Z for Zirconia, 1 for One-stage surgery. Z1®Implant Giving you confidence in implantology. ✓ Anti-bacterial shield ✓ Ideal in fresh extraction sockets ✓ Immediate aesthetic result Proven economics for a ✓ Reduced chairtime ✓ Practice development ✓ Patient satisfaction ✓ Only 1 surgery ✓ No healing abutment ✓ Visibility of the connection ✓ 98.6%* success rate ✓ Pure Titanium and Y-TZP Zirconia ✓ Suitable for all prosthetic solutions *Z1 implants are medical devices of class IIb manufactured by SUDIMPLANT SAS. Information collected from the data of the Smiletranquility® Program based on 15.534 patients with Z1 implants from 01/2014 to 01/2016. Unique, like your smile

editorial Keeping up the momentum of ceramic implants Georg Isbaner research Promoting osseointegration of ceramic implants Dr Dominik Nischwitz Zirconia implant: Close to the natural root? Dr Fabrice Baudot, Dr Giancarlo Bianca & Dr Pascal Eppe page 10 Quality assessment of ceramic implants Dr Dirk U. Duddeck case report Restoring the function and aesthetics of central incisors Dr Phillippe Jourdan Implant surgery according to the All-In-One concept Dr Corbin Popp, Dr Rebekka Hueber & Dr Karl Ulrich Volz page 28 Creating natural emergence profi les in the aesthetic zone Dr Paul S. Petrungaro Multiple restoration with two-piece zirconia implants Dr Gernot Obermair Replacement of two incisors with zirconia implants Prof. Curd M. L. Bollen & Dr Ilian Dargel Treating stable periodontitis patients with two-piece implants Drs Alaa Khutaba, Daniel Rotenberg & Hadar Zigdon-Giladi Posterior single-tooth replacement using a two-piece tissue-level implant Dr Dan Hagi page 42 interview A revolution in dental implantology A new concept in ceramic implantology news manufacturer news news about the publisher imprint 03 06 10 16 20 24 28 32 36 40 42 50 52 44 54 58 | content Cover image (SEM) courtesy of medical materials research institute (accredited testing laboratory for the CleanImplant Foundation) www.mmri.berlin issn 1868-3207 Sondernummer • Vol. 5 • Issue 1/2021 1/21 ceramic implants international magazine of ceramic implant technology research Quality assessment of ceramic implants case report Creating natural emergence profi les in the aesthetic zone interview A revolution in dental implantology 04 implants 1 2021

| research 1a 1b 1c 1d 1e Fig. 1: A clinical case example of a multiple tooth replacement with ceramic im- plants: initial clinical situation (a), panoramic radiograph pre-op (b), panoramic radiograph after healing (c), view of the inserted implants after healing (d), view of the definitive restoration (e). 06 implants 1 2021 Promoting osseointegration of ceramic implants Optimised diet and targeted intake of micronutrients Dr Dominik Nischwitz, Germany In traditional oral surgery and implantology, the focus lies mainly on the healing of an implant and the local fac- tors that are necessary to preserve or grow bone and soft tissue. However, the view is still rather confined to the oral cavity. Classically, four methods of bone augmentation are considered: osteoinduction (growth factors), osteo- conduction (bone grafting material as space holder), dis- traction osteogenesis and guided tissue regeneration by means of membranes or the shell technique, among oth- ers. In biological dentistry, we utilise the experience and the knowledge from functional medicine and nutritional science and conduct targeted therapies with micronutri- ents in order to create optimum systemic conditions for a scheduled surgery and to promote subsequent bone and soft-tissue regeneration. Local factors There are different local factors of intelligent bone and soft-tissue regeneration to be considered. Among them are the decontamination of a surgical site (from breath- ing or saliva), the activation of local growth factors such as insulin-like growth factor-1, osteoblasts and plasma proteins by drilling and creating bleeding spots for re- freshening bone and for stimulating osteoblastic activ- ity, and the application of intelligent biomaterials such as platelet-rich fibrin membranes in order to improve the ex- tracellular matrix and to optimise bone and soft-tissue conditions. In addition, the use of microinvasive tech- niques such as piezo- surgery, ozone therapy, technol- ogies for guided implant surgery and improved imaging by CBCT has elevated our medical profession in terms of both dental skill and technical expertise. There is a clear trend towards aesthetics and general health. Dental implants made of ceramics are no longer a controversial subject, but rather the future of implantol- ogy. However, as of today, only 1% of all oral surgeons are placing ceramic implants. Based on ten years of ex- perience and placement of over 4,000 ceramic implants personally, I would argue that further surgical and sys- temic information is required in order to elevate the suc- cess rate of ceramic implants. Ceramic implants heal with

| research 2 3 Fig. 2: The author puts an overriding focus on the systemic support of his patients by means of a targeted diet rich in protein, healthy fats and vegetables in order to alkalise their bodies and to promote their autologous bone healing mechanisms. (© Dr Dominik Nischwitz) Fig. 3: Vitamin D3 in high doses is the basis of the Bone Healing Protocol (BHP®) according to which patients are prepared for implant surgery through the targeted intake of micronutrients in the practice of the author. (© Dr Dominik Nischwitz) shakes are great tools for patients to easily reach the de- sired protein intake. In our practice, the systemic support of patients by means of a targeted diet (Fig. 2) and sup- plementation of the important nutrients has established itself as a standard in the field of oral surgery. Micronutrients Vitamin D3 in high doses is the basis of the bone heal- ing protocol (Fig. 3). Ahead of surgery, we evaluate the vitamin D3 levels in the blood of our patients. In order to be able to treat them in the best possible way, we tar- get a preoperative value of at least 60 ng/ml.5 A myriad of studies indicate that vitamin D3 is a decisive factor for the regeneration of bone and teeth.6–10 Vitamin D3 acti- vates two enzymes that are vital for the mineralisation of bone: osteocalcin and matrix Gla protein. In order for cal- cium not to calcify the arteries, these enzymes are acti- vated by another important co-factor: vitamin K2 (Sub- type MK-7).11 A further important co-factor is magnesium, which contributes to over 400 metabolic processes in the human body.12 Zinc contributes both to maintaining the immune system as well as to activating the vitamin D3 receptors as a co-factor.13 Apart from that, the trace el- ement boron doubles the half-life period of vitamin D3.14 Since micronutrients operate in a synergetic way, suffi- cient vitamin B and C, digestive enzymes and omega-3 fatty acids need to be present in the organism throughout the postoperative phase. Summary References about the author Tübingen-based Dr Dominik Nischwitz is a specialist in Biological Dentistry and ceramic implant dentistry. He is a founding member and the current Vice President of the International Society of Metal Free Implantology (ISMI). Together with his father, he founded the DNA Health&Aesthetics – Center for Biolog- ical Dentistry in Tübingen, Germany, in 2015. Dr Nischwitz is frequently invited as a speaker to dental conferences around the globe. In addition, he recently published his first book titled It's All in Your Mouth: Biological Dentistry and the Surprising Impact of Oral Health on Whole Body Wellness. In addition to the traditional, rather fine surgical craft that is dentistry, we utilise knowledge from functional med- icine and nutritional science. In doing so, we support the endogenous healing capabilities of patients and en- able improved tissue and bone healing and, as a conse- quence, improved healing of ceramic implants as well. The result is fewer failures and even healthier and hap- pier patients. contact Dr Dominik Nischwitz DNA Health&Aesthetics Tübingen, Germany +49 7071 975977 info@dnaesthetics.de https://tap.bio/@DrDome Author details 08 implants 1 2021

| research Zirconia implant: Close to the natural root? Dr Fabrice Baudot & Dr Giancarlo Bianca, France; Dr Pascal Eppe, Belgium Titanium (Ti) implants are generally used to restore function and aesthetics following tooth loss.1 Numerous studies have demonstrated their excellent biocompatibil- ity and high success rates.2, 3 However, the prevalence of peri-implantitis (PI) around Ti implants, should be a daily clinical concern due to their high incidence (Figs. 1a–c; resolution of the case shown in Figs. 8a & b).4 Recent studies have reported the presence of Ti particles around implants with PI compared to a healthy peri-implant en- vironment.5, 6 Galvanic corrosion phenomena in the oral cavity could be related to the physiopathogenesis of PI.7 This issue takes up a large part in most of our confer- ences, and questions the reliability of our long-term im- plant treatments.8 The qualities of zirconia (ZrO2) ceram- ics as a prosthetic restorative material show us in daily use an extremely low bacterial colonisation, and allow soft tissues to act as a barrier to the underlying infection.9 This material is not a thermal nor an electric conductor, consider the current trend in dentistry towards metal-free restorations, and the long-term aesthetic outcome of our restorations. Osseointegration of zirconia compared to titanium Successful integration of implants is based on osse- ointegration (in the hard tissue), and the formation of a peri-implant mucosal seal (in the soft tissues).14 As for the hard-tissue level, the key parameters to evaluate os- seointegration include the measurements of the bone- to-implant contact (BIC) and the implant removal torque values (Fig. 2).15 Most of the studies show no significant differences between Ti and ZrO2 implants.16, 17 Several reviews of the literature mention the osseointegration capacity of ZrO2,18 including a 2016 review, which se- lected 14 articles out of 1,519 publications, with a cu- 1a 1b 1c Figs. 1a–c: Peri-implantitis around an implant in position 46 and the metal-ceramic crown (a), panoramic radiograph showing the type of bone defect (b), bone destruction with granulation tissue around the Ti implant; after attempting periodontal debridement and GBR, it was decided to remove the implant (c). and, thanks to its high inertia, it has excellent chemical stability with almost no ionic release:10 this greatly con- tributes to its biocompatibility observed with periodontal cells, and could explain the absence of allergy or hyper- sensitivity to ceramics.11 ZrO2 implants may be consid- ered as a real alternative to Ti for our patients, especially those with allergies, autoimmune diseases, periodon- tal risk factors and metal intolerances.12, 13 We must also mulative success rate at one year representing 92%. In all these reviews, the authors concluded that ZrO2 im- plants do represent an alternative to Ti, but that further long-term studies are needed to confirm this.19 Different surface treatments have been proposed. For example, a laser-machined surface allows to achieve an increase of the BIC surface due to an increased micro- and macro- roughness. This technique considerably reduces the time 10 implants 1 2021

