DENTSPLY IMPLANTS #2 2014 THE PUBLICATION FOR THE DENTAL IMPLANT TEAM NEWS & TRENDS Stay updated P. 05 ZOOMING IN One-position-only P. 20 ASK THE EXPERTS 2 Q&A´s P. 26 PATIENT PROFILE Life with implants P. 50 magazine voices on quality of life JOCELYNE FEINE INGEBORG DE KOK ANNE BENHAMOU 3 TREATMENT SOLUTIONS IN THE SPOTLIGHT The new DENTSPLY Implants WeldOne concept for intraoral welding Take a look at DENTSPLY Implants’ unique development work 18 PAGES OF CLINICAL INNOVATION
Transcript
DENTSPLY IMPLANTS
#2 2014THE PUBLICATION FOR
THE DENTAL IMPLANT TEAM
NEWS & TRENDS Stay updated P. 05
ZOOMING IN One-position-only P. 20
ASK THE EXPERTS 2 Q&A s P. 26
PATIENT PROFILE Life with implants P. 50
magazine
voices on quality of life
JOCELYNE FEINE
INGEBORG DE KOK
ANNE BENHAMOU3TREATMENT SOLUTIONS
IN THE SPOTLIGHT
The new DENTSPLY Implants WeldOne concept for intraoral welding
Take a look at DENTSPLY Implants’ unique development work
18 PAGES OF CLINICAL INNOVATION
Restoring quality of lifePatients rely on you in order to eat, speak, and smile with confidence. It can be said, you are actually restoring quality of life.
To succeed, you need technology that is well founded and documented in science. That is why we only deliver premium solutions for all phases of implant therapy, which have been extensively tested and clinically proven to provide lifelong function and esthetics.
Moreover, with an open-minded approach, we partner with our customers and offer services that go beyond products, such as educational opportunities and practice development programs.
Reliable solutions and partnership for restoring quality of life—because it matters.
PATIENT PROFILE .........................................50Implants in real life
TRAVEL WITH DENTSPLY IMPLANTS ...............52Visit Paris with us
A WORD WITH ...........................................54
ON THE COVER CLINICAL CASES
Clockwise from top left: Jocelyne FeineAnne BenhamouIngeborg De Kok
PUBLISHER DENTSPLY Implants magazine is published and distributed worldwide by DENTSPLY Implants, P.O. Box 14, SE-431 21 Mölndal, Sweden / Steinzeugstrasse 50DE-68229 Mannheim, Germany.
EDITOR-IN-CHIEF Kerstin Wettby, Senior Manager/Global Marketing Communication & PR.
CONTACT US Editors can be reached at [email protected]. Please e-mail questions, opinions and thoughts on DENTSPLY Implants magazine.
COPYRIGHT All rights reserved, including that of translation into other languages. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording or any information storage or retrieval system, without written permission from DENTSPLY Implants.
TRADEMARKS All trademarks and company names are the property of their respective owners. To improve readability for our customers, DENTSPLY Implants does not use ® or ™ in body copy. However, DENTSPLY Implants does not waive any right to the trademark and nothing herein shall be interpreted to the contrary.
EDITORIAL CONTENT Although great care has been taken in compiling and checking the information in this document to ensure its accuracy, the publisher assumes no responsibility for any errors, omissions or inaccuracies herein. The contents of this document are based on the latest information available at the time of publication. The opinions expressed in this publication are not necessarily those of the publisher or editor-in-chief. Submitted material will be stored electronically for the possibility of publication on the internet, reprints and
in other formats. DENTSPLY Implants is committed to new and innovative knowledge and some subjects may include personalized opinions. Inclusion in this publication does not necessarily imply endorsements of particular philosophy, procedure or product by DENTSPLY Implants.
DESIGN, LAYOUT & PRODUCTION The Bond Communication Agency & Raspberry Road
The new DENTSPLY Implants WeldOne concept for intraoral welding
Take a look at DENTSPLY Implants’ unique development work
18 PAGES OF CLINICAL INNOVATION
Three voices on quality of life06
Industry experts share their results using the latest advancements in implant dentistry.
PAGE 2518 PAGES
OF CLINICAL INNOVATION
CASE STUDIES
04 DENTSPLY IMPLANTS MAGAZINE #2
EDITORIAL NEWS & TRENDS
The freedom of choice is about having the opportunity to choose between several possibilities. The choices you make in your professional role will have consequences; for
you, but more importantly, for your patients and their wellbeing. That’s why it is important to take great care in selecting who and what you work with every day.
AT DENTSPLY IMPLANTS, we are improving, evolving and growing as a company and as a solutions partner. We recently opened the first DENTSPLY Implants office in China, a market where our implant lines ANKYLOS and XiVE have been present and successful since 1998. In conjunction with the opening, we launched the ASTRA TECH Implant System and are looking forward to exciting development and growth in this very dynamic market. We are also preparing for the expansion of ATLANTIS into several new markets, something I know many customers are waiting for.
We have also launched the new ASTRA TECH Implant System EV. This evolution of an already successful and established implant system has received very positive response from customers, which we are happy about. We are also very proud of how this system evolution came to life— by working together with our users.
IN THE END, it is not about dental implants or abutments; it is about the consequences of the choices we make as human beings and as dental professionals. Every day, everything we do is about providing quality of
life. To me, good health is one very important aspect of quality of life. That is why we are here to support you to make the best choices possible for you, your practice, and your patients.
That is also why we at DENTSPLY Implants offer documented, proven and reliable implant treatment solutions and services, as well as a trusted partnership based on respect and a common goal, so that your patients can enjoy good health
and improved quality of life.The choice is yours; we are here
for you when you are ready to make it.
Choosing good health and quality of life
LARS HENRIKSON Group President, DENTSPLY Implants
LARS HENRIKSON
HANS ROSLING MAKES COMPLICATED MATTERS COMPREHENSIBLE GLOBAL HEALTH Access to dental care is a key to better global health, says Hans Rosling, a Swedish professor in global health who has been named among the world’s 100 most influential persons by TIME magazine.
HE IS DETERMINED to make complicated socio-economic development statistics easier to understand and he is known for his TED Talks which are viewed by millions. Although he speaks about very serious issues, his charisma, style and use of props and graphics turn them into entertaining and captivating presentations.
ROSLING IS A co-founder of Gapminder, a non-profit foundation that brings vital data to life. The website contains graphics and tables on everything from poverty levels to unemployment rates, from coal consumption to residential electricity use. Naturally, there are also answers to questions like which country has the best teeth and where do people eat most sugar and sweeteners.
FOUR QUESTIONS FROM HANS ROSLING’S IGNORANCE TESTThe mission of Gapminder Foundation is to fight devastating ignorance with a fact-based worldview that everyone can understand.
1. What do you think is the life expectancy in the world as a whole today? a) 70 b) 60 c) 50
2. What percentage of adults in the world today are literate—can read and write? a) 80 b) 60 c) 40
3. What percentage of the world s one-year old children is vaccinated against measles? a) 20 b) 50 c) 80
4. In the last 20 years, the proportion of the world population living in extreme poverty has... a) Almost doubled b) Remained more or less the same c) Almost halved
To read more about Gapminder, please visit www.gapminder.org.
To catch one of Hans Rosling’s TED talks, please visit www.ted.com.
To become one of his 171,000+ followers on Twitter, go to http://twitter.com/HansRosling
Correct answers: 1 a, 2 b, 3 c, 4 c
Hans Rosling at the world congress in Gothenburg, Sweden, 2012.
#2 DENTSPLY IMPLANTS MAGAZINE 05
Will implants be 3D-printed
TOMORROW?At the beginning of 2014, an
amazing breakthrough took place. Dutch surgeons managed
to implant a transparent, 3D-printed thermoplastic skull in a woman. It may sound like science fiction, but this skull managed to stop a condition, where the original skull never would have stopped growing.
Thanks to the skull’s transparency, the doctors can follow up and see how things are going macroscopically and are, in addition, able to monitor the brain’s activity like never before.
And this is just the beginning. Future versions may include provisions for implants that augment or restore hearing into replacement skulls. Implants that use bone conduction to communicate could be directly incorporated into the skull, one example being Google Glass.
While 3D printing is not new to the dental industry—dentists have taken CT
images and transformed them into 3D printable using CAD software for years—there are groundbreaking developments coming.
Several 3D printing companies promote digitally printed models, dentures, braces, and implants. Instead of the traditional physical and manual production, they claim that precise and immediate images of the mouth, teeth and jaws can be made using intraoral scanners and then 3D printed.
One of the latest inventions is a material called Veroglaze, which is used to print crowns, bridge restorations, diagnostic wax-ups, and other tooth-related objects. It is even colored with the A2 shade, the ivory white shade we all know from the toothpaste ads.
Any drawbacks? Well, the 3D printers have a list price around $80,000.
So, will implants be made or printed in the future? We will surely get back to discuss that further.
33 71percent of tooth replacement in Italy is with implant-supported restorations, making Italy the leading country in the world for implant treatment.
is the number of countries where you can find DENTSPLY Implants subsidiaries and distributors.
SOCIAL DENTISTS MAKE MORE MONEY PRACTICE DEVELOPMENT There are many different social networks available. Seven of them have over 100 million unique visitors every month; Facebook (900 million), Twitter (310 million), LinkedIn (255 million), Pinterest (250 million), Google+ (120 million), Tumblr (110 million) and Instagram (100 million).
ALL OF THEM OFFER quick, cost-effective and direct ways to market a company’s services and products. It only takes a smartphone, tablet or computer to get started. However, to be successful, you need a strategy and clearly defined business goals. With those in place, your efforts do not have to take up much of your time, and the return on investment potential is vast.
HERE ARE SOME recent findings and pointers that might be useful to remember, if, or when you use social networks.• Images in your Facebook posts get twice the engagement as text-only posts.
• Images in tweets get 35% more retweets.• Forget the saying ‘mobile first’, social media is all about ‘consumer first’.• Do not be a megaphone—interact and communicate. • The blog is far from dead—57% of companies with a blog on their website have acquired customers this way.• If all else fails, send a good old text message/sms; over 95% of these are opened and read, 85% within one hour. http://mobile.extremetech.com/latest/221162-the-first-transparent-3d-printed-skull-has-been-successfully-implanted
3D-printing dental implants may be the way of the future.
Follow DENTSPLY Implants on Twitter, Facebook and YouTube.
06 DENTSPLY IMPLANTS MAGAZINE #2
UP CLOSE & PERSONAL
A quick search on Google for the expression “Quality of life” gives more than 500 million hits. But what does the phrase really mean? We decided to ask three distinguished clinicians—Jocelyne Feine,
Anne Benhamou and Ingeborg De Kok—how they interpret quality of life. And we got some very interesting replies.
It is no exaggeration to say that “quality of life” has quickly become a catch-all term. Once an expression largely used by health-
care professionals, now everyone from economists to advertising executives talk about good quality of life. And while this has been an explicit or implicit objective, an adequate definition of the expression has been elusive. Almost all people have their own way of achieving and experiencing good quality of life, and almost all people have their own personal definition of the concept.
SO, IS IT POSSIBLE to pin down this subtle and almost mysterious phrase?
Anne Benhamou, Jocelyne Feine and Ingeborg De Kok are three distinguished clinicians in the dental field. We asked them about their interpretation of quality of life in general and how they believe implant dentistry can improve people’s wellbeing.
“Quality of life is the alignment of one’s expectations and desires with the reality
They keep exploring
quality of life
ANNE BENHAMOU
INGEBORG DE KOK
of one’s life,” says Professor Jocelyne Feine when asked what the expression means in a general sense.
Ingeborg De Kok, Associate Professor at the University of North Carolina, USA, sees it as being able to choose how to live your life and being content with your decision. And for Anne Benhamou, an oral surgeon in Paris, France, quality of life is defined as harmony between the personal and professional life.
THEY ALL AGREE that materialism alone is not enough. To experience true quality of life, one must include less tangible—and more subjective—factors such as friends, family, happiness and physical and mental health in combination with political and cultural aspects such as freedom, a well-functioning local environment and security.
“Quality of life is about taking care of ourselves, but having said that, material items do help,” Anne says.
Another aspect is that the expression is multidimensional. Quality of life can be
THREE VOICES ON QUALITY OF LIFE
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#2 DENTSPLY IMPLANTS MAGAZINE 07
FAMILY: One brother, stepdaughters, grandchildren, nieces and nephews
HOME: Montreal, Quebec, Canada
OCCUPATION: Full Professor in the Faculty of Dentistry, McGill University in Montreal
A HIGHLY QUALITATIVE DAY IN
YOUR LIFE LOOKS LIKE THIS:
Waking up without an alarm, walking my 15-year-old dog and meeting with my graduate trainees. When there is time, I do some pilates exercises and take photos with my Leica.
IF YOU WERE TO NAME ONE PLACE
YOU IMMEDIATELY THINK OF
WHEN YOU HEAR THE EXPRESSION
“QUALITY OF LIFE,” WHAT WOULD
THAT PLACE BE, AND WHY?
My hometown of Montreal, a peaceful, safe and beautiful city, with family and friends nearby. On the other hand, I could certainly be happier if the Montreal winters were shorter!
JOCELYNE FEINE
08 DENTSPLY IMPLANTS MAGAZINE #2
both major global issues and small details in one’s personal life.
“I believe that on a global level, good health is key. Helping people cope with chronic conditions has a major positive impact,” says Jocelyn.
If the global macro level—including fields such as ecology, economics, politics and culture—creates the basics in assessing quality of life, one’s perception can change rather quickly due to positively or negative occurrences on a personal level. Though, the ability to think positive often adds quality of life, and Jocelyne illustrates with a story:
“A young friend of mine was being treated for stage 4 breast cancer. While taking a walk with friends one evening, I fell on an icy path and fractured my femur. My friends heard the cracking sound and were making sympathetic comments as we waited for the ambulance. I told them that they did not need to feel sorry for me and that I felt lucky to have merely broken a bone. I could not feel sorry for myself while my friend was dying. So, I believe that it is my positive perspective on life that adds quality to it.”
A PROFESSIONAL CAREER can also bring quality to life. Anne believes that the combination of raising a family while building a career is a personal achievement that has certainly brought
quality to her life. Her days can include working in a hospital in the morning, running her clinic after lunch and lecturing in the evening, and she takes pride in how she handles this combination.
“MY CAREER GIVES me impact to help people catch up in their social lives and feel more confident around other people,” says Anne.
All of them have distinguished careers, but what are they most proud of?
“It would probably have to be obtaining tenure at the university. I worked hard to get it, and had to manage a lot of challenges along the way. It definitely feels like a validation of all of my efforts,” says Ingeborg, who also treasures the ability to blend interesting science, as well as dental artistry, with the ability to help people, and assist in teaching the next generations of dentists. “I would probably have to divide my career in different fields to answer this question,” Ingeborg comments. “Helping to educate future dentists is extremely fulfilling to me, and I want to ensure that dentists not only provide quality dentistry, but also understand the importance of overall patient care.”
Jocelyne encourages patient-based outcomes in prosthodontic research studies:
UP CLOSE & PERSONAL THREE VOICES ON QUALITY OF LIFE
»
»
JOCELYNE FEINE
INGEBORG DE KOK
“My career gives me impact to help people catch up in
their social lives and feel more confident around other people.”
#2 DENTSPLY IMPLANTS MAGAZINE 09
FAMILY: Three sons
HOME: Paris, France
OCCUPATION: Dentist, oral surgeon, private practice in Paris
A HIGHLY QUALITATIVE DAY IN
YOUR LIFE LOOKS LIKE THIS: I wake up at nine, go to the gym, have a massage, work, have lunch with friends, work some more and then have dinner with my family.
IF YOU WERE TO NAME ONE PLACE
YOU IMMEDIATELY THINK OF
WHEN YOU HEAR THE EXPRESSION
“QUALITY OF LIFE,” WHAT
WOULD THAT PLACE BE, AND
WHY? Italy or Spain, because of the sun, the daylight, the Mediterranean mentality and the Mediterranean quality of life and organization—the best quality of life!
ANNE BENHAMOU
10 DENTSPLY IMPLANTS MAGAZINE #2
FAMILY: Husband and boy/girl twins
HOME: Durham, North Carolina, USA
OCCUPATION: Prosthodontics, Associate Professor at the University of North Carolina
A HIGHLY QUALITATIVE DAY IN
YOUR LIFE LOOKS LIKE THIS:
I make a good connection teaching, facilitate a substantial improvement in a patient’s life, and share some enjoyable time with my husband and children.
IF YOU WERE TO NAME ONE PLACE
YOU IMMEDIATELY THINK OF
WHEN YOU HEAR THE EXPRESSION
“QUALITY OF LIFE,” WHAT WOULD
THAT PLACE BE, AND WHY?
Northern Europe, as the region has a good balance between family, work, education, leisure and culture, and provides access to health care and other important assistance. If I could get that on a Caribbean island, I would definitely move there!
INGEBORG DE KOK
#2 DENTSPLY IMPLANTS MAGAZINE 11
UP CLOSE & PERSONAL
health-related quality of life (OHQoL) has positively affected and convinced the dental industry that implant overdentures are better than conventional dentures.
