Ämnen under MIS Global Conference 2011

Main Topics, Cancun 2011

Site Preparation and Augmentation Techniques in the Esthetic Zone

Dr.Maurice A. Salama

To be a viable treatment choice in the partially edentulous case, the implant-supported restoration must cosmetically equal or surpass that of conventional crown and bridge. This requires development of the edentulous ridge or potential implant restorative site to mimic that of a natural tooth.

The essence in the creation of this illusion of reality is the soft tissue restorative frame. The three-dimensional reconstruction of the implant receptor site comprises two distinct phases:

 Development of the hard tissues

 Reconstruction of the soft tissue

Orthodontic tooth movement can be synergistically combined with periodontal plastic surgical techniques, guided bone regeneration and osseous grafts to effectively establish the optimal foundation for functional and esthetic implant restorations.

Vertical soft tissue and interdental papilla enhancement is frequently combined with innovative second-stage periodontal plastic surgery to create an ideal restorative frame. This program will cover site preparation techniques prior to and at the time of implant placement.

In this presentation long term results of sinus perforations on the success of dental implants will be shared. Also the causes of sinus perforations and treatment modalities for membrane perforations will be presented.

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Causes and Effects of Sinus Membrane Perforations During Sinus Lifting

Dr. Martin Nemec

In recent years, successful results of sinus lifting procedures for the placement of implants has been well documented and has became a good treatment option for the patients with severely resorbed posterior maxilla.

Many authors have reported successful results by using 1-stage or 2-stage sinus lifting procedures. These studies also showed the surgical and postoperative complications

of this technique.

In most of the recent studies, it has been concluded that perforation of the sinus membrane is the main complication of sinus lifting procedures and because of the wide perforation of the sinus membrane, the sinus lifting procedures were abandoned in some of the studies. And also in many studies, it has been concluded that the perforation of sinus membrane may affect the success rates of implants during

sinus lifting procedures.

In this prensetation long term results of sinus perforations on the success of dental implants will be shared. Also the causes of sinus perforations and treatment modalities for membrane perforations will be presented.

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Facing bone augmentation challenges by using biphasic calcium sulfate

Dr. Amos Yahav

Optimal placement of dental implants is essential for obtaining functional and esthetic reconstruction. The contemporary practitioner frequently faces an arsenal of bone grafts to choose from, in order to achieve the optimal result.

Bone augmentation procedures require vast experience and practice to obtain the desired outcomes. In order to obtain an optimal bone regeneration rather than bone repair we need a temporary space maintainer that in time will be replaced with natural bone.

The lecture will present a novel biphasic calcium sulfate bone augmentation material that is suitable for large diversity of bone defects.

This material is self- reinforced therefore is easy to handle, totally resorbed and replaced by bone. While in most cases id does not require membrane coverage. The biphasic calcium sulfate graft can significantly reduce treatment time as well as to improve the dental implantation result.

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3-D Bone Augmentation: Creating the vertical dimension

Prof. Lior Shapira

Vertical alveolar bone loss in partially edentulous patients constitutes a major challenge due to anatomical limitations and technical difficulties. A number of different techniques have been developed to vertically reconstruct deficient alveolar ridges to allow dental implant placement in either a simultaneous or staged approach.

The principles of guided bone regeneration were applied to atrophic jaws and severe vertical defects were treated by means of a titanium reinforced non-resorbable barrier membrane in conjunction with dental implants. This technique is demanding and requires high surgical skills. Autogenous onlay bone block grafts were introduced in the early 1990s to increase the vertical height of the jaws.

However, the morbidity associated with graft harvesting often limit treatment recommendations and patient acceptance in practice. Allogeneic block grafts lack many of the donor site limitations

The allogenic block is serving as a bone conductive material, which in contrast to particulate material, allows stable fixation to the jaw. Preparation of the block prior to surgery can be performed on CT-based computerized jaw model, which facilitate the surgery and lowering the morbidity. The success of all the above procedures is high depended on soft tissue manipulation, tension-free primary closure without graft exposure during the healing period. The principles of the surgical techniques will be presented using animations, cases and videos.

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Conprehensive Management Of The Anterior Maxila With Dental Implants:“The Good, The Bad And Te Ugly”

Dr. Aldo Vicari Padovan

When treating the anterior maxilla with dental implants the diagnosis and treatment planning takes a different perspective. The insertion of the implant is not just a matter of osseointegration but also the 3d location of it in order to provide not only a sound prosthetic but also the esthetic result factor that becomes predominant in these treatments.

