Clinical Masters No. 1, 2017
Cover
/ Editorial
/ Contents
/ TRIBUNE CME —Global knowledge - delivered by world-class faculty in prime locations
/ MASTER EDUCATIONAL GROUP — Melegnano - Italy
/ DR. DOMENICO MASSIRONI AND THE MODIFIED CHAMFER
/ INTERVIEW with — Prof. Edward A. McLaren
/ EDUDENTINTERNATIONAL @ THE GENEVA SMILE CENTER — Geneva - Switzerland
/ SMILE REHABILITATION — A direct therapeutic approach assisted by digital diagnosis and mock-up
/ MANAGING THE PERIIMPLANT MUCOSA: — A clinically reliable method for optimizing soft-tissue contours and the emergence profile
/ CONTINUING DENTAL EDUCATION IN LAKE COMO: BRENNA & LEVRINI
/ JOIN THE CLINICAL MASTERS™ NETWORK
/ INTERVIEW with — Prof. Mauro Labanca
/ DR. ARNALDO CASTELLUCCI Micro-Endodontics Training Center — Florence - Italy
/ COMBINED SURGICAL AND NONSURGICAL — endodontic retreatment for the management of an unusual clinical case
/ COMBINED SURGICAL AND NONSURGICAL — endodontic retreatment for the management of an unusual clinical case
/ ENDO INN TO JOIN THE CLINICAL MASTERS™ PROGRAM IN ENDODONTICS
/ INTERVIEW with — Dr. Gianluca Plotino
/ INTERVIEW with — Dr. Louie al-Faraje
/ LAKE COMO INSTITUTE — Como - Italy
/ BUCCOLINGUAL IMPLANT POSITION AS A CONSEQUENCE OF THE ABUTMENT SHAPE — A paradigm shift
/ Some favorites of our faculty
/ STEIGMANN INSTITUTE Neckargemünd — near Heidelberg - Germany
/ ABOUT THE STEIGMANN INSTITUTE COURSES
/ CLINICAL MASTERS™ — TESTIMONIALS
/ BORG CENTER — Barcelona - Spain
/ INTERVIEW with — Drs. Rodríguez Ciurana & Vela Nebot
/ MIS 2017 GLOBAL LEARNING PROGRAM — Sharing knowledge and experience through education
/ REGISTRATION FORM — Clinical Masters™Program
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[1] =>
Editorial_03.indd
volume 3 — issue 2017
ISSN 2364-4826 (Print)
ISSN 2364-4834 (Online)
www.tribunecme.com
CLINICAL
MASTERS™
2017 Continuing
Education Opportunities
Clinical Masters™ Programs in Esthetic
and Restorative Dentistry, Advanced
Implant Esthetics, Endodontics,
Anatomical Surgery, Digital Workflow
and Esthetics, Implant Dentistry
and Specialist for Regeneration
— Learn from clinical masters at
state-of-the-art facilities in beautiful
locations around the world
Amazing Centers,
Amazing Locations
Athens, Barcelona, Como, Dubai, Florence,
Geneva, Heidelberg, Las Vegas,
Milan, Oslo, Rome, San Diego, Vienna
Photo: Acropolis of Athens | © Kim Pin/Shutterstock.com
Articles by and interviews with
Prof. Testori, Labanca, McLaren,
Drs. Scutellà, Massironi, Dietschi, Lops,
Maggiore, Steigmann, Vela Nebot,
Rodríguez Ciurana, Maggiore, Plotino
and al-Faraje
Article
Esthetic and Restorative
Dentistry
issue 2017 — 1
[2] =>
Editorial_03.indd
Original.
Proven.
Life changing.
The All-on-4® treatment concept
Four implants. A fixed full-arch provisional prosthesis. Same day.*
Since it was first introduced in 1998, the All-on-4® treatment concept has
changed the lives of hundreds of thousands of patients. Today, the
concept is established as the best in its class of solutions, but only when
Nobel Biocare products are combined.
Now supported by 34 clinical studies featuring 2400 patients, many have
tried to mirror this groundbreaking concept, but only Nobel Biocare has
the scientifically documented success to back it up.
Offer your patient life-changing treatment you can both rely on.
New All-on-4® treatment concept
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Register at
nobelbiocare.com/all-on-4course
*Provided stability criteria for immediate loading are fulfilled.
© Nobel Biocare Services AG, 2017. All rights reserved. Nobel Biocare, the Nobel Biocare logotype and all other trademarks are, if nothing else is stated or is evident from the context in a certain case, trademarks of Nobel Biocare. Please refer to nobelbiocare.com/trademarks for more information. Product images are not necessarily to scale. Disclaimer: Some products may not be regulatory cleared/released for
sale in all markets. Please contact the local Nobel Biocare sales office for current product assortment and availability.
[3] =>
Editorial_03.indd
EDITORIAL
— from Torsten R. Oemus
our instructors in their various specialties.
Tribune CME™ programs are well known
for their highly engaging and effective
learning methods, employing some of the
Dear reader,
best dental professionals in state-of-theart learning facilities to provide highly efIt is my great pleasure to introduce the fective training.
third issue of the Clinical Masters™ magazine. When we launched this magazine two Furthermore, I would like to invite Tribune
years ago, it was intended to facilitate a CME™ graduates and other dental profesdeeper understanding of our world-class sionals to join the growing Clinical
Clinical Masters™ Programs. This edition Masters™ Network, a platform for specialfurthers that understanding, featuring ed- ists across the globe to share their skills
ucational opportunities and events at train- and expertise.
ing centers, universities, and companies’
educational centers, programs they I hope that you enjoy reading this edition
support.
of the Clinical Masters™ magazine and I
wish to extend an open invitation to attend
Our base of locations for on-site training one of our international Tribune CME™
continues to grow, with the planning of programs.
upcoming sessions in China, Qatar and
Norway added to our existing training My kind regards,
centers in Athens, Milan, Geneva, Como,
Heidelberg, Barcelona, Berlin, Dubai,
Rome and Florence.
Given this diversity in geography and culture, the centers profiles, featuring the
various locations and cities in which our
courses take place, provide a well-rounded
guide, with tips from our faculty members
on hotels, restaurants and essential things
to see and do. This section gives a personalized, local glimpse into our training
centers and their spectacular surrounds.
As with the previous issues, the magazine
Torsten R. Oemus
features relevant clinical cases that demon- President and CEO
strate the particular skills and expertise of Dental Tribune International
Editorial
Clinical Masters™
issue 2017 — 03
[4] =>
Editorial_03.indd
CONTENTS
3
Editorial
Torsten R. Oemus
6
TRIBUNE CME
—Global knowledge, delivered by
world-class faculty in prime locations
8
10
38
Article
Dr. Francesco Maggiore
COMBINED SURGICAL AND NONSURGICAL
— endodontic retreatment for
the management of an unusual clinical case
44
Interview
Dr. Francesco Maggiore
Clinical Masters™ Program in
Esthetic and Restorative Dentistry
46
Profile
Endo Inn, Oslo, Norway
Profile
Master Educational Group, Melegnano, Italy
48
Interview
Dr. Gianluca Plotino
Article
Dr. Domenico Massironi
DR. DOMENICO MASSIRONI
AND THE MODIFIED CHAMFER
Implant Dentistry
50
12
Interview
Prof. Edward A. McLaren
14
Profile
Edudentinternational @ The Geneva Smile Center,
Geneva, Switzerland
16
Article
Dr. Didier Dietschi
SMILE REHABILITATION
— A direct therapeutic approach assisted
by digital diagnosis and mock-up
Clinical Masters™ Program in
Advanced Implant Esthetics
54
Profile
Lake Como Institute, Como, Italy
56
Article
Dr. Fabio Scutellà and
Prof. Tiziano Testori
BUCCOLINGUAL IMPLANT POSITION
AS A CONSEQUENCE OF THE
ABUTMENT SHAPE
— A paradigm shift
64
FACULTY FAVORITES
66
Profile
Steigmann Institute, Heidelberg, Germany
68
Article
Dr. Marius Steigmann
ABOUT THE STEIGMANN INSTITUTE COURSES
70
CLINICAL MASTERS™ TESTIMONIALS
72
Profile
BORG Center, Barcelona, Spain
74
Interview
Dr. Rodríguez Ciurana & Dr. Vela Nebot
76
Article
MIS 2017 GLOBAL LEARNING PROGRAM
78
REGISTRATION FORM
82
IMPRINT
about the publisher
Clinical Masters™ Program in
Digital Workflow and Esthetics
22
Article
Dr. Diego Lops
MANAGING THE PERIIMPLANT MUCOSA:
— A clinically reliable method for optimizing
soft-tissue contours and the emergence profile
26
Profile
Brenna&Levrini, Como, Italy
28
JOIN THE CLINICAL MASTERS™ NETWORK
Anatomical Surgery Course
34
Interview
Prof. Mauro Labanca
Clinical Masters™ Program in
Endodontics
36
Profile
Dr. Arnaldo Castellucci Micro-Endodontics
Training Center, Florence, Italy
04 — issue 2017
Clinical Masters™
Interview
Dr. Louie al-Faraje
Contents
[5] =>
Editorial_03.indd
EXCELLENCE IS IN THE SIMPLICITY
6 direct veneers in upper front teeth: Body i2 & Azur Effect & Skin White
05
SHADING
TECHNOLOGY
DOUBLE CONSISTENCY
SURFACE GLOSS
ERGONOMICS
Discover the unique advantages of this product
designed by Dr. Didier DIETSCHI
By EdelweissDR AG
Unter-Altstadt 28, Mercandor
6300 Zug / Switzerland
www.edelweissdr.com
Form enhancement of 6 anterior teeth: Body i1 & Skin Bleach
[6] =>
Editorial_03.indd
TRIBUNE CME
— Global knowledge, delivered by
world-class faculty in prime locations
The concept of the Tribune CME (continuing medical education) programs is based
on a blended learning approach. Tribune
CME’s mission is to deliver comprehensive, advanced hands-on training in leadingedge dentistry on a global scale through
– Intensive face-to-face clinical educational sessions and practical training,
conducted at specialized state-of-theart training facilities of prominent faculty members, in locations across the
world
– Extensive self-study opportunities via a
sophisticated e-learning platform, as
well as ongoing support, live mentoring
sessions with experts and peers via our
webinars, premium online video training
on demand and the opportunity to collaborate with peers and the Tribune CME
faculty.
– Advanced clinical mentoring guided by
our international faculty with evidencebased dental teaching methodologies.
The result is an unmatched opportunity for
dentists to achieve their most ambitious
goals for professional development and
their practice’s success.
Clinical Masters™ Programs are offered in:
the American Dental Association (ADA)
and provide ADA CERP credits. ADA
CERP is a service offered by the ADA to
assist dental professionals in identifying
quality providers of continuing dental
education.
Esthetic and Restorative Dentistry
Implantology
Endodontics
Periodontics
Laser Dentistry
Upon successful completion, participants receive a Tribune CME certificate,
which is also endorsed by the educational
institutions associated with Tribune
CME.
Personal branding opportunities: Tribune
CME graduates may make use of the
Clinical Masters™ Program logo to promote themselves and their practice both
online and in print. Further learning and
personal branding opportunities for
Tribune CME graduates are available
through the Clinical Masters™ Network.
Tribune CME programs are recognized by
“Practical training
at specialized, state-ofthe-art facilities of
distinguished faculty
members”
FIND US ON FACEBOOK!
www.facebook.com/TribuneCME
06 — issue 2017
Tribune CME
Presentation
[7] =>
Editorial_03.indd
Certificate of participation
CLINICAL MASTER
RS
TM
IN ESTHETIIC
AND RESTORAT
TIV
VE
DENTISTR
RY
This is to certiffy that Dr. John Smith has successffully passed the theoreticcal and
practical examination of the Clinical MastersTM Program in Esthetic and
Restorattive Dentistry, pursuant to the quality criteria of the American Den
e tal
Association and Tribune CME.
Instructors
Scan the QR code!
Join our Facebook page
and engage with the
Tribune CME community
Dr. Didier Dietschi
Drr. Ed Macclaren
Dr. Domenico Massironi
Drr. Stavros Pelleekkanos
Tribune
r
Group
Holbeinstr. 29, 04229 Leipzig, Germany
info@tribunecme.com / tel: +49 341 4847 4134
www
w.T
TrribuneCME.com
Presentation
Tribune CME
issue 2017 — 07
[8] =>
Editorial_03.indd
MASTER EDUCATIONAL GROUP
— Melegnano, Italy
— Dr. Domenico
Massironi
graduated with honors in
medicine and surgery from
the University of Pavia in
Italy and specialized in dentistry at the same university
with honors too. He maintains a private practice in
Melegnano, where he specializes in prosthodontics
and implant dentistry. He
has made use of the stereo
microscope since 1988. In
2013, he founded MEG with
Dr. Carlo Ghezzi.
He is a member of the editorial board of the International Journal of Esthetic
Dentistry and International
Journal of Micro Dentistry.
He is an active member of
the European Academy of
Esthetic Dentistry, a member of the American Academy of Restorative Dentistry, a diplomate of the
International Congress of
Oral Implantologists, emeritus member of Amici di
Brugg and founder of the
CAD/CAM Academy.
Dr. Massironi has presented
courses and lectured at
congresses both nationally
and internationally. He has
published and lectured extensively on fixed prosthodontics and innovative
treatment modalities in
tooth preparation and esthetic dentistry in the field
of dental implant therapy.
He has addressed prominent university faculties,
national and international
dental academies, and professional institutions, and
has gained widespread
recognition internationally.
Dr. Massironi has written
several articles and two
books: Precision in
Prosthetic Restoration,
co-authored with Alberto
Battistelli and Romeo
Pascetta, and Precision in
Dental Aesthetics, coauthored with Romeo
Pascetta and Giuseppe
Romeo, and translated
into numerous languages.
— Dr. Carlo Ghezzi
graduated in dentistry from
the University of Milan in
1999. He has since then
tutored in periodontology
at the university and was a
visiting professor at the university from 2005 to 2010,
teaching mucogingival surgery. In 2010, he opened
Studio Ghezzi, a dental center specializing in periodontal and implant dentistry
with a focus on minimally
invasive treatments.
Dr. Ghezzi is an active
member of the Italian Society of Periodontology and
Implantology. He has lectured at national and international courses and conferences, and has authored
and co-authored scientific
publications in national and
international journals.
08 — issue 2017
The Master Educational Group (MEG)
is an educational center dedicated to esthetic dentistry with a heart-head-hands
approach to clinical teaching and education. It offers innovative continuous education and interaction with dedicated and
talented dentists, who share their passion
with participants in exploring theory, innovations and technologies in a supportive
environment. The center, in addition to educational and technological areas, offers
operating rooms for multiple live sessions.
www.meg-educational.com
Esthetic and Restorative
Dentistry
Profile
How to get there
The center is located seven kilometers
from Milano Linate Airport. From Milano
Linate Airport, you can take a connecting
bus to Milano Centrale train station to the
center of Milan. Then to get from Milan to
Melegnano:
A chauffeur service is available via
www.mydriver.com. Prices vary based on
the car class, with an average of €57 for
economy class, €65 for business class, €80
for a business van and €90 for first class.
Once at Milano Centrale train station,
Line 3 on the subway will take you to
Melegnano in about 20 minutes.
[9] =>
Editorial_03.indd
What to see and do
— In Melegnano
Melegnano is a town in the province of
Milan, in the Lombardy region. The town
lies 16 kilometers southeast of the city of
Milan. For information on Melegnano and
guided visits, inquire at Pro Loco
(www.prolocomelegnano.it), located in
the Medici Castle. It organizes cultural
activities and local events, including exhibitions.
The Medici Castle is home to history, art
and culture. It boasts two imposing
medieval towers and evidence of Renaissance refinement, among them,
sixteenth-century frescos.
The Church of San Rocco was built in the
fourteenth century and has a rococo
façade and an eighteenth-century interior.
The Church of San Giovanni Battista,
located in Piazza Risorgimento, has medieval origins, but was renovated with a
façade of the early 1900s. It is home to
many artworks, among them a painting
by Bergognone.
Castello
Sforzesco
houses several museums, among them,
the Museum of Ancient Art, the Furniture Museum and the
Picture Gallery.
Parco Sempione is a
large park situated in
the historic center of
Milan.
Santa Maria delle Grazie, a church and Dominican convent, is
the home of Da Vinci’s The Last Supper and Where to eat
a UNESCO World Heritage site.
— In Melegnano
Melemangio, within walking distance of
Where to stay
MEG, offers a fusion of the traditional cui— In Melegnano
sine of Parma and Milan, characterized by a
Ibis Styles Milano Melegnano is located modern interpretation and presentation,
5.5 kilometers from the center and offers both satisfying and fun.
MEG special rates.
www.facebook.com/melemangioristowww.accorhotels.com | TripAdvisor
rante | TripAdvisor
Certificate of Excellence | 3-star
Certificate of Excellence
— In Milan
Hotel Milano Navigli
is in the trendy Navigli neighborhood of
historic Milan offering many clubs,
cafés and vintage
shops.
www.hotelmilanonavigli.it | TripAdvisor
Certificate of Excellence | 3-star
— In Milan
Milan, the busy and fashionable Italian capital, is considered the international arbiter
of taste in fashion and design. As one-time
Imperial Roman capital, it combines a rich
history with a strong sense of place.
Duomo Cathedral, a Gothic cathedral in
the heart of Milan, took almost six centuries to complete and astounds with extravagant detail, including 135 spires and
3,400 statues.
La Scala is probably the world’s most famous opera house. It hosts classical concerts as well.
Museo del Novecento, located in the
Palazzo dell’Arengario, accommodates Milan’s museum of twentieth-century art.
Osteria del Portone, also within walking
distance of MEG, serves typical regional
dishes with a modern twist.
www.osteriadelportone.com
— In Milan
Alice Ristorante is an elegant, warm and
welcoming restaurant with its Mediterranean-influenced cuisine updated to suit
current tastes.
www.aliceristorante.it | 1 Michelin star
Armani/Ristorante offers a combination of
Mercure Milano So- style, elegance and sophistication featurlari is located be- ing contemporary cuisine.
tween the city cen- milan.armanihotels.com | 1 Michelin star
ter and the canals, in
the fashion and de- Cracco serves traditional Milanese cuisine
sign quarter, where the showrooms of the updated with a contemporary twist,
biggest names in fashion and most inno- enhanced by a superbly stocked wine
vative designers can be found.
cellar, boasting as many as 2,000 select
www.mercure.com | TripAdvisor
vintages.
Certificate of Excellence | 4-star
www.ristorantecracco.it | 2 Michelin
stars
NH Milano Palazzo Moscova is set in a
grand neoclassical building, which was Joia provides vegetarian haute cuisine.
formerly Milan’s first train station.
www.joia.it | 1 Michelin star
www.nh-hotels.com | TripAdvisor | 4-star
D’O, in Cornaredo, offers colorful, innovaMagna Pars Suites is a former perfume fac- tive cuisine based on authentic Italian ingretory transformed into a stylish luxury hotel. dients. It is not located in the center of Milan,
www.magnapars-suitesmilano.it
but well worth an out-of-town trip.
