjacent teeth (distance
to adjacent tooth less than 1 mm);
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| case report
Radiographic classification of
retrograde peri-implantitis
Fig. 4
Fig. 5
Fig. 6
Fig. 4: Mild lesion: less than 25 % of the implant length. Fig. 5: Moderate lesion: 25–50 % of
the implant length. Fig. 6: Advanced lesion: more than 50 % of the implant length.
7. immediate implant placement after tooth loss due to
endodontic pathology; and
8. inadequate blood perfusion at the implant site.
Potential reasons may be the following:
1. Insufficient bone quality;
2. prosthetic overload;
3. endodontic pathology of the adjacent teeth (distance
of 2–4 mm);
4. late implant placement with a pathology caused by
perforation due to tooth extraction;
5. endodontically treated adjacent teeth showing a newly
developed pathology (distance to implant of more
than 2 mm);
6. residual or granulation tissue at an edentulous site; and
7. pseudo-lesion (caused by drilling deeper than actual
implant length).
Classification of periapical
implant lesion/retrograde peri-implantitis
according to lesion activity
Active retrograde
peri-implantitis/periapical implant lesion
The radiographic findings correlate with the patient
symptoms and the clinical findings. The patient has a pain
syndrome, there is inflammatory reaction at the tissue
(like swelling), apical pressure point, positive percussion,
etc. Often the translucent area around the implant apex
is not round and seems to spread apically to the bone.
Inactive retrograde
peri-implantitis/periapical implant lesion
The radiographic findings do not correlate with the clinical findings and the patient has no symptoms. Radiographically, a translucent region at the implant apex is observed
which can even be exceeding 50 % of the implant length.
RPI or PIL should not be misinterpreted in cases lacking osseointegration or with implant mobility during the
healing phase or after loading.
16
3 2018
In this classification, the lesion is evaluated in relation to the implant length
(coronoapical direction). The spread of
the lesion beyond the implant apex is
not measured. The lesion is classified as
follows:
– Class 1: lesion less than 25 % of the
implant length (mild lesion; Fig. 4).
– Class 2: lesion 25–50 % of the implant
length (moderate lesion; Fig. 5).
– Class 3: lesion longer than 50 % of the
implant length (advanced lesion; Fig. 6).
This classification considers only two diameters of the
lesion. Further information about 3-D defects, adjacent
teeth, distance to adjacent teeth or implants, as well as
implantation time, clinical findings, symptoms and prostheses, is interesting and these are important factors for
the evaluation of such lesions.1
Prevalence
The information provided in the literature is inconsistent. The prevalence of implants affected by PIL and RPI
is 2.7 % in the lower jaw and 1.6 % in the upper in some
studies.2 Others give 8.2 to 13.6 % when implants are
placed next to teeth that have undergone difficult endodontic therapy or in sites where teeth were extracted
after endodontic complications.2
In our practice, we studied the last 650 implants that
were inserted. There were three true cases of RPI or PIL
lesions (two of these cases are presented in this article),
resulting in a prevalence of 0.46 %. The three implants
affected represented 10 % of all failed implants.
Treatment
Experience has shown that the sooner such lesions are
treated, the higher the possibility for healing. Since there
is no treatment protocol, our efforts are empirical and
often based on oral surgery. An inactive RPI should not
necessarily be treated, but controlled through periods of
regular recall. For active lesions, we suggest the following
four-stage methodology.
Stage 1
In the case of Class 1 and 2 lesions, antibiotic therapy
should be administered. Some clinicians regard amoxicillin with clavulanic acid as appropriate.3 We believe
the initial antibiotic could also be clindamycin if there is no
perforation of the lesion buccally owing to the established
higher bone penetration of this antibiotic. If adjacent
teeth show endodontic inflammation or other pathologies
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[18] =>
| case report
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 7: Pre-operative situation. Figs. 8 & 9: Control radiographs of two implants placed in regions #35 and 36 on the day of implantation. Fig. 10: Situation in
regions #34 to 36: seven days after endodontic treatment. The patient was free of complaints.
(iatrogenic reasons, poor planning), they should be treated
immediately. Thus, some studies have reported cases
in which no bacteria were found on the surface of the
explanted implant after occurrence of RPI.2, 4
Stage 2
If the lesion persists, established empirically from the
oral surgery, the apex should be exposed. If the lesion is
of Class 1 or 2 and the implant is stable, loaded or not, it
should not be removed immediately. Surgical intervention
from the lateral side should be performed if osseointegration has already occurred. Resection of the implant
apex, depending on the extent of the lesion, can reduce
the survival rate of the implant. The surgical procedure
can be standard, rinsing with an antibacterial solution,
application of local anaesthetic, curettage, administration of anti-inflammatory medicaments, drainage, etc. At
the same time, we provide the patient with systemic antibiotic treatment accompanied by low-dose glycocorticosteroids or mefenamic acid. Some authors advise augmentation of the defect and flap closure; we believe this
decision is not mandatory, but depends on the findings
at the implant apex.
Stage 3
If clinical symptoms and patient complaints disappear,
we advise augmentation of the surgical access and coverage with a membrane. At this point, Mohamed et al.
report expecting a higher success rate when resection
of the implant apex is performed; however, in their study,
they evaluated only loaded implants and the augmentation was performed with xenografts.5 Resection of the
implant apex can be an assistive step for Class 3 lesions to reduce the lesion when the thread design is not
favourable for decontamination. Nevertheless, this procedure is of high risk for implant stability and removal
of debris from the cavity. If at this stage of the therapy,
the patient still has complaints, the implant should be
removed.
Stage 4
As long as the apical translucency is no longer evident
and the patient has no complaints, implantation can be
18
3 2018
performed. If primary stability cannot be achieved, guided
bone regeneration should be performed. If symptoms or
complaints cannot be controlled or the risk is high, one
should wait for full bone healing, approximately six months,
and plan for late implant placement. Delayed immediate
implant placement seems to make no sense at this stage.
A treatment protocol is provided by Kishnani et al.6
In general, the treatment of RPI or PIL relies on our
experience and depends on the radiographic and clinical findings. Evident perforation of the buccal plate,
compromised blood perfusion at the implant site and
reduced primary stability describe a totally different situation with a different treatment protocol. Also, an association with the Epstein-Barr virus is a matter of current discussion.
Treatment success rate
Studies report success rates of 46 per cent over four
years.7 Resection of the apex in cases of high primary stability and a lack of complaints seems to improve the success rate. The existing data is not sufficient to draw specific
conclusions or evaluate treatment therapies. The reported
success rates have also not been confirmed and do not
differentiate between classification, symptoms or findings
for the treatment applied. All data at this time is very limited.
Case presentation
The cases in this article concern both PIL and RPI lesions. In the first case, the diagnosis was RPI due to inflammation of the adjacent tooth. The second case was
diagnosed as PIL without evident cause, but contamination via the adjacent tooth was suspected. Both cases
were late implantations without the need for bone augmentation, had entailed submerged healing, re-entry
after four months and fixed prostheses. Both sites had
been edentulous for nine to 15 months. At the time of
implant placement, no pathological findings were made.
Both cases were guided; the planning was assisted with
cone beam computed tomography (CBCT). All preliminary and intraoperative planning and control aim at pre-
[19] =>
AD
venting bone perforation (buccally or lingually).
Both patients reported no complaints
directly after surgery. The RPI patient
reported the first complaints six weeks
postoperatively, while the PIL patient
showed the first symptoms five and a
half months after implantation and one
and a half months after loading of the
implant. Both patients underwent endodontic treatment of one adjacent tooth,
since they showed symptoms also at
these teeth. For the RPI patient, conservative treatment of the adjacent tooth was
planned some days after implant placement (poor planning), but complaints had
occurred earlier.
Case 1 (retrograde peri-implantitis)
This patient received two implants,
in regions #35 and 36 (Figs. 7–9). The
implant in region #35 was placed 2 mm
from the adjacent tooth and 2 mm from
the alveolar nerve loop. The insertion
torque was 55 Ncm. Tooth #34 had been
conservatively insufficiently treated and
the treatment was planned to be performed by the referring dentist after implant placement.
One week after implant placement,
the patient complained about pain at regions #34 to 36. The clinical examination found positive percussion of tooth
#34, no apical pressure point and no
pathological findings in the region of the
implants. The radiographic examination
showed a translucency at the apex of the
implant in region #35 and this evoked
suspicion regarding the adjacent tooth
#34. Endodontic treatment was performed immediately and the patient additionally received systemic antibiotic
therapy. Seven days after the complaints
had resolved, percussion was slightly
positive. After two weeks, no clinical
findings were evident, either at the tooth
or at the surgical site (Fig. 10).
At the time of re-entry, four months
postoperatively, the implants showed
osseointegration and the implant stability quotient (ISQ) was 72 mesiodistally
and 75 buccolingually. Further treatment was performed as planned. The
endodontic treatment was finalised af-
ter loading of the implant. After loading,
at the time of obturation of tooth #34,
the superstructure was removed and
implant stability checked again. The ISQ
value showed 74 mesiodistally and 76
buccolingually.
Case 2 (periapical implant lesion)
This patient received a single implant
in region #36. The adjacent teeth, #35
and #37, showed no pathological findings. Tooth #37 had a sufficient resin
filling placed occlusally and buccally.
Primary stability was very good, the insertion torque was 50 Ncm and the bone
density D2–D3. The ISQ value at insertion was 70. Re-entry and prosthetic
treatment were performed as planned.
The patient received a screw-retained
crown.
Six weeks after loading, the patient
reported mild pain upon biting. Clinically and radiographically, no pathological findings were made. The occlusion
and approximal contact were checked
again. The crown was removed for control of the peri-implant soft tissue. The
implant was then loaded again (Fig. 11).
Eight weeks after initial loading, the
patient reported classic pulpitis complaints at the implant site: positive percussion and apical pressure point. The
radiographic control now showed a lesion at the implant apex, diagnosed as
PIL. The implant underwent surgical
treatment, with a lateral approach at the
implant apex and local antibacterial rinsing. The patient received systemic antibiotic treatment with amoxicillin and clavulanic acid, and the wound was drained.
The crown was removed and a healing
abutment inserted. The ISQ was 72 mesiodistally and 74 buccolingually at this
point (Figs. 12 & 13).
