STARGET

M AGA z I N E f O R C U S TO M E RS A N D PA R T N E RS O f S T R AU M A N N 1 I 2012

the straumann 速 regenerative system

Imprint starget – magazine for Customers and Partners of straumann i © straumann usa i 60 minuteman road i andover, ma 01810 i Phone 800/448 8168 Fax 978/747 2490 i Editors roberto gonzález i mildred Loewen i E-Mail info.usa@straumann.com i Internet www.straumann.us/starget Legal Notice exclusion of liability for articles by external authors: articles by external authors published in starget have been systematically assessed and carefully selected by the publisher of starget (straumann usa). such articles in every case reflect the opinion of the author(s) concerned and therefore do not necessarily coincide with the publisher’s opinion. nor does the publisher guarantee the completeness or accuracy and correctness of articles by external authors published in starget. the information given in clinical case descriptions, in particular, cannot replace a dental assessment by an appropriately qualified dental specialist in an individual case. any orientation to articles published in starget is therefore on the dentist’s responsibility. articles published in starget are protected by copyright and may not be reused, in full or in part, without the express consent of the publisher and the author(s) concerned. straumann® and all other trademarks and logos are registered trademarks of straumann usa and/or of its affiliates. third party corporate names and brand names that may be mentioned may be registered or otherwise protected marks even if this is not specially indicated. the absence of such an indication shall not therefore be interpreted as allowing such a name to be freely used.

editorial

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A New Era in Oral Tissue Regeneration

Dear Valued Customer, It is my pleasure to introduce myself as the new head of Straumann North America, and also to introduce this first installment of STARGET for 2012. The focus of this issue, "The Straumann Regenerative System," is particularly significant for me as I come to Straumann USA as the former Head of Straumann Global Regenerative Sales.

As you know, Straumann provides solutions for both tissue regeneration and GBR including Emdogain™, BoneCeramic™, Straumann AlloGraft, and most recently MembraGel ®, an innovative liquid membrane that can be precisely applied to the surgical site.

You’ll find several interesting articles on tissue regeneration in this issue of Andy Molnar Straumann Executive Vice President North America

STARGET: “Why Repair When You Can Regenerate?“ on page 6, “Redefining the Membrane“ on page 12, and an interview with Prof. Dr. Christoph Hämmerle on the innovation and distinctiveness of MembraGel on page 16. You’ll also see an article on our Esthetic Case Book, which documents 11 cases illustrating the dramatic results that can be achieved through Emdogain, on page 18.

Restorative dentistry has seen breakthroughs over the past few years. This STARGET features articles on the latest development of Straumann CARES ® digital workflow.

We hope you will enjoy the clinical case on Straumann's screw-retained hybrid solution from your peers, and an article based on the interviews with three key opinion leaders on global trends in dentistry.

Enjoy this issue of STARGET and please let us know how we can continue to improve upon it.

Sincerely, Andy Molnar Straumann Executive Vice President, North America

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Overview

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6 The Straumann® Regenerative System offers solutions for oral tissue regeneration – ranging from conservative dentistry to dental restoration. New to the portfolio: Straumann

®

regenerative SyStem

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Straumann® MembraGel®.

Straumann® CareS® digital SolutionS

Straumann, together with 3M™ ESPE™, has introduced a streamlined digital workflow that connects the Lava™ C.O.S. Intra-Oral Scanner to the Straumann® CARES® Digital Solutions platform.

Simply doing more

54 Global Trends – Where is the final destination? We asked three prominent dentists to give us their perspective on things: Lyndon Cooper, Kenneth Malament and Daniel Wismeijer.

Content

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CONT ENT

FOCAL POINT

STRAUMANN ® REGENERATIVE SYSTEM

STRAUMANN ® CARES ® DIGITAL SOLUTIONS

6

Why Repair When You Can Regenerate Instead?

12

Straumann MembraGel® – Re-Defining the Membrane

16

Interview with Christoph Hämmerle

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An Esthetic Case Selection on Straumann Emdogain™

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Straumann Allograft Portfolio Expands

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Evaluating the Precision of Straumann® CARES® Guided Surgery Based on a Clinical Case

RESTORATIVE

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Digital Workflow

30

The Intraoral Workflow

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3M™ ESPE™ Lava™ Ultimate Restorative

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Interview with Mike Rynerson

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Straumann® Anatomic IPS e.max® Abutment

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Immediate Full Mouth Restoration Using Implant-Supported Fixed Hybrid Prosthetics

SURGICAL

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Updated SLActive® Scientific Evidence Brochure

ITI / EDUCATION

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Straumann & Baylor University Launch the First Interdisciplinary Digital Dentistry Course

SIMPLY DOING MORE

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ITI Membership Tops 10,000

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Global Trends

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Straumann AID: Access to Implant Dentistry

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Literature Alerts

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Upcoming 2012 Education Events

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foCal point

STrAUMANN ® reGeNerATive SYSTeM

Why Repair When You Can Regenerate Instead?

The More Complex an Organism is, the Lesser the Capacity of its Body to Perform Regenerative Processes The biological process, or self-sufficient capability to restore deficient tissue is referred to as the ability for regeneration. In contrast to repair, i.e., wound healing, whereby the original biological structure is not fully rebuilt, the goal of regeneration is to completely restore the structure and function of tissue that has been lost or injured. This ability has continuously diminished as creatures have evolved and the complexity of these organisms has increased. Compared to the “champions” of regeneration, present day cnidarians, which can re-grow severed extremities and internal organs that have been lost, this capability in humans, without additional support, is limited to a few types of external tissue.

When the Body’s Own Healing Process “Overshoots its Target“ When a person’s tissue is injured, the body’s repair process, rather than regenerative process, begins.

Here, the body does not primarily attempt to restore the original state and function of the tissue, but rather to close the wound as quickly as possible. This spontaneous healing process involves the formation of connective tissues that penetrate deeply into the original tissue and also remove “good” tissue in the process. During such a “radical” healing process, it is possible that even important functions are permanently destroyed.

Regeneration Can be Guided with Medical Treatment To prevent this type of overcompensation in the healing process wherever possible, strong antiinflammatory drugs are administered today, such as in cases of back injuries. This prevents this destructive process from occurring, in turn making it possible to preserve part of the nerve tissue and mitigating deficits such as paralyses. In medical terms, regeneration entails assisting desirable tissue formation processes, and guiding and limiting the repair mechanisms involved in wound healing as to not impede the regeneration of intact, functioning tissue.

foCal point

Fig. 1: The cnidarians (pictured here, a green anemone, anthopleura xanthogrammica) are equipped with astounding regenerative capabilities that far surpass those of humans.

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StraumannÂŽ regenerative SyStem

The Insertion of Implants Requires Healthy Bone Tissue Great advances in regeneration have been achieved in dentistry over that last 20 years. We can now regenerate the bone tissue of the jaw, opening the door for implants as a treatment for replacing teeth. This has required scientific evidence documenting the physiological processes involved in tissue formation and the necessary aids for controlling these processes. Today, for example, we know that lost or missing bone can only be regenerated by the body when the bone-forming cells can perform their work undisturbed. Without external intervention, this process would have to compete with the rapid natural wound repair mechanism, which would result in the growth of new connective tissue instead of the desired bone tissue.

Fig. 2: The high porosity of StraumannŽ BoneCeramic™ (90 %) allows blood vessels and vital bone to vascularize into the material.

Regeneration Requires Matrices and Membranes Today, one means of guiding the regeneration process requires two aids: a matrix and a membrane.

The matrix keeps the space available for the bone to grow while a membrane serves as a barrier to prevent the connective tissue infiltration of the gingiva.

Straumann® regenerative SyStem

Various types of these matrices and membranes are used today for regenerative purposes. Some of these “placeholders” remain in the body, integrated into the newly formed bone for the rest of the person’s life. Applying membranes for this purpose is also quite complex and time-consuming. Straumann ® MembraGel ® was developed to deal with the disadvantages of the types of membranes used in the past. The time-consuming cutting and fitting of the membrane is unnecessary since MembraGel is applied in liquid form and polymerizes to form a solid film in less than a minute. The resulting hydrogel is biocompatible and completely biodegradable.

Periodontitis – The Greatest Threat to the Periodontium For implantology, the regeneration of the periodontium is equally as important as the new formation of bone, which is destroyed by periodontitis and can ultimately result in the loss of the tooth. Despite numerous attempts to regenerate the destroyed tissue, a breakthrough to achieve complete tissue reformation remains to be seen. Straumann ® Emdogain™ can be used in cases to undo some of this destruction, making it possible to prevent loss of the tooth. Emdogain contains the key components required for building up the cementum and periodontal ligament, important parts of the periodontium.

These elements, or proteins, tap into the body’s own natural ability to rebuild the surrounding tooth structures, using nature’s help.

“Simply Doing More“ – During the Regeneration Process Straumann’s successes in the field of regeneration are promising and we have yet to fully realize our dreams. We are already working on further innovations to guide regenerative processes in an even simpler and more effective manner. We are inspired by two great visions:

»

A matrix for bone augmentation that breaks down fully and can be used without requiring a membrane.

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Guided tissue regeneration that allows for complete preservation of the tooth.

Now making its first entrance into the dental market with Straumann MembraGel, we view PEG technology as the foundation for achieving these goals. Beyond MembraGel, there are numerous combinations and degrees of cross-linking these biocompatible hydrogels, which present an exciting range of possible options. This innovative technology is only in the early phases of trials and development and has enormous potential for the future.

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Straumann® regenerative SyStem

The Straumann® Regenerative System: Everything from a Single Source The Straumann® Regenerative System offers you a variety of solutions for oral tissue regeneration – ranging from conservative dentistry to dental restoration. Our goal is to offer you a variety of predictable and scientifically proven regenerative treatment solutions – all from a single source and in the tried and tested quality that is Straumann’s hallmark.

Tissue Regeneration By mimicking the natural process of odontosis, Straumann® emdogain forms an insoluble, three-dimensional

extracellular

matrix

that

remains on the root surface for 2 – 4 weeks and enables a selective cell population, proliferation and differentiation.

Bone Formation Straumann® allograft is a wide range of bone allograft solutions, allowing you the flexibility to choose the treatment that’s right for your case. Through a commercial partnership with LifeNet Health®, Straumann’s allograft options provide confidence in the safety of the material you use to treat your patients.

Straumann® BoneCeramic™ is a fully synthetic bone

substitute

material

with

excellent

morphology that promotes the new formation of vital bone. It can be used for a series of procedures used for dental bone regeneration.

Bone Healing Straumann® membragel ® is a membrane of the latest generation. It combines unique material properties that have been developed to promote undisturbed bone healing and to simplify the surgical procedure.

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straumann® emdogain™ IS TRUE PERIODONTAL REGENERATION IMPORTANT TO YOU?

Photos courtesy of Dr. G. Zuchelli, Bologna, Italy

before

after

More than 100 clinical publications in peer-reviewed journals demonstrate Straumann® Emdogain to be safe and effective in stimulating the formation of new periodontal soft and hard tissue. These clinical studies involve more than 3000 defects in over 2500 patients.

Contact Straumann Customer Service at 800/448 8168 to learn more about Straumann solutions or to locate a representative in your area. www.straumann.us -4

s1 r esul t l a c i in fit ent cl l bene e xc e l l a c i n i l c t3 t erm L ongomfor c s i d atient L e ss p

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Tonetti MS, et al. Enamel matrix proteins in the regenerative therapy of deep intrabony defects.J Periodontol.

2002;29:317–325.

Froum SJ, et al. A comparative study utilizing open flap debridement with and without enamel matrix derivative in the treatment of periodontal intrabony defects: A 12-month re-entry.J Periodontol. 2001;72:25–34.

Jepsen S, et al. A randomized clinical trial comparing enamel matrix derivative and membrane treatment of buccal class II furcation involvement in mandibular molars. Part I: study design and results for primary outcomes.

J Periodontol. 2004; 75:1150–1160.

McGuire MK, et al. Evaluation of human recession defects treated with coronally advanced flaps and either enamel matrix derivative or connective tissue. Part 1: comparison of clinical parameters.J Periodontol. 2003;74:1110–1125.

