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| content editorial Before the court and on the high seas... Dr Georg Bach research page 6 Laser-assisted protocol for the treatment of peri-implantitis: A long-term retrospective case series Drs Gary M. Schwartz, David M. Harris & Gregori M. Kurtzman case report Full-arch: Full rehabilitation of the upper jaw—Part 2 Dr Dr Michael Rak, Norbert Wichnalek, Arbnor Saraci & Lukas Wichnalek page 16 Straumann Pro Arch with BLT implants in a periodontal patient with hopeless dentition: A fi ve-year follow-up Dr Amin Motamedi 30 years OEMUS MEDIA interview Big data in implant dentistry An interview with Prof. Arjan Vissink page 24 industry Commitment to safety Insights in modern dentistry events Patient-customised concepts: “Implantology 4.0” in Düsseldorf this November Long-awaited Digital Dentistry Show to premiere in Berlin in June 2024 news manufacturer news Statement on the decision of the Berlin Regional Court regarding two-piece ceramic implants about the publisher imprint Cover image courtesy of Nobel Biocare, www.nobelbiocare.com issn 1868-3207 • Vol. 25 • Issue 2/2024 2/24 implants implants implants implants international magazine of oral implantology oral implantology oral implantology m m o o c c . . e e b b o o d d a a . . k k c c o o t t s s – – m m z z a a n n _ _ x x f f g g © © i i research Laser-assisted protocol for the treatment of peri-implantitis case report BLT implants in a periodontal patient with hopeless dentition interview Big data in implant dentistry 04 2 2024 03 06 16 24 31 32 34 36 37 38 39 40 42

| research Laser-assisted protocol for the treatment of peri-implantitis: A long-term retrospective case series Drs Gary M. Schwarz, David M. Harris & Gregori M. Kurtzman, USA Pulsed Nd:YAG dental lasers are surgical tools used to obtain specific surgical objectives as defined in the LANAP (laser-assisted new attachment procedure) for periodon- titis and the LAPIP (laser-assisted peri-implantitis proce- dure) for peri-implantitis. The LANAP using the PerioLase Nd:YAG laser (Millennium Dental Technologies) was intro- duced in 1998 as Laser ENAP,1 and in 2004, the LANAP gained US Food and Drug Administration 510(k) clear- ance (No. K030290) for the claim “laser-assisted new at- tachment procedure (cementum-mediated periodontal ligament new attachment to the root surface in the ab- sence of long junctional epithelium)”. Subsequently, hu- man histology studies2, 3 established that the LANAP re- sulted in “periodontal regeneration—true regeneration of the attachment apparatus (new cementum, new periodon- tal ligament, and new alveolar bone) on a previously dis- eased root surface” (2016 510[k] clearance No. K151763). The LAPIP emerged from the LANAP as a stand-alone procedure.4–7 The indication for the LANAP is moderate to advanced periodontitis, whereas the LAPIP is indi- cated for peri-implantitis treatment. The basic steps in the two protocols are the same and have adjustments for the whole mouth versus a single site, the responses to irradi- ation of root cementum versus implant titanium, and dif- ferences in surgical objectives. A recent review of published studies of peri-implantitis laser treatment concluded that laser treatment enhances bone growth, but a quantitative analysis of bone-level changes is limited.9 The authors called for greater relevance and translation of the research findings to the clinician. This report addresses those concerns with a detailed analysis of the clinical outcomes and a quantitative description of changes in radiographic density two to five years after undergoing a LAPIP in a private practice setting. Dr Schwarz completed training in the LAPIP in Septem- ber 2013. A retrospective analysis of the 222 sequential patients with 437 failing dental implants that were treated during the following three years was performed.7 That study was focused on the short-term efficacy of the LAPIP. A sta- tistically significant reduction of clinical signs of erythema, bleeding and suppuration and reduced probing depth (PD) at the first follow-up visit (median period: 7.6 months; P < 0.001) was noted. The survival rate, the percentage of intact implants, was 94% over the longest follow-up period (median: 13.1 months) among those in the analysis. Fig. 1: Proportion of dental implants in each clinical treatment outcome cat- egory. i Periodontitis: “Inflammation of the periodontal tissues resulting in clinical attachment loss, alveolar bone loss, and periodontal pocketing.”8 ii Peri-implantitis: “An inflammatory process around an implant which includes both soft-tissue inflammation and loss of supporting bone.”8 Clinical signs include inflammation, bleeding on probing and suppuration. It progresses from peri-implant mucositis, which is confined to the soft tissue, to include PD > 4 mm and evidence of bone loss. Peri-implantitis often leads to progressive loss of osseointegration and eventual loss of the implant. 06 2 2024

| research Long-term clinical and radiographic data are presented from the same group of 222 patients. There was a con- tinuum of responses, including long-term successes, par- tial responses with intact implants and implants lost after two years of maintenance with multiple treatments, as well as cases of successful treatments that relapsed after one to two years. Analysis of radiographic data from a sample of successfully treated implants provided a time course for bone regeneration. Methods Collection and analysis were performed of retrospective data, wherein patient records were sorted to find all pa- tients in the practice who had undergone LAPIP treat- ment within the 37-month interval from the first treatment (October 2013) until the date of institutional review board approval (October 2016). A private institutional review board (Quorum Review) granted a waiver of informed consent and approved the retrospective data collection and analysis protocol. Later, the institutional review board approved the retrospective analysis of the long-term follow-up data that is included in this report. The original study was conducted according to standards estab- lished by the Declaration of Helsinki and Good Clinical Laboratory Practice Guidelines. Research standards es- tablished in the original study were maintained in the cur- rent study. The purpose of the original study was a precise statistical analysis of the initial clinical outcome of a single treat- ment, seeking to determine whether there was improve- ment or a lack of improvement at the first follow-up visit. A review was conducted of patients who received the treatment in the three years after the LAPIP training. All patients were included to eliminate selection bias. A staff member went through the medical records of each LAPIP patient and copied data into case report forms. Any iden- tifying information was excluded, and the case report forms were sent electronically to the statistician for data entry and analysis. Data captured included laser settings, demographics, medical history, implant information, ad- verse events, PD (mm; for six pockets) and the presence of clinical signs (bleeding, erythema and/or suppuration). Panoramic and/or periapical radiographs were available for analysis. The statistician excluded patients with miss- ing data from the various analyses. The original group included 222 patients with 437 implants. That study enrolment closed in October 2016. Exclusion of pa- tients with incomplete data resulted in 116 patients with 224 implants available for analysis, including 47% men and 53% women with a mean age of 65.8 years (range: 23–98 years). original analysis. Case report forms of additional follow- up visits were collected, uploaded and added to the orig- inal data set. This resulted in 155 patients with 299 im- plants who had sufficient baseline and follow-up data to determine implant survival and clinical outcomes. Fig. 2: Example of a successful treatment (Case 1), showing changes in radio- graphic defect (mm2), probing depth (PD; mm) and clinical signs from base- line to 30 months later. Violet = cross-sectional area; MB = mesiobuccal PD; B = buccal PD; DB = distobuccal PD; ML = mesiolingual PD; L = lingual PD; DL = distolingual PD; R = redness; B = bleeding; P = suppuration; Tx1 = first treatment. Laser dosimetry The dental laser was a 6 W pulsed Nd:YAG laser (Perio- Lase MVP-7, Millennium Dental Technology) utilising an optical fibre that delivered high-energy pulses of light to the tissue. For the LAPIP, the fibre tip is inserted into the periodontal pocket. Parameters that are set on the con- trol panel are energy per pulse up to 300 mJ; pulse du- ration, variable from 100 to 650 µs; and pulse repetition rate from 10 to 100 Hz. The duration of exposure is con- trolled with a foot switch. The LAPIP details have been published elsewhere4–7 and are only summarised as follows for the protocol specify- ing surgical end points. Achieving those end points is what determines the dosimetry. In Step 2 of the protocol, the distal fibre tip is inserted into the periodontal pocket and passed around the implant several times to initially open the sulcus and then to remove the diseased pocket epithelium and disinfect the tissue, constituting Pass 1 with the laser.10 In Step 4 of the protocol, the fibre tip is inserted into the pooled blood within the sulcus and again passed around the implant, heating and congealing the blood and forming a fibrin clot, constituting Pass 2 with the laser.11 Two years later (September 2018), a second look at the original group of patients was performed. Several pa- tients had follow-up visits beyond the closing date of the Hence, real-time dosimetry is based on these clinical conditions. With a constant laser power (output), the time spent lasing within the sulcus determines the total energy delivered. In other words, a prescribed laser dose does 08 2 2024