Ten weeks after initial loading, the patient reported occlusal complaints at
tooth #37 and the clinical finding was
irreversible pulpitis. Tooth #37 received
an endodontic treatment. Additionally,
antibiotic therapy with clindamycin was
administered (Fig. 14).
Twelve weeks after initial loading, the
patient reported no complaints at tooth
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[20] =>
| case report
Fig. 11
Fig. 12
Fig. 13
Fig. 14
Fig. 11: Radiographic control six weeks after loading. Figs. 12 & 13: Radiographic findings eight weeks after loading. The prosthesis was removed and a
surgical procedure performed at the implant apex. Fig. 14: Ten weeks after initial loading, endodontic treatment of the adjacent tooth was performed owing
to clinical findings.
#37. There were, however, ongoing complaints regarding
the implant region and this led to the removal of the implant 16 weeks after initial loading. The reverse torque for
implant removal was over 200 Ncm, a trephine bur was
not needed. Probing the implant osteotomy showed no
soft-tissue infiltration whatsoever nor a bony defect. After
explantation, the complaints were resolved within the first
week. The symptoms at the implant had appeared many
months after implant placement, thus excluding intraoperative cross-contamination, overheating of the bone,
bone perforation or trauma of anatomical structures.
Discussion
The most common reasons for RPI are cross-contamination by the adjacent teeth, and scar or granulation tissue
at the implant site. The first main reason for RPI can easily
be avoided. As shown in the first case, poor planning or insufficient clinical and radiographic examination can lead to
such iatrogenically induced lesions. The second main
reason is often preoperatively or intraoperatively difficult to determine. Especially old defects, with extraction
of more than six months prior, show no conspicuities
during the drilling protocol and probing before implant
placement.
3. contamination of the implant surface during insertion
or of the osteotomy through saliva or surgical instruments; and
4. apical perforation buccally or lingually.
Furthermore, a detailed patient medical record and
clinical examination should be undertaken to determine
a differential diagnosis to avoid complications (viral infection, human pathogenic viruses, etc.).
The diagnosis of such lesions results in higher implant
survival rates if made early and the extent of the lesion is
small. Clinical cases are poorly documented so far and
there is no consensus regarding treatment protocol. It is
important to incorporate the possibility of RPI and PIL in
the patient consent form and to discuss the necessity of
conservative and periodontal treatment before adopting
a surgical approach.
The survival rate of implants is continuously improving
and their indication increasing. The interaction with other
biological body systems and diseases forces us to face
new challenges with very limited understanding of the
processes taking place.
Both cases are not easy to treat. Adjacent teeth must
be controlled critically before proceeding to surgery.
Osteotomies should be probed for perforations, soft-tissue infiltration or other pathological findings that may increase operative risk. Another issue that has to be considered, for which we still have very poor data, is the
host response after tooth extraction due to periodontal
problems, even in late implantation cases.
Possible causes of RPI should be eliminated preoper
atively or taken care of intraoperatively. These may be
the following:
1. Overheating due to a faulty drilling protocol or its application;
2. bone necrosis through excess pressure from the implant due to a poor osteotomy, insertion torque, bone
expansion technique, etc.;
20
3 2018
Literature
contact
Dr Nikolaos Papagiannoulis
Dental Esthetics
Hans-Böckler-Straße 2a
69115 Heidelberg, Germany
info@dentalesthetics.de
www.dentalesthetics.de
Author details
[21] =>
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| industry
Implant retreatment
Dr Philippe Leclercq, France; Jean-François Martinez, France & Michael Brüsh, Germany
When working with dental implants, a number of specific rules must be followed regarding both the implant
surgery and the prosthesis itself (fixed protheses tending
to have a more favourable prognosis than overdentures).
If these rules are not adhered to, the results are often
unsatisfactory, requiring retreatment.
In such cases, and despite the patient’s desire to quickly
forget the previous treatment, a very strict protocol must be
followed, specifically concerning the length of healing periods. Despite an increase in the overall treatment duration,
this will ensure success of each stage of treatment. The
implant retreatment case outlined in this article will emphasise these different stages in this type of clinical situation.
Fig. 1
Initial case
At the age of 28, the patient was involved in a traffic
accident, which resulted in significant trauma to her maxilla,
including the loss of her central and lateral incisors and
left canine. The shock also led to the loss of alveolar bone
in the same area. The first premolars were absent, probably owing to previous orthodontic treatment.
The original treatment consisted of placing two implants in the residual bone and an anchorage reinforcement screw-retained bridge to maintain a removable
prosthesis, which included five teeth and a large false
gingiva (Fig. 1).
Fig. 5
Fig. 2
Fig. 6
Fig. 3
Fig. 4
Fig. 7
Figs. 1 & 2: Initial prostheses: Lip support was ensured by a large false gingiva, and fractured cosmetic material at the right maxillary canine was evident. The
patient’s smile showed the prosthetic teeth placed off-centre and an infiltration at the right lateral incisal level. Fig. 3: Examination after three years revealed
a negative short-term prognosis for the implants owing to significant recession at the right implant and hyperplastic tissue. Fig. 4: The framework was unscrewed, abutments removed and implants easily removed. Fig. 5: Implant removal site showing even greater deterioration in bone volume. Figs. 6 & 7: The
grafts were harvested from the chin symphysis and firmly attached by surgical screws in the recipient site.
22
3 2018
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Dissatisfied with the treatment, the patient was re-
examined three years after the initial treatment. The patient’s smile showed an infiltration at the right lateral incisal
level and that the prosthetic teeth were placed off-centre.
The lip support, ensured by a large false gingiva, was correct. The cosmetic material of the right maxillary canine
was fractured (Figs. 1 & 2).
Fig. 8
Once the patient’s prosthesis had been removed and an
examination of the site conducted, an extremely negative
prognosis was determined for the implants (Fig. 3), which
is often the case with maxillary overdentures. The right
implant showed a loss of the majority of its vestibular bone, causing significant recession. The tissue was
hyperplastic, making hygiene difficult. The framework was
off-centre presumably because of the implants, which
explained the off-centre axis of the prosthetic teeth.
Fig. 9
Over the past several years, many authors have observed recurrent gingival inflammation as a reaction to using implants for this indication. Engquist noted a gingival
increase in 25 per cent of the cases1; Naert et al. showed
that out of 86 overdentures (6 maxillary, 80 mandibular),
8 observed gingival hyperplasia, primarily in the maxilla
(9.3 per cent) 2; and Jemt et al. observed that after one year
out of 92 maxillary overdentures, 19 patients showed gingival hyperplasia (20.9 per cent), 13 patients had one gingival
correction and five had two corrections.3 In a 1993 study
on maxillary overdentures, Smedberg et al. observed: “The
results show that the prevalence (p < 0.05) for Lactoba
cillus, Prevotella (subspecies) and yeasts in the subjects
with removable prostheses was significantly higher than
in subjects with fixed prostheses. Removable prosthetics were accompanied by a more aggressive peri-implant
plaque.”4 In view of our patient’s unsatisfactory treatment
results, it was thus decided to restart treatment completely.
Fig. 10
Fig. 11
Retreatment
The retreatment followed an extremely precise protocol, especially regarding the length of the healing periods.
To begin, dental impressions were taken to create a resin-
based temporary removable prosthesis. The prosthesis
included palatal support to relieve the vestibular gingival
tissue as much as possible. An aesthetic fitting of the appliance was conducted to straighten the axis of the incisors.
Implant removal
Owing to insufficient osseointegration, the removal
of the implants was fairly easy (Fig. 4). Removal was
accomplished with the aid of an implant removal tool.
Fig. 12
Figs. 8 & 9: The properly compressed PRF membranes permitted complete coverage of the
surgical site, in this instance on the maxilla. Fig. 10: Panoramic radiograph showing the grafts
to be correctly healed and satisfactorily adhered to the recipient bone sites. Fig. 11: Increased
vestibular bone volume allowed positioning of the teeth at the crestal bone level and reduction of
the false gingiva. Fig. 12: A key of the added wax was taken and fabricated in clear casting resin.
24
3 2018
Immediately after implant removal, the temporary removable resin prosthesis with palatal support was inserted. To permit the rapid elimination of inflammatory
residue, it was contra-indicated to suture the recipient
implant site.
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Assessment after implant removal
Three months after implant removal, a clinical and radiographic assessment was conducted. The assessment showed further significant vertical bone loss and
loss in bone volume (Fig. 5). Significant vertical bone loss
is difficult to correct owing to random gingival recovery.
It was thus decided to augment the bone volume by performing a chin bone graft.
Bone graft
Anaesthetic was administered in the maxillary and
mandibular anterior region. For the mandible, the sample was taken from the cortical bone and a section of
the cancellous bone by piezoelectric surgery. The grafts
were harvested from the chin symphysis, as close as
possible to the mandibular inferior ridge to avoid disturbing the incisor’s sensitive innervation, which can be
a frequent complication of the procedure. The vestibular cortical bone scar was perforated with a small round
bur, allowing for rapid revascularisation of the grafts. The
grafts were then positioned and secured in place with
mini-screws (Figs. 6 & 7).
To increase success, a blood sample was taken and
centrifuged according to the Choukroun platelet-rich
fibrin (PRF) technique5 in order to recuperate the fibrin
clots. The clots were compressed between two compresses to evacuate the serum and to form the membranes which were then applied to the surgical site and
in the mandibular harvesting sites (Figs. 8 & 9).
Pre-implant prosthetic study
After four months, according to radiographic examination, the tissue had healed and the bone mass appeared
stable (Fig. 10). New impressions were taken to prepare for
the next step in treatment: the implant drilling guide. After
four months of healing, the increased vestibular bone volume allowed positioning the teeth at the crestal bone and
reduction of the false gingiva using additional wax (Fig. 11).
A key of the added wax was taken and fabricated in clear
Fig. 13
Fig. 14
Fig. 15
Fig. 16
Fig. 17
Fig. 18
Fig. 19
Fig. 20
Fig. 21
Fig. 13: The reopened site showing correct graft integration, a notable increase in cortical bone and excellent vascularity. Fig. 14: Testing of the sterilised
surgical drilling guide proved drilling would be at the centre of the reconstructed bone ridge. Fig. 15: Aadva self-tapping implants were placed. Fig. 16: All five
implants equipped with threaded cover screws and the surrounding tissue sutured. Fig. 17: Loaded implants, healing abutments in situ. Fig. 18: The healing
abutments were removed and replaced with pick-up impression copings secured with self-curing resin. Figs. 19 & 20: Removal of the impression and fitting of
the impression copings with their laboratory equivalent. Fig. 21: Model of the framework, temporarily including the canine, cast in pattern resin.
