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| content Cover image courtesy of TIZIO Hybrid Implants www.tizioimplants.com issn 1868-3207 • Vol. 21 • Issue 2/2020 2/20 implants international magazine of oral implantology research CBCT bone-densitometry for pre-surgical decision-making case report Explantation of an implant in a heavy smoker interview The perfect link between man and technology 04 2 2020 editorial The role of implantology in coming years 03 Dr Rolf Vollmer research page 06 CBCT bone-densitometry for pre-surgical decision-making 06 Prof. Angelo Trödhan case report A viable alternative for complex clinical situations Dr Sepehr Zarrine Explantation of an implant in a heavy smoker Dr Branislav Fatori, Dr Inge Schmitz & Prof. Werner Götz page 14 industry Predictable, immediate results with Tapered Pro implants Improve your implant business case-by-case practice management Practice strategies in the age of corona Dr Anna Maria Yiannikos interview The perfect link between man and technology page 36 DGZI Special Training programme of the DGZI in cooperation with the GBOI Dr Rolf Vollmer DGZI news Application Route for International Practitioners Refl ect on 50 years of implantology in Bremen this autumn news manufacturer news news about the publisher imprint 12 14 20 22 24 26 34 36 37 38 28 40 42

| research CBCT bone-densitometry for pre-surgical decision-making Prof. Angelo Trödhan, Austria Introduction The high prevalence of tooth-related diseases, a grow- ing geriatric population and a rapidly growing awareness to replace lost teeth by dental implants force dentists, oral and maxillofacial surgeons to cope with promises made by implant manufacturers such as “new teeth in one hour”. While implant manufacturers try to maximise their sales numbers by such marketing strategies, it will always be the practitioner’s full responsibility to treat pa- tients with strictly evidence-based treatment protocols, especially when it comes to the immediate functional loading of dental implants. Esposito et al. (2007), Javed et al. (2010), Walker et al. (2011) and Cannizzaro et al. (2012) proved in reviews, Cochrane studies and split-mouth randomised clin- ical trials that primary implant stability—represented by insertion torque values (ITV)—shows a significant correlation between the biomechanical quality of bone and the risk of immediate and long-term im- plant failure when implants are loaded functionally at time of insertion.1–4 Furthermore, experimental and clinical studies published by Turkyilmaz et al. (2007), Pommer et al. (2014) and Wada et al. (2016) proved a significant correlation between primary implant stabil- ity measured by ITV and computerised axial tomog- raphy (CAT) scan-based bone densitometry in native alveolar bone.5–7 Since alveolar bone loss caused by natural atrophy or destructive iatrogenic procedures at the time of tooth extraction demands immediate (“alveolar ridge preserva- tion”) or later (“guided bone regeneration”) bone aug- mentation procedures, Di Lallo et al. (2014) and Troedhan et al. (2014) in randomised clinical studies found a signif- icant difference of primary implant stability when aug- mented alveolar bone was compared with native alve- olar bone.8, 9 Recently, a randomised clinical study was performed by Troedhan et al. (2019) to investigate if a significant correlation between pre-surgical cone-beam computed tomography (CBCT) bone densitometry per- formed with X-Mind trium CBCT (ACTEON) and pri- mary implant stability in augmented sinus sites could be proven. 1 2 4 6 8 06 2 2020 3 5 7 10

| research e u l a V _ U H 1.750 1.500 1.250 1.000 750 500 EasyGraft Crystal ITV EasyGraft Classic ITV Nanobone ITV BioOss ITV ContrGroupNormBone ITV 13 Material 14 opened with ultrasound Piezotome tips (Figs. 2 & 3), the sinus membrane then detached by the hydrodynamic cavitation effect of the Piezotome-tip TKW5 plugged into the approach canal (Figs. 4 & 5) and the subantral scaffold filled with 2 cm of randomly assigned bioma- terial (Figs. 6 & 7), followed by wound closure (Fig. 8). After a mean healing period of 8,4 months X-Mind trium CBCT scans were performed, the digital setup of the future bridge constructed with the AIS 3D app and the bone density determined in the sinus-lift site around a virtual implant (Fig. 9). Standardised implants (4 mm in diameter and 12 mm in length) were then inserted in the position of the virtual implant and insertion torque val- ues (ITV) measured intra-surgically (test groups; Fig. 10). A total of 27 patients with sufficient native subantral crestal bone (min. crest width: 6 mm, height: 12 mm) were screened by X-Mind trium CBCT for bone density with the virtual implant (Fig. 11), the standardised implant in- serted and the ITV recorded (control group). Figure 12 depicts the final result after implant insertion in the patient case shown in Figures 1–9. Study outcomes As can be seen in Fig. 13, the mean CBCT bone den- sity values in Hounsfield units (HU) at the implant site dif- ITV–HU Correlation (Kolmogorov-Smirnov, Spearman’s Rho-test) 1.950 1.750 1.550 1.350 1.150 950 750 550 350 native subantral bone (control) Bio-Oss Nanobone easygraft CLASSIC easygraft CRYSTAL l U H s e u a V d l e fi s n u o H 12 22 32 42 52 62 72 15 Insertion Torque Values ITV in Ncm 08 2 2020

