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| content Cover image courtesy of TBR Dental Group www.tbr.dental issn 1868-3207 • Vol. 21 • Issue 1/2020 1/20 implants international magazine of oral implantology research The dos and don’ts in the handling of PRF case report Peri-implant bone regeneration through laser decontamination industry The next generation biomaterial for soft-tissue augmentation 04 1 2020 editorial Join DGZI on the track for success Dr Rolf Vollmer research The dos and don’ts in the handling of PRF Prof. Shahram Ghanaati, Dr Sarah Al-Maawi, Dr Eva Dohle & Dr Torsten S. Conrad Success rate of dental implants in heavy smokers page 06 Drs Branislav Fatori & Inge Schmitz case report Implant-retained overdenture on a very thin bone ridge Drs Nicola Alberto Valente, Murali Srinivasan & Nicole Kalberer Peri-implant bone regeneration through laser decontamination page 16 Prof. Wilfried Engelke, Dr Christian Engelke, Dr Victor Beltrán & Dr Marcio Lazzarini Sixteen years of follow-up after insertion of a Z1 implant Dr Virgilio Masini industry 03 06 12 16 22 28 The next generation biomaterial for soft-tissue augmentation 32 practice management Feedback done right Andrea Stix, MSc, MBA page 32 interview Reshaping implantology The link between oral disease and oxidative stress news manufacturer news news about the publisher imprint 34 36 38 40 44 50

| research 30° The dos and don’ts in the handling of PRF Prof. Shahram Ghanaati, Dr Sarah Al-Maawi, Dr Eva Dohle & Dr Torsten S. Conrad, Germany Fig. 1: Visualisation of the puncture direction during blood collection. Vein Autologous blood concentrates, and platelet-rich fibrin (PRF) in particular, are increasingly used today to support wound healing and regenerative processes.1 PRF is made from the patient’s own peripheral blood without the addition of anticoagulants. A solid or liquid PRF matrix can be obtained through a single centrifu- gation process, depending on the collection tube that is used.2 Through this centrifugation process, the blood components are separated according to the centrifugal force used. The red blood cells move towards the bot- tom of the tube.3 The platelets and leucocytes are con- centrated in the upper layer, the remaining fibrin ma- trix. Thus, this autologous blood concentrate, which also contains further plasma proteins, is capable of actively releasing different growth factors such as vas- cular endothelial growth factors (VEGF), epidermal growth factors (EGF), or platelet-derived growth factors (PDGF) over a relatively long period of time (up to fif- teen days).4, 5 These growth factors play a key role in the support of wound healing and regenerative processes, since they contribute to the formation of new vessels, epithelialisation and the stimulation of further regener- ative cells.6, 7 The composition and bioactivity of PRF depends primarily on the centrifugal force that is used during centrifugation.3 Several recent studies have demonstrated the influence of the centrifugal force on the composition and bioactivity of the obtained PRF.8–12 It has been shown that the ap- plication of a low centrifugal force for accumulation leads to a significantly higher number of platelets and leuko- cytes in PRF compared to a medium or high centrifugal force.3, 10 Growth factors are released in a similar way. PRF matrices that are prepared with a low centrifugal force release significantly higher concentrations of differ- ent growth factors (such as VEGF, PDGF, EGF, TGF-b1) compared to PRF matrices that are prepared using a higher centrifugal force.8–12 As a result, the so-called Low-Speed Centrifugation Concept (LSCC) was intro- duced, which aims at standardising the production of blood concentrates and enabling reproducible treatment protocols or clinical results.3 This article will particularly focus on the technical aspects of the clinical applica- tion and handling of PRF. The tubes used for the pro- duction of PRF have been specifically developed for this particular purpose. Depending on the clinical indication, two different variants of PRF matrices exist. PRF tubes with a glass surface promote coagulation. During cen- trifugation, a solid PRF matrix is formed. In contrast, the coagulation process can be slowed down by means of plastic-coated tubes. Accordingly, coagulation is slowed down during centrifugation. At room temperature, a PRF matrix remains liquid for about thirty minutes after centrifugation until it eventually coagulates. Protocol RPM (x 100) Duration (min) Centrifugal force (x G) High concentration RCF 2,400 Medium concentration RCF 1,200 Low concentration RCF 600 8 8 8 710 177 44 RCF, relative centrifugal force; RPM, revolutions of the centrifuge per minute. Table 1: Visualisation of the different LSCC protocols (Low-Speed Centrifugation Concept for a centrifuge with a radius of 110 mm). 06 1 2020

| research 3 4 5 Fig. 3: Separating the red phase from the solid PRF phase. Fig. 4: A PRF plug. Fig. 5: A thinly pressed PRF matrix. ous suspension components. The relative centrifugal force (RCF) represents the centrifugal force as a multi- ple of the Earth’s gravity and is often expressed as the value G. Moreover, it is a decisive factor for the result- ing concentration of the sedimented cells and biomol- ecules in PRF. The value G indicates exactly the force required for an optimal centrifugation of a correspond- ing suspension (in this case blood) to obtain the desired sediment (in this case PRF) as final product, and allows the calculation of the necessary speed of the centrifuge rotor for a corresponding tube and centrifuge. is given in Table 1 and should be set on the centrifuge according to the clinical indication (r = 110 mm). In gen- eral, the centrifuge should be placed on a stable and even fundament. When loading the centrifuge with the blood- filled tubes, it is imperative to ensure that any imbalance is eliminated. This means that the tubes must be placed inside of the rotor in such a way that the weight of the tube placed exactly opposite the other is identical (Fig. 2). If the number of tubes is uneven, a tube filled with the equiva- lent volume (such as sodium chloride, for example) must be added to compensate for the weight. For centrifuges where only the rotational speed (revolu- tions of the centrifuge per minute, RPM) can be set, the RCF or the necessary G-value must first be calculated by means of a fixed formula. The relation between ro- tational speed (RPM) and RCF depends on the size of the rotor (r = radius of rotation = distance between the axis of rotation and the bottom of the tube). Here, the fol- lowing formula is used for conversion:14 RCF = 1.12 x ra- dius x (RPM/1,000)2. The relative centrifugal force re- quired for PRF production using the established LSCC 6 Fig. 6: Separating liquid PRF from the red phase by means of a syringe. 08 1 2020 Processing of PRF Immediately after centrifugation, the tubes are carefully removed from the centrifuge and transferred to an ap- propriate tube holder. Owing to the applied RCF and de- pending on the size, shape and density of the blood com- ponents, only two phases can now be visually identified: a red phase at the bottom of the tube, which contains mainly erythrocytes and a PRF phase on top of it, fill- ing up the upper part of the tube. In the case of solid PRF, which is obtained by centrifuging the blood in the red PRF tubes, these two phases coagulate very quickly. In order to separate the solid PRF matrix from the red lower phase, it is recommended to first separate the two phases roughly by cutting them with scissors. In concrete terms, this means carefully lifting up the upper phase of solid PRF with sterile tweezers (the lower red phase is lifted as well) and then roughly separate the two phases in the upper part of the red phase (Fig. 3). The PRF phase (with remains of the red phase) is then transferred into a dedicated PRF box provided for this particular purpose. This PRF box, which has been specially developed for various PRF indications, consists of a stainless-steel container with a self-weighted lid and a large and small stamp. In this box, the remaining parts of the red phase can now be removed from the PRF phase by carefully wiping it off with a blunt object (such as a closed pair of scissors). Thereafter, solid PRF matrices can be further