26
3 2018
[27] =>
industry
casting resin. The implant positions
were decided on and finalised by
drilling placement holes, determining the exact position of the implants (Fig. 12). The correct positioning of implants in relation to the
future prothesis is an important prerequisite for aesthetic and functional
success.
Implant placement
Local anaesthesia was administered and the bone site reopened.
The site showed correct integration
of the grafts, a notable increase in
cortical bone and excellent vascularity throughout the site (Fig. 13).
The sterilised surgical drilling guide
was tested and showed that drilling would in fact be at the
centre of the reconstructed bone ridge (Fig. 14).
After removal of the screws stabilising the grafts, the
guide was placed and drilling (using physiological saline solution) completed. Five Aadva (GC Tech.Europe)
self-tapping Grade 5 titanium microstructure implants
were inserted by slow drilling (Fig. 15). Aspiration with
physiological saline solution was not used at this time
so that the first contact with the titanium oxide would
be the patient’s blood, thus promoting the implants’
|
osseointegration. This specific implantation technique was validated
by Brun et al.6 All of the implants
were equipped with threaded
cover screws and the surrounding
tissue was sutured (Fig. 16).
To minimise risks, the implants
were left unloaded for four months,
as immediate loading of a site such
as this one could have proven to
be problematic.
Implant loading and impressions
After four months, the implants
were loaded using an apically posiFig. 22
tioned flap. The healing abutments
were placed and the flap sutured
around them (Fig. 17). Radiographic analysis and especially a percussion test showed the implants’ perfect
osseointegration. After 15 days of gingival healing around
the abutments, they were removed and the impression
copings were placed and secured with a self-curing resin
(Fig. 18). Impressions were taken and the healing screws
were reinserted (Figs. 19 & 20).
Validation prosthesis
Rather than calling the appliance at this stage a “temporary prosthesis” or “provisional prosthesis”, it is more
Fig. 24
Fig. 25
Fig. 23
Fig. 26
Figs. 22 & 23: The model was scanned before being transferred to a machining centre. Fig. 24: After scanning, the computer prefiguration of the framework
was validated. Figs. 25 & 26: Testing of the titanium framework on the working model and verification of stability.
3 2018
27
[28] =>
| industry
appropriate to call this temporarily placed prothesis, a
“validation prosthesis of the implanto-occluso-prosthetic
concept recommended to the patient”7. Over the course
of several months, this prosthesis validates
–– the osseointegration of the implants;
–– the aesthetic aspect, especially for the anterior teeth;
–– phonation, which is also important for the maxillary
anterior region; 8
–– the patient’s ability to correctly clean the prothesis; and
occlusion and, in this case, the ability of the anterior to
guide the disclusion of the canine groups in protrusion.
Fig. 27
This prosthesis serves as a model for the final prosthesis. It is made with easily modifiable material like resin,
but with a metal framework to guarantee a certain level
of rigidity. In the first step, a model of the framework,
which temporarily included the canine to increase stability, was cast in pattern resin (Fig. 21). The model was
then scanned (Aadva, GC Tech.Europe; two cameras,
2 MP, precision: 10 µm) before being transferred to a machining centre (GM 1000, GC Tech.Europe; Figs. 22–24).
Once back from the machining, the titanium framework
was tested on the working model and its stability was
verified (Figs. 25 & 26).
Fig. 28
The cosmetic material (UNIFAST III resin; surface rendering: OPTIGLAZE color, GC Tech.Europe) was then placed
on the framework (Fig. 27). The bone graft permitted a
maximum reduction of the vestibular false gingiva.
In the following step, the prosthesis was attached
in the mouth with screws and the necessary occlusal
verification was conducted, including maximum intercuspation, protrusion and lateral excursion. The natural
canine on the right was also equipped with a verification tooth. It should be noted, that in lateral excursion
on the left, with the antagonist being the original tooth
equipped with its periodontal ligament receptors, the
canine function was retained; however the group function, which is usually preferred, was neurophysiologically inept (Figs. 28 & 29).
Fig. 29
Fig. 30
The patient’s smile showed that the incisors were now
well balanced and in line with the face’s sagittal plane. Lip
support appeared to be correct and, as often is the case,
this would all be validated by the patient’s surrounding
friends and family (Fig. 30).
Fig. 31
Fig. 27: The cosmetic material placed onto the framework. Figs. 28 & 29: The prosthesis was
attached with screws and the necessary occlusal verification was conducted. Fig. 30: The patient’s smile showing now well-balanced incisors in line with the face’s sagittal plane, lip support
appearing to be correct. Fig. 31: Removal of the validation prosthesis and examination of the
areas of compressed mucosa and difficult for dental hygiene. Reinstallation of validation prosthesis after correction.
28
3 2018
After three months, the validation prosthesis was removed in order to examine the areas where mucosa had
been compressed and dental hygiene difficult. These areas were corrected and the validation prosthesis reinstalled (Fig. 31).
Final prosthesis
After six months, all of the parameters were validated.
The final prosthesis was then fabricated as an exact copy
[29] =>
industry
Fig. 32
Fig. 33
Fig. 34
Fig. 35
Fig. 36
Fig. 37
Fig. 38
Fig. 39
Fig. 40
|
Figs. 32 & 33: Final prosthesis framework and the coping for the right canine tested on the working model. Figs. 34 & 35: After fitting of the zirconia framework, the ceramic was cast using the exact parameters validated by the resin prosthesis. Figs. 36 & 37: Installation of the final prosthesis and verification of
correct occlusion. Screw channels filled with composite. Figs. 38 & 39: Final cosmetic check-up showing correct lip support with the new extremely reduced
false gingiva. Fig. 40: Radiographic check-up after seven years.
of the validation prosthesis, but in a more durable material: zirconia for the framework and ceramic for the aesthetic material.
As with the titanium validation prosthesis, the framework and the coping for the right canine were scanned
and transmitted to the machining centre. They were then
tested on the working model (Figs. 32 & 33). After fitting
of the zirconia framework, the ceramic was cast using the
exact parameters validated by the resin prosthesis (MB
Dentaltechnik, Figs. 34 & 35).
In the following step, the final prosthesis was installed
and the correct occlusion verified: maximum intercuspation, protrusion and lateral excursion. The screw channels were filled with composite (Figs. 36 & 37).
The final cosmetic check-up, validated by the resin prosthesis, showed the lip support with the new extremely reduced false gingiva to be correct (Figs. 38 & 39). This was
achieved owing to the bone graft.
Regular check-ups
Retreatment was regularly monitored with patient
check-ups (Fig. 40). All implant treatments, no matter of
what type, must be rigorously monitored in all treatment
phases, but a retreatment requires even more diligence.
A patient affected by the failure of a
Literature
previous treatment will not accept
even the smallest problem. To this
end, the role of healing periods is thus
essential to retreatment success.
contact
Dr Philippe Leclercq
President of SIOPA (Society for
Oral Implantology and Applied Prosthesis)
Implantological practice
45, rue de Courcelles
75 008 Paris, France
ph.leclercq@siopa.fr
Author details
3 2018
29
[30] =>
| interview
Measuring implant stability
Dr Peter Andersson and Prof. Lars
Sennerby have treated implant patients
together in Italy since 1996. They have
used the Resonance Frequency Analysis (RFA) technique for implant stability
measurements as an integrated part of
their implant protocol since the RFA technique was invented more than 20 years ago.
This is not too surprising, as Prof. Sennerby was
one of the developers of the RFA technique. In this interview, however, Dr Andersson (Fig. 1) took the time to present his experience with the RFA technique and described
how it is used in his clinic on a daily basis.
Dr Andersson, what type of RFA instrument are you
using today? And which are the advantages?
We are using the PenguinRFA system, which has many
advantages in comparison to the old system, not only
from an economical viewpoint—since it is much cheaper.
The Penguin has no wires, it is small, can be kept on the
surgical or restorative trays and used by the clinician without assistance. Another great thing is that the transducer
pegs are made of titanium and can be cleaned and reused. Since we are treating some 200 patients with 400
to 500 implants per year and all implants are measured at
least twice, a mono-use transducer peg is not an option
for us from an economical point of view. The MulTipeg as
used with the Penguin has a long lifespan because it can
resist at least 20 autoclavings. You can really tell that the
PenguinRFA system is made for clinicians by clinicians.
How is the technique used in your clinic?
For us, the use of RFA is part of the routine documentation of our implant cases and we find it more useful than
taking a radiograph of the implant site. Through the years
we have learned that the risk for implant failure increases
with low ISQ readings. As a general rule, all implants are
“You can really tell that the
PenguinRFA system is made
for clinicians by clinicians.”
measured after surgical placement and then again when
commencing the restorative phase, which used to be
after three months of healing.
We are now, however, using a different loading protocol
based on RFA measurements. We always make measurements in mesiodistal and buccolingual directions
and use the highest ISQ value. The readings are kept in
the patient charts. In addition, we keep a simple computerised register of all implant patients, which are given a
unique consecutive number. This is very handy, since we
publish follow-up studies as part of our quality assurance
work from time to time. In this way it is easy to find the
documentation for different patient groups and different
indications for implant treatment.
Fig. 1
Fig. 1: Dr Peter Andersson, Clinica Feltre, Feltre, Italy.
30
3 2018
If we get readings below an ISQ of 65 at implant surgery, we try to improve the stability by either replacing the
[31] =>
interview
implant with a wider and/or longer one or by making a
new osteotomy. A low reading is, however, often depending on soft bone density, which is difficult to manage.
Prof. Sennerby prefers a tapered implant design in this
bone situation and if the ISQ value is still low, the healing
period is extended to four to six months, instead of three
months. Moreover, if implants show low stability at the
time of impression taking, I prefer to prolong the healing
period until the ISQ value is above 70.
|
bility, the implants are allowed to heal with a healing abutment for six weeks (> 70 ISQ), eight weeks (65–70 ISQ) or
twelve weeks (> 65 ISQ) before the first prosthetic appointment. In this way we can save a lot of appointments and
time, which is good for both the patients and the practice.