“In 2002, we published the McGill Consensus Statement, in which we summarized the literature supporting the provision of a minimum of two implants to retain a mandibular overdenture for edentate patients. Because of this statement, my colleague, Dr. Ignace Naert, was able to convince the Belgian government to provide implants for edentate patients in their publicly-funded oral health care program.”
ANNE, JOCELYNE AND INGEBORG are all convinced that dental implants improve the perceived quality of life for patients.
“With just two implants to retain their lower dentures, people can eat what they want and feel confident that their dentures will not move. The psychosocial impact of this alone can considerably raise levels of life quality,” says Jocelyne.
Ingeborg adds that both capabilities and self-confidence are greatly improved when people look, feel and function better. The implants provide freedom since people are able to forget about their mouths and teeth in their everyday life.
What is the next step? How can dental implants improve quality of life even more?
“Shorter treatments, less expensive treatments, less healing and recovery time,” Anne swiftly replies.
Her answer is echoed by Ingeborg, who adds:
“Reducing the time required to receive an implant will clearly contribute to the patient achieving a functional dentition quicker, and continuing to improve the elements that we work with would facilitate a more pleasant experience for the patient in the long run.”
JOCELYNE SUMMARIZES HER wishes for a future where dental implants can provide even more quality of life.
“I believe that it is not important to increase the level of oral health-related quality of life already shown to be associated with implant treatment. What is relevant now is finding more suitable ways to provide this treatment and better OHQoL to larger populations. Thus, the most important advance in dental implant technology would be the development and testing of more accessible implant treatment, as well as procedures that are less invasive and that reduce morbidity. This would produce lower cost procedures, enabling larger populations to benefit from dental implants.”
“We introduced patient-based treatment satisfaction questionnaires that were grounded in the principles of psychophysics and psychometrics, and the rationale was simple: the user of a device (e.g. a prosthesis) is the best person to evaluate its quality.”
Jocelyn believes measuring oral
THREE VOICES ON QUALITY OF LIFE
»
ANNE BENHAMOU
JOCELYNE FEINE
“Reducing the time required to receive an implant will clearly contribute to the
patient achieving a functional dentition quicker.“
12 DENTSPLY IMPLANTS MAGAZINE #2
TREATMENT SOLUTIONS WELDONE—INTRAORAL WELDING
WHY DID YOU DECIDE TO DEVELOP INTRAORAL WELDING?“For many years, immediate loading had been sidelined as it was considered unsafe and risky for the patient. But at the end of the 1990s, there was a notable rise in interest in this technique for the simple reason that patients kept requesting it. Patients did not accept having to leave the dentist’s office without fixed teeth or they refused to use dentures, even for brief periods of time.
Driven by this demand, immediate loading was looked at with far greater interest and began to become more popular. However, because of the belief that immediately loaded implants ran a higher risk of failure, patient treatment plans involved a considerable number of implants with the belief that many of these would be lost as a result of immediate loading. This very often led to prosthetic nightmares. Very quickly it
became apparent that the vast majority of implants osseointegrated successfully, with a subsequent reduction in the ratio between implants and prosthetic crowns—eventually arriving at four implants for an entire arch.
This created a new problem, namely the rigidity of the prosthetic structure. Indeed, the greater the inter-implant distance, the greater the risk of movement in the immediately loaded implant supported prosthesis. This movement was transferred to the bone-to-implant interface, compromising osseointegration with implant failure as a result. Moreover, many patients did not have sufficient bone quantity and/or quality to obtain adequate primary stability for the implants to be loaded. It was for this
reason that, 10 years ago, dental technician Gianluca Sighinolfi and I decided to develop this method, which—thanks to intraoral welding—makes it possible to weld titanium abutments directly and immediately in the mouth, creating stability in the whole implant-prosthetic structure and in doing so, completely eliminating implant micromovement during the healing phase, thereby increasing the success rate.”
DID ANY PROBLEMS OCCUR DURING THE DEVELOPMENT OF THE INTRAORAL WELDING TECHNIQUE?“The simplicity and reliability of intraoral welding enabled a smooth development. Nonetheless, research and testing was carried out with a great deal of time
dedicated to understanding the ideal relationship between bars and abutment ideal thickness, amount of energy required and the optimum degree of applied pressure. After numerous fatigue tests and highly detailed microscopic characterization analysis, we eventually arrived at the ideal conclusions for the
aforementioned factors. This data was incorporated into the software employed in the current WeldOne unit,
In January 2014, after a long period of development and several clinical studies, the new DENTSPLY Implants WeldOne concept for intraoral welding of titanium frameworks was introduced to the international dental community. We talked to the pioneer and inventor of this technique, Dr. Marco Degidi in Bologna, Italy.
FIG. 1. Panoramic x-ray before surgery.
FIG. 5. The bar welded to each abutment (occlusal view).
FIG. 2. Four ANKYLOS implants with the Balance Base abutments.
FIG. 6. Extraorally—the framework is reinforced and retentions are added.
FIG. 3. The welding abutments in place.
FIG. 7. The finished framework.
FIG. 4. The bar welded to each abutment.
FIG. 8. The sandblasted framework.
For stable implant-prosthetic structures chairside
Dr. Marco Degidi.
DOCUMENTATION
#2 DENTSPLY IMPLANTS MAGAZINE 13
which produces welded joints of high quality.”
WHAT ARE THE ADVANTAGES OF INTRAORAL WELDING?“Numerous. You are able to manufacture temporary prostheses supported by a limited number of immediately loaded implants and immediately load implants with low primary stability with predictable results. In addition, the technique is not limited to only the construction of temporary prostheses, but also what we call durable restorations, which are capable of remaining in use for years. Another advantage is the greatly improved passivity of the structure, which always exists as you are working directly in the mouth. And last, but by no means the least, the low costs and high quality compared to some very expensive permanent prostheses.
In short, the principal advantages in regard to other immediate loading techniques are time, cost, precision and quality that are quite simply unbeatable. It is important to note that, as with all chairside techniques, WeldOne requires a normal degree of manual skill and a short period of training in one of the courses we provide.”
WHAT ARE YOUR VISIONS AND FURTHER DEVELOPMENTS?“The intraoral welding technique is completely chairside and as such meets a desire common to a very large number of dentists: to keep the planning, execution and use of implant-prosthesis elements (surgical guides, abutments, restorations) within their office, as far as possible. For the future, we are increasingly working with CAD/CAM to create prosthetic shells that are even more durable, thereby further improving the predictability and durability of the prostheses over time.”
WHAT IS THE DIFFERENCE BETWEEN INDUSTRIAL WELDING AND INTRAORAL WELDING?“The principle used is exactly the same and therefore you are talking about electric resistance spot welding: a flow of electric current, hitting two materials of low electrical conductivity kept in contact by the application of a predetermined quantity of pressure, encounters an obstacle (resistance). This creates an increase in temperature that melts the two metals. If the pressure applied and the quality and thickness of the two metals are appropriate, a welded joint of a very high quality is created.
The difference between this and industrial welding is mainly the time required for the welding process to occur (a few fractions of a second), thereby avoiding all temperature-related problems. This means that you always—and I stress the word ‘always’—stay well within complete safety parameters compatible with the homeostasis of the peri-implant tissues.”
CAN YOU TELL US ABOUT LONG-TERM RESULTS, SCIENTIFIC BACKGROUND AND CLINICAL STUDIES ON THIS NEW TECHNIQUE?“My colleagues and I have published several articles in peer-reviewed journals which examine all the clinical and practical considerations of the technique in full detail. In particular, we have published a study with an up to 6-year follow-up with predictable long-term results.
I would say that the final message, independent of the advantages offered by the intraoral welding technique is, that I really love this technique because it appeals to the soul of a true dentist – someone who takes pleasure from creating work of lasting quality with their own hands—work that they can be truly proud of for years to come.”
FIG. 9. The opaqued framework is placed on the abutments.
FIG. 13. Final restoration in place.
FIG. 10. The hollow restoration filled with composite before relining intraorally.
FIG. 14. Panoramic x-ray after surgery.
FIG. 11. After further packing and polishing, the restoration is completed.
FIG. 12. Final restoration in place (occlusal view).
For stable implant-prosthetic structures chairside
14 DENTSPLY IMPLANTS MAGAZINE #2
Charlotte Almgren, Global Scientific Manager at DENTSPLY Implants, believes complementing clinical outcome measures with the views of patients are crucial to get the full picture of how successful dental implant treatments really are: “We must remember that implants do
more than restore function, they restore happiness and quality of life.”
Several scientific articles state that implants improve quality of life and are superior to conventional prosthetic therapy in various treatment situations, both for removable and fixed implant prostheses and single-tooth replacement.
While conventional dentures are seen as uncomfortable and even embarrassing, which can affect the psychological well-being, dental implant treatments receive much praise. Functions like chewing and speaking are improved, and patients feel more inclined to socialize, thereby living happier lives.
ARE DENTAL IMPLANTS EFFICIENT, SAFE AND RELIABLE IN THE LONG RUN?Clinicians and patients expect a ‘yes’ to that question. But to be able to properly answer that question, at least five years of clinical documentation is required, and DENTSPLY Implants is one of the few providers in the industry with long-term documentation.
“We only market premium solutions, backed by extensive research and solid documentation, which includes numerous published articles on the implant systems’ excellent performance over many years with high implant survival rates,” says Charlotte Almgren.
Choosing DENTSPLY Implants, she concludes, can help clinicians to provide optimal and predictable treatments that will improve the quality of life for their patients.
There is a growing trend to listen to patients when evaluating dental implant treatment, and patients should be able to expect an improved quality of life. This makes solutions from DENTSPLY Implants an optimal choice for long-term results.
Dental implants are for life
1. Arisan, V., N. Bolukbasi, et al. (2010). “Evaluation of 316 narrow diameter implants followed for 5-10 years: a clinical and radiographic retrospective study.” Clin Oral Implants Res 21(3): 296-307.
2. Awad MA, Rashid F, Feine JS; Overdenture Effectiveness Study Team Consortium. The effect of mandibular 2-implant overdentures on oral health-related quality of life: an international
3. Erkapers, M., K. Ekstrand, et al. (2011). “Patient satisfaction following dental implant treatment with immediate loading in the edentulous atrophic maxilla.” Int J Oral Maxillofac Implants 26(2): 356-364.
4. Eitner S, et al. Comparing bar and double-crown attachments in implant-retained prosthetic reconstruction: a follow-up investigation. Clin Oral Implants Res 2008;19(5):530-7.
5. Heschl A, Payer M, Platzer S, et al. Immediate rehabilitation of the edentulous mandible with screw type implants: results after up to 10 years of clinical function. Clin Oral Implants Res 2012;23(10):1217-23.
6. Krebs, M., K. Schmenger, et al. (2013). “Long-term evaluation of ANKYLOS dental implants, Part I: 20-year life table analysis of a longitudinal study of more than 12,500 implants.” Clin Impl Dent Rel Res E-pub Sep 2013, doi:10.1111/cid.12154.
7. Morris, H. F., S. Ochi, et al. (2004). “AICRG, Part IV: Patient satisfaction reported for Ankylos implant prostheses.” J Oral Implantol 30(3): 152-161.
EXAMPLES OF REFERENCES REPORTING ON LONG-TERM RESULTS AND IMPROVED QUALITY OF LIFE
DOCUMENTING SUCCESS
“Implants do more than restore functions, they restore happiness and quality of life,” says Dr. Charlotte Almgren, Global Scientific Manager at DENTSPLY Implants.
THE IMPORTANCE OF LONG-TERM DOCUMENTATION
#2 DENTSPLY IMPLANTS MAGAZINE 15
MY PERSPECTIVE
FRAUKE MÜLLER
W hen I hear the phrase “quality of life,” I instantly think of oral health—I guess it is a dental professional’s curse (and blessing).
To me, oral health gives people the possibility to have a pretty appearance, feel confident that they can chew without problems, finish their meals and choose whatever food they want to eat. Pretty basic, don’t you think?
MY SPECIALTY is geriatric dentistry. To me there are four major areas where I feel that I truly add quality to the daily lives of my elderly patients.
• Restored oral functions. First and foremost, good dental care restores the oral functions, and gives my patients the chance to eat and drink without problems.
• Less pain and fewer infections. Alleviating the pain of my patients and reducing the risk of infections is another important benefit.
• Better self-esteem. With the first two areas in place comes a feeling of well-being and more confidence in using your own teeth.
• A richer social life. We must not underestimate the social context—with improved dental health it is easier for a person to function normally and to feel normal among other people.
MOST OF THE TIME, I carry out this work from my clinic at the University of Geneva in Switzerland, but I also take part in public health actions. The idea is to give people living at nursing homes access to proper dental care so that they too can experience better dental health and an improved quality of life.
ELDERLY PATIENTS are unique and need special dental care. And here is my wish for the future. I want to see implants that require less invasive procedures, which would make them more accessible for the elderly. I also want a reversible concept, meaning implants can be removed and
replaced by other solutions if necessary. I think that would add even more quality of life to my patients. That is why I do what I do.
“Elderly patients need special dental care”
FRAUKE MÜLLER, Professor at the University of Geneva, Department of
Gerodontology & Removable Prosthodontics; Secretary, European College of Gerodontology; Chair, ITI Scholarship Committee
8. Raes, F., J. Cosyn, et al. (2013). “Clinical, aesthetic, and patient-related outcome of immediately loaded single implants in the anterior maxilla: A prospective study in extraction sockets, healed ridges, and grafted sites.” Clin Impl Dent Rel Res 15(6): 819-835.
9. Schliephake H, Rodiger M, Phillips K, McGlumphy EA, Chacon GE, Larsen P. Early loading of surface modified implants in the
posterior mandible – 5 year results of an open prospective non-controlled study. J Clin Periodontol 2012;39 (2):188-95.
10. Wennström JL, et al. Implant-supported Single-tooth Restorations: A 5-Year Prospective Study. J Clin Periodontol 2005;32:567-74.
All references on DENTSPLY Implants products can be easily found in the publication list on dentsplyimplants.com/science
34. Degidi M, Nardi D, Piattelli A. One abutment at one time: non-removal of an immediate
abutment and its effect on bone healing around subcrestal tapered implants. Clin Oral Implants
Res 2011;22(11):1303-07. Abstract in PubMed 35. Degidi M, Nardi D, Sighinolfi G, et al. In vitro infrared thermography assessment of temperature
peaks during the intro-oral welding of titatium abutments. Infrared Physics & Technology
2012;55:279-83. 36. Degidi M, Nardi D, Sighinolfi G, et al. Immediate rehabilitation of the edentulous mandible using
Ankylos SynCone telescopic copings and intraoral welding: A pilot study. Int J Periodontics
Restorative Dent 2012;32(6):e189-94. Abstract in PubMed 37. Degidi M, Perrotti V, Piattelli A, et al. Mineralized bone-implant contact and implant stability
quotient in 16 human implants retrieved after early healing periods: a histologic and
histomorphometric evaluation. Int J Oral Maxillofac Implants 2010;25(1):45-8. Abstract in
PubMed 38. Degidi M, Perrotti V, Shibli JA, et al. Equicrestal and subcrestal dental implants: a histologic and
histomorphometric evaluation of nine retrieved human implants. J Periodontol 2011;82(5):708-15.
Abstract in PubMed 39. Degidi M, Perrotti V, Strocchi R, et al. Is insertion torque correlated to bone-implant contact
percentage in the early healing period? A histological and histomorphometrical evaluation of 17
human-retrieved dental implants. Clin Oral Implants Res 2009;20(8):778-81. Abstract in PubMed
40. Degidi M, Piattelli A, Carinci F. Immediate loaded dental implants: comparison between fixtures
inserted in postextractive and healed bone sites. J Craniofac Surg 2007;18(4):965-71. Abstract in
PubMed 41. Degidi M, Piattelli A, Carinci F. Clinical outcome of narrow diameter implants: a retrospective
study of 510 implants. J Periodontol 2008;79(1):49-54. Abstract in PubMed
42. Degidi M, Piattelli A, Gehrke P, et al. Five-year outcome of 111 immediate nonfunctional single
restorations. J Oral Implantol 2006;32(6):277-85. Abstract in PubMed
43. Degidi M, Piattelli A, Iezzi G, et al. Immediately loaded short implants: analysis of a case series of
133 implants. Quintessence Int 2007;38(3):193-201. Abstract in PubMed
44. Degidi M, Piattelli A, Iezzi G, et al. Wide-diameter implants: analysis of clinical outcome of 304
fixtures. J Periodontol 2007;78(1):52-8. Abstract in PubMed 45. Degidi M, Piattelli A, Iezzi G, et al. Do longer implants improve clinical outcome in immediate
loading? Int J Oral Maxillofac Surg 2007;36(12):1172-76. Abstract in PubMed
46. Degidi M, Piattelli A, Scarano A, et al. Peri-implant collagen fibers around human cone Morse
connection implants under polarized light: a report of three cases. Int J Periodontics Restorative
Dent 2012;32(3):323-8. Abstract in PubMed 47. Degidi M, Piattelli A, Shibli JA, et al. Early bone formation around immediately restored implants
with and without occlusal contact: a human histologic and histomorphometric evaluation. Case
report. Int J Oral Maxillofac Implants 2009;24(4):734-9. Abstract in PubMed
48. Degidi M, Piattelli A, Shibli JA, et al. Bone formation around immediately loaded and submerged
dental implants with a modified sandblasted and acid-etched surface after 4 and 8 weeks: a
human histologic and histomorphometric analysis. Int J Oral Maxillofac Implants 2009;24(5):896-
901. Abstract in PubMed 49. Degidi M, Piattelli A, Shibli JA, et al. Bone formation around one-stage implants with a modified
sandblasted and acid-etched surface: human histologic results at 4 weeks. Int J Periodontics
Restorative Dent 2009;29(6):607-13. Abstract in PubMed 50. Degidi M, Scarano A, Piattelli M, et al. Histologic evaluation of an immediately loaded titanium
implant retrieved from a human after 6 months in function. J Oral Implantol 2004;30(5):289-96.
