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Jochen Mellinghoff: Esthetic advantages offered by 3.3 mm diameter ceramic implants for anterior dental restoration

  The restoration with zirconia implants is discussed due to improved material properties such as low plaque affinity and good biocompatibility as an alternative to titanium implants. This case report describes an esthetically appealing restoration in the premolar region of a young woman. Despite slight bone and soft tissue resorption, implantation without complicated bone augmentation was possible. In patients with thin mucosa biotype in particular, the use of zirconia implants should be considered due to the tooth-colored esthetic. PRODUCT INFORMATION BY THE MANUFACTURER The Straumann® PURE Ceramic Implant is the result of more than 9 years of research and development. It has a natural looking ivory color, a feature that makes the implant look more like a natural tooth and supports the clinician in cases of thin gingiva biotype or soft tissue recession. It has a monotype design based on features of the Straumann® Soft Tissue Level Standard Plus and Straumann® Bone Level Implants. According to a survey (data on file at Straumann), patients would prefer tooth-colored implants, if given the choice between ceramic and metal implants. With the Straumann® PURE Ceramic Implant, clinicians can offer their patients a natural and highly esthetic solution, benefitting from favorable soft tissue attachment around zirconia implants. MORE? All about the STRAUMANN® PURE CERAMIC IMPLANT on STARGET at a glance. Click here PICTURE DOCUMENTATION 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 INITIAL SITUATION A female patient, aged 39 years, in good general health, attended our practice for a consultation. She came from a small town about 70 km away and had found out beforehand from the Internet which dentist in the area offered ceramic implants. The woman was prepared to accept the long trip to reach us because she was worried that the apicoectomy proposed by her own dentist would once again involve introducing new foreign material (sealing material for the apical closure of the root canals) into the bone. She had therefore decided to have the root-filled teeth and associated metal-ceramic crowns removed as well as the periapical granulomas. She formulated her desire for ceramic implants clearly and unequivocally. Particular importance is attached in our practice to an informative initial consultation with new patients. Expectations of both patient and therapist, the “shared therapeutic destiny,” should be addressed in this consultation. The patient in this case is looking for very good function, a high level of aesthetics and well tolerated materials. Our expectations consist of constructive cooperation. This covers a comprehensive history, very good diagnostic options and high-quality surgical and dental technology products. All of these are integrated in a programme of oral hygiene management developed for implant patients. Planning involves detailed explanation of the intended treatment, photographs, models and x-rays (CBCT) (Fig. 1). THERAPY SCHEDULE The patient’s dental chart revealed full dentition restored with plastic filling materials, Teeth numbers 12 and 22 had been crowned after endodontic treatment. The patient complained of problems in the maxillary region between teeth numbers 13 and 23. Pain on pressure was reported in response to digital pressure (thumb and index finger) in the apical region of teeth numbers 12 and 22, differing clearly from the adjacent regions. A clinical diagnosis of suspected apical osteitis was made and was confirmed in the x-ray and CBCT (cone beam computed tomography) images subsequently taken. After being given an explanation and consideration of the various options, the patient decided on extraction of teeth numbers 12 and 22. We selected immediate implantation for the restoration of region 12 and 22. Good experiences with this method allowed us to hold out to the patient the prospect of a shorter treatment period and a high-quality aesthetic outcome. After evaluation of the CBCT, we were able to meet her request for the provision of ceramic implants (Fig. 2). SURGICAL PROCEDURE The two lateral incisors were removed using a Benex extractor (Fig. 3). This reduced the risk of alveolar damage, particularly damage to the vestibular alveolar wall. The alveoli were freed from the inflamed apical tissue by means of intensive curettage. Two monotype, reduced-diameter Straumann® PURE Ceramic implants (diameter 3.3 mm/ length: 12 mm; Fig. 4) were implanted using a surgical drill template. The two ceramic implants could then be inserted into the prepared alveoli with a torque of 35 Ncm (Fig. 5,6). After suturing, impression posts were used to take an impression in order to create long-term temporary restorations. Chairside temporizations were used until these were ready (Fig. 7). PROSTHETIC PROCEDURE With the long-term temporary restorations, the patient was able to go to work and her ability to communicate was not restricted in any other way either (Fig. 8). The