| research 7 Fig. 7: Biologising a collagen-based matrix with liquid PRF. processed either into a PRF plug (Fig. 4) or into a thinly pressed PRF matrix (Fig. 5), depending on the clinical in- dication. For PRF application in the extraction sockets of wisdom teeth, the fibrin clot is placed in the containers in the box, which are specifically provided for this very in- dication, and carefully compressed with the small stamp until the appropriate size of the PRF plug is reached. In order to process PRF into a thinly pressed matrix, the fibrin clot is carefully placed on the grid of the PRF box and processed into a pressed PRF matrix using the self- weighted lid of the PRF box. This pressed PRF matrix can then, for example, be placed as a wound cover on the surgical sites where autologous palatal soft-tissue trans- plants have been removed to support the wound heal- ing process. In addition, it can be used during implant surgeries as a support of the mucosal flap. As opposed to the earlier-described solid PRF, which is produced through centrifugation in glass tubes, the two phases of the blood remain liquid at first for a few minutes if cen- trifugation is done with plastic tubes. The production of liquid PRF opens up the possibility of further PRF appli- cations in the field of regenerative medicine, such as the combination of PRF with bone grafting materials and collagen membranes. The upper, still liquid PRF phase is carefully removed from the remaining lower red phase using a syringe. A 5 ml syringe with a long and wide 21-gauge cannula is best suited for this purpose (Fig. 6). It is recommended that the tube is slightly tilted so that the boundary between the two phases can be seen more easily. In this way as much liquid PRF as possible can be extracted from the tube, without extracting too much of the red phase. With a liquid matrix, the wetting of the biomaterial surface can be carried out in a reproducible fashion. In contrast, based on the preliminary results of the ongoing clinical studies, it is no longer recommended to cut up a solid PRF matrix and mix the obtained pieces with bone grafting material in order to create so-called sticky bone. Current research findings indicate that this can lead to a loss of volume, since the fibrin is resorbed 10 1 2020 after 10 to 15 days, facilitating the formation of cavities in the augmentation sites as a result. In order to biologise biomaterials of different classes and origin, such as bone grafting materials and colla- gen-based membranes (allogeneic, xenogeneic, synthetic), they can be combined with solid or liquid PRF. Here, biomaterials that do not trigger a foreign body reaction should ideally be used. With the help of PRF it is possible to biologise or functionalise these biomaterials, since they themselves do not have any bioactive components, but serve only as a mere scaffold. The functionalisation of biomaterials with endogenous cells, plasma and growth factors that are found in great concentration in PRF should lead to an improved integration of the biomaterial in certain defects and, as a consequence, to an increased regenerative capacity. When combining PRF with bone grafting material and collagen-based membranes, PRF in liquid form should be used. In order to biologise and stabilise these bone grafting materials or membranes, liquid PRF collected in the syringe is drizzled onto them, which also simplifies clinical handling (Fig. 7). A comprehensive list of references can be obtained from the authors. Dr Sarah Al-Maawi Author details Dr Eva Dohle Author details Dr Torsten S. Conrad Author details about the author Frankfurt am Main-based Prof. Shah- ram Ghanaati is a specialist in maxillo- facial surgery and oncology. In 2013, he was appointed Director of the University Cancer Center of the Frankfurt Univer- sity Hospital. He is the Senior Physician and Deputy Director of the Department of Oral and Maxillofacial Plastic Surgery of the Frankfurt University Hospital. In addition, he is the Director of the research laboratory FORM-Lab (Frankfurt Orofacial Regenerative Medicine). contact Prof. Shahram Ghanaati Universitätsklinikum Frankfurt Theodor-Stern-Kai 7 60590 Frankfurt am Main, Germany Phone: +49 69 6301-3744 shahram.ghanaati@kgu.de Author details

| research Success rate of dental implants in heavy smokers A longitudinal study Drs Branislav Fatori & Inge Schmitz, Germany Objective The failure rate of dental implants is reported to be higher in smokers than in non-smokers. The aim of the study described in this article was to compare the success rate of 721 dental implants inserted in 181 smokers with given reports in the literature. In our study, implants from one factory were used and the implants were inserted by one surgeon to exclude individual factors. In order to increase the success rate for dental implants inserted in Diameter (mm) Length (mm) No. Successful Failed 3.70 3.75 3.75 3.75 3.30 4.10 4.10 4.10 Total Table 1a 8.00 10.00 12.00 14.00 12.00 8.00 10.00 12.00 4 182 200 1 38 2 101 193 4 167 182 1 35 2 88 177 721 656 0 15 18 0 3 0 13 16 65 smokers, a specific protocol was established in our den- tal surgery. In the following, the results of two patients are reported in detail. Introduction In general, smoking is reported to increase implant failure and favour peri-implantitis. One possible mechanism that might lead to increased failure rates is a lowering of the blood flow and direct adverse effects on the osteoblasts. If smokers are treated with implants, good bone quality is required. In our study, bone augmentation procedures were necessary in 62 of the cases. With our study, we set out to investigate whether there is a significantly enhanced risk of implant failure due to the increased number of cigarettes smoked per day. Though smoking is a risk factor for implant failure, it is not considered an absolute contra-indication. When im- plant treatment is planned, the patient’s smoking history should first be obtained, including the duration, the in- tensity (past and present), the present status of smoking, the number of cigarettes smoked each day and whether there is any notable passive smoking. Here, the surgeon has to rely completely on the correctness of the infor- mation provided by the patient. To achieve a satisfactory result regarding implant survival, a number of different 1 2 3 Case 1—Fig. 1: The 54-year-old female patient had an extreme periodontal defect at tooth #44 with bone loss at the apical side. Fig. 2: Radiographic close-up. Fig. 3: Final result. 12 1 2020

| research Type Diameter (mm) Length (mm) No. 8 10 12 8 10 12 8 10 12 14 8 10 12 8 10 12 8 10 12 8 10 12 14 8 10 12 8 10 12 8 10 12 8 10 12 14 8 10 12 8 10 12 8 10 12 8 10 12 0 0 47 9 43 62 18 94 92 7 4 4 4 0 0 29 4 48 97 19 39 50 3 0 0 0 0 0 6 0 0 0 8 9 22 0 0 0 0 0 0 0 0 1 0 0 0 2 at the time of surgery, after 24 hours and one month later in order to evaluate the success of the implant treatment. Inflammatory processes were found in 24.1 % of the patients. If necessary, augmentation was done by means of NanoBone (Artoss), Geistlich Bio-Oss bone substi- tute and Geistlich Bio-Gide membranes (both Geistlich Biomaterials). Indication for implants The indications for inserting implants in our study were as follows: – treatment of the edentulous jaw; – single-tooth replacement; – treatment of larger interdental gaps; and – free-end situation. Results Of the 721 implants inserted, 65 implants failed. Conclu- sively, the success rate was at 90.98 %, which is lower compared with our previous study on non-smokers, in which the success rate was 98.70 %.2 In the group of failed implants, most of them (75.4 %) were lost two to four weeks after implant placement owing to a lack of osseointegration. Peri-implantitis occurred in 20 % of the failed implants. This could be traced back to poor oral health and plaque formation. In 4.6 % of the cases, 6 7 Case 2—Fig. 6: Cemented crown in situ. Fig. 7: Final result. Bone-level Bone-level tapered Tissue-level Tissue-level ROX-CERA Tissue-level WP 3.30 3.30 3.30 3.75 3.75 3.75 4.10 4.10 4.10 4.10 4.80 4.80 4.80 3.30 3.30 3.30 3.75 3.75 3.75 4.10 4.10 4.10 4.10 4.80 4.80 4.80 3.30 3.30 3.30 3.75 3.75 3.75 4.10 4.10 4.10 4.10 4.80 4.80 4.80 3.30 3.30 3.30 4.10 4.10 4.10 4.80 4.80 4.80 Table 2 14 1 2020