| research 16 fered significantly (p < 0.05) between all four test groups and the control group. The precise numerical HU values are “translated” by AIS 3D app software and are also colour-coded for easier interpretation at first glance: the brighter the green the CBCT voxel matrix shows around the virtual implant, the higher the bone density, with a virtual neutral threshold of 500 HU. Contrary, the more reddish the CBCT voxel matrix around the digital implant is depicted, the worse the biomechanical bone quality (Fig. 14). The corresponding insertion torque values (ITV) of the inserted standardised implant measured at the location of the transcrestal INTRALIFT approach (Fig. 2) also differed significantly between all test groups and the control group. Figure 15 depicts the cumulative result of the correlation between HU and ITV values for all test groups and the control group. Clinical implications As the presented study proves, contemporary CBCT technology adds another outstanding feature to the gen- eral CBCT-based digital workflow as the first and only tool to safely determine the grade of primary implant sta- bility to be expected at each individual implant site al- ready in the planning phase before the treatment or sur- gery is performed (Fig. 16). By using CBCT-based bone densitometry as an integrated diagnostic step in the digital workflow, the clinician for the first time can de- cide individually for each patient and each implant site whether an implant insertion with immediate prosthetic loading might bear an unacceptable risk of early or de- layed implant loss, and can therefore inform the patient accordingly based on evidence. synthetic bone graft should be considered as gold stan- dard needs to take now a different pathway. In particular, native maxillary bone shows a very weak biomechani- cal quality and this weakness obviously can be substan- tially improved by biomaterials used for augmentations. Therefore, the clinician might be better advised to seek out the highest possible biomechanical quality of regen- erated bone in GBR sites instead of pursuing complete bone regeneration by only native bone (which—histolog- ically proven—is never the case even when using only autologous bone). High-resolution CBCT devices, such as the X-Mind trium used in this study, seem to present an indispens- able non-invasive and patient-friendly tool not only for enhanced diagnosis, treatment plan- ning and the digital workflow but also for clinical research to add new knowl- edge to evidence-based dentistry. Literature about the author Prof. Angelo Trödhan is a specialist in cranio- and maxillo- facial surgery with a focus on traumatology, and reconstructive and cosmetic surgery of the face, and in dentistry. As a leading ultrasonic surgeon and scientist in ultrasonic surgery, dental im- plantology, bone augmentation and maxillofacial surgery, he is regularly invited to lecture at universities and congresses world- wide and to present at international workshops. contact Additionally, the results of this study lead to another in- teresting conclusion: since different biomaterials lead to significantly different biomechanical bone qualities for re- generated bone with precisely correlated higher values in CBCT-based bone densitometry and insertion torque values, the scientific dispute if autologous, xenogeneic or Prof. Angelo Trödhan Erdbergstraße 52–60 Stiege 3, 1. Stock, TOP 5 1030 Vienna, Austria Phone: +43 1 5449128 www.kieferchirurgie.at Author details 10 2 2020

| case report A viable alternative for complex clinical situations Dr Sepehr Zarrine, France Initial situation The patient, a healthy 66-year-old woman, presented with a thin mandibular ridge (Figs. 1 & 2). Her main com- plaint was the poor retention of the prosthesis, causing her pain and discomfort when chewing properly while eating. The same retention problem would also make her very uncomfortable at social events, since she was afraid of the prosthesis slipping when she laughed. Treatment planning ideal solution for treating situations with low bone width. Although ridge augmentation could restore the ridge vol- ume, it would considerably increase surgical morbidity, costs and treatment time. A CBCT examination was con- ducted to allow a more accurate assessment of the an- atomical conditions. It indicated that the open flap ap- proach would be the safest route for this patient and also revealed the ideal implant positions. Surgical procedure During treatment planning with the use of Mini Implants (Straumann), two main situations have to be considered. The first situation is when there is enough bone and keratinised gingiva for the surgery to be performed in a flapless and minimally invasive approach. The second situation is when the patient does not have ideal ana- tomical conditions. In this case an open flap surgical approach must be considered to properly visualise the anatomical situation. This patient presented with over- all thin mandibular bone volume. Mini Implants are the Following a crestal incision to preserve keratinised gin- giva, the flap was carefully raised for proper visualisation of the bone contours (Fig. 3). The drilling protocol com- menced with the osteotomy, to a depth of 6 mm, with the needle drill, and was followed by the use of parallel posts to check the three-dimensional orientation of the implant. After the correct axis had been confirmed, the osteo- tomy with the needle drill was completed up to the full im- plant length. At this point it was possible to determine the bone quality, which was perceived as very hard. There- fore, the implant bed preparation continued with a pilot 1 4 2 5 3 6 Figs. 1 & 2: Clinical evaluation showed a thin mandibular bone ridge. Fig. 3: Open flap. Fig. 4: Parallel pins. Fig. 5: Checking the implant bed with the pros- thesis. Fig. 6: Mini Implants inserted. 12 2 2020

