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| content editorial The right measures at the right time 03 Dr Rolf Vollmer research The key role of vitamin D in immune health and regeneration 06 page 12 Prof. Shahram Ghanaati, Dr Karl Ulrich Volz & Dr Sarah Al-Maawi case report Immediate rehabilitation of a completely edentulous maxilla Dr Jean-Baptiste Verdino Effectively designing the aesthetic zone Prof. Bilal Al-Nawas, Dr Keyvan Sagheb, Dr Stefan Wentaschek & Dr Yasmin Habibi page 16 Pre-prosthetic periodontal plasty with the Er:YAG laser Dr Fabrice Baudot industry Aesthetics for all intends and purposes Dipl.-Ing. Axel Reichert Making your work fl ow in implant dentistry Dentsply Sirona, Sweden Low CHX concentrations with additives effective against biofi lm page 26 Curaden, Switzerland Implant integration made predictable Prof. David L. Hoexter Cover image courtesy of Fotona d.o.o. www.fotona.com manufacturer news news issn 1868-3207 • Vol. 22 • Issue 1/2021 1/21 implants international magazine of oral implantology news about the publisher imprint research The key role of vitamin D case report Immediate rehabilitation industry Aesthetics for all intends and purposes 04 1 2021 12 16 20 24 26 28 30 34 40 42

| research The key role of vitamin D in immune health and regeneration The evidence for supplementation Prof. Shahram Ghanaati, Dr Karl Ulrich Volz & Dr Sarah Al-Maawi, Germany & Switzerland A healthy immune system is the basis of general good health and a good immune defence. It has been proved that individual habits, nutrition and the environment have an influence on our health.1 A balanced and healthy diet in particular is the key to a healthy human body. An un- balanced diet can seriously impair the immune system and increase the risk of chronic disease as a result.1 In the last decade, chronic diseases such as diabetes mellitus, Endogenous synthesis Exogenous intake 7-dehydrocholesterol Vitamin D3 cholecalciferol Calcidiol (25-hydroxycholecalciferol) Calcitriol (1,25-dihydroxycholecalciferol) 1 Fig. 1: Diagram for endogenous synthesis and exogenous vitamin D3 intake. 06 1 2021 obesity and cardiovascular disease have surged sharply in various countries. A major reason for this is an in- creasingly unhealthy living environment and increasingly unhealthy lifestyle choices, especially in industrialised countries.2 The role of food components and especially vitamins has become increasingly important in various areas. In 1928, the German biochemist Adolf Windaus was awarded the Nobel Prize in Chemistry for his work on the correlation between sterols and vitamins, which sparked further research interest in vitamin D.3 Vitamin D can be produced in a physiological way in the human body. Sunlight is essential for this endogenous synthesis, which takes place primarily in the skin, where 7-dehydrocholesterol is converted into cholecalciferol ( vitamin D3) by UVB rays. In order to reach its biologically active form, cholecalciferol undergoes further conversion steps in the liver (calcidiol) and in the kidney (calcitriol). The latter is the biologically active form of vitamin D and acts as a transcription factor. After binding to the vitamin D recep- tor, calcitriol regulates the expression of various proteins in the cell. The physiological mode of action of calcitriol therefore resembles that of a hormone and not that of a vitamin. That is why vitamin D, as a precursor of calcitriol, should rather be regarded as a prohormone (Fig. 1).4, 5 The connection between vitamin D and parathyroid hor- mone was recognised shortly after its discovery. Within this context, the regulatory effect of vitamin D on the min- eral balance of the body and in particular the regulation of calcium and phosphate levels was emphasised.6–8 Fur- thermore, it was established quite early on that vitamin D plays an important role in mineralisation and bone forma- tion. Consequently, many studies have focused on the in- fluence of vitamin D on skeletal health and the treatment of diseases such as osteoporosis. These findings have contributed to vitamin D being primarily associated with bone health in the public perception. However, some studies have shown the positive effect of vitamin D on the immune system too and thus on the gen- eral health of the body. Several studies have shown that vitamin D has a preventive effect on chronic diseases such as diabetes mellitus, hypertension and cardiovascular dis-

