Starget 01/2010 by straumann webmaster

STARGET

01 I 2010

MAGAZINE FOR CUSTOMERS AND PARTNERS OF STRAUMANN

FOCAL POINTS 1 Million SLActive®: the success story of Straumann‘s premium implant surface IPS e.max® CAD restorations by Straumann® CADCAM: a highly esthetic solution for single tooth replacement and restoration New products: Roxolid™ – Straumann® Temporary Abutment Discussion topic “Cheap Implants“: why the Straumann® Dental Implant System is a premium brand Practice benchmarking: discovering and developing unutilized potentials for your practice Straumann and ITI: a high-quality international education program ITI World Symposium 2010 in Geneva: ”30 Years of Leadership and Credibility”

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TABLE OF CONTENTS Internet: www.straumann.com/starget or your specific country website www.straumann.(xy)/starget

03 Editorial

FOCAL POINTS SLActive® 04 Bone regeneration at Bone Level implants with SLActive® surface by F. Schwarz, D. Ferrari, M. Wieland and J. Becker 09 SLActive® launched in South Korea 10 Success story of the premium implant surface SLActive®

Products

Simply doing more

26 Exchanging first experiences with the Straumann® Anatomic IPS e.max® Abutment

46 Why the Dental Implant System is a “premium” solution

28 Straumann® Temporary Abutments

53 “Quality and service come at a price” Interview with Sandro Matter

30 New packaging for nonsterile packaged components 32 Expert opinion on the study by Holger Zipprich et al. 35 Bone Level Implant launched in Brazil

IPS E.MAX® CAD RESTORATIONS BY STRAUMANN® CADCAM Clinical Cases 12 IPS e.max CAD restorations by Straumann® CADCAM ®

14 The Straumann® CADCAM Solution

Roxolid™ 18 Roxolid™ – a new material designed for the specific needs of implant dentistry 22 Reduced-diameter implants as a treatment alternative in risk patients to avoid augmentation procedures by Hannes P. Schierle, Hans O. Werner, Franziska Nagel

36 Synergies for clinical success with an osteoconductive implant surface and bone replacement graft, a novel implant-abutment connection and meticulous occlusal therapy by Barry P. Levin 41 Regeneration of a periodontal defect with Emdogain and a Soft Tissue Level Implant with SLActive® surface, in combination with BoneCeramic by Marlene Teo and Joanne Uy

55 Discovering and developing unutilized potentials for your practice 58 Literature alerts

Education 62 Straumman and ITI: International education program at a high level

Events 64 ITI World Symposium 2010 in Geneva 72 Annual Meeting of the AO in Orlando 74 AEEDC Congress in Dubai 76 Annual Conference of the EAO in Monaco 78 Events overview 2010

Imprint: STARGET – An International Magazine for Customers and Partners of Straumann I © Institut Straumann AG I Peter Merian-Weg 12 I CH-4002 Basel I Phone +41 (0)61 965 11 11 I Fax +41 (0)61 965 11 01 I Editors: Roberto González I Mildred Loewen I E-Mail: starget@straumann.com I Internet: www.straumann.com/starget I Appearance: 4 times per year I Layout/Design: EMS & P Kommunikation GmbH, www.ems-p.com I Printing: Dietschi AG I Hauptstrasse 22 I CH-4437 Waldenburg Legal Notice: Exclusion of liability for articles by external authors: articles by external authors published in STARGET have been systematically assessed and carefully selected by the publisher of STARGET (Institut Straumann AG, Basel). Such articles in every case reﬂect the opinion of the author(s) concerned and therefore do not necessarily coincide with the publisher’s opinion. Nor does the publisher guarantee the completeness or accuracy and correctness of articles by external authors published in

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EDITORIAL Wolfgang Becker Senior Vice President Central Europe

Dear readers,

In our sector, the name Straumann stands for genuine and scientifically well-grounded innovations that set standards and open up new possibilities in implant-supported restorations. Even upon its introduction to the market at the EAO 2005 in Munich, the outstanding osseointegrational properties of SLActive® could be confirmed by numerous studies. Over a million Straumann implants with the SLActive® surface have been sold since then – proof for us that the experts could be convinced. The next major milestone in the story of Straumann products was now presented at the EAO 2009 in Monaco: Roxolid™, the implant material developed specially for the needs of dental implantology. The 3.3 mm diameter Roxolid™ implants may enable an implant-borne restoration even in patients who would otherwise decide against an implant treatment because of a deficiency of available bone and the associated need for augmentation. With Roxolid™ the user can thus reach new groups of patients through timesaving, more cost-effective and less invasive solutions. And finally, in collaboration with Ivoclar Vivadent AG, Straumann now provides an impressive solution for single tooth restorations with the new “IPS e.max® CAD Restorations by Straumann® CADCAM“.