| case report Explantation of an implant in a heavy smoker Literature Dr Branislav Fatori, Dr Inge Schmitz & Prof. Werner Götz, Germany Introduction Dental implants are increasingly being used to restore missing teeth. Thanks to further developments in implan- tology, it is now possible to offer patients an individualised, optimal dental prosthesis. Despite an optimal surgical pro- cedure, implant loss can occur. In the following article, the 1 2 3 4 authors report one case of a heavy smoker in whom an im- plant had to be removed after 4.5 years owing to a mate- rial defect of the screw, despite excellent osseointegration. Heavy smoking (smoking of more than 20 cigarettes per day) is always considered a significant risk for successful long-term osseointegration of implants and is associated with higher rates of implant failure than in non-smokers. Smoking slows down the healing process and reduces the long-term prognosis and service life of dental im- plants to a substantial extent. In a large study conducted by Cavalcanti et al., it was demonstrated that the risk of implant loss is twice as high for heavy smokers as for non-smokers.1 The ingredients of tobacco smoke in- crease susceptibility to gingivitis and periodontitis. Initial clinical situation The patient was female and aged 53. She was a smoker who reported that she smoked 30 cigarettes a day. The bone quality was D3 in the maxilla and D2 in the mandible (Fig. 1). Thorough patient education was carried out and the patient agreed to the publication of her case. Materials and methods Implantation The implantation had been performed five years be- fore with DENTAL RATIO implants (DRS International) of 4.1 mm in diameter and 12.0 mm in length in the max- illa and of 3.7 mm in diameter and 12.0 mm in length in the mandible (Fig. 2). The specific implant system used here allows for earlier loading compared with other sys- tems owing to its specific surface structure. The implan- tation was carried out in a “multiple play” situation, and the implants were restored with conditionally removable screw-retained prostheses. A crestal incision was made while protecting the bone structures. Control follow-ups after implantation were done every week for the first six months and then every two years. Fig. 1: Radiograph showing the situation before the initial implantation. Fig. 2: Radiograph showing the situation immediately after the initial implantation. Fig. 3: Part of a radiograph showing the fractured implant screw prior to removal. Fig. 4: Radiograph showing the situation after implant removal. Intervention After 4.5 years, the implant screw fractured and another intervention was required (Figs. 3 & 4). There was no peri-implantitis. The implant screw was sent in for his- 14 2 2020

| case report 5 7 6 8 Fig. 5: Thin-section view of the explanted implant: there was cancellous bone and soft tissue attached at the middle and crestally; three to four upper threads were approximately 70 % covered with bone crestally; there was attached loose connective tissue and peripherally attached soft tissue consisting of loose con- nective tissue rich in vessels; some bone fragments were detected crestally. When magnified further, tight bone-to-implant contact was visible. Fig. 6: Higher magnification: the bone-to-implant contact was too tight, especially crestally under formation of a 5–10 nm wide amorphous interface; there was lamellar bone with vital osteocytes; osteocytes were near to the implant surface; on the outer bone surface, there were signs of osteogenesis with osteoblast seams and osteoid sediments; peripherally, there was slightly more dermal osteogenesis with formation of osteoblast condensations, osteoids and fragments of mature lamellar bone; there was loose connective tissue rich in cells and vessels with some mastocytes and fat cells; near to the implant, there was accumulation of focal vessels; there were small osteoclasts in a few places; crestally, there was resorption on the surface; no necrosis or infiltrates were detected. Fig. 7: Mi- croscopic image of the explanted implant showing good bone-to-implant contact and successful osteogenesis. Fig. 8: Microscopic image of the explanted implant showing good vascularisation. tological examination, for which the material was pro- cessed conventionally by means of thin-section micros- copy according to Donath and dyed with toluidine blue. The histological examination based on particulate blocks of the explant showed good contact between the bone and explant (Figs. 5–8). Crestally, there was good osseo- integration with good bone-to-implant contact. Near the implant, regular osteogenesis and peripheral contact os- teogenesis could be observed. In addition, there was very good vascularisation in the peri-implant area. No ne- crosis or inflammatory tissue was detected. Bone aug- mentation by means of NanoBone (Artoss) was neces- sary for the replacement of the implant (Fig. 9). Medication After microbiological examination, an antibiotic (Clinda- mycin Aristo 600, Aristo Pharma) was administered (first one tablet three times a day and then one tablet twice a day until the day of surgery). In addition, the patient was instructed to rinse twice daily with Chlorhexamed (GlaxoSmithKline). For the postoperative period, 20 mg prednisolone were prescribed (first one tablet three times a day, then half a tablet three times a day and finally a quarter tablet three times a day). Five arnica globules were prescribed daily to reduce swelling. Directly after the operation, 40 mg of Dexa-ratiopharm (ratiopharm) were injected intramuscularly. Before the operation, the patient was advised to increase her intake of calcium, multivitamins and antioxidants in order to stabilise the immune system. General approach to implant insertion Local anaesthesia was achieved bilaterally with Ultracain D-S forte (Sanofi-Aventis Deutschland). Another mandib- ular anaesthesia was achieved with half an ampoule of Ultracain D-S forte. A 14C scalpel (Aesculap) was used for making the incision, with attention to the optimal pres- ervation of the gingival mucosa.2 With this incision, more keratinised gingiva is obtained, which leads to better healing of implants. The preparation of the osteotomies 16 2 2020

