issn 1868-3207 Sondernummer • Vol. 5 • Issue 2/2021 2/21 ceramic implants international magazine of ceramic implant technology research Room for improvement case report Restoring aesthetics in the mandible events First JCCI held with great success

editorial | Georg Isbaner Managing editor Recognition of two-piece systems The past months have been game-changing for ceramic implantology. For one, manufacturers of two-piece ceramic implant systems are able to refer to new and reliable scientific long-term data. Besides the already known favourable soft-tissue reaction, the data indicates superior osseointegration compared to titanium systems. We are proud to have been able to exclusively interview Dr Roland Glauser, Switzerland, during the 2021 International Dental Show. Dr Glauser elaborates on the study design and the most import- ant findings of the longitudinal study he conducted together with Dr Peter Schüpbach, Switzerland. On top of that, he provides insightful photo material (pages 42 and 43). Modern one-piece ceramic systems have been a tried and tested option in implant therapy for a long time. “However, based on scientific statements and recom- mendations of professional associations, two-piece ceramic implants are still often denied this recognition with the argument that there is a lack of scientific ev- idence and consequently a lack of medical necessity for this type of implant”, it reads in a statement of the European Society for Ceramic Implantology (ESCI), which will exclusively be pre-published here in full (pages 54 and 55). In accordance with their role as a scientific and unbiased expert society and after scrutinising all hitherto available empirical data, the ESCI adopted a consensus paper concluding that the use of two-piece ceramic systems is deemed safe based on scientific evidence and that these systems may now be regarded as a suitable clinical option for implant therapy. Contributing to the two above-mentioned theoretical aspects, one must mention that the reality in dental clinics and continuing education is further along. There is plenty of proof in the present ceramic implants— international magazine of ceramic implant technology. Several research articles, case reports, reviews of recent ceramic implantology events and previews of those that will take place in the near future testify of an extraordinarily active community. That is why the website ceramic-implants.info has been founded a few months ago and a matching LinkedIn-community has been established. In this way we stay abreast of the eclectic need for information of our readers and users. Stay up to date with us and follow us on LinkedIn and be sure not to miss anything. Enjoy your read. Georg Managing editor implants 2 2021 03

Soft tissue augmentation NovoMatrix™ Reconstructive Tissue Matrix – the next generation material NovoMatrix™ Reconstructive Tissue Matrix is an acellular dermal matrix derived from porcine tissue intended for soft tissue applications. The proprietary LifeCell™ tissue processing is designed to maintain the biomechanical integrity of the tissue, which is critical to support tissue regeneration. Indications Localized gingival augmentation to increase keratinized tissue (KT) around teeth and implants Alveolar ridge reconstruction for prosthetic treatment Guided tissue regeneration procedures in recession defects for root coverage Product features Consistent thickness (1 mm) Pre-hydrated Controlled source www.biohorizonscamlog.com Before use, physicians should review all risk information, which can be found in the Instructions for Use attached to the packaging of each NovoMatix™ Not all products are available in all countries. Bone tissue augmentation MinerOss™ A The allograft for outstandingly fast bone remodeling [1] own bone compared to other bone substitutes. [2] Optimal osteoconductivity Fast graft incorporation Complete remodeling potential www.biohorizonscamlog.com [1] Wen et al. J. Periodont. 2019, 1, 734. [2] Schmitt et al. Clin Oral Implants Res. 2013, 24, 576. [3] Kloss et al. Clin Oral Implants Res. 2018, 29, 1163. [4] Solakoglu et al. Clin Implant Dent Relat Res. 2019, 21, 1002-1016. [5] Kloss et al. Clin Case Rep. 2020, 8, 5. References available at: www.biohorizonscamlog.com/references_minerossa ®®

research | fied as hazardous by the U.S. Environmental Protection Agency. Four of the ceramic implant systems examined had a moderately rough implant surface. Only one ceramic implant system showed minimal surface roughness. Clinical studies were documented for three ceramic implant de- signs, and these had a follow-up period of up to three years and results ranging from 82.5 to 100% survival. The two other implant systems did not provide properly conducted clinical records. The results of this study demonstrate that it is techni- cally possible to fabricate largely residue-free zirconia implants. However, the large number of significant con- taminants found in this analysis is a cause for concern, as every factory-related contamination may provoke unwanted adverse biological effects. It is worth noting that all systems evaluated in this study had CE mark- ings or had received U.S. Food and Drug Administration marketing clearance. According to the authors, practi- tioners should always assume that foreign substances and contaminants can lead to undesirable biological effects—unless they have been proved harmless and not an impediment to the process of osseointegration. This precautionary principle should always be the guiding prin- ciple for any medical treatment, the authors concluded. Editorial note: The article, “Quality assessment of five randomly chosen ceramic oral implant systems: Cleanliness, surface topography, and clinical doc- umentation”, referred to in the text is in press. Printed versions of the publication can be requested at publi cation@cleanimplant.org. 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 Author details Dr Dirk U. Duddeck +49 30 200030190 duddeck@cleanimplant.org www.cleanimplant.org AD Identification of jawbone cavities ✔ Helps detoxify the jawbone ✔ Preoperative assurance of the implant result ✔ Reveals focal areas of inflammation around implants Register & Order: SHOP.CAVITAU.DE CaviTAU® Call: +49 89 244 15 44 60 office@cavitau.de www.cavitau.de