Sculean A, et al. Ten-year results following treatment of intra-bony defects with enamel matrix proteins and guided tissue regeneration. J Clin Periodontol. 2008; 35:817-824.

Data on file (McGuire 10 year)

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Straumann® regenerative SyStem

STrAUMANN ® M eMbra G el ®

Re-Defining the Membrane

In 2010, Straumann introduced Straumann MembraGel, an advanced technology membrane that is one of the most significant innovations in guided bone regeneration in recent history.

Created with PEG (polyethylene glycol) hydrogel technology, Straumann MembraGel is applied in liquid form and molds to the defect. Shortly after application, the liquid components solidify, stabilizing the bone graft and providing an effective barrier to tissue infiltration. Straumann MembraGel then biodegrades over time. It is designed to achieve undisturbed bone regeneration, which is a prerequisite for achieving ideal clinical and esthetic results.

“Straumann MembraGel is a key innovation in Guided Bone Regeneration. With the PEG technology we are on the verge of something new, entering a new era in oral tissue regeneration.“ Christoph Hämmerle, University of Zurich

Designed for Improving GBR Procedures Straumann MembraGel provides effective support in bone formation for GBR (guided bone regeneration) cases due to its optimized barrier properties. It facilitates undisturbed bone healing as a basis for the optimal clinical outcome achieved by stabilization of the bone graft material. The precise and easy application simplifies the surgical procedure.

Straumann® regenerative SyStem

Stabilization of the Bone Graft The gel-like consistency of Straumann® MembraGel ® allows for precise application to the surgical site and adaptation to various types and sizes of bone defects.

Solidification and Stabilization Once solidified in situ (20 – 50 seconds after application),

Straumann®

MembraGel

is

designed to stabilize the underlying bone graft to facilitate undisturbed bone regeneration.

Backed by Scientific Documentation Straumann MembraGel is backed by preclinical1,2,3,4,5 and clinical 6 documentation including one- and three-year follow-up data7 presented in 2010 and submitted for publication. The ongoing clinical program with Straumann MembraGel includes over 40 centers and more than 200 patients in Europe and North America.

Straumann® MembraGel Exclusive Education Program Straumann® MembraGel was launched in conjunction with a well-received specialized education program that provides in-depth information on pre-clinical and clinical evidence, hands-on product training and the surgical techniques of this new application. Herbert Früh, Head of Business Unit Regenerative at Straumann explained, “MembraGel has allowed Straumann to bring a brilliant idea to

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Straumann® regenerative SyStem

fruition. It is an innovative technology that requires training. Customers’ initial experience is that it saves time during intraoral application but it is different to handle. For this reason, it was the right decision to combine the launch of the new product with an intensive education program.”

Availability Straumann® MembraGel ® was introduced in Europe and North America toward the end of 2010, with roll-outs to other markets planned in the future.

Hands-on workshop at a Straumann MembraGel education event.

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Humber CC, Sándor GK, Davis JM et al. Bone healing with an in situ formed bioresorbable polyethylene glycol hydrogel mem-

brane in rabbit calvarial defects. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;109:372–384.

2

Jung RE, Lecloux G,

Rompen E et al. A feasibility study evaluating an in situ formed synthetic biodegradable membrane for guided bone regeneration in dogs. Clin Oral Implants Res 2009;20:151–161.

3

Thoma DS, Halg G-A, Dard MM et al. Evaluation of a new biodegradable

membrane to prevent gingival ingrowth into mandibular bone defects in minipigs. Clin Oral Implants Res 2009;20:7–16.

4

Herten

M, Jung RE, Ferrari D et al. Biodegradation of different synthetic hydrogels made of polyethylene glycol hydrogel/RGD-peptide

Straumann® regenerative SyStem

PeG – The TechNOLOGY BehiNd STrAUMANN® MeMbraGel®

Straumann MembraGel is a synthetic, biodegradable in situ-formed membrane made of polyethylene glycol (PEG) which forms a molecular network. The material is biocompatible, is applied in liquid form and sets quickly. Due to its gel-like consistency, it can be applied to cover the exact shape of the defect or augmented area and does not require cutting and trimming to shape before application – unlike traditional GBR membranes.

What exactly is PEG, and what makes it suited to this purpose? PEG is a polymer (a large molecule comprised of repeating structural units). It is produced through the reaction between ethylene oxide and water or the organic compound ethylene glycol, which is often used as a precursor to polymer materials.

PEG is available in a wide range of molecular weights. The molecular weight also determines the consistency of the material, which can vary greatly from waxy-solid to water-soluble liquid states. PEG has a number of properties that are particularly desirable in a number of biological, pharmaceutical and chemical applications: it is highly flexible, non-toxic and non-immunogenic. It is also hydrophilic, meaning that its attachment to biomolecules can increase solubility and decrease aggregation of the molecules.

Thanks to these very advantageous properties, PEG has been extensively used in many medical, pharmaceutical and medical device applications. For instance, it is used as a spray-on adhesion barrier and as a main ingredient in laxatives; as an agent for bowel irrigation prior to surgery or colonoscopy; as an addition to protein medications to extend their effect and increase dosing intervals; and as a carrier in various medications, such as soft capsules, ointments, tablets, and lubricants. Preliminary research is also underway to investigate the potential of PEG as a component in many other exciting applications, such as gene therapy, spinal cord injuries and the suppression of carcinogenesis. The use of PEG as a customizable, liquid-applied membrane is therefore another milestone in a long line of applications for this useful, versatile and extensively researched material.

modifications: an immunohistochemical study in rats. Clin Oral Implants Res 2009;20:116–125.

5

Jung RE, Zwahlen M, Weber FE

et al. Evaluation of an in situ formed hydrogel as a biodegradable membrane for guided bone regeneration. Clin Oral Implants Res 2006;17:426–433.

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Jung RE, Hälg GA, Thoma DS, Hämmerle CHF. A randomized, controlled clinical trial to evaluate a new

membrane for guided bone regeneration around dental implants. Clin Oral Implants Res 2009;20:162–168.

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Ramel C, Halg G,

Thoma D et al. A randomized clinical trial to evaluate a synthetic gel membrane for GBR around dental implants – 1- and 3-year results. European Association for Osseointegration 19th Annual Scientific Meeting, Glasgow, UK, 6–9 October 2010; Abs 055.

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iNTerview

“Being Part of this Network is Something Truly Exciting – Something We’ve Never Done in this Way Before.“

Andy Molnar, Straumann Executive Vice President, North America, interviews Professor Dr. Christoph Hämmerle of the University of Zurich about Straumann® MembraGel ®. professor Hämmerle, our company is introducing membragel by way of an international education-based program. this is a product which has been longawaited in the market; so many people would like to get their hands on it as Prof. Dr. Christoph Hämmerle Chairman of the Department of Fixed and Removable Prosthodontics and Dental Material Science, University of Zurich/Switzerland.

soon as possible. What are your thoughts on this educational approach to the launch?

I think it’s very important to use an educational approach. What we’re dealing with here is a new technology, a new kind of membrane, a new way to apply the membrane. There are a lot of differences from all the membranes we’ve had before. I think it’s very important to launch the product in a well-structured way so that we know what experience we can rely on. It’s also an opportunity to learn about new things we need to become familiar with before we can use a new technology like this successfully and predictably.

“We treated over thirty defects and had minimal complications.

Based on this experience and learning, we moved on to larger defects with a very good success rate once again.“ Christoph Hämmerle

i know you’re excited about membragel and the progress the product is making.

How would you describe your involvement from the start, from inception all the way through the development of the project?

It has been very exciting for us. It’s really special to be there when the original idea is born and then to participate in the development of a new product, which is eventually able to solve problems and improve patient care. With all the sharing, teaching, and feedback we’re getting from different people all over the world, being part of this network is something really exciting, something we’ve never done this way before. For this reason, we’re looking forward to continuing with the

Straumann® regenerative SyStem

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development of this scientific and educational network and

When we conducted our initial study, in which we used a

really benefiting from the process. I think it’s great!

collagen membrane as a control, we did not see any more difficulties with the membrane using the new technology than

from our learning so far, what are the key points that we

with the membrane using the older technology. I think this was

need to pass on to our educators?

the case because we were careful to use small dehiscence

There are three key points. One is that you have to change

defects in non-esthetic areas. We treated over thirty defects

some of your surgical habits to adapt to the new technology,

and had minimal complications. Based on that experience

the new way to apply the membrane. The second is to adhere

and learning, we began to expand to larger defects, again,

to published surgical guidelines. And the third is to begin with

with very good success.

less complex cases until you have had around ten successful cases, and then move on to more difficult cases.

Professor Hämmerle, thank you very much for your time.

It’s much appreciated.

“I think it’s very important to launch the product in a well-structured way so that we know what experience we can rely on.“ Christoph Hämmerle

Returning to the topic of changing habits, this is a new technology, and there is a great temptation to use it in all kinds of different ways because it is rather easy to use and very new and exciting. We need to exercise restraint and really adhere to new practices in aspects of our surgical work.

The second point pertains to the surgical guidelines. We have seen that the surgical guidelines are not always followed accurately. Following the surgical guidelines could improve the practical outcomes when it comes to using this new product.

The third aspect is the size of the defects we tackle first.

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Straumann® regenerative SyStem

GrOwTh iN receSSiON

An Esthetic Case Selection on Straumann ® Emdogain™

Clinicians have been predictably treating gingival recession with Straumann ® Emdogain™ for years and talking about the beautiful smiles they gave back to their patients – we gave them the chance to prove it.

The best cases from the 2009 “Growth in Recession” Esthetic Case Competition were chosen by a renowned international jury to appear in Straumann’s Growth in Recession Esthetic Case Book. This casebook, published in 2011, features eleven cases presented together with the patients’ histories and images of each step to facilitate a detailed understanding of the surgical procedures involved.

This valuable tool is complimentary to you with your next order of Straumann Emdogain. Please reference order code “RECESSION” when placing your order.

Designed to help achieve excellent esthetic results Esthetic Casebook: Straumann® Emdogain The following clinicians contributed their Case reports to this publication:

p Brazil: Dr. Robert Carvalho da Silva, DDS, MS, PH.D. (co-authors: Dr. Julio Cesar Joly, DDS, MS, PH.D., and Dr. Paulo Fernando Mesquita de Carvalho, DDS, MS)

p USA: Dr. Robert Levine, DDS – Dr. Ken Akimoto, DDS, MSD – Dr. Mark I. Gutt, DMD– Dr. Eunseok Eugene Oh, DDS (co-author: Dr. Vincent Iacono, DDS) – Dr. Paul G. Luepke, DDS, MS

p Canada: Dr. Ira Paul Sy, DDS, MS, Dip. Periodontics p Germany: Dr. med. dent. Andreas Hofmann, M.Sc. – Dr. Bjørn Greven (coauthor: Dr. Bernd Heinz)

p Spain: Dr. Ion Zabalegui, MD

Straumann® regenerative SyStem

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“BOTH THE SCIENTIFIC EVIDENCE AND MY PERSONAL ExPERIENCE SUPPORT THAT WITH THE APPROPRIATE CASE STRAUMANN® EMDOGAIN™ SIGNIFICANTLY IMPROVES ROOT COVERAGE COMPARED TO THE CORONALLY ADVANCED FLAP ALONE.” DR. MICHAEL K. MCGUIRE, DDS

Treatment of recession defects with Straumann Emdogain Courtesy of Dr. Paul G. Luepke, DDS, MSD

A referred 23-year-old female patient was presenting with multiple gingival recessions (teeth #8 to #3). The prominent canine showed a Miller Class III recession, the other teeth presented with Miller Class I recessions. The treatment procedure began with a thorough cleaning and scaling of the exposed root surfaces with hand and sonic instruments and was followed by a split thickness flap preparation of a

Dr. Paul G. Luepke, DDS, MS

Zucchelli-style flap (without vertical releasing incisions). A dissection into the vestibular

1996 Master’s degree in Periodontics, University

mucosa allowed for further mobilization.

of Texas at San Antonio Health Science Center, Tx, USA • 1997 Diplomate of the American Board

(EDTA) was applied for two minutes on the root surface.

of Periodontology • 2008 Assistant Professor of

Subsequently, the surgical area was rinsed with sterile saline and Straumann®

Surgical Services Periodontics Division, Marquette

Emdogain™ was applied to the root surfaces. Connective tissue graft (CTG) was

University School of Dentistry in Milwaukee, WI,

harvested from the palate with the single incision technique. The graft was then

USA • 2009 Interim Department Chair of Surgical

split. The CTG was fixed on the root surface and the flap coronally positioned and

Sciences at Marquette University School of Dentistry

fixed with sling sutures.

in Milwaukee, WI, USA

Straumann

®

PrefGel

®

Mechanical tooth cleaning in the surgical area was avoided during the first 4 weeks and a chlorhexidine solution was prescribed. Sutures were removed 10 days after surgery.