| case report Conclusion Smoking has an impact on the general and oral health of patients. Tobacco has a rapid adverse effect on the outcome of all therapeutic interventions in the oral cav- ity. The osseointegration of implants is a risk in smokers, and the risk of peri-implantitis increases in these patients. Various protocols have been tested to evaluate implant survival in smokers. Although dental implants aimed at integrating with the human body have become the state of the art for dental restorations, they are still not always suitable for smokers owing to the aforementioned rea- sons. In order to further research on this topic, it is im- portant to conduct an updated periodic review to sum- marise all of the relevant clinical research results. Editorial note: Dr Inge Schmitz declares that she has no conflicts of interest in relation to this article. Dr Branislav Fatori would like to thank Ulf-Christian Henschen of DRS International (Langenfeld, Germany) and Dr Walter Gerike from Artoss (Rostock, Germany) for their support. about the authors Dr Branislav Fatori has more than 41 years of experience in implantol- ogy and has placed more than 8,000 implants. He was trained at prominent clinics around the globe. Also, he has worked as a long-term training con- sultant for professional societies and implant manufacturers. Dr Inge Schmitz has worked at the Institute of Pathology of the Ruhr-Uni- versity Bochum in Germany since 1990. Her main interests are implantology, stents, electron microscopy and osteo- logy. She studied biology at the same University and completed her PhD at the University of Essen in Germany in 1989. 9 Fig. 9: Clinical situation showing the newly replaced implant. was begun with the 1.80 mm pilot drill and continued with the 2.28 mm drill. For the final drilling, a 2 mm drill was used. The machine-cut implants were placed to a torque of 40 Ncm. To avoid unnecessary pressure on the jaw- bone, each implant was turned to the left for half a ro- tation. This provides optimal blood flow to the implant surface (DENTAL RATIO, MEISINGER) and can minimise or completely avoid bone necrosis. Finally, a periosteal slit was made to achieve flap closure without tension. The surgical site was sutured using vertical sutures (5/0 suture, RESORBA). Follow-up appointments The success of the implant surgery was evaluated in the follow-up examinations on the basis of the following cri- teria: no mobility of the implant, clear sound during the tapping test, inconspicuous periosteal test (Osstell), no pain during the healing period, no infections during os- seointegration, and radiographically no evidence of gaps between the implant and the bony substance around it. In addition, a good macroscopic condition of the implant, low plaque accumulation and the absence of osteolytic signs on the control radiograph served as parameters for success. The osseointegration of the implants placed five years before could be described as good. Discussion contact The existing implant showed good osseointegration af- ter 4.5 years. It can be argued that material properties rarely lead to explantation. The introduction of implants in smokers significantly influenced survival rates, the risk of postoperative infection and marginal bone loss. The results should be interpreted with caution owing to the presence of uncontrolled confounding factors in the in- cluded studies. Recent studies indicate that smoking is a major factor contributing to the failure of dental implants. The authors of this article aim to test the null hypothesis that implant failure rates, the risk of postoperative infec- tion and marginal bone loss are no different in smokers compared with non-smokers. Dr Branislav Fatori Rolandstraße 11 45128 Essen, Germany Phone: +49 201 82188890 info@fatori.de Dr Inge Schmitz Georgius Agricola Stiftung Ruhr Institut für Pathologie Ruhr-Universität Bochum Bürkle-de-la-Camp-Platz 1 44789 Bochum, Germany inge.schmitz@rub.de Author details Author details 18 2 2020

| industry Predictable, immediate results with Tapered Pro implants Tapered Pro implants BioHorizons Camlog, Switzerland Immediate implant treat- Immediate implant treat- ment requires predictability. requires predictability. Tapered Pro implants have Tapered Pro implants have been developed based on been developed based on over 10 years of tapered im- over 10 years of tapered im- plant success. The unique plant success. The unique design elements provide a design elements provide a predictable solution for imme- predictable solution for imme- diate treatment. The Tapered Pro diate treatment. The Tapered Pro implant design features a tapered implant design features a tapered body and deep buttress threads to body and deep buttress threads to provide primary stability. The proprietary provide primary stability. The proprietary buttress thread design compressively loads buttress thread design compressively loads bone, while the tapered body produces a pro- bone, while the tapered body produces a pro- gressive increase in insertion torque during implant placement. The end cutting, self-tapping thread design of the tapered region of the implant allows for controlled implant placement. These features also held to disperse bone chips throughout the osteotomy. The collar of the im- plant is designed with a reduced diameter to preserve vital bone, while maintaining a platform switching design. The unique Laser-Lok microchannels on the implant collar cre- ate a connective tissue attachment and retain crestal bone. fibroblasts. Laser-Lok is fibroblasts. Laser-Lok is the only surface shown the only surface shown to attract a physical, to attract a physical, connective tissue at- connective tissue at- tachment, mimicking the tachment, mimicking the natural connections between natural connections between teeth and surrounding tissue. teeth and surrounding tissue. The prosthetic connection of Tapered Pro im- The prosthetic connection of Tapered Pro im- plants utilises a conical internal hex design for a plants utilises a conical internal hex design for a stable biological seal. The implants are fully compatible stable biological seal. The implants are fully compatible with the current line of authentic BioHorizons abutments and prosthetic parts. The prosthetic geometry of both the implants and the abutments are colour-coded using ano- disation, providing a simple and reliable method to match the correct components together. The Tapered Pro im- plants are also compatible with the BioHorizons surgical kit and the BioHorizons guided surgery kit. The protocols for osteotomy development utilise the current line of ta- pered drills, with protocols for placement in soft bone or dense bone. With the addition of Tapered Pro, BioHorizons broad portfolio of tapered implants provides solutions for broad portfolio of tapered implants provides solutions for all indications. Choose from narrow-diameter 3.0 mm im- all indications. Choose from narrow-diameter 3.0 mm im- plants to wide-diameter immediate molar implants or short plants to wide-diameter immediate molar implants or short 6 mm-length implants to 18 mm-length implants. 6 mm-length implants to 18 mm-length implants. BioHorizons guided surgery system uses an open archi- BioHorizons guided surgery system uses an open archi- tecture design, providing compatibility with various soft- tecture design, providing compatibility with various soft- ware providers and guide manufacturers. For a traditional ware providers and guide manufacturers. For a traditional workflow, BioHorizons comprehensive surgical kit and wide workflow, BioHorizons comprehensive surgical kit and wide range of prosthetics support the complete restorative pro- range of prosthetics support the complete restorative pro- cess. Tapered Pro implants are offered in 3.8, 4.2, 4.6 and cess. Tapered Pro implants are offered in 3.8, 4.2, 4.6 and 5.2 mm diameters, with lengths ranging from 9 to 18 mm. 5.2 mm diameters, with lengths ranging from 9 to 18 mm. Laser-Lok is a proprietary surface treatment exclusively Laser-Lok is a proprietary surface treatment exclusively used on BioHorizons implants. Its success in maintain- ing soft tissue and retaining crestal bone levels can be attributed to over 25 years of research. The surface is developed using laser ablation to create circumferen- tial, cell-sized microchannels around the collar of the implant. The optimal size of these channels allows for attachment and organisation of both osteoblasts and contact BioHorizons Camlog Margarethenstr. 38 4053 Basel, Switzerland Phone: +41 61 5654154 www.biohorizonscamlog.com 20 2 2020

