GEISTLICH BIOMATERIALS
LOCAL NEWS VOLUME 14, ISSUE 2, 2019
Make the Right Choice - Your Special Offer Page 11 PAGE 2-6
PAGE 10
PAGE 17-19
Recent Events
Yxoss CBR The Future Is Now
Osteology Sydney Australasia 2020
PAGE 8-9
PAGE 16
PAGE 21
Regeneration During Sleep
An Interview with Dr Lisa-Heitz Mayfield
Geistlich Live Live-Surgery Broadcast
®
Recent Events
38th Annual Dental Congress 1-4 May | Adelaide
The 38th Annual Dental Congress held in Adelaide this year brought together professionals from every corner of the dental industry for discussions about the science, clinical practice and business of the dental industry. The Australian Dental Association is a not for profit professional membership organisation with an active presence in every state. Over almost 40 years they have built a reputation for putting together congresses with a wide range of relevant topics and this year was no different, with a number of international and local speakers educating the industry on recent breakthroughs in the field of dentistry and the dental business. The comprehensive scientific program included talks by Dr Sascha Jovanovic, Professor Giulio Rasperini, Dr Christopher Ho,
Professor Ivan Darby and many more key opinion leaders. The programme included a range of presentations, hands-on workshops, lunchtime learning sessions, whole of practice sessions and interactive member forums so delegates could listen to presentations and speak to the representatives of the association in a relaxed setting. Geistlich was proud to be a part of such a large-scale event. Our presence included a “What’s your product solution?” booth activity where delegates were asked to pick the Geistlich products they would use for a randomly assigned treatment area. Everyone who answered correctly went into a draw to win a number of prizes including free products! Congratulations to the lucky winners – Darren from All Smiles Centre, Dr David Taub, and Dr Matthew Cohen.
SMS NEOSS 17-19 May | Gold Coast The focus of this year’s Neoss conference for Australia and New Zealand was ‘Navigating the Future’. The event brought together clinicians and academics alike from around the world to present and discuss the future trends in implant surgery and prosthodontics and how this translates into practice. With 185 delegates and 16 incredible speakers, the 3rd SMS Neoss event has been “the most successful event yet". The topics ranged from ‘soft- and hard-tissue maintenance around dental implants; long term follow ups’ to the ‘role of barrier membranes in GBR – 2
GEISTLICH LOCAL NEWS 2-2019
the biological principle revisited’. Our managing director Dr Torben Hackl and the Queensland team had a great time learning about the latest in implant technology over the 3-day program.
Recent Events
Go Pink! 1-31 July | Australia & New Zealand July was Go Pink! month here at Geistlich Pharma Australia & New Zealand, promoting our unique range of soft-tissue matrices, Mucograft® & Mucograft® Seal. During this very special month we delivered over 4oo
limited edition Go Pink! Satchels to our customers. In addition, our Facebook followers were able to join in the fun and enter the ‘Where’s Molly?’ competition,
spotting all 6 Mucograft® Molly’s hidden throughout our video post in a series of street scapes. We hope you enjoy your Go Pink! Satchels and keep looking inside your future order’s for special treats.
NZDA 29-31 July | Wellington This year, the New Zealand Dental Association and New Zealand Dental Industry came together to deliver one event that serves the combined interests of both groups. The comprehensive programme included a team day, a young dentist day, an oral therapist, dental therapist and hygienist’s day and a separate programme for dentists that ran across all three days. After the success of our paper plane toss at the ANZAP conference earlier this year, we took the Plane Toss game to New Zealand – this time with a pink twist. Delegates were to fold their own Geistlich Bio-Gide® paper plane and toss that, along with the Geistlich Bio-Oss® Collagen cube and a Geistlich Mucograft® Seal frisbee into the extraction socket box for their chance to win daily prizes!
Congratulations to Dr Anita Zaveri, Dr Edmond Young and Dr Emily Lin on your well-aimed win!
NZDA Conference images courtesy of Mark Tantrum3
Recent Events
Dr Mario Beretta Hands-On Workshop 28 & 30 May | Perth & Melbourne
Tissue Management for Prevention and Treatment of Peri-Implantitis We were fortunate to welcome Dr Mario Beretta to Australia in May of this year for two hands-on workshops, held in Perth and Melbourne. Dr Beretta is an expert in the fields of Periodontology and Implantology, is based in Milan and happens to be a sky diving enthusiast.
specific surgical procedures utilised in the treatment of peri-implantitis. Hard and soft-tissue grafting techniques were demonstrated, with participants utilising biomaterials in a series of guided bone regeneration exercises, along with soft-tissue grafting procedures.
Attendees were provided with the opportunity to listen to the didactic component of the workshop initially. Dr Beretta focussed on the biological factors which contribute to the development of peri-implantitis, providing scientific data relating to potential risk factors, methods of prevention, and as well as documented treatment options. A detailed discussion of treatment strategies and considerations was followed by a comprehensive review of various clinical cases and videos. The hands-on component provided attendees with an opportunity to practise
We thank Dr Beretta for sharing his knowledge with attendees at both his Perth and Melbourne courses, and we look forward to having him back on our shores in the near future.
Dr Steven Soukoulis Hands-On Workshop 14 June | Sydney
Horizontal Bone Augmentation: An Exploration of Alternate Approaches The evolution of biomaterials over the last three decades has resulted in optimised outcomes in a number of oral regenerative procedures, particularly in the area of complex alveolar augmentation. On the 14th of June, Dr Steve Soukoulis (Specialist Periodontist based in Adelaide) held a workshop in Sydney that explored this concept. He specifically focussed on both the Ridge Split & the Khoury Bone Shield procedures. Dr Soukoulis covered the scientific concepts and surgical protocols necessary to achieve predictable outcomes when dealing with large and complex horizontal alveolar deficiencies. He described in detail the step-by-step decision tree he utilises in his clinical practice when selecting a treatment for these types of cases, and provided a detailed review of 4
GEISTLICH LOCAL NEWS 2-2019
important clinical considerations and equipment. The hands-on component of the day allowed participants an opportunity to utilise piezo surgical equipment (courtesy of NSK) to harvest bone shields, place the implant (courtesy of TRI Implants), and use Geistlich biomaterials to graft the region on pig jaws. Dr Soukoulis provided attendees with valuable tips and suggestions on how best to approach these advanced procedures, which was very much appreciated by all in attendance. Thank you to Dr Soukoulis for sharing his knowledge and expertise on the day. A special thanks also goes to Medartis, TRI Implants and NSK for their support of this event.
Recent Events
Dr Dietmar Weng Hands-On Workshop 12, 14 & 16 August | Sydney, Melbourne & Brisbane
Simplify Your Augmentation: The Impact of Socket Preservation & Cut’n’knot Dr Dietmar Weng (Germany) came to our shores in August of this year for a workshop series held in Sydney, Melbourne and Brisbane. This two-part course structure covered the topics of Extraction Socket Management and Advanced Suturing Techniques. Extraction Socket Management, sometimes referred to as “Ridge Preservation”, is a hot topic at present. A debate still exists as to the efficacy, appropriate case selection and surgical protocols for this kind of procedure within the general dental community. Dr Weng highlighted the fact that this procedure is one of the easiest methods of hard-tissue preservation and augmentation of future implant sites. Attendees were provided an opportunity to discuss both the theoretical and practical considerations
for implementing Extraction Socket Management into their daily clinical practice with one of the world’s foremost experts on the topic. The hands-on workshop allowed participants to practise the concepts they had explored during the lecture, utilising a variety of Geistlich products and protocols. There was a particular focus on reviewing and practising a number of suturing techniques. Suturing is a significant aspect of dental surgery that is so often underestimated, with its impact on soft-tissue healing, in particular, well documented. The Geistlich team would like to thank Dr Weng for his time and for sharing his expertise. He was incredibly well received in each city, and we are looking forward to his next trip to Australia.
Prof Leonardo Trombelli Hands-On Workshop 24 August | Gold Coast
Novel Procedures and Biomaterials for Soft- and Hard-Tissue Augmentation Geistlich Pharma were thrilled to host Prof Leonardo Trombelli for this soldout course held on the Gold Coast, with the hands-on workshop held in conjunction with the Australian Society of Periodontology (ASP) Queensland Branch Clinic Day which was hosted the day before. A full crowd was in attendance to listen to Prof Trombelli initially provide an overview of Geistlich’s novel volumestable collagen matrix, Fibro-Gide®. He discussed the clinical development of the product, along with the appropriate cases in which soft-tissue substitutes would and could be utilised. The significance of soft-tissue augmentation was further identified, with its clinical importance on implant success further highlighted. To round off the didactic component
of the day, Prof Trombelli provided an overview of a novel protocol he has developed to augment the volume of peri-implant hard-tissue, which he has named the sub-periosteal peri-implant augmented layer (SPAL) technique. The hands-on component of the course allowed participants to identify two separate approaches to peri-implant profile augmentation (soft- and hardtissue augmentation) prior to and during implant placement. They were initially provided an opportunity to handle FibroGide®, allowing them to practise softtissue augmentative procedures, whilst accounting for the product’s unique characteristics during a series of pig jaw exercises. Following this, they then practised utilising the SPAL technique to deliver hard-tissue contouring options.
We were once again thrilled to be able to support and partner with a local society in the provision of quality continuous education, and would like to thank the ASP Queensland Branch for providing us with the opportunity to partner with them. Thank you to Prof Trombelli for imparting his knowledge on those in attendance, and we look forward to having him here again soon. 5
Recent Events
ADIA Regional Conferences 30-31 August | Perth The regional trade shows held by the ADIA cater to the specific needs of the dental industry in those states. This allows attendees more time with the Geistlich team compared to the larger more crowded national conferences. Over the two-day conference, the ADIA WA held the state's largest regularly scheduled dental show. The event was held at the Pan Pacific sitting along the banks of the beautiful Swan River. in the heart of Perth. Thank you for bringing your team along, it was a wonderful opportunity to talk to our Geistlich customers in WA.
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Clinically relevant cases and techniques Specific to individual therapeutic areas Focused on peer-to-peer exchange
Soft-Tissue Regeneration
Minor Bone Augmentation
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Dr. Daniele Cardaropoli
Prof. Ronald Jung, Dr. Alfonso Gil, Dr. Tobias Basler
Ridge Augmentation and Delayed Implant Placement on an Upper Lateral Incisor
L-Shape Technique as a means of bone augmentation together with early implant placement
Flyers
Indication Sheet
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Indication Sheet Extraction Sockets
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PD Dr. Daniel S. Thoma
Soft-tissue augmentation in the aesthetic zone
Webinar
Major Bone Augmentation
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Prof. Matteo Chiapasco Dr. Grazia Tommasato
3D bone augmentation using CAD/CAM technology, biomaterials and autologous bone
Online Library
BioBriefs provide a vast number of clinical cases and images via flyers, webinars and an online library at www.bio-brief.com For more information please contact our customer service team on 1800 776 326
6
GEISTLICH LOCAL NEWS 2-2019
A Quick Guide
to Guided Bone Regeneration
Side 1 - Clinical Guide
AL KNO L OUR W IN Y LEDGE O HAN UR DS
Side 2 - Patient Guide
A Quick Guide to Guided Bone Regeneration is dedicated to treatments of Extractions Sockets, Minor Bone Augmentation and Soft-Tissue Regeneration.
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The easy-to-use flip cards provide streamlined information on why and how to treat your patients with Geistlich biomaterials, as well as simplified animations for before and after treatment demonstrations. 7
Focus
Regeneration During Sleep
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GEISTLICH LOCAL NEWS 2-2019
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An energy boost to the brain Anyone who, after having fallen into bed the night before completely exhausted, limp as a rag and with a head filled with befuddled thoughts, awakes in the morning fully refreshed can scarcely understand all that sleep has done for him. A new day begins afresh, full of energy and ideas. How is this “fountain of youth” to be explained? A currently well-regarded theory about the function of sleep proposes that it allows the brain to refill its reserves of energy. In fact, researchers working with Radhika Basheer and Markus Dworak at Harvard Medical School in Boston have been able to establish
What is striking is that it is principally restricted to those areas of the brain which are only active in the Ku ch waking state. The level of ar sk ATP (adenosine triphosphate) a/s hu tt e molecules increases significantly rsto c k) in these areas. ATP is the body’s energy currency and is indispensable for most of its metabolic processes. the energy value of two slices of bread, On the other hand, when mice were but nevertheless, the reduction in kept awake during the period when energy consumption may be the start they were normally asleep, then no signal for refilling ATP reserves, for increase in ATP occurred. But as soon as the creatures nodded off, the ATP producing certain biomolecules such as proteins or fatty acids, and thus for boost switched back on again. It could regenerating the body. thus be concluded that the supply is influenced by the time of day, or by an Night-time cleaning service “inner clock.” Alongside the “energy question,” in the The question remains: why is it that last few years scientists have added a such a supply of energy does not further remarkable aspect to another potential physiological function of also occur in the waking state? The sleep. According to the results of a researchers have an explanation: study conducted by Lulu Xie and her during the waking phase the brain team at the University of Rochester, is constantly engaged in energyNew York, harmful metabolites are intensive nerve activity, and it is careful to ensure the availability of cleared out of the brain during sleep.³ The brain has only a limited amount adequate, uniform levels of energy. It is of energy available, which is used for only through a particular signal, such mental functions during the day. So as falling asleep, that this condition that these functions are not negatively can be overcome. For the first time impacted, it reschedules its main just a few years ago, researchers in the cleaning regime to the after-hours. USA were able to measure how much The brain must decide between two less energy is consumed during sleep functional states, says co-author than in the waking state.² A mediumsized body saves approximately Maiken Nedergaard in the journal 134 kilocalories or 562 kilojoules by Science, “either it is awake and on the alert, or it’s asleep and can have a bit of sleeping, in comparison with lying a tidy up.” awake. This may only correspond to dit:
Bats, cats, chickens, elephants, horses, fruit flies and, of course, human beings – we all need our sleep. And it has to be the right kind of sleep. Just why humans and animals sleep has still not been fully explained, and it is one of the greatest unsolved puzzles in science today. It is highly risky for all creatures to spend several hours unconscious in the natural world. Despite this, sleep is so important that this is an acceptable risk. One thing is certain: anyone who skips his or her nightly rest too long, dies. Moreover, chronic sleep deprivation, or chronic sleep disorders, constitute an added risk factor for a number of conditions, such as influenza, epilepsy, Alzheimer’s disease, obesity or stroke. Sleep is thus very important.
that mice gain a powerful energy boost in the early phase of their sleep.¹ Cre
Being unconscious and defenceless for hours at a time poses a risk for every living creature. What makes sleep so important that it is worth taking the risk?