Abstract in PubMed
DENTSPLY Implants publications
More than 1550 publications
A reference list on the original articles published in peer reviewed journals on
DENTSPLY Implants products
Please click links below to be redirected to reference list of your choice
IMPLANT SYSTEMS ............................................ 2
In those cases where several DENTSPLY Implant products have been used in the same publication, the publication is listed under multiple sections, where relevant.
16 DENTSPLY IMPLANTS MAGAZINE #2
Implant dentistry supports dental professionals with a wide range of therapy options to restore function and esthetics with good predictable results. Certain requirements have to be met by the treating surgical and restorative and the implant system they use in order to achieve these good results. Long-term success of implant-supported reconstructions with optimal function and esthetics require mechanical stability, osseointegration and, in particular, peri-implant hard and soft tissue that is free of inflammation [1]. Short-term success can now be achieved with almost any established implant system available. However, clinical
long-term evaluations over more than 10 or 15 years are very rare. Such long-term studies are often lacking mainly because the design, geometry or surface of most implant systems undergo major changes within short time periods, which makes monitoring and evaluation of a sufficient number of the same implant over a longer time period nearly impossible.
A LONG-TERM STUDY published by Krebs et al on the ANKYLOS implant system
investigated a total of 12,737 implants placed between 1991 and 2011 in 4,206 patients at the University Dental Clinic in Frankfurt, Germany, and shows a cumulative survival rate of 93,3 % [2]. This comprehensive study on the ANKYLOS implant system was possible because the system has remained largely unchanged with regard to design
and function since its launch in 1987. It is characterized by its progressive outer thread, its sandblasted and etched micro-rough surface and its precise, keyed and friction-locked tapered connection [3].
The ANKYLOS implant system has remained largely unchanged in design and function since its launch in 1987. Read about studies that confirm the clinical long-term success of this system.
Long-term evaluation over 20 years
PATIENT 1: Metal-ceramic bridge with mesial cantilever
A 48-year-old female patient presented to the Center of Dental and Oral Medicine at the University in Frankfurt/Main, Germany, in 1992. Her mandible was restored with fixed crowns and bridges from 36 to 45. The first quadrant of the maxilla was edentulous.The patient requested a fixed restoration in this area to improve masticatory function.
Clinical and radiographical examination as well as bone mapping revealed sufficient bone, allowing implant placement without grafting. During surgery under local anesthesia, a paracrestal palatinal incision with a vestibular distal relief incision was carried out. A full thickness miniflap was prepared showing the thickness of the alveolar crest without releasing the periosteum from the buccal bone. After sufficient imaging of the bone, three 3.5 mm x
11 mm ANKYLOS implants were placed in regio 15, 16 and 17 with epicrestal positioning. After saliva-proof wound closure, the implants were left for submerged healing for three months. Subsequent prosthetic restoration was made using a metal-ceramic bridge with mesial cantilever. Clinical and radiographical assessment after 20 years in March 2012 showed stable peri-implant conditions and a stable bone level at the implant shoulders. (Figs. 1 and 2).
FIG. 1
FIG. 2
Control radiograph after implant placement (December 1992).
Radiographical assessment after 20 years (March 2012).
DOCUMENTING SUCCESS THE IMPORTANCE OF LONG-TERM DOCUMENTATION
DOCUMENTATION
»
Dr. Mischa Krebs
#2 DENTSPLY IMPLANTS MAGAZINE 17
PATIENT 2: Metal-ceramic bridge with mesial and distal cantilevers
In January 1992, a 33-year-old female patient presented to the Center of Dental and Oral Medicine at the University in Frankfurt/Main, Germany. She had no missing teeth in the maxilla and an edentulous space in the mandible regio 44 to 47. The patient wanted
FIG. 3
FIG. 4
Radiographical control in regio 44/46 after implant placement (January 1992).
Radiographical assessment after 19 years (November 2011) shows stable bone conditions.
to close the edentulous spaces with a fixed restoration. The bone volume in regio 44 to 47 was sufficient for placing implants without grafting. Implant placement was carried out according to the recommended surgical protocol. A 3.5 mm x 14 mm ANKYLOS implant was placed in regio 45, and a 4.5 mm x 14 mm ANKYLOS implant distally in regio 46, with epicrestal positioning. After three months of submerged
healing, a metal-ceramic bridge and mesial and distal cantilevers were provided. Radiographical assessment after 19 years, in 2011, revealed stable hard and soft tissue conditions around the implants and a stable bone level at the implant shoulders. (Figs. 3 and 4).
18 DENTSPLY IMPLANTS MAGAZINE #2
PATIENT 3: Single-tooth restoration with metal-ceramic crown
In 1993, a 19-year-old male patient with single tooth loss in regio 11 due to trauma came to the clinic. Both ridges showed full dentition except for the lost 11. However, the anterior teeth in the mandible were
FIG. 5
FIG. 6
Situation after implant placement (April 1993).
Radiographical assessment after 21 years (January 2014).
DOCUMENTING SUCCESS THE IMPORTANCE OF LONG-TERM DOCUMENTATION
seriously affected by caries and showed periapical lesions. Tooth 41 was endodontically restored, while an apiectomy was performed on tooth 31 with a retrograde filling; the tooth was extracted later. A 3.5 mm x 14 mm ANKYLOS implant was placed in regio 11 with epicrestal positioning according to the recommended surgical protocol. After the healing period, the implant was restored with a metal-
ceramic, single-tooth crown. Radiographical assessment after 21 years, in January 2014, revealed excellent, stable bone conditions with bone apposition up to the level of the implant shoulders. (Figs. 5 and 6).
DOCUMENTATION
#2 DENTSPLY IMPLANTS MAGAZINE 19
PATIENT 4: Single-tooth restoration with metal-ceramic crown and implant/tooth-supported bridge
In October 1992, a 54-year-old male patient with a single-tooth gap in regio 14 and edentulism in the third quadrant presented to us. He requested a fixed restoration. Following the surgical protocol, we placed an ANKYLOS implant with 3.5 mm diameter and 14 mm length in regio 14, and an implant with 3.5 mm diameter and 11 mm length in regio 36.
THIS TYPE OF CONNECTION with its horizontal offset provides a system-inherent platform-switching, a main feature of the system [4]. Since 2005, the implant shoulder has a microrough surface, which resulted in even better bone apposition in the important area of the implant abutment interface [5].
THE EXCELLENT long-term results in the implant-supported case presented was dependent on the surgical and restorative procedures and the selection of a suitable implant system. Selection criteria for implant systems include mechanical stability of implant components, design, simplicity of application and long-term availability of components.
Long-term survival rates with good function and esthetics in implant dentistry require long-lasting and stable osseointegration and maintenance of peri-implant hard and soft tissue [1]. Scientific studies have shown that
the implant-abutment connection is particularly important in this respect. Freedom from micromovement is an essential prerequisite for long-term tissue maintenance at the connection [7].
THIS CASE SERIES PRESENTS four selected patient cases with follow-up periods of 19 to 21 years, and are examples of the excellent results of the entire study, presenting minimal crestal bone resorption, exceeding the criteria of success described in the literature by far [6]. The results of the study by Krebs et al reveal crestal bone levels that were almost unchanged after 20 years of functional loading of ANKYLOS implants. The clinical long-term success of this system is confirmed by its largely unchanged design and the unlimited availability of all system components have provided dentists with a system that stands for durable and stable implant-supported restorations for their patients.
REFERENCES
1.Redemagni M, Cremonesi S, Garlini G, and Maiorana C, Soft tissue stability with immediate implants and concave abutments Eur J Esthet Dent 2009;4(4):328-37.
2. Krebs M, Schmenger K, Neumann K, Weigl P, Moser W, and Nentwig GH, Long-Term Evaluation of ANKYLOS Dental Implants, Part I: 20-Year Life Table Analysis of a Longitudinal Study of More Than 12,500 Implants Clin Implant Dent Relat Res 2013;[Epub ahead of print].
3. Zipprich H, Weigl P, Lange B, and Lauer HC, Micromovements at the Implant-Abutment Interface: Measurement, Causes, and Consequences Implantologie 2007;15(1):31-46.
4. Cumbo C, Marigo L, Somma F, La Torre G, Minciacchi I, and D’Addona A, Implant platform switching concept: a literature review Eur Rev Med Pharmacol Sci 2013;17(3):392-7.
5. Hermann F, Lerner H, and Palti A, Factors influencing the preservation of the periimplant marginal bone Implant Dent 2007;16(2):165-75.
6. Albrektsson T, Zarb G, Worthington P, and Eriksson AR, The long-term efficacy of currently used dental implants: a review and proposed criteria of success Int J Oral Maxillofac Implants 1986;1(1):11-25.
7. Weng D, Nagata MJ, Bosco AF, and de Melo LG, Influence of microgap location and configuration on radiographic bone loss around submerged implants: an experimental study in dogs Int J Oral Maxillofac Implants 2011;26(5):941-6.
FIG. 7 FIG. 8Control after implant placement at 14 and 36 (October 1992).
Radiographical assessment after 21 years (November 2013). Further implant-supported restorations in 12 and 25/26 alio loco.
After submerged healing, tooth 14 was restored with a metal-ceramic single-tooth crown. As the extensive filling in tooth 34 needed to be revised, we opted for a bridge construction in the third quadrant, which was supported by implant 36 and the natural tooth 34. Assessment after 21 years, in 2013, revealed stable tissue conditions around the implants and the natural tooth 34. In the meantime, tooth 12 and teeth 25/26 have been provided with an implant-supported restoration. (Figs. 7 and 8).
“THE RESULTS OF THE STUDY REVEAL CRESTAL BONE LEVELS THAT WERE ALMOST UNCHANGED AFTER 20 YEARS OF FUNCTIONAL LOADING.”
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20 DENTSPLY IMPLANTS MAGAZINE #2
ZOOMING IN
The success of an implant treatment is defined not only by function, but also by esthetics. The design philosophy of the ASTRA TECH Implant System EV is based on the natural dentition and utilizes a site-specific, crown-down approach with the desired end result in mind to help ensure a successful outcome.
The crown-down planning is supported by the innovative interface providing one-position-only placement of ATLANTIS patient-specific CAD/CAM abutments and self-guiding impression components that require only one hand for precise seating.
The foundation of this evolutionary step remains the unique ASTRA TECH Implant System BioManagement Complex, well-documented for its long-term marginal bone maintenance and esthetic results.
ASTRA TECH Implant System EV Scale: 30:1
Learn more
www.jointheev.com
#2 DENTSPLY IMPLANTS MAGAZINE 21
IN THE SPOTLIGHT
A dental implant system consists of hundreds of components. It includes everything from the highly advanced implant to
simple tweezers. For an optimal function of a system, all parts must interplay. They must fit together and create a smooth and well-functioning totality. If just one part is misaligned, the entire system will suffer. In implant treatment, one misfit can cause unnecessary problems for the dental team and ultimately the patient.
PER ARINGSKOG, R&D Director at DENTSPLY Implants, and his team were well aware of this. To start their development work, they had one of the most thoroughly documented dental implant systems in the business. Decades of research in areas as diverse as mechanical loading and osseous integration had created a product with minimal bone loss and healthy soft tissue.
With this as a foundation, the mission now was to create an implant system that was in every detail intuitive for its users. The set target was that the new ASTRA TECH Implant System EV should be the most user friendly system on the
market. Early on, the team realized that no matter how much they thought and tested on their own, there would always be a gap between what worked well on paper and in the laboratory compared to what worked in the everyday clinical reality. In the real world, one had to add unpredictable situations, users with different knowledge levels and with patients of varying needs.
THE SOLUTION WAS obvious—let the customers take part in the development work. That way you get a product that, already at launch, is tested and adapted to tackle the unpredictable. A product that has its origin where it will be used—in the clinics.
The solution is smart and it works. The method of letting users take part in the development work exists in other businesses. In the software world they have worked with open source code for a long time. Some software developers even publish their software on the Internet. Users and other interested parties can then suggest improvements and further developments. In earlier development projects at DENTSPLY Implants, there have been smaller focus groups involved. This time however, the team took the idea to a whole new level—a group of 47 clinicians that work with dental implants on an everyday basis was formed. They became known as “ambassadors.”
“The response to our initial contacts was very positive. Everyone we asked was enthusiastic about taking part,” says Agneta Broberg Jansson, responsible at Global Product Management for the ASTRA TECH Implant System at DENTSPLY Implants.
A SMALLER GROUP, whose members had long professional experience with dental implants, was contacted first. The R&D and Product Management team had by
The mission was to further develop an implant system that was intuitive to use for anyone working with it; from dental assistants to surgeons, from beginners to experienced users. The solution was as easy as it was brilliant: let the customers take part in the development.
How a modern implant system is developed
»
THE FUTURE DEVELOPMENT OF THE DENTAL IMPLANT INDUSTRY
Take a look at DENTSPLY Implants’ unique development work
Per Aringskog and Agneta Broberg Jansson.
22 DENTSPLY IMPLANTS MAGAZINE #2
IN THE SPOTLIGHT
then developed a system. Now, it was time for their efforts in the laboratory to face reality. The group was asked to evaluate the core system and contribute to the further development and refinement of the system.
“The input given at this stage contri-buted to changes in parts of the system. Some designs were improved in ways we could never have imagined if we had not been open about our work,” says Per Aringskog.
Even if openness and participation turned out to be the key to success, the contents of the project had to be kept secret. DENTSPLY Implants operates in a highly competitive market where many competitors are very interested in using smart solutions, preferably without having to invest in the development work. Secrecy was of the utmost importance for this and similar future projects if they were to bear the expenses. Investing in research and development and constantly challenging and improving is part of the company philosophy.
FOLLOWING THE INITIAL phase, the more basic parts started to fall into place. Now it was time to expand the group of ambassadors and to gather broader and more detailed feedback. But, allowing the
group to grow was risky seen from a secrecy perspective. From the initial single-digit group of clinicians, the group now grew to almost 50 ambassadors on three continents.
“IT IS AMAZING THAT we managed to keep the contents of the project secret. But, the participants were so dedicated that they saw this as their own project. We became one big project team with a great internal loyalty,” says Per Aringskog.
By now, the work intensified. Six DENTSPLY Implants employees visited the ambassadors in their everyday business and held concept handling sessions. The ambassadors also gathered a few times to exchange experiences and thoughts in the early project phase, and the feedback kept coming in.
As the project progressed, Per Aring-skog and his colleagues adjusted the system and new tests took place. After five years of work, only fine-tuning of details remained and eventually everything was ready to be launched.
“Each individual point of view might seem small, but put together everyone has contributed to the final result,” says Agneta Broberg Jansson, one of those who worked closest to the ambassadors.
»
TIMELINE—DEVELOPMENT PROCESS
Development work starts internally at DENTSPLY Implants.
The group grows to 47 clinicians. Concept handling sessions are held.
The first group of ambassadors are contacted and initiated into the work.
ASTRA TECH Implant System EV is launched.
2009 2014
Feedback from the ambassadors is integrated in the development work.
Feedback from the ambassadors is integrated in the development work.
Hello there …MARC WEBER, Senior Manager, responsible for the Global Marketing Management for all product brands at DENTSPLY Implants.
How did the market receive the ASTRA TECH Implant System EV?
“We have put a lot of effort and energy in the launch preparations in 2013 and it was great to see that the introduction was such a success. The feedback from our customers was consistently positive. Besides the fact that our product developers did a great job, we think that the good response is mainly due to the fact that our customers have been very much involved in the further development of the system.”
THE FUTURE DEVELOPMENT OF THE DENTAL IMPLANT INDUSTRY
How did you experience your participation in the Ambassador program?“When I got the Letter of Agreement for the project in 2012, my reaction was divided. On the one hand, I was very proud to be one of the limited number of investigators. On the other hand, I wondered how a successful implant system could be improved. I had successfully worked with the ASTRA TECH Implant System and its four key features for 20 years, and I was very happy to see that these key features did not change and that the scientific documentation of the system was still valid. The major change concerning the surgical implant placement was the need of a higher insertion torque when I followed the standard drilling protocol. I was used to placing the implants manually, using the wrench only for final adjustment. With the new drilling protocol, I had to use the wrench at least half the way down and I wondered if I would see the same stability of the marginal bone. But with the now mandatory use of the cortical drill, I could see the same bone level after the first year of loading.” As a user, what are the main benefits with this way of working?“The web-based documentation is very easy to handle. Although I had a challenge with the placement of one implant, I think the time to identify surgical and restorative challenges is very short.”