| industry Improve your implant business case-by-case Dentsply Sirona Implants, Sweden ware licenses. With Simplant Editor clinicians have the freedom to review, adjust if necessary, and approve the plan anytime and anywhere. This leave leaves the clini- cian with more time to focus and treat patients, and even take on more work. Precision and protection embedded in each plan Precise planning is the best measure of a predictable out- come. Designed to achieve higher accuracy and mini- mise risks involved with standard “free-hand” implant placement, Simplant guides are based on more than 100,000 patient-specific planning cases to ensure confi- dence and peace of mind of clinicians. And patients can rest assured that their data is protected. Clinicians really get the best of two worlds—pay-as- you-go access to the benefits of computer-guided im- plant treatment and Simplant expertise with no software investment and no long-term commitment. And all on a case-by-case basis. about the manufacturer Dentsply Sirona Implants is a solutions provider with more than 40 years of experience in all fi elds and technologies of im- plant dentistry, including surgical guides and digital planning. For more information about our comprehensive solutions for all phases of implant dentistry, visit us at dentsplysirona.com/ implants. contact Dentsply Sirona Implants Aminogatan 1 431 53 Mölndal, Sweden Phone: +46 31 3763000 www.dentsplysirona.com/implants Simplant Planning Service provides clinicians with a solution to improve their implant treatment business with- out compromising the clinical outcome of their case, as well as facilitating the more complex cases. With this ser- vice, clinicians stay in control of their implant planning cases, they have the possibility to rely on an experienced partner to build their business, and they get the tools needed to easily plan and safely execute a surgery. Easy to learn and use—easy access to high-quality Simplant guides The intuitive online system lets clinicians get acquainted with computer guided implant treatment in their own time and on their own terms. Simply fill in the online web or- der form to receive a Simplant planning proposal for re- view within two days. The guide is manufactured within 48 hours after approval by the clinician. Save time and money by outsourcing planning Outsourcing 3D implant planning reduces case time sig- nificantly and it prevents expensive investments in soft- 22 2 2020

| practice management Practice strategies in the age of corona Dr Anna Maria Yiannikos, Germany & Cyprus © Aldeca Productions – stock.adobe.com Dear friends and colleagues, We have all been facing an extremely unknown and dif- ficult situation these past few weeks and yes, it is com- pletely normal to be afraid and feel worried about your clinic’s future in the post-coronavirus era. I would like to begin with a quote from Nelson Mandela, who said: “When conditions change, you must change your strat- egy and your mind. That’s not indecisiveness, that’s pragmatism.” Some may accuse us of being naive, if we continue to be- lieve that patients in the future will behave the same way they did before the COVID-19 crisis, especially during surgical procedures. We should accept this as a fact. The fear of becoming infected has increased significantly in the past few weeks and is expected to remain heightened for the time being. The need for social distancing mea- sures will remain strong. Unnecessary visits to friends, family and others will mostly be avoided and people will become more health-conscious. Cleanliness and proper hygiene should be paramount these days. In the follow- ing I will provide you with 7 essential tips, which, I be- lieve, contain the most important advice I ever gave in an article. 1. Increase electronic engagement For one thing, set up your website and general online presence in a way that makes it easy for people to book appointments online. In addition, offer new patients to send them the required medical documents via e-mail, so they can fill it out at home before coming to an appoint- ment. They can return these completed forms by e-mail as well, in order to reduce waiting times at the reception area of your practice. Moreover, offer patients a quick video meeting with you via Viber, WhatsApp, FaceTime or Messenger, where they can express their dental issues ahead of a physical consultation. This builds trust, since patients can get to know you before an actual physical appointment and they will be reassured that they will re- ceive exactly the treatment they need with you as their dentist. Further procedures can then be carried out at your clinic. Remember: people need encouragement to take action and you will be there for them when they do! 2. Make sure that your patients feel protected Owing to the current pandemic, patients are most likely to be more aware of diseases and, of course, you should continue to take the protective measures that you would normally take during dental procedures—these are ever more important during the COVID-19 period. In addition, you may consider providing additional protective gear like shoe shields for walking around the clinic for your pa- tients. This will make them feel safe and protected during appointments and it shows that their safety is important to you. 3. Reassure patients that they can rely on you Especially in times like these where most people avoid crowded places and try to live by the concept of social distancing, it is vital for you to reassure them that it won’t come to any delays in your clinic. Make sure that you establish a system that both reduces waiting times and keeps physical contact between patients at a minimum. In these uncertain times, it is important to assure patients that they won’t be running into other patients at your clinic and thus bearing the risk of becoming infected. 24 2 2020