Focus The so-called glymphatic system, which was only discovered a few years ago, is particularly important for these nocturnal cleaning activities. It is a network of tiny channels that transport cerebral fluid, and in the cranium it replaces the lymph system, which is responsible for carrying waste products away in the rest of our body. These tiny drainage channels are not controlled by nerve cells but by glial cells, which carry out the actual protective and enveloping functions in the brain. Gaps to allow drainage In order to gain more knowledge about this drainage system, scientists injected a coloured dye into the cerebral fluid of sleeping mice. They were able to establish that it penetrated much more deeply into the tissue during sleep than in the waking state. While the dye penetrated approximately tentimes more effectively into the depths of the drainage system in sleeping animals, it was restricted to the surface of the brain in mice that were awake. At the same time, the researchers showed that the nerve cells contract during sleep, creating gaps. The intercellular space in the brains of rodents that were awake accounted for only 14 percent of the cerebral
Ref; Who sleeps for how long? Illustrations: iStock.com/JuliarStudio/Kristina Velickovic/Route55
volume, while in sleeping animals it was 23 percent. Unusable proteins and other substances can drain away through these nocturnally-formed gaps, along with the cerebral fluid, into the bloodstream. These include β-amyloids that are associated with Alzheimer’s disease, for example. They were cleared away during sleep twice as quickly as during the waking state. The neurotransmitter noradrenalin may well play an important role in these contraction processes, say the researchers, as its concentration is reduced in the sleeping brain. The body needs an adequate amount of sleep in order to carry out this “cleaning service” efficiently. The American researchers suggest that if this is interfered with for any length of time, then substances hazardous
to health can accumulate in the brain and create favourable conditions for diseases such as Alzheimer’s or Parkinson’s disease. Whether it is the replenishment of our energy reserves or the removal of harmful substances that is responsible for our need to sleep - a small miracle of regeneration takes place in our bodies every night. Dr. Klaus Duffner | Germany References: Duffner, K., 2016, Sept 01, ‘Regeneration during sleep’, ’https://www.regeneration-expert.com/en/blogdetail/blog/33/blogtitle/regeneration-during-sleep/, retrieved from the regeneration expert, 2019,July 10. 1. Dworak M, et al.: Journal of Neuroscience, 30(26): 9007 . 2. Jung CM, et al.: J Physiol 2011; 589(1): 235-44. 3. Xie L, et al.: Science 2013; 342(6156): 373-77. 4. Photo Header: iStock.com/Kuzmichstudiohttp:// iStock.com/Kuzmichstudio
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Focus
Yxoss CBR® The Future Is Now
Thanks to a synergistic collaboration, Geistlich as the experts in regeneration is the exclusive marketing partner for the ground-breaking product Yxoss CBR® a customized 3-D printed titanium scaffold developed to regenerate complex alveolar bone defects that can be combined with our best in class biomaterials Geistlich Bio-Oss® and Geistlich Bio-Gide®. Yxoss CBR® - The first customised 3-D printed bone regeneration solution for complex bone defects. ReOss® uses the most up-to-date CAD/ CAM technology available to satisfy patient-specific requirements regarding a planned bone augmentation. In a patented process, a contoured, formstable scaffold is 3-D printed of the purest titanium based on CT- or CBCTimages, allowing customised bone regeneration (CBR®). Yxoss CBR® has the clear potential to revolutionise oral bone augmentation by customizing the commonly used “titanium mesh”, using a digital workflow to fit the individual anatomy of each patient.” Have you ever customized the regenerative procedure together with a surgery guide for the correct prosthetic implant positioning? Now, this is possible with Yxoss CBR® Backward. ReOss® offers the option of integrated implant positioning in the surgical planning. By ordering 3-D designs for Yxoss CBR® you can also order the prosthetic positioning for using the 10
GEISTLICH LOCAL NEWS 2-2019
NEW!
Yxoss CBR® scaffold as a surgical guide for implant placement. You will receive the digital proposal for the digital 3-D design with the opening already integrated in the Yxoss CBR® scaffold for future positioning of the implant pilot drill. After sending your design approval to ReOss, you will receive Yxoss CBR® Backward scaffold for sterilization and implantation. During simultaneous approach or at the time of reopening, Yxoss CBR®Backward with its pre-existing openings, can serve as your surgical guide for the positioning of the implant pilot drill. Further implant insertion steps can be performed after the removal of the scaffold.
Contact your local Geistlich Product Specialist for more details
Make the Right Choice With Geistlich biomaterials you can be: 100%
Satisfied that you are treating your patients with outstanding quality products
100%
Confident that our products are supported by over 1,000 peer-reviewed studies
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Assured that our products do not prevent your patients from donating blood Step in the right direction with our complimentary sockies*
Special Offer
included in your next Geistlich order** * One pair per practice for all Geistlich customers
during Sep-Nov’19 Not applicable for Government and Corporate accounts
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For more information please contact our customer service on 1800 776 326
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Upcoming Events 2019
ADIA Regional Conference – Queensland 11-12 October | Brisbane The regional trade shows held by the ADIA cater to the specific needs of the dental industry in those states. This allows attendees more time with the Geistlich team compared to the larger more crowded national conferences. ADIA Queensland Dental Show will be held from the 11th – 12th October at the Royal International Convention Centre,
Bowen Hills. Here, health professionals will have the opportunity to meet our local product specialists. The less crowded nature of the regional dental shows allows for more time with the specialists to find out all you need to know about our tried and tested range of biomaterials. The team from Geistlich Pharma will be available at booth 44 for the full duration of the event, so why not drop by and say hi.
Geistlich for Excellence 365 29 October – Melbourne | 19 November – Perth | 28 November - Brisbane Continuing to build on our educational platform and after four successful events held in Auckland, Brisbane, Melbourne and Sydney, Geistlich for Excellence 365 is heading around the country again. Geistlich for Excellence 365 is an exclusive networking event aimed at bringing together nurses, practice managers and implant coordinators to facilitate the sharing of ideas, knowledge and best practice examples from their perspective.
The evening includes practical components and interactive discussions addressing critical topics such as patient education, Geistlich products and safety and how your choice of biomaterials effects patients who donate blood. With plenty of opportunities to handle Geistlich products and ask any questions you may have on the topic of bone or soft tissue regeneration, this is a relaxed and enjoyable evening designed for dental teams.
International Association for Dental Research 28-30 November | Brisbane The International Association for Dental Research is holding its 4th Meeting for the Asia Pacific Region at the Brisbane Convention and Exhibition Centre in Queensland. The meeting will be held from the 28-30 November and Early Bird Registrations are now open! The congress will be led by Professor Saso Ivanovski and will include numerous international and local researchers holding sessions in the plenary, symposia and open oral session formats. This is the first time that 12
GEISTLICH LOCAL NEWS 2-2019
the Australian and New Zealand Division of the association has been able to host the prestigious congress for the Asia Pacific Region and Geistlich is proud to be a sponsor of this event.
Register now at: iadr-apr2019.com/registration
For more information contact your local Product Specialist or Customer Service on 1800 776 326, we hope to see you there. Join us to learn more! Page 13 Product Specialists: Vic - Nicola Sharp
0498 123 111
0498 123 451
- Elke Hovatta
WA - Angela Tascone
0498 123 333
Qld - Michael O’Callaghan 0498 123 222
- Rebecca Francis
0498 123 452
Geistlichfor forExcellence Excellence365 365 Geistlich Educational Program for Nurses, Practice Managers and Implant Coordinators Educational Program for Nurses, Practice Managers and Implant Coordinators
Geistlich Pharma Australia & New Zealand Geistlich Pharma Australia & New Zealand
City: Melbourne VIC 3002 City: Park Melbourne 3002 Square Venue: Hyatt, 1 VIC Parliament Venue: Tuesday Park Hyatt, 1 Parliament Date: 29 October 2019 Square Date: Tuesday 29 October 2019 City: Perth WA 6000 City: The Perth WA 6000 Venue: Westin, 480 Hay Street Venue: Tuesday The Westin, 480 Hay2019 Street Date: 19 November Date: Tuesday 19 November 2019 City: Brisbane QLD 4000 City: W Brisbane 4000 Venue: Hotel, 81QLD North Quay Date: 2019 Venue: Thursday W Hotel,28 81 November North Quay Date: Thursday 28 November 2019 Time: 6.30pm - 9.30pm (all venues) Time: 6.30pm - 9.30pm (all venues) To register your interest and stay up to withyour eventinterest details and contact Todate register stayour up friendly on 1800 776 326 or email to date team with event details contact our info@geistlich.com.au friendly team on 1800 776 326 or email info@geistlich.com.au
would likelike to invite youyou to join the the continuing education would to invite to join continuing education program designed for dental nurses, practice managers program designed for dental nurses, practice managers and implant coordinators. and implant coordinators. Due to the great feedback received from our guests since the Due to the great feedback received from our guests since the launch of this program in 2017, we are continuing to build on launch of this program in 2017, we are continuing to build on our educational platform and are introducing some new and our educational platform and are introducing some new and interesting topics related to your work at the practice. interesting topics related to your work at the practice.
Geistlich for Excellence 365 Geistlich Excellence is an exclusive networkingfor event aimed to bring365 together
is an exclusive eventthe aimed to bring together dental auxiliary networking staff to facilitate sharing of ideas, dental auxiliary staff to facilitate the sharing of ideas, knowledge and best practice examples from the nurse’s knowledge and best practice examples from the nurse’s perspective. perspective.
The evening will include a practical component and The evening will include a practical and interactive discussions addressing critical component topics such as interactive addressing critical topics suchofas patient education,discussions products and safety and the right choice patient education, productswho andwant safety theblood. right choice of biomaterials for patients to and donate biomaterials for patients who want to donate blood.
Join us to learn more! Join us to learn more!
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Upcoming Events 2020
Registration now open for Osteology Sydney 2020
19–21 June 2020| Sydney
An interview with Dr Torben Hackl With registrations now open for Osteology Sydney 2020, we caught up with Dr Torben Hackl, Managing Director of Geistlich Pharma Australia & New Zealand in Barcelona. Dr Hackl, please tell readers about Osteology Sydney 2020? TH: Osteology Sydney 2020 will be a fantastic event. We’re drawing on both the experience from the inaugural Osteology event in Melbourne in 2017, where we had almost 300 delegates, as well as the broader Osteology organisation that coordinates events globally. I think we’ll attract a larger and more diverse group to the Sydney event and we’ll be looking to draw people from not only Australia and New Zealand, but also from neighbouring countries in Asia. We have a big focus on major augmentations this time, which will interest maxillofacial surgeons in particular and our international chairman, Prof. Istvan Urban [Hungary] and Prof. Matteo Chiapasco [Italy], will present on that subject. At the same time, we’re also looking to make the program attractive for young researchers or recent graduates so we’ve created a research session that will be chaired by Prof. Sašo Ivanovski where they’ll be able to present their cases. We also have a case session for all delegates. If you have completed a particularly interesting case and you have good documentation, you can submit it and if you’re selected, present it at the congress as well. Another unique feature of Osteology Sydney 2020 is that we’re introducing a stream for the team. I don’t think this has been done before at an Osteology event anywhere in the world so we’ll be offering dedicated team sessions for practice managers, hygienists and implant nurses to participate in, where we’ll discuss more about patient care and aftercare. So, I think with all of that combined, it’s a very well-rounded 14
GEISTLICH LOCAL NEWS 2-2019
From left: Dr Torben Hackl, Prof Lisa Heitz-Mayfield, Prof Istvan Urban program and we hope it’s attractive to attend. I see Osteology Sydney 2020 is running from June 19-21? TH: Yes, Osteology Sydney 2020 is slightly longer than last time. We listened to participants’ feedback from the last Osteology in Melbourne and the feedback was that they loved the handson workshops but they wanted more! So, for 2020, Osteology is dedicating the entire final day of the congress to just hands-on workshops. This will give delegates an opportunity to fully engage with the presenters to have maybe not just one hands-on session, but two and for a longer time. So, the conference will be two full days of lectures and one day of hands-on workshops covering three days in total. In addition, to reduce time out of the practice, we have reversed the order of the event so we will start with the main conference program on Friday and Saturday and then Sunday will be dedicated to the hands-on workshop program. If you don’t want to go to a hands-on workshop, you wouldn’t come on the Sunday? TH: Exactly. You could leave on Saturday afternoon and be back with your family. And how’s the speaker line- up looking? TH: The overall program is decided by
the Osteology Board and Foundation. Our international chairman, Prof. Istvan Urban and our local chairman, Prof. Lisa Heitz-Mayfield, have come up with a great line-up of national and international speakers from Australia, New Zealand, Korea and Europe. The content gets decided by the Board. Obviously, there is an overall topic, which is “2020 Vision for Regeneration” and with that theme in mind, they have designed the lectures and the content around it. As a local affiliate, our task is more to put the program into the framework and organise the conference venue, workshop facilities and just basically facilitate the whole organisation of the congress. If I am a dentist, why would I want to come? TH: I think regardless of whether you’re a dentist or a specialist, whether you’re a maxillofacial surgeon or a periodontist, or whether you’re a practice manager trying to understand the field of regeneration and what this means for your patients, Osteology Sydney 2020 has something to offer for everyone. This congress will really give a very rounded view of bone and soft-tissue regeneration. It will also show some cutting-edge technology that is really new out of Europe including using custom CAD/CAM designed 3D printed titanium meshes, which I think is the future direction in regeneration. If you would like to hear more about that
Upcoming events 2020
Dr Giovanni Zucchelli and if you would like to catch up with colleagues and complete some expert hands-on training, I think this is the conference for you. We know there are a lot of conferences in 2020 in Australia and we hope that we can be a little different than the others by offering a broad spectrum of topics that appeal to a broad audience but on a very focussed area of dentistry that is driving the future of surgery and implantology. And finally, Dr Hackl, have you decided who’s going to be the afterdinner speaker this time? Last time, it was an astronaut from NASA. TH: Yes, well we all know how hard it is to follow an astronaut! Last time it was the launch of Osteology in Australia and I thought it was really fitting to have an astronaut. But I cannot tell you who we’ll have for 2020 in Sydney yet. Of course, there will be an exclusive conference dinner and we do have a beautiful location overlooking the famous Opera House and Harbour Bridge, but I can assure you that you will not be disappointed regardless of who our surprise guest speaker will be. Joseph Allbeury Australasian Dental Practice
Don’t miss the 2nd National Osteology Symposium Sydney, June 19-21 2020. Visit www.osteology-australasia.org 15
Upcoming Events 2020
Speakers finalised for Osteology Sydney 2020
An interview with Prof. Heitz-Mayfield The National Symposium is being jointly chaired by international chair Prof. Istvan Urban from Hungary and National chair, Prof. Lisa Heitz-Mayfield. We caught up with Prof. Heitz-Mayfield at the recent International Osteology Symposium in Barcelona.
Prof. Heitz-Mayfield, it’s great news that we are again seeing an Osteology National Symposium in Australia? LH: Yes, it’s very exciting to have the opportunity to have a second Osteology Conference in Australia. We expect to have a lot of delegates from Australia and New Zealand and also, being in Sydney, I think it will be attractive to overseas visitors. So hopefully we’ll see delegates from other countries in Asia and also Europe participating. As well as being the National Chairman for the event, I believe you’re also only the second lady to be on the Board of Osteology? LH: Yes I am. I’m going to be on the board from June this year and I’m really very pleased to be part of the Osteology Foundation. It’s a wonderful opportunity and I’m looking forward to working together with my colleagues on the many projects the organisation is involved in. Is one of those projects addressing the lack of female speakers on the world stage? LH: Not directly, but I think there are some very good young speakers, both male and female, coming forward and we’ve seen that at this Osteology meeting here in Barcelona. I think that with more women in dentistry and implant dentistry now, we’re going to see more women on the stage. It’s just a matter of time and of course, the quality is very important. That’s what 16
we’re seeing through initiatives from the Osteology Foundation to encourage young researchers and young clinicians to present. I think the next generation is going to be very exciting. And were you involved in the first Osteology National Symposium in Melbourne in 2017? LH: I was a speaker in Melbourne and that was a very well-organised and successful congress. I think the organising committee did a great job and of course it was very well supported by the industry. The hands-on sessions were a particular highlight and I conducted one of those at that congress and the feedback overall was very positive. In Sydney, we’re going to have some really exciting hands-on workshops again as well as a terrific program overall. The international speakers are top class; we have Istvan Urban, Matteo Chiapasco and we also have Rino Burkhardt, plus we’re looking forward to welcoming Rony Jung and Jung Chul-Park. We have a very broad range of speakers. We also have some terrific national speakers from Australia and New Zealand. It’s going to be a comprehensive program with something for everyone from general dentists to maxillofacial surgeons, periodontists to prosthodontists. Everybody should be excited about attending this congress and no matter what your level of dentistry, there’ll be something for you.