research | usually ideal. However, in the upper jaw, the bone is nat- urally less dense. The dentist often only notices whether an implant will stay in place here when drilling or when cutting the thread for the implant into the bone, and even this impression can be deceptive: “There is no re- liable method for predicting the success of dental im- plant insertion before the dental procedure,” according to Prof. Robert Sader from the clinic for oral and facial plas- tic surgery at the Frankfurt university hospital in Germany. One solution is determining the density of the bone using ultrasound. This is because the propagation of ultrasonic waves in bone tissue depends on its density: the more stable the bone, the faster the waves move through it. Scientists at Johannes Gutenberg University Mainz have now investigated for the first time whether the method also allows conclusions to be drawn on the condition of the jawbone. Prof. Bilal AI-Nawas from the clinic for oral and maxillofacial surgery has investigated ultrasonic transmission velocity (UTV) in the lower jaw and pelvic bone of pigs. The results indicate that UTV is an accurate measurement of the level of mineralisation: bone sections with a critical bone density that would prohibit implant insertion were detected by the method in 75% of cases. Thus, determining the quality of the bone in the jaw with the help of ultrasound may even be more effective than radiography.9 Torque and UTV were used to assess the bone implant sites in these studies.10 UTV can be used to analyse the mechanical properties of the teeth after in vitro, in situ and in vivo loading.11 Is there an intra-oral technique to measure bone density? The fundamental suitability of ultrasound for determining bone density and thus the length of time implants are in place has already been scientifically validated.9–11 With ultrasonic devices, dentists can check jawbone quality to predict the success of dental implant insertion. The innovative CaviTAU® is a suitable ultrasonic device for transferring the mentioned findings into routine daily practice: CaviTAU® therefore offers application-oriented reliability for dental implantologists and prevents pre- mature implant loss.12 What is CaviTAU®? 2 Fig. 2: Example of an inconspicuous radiographic image in area #38 (red circle). In contrast, measurement of bone density in area #38 compared with healthy tooth #37 (top left) with ultrasound shows conspicuous red areas in 2D and 3D representation (right). of the measuring unit to be placed inside the patient’s mouth, the acoustic coupling between those parts and the alveolar ridge is performed with the aid of a semi- solid gel. The contact between the jawbone and both the extra-oral ultrasonic transmitter and intra-oral ultrasonic receiver (Fig. 1, left) is optimised and individualised using a special ultrasonic gel cushion that was developed for this purpose. The results are shown on a colour mon- itor that displays different colours depending on the degree of attenuation. Thanks to the latest computerised miniaturisation of the measuring units, CaviTAU® now of- fers a wide range of applications. The CaviTAU® display is able to capture the following physical structures in the dentoalveolar region, with the corresponding colour variations of 91 colour columns per cm2: (a) solid bone in the marginal cortical area (green or white/light blue); (b) healthy medullary cancellous bone (green or white/light blue); (c) chronic inflammatory medullary cancellous bone with fatty degenerative components (red or black/dark blue); (d) fatty nerve structures (yellow/light blue); and (e) extremely dense and complex structures such as teeth, implants and crowns (green or white/light blue; Fig. 2). How to forecast the success of dental implants CaviTAU® generates an ultrasonic wave and passes that wave through the jawbone. This wave is produced by an extra-oral transmitter and then detected and mea- sured by a receiving unit that is positioned intra-orally. Both parts (i.e. the sender and receiving unit) are fixed in a parallel position using a single handpiece. The size of the CaviTAU® receiving unit is configured such that it may be easily placed inside the mouth of a patient. CaviTAU® uses 91 piezoelectric elements that are arranged hex- agonally. The jawbone must be positioned between the two parts of the measuring unit. With respect to the parts The measurement of the quantitative ultrasonic trans- mission rate (UTV) has been established as an innova- tive, objective, valid and reliable method for repeated, non-invasive measurements of bone quality before den- tal implantation.9–12 The use of a small UTV device in this study enabled the recording of intra-oral UTV values in a large and heterogeneous patient population.12 As- sessment of alveolar ridge UTV could provide a method for identifying critical bone quality before implant inser- tion or for monitoring bone healing (mineralisation) after implants 2 2021 09

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case report | 8 9 10 Fig. 8: Implant in final position. Fig. 9: Implant in final position, lateral view. Fig. 10: Suturing of the graft site. ical stability of ceramic implants, particularly in the molar region with high masticatory forces. This clinical case report shows the 4-year follow-up of a Straumann® PURE ceramic implant placed to restore the first molar in the mandible. PURE Monotype Ceramic Implant with full-ceramic crown would, in this clinical case, provide a metal-free, aesthetic and mechanically strong restorative solution. Initial situation A 32-year-old patient with a history of metal allergy and a heightened allergic status (increased IgE levels), without parafunctional habits, presented at the clinic for the replace- ment of missing tooth #36. The tooth had been removed more than five years ago and the patient had avoided res- torations due to concerns about metal allergy. The patient wanted to have a metal-free restoration with a highly aes- thetic outcome. The patient was also concerned about the functionality and mechanical strength of the restoration. Treatment planning During the clinical examination and the analysis of the radio- graphic image in the area of the extracted tooth, a combi- nation of horizontal bone atrophy and a thin gingiva biotype were determined at the planned implant site (Figs. 1–3). The vertical bone dimension allowed the placement of an implant with 4.1 mm in diameter and 10 mm in length. Given the patient’s medical history, high aesthetic expectations and the thin gingiva biotype, it was decided to place the Straumann® PURE monotype ceramic implant. To opti- mise the soft-tissue volume, soft-tissue augmentation with a direct temporary crown was planned. The Straumann® 11 12 Fig. 11: Soft tissue graft. Fig. 12: Fixation of the soft tissue graft. Surgical procedure Under local anaesthesia, a marginal incision to reflect a muco- periosteal flap was made at the intervention site (Fig. 4). The basic and fine implant bed preparation was done according to the Straumann® PURE Monotype surgical protocol. Since the implant is a one-piece monotype, the position indicator was carefully used to ensure the correct final position of the implant (Fig. 5a). A depth gauge was used to calculate the implant immersion depth (Fig. 5b). The use of a profile drill during the fine implant bed preparation avoided excessive compression of the cortical bone and facilitated the inser- tion torque of 35 Ncm (Figs. 6 & 7). To create an optimal soft tissue volume and attachment, the implant was placed 1.8 mm above the edge of the alveolar bone (Figs. 8 & 9). 13 14 Fig. 13: Provisional coping. Fig. 14: Checking the fit of the provisional coping. implants 2 2021 13