healing process was problem-free. The impression for the permanent crowns was made using a single tray with polyether and impression caps compliant with the system (Figs. 9,10). The crowns were manufactured on the basis of milled zirconium dioxide copings veneered with feldspar ceramics (Fig. 11). Cementation with glass ionomer cement produced a secure outcome. Treatment was completed by a functional test (Figs. 12-14). TREATMENT OUTCOME The outcome of the treatment met the planned specifications in terms of both aesthetics and function. The minimally invasive extraction meant that both hard and soft tissue were preserved to the maximum extent possible. Comparison of the periodontal situation after one year on the basis of photographs and x-ray images permits a very good long-term prognosis to be made. (Figs 16-20). CONCLUSION The patient asked for a non-metal, prosthetic implant. As a result of the limited spatial conditions, ceramic implants were selected with a diameter of 3.3 mm. The detailed planning and its implementation mean that it was possible to achieve a more than satisfactory outcome for the patient, the practice and the dental laboratory. The patient has decided to remain in our oral health programme despite the additional travel involved. This means that we will be able to record further developments (Figs. 21-22). Dr. med. dent. Jochen Mellinghoff M.Sc. In practice in Ulm since 1986. 1990 to the present, free-lance lecturing in prevention, practice management, media management and documentation for dentists and doctors, Lectures and courses in implantology with live operations performed by myself. Master of Science, Oral Surgery (Danube University Krems). Certified specialism, implantology. Consultant to the DGI and DGOI. Author, particularly in the field of ceramics implantology. Head of the Quality Circle of the Bavarian Regional Association of the DGI. ITI Study Club Director . Trainer for holistic communication techniques. Qualification as quality auditor (German Accreditation Agency – DAkks). Currently: Practice study on two-piece ceramic implants CLINICAL REVIEW The clinical facts behind the Straumann® PURE Ceramic Implant. BROCHURE Download the brochure for the Straumann® PURE Ceramic Implant. SUBSCRIBE Subscribe to our monthly STARGET newsletter to receive the latest news about implant dentistry. The post Jochen Mellinghoff: Esthetic advantages offered by 3.3 mm diameter ceramic implants for anterior dental restoration appeared first on STARGET COM.

6th IAOCI World Congress: “Evidence-Based Ceramic Implantology — Where Are We Today?”

  February 16 to 18, 2017 at the Kimpton Epic Hotel in Miami, Florida! Welcome to the 6th IAOCI World Congress, an international meeting with a first-rate scientific program delivered by top speakers from around the world. Through this yearly congress, the academy promotes innovative and forward-thinking ideas by means of workshops, lectures, and symposia that enhance the understanding of and the rationale for ceramic implantology. This is a place where scientists, clinicians, students, and manufacturers gather to have access to, learn from, and exchange ideas with the largest community of international experts in dental bioceramics science and technology. No other event will offer a more comprehensive and innovative series of lectures and programs that are dedicated to predictable, aesthetic, and metal-free ceramic implantology. The distinguished speakers from all over the world will be addressing pertinent topics, such as rationale for ceramic implants, zirconia as an implant and implantable material, mechanism of osseointegration of ceramic implants, the latest advancements in zirconia implant design and engineering, and much more! ALREADY CONVINCED? REGISTER NOW!  DOWNLOAD THE ADVANCE CONGRESS PROGRAM LEARN MORE ABOUT THE STRAUMANN® PURE CERAMIC IMPLANT The International Academy Of Ceramic Implantology is the first professional organization built around the idea that ceramic dental implants should be and will become the standard of care for teeth replacement. As a comprehensive resource for patients and dental health professionals, the website provides the latest research, news, and articles on the topics of ceramic dental implants, zirconia and zirconium implants, zirconium oxide, and metal-free dental implants of all kinds. Please join us at the Kimpton Epic Hotel in Miami, Florida, for what will be a unique and total immersion learning experience on all aspects of the science and art of bioceramics and metal-free materials for implant rehabilitation. Miami is a culturally rich and diverse city with a unique identity and is the best setting for an out-of-the-box meeting like IAOCI 2017. SEE YOU IN MIAMI! CLINICAL REVIEW The clinical facts behind the Straumann® PURE Ceramic Implant. Click here BROCHURE The official Straumann brochure for the Straumann® PURE Ceramic Implant. Click here NEWSLETTER Subscribe to our monthly STARGET newsletter to receive the latest news. Click here The post 6th IAOCI World Congress: “Evidence-Based Ceramic Implantology — Where Are We Today?” appeared first on STARGET COM.