Australian practitioners are very upto-date and many of them are right at the cutting edge and leading the way. We should be very proud of our standard in Australia and that’s one of the terrific things about Osteology. It’s very international and you have the opportunity to exchange ideas and to learn from people from all over the world. Osteology, really, has a great vision for the future. We’re also doing something a little different this time too. We’re going to have a team day. The whole practice team is welcome to come to Osteology Sydney 2020. We’re going to have a special morning where dental hygienists and dental assistants together with the practitioners they work with can come and listen to a broad range of speakers looking at everything from infection control to oral medicine and how to look after the cancer patient. We’re going to have a really good program for everybody. I really encourage everyone to block off these dates, 19-21 June 2020. Joseph Allbeury Australasian Dental Practice
Dr Andreas Geistlich & Dr Lothar Schlösser
GEISTLICH LOCAL NEWS 2-2019
Don’t miss the 2nd National Osteology Symposium Sydney, June 19-21 2020. Visit www.osteology-australasia.org
BAIRRDLY YE LR R A E E SUPENDS DS NARY EU DR BFIR B E BER 1 144 SE2P0T2E0M 2019
UNDER THE PATRONAGE OF THE
Upcoming events 2020
2ND NATIONAL
OSTEOLOGY SYMPOSIUM International Chairman Prof Istvan Urban
National Chairmen Prof Lisa Heitz-Mayfield Prof Sašo Ivanovski
SYDNEY 2020 19 – 21 JUNE 2020 WWW.OSTEOLOGY-AUSTRALASIA.ORG
#2020VISIONFORREGENERATION 17
R EEARLY PEER UP SU DSS S ND D EEN IRD BIR B U RUAARRYY BR FEEB 4 1 F 4 1 20 220020
Osteology Symposium Symposium Australasia Australasia2020 2020 Osteology
19 –– 21 21 June June || Sydney Sydney 19
It is is our our pleasure pleasure to to welcome welcome you you to tothe the2nd 2ndOsteology OsteologyAustralasia AustralasiaSymposium Symposium- -2020 2020Vision Visionfor forRegeneration Regeneration- in - in It Sydney. Sydney. The outstanding outstanding scientific scientificprogram programwill willaddress addressstrategies strategiesfor forpredictable predictablehard hardand andsoft-tissue soft-tissueregeneration regeneration providing The providing practitioners with with cutting cutting edge edge knowledge knowledgetotoprovide providethe thelatest latestininregenerative regenerativedental dentalmedicine medicinefor forthe thebenefit benefitofof practitioners their patients. patients. Linking Linking Science Science and and Practice, Practice,international internationaland andnational nationalrenowned renownedexperts expertswill willdiscuss discusskey keytopics topics their in regeneration combining evidence-based data with clinical expertise. Topics covered will include periodontal in regeneration combining evidence-based data with clinical expertise. Topics covered will include periodontal regeneration, soft-tissue soft-tissue management, management, innovative innovative and and novel novel technologies, technologies,ridge ridgepreservation preservationand andmajor majorbone bone regeneration, augmentation techniques. techniques.There Therewill willbe besomething somethingfor forall allprofessionals professionalsatatall alllevels. levels. augmentation In addition addition to to the the plenary plenary lectures lectures this this 3-day 3-day program programwill willhighlight highlighta acase casecompetition competitionsession sessionand anda aresearch research In competition including including preclinical preclinical and and clinical clinicalresearch researchcategories. categories.This Thiswill willbebeananopportunity opportunityfor forresearchers researchersand and competition clinicians, at at all all stages stages of of their theircareer, career,to topresent presenttheir theirbest bestwork workand andchallenges. challenges.Full-day Full-daypractical practicalworkshops workshops will clinicians, will be conducted by our international speakers, to give the unique opportunity to practise the latest techniques with novel be conducted by our international speakers, to give the unique opportunity to practise the latest techniques with novel materials guided guided by by experts expertsin inthe thefield. field. materials We are are also also excited excited to to announce announce the thePractice PracticeTeam TeamSession Sessiondesigned designedtotoappeal appealtotoall allmembers membersofofthe theregenerative regenerative We team including including dental dental assistants, assistants,dental dentalhygienists, hygienists,therapists, therapists,and andpractitioners. practitioners. team Don’t miss miss this this opportunity opportunityto tobecome becomeengaged engagedwith withregenerative regenerativedental dentalmedicine medicineatatthe thehighest highestlevel. level. Don’t We look look forward forward to to seeing seeingyou youat atthe theOsteology OsteologySymposium SymposiumSydney SydneyininJune June19-21, 19-21,2020! 2020! We
Scientific Co-Chairs Co-Chairs Scientific Prof Istvan Istvan Urban Urban Prof -- Hungary Hungary (International (International Chair) Chair)
ProfLisa LisaHeitz-Mayfield Heitz-Mayfield Prof --Australia Australia (National (NationalChair) Chair)
ProfSašo SašoIvanovski Ivanovski Prof - -Australia Australia (National (NationalResearch ResearchChair) Chair)
International International Speakers Speakers
Prof Prof Istvan Istvan Urban Urban Hungary Hungary
18
Prof ProfRonald RonaldJung Jung Switzerland Switzerland
GEISTLICH LOCAL NEWS 2-2018
Prof ProfMatteo MatteoChiapasco Chiapasco Italy Italy
Prof ProfRino RinoBurkhardt Burkhardt Switzerland Switzerland
Asst Prof Jung Chul Park Asst Prof Jung Chul Park Korea Korea
PROGRAM
PROGRAM PROGRAM FRIDAY, 19 JUNE 2020
FRIDAY, 19 JUNE 2020 FRIDAY, 19 JUNEFRIDAY, 2020 19 JUNE 2020
OPENING Istvan Urban (HU) Lisa Heitz-Mayfield (AU)
OPENING OPENING OPENING Istvan Urban Istvan Urban (HU)(HU) Istvan Urban (HU) Lisa Heitz-Mayfield (AU) Heitz-Mayfield Lisa Lisa Heitz-Mayfield (AU)(AU)
MORNING
SATURDAY, 20 JUNE 2020
SATURDAY, SATURDAY, 20 JUNE 2020 202020 JUNE 2020 SATURDAY, 20 JUNE
SESSION 1 - BONE
SESSION 1 - CASE
REGENERATION
Ronald Jung (CH)
RESEARCH
SESSION 1 - BONE SESSION 1 - BONE SESSION 1 SESSION RESEARCH SESSION 1 - CASE RESEARCH TEAM SESSION SESSION COMPETITION TEAM AUGMENTATION IN FOCUS 1 - CASE COMPETITION RESEARCH SESSION SESSION 1 - BONE AUGMENTATION IN FOCUS SESSIONSESSION Moderators:TEAM PATIENT CARE AND PATIENT CARE AND AUGMENTATIONSESSION INCASE FOCUSCOMPETITION Isabella Rochietta (UK) COMPETITION PATIENT CARE AND AUGMENTATION IN FOCUS PREPARATION (UK)Moderators: Moderators: Istvan Urban (HU)Isabella Rochietta PREPARATION (PART 1) Istvan Urban (HU) Istvan Urban SESSION (HU) Istvan Urban (HU) (PART 1) Moderators: PREPARATION IsabellaRonald Rochietta (AU)Moderator: Matteo Chiapasco (IT) Jung(UK) (CH) Istvan Urban (HU) Istvan Urban (HU) Moderator: Lisa Heitz-Mayfield Lisa Heitz-Mayfield (AU) Matteo Chiapasco (IT)Urban (HU) Istvan (PART 1) Istvan Urban (HU) Matteo Chiapasco (IT) Wendy Gill (AU) Sašo Ivanovski (AU) Fritz Heitz (AU) Lisa Heitz-Mayfield (AU) Matteo Chiapasco (IT) SESSION 2 - HOT TOPICS SESSION 2 - PERIODONTAL COFFEE BREAK COFFEE BREAK COFFEE BREAK SESSION 2 - HOT TOPICS COFFEE BREAK TEAM SESSION SESSION 2 - PERIODONTAL Ronald Jung (CH)
REGENERATION
PATIENT CARE AND
Lisa Heitz-Mayfield (AU) Mark Bartold (AU) SESSION 2 - PERIODONTAL SESSION 2 - HOT TOPICS TEAM SESSION SESSION TOPICS TEAM SESSION Lisa Heitz-Mayfield (AU) PREPARATION SESSION 2 - PERIODONTAL Mark Bartold (AU) 2 - HOT Saso Ivanovski (AU) Axel(AU) Spahr (AU) REGENERATION PATIENT CARE AND Saso Ivanovski (PART Axel SpahrRonald (AU) Jung (CH) PATIENT CARE AND2) REGENERATION Mike Danesh-Meyer (NZ) Mike Danesh-Meyer (NZ) Mark Bartold (AU) Ronald Jung (CH) PREPARATION (PART 2) Lisa Heitz-Mayfield (AU) PREPARATION Mark Bartold (AU) LUNCH BREAK Spahr LisaIvanovski Heitz-Mayfield Moderator: LUNCH BREAK Saso (AU) (AU) (PART 2) Axel Axel Spahr (AU)(AU) Danesh-Meyer (NZ) 3 - SOFT-TISSUE Sašo IvanovskiSESSION (AU) SESSION LydiaTEAM LimSESSION (AU) SESSION 3 - MANAGING 3 - SOFT-TISSUE 3 - MANAGING SESSION MikeMike Danesh-Meyer (NZ) COMPLICATIONS AUGMENTATION PATIENT CARE AND COMPLICATIONS AUGMENTATION LUNCH BREAK LUNCH BREAK LUNCH BREAK LUNCH BREAK Isabella Rochietta (UK) Ronald Jung (CH) Isabella Rochietta (UK) PREPARATION Ronald Jung (CH) (PART 3 HANDS-ON) Matteo Chiapasco (IT) Istvan Urban (HU) 3 - MANAGING Matteo ChiapascoTEAM (IT)TEAM SESSION SESSION SESSION 3 - SOFT-TISSUE SESSION 3 - MANAGING Istvan Urban (HU) SESSION SESSION 3 - SOFT-TISSUE Janina Christophoru (AU) CARE AND PATIENT COMPLICATIONSJanina Christophoru (AU) AUGMENTATION
AFTERNOON
MORNING
EVENING
AFTERNOON
LUNCH BREAK
COMPLICATIONS AUGMENTATION Isabella Rochietta (UK)(CH) Ronald Jung (CH) Rino Burkhardt SESSION 4 -SESSION CHALLENGES IN SESSION 4 - EMERGING Matteo Chiapasco (IT) (IT) Istvan (HU) (CH) 4 - EMERGING Matteo Chiapasco RinoUrban Burkhardt DECISION MAKING TECHNOLOGIES TECHNOLOGIES Janina Christophoru (AU) Janina Christoforu (AU) Istvan Urban (HU)
PATIENT CARE AND PREPARATION PREPARATION COFFEE BREAK (PART 3 HANDS-ON) SESSION 4 - CHALLENGES IN3 : HANDS-ON) (PART
COFFEE BREAK
DECISION MAKING Guided Biofilm Therapy (EMS)
Moderators: CLOSE DAY 2 Moderators: CLOSE DAY 2 Matteo Chiapasco (IT) Istvan Urban (HU) COFFEE BREAK COFFEE BREAK BREAK Istvan Urban (HU)COFFEE BREAK Jung Chul-ParkCOFFEE (KO) Lisa Heitz-Mayfield (AU) SESSION 4 - CHALLENGES IN
Matteo Chiapasco (IT) Jung Chul-Park (KO)
COFFEE BREAK SESSION 4 - EMERGING Lisa Heitz-Mayfield (AU) SESSION 4 - EMERGING SESSION 4 -MAKING CHALLENGES IN CLOSE DAY 2 DECISION TECHNOLOGIES GALA DINNER DECISION MAKING GALA DINNER Moderators: CLOSE DAY 2 Matteo TECHNOLOGIES Chiapasco (IT) Moderators: SUNDAY, 21 JUNE 2020 Istvan Urban (HU) Jung Chul-Park (KO) SUNDAY, 21 JUNE 2020 Istvan Urban(AU) (HU) Matteo Chiapasco (IT) Lisa Heitz-Mayfield 1 Heitz-Mayfield WORKSHOP 2 WORKSHOP 3 WORKSHOP 4 (AU) Jung Chul-Park (KO) WORKSHOPLisa LATERAL BONE AUGMENTATION AND SOFT-TISSUE RECONSTRUCTION Istvan Urban (HU) GALA DINNER
GALA DINNER
WORKSHOP 3 WORKSHOP WORKSHOP 2MAJOR BONE AUGMENTATION MANAGEMENT OF DIFFERENT APPROACHES TO 1 DIFFERENTSITES APPROACHESMatteo TO Chiapasco MANAGEMENT OF LATERAL VERTICAL AUGMENTATION POST-EXTRACTION (IT) Isabella BONE Rochietta (UK) (INTACTVERTICAL & DEFECTS) POST-EXTRACTION SITES AUGMENTATION CLOSING BY CHAIRMEN DAY 2 AUGMENTATION SUNDAY, 21AND JUNE 2020 Ronald Jung (CH)Rochietta (UK) Isabella (INTACT & DEFECTS) SOFT-TISSUE
FREE PROGRAM Ronald Jung (CH) RECONSTRUCTION WORKSHOP 3 WORKSHOP 1 WORKSHOP 2 WORKSHOP 4 Istvan Urban (HU) LATERAL DIFFERENT APPROACHES TO MANAGEMENT OF MAJOR BONE AUGMENTATION SUNDAY, 21POST-EXTRACTION JUNE 2020 WORKSHOP 1 WORKSHOP 2 WORKSHOP 3 WORKSHOP SITES BONE AUGMENTATION VERTICAL AUGMENTATION Matteo Chiapasco (IT) 4 LATERAL DIFFERENT APPROACHES TO MANAGEMENT OF MAJOR BONE AUGMENTATION WORKSHOP 2 WORKSHOP 3 WORKSHOP 1 & DEFECTS) (INTACT AND SOFT-TISSUE Isabella Rochietta (UK) BONE AUGMENTATION POST-EXTRACTION SITES Matteo Chiapasco 3WORKSHOP 4 MANAGEMENT - (IT) WORKSHOP 1 - LATERAL WORKSHOP 2 - VERTICALLATERAL WORKSHOP OF DIFFERENT APPROACHES TO RECONSTRUCTION Ronald Jung (CH) AND SOFT-TISSUEMODERN HARD AUGMENTATION (INTACT & DEFECTS) BONE AUGMENTATION AND VERTICAL VERTICAL MECHANOSENSITIVE POST-EXTRACTION SITES BONE AUGMENTATION Istvan Urban (HU) RECONSTRUCTION Isabella Rochietta (UK) Ronald Jung (CH) SOFT-TISSUE AND SOFT-TISSUE AND SOFT-TISSUE AUGMENTATION OF AUGMENTATION SURGERY IN THE FIELD OF& DEFECTS) (INTACT Istvan Urban (HU) RECONSTRUCTION MANAGEMENT MAJOR BONY DEFECT Isabella USING Rochietta PERI-IMPLANT MUCOSA RECONSTRUCTION (UK) Ronald Jung (CH) OFFICIAL OF CONGRESS UrbanEND (HU) BEFORE AND DURING Istvan CUSTOMISABLE MANAGEMENT WORKSHOP 3 WORKSHOP 4 WORKSHOP O 1UT WORKSHOP 2 D IMPLANT PLACEMENT TI-MESH L O S OFFICIAL END OF CONGRESS DIFFERENT APPROACHES TO MANAGEMENT OF MAJOR BONE AUGMENTATION LATERAL POST-EXTRACTION SITES Matteo Chiapasco (IT) VERTICAL BONE AUGMENTATION Istvan Urban (HU) Ronald Jung (CH) Matteo Chiapasco (IT) Rino Burkhardt (CH) (INTACT & DEFECTS) AND SOFT-TISSUE AUGMENTATION LUNCH LUNCH(UK) LUNCH LUNCH Isabella Rochietta Ronald Jung (CH) RECONSTRUCTION IstvanWORKSHOP Urban (HU) 1 WORKSHOP 2 WORKSHOP 3 WORKSHOP 4 CONTINUED
SOLD
OUT
Istvan Urban (HU)
CONTINUED OFFICIAL END OF CONGRESSCONTINUED
Ronald Jung (CH)
Matteo Chiapasco (IT)
CONTINUED
Rino Burkhardt (CH)
OFFICIAL END OF CONGRESS 19
MAJ
MAJ
Upcoming Courses
Geistlich Biomaterials In Practise 4 September & 2 October | Sydney Continuing with our very successful ‘Biomaterials in Practise’ complimentary education series, Module 2 focusses on Minor Bone Augmentation on Wednesday 4th of September, 2019. Held in the relaxed environment of our head office in Chatswood, these events have been attended by a wide variety of clinicians interested in furthering their knowledge of the latest developments within the field of biomaterials.