| interview The perfect link between man and technology In 2019, the novel im- plant system by the Ger- man implant manufactur- ing company TIZIO Hybrid Implants was unveiled for the first time. The implant is unique in that it combines the advantages of titanium and ceramics in one sys- tem. In this interview, Jenni- fer Wilken, CEO of the com- pany based in Rostock at the shores of the Baltic Sea, talks about what sets their product apart and gives an outlook on what’s to come for her company in the near future. At IDS 2019, TIZIO Hybrid Implants presented itself to the world for the first time with a novel implant system. Hybrid implants like that have not been seen before. What was key reason behind developing a hybrid implant? The idea of TIZIO Hybrid Implants is rooted directly in expe- rience and draws from practicing dental technicians and dentists. We put great emphasis on a steady exchange with users. Development is characterised by in- terdisciplinary research with engineers, scien- tists and close involve- ment of university clinics on the one hand and by the ex- change of information between medical pro- fessions on the other. In short: every developmental step is made based on di- rect feedback from practice. The vision of Prof. Günter Heimke at the DGOI congress in Hamburg in 1992 (“the goal is to have an implant body made from tita- nium on the inside, whereas the neck and the over- all shape on the outside are made of ceramics”) has finally become reality after more than 25 years. professional We have been dedicating ourselves to the research and development of hybrid materials since 2005. We believe that one must not compromise the preservation of ba- sic bodily functions. This is in keeping with our innova- tive and worldwide unique hybrid implant systems, which “We have been dedicating ourselves to the research and development of hybrid materials since 2005.” we have developed for dental and orthopaedic applica- tions. Produced in Rostock by specialists with decades of experience in the industry, the individual systems will be launched in international markets. At the same time, we are constantly striving to find new solutions for den- tists and patients in order to guarantee them the high- est possible treatment safety and quality at all times. To this end, we collaborate with experts from various dis- ciplines to research and develop innovative materials and processes, always driven by our guiding principle: “TIZIO—the perfect link between man and technology.” Fig. 1: The TIZIO implant system will be available in two versions: as classic two-piece system (TIZIO F3), which enables implantation at bone level and covered healing, and as a system with an extended neck made of ceramics (TIZIO H6), which allows implantations at tissue level. In general, TIZIO offers a wide range of products for a variety of indications. 26 2 2020

ACTEON A true low dose 3D CBCT imaging system TRUE LOW DOSE is the latest X-MIND trium CBCT innovation from ACTEON. A new algorithm associated with an innovative mech- anism brings the X-ray sensor and source closer to the patient, which allows image acquisition with significantly reduced expo- sure time, resulting in a lower dose to the patient. The algorithm applied to these lower-dose projections improves contrast and decreases noise, thus accurately revealing the anatomical struc- tures. With X-MIND trium and ACTEON Imaging Suite software, treatment becomes more efficient and safer, less traumatic and therefore less stressful. Bone density around the implant is as- sessed with a single click, allowing easier clinical decision-mak- ing. X-MIND trium has a small field of view (Ø 40 x 40) and provides ultra-high-resolution images (75 µm). X-MIND trium adapts to the growing needs of dental offices by pairing 2D panoramic with 3D imaging and digital cephalometric analysis when necessary. It is the ultimate Mac-compatible therapeutic tool that adapts to the practitioner’s working environment. ACTEON GROUP 17 avenue Gustave Eiffel, BP 30216 33708 Merignac Cedex, France www.acteongroup.com Straumann A reliable system grounded on premium quality evidence. It is available in Ø 2.4 mm diameter with 10, 12 and 14 mm length options and comes with an integrated Optiloc® prosthetic attachment for low maintenance and high patient comfort. A life-time guarantee is offered on Straumann® Mini Implants. Institut Straumann AG Peter Merian-Weg 12 4000 Basel, Switzerland www.straumann.com Smiling, laughing and eating naturally add to a quality of life that every edentulous patient would love to main- tain. Straumann® Mini Implants offer these patients a less invasive, immediate removable fixation of their overdenture. Dentists can rely on a trusted brand that has a legacy in long-term scientific evidence. It allows dentists to offer more solutions to edentulous patients, even with severe reduced horizontal bone. Patients profit from a convenient retentive system, that is less prone to wear with various retention strength. The implant can be immediately loaded with the denture, meaning less visits and shorter procedures. The Straumann® Mini Implant is a one-piece implant made from Roxolid®, a groundbreaking strong material and SLA®, the best documented surface with long-term scientific 28 2 2020

| manufacturer news PreXion Superior 3D image quality with low radiation exposure 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 spe- cifi cally controllable 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 detailed representation of even the fi nest hard and soft tissue structures 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 100 μm voxel size. 74 μm voxel size (PreXion3D EXPLORER). 3D image with a 150 x 160 mm fi eld of view. 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 complete digital workfl ow: from the scan- ning phase with intra-oral scanners and CBCT devices to the milling phase with machines adapted to your needs, including 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 ergonom- ics and shorter chair times, which is essential in the daily dental practice. Combine supe- rior aesthetics and digital design with Z1 implants and TBR CAD/CAM Index dental solutions today! TBR Dental Group 24, impasse René Couzinet 31500 Toulouse, France www.tbr.dental 30 2 2020