| research software (ImageJ, National Institutes of Health freeware). As the dimensions of the implant were known, the areas were calibrated in square millimetres so that compari- sons could be made over time and across cases. The sum of the defect areas on both sides of the implant is referred to as the cross-sectional area. Cross-sectional areas at follow-up visits of successful cases were con- verted to baseline percentage to estimate the time course of bone regeneration. Results Fig. 3: Example of a partial response to treatment (Case 2), showing changes in radiographic defect (mm2), probing depth (PD; mm) and clinical signs from baseline to 33 months later. Violet = cross-sectional area; MB = mesiobuccal PD; B = buccal PD; DB = distobuccal PD; ML = mesiolingual PD; L = lingual PD; The clinical outcome categories were defined as follows (Fig. 1): · Long-term success: return to healthy PD and an ab- DL = distolingual PD; R = redness; B = bleeding; P = suppuration; Tx1 = first sence of clinical signs treatment; Tx2 = second treatment. not determine the treatment end point; rather, achieving the surgical end point determines the total joules. The surgeon understands that clinical conditions determine the precise laser parameters and the total energy deliv- ered. However, exceeding the recommended dosimetry increases the risk of possible adverse effects. The hard copy printout of the laser dose for Pass 1 and Pass 2 was available for 138 implants, and the mean total energy per implant was 285.8 J. This was divided be- tween the two laser steps. Pass 1 mean total energy was 181.8 J, and Pass 2 mean total energy was 104.0 J. Energy was delivered according to the following formu- las, and sizable case-to-case variance was required to achieve the surgical end points: · Pass 1 total joules delivered = 130 + (10 × aPD) · Pass 2 total joules delivered = 85 + (4 × aPD) These two formulas are not a prescription; they merely define the dosimetry used in this study. On average, Pass 1 required an initial 130 J for all implants, and Pass 2 re- quired an initial 85 J. The formula specifies that the total joules per pass is related to the average probing depth (aPD; the average of six PD measurements). Conse- quently, to estimate the total energy, add ten times the aPD in joules to the initial values for Pass 1 and four times the aPD for Pass 2. Radiographic analysis Film radiographs were scanned and digitised and then the digital radiographs were rotated, cropped and re- sized. Brightness and contrast were not adjusted. Im- ages were arranged in chronological order to illustrate the sequential changes in radiographic density for each case. A technician skilled at reading dental radiographs out- lined the radiographic defect and areas of change in sub- sequent images. The cross-sectional area of the defect within the outlines was measured using public domain · Short-term success: patients with successful outcomes but without follow-up data beyond 12 months · Partial response: failure to meet success criteria but the implant was still intact and stable · Relapse: initial success and then return of clinical signs · Failed: implant lost or removed. The long-term responses to treatment can thus be divided into four general outcomes: successful response (Group 1), partial response (Group 2), spontaneous relapse (Group 3) and lost implant (Group 4). Summary statistics for each of the four groups are presented in this section, followed by one case from each group. Group 1: Successful response This was the most common response, 204 implants (68%) meeting the success criteria of post-treatment PD ≤ 4 mm and no clinical signs at follow-up visits. Most implants in Fig. 4: Example of a successful single treatment that was without clinical signs for over two years, and then the implant presented with signs of re- infection (Case 3), showing changes in radiographic defect (mm2), probing depth (PD; mm) and clinical signs from baseline to 32 months later. Violet = cross-sectional area; MB = mesiobuccal PD; B = buccal PD; DB = disto- buccal PD; ML = mesiolingual PD; L = lingual PD; DL = distolingual PD; R = redness; B = bleeding; P = suppuration; Tx1 = first treatment. 10 2 2024