Individual diagnosis a treatment plans is mandatory to the different clinical cases. the use of soft and hard tissue graft, prp, ppp, alveolar distraction, temporary prosthesis plus the proper insertion of the implant and the posterior prosthetic reconstruction (immediate or delay) will be discussed and show in several clinical cases, don’t worry we will show the good the bad and the ugly!!!

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The synergistic effect of βtricalcium phosphate and calcium sulphate (bonbond with 4bone) for ridge preservation in dehiscence type defect associated with extraction sites.

Prof. Eli E. Machtei

Alveolar bone loss associated with tooth extraction posses a major problem in implants dentistry. Both vertical and horizontal bone loss occur immediately after extraction with 2-4 mm. loss in the first few months. This problem extenuated when the labial or lingual plate is lost due to periodontal disease or as a results of traumatic injury during surgery.

Numerous materials have been used to try and minimize this resorptive process with some degree of success. Autogenous, allogenic, xenogenic and synthetic materials have all been used for this purpose. However, even when using these augmentation materials, a sizeable bone loss still occurs. Furthermore, some of these materials, while preserving the alveolar volume, are going a very slow resorptive process thus despite adequate volume, the amount of vital bone that is available to get osseointegration is low. To the contrary, other materials undergo rapid replacement which results inadequate preservation of the extraction socket.

In this presentation we will show the results of our canine study where the use of combination graft made of βtricalcium phosphate (4bone) and Calcium sulphate (Bonbond ) resulted a predictable ridge preservation with new vital bone in extraction sockets combined with dehiscence type defects in canines.

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The use of Composite Grafts of recombinant human Bone Morphogenetic Protein-2/Acellular Collagen Sponge (rhBMP-2/ACS),Cancellous Freeze Dried Allogeneic Bone(CFDAB) for the reconstruction of alveolarbone defect.

Dr. Michael Peleg

Loss of alveolar bone in the maxilla or mandible may preclude implant placement or compromise positioning thus diminishing the final esthetic result of the restoration.

Bone augmentation may be required in order to optimize esthetic implant placement in alveolar bone deficiency. The size of the defect and morphology of the residual bone at the prospective implant site often influences the selection and surgical management of the donor site.

However, the use of allogeneic bone and rhBMP-2 can provide adequate volume and predictable bone formation in the reconstruction of vertical and horizontal bone deficiency. This lecture will explore the fundamental principles needed for a successful bone graft in compromised clinical situation. The surgical technique will be discussed in detail and potential complications will be reviewed.

Data from clinical studies will be used to demonstrate both the potential value of the composite bone grafts (allogeneic and rhBMP-2) and the value of the MIS implant design in the refinement of the clinical procedures used to achieve ultimate success.

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Presentation of the New "C1" MIS Implant

Dr. Nachum Samet

To be revealed at the conference

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Preprosthetic Surgery 3.0:A paradigm shift

Prof. Federico Hernandez Alfaro

Pre-prosthetic reconstruction of the atrophic jaws has suffered a revolution in the last few years

Development of 3D diagnostic tools has enabled more accurate and precise planning of our reconstructions. In the other hand, minimally invasive surgical principles have been incorporated in the therapeutic armamentarium allowing for less traumatic procedures. Finally the combination of autogenous bone with biomaterials, and the development of tissue engineering techniques are improving our results while diminishing donor site morbidity. In our lecture we will review different atrophic scenarios, and share our management protocols.

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One-piece implants today- limits and possibilities

Prof. Emanuel Bratu

The bone offer of pacients differs significantly in quantity and quality, and soft tissue follows the pattern of these structures. Very often, patients refuse augmentative and orthodontic procedures, which are costly and sometimes involve major risk factors. Therefore, the use of one-piece implants with reduced diameter, is still a treatment option even today, in the era of subgingival healing.

One of modern implant dentistry’s biggest problems is maintaining soft tissue around dental implants, particularly in the aesthetic zone. Implant design has considerable influence on bone and soft tissue levels, and one-piece implants have different characteristics compared to subgingival implants. This type of implant can be used in several clinical situations in the aesthetic zone and in non aesthetic areas.

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Assessing Osseointegration Improvements in Implant Surface Engineering

Dr. Paulo G. Coelho

The classic implant placement protocol with a latency period between surgical placement and prosthetic rehabilitation permits establishment of osseointegration. This methodology has rendered dental implantology one of the most successful treatment modalities in medicine.

However, the quest for reducing the latency period has been endless and in the vast majority of instances at least partially rationalized by implant macro (bulk device design), micro and nanometer scale (surface design) modifications. This presentation is a critical review of current basic surface engineering methods for improving osseointegration, pointing towards what may be regarded as the next generation of endosseous implant surfaces.