Also coming soon is Module 3, focussing on soft-tissue management on Wednesday 2nd October. Why not call the Education team on 1800 776 326 to book your place at one or both of these complimentary sessions? These events fill up fast, so don’t miss your chance to attend these final dates for 2019,
These unique events provide an opportunity to handle the Geistlich range of biomaterials whilst performing some basic hands-on exercises, and time to discuss their indications for use with our Product Specialist and Clinical Science teams.
National Geistlich Clinical Day 11 September & 20 November
National Clinical Day National Geistlich Clinical Day 2019
Clinical Care Standards play an important role in the provision of high-calibre dental care and reducing unwarranted variation in terms of patient outcomes. Geistlich Pharma Australia is continuing the National Clinical Day, which provides dental practitioners with the opportunity to discuss the use of Geistlich products in specific therapeutic areas.
Clinical Care Standards play an important role in the provision of high-calibre dental care and reducing unwarranted variation in terms of patient outcomes. Geistlich Pharma Australia is launching the “National Clinical Day”, which will provide dental practitioners with the opportunity to discuss the use of Geistlich products in specific therapeutic areas. Geistlich’s Clinical Science team will be available to provide answers to any general clinical questions that you may have, and provide you with the pertinent scientific resources in relation to your query. We look forward to you utilising more than 30 years’ of clinical experience and research.
Save the Date: 13 March 2019 12 June 2019 11 September 2019
(9am – 5pm) (9am – 5pm) (9am – 5pm)
20 November 2019
(9am – 5pm)
Arrange your time with Vin on 0499 774 487 or leave your contact details with our customer service team on 1800 776 326 and Vin will get in touch.
The Geistlich Clinical Science team will be available to provide answers to any general clinical questions that you may have, and provide you with the pertinent scientific resources in relation to your query. We look forward to you utilising more than 30 years of clinical experience and research.
Book your FREE consultation on 1800 776 326 20
GEISTLICH LOCAL NEWS 2-2019
MUST WATC H!
Geistlich Live Live Surgery Broadcast – 17 September
This Live Surgery event will provide viewers with an opportunity to explore the concept of extraction socket management in a clinical setting. Dr Tino Mercado will present a clinical case and explore the stepby-step decision-making tree for this therapeutic area. During the live surgery, Dr Mercado will discuss his approach, clinical considerations and recommendations which have been
ca
er
Viewers will be able to view how best to utilise contemporary biomaterials for hard-tissue augmentation, as well as for soft-tissue management. Dr Chris Ho will moderate the event - providing viewers with additional experience, insight and commentary.
rdo
developed over a number of years of his own clinical practise and research.
in Dr T
o
M
Furthermore, there will be an opportunity to gain direct access to the experts - with a live Q & A session made available to all viewers watching in realtime. We hope you will be able to join us at 7pm AEST for the inaugural Geistlich Live Surgery Broadcast To find out more information on CPD contact the Education team on 1800 776 326
o
Extracting teeth is part of everyday clinical practise. We know that once the tooth has been removed, the inevitable consequence is bone loss. Socket and ridge preservation are some of the easiest methods of hard-tissue preservation and augmentation in future implant sites. If the scientific principles of ridge preservation are properly applied to our daily work - patients and dentists will benefit in several ways.
D
h rC
ri s
H
Tune in to Geistlich-anz.live 21
Upcoming Courses
Dr Paolo Casentini Hands-On Workshop 31 October - Melbourne | 2 November - Sydney | 5 November - Auckland
Prosthetically Guided Regeneration: Novel Techniques in Soft-Tissue Thickening & Customised Bone Augmentation Whilst “Prosthetically Driven Implantology” represents a well consolidated concept today, there is still potential for adverse events related to implant supported reconstruction. The presence of bone defects (horizontal and/or vertical) can negatively influence the 3-D implant position, potentially impacting on the implant success or survival.
The development of CAD-CAM technologies such as individualised titanium meshes (i.e. Yxoss CBR®), as well as novel biomaterials, have helped clinicians combat the challenges faced on a daily basis.
The concept of Prosthetically Guided Regeneration (PGR) has been analysed thoroughly, and treatment options have been devised to deal with complex implant cases involving both bone and soft-tissue defects. The PGR protocol will also allow the classification of different degrees of atrophy, and to select the more appropriate reconstructive technique.
Part 2 (Hands-on) - Attendees will be given the opportunity to trial the use of new biomaterials (Geistlich FibroGide®) and devices (Yxoss CBR® system) that can help the clinician to apply these concepts surgically.
Part 1 (Lecture) - A sequence of clinical cases and HD videos will illustrate this new treatment philosophy.
Geistlich Mini-Symposium 1-2 November | Sydney
Considerations for Ridge Preservation & Solutions for Complex Augmentation Cases The Geistlich Mini-Symposium offers attendees with an opportunity to listen to two world-renowned clinicians talking all things oral regeneration. Assoc Prof Stephen Chen - Lecture 1: The inevitable consequence of tooth extraction is resorption and subsequent modelling of the alveolar bone, with a decrease in the dimensions of the ridge. Bone augmentation is often required to compensate for the loss of bone volume, allow implants to be placed in the correct position and to optimise aesthetics. In contrast, ridge preservation aims to minimise this resorption and to enhance the ability for implants to be placed in the correct restorative position. This lecture will review the evidence for bone
augmentation and ridge preservation procedures, and will outline the techniques involved. A discussion on grafting materials and socket closure techniques will be presented.
biomaterials, have helped clinicians combat the challenges faced on a daily basis. A sequence of clinical cases and HD videos will illustrate this new treatment philosophy.
Dr Paolo Casentini - Lecture 2: The concept of Prosthetically Guided Regeneration (PGR) has been analysed and treatment options have been devised to deal with complex implant cases involving both bone and softtissue defects. The PGR protocol will also allow the classification of different degrees of atrophy, and to select the more appropriate reconstructive technique. The development of CAD-CAM technologies such as individualised titanium meshes (i.e. Yxoss CBR®), as well as novel
Dr Paolo Casentini - Hands-on Workshop: Attendees will be given a more detailed overview of the concept of PGR, with the opportunity to trial the use of new biomaterials (Geistlich Fibro-Gide®) and devices (Yxoss CBR® system) that can help the clinician to apply these concepts surgically.
New at Geistlich
Your Local Geistlich Product Specialist Michael Saadeh Sales Manager - Australia & New Zealand M: 0498 123 555 E: michael.saadeh@geistlich.com.au
Paul Thompson Key Account Manager - Australia & New Zealand
Bridget Keenan Sales and Marketing Specialist New Zealand
M: 0498 123 666 E: paul.thompson@geistlich.com.au
M: +64 21 192 8488 E: bridget.keenan@geistlich.co.nz
Michael O’Callaghan Regional Sales Manager - QLD & NSW
Angela Tascone Regional Sales Manager - WA, VIC, SA & NT
M: 0498 123 222 E: michael.ocallaghan@geistlich.com.au
M: 0498 123 333 E: angela.tascone@geistlich.com.au
Matthew Smith Product Specialist - NSW North
Nicola Sharp Product Specialist - VIC
M: 0498 123 444 E: matthew.smith@geistlich.com.au
M: 0498 123 111 E: nicola.sharp@geistlich.com.au
David Ovsepian Product Specialist - NSW South & ACT
Elke Hovatta Product Specialist - VIC & TAS
M: 0498 123 888 E: david.ovsepian@geistlich.com.au
M: 0498 123 451 E: elke.hovatta@geistlich.com.au
Rebecca Francis Sales Associate - QLD
Charmaine Abuan Sales Support Consultant - AU & NZ
M: 0498 123 452 E: rebecca.francis@geistlich.com.au
P: 1800 776 326 E: charmaine.abuan@geistlich.com.au
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Publisher ©Geistlich Pharma AG Subsidiary Australia / New Zealand The Zenith, Tower A, Level 21 821 Pacific Highway Chatswood NSW 2067, Australia Phone +61-(1)-800 776 326 Phone +64-(0)-800 500 043 Fax +61-(1)-800 709 698 Fax +64-(0)-800 500 044 www.geistlich.com.au www.geistlich.co.nz
GEISTLICH BIOMATERIALS
Photo: ©iStock.com / Cecilie_Arcurs
VOLUME 14, ISSUE 2, 2019
FOCUS PAGE 10
OUTSIDE THE BOX PAGE 24
OUTSIDE THE BOX PAGE 34
Around dental implants.
Gaining bone height.
The quest for stability.
How can surrounding tissues support implant success long-term? Experts discuss proven solutions.
Bone block or GBR? Form-stable membrane or customized titanium scaffold? A discussion for treatment options.
Our science comic shows how the L-shape technique was invented by researchers from Zurich and Barcelona.
LEADING REGENERATION.
100
GEISTLICH NEWS 2-2019
Editorial
What is needed around implants Archaeological findings of Celtic, Egyptian and Etruscan dental implants prove just how important a functional set of teeth has always been.
Photo: Roger Schuler
But how does placing an implant affect the surrounding tissues? And which regenerative measures Âsupport the long-term success of Âimplants? As our body works according to an energy saving mode, the alveolar ridge is resorbed when teeth are lost and the formerly supporting bone becomes useless. But this bone loss poses a problem for placing dental implants. To successfully anchor implants and allow them to function, the alveolar ridge, with its bony and connective tissue components, needs to be rebuilt. Bony regeneration cannot be successful without proper soft tissue regeneration. Bone and soft tissue regeneration must go hand in hand, particularly in the oral cavity, where the risk of infection is high, given the broad bacterial flora. I am convinced that new scientific discoveries by Geistlich Research and Development and external, collaborative laboratories will yield a better understanding of bone and soft tissue regeneration. In vitro, pre-clinical and clinical research will not only pave the way for a better understanding of oral rehabilitation mechanisms but, more importantly, also fuel the development of new products for our patients.
Dr. Birgit Schäfer Executive Scientific Manager
3
Issue 2 | 2019
NEWS
6
Geistlich opens new affiliate in Japan
6 Lab time @ Geistlich 7
A hospital ship serving the poorest
7 Do you have a bright idea? 8
Living cells and bony scaffold united
8 New BioBrief with Yxoss CBR® 9
The best kept secret
9
Happy "Gappy Game" winners in Barcelona
10 Around implants How can surrounding tissues support long-term dental implant success? Our experts discuss regenerative solutions for the daily clinical practice.
FOCUS
11 Essential protection from long-term complications Prof. Stefan Fickl | Germany
14
"It is indispensable to treat peri-implantitits as a whole unit" Dr. Hector Sarmiento | USA
18 Protocols for horizontal and vertical bone defects Dr. Sascha A. Jovanovic | USA
22
Time points for bone and soft tissue augmentation Dr. Andres Orozco, Dr. Ehsan Mellati, Dr. Jeremy Vo | Australia
4
GEISTLICH NEWS 2-2019
34 The quest for stability How to improve volume stability after bone augmentation? Prof. Ronald Jung and colleagues found a solution: the L-shape technique. OUTSIDE THE BOX
24
"Most patients like the idea of getting a customized solution" Interview with Dr. Isabella Rocchietta and Prof. Bilal Al-Nawas
28
Five questions for five experts
30
Micro-beauty of regeneration
31
Crispr/Cas9 - a revolutionary tool
Prof. Su Yucheng | China
Dr. Klaus Duffner
34
The quest for stability A comic story about the L-shape technique
OSTEOLOGY FOUNDATION
36 37
Welcome to THE NEXT REGENERATION THE BOX app launched at Osteology Barcelona INTERVIEW
38 39
IMPRINT Magazine for customers and friends of Geistlich Biomaterials Issue 2/2019, Volume 14 Publisher ©2019 Geistlich Pharma AG Business Unit Biomaterials Bahnhofstr. 40 6110 Wolhusen, Switzerland Tel. +41 41 492 55 55 Fax +41 41 492 56 39 biomaterials@geistlich.ch Editor Dr. Giulia Cerino, Verena Vermeulen Layout Larissa Achermann Publication frequency 2 × a year Circulation 20,000 copies in various languages worldwide GEISTLICH NEWS content is created with the utmost care. The content created by third-parties, however, does not necessarily match the opinion of Geistlich Pharma AG. Geistlich Pharma AG, therefore, neither guarantees the correctness, completeness and topicality of the content provided by third parties nor liability for damages of a material or non-material nature incurred by using third-party information or using erroneous and incomplete third-party information unless there is proven culpable intent or gross negligence on the part of Geistlich Pharma AG.
A chat with Jia-Hui Fu in Barcelona Publishing information
5
Geistlich opens new affiliate in Japan
One highlight of the exhibition at Osteology Barcelona was the "Regeneration Lab." Here, Dr. Lothar Schlösser, Director Material Discovery Research of Geistlich Pharma AG, Switzerland, conducted experiments with our collagen materials and discussed how Geistlich R&D uses our scientific knowledge and can support clinical practice. Instructive, impressive, interactive – and most of the time very crowded! (Ed.)
6
GEISTLICH NEWS 2-2019
Photo: Geistlich Pharma AG
Lab time @ Geistlich
In June 2019 Geistlich Pharma launched its own organization in Japan. “Having our own affiliate in Japan is an outward sign and clear acknowledgement of Asia as a growth region. Japan is set to become another strong pillar in our network,” according to Geistlich CEO Paul Note. As the market leader in regenerative dentistry, from the outset Geistlich has been committed to the technically competent use of its products and consequently provides training and courses for professionals. An extensive education and training offer is also being planned in Japan.
A hospital ship serving the poorest
Do you have a bright idea? Are you advocating a new technique, or do you have an idea for a new biomaterial? There is a feedback section on our website that might be of interest! (Ed.)
Photo: Geistlich Pharma AG
Photo: Mercy Ships
If “Mercy Ships” didn’t exist, someone would have to invent them! The eponymous international aid organization gives hope to patients who are unable to access medical services, particularly specialist surgery. Longer-term benefits are assured by projects offering training programs that enable local specialist personnel to help their communities. Because of the meaningful work carried out onboard, Geistlich Pharma supports the “Mercy Ships” with an annual donation. (Ed.)
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Photo: Geistlich Pharma AG
Living cells and bony scaffold united After more that 30 years from its market launch, Geistlich is still investing in research for its pioneering product Geistlich Bio-Oss®. In this image from the Geistlich Cell Laboratory in Switzerland, bone precursor cells, whose cytoskeletons have been stained red, grow on Geistlich Bio-Oss® particles. Over time the cells form an extracellular matrix on the scaffold. The extracellular matrix unites the Geistlich Bio-Oss® particles to form a solid clot. (Ed.)
New BioBrief with Yxoss CBR® A BioBrief explains a surgical procedure step-by-step, using a case study - and provides important tips that can be applied to other cases. The BioBrief includes a flyer with all information on the patient and treatment, as well as a webinar that includes a surgical video and a case library.