What are indications for immediate and early loading?
In our clinic, immediate loading is mainly made in aesthetic cases, where the patient presents with a fractured or lost incisor, canine or premolar—provided that
What is your new loading protocol?
Our experience is that the majority of implants reach
high primary stability (> 70 ISQ) and could actually be
loaded immediately or at least early after placement
(Figs. 2 & 3). This means that the treatment time can be
reduced dramatically. However, in a busy practice immediate loading is a logistic nightmare, so we decided
to apply immediate/early loading only on specific indications and to allow the majority of implants to heal for six
to twelve weeks depending on the ISQ value.
“In this respect, the Penguin
is our best friend.”
we reach an ISQ value of at least 70. Otherwise we follow the protocol as described above. With the digital impression technique, we can give these patients a laboratory made temporary crown the same day, which is very
much appreciated.
In order to rationalise the restorative part of implant
treatment, all impressions are taken digitally in conjunction with surgery. This way the dental technicians have
sufficient time to plan and manufacture a framework or even
a readymade prosthesis. Depending on the primary sta-
In addition, we have developed an early loading protocol for partially edentulous patients where the best
treatment option is extraction of the remaining teeth and
simultaneous placement of four to five implants in the
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[32] =>
Fig. 2
Fig. 3a
Fig. 3b
Fig. 2: Surgical tray with PenguinRFA in a sterile pouch. Figs. 3a & b: Measurement after implant surgery shows an ISQ value of 75.
mandible and five to seven in the maxilla for a full provisional bridge. In these cases, the patients receive a provisional bridge after three days if the majority of implants
have shown an ISQ of 70 and above.
Dr Andersson, what are the results with your new
RFA-based protocol?
In a retrospective analysis the overall survival rate was
98.7 per cent after one to five years of loading. The majority of implants, 75 per cent, could be restored within
six weeks after implant surgery with excellent clinical
outcomes. The remaining 25 per cent of implants were
placed in soft bone or in bone augmentation procedures
and required a longer healing period or even a two-stage
procedure. With our protocol and the use of the Penguin instrument we can minimise the number of surgical
interventions and appointments without compromises
32
3 2018
regarding outcomes. In this respect, the Penguin is our
best friend.
More information can be obtained by visiting the
Integration Diagnostics Sweden booth (B44) at EAO
in Vienna in October.
contact
Integration Diagnostics Sweden AB
Nedergårdsgatan 5
416 54 Göteborg, Sweden
Phone: +46 733 842860
info@penguinRFA.com
www.penguinrfa.com
[33] =>
Targeting
Perfection
Dynamic navigation for freehanded
dental implant placement
Introducing Navident 2.0 with Trace and Place
See for yourself how freehanded guided surgery aids more accurate implant
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within 0.5mm of treatment plan*
*Average error of 0.4mm in internal bench tests with a range of operating conditions.
Easy to use, reducing time and expense
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Provides even greater value from your
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(QDEOHVPLQLPDOO\LQYDVLYHÁDSOHVV
drilling without a physical guide
“TaP is a leap forward to make
Dynamic Navigation the new Gold
Compatible
with any implant
type, drill system
and all CBCTs
currently on
the market
Standard in implantology”
Dr. Luigi Vito Stefanelli, DDS (pictured)
Rome, Italy
Try Navident’s precision guidance for yourself.
Call +32.475.75.52.26 or email info@claronav.com
Visit us at EAO 2018. We are located at S21
www.claronav.com
[34] =>
| interview
Bringing a turnkey restoration
solution to dentists
At the 2017 Greater New York Dental Meeting, 3DISC
launched its Heron IOS intraoral scanner to the world.
Three months later, in February 2018, the US-based
imaging company presented an improved device to attendees of the Chicago Dental Society Midwinter Meeting (Fig. 1). In an interview, Thomas Weldingh, 3DISC
Deputy Group CEO, took the time to present the key
benefits of the Heron IOS for dental professionals.
Mr Weldingh, what can you tell us about the new
scanner?
We seek to cater to the segment of solo and midsize
practices with an easy-to-use and affordable solution.
With the Heron IOS, we have aimed to solve three major challenges that we know of from the existing scanners on the market: dimensions, ergonomics and affordability. We have succeeded in bringing a scanner to the
market that is extremely easy to use, featuring a small,
lightweight hand- and mouthpiece with a rotatable tip for
providing the best possible ergonomic grip (Fig. 2).
The Heron intraoral scanner is one of the lightest
weight colour scanners in the market, weighing only
145 gramme, which is considerably below the average
weight of other colour scanners. The ability to use scanners comfortably is important for dentists and, with its
light weight, combined with the rotatable tip, the Heron
provides one of the best ergonomic solutions in the industry.
“With the Heron IOS, we have
aimed to solve three major
challenges: dimensions,
ergonomics and affordability.”
What are the key benefits of the 3DISC intraoral
digital impression solution?
Our digital scanning product is a uniquely simple hardware and software solution. The dentist simply connects
the Heron to his or her laptop or PC in the clinic, using
the accompanying practical base for desktop use. The
scanner comes with our QuantorClinic software, built on
Fig. 1: Thomas Weldingh presenting the Heron IOS intraoral scanner in Chicago. Photo: © Matthias Diessner, DTI
34
3 2018
[35] =>
interview
|
“The Heron intraoral scanner
is one of the lightest
weight colour
scanners
in the
market.”
Fig. 2: The lightweight hand- and mouthpiece with a rotatable tip provides the best possible ergonomic grip.
exocad’s software platform, which is one of the most
widely used CAD/CAM software platforms in the dental
industry. The Heron IOS was developed and produced at
our facilities in Virginia, USA.
What is planned in terms of clinical testing of the
product?
The Heron IOS has been tested by dentists in the USA
and Europe since spring 2018. We want to ensure that
the product works as intended in the clinical environment
while looking for improvements we can add to the workflow of the clinic and integration with dental laboratories.
Why did you decide to enter the intraoral scanner
market?
The market is dominated by a few larger manufacturers. We believe there is room for an alternative intraoral
system in the marketplace, a system that brings immediate value into the dental practice, making impression
taking simple, hassle-free and cost-effective. Device and
maintenance costs are among the challenges restraining
the adoption of current intraoral scanners, as well as demand for an open and license-free software architecture.
We believe in the need and opportunity to bring a product
to market that meets these challenges.
Why does 3DISC aim to cater for solo to midsize
practices, and what are the benefits such practices
can expect from your products?
Solo and midsize practices are the segment that is currently hesitant to incorporate digital dentistry. Among the
reasons are complexity in the existing solutions and high
prices and maintenance costs. We see a gap and a need
for a product in this segment with first and foremost a
noncomplex and simple price model, and a technology
that is easy to adopt and get started with, without compromising on the performance and quality of the final fit.
Dental practices can expect both high-quality intraoral
imaging and an affordable price point $25,990 without
any annual licensing fees for the Heron intraoral scanner.
For the solo or midsize practice wanting to enter into digital dentistry, we believe that 3DISC is bringing the best
solution to dentists with our Heron IOS.
When and where is the launch and when will the
product be available?
Product shipping will start in the third quarter of 2018
in the Americas, Europe, the Middle East, Africa, Korea,
Southeast Asia, Australia and New Zealand.
Mr. Weldingh, thank you very much.
contact
3DISC Europe ApS
Gydevang 39–41
3450 Alleroed, Denmark
Phone: +45 88 276650
sales@3disc.com
www.3disc.com
3 2018
35
[36] =>
| manufacturer news
Planmeca
Successful digital implant workflow
Planmeca’s software-driven solution for implant dentistry
provides a kind of freedom and flexibility that is hard to
match. Users can efficiently manage their entire implant
workflow with the Planmeca Romexis® software: from CBCT
imaging to intraoral scanning and from implant planning to guide
design. As it is a truly open software, it allows users to utilise
data from Planmeca or other equipment. There are no hidden or
extra fees for importing and exporting files.
Taking an implant plan to actual surgery is now easier than ever,
as the software’s new Planmeca Romexis® Implant Guide module lets users design their own surgical implant guides. This
elevates implant planning to another level, as virtual plans can
accurately be brought to reality. Creating implant guides with
the software requires few simple steps. Users can also flexibly
select their preferred workflow, as completed guide designs can
either be 3-D printed in-office or exported as STL files to a partner lab for 3-D printing.
Planmeca Oy
Asentajankatu 6
00880 Helsinki, Finland
www.planmeca.com
MEDENCY
State-of-the-art diode laser technology
The Italian company MEDENCY has been built upon profound
global expertise in the dental market and dental lasers in particular. “Our flagship product PRIMO combines state-of-the-art diode
laser technology with innovation and the experience of MEDENCY
in the dental industry. PRIMO provides a variety of applications
and is thus a viable alternative to conventional surgical methods
like electrocautery and the scalpel. Owing to its intuitive interface,
the device is easy to use,” stated
the company’s general manager,
Alessandro Boschi.
All products are designed, engineered and manufactured in
Italy—with passion and commitment. “Our overall mission
is to deliver a combination of
cutting-edge products, services and interaction with customers drawing on a wide network of academic partners,” said
Boschi.
The company supports its partners
with tailor-made educational
courses in different countries in
36
3 2018
order to gain practical experience in the use of the system in daily
practice. Using dental laser technology has never been so easy.
MEDENCY Srl
Piazza della Libertà 49
36077 Altavilla – Vicenza, Italy
www.medency.com
[37] =>
manufacturer news
|
curasan
Now online: “Frankfurt Implantology Days” CME lectures
At the end of April, the “Frankfurt Implantology Days” took place
under the scientific chairmanship of Prof. Dr Dr Frank Palm from
Constance, Germany, supported by curasan AG.
Interested parties now have the exclusive opportunity to experience three selected lectures of this international event online.
Participants will receive 1 CME credit if
CME lectures
they have watched the complete lecture
consisting of three particular presentations
and have answered the control questions
correctly afterwards.
Please also visit the social media pages
of curasan AG on Facebook, LinkedIn and
XING, where the technological leader in bone regeneration is
regularly publishing news. Here, the main focus is on scientific
publications about successful applications of curasan products,
information on international events, as well as specific case presentations. Moreover, the company has its own YouTube channel.