| research this group (91%) achieved success after a single treat- ment. Others (7%) demonstrated a partial response and then success after a second treatment, and 2% achieved success after three treatments. The median follow-up period in this group was 18.8 months, and one implant was still successful at 63 months. At the time of the latest analysis, 48% of all implants still showed long-term success (12–63 months). The remaining 20% of successfully treated implants had follow-up periods of less than 12 months, so their long-term outcomes could not be determined. Most of these patients did not return for their scheduled hygiene visits. Case 1 is an example from the group of successful treat- ments (Fig. 2). The patient was an 87-year-old man with a cardiovascular condition and had implants in positions #32 and 42 that supported a mandibular overdenture. He presented with deep pockets (PD = 5.7 mm) accompa- nied by a large defect around implant #42. This had led to acute symptoms, including pain, erythema, bleeding, suppuration and swelling of the vestibule. At the pretreat- ment visit, the labial plate was mostly absent along the buccal aspect of the implant becoming exposed. At six months post-treatment, the clinical signs had resolved, the PD had reduced to 3.8 mm and the area of radiolu- cency had reduced too. At 30 months, the PD was 2.8 mm, and there was a complete absence of clinical signs. Group 2: Partial response Partial responders are implants that improved but still showed some clinical signs, had a PD > 4 mm and never achieved the success criteria. There were 47 implants (16%) in this category. Most were treated a second time at six or 12 months after the first treatment, and several received a third treatment. They continued to exhibit clini- cal signs and had a PD > 4 mm. The median follow-up period in this group was 22 months. Fig. 5: Example of a lost implant (Case 4), showing changes in radiographic defect (mm2), probing depth (PD; mm) and clinical signs from baseline to 30 months later. Violet = cross-sectional area; MB = mesiobuccal PD; B = buccal PD; DB = distobuccal PD; ML = mesiolingual PD; L = lingual PD; DL = distolingual PD; R = redness; B = bleeding; P = suppuration; Tx1 = first treatment; Tx2 = second treatment; Tx3 = third treatment. 12 2 2024 Case 2 is an example of a partial response to treatment (Fig. 3). The patient was a 58-year-old man with Type 2 diabetes, hypertension and hyperlipidaemia and had had an implant (Nobel Biocare Tapered) placed in position #46 in July 2014. The patient presented in December 2014 with a PD of 9 mm around the implant, bleeding and suppura- tion and was treated with the LAPIP. At four months, there was no bleeding, but the PD was still 9 mm, and a second treatment was performed. At 15 months, the clinical signs had improved, and PD was reduced to an aPD of 4.2 mm. At 33 months, the implant was still intact; however, the PD had increased to 5.3 mm, and there was some bleeding on probing. The PD and clinical signs at follow-up visits did not allow this implant to reach the success criteria. Even though bone regeneration is unlikely with a defect this wide, the PD and clinical signs improved and remained improved for almost three years after the first LAPIP treatment, and the implant remained in function at the time of last follow-up. Group 3: Spontaneous relapse There were 32 implants (11%) with initially successful out- comes that demonstrated relapse with the return of in- flammatory markers along with deeper PD. The medium time to relapse was 24 months (range: 11–43 months). Case 3 is an example of a successful single treatment that was without clinical signs for over two years and then presented with signs of reinfection (Fig. 4). The 59-year- old female patient had had an implant (Nobel Biocare Ta- pered; 3.5 × 16.0 mm) immediately placed in position #11. She had no risk factors for peri-implantitis, but four months later, at her first follow-up visit, the implant showed signs of redness and bleeding from 4 mm pockets. Subgingival cement was noted on the periapical radiographs and was removed. The first LAPIP treatment was performed in September 2015. At follow-up visits at nine, 15 and 27 months after the first treatment, all inflammatory mark- ers were absent, and the PD showed progressive improve- ment, good bone fill being noted in the periapical radio- graphs. The apical radiolucency was absent, but a new defect had appeared coronally at 27 months. At 32 months, she showed significant relapse with redness and bleed- ing from pockets that had deepened beyond the pretreat- ment levels. Radiography revealed that the new defect had enlarged. The implant was subsequently retreated. Group 4: Lost or removed implants There were 16 implants (5%) that failed during the follow- up period. The median time to failure after the initial LAPIP treatment was five months (range: one week to 31 months). Four implants were lost within the first month, six more by the first follow-up visit (five months), two at nine months, one at 18 months and three after two years of mainte- nance. One of the last was healthy but ordered extracted by the patient’s physician.

| research Fig. 6: Change in cross-sectional area of the defect as a percentage of the baseline area for seven implants from Group 1. Black circles = success. Case 4 is among the lost implant cases (Fig. 5). The pa- tient was an 81-year-old immunocompromised man with several medical conditions, including cardiovascular dis- ease and a drug-resistant systemic infection. An implant (Nobel Biocare Tapered; 5 × 13 mm) had been placed in position #46, and he was seen six months later with an aPD of 6.8 mm, bleeding at four sites, erythema and radio- graphic evidence of bone loss. At the five-month follow- up visit, bleeding had resolved, and the aPD was reduced to 5.5 mm, but there was still redness and suppuration. By the 18-month visit, the condition had deteriorated. The aPD had increased to 8 mm, and there was bleeding and suppuration. At that time, the patient received a second LAPIP treatment. At 30 months, one PD was 11 mm and the rest were 12 mm, and there was an increase in the ra- diographic size of the defect. A third treatment was per- formed, and the laser dose was increased to 305 J at Pass 1 and 180 J at Pass 2 for that treatment. However, the implant was finally removed 31 months after the first treatment. Change in radiographic density Radiographs from all 299 implants were reviewed to identify interproximal vertical defects at baseline indicat- ing bone loss. Many patients had panoramic radiographs of low resolution, and most bone loss was restricted to the buccal plate, which is not visible in transmission (peri- apical and panoramic) radiography. Only 21 cases were identified, and of these, ten provided measurable base- line and follow-up radiographs. Radiographic data re- flected a similar proportion of outcomes to the PD and clinical sign data. Out of the ten cases, one was from Group 3 (lost implant), two were from Group 2 (partial re- 14 2 2024 sponse) and seven were from Group 1 (successful cases). The cross-sectional areas of the seven successful cases were converted to a percentage of the baseline areas, and those values were plotted at their respective follow- up times (Fig. 6). The data fitted well to a decaying expo- nential function, y=e–0.1x, which suggested that regenera- tion approached 98% by 36 months. Discussion The LAPIP utilises the advantages of laser sulcular de- bridement (e.g. selective tissue removal, bacterial reduc- tion, haemostasis, minimally invasive method) and em- beds the laser components into a medically sound protocol that also includes implant debridement, occlusal adjustment, and detailed pretreatment and post-treatment procedures. Because of these additional therapeutic measures, the outcomes reported here may not be di- rectly comparable with those of many controlled laser studies. PD and clinical signs were analysed. Analysis of the short-term data from 116 patients with complete baseline and follow-up data determined that there was a statisti- cally significant reduction in PD and clinical signs at the first follow-up visit (median: 7.6 months) after a single treatment. The aPD was reduced by 2.0 mm (5.4 mm reduced to 3.4 mm, P < 0.001), and clinical signs of erythema, bleeding and suppuration were reduced by 78–85% (P < 0.001). A recent prospective controlled trial of ten patients who were treated with the LAPIP found similar results: a 1.9 mm PD reduction and decreased bleeding and suppuration.12 Several patients had follow-up visits after the short-term study had concluded. By the time of this long-term anal- ysis, there were 155 patients with 299 implants available to determine long-term survival and response to therapy. The initial survival rate was 94% at 13.1 months (15 were lost out of the 264 implants). The long-term survival rate matched and surpassed the previous results, being 95% at 28.8 months (16 of the 299 implants were lost). In the long term, PD remained ≤ 4 mm, and clinical signs re- mained absent for 68% of the 299 implants. An additional 11% were initially successful, but then presented with a relapse at about two years post-treatment. Sixteen per cent of the 299 implants never achieved success but re- mained intact at 22 months. The clinical healing curve indicated by the average rate of increase in radiographic density for successful cases demonstrated that, on average, bone fill is expected to be 25% complete by three months, 70% complete at one year, 90% complete by two years and 98% complete af- ter three years. It is important to note that this study only sampled interproximal defects, and the analysis may thus not accurately reflect changes to labial bone.