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case report | 4 8 5 6 7 9 10 11 Fig. 4: Placement of two SDS ceramic sinus implants after external lift in regions #15 and 16. Implant #16, placed immediately, did not achieve sufficient primary stability in this case. Figs. 5 & 6: Fixation of a single-unit cage from the BISS using cortical screws in the surrounding bone to provide secondary stabilisation of implant #16, which was placed immediately and did not achieve primary stability, as a tent pole. Placement of a Khoury bone plate on the distal cage arm. Figs. 7 & 8: Allogeneic bone substitute material and autologous bone chips fill the space created. The volume should ideally be slightly over-modelled to allow for physiological shrinkage. Fig. 9: A resorbable collagen membrane protects the bone substitute material in the augmented space. The solid platelet-rich fibrin matrices overlying the bone substitute material promote wound healing and provide better soft-tissue management. Fig. 10: Surgical area after approximation of the wound edges using resorbable sutures. Apical mattress sutures ensured that there was no tensile stress in the soft tissue of the surgical site. Fig. 11: A PTFE membrane was temporarily sutured over the surgical site in accordance with the open healing protocol. an external lift. As a result, the implant is located too far cranially, leading to an altered anatomy of the maxillary sinus area and an extended crown on the implant. This in turn is associated with an increased risk of loosening or fracture of the implant. Although positional stability of bone grafts can at least be ensured by certain estab­ lished systems, these have invariably been associated with multiple surgical procedures. This not only signifi­ cantly increases the likelihood of scar plate formation in the surgical area, but also places a significant burden on the surgeon’s and, above all, the patient’s time, financial and psychological resources. For these reasons, strate­ gies for more immediate treatment options are desirable in the future in order to perform bone augmentation and implant placement as close together as possible. Design, mechanics and functional principle of the concept The BISS—Bone Implant Stabilization System—devel­ oped by the authors enables exactly this approach and pursues the goal of offering the patient implant­supported dental prostheses in almost any initial situation. The func­ tional principles of the system have been proved scientif­ ically in a range of studies.1–20 They form the prerequisite for successful bone formation and will be illustrated in this section using the “tent pole umbrella” principle: a tent pole holds the required space in a stable posi­ tion coronally and/or cranially, and an umbrella attached to it increases the volume. The larger the space created (shaded area), the more voluminous the bone gain.21–25 The main component of the concept is the BISS cage, which embodies the umbrella according to the princi­ ple described and gives the body’s own osteoinductive tissues, such as the periosteum and the Schneiderian membrane, space for regeneration. The cage consists of a titanium body and titanium arms. The body has one or more interfaces at its base—making it a single, double, 12 13 14 15 Fig. 12: Triple cage (used as a double cage) in situ. The primary stable implant #25 stabilised the cage in addition to the cortical screws so that the cage in turn could fix the floating implant #26 in the desired position. Fig. 13: Allogeneic bone substitute material and autologous bone chips fill the space created. Ideally, the volume should be slightly over-modelled to allow for physiological shrinkage. Fig. 14: Surgical area after approximation of the wound edges using resorbable suture material. Fig. 15: A titanium-reinforced PTFE membrane was temporarily sutured over the surgical area in accordance with the open healing protocol. Apical mattress sutures ensured that there was no tensile stress in the soft tissue of the surgical area. implants 2 2021 17

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case report | Treatment planning and preoperative measures A standard treatment planning protocol was followed. A CBCT scan was taken in order to evaluate the bone vol- ume in the edentulous area and to evaluate tooth #11. After evaluation with CBCT and clinical intra-oral examination, a decision was made to extract the mobile tooth #11 and to place a zirconia implant in the edentulous area immedi- ately. Since the defect was in the aesthetic anterior region and the patient had a thin gingival biotype, it was decided to insert a two-piece zirconia implant to avoid a greyish appearance and to satisfy the patient’s expectations max- imally. The width of the bone in the edentulous area #24 was found to be insufficient for implantation (Figs. 4 & 5). It was decided to increase the bone thickness by auto- genous augmentation and then insert the implant. Every aspect of the treatment was shared with the patient. More- over, she was given vitamin C and D supplements for one week preoperatively in order to strengthen the immune system and accordingly to provide better healing of bone and soft tissue. The use of the same vitamin supplements was continued for two weeks postoperatively. Surgical procedure of tooth #11 Since the procedure would be in the aesthetic ante- rior region, it was intended that the patient would not be toothless after the surgical procedure. Before starting the surgical procedure, impressions were taken from the patient for a provisional restoration. After local anaesthe- sia, the extraction of the fractured tooth #11 was done atraumatically. A flap was opened in order to be atrau- matic in the extraction of the tooth, whose crown and root were separated from each other (Fig. 6). At first, a dental extraction forceps was used in the root extraction of the tooth after the crown had been removed. In order not to damage the surrounding tissue and not to traumatise the soft tissue, the tooth was extracted with minimal move- ments without using an elevator. After the extraction of the tooth, the infected tissue in the area was completely cleaned with curetting. Severe loss of the anterior wall of bone due to the fractured crown was seen at the area. Ozone (Ozone DTA J-500, APOZA) was applied for 60 seconds to ensure disinfection of the extraction socket (Fig. 7). With ozone gas, it was aimed to decrease the amount of bacteria at the region,3 increase the amount of oxygen carried by accelerating the blood circulation4 and contribute to the decontamination around the im- plant.5 The cavity was prepared using zirconia drills (ZiBone, COHO Biomedical Technology) in combination with metal drills (Zeramex, Dentalpoint; Figs. 8 & 9). Autologous bone chips were collected during the implant cavity preparation. Meanwhile, two tubes of blood were taken from the patient’s forearm. Vacuum blood collection tubes (two 10 ml tubes) were used for preparing the PRF. The blood samples taken were centrifuged horizontally 6 8 7 9 Fig. 6: Granulation tissue at fractured tooth #11. Fig. 7: Ozone application to the extraction socket of tooth #11. Figs. 8 & 9: Ceramic drills. for 8 minutes at 2,300 rpm in the HORIZON 6 Flex PRF device (Drucker Diagnostics) to make them ready for use in the PRF application (Figs. 10–12). After preparation of the implant socket, one piece of PRF membrane was inserted into the cavity together with a two-piece zirconia implant (Zeramex; diameter: 5.5 mm; length: 10.0 mm), achieving primary stability (Figs. 13–15). The implant collar was sunk 1 mm into the bone to ensure primary stability and enhance aesthetics by promoting a good emergence profile. Gaps around the implant were supported by a mixture of liquid PRF, autologous bone 11 12 10 Fig. 10: The centrifuge used. Figs. 11 & 12: Platelet-rich fi brin production. implants 2 2021 23

