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CAD/CAM - international magazine of digital dentistry

opinion _ implantology I CAD/CAM 1_2013 _The battle of healing times It was but an episode, yet one that caused an in- crediblefuroratthetime:thedebateaboutshortened healing times. Stimulated by a media hype in which the specialised press only played second fiddle and the lay press appeared to be in the lead, the healing times of some implant manufacturers were inflated. Values were corrected downwards almost on a daily basis. Some manufacturers went along with it, while others remained firm. Some participants felt they needed to be at the forefront, others stayed out of it. A short but remarkable ascent was followed by a rapid crash. A personal highlight for me was an article in a tabloidnewspaperthatsaid,“Extractioninthemorn- ing; directly followed by augmentation and implan- tation; a firmly seated supra-construction imple- mented at lunch time, and then endless servings of spare ribs”! As can be seen from this euphoric state- ment, some got carried away, while others had to painfully back-track. What remains is the realisation that, owing to improved surfaces and other condi- tions, the long healing times recommended in the early phase of implantology can in fact be reduced considerably, but not at any cost. _New options for improving the implant site The afore-mentioned dominance of prosthetic implantology was only possible because many new andsaferaugmentationprocedureswereestablished during the observation period, enabling dentists to design the osseous bed for the implant as desired. Revolutionary augmentation procedures in the area of the maxillary posterior teeth, which had been the focus of discussion in the first year of the period in question, constituted another important approach for real progress. Thankstosurgicaltechniquesforsinuslifts,which underwent an incredible number of modifications also with regard to less invasive procedures, it was possible to treat areas of the jaw that had previously been considered impossible or that could only be re- storedforimplantationbywayofhighlyinvasiveor- thodontic procedures. While initial sinus-lift proce- dures were generally reserved for highly specialised centres, they have now become common knowledge in implantology and are offered and performed ex- tensively. _Establishing virtual implantology It seems easy to figure out what the old-school fraction must have thought about the new planning andplacementoptionsfororalimplants.Thisfraction had already had a hard time accepting the develop- ment from surgical to prosthetic implantology, and they were strictly against the new digital procedures thatwereemergingincrediblyquickly.Withtherapid spread of dental volume tomography, which opened anewdimensiontodentalimagediagnostics,amul- titudeofplanningprogramsandaidswereplacedon the market. The suggestion by some opinion leaders to define validity and establish standards with regard to these new techniques, which are generally based on 3-D X-ray data, was especially frowned upon. I feel that a good compromise has been reached, owing to anticipatory and serious discussions held during consensus conferences and congresses, as well as at universities and within the dental associations. These new techniques are immensely helpful in the treatment of complex cases, and they are even indispensable for highly complex cases. The treat- mentofsimplecasesusuallydoesnotrequiretheuse of these techniques. In fact, they should not be used in such cases owing to the radiation exposure when obtaining 3-D data. _Of promises and realities Themes of the congresses during the first decade of the observation period contained generally posi- tive statements and depicted new opportunities in implantology, which exceeded the then current op- tions by far and expressed a belief in boundless growth. This coincided with many positive state- ments and evaluations by implant manufacturers anddistributors.However,allthischangedconsider- ably during the past five years. Suddenly, new topics were given priority, which shaped specialists’ conventions—topics that had previously been partially suppressed if not negated. I remember only too well the implant congress held byaveryimportantAmericanimplantmanufacturer inFrankfurt/Mainin1998,whereIreportedonacon- cept for the treatment of peri-implantitis developed I 19 Fig. 17Fig. 16