Initial situation

6 week follow-up

11 month follow-up

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Straumann® regenerative SyStem

ALLOGrAfT LiNe exPANSiON

Building A Foundation for Success with More Options – Straumann AlloGraft Portfolio Expands Straumann is pleased to expand the options available for you through our commercial partnership with LifeNet Health,® allowing you the flexibility of choice when treating your patient. Processed with LifeNet Health’s proprietary and patented Allowash xG ® technology, Straumann AlloGraft gives you confidence that your graft is safe and effective.

Straumann AlloGraft C/C mix, Mineralized Ground Cortical/Cancellous mix A mix of the strength of cortical bone with the structure of cancellous bone to support bony ingrowth in one product Straumann AlloGraft OCAN (top) and Straumann AlloGraft GC (bottom), electron microscope image, magnification 20x

Straumann AlloGraft OCAN 0.25 cc, Mineralized Ground Cancellous Straumann AlloGraft GC 0.25 cc, Mineralized Ground Cortical Straumann AlloGraft DGC 0.25 cc, Demineralized Ground Cortical For smaller defects, when extensive grafting is not needed Straumann AlloGraft OCAN (left), Straumann AlloGraft GC (middle), Straumann AlloGraft DGC (right), electron microscope image, magnification 20x

SIMPLIFy WITH CONFIDENCE From crown to root, Straumann provides you with the convenience of ordering solutions from one provider – all from the scientifically driven company you know and trust.

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straumann® Cares® digitaL soLutions SEAMLESS CONNECTIONS Pave your way to success. Covering a full product range from temporary restorations to esthetic crown and bridge restorations, Straumann® CARES® Digital Solutions is now featuring: new generation scanner new cAd software new applications leading range of materials Straumann® CARES® Digital Solutions brings modern digital dentistry to dental professionals as a complete system – reliable, precise, and dedicated to your needs.

intra-oraL sCan guided surgery

us

CadCam

Please contact us at 800/448 8168. More information on www.straumann-cares-digital-solutions.com

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Straumann® CareS® digital SolutionS

STefANO STOreLLi, LeONArdO AMOrfiNi, MAUriziO cAMANdONA ANd eUGeNiO rOMeO

Evaluating the Precision of Straumann ® CARES ® Guided Surgery Based on a Clinical Case

Introduction The use of guided surgery is paving the way for the future of implant surgery. Softwarebased pre-operative planning differs considerably from traditional planning with casts and x-ray printouts. The following case report involves a restoration for a partially edentulous woman with a fixed prosthesis preceded by pre-operative planning with the Straumann® Guided Surgery System using coDiagnostix™ (software) and gonyx™ (scan and surgical template fabrication device).

Dr. Stefano Storelli Graduation in Dentistry and Dental Prosthetics at the

Patient History

University of Milan/Italy. PhD in Implant Dentistry.

An 87-year-old Caucasian woman referred to our clinic, asked for a solution for her

Postgraduate in Oral Surgery (class of 2012).

faulty fixed bridge which was causing pain and difficulty in eating. She had never

Lecturer at the Department of Implant Prosthetics at

worn a removable prosthesis and was willing to do anything possible to keep her

the University of Milan. Author of various national

fixed dentition. The patient suffered from an unspecified choreia with symptoms of

and international publications and collaboration on

involuntary movements, and was on aspirin treatment for her high blood pressure.

various transcriptions. ITI and SIO member. Private

Despite these restrictions, she was in a good physical and mental health.

practice in Milan.

Clinically, the following situation was diagnosed: (1) a faulty fixed bridge (7 to 12), still anchored on the left side, where an old implant was still in use, (2) two

Fig. 1

Fig. 2

Fig. 3

Fig. 4

Straumann® CareS® digital SolutionS

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remaining teeth (8 and 11) which were fractured, and (3) a resorption on site 8 and a fracture of 11 revealed by the OPG as well as the inclination of the distal implant placed in 12 (figs. 1 – 3). Under these circumstances the clinician decided to remove the bridge and to restore the patient with a removable prosthesis.

After a couple of weeks the patient stated that it was impossible for her to wear the temporary denture and she returned to the dental practice several times due to fractures to the prosthesis. Therefore, it became apparent that a removable

Dr. Leonardo Amorfini

restoration was not suitable for this patient and that an implant solution had to

Graduation in Dentistry and Dental Prosthetics at the

be taken into consideration. Since minimally invasive surgery was intended, the

University of Milan/Italy. Author of various national

clinician opted for a guided implant insertion in the post-extractive sites.

and international publications and collaboration on various transcriptions. ITI, AO, SICOI and SIO

Treatment Planning

member. Private practice in Gallarate (VA).

A mock-up of the future teeth was evaluated, followed by the preparation of the diagnostic template with the Straumann ® gonyx table. The plate was attached to the barium teeth and the three titanium pins were placed according to the manufacturer’s instructions (figs. 4, 5). The diagnostic guide was tested for

Fig. 5

Fig. 6

Fig. 7

Fig. 8

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STARGET 1 I 12

Straumann® CareS® digital SolutionS

stability in the mouth of the patient before performing the Cone Beam CT scan (fig. 6). The CT showed a remarkable resorption on site 8 and confirmed the inclination of the implant placed in 12. Therefore, the implant to be placed immediately in position 8 was moved to 7 and a miniflap was raised. The implant in position 11 had to deal with the position on the other implant.

The

final

treatment on

3

decided implants

upon in

was

a

positions

fixed

implant

7-11-12.

The

supported

Dental Technician Maurizio Camandona

prosthesis

Teacher of post-graduate courses in dental implant

coDiagnostix™ software was used to plan the treatment (figs. 7, 8). The

technologies at the University of Milan.

implant positions were defined in the software and the resulting template plan

Author and co-Author of professional articles and

was sent to the lab. The implant in position 7 was planned to be a Roxolid ®

reference books. Private practice in Lomazzo

implant with small diameter (Straumann ® Bone Level implant, NC Ø 3.3 mm,

(Como)/Italy, specialized in implant prosthetics,

SLActive ® 12.0 mm); for the implant in 11, a Straumann ® Bone Level implant

ceramics and state-of-the-art technologies (CADCAM

(RC Ø 4.1 mm, SLActive 12.0 mm) was chosen.

etc.). Speaker at national congresses on the topics listed above.

Fig. 9

Fig. 10

Fig. 11

Fig. 12

Straumann ®

Straumann® CareS® digital SolutionS

STARGET 1 I 12

It was possible to identify the implant in 12 as a CoreVent1 Ø 4.0 mm implant placed about 15 years ago and, after some research, some prosthetic component of the respective implant manufacturer was found that was compatible with the internal connection to this implant. After drilling the holes into the scan template according to the template plan, the lab provided the surgical guide (figs. 9 – 11).

Surgical Procedure

Prof. Eugenio Romeo

The two teeth were removed together with the granulation tissue around the

Graduation in Medicine and Surgery in 1984 at the

root of tooth 8 under local anesthesia. The considerable resorption needed to

University of Milan/Italy. Director of the Department

be treated with regenerative material (bovine bone substitute material covered

of Implant Prosthetics at the University of Milan since

by a resorbable collagen membrane) to avoid major alteration of the contour.

1992. Associate Professor since 2005. Author

The surgical guide was placed on the remaining teeth and on the healing

of various educational books and national and

cap of the distal implant (fig. 12). The surgical procedure was performed

international publications. Chairman of the Advanced

according to the surgical plan. The implant in position 7 was positioned after

Oral Implantology course at the University of Milan.

raising a mini-flap and by using the extra-long drill (Ø 2.8 mm) through the

ITI fellow.

Ø 2.8 mm sleeve (figs. 13, 14).

Fig. 13

Fig. 14

Fig. 15

Fig. 16

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STARGET 1 I 12

Straumann® CareS® digital SolutionS

The implant was positioned after the guide had been removed, since the implant, having a diameter of 3.3 mm, cannot be inserted through the Ø 2.8 mm sleeve. The implant in position 11 was placed after using the extra-long drill series (Ø 2.2/2.8/3.5 mm) with the 1 mm reduction handle through the Ø 5 mm diameter sleeve (figs. 15, 16). The implant was positioned through the surgical guide. Transmucosal healing caps were positioned and the bone substitute material was inserted into the extraction sockets. Both sites were covered with the resorbable collagen membrane.

Final Prostheses and Follow-up After 6 weeks, the OPG showed correct healing with no radiolucencies (fig. 17). Clinically, the implants sounded correct and were stable (fig. 18). The healing abutments were removed and screw-retained transfer parts were placed

Fig. 17

Fig. 18

Fig. 19

Fig. 20

Fig. 21

Fig. 22

Fig. 23

Fig. 24

Fig. 25

Straumann® CareS® digital SolutionS

in order to take the impression. The three impression copings were splinted with a bridge of acrylic resin that had been prepared a few days before (figs.

21, 22). The three abutments were placed in position (fig. 22) and the metalceramic prosthesis (fig. 24) was cemented with a removable cement (fig. 23).

After one month of loading, no complications were registered or stated by the patient. By comparing the values obtained by computer planning with the x-ray taken after implant placement (figs. 19, 20), the precision of the system became visible, with the postextractive implant being about 1 mm deeper than planned and without much variability in the other dimensions.

Conclusion The use of computer-guided implant placement allowed expanded treatment options and a fast, minimal invasive surgery for a patient who was not able to withstand long procedures. Producing the guide in such a manner is efficient and it fits well on natural teeth because it has been customized on the patient's impressions. The implant placement in the case reported here demonstrates the reliability of the Straumann ® Guided Surgery system.

With software-based treatment planning, the implants could be placed in the same practiced manner as with traditional techniques – but with higher precision and peace of mind. However, the learning curve for software-based planning should not be underestimated; in addition to familiarization with the software, new surgical techniques have to be applied and the surgeon needs to get accustomed to visualizing the surgical procedure through the software.

STARGET 1 I 12

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diGiTAL wOrkfLOw

Seamlessly Connected with Straumann ® CARES ® Digital Solutions 1. MULTiPLe dATA SOUrceS

Surgical planning

2. STrAUMANN ® cAreS ® viSUAL deSiGN

Straumann ® CARES ® Visual

Digital impression taking

Scan master model

Straumann ® CARES ® Scan CS2

A digital workflow to thousands of scanners

CARES ® 7.0: the open standard software platform

Straumann, together with 3M ESPE, has introduced a

Straumann® CARES ® Visual 7.0 offers a wide range of

streamlined digital workflow that connects the Lava C.O.S.

benefits: the advantages of a flexible, open software

Intra-Oral Scanner to the Straumann® CARES® Digital Solutions

standard – through the Dental Wings Open Software

platform. Parallel to the Cadent iTero ® intraoral scanner,

(DWOS ®) software core – and the quality and predictability

dentists using the Lava C.O.S. scanner are now able to

of the validated workflow of Straumann ® CARES ® – through

transfer digital scan data of the patient’s oral geometry to

specific Straumann software applications. Powered by the

the dental lab using the Straumann® CARES ® system. The

combined resources of the partners, the CARES ® platform

CARES ® platform offers seamless connectivity to thousands

strives for the leading role in dentistry and provides you

of scanners in dental practices worldwide.

with access to future high-class developments of the digital dental industry.