Fans and followers are welcome on all social media channels of
curasan AG.
curasan AG
Lindigstraße 4
63801 Kleinostheim, Germany
www.curasan.de
MIS
Newly enhanced implant system
This past June, at the EuroPerio9 congress in Amsterdam, Netherlands, MIS launched the enhanced SEVEN implant system. Several
key features have been added, that make the internal hex implant
even better. Its biological stability and predictable aesthetics combined with the extensive R&D process which has led to these new
improvements, have given the SEVEN a potential advantage in
soft-tissue preservation and growth, as well as an array of restorative benefits. The combination of its unique features may provide
the dentist with higher predictability, better aesthetic results and
bone preservation.
The implant incorporates the platform-switching design concept.
Implants with a platform-switched configuration have been shown
to exhibit less bone loss when compared to non-platform-switched
implants, which may lead to soft-tissue preservation and growth.
The SEVEN’s root-shaped geometry and unique thread design
enable excellent primary stability, allowing for a simpler and faster
implant placement. With a new, comprehensive
concept for enhanced aesthetics and better bone
preservation in mind, and in order to support the
advanced new implant features, an additional
line of concave abutments has also been added.
The concave emergence profile was designed
for a larger gingival volume, and
along with its gold shading,
offers a better aesthetic
result.
MIS Implants
Technologies GmbH
Simeonscarré 2
32423 Minden, Germany
www.mis-implants.com
3 2018
37
[38] =>
| manufacturer news
Zest Dental Solutions
Integration Diagnostics Sweden
Newly improved
attachment system
Customer-oriented
product design
The LOCATOR R-Tx removable attachment system is the fourth
generation of award-winning patient-removable attachment systems from Zest Dental Solutions. The
new abutment coating is 30 per cent
harder with over 25 per cent greater
wear resistance, and nearly 65 per
cent reduction in surface roughness.
The narrower coronal geometry of the
abutment and the dual engagement of
the retention inserts on the outside of the
abutment allow patients to easily align
and properly seat their overdenture, decreasing potential deformation of inserts,
which could lead to premature wear.
The system utilises the standard 0.050 in/
1.25 mm hex drive mechanism and treats up
to 30° of angle correction using a single set
of redesigned retention inserts with straightforward retention values: zero, low, medium,
high. In addition, all of the necessary components for each individual case are shipped in one convenient vial.
LOCATOR R-Tx is a better, simpler, stronger attachment system
and comes with a 100% Satisfaction Guarantee to prove it!
Integration Diagnostics Sweden is rapidly growing by adding distributors to its global network, closely cooperating
with most major implant companies and constantly adding more implant systems to its MulTipeg assortment.
PenguinRFA is now available in more than 60 countries
by 28 distributors, whereof 7 are industrial partners; thus
covering more than 70 implant systems with MulTipegs.
MulTipegs are made from durable, tissue-friendly titanium
and have sealed magnets, which makes it possible to autoclave them at least 20 times. They are also laser marked with
type numbers to avoid mix-ups or using the wrong MulTipeg. The
PenguinRFA concept is affordable, uncomplicated and with the reusable MulTipegs just what clinicians are asking for. The instrument is
handheld and very user friendly, which makes the learning curve very
short, fulfilling the customers’ demands. Strong business partners add
to the market success.
In addition, the RFA technique has become even more accurate by
creating an ISQ standard calibration system, which means minimised
variance between different MulTipegs. Due to the reference system,
physical misfit between components can be detected and eliminated.
In the future, Integration Diagnostics Sweden will continue to expand its distributor network globally and intensify the research
around implant diagnostics.
Zest Dental Solutions
2875 Loker Avenue East
92010 Carlsbad, CA, USA
www.zestdent.com
Integration Diagnostics Sweden AB
Nedergårdsgatan 5
416 54 Göteborg, Sweden
www.penguinrfa.com
Dentsply Sirona
International Congress on Ankylos: Focus on implant dentistry
More than 1,000 visitors from almost 50 countries
participated in the International Congress on
Ankylos in Berlin, Germany, which took
place on 29 and 30 June 2018. They
experienced how implant dentistry and
a dedicated dental community with
focus on the digital future can create optimal results for patients. The
congress programme featured lectures highlighting the importance of
trusting experience and emphasised
the topics excellence and the digital
future. Additionally, current news and
trends, as well as scientific documentation and clinical evidence were
at the focus of the congress.
38
3 2018
Furthermore, delegates at the congress got an exclusive look
at Acuris, the new conometric concept that uses friction
instead of a screw or cement to secure the crown
and cap to the abutment in the final prosthetic part of implant treatment. This new
solution saves time, improves predictability,
and ensures high-quality end results. Acuris
will include abutments with different angulations and will be available for all three implant systems of Dentsply Sirona Implants.
Dentsply Sirona –
The Dental Solutions Company™
Aminogatan 1
431 21 Mölndal, Sweden
www.dentsplysirona.com/implants
[39] =>
manufacturer news
|
Nouvag
Introducing motor management 2.0
Nouvag’s latest development in the field of implantology is the motor system MD 11 which is now available
in version 2.0. The company has newly implemented the function
of thread cutting and made the device handling even easier than
it already was. During its development, much attention has been
given to a quiet, low-vibration motor running, which is the feature
most likely perceived by patient and surgeon alike. The insertion
of the tubing set is done with very little effort due to the great
visibility of the mounting bracket and easy to reach notches in
the bracket.
To make the set of the MD 11 complete, Nouvag offers all required contra angles such as the 1: 1, 16: 1, 20: 1, 32: 1 and a 70: 1.
The 20: 1 contra angle, also available with LED spotlight, covers
the largest field of the implantologist’s tasks, owing to the sophisticated motor control of the MD 11, which provides sufficient
torque from the lowest possible speed of 15 rpm to the highest
speed of 1,700 rpm.
With the new 20: 1 mini E-type contra angle, in conjunction with
the new electronic motor having a shorter handpiece carrier, the
resting point lies between the surgeon’s thumb and index finger
allowing for better balance and force delivery to the drill.
Nouvag AG
St. Gallerstr. 23–25
9403 Goldach, Switzerland
www.nouvag.com
Straumann
PURE Ceramic Implant System
Nothing is more winning than a light-hearted and happy smile.
With the PURE Ceramic Implant System even very demanding patients can smile with confidence according to the principle “Discover natural PURE white. Love your smile.”
With this implant system, dentists can grant
their patients the best aesthetic, natural and
solid treatment. Patients will benefit from all
the highly aesthetic advantages of a natural
ceramic implant—ivory-coloured like a natural tooth root and even in cases of thin gingiva
biotypes not shining through. No compromises
on aesthetics, reliability or the most natural
choice of material are necessary. Further they
can rely on high-performance zirconia
ceramic material being even stronger
than the gold standard, grade 4 titanium implants.
The Straumann® PURE Ceramic Implant System is the result of
more than 12 years of relentless research and development until the ceramic implants complied with the company’s premium
quality standards. Swiss quality and precision, strength, clinical
success and flexible treatment protocols are combined in an
innovative solution that helps dentists meet the needs of their
patients. Find out more at: pure.straumann.com.
Institut Straumann AG
Peter Merian-Weg 12
4052 Basel, Switzerland
www.straumann.com
3 2018
39
[40] =>
| manufacturer news
Fotona
Making implantology
treatments more effective
Fotona’s LightWalker dental laser is an ideal tool for hard- and
soft-tissue treatments, including applications in implantology.
LightWalker’s Er:YAG and Nd:YAG wavelengths are highly effective for the removal of granulation tissue, the disinfection of the
surgical area after extraction, as well as for the preparation of the
implant bed to achieve longer stability. The beneficial uses of its
high-precision Er:YAG laser for bone ablation are further complimented by using its Nd:YAG laser for efficient deep disinfection
and bio-modulation.
Uncovering the implant during the second stage of implant placement is more patient friendly with Er:YAG laser treatments. Favourable formation of new bone has been observed on Er:YAG and
Nd:YAG laser-treated peri-implant areas. In laser-treated patients,
greater bone-to-implant integration was observed compared to
curette-treated patients.
In addition, with peri-implantitis treatments, laser light has been
shown to provide better access to all parts of the implant surface
when compared to manual curettes or ultrasonic tips.
Fotona d.o.o.
Stegne 7
1000 Ljubljana, Slovenia
www.fotona.com
ClaroNav
State-of-the-art navigation for every day
By using the CBCT image as a kind of map, ClaroNav’s Navident
guides clinicians much like a GPS guides drivers, offering them an
easy-to-use, accurate, highly portable and affordable method for
the planning of desired restorations and implant placements.
With Navident 2.0, the clinician will no longer be required to do
a special extra scan. Instead, he or she will be able to use the
diagnostic scan already available for the patient. The step of making a stent is not part of the workflow as it is no longer required,
saving clinicians valuable time. The usual working steps including
stent, scan, plan and place have thus changed to scan, trace and
place—known as Trace and Place which is a game-changing
development for dynamic navigation. With Trace and Place, the
Navident 2.0 workflow is efficient and user-friendly and can be
seamlessly integrated into daily clinical practice.
“Trace and Place is a real tipping point for dynamic navigation
guidance,” said user Dr George Mandelaris, a periodontist from
Chicago, USA. “It has streamlined and simplified the workflow
in both the diagnostic and surgical phases to allow
state-of-the-art technology to be an everyday
component of my surgical implant practice. I can’t
imagine going back!”
40
3 2018
Clinicians are encouraged
to make use of the opportunity
to learn from masters and interact with
peers at ClaroNav’s EAO booth (S21) in
Vienna, Austria.
ClaroNav Inc.
1140 Sheppard Avenue West, Unit 10
Toronto, Ontario, Canada
www.claronav.com
[41] =>
48TH DGZI INTERNATIONAL
ANNUAL CONGRESS
16
TS
/HO RS VE
U
28 & 29 SEPTEMBER 2018 | HILTON HOTEL DÜSSELDORF, GERMANY
28 & 29 SEPTEMBER 2018
HILTON HOTEL DÜSSELDORF, GERMANY
VISIONS IN IMPLANTOLOGY
© Manninx/Shutterstock.com
© Manninx/Shutterstock.com
CONGRESS PROGRAMME
INCL. SHORT ABSTRACTS
1ST FUTURE CONGRESS IN DENTAL IMPLANTOLOGY
www.dgzi-jahreskongress.de
VISIONS IN IMPLANTOLOGY
1ST FUTURE CONGRESS IN DENTAL IMPLANTOLOGY
Senior Premium Partner
Premium Partner
Premium Partner
Premium Partner
Programme for dentists and dental technicians
FRIDAY, 28 SEPTEMBER 2018
FUTURE PODIUM – Visions in Implantology
09:00 – 09:15
Opening ceremony
Dr Georg Bach/DE
09:15 – 09:45
Assoc. Prof. Dr Christian R. Gernhardt/DE
Tooth preservation and implantology— A future model —
Structural, professional and demographic challenges
MDT Ralph Riquier/DE
Digital competence 4.0— Future prognosis for digital patients:
How much know how does a complete digital dental techno logy require?
