implants international No. 3, 2022
Cover
/ Editorial
/ Content
/ Clinical relevance of the use of implant-supported provisional restorations to contour the emergence profile
/ All-on-four treatment in an atrophic mandible using dynamic guided surgery
/ Cystic lesion management with enucleation and reconstruction followed by delayed implant placement for maxillary premolars
/ Is autologous bone irreplaceable? - Bilateral vertical bone augmentation using allogeneic and autologous bone plates in the mandible
/ Immediately loaded full-arch restoration on four implants in the maxilla
/ “At Neoss, we have the luxury of being able to be more forward-oriented”
/ Interview: Quality products at accessible prices
/ Industry
/ Manufacturer News
/ Events
/ Imprint
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[1] =>
issn 1868-3207 • Vol. 23 • Issue 3/2022
implants
international magazine of oral implantology
research
Clinical relevance of the use of
implant-supported provisional restorations
to contour the emergence profile
case report
All-on-four treatment in an atrophic
mandible using dynamic guided surgery
interview
Quality products at accessible prices
3/22
[2] =>
The Thommen Dental Implant System
MULTIGUARD
Protection Solution
INTEGUARD®
Matrix
EVERGUARD®
Connection
TISSUEGUARD®
Collar
Driven by science, not trends.
[3] =>
editorial
|
Dr Rolf Vollmer
First Vice President and Treasurer of DGZI
Dear colleagues and friends,
After a break due to the COVID-19 pandemic, the annual meeting of the Arbeitsgemeinschaft Dentale
Tech nologie (dental technology working group; ADT)
could take place again, and so I and the German Association of Dental Implantology (DGZI) team could participate in this year’s event in Nürtingen in Germany.
Participants were again able to engage face to face, but
online participation was also made possible by the organiser.
of the S3 guideline of the Deutsche Gesellschaft für
Prothetische Zahnmedizin und Biomaterialien (German
society for prosthetic dentistry and biomaterials) on allceramics, their indications and Regulation (EU) 2017/745
of the European Parliament and of the Council of 5 April
2017 on medical devices. The latter has created a large
burden for laboratories in everyday implementation and
has meant that many materials have had to be taken off
the market for reasons of recertification.
The event focused on the ever-increasing importance of
digital technology—for dentists and dental technicians
alike. One of the most decisive developments in this context is probably digital impression taking. Most of us can
say from personal experience that it simplifies processes,
and patients would like to avoid analogue impressions.
However, despite all the possibilities of digital technology
and the efforts by many congress participants to establish these, current developments cannot (yet) completely
replace our analogue work. After all, analogue knowledge
is of great importance, especially for the further development of technology. It was refreshing to see how, despite
these limitations and bureaucratic burdens, dental technicians continue to pursue innovations for the benefit of our
patients. We can certainly look forward with anticipation
to what digitalisation and further development in the technical field may bring us in the future.
Something new for most of the participants was probably
the job description of the denturist, a trained dental technician who is allowed to carry out prosthetic treatments
independently in Switzerland, for example. Whether it will
be possible for denturists to produce and fit complete
dentures in Germany in the future met with a divided
response and great contention. There are no legal requirements for such a development at present.
More information about the ADT conference can be found
in the editorial section of this issue.
Personally, I hope you have had a wonderful and relaxing
summer holiday and are looking forward to the DGZI’s
annual congress in Berlin on the first weekend in October.
Yours,
In addition to the digital production of crowns and dentures, the focus was on the materials used for their
production. One of the numerous surveys on the experiences of the congress participants made it clear that the
majority of the participants — more than 80 per cent —
now manufacture crowns and dentures metalfree from
zirconia. This topic was also addressed in the discussion
Dr Rolf Vollmer
First Vice President and Treasurer of DGZI
3 2022
03
[4] =>
| content
editorial
Dr Rolf Vollmer
03
research
page 16
Clinical relevance of the use of implant-supported
provisional restorations to contour the emergence profile
06
Dr Marina Siegenthaler
case report
All-on-four treatment in an atrophic mandible using
dynamic guided surgery
12
Dr Jacques Vermeulen
Cystic lesion management with enucleation and reconstruction followed
by delayed implant placement for maxillary premolars
16
Is autologous bone irreplaceable?
24
Dr Ali Tunkiwala & Darshan Parulkar
page 24
Dr Jochen Tunkel
Immediately loaded full-arch restoration on four implants in the maxilla
32
Dr Marco Toia
interview
“At Neoss, we have the luxury of being able to be more forward-oriented” 34
An interview with Dr Robert Gottlander
Quality products at accessible prices
page 46
38
An interview with Salih Sanli
industry
Driven by science, not trends
40
Janine Conzato
manufacturer news
41
events
Younger and more dynamic and exciting than ever before
46
Janine Conzato
Fifty years of experience—strategies for the future
Cover image courtesy of
NucleOSS / www.nucleoss.com
issn 1868-3207 • Vol. 23 • Issue 3/2022
implants
3/22
international magazine of oral implantology
research
Clinical relevance of the use of
implant-supported provisional restorations
to contour the emergence profile
case report
All-on-four treatment in an atrophic
mandible using dynamic guided surgery
interview
Quality products at accessible prices
04
3 2022
48
Dr Rolf Vollmer
about the publisher
imprint
50
[5] =>
TRULY CONICAL PRECISION
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at bone level
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M-1441-ADV-EN-GLO-BHCL-00-052022
easy positioning with excellent tactile feedback
integrated platform switching supporting the
preservation of crestal bone
[1] Semper-Hogg, W, Kraft, S, Stiller, S et al. Analytical and experimental
position stability of the abutment in different dental implant systems with
a conical implant–abutment connection Clin Oral Invest (2013) 17: 1017
[2] Semper Hogg W, Zulauf K, Mehrhof J, Nelson K. The influence of torque
tightening on the position stability of the abutment in conical implant-abutment connections. Int J Prosthodont 2015;28:538-41
www.biohorizonscamlog.com
Oral Reconstruction
International Symposium
13 – 15 October
2022, Munich
[6] =>
| research
Clinical relevance of the use
of implant-supported
provisional restorations to
contour the emergence profile
Dr Marina Siegenthaler
Literature
Dr Marina Siegenthaler, Switzerland
CONVEX CONCAVE
1
What shape emergence profile of single implant
crowns is ideal? Does the use of an implant-supported
provisional restoration affect the clinical outcome and
does its use justify the increase in cost and time?
Introduction
A successful implant therapy is characterised by the
maintenance of healthy and stable peri-implant tissues
over time. Unless anterior implants are loaded immediately, the time between implant placement and insertion of the definitive restoration demands a provisional
restoration in order to increase patient comfort and
Taking of the
implant impression
2
06
3 2022
Delivery of a
concave-shaped
provisional restoration
aesthetics. During this period, changes in the periimplant tissues occur1 which often result in a reduction
of papilla height, an apical displacement of the mucosal
margin and a decrease in thickness of the buccal tissue.2 Subsequent remodelling processes, however, will
then lead to an improvement and stabilisation of the
peri-implant soft-tissue complex after one year. To minimise these changes and to shape the peri-implant tissue, the use of implant-supported provisional restorations has been suggested.3 Surprisingly and despite
the widespread use of implant-supported provisional
restorations in clinical practice, their potential additional
value in terms of aesthetic and clinical outcomes has
only recently been investigated.4
Implant-supported provisional restorations
Implant-supported provisional restorations are commonly used when two-piece implants are placed in the
aesthetic zone, enabling individualisation of the transmucosal, peri-implant mucosa—the emergence profile—in order to better mimic the natural soft tissues and
obtain a stable long-term result. These types of provisional restorations have an obvious benefit in function
and aesthetics; nevertheless, they do increase the treatment cost and time. Other provisional restorations, such
Shaping of the
emergence profile with
flowable composite
Taking of the
final implant
impression
Delivery of
the definitive
restoration
[7] =>
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[8] =>
| research
3a
3c
3e
3g
3i
3b
3d
3f
3h
3j
as splints, can be used as cheaper alternatives to using
implant-supported provisional restorations, but these do
not allow the shaping of the emergence profile. Typically,
the shape of the emergence profile of implant-supported
provisional restorations is either convex or concave
(Fig. 1). However, and despite their wide use in daily
practice, the shape that is most beneficial for the stability of the peri-implant mucosa around screw-retained
restorations remained unclear. Furthermore, whether
the additional investment in time and cost has a clinical
impact was uncertain. A recent randomised clinical trial,
however, addressed these questions and revealed that
provisional restorations had a limited benefit in aesthetic
and clinical outcomes.4
Conditioning of the emergence profile
There are different methods available to condition the
emergence profile, differing in terms of the number of
steps and the resulting shape. The most commonly described shape is a concave shape, allowing space for
the buccal soft tissue. Conversely, a convex contour of
the emergence profile has been recommended when an
implant is placed in a too oral position.5, 6 In order to
avoid creating a niche for bacteria and to enable proper
oral hygiene measures, a concave contour between the
(too oral) implant shoulder and the crown margin is not
recommended.
CONCAVE
CONCAVE
CONVEX
CONVEX
64.3%
64.3%
Frequency of
Frequency
of
Recessions
Recessions
4
08
3 2022
The most commonly used method in clinical practice for
shaping the emergence profi le is described here. After taking an implant impression, an initially under-contoured, implant- supported provisional restoration is
fabricated. The buccal, cervical contour of the provisional restoration already representing the level of the
prospective crown margin—usually mimicking the antagonist. This buccal initially sharp contour is filled
(usually with a flowable composite) to a concave shape,
resulting in slight mucosal pressure that produces local
ischemia, which should subside within a few minutes.
Selective pressure is added on the mesial and distal aspects to allow for papilla formation. Care should be
taken not to apply too much pressure, as this can result in retraction of the tissue, causing recession and,
in the worst case, tissue necrosis. The soft tissue is left
to adapt, and the process is repeated after approximately one week, shaping the emergence profile further
until satisfaction. Typically, two to three appointments
are needed. A final implant impression (including the
shaped emergence profile) is taken and the definitive
restoration delivered according to the previously shaped
tissues (Figs. 2–3j). Alternatively, for example in the premolar region, a healing abutment can be individualised
in the same manner, avoiding the need for an implantsupported provisional restoration and decreasing costs.
The before-mentioned, recent three-arm randomised controlled clinical trial compared the two different emer-
14.3%
14.3%
Frequency of
Frequency
of
Recessions
Recessions
[9] =>
[10] =>
that the shape of the emergence profile should be
taken into consideration when fabricating implant provisional restorations. It should be emphasised that the
use of provisional restorations involved additional costs
of CHF880 and the patients required 2.5 more appointments comp ared with those who had not received
provisional restorations.
100
OR = 13.3
80
(p = 0.03)
60
OR = 3.3
Clinical implications and summary
(p = 0.33)
40
From a clinical point of view and given the present findings, the use of implant-supported provisional restorations might be questioned. It appears that the additional
investment in time and money does not equate to a substantial improvement in aesthetic or c
linical outcomes.
Nevertheless, when an implant-supported provisional
restoration (and crown) is used, a concave emergence
profile shows a greater stability of the mucosal margin,
whereas a convex emergence profile seems to be associated with a higher risk of developing recessions.