How important do you think it is for the development of the dental industry that product developers are open-minded and listen to their customers? “It is very important to listen to the customers. The concepts for the restorations on dental implants are quite different from user to user and these concepts must also be adjusted to the individual situation of the patients. Also, the technical skills of the dental laboratories in different countries must be recognized, as well as the economic situation of the patient. An implant system should be adapted to these different requirements and this is only possible with a good communication between the dental solution provider and the customers.”
DR. HELMUT G. STEVELINGOral surgeon; DGZMK, AgKi and DGI; Germany
DR. KIA REZAVANDISpecialist in Periodontics, 40 Harley Street, London, UK
JOSÉ DE SAN JOSÉGONZALEZ, MDTGonzalez Zahntechnik, Weinheim, Germany
Three perspectives…
IN THE SPOTLIGHT
How did you experience your participation in the Ambassador program?“The approach used in the Ambassador program is not new and, in fact, it is a tried and tested means by which new developments have been introduced to the ASTRA TECH Implant System in the past. Therefore, it is not a surprise that the whole process was well organized from the initial introduction to the OsseoSpeed EV implants and placement protocol, all the way through to the ordering and delivery of components. In short, it has been a pleasure to be involved in what I feel to be very exciting innovations in an already excellent system.”
As a user, what are the main benefits with this way of working?“I have always had a good working relationship with DENTSPLY Implants and this has over the years proved to be extremely successful. I feel this stems from the general ethos of the company and attitude of the personnel involved. Interaction with clinicians at an early stage of development of a product allows for a clear understanding of the objectives that we are aiming to achieve, which will ultimately benefit our patients. For want of a better expression, any teething problems are addressed early and it is invaluable to have the input from the R&D team during this process.”
How important do you think it is for the development of the dental industry that product developers are open-minded and listen to their customers? “Innovation is a process. Starting from a baseline, an idea, the building blocks are put together that ultimately form the end product. Sharing of knowledge and experiences is a necessary part of this process. This requires input from many different people with different expertise, including the end user, the clinician. DENTSPLY Implants has a long tradition in this approach to product development and it is precisely for this reason that I feel the evolution of the ASTRA TECH Implant System has been so successful.”
How did you experience your participation in the Ambassador program?“My participation in this Ambassador program was above my expectations. The exchange of experience between my international colleagues and myself was of great value to me.”
As a user, what are the main benefits with this way of working?“As a user, the main benefits are being part of the development of the products and getting better insights into the new system.”
How important do you think it is for the development of the dental industry that product developers are open-minded and listen to their customers? “It is very important to listen to the customer needs and work together to develop a new system. DENTSPLY Implants’ intention to bring the customers and developers together was very open-minded and a great way of working. I believe it is the first dental company to invite everyone concerned and affected by the system changes—surgeons, periodontists, prosthodontists, general practitioners, and dental technicians, from small clinics to large universities. I am very proud to be a part of this development from the start and to be part of this exclusive group.”
#2 DENTSPLY IMPLANTS MAGAZINE 23
In the development of the ASTRA TECH Implant System EV, approximately 50 “ambassadors” acted as a sounding board and shared their point of view of the system during the development. We asked three of them how they perceived their participation in the project.
Learn more
www.jointheev.com
“IT IS VERY IMPORTANT TO LISTEN TO THE CUSTOMER NEEDS AND WORK TOGETHER TO DEVELOP A NEW SYSTEM.”
24 DENTSPLY IMPLANTS MAGAZINE #2
THENNOW
1877Thomas Edison invented a music player, called the phonograph. It was the first machine that was capable of both recording and reproducing sound.
2014Today digital services, such as Spotify, iTunes and Deezer, have made music much more accessible. On Spotify, around 20 million songs are available.
NOW AND THEN
Evolution and quality of life
DENTAL PROSTHETICS have been around for thousands of years. Archeologists have found primitive versions in Egyptian graves and over the millennia mankind has experimented with countless variants, using for instance gold, ivory and animal teeth attached to existing teeth using gold clamps.
THE PROBLEMS with dentures have been more or less the same from time immemorial. They can fall out, food gets stuck in them, and the wearer’s self-esteem takes a significant hit. When a Swedish scientist in Lund accidentally discovered back in the 1950s that a metal called titanium can integrate fully with bone, hope was kindled.
During the 1960s and ’70s implant technology grew simultaneously in many places in Europe. Sweden has consistently led the way in this sphere and it was Sweden that pioneered what would later be known as the ASTRA TECH Implant System BioManagement Complex.
One fundamental insight among the developers was the importance of working with nature rather than trying to control it. In other words, in order to be able to
create a dental implant that looks like and functions like natural teeth, it is first necessary to understand how teeth work.
WHEN WORK ON THE ASTRA TECH Implant System got under way, it was soon noted that previous dental implant attempts often resulted in bone loss. Stig Hansson, who was the leading developer of the ASTRA TECH Implant System BioManagement Complex, explains:
“Everyone knows that if you don’t use your muscles, they disappear, and if you want bigger muscles, you need to lift weights. It’s the same with bone. If you want to keep bone, you need to keep loading it.”
IN THE MID-EIGHTIES, the concept of load on the bone was not widely known, but this realization led to the development by Stig Hansson and his colleagues of what came to be known as MicroThread minute threads at the implant neck to ensure positive biomechanical bone stimulation and maintained marginal bone level. In parallel with this development, experiments were conducted with the implant surface. What was the best way
to stimulate and speed up the early bone healing process? The result was a chemically modified titanium surface with a unique nanoscale topography that stimulates early bone healing. With the later introduction of the OsseoSpeed surface, the implant had been taken to the next level by incorporating biochemistry.
THESE TWO INNOVATIONS together with Conical Seal Design, which seals off the interior of the implant from surrounding tissue, minimizing micromovements and microleakage, and Connective Contour, which allows for an increased connective soft tissue contact zone, sealing off and protecting the marginal bone, are what we today call the ASTRA TECH Implant System BioManagement Complex.
ALTHOUGH 50 YEARS is a long time in a human being’s lifetime, it is a mere instant in humankind’s history. This short space of time has seen the development of a solution that has renewed the quality of life for millions of people the world over. Whereas the loss of teeth previously led to lifelong suffering, today we can restore quality of life using well-documented scientific methods and products working together with nature to support the natural healing process instead of interfering with it.
During 2014, DENTSPLY Implants introduces ASTRA TECH Implant System EV, the next step in the continuous evolution of the ASTRA TECH Implant System.
From dental prosthetics, with which it was virtually impossible to eat, to implants that are virtually impossible to distinguish from natural teeth. This sounds like a long process of development but the fact is that it all took place in less than 50 years. Join us on a scientific journey towards renewed quality of life for millions of people.
A Swedish success story
#2 DENTSPLY IMPLANTS MAGAZINE 25
CLINICAL CASES
18PAGES OF CLINICAL
INNOVATION
ASK THE EXPERTS EDITORIAL
You asked the experts, they answered.
Dr. Ricarda Jansen talks about the new ASTRA TECH Implant System EV.
CLINICAL CASES
Industry experts share their results using the latest advancements in implant dentistry.
Pre-operative panoramic radiograph for planning purposes. Read the whole case on page 34.
26 DENTSPLY IMPLANTS MAGAZINE #2
DR. RICARDA JANSENDirector Global Clinical Affairs & Education DENTSPLY Implants
CONTENT CLINICAL CASES
with the one-position-only placement of the patient-specific abutments—they are simple and make sense. You can get more information about the clinical application of the implant system evolution. You can see the new ASTRA TECH Implant System EV at various congresses and events around the world—come by, feel the difference and judge for yourself.
IN ADDITION, there are also revolutionary ideas that are intended to facilitate our life with implants. One such innovation is definitely the WeldOne concept. Dr. Marco Degidi, who took the lead in the development of intraoral welding over the last few years, will provide insights into this exciting and unique technology. And Dr. Henrike Rolf will show, through a case study, how it’s done and what to consider when applying this method.
Enjoy the read!
OUR DISHWASHER broke down recently. It’s hard to believe how you get used to this appliance for its support in the household—a new one was needed as soon as possible! Although the departing machine was only four years old, this new generation dishwasher has a few features that simply make sense. Little things that you begin to appreciate immediately, like a door that opens automatically as soon as the washing is done. Not only does it optimize drying, but it also eliminates the annoying steam when you open the door after the washing is done, adding to its practicality. This is especially true for my husband, who wears glasses that would always get fogged up. You think, “Why didn’t anyone think of this before?”
I’M SURE THAT YOU will think the same thing when you get to know the ASTRA TECH Implant System EV—an implant system developed further with features that simply make sense. The ASTRA TECH Implant System has proven itself over the years in clinical use and through scientific studies, and yet, many important features could be optimized and re-integrated with the help of opinion leaders and many of our customers. This not only makes your daily use of it easier, but it also makes the implant system optimally equipped for the future. For example, the self-guiding impression post or the unique ATLANTIS compatibility
Evolution and revolution
EDITORIAL
Even if I personally prefer a somewhat lower primary stability than many clinicians today, the beauty of the ASTRA TECH Implant System EV is that it provides the possibility through the new EV drilling protocol to choose your preferred level of primary stability. This will of course be influenced by the case and even the specific site which may present varying bone densities and thus effect the choice you want to make in the individual implant site. With the ASTRA TECH Implant System EV it should be possible to achieve a range of insertion torques that suit all philosophies.
I like that the new 33 degree gives me the same access height while showing greatly enhanced fatigue properties. I also like that I do not need to keep two cylinders in stock, and above all I have the feeling I never need to re-tighten the new anodized bridge screws! The installation is really simplified with the new Uni Driver EV that increases clinical efficiency. Moreover, the possibilities to have a 3 mm height allow me to solve all clinical situations. I also found the possibilities to have this new Uni 33° available on all the five connection sizes really useful.
What does it mean for the clinician that the drilling protocol for ASTRA TECH Implant System EV allows for preferred primary stability?
What are your thoughts on the new ASTRA TECH Implant System EV UniAbutment 33 degree solution for screw-retained reconstructions?
ASK A QUESTION If you have a question that you want to ask an expert, write to us at [email protected]
MARCO TOIADDS Private Dental Clinic, Italy.
CASE STUDY 005 2014 .........................p 27
Implant-supported immediate restoration in the edentulous maxilla.
By: Dr. Fernando Rojas-Vizcaya
CASE STUDY 006 2014 .........................p 30
Challenging multi-disciplinary approach to a damaged tooth in the maxilla.
By: Michael R. Norton
CASE STUDY 007 2014 .........................p 32
Digital assisted precise planning and manufacturing of a fixed dental restoration.
By: David Guichet, DDS, Debra Wasky
CASE STUDY 008 2014 .........................p 34
Restoration of an edentulous mandible with an existing denture using WeldOne.
By: Dr. Henrike Rolf and Dr. Martin Christiansen
CASE STUDY 009 2014 .........................p 36
Immediate implant placement and digital workflow.
By: Dr. Brian L Wilk, DMD, Barry P. Levin, DMD, Tony Cirigliano
CASE STUDY 010 2014 ..........................p 40
Management of the edentulous patient using the SmartFix™ concept.
By: Dr. Thierry Rouach
MICHAEL R. NORTONBDS FDS RCS(Ed)Specialist in Oral SurgeryImplant & Reconstructive Dentistry, London, UK
ASK THE EXPERTS
“THE INSTALLATION IS REALLY SIMPLIFIED WITH THE NEW UNI DRIVER EV THAT INCREASES CLINICAL EFFICIENCY.”
#2 DENTSPLY IMPLANTS MAGAZINE 27
Implant-supported immediate restoration in the edentulous maxilla
IMPLANT DENTISTRY has become an established form of treatment with good and predictable results for functional and esthetic reconstruction in cases of masticatory dysfunction. As bone in the maxilla is often soft and sometimes insufficient in volume, the edentulous maxilla could be a great challenge for the treating dentist. The type of treatment chosen is crucial for success, in particular when a fixed immediate restoration is requested by patients. In such cases, successful treatment requires primary stability of the implants inserted and a sufficient number of implants to support the superstructure [1].
IN ADDITION, EXACT PLACEMENT is essential and can be achieved by means of computer-assisted planning. At least six implants are recommended to support a fixed restoration in the edentulous maxilla [2]. Moreover, in soft bone, it is necessary to use an implant system that guarantees sufficient primary stability due to its external geometry and its thread design [3].
Another precondition for successful treatment is a tension-free fit of the prosthetic superstructure. Also desirable is primary splinting of the implants by the superstructure, which can be achieved with a milled bar restoration. Utilizing CAD/CAM technology, wide-span solutions can be manufactured today with high precision and accurate fit.
A 69-YEAR-OLD WOMAN presented to our practice. Apart from teeth 17 and 27, her maxilla was edentulous. The remaining teeth could not be permanently preserved due to the periodontal status. A removable temporary denture was anchored to the maxillary molars. The patient requested a fixed restoration to permanently restore masticatory function and esthetics.
The clinical and radiographical examination showed that sufficient bone was available to place implants that would support a fixed restoration (Figs. 1 and 2), and a bar-retained immediate restoration on six OsseoSpeed EV implants was planned. The OsseoSpeed EV implants and the new drilling protocol allow for excellent primary stability, which makes this an ideal treatment solution for this particular case. In addition, the OsseoSpeed surface is especially indicated for use in soft bone applications.
In order to safely and exactly place the implants, the use of a surgical template was planned. The maxillary provisional denture was duplicated and the laboratory created a surgical template from it. The surgical template was used to determine the best prosthetic position for the implants (Fig. 3). After incision and raising a flap, the bone proved to be of good quality and of sufficient volume to ensure a buccal bone wall of approximately 2 mm
PATIENT: A 69-year-old female presented with maxillary partial edentulism and hopeless maxillary left and right second molars. The patient requested a fixed restoration to permanently restore masticatory function and esthetics.
CHALLENGE: Providing the patient with an immediate fixed dental restoration in the edentulous maxilla consisting of soft bone, where primary stability of dental implants is sometimes difficult to achieve.
TREATMENT: An immediate loading protocol using six OsseoSpeed EV implants, Uni Abutment EV and an ATLANTIS ISUS Hybrid prosthesis for final restoration was carried out to restore esthetics and function.
SUMMARY
FIG. 1 Pre-treatment clinical situation.
FIG. 2 Panoramic x-ray view of the remaining bone.
CASE STUDY 005 2014 PRODUCTS USED:
28 DENTSPLY IMPLANTS MAGAZINE #2
after implant placement. In all, six OsseoSpeed EV 3.6 S implants were placed in the maxilla. The recommended drilling protocol was followed, using the Twist Drill EV, Step Drill EV and Cortical Drill EV. The implants were inserted with a torque of 25 Ncm using a contra angle and the Implant Driver EV (Fig. 4). Final installation was carried out manually. Subsequently, 2 mm Uni Abutments EV were manually connected to the implants using the Uni Driver EV (Fig. 5). Uni Abutment EV Temporary Cylinders were placed on the abutments to attach the temporary restoration. The surgical procedure was completed by replacing the soft tissue flaps and suturing around the abutments (Fig. 6).
THE EXISTING PROVISIONAL denture was grinded generously at the level of the temporary cylinders so that it could be safely placed on top of the cylinders. The maxilla was covered with cofferdam to protect the newly sutured surgical wound (Fig. 7). The reduced temporary denture was secured to the cylinders with self-hardening plastic. Afterwards the cylinders were shortened to denture level, and their channels were closed with silicone (Fig. 8). The patient thus received a temporary immediate restoration in one treatment session. Radiographic control showed an excellent fit of the abutments and cylinders and a good positioning of the implants (Fig. 9). After osseointegration of the implants, teeth 17 and 27, which could not be preserved, were extracted.
AFTER EIGHT WEEKS of healing, the temporary denture was removed and the Uni Abutments EV were exposed to prepare for the final impression (Fig. 10). For this procedure, Uni Abutments EV Pick-Ups were connected to the abutments and the impression was made using a customized impression tray (Fig. 11).
WHEN THE IMPRESSION material had set, the pins were unscrewed and the impression was removed. Uni Abutment EV Replicas were attached to the pick-ups in the impression to prepare the master model made from dental plaster stone (Fig. 12). A diagnostic wax-up was created on the model to be able to plan the exact location and dimension of the planned bar structure. The model and wax-up were sent to DENTSPLY Implants manufacturing center, where they were scanned, and the data was transferred to the ATLANTIS ISUS software. Using the software, an ATLANTIS ISUS Hybrid superstructure was designed (Fig. 13). After review and approval of this design by the dentist and dental technician, the framework was milled from a solid block of cobalt-chrome in the DENTSPLY Implants manufacturing center.
FIG. 3 Prosthetically driven guided drilling.
FIG. 5 Installation of the Uni Abutments EV.
FIG. 4 Implant placement.
FIG. 6 Uni Abutment EV Temporary Cylinders attached to the abutments.
FIG. 7 Perforated denture to gain free space around Uni Abutment EV Temporary Cylinders.