| research The correlation between vitamin D levels and the prev- alence of various chronic diseases has been shown in several clinical studies. A meta-analysis of 25 prospec- tive cohort studies has shown that low vitamin D levels increase the risk of developing cardiovascular disease. In about 10,000 patients, the risk of cardiovascular dis- ease was about 44 % higher than in people with healthy vitamin D levels.15 Another study showed a correlation between vitamin D levels and the development of hyper- tension. It examined 8,155 patients suffering from hy- pertension and vitamin D deficiency. After the vitamin D deficiency had been eliminated, 71 % of the patients no longer showed any symptoms or had measurably high blood pressure.16 A positive influence of vitamin D has also been demonstrated in the development of Type 2 diabetes mellitus. It was shown that the number of pa- tients in a prediabetic stage and with a vitamin D defi- ciency was significantly lower than in the untreated group, once the vitamin D deficiency had been eliminated.17 Furthermore, the potential of an anti-infectious or anti - viral effect of vitamin D has been increasingly investigated in recent years. As a result, vitamin D has gained greater significance as a preventive or adjuvant therapy.11, 18 A systematic review has shown that a vitamin D deficiency is associated with a higher viral load in hepatitis B pa- tients.19 Furthermore, it was shown that vitamin D can in- hibit a herpesvirus infection through its anti- inflammatory and supportive defence effect.20 In addition, studies have shown that vitamin D supplementation reduces the prev- alence of influenza infections during influenza outbreaks.21 Another meta-analysis showed that the number of certain vitamin D receptor polymorphisms involved in processing of vitamin D correlates with an increased risk of a viral in- fection. Based on the vitamin D-mediated improved im- mune defence and its potential role as an antiviral agent, 15 10 5 0 s n o s r e p t s e t f o r e b m u N 2 Vitamin D deficiency: 85.7 % 45.8 % 20.8 % 20.8 % 12.5 % > 30 ng/ml 20–30 ng/ml 10–20 ng/ml 0–10 ng/ml Fig. 2: Distribution of vitamin D levels according to a pilot study conducted by the Clinic for Oral and Maxillofacial Plastic Surgery at Goethe University Frankfurt am Main. 08 1 2021 its importance in the prevention of viral diseases is in- creasingly being investigated. Especially in the COVID-19 pandemic, vitamin D supplementation can play an im- portant role in preventing and defeating infection.22 Determination of vitamin D levels and definition of hypovitaminosis Vitamin D is a lipophilic molecule that is transported in the blood by carrier proteins. Approximately 80 % of these molecules are bound to the vitamin D binding protein in this manner. A further 10–15 % are bound to albumin and the rest circulates freely in the blood. The determination of the vitamin D level as part of a routine examination involves measuring the total concentration of all these forms. The 25(OH)D serum concentration is widely rec- ognised as a reliable marker of vitamin D levels.12 Similar to other vitamins and blood components, the vitamin D concentration is usually expressed in nanograms per mil- lilitre (ng/ml) or in nanomoles per litre (nmol/l). Both units are used, depending on the individual testing laboratory. Here, it must be noted that 1 nmol/l equals 0.4 ng/ml. The definition of a healthy vitamin D level and thus hypovita- minosis is a matter of much debate. In the literature, a vitamin D level of less than 30 ng/ml (75 nmol/l) is con- sidered a vitamin D deficiency (hypovitaminosis).13, 19, 23, 24 In various countries, studies have reported a general vitamin D deficiency. Observational studies have docu- mented that the prevalence of vitamin D levels of below 20 ng/ml (50 nmol/l) is as much as 24 % in the US, 37 % in Canada and 40 % in Europe.13, 24 The German Robert Koch Institute reported that 58 % of 18- to 79-year-olds in Germany have a level of below 20 ng/ml (50 nmol/l).25 This vitamin D deficiency pandemic was recognised as such several years ago. However, not much has been done in terms of supplementation and defining a sufficient dose. A pilot study examined the vitamin D levels of medical staff in the clinic for oral and maxillofacial plastic surgery at Goethe University in Frankfurt am Main in Germany. Out of 24 participants, 85.7 % had a vitamin D deficiency with a value below 30 ng/ml, whereas 45.8 % even had a value of below 10 ng/ml (Fig. 2). It is important to empha- sise that a healthy vitamin D value is considered to be be- tween 40 ng/ml and 60 ng/ml. Current guidelines for vitamin D supplementation Given that, in most cases, endogenous synthesis of vitamin D is insufficient owing to limited exposure to sun- light, the body’s vitamin D intake should also come from food or dietary supplements. The amount of vitamin D absorbed can be expressed in two units: micrograms (µg) and international units (IU). One microgram equals 40 international units (1 µg equals 40 IU). These units

| research Vitamin D test < 40 ng/ml ≥ 40 ≤ 80 ng/ml > 80 ng/ml 10,000 IU/day 5,000 IU/day 1,000 IU/day Monitoring after three months 3 Fig. 3: Vitamin D3 dose recommendation of the authors for healthy adults. Nutrition Society estimate the need at 400 IU/day for chil- dren and 800 IU/day for adults.25 The US research insti- tute GrassrootsHealth collected data on the safety of a dose of 10,000 IU/day and found no undesirable side ef- fects.24, 29 The European Food Safety Authority also clas- sifies a dose of 10,000 IU/day as safe, but recommends no more than 4,000 IU/day.22 Clinical supplementation protocols in randomised controlled clinical studies As opposed to the recommendations of various author- ities and institutions, relatively high doses of vitamin D have been administered in randomised controlled clinical trials, and these have in most cases led to the support of therapy. Various clinical supplementation protocols have been used with doses ranging from 1,000 IU/day to 100,000 IU/day. Two different strategies have been pur- sued: one option is to administer a relatively high dose, such as 100,000 IU, once a month to raise and maintain vitamin D levels; and the other option is to supplement with an adequate daily dose (between 5,000 IU/day and 10,000 IU/day) to cover the body’s daily requirements. Most studies have documented an observation period of up to one year and have paid particular attention to the analysis of the dreaded side effect of vitamin D intoxica- tion. However, no vitamin D intoxication was observed in any of these studies. A detailed overview of the respec- tive studies is given in Table 1. Not long after the discov- ery of vitamin D and the recognition of its role in main- taining mineral balance, many diseases, such as asthma, rickets and tuberculosis, were treated in the 1930s and 1940s with extremely high daily doses of vitamin D (be- tween 60,000 IU/day and 600,000 IU/day). These studies reported hypercalcaemia as a result of over-physiological vitamin D concentrations, which led to growing concern regarding vitamin D supplementation. It is important to note that these studies were carried out with much higher doses than the ones currently administered. 10 1 2021 Authors’ dose recommendation for healthy adults Today, the importance of vitamin D for the general health of the body and the immune system is well documented. A vitamin D value of between 40 ng/ml and 80 ng/ml should be aimed for. In contrast to the doses recommended by various associations, there is increasing evidence in cur- rent research that a relatively high daily dose is neces- sary to reach these values. However, there are no uni- form guidelines at this point. Based on the investigated data, we recommend a daily dose that is adapted to the individual needs of the patient. In the case of a vitamin D deficiency (< 40 ng/ml), a dose of 10,000 IU/day should be administered for three months to compensate for the de- ficiency. As a maintenance dose for a vitamin D level in the range of 40–80 ng/ml, a dose of 5,000 IU/day is recom- mended. If the level is higher than 80 ng/ml, it is advisable to reduce the dose to 1,000 IU/day. The vitamin D level should be checked every three months in order to ad- just the dose to the individual needs of the patient (Fig. 3). When supplementing vitamin D, it is equally important to take the patient’s medical history into consideration and, in the case of compromised organ function or metabolic disease, to individualise the dose accordingly. Prof. Shahram Ghanaati Author details Dr Karl Ulrich Volz Author details Dr Sarah Al-Maawi 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 Literature