TripAdvisor Certificate of Excellence | 5-star www.cucinapop.do | 1 Michelin star
Profile
Esthetic and Restorative
Dentistry
issue 2017 — 09
[10] =>
Editorial_03.indd
Dr. Domenico Massironi, Italy
DR. DOMENICO MASSIRONI
AND THE MODIFIED CHAMFER
During the course, Dr. Massironi demonstrated his vision of minimally invasive
dentistry to maintain tissue integrity as
far as possible for a predictable and harmonious result. Over the four days, the
participants were taught the modified
chamfer technique, which can be used
with every type of material and restorative technique currently available.
This marginal finish design is part of a
greater preparation system using rotating
instruments driven by electronic devices,
such as an induction micromotor, and
pneumatic oscillating instruments, without rotation of the working instrument,
that include sonic inserts and manual
instruments, such as rounded chisels. This
method is almost entirely independent of
individual skill and thus suitable for every
clinician, as it is not operator sensitive. It
In mid-October 2016, Drs. Domenico can easily be used by both a novice denMassironi and Stavros Pelekanos held a tist and an expert clinician with immediate
course at the Master Educational Group and reproducible results.
for those wishing to improve their knowledge of esthetic dentistry. Sixteen den- The fabrication of a prosthetic restoration
tists from all over the world attended.
consists of many different steps that
10 — issue 2017
Esthetic and Restorative
Dentistry
Article
[11] =>
Editorial_03.indd
involve both clinicians and dental technicians with the aim of achieving a perfect
anatomical, functional and esthetic integration of the prosthetic restoration into
the patient’s mouth. In this regard, the
preparation of the tooth has always represented one of the most important procedures for the patient’s rehabilitation by
fixed prosthesis.
The modified chamfer described by
Dr. Massironi consists of a preparation
design with a more rounded chamfer curve
compared with the traditional chamfer and
longer than the rounded shoulder, in order
to gain a profile that adapts well to
different types of restorative material. This
modification results in a shallow (and thus
less aggressive) preparation that is less
operator sensitive compared with the
more traditional shapes, such as a rounded
shoulder or 90° shoulder.
The choice of marginal finish for fullcrown prosthetic preparation is usually
according to the clinician’s skill. The latter
depends on what the clinician learned
during his or her undergraduate education
or in postgraduate courses presented by
more experienced colleagues, or his or
her personal expertise. For these reasons,
such choice is often motivated by ease
and experience criteria, though sometimes it may depend on the type of restorative material or on the intrinsic characteristics of the tooth. Furthermore,
abutment height, number of teeth to be
splinted, adhesive cementation system
and esthetic needs may affect the choice.
The proposed modified chamfer design is
innovative and universal, because it may
be adapted to every kind of prosthetic
restoration and marginal closure, including the complete marginal border, the
microborder where the metal, opaque
material and ceramic converge, metalfree methods and CAD/CAM technologies, and shoulder structures or full feldspathic ceramic. Its great versatility is also
associated with its easy clinical use,
because its particular shape makes it less
sensitive to clinical ability; thus, it is less
operator dependent compared with other
common horizontal marginal finish
designs.
The main challenge nowadays is finding
the right balance between a minimally
invasive approach and an excellent esthetic result. Esthetics is a direct consequence
of maintaining the tooth’s health and
function.
Article
Esthetic and Restorative
Dentistry
issue 2017 — 11
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“One has to have some
level of passion. Things
evolved and pathways
opened for me and I just
sort of ended up where
I am, but it was always
something that I was
fascinated with.”
INTERVIEW
with — Prof. Edward A. McLaren
Nathalie Schüller for Dental Tribune International: Prof. McLaren, you began your
career as a general practitioner. What
sparked your interest in esthetic dentistry
and dental design? What were your influences? Perhaps a mentor?
A: I was always interested in dentistry as a
child. After I became a general dentist,
I gravitated toward treating more complex
cases very early on and I wished to specialize. In practicing, I really enjoyed most the
artistic aspect of what I was doing and
I became involved in esthetic dentistry
naturally, because of the interest in that.
I had the opportunity to see the work
of master ceramist Willi Geller when I was
in dental school; it was something I had
never seen or experienced in dental
school—it had not even been talked
about—and it really motivated me. If I had
two mentors, one would be a dentist,
Dr. John Sorensen, and the other a technician, Klaus Müterthies; they took me
under their wings and motivated me to do
what I do.
But like anything, one has to have some
level of passion. I have always enjoyed
working with my hands and the aspect of
esthetic dentistry relating to art is
appealing to me. Things evolved and pathways opened for me and I just sort of ended up where I am, but it was always something that I was fascinated with.
Chairside dentistry is growing, but we have
to adapt to it, change what we do to make
it work. As a doctor, our job is not to adapt
to a technology; our job is to diagnose the
patient and find out what is the best techQ: How important is it to stay up to date with nology available to the patient and then
technological advancements and develop- adapt the technology to the patient. Unments in the field? What does the future hold fortunately, I see it done the other way.
for esthetic dentistry?
A: I read a fascinating book in the early Q: What initially prompted your involvement
nineties about technological changes and in the Clinical Masters™ Program, and what
the need to stay current. In those days, has encouraged you to continue your partechnology was revolutionizing every ticipation? What do you perceive to be the
three to five years, and I think that it is even main benefits of the program for dental
happening at a faster pace now. The author professionals?
emphasized that adult education was im- A: The Clinical Masters™ Program has the
portant to maintain one’s job and retain ability to stay current. The team behind
the ability to function as jobs evolved.
the program work with people who have
Regarding the future of esthetic den- state-of-the-art institutes around the
tistry, the major movement is toward a world. They have the ability to move quickminimalistic approach. The materials are ly if certain instructors are moving up the
improving every day. Right now, I do not knowledge ladder and have the ability to
envision any fundamental changes in the give more current or applicable informashort term other than incredible improve- tion to practitioners. These are really the
ments in what we already have and possibly benefits of these programs. Dental Trithe ability to do 3-D printing of a very bune International as a publishing company
complex colored ceramic restoration, has the ability to market well. This synergy
which will not necessarily affect dentists makes it work: having the right faculty,
per se, but will affect esthetic dentistry. facilities, current materials, company
12 — issue 2017
Esthetic and Restorative
Dentistry
Interview
[13] =>
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partners, as well as a publishing company
that can adequately and exceptionally
market these courses. In the end, all those
things figure in to making a great Clinical
Masters™ Program.
something is going to work as reported Life is a long process and it would be horuntil we have a few years of experience rible to hate what one does for one’s whole
using them.
life.
Q: You teach photography as well. It is an
important tool when making a presentation
at a congress or showing a patient the envisioned treatment outcome. Does it also help
the dentist achieve what he or she needs to
do or is it more for the patient, when the
dentist needs to explain or present
something?
A: Photography and cameras have evolved
so much. Visuals have very high impact for
people: a picture is worth a thousand
words—I think it is worth 10 billion words
if it is the right picture. Any dentist performing esthetic dentistry or anybody
educating a patient does not need to become a master, but definitely needs to
become a reasonable photographer. I am
Q: Is that what appeals to you about the
Clinical Masters™ Program? You are certainly busy and do enough traveling not to have
a need to come all the way to Europe.
A: Yes, I love teaching, but the hopping in
airplanes is getting really old. As one goes
through one’s career, one spreads oneself
and moves in every direction. After a while,
one comes to a phase in which one falls in
with a specific group, like working with
Yannis Roussis in Greece and Dental Tribune, who consistently do a great job of
sponsoring programs and putting on programs. As one human being one can only
do so much, so one ends up gravitating to
the people who have
success, who have staying power. I want to be
a teacher to do what I
do and let other people
who have the expertise
and determination, like
Dental Tribune, do what
they do best. I think that
is the best way to marry
these things. I am a professor at a university
and most universities
generally do a poor job
at postgraduate education; a private company
like Dental Tribune has to stay current or constantly surprised and it bothers me a
it would not stay in business.
little bit that, when it comes to esthetic
dentistry, I see so many people teaching
Q: When I see presentations on esthetic den- portrait classes, really cool classes in which
tistry and the possibilities, I wonder how they are painting lips and so on, taking inmuch more can be achieved; how can the teresting shots, great pictures, artistic to
industry go beyond what is already possible. put on one’s wall, but relative to educating
Are you constantly surprised by the new a patient, I would hope that how to take
techniques and possibilities that arise?
good dental images should be the focus.
A: It seems that there has been incremental improvement of what we already had. Q: You mentioned to me that you are pasObviously, the major achievement that has sionate about what you do. Tell me why. Is it
most impressed people is implants and the because of what it brings to you, what it
improvements there. I would say IPS e.max brings to others, or both?
is a revolutionary material, a really high- A: Yes, I mentioned to you that I am one
strength glass-ceramic, and it appears that of the more unidimensional people you will
we are also going in that direction with ever meet. I think, dream, have nightzirconia, gaining more translucent zirconia. mares, 24 hours a day about teeth; it is in
Those are probably the two areas of ma- my consciousness. One just finds someterials that have developed pretty well. thing one is passionate about, like an artist
I would caution the reader though that we who is passionate about his art. When he
do not have any long-term clinical data for has free time, that is what he does. When
any of these materials, so while they do I have free time, I make teeth. It is fun for
look better, we just do not know if me; it puts me in a special state of mind.
Q: You do your own ceramics. Would you say
that you are a perfectionist or an artist in
your own way?
A: I would like to define myself as an artist.
The more I do that, the more artistic I feel,
the more passion I feel toward esthetic
dentistry and designing smiles. First of all,
one needs to define oneself in a certain
way. A musician is someone who just plays
music, even if she is not very good at it. It
really does help one’s mindset, because we
tend to be self-negative. If one truly wants
to be something, one has to start seeing
oneself doing it.
Q: Is creating your own ceramics also because the results you envision are difficult to
relate to others or it is
difficult to let someone
else do it for you?
A: I would not recommend dentists learn to
do ceramics themselves. Like anything
else, it takes five to ten
years to become pretty
good at it. I do it just
because—and this applies generally to the
things that I do—it is the
thing that gets me into
the most peaceful
state. When I am with
patients, sometimes I am stressed, the
phone is ringing, so even though I love
doing that, when I sit down and create ceramics, it just puts me in such a state of
bliss. That is what I enjoy most about it.
Many dentists take my course thinking
they want to save money by not paying a
ceramist; well, that is the worse reason to
do it. It has to be something that one is
passionate about. What makes a good
esthetic dentist? Someone who likes art,
whether doing the teeth himself or herself,
as composites, or having to evaluate what
is good and bad dental art. That requires a
certain personality. Some people have it,
some do not and one just needs to be honest with oneself. It is about finding something that does not feel like work when one
is doing it; one just enjoys it.
“Any dentist performing
esthetic dentistry definitely
needs to become a
reasonable photographer.”
Interview
Esthetic and Restorative
Dentistry
issue 2017 — 13
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— Edudentinternational
@ The Geneva Smile
Center
The educational goal of
the Geneva Smile Center
– Edudentinternational
teaching facility is to share
long-term experience
and knowledge in conservative adhesive and esthetic
dentistry with visiting
colleagues, helping them
reach their full potential through comprehensive
lectures and hands-on
programs. The center
provides an inspiring, comfortable and efficient setting equipped with stateof-the-art audiovisuals,
including Zeiss microscopes
for each participant and
a 4K-resolution demonstration system. Our vision is
to inspire and lead dentists
to develop confidence and
proficiency and achieve
excellent clinical results to
enjoy a more satisfying and
successful professional life.
— Dr. Didier Dietschi
received his D.D.M. in 1984,
his M.D. in 1989, his Ph.D.
in 2003 and his habilitation
qualification (postdoctoral)
in 2004, all from the University of Geneva. He is
currently a senior lecturer
at the university and is an
associate professor at Case
Western Reserve University
in Cleveland, Ohio, U.S. Dr.
Dietschi is in charge of
anterior adhesive restorations
and periodontal and
implant surgery at the
Geneva Smile Center.
Location
The Geneva Smile Center is located on
Lake Geneva, Europe’s largest Alpine lake,
near its landmark fountain. The main
shopping area in Geneva is just a few minutes away from the center. Geneva, a
trendy paradise, is in the French-speaking
part of Switzerland and home to the
European headquarters of the United
Nations, among over 200 international
organizations. It is a city of culture and art
and one of the greenest cities in Europe
with 20 percent of it green areas, earning
it the appellation “City of Parks.” It is close
to some of the best ski areas in the Alps.
www.edudentinternational.com
14 — issue 2017
EDUDENTINTERNATIONAL
@ THE GENEVA
SMILE CENTER
— Geneva, Switzerland
How to get there
The center is located seven kilometers
from Geneva International Airport.
It will take about 30 minutes to reach the
center by taxi in good traffic conditions.
An alternative is to take the No. 10 bus to
the bus stop near Genève-Cornavin railway station (the stop is called “22-Cantons”), change to the No. 9 bus and get
off at Place des Eaux-Vives.
What to see and do
Follow the story of the Genevan humanitarian movement by visiting the International Red Cross and Red Crescent Museum.
Visit the Globe of Science and Innovation
at CERN, the world’s largest laboratory
for particle physics.
Climb the 157 steps of the twelfthcentury Cathédrale Saint-Pierre for a
breathtaking view of the city.
Esthetic and Restorative
Dentistry
Profile
See the over 6,500 flowers and plants of
the Flower Clock, a fine example of Swiss
precision, in the Jardin Anglais.
Take a guided tour of the Palais des Nations, which houses the United Nations Office
at Geneva (www.unog.ch).
Go skiing in the Alps. Chamonix and Mont
Blanc are located 80 kilometers away.
Megève, 70 kilometers away, originally conceived in the 1920s as a destination for the
aristocracy, is a famous and fancy ski resort.
A lake tour (www.keytours.ch) offers a
wonderful way to discover Geneva.
Explore the shops and antique dealers of
Carouge, close to the city centre, by day
and its trendy bars by night.
Visit the luxury boutiques along the rue
du Rhône to see timepieces of beauty and
indulge at the master chocolatiers.
Go on an outing to the village of Dardagny
to walk among the vineyards and sample the
local wines.
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Shutterstock537792919
Hôtel de la Cigogne, located between the
Old Town and Lake Geneva, occupies a
charming historic building and its accommodation is distinguished by luxury, elegance, comfort and artistry.
www.cigogne.ch | TripAdvisor Certificate
of Excellence | 4-star
Where to stay
The following hotels are all located close
to the Geneva Smile Center and the town Swissotel Métropole, on the rue du Rhône,
center:
the most luxurious shopping street in
Geneva, is a stylish boutique hotel with a
Hôtel Les Armures, ideally located for you panoramic view over Lake Geneva.
to discover the hidden treasures of www.swissotel.com/hotels/geneva
Geneva’s Old Town, is an intimate luxury | TripAdvisor Certificate of Excellence
hotel with origins dating back to the thir- 5-star
teenth century.
www.hotel-les-armures.ch | TripAdvisor Hôtel Longemalle, close to the lake and the
Certificate of Excellence | 5-star
Jardin Anglais, is a haven of tranquility on
the edge of the Old Town.
Hôtel de la Paix, built in 1865 and overlook- www.longemalle.ch | TripAdvisor Certificate
ing the lake, offers refined luxury with a of Excellence | 3-star
contemporary design that retains the elegance of the original Italian architecture. Fraser Suites, ideally located at the center
www.ritzcarlton.com | TripAdvisor Certificate of town. Home with a touch of luxury.
of Excellence
www.geneva.frasershospitality.com
Profile
Esthetic and Restorative
Dentistry
Where to eat
Vertig’O, a restaurant at the Hôtel de la
Paix offering gourmet French cuisine
www.ritzcarlton.com | 1 Michelin star
Le Patio, cuisine almost exclusively based
on lobster and beef
www.lepatio-restaurant.ch
Brasserie Lipp, a typical French brasserie
www.brasserie-lipp.com
THAÏ, authentic Thai gastronomy
www.thai-geneve.com
La Finestra, a cozy restaurant in the Old
Town serving delicious cuisine with an
Italian flavor www.restaurants-geneve.ch
Café Papon, casual French restaurant in
the Old Town www.cafe-papon.com
For more information visit:
www.geneve-tourisme.ch
issue 2017 — 15
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SMILE REHABILITATION
— A direct therapeutic approach assisted
by digital diagnosis and mock-up
Dr. Didier Dietschi, Switzerland
A successful rehabilitation in the esthetic
zone depends on criteria that are wellknown today, and the use of a direct technique is not an exception to the rule. On
the contrary, a general approach without
preparation—or at least an ultraconservative approach (reshaping the enamel or
preparing a cavosurface bevel if necessary)—might even add a hint of additional
complexity. As a reminder, the most
impor tant parameters that must be considered are the following:
– the integration of the shape (teeth in
relation to the smile and the face) and
implicitly its impact on function;
– the shade in the broad sense (in relation
to the tissue and the adjacent teeth),
encompassing mainly the color, the
luminosity/translucency, the chroma,
the opalescence and the fluorescence;
– the surface micromorphology and the
luster of the restorative material; and
– the biological, functional and esthetic
continuity of the restorations.
When considering a rehabilitation in
young patients, who often need professional dental care from their teenage
years, the direct technique is most frequently required because of the anatomical and functional immaturity of the
dental arches. The procedure should include the use of a material or technique
that will make possible the necessary adjustments and modifications resulting
from the ongoing bio-functional dental
development of the patient. Among the
criteria to be considered when selecting
the composite system, the material
strength and its ease of use should be prioritized in order to achieve an optimal
16 — issue 2017
esthetic result. The layering technique
must therefore be effective and simple;
in other words, it is futile to perform complicated multilayering methods in the
daily practice and there is a definite advantage to using products that are based
on the Natural Layering Concept (e.g.,
inspiro, Edelweiss DR; Miris, Coltène/
Whaledent; Essentia, GC; Enamel HRi,
Micerium). This article will highlight the
advantages of this technique that, as its
name suggests, makes use of the anatomical characteristics of the natural tooth
(contour, volume and thickness of the
dentin and enamel). This significantly simplifies the clinician’s work, provided it is
associated with functional and esthetic
planning tools, as described next.
Once the choice of therapeutic approach and restorative system has been
confirmed, it is very important to develop
a comprehensive esthetic and functional
plan in order to improve the communication with the patient and to help the dentist to elaborate his or her restorative and
layering techniques if needed. Nowadays,
simplified approaches are available, compared with the conventional wax-up and
hand-fabricated acrylic mock-ups; indeed,
digital imaging and even programming
tools of numerous CAD/CAM systems
(e.g., CEREC, Dentsply Sirona) offer innovative solutions, also outlined in this
article.1, 2
A successful treatment, especially an
esthetic treatment, relies on the implementation of a standardized therapeutic
approach and clinical protocol, including
ideally any development aiming to make
them more reliable and simpler. The esthetic treatment plan using software tools
(general software, dental software or a
CAD/CAM system) has made a comeback
and its use has become more prevalent,
and is likely to remain so.1, 2 Besides a
Esthetic and Restorative
Dentistry
Article
legitimate concern of simplification and
cost-effectiveness, the thrust of this approach is to contextualize and allow the
preview of the treatment during planning,
before any procedure has been performed in the mouth. The advantage is
twofold, both in terms of communication
and prior acceptance of the result by the
patient. Of course, sensitive situations
with patients who had expected a result
that is impossible to achieve with the therapeutic means at the clinician’s disposal
should be avoided.