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The Importance of Impression technique in Implant-supported Restorations

Dr. Joseph Nissan

The Importance of Impression technique in Implant-supported Restorations Prosthesis fit is a well accepted concept in Implant supported restoration. Misfit of the implant prosthesis may lead to biomechanical complication which influences restoration longevity. An important factor that influences precision of fit is impression accuracy.

Impression technique is one of the mandatory stages that facilitate the fabrication of a successful implant supported – prostheses .The purpose of the presentation is to demonstrate the importance of implant impression techniques. Clinical and laboratory studies will exhibit the accuracy of different common impression techniques (open/closed tray). Advantages, disadvantages and potential solutions will be emphasized in order to achieve a long term implant-supported restorations.

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Osseointegration, a complication for Orthodontic Implants

Dr. Martin Casale Rozo

The anchorage in orthodontics, defined as resistance to unwanted tooth movement caused by the reacting force of orthodontic loading, has always been a challenging problem.

The advent of Temporary anchorage devices (TADs) changed the concept of anchorage from maximum anchorage to absolute and from one-by-one tooth movement to group teeth movement.

By definition TADs are temporary devices; no long-term functional or esthetic role is planned so should be relatively easy to remove. The Orthodontic Implants are the most common and popular TAD; many of them are made of commercially pure titanium or titanium alloy, and have a smooth machined surface that is not supposed to osseointegrate. However, recent evidence suggests that different degrees of Osseointegration may occurs even in immediately loaded Orthodontic Implants.

The Osseointegration would improve the stability and success rate of these devices, but also can make difficult the removal. For that only reason many clinicians questioned the use of Titanium Orthodontic Implants as TADs

The lecture pretends to evaluate Osseointegration of the machined Titanium Orthodontic Implants under different loading conditions and healing times. The biomechanical performance of these types of Implants will be discussed and revealed the benefits and possible complications

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6 mm short threaded implants. A prospective clinical study evaluating the survival and effectiveness.

Dr. Luca Di Alberti

A ‘short’ implant has been defined as a device with a designed intra-bony length of 8 mm or less. Results from literature shows that implant length does not appear to significantly influence the survival rate. Aim of the study is to analyse the survival rate and clinical peri-implant bone of 6mm implants with SLA surface 80 short 6 mm length implant has been positioned and in 40 implants a healing screw has been fitted at time of the surgery with a length compatible with the height of the soft tissues (3-5 mm) and left for a period of 12 weeks. At 12 weeks all implants were loaded with provisional crown for 4 weeks and then a final restoration was performed. This study has reported posivive results and confirmed survival rates for short implants and for wide diameter implants compared to standard implants.

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The Use of Bi Phasic calcium Sulfate in Bone Augmentation Procedures

Dr. Ziv Mazor

Numerous procedures and materials are utilized to augment and preserve the alveolar bone in order to facilitate implants placement. There is an ongoing quest for the ideal grafting material. The ultimate goal is achieving vital bone formation in the implant future site

Bi phasic calcium sulphate alone and with a mixture of other graft materials holds advantages on other types of graft materials in handling, maintaining volume stability, being transformed to vital bone as will be described and shown clinically and histologically. Clinical cases with a follow up of 2 years will be presented.

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Soft and hard tissue changes around the new lends implants using the new switch platform abutment (SPR) and the traditional(CPK) abutment – presentation of newresearch

Dr. Zvika Gutmacher

The assessment of radiographic bone level changes around implants is a secondary or surrogate outcome measure and is commonly used.

Considerations related to marginal bone loss include the types of implants used, one or two stages implant placement, different times for loading, etc.

In addition to several ideas to limit crestal bone resorption, the concept of platform switching (PSW) appears to be promising. PSW refers to the use of a smaller diameter abutment on a larger diameter implant collar; this connection shifts the margin of the Implant Abutment Junction (IAJ) inward, toward the central axis of the implant. The inward movement of the IAJ is believed to shift the inflammatory cell infiltrate to the central axis of the implant and away from the adjacent crestal bone, which is thought to limit crestal bone resorption.

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Controversies in lateral and vertical ridge augmentation procedures: blocks or GBR with particulate allografts

Prof. Carlos E.Nemcovsky, Prof. Gabi Chaushu

Lack of sufficient bone volume may prevent placement of dental implants. Bone augmentation procedures previous or together with implant placement are indicated in these cases.