George Furtado Guimarães: The use of Straumann® Emdogain® in two different clinical scenarios in the same patient

  INITIAL SITUATION A 49-year-old man was referred to our service for evaluation and treatment of gingival recession with root exposure (FDA, tooth 13) and a tooth with a hopeless prognosis because of root resorption (tooth 11) (Fig. 1). After comprehensive examination, no significant health problems and no contraindications for periodontal and implant surgery were detected. For tooth 13, clinical measurements and observations resulted in a diagnosis of a Miller class I recession. For tooth 11, CBCT images (Figs. 2, 3) revealed a bucco-lingual bony defect secondary to previous endodontic surgery in very close proximity to the nasopalatine canal. Although they were not the patient’s main complaint, some esthetic issues were observed in the adjacent teeth. PRODUCT INFORMATION BY THE MANUFACTURER Straumann® Emdogain® for wound healing “Orchestrating Wound Healing” – learn more about the new indication of Straumann® Emdogain®. Click here Straumann® Emdogain® is one of the best documented products in oral tissue regeneration. Its excellent clinical tolerability [1,2] has been demonstrated in over two million surgical applications. Emdogain® contains enamel matrix proteins (amelogenins). When applied to the wound, these proteins form an extracellular matrix that stimulates cells and processes that are fundamental for wound healing [3]. These properties make Emdogain® a unique solution to stimulate and accelerate the healing of wounds and regeneration of tissues. [1] Clinical evaluation of wound healing following multiple exposures to enamel matrix protein derivative in the treatment of intrabony periodontal defects. Heard RH, Mellonig JT, Brunsvold MA, Lasho DJ, Meffert RM, Cochran DL. J Periodontol. 2000 Nov;71(11):1715-21. [2] Clinical safety of enamel matrix derivative (EMDOGAIN) in the treatment of periodontal defects. Zetterström O, Andersson C, Eriksson L, Fredriksson A, Friskopp J, Heden G, [3] Jansson B, Lundgren T, Nilveus R, Olsson A, Renvert S, Salonen L, Sjöström L, Winell A, Ostgren A, Gestrelius S. J Clin Periodontol 1997 Sep;24(9 Pt 2):697-704. 29. Emdogain Promotes Healing of a Surgical Wound in the Rat Oral Mucosa. Maymon-Gil T, Weinberg E, Nemcovsky C, Weinreb M. J. Periodontol. 2016 Jan 16:1-16. TREATMENT PLANNING For the Miller class I recession of the canine, a substantial amount of good quality keratinized tissue was observed at the gingival margin. Consequently, a coronally advanced flap approach was planned, combined with the use of Emdogain®. Regarding the central incisor, a minimally invasive extraction with immediate implant placement and immediate temporization were planned. The bony defect would be addressed using a block bone graft from the posterior mandible. Additionally, nasopalatine content removal was also considered in order to prevent future contact between the implant and that anatomic landmark. Topical application of Emdogain® was envisaged for both situations with the aim of optimizing wound healing. PICTURE DOCUMENTATION 1 guimaraes01 2 guimaraes02 3 guimaraes03 4 guimaraes04 5 guimaraes05 6 guimaraes06 7 guimaraes07 8 guimaraes08 9 guimaraes09 10 guimaraes10 11 guimaraes11 12 guimaraes12 13 guimaraes13 14 guimaraes14 15 guimaraes15 16 guimaraes16 17 guimaraes17 18 guimaraes18 19 guimaraes19 20 guimaraes20 21 guimaraes21 22 guimaraes22 23 guimaraes23 24 guimaraes24 SURGICAL PROCEDURE Tooth 11: After local anesthesia, an intrasulcular incision was made all around the tooth with a 15C surgical blade (Fig. 4). A