20
O
O
C
C
N
L
O
VE
N
O
C
N
TR
C
AV
E
0
X
Frequency of recession (%)
| research
12 months
5
gence profile shapes (convex and concave) to the situation when no provisional restoration was used (control). The study revealed that, at 12 months of follow-up,
64.3% of convex-shaped restorations showed mucosal
recession, whereas concave-shaped restorations showed
only 14.3% (Fig. 4). In the group of patients who did not
receive provisional restorations, mucosal recession occurred in 31.4% at the 12-month follow-up. In addition,
the odds of showing a mucosal recession at 12 months
was 13.3 times higher for convex-shaped restorations
(Fig. 5). A ssuming that mucosal recession can have
substantial effects on aesthetic outcomes, it appears
Posterior zone
(6—8)
Implant-
supported
provisional
restoration?
The use of implant-supported crowns, including provisional restorations, with a concave emergence profile
might be recommended, as they may reduce the risk of
recession. This, however, involves higher costs and
treatment time compared to not using a provisional restoration and will not necessarily improve the aesthetic
outcomes. The current results are based, however, on
12-month data and require further follow-up to confirm
the results.
The following is recommended for clinical practice
(Fig. 6):
– Provisional restorations are indicated for patients with
high smile line or high aesthetic expectations.
– Provisional restorations are not indicated for premolars.
– Patient-specific considerations in this regard apply for
restoration of canines and incisors.
High smile line
High patient expectations/demands
No
1—3
Anterior zone
4—5
6
10
Low to mid smile line
3 2022
No
No
Yes
[11] =>
research
about the author
|
Figure captions
Dr Marina Siegenthaler completed her
studies in dentistry in 2016 at the University
of Bern in Switzerland and received her
DMD in 2018. After working in a private
practice for three years, she is now at the
end of the three-year specialisation training
in reconstructive dentistry and oral im
plantology at the Clinic of Reconstructive
Dentistry at the Centre of Dental Medicine
of the University of Zurich in Switzerland, after which she will be
granted the title of “specialist in reconstructive dentistry” and the MAS
in oral implantology from the University of Zurich. Her clinical focus is
the treatment of complex and aesthetic cases using all aspects of reconstructive and implant dentistry. Her scientific interests lie in the
fields of prosthodontics, implantology and regenerative procedures.
Fig. 1: The shapes of different emergence profiles of implant-
supported provisional restorations.
Fig. 2: The most used method in clinical practice for shaping
the emergence profile.
Figs. 3a–j: The shaping of the emergence profile and sub
sequent impression taking and delivery of the definitive restoration.
Fig. 4: Occurrence of mucosal recessions around convexversus concave-shaped restorations after 12 months.4
Fig. 5: Odds ratio of mucosal recessions for convex-shaped
restorations, concave-shaped restorations and no provisional
restorations (control) after 12 months.4 OR = odds ratio.
Fig. 6: Decision tree for the use of a provisional restoration.
contact
Dr Marina Siegenthaler
Clinic of Reconstructive Dentistry
Center of Dental Medicine · University of Zurich
Plattenstrasse 11 · 8032 Zürich · Switzerland
+41 44 6340404
marina.siegenthaler@zzm.uzh.ch
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[12] =>
| case report
All-on-four treatment in an
atrophic mandible using dynamic
guided surgery
Dr Jacques Vermeulen, France
The all-on-four technique for dental implant treatment
is universally recognised for its efficacy, yet its applicability for atrophic mandibles remains problematic for
many implant surgeons. Implant placement in such clinical situations requires high precision to avoid anatomical
structures such as the mental foramina and to ensure
that the bone volume around the implants is sufficient
for osseointegration.
a later stage. At the initial examination, two implants
had already been lost, just several months after placement of the stabilised prosthesis. A third implant had to
be removed during this same session, as it caused the
patient pain. Only one of the implants could be saved
(Fig. 1).
Case description
Management of an atrophic mandible and an implantsupported prosthesis is an additional constraint for accurate implant positioning. Dynamic guided surgery is
the only means to meet this challenge, as it permits the
predictable result required for rapid loading of a transitional metal–resin prosthesis within 48 hours.
The 70-year-old female patient described in this report
had undergone chemotherapy and radiotherapy in 2014
for breast cancer. She also suffered from pulmonary
problems related to smoking. At the time of consultation, she was considered to be in remission and was in
good general health. After a visit to her primary physician and undergoing blood work, she was cleared for
implant surgery. She had previously had a poor experience with a prosthesis stabilised on four implants and
reported that she was depressed because of her oral
infirmity, which prevented her from eating normally. She
desired fixed mandibular and maxillary restorations;
thus, more appropriate fixed, screw-retained prostheses
were proposed. We suggested starting the treatment in
the mandible and fabricating a removable maxillary
denture compatible with the new occlusal conditions. An
all-on-four maxillary procedure would be performed at
1a
1b
Figs. 1a–c: Pre-op CBCT scan for diagnostic purposes.
12
3 2022
Surgical preparations
Vitamin D supplements were prescribed prior to implant
surgery and the patient was asked to refrain from smoking, starting three weeks before surgery. Preoperative
medication consisted of 100 mg hydroxyzine hydrochloride (Atarax) and 50 mg Loprazolam (Havlane) several
hours before surgery, and nitrous oxide was administered on-site as required. These preoperative drugs are
given so that the patient is as calm and relaxed as possible during the surgery.
The various steps described in this section all take place
during the same session.
1c
[13] =>
case report
|
3a
2
3b
Fig. 2: Bone screw inserted as an intra-oral landmark for registration. Figs. 3a & b: Fixation of the Navident Jaw Tracker B in the patient’s mouth.
Preparation of intra-oral
landmarks for registration
For completely edentulous cases, bone screws provide
an easy-to-use solution for registration landmarks—
landmarks that are apparent both in the patient’s mouth
and in the CBCT scan and serve as reference points for
the purpose of surgical navigation. In dentate cases,
registration is normally performed using the existing
teeth in the arch. We use three to six teeth which meet
all the required criteria as landmarks. We then use an
optically trackable tracer, with a spherical tip, to perform a short trace over the jaw surface, starting at each
landmark location. When these teeth are not available,
bone screws can be used instead. In this case, one remaining implant was used as a reference for matching
purposes, along with two 7.0 × 1.8 mm bone screws.
These bone screws were placed occlusally at gingival
level (Fig. 2).
Preparation of a well-fitting
definitive denture or intermediate replica
The purpose of this step is to create a digital replica of
the denture (STL file), accurately placed on the patient’s
jaw (DICOM file), to allow for the top-down planning of
the supporting implants in Navident (ClaroNav), making
use of the prosthesis and the available underlying alveolar bone. This is done by introducing physical, radiopaque landmarks on to the denture which can be clearly
seen in both the surface scan and the CBCT scan and
hence used to match the two together. We make use
of 1 mm Suremark stickers to add radiopaque markers
to the denture. These peel-and-stick, artefact-free radiopaque markers are very effective and simple to use. They
are affixed to the denture with a special adhesive and
are easily removed after scan completion. Alternatively,
gutta-percha or glass-ceramic markers, which are highly
radiopaque, but do not generate scatter artefacts, could
have been used.
CBCT and surface scan
After placement of the bone screws in the patient’s jaw,
a CBCT scan of the patient wearing the marked denture
is taken. It is important to ensure that the denture is accurately seated on the patient’s jaw and that the patient
is stabilised in the CBCT scanner and seated and that
his or her head is stabilised using a chin rest. In this
case, a bite stick is less optimal, as it may cause slight
dislocation of the denture. The denture should be evaluated to confirm complete seating and ideal positioning.
If incomplete seating occurs, a radiolucent airspace will
be seen in the CBCT scan.
3 2022
13
[14] =>
| case report
4a
4b
4c
Figs. 4a–c: CBCT scan post-op.
The surface scan of the denture is performed when it is
outside of the patient’s mouth. The scan is taken using
an intra-oral scanner. The CBCT and surface scans were
taken in the same session to ensure that the Suremark
stickers remained in the same place. After taking both
scans, the stickers were removed.
with the patient’s jaw is performed by pair-point registration using the bone screws placed in the patient’s jaw
prior to taking the CBCT scan. With pair-point registration, the software will automatically detect the screws
when they are being located by the tracer in the patient’s
mouth. This ensures accurate guidance (Fig. 3). Prior to
surgery, an accuracy check was performed. In this case,
it was done by touching the gingiva or preferably bone
crest. The bone screws were removed after implant
placement (Fig. 4). After the implant placement, several
sutures were placed using #4/0 PTFE thread.
Planning the supporting implants
The CBCT scan is imported into Navident, followed by
importing of the surface scan. The Navident software will
allow for the accurate matching of the denture’s surface
scan with the CBCT scan, based on the reference landmarks in the DICOM file. The supporting implants were
planned based on the denture’s surface scan and the
underlying bone, both demonstrated a good match on
the screen.
The entire procedure, from the moment the patient entered the office to when she left, took only 2.5 hours.
She underwent a photo-biomodulation session before
she left the office, as this analgesic, anti-inflammatory
and cicatrisation technique helps prevent postoperative
inflammation and swelling.
Surgical appointment
Prosthetic considerations
The Navident Jaw Tracker B is secured in position with
bone screws. In maxillary cases, the head tracker may
be used instead. Registration of the patient’s CBCT scan
5
6
Figs. 5 & 6: Prosthetic and functional result.
14
After treatment, transfers are placed on the four multiunit abutments and are joined together with a resin such
3 2022
[15] =>
AD
as LuxaBite (DMG). Thin metal rods are utilised to reinforce the impression. An alginate is used for an impression of the soft tissue. Although an optical impression is
also possible, fabrication of a 3D-printed master model
takes much longer than use of plaster, and we prefer
this last, more traditional technique. The occlusal bite is
taken using the wedge prepared previously. The prosthesis was put in place 48 hours later, the passive fit
was checked radiographically and any required occlusal
adjustments were made (Figs. 5 & 6).
case report
|
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international magazine of oral implantology
Follow-up
The patient was seen again after ten days to remove the
sutures, after 30 days for a general check-up and after
two months for screw tightening and obturation of the
screw access holes. The patient is now seen once a year
for a check-up that involves removal of the prosthesis,
660 nm laser disinfection of the abutments and use of
hydrogen peroxide.
BESTELLUNG AUCH
ONLINE MÖGLICH
research
Clinical relevance of the use of
implant-supported provisional restorations
to contour the emergence profile
Conclusion
case report
Dynamic guided surgery permits the successful management of clinical situations characterised by severe
bone loss. Without this technology, this patient would
have required bone grafting and would have been without a denture for eight months to avoid pressure on the
grafted sites. After the previous failures she had gone
through, this was completely out of the question. Furthermore, as this technique is compatible with flapless or
mini-flap surgery, the incidence of postoperative complications is reduced.
interview
All-on-four treatment in an atrophic
mandible using dynamic guided surgery
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Dr Jacques Vermeulen studied at the
dental school of the Université Nice Sophia
Antipolis (now the Côte d'Azur University)
in Nice in France. After graduating, he
opened his own dental office in the village of Flumet near Chamonix in France.
Dr Vermeulen’s education includes postgraduate studies in prosthodontics, implantology, basal implantology, medical
emergencies at the dental office and facial anatomy at various universities around the globe. Dr Vermeulen has taught numerous
postgraduate dental surgery and implantology seminars and performed live surgeries all over the world.
Dr Jacques Vermeulen
contact
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6 weeks prior to the end of the reference period.