Straumann® CareS® digital SolutionS

3. vArieTY Of MANUfAcTUriNG OPTiONS

VALIDATED STRAUMANN WORKFLOWS

STARGET 1 I 12

4. vArieTY Of PrOSTheTic OPTiONS

HIgH qUALITy RESTORATIONS

Straumann milling centers

For modern implant and restorative dentistry: Customized Straumann ® CARES ® Abutments (Ti, ZrO2), Straumann ® CARES ® Screw-retained bars and bridges (CoCr, Ti)

Copings, crowns and bridges, inlays, onlays and veneers

Resin nano ceramic: 3M™ ESPE™ Lava™ Ultimate Restorative Ceramics: zerion® (ZrO2), IPS e.max ® CAD, IPS Empress® CAD, VITA Mark II, VITA TriLuxe

ExTERNAL WORKFLOWS

Via open STL format

Metals: ticon ® (Ti), coron ®, (CoCr) Polymers: polyamide, polycon ® ae, polycon ® cast2

Straumann milling centers: specialists in prosthetics

A leading material and application range

Straumann has a strong and long-time expertise in CADCAM

The Straumann® CARES ® Digital Solutions portfolio provides

manufacturing

industrial-

a leading range of CADCAM materials and applications –

grade precision and quality. The high reliability of these

according to your needs of serving your customers’ requests

restorations is based on Straumann’s strategy of validated

and of working cost-effectively without compromising on

design software and manufacturing that are compatible

quality: from single-tooth restorations to 16-element bridges

with each other. Via the Straumann milling centers, design

and from well-known to innovative materials like the new

expertise is offered as a service for complex restorations

3M™ ESPE™ Lava™ Ultimate Restorative.

of

prosthetic

restorations

in

such as screw-retained bars and bridges, and as a scan service for customized abutments1.

1

Scan service available in Germany only

2

burn out resin, not for clinical use

IPS Empress® and IPS e.max ® are registered trademarks of Ivoclar Vivadent AG, Liechtenstein. 3M™, ESPE™, Lava™ are trademarks of 3M or 3M ESPE AG. Used under license in Canada.

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Straumann速 CareS速 digital SolutionS

The iNTrAOrAL wOrkfLOw

The Straumann Digital Workflow for Implant Restorations: Designed to be Simple, Accurate and Efficient

The conventional prosthetic workflow using traditional impression taking, casting and waxing techniques can lead to inconsistent impression quality due to human errors. This can result in poor clinical and esthetic outcomes and time-consuming adjustments during seating. Digitalizing these processes can improve this situation from both a professional and business perspective.

From the intra-oral scan to the final restoration Straumann offers a new and complete digital workflow for implant restorations. Starting with an intra-oral scan of the implant site, the customized Straumann速 CARES 速 Abutment or full contour crown is designed to provide accuracy together with time and cost efficiency through the whole restorative procedure.

This kind of digital workflow for implant restorations eliminates cumbersome and time-consuming manual steps in dental practice and in the laboratory. Digital impressions allow immediate quality control by the dentist, and result in an excellent impression being sent to the laboratory. The workflow therefore eliminates or reduces impression retakes and restoration remakes, ensuring that seating appointments are efficient due to the excellent occlusion and contact-points of the restoration.

Straumann® CareS® digital SolutionS

deNTiST Scan the scanbody directly on the implant with iTero™ intra-oral scanning and send the digital data to your partner laboratory.

LABOrATOrY Design the customized Straumann® CARES® Abutment in Straumann CARES Visual and send data to the Straumann milling center for production.

LABOrATOrY Finalize the restoration using the highprecision Straumann® CARES ® Abutment, iTero™ model, Straumann Repositionable implant analog, and full contour crown.

deNTiST Serve patient with high-quality customized restoration designed to provide optimal function and esthetics.

STARGET 1 I 12

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STARGET 1 I 12

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Straumann® CareS® digital SolutionS

3M™ eSPe™ LAvA™ ULTiMATe reSTOrATive

A New Dimension for Dental Materials

3M ESPE and Straumann have partnered up to offer a

to internal structures between 1 and 100 nanometers in di-

new CADCAM restorative material, 3M™ ESPE™ Lava™

mension, defining the nano world. In comparison, a human

Ultimate Restorative, through Straumann® CARES ® Digital

hair is about 200,000 nanometers in diameter, and a typical

Solutions. The material is based on Resin Nano Ceramic

virus is about 100 nanometers long, a size which is at the

(RNC) technology, defining a new material class that com-

outer boundaries of nanotechnology. As size is decreased to

bines the benefits of ceramic based on true nano techno-

nanoscale dimensions, physical properties, e.g., optical cha-

logy and highly cross-linked resin.1

racteristics, get altered, especially when size nears the molecular scale, meaning < 5 nm. These unique properties are in

Entering the field of nanotechnology

the focus when research starts its innovative work to achieve

The field of nanotechnology has expanded dramatically as

materials with greatest efficiencies. In the dental field, 3M™

nanostructured materials exhibit unique properties on the ma-

ESPE™ Lava™ Ultimate Restorative offers an advanced den-

croscale that offer high-potential technological benefits. Typi-

tal material designed and engineered to be tooth-like and to

cally, the critical properties of nanomaterials are attributable

deliver workflow advances.

Human hair: Ø 200,000 nm

1

Virus: Ø 100 nm

3M™, ESPE™, Lava™, Ultimate Restorative is available with release of Straumann® CARES ® Visual 6.2

Nano particle: Ø 1-100 nm

Straumann® CareS® digital SolutionS

STARGET 1 I 12

Straumann® CARES® Restoration made of 3M™ ESPE™ Lava™ Ultimate Restorative. Courtesy of 3M ESPE Ag.

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Straumann® CareS® digital SolutionS

MATeriAL deScriPTiON

3M™ ESPE™ Lava™ Ultimate Restorative is a Resin Nano Ceramic containing approximately 79 % surface-modified nanoceramic particles. The ceramic particles are made up of three different ceramic fillers (of silica and zirconia) ranging between 4 and 20 nm that reinforce a highly cross-linked polymeric matrix.

The ceramic fillers are a combination of: Silica filler: non-agglomerated/non-aggregated, 20 nm Zirconia filler: non-agglomerated/non-aggregated 4 to 11 nm Zirconia/silica cluster filler: aggregated, comprised of 20 nm silica and 4 to 11 nm zirconia particles According to 3M ESPE

Bonded zirconia/silica nano particles clustered and surface treated in a proprietary process. Courtesy of 3M ESPE AG.

Straumann® CareS® digital SolutionS

rNc – A New MATeriAL cLASS 3M™ ESPE™ Lava™ Ultimate Restorative is a new CADCAM material based on Resin Nano Ceramic (RNC) technology, which is defined as a new material class. RNCs consist of nano ceramic components embedded in a highly cross-linked polymeric matrix. The true nanotechnology imparts excellent esthetics, strength and wear resistance. Using RNC technology 3M™ ESPE™ Lava™ Ultimate Restorative is designed to support a streamlined, flexible workflow.

»

Brilliant esthetics – Resin Nano Ceramic for lasting polish

The physical properties of 3M™ ESPE™ Lava™ Ultimate Restorative make this material very similar to the natural translucency and fluorescence of the teeth in its behavior. The Straumann® CARES® Restorations made of it have a glossy appearance when delivered. An easy polishing step taking less than 4 minutes makes the restoration highly brilliant.

»

10-year limited warranty* – Designed to be durable for reliable restorations

The high flexural strength and fracture toughness of the 3M™ ESPE™ Lava™ Ultimate Restorative material make it a strong one-piece restoration. It is not brittle, allowing for chipping-free restorations. The material properties make it possible for the Straumann milling centers to produce thin and minimally invasive restorations, which also open up new treatment possibilities.

» Maintains functional balance – Absorption of chewing forces and less wear to opposing enamel The nanoceramic technology makes it very kind to the opposing tooth regarding abrasion. 3M™ ESPE™ Lava™ Ultimate Restorative absorbs chewing forces and brings a new quality to all single tooth restorations. iMPrOved wOrkfLOw ThrOUGh AdvANTAGeS iN PrePArATiON ANd hANdLiNG The high efficiency of the workflow made possible with 3M™ ESPE™ Lava™ Ultimate Restorative is of special interest for both dental labs and dental practices.

*If all the conditions of the Straumann Guarantee® are fulfilled and if the material is used in strict compliance with approved indications and instructions for use of 3M™ ESPE™.

STARGET 1 I 12

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»

No further processing or firing

Once the Straumann ® CARES ® Restorations made of 3M™ ESPE™ Lava™ Ultimate Restorative are milled and delivered to the dental professional – no firing is required before being seated. The restoration can be polished, characterized with light-cured restoratives, and the anatomy can be changed by addingon or build-up. The abolition of the firing step specially emphasizes the new material category RNC of 3M™ ESPE™ Lava™ Restorative.

»

Easy adjustment. Adjustments and customizations can be carried out extra-orally or intra-orally with

light-cured composite, such as 3M™ Filtek™ Supreme xTE Universal Restorative / 3M™ Filtek™ Ultimate Universal Restorative, for excellent esthetic match.

»

Benefits for dentists, dental labs and patients. Straumann® CARES ® restorations made of 3M™

ESPE™ Lava™ Ultimate Restorative deliver esthetics without the requirement of further processing steps.

They offer advantages across the dental workflow which are of true benefit to dentists, dental labs and patients. 3M™ ESPE™ Lava™ Ultimate Restorative offers high control and efficiency.

STrAUMANN – SPeciALiST iN cAdcAM PrOSTheTicS The new 3M™ ESPE™ Lava™ Ultimate Restorative is indicated for single tooth restorations and can only be processed by using modern CADCAM technology. 3M ESPE and Straumann have partnered up to offer 3M™ ESPE™ Lava™ Ultimate Restorative, through Straumann ® CARES ® Digital Solutions. The backing of Straumann as a reliable provider supports the opportunities this material offers through highlevel milling expertise and qualitative prosthetic outcomes. New treatment options are possible using 3M™ ESPE™ Lava™ Ultimate Restorative via the Straumann milling centers – specialists in CADCAM prosthetics.

For more detailed information on 3M™ ESPE™ LAVA™ Ultimate Restorative, please go to website http://solutions.3m.com/wps. portal/3M/en_US/3M-ESPE-NA/dental-professionals/products/category/digital-materials/lava-ultimate/.

3M™, ESPE™, Lava™, Filtek™ are trademarks of 3M or 3M ESPE AG.

Straumann® CareS® digital SolutionS

STARGET 1 I 12

BeNefiTS fOr deNTiSTS, deNTAL LABS ANd PATieNTS

1. DATA DIgITALIzATION

4. PROCESSINg / POLISHINg

Multiple data sources with Straumann ® CARES ® Digitalization of patient situation with various scanners, the intraoral scanners iTero® or Lava™ C.O.S. and the Straumann® CARES ® Scan CS2 desktop scanner.

No firing required after milling An additional polish makes the restoration highly brilliant.

2. DESIgN

5. SEATINg

Validated workflow through Straumann CARES Visual Quality and predictability of the validated workflow via the specific Straumann software applications.

Easy adjustment Adjustments and customizations can be carried out with lightcured composite.

3. PRODUCTION

6. PATIENT

Straumann CARES restorations in high Straumann quality Thin and minimally invasive restorations made of 3M™ ESPE™ Lava™ Ultimate Restorative via the Straumann milling centers.

Less wear to opposing enamel 3M™ ESPE™ Lava™ Ultimate is not brittle, allowing for chipping free restorations. It shows no abrasion or opposite tooth damage.

ShAdeS AvAiLABLe Eight shades available, four of which include high translucency HIGH Transluscency LOW Transluscency A1 Courtesy of 3M ESPE AG

A2

A3

A3.5

B1

C2

D2

Bleach

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STARGET 1 I 12

Straumann® CareS® digital SolutionS

iNTerview

Scanning 2.0: Digital Impression-Taking with iTero™

Straumann® CareS® digital SolutionS

STARGET 1 I 12

An interview with Michael Rynerson, Straumann Global Head

Straumann implants. True to the motto of our digital portfolio

of iTero™ Sales, on the iTero™ intraoral scanning system.