1a 2b 4a 1b 3a 4b 2a 3b 4c Fig. 1a: Occlusal view before the treatment showing a very thin ridge. Fig. 1b: Frontal view of the ill-fitting mandibular denture. Fig. 2a: Frontal view of the initial clinical situation. Fig. 2b: Preoperative radiograph. Fig. 3a: A flap was raised to obtain a clear view of the underlying bone. Fig. 3b: Preparation of the four implant sites. Fig. 4a: Placement of the four implants. Fig. 4b: The flap was closed with a 4/0 polyamide continuous suture. Fig. 4c: Radiograph taken immediately after surgery. Implant-retained overdenture on a very thin bone ridge Drs Nicola Alberto Valente, Murali Srinivasan & Nicole Kalberer, Switzerland Initial situation A healthy 60-year-old female patient with no medical his- tory presented at our clinic with a non-fitting full mandib- ular denture. Her chief complaints at this point included the lack of retention of her mandibular denture and poor aesthetics, coupled with difficulty in chewing and embar- rassment at social events. The treatment plan comprised the rehabilitation of jaw function and aesthetics with a new set of dentures, including a conventional maxillary complete denture (CD) and a mandibular implant-sup- ported overdenture (IOD) retained by four implants. For standard implants, the ridge would have had to be re- duced by a vertical osteotomy in order to gain thickness and to reach the wider portion of basal bone. However, this would cause both a loss of height and a reduction in vestibule depth, which would be unfavourable for the rendition of the prosthesis (Figs. 1 & 2). After evaluating the patient’s motivation, the decision was made to use the new Straumann® Mini Implants (2.4 mm diameter) with the integrated Optiloc® retention system for a new denture supported by four implants. The implants were planned for placement in the regions 34, 32, 42 and 44. Due to the very limited width of the ridge, open flap sur- gery was planned in order to place the implants safely under direct vision. Surgical procedure After a careful crestal incision, keeping the edge of the blade always in contact with the thin bone ridge, a cen- tral release incision was performed. The flap was raised 16 1 2020

| case report 8a 9a 8b 9b Fig. 8a: Final bite registration was performed. Fig. 8b: Photographs of the patient’s natural dentition helped in preparing the final teeth set-up. Figs. 9a & b: The final set-up was checked during try-in. (PVS) impression material (Figs. 5 & 6). The preparation of the master models and corresponding wax rims and all subsequent laboratory works were carried out in the Swiss-based dental laboratory Zahnmanufaktur Zimmer- mann und Mäder in Bern using the Optiloc® analogues and standard techniques (Fig. 7a). The next clinical steps included verification of the upper and lower lip support (ensuring aesthetic teeth exposure), checking the occlu- sal planes, defining the vertical dimension of occlusion, and final bite registration (Figs. 7b–d). Communication with the dental laboratory using photo- graphs of the patient’s natural dentition was a key fac- tor for successfully preparing the final teeth set-up (Figs. 8a & b). During try-in, the final set-up was checked for lip support, occlusal planes, teeth exposure and occlusal contacts (Figs. 9a & b). Moreover, the patient was able to suggest modifications and give her consent before the final prostheses were prepared. To prevent fractures and ensure the longevity of the mandibular IOD, a polyether ether ketone (PEEK) reinforcement was in- corporated in the final prosthesis (Fig. 10). The new conventional maxillary CD and mandibular IOD on the Optiloc® retention system was then finalised in the dental laboratory, placing the Optiloc® housings and process- ing inserts on all Optiloc® model analogues and following the usual manufacturing procedures. The dental labo- ratory delivered the completed maxillary CD and man- dibular IOD (Figs. 11a & b). During the final consultation, the appropriate retention inserts (low force) Optiloc® were selected and inserted into the housings using the Optiloc® retention insert placement tool (Figs. 12 & 13). The completed conventional maxillary CD and mandibu- lar IOD were then inserted into the patient’s mouth, and 10 11a 11b Fig. 10: A PEEK reinforcement was incorporated in the final prosthesis. Figs. 11a & b: The dental laboratory delivered the completed maxillary CD and man- dibular IOD. 18 1 2020

| case report 12a 12b 13a 13b 14a 14b 20 1 2020 Figs. 12a & b: Retention inserts (low force) Optiloc® were selected and inserted into the housings using the Optiloc® retention insert position- ing tool. Figs. 13a & b: Occlusal and frontal view at the final consultation. Figs. 14a & b: Frontal view of the inserted completed conventional maxillary CD and mandibular IOD. final post-insertion and denture hygiene instructions were given to the patient (Figs. 14a & b). Conclusion The case was successfully handled. The patient was highly satisfied and reported increased functional com- fort and social confidence. The use of four 2.4 mm diam- eter Straumann® Mini Implants to support a mandibular overdenture has proved to be a reliable technique, which guaranteed satisfactory results both for the operator and the patient in a case where traditional techniques with larger diameter implants were not possible. Editorial note: The surgical procedures were performed by Dr Nicola Alberto Valente and prosthetic procedures by Dr Nicole Kalberer supervised by Dr Murali Srinivasan. about the author Dr Nicola Alberto Valente graduated in dentistry from the University Cattol- ica del Sacro Cuore of Rome, Italy. He completed his Master of Science in Oral Sciences and his specialty program in periodontics at the State University of New York at Buffalo, NY, USA. He is a Diplomate of the American Board of Periodontology and has had an ITI Scholarship from the University of Geneva, Switzerland. He has worked as Chef de Clinique in the Unit of Oral Surgery, Service of Maxillofacial Surgery of the University Hospitals of Geneva, University of Geneva until 2019. He will start his new duties as Clinical Assistant Professor at the State University of New York at Buffalo in 2020. contact Dr Nicola Alberto Valente University at Buffalo School of Dental Medicine 250 Squire Hall, 3435 Main Street Buffalo, NY 14214, USA www.dental.buffalo.edu Author details

| case report Peri-implant bone regeneration through laser decontamination Endoscopic paracrestal tunnel technique Prof. Wilfried Engelke, Dr Christian Engelke, Germany; Dr Victor Beltrán, Chile & Dr Marcio Lazzarini, Germany Introduction The recently published S3 guidelines of the German As- sociation of Oral Implantology (DGI) and the German So- ciety of Dentistry and Oral Medicine (DGZMK) state that peri-implant infections can be categorised into peri- implant mucositis and peri-implantitis.1 In peri-implant mucositis, only the supracrestal soft-tissue interface is involved; in peri-implantitis, the bony implant site is also involved.2 Smoking is the main risk factor for peri-implant mucositis, but it is likely that there are further contributing factors, such as cement residue, diabetes mellitus and sex.2 The development of peri-implantitis is particularly favoured by a history of periodontal disease, smoking and interleukin-1 polymorphism.4, 5 The main diagnostic criterion for distinguishing peri-implantitis from peri-im- plant mucositis is the lack of reversibility of the condition. Peri-implantitis can be characterised by putrid secretion, increasing probing depth, pain and radiographic bone resorption. Implant loosening requires a high degree of bone resorption in the case of peri-implantitis. Microbio- logical tests are rather unspecific regarding peri-implant mucositis and peri-implantitis. The goal of non-surgical peri-implantitis therapy is to elim- inate the clinical signs of the infection. In addition to a par- tial or complete reduction in bleeding on probing (BOP), an effective therapy should lead to a reduction in the depth of periodontal pockets.6 To date, deep peri-implant pockets have not been clearly defined, but in most cases, a probing depth of less than 6 mm is considered a treat- ment success.7 There are various treatment protocols used for non-surgical therapy: procedures for biofilm re- moval, antiseptic therapy and adjuvant antibiotic therapy. Surgical peri-implantitis treatment includes surface decon- tamination, adjuvant resectional therapy and, if necessary, I l l u s t r a t i o n I m p l a n t : © J u t / S h u t t e r s t o c k . c o m Fig. 1a: Open surgical peri-implantitis therapy with basal stemmed flap: application and operating direction of the laser for sulcular decontamination (yellow), implant surface decontamination (blue) and bone decontamination (white). 22 1 2020

