MY PERSPECTIVE: “SAVE THE WEATHER, GOTHENBURG IS A BEAUTIFUL CITY.” P 17
InSight THE PUBLICATION FOR THE DENTAL IMPLANT TEAM
Special e dit – Astra T ion World Co ech ngress 2012
NO 3
TALKING TO:
Down-to-earth Hugo de Bruyn values time to
REFLECT PEOPLE:
FOCUS ON:
Lars Henrikson about the industry’s future p 22
When the world came to Gothenburg p 15 CLOSE UP: OsseoSpeed™ p 14
Adapting with nature OsseoSpeed™ TX Profile – anatomically designed implants for sloped ridges Imagine being able to achieve 360° bone preservation around the implant, even in cases with sloped ridges. Now you can. With OsseoSpeed™ TX Profile – a uniquely shaped, patented implant, specifically designed for sloped ridge situations – you no longer have to choose between buccal and lingual marginal bone preservation and esthetics, you can have it all – 360° around the implant. OsseoSpeed™ TX Profile is based on the d ocumented key features and benefits of the ASTRA TECH Implant System B ioManagement Complex™. Used in combination with patient-specific ATLANTIS™ abutments, you and your patients can look forward to long-term function and e sthetics. For more information, please visit www.dentsplyimplants.com
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CONTENTS No 3
16
In May 2012, Astra Tech Dental held the third world congress – in their hometown of Gothenburg, Sweden – and over 2,400 members of the dental community came.
SOLUTIONS AT WORK
32
12
And more… News......................................4 A closer look at...................... 11 Close up................................ 14 Focus on................................ 15 People...................................22 Patient profile......................... 32
Two case studies. 27
We visit the family-owned and operated Town & Country Dental Studios.
Anton Dahlberg about receiving dental implant treatment.
Et cetera................................34
InSight PUBLISHER InSight is published and distributed worldwide by DENTSPLY IH AB, P.O. Box 14, SE-431 21 Mölndal, Sweden. EDITOR-IN-CHIEF Thomas Rundqvist, Project Manager, Global Marketing. SCIENTIFIC ADVISOR AnnaKarin Lundgren, DDS, PhD, Director Global Scientific Affairs. ASSOCIATE EDITOR Jessica Yngvesson, Coordinator, Global Marketing.
CONTACT US Editors can be reached at
[email protected]. Please e-mail questions, opinions and thoughts on InSight 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 IH AB.
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 editorin-chief. Submitted material will be stored electronically for the possibility of publication on the internet, reprints and in other formats. DENTSPLY IH 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 IH AB. TRADEMARKS All trademarks are the property of their respective owners. PRODUCTION Valentin&Byhr, Gothenburg, Sweden. PRINTING Printed in Sweden by Typografia.
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NEWS
Jim Mosch, Executive Vice President at DENTSPLY International and Group President at DENTSPLY Implants, presents the new powerhouse in implant dentistry at the Astra Tech World Congress 2012.
Building a new powerhouse in implant dentistry
I
n June of last year, AstraZeneca announced that they had decided to sell Astra Tech to DENTSPLY International and in August the acquisition was finalized. Now, the organization of the new business – DENTSPLY Implants – is about to be rolled out on all markets. And when the deal was made public, Jim Mosch, Executive Vice President at DENTSPLY International and Group
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President at DENTSPLY Implants, declared: “This is the largest acquisition in DENTSPLY’s 112-year history and provides significant growth and expansion opportunities in the areas of dental and health care for both Astra Tech and for DENTSPLY. We look forward to creating opportunities for a bright future as our new organization evolves.” Today, one year later, the master
plan is beginning to materialize as the new business is introduced to the market. As a result, both DENTSPLY Friadent and Astra Tech Dental will cease to exist as individual companies; instead they will merge and become the new powerhouse in implant dentistry. means that a new, improved and even more competitive dental implant supplier has entered the world market. But what does it mean to be “the new powerhouse” of our industry, we asked Gunny Kron, Director, Global Marketing Communication at DENTSPLY Implants: ”We offer a comprehensive line of dental implants, digital technologies and professional development programs. It is unique in the way it empowers our customers to create predictable and lasting patientIN SHORT, THIS
EDITOR´S NOTE One plus one equals…
W
specific mathematical proof, most of us would quickly and intuitively answer that one plus one equals two. But I will go out on a limb here – one plus one does not equal two, it equals more than two. Why would I say such a thing? Because I truly believe that DENTSPLY Implants is more than the sum of its parts. With the union of two successful and innovative businesses Our vision and – Astra Tech Dental and commitment during DENTSPLY Friadent – a new, completely unique portfolio this journey is to arose, with a much wider improve patient range of products and quality of life.” services, including not only dental implants but also digital technologies and professional development programs. And when you add the 112-year dentistry experience of owner DENTSPLY International, one plus one is definitely more than two. ITHOUT GOING INTO ANY
integration and implementation of DENTSPLY Implants continues all over the world as we speak. Our vision and commitment during this journey is to improve patient quality of life. This belief permeates everything we do, every day. And you can continue to expect the best from us – a thorough scientific approach, long-term clinical evidence, and strong customer focus. THE GLOBAL
specific implant solutions. Our new extended portfolio includes ANKYLOS®, ASTRA TECH Implant System™, XiVE®, and FRIOS®. And, furthermore, we also offer ATLANTIS™ patient-specific CAD/CAM abutments, as well as 3D virtual surgical planning and surgical guides.” Astra Tech and DENTSPLY Friadent customers, the acquisition and merger brings flexibility and convenience through a wider range of products. Several new digital solutions will be introduced, as well as new products for safe bone remodeling, from bone harvesting to grafting, fixation and successful bone regeneration. To learn more about DENTSPLY Implants’ plan for the future, turn to page 22, where Lars Henrikson, Group VP, Marketing, Research & Development and Operations, shares his view on the business and the industry as a whole.
THE NEW EXTENDED PORTFOLIO* INCLUDES:
like to thank all of you who attended the third, and last, Astra Tech World Congress 2012 in Gothenburg, Sweden. I think it is safe to say that it was a congress to remember. But don’t worry, we’ll be back soon with another global event. Stay tuned. FINALLY, I WOULD
TO ALL EXISTING
Facilitate™
WELCOME TO
* Not all product are available in all countries.
BJÖRN DELIN, DDS VP Global Marketing DENTSPLY Implants
DENTSPLY Implants, the new powerhouse in implant dentistry.
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TALKING TO
EAGER TO FIND
NEW ROUTES
His heart is with the patients, his roots deep in the Belgian soil and his head is full of research questions. Hugo De Bruyn likes people and has devoted his entire career to improving the quality of life for people with dental problems. Today he is a Professor and Director of Studies at Ghent University with a vision: by 2025 every dentist will be able to place an implant.