| research Bone‐to‐implant contact Weeks Titanium (%) Zirconia (%) 4 8 12 23.5 ± 7.5 27.1 ± 3.5 Days Titanium (%) Zirconia (%) 55.3 ± 27.6 51.9 ± 14 58.5 ± 11.4 57.1 ± 12.4 14 28 36 45 45 59 Fig. 2: Evidence of ZrO2 osseo integration. for osseointegration. The survival rate currently exceeds 98%, and is comparable to that of new generation Ti im- plants. In regard to the soft-tissue level, the qualitative and quantitative dimensions of the peri-implant mucosa around ZrO2 implants are similar to those of Ti implants (Fig. 3).20, 21 Under these conditions, immediate implanta- tion protocols can also be implemented as for Ti implan- tology (Figs. 4a–h). Soft-tissue behaviour towards zirconia A protective anti-microbial, anti-inflammatory barrier Our implant restorations are inserted on the long-term, in a very septic and aggressive environment. The interface between this environment and the underlying structures (bone, vascular network) is provided by the peri-implant soft tissues. There is a real difference in terms of quality of this interface between a tooth and an implant. In 1991 and 1994, researchers described a fibre-free epithelial junction attachment around transmucosal Ti compared to the Sharpey’s fibres present around teeth, and con- cluded that the peri-implant soft tissues are more frag- ile.22, 23 They offer less mechanical strength, but are also less vascularised and more immune-sensitive.24–26 The long-term stability of peri-implant soft tissues is a key issue both in the fight against PI, and in the aesthetic and functional outcome of implant-supported prosthetic restorations. The quality of the mucosal seal around the transmucosal part of the implant restoration is crucial. In 2006, a list of the important and influential soft tis- sue factors for implant integration was published.27 This study revealed, among other things, that tissue-level im- plants behave better than bone-level implants; Ti and ZrO2 are preferable to gold or feldspathic ceramics for the transmucosal components; smooth surfaces are preferable to rough surfaces; in the case of bone-level implants, disconnection and reconnection of the pros- thetic abutments should be avoided. It therefore appears logically that tissue-level implantology is better with re- spect to soft-tissue integration of implants (Fig. 5) in that issues such as gap problems, hermeticity of the subgin- gival prosthetic parts, the platform switching concept to reinforce the soft tissue seal no longer exist. Ti and ZrO2 seem to be the best materials for the transmucosal in- tegration of our restorations. Integrating biological and aesthetic parameters, what is the best material to choose between ZrO2 and Ti at the soft-tissue level? This is a le- gitimate issue to question. The peri-implant mucosal seal 3 Fig. 3: On the day of impression taking: clinical case of a one-piece implant (Z-SYSTEMS) in site 11 showing perfect soft-tissue integration. acts as a protective barrier towards the underlying struc- tures. There are three fundamental aspects to be con- sidered: the microbiological aspect, the biomechanical aspect related to cell adhesion and proliferation around transmucosal implant structures, as well as the potential release of metal ions that disrupt local immunity.28 Microbiological behaviour of zirconia In a 2002 in vitro and in vivo comparative study on Ti, researchers described the transmucosal ZrO2 interface as an anti-microbial shield.29 This observation was con- firmed by further studies. In 2014, researchers conducted an in vivo study based on the use of split casts worn for 24 hours, comparing ZrO2, smooth Ti and rough Ti.30 Analy- ses of the pathogenic and non-pathogenic flora revealed less microbial adhesion on ZrO2 than on the other two Ti surfaces. Consequently, bacterial colonisation is lower on ZrO2 than on Ti. This was confirmed again in 2016 by the same author, and later on by another researcher in 2018 in a 6-month follow-up study comparing transmu- 12 implants 1 2021

5 7 6 8a 8b Fig. 5: A 5.5 mm diameter implant, placed “supracrestally” 1.6 mm above the bone crest (NobelPearl, Nobel Biocare). Fig. 6: The quality of peri-implant soft tissue achieved with transmucosal ZrO2 provides an antimicrobial barrier effect (CERALOG, BioHorizons Camlog). Fig. 7: Tissue integration of a ceramic-to-ce- ramic restoration on a ZrO2 tissue-level implant. The stability of the soft tissues favours papillae preservation. Figs. 8a & b: Soft-tissue quality and quantity around a one-piece implant Z-SYSTEMS zirconia crown (a), peri-implant bone level stability at five years (b). eration of human fibroblasts (HPLF and HGF) and ex- tracellular matrix cells (IhCEM) compared to Ti and hy- droxyapatite. Due to its properties, transmucosal ZrO2 appears to behave more like natural teeth with respect to soft tissues. This can be illustrated by a 2015 study which shows that blood flows around transmucosal ZrO2 abut- ments are similar to those around natural teeth (Fig. 7).40 ZrO2 appears to be a biomimetic material around which the quality of the peri-implant mucosal joint is better than around Ti. The reduction to biofilm proliferation and the quality of soft tissue integrity which have been demon- strated around ZrO2 provide a double protective barrier for the underlying tissues to chronic inflammatory infiltra- tion and microbial invasion which is probably the main risk factor for PI. Thus, the use of the ZrO2 implant to establish a high quality peri-implant mucosal seal can be considered a preventive approach in the strategy to control PI. Conclusions ZrO2 implants have been around for 20 years, and if at first glance their interest may seem limited to pure aesthetics tdue to their colour. Today we realise that, thanks to their exceptional mechanical properties and optimal biocom- patibility and immuno-compatibility, they certainly rep- resent the future of implantology. Placing ZrO2 implants in our patients is part of a preventive approach to peri- implantitis, because the quality of the peri-implant tis- sues achieved around these implants is an anti-microbial barrier which protects the underlying structures. The ab- sence of oxidation reactions around the ZrO2 implants 14 implants 1 2021 and the reduction of bacterial plaque are real assets for their long-term stability in the particularly aggressive en- vironment of the oral cavity. The latest currently available generations of ZrO2 implants offer mechanical, biologi- cal and aesthetic qualities close to those of natural teeth. Dr Fabrice Baudot Author details and CV Dr Giancarlo Bianca Author details and CV Dr Pascal Eppe Author details and CV contact Literature Dr Fabrice Baudot Saint-Gély-du-Fesc, France +33 4 99060060 dr.baudot34@orange.fr

| research Quality assessment of ceramic implants Does white also necessarily mean clean? Dr Dirk U. Duddeck, Germany When it comes to aesthetics, ceramic implants are undoubtedly the better choice compared with titanium implants. Compared with titanium or titanium alloys, zirconium dioxide has some indisputable advantages. For example, for many users and patients, it is not only the fact of metal-free restoration that speaks in favour of this material but also the comparatively lower plaque affinity and high mechanical load-bearing capacity, combined with the better aesthetics. However, are zirco- nium dioxide implants cleaner than those made of tita- nium and titanium alloys when they leave the manufactur- ing facilities? Are the ceramic implant systems currently available on the market actually free from foreign parti- cles? In order to clarify these questions, random samples of a total of 100 sterile-packaged implants were exam- ined for residues under a scanning electron microscope (SEM). Fourteen of these were made of zirconium diox- ide and the remaining 86 were made of titanium or tita- nium alloys. This recent, not yet published, study by the CleanImplant Foundation, conducted in cooperation with Charité—Universitätsmedizin Berlin in Germany and the University of Gothenburg in Sweden, came to sobering conclusions. Considerable analytical effort The analyses were performed in a testing laboratory accredited according to DIN EN/ISO IEC 17025:2018 to ensure the exact performance of the particle analyses according to DIN ISO 22309:2015, that is, elemental de- termination by energy-dispersive X-ray spectroscopy. The implants were unpacked in a particle-free environment (clean room Class 5 according to DIN EN ISO 14644-1) and subsequently scanned in the same clean room to exclude any laboratory contamination of the test sam- ples. For a scientific study, this is a comparatively huge effort to analyse sterile-packaged implants for factory contamination. However, it was necessary due to the fact that the lead organisation, the CleanImplant Foun- dation, a non-profit organisation that has been promot- Fig. 1: Significant residues from production, handling or the packaging itself were identified under the SEM on almost every third titanium implant analysed in the study. Fig. 2: Considerable impurities were found on titanium implants that stemmed from processing errors in relation to wet-chemical cleaning. 1 2 16 implants 1 2021