With regard to the choice of restorative
material, while also attempting to meet
the multiple requirements related to the
dental biomechanics, function and the
esthetic aspects, the decision criteria
should be redefined in light of the latest
developments in composites and their
longevity properties. A comprehensive
perspective encompassing the long-term
outcome of the tooth and its restoration
should be explained to the patient in order
to assist him or her in determining the
most appropriate choice. Very often, the
best way is to sacrifice the weakest tissue.
Today, a basic approach involving the use
of direct composite resins in addition to
whitening and microabrasion would therefore be a sensible approach for young
patients in need of esthetic treatment, as
highlighted in this article. In this area, a
concept embracing both the shade and
the layering has gradually established itself as the most effective solution.
Editorial note: A list of references is available from
the publisher.
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Fig. 1
Fig. 2
Fig. 1
Pre-op view of a young
patient (14 years old) with
hypoplasia of all of her
anterior teeth (canine to
canine, both jaws).
Figs. 2 & 3
A mock-up was designed
with the CEREC system,
using the veneer program.
The trial shows the
improvement in terms of
form and overall smile
design.
Fig. 3
Article
Esthetic and Restorative
Dentistry
issue 2017 — 17
[18] =>
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Fig. 4
A specific and innovative
bilaminar shade guide
for the clinical application
of the Natural Layering
Concept (i.e., the inspiro
system).
Fig. 4
Fig. 5
The shade selection consists
of two steps, namely the
selection of the dentin and
enamel shades with two
separate samples, which are
then to be combined
with a drop of glycerin gel
between them to favor
good light transmission
through the assemblage.
Fig. 5
Fig. 6
The combined samples are
then applied edge to edge
to check color match.
Here, dentin shade Body i1
and enamel shade Skin
Bleach were selected
(inspiro).
Fig. 6
18 — issue 2017
Esthetic and Restorative
Dentistry
Article
[19] =>
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Figs. 7 & 8
The silicone index made
from the mock-up is used
to place a very thin layer
of flowable composite
(Skin Bleach) to serve as
a matrix for the layers to
follow.
Fig. 7
Fig. 8
Fig. 9
Dentin is built over the
facial natural enamel
surfaces, which were not
prepared at all in this
case, taking advantage
of the overall increase
in tooth volume and
dimension. Dentin is
shaped as the natural
dentin core, with lobes.
Fig. 9
Article
Esthetic and Restorative
Dentistry
issue 2017 — 19
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Fig. 10
A single enamel shade
covers the dentin and
finalizes teeth volume
and form.
Fig. 10
Figs. 11 & 12
Intra-oral views of the
no-preparation restorations placed with the
Natural Layering Concept,
showing the significant
potential of direct
techniques to enhance
natural or postorthodontic smiles in
young patients or anyone
seeking optimal tissue
conservation.
Fig. 11
Fig. 12
20 — issue 2017
Esthetic and Restorative
Dentistry
Article
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MANAGING
THE PERIIMPLANT
MUCOSA:
— A clinically reliable method
for optimizing soft-tissue contours
and the emergence profile
Drs. Andrea Parpaiola, Luca Sbricoli,
Riccardo Guazzo, Eriberto Bressan &
Diego Lops, Italy
Introduction
— Dr. Diego Lops
22 — issue 2017
Distinctive characteristics of the periimplant mucosa differentiate it from periodontal tissue.1 The difference lies in the
absence of cementum. In fact, the collagen bands lie differently at the site of the
implant. The fibers are set in the periosteum at bone crest level and spread parallel to the implant surface, or they align
in broad bands that, in more distant areas,
expand almost perpendicular to the implant surface. These horizontal fibers
seem to bend vertically and appear to
run parallel to the implant’s surface in
the areas nearest to the implant.1, 2 The
connective tissue at the implant interface contains a larger amount of collagen, but fewer fibroblasts and vascular
structures, than the tissue adjacent to
natural tooth structure. 3
The successful restoration of lost
teeth in the anterior region of the mouth
has to meet both esthetic and functional parameters. In addition to the correct
placement of the implant fixture, it is
essential to achieve a soft-tissue morphology that is as physiologically realistic
as possible. An impression obtained with
standard copings enables the 3-D position of the implant fixture to be reproduced on a laboratory model. However,
the reproducibility of the periimplant
soft tissue is often difficult to control,
and this can compromise esthetics in the
final implant restoration. Most healing
abutments have a cylindrical shape,
which is not suitable to reproduce
Digital Workflow and
Esthetics
Article
correctly the emerging profile of the
natural teeth. The dental technician can
model an implant-supported prosthesis
with a cylindrical profile or with a more
appropriate esthetic profile based only
on an assumption of the shape suited to
the clinical situation. In fact, final tissue
heights of the papillae and buccal gingival margins, relative to their pre-implant
position, are ultimately dictated by the
post-healing levels and position of the
interproximal and facial bone.
Because of its characteristics, the
periimplant mucosa can be modified by
a sculpting process based on the principle that soft tissue becomes modifiable
after controlled, constant compression.
Especially in patients with a thick gingival
biotype, this tissue can be manipulated
to reproduce the normal scalloped, parabolic gingival contours. Different approaches have been suggested by the
current literature on soft-tissue profiling.4–6 All of these focus on establishing
a contour of the provisional prosthesis
that is as accurate and stable as possible
so that it can be faithfully reproduced in
the definitive prosthesis.
The present paper describes a method
that has been consolidated over several
years of clinical practice for the periimplant soft-tissue profiling in the anterior
areas. By following the procedure described in the next section, it is possible
to recreate, in cooperation with the dental
technician, the correct emergence profile for both single and multiunit prostheses.
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Fig. 1
Fig. 2
Fig. 1
A screw-retained
provisional restoration.
Fig. 2
The soft-tissue aspect
after conditioning with
provisional crowns.
Figs. 3a–d
The provisional restoration
is unscrewed from the
oral cavity, screwed to a
laboratory implant
analogue and embedded
in casting material (a).
Polyether material
poured at the level of the
prosthetic emergence
profile and surrounding
provisional crown (b).
Removal of the
Provisional (c).
A conventional impression
coping screwed on (g).
(d). Note the gap between
the standard coping and
impression material.
Figs. 3a–d
Clinical procedures
This prosthetic procedure is to be used
after the healing of the periimplant
soft-tissue by means of standard healing
abutments so that a round shape of the
periimplant mucosa can be achieved. An
impression can then be obtained by
screwing the standard pickup coping to
the fixture. A polyether (Impregum, 3M
ESPE) material can be used for the impression in order to provide a provisional
screw-retained prosthesis (Fig. 1).
This provisional restoration is provided to
create and condition the periimplant
soft-tissue contours, thus reproducing
the physiological scalloped, parabolic appearance and the tropism of the adjacent
gingiva. The resin provisional prosthesis is
kept in the oral cavity for a period of three
to six months to ensure a stable outcome
of the periimplant soft-tissue conditioning process. During this period, the patient should be followed monthly and the
clinician should adapt the provisional
prosthesis by adding or removing small
Article
Digital Workflow and
Esthetics
amounts of resin as necessary in order to
obtain the required shape for the gingival
contours and the appropriate emergence
profile. This conditioning process has to
be carried out gradually to avoid excessive
compression, which would cause unacceptable discomfort for the patient.
Once the required gingival morphology
has been achieved (Fig. 2), the procedures
for providing the definitive restoration can
be carried out. The implant analogue is
embedded into laboratory stone (or plaster) in a mixing cup and allowed to set. This
issue 2017 — 23
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Figs. 4a–d
Figs. 4a–d
Acrylic resin poured into
the gap (a). The customized
impression coping obtained
after resin polymerization
(b). The customized coping
screwed to the implant
maintains the conditioned
esthetic contour (c). The
customized coping in the
definitive impression (d).
procedure can be done prior to the clinical
appointment to save chair time. At the
time of the clinical appointment, the provisional restoration is removed from the
oral cavity and screwed to the implant analogue. A polyether material is then placed
into the mixing cup (Fig. 3a) so that the
provisional restoration is put into the impression material at the level of the prosthetic emergence profile (Fig. 3b).
This generates a static reproduction of
the soft tissue and in particular of the subgingival portion of the provisional prosthesis. After polymerization of the polyether,
the provisional prosthesis is unscrewed
(Fig. 3c) from the implant analogue and
replaced, in the same supporting cup, with
the stock hexed transfer coping for the
final impression. A space is thus created
between the polyether material and the
24 — issue 2017
impression transfer coping (Fig. 3d); this
space reproduces the morphology of the
periimplant soft tissue. Such procedures
are more suitable for screw-retained provisional restorations because of the simple
removal of the provisional prosthesis from
the implant analogue in the mixing cup.
Next, cold self-curing resin (TEMP RED,
Micerium) is poured into this gap and left
to set (Fig. 4a). A custom transfer coping
for this single implant site is thus obtained
(Fig. 4b). This modified transfer coping is
then removed and screwed on to the implant in the oral cavity (Fig. 4c). The resulting device is an exact periimplant
soft-tissue replica and fits perfectly to the
shape of the marginal mucosa after the
soft-tissue conditioning. No compressive
effect on the mucosa or impression material gaps are generated by the rigid resin
around the transfer coping as sometimes
occurs with the silicone or polyether materials commonly used for precision impressions. A conventional impression can
then be taken. By means of a custom impression device, a definitive impression is
obtained, so the customized transfer coping with the resin remains embedded in the
Digital Workflow and
Esthetics
Article
impression material on the device (Fig. 4d).
Finally, a CAD/CAM abutment can be provided to reproduce the emergence profile
obtained with the provisional prosthesis.
The definitive restoration will be put into
position and naturally follow the scalloped
periimplant marginal mucosa (Fig. 5a). A
stable outcome can be achieved because
of the absence of any soft-tissue compression (Fig. 5b). This method may be used
for the restoration of both single and multiple gaps (Fig. 6).
Discussion
An emergence profile that mimics the
natural tooth should be obtained for successful esthetic implant restoration.
Moreover, it allows proper hygiene, which
is fundamental for implant maintenance.5
The best way to achieve the correct emergence profile is to sculpt the periimplant
mucosa by means of a provisional prosthesis. Only the thick gingival biotype can
be manipulated, as postulated by
Berglundh et al. 3 and Simeone et al.4 In
fact, the thin gingival biotype is not
[25] =>
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Fig. 6
Figs. 5a & b
Figs. 5a & b
Final restoration at baseline
(a). Final restoration one
year after the prosthesis
delivery (b).
Fig. 6
Soft-tissue aspect after
conditioning with provisional crowns for restoration with a four-unit
partial fixed prosthesis.
suitable for sculpting because its compression does not lead to a controlled
scalloping, but to a high risk of soft-tissue
collapse and gingival recession.7
Standard healing abutments and transfer copings do not simulate the crosssection of natural teeth8 because they are
round. Many authors agree that the final
prosthetic rehabilitation must match the
intraorally obtained soft-tissue modifications.5, 9–11 Prefabricated provisional crowns
cannot mimic the complexity and the variations of human soft tissue. Therefore,
only a chairside modification of the provisional restoration can accomplish the optimal result. Moreover, the same authors
agree that provisional restoration has to
be screw-retained to prevent the irritating
side effects of provisional cement on the
periimplant soft tissue, especially in situations in which frequent removals of the
provisional restoration are required. In
addition, crucial for achieving a successful
esthetic outcome is the transfer of the
impression information to the dental laboratory.12 The operator should choose an
easy and reproducible technique to transfer the emergence profile to the impression and therefore the model cast in order
to allow the dental technician to create a
suitable contour for the best esthetic outcome of the final restoration.
The self-curing resin used for contouring the impression coping is common in
the dental practice; moreover, it is easy to
manipulate and inexpensive. It can be
easily poured into the gap between the
coping and impression material as long as
it is fluid. Because of its low shrinkage, the
modified impression coping accurately
reproduces the soft-tissue contour
Article
Digital Workflow and
Esthetics
obtained with the provisional restoration.
Consequently, the exact shape of the
resin-generated emergence profile will be
transferred to the definitive restoration.
Another important advantage of this
technique is that the patient is not left
without the prosthesis for a long period
during the definitive impression procedures; in fact, the customized transfer
coping can support the periimplant
mucosa. Tissue collapse and volumetric
changes will be avoided and the softtissue sculpting will remain stable. Furthermore, the technique presented is
easily reproducible and does not require
particular operator skills.
Conclusion
In highly demanding areas, where a good
esthetic outcome is as essential as the
function of the implant-supported restoration, soft tissue can be modified to
obtain an optimal emergence profile and
gingival contours with a physiological
appearance as realistic as possible. The
method described allows for faithful reproduction of the conditioned soft tissue
when the final impression is taken; thus,
its reproduction on the definitive restoration is possible. The main advantage of
this approach is the easy and reproducible
use of an inexpensive material that is
easily available to clinicians.
Editorial note: A list of references is available from the publisher. This article was
first published in the Journal of Esthetic
and Restorative Dentistry (Vol. 25, No. 5,
2013, 317–23).
issue 2017 — 25
[26] =>
Editorial_03.indd
such as CAD/CAM, esthetic restorative
dentistry, clear aligner treatment and
sleep disorder treatment. It is possible to
attend both theoretical and practical
courses, as well as perform live surgery.
The center occupies a total area of
1,000 m2 and operates 13 dental chairs.
Furthermore, it features 15 laboratory
seats to create a combined course for dentists and their technician colleagues.
If more than a short clinical course is
desired, there is also the possibility of
organizing a tailor-made clinical course for
a small group of clinicians on a variety of
topics, in which they will assist Dr. Franco
Brenna or Prof. Luca Levrini in their clinical activity on a daily basis.
Brenna & Levrini is open to collaborating with the industry to organize continuing education for clinicians in an innovative
clinic, located in one of the most popular
tourist destinations in the world. This
offers the perfect combination of excellent education along with an exclusive
travel experience.
CONTINUING
DENTAL EDUCATION
IN LAKE COMO:
BRENNA & LEVRINI
Brenna & Levrini and Associates provides
dental care and education in Lake Como,
Italy. The project of creating a facility
entirely devoted to dental care originated
long ago on the shores of one of the most
beautiful lakes in the world and the center
opened its doors in late 2015. The dream
was combining excellent professional
treatment for patients along with the possibility of educating students and colleagues in the same context.
The merging of both an academic background and hands-on expertise was the
backbone of the project. The vision was
providing comprehensive care and education based on the belief that delivering
dental care via an interdisciplinary clinical
pathway would enhance the patient experience and the treatment outcome.
In keeping with this line of thought, the Further information can be obtained at
educational courses offered in the clinic info@brennalevrini.it
cover a wide range of cutting-edge topics, and on +39 031 570355.
26 — issue 2017
Digital Workflow and
Esthetics
Profile
[27] =>
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[28] =>
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JOIN
THE CLINICAL MASTERS™
NETWORK
APPLY NOW!
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28 — issue 2017
Clinical Masters™ are featured as top experts with a profile page on
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their research with a broad audience, provides international advertising
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Clinical Masters™
Network
Presentation
[29] =>
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Clinical Masters™ are encouraged to
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Do you have impressive cases and materials to prove your experience? Please
submit them to us to be admitted as a
member of the Clinical Masters™ Network
after review and approval by our faculty.
Clinical Masters™
Network
Presentation
issue 2017 — 29
[30] =>
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THE THE CLINICAL MASTERS™
NETWORK
— The following experts offer our Clinical Masters™ Programs
at eight advanced education centers in beautiful locations:
— Dr. Marius Steigmann
Steigmann Institute – Heidelberg, Germany
www.steigmann-institute.com
— Dr. Louie
ie al-Faraje
al-F
California Implant Institute
stitute – San Diego, California, U.S.
www.implanteducation.ne
et
ier Vela Nebot
BORG Center – Barcelona, Spa
Spain
www.borgbcn.c
.com
— Dr. Didier Dietschi
Edudentinternational @ the Geneva
Smile Center – Geneva, Switzerland
www.genevasmilecenter.ch
The Clinical Masters™ Network
www.Clinical-Masters.com
30 — issue 2017
Clinical Masters™
Network
Presentation
[31] =>
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— The Clinical Masters™
Network is a select group
of dental professionals
from all over the world
who are distinguished for
their skills and expertise.
You too can join this
network by successfully
completing one of our
Clinical Masters™ Programs or by submitting
cases to demonstrate
your experience and
expertise.
— Dr. Domenico Massironi
Master Educational Group
Melegnano, Italy
www.meg-educational.com
— Dr. Franco Brenna & Dr. Luca Levrini
Levrin
Brenna&Levrini – Como, Italy
www.brennalevrini.it
— Prof. Tiziano Testori
Lake Como Institute – Como, Italy
www.lakecomoinstitute.com
— Dr. Arnaldo Castellucci
Dr. Arnaldo Castellucci
Micro-Endodontics Training Center –
Florence, Italy
www.endocastellucci.com
Clinical Masters™
Network
Presentation
issue 2017 — 31
[32] =>
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Tribune CME would like to invite you to join a
select group of the world’s most successful
clinicians at the Clinical Masters™ Network
—with a unique opportunity to become a
featured top expert!
The Clinical Masters™ Network is an international community of prominent
dental specialists who have completed the Clinical Masters™ Programs.
There are a host of advantages to being a
member of the growing Clinical Masters™
Network, including the following:
– Exclusive inclusion in the global Clinical
Masters™ list of top dental professionals around the world.
– Full access to our growing library of
learning resources.
– The opportunity to market yourself
through advertisements, newsletters
and social media shared with a global
community of dental experts and prospective patients.
– The ability to share your knowledge and
expertise on topics in your specialty and
establish yourself as a thought leader in
your region.
– Networking with distinguished dental
experts around the world.
So how can you get involved?
Visit www.clinical-masters.com to register—it only takes a few
minutes and is completely free!
32 — issue 2017
Clinical Masters™
Network
Invitation
[33] =>
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[34] =>
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INTERVIEW
with — Prof. Mauro Labanca
“The course is
not aimed at
any particular
group based on
their experience
or age; we
provide a map
of anatomical
surgery.”
Q: Prof. Labanca, how did you become involved in the Clinical Masters™ Program?
A: I started offering this course in Brescia,
Italy, in 2001, once a year, to Italian-speaking dentists. From 2005, I also offered the
course in Vienna, Austria, still for Italian
dentists, until 2015. Starting in 2016,
I brought it back to Brescia, where I teach
anatomy at a medical school. It has been a
great success; so much so that last year we
had to offer two courses in Italy and had
many new participants who learned about
it from their colleagues. This means that
we have to do very little to promote it.