In the latest BioBrief, Prof. Matteo Chiapasco and Dr. Grazia Tommasato demonstrate the regeneration of a vertical and horizontal bone defect in the posterior mandible – integrating digital planning and the CAD/CAM solution Yxoss CBR®.
A surgery movie is part of the BioBrief, focusing on the question of how to perform the releasing incision – a procedure that is key for soft tissue management. (Ed.)
More information:
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GEISTLICH NEWS 2-2019
The best kept secret
Photo: Sooli GmbH
Many people wonder how Geistlich Bio-Oss® is produced. The new film "The best kept secret" reveals part of the secret. Cornel Imhof, Director Material Development and Production Technology at Geistlich Pharma, leads the observer through “black box stations” that the famous bone substitute must pass on its long journey to the dentist. (Ed.)
Happy “Gappy Game” winners in Barcelona
Photo: Geistlich Pharma AG
Geistlich's video game Gappy - Preserve the Ridge has been online during 2018. The highest ranking in the two rounds of play was achieved by Dres. Changdong Kang, Korea, Darren Sue, New Zealand, Marc Faura & Elias Casals, both from Spain and Patricia Risso, Uruguay. They won free entry for the International Osteology Symposium 2019 in Barcelona – where they met Dr. Terance Hart, Director of Research for a get-together. (Ed.)
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Around implants.
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GEISTLICH NEWS 2-2019
Illustration: Quaint
How can surrounding tissues support long-term dental implant success? Our experts discuss regenerative solutions for the daily Âclinical practice.
Soft tissue management around implants
Essential protection from long-term complications Prof. Stefan Fickl | Germany Department for Periodontology Julius-Maximilian University of Würzburg Private practice, Fürth
For long time, soft tissue management was seen as purely esthetic. But around implants both keratinized tissue and sufficiently thick soft tissue have protective functions. In our practice, soft tissue management – in the form of flap advancement, rolled flap, connective tissue or collagen matrix grafting – is part of the treatment in approximately 80 percent of our cases.
What soft tissue conditions are beneficial? In terms of the quality of the surrounding soft tissue, augmenting an approximately 2 mm band of attached keratinized mucosa should be the goal to establish stable, long-term conditions. One review concluded that a lack of adequate keratinized mucosa is associated with more plaque accumulation, tissue inflammation, mucosal recession and attachment loss.1 As to the quantity (thickness and height of the peri-implant soft tissue cover), studies show that thicker peri-implant soft tissue leads to less bone resorption. Thus Linkevicius et al. were able to show that 2 mm thick peri-implant soft tissue induces significantly less crestal bone loss than a soft tissue thickness of less than 2 mm.2 This phenomenon may be explained by the necessary establish-
ment of an apical biological width with thin marginal mucosa and two-part implants. The group was able to show that peri-implant soft tissue augmented with biomaterials behaves in a similar way to "naturally thick” soft tissue.2 It was also determined, using the highest level of evidence (Osteology Consensus Conference), that soft tissue augmentations protect against crestal bone resorption.3 Today it must therefore be concluded that the target for soft tissue thickness should be 2 mm, and the target for attached mucosa also 2 mm (fig. 1).
Techniques for gaining keratinized mucosa Free mucosal transplants are the gold standard for augmenting attached keratinized mucosa. Free mucosal transplants, however, have various other disadvantages in addition to painful removal and the increased risk of complications. These include scarring and insufficient adaptation to the surrounding soft tissue. According to a retrospective case control study from our working group, covering extraction sockets with gingiva punch products produces considerably more scars, contractions and color deviations than the collagen matrix Geistlich Mucograft® Seal.4 We consider Geistlich Mucograft® Seal to be preferable as a closure for extraction sockets.
Techniques for volume thickening Subepithelial connective tissue transplants are the current gold standard for augmenting the volume of soft tissue around implants. However, clinical studies show that
a similar tissue volume can be obtained with a volume-stable xenogeneic collagen matrix (Geistlich Fibro-Gide®).5,6 In this respect this development is interesting for clinicians, as removing subepithelial connective tissue transplants or advancement flap techniques for thickening soft tissue are often very complex and technically sensitive procedures. The introduction of collagenous soft tissue matrices has reduced patients’ surgical burden. These modern methods also allow soft tissue augmentations for increasing tissue thickness in the posterior zone. As an approximate value, the use of the collagen matrix can be assumed to increase soft tissue thickness by 1-1.5 mm. In terms of the 2 mm protective soft tissue thickness requirement, this means that sufficiently thick soft tissue can be achieved in a single soft tissue augmentation.
Points in time The soft tissue can be improved at different times. A Ridge Preservation can be performed immediately after tooth extraction. Using a porcine collagen matrix (Geistlich Mucograft® Seal) for covering the extraction socket can achieve a better and faster soft tissue closure with only minor scarring.4 Soft tissue can also be thickened at the same time as the implantation. In this context Geistlich Fibro-Gide® is a tested means for improving peri-implant soft tissue thickness prior to uncovering implants. Late soft tissue thickening after the implantation can be more difficult. Scientific data show that secondary soft tissue correction brings little success.7 Accordingly, I prefer proactive
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soft tissue augmentation to subsequent correction and from the outset try to avoid the formation of thin or dehiscent soft tissue around a prosthetically treated implant.
All parameters fulfilled The clinical case in Figure 2 shows a patient with a thin and poorly attached mucosa. The aim here was to achieve all the targets required for sufficient peri-implant tissue – 2 mm attached mucosa plus 2 mm soft tissue thickness – by augmenting volume and subsequently managing the soft
tissue. Geistlich Fibro-Gide® was placed at the time of the implantation to allow primary healing beneath the mucosa. Visibly, Geistlich Fibro-Gide® thickened the soft tissue significantly. The collagen matrix Geistlich Mucograft® was then used with open healing at the time the implants were exposed in order to obtain an augmented band of attached mucosa.
“The target for soft tissue thickness should be 2 mm, and the target for attached mucosa also 2 mm.”
Why this approach? As already alluded to, soft tissue formation after a complication, e.g., implant dehiscence and/ or poorly at-
Soft tissue volume
A band of keratinized tissue > 2 mm around an implant is associated with:
A soft tissue volume >2 mm around an implant is associated with:
– Less brushing discomfort 8 – Less plaque 8 – Less inflammation 8 – Less mucosal recession 1 – Less attachment loss 1 – Less early implant failure 9 – Less peri-implantitis 10
– Higher papilla scores 3, 11 – Less mucosal recession 3, 11 – 5-times less crestal bone loss 12
Illustration: Quaint
Keratinized tissue
FIG. 1: Illustration showing the target amout for the attached mucosa and for the soft tissue.
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FIG. 2: Soft tissue augmentation procedure using Geistlich Fibro-Gide速 and Geistlich Mucograft速. B
C
D
E
F
Photos: Stefan Fickl
A
| A Clinical situation with insufficient soft tissue thickness. | B Augmentation of soft tissue thickness with Geistlich Fibro-Gide速 at the time of implant
placement. | C Primary wound closure. | D Partial thickness flap elevation on the buccal side 4 months after implant placement and soft tissue thickening. Note the established thickness of the buccal soft tissue. | E Rolling flap and apically repositioning to position the attached mucosa on the buccal side of the implants. Geistlich Mucograft速 to create additional keratinized mucosa in situ. | F Final reconstruction.
tached mucosa to a prosthetically treated implant, is a difficult and less predictable process. For this reason the above-mentioned soft tissue augmentations prior to prosthetic restoration are key to avoiding middle- and long-term complications.
Conclusion for clinical practice Autologous transplantation of soft tissue may still be the standard technique for improving peri-implant health, but the use of collagen matrices extends the indication and the clinical options for improving soft tissue and ensuring patients a long-term and stable soft tissue peri-implant solution.
References 1
Lin GH, et al.: J Periodontol 2013; 84:1755-67.
2 Linkevicius T, et al.: Clin Implant Dent Relat Res
2015; 17(6):1228-36. 3 Thoma DS, et al.: J Clin Periodontol 2017; 44: 185-194. 4 Fickl S, et al.: Int J Periodontics Restorative Dent
2018; 38:e1-e7. 5 Thoma DS, et al.: Clin Oral Implants Res 2018; 29
Suppl 15:32-49. 6 Zeltner M, et al.: J Clin Periodontol 2017; 44:446-53. 7 Burkhardt R, et al.: JClin Oral Implants Res
2008;19(5):451-7. 8 Souza AB, et al.: Clin Oral Impl Res 2016; 27:650-55. 9 Sarmiento HL, et al.: Int J Periodontics Restorative
Dent 2016; 36(5):699-705. 10 Baqain ZH, et al.: British Journal of Oral and
Maxillofacial Surgery 2012; 50:239-43. 11 Thoma DS, et al.: J Clin Periodontol 2016;
43(10):874-85. 12 Thoma DS, et al.: Clin Oral Implants Res 2014; 41
Suppl 15:S77-91.
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Peri-implantitis
“It is indispensable to treat peri-implantitis as a whole unit” Dr. Hector Sarmiento | USA Department of Periodontics and Implant Dentistry, University of Pennsylvania, Philadelphia. Private Practice, New York Interview conducted by Dr. Giulia Cerino & Verena Vermeulen
Dr. Hector Sarmiento has broad experience in the treatment of peri-implantitis. He recently published a new classification system and a basic treatment protocol with different surgical alternatives. We asked him to share his findings and opinions.
Dr. Sarmiento, how often do you see peri-implantitis in your daily practice? Dr. Sarmiento: A lot of my referring doctors know that I specialize in this area. I would say that around 70 percent of my patients suffer from some sort of biologic complication resulting from an implant in need of repair.
That’s a rather high percentage… Dr. Sarmiento: It is, but you have to remember that the number of those with peri-implantitis is quite high. About ten percent of all implants end up developing
peri-implantitis after eight years. Peri-implantitis bone levels are influenced by not only pathological, but also non-pathological conditions. Our understanding of peri-implantitis has certainly evolved over the past decades. However, its classification is limited to descriptions of disease progression or to classification that involves soft and/ or hard tissues (periimplant mucositis or peri-implantitis).
Is that why you have published a new classification system?1 Dr. Sarmiento: We published the first classification system based on etiology.
Etiology of peri-implantitis1
78.8%
8.5%
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GEISTLICH NEWS 2-2019
Pathogenic bacteria
Iatrogenic factors
Plaque, biofilm, calculus,…
Buccal implant placement, inadequate interimplant distance, …
We wanted to identify various etiologies for peri-implantitis and to establish a classification system based on the pathogenesis.
What were your principal findings? Dr. Sarmiento: Most of the bone loss was related to one of the following factors: 1) biofilm, including iatrogenic factors, 2) exogenous irritants, 3) the absence of keratinized tissue and 4) intrinsic pathology. This classification system allows for the clinician to properly diagnose peri-implantitis based on the etiology. (Fig. 1)
Does this mean adopting therapy based on etiology? Dr. Sarmiento: Indeed. When a diagnosis is related to a bacterial component, the clinician can use nonsurgical or surgical therapies, or a combination of both, to prohibit the further progression of the disease. In addition to creating that targeted therapy, the clinician should have a better sense in predicting intervention and prognosis of the implant. I fully advocate that the determination of the underlying cause of peri-implantitis will strongly aid the clinician in the choice of a successful surgical procedure.
For example, if excess cement were to be found on the implant surface, removing the source should lead to the elimination of the causative factor; thus leading to a regenerative approach. If the implant were to break down from the lack of keratinized tissue, soft tissue enhancement in this case should be considered while decontaminating and repairing the implants.
Could you give us an example? Dr. Sarmiento: If you have an implant with bone loss that is related to an inflammatory response to biofilm, that implant may have a lower efficacy and a diminished long-
2.2%
5.5% 4.8% Exogenous irritants
Absence of k eratinized tissue
Residual cement, smoking, impacted food debris, …
Absence of attached gingiva, lack of keratinizied tissue with or without muscle attachment,…
Extrinsic pathology Proximal periapical pathology, proximal carcinoma ,…
FIG 1: Etiology of peri-implantitis for the implants included in the study of Sarmiento et al.1 (Clinical study, 152 patients, 270 implants).
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term prognosis. On the other hand, if you have an implant that has bone loss related to residual cement, that might be easier to treat, hence leading to a predictable response to treatment and an effective prognosis. Once implants are treated and the surfaces are properly detoxified, the success of a regenerative approach will be dependent upon proper diagnosis but will have a better prognosis.
Are targeted preventions based on etiology also possible? Dr. Sarmiento: They absolutely are! The main cause usually involves bacteria, which is why patients need to be on strict hygiene regimens. As noted in our study,1 78.8% of the cases involving peri-implantitis were related to biofilm or bacteria induced inflammation with bone loss.
Would a better understanding of microbiology help? Dr. Sarmiento: As we continue to conduct more research on peri-implantitis, we must focus on the initiation of the disease progression and its impact on its severity. I believe that understanding the microbiology of peri-implant mucositis has to be the main focus of the prevention of peri-implantitis.
In addition to the classification you have also published a basic treatment protocol followed by different surgical alternatives.2 Dr. Sarmiento: We published the treatment option to have a basic protocol for how to treat peri-implantitis in a predictable manner, especially when it comes to the regenerative approach. The levels of debridement and decontamination are key. (Fig. 2) After proper mechanical debridement and surface detoxification using a combination of chemical solutions and lasers, a bone
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graft should be chosen based on characteristics that the literature have shown us to be superior. When it comes to peri-implantitis, we routinely elect a xenogenic bone substitute. All GBR fundamentals should be taken into consideration, including stabilization of a collagen membrane and tension free repositioning of the soft tissues.
“Understanding the microbiology of peri- implant mucositis has to be the main focus of the prevention of peri-implantitis.” However, none of the surgical approaches proved to be better in terms of probing depth and bleeding on probing… Dr. Sarmiento: Having gathered all our results, we concluded from our investigation that the three different surgical approaches can all be effective in treating peri-implantitis. Nonetheless, an assessment involving risks and benefits that consider both functional and esthetic outcomes of each approach should be carried out.
Risk/ benefit assessment? Dr. Sarmiento: This would entail a detailed clinical and radiographic examination of each patient as well as the use of nonsurgical treatment prior to surgery. After the assessment is done, the elimination of etiology is of extreme importance, followed by the restoration of the health of the implants’ surrounding soft and hard tissue. Lastly, to ensure the most effective longterm outcomes, patients undergoing sur-
gical therapies for peri-implantitis should have three-month maintenance recalls.
Using your regenerative approach, how many implants are you able to maintain over a peri od of about five years? Dr. Sarmiento: We have been able, and it is proven, to be quite successful in saving many implants. As studies have shown, the success rate is high. We too have had a high degree of success, in the over 500 peri-implantitis cases we treated using a regenerative approach with Geistlich Bio-Oss®.
What conclusions can we draw from the etiologic factors? Dr. Sarmiento: According to the classification system, it was evident that many breakdowns occurred due to excess cement. We broadly recommend using a screw retained restoration, however, if that is not possible, the clinician must take all and every precaution when cementing crowns. The clinician also should make sure to follow up periodically with patients by having proper maintenance visits so that the absence of gingival inflammation is ensured. When considering soft tissue, the main priority here is to ensure, not only, that keratinized tissue is present, but attached gingiva is present as well. There are several surgical solutions including new soft tissue graft substitute materials such as 3D collagen matrices that have so far proven to be very successful; providing positive outcomes. Lastly, the clinician can always consider the gold standard in soft tissue augmentation with the utilization of the connective tissue graft and free gingival graft, when appropriate, harvesting the graft from the patient’s own palate.