| case report Fig. 2: Endoscopic equipment to guide laser fibres for peri-implant bone decontamination. that could support modern peri-implantitis treatment based on a minimally invasive therapy concept, given that their concepts can be combined in order to safely de- contaminate the implant surface. Kim et al. made a small labial incision with subperiosteal tunnelling for horizon- tal ridge augmentation.15 They used bone grafts, which were placed in the soft-tissue pocket created by tunnel- ling and subsequently fixed by conventional means so that they could successfully integrate implants into the alveolar ridge in the context of a two-stage procedure.15 Montevecchi et al. reported cases of peri-implantitis in which fibres of dental floss attached themselves to the implant superstructure and, as a result, gave rise to peri-implantitis.16 They were able to remove these fibres using a periodontal endoscopic technique and, in doing so, promote healing. The healing was confirmed over a six-year period. An endoscopically supported therapy in implant dentistry was described by our working group for implant cavities and for sinus floor augmentation in a closed procedure.17, 18 In this context, a tunnel tech- nique was carried out laterally for the augmentation of the sinus floor, in which the entire basal maxillary sinus mu- cosa was detached and tunnelled through without hav- ing to cut a bony window, which made the procedure less invasive. In 2003, Sennhenn-Kirchner and Engelke reported on a procedure in which peri-implantitis can be successfully treated by endoscopic tunnelling and the use of a di- ode laser.19 The laser is used for decontaminating the ex- posed implant surfaces, followed by augmentation of the peri-implant bone defects.19 The authors found that ra- diographic defect filling and a reduction in probing depths can be achieved, with no postoperative infections and no augmentation losses observed in five patients with eight implants.19 Prior to the operation which their research is based on, the probing depths were deeper than 6 mm and, afterwards, between 3 and 4 mm.19 Sennhenn- Kirchner and Engelke emphasised the satisfaction of the patients owing to the minimally invasive nature of the pro- cedure.19 However, there has not been a good solution, thus, far to the problem of accessing contaminated and infected implants, since most endoscopes do not feature working shafts particularly designed for this kind of appli- cation. This paper presents a concept that allows for tar- geted and visually controlled implant decontamination, removal of granulation tissue and simultaneous augmen- tation without the need for open-flap reflection. Case report A 48-year-old female patient presented with an in alio loco placed exposed titanium screw-retained implant. Upon examination, a triangular bony defect situation was noted, extending into the middle third of the implant. In addition, there was secretion of pus. Upon pressure, the patient experienced a feeling of tension and local pain. Explan- tation of the implant and bone regeneration measures for the purpose of a new restoration were discussed. Various possible treatment protocols were explained to the pa- tient, and minimally invasive microsurgical treatment us- ing the tunnel technique was proposed. The patient was thoroughly informed about possible risks and the overall problematic prognosis. In the tunnel technique, the im- plant surface is reached through an entrance fashioned away from the implant, without interrupting the continu- ity of the peri-implant tissue cuff. In order to gain an opti- mal view in the tunnelled area throughout the procedure, support immersion endoscopy is used (Fig. 1b). The operation was performed via a mesial tunnel en- trance outside the surgical field and under local anaes- thesia. After access away from the implant through a ver- tical mucosal periosteal incision, subperiosteal tunnelling was performed up to the affected implant. The surface of the implant was visualised by advancing the endoscope 24 1 2020

| case report while perfusing the tunnel with a sterile sodium chloride solution. The gingival cuff could be mobilised towards the occlusal plane via a high vestibular periosteal slit. Gran- ulation tissue was removed and the implant surface de- contaminated under direct endoscopic vision without ir- rigation. Decontamination was done with a GaAlAs laser set at 1 W and at a wavelength of 809 nm (Fig. 3). The exposure time was 20 seconds. Four repetitions in con- tact mode were enough to produce sterile conditions.20 After filling the defect with tricalcium phosphate ceramic and locally obtained autogenous bone particles, the minimally invasive access was closed with two button sutures. The postoperative medication consisted of an analgesic (paracetamol, 500 mg, if necessary) and a sin- gle dose of antibiotic (clindamycin, 600 mg). The post- operative course was inconspicuous, and the augmenta- tion height showed that the defect had been completely regenerated. In the re-entry to expose the implant after four months, a complete bony covering of the implant could be observed vestibularly (Fig. 4). The prosthetic restoration was performed by the family dentist. Discussion The concept of microsurgical peri-implant bone regener- ation using the tunnel technique complies with the DGI/ DGZMK guidelines and has two significant advantages: firstly, the cervical gingival cuff around the implant is pre- served, and secondly, augmentation material can be se- curely positioned in a zone of optimal perfusion through the local periosteum. This significantly reduces the risk of postoperative recession and promotes bone regenera- a c b d Fig. 3: Intra-op situation: mucosal incision away from implant (a), vestibular mucosa (b), laser fibre in the fundus of the bone pocket (immersion) (c), decontamination of the bone pocket (without immersion) (d). 26 1 2020 tion. Support immersion endoscopy allows a minimally invasive approach away from the implant. The different types of support and irrigation shafts allow preparation under immersion. Blood and secretion are immediately removed by the irrigation flow and do not interfere with the preparation of the operation site. After exposure of the infected part of the implant surface inside the tunnel, laser decontamination should be done in an aerobic en- vironment, reducing heat generation and, thus, allowing for targeted decontamination. Using intermittent irriga- tion, the operating field can be freed from detritus and secretion at any time. Finally, surface decontamination is done in the open operation area. The size of the tunnel entrance and its localisation can be reduced to such an extent that large-area detachment of the flap and basal flap extension by periosteal slitting can be avoided with- out compromising visualisation of the contaminated im- plant surface. Bleeding in the tunnel can be stopped by means of vaso- constrictors or direct laser coagulation so that an opti- cally perfect assessment of the critical parts of the bone pockets is possible using support immersion endoscopy. Removal of granulation tissue with a laser has the ad- vantage that a low-bleeding preparation technique facili- tates the precision of the subsequent steps significantly. This advantage of the endoscopic technique can also be used for tunnel procedures in primary bone augmen- tation, allowing reliable intraoperative quality control of the microsurgical measures even without flap reflection. If dealing with fixed implants, it is not advantageous to remove the superstructure before the operation, since the operating direction is apical. Removal should only be carried out in pathological situations, for example inac- curacies in fit. In the case of extensive interdental or oral defects, multiple tunnelling sessions might be necessary. Their indication should be clarified beforehand by means of 3D imaging. In the case that is described in this arti- cle, 3D diagnosis was not desired by the patient. Based on the extensive experience of the authors with the de- scribed procedure, it can be stated that the tunnelling of apicoapproximal peri-implantitis is advantageous for the majority of referred peri-implantitis cases and that the frequency of dehiscence may be significantly re- duced by modifying the approach. The recommended treatment sequence for the peri- implantitis therapy described in this article is as follows: – Granulation tissue is first removed completely. – The implant surfaces exposed in the tunnel are safely decontaminated. – After decontamination, suitable augmentative proce- dures are performed for radiographically detectable filling of intraosseous defects. The choice of suitable procedures depends on the clinician’s experience. The use of bone block grafts can also be considered if the tunnel entrance is wide enough.