I wanted to bring this course to an international audience as well and started to
offer the course again in Vienna in 2016,
but in English. I had known about and been
34 — issue 2017
interested in the Clinical Masters™ Program as a mean of making the course international. I feel our course is so important and unique that dentists all over the
world could benefit from it. Becoming part
of the Clinical Masters™ faculty gave me
a great opportunity to do so.
Q: For what reason did you decide to offer
your course in Vienna rather than Italy, since
you were already offering it there?
A: This is an essential course and it can only
be given in an anatomical institute, not in
a dental school or in any private venue.
Mainly, the location in Italy did not allow
us to offer the course to as many participants as we could (12 in Italy, 20 in Vienna).
Also, Vienna is more central and thus more
Anatomical
Surgery
Interview
accessible from other countries, so it is
better suited as an international location.
Q: Why do you think there is a need for this
course? Do dentists not receive this kind of
training during their studies?
A: There is usually a huge lack of information about anatomy. The participants in this
course may be students or practicing dentists. Perhaps they do not have enough
experience of surgical treatments or they
might have done their surgical training
without sufficient anatomical guidance.
Learning more about anatomy is the right
way to start. In a way, it is like getting a
map of a city. One might need a map of
Vienna because one is new to the city and
needs to find one’s way about or because
[35] =>
Editorial_03.indd
“There is usually a huge
lack of information about
anatomy. The participants
in this course may be
students or practicing
dentists. Perhaps they
do not have enough
experience of surgical
treatments or they might
have done their surgical
training without sufficient
anatomical guidance.
Learning more about
anatomy is the right way
to start.”
one has been living there for years, but did
not know enough of the city. A map will
allow one to understand why it is better to
go this way, move in this or that direction.
The course is not aimed at any particular
group based on their experience or age;
we provide a map of anatomical surgery.
Through this course, participants will gain
more skills and confidence in moving inside
the “city”, guided by the anatomical landmarks of their patients.
Q: What would you say are the most important aspects that make this course unique?
A: There is a major difference between this
and other courses in which cadavers are
dissected. In anatomy, dissection is useful
and important, but not for learning how to
perform surgical procedures.
Our course is an anatomical and surgical
course. We demonstrate the most important surgical procedures, for example a
sinus lift augmentation, guided by the
anatomy. We do not tell the participants
how to perform a sinus lift, since the
course is not about surgical techniques or
the materials and instruments they need,
as well as the latest versions available on
the market. The advantage for companies
is that they can assist the participants who
use their products and share the information about the course.
Lastly, we work with fresh specimens,
not fixed ones. If one uses a fixed specimen
in performing anatomical procedures,
some structures are lost. A fixed specimen
is perfect for dissection where one only
needs to see the anatomical structure that
is the focus, but one needs to see the most
important structures, the nerves and arteries, in performing any surgical procedure. The fresh specimens are frozen and
kept at –80 °C and then thawed so that
they are perfectly preserved and their anatomical structures clearly recognizable.
With our specimens, all the arteries have
been injected with a special rubber (red
resin) to retain the same dimensions and
consistence of those of a living patient.
which procedure should be used. Technique and surgical procedure are mainly a
matter of personal preference or background. Our goal is to give participants, no
matter the technique they use, information to avoid anatomical risks. For example,
in placing an implant, we focus on the relevant anatomical structures to be considered. That is the main issue. Surgical techniques may be different, but anatomy is
the same all over the world.
Furthermore, this is the only current
noncommercial course. Companies provide us with materials of course, but they
are partners and supporters only. My colleagues, professors of anatomy whom I
teach with, and I are totally independent.
We do not receive payments from any of
the companies that provide materials and
instruments, allowing us to maintain our
independence. We seek to share anatomical information, and this is not linked to
products or materials as surgical procedures are. We have an association with 15
companies, the most significant in their
field. The participants have access to all
Interview
Anatomical
Surgery
Q: How is the course organized? How many
people attend the course?
A: We have ten workstations at which the
twenty participants work in pairs. Every
workstation has two tutors, one for anatomical questions and one for dental and
surgical questions. Questions arise in both
disciplines and I can answer the ones related to surgery, but an anatomical specialist answers questions on the anatomy.
Anatomy is a very wide field and our tutors
are full professors specialized in orofacial
anatomy.
Such topics as diagnosis, developing a
treatment plan, biological assessment,
guided surgery and using the materials
available are covered during the teaching
section. In the practical part, we perform
surgical techniques to demonstrate the
areas of risk, prevention and management
of failures, and pain management in
dentistry.
issue 2017 — 35
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DR. ARNALDO CASTELLUCCI
Micro-Endodontics
Training Center
— Florence, Italy
Location
Dr. Arnaldo Castellucci Micro-Endodontics Training Center.
With over 35 years of practice, Dr. Arnaldo
Castellucci is an internationally recognized specialist in the field of endodontics.
Owing to his passion for teaching and experimenting, passed on to him by Prof.
Herbert Schilder, he established a training
center at his practice, where he passes on
all the knowledge he has gained over the
years to students and colleagues in search
of a greater degree of specialization with
today’s modern technologies. At the center,
there is a classroom with ten workstations
equipped with an operating microscope
and the necessary instruments to perform
the procedures taught in the best way possible on mannequins and plastic models.
Dr. Castellucci offers his theoretical and
practical courses throughout the year, ensuring flexibility for anyone not able to participate during certain periods of the year.
www.endocastellucci.com
Florence, the capital of Tuscany is a cultural, artistic and architectural gem. One
of its most influential families, the Medicis,
not only sponsored the arts, but were of
great importance owing to their thriving
commercial activity and subsequent political influence. Florence is considered to be
the birthplace of the Italian Renaissance,
home to creative geniuses and scientific
masterminds, who left their legacies in the
city’s many museums and art galleries. Florence’s economic strength fostered the
growth of mercantile guilds and attracted
an influx of immigrants. Today, the city is
known for its dedication to its artistic and
historic patrimony and is regarded as one
of the top destinations in the world.
www.lonelyplanet.com/italy/florence
— Dr. Arnaldo
Castellucci, M.D., D.D.S.
graduated in medicine at
the University of Florence
in 1973 and specialized in
dentistry at the same university in 1977. From 1978 to
1980, he attended continuing education courses on
endodontics at Boston University School of Graduate
Dentistry (now the Boston
University Henry M. Goldman School of Dental Medicine) in the U.S. As well as
running a practice limited to
endodontics in Florence, he
is Professor of Endodontics
at the University of Cagliari
dental school in Italy and
Professor of Surgical Endodontics at the
University of Naples
Federico II oral surgery
department, also in Italy.
Dr. Castellucci is the
founder and President of
the Warm Gutta-Percha
Study Club and of the
Micro-Endodontics Training
Center in Florence, where
he teaches and gives handson courses. He is past
President of the Italian
Endodontic Society, past
President of the International Federation of
Endodontic Associations,
as well as an active member
of the European Society
of Endodontology, the
American Association of
Endodontists and the Italian
Society of Restorative
Dentistry.
An international lecturer,
Dr. Castellucci has
published more than
60 articles and is the author
of the book Endodontics. He
is the past editor of
the Giornale Italiano di
Endodonzia (Italian journal
of endodontics) and
L’Informatore Endodontico
(endodontic informer) and
is the Editor-in-Chief of
Endo Tribune Italy.
How to get there
The city center is located 8 kilometers
from Peretola airport. It can be reached in
about 15 minutes by taxi and about 20 minutes by bus on the Vola in Bus shuttle (run
by Busitalia Sita Nord), which operates between the airport and the central railway
station of Santa Maria Novella.
www.fsbusitalia.it
What to see and do
The Uffizi Gallery, one of the most famous
museums in the world, houses unique artworks and masterpieces by artists such
as Botticelli, Michelangelo, Da Vinci and
Raffaello.
The Accademia Gallery is, with the Uffizi,
one of the most visited museums in Florence. Here you will be able to appreciate
the beauty of Michelangelo’s David.
The Ponte Vecchio, or old bridge, was for
a time, the only bridge in Florence across
the Arno River. There have been shops on
the bridge since the thirteenth century—
originally, all types of shops, but at the end
of the sixteenth century limited to only
goldsmiths and jewelers.
The Medici Chapels form part of the complex of San Lorenzo. The church of San
Lorenzo was the official church of the Medici
family and became their final burial ground.
Medici Villa at Castello, just a few kilome-
36 — issue 2017
Endodontics
Profile
ters from Florence’s historical center, is an
elegant villa with a splendid Italian garden.
Botticelli’s Birth of Venus and Allegory of
Spring (now at the Uffizi Gallery) were commissioned by Lorenzo de’ Medici for this
villa. The villa is not open to the public, but
its gardens can be visited free of charge.
Palatine and Modern Art galleries at the
Palazzo Pitti. The Palatine Gallery includes
wonderful works by Renaissance artists. The
Modern Art Gallery mostly houses works by
Italian artists from the end of the eighteenth century to the beginning of the
twentieth century.
Palazzo Vecchio, located next to the Uffizi Gallery, is one of the most famous symbols of Florence. From its tower, you can
enjoy a wonderful view of the city.
The Cappella Brancacci is a chapel in the
Basilica di Santa Maria del Carmine with
magnificent frescoes painted by Masolino
da Panicale, Masaccio and Filippino Lippi.
Corridoio Vasariano, built to allow the
[37] =>
Editorial_03.indd
Medicis to move between their two
palaces, is a covered passageway connecting Palazzo Vecchio with the Palazzo Pitti.
The Museo di Palazzo Davanzati is housed
in a fourteenth-century palace, once
home to the wealthy Davanzati family, and
its present arrangement aims at reconstructing the setting of an old Florentine
home.
The Museo dell’Opera del Duomo contains many of the original works of art created for the Cattedrale di Santa Maria del
Fiore, including masterpieces by Ghiberti,
Donatello, Luca della Robbia, Antonio Pollaiolo, Verrocchio and Michelangelo.
The Museo di San Marco, occupying a
vast area of the Dominican convent of San
Marco, founded in 1436, showcases the
work of Fra Angelico, who frescoed extensive parts of the convent.
Where to stay
The following hotels are all located within
two kilometers of the Micro-Endodontics
Training Center and the town center:
The Hotel Regency boutique hotel, situated
in a quiet residential area, is the result of
careful restoration of an original Florentine villa.
www.regency-hotel.com | TripAdvisor
Certificate of Excellence | 5-star
Hotel Monna Lisa is housed in a fifteenthcentury renaissance palace and offers oldworld rooms surrounded by peaceful,
landscaped gardens.
www.monnalisa.it | TripAdvisor Certificate
of Excellence | 4-star
Hotel Santa Maria Novella set in a picturesque square, offers well-appointed
rooms and its rooftop terrace overlooks
the Basilica of Santa Maria Novella.
www.hotelsantamarianovella.it
TripAdvisor Certificate of Excellence
4-star
Hotel Plaza Lucchesi, overlooking the Arno
River, is a very elegant hotel offering
amazing views of the landscape and the
city from its rooftop terrace, where you
can enjoy a drink or a swim.
www.hotelplazalucchesi.it | TripAdvisor
Certificate of Excellence | 4-star
Hotel Villa Liana offers accommodation in
a nineteenth-century villa, a former British
consulate, boasting the original ceiling
frescos and set in an English-style garden.
www.hotelliana.com | TripAdvisor Certificate of Excellence | 3-star
Where to eat
Winter garden by Caino, in the elegant setting of a sophisticated winter garden, is a
collaboration between Chef Michele
Griglio and Chef Valeria Piccini that sets
new heights for a refined restaurant experience.
www.restaurantbycainoflorence.com
1 Michelin star
Panini Toscani is an Italian delicatessen
serving paninis and a selection of cheeses
and cold meats (no dinner).
Profile
Endodontics
The following trattoria and ristorante
serve typical Tuscan cuisine:
Trattoria Coco Lezzone—Dr. Castellucci’s
favorite
www.cocolezzone.it
Perseus—the house specialty is Florentine
steak.
www.casatrattoria.com
Trattoria 13 Gobbi
www.casatrattoria.com
Trattoria I’ Parione
www.parione.net
Il Cibrèo offers fine, inventive cuisine
inspired by traditional dishes.
www.edizioniteatrodelsalecibreofirenze.it
For more information visit:
www.firenzeturismo.it
issue 2017 — 37
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COMBINED SURGICAL
AND NONSURGICAL
— endodontic retreatment for
the management of an unusual
clinical case
Dr. Francesco Maggiore, Italy
Introduction
The ultimate goal of endodontics is to
treat or to prevent endodontic pathology
by properly cleaning, disinfecting and filling the complete root canal system. This
is generally achieved by one of the three
major endodontic therapies:
1. Orthograde or conventional endodontic treatment is delivered when the tooth
presents with pulpal or periapical pathology and has not received any previous
endodontic therapy.
the endodontic pathology and caused
morphological alteration of the apical
third of the root, requiring surgical intervention to be properly managed. The
present article reports on an unusual clinical case treated by nonsurgical endodontic retreatment followed by surgical endodontic retreatment in order to remove
a foreign metallic object from the periapical tissue and to properly treat the
apical third of the root. The object was
afterward identified as a wrongly positioned endosseous implant that was responsible for the symptomatology.
2. Nonsurgical endodontic retreatment is
delivered when the tooth has been treat- Case report
ed previously, but the periapical pathology persisted or reoccurred after a period A 57-year-old female patient was referred
and the tooth is accessible using a coronal to our clinic in order to evaluate a sympapproach.
tomatic tooth #23. The patient had spontaneous pain in the left upper jaw, in the
3. Surgical endodontic retreatment is vestibule of the tooth #23. At the clinical
generally performed when the endodon- examination, the tooth presented with a
tically treated tooth still presents with a composite restoration, was negative to
periapical pathology, but a coronal ap- the vitality test, and was sensitive to perproach is not feasible because of pros- cussion and palpation. The clinical examthetic restorations or if it is not able to ination revealed the presence of a scar in
resolve the periapical problem. In these the vestibule of the left upper jaw due to
cases, the incision of a surgical flap and a previous surgery (Fig. 1). The radioretrograde management of the apical graphic examination showed previous
third of the root is required.
endodontic treatment of tooth #23, a
shortening of the root and an apical raEven though the majority of endodontic diolucency associated with a suspected
cases are treated using one of the gutta-percha cone or a radiopaque post
above-mentioned modalities, clinical sit- beyond the apical third of the root (Fig. 2).
uations arise in which the orthograde ap- The anamnestic data were noncontribuproach or the surgical approach alone is tory. On the basis of the clinical and ranot able to clean and disinfect the com- diographic examination, a diagnosis of
plete root canal system and to provide a previous endodontic treatment with a
hermetic apical seal. In these cases, a symptomatic periapical lesion was made.
combined orthograde and surgical ap- Since the material in the apical third was
proach is required. Very often, these are thought to be a gutta-percha cone of largcases in which the tooth received previous er size, and assuming it would be possible
endodontic treatment that did not resolve to remove it with an orthograde approach,
38 — issue 2017
Endodontics
Article
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Fig. 2
Fig. 1
Fig. 3
Fig. 1
Clinical photograph of the
vestibule in the left upper
jaw. Note the scar resulting
from the previous surgery.
Fig. 4
Fig. 2
Pre-op radiograph of this
unusual case affecting the
maxillary left canine. Note
the periapical radiolucency
around the metal post.
Fig. 3
Clinical photograph of the
metal ring in the apical
third of the root canal.
Fig. 4
Intra-op radiograph with
the file in the canal. Note
the full length of the metal
post extruding into the
periapical tissue.
nonsurgical endodontic retreatment was
suggested to the patient.
The tooth was anesthetized, a rubber
dam was placed and an access cavity was
created in order to reach the root canal.
After removal of the old gutta-percha filling material up to the apical third of the
root, the endodontic file was unable to
progress farther and a solid stop was felt.
Exploration of the apical third under an
operating microscope was performed.
Under high magnification, the presence of
a metal ring tightly wedged in the apical
Article
Endodontics
part of the canal was seen (Fig. 3). The
metal ring was filled with old gutta-percha.
The intraoperative radiograph with the file
in place revealed the full length of the metal post extruding into the periapical tissue
(Fig. 4). The multiple attempts to remove
the metal object via an orthograde approach were unsuccessful. The tooth was
medicated with calcium hydroxide and the
patient rescheduled for surgery at the next
appointment.
At the next visit, the patient was anesthetized, and under rubber dam isolation, the
issue 2017 — 39
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Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 5
A paramarginal rectangular
flap was raised to reach the
apical third of the maxillary
canine.
Fig. 6
Once the flap had been
raised, an endosseous
implant became visible
under the mucosa.
Fig. 9
tooth was opened and the canal filled with
a pulp canal sealer and warm gutta-percha
released from the Obtura II syringe
(Obtura Spartan Endodontics). After
completion of the root canal filling, the
surgical treatment followed. A paramarginal flap was incised (Fig. 5), and after
elevation of the soft tissue, an endosseous
implant became visible under the mucosa
(Fig. 6). The implant was wrongly positioned in the submucosa rather than in
the bone and was actually responsible for
the painful symptomatology.
In order to eliminate the metallic object,
the bone around the post was gently curetted (Fig. 7) and the implant was
vibrated with ultrasonic tips. The implant
was very tightly wedged in the root, and it
was thus decided to cut the apical part of
the root containing the metallic post.
Once the apical part of the root, together
with the metal post, had been removed
(Fig. 8), inspection of the resected root
surface was performed under the operating microscope under high magnification.
The resected root presented with a metal
ring that corresponded to the cave part of
the implant (Fig. 9). Since the metal ring
contained old gutta-percha that was potentially infected, attempts to loosen the
metal ring with ultrasonic tips were made
(Fig. 10). Using ultrasonic tips, the metal
40 — issue 2017
Endodontics
Article
Fig. 7
The implant was released
on the sides.
Fig. 8
The implant was removed.
Fig. 9
Exploration of the resected
root surface at high
magnification. Note that
the metallic post was filled
with gutta-percha at the
bottom and strongly
engaged in the root canal.
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Fig. 10
Fig. 11
Fig. 12
Fig. 13
Fig. 10
Retrograde preparation
with ultrasonic tips.
Fig. 11
The metallic ring was
removed.
Fig. 14
ring was displaced (Fig. 11). The apical part
of the root was further cleaned with ultrasonic tips and filled with grey mineral trioxide aggregate (MTA; Figs. 12 & 13). The
surgical flap was closed using 7-0 monofilament sutures (Fig. 14). The immediate
postoperative radiograph showed good
adaptation of the MTA in the apical part of
the root (Fig. 15). The sutures were removed 48 hours after the surgery (Fig. 16).
At the following control appointment,
the patient was asymptomatic and the soft
tissue showed good healing. The patient
was recalled one and three years after the
surgery. At the recall appointments, the
tooth was asymptomatic and showed good
stability. The three-year follow-up radiograph showed bone regeneration and reformation of the lamina dura around the
amputated root (Figs. 17 & 18).