| research 3 4 5 Fig. 3: In eight of the 14 ceramic implants analysed, surfaces were found to be largely free of residue. Fig. 4: In six of the ceramic implants analysed, larger amounts of predominantly carbonaceous, organic residues were detected. Fig. 5: Polyoxymethylene, a colourless, semi-crystalline polymer that originated from the packaging material, was detected in significant quantities and in particular on the first threads of some of the ceramic implants analysed. balance was suspected to be a possible main cause of peri-implantitis.2, 3 Particularly early cases of peri- implantitis can possibly be explained as being a conse- quence of increased exposure to foreign bodies, which already starts during insertion of an implant with resi- dues from manufacturing, handling or packaging. In the literature, organic foreign materials especially are as- sociated with initial bone loss or even peri-implantitis.4 Foreign particles with a size of 0.2–7.2 µm are classi- fied as pro-inflammatory.5, 6 After phagocytosis by mac- rophages, increased expression of tumour necrosis factor-, interleukin-1, interleukin-6 and prostaglandin E2 was demonstrated, which in turn stimulates the differen- tiation of osteoclast precursors into mature osteoclasts.7 Increased osteoclast activity due to small-volume particle contaminants would particularly explain clinically signifi- cant bone loss of individual implants in the early stages of healing or the early occurrence of peri-implantitis. The discussion about the clinical consequences of filmlike and particulate contamination is as old as implantology itself. Already more than 30 years ago, when looking at non-osseointegrated implants, that is, implants encap- sulated in connective tissue, Donath, Büsing et al. found conspicuous foreign body giant cells in the surrounding area of foreign material deposits and suspected that im- purities of the implant material could be a main cause.8, 9 Summary Even though some suppliers of ceramic implants promote zirconium dioxide as the better implant material, there is just as much light and shadow regarding implants of this material as there is with implants made of titanium or tita- nium alloys. The mere fact that zirconium dioxide implants are white and are usually sintered at high temperatures should not obscure the fact that the sensitive surface can also become contaminated in subsequent processes. Contaminations of implant surfaces can technically be avoided over the entirety of the highly complex processing and packaging process. This is proven by the good results of many titanium and ceramic implants included in the same study. Whether we as practitioners should accept avoidable contamination of sterile-packaged implants is another question. Patients today are no longer unsuspect- ing supplicants, but informed and educated purchasers of medical services. In times when patients inform them- selves in great detail about the advantages and disad- vantages of vector- or mRNA-based vaccines before a vaccination and can even name the respective manufac- turers, we as dentists would be well advised to have con- vincing answers to questions about the quality of those implant systems that we use in our practices and clinics on a daily basis. More information and study results can be found on the project’s website: www.cleanimplant.org Literature about the author Dr Dirk U. Duddeck studied biology and dentistry and specialised in oral implantology. He is a guest researcher at Charité—Universitätsmedizin Berlin and founder and head of the non-profit organisation CleanImplant Foundation, both in Berlin in Germany. contact Dr Dirk U. Duddeck Head of the CleanImplant Foundation Berlin, Germany +49 30 200030190 duddeck@cleanimplant.org www.cleanimplant.org Author details 18 implants 1 2021

| case report Restoring the function and aesthetics of central incisors Literature Dr Philippe Jourdan, France A 62-year-old male patient was referred to the practice of the author after failed endodontic treatment of teeth #11 and 21, which had made the tooth roots mobile (Figs. 1 & 2). The patient had attended the practice several times in the past to have the central incisor crowns refit- ted, since they had kept falling off. Owing to the hopeless prognosis of the existing restorations, treatment options for restoring tooth #11 and 21 were discussed with the patient, who decided on extraction and replacement of these teeth with two dental implants. Radiographs were taken to confirm that the patient had sufficient quantity Fig. 1: CBCT scan of endodontic failure of teeth #11 and 21. and quality of bone to support implant placement. Two 15.5 × 4.0 mm Z1-infinity implants with a zirconia collar height of 1.5 mm (TBR Dental) were planned for. The only indication for which the author uses the longest implants available, as was done in this case, is in post-extractive situations, because, in order to obtain sufficient primary stability, the implant needs to go beyond the apex of the extracted tooth. Implant placement Surgery began with using the piezo-surgical unit to atrau- matically extract the roots of the central incisors (Fig. 3). The sockets were cleaned manually and an Er:YAG la- ser was used to remove the periodontal ligaments. The implant sites were prepared by creating osteotomies in each socket, the implant sites parallel to each other and positioned palatally (Fig. 4). The implants were placed into the sockets at 15 rpm (Figs. 5 & 6). Using a contra- angle handpiece makes this process much quicker and easier than carrying it out manually. Impression copings designed for taking closed-tray impressions were fitted once the implants had been placed (Fig. 7). Acrylic was applied around the impression copings and the excess material was removed distal to the lateral incisors. The acrylic was then used to take a closed-tray impression, which was treated by the dental technicians at the in- tegrated dental laboratory at the author’s practice. This impression taking technique is easier, faster and more accurate than other methods and one that the author of- ten uses in cases where there are multiple implants and joined crowns. Thereafter, healing abutments of 5 mm in height were fitted temporarily to maintain the soft tissue while the provisional restorations were produced by the laboratory. At the same time, a grafting material called sticky bone (Fig. 8) was placed in order to regenerate the bone in this area. An allograft (Bone Bank Allografts) was mixed with a liquid platelet-rich fibrin (PRF) to create the high-viscosity sticky bone grafting material.1, 2 A biopsy punch was then used on an PRF membrane to create two holes that were 2 3 4 Fig. 2: Central incisors before implant surgery. Fig. 3: Preparation and extraction of central incisors. Fig. 4: Osteotomy preparation for implant placement. 20 implants 1 2021

| case report 10 11 12 13 14 15 16 17 18 Fig. 10: Surgical site sutured together. Fig. 11: Provisional crowns. Fig. 12: Abutments fitted two hours post-op. Fig. 13: Provisional crowns fitted using cement. Fig. 14: Provisional crowns after seven months of healing. Fig. 15: Soft-tissue healing after removal of provisional crowns. Fig. 16: Definitive crowns on cast. Fig. 17: Definitive crowns fitted. Fig. 18: The result three months after placement of the definitive crowns. tial threat to the success of bone-level implants, but not necessarily to tissue-level implants, especially if the im- plant is a Z1. In this regard, the soft tissue attaches itself to its zirconia collar, creating a natural barrier between the implant and the soft tissue and thereby reducing the risk of infection. If it had been available at the time, a Z1 implant with a 2.5 mm zirconia collar height would have been used in this case, replacing the transgingival barrier that the dental technicians had created with the acrylic composite around the titanium abutments. This would have created greater surface adhesion between the zir- conia collar and the soft tissue, ensuring that the implant was even more impervious to bacterial infiltration at the crestal bone level. around the collar.6 As such, even if there is a minimal de- gree of recession, the result of treatment with this partic- ular implant is always highly aesthetic: the collar mimics the function and appearance of a natural tooth. Further- more, this implant offers time-saving advantages. For in- stance, it promotes regeneration of the soft and hard tis- sue simultaneously for accelerated healing. This implant is also placed in one surgical step, which saves both the patient and the clinician an additional appointment. This is not necessarily the case with bone-level implants, as the surgical site has to be accessed after the implant has been placed, resulting in longer treatment times. This is why the Z1 is the preferred option for the author in most of his implant cases. A tissue-level implant should be the most commonly used type of dental implant as opposed to a bone-level system, which makes no biological sense to use. So long as a tissue-level implant is placed, restored and main- tained properly, the risk of complications is minimised. The numerous other benefits of the implant used were apparent throughout this case. As it is a tissue-level sys- tem with a transgingival portion made of zirconia, ex- ceptional aesthetics can be achieved with this implant that are superior to that achieved by bone-level implants, as well as other tissue-level implants that are fully tita- nium. Some degree of recession is inevitable with implant treatment, but the titanium components of conventional bone-level and tissue-level implants are more likely to be- come visible through the gingiva, thus compromising the overall visual result. To combat this issue, the zirconia collar of the implant encourages fibroblast cells to ad- here and proliferate, creating an effective soft-tissue seal about the author Dr Philippe Jourdan is a dentist from France who specialises in oral sur- gery. Between 1983 and 1988, he completed several postgraduate train- ing programmes in both Toulouse and Marseilles in France. Since 1986, he has led a private practice in Balma in France. contact Author details Dr Philippe Jourdan Balma Dentaire Balma, France +33 5 62576222 selarl-balma-dentaire.chirurgiens-dentistes.fr/fr 22 implants 1 2021

| case report Implant surgery according to the All-In-One concept Dr Corbin Popp, USA; Dr Rebekka Hueber & Dr Karl Ulrich Volz, Switzerland The 72-year-old female patient presented on referral for a comprehensive biological approach to restore her failing prosthetic dental work composed of porcelain-fused-to- metal crowns and bridges (Fig. 1). Her motivations were to maintain overall health and to have lasting dental work with biocompatible materials. She had a history of trauma, multiple missing teeth, multiple root canal therapies, a history of recurrent decay and periodontal disease. Her occlusion appeared to have a mandible-to-cranial base discrepancy with significant first touch and slide coupled with multiple posterior interferences. She reported previ- ous migraine and clenching at times. The long spanning PFM bridge from #14–24 was class 1 mobile. Additional PFM crowns were at #16, 17, 25, 26, 36, 44, 46. In ad- dition, she had multiple failing root canal treated teeth #15, 14, 25 and questionable prognosis for #24 with peri- odontal bone loss. She had slight mobile lower incisors with moderate recession and subsequent black triangles were apparent with moderate crowding. Aesthetically, the patient was unhappy with the shape of her current teeth. After complete examination, she expressed in- terest in a comprehensive programme to restore her bite using non-metal materials. Immediate implantation with ceramic implants (SDS Swiss Dental Solutions) ac- cording to the All-In-One concept (SWISS BIOHEALTH) and long-term fixed temporaries were discussed. She was referred to the Swiss Biohealth Clinic for surgical planning, once she had completed the pre-surgical site work of the first author, who removed metal PFM restorations and mercury fillings, and placed composite core build-ups with Luxatemp provisional crowns (Fig. 2). Preoperative measures The initial examination at the Swiss Biohealth Clinic re- vealed that teeth #5, 6, 12 and 13 were not worth preserv- ing due to horizontal and vertical bone loss in the max- illary anterior region. The CBCT scan revealed ischemic osteonecrosis in the sense of FDOJ (fatty- degenerative osteonecrotic jawbone; Fig. 3). A vital part of the SWISS 1 4a 2 4b 3 5 Fig. 1: Initial clinical situation. Fig. 2: Situation after metal removal and composite core build-ups. Fig. 3: Panoramic radiograph pre-op. Figs. 4a & b: Intraop- erative situation of the upper front, augmentation with autologous bone chips and osteosynthesis screws (a), insertion of sticky bone on the buccal plate of the upper front (b). Fig. 5: Post-op view of the upper jaw. 24 implants 1 2021