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[16] =>
| case report
Cystic lesion management with
enucleation and r econstruction
followed by delayed implant
placement for maxillary premolars
A step-by-step workflow
Dr Ali Tunkiwala & Darshan Parulkar, India
Introduction
It is common practice to use delayed implant placement
in patients whose teeth have been lost due to infection
in the site. In case of long-term pre-existing infections,
there is always a possibility that the implants will be
negatively affected. According to Resnik and Misch, this
occurs p
rimarily because of the microbial interference in
the healing process caused by pre-existing inflam
mation.1 Pre-existing inflammatory conditions such as
periodontitis will release inflammatory factors, increasing the risk of secondary infection.2, 3 However, animal
research, h
uman case reports and case series, and
prospective studies have confirmed that there is no
d ifference in the success rates of delayed implant
placement in sites associated with chronic periapical
pathology and immediate implant placement in similar
conditions.4, 5 This case report aims to illustrate the
workflow involved in managing a cystic lesion around a
maxillary first premolar with a staged grafting approach
and delayed implant placement.
A delay in implant placement is often accompanied
by residual bone resorption, compromising the bone
volume and causing a more significant labial or lingual
discrepancy between the implant and the prosthesis.6, 7
T herefore, to preserve the alveolar bone level and to
reduce the treatment time, an immediate implant placement approach is becoming a popular choice compared
with the delayed approach.6 In this clinical case, despite
the advantages of immediate implant placement, we
d ecided on delayed implant placement to avoid the
Fig. 1: Pre-op clinical situation, showing a small, localised swelling deep in the vestibule next to the first premolar and a cross bite.
16
3 2022
[17] =>
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[18] =>
| case report
ossible risk of microbial interference in the healing
p
p rocess.1 Additionally, we preferred delayed implant
placement because the size of lesion was large and
there was insufficient bone for immediate implant stability.1 Furthermore, the implant diameter, selected on the
basis of the planned emergence profile and interdental
space, appeared to be too small to enable the implant
to have adequate contact with any residual, nonaugmented bone.8, 9 This is why we finally decided to
leave the bone to heal unloaded without the stress of
simultaneous osseointegration, choosing a staged, delayed approach.
Case presentation
A 30-year-old non-smoker with no chronic disease
presented to our clinic with a history of conservative
periodontal treatment and with the main complaint of
dull pain in the maxillary right first premolar region. The
patient was systemically healthy and extensively eva
luated for clinical signs, suitability for implant treatment
and the risk of postoperative complications. Clinical
examination revealed healthy gingival tissue in most
areas and discoloured crowns of teeth #15 and 16,
requiring restoration (Fig. 1). The preoperative CBCT
scan showed a circumscribed radiolucency of approximately 9 × 6 mm at the periapical region of tooth #14. It
also showed endodontic treatment on both teeth #15
and 16. Prior to the surgery, thorough medical consultation was done and possible risks of and alternatives to
the treatment were explained to the patient.
athology before placing the implant and to maximise
p
the soft and hard tissue available for primary healing
and bone augmentation. Under sterile conditions, local
anaesthesia (2% lidocaine hydrochloride with 1:80,000
adrenaline) was administered before tissue separation
and extraction. Surgical access to the cyst was obtained
through an incision mesial to the canine, respecting the
papillae, to the distal sulcus of tooth #16. A f ull-thickness
flap was carefully elevated using a periosteal elevator.
Tooth #14 was extracted atraumatically using forceps
and elevators, and the cystic defect was exposed
simultaneously. Enucleation of the lesion was carried
out, followed by socket degranulation using curettes
and saline solution for irrigation (Fig. 2).
The extraction socket was filled with a highly porous
anorganic porcine bone mineral matrix (MinerOss XP,
BioHorizons Camlog; Fig. 3).10 MinerOss XP has high
p orosity, allowing for optimal osteoconductivity and
adequate space for new bone deposition. Scanning
electron microscope studies have shown that its porous
structure is close to that of natural bone mineral.10 Additionally, its rough surface facilitates cell adhesion and
spread for bone ingrowth.10
Surgical procedure
The graft was then covered with Mem-Lok resorbable
collagen membrane (BioHorizons Camlog; Fig. 3), which
served as an effective barrier membrane for bone re
generation. This resorbable collagen membrane is
engineered from highly purified Type I bovine collagen,
which provides a predictable resorption period of 26–38
weeks.11 The defect was then closed with a #4/0 resorb
able suture thread.
One hour before the surgical procedure, the patient
received a prophylactic dose of 1 g amoxicillin and per
formed a 2-minute rinse with 0.2% chlorhexidine. The
aim of the surgical protocol was to eliminate the
The patient was prescribed antibiotics for seven days
and a chlorhexidine mouthrinse for two weeks. We
demonstrated a roll–stroke brushing technique and
encouraged the patient to maintain good oral hygiene.
3
2
Fig. 2: Incision with extension from the mesial part of tooth #13 to the distal sulcus of tooth #16 and full-thickness flap preparation. Situation after tooth
extraction and meticulous debridement of the cystic lesion. Fig. 3: The graft was covered with a collagen membrane to serve as an effective barrier for guided
bone regeneration.
18
3 2022
[19] =>
case report
4b
4c
4a
4d
4e
4f
4g
4h
|
Figs. 4a–h: Preparation of the osteotomy site and placement of the implant. Fig. 5: Intra-oral periapical radiograph confirming the correct position of the
implant and cylindrical healing abutment.
There were no adverse clinical symptoms reported by
the patient, and healing was satisfactory. Implant placement was planned in the premolar region after six
months. We opted for a single surgical protocol for loadfree and non-submerged healing to ensure predictable
osseointegration.
Results of guided bone grafting procedure
tial pilot drill was checked for appropriate axial position
and distance relative to the adjacent teeth using a guide
pin. With the corresponding flex drills, the diameter of
the implant bed was expanded under copious irrigation.
The final drill was the profile drill used to match the coronal geometry of the implant with the implant bed. After
the sequential drilling, a CONELOG PROGRESSIVE-
LINE implant of 4.3 × 13.0 mm (BioHorizons Camlog)
A radiographic examination after six months showed
that the previously infected area had filled completely
with bone. The control CBCT scan revealed bone of
9.16 mm in width buccolingually and bone of 6.29 mm in
width coronally. Clinically, the area had healed well with
no further symptoms or complications, and the site was
covered with healthy gingiva and sufficient bone into
which to place an implant.
Implant site preparation
The placement of the implant was planned to follow the
visual orientation on the CBCT scan. Upon reflecting of
a full-thickness flap, the osteotomy site was prepared
efficiently using a few well-aligned drilling steps. The ini-
5
4h
3 2022
19
[20] =>
| case report
6a
6b
6c
Figs. 6a–c: Wound closed with single interrupted sutures (a). Tissue demonstrating excellent healing after removal of the healing abutment (b). CONELOG
scan body screwed on to the CONELOG PROGRESSIVE-LINE implant to register the 3D position of the implant (c).
The screw-mounted post is very helpful in situations requiring intra-operative correction of the 3D position of
the implant that might be necessary during insertion, for
instance, next to the sinus or in very soft bone. Owing
to the coronal anchorage thread of the CONELOG
PROGRESSIVE-LINE implant, high primary stability
could be achieved—even in the very soft bone of the
maxilla and in the augmented area. Implant torque during placement was up to 40 Ncm. The correct position of
the implant and the cylindrical healing abutment (of 4 mm
in gingival height) was confirmed by an intra-oral periapical radiograph (Fig. 5). The flap was readapted and the
wound closed with single interrupted sutures using #4/0
Cytoplast PTFE thread (BioHorizons Camlog).
cylindrical healing abutment, the tissue demonstrated
good healing, and the site was ready to be restored
(Figs. 6a–c). A CONELOG scan body was screwed in to
register the 3D position of the implant. The implant was
scanned intra-orally using an optical scanner, and the
data was then sent to the laboratory for the prosthetic
restoration (Fig. 7). A custom model was printed in the
laboratory, and a straight CONELOG Esthomic abutment of 1.5–2.5 mm in gingival height served as a base
for the zirconia structure. The definitive zirconia restoration was bonded to this structure, resulting in a
screw-retained and retrievable full-contour crown
(Figs. 8a–c). The post-restorative intra-oral radiograph
done on the same day as the prosthetic crown delivery
showed a satisfactory fit of the zirconia crown and the
ideal preservation of the coronal bone in the interproximal area (Figs. 9a–10b).
Restoration of the implant
Discussion
The patient was recalled four months later. Radiographic examination of the implants showed that the
implant had fully osseointegrated. After removal of the
Dimensions of the lesion and inadequate morphology
and non-effective debridement of the area are some of
the factors that need to be considered when placing an
was placed in slightly subcrestal position (Fig. 4) employing a screw-mounted post.
7a
7b
Figs. 7a & b: Intra-oral scans of the implant.
20
3 2022
[21] =>
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[22] =>
| case report
9a
8a
8b
8c
9b
9c
Figs. 8a–c: CONELOG Esthomic abutment (a) and definitive zirconia restorations on the model (b & c). Figs. 9a–c: Final post-restorative images, lateral view.
implant in the area of pre-existing infected cysts. This
case report has demonstrated that the placement of an
implant in the area of a pre-existing infected cyst requires
antibiotic administration and thorough alveolar debridement at the site of the cyst. We opted for the approach of
Chen et al. considering that immediate implantation
involves the risk of contamination of the implant by the
residual infection, which can affect the process of osseo
integration.12
However, the discussion is ongoing. Some authors
support immediate placement into infected extraction
sockets, as they consider the benefits of reduced bone
resorption and treatment time superior to the potential
negative effect on osseointegration.13 However, very little
clinical data is available for immediate implant placement
in infected cysts.
Even if the design of the implants has been improved
when it comes to reliable achievement of high primary
stability—such as you can expect from the implant
10a
Figs. 10a & b: Final post-op radiograph on the same day of definitive restoration.
22
3 2022
s ystem used in this case—many authors still claim that a
minimum of 3–5 mm of residual apical bone is necessary
to stabilise an immediately placed implant.14, 15 In the
current case, a pre-extraction CBCT scan of the available apical bone showed that the cyst size was greater
than the implant diameter selected, based on the limited
interdental space and the planned emergence profile of
the implant site. Using a wider-diameter implant would
have required placing it more apically to stabilise it. This
and the fact that osseointegration might be limited in an
infected area finally led to the decision of a staged
approach.
Therefore, we decided in this case to first increase the
available bone by staged guided bone regeneration. The
bone grafting material facilitates new bone deposition
and the adhesion of bone cells and their ingrowth.16
The implant loading was delayed for three months to
avoid the risk of interference with the new bone formed
at the implant–bone interface resulting from surgical
trauma.17
10b
[23] =>
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case report
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Conclusion
This clinical case study concluded that guided bone
regeneration followed by delayed implant placement in
the infected cyst site produces predictable outcomes.
As long as the infected site is meticulously debrided, the
newly formed bone can be loaded with an implant in a
short time frame. Implants designed to reliably reach
high primary stability help to provide confidence when
placed in soft and newly formed bone.
Acknowledgement:
We would like to acknowledge the support of Adaro
Dental Laboratory in Mumbai in India for the ceramic
work produced with a digital workflow.