You have used Geistlich Fibro-Gide® as well…
Dr. Sarmiento: Right, I have actually been incorporating soft tissue enhancement into my treatments for the past four years. It has been pretty challenging to get the patients to agree to a second soft tissue graft harvest procedure, considering they have already had an invasive surgical procedure to save their implants. For a while, I was searching for a biomaterial to replace the harvest grafts. Using Geistlich Fibro-Gide® in the last 13 months has led to significant improvements, facilitating my approach. It has also been a great asset in getting patients to move forward with their treatment plans. In my practice, patients have been more willing to accept the peri-implantitis treatments, once Geistlich Fibro-Gide® was introduced.
Evidence is still rare in this field. How do you communicate this to your patients? Dr. Sarmiento: There is an abundance of published surgical techniques. If the etiological factors of the disease are understood, you will be able to know whether a treatment is predictable or not. A patient has to understand that even when grafting a case that is not so predictable, your goal is still to save the implant. The patient must be informed of every technique being used and the fact that it might
not work for ten years. Understanding that placing implants will not necessarily be a long-term solution is an immensely important idea that has to be shared with the general population. References 1
Sarmiento HL, et al.: Int J Periodontics Restorative
Dent 2016; 36(5):699-705. 2 Sarmiento HL, et al.: Int J Periodontics Restorative
Dent 2018; 38(5):665-671. 3 Berglundh T, et al.: J Clin Periodontol 2018; 45 Suppl
20:S286-S291.
FIG 2: Surgical alternatives for treating peri-implantitis. The basic surgical protocol (pre-medication, flap preparation, debridement, and decontamination) is followed by one of the three options.2
Is there a real clinical need for a soft tissue substitute such as Geistlich Fibro-Gide® in the context of peri-implantitis treatment? Dr. Sarmiento: Of course; I think that because we had been so focused on treating peri-implantitis with just enhancement of hard tissue, we did not realize the deficiencies brought up by soft tissue enhancement. It is absolutely crucial to be treating peri-implantitis as a whole unit involving both soft and hard tissue, which is exactly why we want to move forward with incorporating soft tissue management in treating peri-implantitis.
Pre-medication 2 g amoxicilin (or 600 mg clindamycin) 15 mL 0.12% chlorhexidine
Flap preparation Partial-thickness flap Full thickness flap
What are your opinions on the new peri-implantitis classification from the World Workshop?3 Dr. Sarmiento: I was delighted to see the American Academy of Periodontology working to build more awareness for peri-implantitis. The breakdown when a clinician doesn’t have radiographic history of an implant being treated is so important, and I am glad they highlighted that.
Debridement Gross debridement with ultrasonic device and an implant protective cap and titanium curettes to remove residual cement Fine debridement with titanium brushes
Decontamination
OPTION 1: Regenerative surgery
5% hydrogen peroxide
OPTION 2: Resective surgery
0.9% sodium chloride solution Er:YAG laser
OPTION 3: A pically repositioned flap surgery
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Guided Bone Regeneration
Protocols for horizontal and vertical bone defects Dr. Sascha A. Jovanovic | USA Associate Professor, Loma Linda University Chairman, gIDE Institute, Los Angeles Past-President, European Association for Osseointegration (EAO) Private practice in Implant Therapy and Periodontics, Los Angeles
Dental implant therapy has shown tremendous long-term bone and soft tissue stability when enough bone volume is available at the time of implant insertion. On the other hand, insufficient bone volume around dental implants can be a significant risk factor and negatively affect the longterm prognosis.1 Several techniques for augmenting bone defects have been developed. They include protocols both for bone augmentation before implant placement (two-stage approach) and simultaneously with implant placement (one-stage approach), along with adjunctive materials such as bone blocks, particulate bone substitutes, autologous bone chips, form-stable devices, collagen and dense polytetrafluoroethylene membranes (d-PTFE) membranes, fixation screws and pins and bone harvesting devices.
Guided Bone Regeneration: Backed by science Among the techniques for horizontal and vertical bone augmentation, GBR is one of the most investigated and evidence-based approaches. It produces predictable re-
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GEISTLICH NEWS 2-2019
sults and high, long-term implant survival rates.1,2 Studies show that the survival rates of implants placed into augmented bone do not differ from the survival rate of implants placed into pristine bone.3 The technique is based on sound biological principles with a step-by-step clinical protocol. The surgical complication rate ranges from low to high, categorizing the procedure at times as technique sensitive. The rate of complication largely depends on proper patient selection and diagnosis, detail-oriented surgical steps, careful patient follow-up and optimal choice of biomaterials. For smaller bone defects a simultaneous GBR approach delivers the same results as a staged GBR approach. With large horizontal ridge atrophy and vertical defects, a staged protocol seems to be more predictable and produce better results.4 GBR can be conducted with a 1:1 mixture of autologous particulate bone and anorganic bovine bone substitute (Geistlich Bio-Oss®) in combination with a native collagen membrane (Geistlich Bio-Gide®)
or, for larger horizontal or vertical defects, in combination with a form-stable, titanium-reinforced d-PTFE membrane. The following sections describe the three main protocols used in our clinical practice and our training programs.
GBR Protocol 1: Implant dehiscence and fenestration defects In 1992 we published our first study on the GBR protocol around dehisced implant surfaces in 12 patients,5 and one of the patients who was treated for amelogenesis imperfecta is still in follow-up after 29 years with stable crestal bone and successful implants. In 2018 we published modifications and the results of 45 consecutive cases (63 implants) treated with our layered bone graft and GBR protocol, and followed the patients for 30 months after loading. No patient dropped out of this study, stable bone and soft tissue was noted and no implant or prosthesis failed (see details in Box 1: GBR Protocol 1: Treatment steps).6
“Periodontal problems have to be solved before the treatment starts and compliance with recall intervals has to be guaranteed with minimal to no plaque deposits. ”
GBR Protocol 1: Treatment steps > Periodontal and soft tissue preparation >M id-crestal incision into the keratinized tissue > Elevation of full-thickness flap beyond mucogingival junction and at least 5 mm beyond the bone defect > Two vertical incisions at least one tooth away from the defect >R ecipient site cleared of soft tissue remnants > Autologous bone harvested with a minimally invasive cortical bone collector >D ecortication holes (1 mm bur) at recipient site > I mplants inserted and guided by a surgical template > Exposed threads covered with 2 mm of autologous bone, covered by 2 mm of Geistlich Bio-OssÂŽ and covered by a Geistlich Bio-GideÂŽ > Membrane stabilized with sutures or fixed with titanium pins both on the vestibular and on the lingual/palatal site > Periosteal releasing incisions for tension free flap advancement > Combination of horizontal mattress PTFE suture and single interrupted sutures > Temporization of surgical site with no tissue contact > Uncovering six-months after implant placement and GBR ,with mucogingival procedure to increase soft tissue thickness and keratinization > Preferably simultaneous abutment and CAD/CAM fabricated, screw-retained implant crowns delivered
The key point is to apply this GBR protocol to smaller bone defects, and an accurate CBCT diagnosis is critical for selecting a bone volume between 4 to 6 mm in width. The combination of autologous bone in contact with the implant and anorganic bovine bone on top is the key to success (Fig. 1). While the autologous bone has osteoinductive and osteogenic properties, the anorganic bovine bone maintains the volume and contour in the long-term. ÂCollagen membranes are advantageous compared to expanded polytetrafluoroethylene (e-PTFE) membranes in this indication because of the favorable soft tissue healing and because they do not have to be removed. Their lack of form stability can be overcome by the bone mixture and accurate fixation of the membrane that allows immobilization of the graft material.
GBR Protocol 2: Larger horizontal defects In 1995 we published the use of space-making titanium-reinforced e-PTFE membranes for large horizontal defects and this was later modified to resorbable
FIG. 1: Clinical case pictures of a patient treated in 2007 with a simultaneous resorbable GBR treatment protocol 1 in a thin healed ridge of 4 mm width
showing stable crestal bone and soft tissue margin after 12 years of function.7 B
C
D
Photos: Sascha Jovanovic
A
| A Esthetic implant placement resulted in labial bone dehiscence. | B Simultaneous resorbable GBR procedure with 2-layer bone graft. | C Radiograph
of implant and abutment after 12 years. | D Facial view of restoration on mandibular right lateral incisor following rehydration. Esthetic team work with Dr. Pascal and Michel Magne (Los Angeles, CA).
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GBR Protocol 3: Treatment steps > Full thickness mid-crestal incision into the keratinized gingiva > Vertical incision at least one tooth away from the surgical site (5 mm away in case of an edentulous area) > Reflection of a full thickness flap beyond the mucogingival junction and at least 5 mm beyond the bone defect with a periosteal elevator > Recipient site cleared of soft tissue remnants > Multiple decortication holes into recipient bed with a 1 mm drill > Harvesting of autologous bone and placement of 1:1 mixture of autologous bone and anorganic bovine bone particles, and placement of the graft in the defect area > Covering the immobilized graft with a titanium-reinforced PTFE membrane and fixing it with bone tacks or screws > Maxillary vertical cases can be combined with a sinus floor elevation to achieve additional apical bone height > If the edges of the membrane are not well adapted, a bilayer collagen membrane (Geistlich Bio-GideÂŽ) is put over the non-resorbable membrane to close any open space in the grafted area > Periosteal releasing incision > Suturing of the flap in two layers (tension-free): horizontal mattress sutures 4 mm from the incision line, single interrupted sutures to close the edges of the flap and leave at least a 4 mm thick connective tissue layer between the membrane and the oral epithelium (to prevent exposure of the membrane) > Closure of vertical incisions with single interrupted sutures > Implant placement 9 to 12 months later
membranes in one-wall large horizontal defects.8 For these larger horizontal defects, a staged GBR procedure is safer and more predictable than a simultaneous GBR and implant approach. The bone graft (now a larger volume mixture of autologous bone and anorganic bovine bone) can be covered with a native collagen membrane (Geistlich Bio-GideÂŽ) or with a titanium-reinforced d-PTFE membrane depending on the severity of the bone deficiency. In general, one-wall large buccal defects with a CBCT bone width of 3 to 4 mm can be grafted and covered with a collagen membrane fixed with pins both lingually/ palatally and buccally. In cases with severe two-wall horizontal resorption and with a CBCT bone width of less than 3 mm the autograft/bone substitute mixture is cov-
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GEISTLICH NEWS 2-2019
ered with a non-resorbable d-PTFE membrane fixed with screws on the periphery. Healing periods of six to eight months are used in this GBR protocol, and over 5 mm of new horizontal bone is created, as evidenced in multiple clinical studies.9,10 This creates enough bone width for predictable implant placement. Soft tissue management before, during and after the GBR technique is essential to ensure healthy, thick soft tissue for tension-free flap closure and to create enough keratinized tissue for implant success.
GBR Protocol 3: Vertical bone defects Vertical ridge augmentation is the most challenging of the GBR protocols, as it
aims to regenerate large amounts of vertical and horizontal bone with little or no bone walls to use as a base for the bone formation. For the blood supply to reach the full distance from native bone into the outer part of the grafted area and for complete mineralization to take effect, a longer healing period of 9 to 12 months is needed. In addition, to protect the bone graft from soft tissue invasion during the healing period, a space making device with long-term cell exclusion and a thick and advanced soft tissue flap is needed to provide a closed healing environment for the GBR-grafted area (Fig. 2). When treating vertical bone defects, a titanium-reinforced e-PTFE membrane was designed, and we tested the first prototype designs in 1993 and published for the first time in 1995 in our animal and human studies.8-11 The large amount of clinically documented cases has shown that a maximum vertical gain of 12 mm is possible with a mean of more than 5 mm and a horizontal gain of 8 to 10 mm, which is sufficient in most cases to place an implant in the optimal esthetic position. (see details in Box 2: GBR Protocol 3: Treatment steps). 12,13
Key to success Placing an implant into vertically augmented bone is rather challenging, because the bone is still early in its mineralization nine months after augmentation. Therefore, implant placement in this indication should be done by an experienced surgeon, and implant selection has to be performed carefully. As in all GBR procedures, it is mandatory to select the right kind of patient for this challenging procedure. Periodontal problems have to be resolved before the treatment starts, and compliance with recall intervals has to be guaranteed with
FIG. 2: Clinical case pictures of a patient treated with a non-resorbable d-PTFE staged GBR protocol
3 treatment for a severely vertical resorbed ridge in the anterior maxilla. A
D
GBR Key to Success: gIDE Institute Protocol
E
B
Photos: Sascha Jovanovic
C
| A Buccal view of a vertical defect in the anterior maxilla. | B Vertical augmented ridge result after
9 months at d-PTFE removal time and implant placement. | C Final esthetic work with stable gingival margins performed by Dr. Mintrone (Sassuolo, Italy). | D Radiograph of the regenerated bone, tooth 12. | E Radiograph of the regenerated bone, tooth 22.
minimal to no plaque deposits. Regarding bone graft biomaterial, we always stick with the proven combination of autologous bone plus xenogeneic bone substitute – for the combination of osteoinductive properties and long-lasting volume stability – plus collagen or PTFE membranes depending on the defect (horizontal/vertical/combined). The need for and benefit of adding platelet-rich plasma (PRP) or platelet-rich fibrin (PRF) is still to be fully seen but has possible early wound healing benefits that could help with flap closure. (see details in Box 3: GBR Key to success).
References 1
Lutz R, et al.: Clin Oral Implants Res 2015; 26 Suppl 11:103-22.
2 Sanz-Sanchez I, et al.: J Dent Res 2015;
94:128S-142S. 3 Donos N, et al.: J Clin Periodontol 2008; 35:173-
202. 4 Meloni SM, et al.: Clin Implant Dent Rel Res 2017;
19:38-45. 5 Jovanovic SA, et al.: Int J Oral Maxillofac Implants
1992; 7(2):233-45. 6 Meloni SM, et al.: Eur J Oral Implantol 2018; 11(1):
89-95. 7 Magne P, et al.: J Prosthet Dent 2008; 99(1):2-7. 8 Jovanovic SA, Nevins M: Int J Periodontics Restor-
ative Dent 1995; 15(1):56-69. 9 Urban IA, et al.: Int J Periodontics Restorative
Dent 2013; 33(3):299-307. 10 Urban IA, et al.: Int J Oral Maxillofac Implants
2011; 26(2):404-14. 11 Jovanovic SA, et al.: Int J Oral Maxillofac Implants
1 Establish periodontal health in natural dentition 2 Prepare soft tissues in the GBR/implant site before, during and/or after treatment to increase mucogingival thickness and keratinization 3 Full-thickness flap elevation (remote or papilla preservation) 4 Clean and perforate bone surface 5 Release periosteum to advance flap and achieve tension-free closure 6 Trim membrane - native collagen (horizontal GBR) or d-PTFE (horizontal/vertical GBR) 7 Harvest autologous bone with scraper and place in saline/ blood 8 Prepare anorganic bovine bone substitute with saline/ blood 9 Mix bone graft in a 1:1 ratio of autograft and anorganic bovine bone substitute 10 Apply and fix membrane with suture/tacks/screws 11 Place bone graft mixture 12 Adapt and fix membrane to cover the complete bone graft 13 Advance flap and close using PTFE suture with horizontal mattress and single interrupted suture 14 Temporize site with no tissue contact 15 Allow healing period of 6+ months for horizontal GBR cases and 9+ months for vertical GBR cases
1995; 10(1):23-31. 12 Urban IA, et al.: Int J Oral Maxillofac Implants
2014; 29:185-93. 13 Simion M, et al.: Clin Oral Implants Res 2001; 12(1):35-45.
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Which measure when?