“Seamless Connections,” Straumann will now take the next step together with our customers. The new digital workflow

How do you view the market acceptance for a system such

is the basis for increasing efficiency and quality, and

as itero?

facilitates the cooperation between surgeons, dentists, and

Interest in digital impression-taking is truly tremendous. In

dental laboratories significantly. We view digitalization as

particular, we have experienced this at congresses where the

a pronounced added value for customers at every stage of

system is demonstrated live. Commercially, the iTero system

the workflow.

with its highly developed 3D technology has gained a leading position in the USA. We also enjoy widespread interest from dentists and dental laboratories across Europe, where we

“The role as a center of digital competence makes

have achieved a leading position in intraoral scanning in

the laboratory an important partner for the dentist.”

some markets. There are a number of good reasons for

Michael Rynerson

deciding in favor of iTero: user-friendliness, precision, and efficiency – also in terms of time and costs. Of course there is an emotional element too – many of our customers are

Can you explain digital workflow for implants in more detail?

passionate about adopting great new technologies for the

Following the recovery period, a scanbody is screwed onto

benefit of their patients.

the implant. The dentist scans the scanbody and the adjacent teeth in sequence and immediately sees on the screen the

What role does itero play in the Straumann portfolio?

completed digital impression. The scanbody provides the

Intraoral scanning is an integral part of our digital portfolio

necessary data on the position of the implant in the scan.

because it is the most direct link between the restorative

Then the data is forwarded to the laboratory for the design of

dentist, the laboratory, and our CARES production centers.

the customized Straumann CARES abutment in CARES Visual.

Our focus is on solutions which enable our customers to offer

The laboratory sends the production data to Straumann

their patients the best possible treatment available on the

for fabrication of a CARES custom abutment, and orders a

market. The advantages of iTero make intraoral scanning a

precision-milled iTero™ model from an iTero Regional Milling

key technology in dentistry and, thus, of interest to all dental

Center. The laboratory orders a Straumann Repositional

professionals.

Implant Analog that fits into the iTero model.

are there any innovations especially for implantologists?

are dental laboratories also a target group for itero?

®

As an innovative company, Straumann has developed a

In most cases modern dental laboratories are already centers

complete digital workflow, from intraoral scans to Straumann

®

of competence for digital technology – with CADCAM

CARES ® copings and crowns, to customized abutments for

being a top subject for some time now. This role as a center

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STARGET 1 I 12

Straumann® CareS® digital SolutionS

of digital competence makes the laboratory an important

What does the future hold in your opinion?

partner for the dentist. Thus, the iTero™ system also offers the

For me it is not a question of will the majority of dentists

dental laboratory new service opportunities. This is of special

work predominantly with intraoral scanners, but when will

value because cooperation is closely linked via the intraoral

this become reality. We have all seen a similar revolution

scan workflow.

in photography. Who still uses film cameras these days?

Popular smartphones are another good example of how

are there other possibilities for using itero as part of the

digital impression technology will evolve. iTero is comparable

digital workflow?

to smartphones in so far as it is a platform for a range of

We are presently uniting the various workflows to provide

dental services that can be expanded through the installation

optimum compatibility. For example, our surgical planning

of new software applications. If you will, iTero™ is an

software, the Straumann Guided Surgery System, combines

extremely precise digital 3D camera with which dentists can

the DVT and CT information on the bone situation to a 3D

already cover a wide range of restorative and orthodontic

image for implant planning. Even today, we can already

indications today. Future developments of the software and

combine such data sets with intraoral scanning information

connected services will generate added value. In short,

to provide better documentation on the bone, soft tissue and

if somebody purchases an iTero™ scanner today, they

tooth situation. This allows improved surgical and prosthetic

should have confidence that it will continue to gain in value

planning.

through software innovations. The system already generates

®

considerable added value, we are only really at the beginning Cadent, the manufacturer of itero, is part of align

of this technology – the development potential for the next

technology as of april 2011. What are the implications?

few years is enormous. For example, in future one could well

Align Technology is a heavyweight in the orthodontic industry

imagine taking 3D “snapshots” of patients at their first visit

and includes invisalign™ in its portfolio, a well-known and

and after subsequent treatments. Thus, dentists could not only

widely used digital service for orthodontic treatments.

document tooth situations in a digital manner, but would be

Therefore Align truly understands digital dentistry, as well

better able to assess future developments in the patient’s oral

as knowing the needs of dental professionals, making them

condition. Today, dentistry is still very reactive in many cases

an ideal new home for the iTero™ technology. Furthermore,

– using digital tools dental professionals will be able to be

because Straumann is the exclusive distribution partner for

much more proactive.

iTero™ in Europe, and, since February of this year, also official distribution partner for iTero™ in North America, Straumann is one of the closest and most important partners of Align. Our cooperation to date with Align has been superb and we are enthusiastic about continuing our partnership.

Straumann® CareS® digital SolutionS

STARGET 1 I 12

iNTrA-OrAL ScAN viA iTero™ The highly advanced intraoral scanner iTero utilizes parallel-confocal 3D imaging and is thus 100 % powder-free and autofocus. Both features allow the dentist to place the scanning head directly on the teeth to take a series of 3D images which are combined into a precise 3D representation of the patient’s teeth. This provides stable handling as well as high precision and is often more pleasant for the patients than conventional methods. iTero guides the treating professional from tooth to tooth, similar to an automobile navigation system. The scanner is not only easy to operate, but also inspires patients as they can follow every step on the screen.

41

DID yOU KNOW? Straumann is the #1 dental implant system worldwide

reStorative

STARGET 1 I 12

ALL-cerAMic reSTOrATiONS

Straumann ® Anatomic IPS e.max ® Abutment

by Straumann ® and Ivoclar Vivadent ®

Combining Outstanding Properties – Now Available for NC

of a custom restoration in combination with the flexibility and

Straumann is the partner of choice for innovations in implant

predictability of a stock abutment.

and restorative dentistry. Ivoclar Vivadent is the established specialist in ceramic materials and final restorations. The

High-end esthetics: all-ceramic zirconium dioxide (ZrO2)

synergy of technologies has resulted in a premium esthetic

material in two shades for natural-looking restorations.

solution: the Straumann Anatomic IPS e.max Abutment, now

Effectiveness: pre-shaped abutment, straight and angled

also available for Narrow CrossFit ® (NC).

design in two gingival heights for cost-efficient restoration.

Predictability: Straumann Anatomic IPS e.max Abutment –

Esthetics by Design

strong connection between the implant and the restoration.

Designed by Straumann and produced by Ivoclar Vivadent

Flexibility: modifiable abutment (chair-side and lab-side) for

to fit a range of patient needs, this abutment is specifically

screw-retained and cemented all-ceramic restorations.

intended for reliable use and esthetic results and offers great flexibility in its application. It gives you the high-end esthetics

Now also available for Straumann® Narrow CrossFit ® (NC) Bone Level implants

Color: white (MO 0)

Article No.

022.2812

022.2814

022.2822

022.2824

022.2832

022.2834

022.2842

022.2844

GH 2 mm

GH 3.5 mm

GH 2 mm

GH 3.5 mm

Color: Shaded (MO 1)

Article No.

43

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STARGET 1 I 12

reStorative

Screw-retained full ceramic restorations

Cemented full ceramic restorations

»

» individualized emergence profile

directly veneered

»

»

overpressed

cemented

The abutment serves as an excellent basis for cost-efficient restorations for those clinicians looking to transition into the all-ceramic world of dental restorations.

» » » »

Different shades Different gingival heights Straight and angled RC and NC

shaded (MO 1)

IPS e.max ® is a registered trademark of Ivoclar Vivadent AG, Liechtenstein.

white (MO 0)

reStorative

STARGET 1 I 12

cOrBiN PArTridGe ANd BreNT GArriSON

Immediate Full Mouth Restoration Using Implant-Supported Fixed Hybrid Prosthetics

Initial Situation

maxilla using the implant planning software. Four Straumann速

A 49-year-old woman with an unremarkable medical history

Bone Level implants1 were planned for the maxilla and four

presented for a full mouth extraction. Severe periodontal

Straumann速 Soft Tissue Level implants2 were planned for the

disease was present in addition to mobile teeth and noted

mandible (figs. 3, 4). The posterior implants in the areas

bone loss (figs. 1, 2). She indicated that she wanted to

of #14 and #25 were angled to avoid the sinus and still

have an implant-supported fixed prosthesis in order to avoid

provide for first molar occlusion in the final prosthesis. A

having to wear traditional dentures long term.

guided surgical stent was then ordered through the software for the maxilla. The referring office supplied the immediate

Treatment Plan

denture prior to surgery. The patient was scheduled for surgery

A CT scan was performed and converted into implant

approximately one month after the second consultation to

planning software. Upon examination of the CT scan and

allow for creation of the stent and immediate dentures.

reconsultation with the patient, it was determined that four implants in each arch would be placed to support a fixed

Surgical Procedure

prosthesis. Using the converted scan, the implant sizes and

The initial phase of the surgery involved removing all of the

locations were planned for both the mandible and the

existing teeth with the exception of the #38 and #48, due

Fig. 1

Fig. 2

Fig. 3

Fig. 4

Fig. 5

Fig. 6

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STARGET 1 I 12

reStorative

to nerve involvement. The patient was sedated and the teeth were extracted as atraumatically as possible. Once the teeth were removed, the maxillary arch was exposed and the surgical stent was secured to the maxilla. The osteotomies were performed through the guide using a Straumann® Guided Surgical Kit with a final drill diameter of 3.5 mm (fig. 5). Stabilization pins were used to secure the stent while other osteotomy sites were prepared. The four Straumann ® Bone Level implants were then placed with primary stability using a hand piece at 35 Ncm (fig. 6). Sutures were used for ridge closure in a continuous and interrupted fashion.

Corbin G. Partridge, DMD

Attention was then directed to the mandible, where osteotomies were performed

Oral and maxillofacial surgeon. Full-time private

in the areas of #36, #33, #43 and #46. The Standard Plus implants were placed

practice at Northeast Oral and Maxillofacial

in the anterior sites #33 and #43. The Regular Neck Tapered Effect implant

Surgery in Indianapolis, Indiana. He has published

was placed in the area of #36 and the Wide Neck Tapered Effect implant was

several papers in both the Journal of Oral and

placed in the area of #46 (fig. 7). All implants were placed with primary stability

Maxillofacial Surgery and the Journal of the Indiana

using a hand piece at 35 Ncm. No sutures were required as the mandibular ridge

Dental Association. He served in the U.S. Army as

was not exposed.

the Executive Officer of the Head and Neck Surgery Team with the 47th Combat Support Hospital in Mosul, Iraq during Operation “Iraqi Freedom“ 2005 – 2007. He is an ITI member.

cpartridge@neomsindy.com

Fig. 7

Fig. 8

Fig. 9

Fig. 10

reStorative

STARGET 1 I 12

Prosthetic Procedure Immediately after the implants were placed, impression posts were attached and impressions of both arches were taken. After the impressions were taken, healing caps were placed on all implants, the impressions and immediate dentures were sent to the lab, and the patient left the office. Using the impressions, the lab converted the immediate dentures into screw retained immediate prostheses, which were heat cured overnight (figs. 8 â&#x20AC;&#x201C; 10). The patient returned to the office the next day for placement of the provisional prostheses. The healing caps were removed

Brent T. Garrison, DDS, MSD

and the appropriate abutments were placed. The maxillary prosthesis was placed

Oral and maxillofacial surgeon. Full-time private

over the abutments and attached using four screws, with the mandibular prosthesis

practice at Northeast Oral and Maxillofacial Surgery

fixed in a similar fashion (figs. 11, 12). The patientâ&#x20AC;&#x2122;s bite was adjusted using a

in Indianapolis, Indiana. He has published several

handpiece with a denture bur. Once the adjustments were finished and the patient

articles and given numerous presentations on all

was satisfied with her bite, a temporary filling material was placed in the screw

aspects of oral and maxillofacial surgery. He has

holes of the prostheses and final x-rays were taken (figs. 13 â&#x20AC;&#x201C; 17). The patient was

served terms as President of the Great Lakes Society

given instructions for post-op hygiene and told not to chew for eight weeks to allow

of Oral and Maxillofacial Surgery, the Indiana Society of Oral and Maxillofacial Surgeons and the Indianapolis District Dental Society. He is Assistant Clinical Professor of Oral and Maxillofacial Surgery at the Indiana University Medical Center. He is an ITI member.

bgarrison@neomsindy.com

Fig. 11

Fig. 12

Fig. 13

Fig. 14

47

STARGET 1 I 12

48

reStorative

for proper integration, after which a limited soft-chew diet was recommended. This is recommended due to the limited strength of the provisional prostheses, which serve a more esthetic rather than functional purpose.