12 13a 14b 15 13b 16 14a 17 Fig. 12: Intra-oral situation four weeks after surgery. Figs. 13a & b: Situation at three months post-op: perfect healing of the implants (a), new PMMA tempo- raries (b). Figs. 14a & b: Balanced occlusion following OBI occlusal design. Fig. 15: Intra-oral situation after osseointegration of all implants. Fig. 16: Frontal view of the final restoration. Fig. 17: Panoramic radiograph after final prosthetic treatment. enced no swelling on the surgical site and an instant re- lief of most of her symptoms. After a few days, she was able to return home to the US. Postoperative care to a Perio M testing, all implants appeared well integrated and were ready for loading (Fig. 15). The permanent pros- thesis was delivered with Ketac CEM (3M ESPE; Figs. 16 & 17). A final protective maxillary orthotic was fabricated for long-term protection and potential clenching. Twelve days postoperative, the patient reported no pain. She was taking 400 mg ibuprofen every eight hours. De- spite a slight recession in the upper palatal area and mild swelling, the tissue was healing well without redness or drainage (Figs. 8–10). Near the surgical sites, procaine without epinephrine, vitamin B12, Traumeel, and Lym- phomyosot (Schwabe Austria) were infiltrated, followed by 11 gamma ozone injections. At the one-month follow- up, she returned for the removal of the remaining sutures (Figs. 11 & 12). The Foundation for Bioesthetic Dentistry (OBI) method was discussed to achieve the most stable condyle position and to simulate an increase in the verti- cal dimension of occlusion to expand the restorative re- building options. At the three-month follow-up, Alginate impressions (Dentsply Sirona) were taken to fabricate a maxillary orthotic (Fig. 13a). Multiple adjustment visits to balance the orthotic followed. The patient had significant improvement with her migraine headaches over three months time. Challenges included hyper-eruption of the lower anteriors, mobile lower teeth with black triangles and recession, in addition to lingual positioned lower ca- nines. The lower anteriors were restored with resin (Flow A1, GC Universal) using a modified Bioclear Method. The titanium fixation screws were removed and new up- per PMMA splinted partials were delivered in three sec- tions (#15–14, 13–23, 24–25). The upper implant abut- ment was prepared with a red stripe diamond football bur (Brassler). Due to aesthetic concerns of the patient, the PMMA crowns were relined and recemented with a darker temp CEM (Telio A3; Fig. 13b). The lower perma- nent crowns (Activa) were bonded and refined to a bal- anced occlusion (Fig. 14). The upper arch was completed removing the provisional in sections from anterior to pos- terior. An anterior jig was fabricated to preserve the bite in a tripod fashion. The upper implant abutments were final- ised using red strip diamond burs with chamfer margin at or slightly below the gingiva. Additional crowns were de- livered on the remaining natural teeth #16, 26. According Conclusion This case is a good example of how failing dentistry and potential inflammatory sites are removed, zirconia im- plants are immediately placed according to the SWISS BIOHEALTH CONCEPT, and long-standing partial eden- tulism is rehabilitated utilising multiple sets of interim prostheses. This is a viable treatment option for patients with partial or complete edentulism who are looking for a biocompatible non-metal solution. Dr Corbin Popp Author details Dr Rebekka Hueber Author details Dr Karl Ulrich Volz Author details contact Dr Corbin Popp BioDentist™ Denver, CO, USA +1 303 3339000 drpopp@biodentist.com 26 implants 1 2021

| case report Creating natural emergence profiles in the aesthetic zone Literature Dr Paul S. Petrungaro, USA Tooth replacement with dental implants is considered the standard of care for replacing the natural tooth system in the contemporary practice of dentistry. Their success rates have been well documented in the dental literature over the last half century. Ad- vances in surgical and pros- thetic techniques have al- lowed for more conservative surgical approaches to pave the way to achieve more pre- dictable wound healing and less soft tissue changes: crit- ical issues in the aesthetic zone. Metal-free implant de- signs are proving to be an additional component to achieving natural soft-tissue emergence profiles and elim- inate the potential for soft- tissue complications that tita- nium implants and abutments present, especially in com- promised soft-tissue volume and thickness. The following article will demonstrate the immediate restoration pro- cedure in the aesthetic zone with multiple implant place- ment and provisionalisation utilising one-piece metal-free implants. The use of dental implants for tooth replacement procedures has become commonplace in the treatment planning process for dentists and dental specialists.1, 2 During the last twenty years, variations in the conventional, multistep process of implant reconstruction have begun to demonstrate the benefits of immediate restoration, especially in the aesthetic zone.3–8 These benefits include minimally inva- sive protocols, shortened treatment times, preservation of soft-tissue contours and emergence profiles, and de- livery of a stable, aesthetic, provisional restorations (in- stead of a removable temporary) that can begin the pro- cess of tissue sculpting and forming the final emergence profile.9–11 Ensuring the appropriate volume and quality of the peri-implant soft tissues, especially in the aesthetic zone, is paramount not only for the peri-implant environ- ment and long-term maintenance of bone levels but also for long-term aesthetic results that can be achieved.8–11 The incorporation of metal-free dental implant designs into, not only the holistic dental practice, but also for rou- tine daily use in the contem- porary general and specialty practice has increased over the last several years.12–16 The benefits of zirconia dental im- plants, which include a high level of biocompatibility, re- ductions in the formation of biofilm and its resultant de- crease in bacterial plaque ac- cumulation, heightened level of fracture toughness, and the reduction in bone loss lev- els long-term in the implant bone crest, and soft tissue attachment areas, are a dis- tinct alternative to titanium for an implantable implant mate- rial.17–21 Conventional titanium two-piece implant designs have been extensively stud- ied over the last 25 years in regard to the connection be- tween the implant/abutment complex, and the micro-gap issue that exists and can be an introductory point for bacterial invasion into the peri-implant environment, becoming an initiation point for crestal bone loss and peri-mucositis and peri-implantitis formation.22–28 One- piece titanium implant designs theoretically reduced the micro-gap issue, but design limitations can increase aesthetic complications and accelerate peri-implant and bone and soft-tissue loss. Two-piece zirconia im- plant designs reduce the micro-gap issue as a result of the decrease in biofilm formation and the reduction in soft-tissue inflammation, an important pre-curser to peri-mucositis and peri-implantitis.29 One-piece zirconia implant designs offer additional benefits in that elimina- tion of the micro-gap space between the zirconia implant and abutment being non-existent and reduction of biofilm formation virtually eliminated. In various zirconia implant Fig. 1: Pre-treatment patient smile. 28 implants 1 2021

| case report 9 12 15 10 13 16 11 14 17 Fig. 9: Atraumatic tooth removal maxillary anterior, occlusal view. Fig. 10: Minimally invasive implant placement, SDS one-piece tapered implants, facial view. Fig. 11: Minimally invasive implant placement, SDS one-piece tapered implants, occlusal view. Fig. 12: 3D printed provisional shell to be retrofitted to abutment portion of one-piece SDS implants. Fig. 13: Immediate postoperative clinical view, maxillary anterior. Fig. 14: Two-month postoperative clinical view with provisional restoration removed. Fig. 15: 3D scanning of corrected abutment and tissue contours to create secondary provisional restoration. Fig. 16: Digital design of corrected contours to additionally sculpt and create natural soft-tissue contours in the interdental and facial emergence profiles of the implant sites. Fig. 17: Clinical appearance 10 days post-seating secondary aesthetic provisional restoration. moved by an atraumatic tooth removal process, preserv- ing the gingival soft tissue emergence profiles (Figs. 8 & 9). Please note the tissue hyperplasia and inflammation in the maxillary right area. Care is taken to not disrupt the natural tissue emergence profiles, facial gingival margin and remaining alveolar contours to perform a minimally invasive implant placement and bone regeneration pro- cedure. Following site preparation, the extraction sites were replaced with one-piece implants (SDS Swiss Den- tal Solutions) and two-piece implants (SDS Swiss Den- tal Solutions) in the second premolar sites (Figs. 10 & 11). All implants achieved an initial torque measurement of 50 Ncm. Following minimally invasive implant placement, autol- ogous platelet-rich fibrin, prepared from a blood draw pre-surgically, was used to rehydrate a fully resorb- able ceramic graft material (Osseolive, curasan) and the A-PRF/Osseolive complex placed peri-implant in the void between the implant surface and the residual buccal plate gap space remaining post-extraction and implant placement. Digital scanning post-insertion of the im- plants and communication with the original 3D smile de- sign allows for printing off of the provisional shell (Fig. 12). The provisional shell is then retrofitted, and margins ver- ified. Cementation of the provisional is then completed with ETC temporary cement dual cure (Parkell). Excess cement is removed, and bite evaluation/adjustment com- pleted. The immediate postoperative clinical view can be seen in Figure 13. Two months post-implant placement the patient was appointed for 3D scanning and second- ary provisional fabrication. Figure 14 demonstrates the clinical appearance of the zirconia implants and resul- tant soft tissue contours obtained from the initial im- 30 implants 1 2021