Time points for bone and soft tissue augmentation Dr. Andres Orozco | Australia Periodontist – Periodontics & Dental Implant Centre Indooroopilly
Many combinations of bone and soft tissue management sequences are possible. Clinicians offer their preferred approaches after tooth extraction, discussing indications and advantages. RIDGE PRESERVATION & SOFT TISSUE MANAGEMENT > LATE IMPLANT PLACEMENT
Technique Dr. Orozco: The tooth is removed as atraumatically as possible1 and the socket cleaned. Ridge Preservation (RP) is done with Geistlich Bio-Oss® granules, and the socket is covered with Geistlich Mucograft® Seal. After a minimum of 6 months, I insert a single-stage dental implant with a narrow healing abutment plus a SCTG on the buccal aspect to thicken the soft tissue before closing the flap. Shaping is done at the osseointegration check, 3 to 4 months post implant placement. Dr. Mellati: I use Geistlich Bio-Oss® granules for large defects and Geistlich Bio-Oss® Collagen for smaller defects. Geistlich Bio-Gide® is used for damaged or
Dr. Ehsan Mellati | Australia Periodontist – Precision Periodontics Chatswood
missing buccal wall. In the esthetic zone, I may use SCTG or FGG for soft tissue augmentation. If some part of the implant will end up in native bone at the time of placement, I would wait 4-6 months. If implant is going to be placed in 100% grafted bone, I would wait 6-9 months. Dr. Vo: In terms of soft tissue management during RP, FGG works a little better, as it is more robust to suture, particularly where access is more difficult. I would use Geistlich Mucograft® Seal for anterior sites. Following RP, waiting 6 months is enough before implant placement; 9 months would be more appropriate for staged augmentation. When and why? Dr. Orozco: RP performed at the time of extraction minimizes the need for further bone augmentation. Soft tissue management with Geistlich Mucograft® Seal ensures a good amount of keratinized tissue for later implant placement. Dr. Mellati: Mainly for anterior sites when early placement cannot be considered, e.g. due to large defects of endodontic origin. Dr. Vo: I stage the approach in cases of soft tissue deficiency or if the patient intentionally wants to delay implant placement. RIDGE PRESERVATION > LATE IMPLANT PLACEMENT WITH GBR & SOFT TISSUE MANAGEMENT
Dr. Jeremy Vo | Australia Periodontist – Australian Dental Specialists Sydney
Technique Dr. Orozco: With a significant defect in the buccal bone wall, I perform RP with Geistlich Bio-Oss® granules and Geistlich Bio-Gide®. I prefer Geistlich Bio-Oss® Collagen if I need to enter earlier (6 rather than 9 months). At the late implant insertion, I perform further augmentation in conjunction with the implant placement, using Geistlich Bio-Oss® granules and Geistlich Bio-Gide® for the minor GBR procedure. I shape Geistlich Bio-Gide® with a biopsy punch, and then place it over the abutment, to protect the newly augmented region from soft tissue infiltration. SCTG is used to provide a peri-implant contour and "bulk-up" the tissue. Dr. Mellati: When RP is done at the time of extraction, GBR is rarely needed at the time of implant placement in posterior areas. In anterior areas, sometimes further GBR and soft tissue management is needed – espec ially in esthetically demanding cases. When and why? Dr. Orozco: When socket wall defects are present and/or when traumatic tooth extraction is unavoidable. Although RP does not prevent later GBR, it is still less invasive and allows for sufficient soft tissue volume. Dr. Mellati: When further GBR is required after RP, it is mostly for contour augmentation to achieve a better soft tissue profile. Simultaneous GBR and soft tissue management using SCTG is surgically challenging,
so I rather separate these two procedures and "create one miracle at a time." RIDGE PRESERVATION > DELAYED IMPLANT PLACEMENT & SOFT TISSUE MANAGEMENT
Technique Dr. Mellati: SCTG is sutured to inside of the flap in a way to add volume to the both buccal and crestal dimensions. Once Geistlich Fibro-Gide® is launched, it would make a useful alternative in such situations. Dr. Vo: With Geistlich Bio-Oss® Collagen and Geistlich Bio-Gide®. I will be happy to try Geistlich Fibro-Gide® when it is available in Australia. When and why? Dr. Mellati: Soft tissue management is more commonly needed in anterior sites. In posterior sites, it may be needed where there is very limited keratinized tissue. In such cases, apically repositioned flaps plus Geistlich Mucograft® can be used instead of FGG. Dr. Vo: To develop the peri-implant profile. Use in anterior sites is indicated, as it will enhance esthetics. IMMEDIATE IMPLANT PLACEMENT & GBR &
Bio-Oss® granules between the implant and the buccal plate. A SCTG is placed on top of the graft material, then a customized or anatomical healing abutment is delivered to seal the socket. This allows for the retention of the contour and anatomy of the pre-existing soft tissues.2 Dr. Mellati: I am not a big fan of IIP. If indicated, I do a flapless approach and use either Geistlich Bio-Oss® or Geistlich Bio-Oss® Collagen for supplementary filling in the jumping gap, and use SCTG for bulking up the soft tissue profile. I follow this with immediate provisionalization. Dr. Vo: A split-thickness flap is required with a design based on the GBR area and the amount of access needed. A SCTG is used for the soft tissue management component. When and why? Dr. Orozco: It is my preferred option. We can use as much of the existing bone as possible, and, in many cases,3 it does not involve flap elevation. The socket walls must be undamaged, and primary stability must be achievable. Placing bone substitute reduces/compensates resorption of the buccal bone after the immediate implantation in fresh extraction sockets.4
EARLY IMPLANT PLACEMENT & GBR & SOFT TISSUE MANAGEMENT
Technique Dr. Mellati: Performing GBR and simultaneous soft tissue management is surgically challenging, and I prefer to separate these procedures. When and why? Dr. Mellati: Early placement is my preferred method for most anterior sites. If soft tissue augmentation is required in addition to GBR, I tend to leave it for the second stage (implant uncovery). Dr. Vo: Not regularly, due to the nature of the flap required for each individual procedure. Rather, I prefer to augment the soft tissue at a later stage, often with a rolling flap.
References 1
Oghli AA, Steveling H: Quintessence Int 2010; 41(7):605-9.
2 Tsuda H, et al.: J Oral Maxillofac Implants 2011; 26(2):427-36. 3 Sanz I, et al.: Clin Oral Implants Res 2012; 23 Suppl 5:67-79. 4 Sanz M, et al.: Clin Oral Implants Res 2017; 28(8):902910.
SOFT TISSUE MANAGEMENT SIMULTANEOUSLY
Technique Dr. Orozco: The implant is placed directly after tooth extraction, and I use Geistlich
Dr. Mellati/ Dr. Vo: If a strict set of criteria is met - intact socket walls, good palatal/lingual bone to achieve primary stability, thick tissue phenotype, and no large infection.
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OUTSIDE THE BOX
Gaining bone height
“Most patients like the idea of getting a customized solution� Interview with Dr. Isabella Rocchietta and Prof. Bilal Al-Nawas conducted by Dr. Marcelo Calderero and Verena Vermeulen
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Photo: Geistlich Pharma AG
Bone block or GBR? Form-stable membrane or customized titanium scaffold? We discussed vertical ridge augmentation treatment options with two experts: Dr. Isabella Rocchietta, United Kingdom and Prof. Bilal Al-Nawas, Germany.
FIG. 1: Yxoss CBR® is an innovative customized
3-D printed titanium scaffold for regeneration of complex bone defects. ReOss® (manufac turer) offers the option of integrated prosthesis positioning in the surgical planning.
What was the first technique you learned and practiced for vertical ridge augmentation? Dr. Rocchietta: I began with GBR, and though I have tested other techniques, I will probably stay with that approach. Prof. Al-Nawas: Maxillofacial surgeons are always trained first with bone blocks, but later I learned about titanium meshes and the GBR concept.
Two recent reviews compare techniques for vertical ridge augmentation and come to the same conclusion: distraction osteogenesis has the highest bone gain, but also the highest complication rate.1,2 Is there a trade-off between gain and predictability? Prof. Al-Nawas: I wouldn’t say so. It is difficult to compare techniques, such as distraction osteogenesis and GBR based only on those two parameters. There are other factors. Undergoing distraction osteogenesis is much more intense and time consuming for the patient than un-
dergoing GBR. Although simple numbers might suggest superiority of one technique over the other, such a conclusion would be an oversimplification. Dr. Rocchietta: I agree. For example, sometimes systematic reviews can be difficult to interpret, because the numbers shown are the average mean. But every, single surgical procedure is related to the surgeons themselves. Which technique works well depends on the indication and on the surgeon’s skills, his or her experience and learning curve.
Bone blocks are still very common for vertical ridge augmentation. Looking at the data, is this still justified? Prof. Al-Nawas: Their resorption pattern and differing quality make blocks unpredictable. We don’t know whether they turn into vital bone or not. With the allogeneic bone blocks we have further problems. We don’t know which patients they come from, which drugs those patients used, and so on. These factors might have an impact on treatment outcome.
GBR is the more predictable approach? Dr. Rocchietta: Definitely. The combination of a particulate material – for example, autologous bone chips mixed with anorganic bovine bone particles plus a form-stable element – makes more sense from a biological perspective.
Several form-stable elements are currently available – titanium scaffold, e-PTFE membrane, bone shield, etc. Prof. AlNawas, you use the customized titanium scaffold Yxoss CBR® in your daily practice. Do you see an advantage compared to other options? Prof. Al-Nawas: Advantage may not be the right word, because there is never one technique that is better than others. It’s rather a question of what a surgeon is used to and can handle. But as I treat many patients with complex defects - comprising more than three teeth or a curved area of the alveolar process – I benefit from the fact that Yxoss CBR® is, in those cases, rather straightforward to use.
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“The preplanning approach allows the patient to be more involved in the decision-making process.” Prof. Bilal Al-Nawas
What feedback do you get from your patients when you use Yxoss CBR®?
As you said, this option involves extensive digital preplanning. Do you see a trend towards more planning and fewer onsite decisions? Prof. Al-Nawas: Yes. The planning becomes longer, the surgery time shorter. The benefits of this are more precision, fewer complications and more predictability also with regards to cost. Two treatment options, such as placing short implants vs staged augmentation with long implant placement, have different costs, and the decision for one approach or the other should not be made after opening the flap, to be dramatic. The preplanning approach allows the patient to be more involved in the decision-making process.
Dr. Rocchietta: In countries such as the United Kingdom, where I practice, this is also a legal requirement. We must provide proof that we have preplanned a patient’s case and have informed him or her accordingly. The preplanning – be it digital or with a plastic model – allows us to better visualize the case and in greater detail than by simply opening a flap and “having a look.”
Dr. Rocchietta, you primarily work with titanium-reinforced membranes. What are the advantages? Dr. Rocchietta: These membranes are very straightforward to use. The preplanning might take less time compared to, for example, Yxoss CBR®, because after choosing the appropriate size, dimension and shape, the membrane can be easily adapted on-site. The surgeon does not have to wait for a material that is customized elsewhere.
3.46 mm
12.1%
4.18 mm
23.9%
8.04 mm
47.3%
Prof. Al-Nawas: There are several aspects that make this approach appealing to them. First, the result of the digital planning I show them to explain the treatment. This is crucial. If patients do not understand the treatment, they do not understand possible complications and cannot help with better healing. Sec-
ond, most patients like the idea of getting a customized solution created especially for them. And third, 3D printing has a modern, impressive appeal.
Mean bone gain Complication rate Distraction osteogenesis
Guided Bone Regeneration (GBR)
Bone blocks
FIG. 2: Mean bone gain and complication rate associated with common procedures for vertical ridge augmentation.1
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Photo: Geistlich Pharma AG
FIG. 3: Bone block or GBR? Dr. Isabella Rocchietta (left) and Prof. Bilal Al-Nawas (right) discuss the topic.
“Several elements are key to vertical ridge augmentation success and they depend on proper training, surgical skills and experience.” Dr. Isabella Rocchietta
Prof. Al-Nawas: I agree. The PTFE membranes, however, have limitations, for example, for large or complex cases.
You are both very experienced surgeons. Is it conceivable we might one day have a technique for vertical bone augmentation that makes the treatment predictable for less experienced surgeons?
Dr. Rocchietta: Very true. When the defect is so large that one membrane is not enough, this concept is no longer straightforward. One needs to combine several membranes, adapt them to one another while avoiding open spaces. In my opinion, here the Yxoss CBR® concept with its prefabricated one-piece titanium scaffold has very clear advantages.
Dr. Rocchietta: This would be a very difficult and risky statement from my perspective. There are several elements that are key to vertical ridge augmentation success. One very important factor is soft tissue management. These key elements depend on proper training, surgical skills and experience. The form-stable device is only one part of the treatment. Choosing one device over the other will not
From my perspective it’s also easy to remove the membrane, easier than removing a titanium grid.
make it much simpler per se. What we can achieve, however, is shorter surgery time, fewer complications and more predictability. Prof. Al-Nawas: I absolutely agree. References 1
Urban IA, et al.: J Clin Periodontol 2019 22. [Epub
ahead of print] 2 Saletta JM, et al.: Int J Oral Maxillofac Surg 2019;
48(3):364-72.
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Points of view
Five questions for five experts We asked five renowned clinicians to answer five questions about bone regeneration. Results: 25 professional and personal insights.
Prof. em. Niklaus P. Lang | Switzerland
Prof. Lisa Heitz-Mayfield | Australia
University of Bern
University of Western Australia
Bone regeneration: I am expecting that…
Bone regeneration: I am expecting that…
We may get advances as our knowledge increases on the molecular level of wound healing. The addition of predictable growth factors and their dosage in a particular procedure needs further study.
There will be advances in the fields of bioactive materials and personalized 3D engineered grafts. As part of a push toward personalized medicine, I expect new materials and techniques.
Bone biology: I would like to discover…
Bone biology: I would like to discover…
A factor that determines the speed and quality of bone formation in the wound healing sequence.
The key factors in enhancing angiogenesis to enable predictable bone regeneration in compromised situations such as osteoporosis and diabetes.
And I would like to have discovered… The first BMP to influence wound healing in bony lesions.
Your opinion about 3D-printing ? It is in a very experimental stage of development. It needs years to get realistic treatment outcomes.
The happiest moment of my career was when I… I met Harald Löe, Sigmund Ramfjord and Jan Lindhe. Regarding the clinical activity, it was to witness the first ever bone augmentation in a human jaw under the influence of Prof. Sture Nyman.
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And I would like to have discovered… Osseointegration.
Your opinion about 3D-printing? An exciting approach to individualizing reconstructive techniques for challenging situations.
The happiest moment of my career was when I… Shook hands with my PhD opponent Prof. Jan Lindhe following the successful defense of my thesis “Regeneration in periodontal and endosseous implant treatment.”
Dr. Tara Aghaloo | USA
Dr. Bo Chen | China
Prof. Reinhard Gruber | Austria
UCLA School of Dentistry
Beijing University School of Stomatology
University Clinic of Dentistry Wien
Bone regeneration: I am expecting that…
Bone regeneration: I am expecting that…
Bone regeneration: I am expecting that…
Regenerative solutions will tackle both hard and soft tissue of alveolar ridge defects.
3D printing of bone augmentation procedure will enable more predictable results in critical situation for implant placement.
New therapies will be based on the fundamentals of bone biology and considering the regional anatomic domains.
Bone biology: I would like to discover…
Bone biology: I would like to discover…
How to achieve predicable vertical bone augmentation in our daily practice.
The intrinsic properties of bone that explains the favorable properties of graft consolidation.
And I would like to have discovered…
And I would like to have discovered…
The 3D prefabricated titanium mesh with easy removal for severe vertical bone defects.
The role of osteocytes in the control of bone turnover and bone regeneration.
Your opinion about 3D-printing ?
Your opinion about 3D-printing ?
It will facilitate bone augmentation for severe bone defect - either by 3D-printing of titanium mesh or of bone block substitute.
In personalized medicine, there is a growing interest in future clinical application of 3D printed scaffolds. Biology cannot be easily customized.
Bone biology: I would like to discover… The genetic link to alveolar bone atrophy.