| case report Full-arch: Full rehabilitation of the upper jaw—Part 2 Literature Dr Dr Michael Rak, Norbert Wichnalek, Arbnor Saraci & Lukas Wichnalek, Germany The complete rehabilitation of a compromised residual dentition represents a major challenge in terms of implant treatment as well as function and aesthetics. In particular, there is great demand for fixed restorations that both achieve aesthetics and restore function. In addition, pa- tients are increasingly interested in biocompatible resto- rations and surgical concepts that take biological criteria into account. Biological dentistry employing metal-free implants and zirconia dentures can meet this demand ef- fectively. In the first part of this case report, we dealt with the diagnosis of the patient and the case’s special fea- tures, the preparation of the patient for surgery and the surgical procedures of tooth extraction and immediate implant placement.1 In this second part, the prosthetic restoration will be described. From Part 1, recall that the 41-year-old patient wanted a biologically neutral and metal-free comprehensive reha- bilitation of his compromised residual maxillary dentition and caries treatment of his mandibular teeth. In the max- illa, the patient retained tooth #17 and part of tooth #25, as well as the roots of teeth #13 and 15, and had a bridge replacing teeth #12 to 22. The remaining maxillary denti- tion had already undergone endodontic treatment and was not worth preserving. In the mandible, teeth #47, 45, 36 and 37 had carious lesions, and tooth #46 was devit- alised and decayed and showed extensive apical whiten- ing radiographically. The remaining mandibular teeth were vital. Moderate chronic periodontitis was diagnosed in both the maxilla and mandible. Prosthetic restoration The success of restoration is highly dependent on care- ful planning, requiring the exchange of information be- tween the dentist, patient and dental technician. Planning revolves around the following questions: What are the patient’s expectations? What is realistic and technically feasible? It is extremely important to involve the patient in the entire decision-making process; after all, it is the patient who will have to live with the finished work. Once all the important matters have been clarified, we first fab- ricate the planned prothesis as a prototype (temporary restoration) and then have everything checked in the mouth. 16 2 2024 1 2 3 Fig. 1: Prototype in situ after about three months of healing. Fig. 2: Com- pletely irritation-free gingiva with beautifully healed implants after about three months of healing. Fig. 3: Silicone impression of the situation with the tem- porary restoration removed.

| case report part of this article. Practice has shown us time and again that, despite immense technical, instrumental and computer- assisted effort, there is always a discrepancy between the appliance and the biomechanical system of hard and soft tissue. The true measure is in the patient’s mouth, not in the precise, mathematically calculated condylar paths and eccentric excursions of a virtual articulator. An occlusal restoration is always a compromise. Occlu- sion is not something that can be measured. Occlusion is something individual. Even at the beginning of articula- tion research, dental technology greats such as Dr Alfred Gysi, Rudolph L. Hanau and Dr Rudolf Thielemann rec- ognised that a biological system cannot be implemented on a mechanically and mathematically precise mastica- tion simulator. Carl Hildebrand, the founder of VITA Zahn- fabrik, said in the 1930s: “Occlusion cannot be under- stood from observation of the morphology of individual teeth but rather from the living structure (cybernetics) of the entire organism.”2 Following this guiding principle, we use our patient as the best articulator a dental technician could wish for. During the osseointegration of the im- plants, the prototype serves to record the eccentric movements manifesting in patient-specific wear facets, which we can then transfer directly to the final resto- ration. The dental practice scans the prototype in situ when the patient visits the practice for a check-up and follow-up care and sends the data obtained in this way to the laboratory for transfer of the wear facets directly to the final restoration. Follow-up appointment in the practice The patient came back to the practice after a healing pe- riod of around three months. After scanning the prototype, 4 Fig. 4: After replacement of the temporary restoration on the implants. Our focus is always on the whole person. Therefore, the patient’s posture and, most importantly, his or her com- fortable occlusion are central role to our approach. Par- ticularly with such a compromised residual maxillary den- tition, it is important to consider that the patient may have adapted to an incorrect occlusion over the years. We therefore check posture to determine whether we need to intervene therapeutically in advance with the help of splint therapy. We then discuss the patient’s wishes and select the desired tooth shape together. Based on all this information, we create a prototype in our laboratory that corresponds to the final restoration in terms of shape and design. The prototype in this case was made of acrylic based on the intra-oral scan of the patient with and without his existing bridge and a conven- tional fully adjustable articulator. From this data, we first generated a virtual wax-up, from which we also prepared the various surgical aids—the surgical guide and various transparent verification templates—as shown in the first 6 5 7 Fig. 5: Plaster model created based on the silicone impression. Fig. 6: Digitised model. Fig. 7: Design of the three bridges. 18 2 2024