FIG. 9 Peri-apical x-ray showing the implants at bone level.
FIG. 8 Abutment access covered with silicone.
FIG. 10 Uni Abutments EV exposed for impression taking.
FIG. 11 Uni Abutment EV Pick-Ups attached to the Uni Abutments.
FIG. 12 Uni Abutment EV Replicas.
CASE STUDY 005 2014
IMPLANT-SUPPORTED IMMEDIATE RESTORATION IN THE EDENTULOUS MAXILLA
#2 DENTSPLY IMPLANTS MAGAZINE 29
REVIEW OF THE precise fit was controlled and verified in production as well as carried out using the master model (Fig. 14). With the previously created wax-up, the final restoration was completed. The ATLANTIS ISUS Hybrid superstructure was installed to the abutments with a torque of 15 Ncm (Fig. 15). The screw channels were subsequently sealed with composite. The contact area of the denture with the maxillary mucosa was designed in a slightly convex form that prevents air from escaping, avoids phonetic problems and food impaction, and allows for good oral and denture hygiene (Fig. 16). The control radiographs showed the marginal bone to be at the level of the implant shoulder and also an excellent fit of the prosthetic restoration (Fig. 17). Esthetics and function were ideally recreated and the upper lip was well supported by the prosthesis. The patient was very satisfied with the result (Fig. 18).
RESTORATION OF THE edentulous maxilla with an implant-supported fixed restoration presents great challenges for the treating dentists. The present case describes how an excellent prosthetic restoration can be created both in terms of function and esthetics using the ASTRA TECH Implant System EV and an ATLANTIS ISUS patient-specific implant superstructure.
FIG. 15 Final prosthesis secured clinically.
FIG. 13 ATLANTIS ISUS Hybrid virtually designed.
FIG. 17 Peri-apical x-ray showing the perfect fit of the restoration.
FIG. 16 Final restoration.
FIG. 14 ATLANTIS ISUS Hybrid designed with retention elements.
FIG. 18 Final esthetic outcome.
DR. FERNANDO ROJAS-VIZCAYA DDS, MSDepartment of ProsthodonticsUniversity of North Carolina, Chapel Hill, NC, USADirector of the Mediterranean Prosthodontic Institute, Castellon, Spain
1. Cooper, L., I. J. De Kok, et al. (2005). “Immediate fixed restoration of the edentulous maxilla after implant placement.” J Oral Maxillofac Surg 63(9 Suppl 2): 97–110.
2. Thor, A., K. Ekstrand, et al. (2014). “Three-year follow-up of immediately loaded implants in the edentulous atrophic maxilla: A study in patients with poor bone quantity and quality.” Int J Oral Maxillofac Implants 29(3): 642–649.
3. Norton, M. R. (2011). “The influence of insertion torque on the survival of immediately placed and restored single-tooth implants.” Int J Oral Maxillofac Implants 26(6): 1333–1343.
References
30 DENTSPLY IMPLANTS MAGAZINE #2
Challenging multi-disciplinary approach to a damaged tooth in the maxilla
CASE STUDY 006 2014
THIS DEMANDING CASE required a precise evaluation of the different alternative approaches and clinical decision making before deciding on the final treatment. A surgical approach would have involved extraction of teeth 11, 12, and 21 and enucleation of the significant cyst seen in the pre-surgical CBCT followed by bone grafting to
fill the cavity. This would have required placement of an additional one or two implants and restoration with either three single implant-retained crowns or an implant-supported three-unit bridge. It was determined that the surgical approach was too traumatic and would cause extensive loss of vital tissues, making
it difficult to establish a good esthetic result later on. It also would have required the patient to lose three of his four front teeth, which would have been psychologically traumatic. Endodontic therapy was chosen instead in order to decompress the cyst and thereby save the teeth, retain the ridge form and preserve the interdental papillary tissue and architecture.
THE INITIAL VIEW of the linked crowns at the 11 and 21 sites showed an un-esthetic appearance with poor soft tissue health and color (Fig. 1). A pre-surgical radiograph revealed root of tooth 21 to be resorbing, with apical radiolucency at 11 (Fig. 2). After extraction
FIG. 1 Pre-treatment clinical situation.
FIG. 3 Extraction socket of tooth 21.
FIG. 5 Temporary restorations.
FIG. 7 Virtual placement of a 4.8 mm x 13 mm OsseoSpeed EV implant.
FIG. 2 Pre-treatment radiographic situation.
FIG. 4 Socket graft regio 21.
FIG. 6 Healthy soft tissue conditions one year post grafting.
PATIENT: A 30-year-old male was referred for replacement of a failing maxillary left central incisor, which had been avulsed and re-implanted at the age of 11.
CHALLENGE: Additionally, the adjacent central and both lateral incisors were damaged in the trauma. The patient presented with a large peri-apical radicular cyst that required endodontic treatment of teeth 11 and 12.
TREATMENT: Tooth 21 was eventually replaced with a 4.8 mm x 13 mm OsseoSpeed EV implant using a one-stage transmucosal protocol with HealDesign EV. The implant was permanently restored with an ATLANTIS patient-specific abutment and an IPS e.max crown, along with conventional IPS e.max crowns on teeth 12, 11 and 22.
SUMMARY
Pre-surgical CBCT.
#2 DENTSPLY IMPLANTS MAGAZINE 31
Challenging multi-disciplinary approach to a damaged tooth in the maxilla
FIG. 11 ATLANTIS Abutment positioned in the plaster model with gingiva mask.
FIG. 13 ATLANTIS Abutment in gold-shaded titanium in situ.
FIG. 15 Occlusal view of the final restorations.
FIG. 9 Implant Pick-Up EV 4.8 and Implant Replica EV 4.8 in impression material.
FIG. 12 Final individual full ceramic lithium disilicate crowns.
FIG. 14 Facial view of the final restorations.
FIG. 16 Radiographic image at insertion of final crowns.
FIG. 8 Implant placement regio 21 and a HealDesign EV 4.8.
FIG. 10 Virtual design of an ATLANTIS Abutment.
of tooth 21, resorption of the socket wall was evident (Fig. 3). Therefore a graft with bone substitute material and coverage with a membrane was performed (Fig. 4) to prevent collapse of the buccal plate. The wound was sutured and a laboratory-made four-unit temporary restoration was delivered (Fig. 5).
ONE YEAR WAS allowed for post-graft healing as well as to allow for decompression of the radicular cyst. At the conclusion of that time, the soft tissue appeared healthy (Fig. 6). Figure 7 shows the virtual placement of a 4.8 mm x 13 mm OsseoSpeed EV implant, as viewed in a cone-beam computerized tomographic (CBCT) scan using the SIMPLANT software.
The implant was placed utilizing a flapless approach and a 4.8 Ø 6.5 mm HealDesign EV abutment was placed to support trans-mucosal healing (Fig. 8). After impression taking, the Implant Replica EV was connected to the Implant Pick-Up EV (Fig. 9). A plaster model was created and scanned.
THESE DATA WERE transferred into the ATLANTIS VAD software. Fig. 10 shows the virtual design of an ATLANTIS abutment in gold-shaded titanium. This abutment was placed in the model with gingiva mask, and final individual full ceramic lithium disilicate crowns (IPS e.max) were created (Figs. 11 and 12).
The ATLANTIS abutment in gold-shaded titanium was installed using an abutment screw tightened to 25 Ncm (Fig. 13). Figures 14 and 15 show the facial and occlusal view of the final restorations at delivery, with full ceramic crowns at teeth 12, 11, 21, and 22. A radiographic image taken at insertion of the final crowns demonstrates an excellent restorative fit with stable marginal bone levels (Fig. 16). Six months after insertion of the crowns, a follow-up examination of the patient revealed excellent peri-implant tissue health (Fig. 17).
FIG. 17 Excellent peri-implant tissue health six months after insertion of the final restorations.
MICHAEL R. NORTONBDS FDS RCS(Ed)Specialist in Oral SurgeryImplant & Reconstructive DentistryLondon, UK
Adjunct Clinical Professor, UPenn, Philadelphia, PA, USA
PRODUCTS USED:
32 DENTSPLY IMPLANTS MAGAZINE #2
Digital assisted precise planning and manu facturing of a fixed dental restoration
CASE STUDY 007 2014
A 66-YEAR-OLD female wanted information about implants. The initial examination revealed several teeth with caries and defect fillings. The panoramic radiograph also showed severely decayed, fractured, and supraerupted teeth (Figs. 1 and 2). The posterior maxillary teeth were subsequently extracted, and socket preservation grafting was performed. Following a three-month healing period (Fig. 3), a cone-beam computerized tomographic (CBCT) scan was performed and imported into SIMPLANT software. Careful analysis of the clinical situation resulted in a treatment plan for placing two 4.8 mm OsseoSpeed EV implants in the molar region. These were distally angled by 30 degrees to support first molar occlusion. Two 4.2 mm OsseoSpeed EV implants were also placed in the first premolar positions. A 3.6 mm OsseoSpeed EV implant was planned for the maxillary right lateral incisor position. The SIMPLANT software was used to plan the most suitable positions for the implants (Fig. 4).
A SIMPLANT GUIDE was ordered and used for the first drilling steps (Fig. 5). All implants were placed by hand with the guide removed. HealDesign EV was used during the healing phase (Fig. 6). After three months, Implant Pick-Ups EV were connected to the implants (Fig. 7). Following impression taking, the Implant Replicas EV were assembled to the Implant Pick-Ups EV in the impression (Figs. 8 and 9). After the
FIG. 2 Pre-treatment clinical situation.
FIG. 4 SIMPLANT software for planning the implant positions.
FIG. 6 Color-coded HealDesign EV in place.
FIG. 8 After impression taking, the interfaces of the impression posts were revealed in the impression.
FIG. 10 Online ATLANTIS WebOrder showing the patient-specific abutments with a digital wax-up transparent overlay.FIG. 1 Pre-treatment panoramic radiograph.
FIG. 3 Intraoral condition three months after extraction and grafting.
FIG. 5 SIMPLANT Guide for the first drilling steps.
FIG. 7 Implant Pick-Ups EV in position.
FIG. 9 Color-coded Implant Replicas EV are assembled to the Implant Pick-Ups EV in the impression.
FIG. 11 Occlusal view of the full-contour digital wax-up prior to digital cutback.
PATIENT: A 66-year-old female patient presented with several decayed, fractured and supraerupted teeth in the upper jaw.
CHALLENGE: The patient required a fixed prosthetic restoration. This superstructure had to be fixed to implants as well as natural teeth and therefore was in need of a very stable and precisely fitting framework.
TREATMENT: Extraction of the hopeless teeth and socket preservation grafting were performed. Five OsseoSpeed EV implants were placed; the two in the molar region were angled by 30 degrees. Afterwards a restoration with high-strength zirconia framework and a precise cutback for the veneering porcelain was digitally designed and fabricated. The patient was very satisfied with the fit and esthetic outcome of the bridge.
SUMMARY
#2 DENTSPLY IMPLANTS MAGAZINE 33
Digital assisted precise planning and manu facturing of a fixed dental restoration
FIG. 12: Patient-specific ATLANTIS abutments with corresponding screws.
FIG. 14: Healthy and clean implant sulcus evident at all of the sites to be restored.
FIG. 16: Clinical situation on the day of final restoration.
FIG. 18: Facial view revealing natural looking restorations in place on both teeth and implants.
FIG. 20: Radiographs of implants in the molar, premolar and lateral positions, along with the remaining natural dentition.
FIG. 17: The maxillary arch restoration with occlusal and interproximal zirconia.
FIG. 19: A lateral view displaying healthy peri-implant and gingival tissues.
DAVID GUICHET, DDSProsthodontist, Private PracticeOrange, CA, [email protected]
Thank you to Debra Wasky, Dental Technician.
final impression, the master cast was scanned. A fully anatomical digital wax-up was merged over the master cast and uploaded. ATLANTIS abutments were designed using the ATLANTIS VAD software (Fig. 10).
ATLANTIS abutments were machined and scanned, and a final digital wax-up was performed. (Fig. 11). The corresponding color-coded abutment screws were included (Fig. 12). Full CAD/CAM PMMA provisional restorations were manufactured and assembled with the ATLANTIS abutments. The distal angulation of the molar implants is shown in Figure 13.
A healthy and clean implant sulcus was evident at all of the sites to be restored (Fig. 14). The ATLANTIS abutments were delivered, installed, and tightened to 25 Ncm with the provisional restorations to assist in shaping the implant sulci (Fig. 15). Following a one-month provisionalization period, the patient was scheduled for delivery of the final restorations (Fig. 16).
THE RESTORATIVE design called for all interproximal and occlusal contacts to incorporate high-strength zirconia. A digital cutback of precisely 0.8 mm was used for the veneering porcelain in the areas where stresses are low and esthetic demands are high.
Treatment of this patient utilized digital processes and multiple merged data sets to make planning and treatment more accurate and efficient. In addition, it enabled creation of fixed dental restorations that are supported by dental implants and natural teeth. Figures 17 to 22 show the clinical and radiographic views of the final restorations and highly esthetic outcome.
FIG. 22 The patient’s smile following maxillary arch reconstruction of her remaining natural teeth and implants.
PRODUCTS USED:
34 DENTSPLY IMPLANTS MAGAZINE #2
Restoration of an edentulous mandible with an existing denture using WeldOne™
WITH BETTER ACCESS to information about implant restorations and an increasing unwillingness to accept a poorly fitting full denture, more and more patients are seeking implant-supported fixed restorations—even those patients who have significant financial constraints [1, 2]. For those patients, the WeldOne concept gives clinicians the option of delivering an affordable chairside restoration. In 2006, Degidi et al. presented a protocol for immediate loading of multiple implants by intraoral welding of a titanium wire to specific implant abutments, in order to achieve a metal-reinforced, individual immediate restoration [3, 4, 5].
THE PATIENT PRESENTED in this case report had been treated in the authors’ practice for 15 years. For 8 years, she had functioned successfully with two maxillary implants supporting a telescopic denture. In the mandible, she had a full denture, which was about 12 years old and no longer functioning satisfactorily due to alveolar ridge atrophy. The patient, a retiree, was seeking an affordable fixed restoration. For planning and counseling purposes, a pre-operative panoramic x-ray was taken (Fig. 1). As the patient did not want to be without her denture but still required a fixed restoration, the implant restoration was planned in accordance with the WeldOne concept.
In the third and fourth quadrant, the inferior alveolar nerve was locally anesthetized (2% articaine, adrenaline 1:100,000) at the mental foramen. The sites planned for implant placement were bilaterally exposed using crestal incisions and trapezoid-shaped relief incisions. The mucoperiosteal flap was completely raised, and the alveolar ridge was exposed. The incisions were made so as to preserve the mucosa between the planned placement sites.
A CYLINDRICAL SCREW IMPLANT with a grit-blasted and acid-etched surface and an internal hex connection (XiVE, diameter 3.8 mm) was placed in each of the regions 33, 34, 43, and 44 (Fig. 2).
FIG. 1 Pre-operative panoramic radiograph for planning purposes.
FIG. 3 Temporary XiVE Welding Abutments on the implants.
FIG. 6
FIG. 2 Four XiVE implants immediately after placement.
FIG. 4 Passive fit of the welded construction.
FIG. 5 AND FIG. 6 The final incorporated restoration.
PATIENT: A female with an edentulous mandible and a gingiva-supported full-arch denture seeking a stable fixed full-arch restoration.
CHALLENGE: Intraoral welding to integrate a titanium framework into an existing denture on the day of implant placement.
TREATMENT: The patient received a fixed temporary restoration reinforced by an intraorally welded titanium framework. Abutments were screwed into the implants and splinted with a titanium wire by intraoral welding. Then the finished framework was polymerized into the denture for reinforcement. With this procedure, high costs for a completely new prosthetic restoration can be avoided.
SUMMARY
1. Pommer B, Zechner W, Watzak G, Ulm C, Watzek G, and Tepper G, Progress and trends in patients’ mindset on dental implants. I: level of information, sources of information and need for patient information Clin Oral Implants Res 2011;22(2):223-9.
2. Baracat LF, Teixeira AM, dos Santos MB, da Cunha Vde P, and Marchini L, Patients’ expectations before and evaluation after dental implant therapy Clin Implant Dent Relat Res 2011;13(2):141-5.
3. Degidi M, Nardi D, and Piattelli A, Prospective five-year follow-up of immediate definitive rehabilitation of the edentulous patient using an intraoral welded titanium framework ZZI Zeitschrift für Zahnärztliche Implantologie 2012;28(4):326-338.
4. Degidi M, Nardi D, and Piattelli A, Immediate definitive restoration of the edentulous patient using an intraoral welded titanium framework: a study of twenty consecutive cases TITANIUM 2009;1(2).
5. Degidi M, Gehrke P, Spanel A, and Piattelli A, Syncrystallization: a technique for temporization of immediately loaded implants with metal-reinforced acrylic resin restorations Clin Implant Dent Relat Res 2006;8(3):123-34.
6. Ledermann PD, Stegprothetische Versorgung des zahnlosen Unterkiefers mit Hilfe von plasmabeschichteten Titanschraubenimplantaten Dtsch Zahnärztl Z 1979;34(12):907-911.
