C3 ◊Page C2 memories or images are trained until they function largely automatically and only a few stimuli from the con- sciousness are necessary. For his procedure, Schröck employed a memory of walking barefoot through an ice-cold mountain lake. “I chose this memory for two rea- sons. The feet are physically furthest away from the mouth and thus from the site of surgery, and I associate a strong feeling of euphoria with this memory. Euphoria and fear or nega- tive pain tend to be mutually exclu- sive in my world,” he explained. He continued: “The art of self- hypnosis is to consciously self- IMPLANT TRIBUNE Dental Tribune Middle East & Africa Edition | 5/2021 regulate oneself on one level in order to have unconscious experiences on another level. That means you are not switched off or entirely passive in self-hypnosis. As soon as I became too aware of what was happening in my mouth, I directed my attention back to my resource place in the mountain stream.” For the most part, Schröck only felt greatly diminished pain during the operation. Keeping an eye on bleeding behav- iour and hand signals “The team was slightly nervous before the operation,” Lindemann said. All eventualities during the pro- cedure—for example, what would happen if the patient did experience severe pain—were considered by the dental team in advance, so the nerv- ousness quickly dissipated once the operation had begun. When asked to what extent the team supported the patient during the procedure, Lindemann replied: “We created a very calm and relaxed environment. In addition, we agreed on signals that the patient should give us in case he felt pain or he needed a break to get back into a deep enough state of hypnosis.” During the placement of a single im- plant with minor osseous augmen- tation in an open procedure in the mandible with subsequent suture closure, the dental team had to pay particular attention to the bleeding behaviour, which differs from that under vaso-constriction. A matter of trust Although the hypnotherapist was convinced that his self-experiment would succeed, he harboured some doubts. In the run-up, he asked him- self whether he would really manage to concentrate for the entire dura- tion of the surgery. “I am very satis- fied with the result. In retrospect, I was even a little surprised at how quickly it went, and how easy it was to turn off the pain,” Schröck ex- plained. He failed only to control the bleed- ing to a level less than one would ex- pect without anaesthesia. “There are enough studies and case vignettes in which similar things have been proved. Unfortunately, in the heat of the moment, I forgot to focus on that too.” However, he plans to work on that aspect in the subsequent opera- tion, during which the cover screw will be removed. According to Lindemann, the mu- tual trust between the patient and the team made it possible to fully concentrate on the operation. He concluded: “I am grateful for my great team and for the trust that our patient placed in me.” Graphene coating that releases antibacterial acid prevents formation of biofilm on dental implants By Franziska Beier, Dental Tribune International GOTHENBURG, Sweden: Biofilm for- mation on dental implants is a major challenge for dental professionals. It causes patients great inconvenience and entails considerable costs. Now, by covering a graphene-based mate- rial with bactericidal molecules, re- searchers from Chalmers University of Technology in Gothenburg have developed a novel material designed to prevent infections. A variety of drugs and molecules with antibacterial properties are available on the market; however, for them to be used in the body, they first have to be attached to a material which can be challenging and labour- intensive to produce. First author Dr Santosh Pandit from the Depart- ment of Biology and Biological Engi- neering at Chalmers explained in a university press release: “Graphene offers great potential here for inter- action with hydrophobic molecules or drugs, and when we created our new material, we made use of these properties. The process of binding the antibacterial molecules takes place with the help of ultrasound,” said Pandit. The researchers covered graphene material with usnic acid, which shows—according to previous stud- ies—good bactericidal properties. In addition, it has been tested for its resistance to the pathogenic bacteria Staphylococcus aureus and Staphylo- coccus epidermidis, which are known to cause biofilm formation on medi- cal implants. The usnic acid was successfully in- tegrated into the surface of the gra- phene material, and the researchers observed that the usnic acid mol- ecules were released in a controlled and continuous manner, thereby preventing the formation of bio- films on the surface. “This is an es- sential requirement for the method to work,” explained Pandit. Pandit added that the results show that the method for binding the hy- drophobic molecules to graphene is simple. “It paves the way for more effective antibacterial protection of biomedical products in the future. We are now planning trials where we will explore binding other hy- drophobic molecules and drugs with even greater potential to treat or pre- vent various clinical infections,” he continued. The study, titled “Sustained release of usnic acid from graphene coat- ings ensures long term antibiofilm protection”, was published on 11 May 2021 in Scientific Reports. A new approach for patients on direct oral anti-coagulant medication Fig. 1: The reduced size of position #14. Figs. 2a & b: Dental panoramic tomogram (a) and periapical radiograph (b) prior to implant placement. Fig. 2a Fig. 2b By Dr Stefan Grümer & Melissa Yüce, Germany Implant placement is a surgical procedure employed in accord- ance with the individual wishes of patients. It can often be avoided by choosing conventional, non-surgical alternatives. In particular, in cases of patients with haemorrhagic di- athesis or patients undergoing anti- coagulant therapy with direct oral anti-coagulants (DOACs), the risk of undesired side effects, with even life-endangering consequences, nec- essarily led to a strict selection of patients who are suitable for dental implants. A new laser- supported ap- proach in implantology for patients undergoing anti-coagulant therapy has been developed by the Aachen Institute for Continuous Medical and Dental Education in coopera- tion with the Clinic for Cardiology, Pneumology, Angiology and Inter- nal Intensive Medicine of the RWTH Aachen University hospital in Ger- many. Case presentation Nowadays, the number of implants placed in patients with a higher average age and in medically com- promised cases is rising. Particularly cases of patients undergoing DOAC therapy, with the advantage of no need to permanently control the coagulation parameters, are rising significantly. Despite the advice of cardiologists not to stop or interrupt the medication, these patients often request implants. In addition, for only two DOACs does an antagonist drug exist. For three other DOACs, there is no antagonist drug yet, lead- ing to an increase in possible postop- erative complications. Nevertheless, among this group of patients, the demand for implants is rising as well. To fulfil these wishes while following the advice of the cardiologist, a new transgingival, nearly blood-free sur- gical protocol has been developed. The following case describes this pro- ÿPage C4