| case report Immediate rehabilitation of a completely edentulous maxilla Combining regular and zygomatic implants Dr Jean-Baptiste Verdino, France 1 2 Fig. 1: Initial situation (after third molar extraction). Fig. 2: Panoramic radiograph. Initial situation Treatment planning A 66-year-old female patient presented to the dental of- fice of the author complaining about her partial denture (she had one remaining natural tooth), which was unstable, caused discomfort and had a poor aesthetic appearance. This denture had been in place for 20 years and had been deficient for more than 15 years. The patient was a non-smoker and healthy and did not take any medication. The soft tissue was quantitatively and qualitatively in good shape (Fig. 1). There were no molars in the mandible. The panoramic radiograph showed a lack of bone in the posterior of the maxilla (Fig. 2). The CBCT scan showed remaining bone in the canine re- gion on both sides and confirmed a lack of bone in the posterior of the maxilla on both sides. The remaining tooth (a third molar) was planned to be removed on the left side, as well as a small piece of root under the mucosa (Figs. 3–5). It was decided to place two regular implants in the anterior area, combined with two Straumann zygomatic implants (one on each side), in order to provide the patient with a complete screw-retained fixed restoration immediately af- ter the surgery. The anatomical situation in the posterior area was classified ZAGA 1/2, and thus two round zygo- matic implants were to be inserted. The main advantages 3 4 5 Fig. 3: CBCT scan showing remaining bone. Fig. 4: CBCT scan showing the right side. Fig. 5: CBCT scan showing the left side with a remaining root piece. 12 1 2021

14 17 15 16 Fig. 14: Template filled with occlusal registration paste used to transfer the model to the articulator. Fig. 15: Note the convex shape of the bridge. Fig. 16: Frontal view. Fig. 17: Clinical situation 3 hours post-op. Fig. 18: The patient’s new smile. Fig. 19: Control dental panoramic tomogram. 18 19 Another important parameter for surgical success is the ability to visualise the emergence of the apex of the zygo- matic implant at the buccal face of the zygomatic bone. Thus, the surgeon can be sure that the implant is properly in place (Fig. 8). A Straumann multi-unit abutment (gingival height: 1.5 mm; Institut Straumann) was placed, tightened to 35 Ncm and covered with a healing cap. Resorbable sutures were used to close the flap, and particular attention was paid to the soft-tissue management around the abutment, resulting in a thick amount of keratinised gingiva around the abutment (Fig. 9). The second phase of surgery followed the same pattern: a regular implant placed in the anterior ( Anthogyr Axiom PX implant; diameter: 3.4 mm; length: 10.0 mm; multi-unit abutment; gingival height: 1.5 mm; di- ameter: 4.8 mm) and a second ZAGA round Straumann zygomatic implant of 40 mm in length with a 1.5 mm multi- unit abutment placed posteriorly. As for the right side, the anatomical situation (ZAGA 1/2) allowed for the placement of a cervical emergence close to the top of the bone crest with surrounding bone around the implant (Fig. 10). The initially elevated flap was closed with resorbable sutures. to improve the adhesion of the PMMA to the titanium. The bridge must be smooth and convex in all directions (Fig. 15). This hinders plaque retention and eases hygienic maintenance, both parameters which contribute greatly to the long-term prosthetic success (Fig. 16). Approximately 3 hours after the surgery, the bridge was screwed in place, the occlusion was controlled and the ability of the patient to reach every part of it with an interproximal brush was con- firmed (Fig. 17). Follow-up instructions regarding mastica- tion (to avoid hard food and eat only what can be cut with a fork) were given, and four appointments were scheduled to double-check the healing process. The patient was invited to show her new smile, and she expressed a high level of initial satisfaction (Fig. 18). A control panoramic radiograph was performed, which confirmed the accurate placement of the implants and superstructure (Fig. 19). Acknowledgement: The author thanks Jean-Michel Moal, dental prosthetic technician at Verdino dental practice in France, for his outstanding contribution. Prosthetic procedure about the author At the second appointment, an aesthetic try-in was validated by the patient in order to obtain her agreement on the shape and shade of the teeth. This enabled the manufacture of a translucent resin occlusal rim by simple duplication of the try-in (Fig. 11). This approach authorised the occlusal registra- tion, by filling the resin occlusal rim with occlusal registration paste (JET BLUE BITE, COLTENE; Fig. 12) to stabilise it, before placing the material between the two jaws. The exact posi- tions of the implants were registered with a plaster impression, using screwed transfer copings and an open tray (Fig. 13). Laboratory procedure The master model was cast in plaster and mounted on a semi-adjustable articulator by means of the template (Fig. 14). The pre-existing acrylic bridge was connected to the tem- porary titanium cylinders, previously covered with silane Dr Jean-Baptiste Verdino is a French dentist who graduated from Aix-Marseille University in France in 1985. He cur- rently runs an exclusive private prac- tice in Hyères in France specialising in implant dentistry. In addition, he is an internationally published author with a specific interest in zygomatic implants. contact Dr Jean-Baptiste Verdino 13 Avenue Gambetta 83400 Hyères France Phone: +33 4 94650551 docjbv@cabinetverdino.fr Author details 14 1 2021

| case report Effectively designing the aesthetic zone Prof. Bilal Al-Nawas, Dr Keyvan Sagheb, Dr Stefan Wentaschek & Dr Yasmin Habibi, Germany Medical history An otherwise healthy 65-year-old male patient presented with a tooth 12 that was not worthy of preservation, and a request for implantological restoration (Figs. 1a–c). The initial situation shows a crown that is clearly angulated vestibular, and inflamed, slightly reddened and swollen vestibular mucosa with partial loss of the papillary tips. First, atraumatic extraction of tooth 12 was performed with preservation of the alveolar walls (Fig. 2a). The ves- tibular lamella was already resorbed due to the inflamma- tory process (Fig. 2b) caused by a longitudinal fracture (Fig. 2c). Complementing this, the alveolus was recon- structed in terms of ARP (Alveolar Ridge Preservation) using autologous platelet and fibrin concentrate (plate- let-rich fibrin–PRF) in combination with the β-tricalcium phosphate collagen matrix (CERASORB® Foam, curasan; Figs. 3a–c). In order to achieve optimal shaping of the soft tissue, the gap was provisionally addressed with a removable interim prosthesis. Pre-surgical planning After a healing phase of 6 months (Figs. 4a–c), the pre-implantological planning was carried out using digital volume tomography and an X-ray template. Evaluation 1b 1c 3a 1a 2c 2a 2b 3b 3c Fig. 1: The initial clinical situation with tooth 12 having a longitudinal fracture and not worthy of preservation. Fig. 2: Atraumatic tooth extraction (a) with curettage of the granulation tissue (b) and inflammatory loss of the vestibular bone lamella (c). Fig. 3: ARP using I-/A-PRF in combination with the β-tricalcium phosphate collagen matrix CERASORB® Foam (a), filling of the non-intact extraction socket with the biologised β-tricalcium phosphate collagen matrix CERASORB® Foam (b), socket seal with the A-PRF (c). 16 1 2021