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case report | 5 6 discussion, the patient decided on this treatment option. The main reason for his decision was the prognosis of less inflammation of the peri-implant tissue with ceramic implants and a metal-free solution. Surgical and restorative protocols Curettage and laser debridement with a 940 nm wave- length diode laser (BIOLASE) of the alveolar socket was performed after extraction of tooth #36. Surgical guide- lines for the drilling protocol were followed, and two- piece zirconia dental implants (AWI G-Line) of sizes 3.9 × 12.0 mm and 4.5 × 10.0 mm were used for the re- placement of teeth #35 and #36 (Figs. 3 & 4). Both im- plants were inserted with the connection level supragin- gival to a torque of 35 Ncm. The transgingival shoulder with its smooth surface provides the optimal conditions for soft-tissue adhesion. Primary stability was achieved. The implants were covered with cover screws in situ, and the site was closed without any grafting procedure. Four months after surgery, the restorative process began with removal of the cover screws and placement of straight cementable zirconia abutments with external threads (Figs. 5 & 6). The abutments were screwed and cemented with glass ionomer cement (SHOFU) for a permanent abutment–implant connection. The glass ionomer ce- ment was applied only to the external threads and was torqued to 15 Ncm. The abutments were prepared like a natural tooth with red-ring diamond burs, followed by a conventional impression taking procedure for definitive restoration. The soft tissue was healthy and keratinised around these abutments when direct impression taking was performed (Fig. 7). Monolithic zirconia crowns were selected as the prosthetic solution (Fig. 8). To achieve a tension- and bending-free connection between the restorations and the implants, the zirconia restorations were cemented intra-orally to the abutments according to the standard procedure using glass ionomer cement (Figs. 9a & b). 7 8 implants 2 2021 29

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case report | In locations #12 and 14, an allograft (Cortical Mineralized/ Demineralized Blend, Maxxeus) was mixed with a liquid platelet-rich fibrin (PRF) to create a high-viscosity bone graft- ing material that is adhesive to the natural bone, achieves quicker healing and supports the immune response. The fibrin is extracted from the patient’s blood sample by spin- ning it in a centrifuge. The graft was applied to fill up any remaining space around the implants and on the buccal side. The implant area bone was flattened. The abutments were partly covered by the grafting material as well (Fig. 5). A PRF membrane was then applied to fit snugly around the healing abutments and to cover the bone grafting material on the labial and buccal sides. To allow the abutments to peek out, holes were punched into the PRF membrane with a biopsy punch. The PRF membrane is designed to hold the bone grafting material in place as well as promote the growth of soft tissue. The surgical sites were then sutured using PTFE suture thread. Upon being made ready, the provisional restoration was fitted and then attached using Temp-Bond cement (Kerr; Fig. 6). A mix of air and water was sprayed over the gingiva to remove any clinging cement residue, to prevent it from invading the operation sites. After the pa- tient was checked again by the anaesthetist and after some resting time, during which he was provided with postoper- ative care instructions to promote healing, he was released. In terms of postoperative care, the patient was called in for check-ups every two to four weeks. After two weeks, the su- tures were removed. After one month, it was found that the implants had achieved proper stability, and after six weeks, the membrane was removed with a probe. Prosthetic restoration After a total of five months of healing, the patient was invited back to the practice to evaluate restoration in his upper jaw. There was perfect healing of the gingiva with no signs of inflammation around the implant areas or at the papillae. At removal of the provisional restoration and abutments, a clear pink profile was exposed with healthy soft tissue around the zirconia collars of the implants. A panoramic photo- graphic and CBCT scan showed that the bone was healthy around the implants. In two further sittings, the provisional restoration was replaced by another provisional restoration, made of acrylic, before the definitive complete restoration made of zirconia. The procedure for this was as follows. A total of eight tailor-made zirconia abutments designed by our in-house dental technician were made, aided by CAD/CAM. The new acrylic provisional restoration was placed over this and bonded with Temp-Bond. At the following appointment, the acrylic restoration was removed to take an impression again of the zirconia abutments (Fig. 7). Two weeks later, the definitive complete denture made of zirconia was delivered without glazing. The colour and shape were evaluated before it was glazed. One week later, the denture was cemented with Premier Implant Cement (Premier Dental; Fig. 8). The patient expressed his delight at the functional and aesthetic result and said the teeth felt natural in his mouth (Fig. 9). 6 8 7 9 Fig. 6: Provisional acrylic restoration fitted and healing site sutures. Fig. 7: Intra- oral situation of upper jaw with zirconia abutments. Fig. 8: After placement of zirconia complete denture. Fig. 9: Final result: the patient’s smile. Conclusion Two-piece zirconia implants were chosen over one-piece implants for the upper jaw, as these are much easier to handle in case of breakage or implant failure, in which case the entire implant does not need to be lost. The use of zirconia is almost an obvious choice these days, not least for the aesthetic advantage of avoiding a grey border shim- mering between the tooth and the gingiva. In addition, there is the important and scientifically proven advantage of zirconia, being non-metal: biocompatibility with the hard and soft oral tissue. The two-piece implants in our case were cemented. In many cases, a two-piece implant will be screwed, which is more friendly to the gingiva in that it avoids the need for cement, which could potentially harm the soft tissue. about the author Dr Nashat Gara is a leading Israeli implantologist and aesthetic dental surgeon. In 1995, he graduated with a DMD from Goethe University in Frankfurt am Main in Germany. In 2010, he completed an MSc in oral surgery and implantology at Danube University Krems in Austria. He established his own private dental centre in Tel Aviv in Israel in 2000. In 2010, he took over a dental practice in Hilversum in the Nether- lands, which provides implant and surgical procedures to patients from the Netherlands and Belgium. Author details contact Dr Nashat Gara +972 54 6673180 shenlin.ng@gmail.com implants 2 2021 33

11 12 13 14 Fig. 11: Both anterior implants were uncovered using a tissue trimmer (NTI-Kahla), retrieval of the healing caps. Fig. 12: After preparation of the remaining natural teeth, an impression was taken including impression copings on the implants (open-tray technique). Fig. 13: Healing abutments were inserted on to the implants for soft-tissue adaptation. Fig. 14: Provisional restoration inserted. sequent bone healing, two ceramic implants were to be placed in these regions. In addition, all remaining natural teeth required new prosthetic restoration with crowns. Materials The implants used in this case were Zeramex XT im- plants (Dentalpoint) with diameters of 4.2 mm (regular base) and 5.5 mm (wide base) and a length of 10.0 mm. In addition, maxresorb inject (botiss biomaterials) and a Jason membrane (botiss biomaterials) were used as part of the bone grafting procedure to cover the bony structures (Figs. 6–14). Conclusion After more than ten years of working with two-piece ceramic implants and with more than 1,100 Zeramex implants of several types and generations having been placed, the author feels confident in using this technol- ogy in conjunction with ceramic implants restored with bridges. In his daily routine, the Zeramex XT implant with its internal geometry in combination with the carbon fibre- reinforced high-performance PEEK screw (Vicarbo screw) allows patient-specific prosthetic restorations, in- cluding bridgework and removable dentures, with reliable long-term success, including stable aesthetic outcomes (Figs. 15–19). 15 17 16a 16b 18 19 Fig. 15: Delivery of the final posterior superstructures. Figs. 16a & b: Definitive anterior bridgework: anterior view (a) and occlusal view (b). Figs. 17 & 18: Image of the harmonious interaction of the prosthetic restoration with the lip line. Fig. 19: X-ray to control the fit of the prosthetic restorations after four months. Practical relevance about the author Alveolar ridge-splitting and expansion techniques are suitable and well-established methods for managing narrow residual bone with relatively minor effort.1 Differ- ent techniques and utilisation of various types of instru- ments are described in the literature, and only minor dif- ferences between them are reported regarding survival of the implants.2, 3 Furthermore, study reviews have revealed a low rate of intra- and postoperative complications, such as buccal wall fracture, which requires careful prepara- tion of the ridge and prudent selection of patients.4 Based on the clinical experience of the author, the technique employed for this case works particularly well in com- bination with ceramic implants owing to their high bio- compatibility and material properties.5 contact Dr Michael Leistner info@dent-design.de Dr Michael Leistner is a Germany- based dentist specialised in den- tal implantology, focusing particularly on the use of ceramic implants. He runs a private practice in the city of Merzhausen in Germany. Author details References implants 2 2021 35