| case report Fabrication of the final maxillary restoration We regard zirconia as a material with the greatest possi- ble benefit for the patient. Compared with conventional titanium implants, zirconia offers several advantages. One of the main advantages of implants made of zirconia is their excellent biocompatibility. Zirconia is considered hypoallergenic, making it an ideal choice for patients with metal sensitivity or allergies. Unlike titanium, zirconia does not trigger any adverse reactions in the body, ensuring a comfortable and stress-free dental implant experience. In addition, zirconia implants have remarkable resistance to corrosion and plaque build-up, reducing the risk of peri- implantitis. The non-porous surface of zirconia prevents the adhesion of bacteria, resulting in healthier gingivae and greater longevity of the implant.4 In order to avoid compromising the advantages of the zirconia implants placed, the dental team jointly decided on zirconia for the prosthetic restoration as well. Therefore, after receiving the data from the practice, we fabricated the final resto- rations in zirconia. Our laboratory has preferred mono- lithic restorations since 2005. The restoration was constructed as three bridges. This approach takes into account cranial respiration, ensuring that no pressure is exerted on the delicate masticatory and cranial bone system. Based on the silicone impres- sion, we produced a plaster model according to the usual procedure (Fig. 5). We scanned this and digitally de- signed the desired bridges (Figs. 6 & 7). In our approach, we always design all basal surfaces that rest on the gin- giva to be fully sealed from the outset. We then sent the data collected in this way to our milling centre, which sent us the three unprocessed milled bridges (Fig. 8). After the first firing, the advantages of the zirconia chosen (VITA YZ ST, VITA Zahnfabrik) were already evident from the impressive aesthetics (Fig. 9). The shade characteri- sation of the bridges was then carried out using the VITA AKZENT Plus stains. For even better aesthetics, addi- tional individualisation was carried out with the VITA YZ EFFECT LIQUID infiltration shades. After the final glaze firing, we polished the aesthetically important areas and all the areas that would be in contact with the gingiva to a high gloss like we usually do (Figs. 10 & 11). In our opin- ion, this creates a restoration that is supportive of gingival health, having the advantage of what is described in bi- onics as the lotus effect, which refers to the low wettabil- ity of a surface, as can be observed on the lotus plant. Water gathers on the leaves in spherical droplets or slides off the leaves, taking all dirt particles on the surface with it.5 In principle, this surface not only improves aesthetics, but also reduces plaque adhesion to the restoration, pro- motes long-term stability and reduces abrasion on the 14 16 Figs. 14–17: Final restorations in place. 20 2 2024 15 17

| case report contact Dr Dr Michael Rak Practice for biological dentistry, environmental dentistry & ceramic implantology Wettersteinstraße 9 82347 Bernried on Lake Starnberg Germany +49 8158 2656 info@praxis-dr-rak.de www.praxis-dr-rak.de Dr Dr Michael Rak Dental technology Norbert Wichnalek Arbnor Saraci Lukas Wichnalek Hochfeldstraße 62, 86159 Augsburg, Germany +49 821 571212 info@wichnalek-dl.de www.highfield.design Norbert Wichnalek Arbnor Saraci Lukas Wichnalek about the authors Dr Michael Rak qualified as a dentist from Heidelberg Univer- sity in 2008 and then went on to study human medicine at LMU Munich, both in Germany, and in 2014 gained his licence to prac- tise medicine. While still studying human medicine, he completed his dentistry residency at Dr Georg Hägler’s practice for oral and 23 Fig. 23: Patient delighted with the natural-looking aesthetics of the final res- toration. Conclusion In our opinion, this case demonstrates the impressive re- sults that are possible when the dentist, dental technician and patient work together and all the tools available to us are used at the appropriate time. We regard disinfection using plasma as essential, whether during implant place- ment or in the fabrication of restorations. The cleaner the materials used, the more healthy tissue is supported and the lower the risk of contamination of the materials jeop- ardising the longevity of the entire implant–restoration system. 24 Fig. 24: Final radiograph. 22 2 2024

| case report Straumann Pro Arch with BLT implants in a periodontal patient with hopeless dentition: A five-year follow-up Dr Amin Motamedi, Iran Nowadays, patients are not merely concerned with the functionality of their dentition, but aspire for natural aes- thetics and predictable results. Consequently, the com- prehensive rehabilitation of edentulous patients has emerged as a critical challenge, needing a fusion of di- verse dental specialties, advanced technologies, and innovative treatment modalities. 1 2 Fig. 1: Initial intra-oral situation. Fig. 2: Mandibular occlusal view after scaling and root planing. 24 2 2024 Full-arch fixed dental prostheses present high survival and success rates. In recent years, several clinical stud- ies and systematic reviews have demonstrated that the early and immediate functional loading of dental implants can be as effective as conventional loading protocols.1, 2 Immediate loading of dental implants offers various ad- vantages, including time-savings, enhanced aesthetic and occlusal function, elimination of the need for provi- sional removable prostheses, avoidance of secondary surgical procedures and preservation of the residual al- veolar ridge.3 The following case report demonstrates the successful management of a patient with a hopeless dentition and the desire for a long-term fixed solution. Through peri- odontal and orthodontic treatment and implant-supported rehabilitation with four Straumann Tissue Level implants in the maxilla and six Straumann Bone Level Tapered (BLT) implants in the mandible, we fulfilled her expecta- tions. The interdisciplinary approach employed in this clinical scenario reflects the collaborative synergy be- tween dental professionals, each contributing their ex- pertise to create a customised treatment plan that re- newed not only the patient’s smile but also her confidence and quality of life. Initial situation A 67-year-old female patient without any relevant medical history came to the clinic seeking a solution for her oral health concerns. She stated that for as long as she could remember she had been experiencing feelings of embar- rassment about her mouth. Her ongoing struggles with bleeding gingivae and mobile teeth had significantly hin- dered her ability to eat and smile confidently. She ex- pressed her desire for fixed rehabilitation of her failing dentition and emphasised her inability to tolerate tradi- tional removable complete dentures at any treatment step.

| case report 3 4 Fig. 3: Panoramic view: severe bone loss in the anterior mandible. Fig. 4: Right side 3D CBCT view: severe bone loss in the anterior mandible and posterior maxilla. The intra-oral examination revealed inadequately treated teeth and dentition with a mostly poor prognosis in terms of preservation and pros- thetic restoration. In the maxilla, she presented with two metal–ceramic bridges from tooth #16 to tooth #14 and from tooth #24 to tooth #27, and the abutment teeth presented with mobility and cervical caries. The mandible presented with deep periodontal pockets, active infection, mobility, suppuration and bleeding on probing, especially regarding tooth #42, and only the root of tooth #36 remained (Figs. 1 & 2). The radiographic assessment showed moder- ate bone resorption around the maxillary anterior teeth and bone loss around the abutment teeth. In the lower jaw, severe alveolar bone resorption was observed, particularly in the anterior around tooth #42 (Figs. 3 & 4). According to the Interna- tional Team for Implantology’s SAC classifica- tion, the patient case was categorised as com- plex in terms of the surgical classification and advanced in terms of the prosthodontic classifi- cation (Fig. 5). Treatment planning Through a comprehensive discussion of the available treatment options with the patient, it was determined that a comprehensive peri- odontal treatment would be carried out in the upper jaw, and all the mandibular teeth would be extracted. Immediately thereafter, BLT im- plants using the Straumann Pro Arch system would be placed. 5 Fig. 5: ITI SAC classification tool indicates high surgical and medium prosthetic com- plexity. 6 Fig. 6: Periodontal therapy in the maxilla including root planing, GTR, and soft-tissue grafting. 26 2 2024