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Facts in brief Name: Hugo De Bruyn Family: Wife and children Home: A farm between Brussels and Ghent, Belgium Born: 1960 Admires: People that are willing to learn something new
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TALKING TO
“Every academic should regularly meet dentists who The question makes Hugo De Bruyn laugh out loud. It work in the field. If we just sit here at the university, was certainly not the type of question he had expected we soon become isolated; it’s important to know what when he said yes to an interview with InSight. But he dentists are thinking and how patients perceive things,” is a storyteller and our conversation has strayed a little says Hugo. and now we find ourselves talking about donkeys. He Perhaps Hugo brought this down-to-earth, practical has three. approach along with him from his “Would you like to buy one? Or is this childhood. just a journalist’s trick to gain an insight He grew up in the Belgian countryside. into my finances?” he asks, laughing His dad was a mushroom cultivator and as again. a young man Hugo had plans to take over It is easy to understand why so many and modernize his father’s business. people think that Hugo is a talented “He advised against it. You’ll have to speaker. He has an involvement and work too hard,” he said. I guess he figured presence in whatever he may be I was not up to hard work,” says Hugo, discussing, be it donkeys or research. laughing. He likes lecturing and teaching and So, Hugo chose to study dentistry. But says that it’s fun to meet people who soon after he completed his studies, he like to learn things. With that in mind, realized that he did not want to work as a you have to admit that he has wound up dentist. He was given assignments he found with the perfect profession. uncomfortable to perform. And besides, he Hugo is a dentist by profession, but wanted other challenges than he perceived With approximately 600,000 today he is a Professor and Director of there to be in everyday general dentistry. inhabitants, Ghent is the fourth largest city in Belgium. Studies at the Department of Dentistry at Ghent University in Belgium. He came THE SOLUTION WAS FURTHER education. In 1983, here in 2004, and as a new employee there were basically two specialist routes to his assignment was to develop the choose from – periodontics or orthodontics. department, taking it from being a mix of periodontics And since Hugo wanted to see the results of his work and prosthetics to becoming an official specialist center. right away, not after two or three years, his only choice And he succeeded. was periodontics. But then he would have to leave Belgium for Holland. So, said and done, that’s what he THEY RECEIVED ACCREDITATION in 2005, and since then did – not returning before 1988, by which time he had Hugo has continued to extend the department. He has acquired a doctorate and spent a year in post-doctoral constantly directed his research toward implantology studies in implantology in Malmö, Sweden. and has been an eager advocate of dentists’ learning Since his time in Malmö he has wondered why more about the discipline. Not just in theory, but also in implantology has not advanced further. Why aren’t practice. dentists taught how to place an implant? His wondering HOW MUCH DOES A DONKEY COST THESE DAYS?
Every academic should regularly meet dentists who work in the field. If we just sit here at the university we soon become isolated.”
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has only grown as his own research has shown time after time, just how important an implant can be for the patient. It is all about the quality of life. Hugo talks about oral handicap as a social stigma. People become withdrawn and lose their confidence. “When I founded my private clinic focused on implantology and periodontics back in 1988, right after my return from Malmö, it was the first in Brussels. Back then everything was done at the university, but I felt that a dentist’s knowledge and understanding of the patient was lost as soon as they had to refer the entire treatment. An implant is not just a dental procedure, it is treating a patient.” Hugo points out that to achieve a much greater quality of life, only minor surgery is required. He feels that the patient’s point of view often gets lost in discussions about esthetics. And here Hugo’s practical side emerges again.
Function before esthetics; practice before theory. “We’re currently working on a report that shows how a dentist’s understanding of how effective a treatment is can differ completely from the patient’s. The patient might be really pleased while the dentist feels things are kind of so-so.” this is a shame. He feels that the basic problem is that the profession tends to obsess about esthetics and expensive, complicated remedies when all the patient wants is a functional solution. “Sometimes I show pictures of 20-year-old solutions that maybe don’t look too good and I hear my students draw their breath nervously. But the patient in the picture was really pleased with what he got.” He draws a parallel: “If you study cars on the highway, you’ll see a lot more Fords than Porsches,
AND HUGO THINKS
perspectives on Hugo De Bruyn STIJN VERVAEKE Periodontologist, University of Ghent and working on a PhD with Hugo as a mentor. “I know Hugo as someone who gives young people opportunities. Before I started in his department, I never thought about the possibility of working on a PhD. But during the perio-program, I started to get interested in research because of his contagious enthusiasm. Hugo is a first class motivator. Sometimes I wonder when he sleeps... even when you send him an email in the middle of the night, you get an answer right away. But above all, he is a very nice person who is committed to his family and to the people working at his department.” BEA VAN DINGENEN Hugo’s wife of 22 years, dentist and general practitioner for 20 years. “Hugo is someone who always has plans in his head. He can solve problems very quickly by reacting immediately. His motto is: do what you can do immediately, so you don’t have to think about it anymore. Hugo is always in for new things and new contacts and experiences on a professional level. At home – when he’s not preparing a new lecture, an article or another congress – he likes to be with the family and enjoys being at home.” ULF LINDÉN Retired dentist, specialist in prosthetics and former clinical department head, has known Hugo since 1987. “I got to know Hugo when I was giving a course in implantology at the Dental School at Malmö University College in 1987. Hugo is always full of surprises, with many things going on at the same time. He is devoted to his mission. He’s been preaching about the advantages of dental implants ever since the course in Malmö. When he was running his private practice, he gave courses in the cellar of the nearby Brussels Cathedral. So you see what I mean when I say preaching.”
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TALKING TO
Hugo has three donkeys on his farm outside Brussels. “They are great lawn mowers.”
or the last three years all of our student dentists F in Ghent must be able to place a single implant.” and the Ford drivers won’t be dissatisfied because they think their cars are excellent. Sure, they would probably prefer Porsches, but they can’t afford them.” “In the implant business, we seem to think everyone should be driving Porsches. That won’t work. Sometimes in lectures and at conventions people show cases that are extremely complicated, but in reality such cases make up perhaps just five percent. The other 95 percent can be taken care of cheaper and simpler.” help as many patients as possible it is important to understand what they need, and to bring down the cost of treatment. More dentists need to know how to do the simpler procedures. Today, Hugo is responsible for around 150 student dentists and he is personally able to influence the education’s form and content. “For the last three years, all of our student dentists at Ghent must be able to put in a single implant. They naturally have the support of a specialist but every student performs a complete treatment from scratch. Next year we’ll start having them put in retained dentures.” TO BE ABLE TO
things Hugo cannot do without HUMOR GOOD FOOD/ CHAMPAGNE STUDENTS IN TRAINING FOR SPECIALIST OR RESEARCHER
10
charge. But Hugo points out potential pitfalls. Just how much assistance should he accept from dental implant companies? There is a risk of damaging the academic reputation. At Ghent they work with several different implant systems in order to maintain their objectivity, and they have gained recognition for their comparative studies between different implant systems. In his efforts to achieve his goal of more dentists with the ability to place implants, he has met a certain degree of resistance, not least from professional groups that feel he is trespassing in their areas. But Hugo knows he just has to accept it. “Change requires boldness. Today we’re doing less and less prosthetics and more and more implant-supported prosthetics. It’s important that we think along modern lines and not do things the way we did 50 years ago. I can envision a 2025, where a patient visits the dentist having lost a tooth and the dentist places an implant and a new tooth. Implants are already so much better today than they were just a few years ago. The profession is advancing – we must be bold and advance with it.” One last thing. For those who wonder: a donkey costs around USD 800–1,000. But there’s a discount if you buy more than one at a time. According to Hugo. OH YES, RIGHT.
this part of the training would not be possible without the support of the dental implant industry; he is able to offer patients treatment free of HUGO TELLS US THAT
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A CLOSER LOOK AT
One universe among seven billion others One person can enjoy a certain wine while another shudders at it. One person thinks that a piece of clothing is extremely practical and comfortable while another wants to crawl out of their skin by the thought of having to wear it. Some think this text is exciting – others sigh and turn the page.
E
veryone has probably experienced that we humans perceive the surrounding world in different ways. You do not meet too many people during your lifetime who share all of your values, opinions and feelings; if that is even possible. There are many different reasons for this. In fact, you can take it to such a fundamental level as quantum mechanics. This category of physics emerged in the beginning of the 20th century and seeks to describe our reality in the most fundamental way – the subatomic level. And strange things happen there. Reality is transformed from something certain to something intangible.