Outcome The patient returned to the office for her one week check, and was healing well. She will wear the provisional fixed prostheses for approximately six months, allowing the ridges to form fully and heal. At this time, she will return to the office for final impressions, which will be used by the laboratory to create the permanent bar retained prostheses. Combining the milled bar-retained prostheses with the splinted Straumann® SLActive ® implants will result in a strong and permanent alternative to traditional dentures.

1

4x Straumann® Bone Level Implant RC Ø 4.1, 12 mm SLActive.

2

2x Standard Plus RN Ø 3.3, 12 mm

SLActive/1 x Tapered Effect WN Ø 4.8, 12 mm WN/1 x Tapered Effect RN Ø 4.1 x 10 mm)

Fig. 15

Fig. 17

Fig. 16

SurgiCal

STARGET 1 I 12

50

STrAUMANN ® SLa ctive ®

Updated SLActive Scientific Evidence Brochure

The Straumann SLActive implant surface offers confidence in all treatments thanks to its unique properties of hydrophilicity and chemical activity, which help to accelerate the osseointegration process.1 The excellent osseoconductive properties of the SLActive surface have been supported by numerous preclinical and clinical studies.

Now clinicians can access the updated SLActive Scientific Evidence Brochure to review some of the key scientific studies supporting the SLActive implant surface. The newly available and updated version of the SLActive Scientific Evidence Brochure features summaries of 14 preclinical and 7 clinical studies on SLActive. A few new clinical studies from this information-rich brochure are highlighted below. If you wish to have an SLActive Scientific Evidence Brochure sent to you, please contact your local Straumann territory manager or contact the Straumann Customer Service team at 800/448 8168.

A prospective study on 3 weeks loading of chemically modified

Early loading of nonsubmerged titanium implants with a

titanium implants in the maxillary molar region: 1-year results

chemically modified sand-blasted and acid-etched surface:

M. Roccuzzo, T.G. Wilson Int J Oral Maxillofac Implants 2009;24:65–72.

6-month results of a prospective case series study in the posterior mandible focusing on peri-implant crestal bone

Abstract: SLActive

®

implants were placed in the posterior

changes and implant stability quotient (ISQ) values

maxilla, which tends to have lower bone density, and loaded

Bornstein MM, Hart CN, Halbritter SA, Morton D, Buser D.

after 3 weeks. Preliminary results suggest no complications

Clin Implant Dent Relat Res 2009;11(4):338-347.

and no early implant failures in this challenging indication.

Abstract: Forty patients received 56 SLActive ® implants, Conclusions

which were functionally loaded after 3 weeks. Implant

Successful functional loading is possible in the maxillary

stability (ISQ) was measured at various time points for up

molar region after 3 weeks with SLActive implants

to 26 weeks and showed a steady increase from implant

Implant survival was 100 % after 12 months in low

placement to week 26.

density bone

The procedure represents an important step toward faster healing and increased treatment predictability

Conclusions

Early loading with SLActive implants 3 weeks after placement in the posterior mandible has a low risk for early failures

1

Compared to SLA in an animal model

Definitive functional restoration after 3 weeks is possible

SurgiCal

STARGET 1 I 12

Early loading at 21 days of non-submerged titanium

A multicenter prospective ‘non-interventional’ study to

implants with a chemically modified sandblasted and

document the use of and success of Straumann ® SLActive

acid-etched surface: 3-year results of a prospective stu dy

implants in daily dental practice

in the posterior mandible

Luongo G, Oteri G. 24th Annual Meeting of the Academy of Osseointegration,

Bornstein MM, Wittneben J-G, Brägger U, Buser D. J Periodontol

February 26-28, San Diego, CA, USA; poster P220. J Oral Implantol 2010;

2010;81(6):809-818.

36(4):305-314.

Abstract: SLActive ® implants were placed in patients and

Abstract:

functionally loaded after 21 days; clinical and radiographic

conducted, in which 276 SLActive implants were placed and

parameters were evaluated for up to 36 months. No implants

documented in 218 patients according to situations where

were lost and clinical attachment levels and probing depths

implants would normally be placed. After 1 year the survival

were improved versus historical SLA

®

controls.

A

multicenter

non-interventional

study

was

and success rate was 98.2%, similar to that observed in strictly controlled clinical trials.

Conclusions

Early loaded SLActive implants can achieve and maintain

Conclusions

successful tissue integration over 3 years

The 1-year cumulative survival and success rate was 98.2%

The procedure offers rehabilitation with a definitive resto-

All failed implants were associated with a simultaneous

ration after 3 weeks, increasing cost-effectiveness for the patient

sinus floor augmentation procedure

The success rate of SLActive implants in daily practice is

Loading after 3 weeks can be recommended in defined

similar to that observed in formal clinical trials with strictly

clinical situations for standard sites without bone defects

controlled patient populations

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international team for implantology

Straumann & Baylor University Launch the First Interdisciplinary Digital Dentistry Course On July 29-30, 2011, twenty-four dental professionals braved the Dallas, Texas drought and 100+ degree temperatures to learn about the digital dentistry workflow at Baylor University’s College of Dentistry.

Over the course of two days, the participants—comprised of clinicians and lab technicians—learned about where the dental world is headed and how interdisciplinary digital dentistry will continue to play a larger part in their practices and labs. The course, cosponsored by Straumann, was designed for the interdisciplinary team (surgeon, restorative dentist and lab technician) to attend and learn about the different digital technologies available to each member of the team, and to understand how each team member and their technology plays a role in achieving optimal patient care and esthetic results.

Participants were exposed to all of the links in the digital dentistry chain, including Straumann Guided Surgery Planning Software, the gonyx table, the iTero scanner, and the CS2 scanner.

It was a jam-packed two days, filled with lectures, case presentations and hands-on sessions.

Participants learned how to treatment plan implant cases with the Straumann Guided Surgery treatment planning software and how a radiographic template and surgical guide can be made with precise accuracy on a gonyx table. They also experienced firsthand how to take an intra-oral impression with an iTero system and how to open an iTero file into the CS2 CADCAM scanner and design a coping, abutment or crown.

It was an excellent course, and many of the attendees left excited to start incorporating digital dentistry into their practices.

The advice from previous attendees is to register as a team- many who came alone said they wished they had brought their interdisciplinary team members.

Baylor will host this course again July 27-28, 2012. If you are interested in learning more about the Interdisciplinary Digital Dentistry Courses, please contact the Straumann Education Department at 800/448 8168 and press 5, or register on the Baylor CE website at: http://www.bcdce.com/courses/ course/category.php?id=2

international team for implantology

STARGET 1 I 12

ITI Membership Tops 10,000

Basel, Switzerland – The International Team for Implantology

strong demand by colleagues for evidence-based education

(ITI), a leading academic organization dedicated to the

and treatment guidelines that are delivered independently of

promotion of evidence-based education and research in the

commercial interests.“

field of implant dentistry, announced on October 17, 2011 that it had welcomed its 10,000th member. This achievement

“I heard about the ITI several years ago and since then traced

marks another milestone in the 31-year history of the ITI.

its activities,“ said Dr. Shand. “After attending several ITI education courses in Melbourne and working with a number

This growth is due in large part to the recently launched

of esteemed ITI Fellows in Australia including Dr. Anthony

ITI Study Club concept, which has evoked an overwhelming

Dickinson and Dr. Stephen Chen, I was immediately drawn

response around the globe. Exceeding its own expectations,

to becoming a member of this global organization with its

the ITI to date has established more than 500 Study Clubs on

wealth of benefits that will significantly enhance both my

every continent. Free participation in ITI Study Clubs as part

professional activities and international perspectives.“

of the annual benefits package has proven to be a significant membership value. ITI Study Clubs are characterized by an

Established in 1980 by a small group of visionary pioneers

approach to learning through presentations and interactive

led by Prof. Dr. André Schroeder and Dr. Fritz Straumann, the

discussion in relatively small groups at a local level. They

ITI has championed the cause of implant dentistry since the

represent an efficient platform from which to disseminate and

early days, playing a continuous role in its development to

exchange knowledge on the latest treatment approaches in

the present day. Today, the organization has a true global

implant dentistry.

presence through its 27 national or regional Sections. The ITI takes a leading role all over the world in continuing

The 10,000th member of the ITI is Dr. Jocelyn Shand, a

dental education and the development of standard treatment

well respected Oral & Maxillofacial Surgeon from the Royal

methods to ensure reliable outcomes. In addition, the ITI is the

Children’s Hospital, University of Melbourne and President

largest non-governmental organization worldwide to award

of the Australian & New Zealand Association of Oral &

research grants in implant dentistry.

Maxillofacial Surgeons. She was welcomed personally by the ITI President Prof. Dr. Daniel Buser and the leadership

The ITI welcomes all appropriately qualified professionals with

team of the ITI Section Australasia.

an interest in implant dentistry as members of the organization.

Membership of the ITI offers a wealth of benefits and the

“We are very pleased with the current membership

highest quality educational support as well as the opportunity

development and the opportunity to welcome our 10,000th

to meet likeminded professionals through the extensive event

member,“ said Prof. Buser. “The continued growth of the

schedule. Dental practitioners who are interested in finding

ITI, which is a result of the systematic implementation of our

out more or joining the ITI should go to www.iti.org.

strategic Vision 2017 developed in 2007, is a clear sign of the

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deNTiSTrY ON The MOve

Global Trends â&#x20AC;&#x201C; Setting the Pace of Innovation and Progress in Dentistry

Simply doing more

Where are We Headed?

How will the worldâ&#x20AC;&#x2122;s demographics, technologies and economies develop in the future? Will these developments impact implantology, dentistry and the other related medical disciplines? The answers to these questions determine how Straumann designs our products and services, and how we drive innovations. Perhaps the most globally influential trend is the aging population and the attendant need for health services, including restorative dentistry. Practices of the future will look different than those of today.

In the Beginning, There Was Titanium In the 1970s, the discovery of titaniumâ&#x20AC;&#x2122;s osseointegrative properties and high compatibility with the human body led to the development of dental implants for the replacement of lost teeth and anchoring of prostheses. Key advantages of implants over conventional denture techniques allowed manufacturers and specialized dentists to develop a new discipline of dentistry, which has since evolved into todayâ&#x20AC;&#x2122;s standard treatments with restorative dentistry.

The Excitement Continues Nearly forty years after discovering the osseointegration of titanium, we are entering the next quantum leap in dentistry: the digitalization of restorative dentistry. This will have tangible effects on the way we look at various occupations and, in turn, how dental experts work together. New products and innovations are constantly developed, potentially leading to new treatment opportunities.

STARGET interviewed three prestigious dental specialists on trends and new technologies in restorative dentistry: lyndon Cooper, Kenneth malament and daniel Wismeijer.

STARGET 1 I 12

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restorations on a metal frame? Zirconia? What if the patient only has enough bone for 6 mm implants? Should we graft LYNdON cOOPer Stallings Distinguished Professor, Professor & Chair, Dept. of Prosthodontics; University of North Carolina School of Dentistry

bone and place 8 mm or 10 mm implants, or is 6 mm enough?