| case report 7 8 9 10 Fig. 7: Bone reduction due to severe alveolar bone destruction. Fig. 8: Placement of six Straumann® BLT implants with optimum anterior posterior distribution to ensure an optimal force distribution. Fig. 9: A minimum of 2 mm buccal bone thickness to create stable long-term bone around implants. Fig. 10: Tension-free softtissue closure by periosteal releasing and apical mattress sutures. 28 2 2024 The treatment workflow included: 1. full-mouth scaling and root planing and oral hygiene instructions; 2. periodontal surgery and soft-tissue grafting of the maxillary anterior teeth; 3. orthodontic treatment of the maxillary anterior teeth; 4. implant placement in the posterior maxilla; 5. extraction of the mandibular teeth; 6. prosthetic and aesthetic analysis; 7. preparation of a provisional mandibular full-arch prosthesis; 8. preparation of an analogue implant insertion guide; 9. immediate implant placement and bone aug- mentation in the mandible; 10. immediate loading of the mandibular implants; 11. placement of the final monolithic zirconia screw- retained prostheses; and 12. supportive periodontal therapy (every three to four months). Surgical procedure Initially, the patient was scheduled to undergo a comprehensive periodontal treatment regimen that included oral hygiene instructions, scaling and root planing, and regular follow-up evaluations. Clini- cally, significant improvements were noted in oral hygiene, gingival health and periodontal pocket depths. Subsequently, periodontal therapy was performed in the maxilla, including root planing, guided tissue regeneration and soft-tissue grafting (Fig. 6). As the patient also expressed a desire for enhanced aesthetic outcomes, it was decided to improve the alignment of the maxillary teeth through orthodontic treatment before implant placement in the maxilla. In the maxillary arch, two 4.1 × 12.0 mm Straumann Tissue Level implants and two 4.8 × 10.0 mm Straumann Tissue Level implants were surgically positioned in regions #16, 14, 24 and 26. After this, under local anaesthesia, a mucoperiosteal flap was elevated, and an atraumatic extraction tech- nique was employed to remove all the mandibular teeth with the aim of preserving the soft and hard tissue and minimising any potential trauma. Fur- thermore, reduction of the crestal alveolar bone was carried out using a straight surgical handpiece with copious sterile saline irrigation to address the significant bone deficiency, thereby augmenting the available bone volume to optimise the place- ment of dental implants (Fig. 7). The same day, a thorough prosthetic and aesthetic analysis was conducted for the fabrication of the immediately loaded fixed mandibular full-arch prosthesis, along

| case report 15 16 Fig. 15: Three years follow-up panoramic view demonstrates stable periodontal and peri-implant bone. Fig. 16: Three years follow-up shows healthy, stabIe soft tissue and prosthesis. At the three-year follow-up, the periodontal and peri- implant bone was stable, demonstrating the long-term success of the initial treatment (Figs. 15 & 16). After five years, clinical and radiographic examination of the im- plant rehabilitation were carried out and demonstrated the continued long-term success of the initial treatment (Fig. 17). for any practice. The Straumann Pro Arch workflow offers a more predictable and simplified approach with a proper anterior–posterior distribution that pro- vides optimum force distribution and also, for your patients, reliability, com- fort and compliance for an excellent long-term result.” Literature Treatment outcomes Utilisation of BLT implants following the Straumann Pro Arch concept in a patient with compromised periodontal health delivered exceptional results, including the health of both soft and hard tissue, functional improvement and enhanced aesthetics. This system allowed for immediate implant loading and successful osseointegration. The pa- tient was satisfied with the results. Author’s testimonial “Full-arch immediate implant restorations in patients with advanced periodontal deterioration can be challenging about the author Dr Amin Motamedi holds a DDS and an MSc in periodontics from Shahid Be- heshti University of Medical Sciences in Tehran in Iran and completed the fellow- ship in laser therapy in dentistry at the Aachen Dental Laser Center in Germany and the master clinician programme in implant dentistry at the Global Institute for Dental Education in Los Angeles in the US. He is a fellow of the International Team for Implantology and served as the chair of and postgraduate programme director in the periodontics department at the dental school of Kerman University of Medical Sciences in Iran. He runs his own specialist practice in Kerman. 17 Fig. 17: Stable periodontal and peri-implant bone at five years follow-up pan- oramic view. contact Dr Amin Motamedi Dental and Implant Clinic Kerman, Iran +98 34 32470628 www.motamediclinic.com Dr Amin Motamedi 30 2 2024

| interview m o c . e b o d a . k c o t s – l o p i t t i S © Big data in implant dentistry— “We are standing at the beginning” An interview with Prof. Arjan Vissink on the current state of big data in implant dentistry Big data and artifi cial intelligence in implant dentistry have become signifi cant topics in contemporary discus- sions. In this interview, Prof. Arjan Vissink, a renowed oral and maxillofacial surgeon from the Faculty of Medical Sciences of the University of Groningen in the Nether- lands, provides an insightful exploration of this subject. He delves into the current state of big data in implant dentistry, its future uses and its challenges. Prof. Vissink, what possibilities does big data offer in dentistry right now, and what does the future hold? Very few studies have used big data in im- plant dentistry. We are standing at the be- ginning. Not much can be said yet of the impact of observations from big data in implant dentistry with regard to diagnos- tics, risk profi les and prognosis. So far, there has only been cursory study done in this area. Some aspects explored include implant type and diameter used (irrespec- tive of the brand), indication and applica- tion, for example immediate or delayed loading, and whether bone augmentation was needed, in addition to general health perspectives, such as smoking, diabetes, immunological diseases, radiotherapy in the head and neck region, and bisphos- phonates, with regard to overall implant survival. It has also been investigated whether an oral surgeon or perio- dontist has a better implant outcome, but the indications for implant placement were not assessed. Whether im- plants are good solutions in elderly patients has also been studied, specifi cally for supporting prosthetic resto- rations and how underlying diseases could compromise the outcome in this situation. The data reported so far is not suffi ciently robust to guide decision-making. Technical innovations are being developed faster than ever before. When will big data be more commonly used in dental practice? At the moment, there is no direct use of the results of big data studies in implant dentistry for daily dental prac- tice. Only very rough overall data is available, and it is not tailored to the individual patient. There is no data available on immediate or de- layed placement, immediate or de- layed loading, one- or two-stage procedures, or when an implant site should be considered com- promised, etc. We should fi rst be- gin to better record implant proce- dures, restorations, procedures used in the upper and lower jaw, situations that necessitate bone regeneration, the implant platform used and more. From such data, better general conclusions could be drawn, and eventually, better recommendations for the individ- ual patient could be made. Al- though innovations are evolving rapidly, it will be quite some time before the dental prac- tice and the individual patient in particular will benefi t from these achievements. Can you share some tips for dental professionals who want to get more involved with artifi cial intelli- gence and the use of big data? 32 2 2024

