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CAD/CAM - international magazine of digital dentistry

opinion _ implantology I I 21CAD/CAM 1_2013 discussion. Implant versus tooth preservation has been a frequent debate at conventions and implant symposia in recent years. In my opinion, this would not have been possible ten years ago. _Trouble-shooting concepts Unexpected complications, such as implant frac- ture and failure of implant supra-structure connec- tions (Figs. 18–21), necessitated the development of surgical and prosthetic trouble-shooting concepts and modification of constructions in implant and abutment design. However, these were not readily available and have not yet been finally agreed upon. In other words, they cannot be said to be common knowledge in implantology, at least not in the treat- ment of peri-implantitis. Similar statements can be made with regard to pre-implantology arguments, where a pleasing variety of surgical techniques and materials is listed, but no generally valid scheme has been agreed upon. Thefactthattheneedtodevelopandconveythese trouble-shooting concepts is generally recognised today and that these concepts are yet widely sup- ported by the participants on the implant market is gratifying. The specialist press has made a valuable contributionhereandcontinuestodoso—numerous articlesthatreceivedagreatdealofattentionduring thepast15yearsarethosethatdealtwithimplantol- ogy and implant-prosthetic trouble-shooting. _Digital implantology I consider the establishment of 3-D diagnostic imaging, with all associated possibilities, to be the significant development during the 15-year obser- vationperiod.Itistruethatonlyimplantologistsused the new 3-D technology during the initial phase of dental volume tomography (because they made up the group of dentists who could actually afford this expensiveequipment);nevertheless,3-Dtechnology constituted a quantum leap for dental diagnostic imaging as a whole. Today, we have almost unbelievable possibilities atourdisposalthateventhegreatestoptimistswould not have considered possible 15 years ago: highly complex patient cases can now receive minimally invasive treatment and have implants placed even without the need for augmentation. Our first case shows a highly atrophied mandible, in which four implants could be placed without anyprioraugmentationowingto3-Ddataandplan- ning (Figs. 22–24). Three-dimensional diagnostics are sometimes also employed to clarify facts when complicationshavearisen,forexampleneurallesions after implantation (Figs. 25 & 26) and bone necrosis after administration of bisphosphonates, and erro- neously diagnosed as peri-implantitis (Fig. 27). _My personal conclusions It is difficult to draw a conclusion regarding the development of implantology over the past 15 years becauseithasbeensomultifacetedandrapid.Tocon- clude, I would therefore like to quote my academic teacher and former supervisor, Prof. Wilfried Schilli, who, as a founding member of the International Team for Implantology, was undoubtedly among the pioneersofimplantologyandhascontributedtoim- proving implantology through his university work: “Who would have thought that implantology could develop like it did in less than twenty years.” This very true statement encompasses many as- pects: the admiration and appreciation of what has been achieved, the satisfaction with having initiated a procedure that is considered to be the safest in the entire field of medicine, and some criticism re- garding any development in oral implantology that did not turn so well or went off course._ Dr Georg Bach Rathausgasse 36 79098 Freiburg/Breisgau Germany Tel.:+49 761 22592 doc.bach@t-online.de CAD/CAM_contact Fig. 24 Fig. 25 Fig. 26 Fig. 27