periotome was used to sever both the supracrestal fibers and the interproximal periodontal ligament fibers (Fig. 5). A forceps was carefully applied with slow rotational movements to luxate and extract the tooth (Fig.6). Every effort was made not to jeopardize the remaining buccal plate. Lucas curettes were used to remove all granulation tissue (Fig. 7). The communication between the alveolar socket and the nasopalatine canal (Fig. 8) was confirmed, and all the soft tissue contents in the canal were enucleated using round carbide burs (Fig. 9). The implant was placed against the palatal wall so as to achieve sufficient torque for immediate temporization (Fig. 10). Subsequently, the bone donor site was accessed. A full-thickness incision was made 3 mm below the mucogingival junction from the ascending ramus of the mandible to the distal aspect of the first molar. A flap was raised, and bone blocks measuring 8 mm and 6 mm in diameter were removed using trephine burs (Fig. 11). Sutures were placed. At the implant site, a 6-mm diameter bone block was used to completely fill the nasopalatine canal. Two further blocks were used to repair the buccal and lingual bony defects. The blocks were positioned in a press-fit manner until they were completely stable (Fig. 12). The residual gap was filled with autogenous bone particles. Interrupted sutures were placed in the interdental papillae only. An abutment was selected for a cemented provisional crown, and temporization was performed based on an ideal crown prototype (Figs. 13, 14). “MY PERSONAL RESEARCH ON USING EMDOGAIN® FOR THE WOUND HEALING AS PART OF DENTAL IMPLANTATION PROCEDURES DEMONSTRATED THAT THE PRODUCT STIMULATES BLOOD VESSEL FORMATION AND THEREFORE ENHANCES WOUND HEALING. USING EMDOGAIN® IN MY DAILY IMPLANT AND GRAFT CASES MAY OPTIMIZE MY WOUND HEALING RESULTS AND CONSEQUENTLY MY PATIENT’S SATISFACTION.” GEORGE FURTADO GUIMARÃES Tooth 13: After local anesthesia, an intrasulcular incision was made from the base of the recession to the point where it meets the vertical incisions. Two oblique, bevel incisions were made with a 15C surgical blade mesially and distally to the intrasulcular incision and extended beyond the mucogingival line, creating a trapezoid flap. An initial partial-thickness flap of the interproximal papilla was made using a Beaver® mini blade (Fig. 15), and a full-thickness flap was then raised apical to the recession up to the mucogingival line. Subsequently, a partial-thickness dissection was made apical to this line to promote a tension-free coronal displacement of the flap (Fig. 16). The interproximal papillae were de-epithelialized with microsurgical scissors (Fig. 17). Following soft tissue management, tooth decontamination was performed with Gracey curettes and special burs. A 24% EDTA gel (Prefgel®) was applied to the root surface for 2 minutes and then completely rinsed off with sterile saline. Emdogain® was then applied to the entire root surface (Fig. 18). The flap was positioned coronally above the cementoenamel junction, and a 5.0 nylon suture was carefully placed (Fig. 19). Upon completion of the surgical procedures, Emdogain® was topically applied to the soft tissue manipulated during surgery (teeth 13 and 11) with the aim of enhancing soft tissue healing (Fig.20). The patient was instructed not to rinse or brush his teeth on the day of the surgery to prevent early loss of the Emdogain® gel. Sutures were removed 14 days postoperatively, at which time the healing process was assessed (Fig.21), and new hygiene instructions were issued. The prosthetic phase was also scheduled at this stage.   