D A BECOME AN AUTHOR for ceramic implants— international magazine of ceramic implant technology for implants — international magazine of oral implantology Interdisciplinary, transparent & market orientated issn 1868-3207 • Vol. 22 • Issue 3/2021 3/213/21 implants implants implants oral implantology oral implantology issn 1868-3207 Sondernummer • Vol. 5 • Issue 2/2021 2/21 ceramic implants international magazine of ceramic implant technology case report case report Delayed immediate implant soft-tissue management interview interview On remaining vigilant events events research Room for improvement case report Restoring aesthetics in the mandible events First JCCI held with great success www.oemus.com Become part of a successful network and benefit from a wide reach and high level of awareness Your benefits: • author’s profile at ZWP online • specimen copies • offprints • speaking engagement* Please contact Mr Johannes Liebsch: j.liebsch@oemus-media.de Phone: +49 341 48474-140 *according to the required profile Holbeinstraße 29 · 04229 Leipzig · Germany · Phone.: +49 341 48474-201 · s.schmehl@oemus-media.de O EM U S M E D I A AG 9 Fig. 9: Radiograph immediately after surgery. systems such as CERALOG Hexalobe (CAMLOG), which was used in the case described in this article. Management Prior to the operation, an immedi- ate implantation treatment plan using the two-piece dental implant system CERALOG was developed on the basis of radiographic imaging (Fig. 1) and 3D planning (Orthophos SL 3D, Dentsply Sirona). In a first surgical step, a flap was elevated, both teeth #11 and 21 were extracted, and extensive peri- apical cysts were removed (Figs. 2–4). Two implants, 12 mm in length and 4 mm in diameter, were then immedi- ately inserted (Fig. 5). Afterwards, an optical impression (CEREC Omnicam, Dentsply Sirona) was taken for the production of CAD/CAM-designed in- dividual abutments (Fig. 6), which were planned to be seated at the implant exposure after six months. The two- piece implants were covered with bony chips gained from the posterior re- gion of the mandible during the surgi- cal procedure by means of a Geistlich SafeScraper TWIST (Geistlich Pharma; Fig. 7). The operation site was then sutured for covered healing of the im- plants (Fig. 8). In addition, a radiograph was taken immediately after surgery (Fig. 9). The individual abutments, which had been designed and produced post - 10 11a 11b Fig. 10: Situation three months after implant insertion. Figs. 11a & b: Design and production of the individual abutments and crowns.

The innovative specialist society for modern metal-free implantology Benefit from the dual membership offer: Join ISMI and IAOCI now Benefits ISMI and IAOCI join forces interview | Effective public relations Drs Sammy Noumbissi (US) and Karl Ulrich Volz (Swit- zerland) are two of the most experienced surgeons world- wide when it comes to modern one-piece and two-piece ceramic implants. In the past 20 years, the two combined have successfully placed several thousand ceramic im- plants. Moreover, they are the founding presidents of the first two international expert societies for ceramic implan- tology—the International Academy of Ceramic Implantol- ogy (IAOCI) and the International Society of Metal Free Implantology (ISMI). Ceramic implants had the opportu- nity to interview the two about future joint activities. Editorial note: The ISMI initially planned to hold its 2020 annual congress in May in Berlin, for the first time in co- operation with the IAOCI. Owing to the current COVID-19 pandemic, however, the decision was made to postpone the event to 2021 and it is now set to take place on 7 and 8 May 2021 in Düsseldorf. For more information, contact the organiser at events@oemus-media.de. Drs Noumbissi and Volz, you two have been friends and colleagues for many years. Now, the IAOCI has also officially joined ISMI as an educational partner for its 2021 annual congress. What’s the main reason behind you two joining forces? Dr Volz: Sammy, whom I extremely respect as a great surgeon, ambitious teacher and very honest friend, is truly committed to pushing the paradigm shift regard- ing ceramic implants forward. He dedicates and com- mits himself entirely to his expert society, the IAOCI. Yet, ceramic implants represent only a small share of the entire dental implant market. It thus makes a lot of sense to join forces and to support each other in our activities and conferences. ISMI will be organising congresses in the German-speaking countries and in northern Europe, and the IAOCI will take care not only of the US but also of Latin America, Africa, Australia and possibly Asia. Benefit from a strong community that elevates the marketing of your practice through effective public relations strategies. Personal online member profile ISMI provides a personal profile of all active members on their website —free of charge. In addition, the ISMI patient platform provides important information for patients and features a search tool with which patients can find their perfect dentist. implants 1 2020 57 CERAMIC IMPLANTS STATE OF THE ART Discount on congress fees Come and join us! Attend the Annual Meeting of ISMI in Berlin on 24 and 25 June 2022 and benefit from first-rate continuing education. ISMI members receive a special dis- count on the participation fee. 6 TH ANNUAL MEETING OF 24./25. Juni 2022 Berlin Get exclusive access to ISMI’s extensive online archive. Discuss all relevant ques- tions regarding metal-free implantology with experts and colleagues from around the world and enjoy free access to the online archive where you will find informa- tive training videos and clinical case reports. Online archive for specialists Newsletter The ISMI newsletter keeps you up to date with the latest scientific trends, products, and events on a regular basis. It also features user reports as well as a wide range of information and tips on the subject of metal-free implantology. Specialist magazine As a member of ISMI, your membership fee includes a subscription of the inde- pendently published English language magazine ceramic implants—international magazine of ceramic implant technology. Published twice a year, the magazine offers specialist articles and event reports as well as industry- and science-related news from the international world of metal-free implantology. In addition, ceramic implants pro vides information about manufacturers and their latest products. issn 1868-3207 Sondernummer • Vol. 5 • Issue 2/2021 2/21 ceramic implants international magazine of ceramic implant technology ISMI e.V. Office Leipzig Holbeinstraße 29 | 04229 Leipzig | Germany Phone: +49 800 4764-000 | Fax: +49 800 4764-100 office@ismi.me | www.ismi.me Become a member of ISMI an IAOCI now— with our dual membership! research Room for improvement case report Restoring aesthetics in the mandible events First JCCI held with great success