7. Degidi M, Nardi D, and Piattelli A, Immediate rehabilitation of the edentulous mandible with a definitive prosthesis supported by an intraorally welded titanium bar Int J Oral Maxillofac Implants 2009;24(2):342-7.
References
CASE STUDY 008 2014
#2 DENTSPLY IMPLANTS MAGAZINE 35
Restoration of an edentulous mandible with an existing denture using WeldOne™
Measurement of the insertion torque using a surgical motor FRIOS Unit E, a former DENTSPLY Friadent product (OEM by W&H), demonstrated that the four implants were primarily stable, with each torqued to 35 Ncm. Along with the plan for immediate rigid splinting, this minimized the risk of implant failure during the healing phase and indicated that immediate loading could safely and predictably be carried out. XiVE Temporary Welding Abutments and the corresponding retaining screws were placed into the internal hex connection of each implant (Fig. 3).
According to the manufacturer’s instructions, a titanium wire of 1.5 mm in diameter should be used for distances between welding abutments of up to 8 mm, with a 2.0 mm diameter titanium wire indicated for distances of 8 to 15 mm. For the present case, a 2.0 mm diameter wire was chosen. To accommodate the horizontal and vertical space available, the wire was bent using the Soft and Sharp Curver (IOW-Kit, Ustomed Instrumente, Tuttlingen) until the wire was aligned in a gap-free and passive way with the abutments to be welded. The titanium wire was retained in position, and the welding clamp of the WeldOne Unit was applied to the most easily accessible abutment, in this case # 33, while making sure that the clamp was as centered and vertical as possible.
THE WELDING UNIT was set to the welding parameter “high” (specified for the 2.0 mm wire), and the welding impulse was triggered by pressing the switch “weld” and stepping on the foot pedal. Additional irrigation was occasionally applied.
After welding, the welding clamp was maintained in position for approximately 3 seconds to dissipate potential residual heat through the electrodes. Subsequently the welding clamp was opened and removed. Then the three remaining joints were welded in the same way. In order to control the precise fit of the construction, the retaining screws were removed, and a Sheffield test was conducted (Fig. 4).
The titanium framework was removed from the patient’s mouth. Additional retention was added extra-orally using 1.5 mm diameter titanium wire to achieve the appropriate reinforcement and the “medium” welding parameter. The titanium framework was treated and shortened with a diamond separating disc, and then sandblasted and matted with opaque. The tension-free fit was again checked in the patient’s mouth, and the structure was inserted into the oral cavity using a single, easily accessible retaining screw. Meanwhile the existing full denture was hollowed from the basal direction.
IN THE ORAL CAVITY, the framework was again inspected to ensure there were no tensions or disturbances. The prepared and hollowed denture was activated with reline bonder and filled with relining material. Then it was placed over the screwed-in titanium framework and allowed to polymerize.
Once the relining material was set, the inserted retaining screw was loosened, the denture was removed, and the pontic design of the basal area was refined to enable better hygiene.
While the denture was being completed in the laboratory, the wound was closed using 5.0 Gore suture material. The prosthetic restoration was then screwed in with the retaining screws using a hex driver 1.22 with a torque of 24 Ncm. The access holes were closed with light-curing composite. Occlusion was tested and finally adjusted. The patient was advised to consume a soft diet for four weeks and given analgesics to use when needed and chlorhexidine rinsing solution to be applied three to four times daily. In addition, she was given detailed instructions on oral hygiene.
After one week, the denture was unscrewed, the sutures were removed, and the wound was inspected. Healing was proceeding uneventfully. Figures 5 and 6 show the final incorporated restoration.
THE APPROACH TO bar-supported immediate loading of dental implants first described by Ledermann in 1979 is still relevant today [6]. In the present case, it enabled the patient to be provided with a fixed temporary restoration using her existing denture, with which she was very satisfied. She received a stable and affordable restoration for her edentulous mandible.
By reinforcing the existing denture with an intraorally welded titanium framework, it is possible to provide temporary and durable restorations on the day of surgery to edentulous patients with old and poorly fitting dentures [7]. In this case, we used temporary abutments for the welded framework as the patient required a new prosthetic reconstruction within the next two years. However, durable restorations can be manufactured with the described technique using Welding Sleeves for MP Abutments if a new prosthesis is not planned within the next years. High costs for prosthetic restorations can be avoided by using this concept. Given the continuously aging population, patients who have not been able to benefit from high-quality implant-supported prosthetics so far can be restored sufficiently and receive good oral rehabilitation.
APART FROM ABSOLUTE medical contraindications and fear of surgery, the main reason why many patients decide against implant-supported reconstructions is due to cost concerns. The concept illustrated here provides opportunities to this group without worrying about a loss of quality in the restoration. While other types of implant restorations will continue to be legitimate, the authors consider the prosthetic restoration described here to be a valuable therapeutic complement.
DR. HENRIKE ROLF, M.SCPrivate practice, Buxtehude, Germany
DR. MARTIN CHRISTIANSEN, M.SCPrivate practice, Seevetal, Germany
PRODUCTS USED: WeldOne™
36 DENTSPLY IMPLANTS MAGAZINE #2
CASE STUDY 009 2014
Immediate implant placement and digital workflow
IMMEDIATE IMPLANT therapy is a clinically validated procedure [1]. In the anterior dentition, success is measured not only by implant survival and stable bone levels, but by long-lasting, esthetically-pleasing outcomes. This is accomplished by satisfying several biologic and restorative criteria.
Implant position is crucial in terms of developing proper restorative emergence profile and establishing facial and proximal soft tissue levels. Fixtures should be palatally-positioned [2], and not in close proximity to the facial bone. This often requires that the implant diameter selected be smaller than that of the root being replaced. This facilitates formation of a clot between the socket walls and implant, leading to modeling and remodeling of native bone. The fate of the facial bone, often consisting of 100% bundle bone in its marginal portion, is of great importance. Regardless of surgical approach (such as flap vs. flapless, graft vs. non-graft, membrane vs. no membrane), this aspect cannot be ignored [3]. Being a “tooth-dependent” tissue, bundle bone loses its embryologic function of supporting periodontal tissues once extractions are performed [6, 7]. Often, especially in the anterior dentition, this facial bone wall is extremely thin prior to extraction [4, 5]. Compensation for post-extraction dimensional changes can be critical for long-term esthetic success.
SOME ADVOCATE retention of the periosteum (flapless placement) for bone preservation [8, 9], but this cannot be assumed to be a predictable technique, especially in sites of thin periodontal biotypes. Augmentation, including flap reflection and facial grafting, can sometimes be advantageous. Materials capable of supporting new hard (osteoconductive) and soft tissue ingrowth and regeneration should be utilized in these cases.
PATIENT: A 41-year-old male presented with a fracture of the maxillary left central incisor.
CHALLENGE: A hopeless maxillary incisor must be extracted and replaced with an immediate implant simultaneous with tissue augmentation and immediate provisionalization.
TREATMENT: Immediate placement and immediate provisionalization was performed with the ASTRA TECH Implant System EV. The permanent restoration was made, utilizing ATLANTIS IO FLO scan body, an iTero intraoral digital scanner and an ATLANTIS patient-specific abutment. Implant treatment of the subgingival fracture of tooth #9 (#21) was selected as the more efficient and predictable therapy for this case. By further leveraging technology such as intraoral scanning, the treatment process is further streamlined with a digital workflow that supports an optimal and patient- specific outcome.
FIG. 1 Pre-treatment situation.
FIG. 3 Lateral view of implant after placement.
FIG. 5 A 4.2 Implant Pick-Up EV is used for the impression taking.
FIG. 7 The site is reopened for placement of the same bone graft was placed over the facial cortex and covered with a dermal allograft, which was adapted, via a tissue punch around a HealDesign EV.
FIG. 9 Radiograph showing implant and healing abutment in place.
FIG. 2 Palatal positioning of an OsseoSpeed EV 4.2C x 13.0 mm implant.
FIG. 4 Obturation of the void between the implant and the socket walls was accomplished with a mixture of FDBA and DBBM.
FIG. 6 The impression was poured with an implant replica in place to facilitate provisionalization.
FIG. 8 The flap was then sutured securely around the healing abutment with resorbable sutures.
FIG. 10 A Temp Abutment EV 4.2 was modified and covered with opaque composite resin prior to addition of bis acryl and flowable composite resin.
SUMMARY
#2 DENTSPLY IMPLANTS MAGAZINE 37
Immediate implant placement and digital workflowValentini [10] demonstrated esthetic success of immediate implants in sites where bone grafting and collagen membranes were utilized at the time of extraction and implant placement.
SOFT TISSUE AUGMENTATION in relation to implant therapy, often accomplished with subepithelial connective tissue grafts, has been recommended to enhance the cosmetic appearance [11]. The time involved in procuring and closing the soft tissue and its donor site, along with the increased morbidity associated with this step, may preclude its implementation in therapy. Palatal anatomy may also preclude its use in certain situations. In patients with shallow palatal vaults, the proximity to neurovascular structures can prevent the procurement of soft tissue graft or minimize their dimensions. Also, the increased operating time and morbidity associated with autogenous connective tissue grafting cannot be ignored. Dermal allograft can, in appropriate situations, serve as a viable alternative. Soft tissue augmentation may still be desired, not only for esthetic reasons, but also to preserve marginal bone levels around implants. Formation of biologic width around implants is a physiological “must.” If needed, it will develop at the expense of the marginal bone. It has been demonstrated that implants with “thick” soft tissues maintain more coronal marginal bone levels compared to those with “thin” soft tissues [12]. Dermal allografts have been used to “thicken” soft tissues and eliminate autogenous soft tissue grafts. Consisting of collagen, these grafts may also serve as cell-occlusive membranes, serving the dual function of tissue-thickening agent and guided bone regeneration (GBR) [13].
PROVISIONALIZING IMMEDIATE IMPLANTS may enhance esthetics [14, 15, 16, 17, 18]. Preserving soft tissue levels and developing prosthetic emergent profiles can be more efficacious with a provisional crown versus a round, non-anatomically-shaped healing abutment. The retention of provisional restorations may also play a role in the success of therapy. Stability of the restoration and avoiding early removal can be critical for successful osseointegration as well as not disturbing the initial soft tissue remodeling around the crown(s). Screw-retention, though more technique-sensitive compared to cement-retained fabrication, allows for tightening of the temporary crowns and elimination of possible cement-associated, biologic complications [19].
The following case report (Figs. 1–22) demonstrates how a hopeless maxillary incisor is extracted and replaced with an immediate implant simultaneous with tissue augmentation and immediate provisionalization.
Following papilla-sparing, facial flap-reflection, tooth #9 (#21) was carefully extracted. The alveolus was debrided with manual and ultrasonic instrumentation.
FIG. 13 Provisional restoration two months post-op.
FIG. 15 Healthy peri-implant soft tissue after removal of the provisional crown.
FIG. 17 Digital model with ATLANTIS IO FLO scan body.
FIG. 19 The unique interface design of the ASTRA TECH Implant System EV allows for one-position-only placement of ATLANTIS patient-specific abutments.
FIG. 12 Provisional restoration ten days post-op.
FIG. 14 Radiograph two months post-op.
FIG. 16 ATLANTIS IO FLO scan body placed for digital impression.
FIG. 18 Patient-specific ATLANTIS Abutment in zirconia.
PRODUCTS USED:
FIG. 11 The restoration was torqued to 15 Ncm and placed out of occlusal contact with the opposing mandibular teeth, and light contact with the adjacent teeth.
38 DENTSPLY IMPLANTS MAGAZINE #2
CASE STUDY 009 2014
It was then conditioned with doxycycline for about 3 minutes, followed by sterile saline irrigation. Palatal positioning of an OsseoSpeed EV 4.2C x 13.0 mm implant was performed. The OsseoSpeed EV implant has been shown to be significantly stronger than its predecessor (OsseoSpeed TX) [20]. In a prospective multi-center study, Stanford, et al [21] demonstrated that the ASTRA TECH Implant System EV performed equally as compared to the ASTRA TECH Implant System TX regarding radiographic bone levels, with a subjective sense of greater stability at time of placement.
Obturation of the void between the implant and the socket walls was accomplished with a mixture of approximately 3:1 freeze-dried bone allograft (FDBA) and deproteinized bovine bone mineral (DBBM). A 4.2 Implant Pick-Up EV impression post was tightened and the facial flap repositioned with temporary sutures to protect the underlying tissues during a surgical impression.
THE IMPRESSION WAS poured with an implant replica in place to facilitate provisionalization at the restorative dentist’s office immediately after surgery.
The site was then reopened and the same bone graft was placed over the facial cortex and covered with a dermal allograft (SYMBIOS PerioDerm GBR, DENTSPLY Implants NA), which was adapted via a tissue punch around a HealDesign EV healing abutment. SYMBIOS PerioDerm GBR was selected as the desired material due to its structural integrity, closely resembling that of human tissue. Viable cells and antigens are removed without damaging the remaining matrix, which serves as a framework for cellular infiltration and vascularization.
The flap was then sutured securely around the healing abutment with resorbable sutures. The patient was prescribed amoxicillin 500 mg for ten days, a six-day course of methylprednisolone (Medrol Dosepak), Etodolac 400 mg for analgesia and Chlorhexidine Gluconate rinses bid. He was instructed to avoid all mastication in the anterior dentition for at least six weeks.
Immediately after surgery, the patient reported to his restorative dentist’s office for fabrication and delivery of a screw-retained, provisional restoration. A temporary abutment (Temp Abutment EV 4.2) was modified and covered with opaque composite resin prior to addition of bis acryl and flowable composite resin. It was contoured and polished and the facial/incisal screw access channel covered with Teflon tape then flowable composite resin. This restoration was torqued to 15 Ncm and placed out of occlusal contact with the opposing mandibular teeth, and light contact with the adjacent teeth.
THE PATIENT WAS seen for post-operative appointments at ten days and again at eight weeks at the surgeon’s practice. Soft tissue health was confirmed, radiographic bone levels were relatively unchanged and no mobility of the provisional restoration or implant was noted.
The patient returned to the restorative dentist for the initiation of restorative therapy at about ten weeks.
Removal of the provisional crown demonstrated physiologic development of the peri-implant soft tissues.
Rather than taking an elastomeric impression, an ATLANTIS IO FLO (scan body) for ASTRA TECH Implant System EV was placed for digital impression of the implant with an iTero intraoral scanner. Using a CAD/CAM impression system allowed for an extremely accurate impression of both the soft tissue and the implant position to be taken quickly and easily, providing the laboratory with all necessary landmarks to create a very natural emergence profile for the final restoration. Using the iTero impression system also allowed us to have an ATLANTIS patient-specific
IMMEDIATE IMPLANT PLACEMENT AND DIGITAL WORKFLOW
FIG. 21 Radiograph at the day of delivery of the final restoration
FIG. 22 Lateral view displaying healthy peri-implant and gingival tissues.
FIG. 20 Radiograph of implant and abutment in place.
#2 DENTSPLY IMPLANTS MAGAZINE 39
abutment fabricated for this case. The unique interface design of the ASTRA TECH Implant System EV allows for one-position-only placement of ATLANTIS patient-specific abutments, making the impression-taking and final delivery very easy and uncomplicated.
The ATLANTIS Abutment was fabricated with the unique combination of four key features called the ATLANTIS Abutment BioDesign Matrix, which includes ATLANTIS VAD (Virtual Abutment Design) software that takes into consideration the final tooth shape, the edentulous space and the adjacent teeth in the design of the abutment. The Natural Shape of ATLANTIS Abutments is the emergence profile based on individual patient anatomy while the Soft-tissue Adapt helps to provide optimal support for the soft tissue. Lastly, the abutment-to-implant Custom Connect provides a strong and stable fit.
The final prosthetic restoration consisted of an all-ceramic lithium disilicate crown (IPS e.max, Ivoclar Vivadent) providing an excellent esthetic outcome. The all-ceramic crown was cemented with resin cement after tightening of the abutment screw to 25 Ncm and plugging the access with white Teflon tape. Figure 22 shows the nice esthetic result of the final restoration.
DR. BRIAN L. WILK, DMDChalfont, PA, USAhighpointdental.com
TONY CIRIGLIANO, CDT Feasterville, PA, USAbroadway-dental.net
BARRY P. LEVIN, DMDElkins Park, PA, USAwww.aperiodoc.com
1. Sanz M, Cecchinato D, Ferrus J, et al. A prospective, randomized-controlled clinical trial to evaluate bone preservation using implants with different geometry placed into extraction sockets in the maxilla. Clin Oral Implants Res. 2010;21(1):13-21.
3. Araujo MG, Lindhe J. Ridge alterations following tooth extraction with and without flap elevation: an experimental study in the dog. Clin Oral Implants Res. 200920(6):545-549.
4. Huynh-Ba G, Pjetursson BE, Sanz M, et al. Analysis of the socket bone wall dimensions in the upper maxilla in relation to immediate implant placement. Clin Oral Implans Res. 2010;21(1):37-42.
5. Braut V, Bornstein MM, Belser U, Buser D. Thickness of the anterior maxillary facial bone wall-a retrospective radiographic study using cone beam computed tomography. Int J Periodontics Restorative Dent. 2011;31(2):125-131.