| case report Sixteen years of follow-up after insertion of a Z1 implant Dr Virgilio Masini, Italy In the following case report, Italy-based oral surgeon Dr Virgilio Masini describes how the advantages of a tita- nium implant with a zirconia collar can ensure long-last- ing function and aesthetics. In 2003, a 40-year-old female patient presented with a removable prosthesis in the region of tooth #24, which had been extracted the year before owing to a fracture (Fig. 1). Treatment options for restoring region #24 with a fixed solution were discussed with the patient, who wanted a more comfortable alternative to the removable restoration that she had. The patient decided to have a dental implant placed and restored with a metal–ceramic prosthesis in order to avoid damaging the two adjacent teeth. A radiograph was taken to assess whether the pa- tient had adequate width and height of bone for implant placement (Fig. 2). This revealed that, as a result of the fracture of the extracted tooth #24, the patient had lost a large part of the buccal bone plate. The radiograph also showed that the patient had retained the residual root of tooth #48. To ensure sufficient quality and quan- tity of buccal bone, it was decided that the residual root of tooth #48 would be extracted at the same time as implant placement in region #24, and the bone surrounding the tooth root would be used as part of a guided bone regen- eration (GBR) procedure. To maintain the hard and soft tissue more coronally, a 13 x 4 mm Z1 implant (TBR Dental) with a zirconia collar height of 3 mm was planned for. Implant placement The surgical aspect of treatment began with the ex- traction of the residual root in the region of tooth #48. At the same time, fragments of bone from the surrounding area of the surgical site were extracted and mixed with hydroxyapatite of equine origin. Once the extraction site had been closed and sutured together, a delayed implant placement protocol was followed for region #24. This in- volved making an incision in the gingiva and raising a flap to expose the buccal bone. The hole was then drilled before the implant was placed successfully at soft-tissue level and a cover screw fitted (Fig. 3). At this point, GBR was performed using the fragments of the bone taken from the surrounding area of tooth #48 (Fig. 4), which were placed on the buccal bone of the implant site and covered with a resorbable collagen membrane (Fig. 5) that was fixated with a micro screw. A radiograph was taken to confirm that the implant was positioned correctly (Fig. 6), and the patient was given appropriate post-sur- gery care instructions. Implant restoration Six months after placement, the implant was reviewed and found to be stable. The patient had experienced a slightly prolonged period of post-surgical oedema, but this had been effectively controlled with non-steroidal anti-inflammatory medication. As a result, the soft-tissue was pink and healthy and there were no signs of inflam- mation (Fig. 7). The implant was restored with a straight 1 2 Fig. 1: Removable prosthesis in the region of tooth #24. Fig. 2: Panoramic radiograph prior to implant surgery. 28 1 2020

| case report 7 8 9 10 Fig. 7: Post-implant placement healing. Fig. 8: Apically positioned flap. Fig. 9: Cleaning of the surgi- cal site. Fig. 10: Follow-up of the implant ten years after the surgery. Fig. 11: Radiograph of the implant 16 years after the surgery. Fig. 12: Soft-tissue appearance 16 years after the surgery. plant. After placement of the implant restoration, the pa- tient expressed how enthusiastic she was with the overall outcome. Review During a routine check-up in 2013, the implant was re- viewed. The patient was very happy with the final result and remains a regular patient of the practice. The gingiva around the implant was pink and the papilla had also been maintained so that the implant restoration demon- strated aesthetics and function similar to those of the natural teeth (Fig. 10). The zirconia collar of the Z1 im- plant had encouraged optimal healing of the soft tissue around the implant to create an excellent emergence pro- file. It also eliminated the risk of the titanium components becoming visible through the gingiva. Sixteen years after the surgery, the implant was reviewed again and the final outcome remained unchanged. A radiograph showed that there was minimal bone resorption and that the im- plant was stable (Fig. 11). The soft tissue also appeared healthy and there was no difference between the implant restoration and the surrounding natural teeth (Fig. 12). Discussion Prior to implant placement, the patient in this case had experienced bone loss as a result of the fracture of the extracted tooth #24. However, the zirconia collar of the Z1 implant was able to stabilise the soft tissue coronally at the implant site, a result that had improved over time. The benefits of the Z1 implant are mainly aesthetic, as it helps manage the soft tissue and improves plaque con- trol. Indeed, zirconia surfaces demonstrate a lower affin- ity to bacteria compared with titanium.2 The Z1 implant system is my implant of choice in cases in which I want to maintain the soft tissue and avoid bone augmentation (for instance, in the case of immediate post-extraction implants with moderate loss of the buccal bone plate). In the molar area of patients who have difficulty controlling plaque, I also prefer to position the implant edge at tis- 11 12 sue level or even slightly supragingivally. This case ul- timately demonstrates that choosing a top-quality im- plant solution can help ensure that patients benefit from an outstanding, long-lasting restoration that is highly aesthetic and functional. Literature about the author Dr Virgilio Masini graduated in medi- cine and surgery with honours from the Sapienza University of Rome in Italy in 1982 and specialised in dentistry with honours at the University of Rome Tor Vergata, Italy. He has a special inter- est in implantology. For three years, Dr Masini attended the Maxillofacial Surgery Complex Operational Unit at the University Cattolica del Sacro Cuore in Rome. Dr Masini has also taught in the master of oral surgery and implantology pro- gramme at the Gabriele d’Annunzio University of Chieti–Pescara, University of Naples Federico II, Sapienza University of Rome and Vita-Salute San Raffaele University in Milan, Italy. contact Dr Virgilio Masini Via Piave 7 00187 Rome, Italy Phone: +39 06 8540759 www.odontoiatriadrmasini.it Author details 30 1 2020

| industry The next generation biomaterial for soft-tissue augmentation OEMUS MEDIA, Germany © Camlog On 17 January 2020, Camlog DACH organised the first NovoMatrix™ expert round table in Wimsheim, Germany. At this meeting, the clinicians involved in the pre-launch phase, gathered to exchange and discuss their experiences with the new biomaterial. After the presentation of the clinical and pre-clinical studies per- formed by Dr Gerhard Iglhaut (Germany) and Dr Edward Pat Allen (USA), the ex- perts split in six groups to share and dis- cuss their clinical experience. Each round table focussed on one of the following in- dications: gain of keratinised tissue, re- cession coverage, or augmentation of soft tissue around implants. The meeting was considered a great success by the partic- ipants. The content and structure of the meeting was regarded as highly scientific and was appreciated by the experts. The following fundamental messages could be extracted from the expert round table: the exceptional handling character- istics and contoured shape are well suited for soft-tissue augmentations around teeth and implants, root recession cov- erage, and are designed to be used with different surgical techniques, to reduce time for product trimming, and to make intraoperative placement easier and more predictable. There was a consensus that additional clinical testing is needed, in- cluding long-term follow-up and further clinical studies with NovoMatrix™. How- ever, very good healing could already be seen in early stages. For over 20 years, LifeCell™, an Allergan affiliate and leading global medical tech- nology company, has been developing in- Fig. 1: The participants of the recently held NovoMatrix™ expert round table with the Camlog team. 32

