implants - international magazine of oral implantology

editorial I I 03implants1_2013 _Now that we are on the verge of IDS, InternationalDentalShow,Ipersonallyameagertosee whatisgoingtobepresented,especiallywithregardtothelatestdevelopmentsinboneaugmenta- tion materials. Osteogenesis takes place only in the sense of enclosing newly formed bone, which remainsabiofunctionallyforeignbodywithintheaugmentedareaformanyyears.Themaxillarysi- nus seems to be a special subject and location with regard to osteogenesis. In sinus lift procedures withorwithoutsimultaneousimplantation,manymaterialsareworkingverywellbecauseofitsspe- cialconditions.Lundbergetal.foundoutthatthesinusisasterilecavity.Itssterilityisbasedonthe epithelium cells’ potential to produce nitric oxide, which has an aseptic effect. Another important factorfortheregenerationoftheaugmentedmaterialisthebloodsupply,accordingtoBennerand Schlehhuber. I think we all agree that, for small multi-wall defects, xenogeneic grafts are helpful and usually produce a non-vital, hard ceramic regeneration result. The subsequent drilling at such sites, how- ever,isprobablynotapleasure.Inaddition,manyxenogeneicmaterialscannotbeabsorbedandthe blendingofautologousbonewithxenogeneicmaterialseemsachallenge.IntheirstudiesattheUni- versity of Düsseldorf, Becker and Schwarz observed the best results with 50 % and a minimum of 30 % of autogenous bone in a mixture with a two-phase bone substitute material. Sinus lifts by crumblygraftsareeasytohandle,buttheyshouldbegivenatleastsixtotwelvemonthstoheal.This amountoftimecanbeadisasterforthepatient.Ifitcomestoaninfection,thedecompositionprod- uctsofconsequentmasscelldeathsareafeastforinvadingbacteria.Thesituationforverticalaug- mentationisevenworse.Bonegraftmaterialsofvaryingformsareavailableinunlimitedquantities, whichmightmakethemsuitableevenforlargedefects.Butdotheyreallyhavehighresorptionsta- bilityanddotheythusserveasguiderailsfortheingrowthsofnewbloodvesselsandasubsequent osteoneogenesis? In endogenous bone augmentation, I transfer vital cells, mineralised bone, fibrin and platelets andachieveahighbiologicalpotencyforregeneration.Inaddition,Icanthenbesurethattherewill benoproblemswiththematerialIaddedtothebonystructures.Thefearofasecondsurgicaldefect is justified, but for smaller defects I can usually use the bone from the surgical site or nearby. Fur- thermore,Idonothaveadditionalmaterialcostswithautologousbone.Becauseoftheseconsider- ations,Istillusetheendogenousboneforaugmentation. The surgeon has to decide upon the procedure after investigating the amount of bone that is missing.Forthis,DGZIwantstosupportourcolleaguesbypostgraduateeducationandaidtodeci- sion-making. IhopetoseeyouallinCologne,Germany,atourDGZIboothandlookforwardtodiscussingevery- thingwhichcanmakeourlifeeasierandhelpourpatientsinthefuture. Yours, DrRolfVollmer New augmentation materials—What is the gold standard? Dr Rolf Vollmer