| case report 7c 8b 7d 8c 8a 8d Figs. 7c & d: In a condition of good primary stability, transgingival healing could be initiated with a narrow healing abutment. Fig. 8: Prior to the final restoration, bland peri-implant soft tissue with sufficient volume (a & b) was seen. The far-palatal and steep angulation of the implant axis allowed a screw-retained restoration in the final prosthetics (c & d). Four weeks after placement of the final crown, the peri-implant soft tissue situation was satisfactory, but complete reconstruction of the papilla tips was not achieved. selected in order to enable screw-retained restoration with the future crown and simultaneously achieve a broad vestibular hard- and soft-tissue volume (Figs. 7a–d). Thus the implant axis deviates significantly from the former nat- ural tooth axis. A tapered implant design with a diameter of 3.3 mm was selected in order to both account for the clinical dimension of the gap and guarantee high primary stability of the implant for transgingival healing. Prosthetic restoration After a healing phase of three months, the final pros- thetic restoration was initiated under satisfactory hard- and soft-tissue conditions (Figs. 8a & b). By implemen- tation of the pre-prosthetic planning of the implant axis, it was possible to achieve a screw-retained solution for the single-tooth crown (Figs. 8c & d). The final prosthetic restoration is a fully ceramically veneered high-gold crown for avoidance of an adhesive gap. Replacement of the adjacent plastic filling on tooth 23 could have been considered for harmonisation of the aesthetics. Never- theless, the patient’s aesthetic requirements were met, especially in view of the initial clinical situation. The patient was very satisfied with the result, although objectively no reconstruction of the papilla tips was achieved. However, further “maturing” of the papillae over the course of time is to be expected. about the author Prof. Bilal Al-Nawas is a Germany- based dentist specialised in maxillo- facial and plastic surgery. From 1986 to 1996, he has been studying medicine and dentistry in Frankfurt, Saarbrucken and Zurich. He obtained a PhD in den- tistry in 1993 and a PhD in medicine in 1997. Today, he is the Medical Director and Head of the Department for Oral and Maxillofacial Surgery, Plastic Surgery at the University Medical Center of the Johannes Gutenberg-University Mainz. contact Prof. Bilal Al-Nawas University Medical Center of the Johannes Gutenberg-University Mainz Head of the Department for Oral and Maxillofacial Surgery, Plastic Surgery Augustusplatz 2 55131 Mainz, Germany al-nawas@uni-mainz.de Author details 18 1 2021

| case report Pre-prosthetic periodontal plasty with the Er:YAG laser Dr Fabrice Baudot, France 1a 1b Figs. 1a & b: Pre-op situation: unattractive gingival smile and alteration of dental structures (a), post-op situation (b). A minimally invasive approach is a global philosophy that has extended to all medical disciplines (there have been nearly 100,000 publications on this subject since 1992), and periodontics is not at the margin of this general trend. The objectives of this approach are to improve the operative and postoperative comfort of patients and to optimise the results of interventions. The Er:YAG laser is a microsurgical tool in the service of this concept. Thanks to its novel oper- ating mode, it allows the clinician to perform operations in accordance with all the criteria of a minimally invasive ap- proach. Tissue is treated on the basis of respecting vascular and anatomical structures in a microsurgical manner, thus reducing postoperative effects and improving the reliabil- ity of the results.1 To illustrate the microsurgical operative capacities of the Er:YAG laser, we present in the following a clinical case of pre-prosthetic periodontal preparation which was performed by tissue sculpting and without a flap. Case presentation The female patient came to the consultation for an aes- thetic and functional evaluation of the maxillary anterior sector. She complained about the condition of her teeth and the unattractive appearance of her gummy smile. She had received several professional opinions before, and all of them included crown lengthening surgery by osteotomy via a full-thickness access flap. This prospect frightened the patient, which was why she was looking for an alternative approach. We suggested Er:YAG laser-assisted pre-pros- thetic periodontal plasty under an operating microscope. 2 3 Fig. 2: Intervention with Er:YAG laser under an operating microscope. Fig. 3: The applicator of the Er:YAG laser (2,940 nm) is very ergonomic. The laser is in the handpiece. 20 1 2021