The patient was referred to our clinic
for endodontic treatment on a different
tooth ten years after the surgery. A control of tooth #23 was done. It had remained
symptom-free, and the ten-year follow-up
radiograph showed a stable bone condition
and the absence of any apical radiolucency
(Fig. 19). Inspection of the soft tissue
showed barely visible evidence of the incision (Fig. 20).
Article
Endodontics
Fig. 12
Control of the root canal
after retrograde preparation (at 20×magnification).
Note the cleanness of the
canal walls.
Fig. 13
Inspection of the MTA
retrograde filling using a
micromirror
(at 20×magnification).
Fig. 14
The flap was closed with
7-0 monofilament sutures.
issue 2017 — 41
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Discussion
The present case report has demonstrated that sometimes an approach combining both orthograde and surgical treatment is required in order to treat
previously endodontically treated teeth
and to provide a long-term favorable outcome. The decision to proceed surgically
or nonsurgically is sometimes determined
by the intraoperative conditions. It should
be noted that CBCT was not available to
the clinicians at the time of the surgery.
Nowadays, preoperative examination
using CBCT provides valuable information
for the diagnosis and treatment of endodontically compromised teeth. Furthermore, the case report has shown that the
microsurgical approach under the high
magnification of the operating microscope, together with the use of dedicated
ultrasonic tips and biocompatible material, was crucial for the long-term success
of the treated tooth.
Fig. 16
Fig. 15
Fig. 18
Fig. 15
Post-op radiograph.
Fig. 16
The condition of the soft
tissue immediately before
suture removal.
Fig. 17
Radiographic control three
years after surgery. Note
the good reapposition of
the bone and the reformation of the lamina dura
around the amputated root.
Fig. 17
Fig. 18
Soft-tissue control three
years after surgery. Note
the esthetic healing of the
soft tissue. Teeth #22 and
#23 presented with new
cervical fillings.
Fig. 19
Fig. 19
Radiographic control ten
years after surgery. The
tooth had maintained a
stable bone condition and
no apical radiolucency was
visible.
Fig. 20
Fig. 20
Soft-tissue control ten
years after surgery.
42 — issue 2017
Endodontics
Article
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INTERVIEW
with — Dr. Francesco Maggiore
Q: Dr. Maggiore, you are considered a prominent expert in the field of endodontics, what
is the state of endodontics today?
A: Endodontics is a very solid discipline
and represents one of the most fascinating specialties in modern dentistry. The
technological and scientific achievements
of the past decades have been enormous.
For years, the goal of the specialty has
been to raise the bar of endodontics, that
is the standard of the routine root canal
therapy performed by both general dentists and endodontic specialists. Probably
now we are confident in saying that the
bar has been raised and many endodontic treatments once considered challenging are actually properly managed by specialists and by well-trained general
dentists.
trying to detect the apical constriction.
It was the era of what I call “tactile endodontics”—everything relied on fingers.
Nowadays, under proper magnification
provided by the operating microscope,
we can clearly see the exact number and
location of root canals, and using an apex
locator, we can precisely detect the apical
constriction. With the right skills and
training, the use of the operating microscope allows the operator to have each
step of the procedure under visual control. This can be accomplished by microscope users, both endodontic specialists
and general dentists alike. This is what I
term “visual endodontics.”
The scientific advancements are many,
including the knowledge of the anatomical variation of each tooth and the histological response of the human body to
different materials or biomaterials used
in endodontics. Scientific advancement
is the understanding of why, when and
how an endodontic file breaks and eventually how to prevent separation. Scientific advancement is also the awareness
that we are dealing with a sophisticated
biofilm complex rather than with single
bacterial species. This has given rise to
the prominent role of irrigation protocols
and modalities in everyday practice.
Q: What have the major advancements in
endodontics been? You mentioned technological and scientific achievements.
A: Yes, not only has technology advanced,
but science has too. Electronic apex locators, operating microscopes, nickel–
titanium rotary instruments, warm guttapercha filling techniques, CBCT and
bioceramic materials are only some of
the technological innovations that have
drastically changed the way endodontics
is practiced today compared with a few
years ago. In the past, practitioners had Q: What are the differences between general
to rely on their tactile sense when explor- dentists and endodontic specialists in pering the pulp chamber of a tooth or when forming endodontic treatment?
44 — issue 2017
Endodontics
Interview
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The scientific advancements are
many and include knowledge of the
anatomical variation of each tooth,
the histological response of the
human body to different materials,
and the biomaterials used in
endodontics.
A: There are many differences and probably different commitments. A general
dentist has to provide the full range of
treatments for his or her patients, including endodontic treatment. This is a considerable task. In the U.S., the majority
of root canal therapies are actually performed by general dentists and this is
probably true everywhere around the
globe.
General dentists should be confident
in providing primary endodontic therapy,
that is, conventional endodontics. They
should take advantage of the technological innovations in endodontics and use
them to their best ability. They should also
be aware of what can be achieved in the
hands of a specialist, that certain treatments are feasible, that many endodontically compromised teeth can still be saved
and have a good long-term prognosis.
Endodontic specialists complete
advanced education in endodontics
through a postgraduate program. Generally, they limit their practice to endodontics. They provide conventional endodontic treatment, but mainly treat
challenging cases of complex anatomy,
multirooted teeth, traumatized teeth,
endodontic retreatments and endodontic microsurgery.
Many patients would like to retain their
natural dentition for as long as possible.
Endodontic specialists can provide a wide
range of treatments in many cases. Communication between general dentists and
Interview
Endodontics
endodontists is very important for successful patient management. In this
regard, case selection is a key factor for
a general dentist. In fact, many general
dentists know that, in certain clinical situations, the best service they can provide
to their patients is to refer them to the
specialist. A cautious general dentist
knows also when the case has to be
referred, before it is too late, that is,
before a perforation occurs or before an
instrument separation ruins his day. Even
in these challenging situations, however,
very often, a specialist can still save the
tooth. This is probably one of the commitments of an endodontic specialist, to
shift the prognosis of an endodontically
compromised tooth.
Q: What is the aim of your course in the
Clinical Masters™ Program in Endodontics?
A: The purpose of the course is to share
with participants our clinical experience
and knowledge. Most of my everyday clinical work focuses on retreatments, nonsurgical and surgical. Over the years, we
have identified which instrument or
approach works best in the particular clinical situation. Participants will be guided
through treating complex clinical cases
and learning new technologies, materials
and techniques step by step, keeping in
mind the philosophy of a safe and efficient
approach.
Thank you very much for the interview.
issue 2017 — 45
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ENDO INN TO JOIN
THE CLINICAL MASTERS™ PROGRAM
IN ENDODONTICS
Endodontic retreatment component:
Retreatment of the MB1 canal will be performed by first removing intra-canal
obturation materials with ultrasonic tips
and new dedicated NiTi retreatment files.
About Endo Inn
Endo Inn, located in Oslo, Norway, was
established to provide training in
endodontics. The aim is to introduce to
both general dental practitioners and specialists the latest technology in the
specialty of endodontics in order to achieve
the essential biological requirements for
predictable successful outcomes.
During the course, the participants will be
working on custom-made workstations,
Post-treatment endodontic disease:
with operating microscopes connected
Theory and hands-on course | 4 days
to high-definition monitors. Micro-CT
In this nonsurgical endodontic retreat- 3-D printed transparent and opaque teeth
ment and endodontic microsurgery work- will be provided during the workshops so
shop, the participants will be working on that the participants gain knowledge of
dental models with 3-D printed teeth and skills in working within the complex
under an operating microscope. All of the internal root canal anatomy. CBCT techmodels will be studied preoperatively by nology will be used to control the endCBCT and the treatment will be planned odontic treatment performed by each
accordingly.
participant.
46 — issue 2017
Endodontics
Profile
– Management of problems caused by
previous treatment (by-passing ledges,
elbows and separated instruments)
– Dislodging and removal of fractured
instruments
– Repair of apical and furcation perforations with bioceramic materials.
Endodontic microsurgery component:
Several microscopic instruments will be
demonstrated and used during the surgical exercises, such as micro-scalpels,
micro-mirrors, micro-spatulas, microcondensers and micro-suture holders.
– CBCT planning for apicoectomy of a
maxillary and mandibular molar
– Flap design and microscopic bone and
root resection with lesion curettage
– Exercise on root canals and isthmus
retrograde preparation with ultrasonic
tips, followed by retrograde cavity sealing with a bioceramic material.
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About Dr. Gilberto Debelian
Dr. Gilberto Debelian received his DMD
from the University of São Paulo, Brazil,
in 1987. He completed his specialization
in endodontics at the University of Pennsylvania, U.S., in 1991 and received the
Louis I. Grossman Postdoctoral Student
Award in Endodontics.
He taught as a clinical instructor and
associate professor in the postdoctoral
endodontic program at the Section of
Endodontics at the University of Oslo,
Norway, from 1991 to 2001 and from 2006
to 2010.
He concluded his Ph.D. studies at the
University of Oslo in 1997 in endodontic
microbiology and received two scientific
awards from the European Society of
Endodontology and the Norwegian Dental
Association, both in 1997.
Currently, Dr. Debelian is an adjunct
associate professor in the postgraduate
program in endodontics at the University
of Pennsylvania. He maintains a private
practice limited to endodontics, as well as
an advanced endodontic microscopy center. Furthermore, he is the author of four
books and has written more than 60 scientific and clinical papers.
Profile
Endodontics
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INTERVIEW
with — Dr. Gianluca Plotino
ments in diagnosis owing to
CBCT or improvements in
the quality and safety of the
instruments that we use for
root canal preparation owing
to the newest manufacturing
processes and thermal treatments, for example. Furthermore, research in the field of
disinfection and on the development of new filling materials has given us the ability to
Q: Dr. Plotino, you are a much-respected treat even the most desperate endodontic
lecturer and researcher in the field of end- cases, enhancing the outcome of the treatodontics. How would you characterize your ment.
approach to teaching, and how has this
changed over time?
Q: You are scheduled to speak at the upcomA: When I was a student at the Università ing ROOTS SUMMIT 2016 in Dubai. What are
Cattolica del Sacro Cuore in Rome, Italy, you looking forward to the most about the
I had an endodontics professor who conference?
sparked my passion for this specialty and I A: In my presentation, I will seek to convey
later started teaching and supervising stu- an in-depth understanding of the mechandents in their graduation thesis. I work only ics of reciprocating motion in relation to
part time at university—now at the Sapi- endodontic instruments and why it repenza University of Rome—but I still really resents a great advancement in the safety
enjoy lecturing and supervising students and quality of dental practice. I will share
in their research programs. It is always a my research on this topic and above all
pleasure to guide young dentists in their demonstrate how it can be applied in the
first steps to becoming endodontists. Fi- daily clinical practice of both general dennally, I am most fortunate to have the op- tists and endodontic specialists.
portunity to give lectures worldwide, because it entails a mutual exchange of ideas Q: What do you hope a dental professional
with colleagues and this makes for great will gain from participating in the Clinical
intellectual stimulation.
Masters™ Program in Endodontics?
A: Dentists have to approach dental pracQ: How can a conservative approach to end- tice intensely, seeking to achieve clinical
odontics benefit a field that has undergone expertise. While dental schools do a great
incredible advancements in materials and job of providing a solid foundation for a
digital technologies?
career, it is not enough, so it is up to denA: Incredibly! New technologies and tists to build on that foundation by pursudevices are drastically changing our pro- ing postgraduate advanced clinical training
fession each day. Consider the improve- that exemplifies today’s top dentists. They
48 — issue 2017
Endodontics
Interview
should have interest in what they do and
seek to perform to their best to achieve
the highest clinical results through continuing to advance their education and
training and keeping up to date.
Q: What is the aim of the course, and how
does this differ from other courses?
A: The aim is to train the participants to
become the best endodontics practitioners. We seek to inspire in them our
passion for this discipline of dentistry and
share our skills to equip them to perform
top-level treatments and deal with the
most difficult of situations.
Q: What are some of your current research
areas of interest?
A: I like to conduct research to confirm my
clinical experiences and this is the reason
I have published so many articles in some
of the most prestigious scientific journals
of our field on several topics regarding
both endodontics and restorative dentistry. The main current research areas of interest are how new treatments may improve the quality and performance of
mechanical endodontic instruments, and
this is being investigated through the most
advanced technologies.
Q: In your opinion, what are some of the
main challenges that face endodontists
today?
A: They must help patients see the value
of their clinical work and need to understand the importance of an effective case
presentation, since it ultimately determines what kind of dentistry they are able
to perform. Today, it is also important to
master the business of dentistry to build a
successful practice.
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Essential Dental Media
Dental Tribune International
The World’s Largest News
and Educational Network
in Dentistry
www.dental-tribune.com
[50] =>
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Q: How have technological advancements
changed oral implantology since you first
started practicing in this field?
A: Implant dentistry is changing at a rapid
rate, primarily driven by the results of
current research and the advancement in
technology and products. Only by updating our knowledge and skills constantly
will we be able to keep pace with current
trends.
When I started, there were no tapered
implants, implants with internal hex, advanced surface technologies, computerguided surgical stents, drill stoppers or
other such useful tools. I would say the
most useful tool in our armamentarium
these days is CT imaging. Today’s oral implantology clinicians have the advantage
of cone beam volumetric imaging. CT
technology allows us to visualize the patient’s anatomy and pathology like never
before. With these images, we can
measure the exact distance available for
implant placement below or above certain
anatomic landmarks, measure the exact
bone density, measure precisely the width
of the available alveolar ridge and select
the most suitable locations for the
planned implants. This leads to improved
planning and reduced morbidity and reduces our liability.
INTERVIEW
with — Dr. Louie al-Faraje
Q: What sets the California Implant Institute apart from its competitors?
A: Oral implantology is a complex discipline. Many factors must be taken in consideration when developing a treatment
plan involving dental implants. These factors include the patient’s anatomy; the
patient’s general health; the patient’s bone
density; horizontal and vertical spaces of
occlusion; the soft-tissue biotype; parafunctions (if any); the smile line; the patient’s age, sex and size; opposing dentition
and the location of the implants in the
mouth (posterior vs. anterior placement).
The California Implant Institute offers the
most comprehensive dental implant training program in the world, covering all
areas that are pertinent to oral implantology. The extensive live-patient surgical
component of the master’s program is
unique. Our curriculum and world-famous
faculty make ours the most sought after
program in the world.
50 — issue 2017
Implant
Dentistry
Interview
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Q: How can dentists benefit from enrolling
in the Master of Oral Implantology program?
A: The Advanced Surgical and Prosthetic
Master of Oral Implantology Training Program at the California Implant Institute is
the only one of its kind. It consists of seven highly structured modules that ensure
dentists will receive the most comprehensive dental implant training available.
Module 1 consists of the institute’s signature Fellowship Program, in which dentists
gain fundamental knowledge and skills
through in-class lectures, hands-on laboratory sessions, online webinars and live
surgical demonstrations.
Module 2 is the hands-on cadaver module,
in which participants improve their clinical
skills by performing advanced and complex procedures on human specimens.
Module 3 consists of the live-patient surgical training programs held at the institute’s Baja office in Rosarito, Mexico. All
dentists and patients are shuttled from
San Diego to the Mexico site. The participants take a total of four live-patient externships of six days each. Each externship
includes 3–4 hours of treatment planning
each morning. Course material and surgical DVDs are provided before each program to enhance the learning experience.
Module 4 offers the unique opportunity
for participants to shadow and assist one
of the institute’s prosthodontists on-site.
During this module, the participants are
exposed to complex cases, treatment
planning for those cases, occlusion design
and proper hygiene protocols for implant
patients. Other topics include documen-
tation of implant cases, the informed patient consent process, capturing the necessary extraoral and intraoral photographs
for precise implant treatment planning,
digital smile design for aesthetic and complex cases, and dental laboratory training
for immediate implant provisionalization.
Module 5 provides live-patient oral sedation training.
Module 6 is a five-day module covering a
wide range of topics related to CAD/CAM
and computer-guided surgical training,
with a hands-on workshop.
Module 7 is the academic and research
component of the program. Dentists are
encouraged to make use of the institute’s
resource center throughout in order to
complete the following academic assignments:
– Watch 50 surgical videos on the institute’s private YouTube channel
– Complete the research/literature review
assignment
– Provide documentation for five clinical
cases:
– Two single-implant fixed cases
– Two multiunit implant cases (bar
overdenture and locator overdenture
will fall under this category)
– One full-arch fixed implant case.
Q: What have previous participants said
about the program?
A: “The surgical externship courses were
an incredible learning experience for me.
There is no better way, in my opinion, to
learn the necessary skills required for implant placement than to actually
Interview
Implant
Dentistry
participate in a well-supervised program
like this. There is so much to learn and gain
knowledge in while doing the surgery and
while assisting and observing over the six
days, during which hundreds of implants
are placed.”
Dr. Wayne Young— general dental practitioner, Calgary, Alberta, Canada
“Your fellowship program has opened a
new chapter in my dental career. Your
great personality, encouragement, professional staff, handouts, binders, articles,
hands-on sessions, outstanding lectures
and live-surgery presentations have given
me the lifelong confidence to diagnose
and treat patients with implants. I proudly apply your knowledge and techniques
at my dental practice. Thank you for your
outstanding performance, incredible service and hospitality.”
Dr. Peter Zahedi—general dental practitioner, San Rafael, California, U.S.
“I have been placing implants for over
seven years and found the course to be
invaluable. You provided information that
could be implemented after each session.
The course is well structured for both the
novice and the more experienced. I believe this course to be a must for anyone
interested in or continuing their education in implant dentistry. You will be hard
pressed to find a more well-prepared and
organized teacher. The live surgeries and
hands-on portions of the course pay for
themselves.”
Dr. Robert Matiasevich Jr.
issue 2017 — 51
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MASTER OF ORAL
IMPLANTOLOGY PROGRAM
San Diego, California
ADVANCED SURGICAL & PROSTHETIC
IMPLANT TRAINING PROGRAM
The advanced surgical & prosthetic Master of
Oral lmplantology Program is designed for
general dentists of all implant experience
levels, as well as specialists in the fields of
prosthodontics, periodontics and endodontics.
The goal of the program is to provide doctors
with the right tools for a successful career in
implant dentistry.
The California Implant Institute and its world-renowned faculty have developed
the most comprehensive curriculum focusing on essential information that is
immediately useful to doctors, their staff, and their patients. Through in-class
interactive lectures, online webinars, hands-on laboratory sessions, live-patient
surgical experiences, and much more, participants will gain the highest level of
knowledge and technical skills necessary to provide safe, appropriate, and
efficient treatments.
Understanding the value of the time invested to complete the Master of Oral
lmplantology Program, CII offers a unique opportunity for doctors to fully
customize their program track to best fit their availability while having the least
impact on their practice.
One-year and two-year tracks available
Training Overview
The Program consists of 7 modules
for a total of 1,000 CE units:
• Didactic / In-Class Lecture Module
Over 60 days of interactive academic learning
• Live-Patient Surgical Module
Perform 30+ surgical implant placements and
20+ bone grafting procedures
• CAD/CAM Computer Guided Module
Hands-on workshop focused on implant surgery
• Implant Prosthodontics Module
Hands-on implant-oriented occlusion workshop
and on-site shadowing of a Prosthodontist
• Hands-On Cadaver Module
• Oral Sedation Certification Module
Visit the CII website for detailed curriculum and schedules.