| manufacturer news Geistlich Biomaterials Combined implant and augmentation planning in 3D The titanium mesh ReOss® from Geistlich Biomaterials now offers practitioners the option of integrated implant positioning during surgery planning. When ordering a patient-specific 3D grid struc- ture, which is created on the basis of CT or CBCT image data, implant positioning in 3D can be additionally requested. The Yxoss CBR® mesh can thus also be used as a template for orientation. Dr Marcus Seiler, developer of the system, states that practitioners can now forgo the use of a drill template when treating complex bone defects, such as horizontally and vertically combined bone defects. According to Sailer, the drill holes in the grid structure would also considerably simplify the insertion of bone grafting ma- terials, which leads to shorter chair times as a result and the risk of the procedure is significantly reduced for the patient as well. Geistlich Biomaterials Vertriebsgesellschaft mbH Schneidweg 5 76534 Baden-Baden, Germany www.geistlich.de TIZIO Hybrid Implants Implants made of titanium or ceramic? Neither dental practitioners, nor patients need to be confronted any longer to this either-or-question. Thanks to the innovative glass soldering technique, it will henceforth be possible to create a firmly bonded compound between titanium and dental ceramic in order to merge the benefits of both materials. The titanium core in- side the hybrid implant gives the usual safety and stability, as well as high prosthetic flexibility and ultimately the required treatment quality. The outer ceramic shell coated with a glass matrix ensures an optimal tissue compatibility, improved aesthetics furthermore less plaque accumulation and thus a lower risk of peri-implantitis. Simultaneously, we constantly aim for innovative solutions in order to give both, patients as well as dental practitioners, the highest possible therapeutic safety and quality. For this purpose, we per- form research and development on innovative materials with peo- ple from various disciplines, being driven by our guiding principle: TIZIO – The best bonding between man and technology. TIZIO Hybrid Implants GmbH Breite Straße 16 18055 Rostock, Germany www.tizioimplants.com 32 2 2020

| DGZI Special Training programme of the DGZI in cooperation with the GBOI Time-saving—efficient—innovative Dr Rolf Vollmer, Germany Dear colleagues, The German Association of Dental Implantology (DGZI) established and registered in 1970 is the oldest dental implantology association in Germany and represents in their more than 45 years of history practice-oriented and science-based implant dentistry and has set standards in oral implantology in Germany. DGZI is a non-profit as- sociation active in the field of dental implantology. DGZI is focusing its activities on the continuing education and training of dentists active in the field of dental implantol- ogy in Germany and abroad. The goal of these activities is to improve both quality and quality assurance as well as the safety of therapies in the interest of patients on the one hand, and providing factual information on existing and new therapeutic possibilities of implant-based tooth replacement on the other hand. Cooperation with univer- sities and professional associations at home and abroad serve to support these objectives. Our DGZI curriculum as a continuing educational/post graduate programme is running in Germany for more than 20 years. In addition to numerous scientific trainings and projects we always actively support our colleagues, dental tech- nicians and the entire team with a premise of a profes- sional association founded in 1970. With more than 4,000 members in Germany and more than 13,000 cooperative members worldwide, the DGZI is one of the international best networked implant specialist societies in Germany. As a modern professional company we offer a variety of training concepts and postgraduate training structures for the entire dental team. The international annual con- ference is the highlight in the implantology training land- scape and beyond the borders of DGZI member’s inte- gral part of the training calendar of a variety of national and international dentists and their teams. Since 2002, the German Board of Oral Implantology (GBOI), also ini- tiated by the DGZI, offers its training to dental colleagues from around the world. The German Board’s mission The German Board of Oral Implantology (GBOI) is an in- dependent organisation that is sponsored by the German Association of Dental Implantology. The Board’s mission is to elevate the standards, and to advance the science and art of dental implantology by encouraging its study and improving its practice. The GBOI is chartered since 34 m o c . k c o t s r e t t u h S / k c o t S S F ©

| DGZI Special DGZI supports practitioners in Becoming ABOI/ID Diplomates In 2019 the American Board of Oral Implantology (ABOI) in the US decided to make the ABOI/ID Diplomate examination avail- able for experienced dental practitioners internationally. The ABOI has an independent examination committee chartered by the American Academy of Implant Dentistry (AAID), the official US partner of DGZI. The DGZI board has defined the necessary con- ditions. Graduates of the “DGZI Curricu- lum Implantology”, as well as holders of both “Expert in Dental Implantology” and “Specialist in Oral Implantology” certifica- tion are now eligible to apply for this ex- amination to become ABOI/ID Diplomates. DGZI can offer its support on request in preparing for the written and oral exam- ination through a preparatory seminar, in which situations similar to an examination are played through and specific contents DGZI Online Campus International online training wherever you are The structure and content of DGZI’s successful implantology curriculum was revised in 2019. All participants now have access to the ITI Academy, where young dentists with little experience in implantology can learn the basics of implant dentistry. All participants in the curriculum will start their training in the new “DGZI Online Campus”. This has been completely redesigned and enables e-learning from all devices and from anywhere you have online access. The theoretical basics of implant den- tistry are well presented and taught in sepa- rate modules. Each module ends with a learning success check, which can be practised as often as required in advance in test examinations. After successful online training, three practice-related compulsory modules and two therapy-related optional modules follow. The curriculum is supported by special learning materials of the DGZI Online Campus. Start with the new concept of the DGZI online training at home or wherever you are—that is Blended Learning! Now at DGZI! Contact: sekretariat@dgzi-info.de; info.vollmer@t-online.de 36 2 2020 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 pre- pare for the examination via distance e-learning. The e-learn- ing preparation can be started at short notice at any time. The first oral preparatory examination date is scheduled for the 50th International Annual 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 informa- tion via e-mail at info.vollmer@t-online.de. Source: DGZI m o c . k c o t s r e t t u h S / s s u m a e s / a d o o v a d ©