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about the authors
1/22
issn 1868-3207 Sondernummer • Vol. 6 • Issue 1/2022
Dr Ali Tunkiwala is a director of Impart Education, a continuing education
academy in Mumbai in India, which
nurtures motivated clinicians toward
predictable, evidence-based dental practice through extensive training and lectures. Since obtaining his master’s
degree in prosthetic dentistry in 1998,
he has focused on placing and restoring implant cases efficiently using conventional and digital
techniques. He has maintained a dental practice for over
25 years in Mumbai, where he spends most of his time conducting implant and aesthetic dentistry procedures, as well as
full-mouth rehabilitation. Besides being an accredited member
of the American Academy of Cosmetic Dentistry and a fellow
and diplomate of the International Congress of Oral Implantologists since 2005, Dr Tunkiwala is a fellow and diplomate of
the Indian Society of Oral Implantologists. He also serves on
the editorial board of various journals in dentistry.
ceramic
implants
international magazine of ceramic implant technology
research
Dental implants and
bone marrow defects
case report
issn 1868-3207 • Vol. 23 • Issue 3/2022
implants
3/22
Ceramic implant placement
in a medically compromised patient
industry
Patent™—the proven master of zirconia implants
international magazine of oral implantology
Darshan Parulkar is an oral and maxillofacial surgeon based in Mumbai in
India. After graduating in 1998, he has
maintained a surgical referral practice
with focus on implant surgeries. His
area of interest has been hard and soft
tissue augmentation procedures. He is
a fellow and diplomate of both the International Congress of Oral Implantogy
and the Indian Society of Oral Implantologists.
research
Clinical relevance of the use of
implant-supported provisional restorations
to contour the emergence profile
case report
All-on-four treatment in an atrophic
mandible using dynamic guided surgery
Dr Ali Tunkiwala
Literature
interview
Quality products at accessible prices
contact
Dr Ali Tunkiwala
dralitunki@gmail.com
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[24] =>
| case report
Is autologous bone irreplaceable?
Bilateral vertical bone augmentation using allogeneic and autologous bone plates in the mandible
Dr Jochen Tunkel, Germany
Introduction
In one study, the result was stable ten years after
implantation, only 0.8% further resorption o
ccuring.12
Disadvantages of this method, however, were found to be
a high dehiscence rate of 9.5–27.2% and integration of
the xenogeneic bone substitute material into the con
nective tissue rather than the bone.10,11 For this reason,
De Stavola and Tunkel’s method modified the procedure
so that the augmentation was carried out u
sing the shell
technique, which led to a significant reduction in resorption.13 Additional GBR with xenogeneic bone substitute
material and collagen membrane was then performed
during the implantation session. With this method, known
as “augmentative relining”, an additional bone gain of 17%
could be achieved. Clinically and radiographically, the incorporation of the biomaterial into the regenerated bone
was demonstrated. There was no further resorption of the
regenerated bone up to the point of prosthetic restoration.
Tooth loss due to endodontic or periodontal problems is
generally associated with loss of bony structures. The
consequent insertion of an implant demands the restoration of bony structures, which is a procedure of varying
complexity.1 Bone block transplantations and guided
bone regeneration (GBR) have demonstrated predictable and successful outcomes as therapeutic methods
for alveolar ridge augmentation in dental implantology.2
Autologous bone transplants are generally accepted to
be the gold standard in augmentation surgery..3, 4
3D reconstruction, or the shell technique, is a specific
form of autologous bone grafting. Thin cortical bone
blocks are initially used to restore the contours of the
alveolar ridge, and the resulting gaps are then filled with
autologous bone chips.1,5 The short- and long-term
results after augmentation with the aid of the shell technique have demonstrated low complication rates and a
stable bone volume even ten years after surgery.6–9
There is a great desire to avoid bone harvesting, both
on the part of the patient and the practitioner, so most
dentists working in implantology try to avoid autologous
bone harvesting. Another, more serious, disadvantage
of autologous bone transplantation is the limited amount
of bone available intra-orally.
In addition to using the shell technique, there is the possibility of reducing resorption processes by combining block
transplantation with GBR.10,11 With full block transplants, it
has been shown to be possible to reduce the resorption
between augmentation and implantation to 5.5–7.2%.10–12
1
2
Figs. 1 & 2: Slight elongation of the maxillary posterior teeth.
24
Allogeneic bone materials seem to be the closest to
autologous bone transplants in clinical applications.14
3 2022
[25] =>
case report
|
Fig. 3: Pre-op CBCT scan showing vertical bone defects in the third and fourth quadrants.
llogeneic full block transplants are, however, subject to
A
similar resorption processes to autologous full block
transplants. 3, 10, 11, 15, 16 The complication rate is also
higher with allogeneic full block transplants than with
autologous bone transplants.17 However, a split-mouth
case series showed that the use of cortical allogeneic
bone plates produces results that are equivalent to
those of autologous bone plates in terms of regeneration, resorption and complication rates and thus could
solve the problem of insufficient intra-oral bone availability and reduce morbidity.18
In this case report, a patient with a limited amount of
bone available intra-orally underwent vertical bone
augm entation and two-stage implantation with aug
mentative relining on both sides of the lower jaw.
One half of the jaw was treated with autologous and the
other side with allogeneic bone plates. There was equivalent healing on both sides without complications and
only a low rate of resorption.
Initial situation
one bone block harvesting and have the other site
rebuilt with allogeneic bone plates. The sequence of the
treatment would be as follows:
1. bone harvesting from the right retromolar area;
2. 3D vertical bone augmentation in the fourth quadrant
utilising the shell technique with autologous bone
plates and chips;
3. 3D vertical bone augmentation in the third quadrant
utilising the shell technique with allogeneic struts and
autologous bone chips;
4. four months of healing;
5. insertion of implants in regions #47, 46, 35, 36 and 37,
combined with augmentative relining using collagen membranes and deproteinised bovine bone mineral particles;
6. four months of healing;
7. second-stage surgery with Kazanjian vestibuloplasty,
combined with step incision on both sides; and
8. rehabilitation after six weeks.
Surgical procedure
Treatment planning
At the start of the procedure, a bone block was harvested from the right retromolar area (Fig. 4) with the aid
of a micro-saw and was then split lengthwise using thin
diamond disks. These plates were thinned to a thick
ness of about 0.5 mm with a Safescraper Twist (Geistlich
Pharma), and autologous bone chips were collected at
the same time. The plates obtained in this way were
fixed buccally and lingually in regions #47 and 46 with
four micro-screws (Fig. 5). The resulting bony envelope
was next filled with the autologous bone chips with the
application of slight pressure (Fig. 6). Finally, blunt mobilisation of the floor and a periosteal incision were
performed in the buccal region in order to enable the
augmented area to be covered.
In order to place implants in the correct prosthetic
position, vertical augmentation would be absolutely
essential. The amount of bone that had to be harvested
could not be gained in just one retromolar bone harvesting area. Therefore, the patient was advised to undergo
The augmentation then took place in the third quadrant.
To this end, two allogeneic bone plates (maxgraft
cortico, Straumann) were first opened and immersed in
sterile saline solution for 10 minutes. During this time,
the flap was prepared in regions #35–37 (Fig. 7). The
A 60-year-old female patient was referred for implantation with bone augmentation. Her general medical
history showed no particular features that would restrict
the surgery. There was a bilateral free-end situation in
the lower jaw with teeth #47, 46, 35, 36 and 37 missing
and a vertical bone defect of approximately 5 mm in loss
of height. There was slight elongation of the maxillary
posterior teeth, which, after consultation with the referring dentist, was corrected by grinding (Figs. 1 & 2). The
preoperative CBCT scan confirmed the vertical bone
defects in the third and fourth quadrants (Fig. 3).
3 2022
25
[26] =>
| case report
4
5
6
7
8
9
Fig. 4: Retromolar bone harvesting in the fourth quadrant. Fig. 5: Buccal and lingual fixation in the fourth quadrant. Fig. 6: Filling of the bone bed in the
fourth quadrant. Fig. 7: Initial situation after opening in the third quadrant. Fig. 8: Buccal and lingual fixation in the third quadrant. Fig. 9: Filling of the
bone bed in the third quadrant.
10
11
Figs. 10 & 11: Panoramic radiograph with reference balls after a four-month healing period.
12
13
14
15
16
17
Figs. 12 & 13: After removal of the micro-screws after crestal incision and flap raising. Figs. 14 & 15: Sufficient bone availability in the buccal and lingual
areas, with a thickness of approximately 1–2 mm. Figs. 16 & 17: Membrane secured with resorbable sutures on the lingual side of the flap.
26
3 2022
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[28] =>
| case report
allogeneic bone plates were divided according to the
anatomical situation and fixed buccally and lingually in
the third quadrant using four micro-screws (Fig. 8). The
resulting cavity was then filled with autologous bone
chips that were left over from the augmentation in the
fourth quadrant (Fig. 9). The wound was closed ana
logously to the procedure in the fourth quadrant.
After a four-month healing period, a panoramic radiograph with reference balls revealed a clear vertical bone
gain after four months in both quadrants (Figs. 10 & 11).
The third and fourth quadrants were reopened before
implantation. To this end, the micro-screws were removed on both sides after the crestal incision and flap
raising (Figs. 12 & 13). Straumann Bone Level Tapered
implants (SLActive) were then inserted in region #35
(diameter: 4.1 mm; length: 10.0 mm), 46 and 36 (dia
meter: 4.8 mm; length: 10.0 mm) and 47 (diameter:
4.8 mm; length: 8.0 mm) according to the manufacturer’s
instructions. After the implants had been inserted,
18
19
20
sufficient bone was seen to be available in the buccal
and lingual areas, having a thickness of approximately
1–2 mm (Figs. 14 & 15). After buccal incision of the periosteum, a collagen membrane was attached to the
apical periosteum with resorbable sutures. The alveolar
ridge section was then covered with bovine bone material with a layer thickness of one particle size (1–2 mm).
The membrane was secured with resorbable sutures on
the lingual side of the flap (Figs. 16 & 17). The final step
was the plastic covering of the augmentative relining
(Figs. 18 & 19).
After a healing period of four months, the implants were
exposed. As the area had been augmented twice, there
was a lack of keratinised tissue in the region of the implants (Figs. 20 & 21). Consequently, a vestibuloplasty
according to the Kazanjian technique was performed.19, 20
To this end, after the initial preparation of a supramuscular mucosal flap, the muscle was sharply separated
from the periosteum in an apical direction. The mucosal
21
19
22
23
24
25
Figs. 18 & 19: Close-ups from the post-op dental panoramic tomogram after implantation and guided bone regeneration from augmentative relining in the
third and fourth quadrants. Figs. 20 & 21: Tissue after a healing period of four months. Figs. 22 & 23: Conical gingival formers with diameters of 5.0 mm
in region #35 and 6.5 mm in regions #47, 46 and 36. Figs. 24 & 25: Post-op situation on the panoramic radiograph.
28
3 2022
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26
27
28
29
Figs. 26–29: Stable peri-implant bone conditions and sufficient keratinised tissue, clinically free of inflammation, after a six-week healing period.
flap was secured to the periosteum with resorbable
s utures. Finally, the implants were exposed by stab
incisions. Conical gingival formers with diameters of
5.0 mm in region #35 and 6.5 mm in regions #47, 46 and
36 were used as healing abutments (Figs. 22–25).
Dr Jochen Tunkel
Literature
Prosthetic procedure
After a healing period of six weeks, the prosthetic restoration was carried out by the referring dentist. The final
check-up showed stable peri-implant bone conditions
and sufficient keratinised tissue, clinically free of inflammation (Figs. 26–29).
Treatment outcomes
The augmentative relining technique can also be carried
out with allogeneic bone plates. No clinical problems
were observed in association with this procedure, and
there were signs of good integration of the xenogeneic
bone substitute into the augmented bone.