Strange? Yes, but no less fascinating. Because this would ultimately mean that we humans create our own reality. Literally. When no one observes “reality” it exists no more than as a probability. But interpreting quantum mechanics is difficult and something that science has long struggled with. But let us leave the quantum world and instead look at our surroundings from an everyday point of view. We humans experience the physical world around us through five senses and by how the brain interprets the collected information. Every link in this chain is unique to each person. Let us take how people experience colors as an example. a color enters our brain via the eyes. So how “good” our eyes are effect how we experience the world. Things that affect this process are, for instance, color blindness or aging. The latter may, in some cases, cause clouding in the crystalline lens of the eye, which stops part of the blue light from reaching the retina. How the brain interprets these colors also varies. The vast majority of people and animals react similarly to certain basic colors. Red symbolizes warning, green security and safety. But there is also the factor of cultural interpretation. In one culture, white may symbolize purity and innocence while it may mean death in another. And then we have the purely personal references. This is just a small fraction of one of our sense’s possibilities for variation. And, then we have four more to keep us occupied. Upon closer reflection, it is almost a miracle that we perceive the surrounding world similarly enough to carry on a conversation about it in the first place. Based on this we should, scientifically speaking, have a certain measure of understanding and respect for each other’s different opinions and interpretations. INFORMATION ABOUT
his would ultimately T mean that we humans create our own reality.”
perceive to be objects, e.g. electrons, are dissolved into waves without definite positions in space. The fact is that a particle, according to the Copenhagen interpretation of quantum mechanics, cannot be said to exist in a definite position in space until someone attempts to measure it. Then the “probability distribution” collapses into a definite position. In simple terms, one can say that it is not until an observer examines the location of an electron that it actually begins to exist in a specific place. WHAT WE
Three interpretations of quantum mechanics • The Copenhagen interpretation This interpretation holds that nothing may be said about the quantum physical system until a measurement is made. One particle has no definite position until someone attempts to measure it. • Many-worlds interpretation In this interpretation, it is said that every conceivable outcome of a measurement is realized and the universe divides itself into as many parts as the number of conceivable outcomes of measurement. • Shut up and calculate A type of noninterpretation that says that quantum mechanics provides good results, but to try to interpret them leads more to philosophy than to physics.
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IN THE LABORATORY
50 years of quality and innovation A Town & Country Dental Studios tradition Celebrating their 50th anniversary, family-owned and operated Town & Country Dental Studios is a dental laboratory like no other. The foundation of their company comes from its President and owner Barry Lampert, CDT, who has been working in the dental technology field since 1957. With the support of his sons David Lampert, MBA, and Steven Lampert, Tech Support Manager, and their team of technicians including CDT’s, MDT’s and a retired DDS, they are driven by principles of quality and service from top to bottom. With many of their staff employed by the company for over 20 years, they have the skill, knowledge, expertise and commitment to insure their client’s total satisfaction. We spoke with David Lampert to learn more. HOW HAS DIGITAL CAD/CAM TECHNOLOGY AND SOLUTIONS SUCH AS ATLANTIS™ PATIENT-SPECIFIC ABUTMENTS BEEN LEVERAGED IN YOUR BUSINESS?
“We have incorporated the newest equipment and technologies including several CAD/CAM systems. We are also certified to handle files for all the major digital impressioning systems currently on the market. ATLANTIS™ abutments however, remain a core product of Town & Country Dental Studios’ implant offering. By combining the benefits of CAD/CAM patient-specific abutments with our exclusive Simpl™ restorative protocol, we have introduced our clients to a highly successful yet simplified and complete implant restorative system. We have now produced over 20,000 Simpl cases and have a 99 percent satisfaction rate; an amazing success rate to say the least. ATLANTIS™ patient-specific abutments are best of what technology should FACTS IN BRIEF be able to offer. A good technology should give you a better quality, FOUNDED: 1962 quicker turnaround time, efficient LOCATION: Freeport, New York production and help control costs. NUMBER OF EMPLOYEES: 94 ATLANTIS abutments give us IMPLANT RESTORATIONS/YEAR: over 10,000 all of this and more. In addition to the excellent abutments, what makes ATLANTIS really great is the relationship that Town & Country has had with the people at Atlantis
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At Town & Country, commitment to quality is a family tradition; (left to right) Steven, Barry and David.
Components Inc., Astra Tech Dental and now DENTSPLY Implants. The partnership is unique and special and gives both companies the mutual support and the mutual success. This first-class partnership has really worked well; our clients and their patients have greatly enjoyed the benefits of this relationship. Using advanced technologies to grow our business has proven to be very successful for us at Town & Country. ATLANTIS has proven itself to be a great technology. That is the main reason why we continue to utilize ATLANTIS and why we are very excited about the future.” WHAT DO YOUR CUSTOMERS MOST APPRECIATE ABOUT YOU?
“Today more then ever, clinicians want and need to work with laboratories that truly understand the importance of quality restorations and excellent customer service – all at reasonable prices. This is what customers most appreciate from Town & Country. Many of our clients consider us partners in their overall practice success. We give them 100 percent and we know our efforts are a direct reflection of their patients’ satisfaction. We take that responsibility very seriously and work hard everyday to meet those demands.”
Operating in a state-of-the-art facility uniquely located on the waterfront with big, bright windows throughout that supply natural light all day long, Town & Country is a wonderful place to work.
WHICH AREAS ARE YOU FOCUSING ON TO CONTINUE TO MEET THE DEMAND OF YOUR CUSTOMERS AND THE GROWTH OF YOUR BUSINESS?
“First and foremost, we continue to emphasize the importance of quality products and services. Our ongoing policy of continual improvement in quality and work flow efficiency assures that our customer gets what they want, when they want it. We use technology wherever we can to enhance this improvement and work flow. It also helps us to keep our prices under control which our customers greatly appreciate. The continued convergence of digital technologies in dentistry will be an important area for us to watch and we intend to test and purchase the best technologies to help improve both quality and service. Digital impression systems, new scanning systems, new material choices and even a new phone system are some of the things we are looking at currently. In addition, we just recently began to offer the ATLANTIS™ Crown Abutment for screw-retained, single-tooth restorations, which we believe will be a very successful product launch.” WHAT ARE THE KEY TRENDS AND DRIVERS THAT YOU SEE WITHIN THE IMPLANT INDUSTRY TODAY?
“CAD/CAM technology is a key trend that has been driving the implant industry to new heights primarily due to consistent product outcome and predictability. The trend towards minimally-invasive surgical procedures forms another key factor driving the growth of the dental implants market. As the standard of care continues to move forward toward implants first, we no longer have to
prepare adjacent teeth to restore an edentulous space. We are starting to see the use of intraoral scanners to capture images of implant scan bodies for a total digital workflow which has proven to be the most accurate implant restorations in regards to fit, bite and contacts. Also the use of CBCT (cone beam computed tomography) for 3D image analysis and implant placement and planning is constantly improving.” WHERE DO YOU ENVISION TOWN & COUNTRY AND THE IMPLANT INDUSTRY FIVE YEARS FROM NOW?
“With all the constant change happening around us, it will be increasing important to work with companies directly responsible for moving the industry forward. We have been working with many of the major implant companies since 1982 when we became the first Brånemark certified lab on the East Coast. We currently are members of DENTSPLY Implants’ PEERS (Platform for Exchange of Education, Research and Science) and Super Elite Laboratory Group. PEERS is designed to promote enhanced partnership between DENTSPLY Implants and dental implant professionals, as well as to facilitate collaboration among its members. Town & Country is very proud to be one of the largest implant laboratories in the country. During the next five years we will continue to work with DENTSPLY Implants in the education and advancement of digital implant technologies. As it has been for the last 50 years, we are fully committed to servicing our clients with the highest level of support, knowledge and quality. That will continue today and many years from now.
As Implant Advisor, Jerilyn supports the team approach for all implant cases.
“ATLANTIS™ patientspecific abutments are best of what technology should be able to offer.”