| industry* Commitment to safety Celebrating extended and new Trusted Quality seals awarded by the CleanImplant Foundation © CleanImplant Foundation . i i m a e t l a i r o t i d e e h t f o n o n p o e h t t c e fl e r t o n o d d n a s r o t u b i r t s d r o s r e r u t c a f u n a m e h t y b d e d v o r p e r a y r o g e t a c s h t n i s e c l i i i i t r a e h T * More and more implant manufacturers recognise the value that the CleanImplant award brings to practitioners and their patients. The plethora of implants available from an increasing number of companies brings into question whether a uni- versal standard of quality in production and packaging exists for surface cleanliness. This presents as a conun- drum for dentists worldwide regarding their choice of fi x- ture to provide optimal patient care. The increased inci- dence of peri-implantitis warrants a revisiting of critical thinking as to its source. The presence of surface con- taminants is recognised as a contributing factor of the sequelae of biological complications that can occur. Receipt of the Trusted Quality seal awarded by the CleanImplant Foundation after rigorous peer- reviewed analysis and testing refl ects a manufacturers’ commitment to ensuring surface clean- liness, a possible X factor in failed osseointegration. The Trusted Quality seal remains in place for a two-year cycle after which the implant must be retested to re-establish its surface cleanliness status determined within the framework of the CleanImplant consensus-based guideline. “After rigorous and exten- sive testing, we are pleased to extend the CleanImplant Quality seal for an additional two years to the products from Swiss Dental Solution from Switzerland and Ger- man manufacturer medentis medical, BTI from Spain and the Korean producer MegaGen”, Dr Dirk U. Duddeck, Founder and Head of Research at CleanImplant pointed out. “The implant UnicCa from BTI and MegaGen’s AnyRidge System went through a fourth re-evaluation process for which they were awarded the special CleanImplant award for “Long- Term Proven Excellence” 34 2 2024

| industry* Insights in modern dentistry Making implantology simple with the MIS digital workfl ow MIS digital workfl ow for conical connection implants. Digital workfl ows connect the dots in modern dentistry by merging several connected procedures into one com- plete treatment. The harnessing of digital tools facilitates accurate diagnosis and treatment planning, signifi cantly improving patient outcomes and clinical effi ciency. Being part of Dentsply Sirona, MIS Implants Technologies is uniquely positioned to offer its customers comprehensive digital workfl ows, combining MIS solutions with the latest Dentsply Sirona equipment and materials. MIS has been investing in digital solutions for many years, and the company has watched with enthusiasm as its digital workfl ow has been adopted by clinicians around the world. The workfl ow incorporates digital imaging, intra-oral scanning, guided surgery and CAD/CAM tech- nologies designed to enhance every step of the treatment process. According to Orit Kario, digital solutions prod- uct manager at MIS, the aim is to simplify treatment for clinicians, laboratories and patients through seamless communication and data transition. MIS offers workfl ows for single-tooth, partial-arch and full-arch procedures that are tailored to general dentists and specialists and the setting, whether chairside or lab- oratory. They include implant-level and tissue-level solu- tions and enable implant-to-crown procedures. For example, the company’s workfl ow for conical con- nection implants begins with a Primescan intra-oral scan and effi cient prosthetically driven MSOFT planning, as- sisted by the MCENTER team, which provides compre- hensive digital dentistry services and detailed surgical plans. In the surgical step, bone augmentation is done with the use of OSSIX biomaterials, and clinicians benefi t from the advantages of the unique MGUIDE surgical guides. The C1 implant and MIS CONNECT stay-in abut- ment provide primary and long-term stability and offer the ability to maximise tissue-level restoration, and the use of a computer-guided approach contributes to the reduction of patient visits, treatment steps and correc- tions. For fi nal restoration, MIS customers are offered a wide range of implant-level and tissue-level digital pros- thetic solutions, all implemented in leading CAD software. Kario said that being a Dentsply Sirona company allows MIS to offer clinicians signifi cant advantages. She ex- plained: “MIS can offer its customers a complete digital workfl ow that incorporates the MIS guided surgery system, the unique implant connections and the com- prehensive digital prosthetic line, in combination with Dentsply Sirona equipment and materials, all under one roof. We believe that providing tools of this quality strengthens the brand and contributes to customer trust.” What can clinicians and laboratories gain from adopting the digital workfl ow? Kario emphasised: “Digital work- fl ows address procedural challenges that impact clinical effi ciency, may improve profi t potential and drive actual practice growth.” To learn more, visit www.mis-implants.com/products/ digital-workfl ow. contact MIS Implants Technologies P.O. Box 7 Bar Lev Industrial Park 2015600 Israel info@mis-implants.com www.mis-implants.com 36 2 2024 . i i i m a e t l a i r o t i d e e h t f o n o n p o e h t t c e fl e r t o n o d d n a s r o t u b i r t s d r o s r e r u t c a f u n a m e h t y b d e d v o r p e r a y r o g e t a c s h t n i s e c i i l i t r a e h T *

| events* Long-awaited Digital Dentistry Show to premiere in Berlin in June 2024 Fig. 1: The Badeschiff is a picturesque fl oating public swimming pool area overlooking the Spree river. Fig. 2: The Escobar is an extension of the Badeschiff that includes a covered bar area. Now is an exciting time for dentistry. Technological in- novations lie at the heart of the profession and are signifi - cantly advancing personalised dental care. To provide a platform to celebrate digital innovations in the fi eld and educate the dental team, DDS.Berlin has collaborated with the Digital Dentistry Society, and they are bringing a highly immersive experience to the capital of Germany— the Digital Dentistry Show. Scheduled for 28 and 29 June 2024 at the Arena Berlin, the event promises to deliver engaging educational and social opportunities with a special focus on digital products and the digital workfl ow in dentistry. Through live product presentations, workshops, discus- sion sessions and an exhibition, the 2024 Digital Dentistry Show seeks to provide attendees with fi rst-hand knowl- edge of digital dental products and services and to offer space for personalised ad vice and face-to-face interac- tions with industry leaders. With the focus on robust re- search evidence, the scientifi c programme will feature presentations by prominent opinion leaders, including Drs Henriette Lerner, Alessandro Cucchi, Raquel Zita Gomes, Paul Schuh and Marcus Engelschalk, and cover a wide range of topics, such as artifi cial intelligence, the digital workfl ow in maxillofacial surgery and full-arch re- habilitation, and digital bone surgery. Attendees will have the opportunity to earn up to 16 continuing education credits. Besides a strong educational aspect, the 2024 Digital Dentistry Show will serve as a social hub for dental ex- perts, professional organisations, manufacturers and publishers who are looking to form or expand their net- work of like-minded, future-oriented individuals. To be hosted at one of Berlin’s industrial pearls, the unique event location offers a rich history and a distinctive mod- ern feel. The adjacent Escobar and the Badeschiff spaces will enhance the relaxed and jovial atmosphere, under- lining the informal and engaging nature of the show. The 2024 Digital Dentistry Show is expected to attract over 2,000 eminent dental professionals from around the world. You are invited to be one of them! More information on registration and the scientifi c pro- gramme can be found at www.dds.berlin. Admission to the event is free of charge. Fig. 3: Attendees will also have access to the Sonnendeck of the Escobar, where they will be able to enjoy delicious food and drinks. contact DDS.Berlin Event info@dds.berlin www.dds.berlin 38 2 2024 . i i i m a e t l a i r o t i d e e h t f o n o n p o e h t t c e fl e r t o n o d d n a s r o t u b i r t s d r o s r e r u t c a f u n a m e h t y b d e d v o r p e r a y r o g e t a c s h t n i s e c i i l i t r a e h T *