Recommendations
In cases of limited vertical bone availability, when the patient requests a fixed restoration on the posterior area of
the mandible, the shell technique for bone augmentation
is our first choice, as it offers high predictability combined
with low complication and resorption rates. Usually, the
patient chooses whether to opt for allogeneic or autologous bone shells. In the case of bilateral sites that need
to be treated, we often choose the combined approach,
as we can easily harvest enough autologous bone chips
without a second bone harvesting site in order to reduce
morbidity and provide a better patient experience. In my
daily practice, the allografts have proved to perform
equally effectively as autografts in terms of complication
and resorption rates with less morbidity.
30
3 2022
about the author
Dr Jochen Tunkel completed his dentistry degree at the University of Würzburg
in Germany in 1998 and specialised in
periodontics through the German Society
of Periodontology in 2003 and in implantology through the German Association of
Oral Implantology and European Asso
ciation of Dental Implantologists in 2004.
In 2006, he obtained a master of oral
medicine in implantology at the International Medical College,
associated with the University of Münster in Germany. He taught
periodontics at the M
ünster university h ospital from 2004 to 2015
and has worked in a joint private practice in Bad Oeynhausen in
Germany since 2007. His practice is accredited by the European
Centers for Dental Implantology and is a S traumann centre of dental education. Dr Tunkel is an International Team for Implantology
fellow and speaker, and a visiting and supervisory consultant at the
German A ssociation of Oral Implantology, German Society of Periodontology and academy for practice and science, a provider of
further dental training.
contact
Dr Jochen Tunkel
Königstraße 19
32545 Bad Oeynhausen
Germany
info@fachzahnarzt-praxis.de
[31] =>
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[32] =>
| case report
Immediately loaded full-arch
restoration on four implants
in the maxilla
Digital workflow and surgery,
including definitive restoration
Dr Marco Toia, Italy
A 78-year-old male patient with an ASA physical status
of II and a previous history of implant treatment requested
an implant-supported restoration. Four PrimeTaper EV
implants (Dentsply Sirona) were inserted according to
digital planning, and the two distal implants were angled
to make the best use of the height of the bone crest.
1
3
2
MultiBase EV abutments (Dentsply Sirona) were inserted,
and an immediate impression was taken. Four hours after the start of the appointment, a temporary screwretained implant-supported restoration was delivered to
the patient. After healing of the site, a digital impression
was taken for the definitive restoration, which was realised with a full monolithic zirconia sleeve on an Atlantis
BridgeBase suprastructure.
4
5
6
7
8
9
10
Fig. 1: Pre-op view of the edentulous maxilla, showing the healing area on the right side where the original implants had been removed. Fig. 2: Digital implant
treatment planning was performed in Simplant software (Dentsply Sirona) with a bone reduction guide mask for four implants in the maxilla. Fig. 3: A surgical
guide was used for the first drill to ensure precise implant positioning. Fig. 4: After making the surgical incision, the bone reduction guide was placed to de-
32
3 2022
[33] =>
case report
11
12
14
|
13
15
16
17
18
24
19
20
termine the amount of bone reduction needed. Fig. 5: The FRIOS MicroSaw
(Dentsply Sirona) was used to remove bone to create a flat and homogenous
bone plate. Guide pins were used to check the implant positions. Fig. 6: The
recommended drilling protocol for PrimeTaper EV was followed for implant
placement in position #12. The drilling procedure ended with the #4 PrimeTaper
drill. The #5 PrimeTaper drill was used for 2 mm cortical preparation. Fig. 7:
A PrimeTaper EV 4.2 × 11.0 mm implant was placed in position #12. Fig. 8:
A PrimeTaper EV 4.2 × 13.0 mm implant was placed at a 30° angle in position #15. Fig. 9: Occlusal view of the four abutments in place. Fig. 10:
MultiBase EV pick-up copings were attached and tightened (5–10 Ncm) for
the impression, taken using Aquasil Ultra+ low-viscosity impression material
(Dentsply Sirona). Autopolymerising flowable resin was used to secure the
copings. Fig. 11: MultiBase EV temporary cylinders and autopolymerising
resin were used to attach the denture. Fig. 12: Occlusal view of the temporary screw-retained restoration. Fig. 13: Radiographic evaluation of the temporary screw-retained restoration. Fig. 14: Temporary restoration in place
four hours after the start of the appointment. Fig. 15: Healed soft tissue
with abutments in place. Fig. 16: Atlantis IO FLO-S scan bodies in place for
intra-oral scanning for manufacturing of the definitive restoration. Fig. 17:
Try-in of the fixed Atlantis BridgeBase suprastructure. Fig. 18: Radiographic
evaluation showing passive fit of the suprastructure. Fig. 19: The full monolithic zirconia sleeve was tried in on top of the suprastructure prior to cementation finalising the definitive restoration. Fig. 20: Definitive restoration seated.
Fig. 21: Radiographic evaluation twelve months after implant placement.
21
26
about the author
Dr Marco Toia graduated in dentistry
from the University of Milan in Italy in
2001 and specialised in orthodontics in
2004 and oral surgery in 2007 at the
same university. He received his PhD from
Malmö University in Sweden in 2020 on
clinical and mechanical aspects of implantsupported screw-retained multi-unit CAD/
CAM metal frameworks. Dr Toia is in private practice in Milan and conducts research in affiliation with
Malmö University. He is an active member of the Italian Academy of
Osseointegration, the Italian president of PEERS (the Platform for Exchange of Experience, Research and Science, founded by Dentsply
Sirona) and an ordinary member of the Italian Academy of Prosthetic
Dentistry and European Association for Osseointegration.
Dr Marco Toia
contact
Dr Marco Toia
+39 0331 623144
www.studiotoia.com
3 2022
33
[34] =>
© Dental Tribune International
| interview
Fig. 1: Neoss CEO Dr Robert Gottlander (left) and Dental Tribune International CEO Torsten Oemus at the Neoss booth at EuroPerio10.
“At Neoss, we have the luxury
of being able to be
more forward-oriented”
An interview with Dr Robert Gottlander, CEO of Neoss, Sweden
Franziska Beier, Dental Tribune International
At EuroPerio10, Dental Tribune International met up
with Dr Robert Gottlander, who took over the position of
CEO and President of Neoss at the end of 2020. In this
interview, he shared his vision for the future of his company and how dentistry is changing and with it the
demands for manufacturers and explained what makes
Neoss’s new high-precision intra-oral scanner unique.
34
3 2022
Dr Gottlander, this year, Neoss is celebrating 20 years
of intelligent simplicity. You invited the dental community to join your company from 9 to 11 June in
Gothenburg in Sweden for Integrate 2022. Can you
tell us a bit more about the event?
Neoss is in a period of change. We are building on
strong product lines and strong research and increased
[35] =>
interview
communication. We had over 600 participants, and
from what I heard from external and internal participants, they really enjoyed it. The goal for us was to
integrate, educate and celebrate. Our basic feeling is
that education “only” is no longer sufficient, because
people are used to getting new information on the Internet, especially since the pandemic. What is lacking is
exchange. Our event offered short lectures and the
opportunity to engage with speakers and other participants by asking questions and having discussions. In
addition, we offered evening events, like themed dinners. We thought that this mixture would attract participants, and it really did. The meeting as such exceeded our expectations, and we are very happy with
the outcome.
You called the meeting “Integrate 2022”. Does that imply a further integration process in the coming years?
The basic plan—which has not been officially confirmed
yet—is to have five to seven small meetings in different
countries next year and to have another Integrate meeting in 2024. That’s the plan, but we will have to see
whether it works out.
I really like the name “Integrate” because for a lot of
dentists daily work is about integration. I think that what
we have learned during the pandemic is that we really
have to integrate all parts of the dental community,
including clinicians and manufacturers. The dental community works better if it’s integrated and when we all
work together.
Choosing Gothenburg as the location for the meeting was probably no coincidence, considering that
Neoss has its origins in the city and Gothenburg is
very closely connected with Per-Ingvar Brånemark,
who was central to osseointegration research.
Neoss is based on the tradition of implantology from
Gothenburg. We try to stick to the basics, to follow
Brånemark’s principle, which was to always think about
the patient. Therefore, as a company, we think about
what we need to do for the clinician in order to get the
best outcome for patients.
The office in Gothenburg is very close to the University
of Gothenburg’s dental school, and we are in the same
building as the Department of Biomaterials. I think that
Neoss is more focused on science than other implant
companies are—although, I don’t know if we are an
implant company. I don’t think so. I don’t want us to be.
What do you want Neoss to be, if not an implant
company?
I think we would like to be a company that helps dentists treat patients in the best possible way, in an
ease-of-use way but with predictable results. Today,
implants are very different from what they used to be
|
40 years ago, and I think that implants in the coming
20 years will be different too. The tools being used—
such as scanners and software—are also being used
in many other treatments. Three decades ago, an implant crown used to be made completely differently
from a crown for a tooth. Today, there is no difference.
In this way, implant dentistry has come closer to other
fields of dentistry. This shift is evident in all of the traditional implant companies b ecause they are different
from what they were 20 or 30 years ago. At Neoss, we
want to offer technology that is easy to use and to
stick to our intelligent simplicity. Simplicity has always
been important, but I think it is b ecoming even more
important.
In my opinion, this development has to do with today’s
dental education system. When I went to dental
school, we learned a lot about very few things. Today,
there are so many different dental specialties; however,
the time students spend in dental schools has not
been expanded. Therefore, today’s students learn, I
don’t want to say little, but less about a lot. As a result,
when they leave dental school, they need to find a way
to get more education. In addition, students and
c linicians have changed their view of life. When I gra
duated, the main goal was to become a specialist or to
have one’s own private practice. Today, a lot of dental
students want to be employed, and that means that
the requirements for manufacturers are changing. We
have to develop prod ucts and handle education in a
different way. At Neoss, we aim to back up our products with an immense effort in training and education
because I believe manufacturers have to take responsibility for showing dental professionals how our
products are supposed to be used.
So, with regard to your question about what I think
Neoss should be—these are the topics we try to think
about. We are not a large company, and I think that the
biggest advantage of that is that we do not have to
adhere to a strict traditional structure and this flexibility
gives us the possibility of doing things that will make a
difference in the future. Legacy implant companies need
to concentrate on how to manage their business. At
N eoss, we have the luxury of being able to be more
forward-oriented.
Many implant companies are branching out into
areas that are not part of their core business—such
as aligners and intra-oral scanners. Neoss just
launched the NeoScan 1000. What was the rationale
for this product?
We have had the ScanPeg for five years. It is the smartest digital workflow product currently on the market,
offering the combination of a scanning abutment and a
healing abutment. I thought: this is really smart, but we
cannot really sell it unless we also offer a scanner.
3 2022
35
[36] =>
© Dental Tribune International
| interview
Fig. 2: The new NeoScan 1000 scanner from Neoss is easy to use, very precise and fast.
What makes your scanner unique?
We stuck to the easy-to-use approach. I really believe in
intelligent, simple use built on science. When developing
the scanner, we did not focus on multiple software
features but on it being fast, precise and really easy to
work with. It’s very lightweight—it only weighs 198 g—
so basically the weight of a smartphone. The mirror is a
bit lower, so the captured image is larger than usual. If
something is missed while scanning, the user can go
back and the scanner will pick it up quickly, which really
reduces the scanning time. It has one button for the
upper jaw and another one for the lower jaw, so actually
the user can’t do anything wrong.
So, it’s idiot-proof?