implants The magazine has established itself in the community with great success. Now onto the next step: ceramic-implants.info is online. Check out the website and follow us on LinkedIn! Holbeinstraße 29 · 04229 Leipzig · Germany Phone: +49 341 48474-0 · info@oemus-media.de © PerigTemplate – stock.adobe.com

What further properties must an implant possess to achieve such accelerated hard- and soft-tissue healing? With a view to the current literature, the architecture and the structure of the implant surface as well as its chemical properties are crucial for achieving a rapid healing cascade. In the case of modern implant surfaces and in particular the surface of the Patent™ Dental Implant System, which I have investigated together with Dr Peter Schüpbach as part of an animal model study, another decisive mechanism can be observed: bone debris and a bone smear layer are found along the free implant surface that has not yet been in contact with the surrounding bone. I have been conducting research on this very topic together with Dr Schüpbach for 14 years now, and we have found that this area in particu- lar has high osteogenetic potential. Furthermore, in our re- search on the Patent™ Dental Implant System, we have found that especially its highly rough surface in the endosseous part, which is at least twice as rough as other well-established implant surfaces, has a beneficial impact on bone healing. With its highly rough surface, the Patent™ Implant is virtually at the other end of the scale of Albrektsson and Wenner- berg. Owing to the contact osteogenesis described ear- lier, which is facilitated by this highly rough implant surface, the Patent™ Implant system achieves an enormously high bone–implant contact already a short time after insertion. You mentioned an animal model study that you con- ducted in collaboration with Dr Schüpbach to evaluate the healing around Patent™ Implants. How was this set up, and what were your results? Since we wanted to create conditions that were as con- trolled as possible, we chose a preclinical study design. To establish real-life transferability, we decided to work on mini-pig animal models and did what is done in clinical practice in the same way: we extracted teeth and subse- quently placed implants in immediate implant placement procedures. After healing times of four and eight weeks, respectively, we removed the placed control and test im- plants. The control implants were established titanium implants and the test implants were Patent™ zirconia im- plants. We deliberately avoided influencing factors such as bone augmentation. In cross section, we were then able to take a close look at the healing of the soft tissue and bone at the two explantation time points. For us, the unknown variable was what happens at the free surface at which the implant comes into direct contact with the bone. Upon evaluating the data, our preliminary conclusion is that the healing success of the Patent™ Implant surface outper- forms that of all other surfaces investigated in compara- ble animal model studies to date. Whereas a bone–implant contact value of just 30–40% has been documented for machined implants after a healing period of 12 weeks—the steady state in mini-pigs—and a value of about 60% at the time of the steady state has been found in studies on mod- ern implant surfaces, Patent™ Implants achieved a value of about 70% already four weeks after insertion. Furthermore, “The healing success of the Patent™ Implant surface outperforms that of all other surfaces investigated in comparable animal model studies to date.” 4 we found that the steady state for Patent™ Implants was al- ready reached after a healing time of eight weeks at the latest. For everyday clinical practice, this means that regardless of the protocol that is being followed, practitioners and patients have greater security at an earlier stage and they can assume that even 20 years after implant placement—with a possi- ble gingival retraction of 1.0–1.5 mm—no major problems will occur. As far as I am concerned, this is the compelling argument for Patent™ Implants from a biological point of view. The second surprising finding from our study is that the vertical histoarchitecture of sulcular epithelium, junctional epithelium and connective tissue at the soft-tissue level around Patent™ Implants has a highly favourable struc- ture and that the soft-tissue seal around these implants remained consistently above soft-tissue level after a healing period of four weeks. In contrast, significant accumulation of calculus and plaque was observed around the control implants, spreading downward towards the junctional ep- ithelium, the point at which the human body begins to react. This is consistent with observations from the litera- ture that plaque accumulation around zirconia implants is significantly lower than around titanium implants. In conclusion, what do you believe are the advantages of the Patent™ Dental Implant System, as opposed to other leading zirconia technologies on the market? The Patent™ Dental Implant System is purposefully designed to meet the material characteristics of zirconia. I must say that Zircon Medical has truly mastered the complex manufacturing process. The outcome is a unique hydrophilic surface on the intra-bony part. As mentioned, we have seen in preclinical and clinical investigations on the Patent™ Dental Implant System that the implant out- shines all previously documented systems (titanium as well as zirconia systems) in terms of bone healing speed. Not least because of the incredibly positive feedback from pa- tients, I am convinced that the Patent™ Dental Implant System will change many things in dental implantology for the better. contact Video: Dr Glauser on Patent™ About Dr Roland Glauser Zircon Medical Management, Switzerland, +41 44 5528454, www.mypatent.com implants 2 2021 43

May 19-22, 2022 • Save The Date! 11th IAOCI WORLD CONGRESS Washington, DC CERAMIC IMPLANTOLOGY: 3 DAYS OF EXCEPTIONAL EDUCATION HANDS-ON COURSES AND NETWORKING Past Presenters and topics include: Andrea Borgonovo, Jaafar Mouhyi, Ulrich Volz, Heinz Kniha, Marcel Wainwright, Daniel Olmedo, Jerome Chevalier, New Generation of Zirconia Based Ceramic Materials, The Corrosion Problem in Implant Dentistry, Blood Concentrates for Optimal Bone Healing and Osseointegration and Tissue & Cell Behaviour Towards Zirconia... www.iaoci.com American Society o f Ceramic Implantology