PROSTHETIC PROCEDURE After a healing period of 3 months, the prosthetic procedure was performed. In accordance with the patient’s wishes and esthetic needs, teeth 21 and 12 were also prepared (Fig. 22), and individual temporary crowns were made. A tooth-whitening procedure was also carried out (Procedure, products) in both upper and lower arches to optimize the final esthetic outcome. At the time of impression-taking, the abutment torque was confirmed and a customized impression coping was used to copy the resulting profile obtained with the temporary crown. Individual zirconia-ceramic crowns were made and permanently fitted (Figs. 23, 24). FINAL RESULT During the first two weeks postoperatively, the patient was followed up every other day to ensure that adequate healing was taking place. Aspects related to inflammation, infection, re-epithelialization of the surgical incisions and soft tissue maturation were assessed. Satisfactory postoperative wound healing was achieved without complications. The combination of a coronally advanced flap and Emdogain® proved to be a good treatment option for this Miller class I case, which resulted in a positive outcome. Immediate implant placement with immediate temporization promoted a satisfactory initial result for the patient. Topical Emdogain® application aided in wound healing, based on the angiogenic properties previously reported by the authors themselves (Guimarães et al. 2015). Although a considerable number of surgical sites were involved at the same time, the patient was highly satisfied and reported no postoperative pain. Regarding the restorative aspects of this case, which was the patient’s main concern, a highly satisfactory esthetic result was obtained. The tooth-whitening procedure and the zirconia-ceramic crowns were key to achieving such goals, in terms of both esthetics and function. CONCLUSION Gingival recession cases are often challenging, especially in the context of immediate implant placement. Careful treatment planning is therefore crucial to a positive long-term outcome. Treatment combining a coronally advanced flap and Emdogain® in the case presented here permitted complete root coverage and satisfactory esthetics. Both the grafted alveolar bony defects and the nasopalatine canal content enucleation were regarded as predictable and important for long-term implant performance. Immediate implant placement and temporization to replace the central incisor provided the patient with good immediate esthetics and contributed to the preservation of the soft tissue architecture during the healing phase which, in turn, was paramount in the final restoration. This case was realized with the support of Dr. James Carlos Nery, PhD, and Silvio Arouca, MSc. Prof. Dr. George Furtado Guimarães DDS Private dental surgeon, Brasília, Brazil. Lecturer and Researcher in Implantology and Periodontology, São Leopoldo Mandic Institute and Research Center, Brasília, Brazil. Coordinator of Specialist Training and Master’s degree, São Leopoldo Mandic Institute and Research Center, Brasília, Brazil. Co-authors: James Carlos Nery PhD, Silvio Arouca MSc BROCHURE Download our brochure for more information on how to improve wound healing in implant surgery procedures by using Straumann® Emdogain®. CLICK HERE MORE? All about Straumann® Emdogain®. CLICK HERE SUBSCRIBE Subscribe to our monthly STARGET newsletter to receive the latest news about implant dentistry. CLICK HERE The post George Furtado Guimarães: The use of Straumann® Emdogain® in two different clinical scenarios in the same patient appeared first on STARGET COM.