Yes, that’s my point! [laughs] This scanner is for dentists
who want a simple scanner that takes a precise picture
at a very competitive price. I think that at the moment
it’s the scanner with the best price–per formance ratio
on the market. Most other scanners in the same price
range don’t have a colour mode or don’t work at the
same speed. The speed of our product is the same as
that of high-end scanners. We just don’t have all the different modules for the software. However, it’s truly
open. The dental professional can incorporate the
scanned data into other design and scanning software.
It’s for dental professionals who want to focus on their
clinical work. We presented data at Integrate 2022
which shows that the precision of our scanner is at least
as good as the leading brands on the market today.
36
3 2022
EuroPerio10 is one of the first major shows to take
place since the COVID-19 pandemic began. How
does it feel to be back?
I think that it’s great to be back and to be able to communicate and see people again. I personally really enjoy
it. I think that it is different to before COVID-19 because
now shows are more about getting together and socialising. Our coffee machine at the booth is constantly
running. [laughs]
To come back to Neoss at EuroPerio, we have another
product that we wanted to highlight: NeoGen, which is a
non-resorbable PTFE titanium membrane. These membranes are actually not easy to work with, but if used
correctly can achieve vertical bone growth in a way that
is amazing. We have had this product for five to six
years, and it has been well researched.
I joined Neoss because of its great implant product line,
including its easy use and predictable, well-researched
outcomes—and because of its novel products, such as
the ScanPeg and PTFE membrane. Very few companies
have such an offering.
contact
Neoss GmbH, Germany
+49 221 96980-10
info@neoss.de
www.neoss.com
Neoss
[37] =>
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[38] =>
| interview
Quality products at accessible prices
An interview with Salih Sanli, NucleOSS, Turkey
Timo Krause, Germany
NucleOSS was established in 2001 in Izmir by Sanlilar
Ltd. Over the past decades, the company evolved to a
highly reliable implant manufacturer. In this interview
with implants, NucleOSS CEO Sahli Sanli discusses
the company’s values and gives a slight outlook of the
NucleOSS future.
The last two years marked significant challenges for
the world. How could you encourage your company
to keep the paste of this fast moving and changing
industry?
As NucleOSS, we are aware that the greatest legacy we
will pass on to future generations is a livable nature and
environment. NucleOSS establishes its environmental
policy and transfers the corresponding corporate culture to its employees, production processes and suppliers through various trainings. We work continuously for
What are your plans especially for the future? Any
specific ideas for Germany?
NucleOSS will have a re-start at EAO Congress in
Geneva. We are looking forward to presenting our products worldwide but first we would like to establish our
strengths in Europe. As part of our open approach to
change, which is the first prerequisite for growth and
progress, we are developing our export network day by
day. To do this, we use our effective distribution network.
Our company in Germany is leading the way for this,
suitable solutions in close cooperation with our 14 domestic partners and as well as our more than 20 international partners.
Will you be participating in this year’s trade shows
and congresses? If so, what can customers look forward to?
“Our ultimate goal is to
offer quality products at
affordable prices and to be
a brand that allows everyone
to trust their smile.”
a clean and livable environment with the understanding
of “Smile for the Future”. That said, we are a family at
NucleOSS and this is our highest value and motivation.
With the T6 implant system, you launched a new era
of high quality and yet affordable implant systems.
How can you ensure this high demand and quality in
your production?
We want to produce the best, most biocompatible and
cleanest dental implants for our customers by combining our meticulous research and development studies
and knowledge with a world-class precision manufacturing protocol. We share our knowledge, experience,
scientific data and research findings with our clinicians
and academics through the Together for Implantology
Academy (TFI Academy), which we established to enhance the effectiveness of our ongoing R&D studies.
38
3 2022
We will be at EAO Congress in Geneva with our team
and we are looking forward to our customers and all
dentists that are looking for a high-quality dental implant
system designed to provide a beautiful smile.
contact
NucleOSS
+90 232 7990304
www.nucleoss.com
[39] =>
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[40] =>
| industry
Driven by science, not trends
Janine Conzato, Germany
The innovative company Thommen Medical has been
dedicated to a single goal since the beginning: To produce the best possible dental implant system. They consistently rely on Swiss precision in manufacturing, rigorous quality controls and close collaboration with the best
experts in dental medicine worldwide. This results in a
unique dental implant system that combines Swiss quality, simplicity and an innovative design, based on over
35 years of clinical experience.
The company focuses on dental implantology and clearly
positions itself as an expert in dental implants. The production takes place at the company’s facility in Grenchen,
Switzerland. However, part of the recipe for success is
that the company invests in ecology, research and the
social responsibility of the dental manufacturer in addition to innovative product development.
Under the name “Thommen Medical Education”, Thommen
Medical offers training at the highest level, carried out by
clinicians who are leaders in their fields on the one hand,
and on the other hand, through their practical and pragmatic approach, are able to pass on directly applicable
knowledge. Participants receive scientifically based and
practice-oriented knowledge that they can use in their
daily work. Knowledge that can be used to further optimise not only the clinical results, but also the intraoperative, dental-technical, and organisational processes related to dental implants.
1
As an internationally active company, Thommen Medical
is also present at numerous congresses and events. This
year’s EuroPerio in Copenhagen was no exception. The
company’s symposium took place on the second day of
the congress and was very well attended. In it, Prof.
Leonardo Trombelli, Prof. Stefan Renvert and Prof. Markus Hürzeler addressed the question of whether implant
rehabilitation in stage IV periodontitis patients is a permanent solution or the genesis of future problems. The
experts looked at the question from periodontal, implantological and interdisciplinary perspectives. The symposium was chaired by none other than periodontist
Dr Otto Zuhr, who has been a board member of the
Deutsche Gesellschaft für Parodontologie.
It is important to the Swiss company that research, development and the further development of the company
are always congruent and financially viable. If you grow
too fast, you can also jeopardise a solid foundation. That
is not Thommen Medical’s philosophy. When a new product comes onto the market, it is absolutely reliable and
mature. And this serious development takes time.
Thommen Symposium
Thommen Medical
contact
Thommen Medical AG
info@thommenmedical.com
www.thommenmedical.com
2
Fig. 1: Dr Otto Zuhr welcomes the participants at the Thommen Symposium at this year’s EuroPerio in Copenhagen. Fig. 2: Dr Otto Zuhr, Prof. Markus Hürzeler
and Prof. Stefan Renvert (from left) at the Thommen Symposium at the EuroPerio in Copenhagen on “Implant-supported rehabilitation in stage IV periodontitis
patients: permanent solution or source of future problems?”
40
3 2022
[41] =>
manufacturer news
|
Last call for current quality
assessment study and education
on implant impurities ex-factory at
the EAO Congress in Geneva
The non-profit CleanImplant Foundation will attend the
29th Scientific Congress of the European Association for
Osseointegration (EAO) from 29 September to 1 October 2022 with its information booth at F 50. In the setting
of the European congress, the Foundation continues its
global awareness campaign concerning productionrelated contamination on new, sterile-packaged implants.
On the same occasion, Dr Dirk U. Duddeck, Managing
Director and Head of Research at CleanImplant, aims to
advance the implant procurement for the Foundation’s
current and fifth overall scientific study on the quality
of dental implants. The presence of numerous implant
manufacturers is sought to conclude the collection process, initiating the next iteration of the large-scale quality
assessment study conducted in collaboration with internationally renowned universities such as the Charité–
University Medicine in Berlin, Germany.
In what has become the most extensive overview of surface cleanliness performances across the entire industry, the surfaces of commercially available implant systems are examined for concerning remnants from the
production processes using complex, state-of-the-art
SEM analyses. To ensure a comprehensive overview of
the manufacturing quality of the implants available for
sale on the market, the implant types to be tested
were, in advance, selected by the Foundation’s scientific
advisory board. All implant manufacturers with implants
examined in the study are invited to participate in this
study.
Results of the previous year’s studies are alarming: Over
a third of all sterile-packaged and “ready-to-use” implant types exhibited significant levels of foreign particles and concerning residues on their surfaces. However, there is an easy way to avoid purchasing untested,
risky implants. At the information booth in Geneva,
CleanImplant experts will inform about these contaminants’ impacts and advise on selecting the best implant
systems: With the “Trusted Quality”-seal, CleanImplant
creates transparency and awards implant systems with
a high-quality surface. To date, selected implant types
© CleanImplant Foundation
CleanImplant Foundation experts continue the global awareness campaign
concerning production-related contamination on new, sterile-packaged implants. CleanImplant Managing Director and Head of Research, Dr. Dirk U.
Duddeck (left), will give insights and information about the latest study results
to all interested colleagues at booth F50.
carrying the coveted seal are from manufacturers
such as Biotech Dental, bredent medical, BTI, CAMLOG,
Global D, medentis medical, MegaGen, NucleOSS,
Sweden & Martina, Zircon Medical, and SDS. The quality
seal is valid for two years. Other implant systems are
currently undergoing the testing process.
contact
CleanImplant Foundation
+49 30 200030190
www.cleanimplant.com
3 2022
41
[42] =>
| manufacturer news
Straumann
The tapered standard
The Straumann® BLT implant has been introduced to the markets
in 2015. Since then, it has become the most popular and most used
implant line of Straumann Dental Implant System. Building on the
clinically proven features, the BLT implant offers a powerful combination of Roxolid®, SLActive®, Straumann’s high performance
surface for high predictability and accelerated osseointegration,
and an anatomical fit, thanks to the slim and tapered implant body.
With a portfolio range from implant diameter 2.9 mm, to 3.3, 4.1
and up to 4.8 mm all tooth positions can be treated, be it single
tooth, small bridges, or full arch rehabilitations. For the latter, with
Straumann® Pro Arch, a scientifically proven immediate fixed, full
arch solution for an immediate, aesthetic, and reliable outcome is
offered. The Straumann® BLT implant system was designed for a
natural look and feel, providing great flexibility and a balanced
prosthetic portfolio for the everyday use.
Institut Straumann AG, Switzerland
+41 61 9651111
www.straumann.com
Dentsply Sirona
Preserve smiles with DS PrimeTaper implant system
DS PrimeTaper implant system features a tapered implant with a
progressive thread design inspired by the proven classic design of
Astra Tech Implant System, including MicroThread on the implant
neck, the OsseoSpeed surface for long-term bone maintenance
and aesthetics, and the conical EV connection for restorative
flexibility and ease.
The variable thread shapes on the implant contribute
to initial and immediate stability and cutting efficiency, linear torque build-up throughout the implant installation for predictable implant placement,
and immediate installation stability for all implant
cases.
Excellent aesthetics begin with careful planning and
DS PrimeTaper implant system offers a comprehensive digital solution for implant placement to provide
improved efficiency throughout the workflow and reliable results, even in fully edentulous patients. Add
Primescan for Atlantis suprastructures for seamless digital implant workflows where everything works in harmony
to help preserve the patients’ smile.
Dentsply Sirona, Sweden
+46 31 3763000
www.dentsplysirona.com/dsprimetaper
42
3 2022
[43] =>
manufacturer news
|
Integration Diagnostics
Monitor osseointegration
With its core philosophy of easy, affordable and accessible products,
Integration Diagnostics have supplied the dental implant market with
Penguin RFA since 2015. Penguin accurately and predictably measures
implant stability to support the dentist’s decision for when to load an
implant. As implant dentistry continues to trend towards a more limited
or in some cases eliminated healing phase prior to loading, accurate
techniques to support the clinical teams’ decisions become more important. If case conditions are suboptimal, poor implant stability could increase the risk for implant failure. To measure and confirm osseointegration and implant stability before loading, potentially improves the
outcome for the patient as well as helps the dentist develop a more efficient protocol and treatment.