• Academic and Research Module
Faculty Members
Louie Al-Faraje, DDS
James L. Rutkowski, DMD, PhD
Diplomate, American Board of Oral Implantology
Academic Chairman, California Implant Institute
Diplomate, American Board of Oral Implantology
Past President, American Board of Oral Implantology
Mamaly Reshad, DDS, MSc
Patrick Palacci, DDS
Former Section Chair for Fixed Prosthodontics and
Operative Dentistry, University of Southern California
Christopher A. Church, MD
Diplomate, American Board of Otolaryngology
Director, Loma Linda University Sinus and Allergy
Head of Brånemark Osseointegration Center
in Marseille, France
Domenico Cascione, CDT, B.S.
President of OPERART LLC, a dental laboratory
in Santa Monica, California
www.implanteducation.net
info@implanteducation.net
+1 858.496.0574
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LAKE COMO INSTITUTE
— Como, Italy
— Lake Como Institute
The Lake Como Institute is
a center dedicated to
higher education in implantology. Our teaching is
based on scientific and clinical research, and we adopt
an interdisciplinary teamwork approach to our work.
Our clinic of excellence is
based on established protocols and attention to detail,
two factors that we regard
as important for achieving
a long-lasting result. With
our work philosophy of
seeking to achieve the best
results, combined with our
30 years of clinical experience, we offer an innovative
course that will allow you
to provide better treatment
to patients, who rely on your
professionalism for their
oral health.
www.lakecomoinstitute.com
Location
The Lake Como Institute is located in the
town of Como, famous for its silk manufacturers. Within what remains of its
twelfth-century walls is a charming historical center. The town is set on the shores
of Lake Como, situated in a basin surrounded by wooded mountains and said to
be the most beautiful of the Italian lakes.
There is plenty to see while strolling
around, including stunning villas, gardens,
and sites of historical and cultural significance.
www.lonelyplanet.com/italy/lombardyand-the-lakes/lago-di-como
How to get there
From Milano Malpensa Airport, located
about 1 hour away by car, you can take the
Malpensa Express train to Como.
www.malpensaexpress.it
From Lugano Airport in Switzerland, located about 20 minutes away by car, you
can take a shuttle bus to Lugano, and then
a train from Lugano station to Como
S. Giovanni station.
www.trenitalia.it or
www.sbb.ch
From Milano Linate Airport, you can take
a connecting bus to Milano Centrale station and catch a train to Como S. Giovanni
station (trains depart hourly).
The following transport options are available via the institute:
– A private mini-van for up to seven passengers, from Milano Malpensa Airport
to Como.
– A private car (up to three passengers),
one way from Milano Malpensa Airport
to Como.
– Transportation from Il Caravaggio International Airport (Orio al Serio International Airport).
– Transportation from Milano Linate
Airport.
Further information can be requested in
this regard via the institute.
54 — issue 2017
— Prof. Tiziano Testori
What to see and do
Como is a very small old town and the best
way to get to know it is by exploring its narrow passages, old streets, quaint markets
and piazzas, stopping to enjoy a cappuccino on the terrace of one of its many
cafés.
The remarkable eleventh-century Romanesque Basilica di Sant’Abbondio has a
beautiful fresco series inside the apse and
a university occupies what was once the
cloister.
Lake Como’s shores feature a varied
landscape of fields, forests, imposing
rocks, charming villages facing the lake
and magnificent mansions with beautiful
gardens, particularly from Cernobbio to
Gravedona and Bellagio. The following include only some of the innumerable sights:
The middle of Lake Como, where its three
branches come together, offers a spectacular view of the whole promontory of
Bellagio, of the northern Grigna mountains overlooking Valsassina, and of the upper basin against the backdrop of the Alps
if the skies are clear. It has the mildest
climate and can be reached by boat.
www.taxiboat.it
Besides the glorious views of the Lecco
branch of the lake, which turns southwards, there are natural springs, like
Fiumelatte, described by Leonardo da
Vinci, and the impressive Orrido di Bellano
(gorge), situated not far from the Renaissance Villa Monastero at Varenna.
Advanced
Implant Esthetics
Profile
Received his M.D. in 1981,
his D.D.S. in 1984, and his
specialty qualification in orthodontics in 1986, all from
the University of Milan in
Italy. He is currently head of
the section of implantology
and oral rehabilitation at
the University of Milan’s
dental clinic at I.R.C.C.S.
Istituto Ortopedico Galeazzi.
He is also a visiting professor at the College of
Dentistry at New York
University in the U.S. and an
assistant clinical professor
in the Department of
Biomedical, Surgical and
Dental Science at the
University of Milan. Prof.
Testori is a fellow at the Division of Oral and Maxillofacial Surgery and Advanced
General Dentistry at the
Miller School of Medicine,
University of Miami, U.S.
He is President elect (2017–
2018) of the Italian Academy of Osseointegration and
a past President (2007–
2008) of the Italian Society
of Oral Surgery and Implantology. He serves on the
editorial board of the International Journal of Oral and
Maxillofacial Implants, European Journal of Oral Implantology, and International
Journal of Periodontics and
Restorative Dentistry. He is
the author of 104 peerreviewed publications and
four books on implantology.
[55] =>
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Where to stay
All of the following hotels are located
within a reasonable distance to the institute. If you would like to stay right on the
lakefront, you might want to consider one
of the following hotels:
Albergo Terminus dates back to the nineteenth century and has an enchanting view
across Lake Como.
www.albergoterminus.it | 4-star
Palace Hotel is an historical art nouveau
palace overlooking the lakefront.
www.palacehotel.it | TripAdvisor Certificate of Excellence | 4-star
Hotel Metropole Suisse is located along the
harbor with views of Lake Como and the
Alps.
www.hotelmetropolesuisse.com
TripAdvisor | 4-star
Not on the lakefront, but also centrally
located are the following hotels:
Albergo Del Duca, with an attractive setting on a pedestrian square, offers the hospitality of a family-run business.
www.albergodelduca.it | TripAdvisor
Certificate of Excellence | 3-star
Avenue Hotel is located in a historical building and offers rooms with a colorful and
sophisticated design.
www.avenuehotel.it | TripAdvisor
Certificate of Excellence | 4-star
Where to eat
I Tigli in Theoria, situated in the old palazzo
and adjunct to Theoria art gallery, provides
a combination of gourmet cuisine, art and
history.
www.theoriagallery.it | 1 Michelin star
La Colombetta is a cozy restaurant offering
regional cuisine, with fish dishes as its specialty.
www.colombetta.it
Profile
Advanced
Implant Esthetics
The Market Place offers innovative and hip
Italian cuisine.
www.themarketplace.it
L’Antica Trattoria serves seasonal, traditional Italian cuisine with specialty meat
dishes cooked on the fire in view of guests.
www.lanticatrattoria.co.it
Tira, mola e meseda provides Italian cuisine,
especially dishes from Lombardy (risotto,
ossobucco)
www.tiramolameseda.it
Capitan Drake Enoteca is a small bar offering, New Zealand, Italian and Mediterranean cuisine.
www.facebook.com/Capitan-DrakeEnoteca
For more information visit:
www.lakecomo.it
issue 2017 — 55
[56] =>
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BUCCOLINGUAL IMPLANT
POSITION AS A
CONSEQUENCE OF THE
ABUTMENT SHAPE
— A paradigm shift
Dr. Fabio Scutellà & Prof. Tiziano Testori, Italy
— Dr. Fabio Scutellà
— Prof. Tiziano Testori
56 — issue 2017
Introduction
Implant rehabilitation in the esthetic zone,
especially in the upper arch, has always
posed a number of challenges. Although
high survival rates for implants in this
region are well established, the new concept of success that involves soft-tissue
integration depends on several factors.
The pink esthetic score, white esthetic
score and implant esthetic score1-3 are
indexes usually used to evaluate the
esthetic success of an implant rehabilitation. Many factors play an important role
in the esthetic outcome of any implantsupported restoration. Among some of
the major keys to success are an awareness
of the possibility of sudden resorption of
the buccal plate (bundle bone), along with
accurate 3-D implant planning and positioning.
Many publications have addressed the
problem of buccal plate resorption4, 5 and
a recent literature review6 investigated
the magnitude of dimensional changes in
alveolar hard and soft tissue occurring for
up to 12 months after tooth extraction in
humans. The review found that, six months
after tooth extraction, horizontal bone
loss ranged from 29 to 63%, and vertical
bone loss ranged from 11 to 22%.
Advanced
Implant Esthetics
Article
If not promptly and correctly addressed,
this phenomenon may compromise the
final esthetic restorative result and even
affect implant survival. Stability of the
alveolar bone is paramount for maintaining the stability of the surrounding softtissue and guaranteeing a high level of
esthetics over time.
Regarding implant positioning, several
papers have offered guidelines regarding
optimal 3-D positioning. However, since
the most commonly used finishing line for
restorative abutments is the horizontal
type, guidelines for implant positioning
have been conceived exclusively for that
kind of geometry, but what if the abutment
has a vertical rather than a horizontal finishing line?
The close relationship between the
implant position, the abutment finishing
line geometry, and the crown angles and
contours is evident. The aim of this paper
is, thus, to provide recommendations based
on clinical evidence regarding the buccolingual implant position in the esthetic
zone whenever a feather-edge (shoulderless) abutment is chosen. In such cases,
new guidelines should be taken into consideration to ensure a better soft-tissue
response.
[57] =>
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Fig. 1a
Fig. 1b
Fig. 1c
Figs. 1a–c
(a) In the mesiodistal
direction, the implant
should be placed
1.5–2.0 mm from adjacent
teeth and 3.0 mm from
other implants.
(b) In the apicocoronal
direction, the implant
position should be 2–4 mm
below the midfacial aspect
of the free gingival margin.
(c) In the buccolingual
direction, the implant
should be placed palatal
to the incisal edge.
Implant position in the esthetic
zone
The optimal implant position and diameter
for the esthetic zone have been investigated extensively, with many authors proposing different approaches. Buser et al.,
attempting to identify the ideal implant
position, stated that, in the mesiodistal
dimension, the implant should be positioned no closer than 1.0–1.5 mm to the
adjacent root surface(s);7 between two
adjacent implants, the mesiodistal distance
should be within 3.0 mm. However, when
applying platform-switching, placement
of implants closer than 1.5 mm to the
adjacent tooth has been deemed acceptable and capable of maintaining the bone
peak.8
In the apicocoronal direction, Tarnow’s
assumption that “a maximum of 5 mm
distance from the alveolar crest to the
contact point is necessary to obtain correct soft tissue esthetics in natural teeth”9
has been verified also for implants.10 Choquet stressed the importance of the apicocoronal position for preserving papillae
and found in a retrospective study that,
when the distance between the contact
point and the bone was 5 mm, the papilla
was present in 100% of the cases. More
properly, the platform of the implant
should be located 2–4 mm below the
Article
Advanced
Implant Esthetics
midfacial aspect of the free gingival margin.11 Bashutski12 and Grunder13 agree that,
in the buccopalatal dimension, the implant
should be inserted to preserve at least
2 mm of buccal bone.
Factors affecting mucosal recession
around single-tooth immediate implants
have also been evaluated in a systematic
review.14 The authors suggested that, in
highly esthetic cases, undersized implants
should be selected and placed at the cingulum to enhance soft- and hard-tissue
growth (Figs. 1a–c).
Importance of the biotype
One prerequisite for managing implant
restorations in the esthetic zone is the
presence of thick soft tissue surrounding
the implant. Gingival biotype is used to
describe the thickness of the gingival tissue
in the faciopalatal dimension and it is classified into two main categories: thin and
thick.23 The difference between the two
biotypes is defined by the visibility of a
periodontal probe through the gingival
tissue: If it is visible, the biotype will be
regarded as thin; if it is not visible, it will be
classified as thick.
A study performed by Kan et al. analyzed
the dimension of the periimplant mucosa
around two-stage maxillary anterior singletooth implants in humans after one year
of function. The study showed a greater
issue 2017 — 57
[58] =>
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Fig. 2a
Fig. 2b
Fig. 3
Figs. 2a & b
(a) A natural maxillary
tooth.
(b) The lateral view shows
a convexity corresponding
to the cervical contour.
periimplant mucosal dimension in the presence of a thick periimplant biotype compared with a thin biotype.24
It has also been suggested that a direct
correlation exists between gingival biotype
and susceptibility to gingival recession after
surgical and restorative procedures. There
is agreement in the literature regarding
the influence of soft-tissue thickness on
implant survival and long-term success. Fu
et al. have proposed an approach to increasing soft-tissue thickness through the
esthetic triad and PDP management, in
which “P” is the implant position, “D” is the
implant design and “P” is the prosthetic
design.15 They indicate as key factors the
use of platform-switched or parallel-walled
implants, more palatal and apical implant
placement, and concave prosthetic designs
to reduce periimplant bone and softtissue loss.
Abutment shape and contour
Working on the abutment shape and contour has been one of the present authors’
main tasks in recent years, with a specific
focus on the portion of the abutment
58 — issue 2017
located below the gingival level. The
implant–abutment contours can be divided
into two separate portions: the critical
contour (the area of the implant abutment
and crown located immediately apical to
the gingival margin) and the subcritical
contour (located apical to the critical contour). These two entities will exist provided
that sufficient running room (defined as
the distance from the implant neck to the
free gingival margin) is present. Both the
critical and the subcritical contours, if properly modulated and shaped, may be used
to modify the esthetic outcome of the
restoration.16
As already summarized, to prevent buccal bone resorption, the literature suggests
placing the implant at the cingulum of the
future restoration14 or 1.5–2.0 mm palatal
to the incisal margin of the central maxillary
incisor.13 However, this approach can lead
to problems that may jeopardize the
esthetic outcome and the survival of the
implant. For one thing, the crown contour
created by such placement is substantially
different from what exists in nature. In
natural dentition, the tooth contour is basically formed by two separate entities: the
emergence profile and the cervical contour.
Advanced
Implant Esthetics
Article
Fig. 3
The EA is formed by the
junction of a line through
the long axis of the tooth
(red line) and a tangent
drawn to the coronal of
the tooth as it emerges
from the sulcus (blue line).
Crown contour and emergence
profile
The emergence profile is straight and corresponds to the part of the tooth emerging from the gingiva. The cervical contour
is convex and located at the bottom of
the gingival sulcus, corresponding to the
area where the enamel overlaps the cementum at the cementoenamel junction
(Figs. 2a & b). This convexity has been
identified by Wheeler,17 who referred to it
as the cervical ridge or cervical contour,
and it has the function of holding the
gingiva under definite tension.
[59] =>
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Figs. 4a–g
(a) The center of the
implant corresponds to the
cingulum of the adjacent
teeth.
(b) Occlusal view of the
final zirconia abutment. The
distance A–B would be
filled by the cervical
contour of the final crown.
Fig. 4b
Fig. 4a
(c) Frontal view of the final
zirconia abutment.
(d) The provisional
restoration in place.
(e) The definitive lithium
disilicate crown with a
cervical contour beyond
the physiological parameters determined by the
implant position associated
with a vertical finishing line
geometry.
(f) One-year follow-up
of the final crown showing
signs of tissue reaction.
Fig. 4d
Fig. 4c
(g) Radiograph of the
definitive crown.
Fig. 4f
Fig. 4e
The amount of this convexity is given by
the value of the emergence angle (EA),
which is defined as “the angle formed by
the junction of a line through the long axis
of the tooth, and a tangent drawn to the
coronal of the tooth as it emerges from
the sulcus”18, 19 (Fig. 3). The EA was recently
measured on natural maxillary extracted
teeth19 and it was found to have a mean
value of 15°.
In implant rehabilitation, the value of
the EA and the convexity of the cervical
contour are influenced by the buccopalatal
position of the implant. The more palatal
the implant placement, the greater the
EA and cervical contour. Since the main
task of the restorative dentist is always to
make artificial crowns appear to be and
function like a natural tooth, the artificially
recreated angles and contours should be
reproduced as closely as possible to nature.
Changing the implant position
according to the abutment shape
For the past decade, the present authors
have been working mainly with shoulderless abutments (both for implants and
natural teeth). In doing so, it has become
apparent that implant placement following
the conventional guidelines often results
in the fabrication of crowns with subcritical contours that differ greatly from those
of a natural tooth. Figures 4a–g show an
implant placed according to the conventional guidelines (i.e., at the cingulum of
the future restoration) and restored using
a shoulderless abutment. This resulted in
a final restoration with an excessively convex EA that in the short term (one year)
was already causing the surrounding soft
tissue to react adversely.
Fig. 4g
Article
Advanced
Implant Esthetics
issue 2017 — 59
[60] =>
Editorial_03.indd
Figs. 5a–c
(a) The long axis of the
implant corresponds to the
incisal edge of the future
restoration, allowing a
physiological EA.
(b) The long axis of the
implant corresponds to the
cingulum of the future
restoration.
(c) The implant is placed
more palatal, creating an
unfavorable undercut that
will make very difficult the
cement removal.
Figs. 6a–c
(a) Failing implant-supported porcelain-fused-tometal crown on tooth #26.
Fig. 5b
Fig. 5a
Fig. 5c
(b) Radiographic evaluation.
(c) The crown removed
along with the implant. The
presence of undetected
cement was the reason for
the failure.
Fig. 6a
Conventional guidelines for implant
placement have been conceived and
widely adopted for restorative abutments
made with a horizontal preparation
(shoulder or chamfer). However, as can
be seen in Figure 5, placing an implant
with a shoulderless abutment with a cingular (Fig. 5b) or palatal (Fig. 5c) position
would lead to a crown with an EA and
cervical contour far from the anatomical
ones described by Wheeler and Du.17, 20
However, when the implant is slightly
more buccally positioned, as in Figure 5a,
the EA and cervical contour look much
more natural and physiological.
Currently, there is no evidence that
an excessive artificial cervical contour
is either beneficial or detrimental to
soft-tissue stability, even though, according to the authors’ clinical experience,
some adverse soft-tissue behavior has
been noted when such crown contours
Fig. 6b
are designed (Fig. 4f). However, increasing the convexity of the subcritical contour will create an undercut which will
ultimately make cement removal, for a
cemented crown restoration, much more
difficult. Leaving residual cement inside
the gingival sulcus is more likely to occur
with restorations such as those illustrated
in Figures 5b and c, thus placing the
implant at great risk of periimplantitis
and possible loss21 (Figs. 6a–c).
Whenever a shoulderless preparation
is the geometry of choice, it is therefore
advisable to change the position of the
implant in a more vestibular direction,
with the long axis corresponding to the
incisal edge of the future restoration
or of the adjacent teeth. This position
will allow the creation of physiological
crown profiles and angles closely re sembling those of a natural tooth 22
(Figs. 7–9).
Fig. 6c
60 — issue 2017
Advanced
Implant Esthetics
Article
[61] =>
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Figs. 7a & b
(a) Failing tooth-supported
PFM crown on tooth # 21.