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CLOSE UP
When studying the early stages of osseointegration to implants with a fluoride-modified surface – OsseoSpeed™ – the amount of new bone that formed within the first two weeks of healing was larger at fluoride-modified implants than at the control implants. In addition, the amount of bone-to-implant contact that had been established after two weeks were significantly larger at the fluoride-modified implants than at the control implants. It is suggested that the fluoride-modified implant surface promotes osseointegration in the early phase of healing following implant installation.*
Scale 100:1 * Berglundh T, Abrahamsson I, Albouy J-P, Lindhe J. Bone healing at implants with a fluoride-modified surface: an experimental study in dogs. Clin. Oral Impl. Res 18, 2007; 147–152.
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Photo courtesy: Professor Tord Berglundh DDS, PhD, Department of Periodontology, The Sahlgrenska Academy, University of Gothenburg, Sweden.
OsseoSpeed™
FOCUS ON
The full story
When the world came to Gothenburg In May 2012, Astra Tech Dental continued its journey of creating the future of implant dentistry by returning to its roots with the third world congress. In their hometown and the birthplace of osseointegration – Gothenburg, Sweden – they welcomed over 2,400 members of the dental community to come together, share experiences and create the future.
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FOCUS ON
Four days – that passed by in a flash The world congress became a memorable event to all the delegates. The four days were filled with exciting sessions by the most prominent names in the industry, one-on-one discussions and great entertainment. On the next few pages, InSight gives you highlights and a recap.
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MY PERSPECTIVE
A GOOD MORNING WITH ASTRA TECH
Presentations given through the dynamic morning programinspired format focused on the evolutionary approach within implant dentistry and upcoming innovations. Answers to such questions as: “Where do we come from and what has been accomplished so far?” and “What are the natural next steps for implant dentistry?” were discussed.
ARNIE ROSEN, DDS, Department of Prosthodontic and Operative Dentistry, Tufts University School of Dental Medicine, and private practice, Boston, MA, USA.
Did you miss the congress? No worries! Let Arnie Rosen take you through the event – in his own words. Boston to Gothenburg through London was long, but well worth the trip. MAY After the exhausting flights, we immediately felt a sense of comfort and relief at the airport by the warm greeting from members of the North American marketing team. From that point on, all of the local arrangements were taken care of with precision and great hospitality. Save the weather, Gothenburg is a beautiful city. We worked hard to stay awake to get on the right time schedule. At about 3 PM I thought I’d fall asleep on my feet, but a light jog brought me back to life and I made it awake and alert for the first international PEERS (Platform for Exchange of Education, Research and Science) reception later that evening at the company headquarters. I called it a day before midnight. TUE
8
RESEARCH COMPETITION The Research Competition received over 100 exciting and inspiring poster abstracts in the categories clinical research and basic research; the winners were Dr. Francesco Pieri, Italy, and Dr. Theofilos Koutouzis, USA, respectively.
I woke up, got my head on straight, I think, and made a dash to the MAY PEERS luncheon at 11:30 AM, where we got our first real taste of Swedish cuisine. By the afternoon we were all fully engaged in the first international PEERS meeting, which was a unique opportunity for this group of dental professionals from several countries to share experiences and WED
9
ASTRA TECH SCIENTIFIC AWARD 2012 The prestigious award was given to Professor Tord Berglundh, Sweden, for his significant contribution to research related to oral implants. Being the winner of the Astra Tech Scientific Award, Professor Berglundh received SEK 100,000.
THE FLIGHT FROM
10.5 HOURS LATER
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FOCUS ON
Making the right abutment choice In her Astra Tech World Congress 2012 presentation, Ingeborg De Kok, DDS, MS, shared with the audience the features and functions that are key in selecting an appropriate implant abutment.
Ingeborg De Kok, DDS, MS, from the Department of Prosthodontics, University of North Carolina School of Dentistry, Chapel Hill, NC, USA.
The market for components used to restore dental implants has exploded in recent years. New designs and materials, which promise enhanced features and benefits, make clinicians’ choices for restoring clinical cases more difficult than ever before. true is that the function, longevity, and the peri-implant soft tissue esthetic outcomes of the dental implant can be greatly influenced by the design and material of the abutment supporting the dental prosthesis. “It is critically important when restoring dental implants that the chosen abutment provides the correct subgingival contours and emergence profile,” explained Dr. De Kok. “An abutment should develop or enhance natural architecture and protect biological function.” HOWEVER, WHAT REMAINS
in detail basic abutment functionality and attributes necessary for attaining a minimum level of clinical success – regardless whether they support screw- or cement-retained prostheses, and/or are based on prefabricated or patient-specific designs. Beyond these functions and features, the great variety of abutment designs and materials can deliver other desirable effects, especially in challenging DR. DE KOK DESCRIBED
What brought you to the congress? DEHUA LI, 47 Director and Professor, Department of Oral Implants, School of Stomatology, The Fourth Military Medical University Xi’an, China “This is a big conference, offering a different angle to the future of dental implants. The program yesterday (Thursday) morning was fantastic. It didn’t just give knowledge and technical information – more than anything it inspired the audience. I think that’s very interesting. I’m having a very good time, much better than the weather outside.“
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CHRISTIAN HEROLD, 38
AL-SAYED ARWA ALI, 37
General dentist, Würzburg, Germany
Head of Periodontics and Dental Implant Sections, The Riyadh Military Hospital, Saudi Arabia
“I came here to get input on new methods. When I was at Astra Tech’s congress in New York 2006 everybody was talking about flapless implants and at the event in Washington 2008 that had changed. Methods certainly develop over time, so now I hope to find out what is new. I’ve now been to all of Astra Tech’s world congresses, and I think they’re great.”
“With more than 5,000 implant surgeries yearly, we are considered the biggest implant center in the world. So, I came here to learn more. I wanted to attend the Astra Tech congress as soon as I saw the program. It is very profound and covers all the important issues this year. This is the first time that I’ve attended an Astra Tech congress and I’m really impressed. Lots of activities and things to see.”
collegiality in a manner that few ever experience. This was special. the Opening Session created an eerie and special feeling. MAY The entertainment was like a cleansing of the palate and provided an upbeat sense of anticipation for the beginning of the congress. The opening session featured a 50-year historical perspective of Tomas Albrektsson, the researcher’s discipline of Jan Lindhe, the insight of Christoph Hämmerle, the creativity of Lyndon Cooper, and the inspiration of Hans Rosling (fantastic presentation). The afternoon parallel sessions provided something for everyone, including the opportunity THU
10
THE VENUE OF
n abutment should develop or enhance natural A architecture and protect biological function.” Lyndon Cooper and Hans Rosling in a discussion.
clinical situations. In particular, abutments may allow for transitional contouring, axial wall height, implant (mis-)angulation and marginal adjustments. Furthermore, material and color options may promote more esthetic outcomes.
to explore Astra Tech Dental technologies on the exhibition floor along with the issue of global access to water to combat disease, hunger, and poverty through the Water is LIFE for WaterAid campaign highlighted in the meeting. The afternoon ended with presenters and an expert panel discussing planning, treatment, and outcomes. Thursday evening was the Welcome Reception, where over 3,000 delegates, guest and staff were brought together for food, drinks and activities at the famous Gothenburg Opera House.
are worth more than words, and Dr. De Kok brought to life her presentation with impressive clinical results using a number of abutments from the ASTRA TECH Implant System™ portfolio. The highlight of which was a patient-specific ATLANTIS™ abutment used in an incisor restoration. NATURALLY, PICTURES
ROBERT MARSHALL, 57
JOANNE CUNLIFFE, 43
General practitioner, focusing on cosmetic dentistry, Concord, NH, USA
Consultant restorative dentistry, Manchester, UK
“I’m really a big proponent of full mouth reconstruction and I like to learn more techniques on restoring peoples’ mouths and changing their lives. The more I learn, the more I can bring the cost down – and the more people I can serve. I think there’s a big need out there for implants and cost is a major factor stopping people from having them.”