| case report Multiple restoration with two-piece zirconia implants Literature Dr Gernot Obermair, Italy In the early days of implant dentistry there was a strong focus on osseointegration to make sure that the implants stayed in the bone for a long time. In recent years, the focus has shifted to soft-tissue integration and different prosthetic components to realise long-term aesthetic re- sults with healthy gingiva and stable tissue levels. How- ever, the increased complexity of the solutions and the phenomenon of peri-implantitis has created a lot of chal- lenges for current systems, jeopardising their long-term success. The implant system inserted in following clinical case (Patent™ Dental Implant System, Zircon Medical) has a patented surface and is significantly rougher than other systems. Also, it’s integrated abutment eliminates a micro-gap and the high-tech glass fibre post offers ef- fective retention and load distribution for the superstruc- ture. In addition, the implant system’s success is backed by clinical long-term follow-up.1 Studies indicate that the survival rates of ceramic implants are on par with titanium implants, and that stable marginal bone levels as well as soft-tissue integration are superior to titanium implants.2, 3 These properties lead to complete biointegration of the implant system. Initial situation A 59-year-old male patient with partial edentulism asked for dental implants. Teeth had been extracted more than one year prior to implant placement due to periodontitis. Implants were planned in regions 15, 24, 25, 26 and 36. Bone quality was D3 in region 24–26 and D2/D3 in region 15 and 36. The implant selection is presented in Table 1. Pretreatment Teeth were extracted and socket preservations with PRGF (plasma rich in-growth factors) were carried out. No further bone augmentation procedures were per- formed. Gentle periodontal treatment was performed successfully on the remaining teeth. A titanium stimula- tion test was done, which revealed significant inflamma- tory values with regard to titanium particles. As a result, a metal-free solution (Patent™, Zircon Medical) was se- lected for the patient. A treatment plan was then devel- oped and surgical guides were fabricated to allow pre- cise flapless surgery. 2 2 3 1 Fig. 1: Implant insertion. The Patent™ implant has a hydrophilic surface. Fig. 2: Control radiograph at the time of surgery. Fig. 3: Glass fi bre posts cemented and prepared after a healing period of three months. Note the healthy soft tissues. 32 implants 1 2021

| case report 10 11 12 be seen in Figure 11. In region 36, another single-tooth implant was placed (Fig. 12). The implant was slightly exposed after insertion. However, the soft tissue is ex- pected to grow to some extent over time. The control radiographs show very stable marginal bone levels (Figs. 13 & 14). Conclusion The implant system used in the here described case of- fers a high degree of prosthetic flexibility in combination with the glass fibre post. Single units or bridge construc- tions can be realised in a very efficient way using conven- tional dentistry techniques. Thanks to the roughness of the implant surface, complete biointegration of the ma- chined transmucosal part with the surrounding bone can be achieved. In combination with the microgap-less de- sign, very stable tissue levels are achieved (Figs. 3, 10, 13 & 14). The implant system has shown survival rates that are on par with titanium, as well as a favourable soft- tissue interaction. about the author Dr Gernot Obermair is an Italy-based dentist who specialises in ceramic im- plantology and three-dimensional guided surgery. He currently runs the private practice Happy Implant – Dental Implant Center in Bozen in Italy. In addition, he is a member of the International Society of Metal Free Implantology (ISMI). contact Dr Gernot Obermair Happy Implant – Dental Implant Center Bozen, Italy +39 0471 300082 gernot@happy-implant.com www.happy-implant.com Author details 13 14 Fig. 10: Control radiograph after prosthetic delivery. Note the stable marginal bone levels. Fig. 11: Single-tooth implant in position 15. Fig. 12: Single-tooth implant in position 36. Figs. 13 & 14: Control radiograph at the time of im- plant placement and at the time of prosthetic delivery. Very stable marginal bone levels. 34 implants 1 2021

| case report Replacement of two incisors with zirconia implants Literature Prof. Curd Bollen & Dr Ilian Dargel, UK & Netherlands Modern implant dentistry is a continuously changing discipline in which high-tech approaches are involved to optimise the treatment results. An increasing number of cases are performed with guided surgery systems or even with navigated implant placement.1, 2 The complete digital workflow, including cone beam computed tomog- raphy (CBCT) scans, intra-oral scans and prosthetic 3D printing, is nowadays gaining in importance.3 Moreover, we are seeing changing trends in the applied implant ma- terials. For more than 60 years, titanium was the primary implant material used. Recently, a shift towards biological approaches can be seen in society overall: green energy supply, clothes recycling and biological food products. As a significant consequence, the use of more biocom- patible, metal-free and non-toxic materials in oral reha- bilitation is booming. Therefore, zirconia (a very biocom- patible material) is playing an important role in implant dentistry, not only as the actual preferred crown material but also as the material of choice for fabricating “healthy” dental implants.4 Several reasons can be highlighted for this paradigm change in implant material: firstly, zirconia is a white mate- rial, offering better aesthetic results than greyish titanium, especially in patients with a thin biotype; secondly, zir- conia is extremely biocompatible, showing perfect soft- tissue adaptation and limited plaque retention;5 thirdly, zirconia is metal-free; fourthly, the material is very strong (in many respects even stronger than titanium); fifthly, it has not been associated with peri-implantitis (yet); and lastly, zirconia is a really bio-inert material with no (tribo-)corrosion. Types VI and V of commercial pure tita- nium, on the contrary, show high levels of tribo-corrosion, which could explain the growing increase of titanium al- lergy and which could also be related to the growing in- cidence of peri-implant infections.6 These important as- pects are the main reasons why zirconia could be the future of implant dentistry.7 The case presented in this article is a clear example of the optimal application of ce- ramic dental implants in an aesthetic prosthetic anterior rehabilitation. It involved the replacement of two infected teeth with two two-piece zirconia implants. Initial situation This 37-year-old female patient presented to our clinic at the end of 2016. Her ASA score was I and she claimed to have never smoked. Her alcohol consumption was moderate. In 2013, this patient was involved in a minor car accident, causing damage to her maxillary anterior teeth. In particular, teeth #11 and 21 sustained significant trauma. An endodontic treatment was only performed on tooth #21 at that time. On tooth #11, no endodontic treatment was indicated by her former dentist. This tooth showed severe untreated root caries in combination with an inadequate distal composite filling on our initial radio- graph. Both central incisors had buccal composite resto- rations (Fig. 1). On both apices, cystic inflammation was 1 2 Fig. 1: General intra-oral situation at baseline in 2016. Fig. 2: The panoramic radiograph. 36 implants 1 2021

| case report 13b 14a 14b Fig. 13b: Panoramic radiograph after six months. Fig. 14a: Clinical situation two years after initial surgery. Fig. 14b: Periapical radiograph after two years. detectable (Fig. 2). The patient complained of diffuse pain at the apical area of tooth #11 especially. Slight mobility of teeth #11 and 21 was detected. An additional CBCT scan was taken in order to evaluate the endodontic treatment of tooth #21 and the apical situation of tooth #11 (Fig. 3). The radiographic situation clearly revealed that both teeth were unsalvageable and had to be removed at the ear- liest. The buccal bone plate of both teeth showed two clear fenestrations, but no dehiscences (Fig. 4). It was therefore decided that immediate implantation, after ex- traction, was a proper indication for this case. Implant placement Two weeks later, the patient was scheduled for surgery under local anaesthesia. Both teeth were carefully and atraumatically extracted without raising a flap. Tooth #11 showed a root fracture (Fig. 5). Both cysts were metic- ulously removed, and the alveoli were extensively dis- infected with ozone therapy. Both fenestrations were clearly detectable. Before the surgery, five tubes of ve- nous blood were collected through venepuncture of the right median cubital vein. The blood tubes were used to prepare concentrated growth factors (A-PRF technique according to Choukroun8). All the tubes were used to pre- pare concentrated growth factor-rich membranes. Be- fore application, all the membranes were impregnated with metronidazole powder (40 mg/ml). After strictly fol- lowing the drilling protocol of the implant system (SDS Swiss Dental Solutions), an A-PRF membrane was plugged into the apical part of the prepared osteotomy to fill up the fenestration. Afterwards, the two selected im- plants (SDS1.1–4.6, 4.6 × 14.0 mm) were wrapped in the other previously prepared A-PRF membranes and were placed following the SDS protocol (Figs. 6a & b). High ini- tial stability was obtained for both implants. operatively nor postoperatively. The patient was asked to rinse twice per day with chlorhexidine (2 mg/ml) for a duration of 60 seconds for ten days. As for an anal- gesic, ibuprofen (600 mg, a maximum of four times per day) was prescribed. The patient was also instructed to take supporting vitamins D3 and K2 (15 µg and 75 µg, respectively, per day), starting one month before surgery until two months after surgery, to optimise bone qual- ity. Immediately after implant insertion, two provisional acrylic crowns were prepared and placed with tempo- rary cement. Both crowns were placed out of the occlu- sal plane, avoiding early loading of the freshly placed im- plants (Fig. 7). Further surgical interventions Owing to the apical disbalance in the soft-tissue level at both crowns, a small grafting procedure was per- formed two months after the implant insertion. A con- nective tissue graft was harvested from the tuberosity area in the third quadrant and placed with a tunnel pro- cedure. After the graft had healed completely two weeks later, an improved aesthetic result was obtained (Fig. 8). This surgery was combined with the procedure to re- move the neuralgia-inducing cavitational osteonecrosis at positions #28 and 38, according to the theory and procedures of Dr Johann Lechner.10 The cavities were afterwards filled with A-PRF plugs (Fig. 9). After an os- seointegration period of four months, the final prosthetic procedure was performed. First, the two abutments were intra-orally prepared with a diamond bur at high speed and with extensive cooling. The gingival margin was then adapted with a laser (Epic Pro, BIOLASE). Finally, a dig- ital impression with an intra-oral scanner (3Shape) was taken (Figs. 10a & b).11 Definitive prosthetic restoration and recalls No sutures were placed. Local injections with dexameth- asone (4 mg/ml) were performed to reduce postoperative swelling. No antibiotics were administered, neither pre- Two CAD/CAM crowns were fabricated in the dental lab- oratory. Both crowns were prepared from zirconia and 38 implants 1 2021