| news Statement on the decision of the Berlin Regional Court regarding two-piece ceramic implants In its ruling dated 6 June 2023 (case reference: 24 O 184/21), the Berlin Regional Court (LG) made a determi- nation that diverged from the expert opinion procured, refusing to acknowledge the medical necessity of treat- ment involving two-piece ceramic implants. Conversely, the Ulm Regional Court, in its judgement of 28 July 2023 (Ref.: 3 O 75/22), affi rmed the medical necessity based on the expert testimony presented. A task force convened by the DGZI, comprising Dr Elis- abeth Jacobi-Gresser, board member and continuing education offi cer, along with Assoc. Prof. Dr Stefan Röh- ling, board member, and including specialist lawyer for medical law and certifi ed compliance offi cer Anja Mehling and Dr Alexander Raff, dentist and editor of the dental fee commentary Liebold/Raff/Wissing, unequivocally asserts its position on this matter. In response to the Berlin Regional Court’s decision of 6 June 2023, the Implantology Consensus Conference (KK) issues the following joint statement: “Two-piece ceramic implants fulfi l the criteria of a medically neces- sary treatment modality provided that the same stan- dards applied to titanium implants are adhered to during implant planning and indication determination.” Evidence supporting two-piece ceramic implants Two-piece ceramic implants have emerged as a viable alternative to titanium implants, demonstrating equiva- lency in restoration while offering superior biocompati- bility. Notably, they exhibit reduced bacterial adhesion 1 2 3 Fig. 1: Dr Elisabeth Jacobi-Gresser, Member of the Board Fig. 2: Assoc. Prof. Dr Stefan Röhling, Member of the Board Fig. 3: Anja Mehling, specialist lawyer for medical law and and advanced training offi cer of the DGZI. of the DGZI. certifi ed compliance offi cer. 40 2 2024

| about the publisher Congresses, courses and symposia implants FDI World Dental Congress 12–15 September 2024 Istanbul, Turkey www.fdiworlddental.org National Osteology Symposium 26–28 September 2024 Paris, France osteology.org IAO-EAO-SIdP Joint Meeting 24–26 October 2024 Milan, Italy congress.eao.org/milan/en/ 53rd International Annual Congress of DGZI 8–9 November 2024 Düsseldorf, Germany www.dgzi.de French Dental Association Annual Meeting 26–30 November 2024 Paris, France adfcongres.com/en/homepage/ Imprint Publisher Torsten R. Oemus oemus@oemus-media.de Board Ingolf Döbbecke doebbecke@oemus-media.de Lutz V. Hiller hiller@oemus-media.de Torsten R. Oemus oemus@oemus-media.de Chairman Science & BD Jürgen Isbaner isbaner@oemus-media.de Chief Editorial Manager Dr Torsten Hartmann (V. i. S. d. P.) hartmann@dentalnet.de Editorial Council Dr Rolf Vollmer info.vollmer@t-online.de Dr Georg Bach doc.bach@t-online.de Dr Suheil Boutros SMBoutros@aol.com Editorial Management Dr Alina Ion a.ion@oemus-media.de Executive Producer Gernot Meyer meyer@oemus-media.de Product Manager Timo Krause t.krause@oemus-media.de Art Director Alexander Jahn a.jahn@oemus-media.de Designer Aniko Holzer a.holzer@oemus-media.de Customer Service Lysann Reichardt l.reichardt@oemus-media.de Published by OEMUS MEDIA AG Holbeinstraße 29 04229 Leipzig, Germany Phone: +49 341 48474-0 Fax: +49 341 48474-290 kontakt@oemus-media.de Printed by Silber Druck GmbH & Co. KG Otto-Hahn-Straße 25 34253 Lohfelden, Germany implants— international magazine of oral implantology is published in cooperation with the German Association of Dental Implantology (DGZI). DGZI DGZI Central Offi ce Paulusstraße 1 40237 Düsseldorf, Germany Phone: +49 211 16970-77 Fax: +49 211 16970-66 offi ce@dgzi-info.de www.dgzi.de www.oemus.com www.implants.de Copyright Regulations implants—international magazine of oral implantology is published by OEMUS MEDIA AG and will appear with one issue every quarter in 2024. The magazine and all articles and illustrations therein are protected by copyright. Any utilisation without the prior consent of editor and publisher is inadmi ssible and liable to prosecution. This applies in particular to duplicate copies, translations, microfi lms, and storage and processing in electronic systems. Reproductions, including extracts, may only be made with the permission of the publisher. Given no statement to the contrary, any submissions to the editorial department are understood to be in agreement with a full or partial publishing of said submission. The editorial department reserves the right to check all submitted articles for formal errors and factual authority, and to make amendments if necessary. No responsibility shall be taken for unsolicited books and manuscripts. Articles bearing symbols other than that of the editorial department, or which are distinguished by the name of the author, represent the opinion of the aforementioned, and do not have to comply with the views of OEMUS MEDIA AG. Responsibility for such articles shall be borne by the author. Responsibility for advertisements and other specially labeled items shall not be borne by the editorial department. Like- wise, no responsibility shall be assumed for information published about associations, companies and commercial markets. All cases of consequential liability arising from inaccurate or faulty representation are excluded. General terms and conditions apply, legal venue is Leipzig, Germany. 42 2 2024

Y R T S I T N E D F O E R U T U F E H T G N I L I E V N U O H S Y R T S I T N E D L T I G I D 28 & 29 JUNE 2024 DIGITAL DENTISTRY SHOW E N R Register at www.dds.berlin Digital Dentistry Show In collaboration with Digital Dtit it U N V E I L I N G T H E F U T U R E O F D E N T I S T R Y