“I came for the scientific background and to learn about new research results. And, I have found out more about short implants, which isn’t something that we use in everyday practice at the moment. However, after this I will definitely think more about using short implants as opposed to sinus grafting.”
FRI
11
FRIDAY’S A GOOD
Morning with Astra Tech program was a highpoint in the MAY congress. Dennis Tarnow, as always, challenged attendees with a variety of difficult conditions and discussed how dental implants can improve the quality of life for a 90-plus-year-old male. He finished with a magnificent complex case demonstrating multidisciplinary treatment planning and replacement of two maxillary central incisors with
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FOCUS ON
Andrea Parpaiola, DMD, from Padova University in Italy.
Clinical considerations in a virtual world As a natural follow-up to Dr. De Kok’s abutment presentation, Andrea Parpaiola, DMD, discussed various clinical considerations when using CAD/ CAM technology to design abutments.
manipulated by using temporary crowns. “Although CAD/CAM techniques facilitate the creation of the ideal abutment,” comments Dr. Parpaiola, “communication between clinician and dental technician remains of utmost importance, so that the final restoration is optimal.” development of a scalloped periimplant soft tissue, and how this profile is transferred to the ATLANTIS™ definitive restoration, Dr. Parpaiola presented several clinical cases. These cases showed that by using ATLANTIS VAD™ it is possible to design anatomical abutments that provide improved soft tissue support, while they also define precise margin location. Dr. Parpaiola concluded his presentation by showing data from a yet unpublished study using ATLANTIS™ abutments in upper and lower jaws. The data, which demonstrated no major prosthetic complications, suggests that ATLANTIS™ abutments promote soft tissue healing. TO ILLUSTRATE THE
In particular, he focused on patient-specific ATLANTIS™ abutments, which are designed in a proprietary software environment called virtual abutment design, or ATLANTIS VAD™. is instrumental in supporting the concept that the morphology of an abutment should ideally be determined by the morphology of the restoration it is intended to support. This concept is crucial in the rehabilitation of the esthetic area, where the emergence profile of the implant-supported definitive prosthesis can be AS HE DESCRIBED, ATLANTIS VAD™
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profile implants. Clark Stanford’s presentations showcased the capabilities of the ASTRA TECH Implant System™. Stig Hansson’s presentation provided insight into the engineering genius that went into the implant design, in particular, MicroThread™, for the distribution of stress on marginal bone. Finally, Tord Berglundh, demonstrated the discipline of
A scene from the International Dinner.
Hans-Göran Gröndahl, DDS, PhD, from the Institute for Postgraduate Dental Education, Jönköping, Sweden.
Getting the dose right Hans-Göran Gröndahl, DDS, PhD, presented radiologic and radiographic factors that influence the radiographic quality and dose, and he suggested how to minimize their effects. From 1998 to 2008, radiation exposure from diagnostic examinations worldwide has nearly doubled. This makes getting the dose “right” critically important. separates quality of diagnostic radiology into two subcategories: operational quality and professional quality. As might be expected, operational quality focuses on radiographic specific parameters, whereas professional quality relates to the overall radiological process. “Cone beam computed tomography (CBCT) has come a long way in 15 years,” states Professor Gröndahl. “And it’s obvious by the number of different machines available that not all CBCTs are alike.” PROFESSOR GRÖNDAHL
true, factors governing radiographic image quality remain dependent on a process that begins with exposing a patient to radiation and results in a radiographic image. During this process, four factors affect the quality of the resulting radiographic image: sharpness, contrast, noise and distortion. By trying to minimize the effects of these factors – and increase image quality – a patient is likely exposed to ALTHOUGH THIS IS
unnecessary radiation. So, what is the trade off and can risk be minimized? To help us understand how these factors interrelate, Professor Gröndahl presented multiple CBCT images taken using varying parameters: exposure factors, scanning times, irradiated volumes and volume positions. He explained that finding the correct balance falls under the concept of professional quality. begins with clinical examination and the decision that justifies a radiographic examination, and goes all the way through to the type of examination performed,” states Professor Gröndahl. Clinical radiologists’ ability to determine the optimal trade-off between image quality and exposure dose for the implant patient is extremely critical. Thankfully, evidence from a 2010 study* demonstrates that the majority of radiologists remain fairly confident in their ability to identify critical structures even in images taken with low radiation doses. Therefore, their guiding principle should continue to be “getting what you need at the lowest possible radiation dose.” “PROFESSIONAL QUALITY
clinical research that is identified with the ASTRA TECH Implant System™. The remainder of the day was filled with parallel sessions. The Friday evening International Dinner was a magnificent evening of food, entertainment, and dancing. The after party kept everyone up until 2:30 in the morning. at 8:30 am on Saturday. Dedicated attendees made their way to the MAY final sessions despite a long evening of entertainment. Lars Rasmusson had hard and soft candies handed out to all of the attendees in the auxiliary session as a novel way to demonstrate the difference between healthy bone and osteoporotic bone. I’m not sure how many candies were tested to make sure the demonstration was accurate. Finally, the closing session titled, “A continuous evolution – function and esthetics,” brought everyone together for one last time with the Astra Tech Scientific Award and presentations by Rhonda Jacob, Craig Misch, Jan Wennström, and Michael Norton. For those who had flights out the following day, there was a time left on Saturday to walk the city, enjoy the half marathon, discuss the incredible few days that passed by in a flash, and the sun that had finally broken through. SAT
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PROGRAMS STARTED
ARNIE ROSEN, DDS
*Dawood, A. and Brown, J. 2010 in press.
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PEOPLE
Facts in brief Name: Lars Henrikson Occupation: Group VP, Marketing, R&D and Operations, DENTSPLY Implants Education: DDS from the University of Gothenburg, Sweden, where he also met his wife Raised: Outside of Karlstad in Värmland, Sweden Family: Wife, three sons and a grandchild Interests: Played soccer in his youth, now a huge ice hockey fan, especially of Karlstad’s elite club Färjestad
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The dental implant industry, still
RISING W
hen we meet Lars Henrikson he is in a terrific mood. Ten seconds before the interview he received news that he had become a grandfather for the first time. And, in addition, his middle son will be getting married during the coming weekend. That is a lot to experience at once, as a father and grandfather. But he is also busy as Group VP, Marketing, R&D and Operations. Even more so now, when his previous company, Astra Tech, has been acquired by DENTSPLY International and now operates under the name DENTSPLY Implants. Lars has worked at Astra Tech since 2003 and has been along for a ride that probably only those who work for the company truly thought was possible.
He has followed the company all the way from a small, innovative newcomer to a multinational giant. In the new organization, Lars will be responsible for marketing as well as research and development, which is the focus of our conversation. HOW DO YOU SEE THE FUTURE OF DENTAL IMPLANTS?
“The future looks exciting because this is a field where business opportunities are still developing. I believe in a strong, long-term growth of this market.” SO IN TEN YEARS, THE MARKET COULD HAVE DOUBLED?
“This could very well be the case, assuming normal economic development and no economic
meltdown. If you look at market penetration, that is how many of a country’s citizens have dental implants, it is low in most countries, both in new and established markets. The United States is currently growing by close to 10 percent per year but compared with Italy, for example, the American market needs to be four times as big in order to reach the same degree of penetration. Simply put, there is an enormous need out there that is not being met.” CAN YOU GIVE ANY SPECIFIC NUMBERS?