| practice management Andrea Stix, MSc, MBA; Germany © Tartila – stock.adobe.com In order to avoid stress and disharmony in the daily work routine and to appear professionally as a team to the out- side world, clear communication with one another is im- portant. Reciprocal feedback is therefore of vital impor- tance in order for communication in the dental practice to be as simple, appreciative and smooth as possible. What needs to be taken into account in this regard will be high- lighted in this article. Feedback is important Why we need feedback is explained by American social psychologists Joseph Luft and Harry Ingham in a model that sets out conscious and unconscious personality and behavioural traits. Their Johari Window, a combination of the psychologists’ first names, is divided into quad- rants and shows the differences in self-perception and perception by others. The open quadrant relates to what one reveals about oneself and what is known or visible to others. This includes external characteristics such as appearance, manners or even physical reactions, as well as internal attitudes and behaviour. The hidden quadrant is what a person knows about himself or herself, that is, things that he or she is aware of, but either unknowingly does not make available to others or consciously hides from them. The blind quadrant is everything that a per- son conveys and is perceived by the recipient without the sender being aware of it. Others thus recognise be- haviours and characteristics that one does not perceive in oneself. Only through constructive feedback can in- formation be moved from the blind quadrant to the open quadrant. It also allows reflection on things that we un- consciously keep from others. Feedback is an effective instrument to support colleagues or employees in their personal development. Unfortunately, the potential of this powerful tool often remains unexploited in many com- panies. What is feedback? The term “feedback” refers to a response to or assess- ment of a person’s behaviour. It is a central process by which a reaction is conveyed. With feedback, we inform someone about how we perceived and experienced his or her behaviour. In this way, we invite the other person to employ metacommunication, that is, to talk about his or her behaviour. The most common feedback error is crit- icism of personality traits—and that is exactly what turns feedback into ridicule. Discussion in this manner of one’s personality—which cannot be changed—is insulting and abusive, and no good or fruitful outcome can come from it. Authentic feedback, however, always aims at a positive change in behaviour; it is constructive and supportive. Feedback complements self-perception through exter- nal assessment and external perception. Feedback can Johari Window (Joseph & Harry Ingham, 1995) Conscious and unconscious personality and behavioural traits Known to self Not known to self s r e h t o o t n w o n K n w o n k t o N s r e h t o o t OPEN BLIND HIDDEN UNKOWN 34 1 2020

| interview Reshaping implantology New solution to reduce guesswork of site preparation Nobel Biocare, Switzerland When it comes to inno- to inno- vations in implant den- vations in implant den- tistry, the refinement of site tistry, the refinement of site preparation has fallen be- preparation has fallen be- hind the advancements of im- hind the advancements of im- plant design. Prof. Stefan Holst, plant design. Prof. Stefan Holst, Vice President of Premium Im- Vice President of Premium Im- plants at Nobel Biocare and co-author at Nobel Biocare and co-author of an original research study with Stanford Uni- versity on the OsseoShaper™ design and biolog- ical benefits, describes some of the challenges pre- sented by conventional drilling protocols and explains how this new device has been designed to overcome these problems. Prof. Holst, what is the new OsseoShaper™ device? The OsseoShaper™ is a completely new approach to site preparation that addresses some challenges of con- ventional drilling protocols. Instead of using high-speed drills to create an osteotomy, the OsseoShaper™ gently ‘shapes’ it in a controlled way. It has been developed as part of our recently announced Nobel Biocare N1™ im- plant system. Site preparation protocols have hardly changed in over 50 years. What inspired you to focus on such well-established methods? Our very first step in developing a new implant sys- tem was to examine every stage of implant treatment based on our 50 years’ clinical experience. What are the main challenges clin- the main challenges clin- icians have? How can icians have? How can we try to avoid more er- we try to avoid more er- rors? How can we optimise rors? How can we optimise workflows? It became clear workflows? It became clear that drilling protocols can be im- that drilling protocols can be im- proved, both practically and biologi- proved, both practically and biologi- cally. So, we funded new basic research cally. So, we funded new basic research to better understand the biology of bone heal- ing, which is relevant to early integration and long- term performance. With this refined understanding, we could engineer features that embrace biology before even a single prototype of OsseoShaper™ was made. This approach has made this new and exciting tech- nology possible. How did that research influence the design? Research at Stanford University showed how conven- tional high-speed drilling creates heat, causing bone cell death around the osteotomy,1 and that this Zone of Death leads to bone resorption and remodelling. The common way to reduce heat is water irrigation. How- ever, this has another drawback—it washes away the bone chips that can speed up peri-implant bone for- mation, which can help early osseointegration and sta- bility. This is why we developed the OsseoShaper™ to operate at slow speed; it reduces the Zone of Death compared to a high-speed protocol and eliminates the need for water irrigation.1 The OsseoShaper™ has also been designed for bone chips to remain inside the Fig. 1: In most cases, site preparation for the N1™ implant system involves only two surgical steps: creating depth and angulation with the OsseoDirector™, then shaping the osteotomy with the OsseoShaper™. The OsseoShaper™ creates an implant site that refl ects the macro-design of the N1™ implant. Fig. 2: The OsseoShaper™ has also been designed for bone chips to remain inside the osteotomy. 36 1 2020

| interview The link between oral disease and oxidative stress “The link between oral disease and oxidative stress is still not that widely known.” Dr Lenka Banasova runs her own dental centre, Pearl Dental, in the Slovakian capital of Bratislava, where she focusses on periodontics and implant dentistry. Most im- portantly, however, she is one of the few dentists to touch on the largely neglected topic of oxidative stress and its relevance to the fields of periodontology and implantol- ogy. In this interview, she explains how natural antiox- idants—as contained in CURAPROX Perio Plus+—can improve therapy. Dr Banasova, could you explain to our readers what oxidative stress is? Oxidative stress is an imbalance of free radicals and an- tioxidants in the body, which can lead to cell and tissue damage. On the one hand, this occurs naturally and plays a role in the ageing process. The body’s natural immune response can trigger oxidative stress temporarily. This type of oxidative stress causes mild inflammation that goes away after the immune system fights off an infection or repairs an injury. On the other hand, a large body of sci- entific evidence suggests that long-term oxidative stress contributes to the development of a range of chronic con- ditions. Such conditions include cancer, diabetes, heart disease, atherosclerosis, Parkinson’s disease, periodon- titis and many other diseases. Are there ways to avoid or reduce oxidative stress? Several risk factors contribute to oxidative stress and excess free radical production. These can include diet, lack of exercise, smoking, alcohol consumption, certain conditions, such as obesity, medications, and environ- mental factors, such as pollution and radiation. While you can’t completely avoid exposure to free radicals, you can make lifestyle choices regarding your diet, exercise, en- vironment and so on to help keep your body in balance and prevent damage and disease. And this includes your oral health as well—and, I would say, patients are still not aware enough of how important oral health is for their general health. During recent years, we have seen a rise in oral disease related to oxidative stress. How familiar is the average dental professional with oxidative stress, though? Is it considered during diagnosis or treatment? All dentists know that oral health is an important aspect of overall well-being and that numerous systemic condi- tions and diseases have oral origins, but I think the link between oral disease and oxidative stress is still not that widely known. To give you an example: saliva acts as the first line of defence against free radicals through antiox- idants, and in the event of an infection, increased gen- eration of free radicals means they outnumber antioxi- dants to initiate oxidative stress. However, I have noticed that there are more and more studies and articles in the area of medicine and also in the field of dentistry that are mentioning oxidative stress. During diagnosis, patients’ general condition and potential oxidative stress causes should be considered. Smoking for example is regarded 38 1 2020