Integration Diagnostics
Sweden AB, Sweden
+46 31 202024
info@idsab.com
www.penguininstruments.com
Penguin instruments are used with MulTipegs; measuring devices manufactured in durable, tissue friendly titanium with sealed magnets. The
design enables the MulTipeg to be autoclaved and reused up to 20 times,
which, when considering environment impact and cost effectiveness is
beneficial. The MulTipegs can be used for all major implant systems and
are laser marked with type number, have an optimal platform fit and are
ISQ standard calibrated.
At EAO 2022, Integration Diagnostics will release the new generation
Penguin instrument—Penguin II. With an updated design and added
features, this will meet dentist demands when searching for an uncomplicated system to monitor osseointegration, manage risk patients and
reduce treatment time.
Penguin instruments—removes doubt!
More information can be obtained by visiting the Integration Diagnostics
Sweden booth (E037) at EAO Congress in Geneva.
Thommen Medical
New gingiva former narrow—
the solution for optimal soft tissue management
Inflammation-free gingiva and sufficient soft tissue volume are central
to the long-term success of an implant restoration. From now on, the
new gingiva former narrow from Thommen Medical provides more flexibility in soft tissue management—for best possible outcomes. In combination with the gingiva former standard, the new gingiva former narrow
can be used to exert controlled compression on the soft tissue in a twostage procedure.
Thommen Medical AG, Switzerland
+41 32 6443020
info@thommenmedical.com
The narrow shape is the optimal basis for aesthetic and functional
peri-implant soft tissue, as the tighter wound closure promotes effective
wound healing. The narrow design reduces tension around the suture and
minimises free wound surfaces. Thereby, the risk of infection is limited
while optimal blood circulation is supported.
3 2022
43
[44] =>
| manufacturer news
Neoss
Digital dentistry made easy
As part of Neoss’ milestone celebration delegates at the Neoss
Integrate 2022 congress in Gothenburg, Sweden were given the
first access to the NeoScan 1000 intra-oral scanner which is set
for full commercial launch in September 2022. “I am excited to
introduce the NeoScan 1000 into our range of intuitive dental solutions. The performance of the scanner is beyond my expectations
with clear competitive advantages. The scanner will allow Neoss
to significantly expand its proprietary digital dental offering,” says
Dr Robert Gottlander, CEO and President of Neoss Group. Designed
for scanning accuracy and speed, the compact, lightweight scanner provides the possibility for a flexible workflow with open and
compatible output at a competitive price. “The NeoScan 1000 is a
superfast, lightweight, and easy-to-use scanner. I had the plea-
sure of being part of early testing and have used the scanner for
several digital impression indications at my clinic with excellent
results. Digital dentistry is in need of more cost-efficient solutions
so that clinicians can use it to its full potential. The NeoScan 1000
has the potential to do just this,” says Dr Marcus Dagnelid, DDS,
board-certified prosthodontist. With an easy USB cable connection and full touch screen support, the NeoScan 1000 is sure to
please and excite dental professionals alike!
Neoss GmbH, Germany
+49 221 9698010
info@neoss.de
www.neoss.com/neoscan1000
BioHorizons Camlog
The next generation soft-tissue augmentation material
When choosing a biomaterial, there is a strong demand in clinical
practice for predictable outcomes. For over 20 years, LifeCell, a
leading global medical technology company, has developed innovative products for use in a wide range of applications. BioHorizons
Camlog expands its soft-tissue portfolio to bring NovoMatrix, an
innovative soft-tissue augmentation material. N
ovoMatrix is an
acellular extracellular dermal matrix consisting of tissue-engineered
porcine material. It is a breakthrough in xenogeneic process-
ing ensuring a structurally intact, undamaged scaffold that supports cell and microvascular ingrowth. The proprietary tissue processing allows for rapid revascularisation, cell repopulation and
minimal inflammation. NovoMatrix comes pre-hydrated and ready
to use and offers a true alternative to autogenous soft-tissue
grafts and c urrent products on the market. The NovoMatrix indications include guided tissue regeneration procedures in recession defects for root coverage, localised gingival augmentation to
increase keratinised tissue (KT) around
implants and natural teeth, and alveolar ridge reconstruction for prosthetic
treatment.
Camlog Biotechnologies GmbH
Switzerland
+41 61 5654141
www.biohorizonscamlog.com
44
3 2022
[45] =>
manufacturer news
|
Argon Medical
K3Pro gives no chance
of bacterial colonisation!
The sustainability of implantological success has many factors. In
addition to the absence of mechanical complications, the lowest
possible bacterial load is indispensable for the service life of
implant-supported restorations. Mucositis and peri-implantitis are
biological complications that should be avoided at all costs in the
area of peri-implant hard and soft tissue. Numerous clinical studies have shown that gaps in multi-unit implant systems are entry
gates for microorganisms and have negative consequences for
bacterial colonisation of the peri-implant mucosa. Colonies of bacteria in the implant interior that migrate are a main factor for the
development of biofilms.
The prevention of peri-implantitis therefore begins with the selection of the implant: if the focus is on the design of the implant–
abutment connection and in particular the freedom of micromovement—and thus bacterial tightness—K3Pro from Argon Dental
with its Peri-Protect-Design is the way to go. Its unique severalmillimetre-long yet reversible tapered connection not only successfully eliminates micromovements, but also seals reliably. You
as the practitioner, who can rely on sustainable hard and soft tissue stability with K3Pro, are not the only winner: your patient also
benefits and enjoys a biologically proven bacteria-proof and odourfree implantological restoration that poses no risk whatsoever to
microbial contamination of the oral flora.
We are Creating Stable Tissue. Be part of it and realise highly biological solutions with us.
Argon Medical, Germany
+49 6721 3096-0
www.argon-medical.com
ClaroNav
Introducing Navident 4: Why do I need one?
Are you constantly looking for ways to elevate and differentiate
your practice from mainstream dental providers? We know the
challenges you face when you are aiming for the highest levels of
performance and results—both functionally and aesthetically.
Navident provides breakthrough surgical navigation with advanced
function and form. From more efficient single implant replacements to a fully edentulous rehabilitation workflow, Navident is
poised to revolutionise and differentiate your practice: Conduct
high-precision implant treatments quickly and confidently. Reliably detect important anatomical structures. Locate root canals
and other fine anatomical structures with precision and efficiency.
High-precision navigation of your piezotome enables accurate assessment and predictable outcomes.
The new Navident system is equipped not only with next-generation,
3X resolution camera technology, but also provides everything
from ergonomic design to reimagined touchscreen interface, and
is created to provide smooth workflow integration for clinicians at
every stage of their career. Precision dentistry for the precision
dentist.
Navident 4 comes in cart-based or new wall or ceiling mount configurations for ultimate versatility. Navident 4 is now available at a
special pre-order price and shall be showcased at the EAO Congress in Geneva (booth G10).
ClaroNav, Canada
+1 647 951-1525
anna@claronav.com, www.claronav.com
3 2022
45
[46] =>
| events
EuroPerio10 brought together an amazing diversity of over 130 speakers from around the world. (© EFP)
Younger and more dynamic and
exciting than ever before
Janine Conzato, Germany
Copenhagen delighted visitors to this year’s EuroPerio—
both with its location and beautiful weather. From 15 to
18 June, attendees were offered an engaging programme
covering innovations and proven classics of the dental industry. A leading global congress for periodontics and
implantology, EuroPerio once again pleased visitors and
industry participants alike.
EuroPerio10 promised to be one of the best events in the
history of the European Federation of Periodontology
(EFP), which organises the meeting, and this expectation
was realised: this year’s congress was considered by
both visitors and industry participants to be the most exciting yet. Prof. Phoebus Madianos, chair of EuroPerio10,
said: “EuroPerio attracts the best speakers, scientists
and clinicians from around the world to the Olympic
Games of dental congresses.” This fosters experiences
for all participants that will have a lasting impact on the
entire dental world.
In a similar spirit of enduring influence, the organisers decided to hold the congress in the most sustainable city in
Europe and incorporated sustainability in the event on
many levels. Instead of receiving the traditional programmes distributed on-site, all participants could download a free congress app with all the information about
the event, reducing paper use by 50% compared with
EuroPerio9. In addition, all participants received a free
ticket for public transport, and only local and seasonal
food was served.
Marking EuroPerio’s 30th anniversary, the tenth edition attracted more than 7,000 participants from 110 countries,
and the proportion of younger attendees was noteworthy: 66% of the participants were under 45 years old and
33% under 35 years old. Original research was presented
in more than 900 scientific abstracts during the congress.
46
3 2022
There were 41 scientific sessions on emerging topics of
interest to practitioners, researchers and academics,
presented by over 130 high-profile speakers from more
than 30 countries.
The research covered a wide range of topics, including
new areas of study, such as the role of artificial intelligence in the diagnosis and treatment of periodontitis.
New findings on areas already studied were also presented, including the long-term outcomes of periodontal
treatment and the associations between periodontal disease and heart disease, diabetes, premature birth and
lung function.
A significant highlight of the EuroPerio10 programme was
the presentation of the first European guideline on the
treatment of Stage IV periodontitis. Commenting on this,
EFP President Prof. Andreas Stavropoulos said, “The
EFP is the global benchmark in periodontal health and
disease. The EFP’s main mission is to raise awareness of
the importance of periodontal disease and health, and
our motto is periodontal health for a better life. This is
what we communicate to society and policymakers so
that we can influence decision-making and improve oral
health.”
He concluded by saying, “Our main educational event is
EuroPerio, and this edition has attracted a very young
audience, […] we look forward to seeing the dental community again at EuroPerio11 from 14 to 17 May 2025 in
Vienna in Austria.”
Picture gallery
contact
European Federation of
Periodontology, Spain
www.efp.org
[47] =>
events
|
51st International Annual Congress of the DGZI
University meets practice—A congress for the entire practice team
Berlin is always worth a visit. There is hardly any other German
metropolis where advanced training, culture and leisure can be
better combined. Many reasons to travel to the German capital.
And a visit to the DGZI Annual Congress at the Vienna House
Andel’s Berlin is worthwhile for the entire practice team.
The focus of the 51st Annual Congress of the German Association
of Dental Implantology (DGZI) in Berlin will be the claim to be a
guideline in implantology for the participants. They should not only
know where the joint implantological journey is going but should
also be personally able to play a significant role in shaping the
route. The DGZI has had this aspiration for the past 50 years and
will continue to have it for the next half century!
Conflict areas in the areas of bone augmentation, implant prosthetics and material selection for the implant are deliberately presented, illuminated, questioned and practice-relevant evaluations
are given. And —sometimes deliberately—the question will be
asked whether it always has to be the “high-end”!
A top-class university team of speakers as well as numerous
practitioners will present the latest developments in lectures,
surgical tutorials and table clinics and discuss them with you.
Parallel to the 51st Annual Congress of the DGZI, with a joint industry exhibition as well as joint table clinics, the MUNDHYGIENETAG
will take place in Berlin. In any case, this is also an event for the
whole practice team!
We look forward to your visit and an exciting congress in Berlin!