“The markets that have the highest penetration in Europe have around 25 implants placed per 10,000 inhabitants. But it varies greatly amongst different countries. In England the number is around 2, in Sweden around 20.
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PEOPLE
THERE ARE MANY STUDIES AND RESEARCH PAPERS SHOWING THAT THE QUALITY OF LIFE INCREASES WITH DENTAL IMPLANTS, DESPITE THE TREATMENT BEING RELATIVELY UNCOMMON. HOW SO?
“Many dentists work fairly independently in their offices and are pleased with how their clinics are running. However, the knowledge you possess is the same as you received in dental school. Dental implants are essentially viewed as something advanced and somewhat difficult. It is simpler to perform the traditional
treatments. In this case, we must provide dentists with education programs, service, and support, explaining the benefits of the implant solution. We are very focused on this. The number of dentists that place implants increases every year.”
HOW DO YOU SEE THE BALANCE BETWEEN HOW ARE THINGS IN DENTAL SCHOOLS TODAY?
ESTHETICS AND ADVANCED SOLUTIONS – VERSUS
DO DENTAL IMPLANTS HAVE A HIGHER PRIORITY
SIMPLER AND LESS EXPENSIVE ALTERNATIVES?
NOW?
“I don’t think that one excludes the other. I can understand those who think that the focus on esthetics sometimes take over. But the majority of those who receive implants today do have extremely high esthetic demands, which we have to be able to meet. Approximately 85 percent of the cost of an implant treatment comes from the work provided by surgeons, dentists, and dental technicians. The other 15
“Yes, however, changing the education system is a slow process. But it is
The foundation will still be the philosophy that we’ve always followed – well-documented products and well-developed service and support.” 24
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happening. Today the vast majority of schools have some form of implant training as a part of their basic education. We would of course prefer if there was even more focus, but things are definitely moving in the right direction.”
The first thing that struck Lars when he joined Astra Tech in 2003 was the great commitment and confidence in their products. “They said that they would be number one in the dental implant industry. And at that time they were almost unknown. I became fascinated by the people who worked there.”
percent is the actual components, that is, what we are selling. So what we can do to reduce the cost is to put even more emphasis on research and development – to make our system simpler and safer to work with. We also have a large group – edentulous patients – who has a totally different set of demands. With the help of digital systems, you can do all of the planning in advance and, in the best-case scenario, take care of everything with one single treatment. Then the cost is significantly reduced. But even the simplest solutions demand a number of implants and surgery.” SO, DIGITAL DENTISTRY. IS THAT A KEY TO REACH MORE PEOPLE?
“Yes, absolutely. Digital dentistry creates the opportunity to treat patients in simpler, faster and safer ways. And the
cost also decreases. But one must never be satisfied. You have to always try to make the product simpler, safer and more robust. And we constantly look at how to improve the big picture, shorten healing time, and reduce the risk of complications.” AS DENTSPLY IMPLANTS, WILL YOU GAIN
“The foundation will still be the philosophy that we’ve always followed – well-documented products and well-developed service and support. We want the customers to feel that we are the best company that they can work with. But we will also be able to offer more products that are needed to solve different clinical problems.
GREATER RESOURCES FOR RESEARCH AND DEVELOPMENT WORK?
SO CUSTOMERS CAN STAY CALM, BUT WILL THEY
“Yes, it is one of the great advantages of the acquisition. We get a larger development organization and better opportunities to pursue both more and broader projects. We also get a wide and more comprehensive product portfolio to offer our customers.”
STILL RECOGNIZE THE COMPANY?
HOW WILL THE CHANGE IN OWNERSHIP BENEFIT YOUR CUSTOMERS?
“Former customers of both Astra Tech Dental and DENTSPLY Friadent should rest assured that the products they have come to know and trust will continue to be fully supported, enhanced and developed. As a business, DENTSPLY Implants remains committed to core values that focus on customer service and products of the highest quality.”
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Abutments as individual as your patients
Available fo major imp r all lant systems
Discover why ATLANTIS™ CAD/CAM abutments are the natural choice for patient-specific, cementretained implant prosthetics. ATLANTIS™ abutments are designed and produced for the specific Courtesy of Dr. Julian Osorio, Dr. Keith Phillips and Dr. Harold van der Burg edentulous spaces they will fit and in relation to the surrounding teeth and soft tissue, taking biology, anatomy and engineering principles into consideration. The result is a unique combination of four key features, known as the ATLANTIS BioDesign Matrix™.
ATLANTIS BioDesign Matrix™ The four features of the ATLANTIS BioDesign Matrix™ work together to support soft tissue management for ideal functional and esthetic result. This is the true value of ATLANTIS™ for you and your patients.
Find out more how ATLANTIS™ can bring simplicity and esthetics to your practice. Contact your local sales representative today or visit www.atlantisabutment.com
TLANTIS VAD™ A Designed from the final tooth shape.
Natural Shape™ Shape and emergence profile based on individual patient anatomy.
Soft-tissue Adapt™ Optimal support for soft tissue sculpturing and adaptation to the finished crown.
Custom Connect™ Strong and stable fit – customized connection for all major implant systems.
2
case st featuring udies so from DEN lutions TSP Implants. LY
SOLUTIONS AT WORK The reliability of DENTSPLY Implants products is supported by solid clinical documentation. This commitment to documentation is at the core of the company’s quality systems. InSight presents two case studies where you can see solutions at work for patients like yours.
28 Immediate replacement of a maxillary central incisor using OsseoSpeed™ TX Profile implant.
30 Delayed and immediate protocols with the ANKYLOS® implant system.
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CASE STUDY #1
Immediate replacement of a maxillary central incisor using OsseoSpeed™ TX Profile implant Case summary
of local anesthetic, a localized, papilla-sparing, facial flap was reflected. Using periotomes and forceps, extraction was carefully performed, preserving the thin facial cortex. The sloped nature of this bone was evident as the midfacial osseous crest was in an apical position relative to the proximal bone. An OsseoSpeed™ TX Profile implant was selected to position the buccal top of the implant approximately 3 mm apical to the proposed gingival zenith of the future restoration, dictated by the surgical stent. This level approximated the level of the facial bone, and prevented over-seating of the implant top relative to the proximal and palatal bone levels. FOLLOWING ADMINISTRATION
PATIENT: A 78-year-old woman, with an
unrestorable maxillary central incisor (tooth 21). She is not receptive to wearing a removable interim prosthesis, but accepts that the tooth requires extraction. CHALLENGE: A maxillary central incisor is
replaced with an immediate implant and provisionalized simultaneously. In addition to immediate placement, hard and soft tissues are augmented to provide long-lasting stability and esthetic results. TREATMENT: The pre-treatment examination
included ruling out possible infections, verifying an immediately-temporized implant can be placed out of occlusal function, and cone-beam CT scan to evaluate hard tissues available for immediate placement and implant stability.
Documentation
screw was tightened to 15 Ncm, a dermal allograft (Perioderm*; DENTSPLY Implants, North America) was sutured around the temporary crown serving as a tissueocclusive barrier (GBR) and a means of soft tissue augmentation. Adaptation of the flap, intentionally positioning the ONCE THE ABUTMENT
*Products manufactured by MTF
FIG. 1 78-year-old patient presents
FIG. 2 Cone beam CT scan utilized
FIG. 3 A localized, papilla-sparing,
FIG. 4 Extraction is carefully
FIG. 5 The sloped nature of the bone
FIG. 6 The implant is positioned
FIG. 7 A screw-retained provisional
FIG. 8 Mineralized, cortical/cancellous
with an unrestorable maxillary central incisor (tooth 21).
is evident, making the OsseoSpeed™ TX Profile implant an ideal solution.