| manufacturer news bredent medical Highest primary stability—now with conical-parallel connection The new copaSKY implant line from bredent is particularly dis- tinguished by the stable and retrievable conical-parallel-walled interface, which enables easy removal of the prosthetics. The unique neck design and short implant–abutment connection also allows ultrashort implants. Due to the deposition of bone chips on the backtaper, a subcrestal implant position can also be selected. copaSKY uses the same surgical tray as all other SKY implants. And the enhanced prosthetic offering one connection that fi ts all diameters of implants, simplifying storage and reduc- ing inventory. The material of choice is BioHPP, which provides a natural chewing sensation and built-in shock absorber effect to protect implants. Also new is the form-fi t connection for bolted bridge components. The high accuracy of fi t directs the lateral load directly onto the abutment, i.e. the risk of screw loosening and fractures is greatly reduced. The integrated angled screw channel provides excellent aesthetic results when transversally threaded. bredent medical GmbH & Co. KG Weißenhorner Straße 2 89250 Senden, Germany www.bredent-implants.com TBR Dental Tissue-level implant and digital workfl ow Combining a titanium body and a zirconia collar, the worldwide unique Z1® implant offers many advantages. It is a tissue-level implant and thus only one surgical procedure is required. In addition, the zirconia collar promotes soft-tissue healing and provides optimal aesthetic results for the patient. With the launch of its new range Index, TBR is now offering clinicians a com- plete digital workfl ow: from the scanning phase with intra-oral scanners and CBCT devices to the milling phase with machines adapted to your needs, in- cluding suitable CAD/CAM software, associated materials and consumables. The virtuous combination of implantology with the Z1 implant system and the Index digital workfl ow ensures optimal ergonomics and shorter chair times, which is essential in the daily dental practice. Combine superior aesthetics and digital de- sign with Z1 implants and TBR CAD/CAM Index dental solutions today! TBR Dental Group 24, impasse René Couzinet 31500 Toulouse, France www.tbr.dental 40 1 2020

| manufacturer news PreXion Superior 3D image quality with low radiation exposure 100 μm voxel size. 74 μm voxel size (PreXion3D EXPLORER). 3D image with a 150 x 160 mm fi eld of view. With many 3D-imaging systems today, good image quality is usually accompanied by high radiation exposure. Developed specifi cally for the European and US-American market, the new CBCT system PreXion3D EXPLORER offers the highest possible image quality at the lowest possible radiation levels. With a specifi cally controlla- ble pulse generator, radiation is generated only when necessary to achieve the highest imaging quality. For a 20-second-long scan in ultra-HD 3D-mode, radiation exposure is only between 4.4 and 5.8 seconds. For a 10-second-long scan in standard scan 3D-mode, it is a mere 3.2 seconds. The small voxel size enables a more de- tailed representation of even the fi nest hard and soft tissue struc- tures in ultra-high defi nition. The short image reconstruction times ensure a seamless workfl ow. The PreXion3D EXPLORER convinces with easy handling and extensive planning programmes that cover the entire range of indications. With the 3D-analysis function, fi elds of view (FOV) sizes of 50 x 50, 150 x 80 and 150 x 160 mm can be generated, offering numerous fl exible diagnostic options for oral surgery, implantology, periodontology, endodontics, orthodontics, and general dentistry. PreXion (Europe) GmbH Stahlstraße 42 65428 Rüsselsheim, Germany www.prexion.eu (4.8/5) and suitability (4.8/5) when using the new system. Not only is BLX being used in all immediate placement procedures, but it is also a great solution for all other treatment protocols —including conventional placement and loading. Available diameters range from 3.5–6.5 mm. Together with the legend- ary technologies Roxolid® and SLActive®, BLX is a great solu- tion, designed for reliably and predictability in all indications. Institut Straumann AG Peter-Merian-Weg 12 4002 Basel, Switzerland www.straumann.com Straumann BLX gains vast initial traction Today, the demand for short and reliable protocols is increas- ingly growing. Always in line with market trends, Straumann set out to create a tailor-made answer to these needs: posi- tioned as “the next-generation solution for confi dence beyond immediacy,” the new BLX implant system offers clinicians a valuable tool that combines innovative design and surface technology with high-performance material. Since its European debut at IDS 2019, Straumann rolled out a global roadshow involving local launches and premier events, culminating in a successful North America and Brazil launch in August of 2019. The system is now available in more than 50 coun- tries with over 150,000 BLX implants sold. More than 3,000 clinicians are already using BLX. The feedback has been incredibly positive, particularly when it comes to primary stability. Research into 615 cases found overall user sat- isfaction to rate at 4.5 out of 5. In addition, a study of practitioner attitudes at 12 dental practices reported high user satisfaction for primary stability (4.6/5), effi ciency 42

| news t e r s t o c k . c o m © T T s t u d i o / S h u t Register now! Programme Ceramic implants–state-of-the-art Discussed in May in Berlin The sixth Annual Meeting of the International Society of Metal Free Implantology (ISMI) will be held on 8 and 9 May 2020 in the Steigenberger Hotel Am Kanzleramt in Berlin, Germany. An internationally renowned team of speakers will craft a high-rate scientifi c programme. Dr Dominik Nischwitz, ISMI President and Scientifi c Director of the event, comments: “[…] the success of our international endeavours is underlined by the fact that the International Academy of Ceramic Implantology is the offi cial partner of our conference.” Held under the theme “Ceramic im- plants – State of the art”, the two-day event will kick off on Friday TV linked to sugar consumption and Rotten teeth in children with two pre-congress symposia, involving the live streaming of a surgery. The highlight of the fi rst congress day will be the ISMI White Night, held in the Beletage of the renowned borchardt in the heart of Berlin, where participants and speakers will be able to wind down in an informal atmosphere. Saturday will then be dedicated to scientifi c lectures. On both congress days the lec- tures will be simultaneously translated from German to English and vice versa. Source: OEMUS MEDIA AG A new study discovered that young people are a third more likely to eat sugary foods (33 %) and signifi - cantly more likely to have decaying teeth (39 %), if they watch over 90 minutes of television each day. More than one in two (53 %) children watch- ing television for more than 90 minutes a day have some form of tooth decay. Youngsters who eat sugary foods while watching TV are also more than twice as likely to have decaying teeth than those who choose to avoid them. Dr Nigel Carter OBE, CEO of the Oral Health Foundation, believes there needs to be a change in the snacking culture around televi- sion: “There is a clear relationship between the time children spend watching television and how much sugar they are consuming. As a population, our children are having too much sugar too often and it is leading to unacceptable rates of tooth decay.” The study, titled “The infl uence of television on the food habits of schoolchildren and its association with dental caries” can be accessed online at doi.org/10.1002/cre2.244. © b a c k u p _ s t u d i o – s t o ck.adobe.com Source: Oral Health Foundation 44 1 2020

| news DGZI supports practitioners in Survival rates of Becoming ABOI/ID Diplomates Short implants investigated In 2019 the American Board of Oral Implantology (ABOI) in the US decided to make the ABOI/ID Diplomate exam- ination available for experienced dental practitioners internationally. The ABOI has an independent exam- ination committee chartered by the American Academy of Implant Dentistry (AAID), the official US partner of DGZI. The DGZI board has defined the necessary conditions. Graduates of the “DGZI Cur- riculum Implantology”, as well as holders of both “Expert in Dental Implantology” and “Specialist in Oral Implantology” certification are now eligible to apply for this examination to become ABOI/ID Diplomates. DGZI can offer its support on request in preparing for the written and oral examination through a preparatory seminar, in which situations similar to an examination are played through and specific contents for the oral examination are conveyed. The preparation for the written examination is based on our English language “Guide Book Implantology”, which helps applicants to comfortably prepare for the examination via distance e-learn- ing. The e-learning preparation can be started at short notice at any time. The first oral preparatory examination date is scheduled for the 50th International An- nual Congress of DGZI, which will be held on 6 and 7 November in Bremen, Germany, and to which you are cordially invited. The examinations will take place one day ahead of the congress, on 5 November 2020. If you are interested in this new offer, please contact Dr Rolf Vollmer (First Vice President and Treasurer of DGZI) for more information via e-mail at info. vollmer@t-online.de. Researchers from Miguel Hernandez University in Elche, Spain, evaluated the survival rates of 4 x 6 mm implants in fresh extraction sockets. The study involved 261 patients who had undergone implant surgery. The team analysed 167 single implants with a follow-up of over five years. The survival rate was 97.6 % (98.8 % in the mandible and 95 % in the maxilla). The main cause of implant failure was found to be peri-implantitis (PI), which accounted for 69.2 % of failures. The study found that for implants placed in sites m o c . k c o t s r e t t u h S / F v s k e l A © where horizontal regenera- tion had been performed (total of 46 implants), the survival rate was 100 %. It was found that the survival rate of short implants is comparable with that of standard-length implants in the short and medium term. The authors note that the placement of im- mediate implants post-extraction is a risk factor for survival. The study, titled “Prospective study of 535 Astra 6 mm short implants with 1 to 9 years of follow up” can be accessed online at onlinelibrary.eao.org. Source: DGZI Source: EAO PerioTrap—a highly specific Substance against periodontitis Periodontitis is one of the most common infectious diseases in the world today. Under the leadership of Dr Mirko Buchholz, a team of researchers from the Fraunhofer Institute for Cell Ther- apy and Immunology in Halle (Saale) in Germany has now devel- oped a highly specific antibiotic against the disease. According to Dr Buchholz, the active compound is effective in two ways: it can only be absorbed by the pathogens and it also only works on them. The active compound does not target the rest of the organism and thus fewer reserve antibiotics are needed. In this way, the new drug makes a major contribution to fighting the risk of multi-resistant germs. The effect of the substance is based on the blocking of an enzyme, which is required for the “nutrition” of the bacterium, and on a specific transport mechanism for iron. It has already been patented by the start-up company “PerioTrap 46 1 2020 Pharmaceuticals”. They are currently looking for investors in or- der to lead the product from the preclinical phase to market entry. Source: Univations GmbH/Investforum Startup-Service