ITI World Symposium 2017: “Key Factors for Long-Term Success”

  The International Team for Implantology (ITI) is holding the next edition of its flagship event – the ITI World Symposium – in 2017 from May 4 to 6 in Basel, Switzerland. The scientific program along with the faculty list have been published on the ITI World Symposium 2017 website at The main theme of the meeting is “Key factors for long-term success”. Find out why Prof. Irena Sailer and Prof. Urs Belser think you need to be in Basel, Switzerland for the ITI World Symposium 2017: VIDEO For more information and to register for the most important implant dentistry meeting in 2017, go to the ITI World Symposium website: WEBSITE Keys to the entire treatment cycle from diagnosis through treatment to aftercare More than 80 speakers from all over the world will be sharing their expertise in a series of plenary and parallel breakout sessions over three days. They will be providing keys to the entire treatment cycle from diagnosis through treatment to aftercare, offering sustainable long-term solutions. In addition to the field’s leading international speakers, the faculty also includes a broad cross-section of young and talented specialists from around the world, representing a diversity of evidence-based approaches and the next generation of implant dentistry. The Scientific Program Committee led by Prof. Dr. Daniel Wismeijer has designed a practically oriented program of information and approaches that participants can immediately implement in daily practice. To ensure that the take home messages are directly accessible to as broad an audience as possible, all plenary sessions will be simultaneously translated from English into nine languages. What will be important tomorrow?  “With the theme ‘key factors for long-term success’, the aim is not only to highlight what is state of the art today but also what will be important tomorrow – looking at the technology and approaches that are set to direct practice in the near future,” explained Daniel Wismeijer, Chair of the Scientific Program Committee. “Our speakers are providing keys to various areas within implant dentistry and are also showing how they can be used to open doors to best practice.” The role of technology in our lives is the theme of keynote speaker Dr. Kevin Warwick, a leading cybernetics researcher at the University of Coventry whose area of study is artificial intelligence, robots and cyborgs. Kevin Warwick will be taking a look at how healthcare is developing in the light of technological advances. By contrast, the groundbreaking work of the ITI in the field of implant dentistry during its 37-year history forms the subject of a presentation by Dr. h.c. Thomas Straumann and Prof. Dr. Daniel Buser. Pre-Symposium Corporate Forum The World Symposium scientific program is complemented by a half-day Pre-Symposium Corporate Forum presented by Straumann, Morita and botiss, where opinion leaders talk about their experience with the latest products and technologies. The extensive industry exhibition provides participants with a perfect opportunity to visit key companies, see what’s new and find out how they can apply it in daily practice. THE LOCATION The ITI World Symposium is being held at the Messe Basel within the halls designed by renowned Basel architects Herzog & de Meuron. The unique facade of twisted aluminum bands encloses the ITI World Symposium 2017 setting that is inspired by the dynamic world of modern airports. Bustling departure gates, quiet lounges and a lively exhibition zone provide ample opportunity for the event’s more than 4,200 anticipated visitors to meet and network while taking part in an exciting scientific journey. This is further facilitated by an innovative technology service that allows participants to exchange and gather information using a small interactive device. Any information gathered continues to be accessible and up to date in the “cloud”, which eliminates the need to produce and carry around large amounts of paper during the event. By choosing Basel as the event location, the ITI is returning to its roots and home base. The city itself provides a beautiful backdrop to the event, with a charming old town that is easily accessible from all the hotels and the congress venue. ABOUT THE ITI The International Team for Implantology (ITI) is an academic association that unites professionals around the world from every field of implant dentistry and related disciplines. It actively promotes networking and exchange among its membership of currently more than 15,000. ITI Fellows and Members regularly share their knowledge and expertise from research and clinical practice at meetings, courses and congresses with the objective of continuously improving treatment methods and outcomes to the benefit of their patients. In 36 years, the ITI has built a reputation for scientific rigor combined with concern for the welfare of patients. The organization focuses on the development of well-documented treatment guidelines backed by extensive clinical testing and the compilation of long-term results. The ITI funds research as well as Scholarships for young clinicians, organizes congresses and continuing education events, and runs more than 600 Study Clubs around the globe. The organization also publishes reference books such as the ITI Treatment Guide series and operates the ITI Online Academy, a peer-reviewed, evidence-based e-learning platform with a unique user-centric approach. The post ITI World Symposium 2017: “Key Factors for Long-Term Success” appeared first on STARGET COM.


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