28
After achieving primary implant stability, the space between the implant and the facial bone was obturated with a mineralized allograft ((FDBA*; DENTSPLY Implants, North America). A screw-retained provisional crown, formed onto a Temporary Abutment Profile, using the vacuum-formed template based on the pre-existing situation, was fabricated.
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to evaluate availability of hard tissue for immediate placement.
approximately 3 mm apical to the proposed gingival zenith.
facial flap is reflected.
crown is fabricated.
performed, preserving the thin facial cortex.
allograft is utilized to obturate the defect between implant and facial cortex, and a thin layer is applied on the external facial bone surface.
The OsseoSpeed™ TX Profile implant fits this situation, possibly preventing facial dehiscences from developing.”
gingival margin slightly coronal to the desired location, was achieved. The occlusion of the provisional crown was carefully inspected to assure no contact with the opposing mandibular incisors in centric relation and excursive movements. The patient was strongly advised to avoid any masticatory forces in her anterior dentition for at least four weeks. post-op, stability of the implant and hard and soft tissue levels was confirmed, and the patient was referred back to her dentist for definitive restorative care. The implant was restored with an ATLANTIS™ Abutment, zirconia, and an all-ceramic crown. The characteristics of the AT SEVEN WEEKS
OsseoSpeed™ TX Profile implant were leveraged in this case. First, the OsseoSpeed™ implant has a welldocumented, fluoride-modified surface, achieving rapid osseointegration. Second, the sloped top of the implant approximates the anatomic situation of an anterior extraction socket more accurately than an implant with a flat top. By design, an implant with a margin 1.5 mm more apical than the proximal levels allows the surgeon to avoid over-seating the implant relative to the proximal bone, which may complicate oral hygiene and compromise long-term peri-implant health, by minimizing mesial and distal soft tissue dimensions. The natural healing of the alveolar ridge
also results in a sloped anatomic form following extraction. The OsseoSpeed™ TX Profile implant fits this situation, possibly preventing facial dehiscences from developing, which could greatly compromise esthetically sensitive regions of the dentition. To also compensate for the healing of the extraction site, hard and soft tissue augmentation was performed to attempt to offset the inevitable loss of bundle bone on the facial aspect of the implant. BARRY P. LEVIN, DMD
Diplomate, American Board of Periodontology, Clinical Associate Professor, University of Pennsylvania, PA, USA*
All trademarks are the property of their respective owners.
FIG. 9 A dermal allograft (Perioderm)
FIG. 10 Adaptation of the flap,
FIG. 12 Patient is referred back to
FIG. 13 The implant is restored with
is sutured around the temporary crown.
her dentist for final restoration.
intentionally positions the gingival margin slightly coronal to the desired location.
a CAD/CAM ATLANTIS™ Abutment in zirconia and an all-ceramic crown.
FIG. 11 Seven weeks post-op, stability
of the implant and hard and soft tissue levels are confirmed.
Restorative treatment by Dr. Mona N. Patel, Abington, PA, USA *Private Practice Limited to Periodontology & Dental Implant Surgery, Elkins Park, PA, USA
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CASE STUDY #2
Delayed and immediate protocols with the ANKYLOS implant system ®
Case summary
a posterior or anterior region of the mouth, we must always be cognizant of the function and esthetics of that particular area. Bone preservation is certainly a key factor for both. In the past, some of the basic reasons for bone loss have been ill fitting components that create the microgap and micromovement of the implant-abutment junction. WHETHER RESTORING
PATIENT: A 45-year-old female in need of
replacement of teeth in two areas of the mouth at two separate times. CHALLENGE: To replace the teeth in the
area of a fractured tooth and ailing implant with the most predictability for function and esthetics. To replace a fractured tooth within the esthetic zone where the patient’s time and esthetics are of paramount importance to her. TREATMENT:
Case 1: After extraction of tooth 16, there was a healing period of six months prior to sinus augmentation with a simultaneous approach of placing ANKYLOS® implants for tooth areas 16–17. Case 2: Immediate placement and provisionalization after extraction was used. Different types of stock abutments were used in each situation to achieve optimal results.
conical connection of ANKYLOS® implants offer the following advantages: 1) a built in horizontal offset (platform switching) concept, 2) no microgap, and 3) no micromovement. By utilizing the built-in advantages along with the predictability of a unique subcrestal placement design, a truly predictable functional and esthetic restoration can be realized over a long period of time. Subcrestal placement with this
THE OPTIMIZED
contiguous Morse taper connection is more capable of preserving the inter-implant crestal bone in addition to showing a benefit to decreasing the surrounding bone stress and strain.1 By also taking advantage of not having to deal with a prosthetic platform, the margin and emergence profile are independent of the size of the implant. This subcrestal placement in conjunction with a narrow and concave emergence profile of the abutment creates a space for bone and soft tissue, which helps mask the underlying metal components, thus enabling the use of stock abutments. This “biologic zone” created is unique to the ANKYLOS® implant system. This is a tremendous advantage as the evidence suggests new bone will form on the top part of the implant platform.2
Documentation
FIG. 1 Patient presents with a
FIG. 2 Following six months of
FIG. 3 Soft tissue shaped with sulcus
FIG. 4 Stock abutment in place.
FIG. 5 Delivery of implant crowns (16
FIG. 6 Three-year post-op shows
FIG. 7 Three-year radiographic image
FIG. 8 Four-year CBCT of 16 and 17.
fractured tooth and ailing implant.
and 17).
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healing, a sinus augmentation was performed and two ANKYLOS® implants were placed.
healthy soft tissue maintained.
formers.
of 16 and 17.
Sub-crestal placement with this contiguous Morse taper connection is more capable of preserving the inter-implant crestal bone.” The patient presented with fractured tooth 16 and an ailing implant 17. Tooth 16 was extracted, the area grafted using Bio-Oss Puros Autologous bone with PRP (Geistlich, North America) and covered with a membrane. Six months later, the sinus was augmented and two ANKYLOS® implants (4.5 mm diameter x 9.5 mm length and 3.5 diameter x 9.5 mm length) were placed simultaneously in areas 16 and 17. Final crowns were seated seven months later. Ideal placement allowed eventual customization of Standard Abutments with ultimate replacement by two nonsplinted crowns. Post-op radiograph and CBCT scan show bone preservation entirely around the implant body on all surfaces. CASE 1:
Three years later, the same patient returned with fractured tooth CASE 2:
14. The hopeless tooth was extracted and replaced with a 4.5 mm diameter x 9.5 mm length ANKYLOS® implant. Primary stability for immediate provisionalization was achieved. Subcrestal placement ensured predictability of bone retention and the built-in horizontal offset ensured preservation especially at the critical facial-cervical area. Ideal placement allowed a pre-machined Standard Abutment to be utilized within the biologic envelope. Three months later, the provisional crown was removed, and an abutmentlevel impression utilizing an ANKYLOS® Standard TransferCap was taken for fabrication of the final crown. Use of this abutment allowed us to take advantage of the “one abutment, one time” concept, which refers to the placement of the final abutment at the time of implant placement.
This approach allows the soft tissue to remain undisturbed resulting in predictable esthetic outcomes. As demonstrated through this one patient who presented with two different case scenarios, the versatility of the ANKYLOS® implant system can be utilized to meet both the functional and esthetics needs of each patient. Chu C, Hsu J, et al. Biomechanical Evaluation of Subcrestal Placement of Dental Implants: In Vitro and Numerical Analyses. J Periodontol 2011;82:302–310. 1)
Degidi M, Perrotti V, et al. Equicrestal and Subcrestal Dental Implants: A Histologic and Histomorphometric Evaluation of Nine Retrieved Human Implants. J Periodontol 2011;82:708–715. 2)
BARRY GOLDENBERG,
DMD, MS, Prosthodontist, Private Practice, St. Louis, MO, USA
All trademarks are the property of their respective owners.