OEMUS MEDIA AG · Leipzig, Germany
event@oemus-media.de
www.dgzi-jahreskongress.de
© Patino/Shutterstock.com
Fotona
Innovative laser treatments presented at 12th LA & HA Symposium
More than 70 clinical lecturers from around the world and
over 500 attendees assembled together at the 12 th annual
Laser & Health Academy (LA & HA®) Symposium, held in late May in
Portoroz, Slovenia. The annual event, sponsored by the manufacturer Fotona, is organised to present, share and discuss the
latest knowledge and clinical experiences in the field of medical
laser treatments. Some of the topics covered this year included:
Clinical Applications of the LightWalker Laser in Regenerative and
Resective Periodontal Surgery; Solving the Problem of Peri-implant
Complications; Using the LightWalker for Oral Surgery; and Clinical
Experiences with Laser-Assisted Orofacial Pain Management.
The Laser and Health Academy (LA & HA®) is a non-profit organisation dedicated to the promotion of research, education, and
publishing in the field of laser medicine. LA & HA® also serves as a
comprehensive platform for continuous education in the medical
laser community, with numerous professional workshops offered
worldwide on a wide variety of medical laser topics.
LA&HA, Laser and Health Academy, Slovenia
journal@laserandhealth.com
www.laserandhealthacademy.com
3 2022
47
[48] =>
| events
Fig. 1: The ADT held its 50th annual conference this year.
Fifty years of experience—
strategies for the future
Dr Rolf Vollmer, Germany
This year, the Arbeitsgemeinschaft Dentale Technologie
(dental technology working group; ADT) celebrated its
50th annual conference in Nürtingen in Germany from 16
to 18 June. The ADT offered visitors a wide-ranging overview of relevant new publications and the latest research
results and promoted exchange between dental technology, dentistry, academia and industry, creating opportunities for exchange on an equal footing.
In six workshops and 28 lectures, those interested in
dental technology and dentistry had the opportunity to
learn about the current state of development of dental
technologies. The topics ranged from the transformation
of dental technology and the shortage of skilled workers
in the industry to technical topics such as the use of digital technologies for removable dentures and minimally
invasive prostheses. The lectures were analysed in detail
by dental technician Oliver Beckmann and Vice President of the German Association of Dental Implantology
Dr Rolf Vollmer regarding their significance in practice.
Digital impressions were met with great interest overall,
and the high percentage of dental practices and laboratories that already use them, both for the fabrication of
crowns, bridges and splints and for printed models in
the laboratory, was surprising. It was interesting that
studies have shown that printed models do not have
permanent volume stability. Consequently, before the
models are sent to the customer with the finished work,
they must be printed out again and the model has to be
adjusted manually, if necessary.
It is also possible to implement the corresponding occlusal concepts in the digital world. The participants agreed
3
2
Fig. 2: Discussion in the expert panel (from left): Axel Springer, dental technicians Werner Gotsch and Florian Schmidt, Dr Ingo Baresel and ADT board member
Dr Jan-Frederik Güth. Fig. 3: Dental technician Oliver Beckmann, Frederik Schroll and DGZI Vice President Dr Rolf Vollmer at the DGZI booth.
48
3 2022
[49] =>
events
that milling removable partial dentures, for example, is
very time-consuming and wasteful of material, but ultimately delivers good quality. A favourable option is the
additive technology of powder bed fusion which allows
the printing of several removable partial prostheses in
one job. The long-term quality of this remains to be seen.
There are also possibilities for the production of complete
dentures. Both the dental crowns and the base of the
dentures can be produced by printing or milling, but like
the milling of removable partial dentures, the large amount
of material required must be considered. The excess
material must then be recycled again. Furthermore, there
are currently no plastics that allow relining or repair from
the same material. Although it is possible to print complete denture bases, studies have shown that the surface
is too rough and therefore very susceptible to plaque
adhesion.
|
not possible to prescribe standards for the individual
shade. In this area, like in others, the manual skills and
experience of the technician are indispensable.
Under the topic of treatment without implants, various
cases of and indications for all-ceramic adhesive bridges
in the anterior and posterior regions were presented.
These were indicated mainly for adolescent patients who
were too young for implant placement or for whom orthodontic treatment was not able to adequately retain the
space for an implant. Durability was reported to be very
good, to the extent that many patients later decided not
to have implants.
As a conclusion of the event, one could say that analogue
knowledge and skills are indispensable for digital work.
Finally, innovative processes and possibilities in referral
networks were presented in an impressive way under
the topic of digitalisation for surgery. In this respect, team
spirit and practice are of enormous importance.
Another interesting topic was the shade consistency of
artificial teeth. It was impressively explained that Shade
A3 is not always Shade A3. In an elaborate investigation,
samples of the same shade were produced by different
companies, and the result was that almost every sample
appeared to be of a different shade to that of the shade
guide. The shade is determined by the different layer
thicknesses of the materials solely. There is certainly still
much to be done in this respect, and unfortunately it is
contact
Arbeitsgemeinschaft Dentale Technologie, Germany
www.ag-dentale-technologie.de
AD
ceramic implants
is ONLINE!
e-paper · news · articles
community · newsletter
© PerigTemplate – stock.ad
obe.com
Visit us at: ceramic-implants.online
OEMUS MEDIA AG
49
Holbeinstraße 29 · 04229 Leipzig · Germany
3 2022
Phone: +49 341 48474-0 · info@oemus-media.de
[50] =>
| about the publisher
Congresses, courses
and symposia
implants
Imprint
Premiumpartner:
Publisher
Torsten R. Oemus
oemus@oemus-media.de
DGZI
30 September/1 October 2022
NEW: Vienna House Andel’s Berlin
51st International Annual
Congress of DGZI
© Alexandr
Bakanov – stock.adobe.com
30 September–1 October 2022
Berlin, Germany
www.dgzi-jahreskongress.de
CEO
Ingolf Döbbecke
doebbecke@oemus-media.de
Member of the Board
Lutz V. Hiller
hiller@oemus-media.de
Chairman Science & BD
Jürgen Isbaner
isbaner@oemus-media.de
Chief Editorial Manager
Dr Torsten Hartmann
(V. i. S. d. P.)
hartmann@dentalnet.de
Dental World 2022
13–15 October 2022
Budapest, Hungary
www.dentalworld.hu
Editorial Council
Dr Rolf Vollmer
info.vollmer@t-online.de
Dr Georg Bach
doc.bach@t-online.de
Dr Suheil Boutros
SMBoutros@aol.com
Editorial Management
Janine Conzato
j.conzato@oemus-media.de
Executive Producer
Gernot Meyer
meyer@oemus-media.de
ICOI World Congress 2022
3–5 November 2022
Las Vegas, USA
www.icoi.org
IDS – International Dental
Show 2023
14–18 March 2023
Cologne, Germany
www.ids-cologne.de
50
3 2022
Art Director
Alexander Jahn
a.jahn@oemus-media.de
Designer
Fanny Haller, Pia Krah, Sarah Schröter
grafik@oemus-media.de
Customer Service
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m.mezger@oemus-media.de
Published by
OEMUS MEDIA AG
Holbeinstraße 29
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Fax: +49 341 48474-290
kontakt@oemus-media.de
Printed by
Silber Druck oHG
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34253 Lohfelden, Germany
implants
international magazine of oral
implantology is published in cooperation
with the German Association of Dental
Implantology (DGZI).
DGZI
DGZI Central Office
Paulusstraße 1
40237 Düsseldorf, Germany
Tel.: +49 211 16970-77
Fax: +49 211 16970-66
office@dgzi-info.de
www.dgzi.de
www.oemus.com
www.implants.de
Product Manager
Timo Krause
t.krause@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 2022. 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, translations,
microfilms, and storage and processing in electronic systems.
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
agreement with a full or partial publishing of said submission. The editorial department reserves the
right to check all submitted articles for formal errors and factual authority, and to make amendments
if necessary. No responsibility shall be taken for unsolicited books and manuscripts. Articles bearing
symbols other than that of the editorial department, or which are distinguished by the name of the
author, represent the opinion of the aforementioned, and do not have to comply with the views of
OEMUS MEDIA AG. Responsibility for such articles shall be borne by the author. Responsibility for
advertisements and other specially labeled items shall not be borne by the editorial department. Likewise, no responsibility shall be assumed for information published about associations, companies and
commercial markets. All cases of consequential liability arising from inaccurate or faulty representation
are excluded. General terms and conditions apply, legal venue is Leipzig, Germany.
[51] =>
© MIS Implants Technologies Ltd. All rights reserved.
PERFECT
MATCH
MIS CONICAL CONNECTION. MAKE IT SIMPLE
MIS conical connection feature a 12-degree friction fit which ensures a secure seal
and minimal micro-movements. Visit MIS Blog to get tips from experienced,
world-renowned implant specialists on optimizing working with conical connection
implants and restorative components: www.mis-implants.com/blog
[52] =>
CAN’T BUY ME LOVE
The CleanImplant Trusted Quality seal* is not
for sale. It must be earned.
Patent
Zircon Mecidal
UnicCa
BTI
In-Kone
GLOBAL D
BlueDiamond
MEGAGEN
AnyRidge
MEGAGEN
Conelog
CAMLOG
Kontact S
BIOTECH DENTAL
ICX-Premium
MEDENTIS MEDICAL
Prama
SWEDEN & MARTINA
SDS 1.2
SWISS DENTAL
SOLUTIONS
whiteSKY
BREDENT MEDICAL
T6
NUCLEOSS
SDS 2.2
SWISS DENTAL
SOLUTIONS
* These implant systems were awarded the CleanImplant „Trusted Quality“ seal after an unbiased and peer-reviewed quality assessment.
Receive quality information about your implant in use.
Provide more safety for your patients and avoid negligence claims.
Win new patients as a CleanImplant Certified Dentist.
Find out more. Join in and support the charitable initiative.
More information about this non-profit initiative:
www.cleanimplant.com/dentists
)
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[cover] => ![implants international No. 3, 2022]()
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[1] => Array
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[title] => Editorial
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[title] => Clinical relevance of the use of implant-supported provisional restorations to contour the emergence profile
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[title] => All-on-four treatment in an atrophic mandible using dynamic guided surgery
[page] => 12
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[5] => Array
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[title] => Cystic lesion management with enucleation and reconstruction followed by delayed implant placement for maxillary premolars
[page] => 16
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[title] => Is autologous bone irreplaceable? - Bilateral vertical bone augmentation using allogeneic and autologous bone plates in the mandible
[page] => 24
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[7] => Array
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[title] => Immediately loaded full-arch restoration on four implants in the maxilla
[page] => 32
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[8] => Array
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[title] => “At Neoss, we have the luxury of being able to be more forward-oriented”
[page] => 34
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[9] => Array
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[title] => Interview: Quality products at accessible prices
[page] => 38
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[title] => Industry
[page] => 40
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[title] => Manufacturer News
[page] => 41
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[title] => Events
[page] => 46
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[title] => Imprint
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/ Editorial
/ Content
/ Clinical relevance of the use of implant-supported provisional restorations to contour the emergence profile
/ All-on-four treatment in an atrophic mandible using dynamic guided surgery
/ Cystic lesion management with enucleation and reconstruction followed by delayed implant placement for maxillary premolars
/ Is autologous bone irreplaceable? - Bilateral vertical bone augmentation using allogeneic and autologous bone plates in the mandible
/ Immediately loaded full-arch restoration on four implants in the maxilla
/ “At Neoss, we have the luxury of being able to be more forward-oriented”
/ Interview: Quality products at accessible prices
/ Industry
/ Manufacturer News
/ Events
/ Imprint
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