(b) Pre-op radiographic
control.
Figs. 8a–c
(a) Digital planning of the
implant surgery.
(b) The surgical guide
made accordingly to the
3-D planning.
(c) Guided implant
positioning through
the surgical guide.
Fig. 7a
Fig. 7b
Fig. 8a
Fig. 8b
Fig. 8c
Article
Advanced
Implant Esthetics
issue 2017 — 61
[62] =>
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Figs. 9a–i
(a) Occlusal view of the
implant in place at the time
of the final impression.
The center of the implant
(yellow circle) corresponds
to the incisal edge of the
adjacent teeth.
(b) A shoulderless zirconia
abutment.
(c) The final crown on top
of the abutment.
(d) The ideal placement
of the implant will generate
the correct cervical
contour and EA.
Fig. 9a
(e & f) Frontal and occlusal
views of the final zirconia
abutment in place. The
screw access hole has been
filled with PTFE and
composite.
(g & h) Final lithium
disilicate crown cemented,
with the final radiographic
control.
(i) Smile with final
restoration.
Fig. 9b
Fig. 9e
Fig. 9c
Fig. 9d
Fig. 9h
Fig. 9f
Fig. 9g
Conclusion
Fig. 9i
62 — issue 2017
Whenever a vertical (shoulderless) preparation has been chosen for the definitive
implant abutment rather than a horizontal (shoulder or chamfer) preparation,
changing the buccolingual position of
the implant is recommended, especially
in the esthetic zone. The long axis of the
implant should correspond to the incisal
edge of the future restoration or of the
adjacent teeth, assuming that 1.5–2.0
mm of the buccal bone can be maintained. This is the only position that
Advanced
Implant Esthetics
Article
enables fabrication of a restorative crown
with a cervical contour resembling, as
close as possible, what nature originally
provided. It also eliminates problems
with cement removal, greatly reducing
the incidence of iatrogenic periimplantitis and making hygienic procedures
much easier. Scientific data substantiating these observations are lacking. Therefore, randomized and prospective clinical trials are necessary.
Editorial note: A list of references is available from
the publisher.
[63] =>
Editorial_03.indd
www.dds.world
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THE MOST
COMPREHENSIVE
RESOURCE
IN DENTISTRY
*Registration is free until 31 August 2017.
[64] =>
Editorial_03.indd
Some favorites of our faculty
ICON A5
The inherent function
of every feature is
expressed through its
design. It’s why the
A5 looks as dynamic
as the experience it
delivers. The A5 uses
the most cutting-edge
materials and techniques to achieve its
stellar performance.
A perfect blend of art
and science.
© ICON Aircraft
www.iconaircraft.com.com
OPMI PROergo
Traveling
One of Dr. Plotino’s
favorite pastime.
© Dr. Gianluca Plotino
Comfort and precision. What you
see when looking at OPMI
PROergo from ZEISS is a surgical
microscope with a sleek,
attractive design that matches
the overall image of any practice.
What you do not see is the heart
and soul of the instrument–the
technology that drives it. The
cables, light source, light guide
and control console have all been
completely integrated into the
microscope.
© Carl Zeiss | www.zeiss.com
Instruments
CRLabanca
Labanca Malleable Retractor,
made from malleable stainless
steel for easy modification of
retractor shape and angle.
They feature an anti-reflective
matte finish under lighting
and are available in three
sizes.
ROTOR BIKES – custom made
bicyles since 1996
As enthusiasts and with close ties to
the industrial culture ROTOR BIKES
is well aware that there is no end to the
vast possibilities the beautifully
simple and timeless construction of
the bicycle.
© ROTOR BIKES GmbH| www.rotorbikes.com
PPlabanc36
Labanca Periosteal, for
reflecting and retracting
the mucoperiosteum.
© Hu-Friedy | www.hu-friedy.com
64 — issue 2017
Faculty Favorites
[65] =>
Editorial_03.indd
XA ABUTMENT
Developed in collaboration with BORG center, the new
XA range of prosthesis comes from the biological
concept that correlates healthy soft tissue and longlasting hard tissue. The presence of a micro-threading
at the basis of the abutments guides the fibroblast
growth and stimulates the production of collagen,
supporting the bone regeneration thanks to the tapered
morphology of the abutment and helping in preserving
the over time.
© Sweden & Martina
www.sweden-martina.com
KREAFUNK TOCHARGE BLACK EDITION
Powerbank, 7 × 11 cm with high performance
6,000 mAh Lithium battery. Suitable for smartphones,
tablets, PSP, MID, cell phones, MP3, GPS and
similar devices. Automatic Power on and off. Dual
power output 5V/1A & 5V2.1A. Antislip surface.
© Kreafunk | www.kreafunk.dk
PELEKANOS
INSTRUMENTS SET
Minimal invasive
surgery, in
combination with
ergonomics and optical
magnification,
are essential for
optimal post-surgical
wound healing and
patient comfort.
Therefore this surgical
kit includes carefully
selected instruments
in order to
simplify the surgical
procedures for implant
and periodontal
therapy.
CICLOTTE TONINO LAMBORGHINI
Ciclotte is an innovative exercise bike, designed and
made in Italy, that combines idea, form and
technology rethinking the traditional aesthetic and
functional values of an exercise bike. Ciclotte has
been manufactured using exceptional materials like
carbon, steel and glass fibers and represents a
complete innovation in the fitness sector thanks to
the unique technology of the epicycloids
transmission system.
© Hu-Friedy | www.hu-friedy.com
© Ciclotte | www.ciclotte.com
Photographer: Ezio Manciucca, Designer: Luca Schieppati
Faculty Favorites
issue 2017 — 65
[66] =>
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STEIGMANN INSTITUTE
Neckargemünd
— near Heidelberg, Germany
— Steigmann Institute
— Dr. Marius Steigmann
The Steigmann Institute is a
private teaching institution
founded in 2006. Its mission is to teach dentists all
aspects of dental implantology, with the focus on softtissue management and
bone regeneration.
received his degree in
dental medicine in 1987
and his Ph.D. in 2005, both
from the University of
Medicine and Pharmacy
of Tîrgu Mureş in Romania.
He is the founder and
director of the Steigmann
Institute.
www.steigmann-institute.com
Location
The Steigmann Institute is located in the
popular vacation town of Neckargemünd
along the Neckar River. The town has more
than a thousand years of history and many
of the seventeenth-century buildings have
retained their original charm. There is a
lively cultural scene with a wide range of
activities, and its proximity to Germany’s
famous university town of Heidelberg is a
great attraction.
www.lonelyplanet.com/germany/
baden-wurttemberg/heidelberg
How to get there
Heidelberg is located one hour south of
Frankfurt am Main. You can book a train
ticket to Heidelberg on the national railway website: www.bahn.de. Alternatively,
you could take a Lufthansa airport shuttle
from Frankfurt Airport to Heidelberg. The
bus route terminates at the Crowne Plaza
Heidelberg City Centre hotel. Buses run
every hour between 7:00 a.m. and 10:30
p.m. The meeting point for the shuttle is
at Terminal 1, “THE SQUAIRE WEST”, next
to the Deutsche Bahn long-distance trains
(exit next to the REWE supermarket).
Seats are guaranteed if they are reserved
three days prior to your arrival. The exact
bus schedule and information on reservation procedures are available at
www.transcontinental-group.com.
What to see and do
The ruins of the once-grand Heidelberg
Castle rise up on a rocky hilltop over the
66 — issue 2017
city. The castle holds the largest wine
barrel in the world, standing seven meters
high and eight and a half meters wide, and
holding 220,000 liters of wine. In
the castle grounds is the Deutsches
Apotheken-Museum, which recounts the
history of Western pharmacology.
Heidelberg Old Town is filled with architectural gems. Visit the town hall, the Old
University and historic buildings like the
1592 Renaissance townhouse called
“Knight St. George,” and enjoy the openair cafés dotted along the market squares.
The Old Town is also home to a third of all
the shops in Heidelberg.
Untere Straße, a narrow cobblestone
street that runs parallel to the river and
the main pedestrian street in the Old
Town, is filled with great bars, coffee shops
and inexpensive eateries.
The Gothic Heiliggeistkirche, Heidelberg’s famous church, was at one time
used by both Catholics and Protestants.
The top of its spire offers a bird’s-eye view
of the town.
According to tradition, Heidelberg’s
philosophers and university professors
would walk and talk along the Philosophers’
Way, which runs along the side of the Heiligenberg. It passes through the forest and
commands panoramic views of the castle.
The university library, built in Wilhelmian
style, holds superb collections, including
rare books and prints in its exhibition
room.
A boat trip down the Neckar offers a different view of the townscape.
www.weisse-flotte-heidelberg.de
Advanced Implant
Esthetics
Profile
[67] =>
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Shutterstock 563628430
Europäische Hof Heidelberg, overlooking
the city gardens, is a luxury hotel dating
back to 1865 in the heart of Heidelberg’s
historic centre.
www.europaeischerhof.com | TripAdvisor
Certificate of Excellence | 5-star
Heidelberg Marriott Hotel looks out over
the beautiful Neckar River and is close to
the university and a short distance from
the Old Town.
www.marriott.com
Where to stay
Both in the heart of the city and within
walking distance of the Old Town, Heidelberg University and Heidelberg Castle are
the following:
Crowne Plaza Heidelberg City Centre is a
hotel providing centrally located stylish
accommodation.
www.crowneplaza.com | TripAdvisor
Certificate of Excellence | 4-star
Leonardo Hotel Heidelberg City Center, set
along a cobblestone square, is a relaxed
hotel with a modern façade and a
15-minute walk from the Heidelberg train
station.
www.leonardo-hotels.com/leonardohotel-heidelberg-city-center | 4-star
Hotel NH Heidelberg is a 12-minute walk
from Heidelberg train station, two kilometers from the Church of the Holy Spirit and
less than three kilometers from Heidelberg Castle.
www.nh-hotels.com/hotel/nh-heidelberg
| TripAdvisor Certificate of Excellence
| 4-star
Profile
Advanced Implant
Esthetics
Where to eat
Weisser Bock offers regional specialties
with a twist.
www.weisserbock.de
Heidelberger Kulturbrauerei offers homebrewed beer and regional specialties in an
Old Town hotel.
www.heidelberger-kulturbrauerei.de
zum Roten Ochsen, built in 1703, has been
owned by the Spengel family for more
than 170 years. Enjoy good German-style
food in this historical building, with music
from the piano man.
www.roterochsen.de
Weisses Rössel Cavallino Bianco is a small
Italian restaurant located in the center of
Heidelberg.
www.weissesroessel.de
For more information visit:
www.tourism-heidelberg.com
issue 2017— 67
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ABOUT
THE STEIGMANN INSTITUTE
COURSES
Dr. Marius Steigmann, Germany
Clinically, it is a tremendous challenge to
create natural gingival esthetics after
immediate or delayed implant placement.
Stability of the soft tissue during implant
surgery is of major importance for the
implant site and adjacent teeth. For cases
in which only the tooth is compromised
and not the soft-tissue or osseous form,
a flapless surgery can be performed. In
cases of localized horizontal or vertical
deficiency, dehiscence or fenestration,
another approach is necessary. From a
prosthetic prospective, the soft-tissue
architecture around implants has to be
similar or close to that of the natural
tooth. While the dental laboratory can
deliver the best functional and esthetic
work, it will be harmonious only if the
soft-tissue dimensions are maintained or
developed surgically or with the help of
the prosthetic reconstruction. Singleimplant placement has proved to be more
predictable than multiple-implant placement. In the case of multiple implants and
delayed loading, it is possible to form a
68 — issue 2017
Advanced
Implant Esthetics
Article
soft-tissue profile with provisionals or
proceed directly to the final reconstruction. This is done with the help of a wax-up
on the final metal frame to control the
pressure of the soft-tissue intraorally.
[69] =>
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Soft-tissue management
for bone augmentation
Different tissue biotypes react differently
to surgical trauma. For this reason, we
have adapted the surgical approach to the
biotype (tissue thickness) specific to each
patient and the location in the oral cavity.
The tissue thickness dictates the way it is
manipulated for high-volume augmentation. Thick biotypes can be managed in a
conventional manner. However, thin biotypes require new surgical approaches
with specific instruments. This course will
describe step by step the gain of softtissue for tension-free closure even in
cases of reduced soft-tissue thickness.
The course will define predictable
soft-tissue manipulation around implants
according to soft-tissue biotype. Learning
from our clinical experience in soft-tissue
manipulation, we can adapt soft-tissue surgery. We need to graft more, to manipulate
the soft tissue, to treat each particular
case.
There is little data in the literature on
adapting surgery according to soft-tissue
thickness. Most articles describe the same
kind of surgery for all cases, with no distinction between biotypes. With this in
mind, we have to adjust surgery to the
tissue conditions for better soft-tissue closure in cases of grafting and for better
esthetics. This means individualized flap
design for every tissue type. The next step
will be the development of instruments,
but more than that, of implant surfaces
and biomaterials that address not only the
bone but also the soft tissue. Adapting
therapy to soft-tissue biotype is changing
the way we approach implant dentistry.
Soft-tissue management
for the esthetic zone
Function and esthetics with implant treatment depend on case selection, surgical
planning and prosthetic reconstruction.
Each of these has evolved dramatically
over the years. The latest implant designs
increasingly help the clinician in achieving
these goals in the esthetic zone. Incorrect
flap design leads to dramatic failure in this
sensitive soft-tissue zone. The course will
address the requirements for modern flap
design according to the necessary amount
of bone and soft-tissue regeneration.
Prosthetic soft-tissue
development in implant
dentistry
The main purpose of this course is to
explain, demonstrate and teach softtissue development around implants with
the help of prosthetic components in
fixed, single- and multiple-implant
placement.
The course will cover abutment design
for ideal soft-tissue support, pontic design
for esthetic soft-tissue development,
emergence profile design for the crown
and abutment, different wax-up modalities, esthetic try-ins for different therapeutic phases, crown margin definition,
gingival management with temporaries,
and mock-ups.
Soft-tissue complications
and full-arch restoration
With the increasing number of implants
being placed in the esthetic zone according to immediate or delayed protocols, we
face soft-tissue complications like recession of the soft-tissue and papillary loss.
There are no predictable methods documented in the literature regarding how to
increase the soft-tissue height for the
papillae or correct recessions around
implants.
The course will demonstrate individualized approaches to correct papillary loss
in the esthetic zone using modern flap
design techniques. Furthermore, increasing soft-tissue thickness and moving the
soft tissue coronally after recession around
implants through surgery and prosthetic
methods will be described.
Article
Advanced
Implant Esthetics
Soft-tissue management:
Vertical augmentation
Vertical bone loss represents a major surgical challenge in the implant treatment
of the posterior mandible, owing to anatomical factors and technical difficulties.
Proper management of the soft-tissue is
crucial for success of any regenerative
procedure: A complete and stable closure
of the flaps during healing is essential to
prevent contamination and infection and
allow for undisturbed graft healing and
incorporation. This prerequisite can be
accomplished only if buccal and lingual
flaps are sufficiently released, in order to
obtain a passive coverage of the augmented area, stabilizing it with tension-free
sutures. In the posterior mandible in particular, the use of conventional periosteal
incisions is not always sufficient for a
proper buccal flap passivation, often
being limited by anatomical factors.
Over time, bone augmentation has
moved from highly specialized clinics into
the dental office. With the help of modern
grafting material, the augmentation
volume in the dental office has increased
year by year. However, the main issue
remains soft-tissue closure for highvolume augmentation, especially in the
posterior mandible and posterior maxilla.
We have developed special flap designs
and suturing techniques specific to location to address this ongoing problem of
soft-tissue management. The participants
will learn about and practice soft-tissue
closure according to location.
issue 2017 — 69
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CLINICAL MASTERS™
— TESTIMONIALS
For this new edition of the
Clinical Masters™ magazine,
this is what the participants
had to say about their
experience of the programs
and presenters this year.
ENDODONTICS
—June 2016, Athens, Greece
The course was really impressive and
informative.
Dr. Mohammad Mortzavi (Iran)
ADVANCED IMPLANT ESTHETICS
—October 2016, Heidelberg, Germany
Heidelberg was a very nice experience.
Dr. Marius Steigmann was an inspiration,
and I learned a lot of new techniques
in flap design, suturing and implant
placement. For me, this was a revelation
and I’m thrilled to have benefitted from
this experience.
Today, two days after the completion of the
course, I placed two implants in two
different patients, and I used Steigmann’s
technique when performing guided
bone regeneration in the esthetic zone.
I’m very excited and inspired.
Dr. Karleif Taksdal (Norway)
I was completely satisfied and gained a lot
of knowledge. The theoretical part was
quite understandable and perfectly fitted
with the hands-on practice afterwards.
Dr. Dimitra Tsangaratou (Greece)
Dr. Didier Dietschi’s presentations were
amazing and I would recommend the course
to my colleagues.
Dr. Andrea Ferrazzi (Italy)
Good proportional combination of theory
and practical exercises. Very good
organization overall.
Dr. Curd Bohlen (Netherlands)
APPLY NOW!
www.Clinical-Masters.com
70 — issue 2017
ESTHETIC AND RESTORATIVE DENTISTRY
—February 2016, Geneva, Switzerland
Very organized course in a really welcoming
environment, perfect for learning.
Dr. Didier Dietschi’s presentations were
amazing and offered great content.
Dr. Zahira Mendoza (U.S.)
Clinical Masters™
Testimonials
[71] =>
Editorial_03.indd
It was more than I expected! Dr. Stavros
Pelekanos is probably the best lecturer that
I’ve met. He shared everything with us
and was totally available to help with the
hands-on practice when we needed his help.
Dr. Francisca Micola (Romania)
Dr. Stavros Pelekanos was a wealth of
knowledge. His approachable personality
and eagerness to answer questions made
his session really enjoyable and informative.
I am looking forward to learning with
him again.
Dr. Ibrahim al-Salti (Australia)
Very satisfied. Exceeded my expectations.
Would definitely recommend to others.
Dr. Dominic Gordon (Poland/Jamaica)
The program was much better than I
expected. Well done!
Dr. Nektarios Tsoromokos (Great Britain)
It was a really helpful experience which taught
me a lot; a really good course. The hands-on
practice with the microscope and videos
Dr. Domenico Massironi showed us was my
favorite part.
Dr. Francisca Micola (Romania)
ESTHETIC AND RESTORATIVE DENTISTRY
—October 2016, Milan, Italy
The way the microscope training was delivered
was the highlight of the course for me.
Dr. Domenico Massironi’s presentation was
done with utmost effectiveness and knowledge, addressing problems which can arise
in the daily practice.
Dr. Mehmet Kalcay (Turkey)
The way that the course material was
delivered was excellent. Dr. Stavros Pelekanos
and his team were really efficient in delivering
the course content and made sure everyone
got the help they needed.
Dr. Mehmet Kalcay (Turkey)
As a new practicing dentist, this course was a great
opportunity to learn more and improve my learning
and practice skills with great teachers who were
greatly supportive. It also helped me to have more
self-confidence. I am very much looking forward
to the next session.