The ICD expands Its educational initiatives The International College of Dentists’ (ICD; 12,000 members in 122 countries), advocates for humanitarian and educational oral health initiatives worldwide. The ICD and Washington University Dental Alumni Association offer annual scholarships to dental students, demonstrating concern about high dental education costs. Three inaugural scholarships of $2,500 were awarded in 2019. ICD’s Get Smart About Antibiotics programme raises aware- ness and shares resources about the global public health issue of antibiotic resistance, including a video that provides a free Continuing Education credit. ICD maintains key partnerships with the US Centers for Disease Control and Prevention and other enti- ties to share critical data. The ICD has been honouring the world’s leading dentists since 1920™ and celebrates its Centennial in 2020. Centennial events are taking place globally, concluding November in Japan with an international induction ceremony, gala banquet and humanitarian symposium. For more information, go to www.ICD100.org. © ICD The Presidents of the ADA and FDI lent their organisations’ support to the global launch of the College Centennial. Source: ICD Second EACim Congress To take place in Brussels Those who were not able to attend last year’s congress of the European Academy for Ceramic Implantology (EACim) in Paris can already look forward to this coming spring: on Saturday, 25 April 2020, the second congress of the EACim will take place at the hotel Le Plaza in Brussels in Belgium. The congress, chaired by Prof. Carlo Maiorana from the University of Milan in Italy, will be held under the guiding theme “Large Reconstruction with Ceramic Implants” and comprise various lectures from internationally recognised speakers. In addition, one day ahead of the main congress, on Friday, 24 April, there will be an optional workshop titled “Digital Workflow with Ceramic Implants” which interested participants can attend. The manufacturing companies bredent medical, CAMLOG, Nobel Biocare, Zeramex, ZiBone and Z-Systems will be supporting the congress as industry partners. More information on this year’s event and the registration possibilities can be found online at www.eacim-ceramic-implantology.com. Source: EACim 48 1 2020

| about the publisher Congresses, courses and symposia implants Designer Sandra Ehnert s.ehnert@oemus-media.de Theresa Weise t.weise@oemus-media.de Customer Service Marius Mezger m.mezger@oemus-media.de Published by OEMUS MEDIA AG Holbeinstraße 29 04229 Leipzig, Germany Tel.: +49 341 48474-0 Fax: +49 341 48474-290 kontakt@oemus-media.de Printed by Silber Druck oHG Otto-Hahn-Straße 25 34253 Lohfelden, Germany implants international magazine of oral implantology is published in cooperation with the German Association of Dental Implantology (DGZI). DGZI DGZI Central Offi ce Paulusstraße 1 40237 Düsseldorf, Germany Tel.: +49 211 16970-77 Fax: +49 211 16970-66 offi ce@dgzi-info.de www.dgzi.de www.oemus.com www.implants.de Imprint Publisher Torsten R. Oemus oemus@oemus-media.de CEO Ingolf Döbbecke doebbecke@oemus-media.de Members of the Board Jürgen Isbaner isbaner@oemus-media.de Lutz V. Hiller hiller@oemus-media.de Chief Editorial Manager Dr Torsten Hartmann (V. i. S. d. P.) hartmann@dentalnet.de Editorial Council Dr Rolf Vollmer info.vollmer@t-online.de Dr Georg Bach doc.bach@t-online.de Dr Suheil Boutros SMBoutros@aol.com Editorial Offi ce Georg Isbaner g.isbaner@oemus-media.de Johannes Liebsch j.liebsch@oemus-media.de Executive Producer Gernot Meyer meyer@oemus-media.de Product Manager Timo Krause t.krause@oemus-media.de Art Director Alexander Jahn a.jahn@oemus-media.de Copyright Regulations implants international magazine of oral implantology is published by OEMUS MEDIA AG and will appear with one issue every quarter in 2020. The magazine and all articles and illustrations therein are protected by copyright. Any utilisation without the prior consent of editor and publisher is inadmi ssible and liable to prosecution. This applies in particular to duplicate copies, translations, microfi lms, and storage and processing in electronic systems. Reproductions, including extracts, may only be made with the permission of the publisher. Given no statement to the contrary, any submissions to the editorial department are understood to be in agreement with a full or partial publishing of said submission. The editorial department reserves the right to check all submitted articles for formal errors and factual authority, and to make amendments if necessary. No responsibility shall be taken for unsolicited books and manuscripts. Articles bearing symbols other than that of the editorial department, or which are distinguished by the name of the author, represent the opinion of the aforementioned, and do not have to comply with the views of OEMUS MEDIA AG. Responsibility for such articles shall be borne by the author. Responsibility for advertisements and other specially labeled items shall not be borne by the editorial department. Like- wise, no responsibility shall be assumed for information published about associations, companies and commercial markets. All cases of consequential liability arising from inaccurate or faulty representation are excluded. General terms and conditions apply, legal venue is Leipzig, Germany. 6th Annual Meeting of ISMI 8–9 May 2020 Berlin, Germany www.ismi-meeting.com 20 ITI World Symposium 14–16 May 2020 Singapore www.iti.org/worldsymposium2020 Bicon World Congress 2020 12–13 June 2020 Prague, Czech Republic www.biconprague.com Premium Partner: VISIONS IN IMPLANTOLOGY BREMEN 6./7. November 2020 50. Internationaler Jahres- kongress der DGZI e.V. 3. Zukunftskongress für die zahnärztliche Implantologie DGZI International Annual Congress 6–7 November 2020 Bremen, Germany www.dgzi.de AAID Annual Conference 11–14 November 2020 Altlanta, GA, USA www.aaid.com/Annual_Conference/ 50 1 2020

See the future unveiled Experience the innovations set to reshape implantology. Join us for three science-focused days with key industry speakers and exciting hands-on sessions. April 16-18, 2020, Mandalay Bay Resort, Las Vegas. nobelbiocare.com/symposia Sharpen your skills Scan to learn more and register GMT 65433 GB 1912 © Nobel Biocare Services AG, 2020. All rights reserved. Nobel Biocare, the Nobel Biocare logotype and all other trademarks are, if nothing else is stated or is evident from the context in a certain case, trademarks of Nobel Biocare. Please refer to nobelbiocare.com/trademarks for more information. Product images are not necessarily to scale.