And I would like to have discovered… Runx2, a key transcription factor important in osteoblast differentiation.
Your opinion about 3D-printing ? I think this is the future of bone augmentation. However, I don’t think that we have the materials that can meet our regenerative requirements at this time.
The happiest moment of my career was when I… Received my first research grant. It was so much work and so much effort, and it really improved my confidence in my research and writing abilities. I knew at that point that I wanted to be both a surgeon and a scientist.
The happiest moment of my career was when I… Achieved a successful bone regeneration in a patient with a severe defect. It enabled ideal implant placement by bone substitute and membrane, avoiding the harvesting of extra oral donor site.
The happiest moment of my career was when I… Was formally appointed Professor for Oral Biology, apart from the birth of our three children – Lilly, Theo and George.
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Histology
Micro-beauty of regeneration Prof. Yucheng Su | China Director of Dental Implant Center, Peking Union Medical College Hospital (PUMCH)
“Micro-beauty of regeneration, paint your palette blue and red. Shadows on the sea, sketch the sun and the cloud. A melody rose from the bottom of my heart.” The resorbable collagen membrane Geistlich Bio-Gide® was applied to cover an intraosseous defect prepared in the area of the rabbit’s iliac. After two months, uneventful healing with new bone formation guided by the membrane was noted. Histologic observation revealed that the membrane had covered the newly formed bone in the early stage of healing to provide a protected environment for bone regeneration (Fig. 1, HE, x13). The porous structure of the membrane became the scaffold for osteoblast cells to grow and to secrete osteoid (Fig. 2, HE, x33). References 1
Su Yucheng. Implant Dentistry[M]. People’s
Photos: Yucheng Su
Medical Publishing House 2014:465-65.
FIGS. 1, 2: Hematoxylin and eosin (H&E) staining after GBR procedure using Geistlich Bio-Gide® in New Zealand rabbit model.1
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A revolutionary genetic tool
Photo: ©iStock.com/undefined
In the past few years a new gene splicing method has fundamentally changed the game for genetics: Crispr/Cas9. These “gene scissors” allow DNA genome building blocks to be modified with previously unimaginable precision.
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Dr. Klaus Duffner
At the end of November last year there was an international outcry: Chinese biophysicist Hè Jiànkuí from the University of Shēnzhèn reported the birth of twin girls whose genetic makeup had been genetically modified in the embryonic stage so that they were resistant to HIV. Shēnzhèn University was “profoundly shocked” by this transgression, and countless scientists and politicians were likewise outraged. Shortly afterwards the public authorities arrested Hè, and he is facing punishment. This manipulation of the genome was made possible by a new technique that is considered one of the greatest developments in molecular biology: the “gene scissors” Crispr/Cas9.
In the beginning: Bacteria fight off viruses As is so often the case with groundbreaking discoveries, Crispr/Cas9 began with
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an observation: bacteria can effectively defend themselves against hostile viruses. This defense is based on the so-called Crispr/Cas system. When a virus binds to a bacterial cell and injects its genetic material, a short section of it is inserted between the Crispr sequences of the bacterial DNA. These sections are a kind of library of all pathogens the cell has confronted in the past. In the event of a new infection, Crispr/Cas provides a “memory” for the bacteria’s defense against infection, enabling it to cut up the virus and render it harmless. This library is preserved for generations, because it is passed on from the bacterium to its descendants. Thus, as with epigenetics an acquired property is inherited – a mechanism that violates Darwin’s concept of evolution. Today we know that about onehalf of all known bacteria have a Crispr/ Cas defense system. Depending on the type, two large Crispr/Cas classes are distinguished. Class-I systems comprise protein complexes consisting of many molecules, whereas class-II systems comprise only one cutting protein each.
Targeted mutations In 2011 and 2012, Emmanuelle Charpentier and Jennifer Doudna of Berkeley University, California, published the basic research results on bacterias’ Crispr/ Cas9 defense in the leading profession-
“Crispr/Cas9 and other methods of ‘genome editing’ promise a plethora of application possibilities.” al journals Nature and Science. One year later, Zhāng Fēng of the Broad Institute of Cambridge published how the method can be applied to higher organisms as well, for Crispr/Cas9 works not only in bacteria but also in cells with nuclei, i.e., in plants, animals and humans. The Crispr/Cas system is based on three components: 1) A short RNA molecule serves as a genetic recognition sequence. Such a “probe” can be produced relatively
easily and matches the nucleotide pattern of the respective DNA target sequence. 2) It is linked to the so-called tracrRNA. 3) This RNA complex in turn attaches itself as a “guide” to an enzymatic cutting tool, the Cas9 protein. This completes the molecular “gene scissors” consisting of RNA recognition sequence, tracrRNA and Cas9 scissors. Now the triple complex binds to a specific location on a target DNA and cuts it up with the Cas9 scissors. The American scientists realized the potential of this mechanism. Since the recognition RNA sequence can be varied easily, it is now possible to determine exactly where the molecular gene scissors bind and cut the target DNA. It is true that a cell is able to repair such a cut; however, this repair is usually incomplete, resulting in reading errors. In other words, by cutting up the target DNA, genes can be specifically “switched off.” In addition, individual DNA building blocks or larger functional DNA sections can also be inserted into the cut, and thus completely new properties implanted very precisely into the genome.
No chance for chance Crispr/Cas9 and other methods of socalled “genome editing” promise a plethora of application possibilities. In plant and animal breeding, for example, geneticists are trying to create more productive or disease-resistant varieties and breeds. These include, for example, mildew-resistant wheat, starch-enriched
corn or potatoes that can be stored at low temperatures. The basic mechanism – induction of a double-strand break and subsequent cellular repair – is the same mechanism that follows natural mutations. Mutation breeding in plants is likewise based on this process. Previously, however, such breaks were triggered in an uncontrolled manner, often through irradiation or chemicals. So it was a matter of chance at which point in the genome of a plant the new, additional gene might be integrated. With genome editing and especially with Crispr/Cas9, results are no longer left to chance, because editing occurs at single, pre-determined points. However, even with Crispr/Cas9, unintentional mutations can occur, albeit rarely. Since such so-called “off-target” mutations might have serious consequences, especially in the medical field, scientists have cautiously continued the development of Crispr/Cas9 and other protein scissors to improve accuracy. For example, new Crispr/Cas9 variants cut only a single DNA strand, which significantly reduces the number of missing or additional base pairs (22). If the two single strands are cut at staggered positions, producing “sticky ends,” i.e. DNA ends with complementary over-hangs, the accuracy of the genetic modification is significantly improved.
Many things still remain unclear For years scientists have been trying to address certain diseases by specifically altering the genetic makeup, but mostly unsuccessfully. Since the discovery of the Crispr/Cas9 system, hopes have risen. The first positive results have been reported: a treatment for Duchenne muscular dystrophy (DMD). This condition is based on the mutation of a gene that produces the protein dystrophin – an im-
portant component of muscle fibers. After a Crispr/Cas9 treatment, slightly elevated levels of the protein could be detected. In initial clinical studies, the new genome editing methods have also been tested in HIV and cancer patients. However, scientists are still struggling: so far gene repair works in comparatively few human cells, since the repair mechanism is active only in reproducing cells; but most cells in the body do not replicate. In addition there is a question of how to get the gene scissors to their site of action within the body’s cells. Both the stomach and the immunocytes in blood destroy such proteins. It is possible that vehicles such as nanoparticles (e.g., liposomes) might be able to transport Crispr/Cas9 molecules directly inside cells. Harmless or artificially inactivated viruses are also being tested as transport vehicles. Whether defective genes already in the germ line should be repaired – i.e., in egg and sperm cells or in embryos, as seems to have happened to the Chinese twin girls – is highly controversial, for ethical reasons. Most scientists disagree with this approach, since it would pave the way to “designed humans.” Literature 1 https://www.transgen.de/forschung/2564.crispr-genome-editing-pflanzen.html 2 https://www.mpg.de/11033456/crispr-cas9-therapien 3 https://www.spektrum.de/wissen/wie-funktioniert-crispr-cas9/1441060 4 https://www.pharmazeutische-zeitung.de/ausgabe-442016/das-zellulaere-baukastensystem/ 5 https://www.die-debatte.org/genchirurgie-medizin/ 6 https://www.transgen.de/aktuell/2595.nobelpreis-crispr-patente.html
FIG. 1: Genetically modified plants. Photo: ©iStock.com/Pogonici
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© Studio Nippoldt, Berlin
References: see page 39 OUTSIDE THE BOX
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Osteology Barcelona 2019
Welcome to THE NEXT REGENERATION Basil Gürber | Osteology Foundation
In April 2019 Barcelona was the place to be for everybody interested in oral regenerative therapies, with the International Osteology Symposium attracting 2,800 scientists and clinicians from more than 70 countries around the world.
Session to a targeted audience. When asked about the Case Session, Araújo said, “With this interactive format, participants had the opportunity to get the best out of their cases. They shared their knowledge and expertise, discussed the cases with colleagues from all over the world and got recognition for the excellent work they do.”
The International Osteology Symposium was held for the 6th time between 25–27 April, 2019, in Barcelona. Under the motto “THE NEXT REGENERATION,” the congress covered the latest technologies, developments and techniques in the field of Oral Regeneration, and included hands-on workshops, the Research Forum, the first Case Session and the launch of THE BOX app.
The congress in beautiful Barcelona drew to a conclusion. The city embodied modernity, culture, freshness and the light of the Mediterranean Sea. All of this, combined with the quality of the scientific program and professional networking of the Osteology Foundation’s International Symposia, was a great cocktail for a successful symposium.
The scientific program Together with the Foundation’s Education Committee, the two Chairmen of the symposium, Christoph Hämmerle, Switzerland, and Maurício Araújo, Brazil, put together a program covering all aspects of oral regeneration, including the latest developments in techniques and technologies, while also giving the next generation of experts the opportunity to present.
Linking Science with Practice in Regeneration Discussing the next generation of technologies, developments and techniques also includes covering the latest results from research. Part of the program was dedicated to science. More than 288 posters were displayed in the exhibition, and on Friday the authors of the six best abstracts in both clinical and basic research presented the content of their posters in the Research Forum. In addition the outcome of the XIII European Workshop of the European Federation of Periodontology in collaboration with the Osteology Foundation, a consensus conference on bone regeneration, was presented and discussed. All with the goal of ensuring that clinicians can orient themselves in the science of regeneration.
For the first time: Case Session and Competition Prior to Osteology Barcelona, participants were invited to submit a clinical case to THE BOX and participate in the first Case Competition at an International Osteology Symposium. 178 cases in six competitive categories were submitted. The jury assessed the cases based on the outcome and criteria, such as creativity and originality of the treatment and the biological principles behind the technique. The winner in each of the competition categories received a free registration for the congress and presented their case in the Case
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2800 partic ipan 70 countrie ts s 5 hands-on workshops 178 cases 288 posters
Osteology Barcelona 2019
THE BOX app launched at Osteology Barcelona Basil Gürber | Osteology Foundation
To create an even better interactive experience, the Osteology Foundation launched the app version of THE BOX. Among established features like the symposia and the newsfeed function, an augmented reality interface has been integrated into the app. It is now available, free of charge, in both app stores for Android and iOS. Previously only a web-based version of THE BOX was available. To create an even better and simpler user experience, the Osteology Foundation decided to develop the app version. Christian Schmitt, Germany, member of the Osteology Foundation Expert Council and project leader of THE BOX project says: “Enhancing discussions and exchange within the field of oral regeneration is one of the goals of the platform we developed. By making the platform more accessible to those using smartphones, I think we have taken a huge step in this direction.” Referring to the symposia function of the app, Schmitt went on to explain: “It is possible to ask the speaker questions, read abstracts, browse through the submitted posters and see the Osteology congress programs. In my opinion this really produces added-value for the participant.”
What is THE BOX? THE BOX is an online platform that provides information and tools while connecting scientists and practitioners worldwide. Tools like the Case Box, the Challenges & Complications Forum and the Surgical Checklists support the clinician in his daily life. Tools like the Research Wizard or the Biostatistics Wizard are there to support researchers in setting up a research project or to find the right test for their data. Among these tools, additional information is available on the Global Osteology Community Platform. The user can find the online versions of “Oral Regeneration in a Nutshell” and the “Osteology Research Guidelines.” And last but not least, for free users can participate in the Oral Regeneration Topic, which is chosen every six months. It consists of a scientific radar, a conversation with the author of an important study on the subject and an interactive webinar. THE BOX app is now available in the Google Play store for Android and in the App Store for iOS. Download it now – it’s free!
Merging online and offline Among the established features, an augmented reality interface was also integrated into the app. Augmented reality is the perfect technology for adding extra value to offline content. Multiple scanning points were available at the Osteology booth as well as around the congress center in Barcelona, creating a new experience for the congress participants and bringing the creative activities of the Osteology Foundation even closer to the participants.
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Interview
A chat with Jia-Hui Fu in Barcelona Interview conducted by Verena Vermeulen
Dr. Fu, you have lived, studied and practiced both in Singapore and the USA. What did you and your US colleagues learn from each other? Dr. Fu: I learned from my US colleagues how to communicate better with patients, for example, using positive words to motivate and encourage them. In return I certainly trained my co-residents how to use chop sticks and shared more about my country, Singapore and our unique culture. You attended the Osteology Research Academy in Hong Kong. How important are education and collaboration? Dr. Fu: The academy was an eye-opener for me. These courses unite many individuals with a common goal in their professional lives. It allows us to learn from each other, to build a relationship and to catch up after the course. Now we can build a strong scientific community.
project I did during my Master Program in Michigan, so it was a great testimony to the mentorship and the world class education that you can get there. It was also the first time that University of Michigan won this prize. I am very happy to be able to contribute to my alma mater.
What do you like to do in your free time? Dr. Fu: I love to spend time with my two kids. They grow up so quickly – suddenly they start going to school. I enjoy taking them on trips to explore different parts of Singapore and overseas to learn more about other countries and cultures.
Is there a special moment you remember? Dr. Fu: Professor Lang shared his professional journey with us – the people he had met, the challenges he had faced and how he overcame those difficult times. It was inspiring. As somebody young in this field, you can totally appreciate all the challenges that he described (laughs). You realize that you are not alone with these experiences and someone so successful had faced them as well and obviously overcame them.
If you received a huge research grant, on what would you spend it? Dr. Fu: The gingival phenotype of the Asian population is very thin, and I believe it has an impact on the success of GTR treatment. I would like to investigate whether soft tissue thickening is beneficial in these patients and what materials work best in this indication. You have won several prizes. Which one was most important for you? Dr. Fu: Surely the André Schroeder award! This is one of the most prestigious awards in implant dentistry. I received it for a
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GEISTLICH NEWS 2-2019
Photo: Andreas Butz
We talk more and more about the functional aspects of soft tissue management. Where do you see the biggest benefits? Dr. Fu: In preventing a disease from happening. The thick soft tissue around teeth or implants acts as a strong physical barrier against trauma and inflammation. So soft tissue thickening before or during regenerative treatments may have a strong impact on esthetics and long-term success.
Ass. Prof. Dr. Jia-Hui Fu studied at the National University of Singapore and finished her master’s degree in Periodontics and Implant Dentistry at the University of Michigan. She is a Diplomate of the American Board of Periodontology and an Assistant Professor at the National University of Singapore. The André Schroeder Research Prize 2014 is among the prizes she has won and she is a member of the Osteology Research Council.
Issue 1 | 20 will be published in March / April 2020. FOCUS
Prevention > Preventing bone loss after immediate implant placement > Preventing bone loss after tooth extraction > Preventing peri-implantitis >P reventing complications using proper soft tissue management
References 1
Mir-Mari J, et al.: Clin Oral Implants Res 2016; 27(2):258-65.
2 Mir-Mari J, et al.: Clin Oral Implants Res 2017; 28(6):631-639.
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