09:45 – 10:15
Prof. Dr Wolfgang Henseler/DE
Dentist 4.0 — How one should be thinking in the age of
digitalisation
10:15 – 10:45
TABLE CLINICS (TC) – Visions in Implantology
15:00 – 15:45
15:45 – 16:00
16:00 – 16:45
16:45 – 17:00
17:00 – 17:45
Session 1, TC table 1–24
Change of table
Session 2, TC table 1–24
Change of table
Session 3, TC table 1–24
Note: Please specify the numbers of
your chosen table clinics (total of
three) on the application form below.
Dr Arpad Alexander Toth/DE
TC
1
From clinician to clinician: Fully digital
prosthetic workflow with ultra-short implants
Dr Kai Zwanzig/DE
TC 2
Guided surgery in implantology —
The digital has to merge with the analog
Speaker and podium discussion
The future podium speakers and clinician Dr Kay Vietor
are discussing the importance of the presented
developments for the daily work of implantologically
working dentists with the scientific director/moderator.
Participants have the option to actively participate in
the discussion via the interactive chat feature.
TC 3
Dr Kay Vietor/DE
Intraoral scanning in implantology —
Temporary trend or new standard?
TC 4
Prof. Dr Marcel Wainwright/SE
The intra lift — A proven method
for the internal sinus lift
Coffee break/Dental exhibition
TC 5
Dipl.-Ing. Dipl.-Inf. Frank Hornung/DE
CranioPlan® 3-D procedure for determining
the occlusal plane. Milled interim restoration
TC 6
Dr Marc Hansen/DE
The external sinus lift —
Update and long-term results
TC 7
Axel Reimann/DE
Update on local anaesthesia —
Interesting facts for the dental practice
TC 8
Prof. Dr Georg-H. Nentwig/DE
Augmentation without membrane:
When is it a sensible alternative?
10:45 – 11:00
11:00 – 11:30
LIVE SURGERIES
11:30 – 12:30
T ransmission of live surgery 1
Dr Thomas Barth/DE, Dr Stefan Ulrici/DE
Christian Barth, DDS/DE
The iSy solution — One click, one scan, one shift.
With minimalisation to success
12:30 – 13:30
Transmission of live surgery 2
Dr Michael Back/DE
Dr Dr Dr Oliver Blume/DE
maxgraft® bonebuilder— Safe application
of patient individual bone blocks
TC 9
IA
BLE CPD
IA
Premium Partner
N
I
Premium Partner
/HO RS VE
U
Dr Sebastian Schmidt/DE,
Co-speaker DT Bernhard Zierer/DE
3-D bone milling with fully guided
simultaneous implantation
R
IF
I
Premium Partner
R
IF
CREDIT PO
Senior Premium Partner
16
TS
CREDIT PO
48TH DGZI INTERNATIONAL
ANNUAL CONGRESS
UP TO
N
BLE CPD
UP TO
[42] =>
Programme for dentists and dental technicians
FRIDAY, 28 SEPTEMBER 2018
SATURDAY, 29 SEPTEMBER 2018
TABLE CLINICS (TC) – Visions in Implantology
SCIENTIFIC PRESENTATIONS – Visions in Implantology
TC 10
Dr Bergen Pak/DE
3-D navigated implantology —
From implant to crown
08:45 – 09:00 Dr Georg Bach – Scientific director
Prof. Dr Herbert Deppe – DGZI president
Welcome and introduction of the speakers
and scientific programme
Priv.-Doz. Dr Friedhelm Heinemann/DE
TC 11
Implantological and implant-prosthetic
planning with reduced-diameter implants
PODIUM 1
Dirk-Rolf Gieselmann/DE
aMMP-8 chairside immuno diagnostics as
basis for the successful peri-implantitis
prevention
09:00 – 09:30
Elika Madani, DDS/DE
Univ.-Prof. Dr Dr Ralf Smeets/DE
GTR/GBR techniques — Where do we stand?
What is new? Where will this journey take us?
Dr Elisabeth Jacobi-Gresser/DE
TC 13
Co-speaker Prof. Dr Daniel Olmedo/AR
Successful, aesthetic, sustainable and more
biologically compatible implantation with
zirconium dioxide implants
09:30 – 10:00 Prof. Dr Dr Florian Draenert/DE
Bone management in dental implantology:
Biology and materials instead of biomaterials
TC 12
TC 14
Dr Umut Baysal/DE
Function and aesthetics in implant prosthetics
10:30 – 11:00 Prof. Dr Werner Götz/DE
Bioengineering in regenerative dentistry —
Where will the journey take us?
Dr Ralph Griesbach/DE
TC 15
Everything my patients desire: Aesthetics —
longevity — economic efficiency
TC 16
TC 17
Dr Manuel Bras da Silva/DE
Newest techniques in implantology:
GBR, GTR, plastic occlusion without periosteal slicing
and biological dentistry
Dr Theodor Thiele, M.Sc., M.Sc./DE
Sinus lift and bone regeneration at the sinus floor:
Comfortable and safe with sinus and GBR kits
Dr Stefan Helka/DE
TC
18
Augmentation in practical application — What does
actually work and what is really necessary?
TC 19
TC 20
TC 21
TC 22
10:00 – 10:30 Prof. Dr Thorsten M. Auschill/DE
Innovative concepts in the therapy of peri implant diseases
11:00 – 11:15
Speaker and podium discussion
11:15 – 12:00
Break/Dental exhibition
PODIUM 2
12:00 – 12:30 Prof. Dr Martin Lorenzoni/AT
Digital planning, diagnostics and navigation
in implant prosthetics
12:30 – 13:00
Prof. Dr Dr habil. Andree Piwowarczyk/DE
CAD/CAM in implantology — From the planning stage up
until the final restoration
Dr Ingmar Schau/DE
Larger number of cases and more success in
implantology
Achim Kettler/DE
Co-speaker Thomas Borrmann/DE
Getting to know the coDiagnostiX implant
planning software with an easy case example
13:00 – 13:30
rof. Dr Dr Ralf Smeets/DE
P
Implantology news — Increasingly thinner, shorter, whiter?
13:30 – 13:45
Speaker and podium discussion
13:45 – 14:40
Break/Dental exhibition
Dipl.-Volksw. Christian Wünsch/DE
Nitrous oxide sedation — The concept of
this well-known dental sedation method
Prof. Dr Mauro Marincola/IT
360-degree application options of SHORT implants
TC 23
Dr Endre Varga, DMD, DDS, PhD/HU
Navigated surgery is the future —
but it also has to fit
TC 24
Dr Jan Erik Janson/DE
New paths in navigated surgery
with BoneTrust® guide
18:00 – 21:00
PODIUM 3
14:40 – 15:00
Prof. Dr Daniel Olmedo/AR
Biological effects of titanium particles:
Factors to consider in implantology
Dr Elisabeth Jacobi-Gresser/DE
15:20 – 15:50
Prof. Dr Andrea Mombelli/CH
15:50 – 16:20
Prof. Dr Dr Knut A. Grötz/DE
Evidence of patient specific risk factors in implantology
Ceramic vs titanium: Where will the journey take us?
GET-TOGETHER AT THE CONGRESS/EXHIBITION AREA
Evening event at the Hilton Hotel Düsseldorf, Germany
Free for congress participants and exhibitors.
Price per accompanying person (incl. drinks and snack)
15:00 – 15:20
Extending the implant indication
(systemic diseases, risk patients et al.)
€ 35 excl. VAT
16:20 – 17:00
www.dgzi-jahreskongress.de
Speaker and final discussion
[43] =>
Programme for dental assistants
Organisational matters
FRIDAY & SATURDAY, 28 AND 29 SEPTEMBER 2018
Visions in Implantology
HYGIENE SEMINAR
Further education and qualification as Office Hygiene Commissioner
for the dental practice
Friday, 28/09/2018
12:00 – 19:00
Saturday, 29/09/2018 09:00 – 19:00
ORGANISER
DGZI e.V.
Paulusstraße 1 | 40237 Düsseldorf | Germany
Phone: +49 211 16970-77
Fax: +49 211 16970-66
sekretariat@dgzi-info.de
www.dgzi.de
QMC SEMINAR
Training as Quality Management Commissioner QMC
Friday, 28/09/2018
09:00 – 18:00
VENUE
Hilton Hotel Düsseldorf
Georg-Glock-Straße 20 | 40474 Düsseldorf | Germany
Phone: +49 211 4377-0
www.hiltonhotels.de
SCIENTIFIC PRESENTATIONS
Saturday, 29/09/2018
09:10 – 09:50
Prof. Dr Stefan Zimmer/DE
Electric or manual: What is the better cleaning method?
09:50 – 10:30
Prof. Dr Stefan Zimmer/DE
Tooth paste — Balm for the teeth
10:30 – 11:15
Break/Dental exhibition
11:15 – 12:00
Prof. Dr Mozhgan Bizhang/DE
Interdental space and tounge — What is still part of good
oral hygiene?
12:00 – 12:45
Prof. Dr Nicole B. Arweiler/DE
When normal oral hygiene is not enough — What do I
recommend for patients with increased risk of disease?
12:45 – 13:15
Priv.-Doz. Dr Gregor Petersilka/DE
Brushed properly and still periodontitis?
Why oral hygiene is often not enough?
13:15 – 14:30
15:15 – 16:00
Priv.-Doz. Dr Gregor Petersilka/DE
What are the benefits of oral irrigators and Co.?