I’m not suggesting there is only one answer, but together the profession and industry can use evidence to determine which therapies provide maximum return on patient investment with a minimal number of interventions and components.

What about standards for products?

How can the implant industry serve its customers better?

One implant system rarely covers everything, so you may

Implant therapies are evolving rapidly, yet dentists with

need at least two different systems. There may be some value

mature practices learned little about implants in dental school

in diversity. However, I also see value in having evidence

10 years ago. The industry must continue to help educate

based standards and shared criteria that reflect clinical

dentists. There needs to be an ethical discussion between

outcomes. It would be good to have efficacy data for implants

the industry and the profession about standards in product

tested six to 12 months before a product is sold. The drug

testing, documentation and training. Finally, the industry truly

industry gathers data after the product has been introduced.

serves both patient and dentist by providing clinical data

That model might work for our very fast product evolution.

about the products. How many implants failed? We clinicians care and need to know.

Have we reached the limits in osseointegration?

We continue to improve the osseointegration potential of implants, but we still must learn to identify high risk patients

“The industry must continue to help educate den-

and develop successful strategies for them. From a broader

tists. There needs to be an ethical discussion be-

perspective, our knowledge of how soft tissues integrate

tween the industry and the profession about stan-

with the abutment is very immature. We need new scientific

dards in product testing, documentation and train-

understanding so we can get healthy soft tissue integration

ing.“ Lyndon Cooper

that protects the underlying bone, stays free of inflammation and looks natural.

Will dentistry develop standards of care?

is peri-implantitis a latent epidemic?

Simplification and standardization can improve the quality of

We don’t know; we don’t fully appreciate its incidence or

care. For example, what possibilities exist for an edentulous

prevalence. We must acknowledge its presence and dentists

maxilla – four, six or eight implants? Ceramic or acrylic

must evaluate implants regularly for inflammation and act appropriately. Does the inflammation begin at the implant

Simply doing more

STARGET 1 I 12

surface, at the implant-abutment interface, or at the abutment

complex restoration of defects. These three developments

itself? The solutions could be very different.

really open the door for tremendous growth in implant dentistry.

How has the economic crisis affected dentistry?

US laboratories are making fewer crowns and veneers, while

What will the relevance of prosthodontics be in the future?

removable and complete denture volume is less affected,

As we move to smarter, more capable technologies, we need

suggesting that people still need teeth but they have adopted

better understanding of how to create occlusion, form, color,

a cost-conscious attitude. The growth of implant sales has

and natural esthetic appearance within the whole mouth.

been slower since 2008. The growing debate about

These are the concerns of the specialty of prosthodontics,

nationalized healthcare in the US is fueling new discussion

and I am very confident in its future.

about access to dental care.

“Preventive dentistry is more successful than ever before, but many people don’t go to a dentist regularly, and their mouths show the usual levels of decay and periodontal problems.“ Kenneth Malament

keNNeTh MALAMeNT Clinical Professor of Postdoctoral Prosthodontics, Tufts School of Dental Medicine, Boston

Will better prevention reduce the need for prosthodontics?

I don’t think so. Preventive dentistry is more successful than ever before, but many people don’t go to a dentist regularly, and their mouths show the usual levels of decay and periodontal problems. Also, people are still affected by accidents and disease. Dental restorations break and cause serious problems. In my practice, I haven't seen any diminution of

What have been the most significant developments in

required care.

prosthodontics in the past two to three years?

Digital scanning equipment and software continues to improve.

are the products coming onto the market adequately tested?

Then, for the very first time a material, lithium disilicate, has

No. Look at the whole cosmetic dentistry concept, where people

shown no signs of breakage over 2½ years. This monolithic

were putting plastics on everything and considering it conventional

material can be CADCAM’d to full contour in one step,

and thorough and long-term successful dentistry. Bacteria grow

unlike the bilayer materials. Finally, bone grafting materials

on and within resinous materials, and can cause serious

and techniques have significantly improved, allowing more

breakdown when they attack tooth structure. Recent research on how ceramic materials flex and fracture has completely

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changed the way we understand the mechanics and strength of ceramic materials. As we develop new materials, we must

dANieL wiSMeijer

understand and test them better.

Professor & Chairman, Dept. Oral Function & Restorative Dentistry;

are high-end esthetics out of reach for the average patient?

Head, Oral Implantology & Prosthetic

Right now, access to great esthetics is limited by the supply of

Dentistry Section, Academic Center

great dentist/technician teams. As we move to smart systems,

for Dentistry, Amsterdam (ACTA)

the expertise of the best practitioners will be built into the software. I think CADCAM dentistry will eventually drop the price of dentistry, but I’m not sure when.

do you think all of dentistry is going to become digital?

A dentist’s work is two-fold: handicraft and oral medicine. It will be a while before we digitize interaction with the patient,

“As we move to smart systems, the expertise of the

looking at the medical and psychological background,

best practitioners will be built into the software.“

diagnosis, and individual treatment design. On the handicraft

Kenneth Malament

side, digital radiography improves diagnostics and reduces chemical

waste.

Starting

with

oral

scanning,

digital

articulators and planners will replace physical models, What major advances do you expect in the near to mid

and the whole workflow will become digital, ending in

term?

CADCAM production. Once we get good light images of

Low-radiation, noninvasive CT scanning for all dental

the teeth, a machine will also produce the prosthesis in the

impressions while the patient sits in a chair. Spectrophotometric

right color.

color analysis will help design the whole mouth on a giant computer monitor.

is digitalization the most important trend in dentistry now?

It’s where things are happening. Virtual implant planning

Has the economic crisis had an effect on prosthodontics?

is getting more precise, and computer manufacturing of

No. The companies that will win in the next 10 years are

prosthetics is getting simpler than the casting method. We

those that best integrate the technologies and educate

can design the treatment digitally (site, position, implant type,

dentists and technicians. The real explosion will come from

superstructure) and insert the implants plus superstructure

well-funded industrial giants who are very active players

in one treatment sequence with a fault margin of 40 μm

within the story.

– the width of the thinnest human hair. Everything is more controllable, and if something doesn’t fit during the digital design phase, we can correct it before it reaches the patient.

So the digital environment is going to be very important.

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STARGET 1 I 12

What do you see as the biggest risks in digital dentistry?

What sort of innovations can we expect in the next years?

We will become more dependent on commercial software.

Improved navigation, so the dentist can monitor inside the

Some jobs will be lost. In order to rely on machines and

bone and teeth as he or she works. Apparatuses that convert

software, the safety standard must be very high. And in order to

hand movements into very small precise machine movements

rely on internet communication, the transmission, security, format

will make micro treatment possible. Finally, I hope companies

and integrity of private medical information must be ensured.

agree on data standards, so all the machines and software

Finally, the machines are not cheap, and it may be a long time

can communicate with each other.

before we can deliver digital dentistry at a lower price.

How will technological changes affect current dentists?

Young graduates will want to practice digital dentistry. Mature dentists close to retirement face the choice of investing in new technologies to attract young dentists who will then buy their practices, or continuing the old way and losing some of their original investment. There is no choice in between. If they want to stay in dentistry they will have to invest in new technologies. does digitalization get ample attention in dental education?

Students leaving ACTA in a few years will be used to working with intra-oral scanning, cone beam CT scans, digital planning, drill guides, and CADCAM. As they join practices, they will show other dentists the new techniques. We are lucky that our school is new and so are all the fittings. Many other schools are looking at what we are doing, but it will take them time to convert.

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STrAUMANN Aid: AcceSS TO iMPLANT deNTiSTrY

A Meaningful Contribution to a Different Quality of Life

effecTive ANd PrAcTicAL cONTriBUTiONS

AcceSS TO deNTAL SOLUTiONS

TO SOcieTY

‘Straumann AID’ (Access to Implant Dentistry) is our structured

Providing high quality, safe, effective, and lasting solutions that

global program to assist patients who need implant treatment

restore dental function and enhance the quality of life is perhaps

but are unable to afford it. Through this program, we donate

the greatest contribution we can make to society. In 2009,

all the Straumann products necessary, relying on dentists in

around a million patients spread across 70 countries invested

the ITI network to provide the clinical services without charge.

in a Straumann dental solution, and we have simply done more to make certain that it will meet their expectations for

SPONSOriNG deNTAL cAre ArOUNd The GLOBe

many years to come.

Our strategy for corporate sponsorship is to concentrate primarily on charitable activities where we can have the

At the same time, many people around the world are unable to

greatest impact, based on our own competencies and the

benefit from dental care due to geographic and economic

collaboration of our partners. For this reason, we focus on

limitations. As a leader in our industry and as a responsible

dentistry-related programs that help people who do not have

corporate citizen, we believe we have a duty to help in

access to dental care or cannot afford implant dentistry.

a practical, meaningful way. Our aim is to ensure that our contributions benefit not only the recipients but also, indirectly,

Basic dental care and oral hygiene programs

our other stakeholders.

We continued our tradition of sponsoring charitable missions and activities that bring basic dental care and education to the underprivileged. Our contributions in 2009 included support for the following:

p SDI Secours Dentaire International, treating patients in Tanzania

p A team of young dentists from the University of Connecticut Health Center, School of Dental Medicine to provide dental treatment and oral hygiene to underprivileged children in Chile

p The ‘Hope for All’ project to sponsor the education of two dental students in Cambodia

p A team of young dentists from the Dental Institute of Basel University, to provide dental treatment to orphaned children in Cambodia

Providing dental treatment and oral hygiene to underprivileged children.

Simply doing more

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p Three teams of young dentists from the Dental Institute of Zurich University, to provide dental treatment to children in the Dominican Republic, Guatemala and the Ukraine

p The Smile Charity Foundation/Korean Universities and Schools of Dentistry, to improve the oral health of disabled persons and to provide scholarships in Korea.

In each case the sponsorship goals were met. Thanks to the assistance of our dental partners, these projects have been an extremely efficient use of funding and have made a real difference to hundreds of people, most of whom are children.

We intend to continue our global charitable activities with the goal of providing access to dental treatment to disadvantaged people. Although economic downturns frequently result in reduced charitable giving, we plan to continue our Straumann The joy of dentistry! One of several hundred children treated through dental projects sponsored by Straumann.

AID program and to support the National Foundation for Ectodermal Dysplasia (NFED) and other relief projects. We will continue to focus our charitable sponsoring on fields related to dentistry, where we feel we have most to offer and where our involvement is appreciated by our stakeholders.

Ectodermal dysplasia Ectodermal Dysplasia (ED) refers to a group of genetic disorders characterized by abnormal development of the skin

Ectodermal dysplasia patients are typically stigmatized by severely malformed or missing teeth in addition to other debilitating symptoms.

and associated structures. Patients typically have few teeth and the teeth they do develop are usually severely malformed. On average, each ED patient in the US faces dental charges of $28,000. This is a considerable burden because more than 50% of patients are not covered by insurance. The NFED, based in Mascoutah, Illinois, is committed to providing help and hope to families around the globe who are affected by this condition.

This picture demonstrates the tremendous difference that treatment can make.

STARGET 1 I 12

WE CONTINUE OUR TRADITION OF SPONSORING CHARITABLE MISSIONS AND ACTIVITIES THAT BRING BASIC DENTAL CARE AND EDUCATION TO THE UNDERPRIVILEGED.

Today, several thousand individuals affected by ED in more than 65 countries receive services from the Foundation, which has provided financial assistance and information, in addition to connecting affected families with each other and with practitioners.

Once patients reach adulthood, they can be treated with dental implants, which make a significant difference. Straumann provides free implants to ED patients, but these represent a small portion of the overall treatment costs. We work with the NFED to expand its network of dental professionals who provide free services to ED patients; we also support the foundation with financial aid.

Cleft lips and palates (Clefts) Cleft lips and palates (clefts) are one of the most common

We contribute to dental relief projects to provide treatment and instruction on oral hygiene to orphans.

major birth defects in developing countries and occur in 1 in 600 to 1000 births. Despite the fact that surgery is straightforward, it is not widely available, with the result that millions of children suffer from unoperated clefts. Although the condition is not usually life-threatening, patients are stigmatized by their appearance and have great difficulty in eating and speaking. Straumann contributes to non-profit organizations providing free surgery to children with clefts in developing countries.