6. Botticelli D, Berglundh T, Lindhe J. Hard-tissue alterations following immediate implant placement in extraction sites. J Clin Periodontol 2004;31:820-828.
7. Botticelli D, Renzi A, Lindhe J, Berglundh T. Implants in fresh extraction sockets: a prospective 5-year follow-up clinical study. Clin Oral Impl Res. 19,2008:1226-1232.
8. Lee, EA, Gonzalez-Martin O, Fiorellini J. Lingualized flapless implant placement into fresh extraction sockets preserved buccal alveoloar bone: a cone beam computed tomography study. Int J Periodontics Restorative Dent 2014;34:61-68.
9. Blanco J, Nunez V, Aracil L, Munoz F, Ramos I. Ridge alterations following immediate implant placement in the dog: flap versus flapless surgery. J Clin Periodontol 2008;35:640-648.
10. Valentini P, Abensur D, Albertini JF, Rocchesani M. Immediate provisionalization of single-extraction-site implants in the esthetic zone: a clinical evaluation. Int J Periodontics Restorative Dent. 2010;30(1):41-51.
11. Grunder U. Crestal ridge width changes when placing implants at the time of tooth extraction with and without soft tissue augmentation after a healing period of 6 months: Report of 24 consecutive cases. Int J Periodontics Restorative Dent 2011;31:9-17.
12. Linkevicius T, Puisys A, Linkeviciene L, Peciuliene V, Schlee M. Crestal bone stability around implants with horizontally matching connection after soft tissue thickening: a prospective clinical trial. Clin Implant Dent Rel Res 2013;1-12.
13. Levin, BP. The Dual Function of a dermal allograft in immediate implant therapy. Int J Periodontic Restorative Dent. 2014 (accepted for publication).
14. Becker W, Doerr J, Becker BE. A novel method for creating an optimal emergence profile adjacent to dental implants. J Esthetic Restor Dent 2012;24,395-400.
15. Cabello G, Rioboo M, Fabrega JG. Immediate placement and restoration of implants in the esthetic zone with a trimodal approach: Soft tissue alterations and its relation to gingival biotype. Clin Oral Impl Res 24,2013:1094-1100.
16. De Bruyn H, Raes F, Cooper LF, Reside G, Garriga JS, Tarrida LG, Wiltfang J, Kern M. Three-years clinical outcome of immediate provisionalization of single OsseoSpeed Implants in extraction sockets and healed ridges. Clin Oral Impl Res. 24,2013:217-223.
17. Levin, BP. Immediate temporization of immediate implants in the esthetic zone: evaluating survival and bone maintenance. Compendium 2011;32:52-63.
18. Levin, BP, Wilk BL. Immediate provisionalization of immediate implants in the esthetic zone: A prospective case series evaluating implant survival, esthetics, and bone maintenance. Compendium 2013; 34:2-10.
19. Shapoff CA, Lahey BJ. Crestal bone loss and the consequences of retained cement around dental implants. Compendium 2012;33(2):94-102.
20. Jansson H, Hellqvist J. Functionality of a further developed implant system. Mechanical integrity. Clin Oral Implants Res 2013;25(Suppl. 9) 166.
21. Stanford C, Raes S, Cecchinato D, Brandt J, Bittner N. Clinical interim data from a prospective, randomized, controlled, multicenter, 5-year study comparing two versions of an implant system. Clin Oral Implants Res 2013;24(Suppl. 9):150.
References
40 DENTSPLY IMPLANTS MAGAZINE #2
Management of the edentulous patient using the SmartFix™ concept
CASE STUDY 010 2014
USE OF IMPLANT-SUPPORTED dentures to restore completely edentulous patients, as described by Brånemark et al. (1985) [1], paved the way for the treatment of partial edentulism and single missing teeth. Originally, all prostheses were screw-retained so that regular checks could be performed and dentists could intervene if problems developed. The cement-retained prosthesis was introduced later, mainly to optimize the esthetics of prosthetic restorations but also to enable use of conventional denture techniques [2].
In the clinical case described here, the patient presented wearing conventional, removable total dentures. After discussion of various treatment options, a decision was made to move towards screw-retained prostheses on six implants in the maxilla and five in the mandible.
Screw-retained prostheses offer the following advantages:• They can be removed easily, if necessary, for
publications)• Connection via stock abutments (Balance Base
abutments) ensures an excellent accuracy of fit.• The use of abutments shifts the surface of prosthetic
work coronally. If the patient has thick soft tissue, this simplifies the clinical procedures.
• Avoiding the use of cement to secure the prosthesis prevents any risk of residual cement, which can result in peri-implantitis.
THE IMPLANTS WERE inserted following a conventional drilling protocol using the existing denture as a surgical
PATIENT: A 70-year-old male patient presented in our office wearing conventional removable total prosthesis. He was no longer satisfied with the fit of the denture and asked for a fixed restoration.
CHALLENGE: Patients with edentulous jaws are looking for prosthesis with stable fit and good esthetics. Due to bone loss, especially in the maxilla, this objective can often only be achieved with several surgical procedures. If patients refuse surgical procedures, alternative treatment options have to be discussed.
TREATMENT: In this case, six ANKYLOS implants were placed in the upper jaw and five in the lower jaw. The distal implants were placed in an angle (SmartFix concept) to avoid additional surgical treatment, such as sinus floor augmentation in the maxilla. With this concept an optimized load distribution of the prosthetic restorations in both jaws could be achieved and provide stable prosthesis with a good esthetic outcome.
SUMMARY
FIG. 2 Paralleling pins in the drilling sites demonstrate the angle of the most distal implant.
FIG. 1 The existing removable denture was used as a guide for implant placement.
DIAGRAM 1 Due to the oblique position of the implants, the prosthetic support polygon was wider on the distal side, better utilizing the local bone.
DIAGRAMS 2A AND 2B The distal implants are placed in an angle to avoid anatomical obstacles (SmartFix concept).
DIAGRAM 2B
#2 DENTSPLY IMPLANTS MAGAZINE 41
Management of the edentulous patient using the SmartFix™ concept
PRODUCTS USED:
guide. The most distal implants were slightly angled (Figs. 1 to 4), which offered several advantages in this case:
• It avoided the need for a sinus grafting procedure, which the patient had rejected.
• It enabled the use of longer posterior implants, which ensured better anchorage.
• It increased the inter-implant distance.• It better distributed the occlusal loads (Diagram 1).
THE IMPLANTS WERE placed sub-crestally to benefit from the advantages associated with the ANKYLOS implant system (TissueCare Concept). The implant placement heads were unscrewed, and four straight Balance Base abutments were placed on the anterior implants and tightened to 25 Ncm (Fig. 5). Two criteria must be considered when choosing the abutment: the orientation of the implants and the thickness of the mucosa. The height of the abutments should be chosen based on the quantity of soft tissue in order to optimize the esthetic result.
Due to the angulation of the posterior implants, the SmartFix concept was followed. The SmartFix concept is a prosthetic implant procedure used for the immediate restoration of edentulous patients using screw-retained bridges or bars in the maxilla and mandible. This design compensates for the angulation of implants by using an angulated Balance Base abutment, which includes two components. In order to achieve a common axis of insertion, ANKYLOS Balance Base abutments angled at 15° or 30° are mounted on implants placed in an angle (Figs. 6 and 7) (Diagrams 2, 3, 4 and 5).FIG. 7 Angled Balance Base abutment.
FIG. 5 Straight Balance Base abutments were placed in the anterior sector, and angled abutments were used for the most distal implants.
FIG. 6 Placement of the body of the angulated Balance Base abutment using the seating instrument and 1 mm hex screwdriver.
SmartFix™
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DIAGRAM 4 Screwing in of the angled Balance Base abutment.
DIAGRAMS 5A AND 5 B Screwing in of the head of the angled Balance Base abutment.
5B
DIAGRAM 3 Angled Balance Base abutment in two parts.
FIG. 4 The six implants placed in the maxilla.
FIG. 3 Insertion of the implants with subcrestal positioning.
42 DENTSPLY IMPLANTS MAGAZINE #2
THE TWO COMPONENTS of the angled Balance Base abutment are pre-mounted on a flexible seating instrument. The seating instrument is made of PEEK plastic and can be pre-formed outside of the oral cavity if necessary in order to simplify placement of the abutment in the implant. The body of the angled abutment is positioned first. The abutment platform must be parallel to the occlusal plane. The 1 mm hex screwdriver is used to tighten the abutment body to 15 Ncm. Due to the sub-crestal positioning of the implant, the correct placement of the abutment must be checked. Additional preparation of the surrounding bone may be necessary.
THE SEATING INSTRUMENT is then removed from the body of the angled Balance Base abutment by rotating to the left. Then it is rotated 180° to position the head of the abutment. The head is first screwed on manually using the seating instrument. Then the 1.8 mm hex screwdriver is used to finish tightening to 25 Ncm.
Once the abutments are in place, the tissues are sutured.
In this clinical situation, a decision had been made to use the patient’s full dentures as a temporary prosthesis. The dentures were adjusted to accommodate the implants (Fig. 8), and the retention copings were positioned on the abutments. A dam was put in place to protect the implants and sutures, and liquid resin was injected around the retention copings. For added security, the copings were put in place two by two. Once all the copings were secured to the denture (Fig. 9), metal reinforcement was placed, and the denture was polished.
The same surgical procedures were used to place five implants in the mandible (Fig. 10).
FOUR MONTHS AFTER surgery, the temporary prostheses were removed, and osseointegration was verified (Fig. 11).
The impression is a crucial step, and it must be done with precision. Due to the large number of implants, a pick-up impression was most suitable. In this technique, the transfer parts remain connected in the impression after removal from the impression tray (Figs. 12 to 14).
To limit movement of the transfer posts and compen-sate for deformation due to the withdrawal of material, many authors have proposed splinting of the transfer posts. Brånemark et al. (1985) [1] proposed connecting the transfers in the mouth using resin on a silk thread
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CASE STUDY 010 2014
FIG. 9 Denture base before amplification with a wire and polishing.
FIG. 11 Check of osseointegration at 4-month follow-up.
FIG. 10 Patient at the end of the session with his two temporary prostheses stabilized on implants.
FIGS. 12 A AND B The pick-up transfers are placed on the abutments in the maxilla and mandible.
FIG. 12 B
FIG. 8 The patient’s denture was hollowed out to accommodate the implants, and the abutments were protected by caps.
MANAGEMENT OF THE EDENTULOUS PATIENT USING THE SMARTFIX™ CONCEPT
#2 DENTSPLY IMPLANTS MAGAZINE 43
FIGS. 15 A AND 15 B Models of the upper and lower jaw with plaster keys.
FIGS. 13 A AND 13 B Mandibular impression with and without the abutment analogs.
FIGS. 14 A AND 14 B Maxilla impression with and without the abutment analogs.
FIG. 15 B
FIG. 13 B
FIG. 14 B
framework. Loos [3] suggested using orthodontic wire as a support for the castable resin. However, the quantity of resin used for connecting the transfers is very large. Polymerization of the resin is accompanied by an increase in temperature, which can be minimized with irrigation [4]. According to Mojon et al [5], the shrinkage of Palavit G and Duralay resin is 6.5% and 7.9%, respectively, after 24 hours. The majority (80%) of this shrinkage takes place at the end of 17 minutes at room temperature. For Moon et al [6] the greater the quantity of resin used, the greater the shrinkage.
The impression was disinfected and rinsed, and the abutment analogs were connected to the transfer posts. Laboratory silicone was injected around the implant sites to create a soft-tissue mask.
The working model must be validated prior to the prosthetic procedure. This step allows the precision of the impression to be verified. It is indispensable when performing restorations of medium or large areas. Different techniques have been described, but the plaster key technique is preferred by the author (Figs. 15a and b).
THIS TECHNIQUE CONSISTS of manufacturing a plaster key of fine thickness around the pick-up transfer posts screwed onto the model. This key is then positioned in the mouth over the implants, and a Sheffield test is performed to verify passivity. The most distal transfer post is screwed onto the implant, and any adjustment errors in the other implants are noted. The remaining transfer posts are then screwed down successively. An adjustment error is characterized by a fracture in the plaster key. Depending on the size of the defect, a decision is made either to renew the impression or modify the model. If the model is modified, the transfer posts are screwed down in the mouth over the implants, and the fractured key is repaired by adding quick-setting plaster. The working model is then modified by shifting the analog to adapt it to the key. Making a new impression is preferable.
Once the impression has been checked, the model can then be used to manufacture the frameworks. This can be done conventionally or by using computer-aided design/computer-aided manufacturing (CAD/CAM) technology.
In the present case, castable cylinders were used for making the metallic framework. A complete diagnostic wax-up of the prosthesis was done on the cylinders. Silicone keys were made to record the contours of the prostheses. The thickness was then reduced to »
44 DENTSPLY IMPLANTS MAGAZINE #2
1. Branemark P.I, Albrektsson T, Zarb GA, editors. Tissue-integrated prostheses: Osseointegration in clinical dentistry. Chicago: Quintessence; 1985.
2. Anderson B, Odman P, Lidvall AM, et al. Single tooth restoration supported of osseointegrated implants: Result and experience from a prospective study after 2 to 3 years. Int J Oral Maxillofac Implants 1995(10): 702-711.
3. Loos LG. A fixed prosthodontic technique for mandibular osseointagrated titanium implants. J Prosthet Dent 1986; 55: 232-42.
4. Ness EM; Nicholls JI; Rubenstein JE; Smith DE. Accuracy of the acrylic resin pattern fort he implant-retained prothesis. Int J Prosthodont 1992; 5: 542-549.
5. Mojon P; Oberholzer JP; Meyer JM; Belser UC. Polymerization shrinkage of index and pattern acrylic resins. J Prosthet Dent 1990; 64: 684-8.
6. Moon PC, Eshleman JR, Douglas HB, Garett SG. Comparison of accuracy of soldering indices for fixed protheses. J Prosthet Dent 1978; 40: 35-8.
7. Riedy SJ, Lang BR, Lang BE. Fit of implant frameworks fabricated by different techniques. J Prosthet Dent 1997; 78; 596-604.
References
DR. THIERRY ROUACH Dental Surgeon, Former Assistant in the Paris Hospitals, D.U. of Surgical Implantology and Prosthetics, Paris VII, Post Graduate Implantology New York University, Private Practice in Paris, France
Thank you to the Safadi Laboratory, Paris, France.
accommodate the cosmetic material. The wax model was coated, and the frameworks were cast. The fitting of the framework is a core step (Figs. 16 and 17).
DIFFERENT METHODS enable determination of the quality of fit:
• Verification by direct visual inspection.• Tactile verification with a sharp probe (accuracy to
the nearest 100 µm).• Radiographic verification (accuracy to the nearest
200 µm with a correctly angulated retroalveolar area).• Verification using the Sheffield test.If the fit is correct, a wax bite is made on the framework
to validate the intermaxillary relationship. If a mismatch is found [7], the framework can be cut using a fine disk. The different parts are repositioned on the implants and secured with autopolymerizable resin. The new position of the framework is recorded in a second stage impression. Once the frameworks are validated, the prosthetic restoration is complete. All the verifications and prosthetic corrections were performed. The prosthesis was put in place, the fit and passivity were checked once again, and the occlusion was refined (Figs. 18 and 19). The prosthetic screws were tightened, and the screw-access channels were temporarily sealed.
After 7 to 15 days, the access channels were uncovered, and the tightness of the screws was checked. The access channels were then covered with cotton or gutta percha, and the occlusal access was closed using composite.
BY COMBINING STRAIGHT and angled Balance Base abutments, the SmartFix design concept enables the simple creation of screw-retained prosthetic restorations in clinical situations where anatomical obstacles (such as the sinus or inferior alveolar nerve) would have complicated the treatment.
FIGS 16 AND 17 Mandibular framework on the model and in the mouth.
FIG. 17
FIGS. 18 AND 19 Completed prosthesis with screw-access channels temporarily sealed.
FIG. 19
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CASE STUDY 010 2014
MANAGEMENT OF THE EDENTULOUS PATIENT USING THE SMARTFIX™ CONCEPT
#2 DENTSPLY IMPLANTS MAGAZINE 45
PRODUCT NEWS
USING SIMPLANT computer guided implant treatment with ASTRA TECH Implant System EV unlocks the potential of digitally-driven, crown-down planning for enhanced treatment outcomes for the benefit of the patients. SIMPLANT is a comprehensive system based on 3D imaging, allowing for precise implant planning and predictable restorative results. It also facilitates clear visualization of the case, enabling comprehensive patient communication for increased case acceptance.
The patient-specific SIMPLANT SAFE Guide brings the diagnostics to another dimension, providing the seamless link between the digital treatment plan and the surgery. With the choice for a bone-, mucosa- or tooth-supported SIMPLANT Guide, you can perform your preferred surgical technique with confidence.
THE DESIGN PHILOSOPHY of the new ASTRA TECH Implant System EV is based on the natural dentition and utilizes a site-specific, crown-down approach with the desired end result in mind to help ensure a successful outcome. Combined with the benefits of using SIMPLANT
Unlocking digital potentialTHE UNIQUE COMBINATION OF SIMPLANT AND ASTRA TECH IMPLANT SYSTEM EV
computer guided implant treatment it is now possible to fully explore the potential of this design philosophy and enhance the treatment outcomes.