Final discussion
CONCEPT | ORGANISATION | REGISTRATION
OEMUS MEDIA AG
Holbeinstraße 29 | 04229 Leipzig | Germany
Phone: +49 341 48474-308 | Fax: +49 341 48474-290
event@oemus-media.de | www.oemus.com
Registration form via Fax to
+49 341 48474-290
DENTAL ASSISTANTS
Hygiene seminar (Friday and Saturday)
Dentist
Dental Assistant
Team fee (Dentist + Dental Assistant)
Conference fee** for both days/per person
€ 275 excl. VAT
€ 224 excl. VAT
€ 448 excl. VAT
€ 118 excl. VAT
QMC seminar (Friday)
Conference fee** per person
€ 109 excl. VAT
€ 59 excl. VAT
Presentations (Saturday)
Dentist
Medical/Dental Assistant (with Proof)
Conference fee** per person
€ 185 excl. VAT
€ 109 excl. VAT
€ 59 excl. VAT
** Incl. coffee breaks, drinks and lunch. The conference fee has to be paid by every participant.
I would like to register the following persons bindingly for the 48th DGZI International Annual Congress/1st Future Congress in Dental Implantology
on 28 and 29 September 2018 in Düsseldorf, Germany (Please mark accordingly):
Online registration: www.dgzi-jahreskongress.de
yes
Friday
___ ___ ___
no
Saturday (of chosen table clinics))
Academic titel, last name, first name, profession
DGZI-member
Participation
or by mail to
Academic titel, last name, first name, profession
OEMUS MEDIA AG
Holbeinstraße 29
04229 Leipzig
Germany
€ 375*
€ 450*
€ 350*
€ 380*
€ 118 excl. VAT
Early bird discount for all reservations made before 30 June 2018: 5 % of the congress fee.
For daily tickets the congress fee and conference fee are reduced by half.
Break/Dental exhibition
48TH DGZI International
Annual Congress
TEAM FEES
Friday, 28 September and Saturday, 29 September 2018
Dentist + dental technician DGZI-member
Dentist + dental technician non-member
Dentist + Assistant DGZI-member
Dentist + Assistant non-member
Conference fee** per person
* The reservation is made on behalf of and on the account of DGZI e.V. incl. 7 % VAT
14:30 – 15:15
Prof. Dr Thorsten M. Auschill/DE
Systematic periodontal follow-up care
16:00 – 16:15
CONGRESS FEES
Friday, 28 September and Saturday, 29 September 2018
Dentist/dental technician DGZI-member
€ 275*
Dentist/dental technician non-member
€ 325*
Medical Assistant (with Proof) DGZI-member
€ 120*
Medical Assistant (with Proof) non-member
€ 135*
Students (with Proof)
only conference fee
Conference fee**
€ 118 excl. VAT
Hygiene seminar (Fr./Sa.)
QMB seminar (Sa.)
Presentations (Sa.)
Programme Dental Assistant
yes
Friday
___ ___ ___
no
Saturday (of chosen table clinics))
Hygiene seminar (Fr./Sa.)
QMB seminar (Sa.)
Presentations (Sa.)
DGZI-member
Programme Dental Assistant
Participation
Evening event on Friday, 28 September 2018 ____ (# of persons)
Stamp
I am hereby agreeing to the general terms and conditions of the 48th DGZI
International Annual Congress.
Date, Signature
implants 3/18
E-mail address (Please declare, you will receive the invoice and certificate via e-mail.)
[44] =>
| events
Photo: © EFP
Best of EuroPerio9
10,232 periodontists and other oral health professionals from all over the world travelled to Amsterdam,
Netherlands from 20 to 23 June to learn about the latest research on periodontal disease and implants at
EuroPerio9—one of the leading congresses in periodontology and implant dentistry.
EuroPerio9 participants came from 111 countries, with
the Netherlands, Germany and France bringing the largest
delegations from within Europe. Japan, Brazil and Mexico were the biggest groups from overseas. 25 per cent
of delegates were non-European.
The scientific programme included over 1,720 abstracts that were presented in research sessions, setting
another record for EuroPerio9. Additionally, 134 speakers made invited presentations in 42 lectures and special
sessions. The new formats including PerioTalks, nightmare sessions, live surgery, debates, treatment planning
interactive sessions, the perio contest and 3-D sessions
were very popular with delegates. 308 moderated abstract and poster presentations also took place.
Congress chair, Michèle Reners, said that she would
remember “the PedTalks, the Master Clinician Session
on ‘Saving teeth’ and the nightmare sessions” among the
memorable EuroPerio9 sessions. Søren Jepsen, chair of
the scientific programme highlighted the video “Cell-toCell Communication—Peri-implantitis and its Prevention”
as one of the sessions he enjoyed the most. He further
stated: “Also the session on live surgery was quite amazing: 4,500 people sitting together quietly and concentrating on what was going on is something I had never
experienced before. I think the session on the new classification of periodontal diseases is also a landmark event.”
Visit www.efp.org/europerio9/programme/scientific for
more details.
44
3 2018
The session about the new classification of periodontal and peri-implant diseases, a consensus from the recent World Workshop in Chicago, drew large crowds.
Significant differences with the previous 1999 classification were announced, such as the replacement of the
“chronic” and “aggressive” distinctions by a model with
stages and grades (see p. 48).
Intense social media interactions also played an important role at EuroPerio9. The social media team made
up of volunteers from various countries, reported on every single session at the congress. For the first time, a social media wall allowed attendants to see what was trending at the meeting through the #EuroPerio9 hashtag. The
newly launched EFP Instagram account now has over
1,100 followers and the EuroPerio9 playlist on the EFP
YouTube channel had over 10,400 views. Facebook engagement was up 200 per cent and Twitter impressions
were up 30 per cent. Regarding the EFP website, on
Wednesday a record peak of 13,000 individuals looked
at 54,000 pages. All three press conferences were livestreamed on Facebook.
Such record-breaking attention and attendance, as
well as the presentation of leading research in periodontal science confirmed EuroPerio as the place to be for
the latest news about periodontal health. EuroPerio10 will
take place from 2 to 5 June 2021 at the Bella Center in
Copenhagen, Denmark.
contact
European Federation of Periodontology
Antonio Lopez Aguado 4
28029 Madrid, Spain
www.efp.org
[45] =>
events
|
Nobel Biocare announces
new products and partnerships
A new ceramic implant, as well as an innovative device
for long-term implant care and maintenance were among
the highlights Nobel Biocare presented during a press
conference at EuroPerio9 in Amsterdam in June (Fig. 1).
There, the company also invited to its Global Symposium in 2019, which will take place from 27 to 29 June at
the Mandalay Bay hotel and convention centre in Las
Vegas, USA.
With the 100 per cent metal-free NobelPearl implant
system, dental professionals have everything they need
for a successful start in ceramic implantology (Fig. 2).
Developed as an alternative to titanium implants and for
an increasing number of patients who prefer metal-free
solutions for the look and feel of natural teeth, this new
two-piece ceramic implant was designed for excellent
soft-tissue attachment and low inflammatory response. Its
cement-free internal connection boasting a screw made of
carbon fibre reinforced PEEK supports a natural soft-tissue appearance and helps to avoid the risks often associated with excess cement during intraoral cementation.
NobelPearl is available for a broad range of indications,
from single to multiple unit, and follows established workflows for two-piece implants. It will also be integrated into
the digital workflow that includes treatment planning with
the NobelClinician Software and guided implant surgery
with NobelGuide pilot drilling. Additionally, clinicians will
be able to offer patients the NobelPearl Ceramic Base
CAD/CAM solution using DTX Studio design software
later this year.
In partnership with GalvoSurge Dental AG, a Swissbased manufacturer of dental devices, Nobel Biocare
further intends to bring to market an innovative cleaning
system for long-term implant maintenance on all major
implant brands. The GalvoSurge Dental Implant Cleaning System provides a unique protocol for decontamination of dental implants by removing the bacterial biofilm
attachment directly from the implant surface. The technology is based on an electrolytic process that activates
the production of hydrogen, which lifts off the bacterial
film. The ground-breaking process aims to be atraumatic
and pain free, only takes 2–3 minutes per implant and
maintains the implant surface integrity. Available in 2019,
the implant cleaning system will exclusively be distributed
worldwide by Nobel Biocare.
For more information about the new products and the
Global Symposium please visit www.nobelbiocare.com.
contact
Nobel Biocare Services AG
P.O. Box
8058 Zurich-Airport, Switzerland
www.nobelbiocare.com
Fig. 1: Vice President Global Research, Products & Marketing Stefan Holst, President Hans Geiselhöringer, and Vice President Multi-brand Strategy Sandro Matter
(from left). Fig. 2: The NobelPearl two-piece ceramic implant solution. Photos: © Nobel Biocare
Fig. 1
Fig. 2
3 2018
45
[46] =>
| events
© Muzhik/Shutterstock.com
Implantology & Modern Dentistry
Verona, Italy, May 2019
In close cooperation with the University of Verona, the
Giornate Veronesi—the Days of Verona—will be held from
3 to 4 May 2019. It will be the fourth time that OEMUS
MEDIA AG will hold a dental event with special Italian flair.
Locations of the congress are the University of Verona,
as well as the congress resort VILLA QUARANTA on the
outskirts of Verona. The scientific hosts of the congress
are Prof. Dr Pier Francesco Nocini/IT and Prof. Mauro
Marincola/IT.
The event series started back in 2013 with great success in cooperation with the Sapienza University of
Rome, Italy. Now the “Giornate Romane” will turn into
“Giornate Veronesi”—the event will be the same but the
location another. In 2019, the high-class event will thus be
hosted in Verona, Italy, in close cooperation with the University of Verona. The credo of the event will be to combine high-quality scientific lectures and Italian lifestyle. On
that occasion, the content of the programme has been
extended enormously. Beyond the main podium concerning dental implantology, OEMUS MEDIA AG now
also provides a programme for general dentistry as well
as a programme for dental assistants. An innovative concept regarding both the content and the organisation has
been applied to make this educational congress a oneof-a-kind experience for all participants.
The event will start on Friday morning with a scientific
session at the University of Verona. Bus shuttles will
46
3 2018
ensure the transfer for all participants. In the afternoon,
a live-surgery broadcasted at the congress hall of VILLA
QUARANTA and table clinics will round up the day. On
Saturday, more scientific lectures will be held at the
congress resort VILLA QUARANTA.
The Giornate Veronesi promise many opportunities for
direct discussions with all lecturers, colleagues and the
industry partners. The programme, the get-together on
Friday and the typical Italian dinner with wine and music
on Saturday will leave much space for conversation and
dental exchange.