| case report 10 11 Fig. 10 Definitive restorations in place on the day of placement at eight weeks postoperatively. Fig. 11: The final outcome brought complete satisfaction to the patient. tween soft tissue and bone allows very precise selective ablation. Under high-magnification optical guidance, the surgeon can operate layer by layer by subtraction in a microsurgical manner. Once the bone has been removed from the soft tissue, it is possible to sculpt the bone in order to restore the biological space around the root homothetically and safely for the dentine and cementum by relying on the difference in water load between bone and dentine. The decreasing water load gradient at this level is conducive to safe ablation with the Er:YAG laser. Under visual control, the periodontal ligament is irradiated si- multaneously to the bone while preserving the tooth root. To perform this microsurgical operation, the surgeon has six setting parameters at his or her disposal: three ad- justment parameters to determine the power of the laser beam on the machine (i.e. the amount of energy trans- mitted to the targeted tissue; frequency of impacts; and water flow rate, which allows modulation of the effect of the delivered power) and three parameters in the sur- geon’s hand (i.e. the distance between the beam and the target, beam angulation, and exposure time). By mod- ulating these different parameters, the surgeon sculpts the tissue being operated on according to his or her sur- gical planning. Compared with conventional instrumentation, the Er:YAG laser offers the following advantages: – It improves operating ergonomics (the surgeon oper- ates with only one instrument on both soft and hard tissue; ultra-precise selective action on different tissue layers; clearance of the operating field rinsed by the laser spray, which allows operation without bleeding). – The layer-by-layer approach allows a flapless pro cedure. – The excellent water absorption of the Er:YAG laser al- lows surgery in the very restricted space of the sulcus without altering the adjacent tissue. – Tissue sculpting is a novel procedure compared with conventional incision and milling. It allows simple and intuitive intervention in complete safety. – The postoperative results are excellent because the vascularisation of the operated tissue is preserved and the adjacent tissue is not traumatised by the elevation of a flap. Also, healing is quicker.5 – The Er:YAG laser decontaminates tissue by its bacteri- cidal effects.6, 7 Thus, the perfectly clean surgical field heals all the better. Bacteraemia is reduced compared with conventional instrumentation.8 Conclusion In the clinical case described in this article, the Er:YAG laser allowed us to perfectly meet the patient’s expec- tations (Fig. 11). Her smile was restored corresponding to her desires by preparing the periodontal tissue with- out creating a flap. The treatment result was considered stable at the follow-up after five years. As we have seen, this type of intervention is simple, reliable and secure. It is perfectly accessible within the framework of a general dental practice. There needs to be more research on the Er:YAG laser in the future, and it deserves to be integrated into our workflows owing to its great versatility. about the author Dr Fabrice Baudot is a French dentist specialised in periodontics and implan- tology. He currently leads a practice that focuses on laser-assisted microsurgery. His therapeutic approach is always based on minimally invasive surgery. Dr Baudot is frequently invited to speak at international dental conferences, and he is the author of numerous scientific publications. In addition, he is one of the founding members of the European Academy of Ceramic Implantology. Author details Literature contact Dr Fabrice Baudot Impasse des Trois Pointes 65 34980 Saint-Gély-du-Fesc France Phone: +33 4 99060060 dr.baudot34@orange.fr 22 1 2021

| industry 1 2 5 3 4 Fig. 1: Zolid Gen-X is available in all common heights on the market (12, 14, 16, 18, 20, 22, 25 mm). – Fig. 2: Zolid Gen-X 16 mm. Fig. 3: Zolid Gen-X 22 mm with proportionally increased polychromatic shade content. Fig. 4: Zolid Gen-X 25 mm with extended monochromatic gingival component. Fig. 5: Visualisation of the shade distribution of a nested restoration made of Zolid Gen-X with the Ceramill Match 2 CAM software. Fig. 6: Optimally aligned restorations with a high gingival component (“REAX” bridge) to achieve the correct VITA shade while observing the asymmetrical shade distribution. 6 Aesthetics for all intends and purposes Optimising outcomes in implant restorations Dipl.-Ing. Axel Reichert, Austria Industrial multilayer pre-shaded zirconium-oxide blanks have established a strong positive trend in the dental market for quite some time now and form part of the established state-of-the-art across a wide variety of facets in terms of integrated colour design. They ensure simple, fast and highly accurate reproducibility of co- lour and translucency in everyday laboratory work. For the user to be able to assess which underlying “ optics” are hidden in the blank, nesting concepts are often necessary. However, these must first be imparted to the user so that the desired tooth shade prevails after sin- tering. If additional pronounced gingival sections are to be added, which of course cannot meaningfully be ac- counted for in terms of shade in a tooth-coloured blank, then a simple “symmetrical” or evenly distributed shade gradient is often no longer sufficient for this purpose. In these cases, users can choose the aesthetic and high- strength Zolid Gen-X zirconia with integrated shade gradient from Amann Girrbach (Fig. 1). Zolid Gen-X is available in 16 VITA shades, two Bleach shades and all common heights on the market. To ensure that the shade gradient of the tooth section is optimally matched with regard to the height of the res- 24 1 2021

| industry Making your work fl ow in implant dentistry Dentsply Sirona, Sweden At any dental clinic, workflow is very important for busi- ness success and patient satisfaction. To reach these key goals, dental practices need to have smart implant workflow solutions in place. In addition, you want to experience flow when treating patients—it will help you overcome challenges, feel confident and find solutions to complex cases. Making your work flow in implant den- tistry revolves around identifying the smoothest and most convenient workflow for each customer, and making sure to deliver whatever is needed to ensure that. With a vast, world-class assortment of products and solutions for im- plant treatment, there are complete solutions that create the best possible workflow and make work flow better. Workfl ow with Astra Tech Implant EV and Azento You might say that a workflow is like a machine. Take out its key part, and it just does not run like it should. Astra Tech Implant EV is such a part. The way it is designed. How you can place it. The handling experience. Its long- term functionality. How it promotes aesthetics decades from now. All that matters. Some of it is directly notice- able, while some is only evident in the future. Still, they all influence your workflow. When you know that the im- plant works and acts like expected, you relax, trust it and focus on your main task—improving the everyday life of your patients. When you do this, you rid them of dental worries, which help them feel better and more confident to do the things that trigger their flow in life. A user of Astra Tech Implant EV knows all this—how the parts of the machinery fit perfectly to form a smoother and efficient process. The right solution and digital tools can improve your work- flow, help to reduce bottlenecks and infuse better team flow at your end. One example of this is Azento, the all-in- one box solution for single tooth replacements. It reduces the costly instrument and materials inventory. You get a fully guided surgical solution. And it is designed to take away time-consuming procedures in order to streamline the workflow, so the team can focus on the core tasks. The result? You stand a better chance of having flow at work, which ultimately boosts your business success. So the sights are set on creating the best possible workflow solutions for implant dentistry professionals by identifying customer-unique solutions that secure high quality treat- ments while saving time and effort. contact Dentsply Sirona Aminogatan 1 41321 Mölndal, Sweden www.dentsplysirona.com/makingyourworkfl ow 26 1 2021