| case report Treating stable periodontitis patients with two-piece implants Drs Alaa Khutaba, Daniel Rotenberg & Hadar Zigdon-Giladi, Israel In patients who suffer from periodontitis, the treat- ment with dental implants can pose unique challenges for clinicians. In most cases, periodontal therapy needs to be carried out first, before implants can be installed successfully. In the following, two clinical cases are de- scribed in which tooth replacement with dental implants was carried out once the patients had successfully com- pleted preceding periodontal therapy. Case 1 Initial situation A 26-year-old female patient visited the Department of Periodontology at Rambam Health Care Campus. She was complaining about “advanced gum disease” and she expressed the fear of losing her teeth. She was healthy and a non-smoker. Periodontal examination re- vealed severe attachment loss in all quadrants, mobility of teeth, poor oral hygiene and insufficient restorations. Plaque and gingival indices were above 70%. The patient was diagnosed with generalised periodon- titis, stage IV, grade C, according to the 2017 workshop on the Classification of Periodontal and Peri-implant Diseases and Conditions (Fig. 1a). Pre-surgical treatment The first phase of periodontal therapy (cause-related therapy) involved a motivational interview as well as an explanation about the cause and progression of her peri- odontal disease. Thereafter, sub- and supragingival de- bridement was performed in all quadrants under local an- aesthesia and systemic antibiotics were prescribed. The hopeless teeth #11, 12, 21 and 22 were extracted and the extraction sockets were filled with an alloplastic material (bi-phasic calcium sulphate). A provisional bridge was in- stalled in the maxilla on #15 and 25. At the re-evaluation appointment six months after the first phase of therapy, the self-oral hygiene of the patient had improved with plaque and gingival indices below 15% (Fig. 1b). How- ever, deep periodontal pockets up to 10 mm remained especially in the posterior segments of the dentition. To further threat the periodontal disease, a second phase of therapy was planned, which involved the extraction of teeth #16, 26 and 28 owing to grade 3 furcation, and re- generative periodontal surgery (Fig. 1c). Repeated root surface debridement was performed for the single-rooted teeth with residual pockets of 5 mm. Six months after the periodontal surgeries, the case was re-evaluated. Intra-oral radiographs and a periodontal chart confirmed 1a 1b 1c 1d 1e 1f 1g 1h Fig. 1: Periodontal and prosthetic treatment of a patient with stabilised periodontitis, stage IV, grade C: baseline clinical findings (a), clinical situation six months after phase one periodontal therapy (b), periodontal regeneration of intra-bony defect (c), CBCT of the edentulous area (d), interdental space al- lowing placement of two implants (e), installation of bone-level titanium implant in the mesial position and two-piece zirconia tissue-level implant in the distal aspect (f), intra-oral radiographs immediately after implant placement (g), uneventful healing of the peri-implant soft tissue (h). 40 implants 1 2021

| case report Posterior single-tooth replacement using a two-piece tissue-level implant Dr Dan Hagi, Canada Diagnosis The patient, a 72-year-old male with well controlled hy- pertension, arthritis and an otherwise unremarkable medical history, presented with decay under the distal abutment of a long standing 4-unit fixed partial denture replacing teeth #15 and #16 (Fig. 1). Radiographic and clinical exams revealed an endodontically compromised #17, that was suspected to be vertically fractured. Also, tooth #18 was periodontally involved and unrestorable. The right maxillary sinus was pneumatised and the pa- tient did not wish to have any sinus augmentation. The abutment tooth #14 exhibited coronal leakage and frac- tured porcelain, but was vital. Treatment plan As the patient wanted a fixed restoration, the only op- tion was an implant-supported restoration. He desired to be completely metal-free as teeth were replaced on the contralateral side with one-piece ceramic implants four years prior. A decision was made to place an implant at tooth #15 and make it a molar size, thus avoiding sinus involvement and giving the patient a first molar occlu- sion. The possibility of the use of a zirconia two-piece dental implant (PURE, Institut Straumann) was discussed and the alternative titanium implant option was also re- viewed. The replacement of the restoration on tooth #14 was also planned. Temporisation initially was to be with a cantilevered restoration from the sectioned bridge. Af- ter healing, a fixed provisional was to be made on the im- plant. The final treatment would involve the sectioning of the fixed bridge, extraction of tooth #17 and placement of the two-piece ceramic implant and healing abutment. After a period of three months and the rigid fixation of the Fig. 1: Preoperative radiograph. Fig. 2: Insertion of the two-piece implant. Fig. 3: Postoperative radiograph: implant is in final position. No violation of the maxillary sinus and placement of the implant at the correct vertical posi- tion. Fig. 4: Healed implant with healing abutment. Fig. 5: Soft tissue imme- diately surrounding the implant. Fig. 6: Scanbody in place. Fig. 7: Soft-tissue health after three months of healing. Fig. 8: Preparation of temporary abut- ment. Fig. 9: Provisional restoration. Fig. 10: Intra-oral scan STL files, lateral view. Fig. 11: Final restoration day of insertion. 1 2 3 4 5 6 7 8 9 10 11 42 implants 1 2021

Straumann Natural ceramic—proven quality PURE ceramic implants have an ivory colour that resembles nat- ural tooth roots. This gives the most natural look even in thin gin- giva biotypes. ZLA, the surface of the PURE ceramic implant, is characterised by macro- and micro-roughness which is similar to the original Straumann SLA surface. In several studies, the ZLA surface has also demonstrated similar healing patterns, healing times and osseointegration qualities with regards to peri-implant bone density and bone-to-implant contact (BIC). In addition, the zirconia-based ZLA surface of PURE implants shows a favourable formation of the epithelial attachment, as well as signifi cant lower bacterial accumulation compared to titanium-based SLA surfaces. Compared to titanium implants, a higher degree of soft-tissue integration around the PURE ceramic implant was observed in scientifi c studies. By placing the Straumann PURE ceramic im- plant system, excellent aesthetic outcomes with favourable soft- tissue attachment and papilla formation around the implant can be achieved. Institut Straumann AG Switzerland +41 61 9651111 www.straumann.com Dentalpoint Zeramex Digital Solutions expanded Zeramex Digital Solutions expanded Zeramex is pleased to introduce another ground-breaking Zeramex is pleased to introduce another ground-breaking innovation to implant dentists: new custom gingiva formers innovation to implant dentists: new custom gingiva formers made of zirconium oxide as well as three-unit monolithic made of zirconium oxide as well as three-unit monolithic bridges are now available and can be ordered via Zeramex bridges are now available and can be ordered via Zeramex Digital Solutions. These brand new metal-free products offer Digital Solutions. These brand new metal-free products offer new levels of customisation and flexibility when it comes to the new levels of customisation and flexibility when it comes to the prosthetic treatment options of Zeramex XT implants. Accord- prosthetic treatment options of Zeramex XT implants. Accord- ing to Dentalpoint CEO Adrian Hunn, Zeramex has achieved an- ing to Dentalpoint CEO Adrian Hunn, Zeramex has achieved an- other milestone with this. “Digitalisation and the use of ceramics other milestone with this. “Digitalisation and the use of ceramics are currently the key trends in implantology. With Zeramex, we are currently the key trends in implantology. With Zeramex, we aim to play a leading role in both trends and our expansion of the aim to play a leading role in both trends and our expansion of the Zeramex Digital Solutions product portfolio with ceramic custom- Zeramex Digital Solutions product portfolio with ceramic custom- ised gingiva formers and monolithic bridges has brought us a sig- ised gingiva formers and monolithic bridges has brought us a sig- nificant step closer to this goal.” Along with the R&D department at Zeramex, collaboration with external laboratories has played a central role in the development of Zeramex Digital Solutions. In ad- dition to the production of custom restoration options, the digital workflow from Zeramex offers clinicians a service for processing digital data or for finishing restorations. Dentalpoint AG Switzerland +41 44 3883636 digitalsolutions@zeramex.com digitalsolutions@zeramex.com 44 implants 1 2021

TAV Dental Innovation for a healthier world TAV Dental is focused on developing and manufacturing zirconia dental products using the advanced ceramic injection technology with a vision to redefi ne the quality of zirconia dental products and its performances and to make these premium implants common worldwide. We offer a variety of solutions in the fi eld of dental implants under one roof. The passion behind developing zirco- nia products for dental implantology is to provide patients with products that are much healthier for their bodies along with the advantage of uncompromising aesthetic results. The white colour of zirconia ceramic implants, its biocompatibility and low affi nity of plaque, along with its high mechanical properties and osse- ointegration, make it a material of choice. TAV Dental offers the one-piece zirconia implant with integrated abutment and the two-piece confi guration with slot connection geometry, which optimises the force transfer ap- plied on the implant connection during insertion and, as a result, simplifi es implant placement. TAV Dental Israel +972 4 9808615-503 www.tavdental.com SDS Swiss Dental Solutions Zircon Medical The “healthy implant”: Ideal biointegration with A supportive therapy concept Patent™ Soft Tissue Level Ceramic implants of the worldwide market leader SDS Swiss Den- tal Solutions are made of high-purity zirconium dioxide without the addition of metal oxides or other factors that would influence its colour. This material is therefore considered immunologically neutral. Prof. Hendrik Terheyden describes zirconia ceramics as a completely inert, sufficiently reacted material. No immune re- actions are to be expected with zirconia, since the material does not lead to the deposition of corrosion products. Furthermore, the crucial role of bone metabolism is widely underestimated: without sufficient supplementation of micronutrients such as vitamins D3, K2 (Subtype MK-7), C as well as magnesium citrate, the storage of calcium in the bone will not succeed sufficiently. Without these nu- trients, the osteoblasts will not synthesise osteocalcin. SDS Swiss Dental Solutions is the only ceramic implant manufacturer that, in combination with SWISS BIOHEALTH, offers a supportive therapy concept as well as a comprehensive offering of high-quality mi- cronutrients. SDS Swiss Dental Solutions Switzerland +41 71 5563670 info@swissdentalsolutions.com Implants Biointegration is critical to the suc- Biointegration is critical to the suc- cess and longevity of an implant. cess and longevity of an implant. Optimal healing between the Optimal healing between the soft tissue, the bone and the soft tissue, the bone and the implant significantly reduces implant significantly reduces the risk of perimucositis and the risk of perimucositis and peri- implantitis. With its unique peri- implantitis. With its unique Patent™ Soft Tissue Level Im- Patent™ Soft Tissue Level Im- plant, Swiss-based dental im- plant, Swiss-based dental im- plant manufacturing company plant manufacturing company Zircon Medical offers a system Zircon Medical offers a system that consists of only two com- that consists of only two com- ponents — a tooth-coloured ce- ponents — a tooth-coloured ce- ramic implant with integrated abut- ramic implant with integrated abut- ment and a high-tech glass fibre ment and a high-tech glass fibre post. The cemented connection be- post. The cemented connection be- tween the implant and the glass fibre tween the implant and the glass fibre post is located above the soft tissue and post is located above the soft tissue and is completely sealed by the dental crown. is completely sealed by the dental crown. This hermetically sealed connection mi- This hermetically sealed connection mi- nimises the risk for micromovements as nimises the risk for micromovements as well as infections and therefore facili- well as infections and therefore facili- tates a durable, reliable biointegration of tates a durable, reliable biointegration of the Patent™ Soft Tissue Level Implants. the Patent™ Soft Tissue Level Implants. To learn more, go to www.mypatent.com. To learn more, go to www.mypatent.com. Zircon Medical Management AG Zircon Medical Management AG Switzerland +41 44 552454 www.zircon-medical.com 46 implants 1 2021