| DGZI Special Refl ect on 50 years of implantology in Bremen this autumn OEMUS MEDIA AG, Germany definition into the conference room and online, an exten- sive range of table clinics with hands-on appeal, an inter- active digital poster presentation and a colourful industry exhibition by selected partners are an integral part of the autumn congress. At the Bremen event, attendees will be given the opportu- nity to reflect on 50 years of implantology, discuss topical questions and paint a picture of prospective implantology in a fruitful interprofessional exchange with dental enthu- siasts, renowned speakers and industry representatives from Germany and abroad. In addition, the organisers have developed a unique and updated congress struc- ture in that the usual fragmentation of the congress into various podiums, workshops and side programmes will be eliminated. On both congress days, all lectures, panel discussions, live surgeries and table clinics will take place on the main podium, which also serves as exhibition area. Parallel to the Future Congress of the DGZI, the annual meeting of the German Association for Laser Dentistry (DGL) will take place in Bremen. The two professional as- sociations will share the congress infrastructure, indus- trial exhibition area and facilities for the table clinics. Ad- ditionally, there will be a special programme dedicated to oral hygiene. For more information, go to www.dgzi-jahreskongress.de or contact the organiser at event@oemus-media.de. The DGZI and the organiser OEMUS MEDIA AG are look- ing forward to welcoming you to the Hanseatic city of Bremen this November. contact On 6 and 7 November 2020, the 3rd Future Congress for Dental Implantology/50th International Annual Congress of the German Association of Dental Implantology (DGZI) will take place in Bremen in Germany. Under the theme “Visions in Implantology: 50 Years—From single Implant to digital Workflow”, the professional association will be celebrating its 50th anniversary. It was in Bremen where a group of implantology enthusiasts helmed by dentist Hans L. Grafelmann founded the DGZI in 1970, the first European professional association dedicated to dental implantology. As one of the main highlights of the highly anticipated event, Presidents, chairmen and board members of the DGI, DGOI, BDO, DGZI as well as Past Presidents of numerous other professional societies will hold scientific lectures as part of the main programme. Being the oldest dental expert society for dental implan- tology in Europe, the DGZI still breaks the mould today and proves its forward-thinking attitude with a highly modern congress concept. First-rate lectures, the live streaming of surgeries and dental procedures in high OEMUS MEDIA AG Holbeinstraße 29 04229 Leipzig, Germany Phone: +49 341 48474-0 event@oemus-media.de 38 2 2020

| news Dr Xavier Struillou elected New President of the EFP of periodontology at the University of Nantes in France, Dr Xavier Struillou succeeds Prof. Filippo Graziani from the University of Pisa in Italy at the top position of the EFP, a scientific organisation that brings together 37 national member societies and more than 16,000 periodontists and other oral healthcare professionals from Europe and around the world. A member of the executive com- mittee of the EFP since 2017 and coordinator of European Gum Health Day 2018, Xavier Struillou is the first Frenchman to lead the EFP since Jean-Louis Giovannoli, who was the federation’s first President back in 1992. Listening to EFP-affiliated societies and collaborating closely with them are high among Struillou’s priorities: “At the EFP we aim to inspire our member societies, to guide them, and to serve them. The heart and the engine of our federation is our 37 affiliated societies. Their drive is the EFP’s drive, and we are deeply indebted to them.” For further informa- tion contact press@efp.org. Source: European Federation of Periodontology Xavier Struillou is the new President of the European Federation of Periodontology (EFP), the global benchmark in periodontal sci- ence and practice and in implant dentistry. Associate Professor Annual meeting of ISMI Postponed to 2021 The International Society of Metal Free Implantology (ISMI) initially planned to hold its 2020 annual congress in May in Berlin, Ger- many. Owing to the travel and other restrictions that have arisen from the current COVID-19 pandemic, however, the decision was made to postpone the event to 2021. The sixth annual meeting of the ISMI is now set to take place on 7 and 8 May 2021 at the Hotel InterContinental in Düsseldorf in Germany. Held under the theme “Ceramic implants—State of the Art”, the two- day event held under the scientific direction of Drs Dominik Nischwitz (Germany) and Karl Ulrich Volz (Switzerland) will kick off on Friday with two pre-congress symposia, involving the live streaming of a surgery via the internet. The highlight of the first congress day will be the ISMI White Night, where both participants and speakers will be able to wind down in an informal atmosphere. Saturday will then be dedicated to scientific lectures. On both congress days, the programme will cover practical expe- riences and current trends in the use of ceramic implants, as well as biological aspects of metal-free implantology. The objective will be to set new standards in this particularly innovative field of oral implantology and to further advancements together with colleagues from around the world. For more information contact the organiser at event@oemus-media.de. Source: OEMUS MEDIA AG © engel.ac – stock.adobe.com 40 2 2020

| about the publisher Congresses, courses and symposia implants EAO Congress 2020 8–10 October 2020 Berlin, Germany www.eao.org 50th DGZI International Annual Congress— Visions in Implantology 6–7 November 2020 Bremen, Germany www.dgzi-jahreskongress.de AAID Annual Conference 11–14 November 2020 Altlanta, GA, USA www.aaid.com/Annual_Conference/ 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 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 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 7–8 May 2021 Düsseldorf, Germany www.ismi-meeting.com 42 2 2020