| industry Low CHX concentrations with additives effective against biofi lm Curaden, Switzerland A recent study at the University of Bern in Switzerland has yielded important findings on one of the most frequently used agents in dental care—chlorhexidine digluconate (CHX)—and the relatively newly discovered Citrox, both of which are in Curaprox’s Perio plus range of mouthwashes, toothpaste and oral gel. According to the results, Perio plus formulations have a stronger inhibitory effect on plaque regrowth than do solutions with the same amount of CHX but no additional ingredients. How do CHX and Citrox act in favour of oral health? CHX is an effective broad-spectrum biocide, antiseptic and disinfectant agent that combats a wide range of Gram- negative and -positive bacteria, yeasts, fungi, and many other kinds of microorganisms. CHX has been proved to have a sig- nificant effect on dental plaque formation and accumulation, and therefore the agent is used in prophylaxis and treatment of dental caries, gingivitis and periodontitis. There are various concentrations of this formula in many specialised oral care products, suitable for both short- and long-term use. A lesser-known ingredient is Citrox, a formulation of soluble bioflavonoids obtained from bitter orange that has a docu- mented broad spectrum of antimicrobial, antiviral and antifun- gal activities against microorganisms present in the mouth. Furthermore, Citrox is praised for being non-toxic and non- allergenic, and not altering taste or staining teeth. The study by the University of Bern shows that Citrox combined with poly-l-lysine and CHX in the formulation of Perio plus sup- ports the anti-biofilm activity and that this mixture can be even more effective than pure CHX of the same concentration. What formulations were tested? The study aimed to analyse, in vitro, new formulations con- taining Citrox and CHX regarding their antibacterial activity against planktonic bacteria and their potential to inhibit 28 1 2021

| industry Implant integration made predictable Prof. David L. Hoexter, USA In recent years, the public’s acceptance of oral implants has been dramatically positive. People are living longer and desire an enhanced quality of life. Being able to eat all the foods they enjoy due to im- proved mastication, not requiring the full dentures of their grandparents, comfortably eating and speaking at the dinner table not only with their children but with their grandchildren, provides greater confidence and enjoyment of life. Implant aesthetics has also played a major role in improved appearance and social con- fidence. Numerous shapes, sizes, widths, surface treatments, different groove surfaces, and other variations in de- sign, have been developed to ensure predictable in- tegration of the oral implant, thus facilitating pros- thetic restoration and return of function. But what about the implant surgical site. How can it be op- timised to ensure predictable integration? One of the practitioner’s pressing questions today is if and when to extract. Will there be enough bone after ex- traction to support endosseous implants and their prosthetic restorations to function as desired. It is generally advisable to extract sooner rather than later, as there is more bone available to support an implant. In waiting you take a risk that you might end up with less bone. The bottom line is—the more bone available, the Fig. 1: Hoexter Luxators: series of instruments designed to facilitate the removal of roots by mesial-distal movement, allowing the preservation of buccal and lingual bone during extraction, while allowing the practitioner to visualise the operating area in comfort and ease. The instruments are available in different incised edges and sizes for various sized teeth and comfortable angulations. more predictable the integration of the implant. Pre- dictability leads to success. In the history of dental extractions, getting the de- bilitated tooth out of the oral cavity as quickly and as painlessly as possible, has been paramount. Af- ter anaesthesia, luxating buccal-lingually is usu- ally the next step. The theory behind this concept is that the buccal bone is usually the thinnest zone of bone retaining the tooth, and thus it provides the least resistance. Anatomically, the buccal plate of bone is usually much thinner than the palatal or lin- gual. However, the easier extraction toward the buc- cal results in the loss of more buccal bone. Heal- ing depends on the blood supply, primarily from the osseous walls of the extraction site. The constant pres- sure from the buccal-lingual luxation leads to ischemia in the remaining thin plate of buccal bone. This ischemia leads to further resorption and loss of the buccal wall. 2a 2b 2c Fig. 2: The Hoexter Luxator in the septal area of the mandibular molar. The force is directed toward the mesial (a); the Hoexter Luxator placed at the distal of the mandibular molar with the force directed in a mesial direction (b); the Hoexter Luxator placed at the mesial of the mandibular molar. The force is directed in a distal direction. With the constant mesial-distal pressure, the root is easily made mobile and removed, thus preserving the buccal and lingual bone (c). 30 1 2021

| industry 3e 3f 3g 3h 3i 3k 3j 3l 3m 3n 32 1 2021 Fig. 3: Case presentation: All four of the roots easily luxated out (e); blood clots in the #46 and #47 sockets (f); osseous graft material inserted into the sockets (g); resorbable membranes placed over the grafts, before su- turing (h); lower right area three months post-op (i); exposed regenerated bone area three months later. Note the full ridge of bone regenerated buc- cal-lingually as well as mesial-distally (j); implants inserted at bone level (k); implant healing abutments in place (l); keratinised area of the mucogingival flap now sutured at the correct level (m); final buccal view of the restored prosthesis with healthy keratinised tissue (n). entire previous void, eliminating the resorptive depres- sion of the buccal bone and the elimination of the oral hygiene, aesthetic and restorative challenges. After the mesial-distal luxation and removal of the indi- vidual roots, leaving the intact walls of extracted roots, it is suggested to utilise an osseous resorbable material and regenerative bone graft material. A GTR technique using a resorbable barrier membrane to cover the osse- ous graft is placed under the flap margins and sutured in place, which, after the correct healing time, will result in bone regeneration that will support an endosseous im- plant in the correct supported position (Figs. 3a–n). The practitioner will be able to provide the optimal prosthetic replacement—one in occlusal harmony, physiologically- shaped for best function, aesthetically pleasing, and easy to maintain. about the author David L. Hoexter DMD, BA, FIADFE, FACD, FICD is Director of the Interna- tional Academy for Dental Facial Esthet- ics and Clinical Professor of Periodon- tics and Implantology, Temple University School of Dental Medicine. A Diplomate in the International Congress of Oral Im- plantology, American Society of Osseo- integration, and the American Board of Aesthetic Dentistry, he publishes and lectures internationally. Dr Hoexter has been awarded thirteen fellowships, including FACD, FICD, and Pierre Fauchard. His practice in New York City is limited to periodontics, implantology and aesthetic surgery. contact Prof. David L. Hoexter DDS, DMD, FACD, FICD Clinical Professor of Periodontology and Implantology Temple University, Philadelphia, USA 300 East 74 Street, Suite 4ABC New York City, NY 10021, USA DrDavidLH@gmail.com Author details