| manufacturer news TBR Dental Implantology 2.0: Z1® tissue-level implant & Index digital workfl ow The worldwide unique Z1 implant, combining a titanium body and The worldwide unique Z1 implant, combining a titanium body and a zirconia collar, offers many advantages, including the benefit a zirconia collar, offers many advantages, including the benefit of being a tissue-level implant that requires only one surgical of being a tissue-level implant that requires only one surgical procedure. The zirconia collar promotes soft-tissue healing and pro- procedure. The zirconia collar promotes soft-tissue healing and pro- vides optimal aesthetic results for the patient. With the launch of its vides optimal aesthetic results for the patient. With the launch of its new range Index, TBR is now offering clinicians a complete digital new range Index, TBR is now offering clinicians a complete digital workflow: from the scanning phase, with intra-oral workflow: from the scanning phase, with intra-oral scanners and CBCT, to the milling phase, with scanners and CBCT, to the milling phase, with machines adapted to your needs including machines adapted to your needs including suitable CAD/CAM software, associated ma- suitable CAD/CAM software, associated ma- terials and consumables. The virtuous combi- terials and consumables. The virtuous combi- nation of implantology with Z1 implants and nation of implantology with Z1 implants and Index digital workflow ensures optimal ergo- Index digital workflow ensures optimal ergo- nomics and allows time saving, which nomics and allows time saving, which is essential in the daily dental practice. is essential in the daily dental practice. Combine aesthetics and digital design with Z1 implants and TBR CAD/CAM Index dental solutions. TBR Dental Group France +33 5 62167100 contact@tbr.dental Z-SYSTEMS Z-SYSTEMS Ceramic Implants—100% Ceramic, 100% Swiss Ceramic implants have been at the cutting-edge of dental implant technology for over a decade, and are becoming increasingly popular with patients and practitioners worldwide. As a market leader, Z-SYSTEMS has taken another leap forward with its in- novative Z5-BL (Bone Level) and soon-to-be-released Z5-TL novative Z5-BL (Bone Level) and soon-to-be-released Z5-TL (Tissue Level): the world’s fi rst two- (Tissue Level): the world’s fi rst two- part, screw-retained implants made part, screw-retained implants made entirely of ceramic. For the fi rst time, entirely of ceramic. For the fi rst time, completely submerged healing is now completely submerged healing is now also possible with ceramic implants. also possible with ceramic implants. The Z5-BL’s advantages are The Z5-BL’s advantages are evident in its beautiful bone level evident in its beautiful bone level design and a unique variety of abutments. A high-precision, ex- tremely stable conical connection between the abutment and the implant makes it possible to use this material even for the occlusal screw. Many practitioners also like to work with tissue level im- plants—especially in biological dentistry. In recognising these plants—especially in biological dentistry. In recognising these clinical demands, Z-SYSTEMS is rapidly following the release clinical demands, Z-SYSTEMS is rapidly following the release of the Z5-BL with an equally-revolutionary Z5-TL. These lat- of the Z5-BL with an equally-revolutionary Z5-TL. est releases build on the proven platform of Z- SYSTEMS heri- est releases build on the proven platform of Z- SYSTEMS tage line: the Z5m, Z5m(t) and Z5c. Each Z-SYSTEMS product tage line: the Z5m, Z5m(t) and Z5c. Each Z-SYSTEMS product features the technology’s unique, patented laser surface for features the technology’s unique, patented laser surface for outstanding osseointegration. The company’s proprietary manufacturing process has produced a top-quality implant family renowned for its great durability. In addition to fi xed restorations, removable locator-like abutments are also possible on all two-piece Z-SYSTEMS implants. Available lengths are 8, 10 and 12 mm and diameters are 3.6, 4.0 and 5.0 mm. Z-SYSTEMS Ceramic Implants Switzerland contact@zsystems.com (for USA/Americans & UK/MEA) support@zsystems.com (for EU costumers) www.zsystems.com 48 implants 1 2021

| interview A revolution in dental implantology A revolution in dental implantology With INPERIO, the Spain-based manufacturing com- With INPERIO, the Spain-based manufacturing com- pany Nanoker Research is entering the ceramic pany Nanoker Research is entering the ceramic implant market with the goal of revolutionising implant market with the goal of revolutionising dental implantology. In order to achieve this, the dental implantology. In order to achieve this, the company utilises two specific materials: a bio- company utilises two specific materials: a bio- ceramic composite on the one hand and a specific ceramic composite on the one hand and a specific bacteriostatic bioglass coating on the other. In this in- bacteriostatic bioglass coating on the other. In this in- terview with ceramic implants, Lidia M. Goyos Ball, terview with ceramic implants, Lidia M. Goyos Ball, medical devices division manager at Nanoker, talks medical devices division manager at Nanoker, talks about the advantages of the company’s novel sys- about the advantages of the company’s novel sys- tem. tem. First of all, what type of implant is INPERIO? INPERIO is an all-ceramic monobloc dental INPERIO is an all-ceramic monobloc dental implant made of our outstanding bioceramic com- implant made of our outstanding bioceramic com- posite. Only the inner screws (prosthetic or accessory posite. Only the inner screws (prosthetic or accessory screws), which do not come into direct contact with the screws), which do not come into direct contact with the body or bodily fluids during their expected use, are me- body or bodily fluids during their expected use, are me- tallic (Ti-6Al-4V ELI, Grade 23). tallic (Ti-6Al-4V ELI, Grade 23). implants made implants made For INPERIO, you utilise bioceramic composite For INPERIO, you utilise bioceramic composite and a bacteriostatic bioglass coating. What is so and a bacteriostatic bioglass coating. What is so special about these materials? from Ti-6Al-4V currently Titanium Titanium from Ti-6Al-4V currently make up 86.2% of all implants. Although mechanically make up 86.2% of all implants. Although mechanically reliable, they present various drawbacks, such as poor reliable, they present various drawbacks, such as poor aesthetics, allergies, peri-implantitis and the release aesthetics, allergies, peri-implantitis and the release of complex metal alloy particles. Our bioceramic com- of complex metal alloy particles. Our bioceramic com- posite combines ceria-stabilised zirconia and alumina posite combines ceria-stabilised zirconia and alumina (Ce-TZP/Al) and is aesthetic by nature. This material’s (Ce-TZP/Al) and is aesthetic by nature. This material’s fracture toughness is superior to that of other ceramic fracture toughness is superior to that of other ceramic materials owing to its intrinsic reinforcement mech- materials owing to its intrinsic reinforcement mech- anism, associated with its phase transformation, called anism, associated with its phase transformation, called transformation toughening or stress-induced martensitic transformation toughening or stress-induced martensitic transformation. Also, this ceramic does not suffer from transformation. Also, this ceramic does not suffer from hydrothermal phase transformation or ageing, which hydrothermal phase transformation or ageing, which affects conventional yttria-stabilised zirconia (3Y-TZP). affects conventional yttria-stabilised zirconia (3Y-TZP). Moreover, Ce-TZP/Al exhibits some plastic deforma- Moreover, Ce-TZP/Al exhibits some plastic deforma- tion (ceramic ductility), a key feature in modern implant tion (ceramic ductility), a key feature in modern implant design. Beyond the well-proven preventive adhesion design. Beyond the well-proven preventive adhesion properties of our composite, which leads to enhanced properties of our composite, which leads to enhanced soft-tissue attachment, our INPERIO system will soft-tissue attachment, our INPERIO system will incorporate a glassy coating on the transgingival incorporate a glassy coating on the transgingival abutment in the near future, once the regulatory cer- abutment in the near future, once the regulatory cer- tification process of our bacteriostatic bioglass is com- tification process of our bacteriostatic bioglass is com- plete. This material acts as a biological seal, prevents the accumulation of bacterial plaque and guaran- tees preservation of bone, which is the main cause of long-term failure of conventional implants. It has been proved to prevent bacterial dysbiosis in the peri- implant sulcus in comparison with both titanium and 3Y-TZP. 50 implants 1 2021 What are INPERIO’s properties regarding loading What are INPERIO’s properties regarding loading and biocompatibility? and biocompatibility? INPERIO is the first ceramic solution that mechani- INPERIO is the first ceramic solution that mechani- cally qualifies for implant insertion torque values up cally qualifies for implant insertion torque values up to 50 Ncm and screw-retained prosthetic solutions to 50 Ncm and screw-retained prosthetic solutions based on a ceramic multi-unit abutment termination, based on a ceramic multi-unit abutment termination, whereas other ceramic systems recommend not ex- whereas other ceramic systems recommend not ex- ceeding 35 Ncm, which does not allow immediate load- ceeding 35 Ncm, which does not allow immediate load- ing. Clinically speaking, INPERIO is suitable for immediate ing. Clinically speaking, INPERIO is suitable for immediate loading protocols and direct screwing to the implant with loading protocols and direct screwing to the implant with primary stability, even in extremely compromised cases. primary stability, even in extremely compromised cases. In terms of biocompatibility, INPERIO has similar success In terms of biocompatibility, INPERIO has similar success rates to titanium implants (> 95%). Owing to its optimum rates to titanium implants (> 95%). Owing to its optimum surface roughness (Sa = 1.4 µm), there is no need to per- form additional aggressive surface treatments to favour osseointegration. In fact, histological studies show that the degree of osseointegration in terms of bone–implant contact is similar to that of titanium implants. In addition, INPERIO’s bioceramic composite (being a ceramic ma- terial) resists corrosion and wear and has high chem- ical stability. Its biocompatibility and enhanced soft- tissue attachment (anatomical emergence profile) are