FIG. 9 Same patient returns three
FIG. 10 Initial situation of fractured
years later, this time with fractured tooth 14.
tooth 14 required extraction of the hopeless tooth.
FIG. 13 The provisional is removed and
FIG. 14 An abutment-level impression
the abutment is ready for a transfer impression.
is taken with an ANKYLOS® Standard TransferCap. The abutment is never removed after initial placement.
FIG. 11 Immediate placement of the
implant subcrestally for ensured bone retention and preservation at the facial-cervical area.
FIG. 15 Radiographic follow-up (two
years for tooth 14; five years for tooth 16 and 17) shows optimal bone maintenance around the implants.
FIG. 12 Ideal implant placement
allowed for the utilization of a pre-machined Standard Abutment.
FIG. 16 Post op: two years for tooth
14; five years for 16 and 17.
Treatment partner: William M. Cohen, DMD, MS, Periodontist
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PATIENT PROFILE
Implants in real life
successful A strategic decision It happened in a matter of seconds, during a friendly game of floorball. Olympic sailor Anton Dahlberg was suddenly tackled from behind. Falling forward he hit his mouth on the sideboard, chipping half of his left front tooth. In the next instant Anton, who had always been a bit afraid of the dentist, was rushed off to the emergency room.
A
nton Dahlberg grew up far from the sea and thus learned to work with boats on different nearby lakes. Early on people noticed that he had a talent for competitive sailing. A talent, however, that probably nobody thought would take him all the way to the Olympic Games. But with the mind of a winner and a strong passion for the sport, he did. In both 2008 and 2012. And, he truly loves the sea. When he is in the boat, he lets go of everything that seems important on land. The senses sharpen as the focus is purely here and now. secret lies in having a sense of the wind and an eye for the water. Where the sea’s surface is darker, the wind is stronger. But even if you find a good wind that allows the boat to sail quickly, sooner or later you will need to change direction. Changing to a weaker wind will make you go more slowly but in the right direction. You ANTON SAYS THAT THE
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have to see the bigger picture and think one step in advance. Be strategic, and sometimes you have to make decisions that seem to slow you down, but that benefit you in the long run. That was how Anton thought when he decided to get a dental implant. the tooth was fixed quickly and easily by gluing on the chipped piece. But it constantly kept falling off. Spending a lot of time traveling, with competitions all over the world, that quickly becomes quite irritating. Especially as the tooth always seemed to chip at the least convenient moment. “I remember during the World Cup in the Netherlands when we went out for the final races. It was really windy and after a while all the boats were called back. And then, out there in the boat, the tooth suddenly fell off again. When I came back to land with a tooth gap, people were looking at me with astonishment. I joked and said that the bar had hit my face, and that it was nothing to be concerned about. As I am, of course, a real Viking,” Anton laughs. IN THE BEGINNING,
has trained full time and, together with his partner Sebastian Östling, just competed in the Olympic Games in London. Success demands 100 percent focus. And there certainly won’t be time to think about when the tooth will fall off next. “I decided to get a dental implant after having spoken to an acquaintance that had one. Getting an implant was, although a bit difficult at first, certainly the right choice in the long run. I’ve had my new tooth for six months now and it feels great. A successful strategic decision.” SINCE 2009 ANTON
Facts in brief Name: Anton Dahlberg Born: 1985 Resides: Stockholm, Sweden Family: Mother, father, sister, brother and girlfriend Competition class: 470. A two-person boat that is represented by both men and women at the Olympic Games.
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ET CETERA
Water – a scarce resource
WATER IS LIFE AT ASTRA TECH WORLD CONGRESS 2012 • Bottled water was not offered during the congress. Instead, ecofriendly, reusable, flat bottles that could be filled at water faucets were handed out to thirsty delegates. • The world’s largest half marathon was held during the weekend of the world congress. A group of 144 runners ran for the world congress team called Run for LIFE. All the entry fees paid by the runners went directly to WaterAid. • Activities at and around the congress resulted in SEK 460,000 (USD 77,000; EUR 57,000) for WaterAid, providing safe, clean water and sanitation for 2,300 individuals in need.
• Each year WaterAid provides around one million people in the world’s poorest countries with access to clean water, and around three million with sanitation. • Since its foundation in 1981, 15.9 million people have gained access to clean water and sanitation thanks to WaterAid’s work. www.wateraid.org
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in excess DID YOU KNOW… …that humans consist of 55–78 percent water, depending on body size. We need between one and seven liters of water per day to avoid dehydration. The exact amount depends on how active a person is, the surrounding temperature, air humidity and other factors.
Jan Eliasson, the Deputy Secretary-General of the United Nations, spoke about the importance of corporate responsibility.
Safe and clean water is something that most of us take for granted to such an extent that the opposite is hard to imagine. But for one billion people, the search for safe, clean water is exactly what occupies their lives – every day.
S
wedish tap water is of very high quality. In fact, it is among the cleanest in the world – consumed without problems of any sort. Just turn the knob, pour a glass and enjoy. And there is no need to be stingy because it is cheap. The cost of 1,000 liters of fresh water is rarely more than SEK 25 (USD 4; EUR 3). Thus, the contrast is severe when facing the fact that over one billion people do not have access to safe, clean water, and that over 2.5 billion people do not even have access to a toilet. As a result of diarrhea and other illnesses caused by lack of water, 4,000 children die each day. attention to this important issue during their world congress, held in Gothenburg, Sweden in 2012, the company collaborated with the international, nongovernmental organization WaterAid, under the slogan “Water is LIFE.” “Our vision is to improve the quality of life of patients worldwide through implant dentistry. Painting with a bigger brush, quality of life also includes making the world a little bit better one person at a time, contributing with our own resources. And that’s the idea behind Water is WANTING TO BRING
LIFE,” says Gunny Kron, Director Global
Marketing Communication, who is the lead for this corporate initiative. An exhibition, centrally located during the world congress, functioned as the heart of the campaign. Money was collected and representatives from WaterAid explained how they work and what challenges they face. Every Swedish krona collected was then matched by the company, thus doubling the total donated amount. Swedish Foreign Minister and currently the Deputy Secretary-General of the United Nations, served as the Chairman of the Board for WaterAid between 2009–2012 and spoke about the importance of corporate responsibility. “I think this initiative is very much commendable and I´m very glad that it has been taken. It shows the importance of mobilizing actors outside the international aid organizations and governments. When a very respected company is involved, it sends the message of responsibility for issues that go beyond the immediate concerns of the company.” JAN ELIASSON, FORMER
NO 3 / INSIGHT MAGAZINE
35
DENTSPLY Implants is the union of two successful and innovative dental implant businesses: DENTSPLY Friadent and Astra Tech Dental*. DENTSPLY Implants offers a comprehensive line of implants, including ANKYLOS®, ASTRA TECH Implant System™, and XiVE®, digital technologies such as ATLANTIS™ patient-specific abutments, regenerative bone products and professional development programs. DENTSPLY Implants is built upon the fundamental values of openmindedness, a thorough scientific approach, a dedication to longterm clinical evidence and a
strong customer focus. Our current DENTSPLY Friadent and Astra Tech Dental customers can rest assured knowing that the world-class products they know will continue to be supported. We are confident that dental professionals around the globe will come to recognize DENTSPLY Implants as their new partner of choice for integrated implant solutions, dedicated support and better patient care.
We invite you to join our journey to redefine implant dentistry.
* DENTSPLY Implants was launched in North America April 2012. Transition to the new business in other geographical locations around the globe will follow.
Facilitate™ www.dentsplyimplants.com
79557-USX-1208 © 2012 DENTSPLY IH
DENTSPLY Implants – the new powerhouse in implant dentistry