| manufacturer news BioHorizons Camlog Sometimes less is more: The PL-FLEX tray The PROGRESSIVE-LINE implant system is based on an implant that is geared to facilitate immediacy concepts such as immediate placement and restoration. With highly effi cient protocols for the implant bed preparation for all bone types, the well-thought-out features of this apically tapered implant are particularly advantageous in soft bone. The new PROGRESSIVE-LINE FLEX tray offers practical benefi ts for the surgical team, and is cost and time effi cient for the dental clinic. The FLEX tray is as small as a postcard! With a reduced number of instruments required for surgery, FLEX offers an effi - cient drilling protocol for multi-implant cases. This streamlining means effi ciency during and after surgery. The drills are clearly marked with colour-coded lines that serve as a guide throughout the drilling protocol. In addition, the in- struments for implant placement are organised according to a surgeon’s preferred surgical placement procedure. Finally, effi ciency and ease of use during surgery is ensured with the visual drill-marks for guidance orientation for drill-depth during surgery. This is all combined in a tray, which has been validated for automated cleaning* and sterilisation. These benefi ts make the FLEX tray a win-win solution for the whole dental team. Find out more today! * Ratchet and holding key cannot be cleaned inside the kit; ratchet must be disassembled for cleaning. See reprocessing work instruction. Camlog Biotechnologies GmbH Margarethenstrasse 38 4053 Basel, Switzerland www.biohorizonscamlog.com Straumann Treating atrophic maxillae with Straumann Zygomatic Implants With this objective in mind Straumann developed new zygomatic implant designs (called Straumann Zygomatic Implants ZAGA Round and ZAGA Flat) based on anatomical placement and conservative surgical procedure which consequently contribute to the preserva- tion of the maxillary bone envelope and a simplifi ed management of soft tissues. Institut Straumann AG Peter Merian-Weg 12 4000 Basel, Switzerland www.straumann.com Edentulism is caused by non or too lately treated oral diseases such as dental decays, periodontitis, trauma or cancer. Nowadays, the percentage of completely edentulous patients is declining but this trend is offset by the growth of the ageing baby boomer population which gives rise to an increase in the numbers of completely edentulous cases. By 2020, an estimated 160 million patients present with one or both fully edentulous arches. All oral rehabil- itation procedures shall allow for insertion of dental implants supporting synthetic teeth into a bone presenting with adequate strength and volume which guaranty mechanical stability and biological durability. Bone grafting proved to be often unsuitable to achieve adequate maxillary bone volume and permit the placement of con- ventional dental implants. In these cases, zygomatic implants should be meaningfully considered. Conceptually it makes sense to get this type of implants with its apical extremity fi rmly anchored in the zygomatic bone and its body further embedded in as much bone as possible in order to render the fi nal rehabilitation biologically and mechanically long-lasting. 34 1 2021

| manufacturer news Amann Girrbach One zirconia for all indications Amann Girrbach has expanded the portfolio of Zolid Gen-X zirco- nias, thus further reducing the complexity of material selection. The highly translucent zirconia with a natural colour gradient is now available in all heights and shades commonly in use on the market. From now on the blanks are available in 12, 14, 16, 18, 20, 22 or 25 mm heights, eliminating all height limitations. The latter is particularly suitable for large-span, implant-supported restorations with a gingival section. The blanks now also cover the complete range of shades. They are available in 16 A–D VITA shades and two bleach shades. With its integrated colour and translucency gradient, Zolid Gen-X zirconia is the material of choice for virtually all common zirconia indications. The fl owing colour and translucency gradient is a perfect imitation of na- ture. With this all-rounder, laboratories can signifi cantly reduce their inventory and save time-consuming selection processes based on the indication and positioning of the respective res- toration. At the same time, users can rely on the advantages of the Zolid HT+ material, which has been proven since 2017 and which forms the basis for Zolid Gen-X. With a fl exural strength of 1,000 MPa, it meets almost every requirement for the stability of the restoration. Amann Girrbach AG Herrschaftswiesen 1 6842 Koblach, Austria amanngirrbach.com curasan Complete bone regeneration with CERASORB® Foam CERASORB® Foam is a multi-porous composite ma- terial made from collagen and pure-phase ␤-TCP granules of different sizes and densities. The gran- ules are embedded in the collagen component and are fi xed by its fi bres. CERASORB® Foam has partic- ularly user-friendly properties. Moistened with blood from the defect or mixed with autologous throm- bocyte and fi brin concentrate, the material can be modelled and inserted into the defect precisely and comfortably. The large contact area with the sur- rounding vital bone allows bone-forming cells to tap into the material and also facilitates the absorption of nutrients and proteins. In addition, CERASORB® Foam is an ideal scaffold for various antibiotics. The special CERASORB® collagen matrix ensures a high level of volume stability after the collagen, which is more rapidly absorbed, has broken down. The high porosity of the gran- ulate, in turn, offers the newly forming bone a stable framework. CERASORB® Foam is completely broken down and replaced by autologous, healthy bone. Over 200 publications prove its success (a list of literature can be provided by curasan upon request). curasan AG Lindigstraße 4 63801 Kleinostheim, Germany 63801 Kleinostheim, Germany www.curasan.de www.curasan.de 36 1 2021