events | 4 5 Fig. 4: Various manufacturing companies including Zeramex/Dentalpoint were invited to share their product innovations with the congress participants. Fig. 5: Dr Karl Ulrich Volz (ISMI president and head of the congress, left) and Marco Gadola (former CEO and current member of the board of Straumann Group). man and vice versa. What was conveyed theoretically in exciting lectures was also demonstrated practically with a live surgery carried out in the surgical facilities of the ad- jacent SWISS BIOHEALTH CLINIC, where implants from the ceramic implant manufacturer SDS Swiss Dental Solutions were inserted, further consolidating the newly acquired knowledge on the part of the participants. In addition to attending the congress in person, all those interested in ceramic implants had the opportunity to either follow the congress online from home via live- stream, which was also transmitted 9 hours later for the international participants, or watch it via interactive Zoom, while also being able to actively participate: during open Q & A sessions, the Zoom-participants were connected live and thus had the opportunity to interact directly with the on-site audience in the training centre. For guests who attended the congress in person, an all-inclusive service was offered for the breaks, allowing them the opportunity for personal exchange during those times. The White Night with its gourmet and bar stations and its musical programme involving a DJ set and live per- formance of a band was certainly another highlight for all guests looking to review the eventful congress days with colleagues in an informal atmosphere. In summary, Dr Volz described the congress as a complete success and said that he was grateful for the fruitful exchange of experience between those attending, some of whom have been using ceramic implant systems for decades to great success. Marco Gadola, speaker at the congress, former CEO and current member of the board of Straumann Group, sees ceramics as the implant material of the future and predicts that in 2025, the clinical use of ceramic implants will have grown by a factor of 40. The second Joint Congress for Ceramic Implantology will take place on 14 and 15 October 2022, again at the SWISS BIOHEALTH EDUCATION CENTER in Kreuzlingen, to jointly discuss topical research results as well as current methods and treatment approaches in relation to ceramic implantology. Three-quarters of the on-site participation capacities for the second event are al- ready booked. More information will be made available in due course at www.swissdentalsolutions.com/en/ joint-congress-ceramic-implantology. contact Ayla Tavit Chief Education Offi cer +49 171 8634815 at@swissdentalsolutions.com 6 7 Fig. 6: Dr Dirk U. Duddeck, Managing Director of the CleanImplant Foundation, awarded Dr Karl Ulrich Volz (CEO of SDS Swiss Dental Solutions) the prestigious “CleanImplant Trusted Quality Certifi cation” for the SDS 2.2 ceramic implant system. Fig. 7: The White Night with its musical programme involving a DJ set and live performance of a band was another highlight for the congress participants. implants 2 2021 47

manufacturer news | 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 cantly 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 ZiBone A wide range of zirconia products Based on more than 30 years of experience, COHO has been producing orthopaedic Based on more than 30 years of experience, COHO has been producing orthopaedic and dental implants, and surgical instruments made from zirconia for many years. and dental implants, and surgical instruments made from zirconia for many years. In collaboration with renowned experts and research units from National Taiwan In collaboration with renowned experts and research units from National Taiwan University, a wide variety of ZiBone zirconia products have been launched in the University, a wide variety of ZiBone zirconia products have been launched in the past, including implant drills, pilot drills, tissue punch devices, tissue trimmers, past, including implant drills, pilot drills, tissue punch devices, tissue trimmers, scalpels, or elevators. COHO is always looking to advance research on surface scalpels, or elevators. COHO is always looking to advance research on surface treatment to reduce metal-related health risks for patients and to facilitate treatment to reduce metal-related health risks for patients and to facilitate safety and convenience during surgery. COHO is currently working towards the safety and convenience during surgery. COHO is currently working towards the market entry of Zircasso, IZI and a tissue- level implant system. In addition, COHO market entry of Zircasso, IZI and a tissue- level implant system. In addition, COHO offers the new Deguide Kit, a set of accurate tools designed and developed by offers the new Deguide Kit, a set of accurate tools designed and developed by Dr Noran Debasso, which provides patients with a simple way to clean their implants Dr Noran Debasso, which provides patients with a simple way to clean their implants and achieve good oral hygiene. Based on a novel, encompassing technique from and achieve good oral hygiene. Based on a novel, encompassing technique from Dr Noran Debasso, the Deguide Kit is a solution that does not require CBCT and that Dr Noran Debasso, the Deguide Kit is a solution that does not require CBCT and that fits every type of dental implants. To find out more, go to www.zibone.com. fits every type of dental implants. To find out more, go to www.zibone.com. COHO Biomedical Technology Taiwan +886 3 3112203 www.zibone.com implants 2 2021 49

One-Day Course BluePoint Brussels Conference Center April 23, 2022 Brussels (Belgium) One-Day Course ON CERAMIC IMPLANTS Co-organised by EACim and Société de Médecine Dentaire (Belgium) MORNING BLOCK FROM 9:00 TO 12:30 • DR PHILIPPE DUCHATELARD (FR: Is Zirconia an Alternative to Titanium in Implant Dentistry? • PROF. ERIC ROMPEN (BE: Osseo- and Muco-integration of Ceramic Implants. AFTERNOON BLOCK FROM 14:00 TO 17:30 • DR GIANCARLO BIANCA (FR: Zirconia implant: Close to the Natural Root? • DR PASCAL EPPE (BE: Prosthetics on Ceramic Implants: The Keys to Success Lecture Program in French. For further info and registration contact: secretariat@dentiste.be https://eacim-ceramic-implantology.com/