THE GUIDED SURGERY assortment of ASTRA TECH Implant System EV is specifically designed for the SIMPLANT application and provides added simplicity and efficiency to the procedure.
• SIMPLANT SAFE Guide with lateral opening for easier access.
• Sleeve-on-drill instruments for simple and safe surgical handling.
• A versatile range of implant designs using one user-friendly surgical tray adaptable to the clinical preferences.
• A seamless digital workflow including the one-position-only placement of ATLANTIS Abutments for a simple restorative procedure.
Using SIMPLANT computer guided implant treatment with ASTRA TECH Implant System EV unlocks the potential of digitally-driven, crown-down planning and enhances the treatment outcomes for the benefit of the patients.
For more information about SIMPLANT with ASTRA TECH Implant System EV, please visit dentsplyimplants.com
WITH ASTRA TECH IMPLANT SYSTEM EV
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PRODUCT NEWS
SYMBIOS WILL BE the new brand in the field of regenera-tive solutions in the global DENTSPLY Implants product portfolio. It unites the values of the former FRIOS brand and the SYMBIOS brand (previously offered in North America only). The global introduction of SYMBIOS completes DENTSPLY Implants’ product portfolio in the field of implant dentistry.
SYMBIOS REGENERATIVE SOLUTIONS includes a compre-hen sive range of products for bone augmentation and periodontal procedures designed to promote excellent bone formation and stability as a crucial base for dental implant treatment. The regenerative solutions provided within the SYMBIOS portfolio consist of the three categories: • Bone graft material• Membranes• Instruments
COMMITTED TO OFFERING superior regenerative solutions with optimal outcomes for each clinical requirement, DENTSPLY Implants will continuously expand the SYMBIOS portfolio with complementary products.
In 2015, two new products are expected to be presented for all countries accepting the CE mark: the SYMBIOS Biphasic Bone Graft Material (BGM) and the SYMBIOS Collagen Membrane SR (slow resorbable).
SYMBIOS Biphasic BGM is a bone graft material derived from red algae, consisting of a composition of hydroxyapatite and tricalciumphosphate. It can be used for reconstruction of bony defects in maxillofacial surgery and augmentations in implant dentistry.
With the SYMBIOS Collagen Membrane SR, DENTSPLY Implants introduces a resorbable collagen membrane to the market. Derived from highly-purified type-I bovine Achilles tendon, the collagen tissue matrix provides a GBR barrier function for 26 to 38 weeks. The membrane which is available in three different sizes is indicated for use in dental surgery procedures, around dental implants and bone defects or ridge reconstructions.
SYMBIOS®
—the new brand for regenerative solutions
For more information about SYMBIOS, please visit dentsplyimplants.com
#2 DENTSPLY IMPLANTS MAGAZINE 47
PRODUCT NEWS
DENTSPLY IMPLANTS now introduces a new feature for ATLANTIS ISUS patient-specific implant supra-structures—angulated screw access.
By angling the screw channel, it is possible to optimally position the prosthetic screw access, and to improve the function and esthetics of the bridge and hybrid restorations.
As a part of the digital solutions offering from DENTSPLY Implants, ATLANTIS ISUS includes a full range of implant suprastructures for all major implant systems.
THE NEW ANGULATED screw access allows the prosthetic screw access to be angled up to 30 degrees off the implant or abutment axis, for optimal esthetics and function. Each angulated screw access connection is individually designed, taking into account the angulation and available height to meet customer requests.
The angulated screw access can be designed for partial and full arch bridges as well as hybrid restorations for all major implant systems. ATLANTIS ISUS Bridge and
ATLANTIS ISUS Hybrid are indicated for fixed prostheses with wide flexibility in therapy and design for partially and fully edentulous patients.
THE NEW ANGULATED screw access provides easy handling procedures with optimized screw head and screwdriver design. Every connection is supplied with a corresponding ATLANTIS ISUS prosthetic screw. The screws are specifically designed for use with the angulated screw access driver feature. Additionally, the hexalobular design of the screwdriver makes engaging the screw easy and ensures that insertion forces are always applied perpendicularly to the screw axis.
ATLANTIS ISUS implant suprastructures are part of ATLANTIS patient-specific prosthetic solutions from DENTSPLY Implants.
To learn more about the ATLANTIS patient-specific prosthetic solutions, please visit www.dentsplyimplants.com
Introducing a new angle on function and esthetics
ANGULATED SCREW ACCESS—A NEW FEATURE FOR ATLANTIS™ ISUS IMPLANT SUPRASTRUCTURES
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”Getting messages across and sharing different experiences, opinions and scientific results require effective communication, and that is what the international p3 program from DENTSPLY Implants is all about,” says Birgit Wilhelm, Senior Clinical Education Key Opinion Leader Development Manager and responsible for this program at DENTSPLY Implants.
THIS EXCLUSIVE PROGRAM, where the three p’s stand for profession, passion and power, is offered to 10–12 carefully selected young professionals from universities and the private sector at a time.
A successful candidate should be dedicated to the field of implant dentistry and headed for a key role in local scientific leadership and/or as an on-stage lecturer for implant therapy, as well as conducting training courses at various levels.
“In addition, you need a visionary attitude and have a desire to work long-term with DENTSPLY Implants,” says Birgit Wilhelm.
AT THE TIME OF WRITING, the fifth p3 program has just begun and all in all
DENTSPLY Implants has developed a unique training program in order to find the voices of tomorrow. All candidates are carefully selected and get a great opportunity to improve their speaking skills, rhetoric and podium presence.
54 dental professionals from 12 countries have entered the program since 2006.
The main focus is on improving speaking skills, rhetoric and podium presence. All training modules are individualized and set-up to reflect the needs of the group. The training consists of a multitude of exercises and throughout the program a coaching institute and well-respected DENTSPLY Implants key opinion leader train and mentor the participants.
AFTER THE TRAINING, participants are admitted into the p3 ALUMNi Forum where they can create personal global networks and interact with fellow p3 graduates, PEERS* chairmen and specially invited guests.
“I think the graduation module of the last program shows how good the p3 program is. We saw lectures on scientific and clinical topics that were, without exception, presented with power, as well as passionate and very professional,” says Birgit Wilhelm. She is convinced the current program will be as successful and concludes: “The new group is just as eager and skillful as the last one, so yes, we will see some great lectures from them in the future.”
PROFESSIONAL DEVELOPMENT
THE p3 PROGRAM IN SHORT
• A global training program for young dental implant professionals that improves speaking skills, rhetoric and podium presence.
• Developed and performed in collaboration with the Institute for Rhetoric and Communication’s “Institute Zienterra,” the mentors Dr. Peter Gehrke and Dr. Orcan Yüksel, as well as certified trainers for specific topics.
• Carefully chosen participants with a great dedication to implant dentistry.
• The first program took place in Germany 2006–2008. The current program started in May 2014.
• The program consists of five training modules, and at least 80 hours of exercises, lectures and presentations.
How great speakers are created
* PEERS, Platform for Exchange of Education Research and Science, a global DENTSPLY Implants network.
PROFESSION—PASSION—POWER
#2 DENTSPLY IMPLANTS MAGAZINE 49
WHAT THE SPEAKERS SAY: QUOTES FROM p3 GRADUATES
“A demanding program with dedicated teachers, through which I made a big step on stage.”
DR. YANNICK SPAEYBenelux, Maxillofacial Surgeon
“I’ve learned a lot to improve my speaker skills and also in my personal life.”
DR. JULIE LAMUREFrance, Periodontist
“An opportunity to meet passionate colleagues from other countries.”
DR. FRANK ZASTROWGermany, Oral Surgeon
“This program made me stronger for my life as a dentist.”
DR. REI NAKAZAWAJapan, Dentist
“Great collaboration of trainers and p3 colleagues with global impact ... in summary: a really amazing time!”
DR. CLAAS OLE SCHMITTGermany, Oral Surgeon
“It is a great program to support skills in public speaking, time management, communication and creating interesting lectures.”
DR. NADINE GRÄFIN VON KROCKOWGermany, Oral Surgeon
p3 international graduates and fellows and PEERS chairmen meet, greet and present in Frankfurt am Main, Germany.
The graduates, coach and mentors of the p3 International Program 2013/2014, together with Birgit Wilhelm of DENTSPLY Implants (far right), at the p3 ALUMNi Forum 2014.
AT THE p3 ALUMNI FORUM:
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PATIENT PROFILE IMPLANTS IN REAL LIFE
See Eliane talk about her implant treatment.
#2 DENTSPLY IMPLANTS MAGAZINE 51
“My only regret is that I did not do it sooner.”
Imagine what it would be like to worry every day about the risk that one of your teeth will fall out. This was the daily life of 50-year-old Eliane. With a dental
implant, she got rid of her problems and rediscovered quality of life. “The implant has really solved my problem in a simple and permanent way,” says Eliane.
The story of 50-year-old Eliane is not unique. The problems she faced are similar to the situation of hundreds of thousands of people around the world. Eliane lives in Paris, France, and works as an industrial project manager
at a laboratory in Paris—an occupation that requires a lot of daily contact and interaction with people. For some time, Eliane had a post-crown that became loose on a regular basis. One day when she was in a meeting with colleagues, her tooth fell out. She really felt very embarrassed and had had enough.
“I made an emergency call to my dentist. I could not continue to live with the risk of losing my tooth,” she says.
For Eliane, there were two solutions available: a bridge or a dental implant. Her dentist recommended a dental implant, as this would avoid damage to her neighboring, healthy teeth. She put her trust in her dentist and went online to find out about the quality of the ASTRA TECH Implant System from DENTSPLY Implants, that he had talked to her about.
AT HER FIRST VISIT, Eliane had the tooth and root extracted under local anesthesia. Then the implant was placed and a temporary crown attached. Eliane returned to work the next morning and she immediately rediscovered a quality of life that she had truly missed for a long time.
“This type of procedure requires local anesthesia so it’s not painful and I was able to go back to work the next day. It was a great feeling,” says Eliane.
Her permanent crown was inserted during the second session a few days later.
“My only regret is that I did not do it sooner! My implant tooth is like a real tooth: no one notices it, I don’t feel it, and
I can talk, eat, laugh and smile with confidence. I no longer worry about my crown falling out.”
IT’S BEEN SIX YEARS now since she got the implant. Eliane visits her dentist regularly for follow-up and monitoring to make sure that everything is going well. She and her dentist are both happy with the results.
“With the OsseoSpeed implant from DENTSPLY Implants, my dentist has truly solved my problem simply and permanently.”
Thanks to her dental implant, Eliane has her smile back and can confidently work as a team member at the laboratory.
“I have rediscovered quality of life. I recommend everybody that has the same problems as I had to learn about and ask their dentist about dental implants.”
“I have rediscovered quality of life.” Eliane is happy with her dental implant.
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Australia/ New ZealandAustriaBeneluxBrazil
ChinaDenmarkDubaiFinlandFrance
GermanyHong KongItalyJapanMexico
North AmericaNorwayPolandPortugalRussia
SpainSwedenSwitzerland
TaiwanTurkeyUnited Kingdom
Welcome to France Paris in 2 minutes
France is not only the largest country in Western Europe, it is also one of the wealthiest nations. French citizens enjoy a high standard of living, with the country performing well in rankings of education, health care and human development.
However, the French dental implant market remains relatively immature and the volume in terms of implants per inhabitant is below average in Western Europe.“The nice thing in this situation is that the market is one of the most dynamic. The reimbursement of prosthetics on implants which will soon be introduced by the general
health refund system will help the dentists to catch up with their neighboring colleagues,” says Thierry Cauche, Managing Director of DENTSPLY Implants in France.
DENTSPLY IMPLANTS has been present in France for many years and today the company is one of the top players. Since implant dentistry remains relatively underrepresented, one of
the main objectives for Thierry Cauche and his team is to preach the good word to the general practitioners.“The younger generation is well educated and is naturally suggesting implants to their patients when needed. But the average dentist is over 48 years old. We are focusing an important part of our resources to creating training programs.”
DIGITAL DENTISTRY is one of the fastest growing segments in the market. Thanks to the vast digital portfolio DENTSPLY Implants is increasingly perceived as the company technologically leading the industry.“I would say that DENTSPLY Implants has made the digital benefits accessible to the vast majority of dental professionals. ATLANTIS has erased the complexity barrier to customized abutments and solutions for all dentists.”
THIERRY CAUCHE continues: “SIMPLANT is also driving our growth. The digital planning and use of a surgical guide diminish the risks and reduce the stress during surgery. And the ASTRA TECH Implant System EV is the first implant solution ever developed to be fully supported by digital solutions. It is a huge breakthrough.”
Moulin RougeThe current cabaret at this world-famous entertainment palace is a good example of how passionate Moulin Rouge is. Around 100 artists use a thousand costumes with feathers, rhinestones and sequins to entertain the visitors. And, to quench their hunger and thirst, Laurent Tarridec, a chef acclaimed by the Guide Michelin, is in charge of the restaurant.
Musée du LouvreThe courtyard of the most visited national museum in the world boasts a main entrance made of glass—the Louvre Pyramid. The magnificent main building, originally a 12th century fortress, holds both antique and modern art, including ancient Greek sculpture Venus de Milo as well as the collection’s crown jewel—Leonardo da Vinci’s Mona Lisa.
Please join us on this two-minute tour of the city of love, culture and food.
Thierry Cauche, Managing Director of DENTSPLY Implants in France.
TRAVEL WITH DENTSPLY IMPLANTS
#2 DENTSPLY IMPLANTS MAGAZINE 53
3Did you know?The name of the oldest bridge crossing the river Seine, Pont Neuf, ironically means “New Bridge.”
Paris was the third most visited city in the world in 2013.
Gastronomic meccaFor many, coming to Paris is to savor French cuisine, as food from a variety of different regions can be enjoyed here. Experience the food markets that change with the seasons or open your mind by tasting the specialties in one of the Guide Michelin-starred restaurants of Paris. There are more than 70 of them—which makes Paris the culinary capital of the world.
La tour EiffelAfter walking up the 1,665 steps (there are elevators too) of the Eiffel Tower, you get a spectacular view over Paris. It is one of the most popular sights in the world, but many, including famous writers like Alexandre Dumas and Guy de Maupassant, disliked it when it was built. The latter even had lunch at the tower’s restaurant every day just to avoid seeing it.
Champs-ÉlyséesThis 1.9-kilometer boulevard stretches between Place de la Concorde and The Arc de Triomphe. Besides a wide selection of high-end restaurants and designer shopping, the avenue is the site for many well-attended events. These include the final stretch of the Tour de France cycle race and a huge military parade on 14th of July (French National Day). If you are to visit one street in Paris, this is it.
Jardin du LuxembourgStroll among statues and flowers in one of Ernest Hemingway’s favorite places. Take the opportunity to play some boule or why not grab one of the public chairs to enjoy your picnic anywhere in this very genuine 25-hectare garden.
The typical Parisian breakfast includes croissants and café au lait.
It takes 60 tons of paint, applied by 25 workers using only brushes, to repaint the Eiffel Tower.
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The Japanese Order of the Rising Sun, instituted in 1875 by Emperor Meiji, is awarded to individuals who have made outstanding contributions to Japan in international relations, promotion of Japanese culture, advancements in their field, and development in the welfare and preservation of the environment.
Jan Lindhe was awarded the order during a special ceremony earlier this year. He receives it for his “outstanding contribution to a greater understanding of Japan.”
“It was a great honor and a recognition of the importance of Swedish periodontology in Japan and around the world, particularly research conducted in Gothenburg,” says Jan Lindhe.
Jan Lindhe is one of the world’s leading clinical research scientists specializing in periodontology and has contributed greatly to the development of the global dental implant industry. For over 40 years, Jan Lindhe has collaborated with Japanese dentists and dental technicians.
HOW IS YOUR RELATIONSHIP WITH JAPAN TODAY? “For the last 30 years, I have spent at least one week a year in Japan and I have strong relationships with Japanese culture, the people and the dental industry. Currently I hold seminars and I am involved in various studies and research projects.
Jan Lindhe is not only known for his research achievements, but also recognized as an author. His textbook, called Clinical Periodontology and Implant Dentistry, is printed in more than 100,000 copies.
WHAT DO YOU THINK ABOUT THE DENTAL INDUSTRY DEVELOPMENT? “I am extremely fascinated by the development of dental implants. I am currently participating in projects regarding the new ASTRA TECH Implant System EV, a great implant system, very robust and easy to use. I am also very impressed by ATLANTIS, which is a brilliant system,” says Jan Lindhe.
“I am extremely fascinated by the development of dental implants.”
A WORD WITH JAN LINDHE | AGE: 79 | LIVES: HOVÅS, GOTHENBURG, SWEDEN
Actor Clint Eastwood has received it, as well as the Oscar-winning director Andrzej Wajda. Now this exclusive group is joined by Jan Lindhe, who has been awarded the Japanese imperial decoration “The Order of the Rising Sun, Gold Rays with Neck Ribbon.”
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