| manufacturer news exocad New exoplan 3.0 Galway now available In December 2020, exocad announced the availability of exoplan 3.0 Galway, the latest version of its implant planning software. The new release supports planning of edentulous cases, including design of surgical guides. “We are excited to announce the release of exoplan 3.0 Galway and enthused about the new possibilities it presents for guided surgery,” said Tillmann Steinbrecher, exocad CEO. “Exoplan 3.0 Galway will provide dental practices and laboratories with a digital workfl ow that offers maximum fl exibility and builds on exocad’s mission to make CAD design as easy as using an app on a cell phone.” Exoplan 3.0 Galway is a powerful, open, and effi cient software package for virtual implant planning. Customised surgical guides can be designed using the Guide Creator software module, and then produced on site—in a laboratory, dental practice, or an external production centre. The software comes in a new, modern user interface, inspired by the Google Material Design system. With more than 40 new features, as well as enhancements to over 60 existing functionalities, the Galway release represents a major expansion of capabilities in guided surgery and improved integration with DentalCAD, exocad’s dental CAD software. be freely designed or based on a prosthesis scan; new tools to speed up the entire planning process; improved implant selec- tion dialog; automatic panoramic curve detection; more implant libraries, now with over 500 implant systems and over 8,500 im- plants from more than 80 manufacturers; virtual tooth extraction on optical scans; possibility to easily mark sinus cavity and check if implants are intruding. All exocad solutions are based on the same technical platform with an open architecture, ensuring the seamless functionality of the digital workfl ow: from virtual prosthesis-oriented im- plant planning with exoplan and designing surgical guides with Guide Creator, to planning and producing the implant-supported, temporary, and fi nal restorations with DentalCAD, exocad’s dental CAD software. “As the world’s premier OEM supplier of dental CAD software, we provide the symbiosis of prosthetic and implant planning,” said Steinbrecher. “Users can achieve predictable results in a cost- and time-effi cient manner, which can ultimately result in increased customer satisfaction.” Exoplan 3.0 Galway is now available in the EU and other select markets. Key highlights of exoplan 3.0 Galway include: Planning of eden- tulous cases and design of the respective surgical guides, including necessary tools, such as dual scan protocol, anchor pin placement, and fi xation guide; surgical and fi xation guides can exocad GmbH Julius-Reiber-Straße 37 64293 Darmstadt, Germany exocad.com exocad.com/exoplan-galway 38 1 2021

| news CareCapital acquires Neoss: Dr Gottlander becomes CEO CareCapital Advisors Limited, an equity investor focused on the dental and oral care industry, announced an agreement to ac- quire Neoss Limited. CareCapital is one of the largest dental in- vestors in the world, having invested more than US$1 billion in the sector, and provides a patient and collaborative environment for dental entrepreneurs and talented executives to realise their customer-centric visions. Neoss is a leading global dental implant company committed to designing intelligently simple solutions that provide reliable and cost-effective patient care with excellent long-term results. The Neoss brand is synonymous with innovation and quality, which has underpinned Neoss’ market leading perfor- mance in 2020 despite the coronavirus pandemic. In conjunction with the transaction, Dr Robert Gottlander has been appointed President and Chief Executive Offi cer of Neoss. With over forty years of dental industry experience, Gottlander has a proven track record in developing and commercialising dental solutions. Source: Neoss ceramic implants The international medium for ceramic implant technology Today, the implant material zirconium dioxide is considered to be on par with titanium owing to its advantages in regard to tensile strength, osseointegration and prosthetic fl exibility. Recent years have seen a rapid evolution of metal-free implant systems and the demand for the highly aesthetic, bio-inert and metal-free material zirconia is steadily increas- ing. In order to keep up with these developments, clinicians need a dedicated magazine that presents the latest industry innovations and their application possibilities. Published twice a year, ceramic implants—international magazine of ceramic implant technology has become an international leading me- dium for metal-free implantology and is regarded a powerful independent platform for the incredibly active international ceramic community. The magazine features research fi nd- ings, practice-oriented specialist articles, event previews and reviews, as well as industry news on the latest in product in- novation. Additionally, it provides comprehensive insight into the activities of various international expert societies. Being an unbiased and independent platform for everyone involved is what distinguishes ceramic implants. The magazine is published by the leading dental publisher OEMUS MEDIA AG and the next instalment will be out in April 2021. For an annual subscription (€30 plus shipping) or a free hard copy, contact subscribe@oemus-media.de. ceramic implants e-paper Source: OEMUS MEDIA AG 40 1 2021 issn 1868-3207 Sondernummer • Vol. 4 • Issue 2/2020 2/20 ceramic implants international magazine of ceramic implant technology research Biological GBR and ceramic implants industry Age-friendly implants interview Laser-assisted prophylaxis around zirconia implants

| about the publisher Congresses, courses and symposia implants Art Director Alexander Jahn a.jahn@oemus-media.de Designer Franziska Schmid grafi k@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 Member of the Board Lutz V. Hiller hiller@oemus-media.de Chairman Science & BD Jürgen Isbaner isbaner@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 6th Annual Meeting of ISMI 7–8 May 2021 Düsseldorf, Germany www.ismi-meeting.com IDS Cologne 22–25 September 2021 Cologne, Germany www.ids-cologne.de 50th DGZI International Annual Congress— Visions in Implantology 1–2 October 2021 Cologne, Germany www.dgzi-jahreskongress.de Copyright Regulations implants international magazine of oral implantology is published by OEMUS MEDIA AG and will appear with one issue every quarter in 2021. 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. 30th annual scientifi c meeting of EAO 14–16 October 2021 Milan, Italy www.eao.org 42 1 2021

SOME STARS SHINE BRIGHTER THAN OTHERS. CLEANIMPLANT QUALITY EVALUATIONS INDEPENDENT, THOROUGH, RELIABLE. In-Kone GLOBAL D AnyRidge MEGAGEN T6 NUCLEOSS ICX-Premium MEDENTIS MEDICAL Conelog CAMLOG BioWin! CHAMPIONS Prama SWEDEN & MARTINA NobelActive NOBEL BIOCARE UnicCa BTI Standard SLA STRAUMANN BlueSky BREDENT MEDICAL We check the quality of implants you use in your practice. Provide more safety for your patients and prevent negligence claims. Find out more. Join the project. More information: www.cleanimplant.com/dentists