All registrations completed before 31 October 2018 will
receive an early bird discount of 10 per cent of the conference fee.
contact
OEMUS MEDIA AG
Holbeinstraße 29
04229 Leipzig, Germany
Phone: +49 341 48474-308
event@oemus-media.de
www.giornate-veronesi.info
[47] =>
SUBSCRIBE NOW!
ONLINE
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ceramic implants—international magazine of ceramic
implant technology
Interdisciplinary, transparent & market orientated
www.oemus-shop.de
implants 3/18
stay updated:
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Guided regeneration
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case report
Immediate placement
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I would like to subscribe for the following journals:
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[48] =>
| news
© sdecoret/Shutterstock.com
Helping clinicians in determining
Dental implant complications
Implants are a preferable substitute to dentures as they are more
comfortable, stable and functional. They can, however, create
problems like peri-implantitis that can cause extensive bone loss.
A recent study, titled “Peri-implantitis: A Comprehensive Overview
of Systematic Reviews”, examined current scientific literature to
gain a better understanding of peri-implantitis and help clinicians
detect and treat the condition more quickly.
The research team from Temple University, USA, collected data
regarding risk factors and microorganisms associated with
peri-implantitis aiming at identifying the best diagnostics and
treatment options available. A higher occurrence of peri-implantitis was found among implant patients who were smokers and
who had periodontitis, uncontrolled diabetes and cardiovascular
disease. Additionally, it was found that implants serve as a surface where microorganisms can settle and grow. Several bacte-
rial species and viruses such as the Epstein-Barr virus were prevalent in patients with implants who had peri-implantitis. These
microorganisms can cause plaque formation and inflammation
characteristic of peri-implantitis. Thus, clinicians now have a
concise list of factors that predispose patients with implants to
peri-implantitis.
“It is important to realise that dental implants require the same
care and maintenance as natural teeth, especially in patients with
a high risk for peri-implantitis,” said author Miriam Ting. Up to date
no standard treatment for peri-implantitis exists. Future work is
required to standardise the definition of peri-implantitis, and larger
clinical experiments are needed to determine the most effective
treatment.
Source: Journal of Oral Implantology
New classification of periodontal and
Peri-implant diseases and conditions
A new global classification system for periodontal health, diseases
and conditions, as well as peri-implant diseases and conditions,
has been announced at the EuroPerio9 congress in June 2018.
© CarmenKarin/ Shutter sto
ck.com
The comprehensive classification was based upon the most contemporary evidence and includes a staging and grading system for
periodontitis, indicating severity and extent of disease, accounting
for lifetime disease experience and taking into account the patient’s overall health status.
48
3 2018
The new classification is the outcome of a joint workshop held by
the European Federation of Periodontology (EFP) and the American Academy of Periodontology (AAP) in Chicago, USA, in 2017.
The workshop included over 100 experts from Europe, America,
Australia and Asia who reviewed existing literature to create a
global consensus that enables care to be standardised for patients
around the world. In the new classification, clinical health is defined for the first time and periodontitis is described in four stages,
ranging from “least severe” (Stage 1) to “most severe” (Stage 4).
The risk and rate of disease progression has been categorised into
three grades. The grading considers risk factors like smoking and
the presence of concomitant diseases, such as diabetes.
“The new classification should provide a globally consistent approach
to diagnosis and management and ultimately improve outcomes for
our patients,” said Prof Iain Chapple, EFP Secretary General.
Source: EFP
[49] =>
news
Acupuncture could reduce
k.c
to
c
rs
t te
Fear of the dentist has multiple reasons and effects, there
is, however, limited research on the impact and possible
treatment methods for dental anxiety. To look deeper into the
topic, researchers from the University of York, UK, have recently
reviewed a number of studies on treating dental anxiety with acupuncture. For the systematic review and meta-analysis, six trials with
a total of 800 patients were chosen. The researchers used a points
scale to measure anxiety, wich was shown to be reduced by eight
points when dental patients were given acupuncture as a treatment.
According to the researchers, this level of reduction is indicating that
acupuncture could be a possibility for treating dental anxiety.
Co-author of the study, titled “Acupuncture for anxiety in dental
patients”, Dr Hugh MacPherson, Professor of Acupuncture Research
at the University of York’s Department of Health Sciences, expressed
om
Dental anxiety
©
ya
le s
sk
r ip
/
ak
Sh
u
that the scientific interest in the effectiveness of acupuncture both as
standalone and as accompanying treatment was increasing.
“If acupuncture is to be integrated into dental practices, […], then
there needs to be more high-quality research that demonstrates
that it can have a lasting impact on the patient. Early indications
look positive, but there is still more work to be done,” summarised
MacPherson.
Source: DTI
Oral Reconstruction Foundation is
Welcoming new chairman and new board members
The Oral Reconstruction Foundation first announced its new chairman at the Oral Reconstruction Global Symposium 2018 in Rotterdam, the Netherlands. The foundation welcomed Prof. Dr Dr Dr Robert Sader, Director and Chair of Oral, Cranio-Maxillofacial and Facial
Plastic Surgery at Goethe-University Frankfurt, Dean for clinical
student affairs and Medical Director of the University Dental Institute
Carolinum as its new chairman. Additionally, Oscar Battegay, Partner
at Battegay Dürr AG attorney-at-law and civil law Notary Public in
Basel, Switzerland, also joined the board of directors. Prof. Dr Irena
Sailer, Head Division of Fixed Prosthodontics and Biomaterials at the
University of Geneva completes the scientific board.
The new board will discuss progressive ideas in regards to the
creation and dissemination of knowledge by funding research proj-
ects and advanced education, as well as sponsoring young scientific talents and will remain faithful to its commitment to “Teaming
up science and education to serve the patient”.
Prof. Sader and Prof. Sailer will support the foundation with ideas
in regards to education and scientific aspects, whereas Oscar Battegay supplies his knowledge as specialist in national and international corporate law in addition to legal and strategic support. All
new board members are selected for a four-year term. The new
members will join the existing board of Prof. Dr F. Guerra (PT), Prof.
Dr T. Taylor (US), Dr A. Schär (CH), Prof. Dr M. Sanz (ES) and Prof.
Dr W. Wagner (DE; Fig. 1).
Source: Oral Reconstruction Foundation
Fig. 1: F. Guerra (PT), O. Battegay (CH), Chairman R. Sader (DE), I. Sailer (CH), T. Taylor (US), A. Schär (CH), M. Sanz (ES),
missing in the picture: W. Wagner (DE).
|
[50] =>
| about the publisher
Congresses, courses
and symposia
implants
Imprint
48th DGZI International
Annual Congress—
Visions in Implantology
28–29 September 2018
Venue: Düsseldorf, Germany
www.dgzi-jahreskongress.de
Publisher
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oemus@oemus-media.de
Designer
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CEO
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Members of the Board
Jürgen Isbaner
isbaner@oemus-media.de
Lutz V. Hiller
hiller@oemus-media.de
EAO Congress 2018
11–13 October 2018
Venue: Vienna, Austria
www.eao.org
AO Annual Meeting
13–16 March 2019
Venue: Washington DC, USA
www.osseo.org/annual-meetings/
Chief Editorial Manager
Dr Torsten Hartmann
(V. i. S. d. P.)
hartmann@dentalnet.de
Editorial Council
Dr Rolf Vollmer
info.vollmer@t-online.de
12–16 March 2019
Venue: Cologne, Germany
www.ids-cologne.de
Giornate Veronesi
3–4 May 2019
Venue: Verona, Italy
www.gironate-veronesi.info
50
3 2018
Published by
OEMUS MEDIA AG
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implants
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SMBoutros@aol.com
with the German Association of Dental
Implantology (DGZI).
Editorial Office
Georg Isbaner
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DGZI
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international magazine of oral
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www.dgzi.de
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www.implants.de
Art Director
Alexander Jahn
a.jahn@oemus-media.de
Copyright Regulations
implants international magazine of oral implantology is published by OEMUS MEDIA AG
and will appear with one issue every quarter in 2018. The magazine and all articles and illustrations therein are protected by copyright. Any utilisation without the prior consent of editor and
publisher is inadmissible and liable to prosecution. This applies in particular to duplicate copies,
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Reproductions, including extracts, may only be made with the permission of the publisher. Given
no statement to the contrary, any submissions to the editorial department are understood to be in
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the right to check all submitted articles for formal errors and factual authority, and to make
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from inaccurate or faulty representation are excluded. General terms and conditions apply, legal
venue is Leipzig, Germany.
[51] =>
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[52] =>
The very foundation of esthetics. Scientifically designed from the ground
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clinical scrutiny, proven performance and hard science. That’s the underlying
beauty of NobelActive. » NobelBiocare.com
GMT 57008 © Nobel Biocare Services AG, 2018. All rights reserved. Nobel Biocare, the Nobel Biocare logotype and all other trademarks are, if nothing else is stated or is evident from the context in a certain case, trademarks of Nobel Biocare. Please refer to nobelbiocare.com/trademarks for more information. Product images are not necessarily to
UECNG&KUENCKOGT 5QOGRTQFWEVUOC[PQVDGTGIWNCVQT[ENGCTGFTGNGCUGFHQTUCNGKPCNNOCTMGVU2NGCUGEQPVCEVVJGNQECN0QDGN$KQECTGUCNGUQHƂEGHQTEWTTGPVRTQFWEVCUUQTVOGPVCPFCXCKNCDKNKV[(QTRTGUETKRVKQPWUGQPN[%CWVKQP (GFGTCN 7PKVGF5VCVGU NCYTGUVTKEVUVJKUFGXKEGVQUCNGD[QTQPVJGQTFGTQHCNKEGPUGFFGPVKUV5GG+PUVTWEVKQPUHQT7UGHQT
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NobelActive®
)
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Editorial
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Content
04 - 04
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Minimally invasive implant dentistry with short or narrow implants
06 - 13
view
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Periapical implant lesion and retrograde peri-implantitis
14 - 20
view
-
Implant retreatment
21 - 29
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-
Measuring implant stability
30 - 32
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-
Bringing a turnkey restoration solution to dentists
34 - 35
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Manufacturer News
36 - 40
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Events
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News
48 - 49
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Imprint
50 - 50
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/ Manufacturer News
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