| interview A new concept in ceramic implantology The team behind Polish ceramic implant system OriCera is convinced that a new era in dental implant- ology will be dominated by metal-free products and that its implant will soon become the most advanced ceramic implant in the world and will contribute to improving the health and quality of life of patients worldwide. In this interview with ceramic implants, Chief Science Officer at OriCera Dr Jarosław Pospiech explains the rationale behind this ambitious view. I met What’s the back story of OriCera? Several years ago, two engineers—Adam Zdybel, a specialist in nanomaterials, and Przemysław Grycza, a specialist in materials processing—with the requisite knowledge and production facilities who were both enthusiastic about the production and marketing of modern dental implants. OriCera initially had a different name and was intended to create a state-of- the-art titanium implant with a reduced osseointegra- tion period. However, Adam introduced us to the cur- rent knowledge on ceramic materials and showed us scientific reports by authors like Curd Bollen, Johann Lechner and Sammy Noumbissi, and we unanimously concluded that ceramics are the future of dental im- plantology. The clinical and biological reasons for this are obvious. Zirconia ceramics especially have excellent biological and physical properties, such as resilience to bending and abrasion. It is an interesting but also a demanding material for the production of implants. The existing ceramic implant systems try to copy titanium solutions, which we believe is not the best approach. Where do you see the biggest problems with ceramic implants? I believe the biggest problem is the insecure connec- tion between the prosthetic component and the implant. In two-piece ceramic implants, many manufactur- ers use screw connections between the implant and abutment which are usually made of metals or comp- osites. From a technical stance, mechanical connections of elements of different physical parameters, such as hardness, are debatable owing to differing abrasion of the materials over time. There is currently not enough clinical data to conclude that these solutions are really safe. Recently, ceramic screws have been used for con- nection. However, we also do not have long-term data to prove the effectiveness of this approach. Research has exposed the structure’s greatest weakness: the 52 implants 1 2021 connection between screw, abutment and implant. The accumulation of stress in these places leads to micro- cracks and, ultimately, implant fracture. In mechanics, screws are usually used for connecting materials with similar strength parameters and with a certain degree of plasticity, like metals or plastics. Ceramics are by nature hard structures with negligible plasticity. After an in- depth market analysis, we decided to develop a screwless, detachable connection without the use of glue or cement. This allows for the removal, placement and eventual replacement of the prosthetic work at any time. The process of removing the crown does not subject the implant to damage by exposure and the formation of areas that initiate rupture. The dentist won’t need to invest in expensive equipment, as placing and removing the crown is rather simple. Digital tech- niques will allow the production of a strength-optimised, stable prosthetic work. Also, in most clinical situations the use of an abutment won’t be necessary. In addition, our connection is aesthetically improved. Apart from the screwless connection that works without the use of glue or cement, are there any other improvements introduced by OriCera? Our goal is also to reduce osseointegration time. Quick prosthetic restoration is important for patients when planning therapy. Based on my long-term clinical obser- vations on the osseointegration of titanium implants, I am convinced that this is possible with ceramic implants too. The surface of the implant body is obviously very important. In this regard, we have achieved a certain gold standard applied successfully in various implant systems. A micro-rough surface design helps to achieve quicker and more successful osseointegration. I believe that we still do not utilise bone to its full regenerative potential. I would also argue that the surgical technique and to some extent the macro-design of the implant, which we have improved in our project, are decisive in this context. When talking about surface porosity, we also have to talk about peri-implantitis. Research in dicates that there is much less inflammation around ceramic titanium systems. Preliminary clinical reports of spontaneous bone regen- eration after cleaning and decontamination procedures around ceramic implants are also interesting. With this in mind, OriCera offers a novel modification of the implant’s cervical part that increases its effectiveness and sim plifies the treatment of the complications mentioned earlier. than around implants

| news ESCI survey on Ceramic dental implants Ceramic implants are establishing themselves in mod- ern implant dentistry as a viable treatment alternative to titanium implants. Owing to their biological advantages, there is an increasing interest in this material both from practitioners and health-conscious patients. Promising short- and medium-term data on the successful use of ceramic implants is already available. However, the topic is still controversially discussed, in part because long-term data is still lacking. Above all, there is a lack of comprehensive knowledge about the use of ceramic implants in the daily clinical practice. Participate now! With a Europe-wide survey, the European Society for Ceramic Implantology (ESCI) aims to provide answers to relevant questions re- garding the handling of ceramic implants in the daily clinical practice and to push forward developments toward a safer and more reli- able use of ceramic implants in patients worldwide. The ESCI further aims to provide an understanding of market developments, assess the readiness for use of ceramic implants, identify and address possible resentments to- wards ceramic implants, evaluate future prospects with regards to distribution, and analyse existing problems in terms of the integration of ceramic implants into practice workflows. The questionnaire was designed by the ESCI Scientific Advisory Board in cooperation with a number of 54 implants 1 2021 renowned partners including Deutsche Gesellschaft für Orale Implantologie (DGOI), Österreichische Gesellschaft für Implantologie (ÖGI), Institut Straumann AG, CAMLOG Biotechnologies AG, Nobel Biocare AG, Dentalpoint AG, Z-Systems AG, COHO Biomedical Technology and Dental Campus Association. The survey results will be scientifically evaluated by the ESCI and published in ap- propriate journals. The ESCI does not pursue commercial goals with this survey and it guarantees to evaluate the results independently and neutrally. No per- sonal data will be collected and the answers will be processed in an anonymous fashion. The survey is targeted at dentists, oral and maxillofacial surgeons with and without ex- perience in ceramic implantology, as well as dental technicians. Participate in today the survey via www.esci-online.com and contribute to a better under- standing of ceramic implants. The survey will only take 5–10 minutes to complete. Alternatively, you can scan the QR code for instant access from mobile devices. Please note that you can switch between English and German. For further information, contact info@esci-online.com. The ESCI is looking forward to your participation! Source: ESCI

| news Capitalising on digitisation with the right strategy Digitisation can bring dental technicians and dentists closer together. How best to exploit these new opportuni- ties in an interdisciplinary team is the topic of Amann Girr- bach’s AG.Live CON virtual congress, which will be held from 20 to 24 April. The event will kick off with a top-class panel discussion in which independent experts such as Prof. Daniel Edelhoff, Prof. Florian Beuer and Prof. An- dreas Moritz discuss the issues governing current patient care: What is the significance of digitisation for dentistry? Is it possible to sustainably narrow the communication gap between dentists and dental technicians and unite both parties in a common, efficient treatment approach? Will all dentists in future be required to offer direct res- torations? The individual problems and approaches to solutions will be dealt with in greater depth covering a wide-ranging programme of specialist presentations from internal and external experts. But theory is only part of the equation. As part of the event, Amann Girr - bach will present numerous new product developments during a virtual expo, including the AG.Live platform, which networks dentists and dental laboratories and thus enables effortless interdisciplinary teamwork. This net- working also supports cooperation in direct restoration, which is increasingly being demanded by patients for un- complicated restorations. Using AG.Live, the dentist can always consult the dental technician, as his/her exper- tise remains indispensable for high-quality restorations. With the new intra-oral scanner and the AG.Live platform, Amann Girrbach offers dentists an easy introduction to direct restorations and enables same-day dentistry in laboratory quality. Dental technicians and dentists can register free of charge for the digital congress at show. aglivecon.digital. In addition, the site provides further in- formation on the congress programme with its numerous presentations. The virtual expo offers the opportunity of making direct contact with Amann Girrbach’s specialists. Source: Amann Girrbach 56 implants 1 2021

| about the publisher Congresses, courses and symposia Imprint Publisher Torsten R. Oemus oemus@oemus-media.de Art Director Alexander Jahn a.jahn@oemus-media.de CEO Ingolf Döbbecke doebbecke@oemus-media.de Designer Laura Wajsprych l.wajsprych@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 www.oemus.com Members of the Board Jürgen Isbaner isbaner@oemus-media.de Lutz V. Hiller hiller@oemus-media.de Editorial Council Dr Michael Gahlert (Germany) Dr Sofi a Karapataki (Greece) Dr Franz-Jochen Mellinghoff (Germany) Editorial Manager Georg Isbaner g.isbaner@oemus-media.de Editorial Offi ce 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 10th IAOCI World Congress 19–21 August 2021 Las Vegas, NV, USA www.iaoci.com/iaoci2021 2nd EACim Congress 24 & 25 September 2021 Brussels, Belgium www.eacim-ceramic-implantology.com Copyright Regulations ceramic implants international magazine of ceramic implant technology is issued twice per year and is a special edition of implants international magazine of oral implantology — the fi rst issue was published in October 2017. 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 res- ponsibility 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 labelled items shall not be borne by the editorial department. Likewise, no responsibility shall be assumed for in- formation 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 58 implants 1 2021

F E E L F R E E T O S M IL E www.tavdental.com