On-the-spot treatment in a Straumann-supported dental relief project in Gambia.

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LiTerATUre ALerTS

Selected Literature of Potential Interest from Recently Published Journals

STRAUMANN ® EMDOGAIN TM

theses after 4 months. Clinical parameters were recorded after 6, 12 and 24 months and radiographic bone level was recorded after 2 years. Implant survival was 100 % for all sys-

Casarin RCV, Ribeiro Edel P, Nociti FH Jr, Sallum AW, Am-

tems. Plaque index and peri-implant inflammation scores were

brosano GMB, Sallum EA, Casati MZ. Enamel matrix de-

higher for the Brånemark implants in the first year. Marginal

rivative proteins for the treatment of proximal class II fur-

bone loss around ITI and Astra Tech implants was similar at 2

cation involvements: a prospective 24-month randomized

years (p > 0.05). The marginal bone loss around Branemark

clinical trial. J Clin Periodontol 2010;37(12):1100-1109.

implants was higher than Astra Tech implants (p < 0.05) but

A total of 12 patients with bilateral proximal furcation defects

similar to ITI implants at 2-year recall appointment (p > 0.05).

≥ 5 mm and bleeding on probing were treated with open flap debridement and EDTA alone (control) or in combination

Nedir R, Nurdin N, Vazquez L, Szmukler-Moncler S,

with EMD (test). Clinical parameters were evaluated prior

Bischof M, Bernard J-P. Osteotome sinus floor elevation

to treatment and after 6, 12 and 24 months. No significant

technique without grafting: a 5-year prospective study. J

differences were observed after 24 months. Probing depth

Clin Periodontol 2010;37(11):1023-1028.

reduction was 1.9 ± 1.6 mm and 1.0 ± 1.3 mm in the test

Osteotome sinus floor elevation was performed without graft-

and control groups, respectively, and the gain in relative

ing in 17 patients (mean residual bone height 5.4 ± 2.3 mm)

horizontal clinical attachment level was 1.4 ± 0.9 mm and

and a total of 25 Straumann SLA® implants (10 mm in length)

0.7 ± 1.3 mm in the test and control groups, respectively.

were placed. Implant survival after 5 years was 100 % and

After 24 months, only five class II furcations remained in the

the mean increase in peri-implant bone was 3.2 ± 1.3 mm,

test group, compared to 10 in the control group (p < 0.05).

while implant protrusion into the sinus decreased from 4.9 ± 1.9 mm at baseline to 1.5 ± 0.9 mm. Mean crestal bone loss

STRAUMANN ® DENTAL IMPLANT SySTEM

was 0.8 ± 0.8 mm, which stabilized over 5 years; bone gain after 1 year was noted at 20 implants. Grafting is therefore not required for bone gain of at least 3 mm.

Bilhan H, Kutay O, Arat S, Çekici A, Cehreli MC. Astra Tech, Branemark, and ITI implants in the rehabilitation

Bosshardt DD, Salvi GE, Huynh-Ba G, Ivanovski S, Donos

of partial edentulism: two-year results. Implant Dent

N, Lang NP. The role of bone debris in early healing ad-

2010;19(5):437-446.

jacent to hydrophilic and hydrophobic implant surfaces in

In 26 patients, Astra Tech implants (42), Brånemark implants

man. Clin Oral Implants Res 2011;22(4):357-364.

(36) and Straumann® implants (29) were placed; abutment

Straumann experimental implants (4.0 mm long and 2.8 mm

connection was performed for the Astra Tech and Brånemark

diameter) with either an SLA or SLActive surface were placed

implants after 3 months and all implants received fixed pros-

in the retromolar region in 28 volunteers and retrieved by

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STARGET 1 I 12

trephine after 7, 14, 28 and 42 days. All surfaces were par-

esthetic scores, with white esthetic scores being slightly su-

tially coated with bone debris and new bone formation was

perior. Mean crestal bone loss was 0.18 mm after 3 years;

observed after 7 days. New bone gradually increased over

bone loss from 0.5 to 1.0 mm was observed at only two

time while fractions of old bone, soft tissue and bone debris

implants, one of which showed minor recession of the facial

gradually decreased. New bone was higher with SLActive

mucosa (< 1 mm).

after 2 and 4 weeks. The change in bone debris:soft tissue ratio changed significantly from 7 to 42 days for both SLAc-

Zupnik J, Kim SW, Ravens D, Karimbux N, Guze K. Factors

tive and SLA. The bone debris:soft tissue ratio suggested that

associated with dental implant survival: a 4-year retros-

bone debris had a significant influence on the initiation of

pective analysis. J Periodontol 2011;82:1390-1395.

bone deposition.

A retrospective chart review of patients at the Harvard School of Dental Medicine (HSDM) who had one of two types of

Buser D, Wittneben J, Bornstein MM, Gr端tter L, Chappuis

rough-surface implants (group A: Straumann SLA速, group B:

V, Belser UC. Stability of contour augmentation and es-

Nobel TiUnite 速) placed by periodontology residents from

thetic outcomes of implant-supported single crowns in the

2003 to 2006 was performed. Demographic, health, and

esthetic zone: 3-year results of a prospective study with

implant data were collected and analyzed by multi-model

early implant placement postextraction. J Periodontol

analyses to determine failure rates and any factors that may

2011;82(3):342-349.

have increased the likelihood of an implant failure. The study

A total of 20 patients received implant-supported crowns on

cohort included 341 dental implants. The odds ratio for an

Straumann Bone Level implants in the esthetic zone, and clini-

implant failure was most clearly elevated for diabetes (2.59)

cal, radiologic, and esthetic parameters were recorded for

and implant surface group B (7.84), and male groups (4.01).

3 years follow-up. All implants were successfully osseointe-

There was no significant difference regarding the resident

grated and stable, with good peri-implant soft tissues after

experience. The success rate for HSDM periodontology resi-

3 years. Good results were obtained for the pink and white

dents was 96.48% during the 4-year study period.

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STARGET 1 I 12

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Cochran DL, Jackson JM, Bernard J-P, ten Bruggenkate CM, Buser D, Taylor TD, Weingart D, Schoolfield JD, Jones AA, Oates TW Jr. A 5-year prospective multicenter study of early loaded titanium implants with a sandblasted and acid-etched surface. Int J Oral Maxillofac Implants 2011;26(6):1324-1332.

A total of 439 implants were placed in 135 partially and fully edentulous patients, with abutments connected after 6 weeks in type II and III bone and after 12 weeks in type IV bone.

Evaluations were performed for up to 5 years, after which the cumulative implant survival and success rates were 99.1% and 98.8%, respectively; all implant failures were between surgery and 1 year. SLA-surfaced implants can therefore be loaded after 6 weeks in type II and III bone and maintain high survival and success over 5 years.

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STARGET 1 I 12

STrAUMANN NOrTh AMericA edUcATiON cOUrSeS

Up coming 2 0 1 2 Educ a t ion Ev en t s

For more information on programs in the US contact the

March 30-21, 2012

Straumann US Education Department at 978/747 2553

The Art, Science and Business of Clinical Implant Practice

or education.us@straumann.com or visit us on the website:

las vegas, nv

www.straumann.us and click on the courses tab.

Lecturers: Dr. Paul Fugazzotto, Dr. Kanyon Keeney

For more information on programs in Canada contact the

April 20-21, 2012

Straumann Canada Department at 905/319 2900 or

The Art, Science and Business of Clinical Implant Practice

education.ca@straumann.com or visit us on the website:

Washington, dC

www.straumann.ca.com and click on the courses tab.

Lecturers: Dr. Paul Fugazzotto, Dr. Kanyon Keeney

March 23, 2012

April 20-21, 2012

Dental Implant Complications Symposium: Etiology,

Digital Interdisciplinary Dentistry

Prevention & Treatment

louisville, Ky â&#x20AC;&#x201C; university of louisville

new york, ny

Lecturers: Dr. Dean Morton, Dr. Jay Beagle, Travis Roy

Lecturers: Dr. Stuart Froum et. al.

Target Audience: Interdisciplinary Team consisting of

Target Audience: Dental Clinicians

Surgeon, Restorative Dentist and Lab Technician

Products: Implants

*must attend in a team

Registration: Straumann.cvent.com/event/march23

Product: SGS, CADCAM, Implants, Restorative Components

March 30-31, 2012

April 23, 2012

Digital Interdisciplinary Dentistry

"Are you Referring to Me?" Strategies for Marketing the

farmington, Ct â&#x20AC;&#x201C; university of Connecticut

Oral and Maxillofacial Surgery Practice

Lecturers: Dr. Don Somerville, Dr. David Shafer

JaWS Society annual meeting

and Charlie Meneguzzo

Dr. David Schwab

Target Audience: Interdisciplinary Team consisting of Surgeon, Restorative Dentist and Lab Technician *must attend in a team Product: SGS, CADCAM, Implants, Restorative Components For more information on this program or to register: http://smile.uthscsa.edu

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STARGET 1 I 12

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April 27-28, 2012

*must attend in a team

Understanding the Basics of Surgical and Restorative

Product: SGS, CADCAM, Implants, Restorative Components

Dental Implant Therapy

For more information on this program or to register:

detroit, mi – university of detroit mercy

http://www.bcdce.com/courses/course/category.php?id=2

Lecturers: Ahmad M. Fard DDS, MS and Anthony Neely, DDS, PhD

August 5-12, 2012

Target Audience: Clinicians

Simplification and Predictability of Implant Dentistry

Products: Implants

alaska Cruise

For more information on this program or to register:

Lecturer: Dr. Robert Vogel

http://dental.udmercy.edu/ce

Target Audience: Entire Implant Team Products: Implants

May 18, 2012

To register please go through www.kennedyseminars.com

Advanced Implant Surgery & Tissue Grafting

and click on “REGISTER NOW“

dallas, tX at Baylor university Lecturer: Dr. Thomas Wilson

November 2-3, 2012 Temple University 2nd Annual Straumann Lecture –

May 19, 2012

Current Trends and Techniques in Planning and Restoring

Advanced Implant Surgery & Tissue Grafting –

Implants in the Esthetically Demanding Patient

Cadaver Course

philadelphia, pa

dallas, tX at Baylor university

Lecturer: Dr. Will Martin

Lecturers: Dr. Thomas Wilson and Dr. Jim Ruskin December 14-15, 2012 June 4-8, 2011

Digital Interdisciplinary Dentistry

ITI Education Week

Baylor university, dallas, tX

Boston, ma

Lecturers: Dr. Frank Higginbottom and Dr. Thomas Wilson Target Audience: Interdisciplinary Team consisting of

July 27-28, 2012

Surgeon, Restorative Dentist and Lab Technician

Digital Interdisciplinary Dentistry

*must attend in a team

Baylor university, dallas, tX

Product: SGS, CADCAM, Implants, Restorative Components

Lecturers: Dr. Frank Higginbottom and Dr. Thomas Wilson

For more information on this program or to register:

Target Audience: Interdisciplinary Team consisting of

http://www.bcdce.com/courses/course/category.php?id=2

Surgeon, Restorative Dentist and Lab Technician

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STARGET 1 I 12

ITI Education Week Boston â&#x20AC;&#x201C; June 4-8, 2012 Comprehensive Implant Dentistry: From Treatment Plan to Clinical Implementation

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STARGET 1 I 12

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Fax +47/23 35 44 80

+1/978 747 2500 Fax +1/978 747 2490

GROWTH IN RECESSION This book, which presents 11 prominent clinical cases, is the product of an international competition organized by Straumann. The objective was to illustrate the esthetic results that can be achieved when using Straumann速 Emdogain in combination with conventional surgical methods in the treatment of gingival recession. See page 18 of this issue of STARGET for more information.

Please contact your local Straumann sales team member if you would like to order a copy of this case book.

03/12 USLIT 395

AN ESTHETIC CASE SELECTION ON STRAUMANN 速 EMDOGAIN