In extreme cases, large bone reconstruction is indispensable before implant placement can be envisaged. Different bone graft materials have been successfully applied in these procedures The ideal bone graft will promote osseous regeneration (“osseoinductive”), allow remodeling of the formed bone into mature lamellar bone, maintenance of the mature bone over time without loss, enable action of bone inductive substances, present lack of toxicity and low risk of infection and be able to fill and maintain a space, where bone regeneration can occur (“osseoconductive”).

Several bone augmentation procedures have been described; however, they may be classified according to the type of bone graft that is used: particulate or block. Both have advantages and shortcomings. Large bone regeneration can be achieved with both procedures. Success of bone augmentation procedures depends on the presence of bone forming cells, primary wound closure over the augmented area, space creation and maintenance where bone can grow and proper angiogenesis of the grafted area.

Factors that influence the choice of the surgical technique are the estimated duration of surgical procedure, its complexity, cost, total estimated length of procedure until the final rehabilitations can be installed and the surgeons’ experience. The presentation will discuss the rationale, indications and methods for the application of bone block allograft and GBR with use of particulate bone allografts and resorbable collagen membranes for lateral and vertical bone augmentation procedures both in the maxilla and mandible and sinus floor augmentation in the extremely atrophic maxilla. Recent data from studies performed by the authors with the different treatment alternatives will be presented. The different indications and treatment alternatives, some of them developed by the authors for vertical and lateral bone augmentation will be illustrated with clinical cases

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The treatment implant peri-mucositis and peri-implantitis with PerioPatch

Prof. John T. Grbic

Patients who develop implant peri-mucositis and peri-implantitis have been shown to be at increased risk for implant failure. The pathogenesis of inflammation around implants and treatment of peri-implant inflammation will be discussed.

The potential to treat patients who do not respond to conventional treatments of peri-implant inflammation with a unique medication delivery system termed the PerioPatch will be presented. The PerioPatch delivers a combination of medicinal herbs to the area of inflammation and this treatment has been shown to have potent effects on the inflammatory response and wound healing. We will discuss the mechanism of action of PerioPatch and present data from clinical trials which have evaluated the ability of PerioPatch to decrease gingival inflammation. The potential of using PerioPatch to treat inflammation around implants will be discussed.

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Sinus lift-The evolution of the method the last twenty years

Dr. Zambaras Dimitrios

Sinus lift (SN) through the last two decades has been well established as a treatment of choice for the dental implants placement in atrophic alveolar ridge. SN is a reliable method, with the advantage of the predictability of the surgical outcome.

In this lecture the last nineteen years’ experience of our department is presented. A total of 720 SL were performed. The SL technique can be divided in two completely different sub-methods: the open one, where a bone window through the anterior bone-wall of the sinus is opened and the closed, where the sinus floor elevation is achieved by the use of bone osteotomes. In our department the open technique presents the majority of the procedures, reaching a percentage of 96%. The use of different bone grafts is described and the use of membranes as well. The results of the SL through the years are presented and the advantages, the disadvantages and the complications of the method are discussed.

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Prosthetics

Prof. Hector Alvarez Cantoni

To be updated

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BondBone

Dr. Giuseppe Cardaropoli

To be updated

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Causes and Effects of Sinus Membrane Perforations During Sinus Lifting

Prof.Cuneyt Carabuda

In recent years, successful results of sinus lifting procedures for the placement of implants have been well documented and have become a good treatment option for the patients with severely resorbed posterior maxilla. Many authors have reported successful results by using 1-stage or 2-stage sinus lifting procedures.

These studies also showed the surgical and postoperative complications of this technique. In most of the recent studies, it has been concluded that perforation of the sinus membrane is the main complication of sinus lifting procedures and because of the wide perforation of the sinus membrane, the sinus lifting procedures were abandoned in some of the studies. And also in many studies, it has been concluded that the perforation of sinus membrane may affect the success rates of implants during sinus lifting procedures. In this presentation long term results of sinus perforations on the success of dental implants will be shared. Also the causes of sinus perforations and treatment modalities for membrane perforations will be presented.

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Implant on a Aesthetic Area Key And Critical Aspects

Dr. Ramon Pereira

At the present time, the aesthetic factor has become a key and important aspect on dental implantology. For this reason, the placement of implants in the anterior maxilar, is a major challenge for clinicians due to the increasing demand or aesthetic demands of patients.

For a successful aesthetic result, is required to do a proper planning of the case, designed according to prosthetic needs, which means to have ideal anatomical conditions or create them where none exist, in order to facilitate three-dimensional implant placement in optimal conditions. During this presentation will discuss the main factors and influential for successful outcome on the placement of implants in the aesthetic zone.

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