manufacturer news | Dentalpoint Your partners for the fully digital workfl ow with ceramic implants With Zeramex Digital Solutions and the new CS 3800 from Carestream Dental, it will now be even more con- venient to plan and implement ceramic implant restorations precisely and completely digital. Zeramex Digital Solutions offers the com- plete digital workfl ow to create patient- individual restorations on Zeramex XT ceramic implants: from abutments and healing caps to monolithic restorations without any cementation gap. All com- ponents made of zirconium oxide are also available as multilayer and stained and glazed—within one week. These CAD/ CAM treatment options are ideally comple- mented by the new CS 3800 intra-oral scanner. Stefan Haupt, Solutions Product Specialist at Carestream Dental, sums up the advantages: “The slim and wireless design of the CS 3800 ensures better handling with increased com- fort during the scanning process. The en- larged fi eld of view as well as the depth of fi eld of 21 mm even enables the simple scanning of edentulous pa- tients.” With the CS 3800, Carestream Dental paves the way to absolute freedom with all the options of a real end-to-end workfl ow. “It is a great opportunity to enter the completely digital workfl ow with Zeramex implants”, explains Adrian Hunn, CEO Dentalpoint, and “we are convinced that two-part ceramic implants and the digital workfl ow will remain the dominant topics in implantology.” Dentalpoint AG Switzerland +41 44 3883636 digitalsolutions@zeramex.com CAMLOG Natural aesthetics with the CERALOG® Implant System The demand for highly aesthetic, natural-looking restorations is continually increasing. This trend favours ceramic implant solu- tions with high levels of biocompatibility, particularly zirconia, known for its excellent soft-tissue compatibility. The CERALOG® Implant AESTHETICS The ivory colour, which is close to the natural tooth colour and the properties of zirconia supports high aesthetic results. System is established and has been in clinical use for more than seven years. It offers a high level of predictability and provides aesthetically pleasing results. The two-piece design of the system that allows for screw-retained prosthetics offers great benefi ts. CERALOG® is easy to use, owing to the simplifi ed prostheses, lean instrumentation, and clearly struc- tured surgical procedure. Options for the treatment workfl ow include fl exible trans- or submucosal healing of the two-piece CERALOG® Hexalobe implant and transmucosal healing of the CERALOG® Monobloc implant. The implants are made of yttria-stabilised tetragonal zirconia, which is a ceramic widely used in the dental industry and other highly demanding medical fi elds. The ivory colour of the material, which is very close to that of a natural tooth, and the properties of zirconia lead to natural-looking results. Zirconia is chemically inert, making it especially suitable as an implant material. Due to its manufacturing process called ceramic injection mold- ing (including sintering and hot isostatic pressing), it offers an outstanding combination of excellent mechanical properties and high strength. IDEAL CONNECTION Hexalobe – the ideal implant–abutment connection for ceramic implants. The torque is transmitted tangentially to the implant, which allows a much higher torque compared to hexagonal connections, and also more rotational stability. CAMLOG Biotechnologies GmbH Switzerland +41 61 5654141 www.camlog.com implants 2 2021 53

m o c . e b o d a . k c o t s — o n N i l E o c N © i news | AD For this statement, the currently available literature was reviewed and clinical experience was taken into account. It objectively and independently refl ects the state of evidence on two-piece ceramic implants, the general background to ceramic implants is presented as an introduction and the current scientifi c assess- ment of the ESCI on two-piece ceramic implants is given. A fi nal legal assessment is not within the realm of responsibility of the ESCI. The key points of the statement are as follows: – The two-piece zirconia implant concept offers ad- vantages over the one-piece concept regarding prosthetic flexibility and clinical indications. – Two-piece zirconia implants can resist clinical mas- ticatory forces. – Fracture resistance and mechanical stability of two- piece zirconia implants may vary as a function of different manufacturing processes, material proper- ties, implant geometries and prosthetic connection concepts. – One- and two-piece zirconia implants demonstrate the same level of osseointegration and biological integrity. – For clinical success, each manufacturer’s guidelines regarding strict application for the specified clinical indications should be followed for the respective two-piece zirconia implant system. – The ESCI Scientific Advisory Board states, based on the conclusions above, that the two-piece zirconia implant concept is appropriate for clinical application. For more information on the recently released consensus statement and the full statement, visit the ESCI website at https://esci-online.com/en/statements. Source: European Society for Ceramic Implantology A ceramic implant with a tapered connection – seriously!

news | New member in the family of certifi ed clean implants: SDS receives the prestigious CleanImplant Trusted Quality Award During the fi rst Joint Congress for Ceramic Implantology (JCCI) in Kreuzlingen, Switzerland, Dr Dirk U. Duddeck, Managing Director of the non-profi t CleanImplant Foun- dation, awarded the sought-after “CleanImplant Trusted Quality Certifi cation” to Dr Karl Ulrich Volz (CEO of SDS Swiss Dental Solutions) for the SDS 2.2 ceramic implant system. After a strict peer-review process, two members of the CleanImplant Scientifi c Advisory Board confi rmed that the test results of fi ve randomly selected implant samples met the CleanImplant consensus-based quality guidelines for contamination-free dental implant surfaces. Dr Volz of SDS was delighted to receive this certifi cate and took the opportunity of highlighting the importance of surface clean- liness in the fi eld of ceramic implantology at his congress. The CleanImplant Foundation aims to raise awareness for a better quality of dental implant systems. Worldwide quality assessment studies performed by the foundation in collaboration with renowned universities showed con- siderable differences in the quality of dental implants made of zirconia and titanium. Source: CleanImplant Foundation The 11th IAOCI Annual Congress 6th Annual Meeting of ISMI To be held in spring of 2022 To be held in Berlin next year Following the great success of the their 10th Anniversary Annual Congress in August of 2021 in Las Vegas, USA, the International Academy of Ceramic Implantology ( IAOCI) is already looking ahead to their 11th Anniversary Con- gress which is going to take place in Washington DC, USA, in the spring of 2022. For the upcoming event, the US-based expert society for ceramic implantology has once again gathered a fantastic line-up of top- tier speakers and scientists to share their professional knowledge and experiences with the audience. Given the success of the poster presentations at past IAOCI congresses, the organisers have decided to continue to host the poster competition and accept both virtual and in-person entries. The list and provisional pro- gramme are going to be posted on the IAOCI website in the upcoming weeks and on an ongoing basis and on- line registration will be made available in due course too (www.iaoci.com/events). Become a member of the IAOCI today at https://www.iaoci.com/membership. SAVE THE DATE Mark your calendars: The International Society for Metal Free Implantology (ISMI) invites interested parties to participate in their 6th Annual Meeting, to be held on 24 and 25 June 2022 in Berlin, Germany. The two-day further training event will commence on Friday with pre-congress symposia involving the live-streaming of surgeries into the conference hall, fol- lowed by the fi rst part of the scientifi c lecture programme. lowed by the fi rst part of the scientifi c lecture programme. Saturday will then be dedicated entirely to scientifi c lec- tures delivered by renowned speakers from Germany and abroad. The theme of the congress will be „Ceramic Im- plants—State of the Art”. On both congress days, the pro- gramme will be complimented by an industry exhibition, where the latest in ceramic implant innovation will be on display. ISMI was founded in 2014 in the city of Constance, Germany, with the aim of promoting metal-free implan- tology as an innovative and particularly forward-looking branch of dental implantology. Since then, the expert society has been providing its members with continuing education offerings dedicated to ceramic implantology on a regular basis. More information on the upcoming Annual Meeting of ISMI will be made available in due course on www.ismi.me and on www.ismi-meeting.com. Source: International Academy of Ceramic Implantology (IAOCI) Source: OEMUS MEDIA AG

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