Dr. Nazanin Sharifsamani (Hungary)
Testimonials
Clinical Masters™
issue 2017 — 71
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Location
The BORG Center is located in Viladecans,
near Barcelona, a city with a rich cultural
heritage and known for its Catalan culture
and distinctive architecture, including several UNESCO World Heritage Sites. It is a
popular tourist destination and boasts one
of the best beaches in the world.
www.lonelyplanet.com/spain/barcelona
—The BORG Center,
or Barcelona Osseointegration Research
Group, is focused on research in oral implantology and its various clinical applications.
The group was established in early 2005
when four specialists in oral implantology
developed a common protocol with good
results to demonstrate that in cases in which
the diameter of the abutment is smaller than
the diameter of the implant bone loss is ostensibly lower. This research, titled “Benefits
of an implant platform modification technique to reduce crestal bone resorption,”
was published in Implant Dentistry in 2006.
Since then, they have lectured worldwide
and have produced and collaborated on a
huge number of publications. We enjoy our
work and are eager to share it with you at
the BORG Center, where we have been
meeting, discussing, teaching and learning
since 2012. We hope to see you soon.
www.borgbcn.com
BORG CENTER
— Barcelona, Spain
— Dr. Xavier Vela Nebot
— Dr. Xavier
Rodríguez Ciurana
obtained his degree in dentistry and medicine from
the University of Barcelona.
He has a private practice in
Barcelona dedicated to implantology and prosthetics.
He is a co-founder of the
BORG Center, conducts
research and regularly publishes articles in leading
international journals. He
has lectured at prominent
national and international
symposiums.
obtained his degree in medicine and surgery from the
University of Barcelona. He
has a private practice in
Barcelona. He is an associate professor at the European University of Madrid
in Spain and is co-founder
of the BORG Center.
How to get there
From Barcelona Airport: The center is an 11to 16-minute drive from the airport by taxi.
From Viladecans: Two buses depart from
the train station every 20 minutes approximately, the VB1 and the VB2. Ask the bus
driver to stop at the Ángel Arañó/Dos de
Mayo bus stop. The center is located two
streets down from the bus stop.
What to see and do
Take a stroll down La Rambla, the worldfamous boulevard stretching about 1.2
kilometers all the way to the Mediterranean Sea.
Wander through the Barri Gòtic (Gothic
quarter), the center of the old city.
Visit the Museu Nacional d’Art de
Catalunya (Catalonia national art museum).
See Antoni Gaudí’s many masterpieces,
seven of which are on the UNESCO World
Heritage List, the most famous probably
being the Sagrada Família basilica and the
beautiful Park Güell, demonstrating perfect harmony of nature and architecture.
A UNESCO World Heritage Site, Palau
de la Música Catalana is a concert hall
exemplary of art nouveau architecture.
72 — issue 2017
Some of the most important craftsmen
and artists of the time were involved in its
creation.
Housed in five Catalan-Gothic palazzos
dating from the thirteenth and fourteenth
centuries, the Museu Picasso is a museum
of the artist’s formative years.
El Paral·lel, a vibrant theater district, is
your destination for all entertainment
and music.
A walk up Montjuïc mountain offers
spectacular views.
For a day trip, take an exhilarating hot-air
balloon flight over Catalonia with
Advanced
Implant Esthetics
Profile
panoramic views of the Pyrénées,
Montserrat, Montseny and the Mediterranean Sea.
Previous participants have enjoyed a
visit to the FC Barcelona Museum and attending a game as well.
www.fcbarcelona.com
Where to stay
AC Hotel Gavà Mar has a seafront location
in a quiet area close to the BORG Center,
but a little far from the center of Barcelona.
www.marriott.com| TripAdvisor
Certificate of Excellence | 4-star
[73] =>
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Hotel 1898, on La Rambla, is housed in a restored colonial-style nineteenth-century
building.
www.hotel1898.com | TripAdvisor
Certificate of Excellence | 4-star
Shutterstock 407568148
Sidorme Viladecans is quite new and a
5-minute taxi ride to the BORG Center.
www.sidorme.com
Where to eat
ABaC Restaurant serves Mediterranean/
Spanish fusion cuisine.
www.abacbarcelona.com | 2 Michelin stars
Freixa Tradició is a very small and old restaurant offering traditional Catalan food.
www.freixatradicio.com
Ziryab Fusion Tapas Bar serves Spanish
cuisine with a Middle Eastern twist.
www.ziryab.es
La Taula is a cozy restaurant providing international cuisine, as well as home favorites.
www.lataula.com
Majestic Hotel & Spa offers luxurious accommodation in a neoclassical building on Passeig de Gràcia, near shopping areas in the
center of Barcelona.
www.hotelmajestic.es | TripAdvisor
Certificate of Excellence | 5-star
Silvestre is an elegant restaurant that
serves international and traditional cuisine
with the option of half-portions for every
dish.
www.restaurante-silvestre.com
Tast-Ller is a small, exclusive Mediterranean restaurant located down a side alley.
www.tast-ller.com
W Barcelona, right on the beach and 30 minutes from the BORG Center, commands
fantastic views over Barcelona and has a
magnificent design.
www.w-barcelona.com | TripAdvisor
Certificate of Excellence | 5-star
For more information visit:
www.barcelonaturisme.com
Profile
Advanced
Implant Esthetics
issue 2017 — 73
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INTERVIEW
with — Drs. Rodríguez Ciurana & Vela Nebot
Q: Drs. Vela and Rodríguez, you refer to
your newest XA abutments, developed with
Sweden & Martina, as paradigm shifting.
Could you please explain what has led you
to this point?
A: The main concern of the clinician is to
minimize the inexorable bone resorption
and apical migration of the soft tissue that
involves multiple problems, including
esthetics and the survival of the restoration in the medium and long term owing
to periimplantitis. We consider that our
approach is a paradigm shift because using
XA abutments and a suitable rehabilitation
protocol not only avoids apical migration,
but also promotes coronal migration of
bone and soft tissue over time. This means
esthetic improvements, as well as protection against periimplantitis.
plant tissue. The evolution of the concept
reflects different phases of our work over
the years. The BORG Center was established in 2012, and the BORG members
began their clinical research in 2004, at
which time we followed the standard protocol: an implant without platform switching (PS), an abutment with an anatomical
profile imitating the shape of the tooth
(divergent shape) and a protocol entailing
multiple disconnections. However, with
this approach, the tissue tended to apical
migration.
74 — issue 2017
Advanced
Implant Esthetics
Q: Apical migration means gingival recession. Did this not compromise the esthetics?
A: Of course. In fact, gingival recessions
gave rise not only to esthetic risk but also
to the risk of periimplantitis. We therefore
evolved our protocol to an implant with PS,
Q: And how is that possible?
an abutment with an anatomical profile
A: Basically, the protocol we apply has been (divergent) and multiple disconnections.
improved and updated to achieve the final The introduction of the PS concept allowed
objective of the stabilization of the periim- us to reduce periimplant bone resorption
Interview
[75] =>
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by improving tissue stability. This concept
allowed us to understand the relationship
between the shape of the abutment and
the stabilization of the tissue by the circular fibers of the connective tissue.
ments allows us to avoid the disconnections and reconnections associated with
the classical protocol of rehabilitation. No
disconnections or reconnections of the
abutments means no tissue destabilization.
For the first time, the abutments are a guide
Q: You have published high-impact literature for the connective tissue and periosteum,
on platform switching since 2006.
which in turn promotes bone growth. That
A: Yes. We have preferred platform - is why we call it a paradigm shift.
switched restorations since we began to
understand the clinical results due to the Q: And what is the function of the microbiology of the tissue. The same understand- threads?
ing led us to the use of straight abutments A: Ok, here are some things that biology
instead of divergent ones because straight has taught us over the last few years. Fibroabutments allowed us to increase the thick- blasts and myofibroblasts are paramount
ness of the tissue and improve the results to the production of the collagen fibers
in a predictable manner. We thus improved that surround the restoration, and science
our protocol to an implant with PS, an abut- has proved that the presence of microment with a straight profile and multiple threads at the base of the abutment prodisconnections.
motes the alignment of both fibroblasts
and myofibroblasts. This alignment encourQ: But, of course, the multiple disconnec- ages the acceleration and increase of the
tions are also a concern.
production of collagen, resulting in collaA: That is true. As we have proved in many gen fibers surrounding the restoration with
articles, every disconnection and recon- more predictability through the micro-
XA abutments and a suitable rehabilitation
protocol not only avoids apical migration,
but also promotes coronal migration of bone
and soft tissue over time.
nection of the abutment in a regular protocol compromises the tissue stability, and
the body response is further apical migration. To avoid this tissue trauma, we
advanced to our latest rehabilitation protocol: an XA abutment with a conical profile and microthreads at the base and zero
disconnections or reconnections on a
platform-switched implant. The use of XA
abutments for threaded and cemented
prostheses allows us not only to stabilize
the tissue, but also to promote its coronal
migration over time.
threads. We are talking about contact guidance, a crucial factor in biological sealing.
Q: And what about compatibility with other
clinical protocols?
A: Absolutely. That is something we had
been working on for a long time until we
finally designed both screw-retained and
cemented abutments compatible with various working protocols (screw-retained
prosthesis or cemented prosthesis) for all
clinical situations (anterior or posterior
region, immediate or delayed loading). The
apparent extreme simplicity is due to multiple biological criteria in seeking the best
Q: So, from divergent to straight and finally possible response of tissue. Its use is simple
to convergent abutments?
and facilitates the work of the clinician
A: The conicity of these convergent abut- and laboratory technician. We believe it
ments promotes the coronal migration of is a genuine game-changer.
the tissue in the short and long term. The
absence of margin on our marginless abut-
Interview
Advanced
Implant Esthetics
issue 2017 — 75
[76] =>
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Dr. Eric Van Dooren
MIS 2017 GLOBAL
LEARNING PROGRAM
— Sharing knowledge and
experience through education
March will mark the start of a series of
workshops organized by MIS Implants
Technologies that will focus on various
topics and be led by world-famous practitioners in different parts of the world.
The offering includes courses on basic
implantology in Germany and China, a
workshop on the MULTIFIX solution in
Portugal and a course taught in Turkey on
the fundamentals of aesthetic smile design.
Dr. Eric Van Dooren, a key opinion leader
in implant dentistry and the co-developer
of MIS’s V3 implant, will be teaching a
course on the VCONCEPT in his training
center in Antwerp in Belgium, where he
has been conducting courses and workshops for the past 12 years. He explained
that the purpose of the center is to offer
courses with a focus on periodontology,
prosthetics and implantology that give
participants the opportunity to witness
live surgeries. Participants enjoy high-tech
audio-visual and are able to take advantage
of live streaming.
The latest series of courses will focus
on the integration between prosthetic and
surgical implant treatment concepts and
will highlight soft-tissue management in
the aesthetic zone, both through theoretical material and a live surgery demonstration.
Van Dooren added: “Since we are focusing on new concepts and trends, the
VCONCEPT really helps us in explaining
that modern implant dentistry is changing
compared to a few years ago.” Van Dooren
also incorporates the MIS MGUIDE guided
surgery solution in the curriculum to show
students that guided surgery today is really
a very predictable tool to obtain excellent
76 — issue 2017
MIS
Company
article
functional and aesthetic results. Furthermore, course participants will plan a case
using the MIS MSOFT guided surgery
planning software.
Participants who have taken Van
Dooren’s courses in previous years have
provided positive and enthusiastic feedback. The hands-on experience with the
MGUIDE system has led to a great response
from dentists, who have begun using these
methods in their practices since attending
the course.
Van Dooren plans to continue lecturing
on these topics and incorporating the V3
implant and MIS digital dentistry tools and
methods in future courses at the training
center.
More information on MIS global educational
events can be found at www.mis-implants.com/
education/MTC.aspx.
[77] =>
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and anytime
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ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providersof continuing dental education.
ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry.
[78] =>
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78 — issue 2017
Clinical Masters™
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[79] =>
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[81] =>
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[82] =>
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— Editorial Board
IMPRINT
— about the publisher
Publisher/President/CEO
Torsten R. Oemus
Business Development Manager
Claudia Salwiczek-Majonek
t.oemus@dental-tribune.com
c.salwiczek@dental-tribune.com
Publisher
Yannis Roussis
Project Manager & Event Services
Sarah Schubert
omnipress@omnipress.gr
s.schubert@dental-tribune.com
Managing Editor
Nathalie Schüller
Executive Producer
Gernot Meyer
n.schueller@dental-tribune.com
g.meyer@dental-tribune.com
Contributing Editor
Brendan Day
— Media Sales Managers
b.day@dental-tribune.com
Marc Chalupsky
Key Accounts
Matthias Diessner
m.chalupsky@dental-tribune.com
m.diessner@dental-tribune.com
Concept & Design
Rhowerk®
International
Melissa Brown
www.rhowerk.de
m.brown@dental-tribune.com
Copy Editors
Sabrina Raaff
Hans Motschmann
Antje Kahnt
a.kahnt@dental-tribune.com
Dr. Spyros Floratos, Greece
Dr. Gianluca Gambarini – Italy
Dr. Werner Götz, Germany
Dr. Nicola M. Grande – Italy
Dr. Marco Gresnigt, Germany
Dr. Daniel Grubeanu, Germany
Dr. Stefan Hägewald – Germany
Dr. Lena Hirtler, Austria
Dr. Bodo Hoffmeister, Germany
Dr. Alireza Houshmand, Iran
Dr. Matteo Invernizzi – Italy
Dr. Sam Kratchman, U.S.
Dr. Philip J. Kroll – U.S.
Prof. Mauro Labanca, Italy
Dr. Diego Lops – Italy
Dr. Marcelo Lucchesi Teixeira – Brazil
Prof. Edward A. McLaren, U.S.
Dr. Francesco Maggiore, Italy
Dr. Domenico Massironi – Italy
Dr. Jörg Neugebauer, Germany
Dr. Mark Onuoha – Denmark
Dr. Patrick Palacci – France
Dr. André Antonio Pelegrine – Brazil
Dr. Stavros Pelekanos – Greece
Dr. Javier Pérez López – Spain
Dr. Claudio Pisacane, Italy
Dr. Gianluca Plotino – Italy
Dr. Giancarlo Pongione, Italy
Dr. Mamaly Reshad – U.S
Dr. Rita Rezzani, Italy
Dr. Natalie Richards – U.S
Dr. Luigi F. Rodella, Italy
Dr. Xavier Rodríguez Ciurana – Spain
Dr. Daniel Rothamel – Germany
Dr. James L. Rutkowski – U.S
Dr. Markus Schlee – Germany
Dr. Fabio Scutellà – Italy
Dr. Branko Sinikovic, Germany
Dr. Ralf Smeets – Germany
Dr. Önder Solakoglu, Germany
Dr. Heike Steffen, Germany
Dr. Marius Steigmann – Germany
Prof. Tiziano Testori, Italy
Dr. Manfred Tschabitscher, Austria
Dr. Roberto Turrini – Italy
Dr. Xavier Vela Nebot – Spain
Dr. Kamil J. Zborowski – U.S.
Asia Pacific
Peter Witteczek
— International Administration
p.witteczek@dental-tribune.com
Education Director
Christiane Ferret
Latin America
Weridiana Mageswki
c.ferret@tribunecme.com
w.mageswki@dental-tribune.com
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Dan Wunderlich
Western Europe
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— International Office
d.wunderlich@dental-tribune.com
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Copyright Regulations
Clinical Masters™ is published by Dental Tribune International (DTI) and is published yearly. The magazine and all articles and illustrations therein are protected by copyright. Any
utilization without the prior consent of editor and publisher is forbidden and liable to prosecution. This applies in particular to duplicate copies, translations, microfilms, and storage
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82 — issue 2017
Clinical Masters™
Imprint
[83] =>
Editorial_03.indd
FrIDay 14 aPrIl
Dr Paulo Kano
Honorary Guest
(Brazil)
CAD/CAM Dentistry
• «Digital total prothese», Mr Max Bosshart & Mr Benoit Gobert
• «All ceramic materials in prosthodontic», Prof Roberto Sorrentino
• «Tips and tricks to enhance the oral rehabilitation», Dr Paulo Kano
• «New Occlusion Concepts with New Restorative Materials», Dr Erhan Comlekoglu
• «Digital Biomimetics – Concepts for predictive treatments», Prof. Dr. Jan-Frederik Güth
[84] =>
Editorial_03.indd
nt
ries
© MIS Implants Technologies Ltd. All rights reserved.
co
u
EXPERIENCE THE GLOBAL SUCCESS
MAKE IT SIMPLE
MIS is a global leader in the development and production of advanced products
and innovative solutions aimed to simplify implant dentistry. Successfully sold and
distributed in over 65 countries worldwide, MIS provides unparalleled service to our
customers. To learn more, visit our website: www.mis-implants.com
®
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/ Editorial
/ Contents
/ TRIBUNE CME —Global knowledge - delivered by world-class faculty in prime locations
/ MASTER EDUCATIONAL GROUP — Melegnano - Italy
/ DR. DOMENICO MASSIRONI AND THE MODIFIED CHAMFER
/ INTERVIEW with — Prof. Edward A. McLaren
/ EDUDENTINTERNATIONAL @ THE GENEVA SMILE CENTER — Geneva - Switzerland
/ SMILE REHABILITATION — A direct therapeutic approach assisted by digital diagnosis and mock-up
/ MANAGING THE PERIIMPLANT MUCOSA: — A clinically reliable method for optimizing soft-tissue contours and the emergence profile
/ CONTINUING DENTAL EDUCATION IN LAKE COMO: BRENNA & LEVRINI
/ JOIN THE CLINICAL MASTERS™ NETWORK
/ INTERVIEW with — Prof. Mauro Labanca
/ DR. ARNALDO CASTELLUCCI Micro-Endodontics Training Center — Florence - Italy
/ COMBINED SURGICAL AND NONSURGICAL — endodontic retreatment for the management of an unusual clinical case
/ COMBINED SURGICAL AND NONSURGICAL — endodontic retreatment for the management of an unusual clinical case
/ ENDO INN TO JOIN THE CLINICAL MASTERS™ PROGRAM IN ENDODONTICS
/ INTERVIEW with — Dr. Gianluca Plotino
/ INTERVIEW with — Dr. Louie al-Faraje
/ LAKE COMO INSTITUTE — Como - Italy
/ BUCCOLINGUAL IMPLANT POSITION AS A CONSEQUENCE OF THE ABUTMENT SHAPE — A paradigm shift
/ Some favorites of our faculty
/ STEIGMANN INSTITUTE Neckargemünd — near Heidelberg - Germany
/ ABOUT THE STEIGMANN INSTITUTE COURSES
/ CLINICAL MASTERS™ — TESTIMONIALS
/ BORG CENTER — Barcelona - Spain
/ INTERVIEW with — Drs. Rodríguez Ciurana & Vela Nebot
/ MIS 2017 GLOBAL LEARNING PROGRAM — Sharing knowledge and experience through education
/ REGISTRATION FORM — Clinical Masters™Program
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