Another topic that concerns our sector is the discussion of the usefulness and benefits of cheap implants. In this edition, we would like to illustrate what Straumann as a premium provider invests and achieves in order to further develop implant dentistry on a scientific foundation, while continuously increasing treatment safety for patients. We also look at the risks that can result from using cheap implants. I hope you find it an interesting read. Sincerely, Wolfgang Becker

STARGET. The information given in clinical case descriptions, in particular, cannot replace a dental assessment by an appropriately qualiﬁed dental specialist in an individual case. Any orientation to articles published in STARGET is therefore on the dentist’s responsibility. Articles published in STARGET are protected by copyright and may not be reused, in full or in part, without the express consent of the publisher and the author(s) concerned. Third party corporate names and brand names that may be mentioned may be registered or otherwise protected marks even if this is not specially indicated. The absence of such an indication shall not therefore be interpreted as allowing such a name to be freely used. Product availability: Certain products and services mentioned in this edition of STARGET may not be available or not yet available in all countries. In case of doubt please contact your local Straumann distributor for information on product availability (addresses of Straumann branches can be found on page 83).

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04 STARGET 1 I 10

SLACTIVE®

FOCAL POINT

Bone regeneration at Straumann® Bone Level implants with SLActive® surface – histological and clinical experiences Department of Oral Surgery, Heinrich Heine University, Düsseldorf, Germany 2 Institut Straumann AG, Basel, Switzerland 1

by F. Schwarz1, D. Ferrari1, M. Wieland2, J. Becker1

A recent review paper3 has summarized the potential of hydrophilic surface modifications (Straumann SLActive®) to support tissue integration of titanium dental implants.

Figures 1a–f: Influence of the defect size on bone regeneration at Straumann® Bone Level Implants with SLActive® surface (4.1 x 10 mm) after 4 weeks of submerged healing in dogs without the additional use of bone grafts or barrier membranes. White bar: indicates the bottom of the defect Yellow bar: indicates the most coronal extent of newly formed bone in contact with the implant surface

Fig. 1a: Defect length: 7–8 mm Percentage of linear defect fill: 65 % Toluidine blue stain (magnification x10)

Fig. 1b: Higher magnification (x30) of Fig. 1a

One part of this review paper focused on the pattern of wound healing at dehisced implants. In particular, previous experimental studies performed in dogs have demonstrated that Straumann® Soft Tissue Level implants with SLActive® surface supported bone regeneration in acute-type buccal dehiscence defects at submerged implants without the additional use of guided bone regeneration or bone augmentation procedures.4 At two weeks, newly formed trabeculae of woven bone, originating from both the lateral walls and the bottom of the defect areas, started to invade the

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dehiscence area. After 12 weeks, SLActive® implants were surrounded by firmly attached, parallel-fibered woven bone. The newly formed buccal aspects of the ridge reached the level of the corresponding oral aspects. In contrast, wound healing at SLA® implants was predominantly characterized by the formation of dense connective tissue at two and 12 weeks, without significant increases in mean new bone height or bone-to-implant contact.4 Similar results were also observed at non-submerged Soft Tissue Level® implants with SLActive®.5 In particular, immunohistochemical analysis

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FOCAL POINT

SLACTIVE®

Fig. 1c: Defect length: 8–9 mm Percentage of linear defect fill: 54 % Toluidine blue stain (magnification x10)

Fig. 1d: Higher magnification (x30) of Fig. 1c

Fig. 1e: Defect length: 10 mm Percentage of linear defect fill: 57 % Toluidine blue stain (magnification x10)

after 1 week of healing in dogs revealed pronounced proliferation of blood vessels adjacent to SLActive® implants, even reaching the central compartment of the defect area. In contrast, at SLA® implants, the primary meshwork of newly formed vascular structures was located at the bottom and lateral aspects of the defect area. Histological and immunohistochemical observations have pointed to greater stabilization of the blood clot at SLActive® implant surfaces, thus promoting the in-growth of new blood vessels from the adjacent alveolar bone. Basically, the blood

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clot acts as a physical matrix that induces and amplifies the migration, proliferation and differentiation of endothelial cells, subsequently leading to improved angiogenesis.6 Osteogenic cells have also been observed to arise from pericytes adjacent to small blood vessels in connective tissue,7–9 thus explaining the improved bone formation at SLActive® implants. At 8 weeks, non-submerged and submerged SLActive® implants revealed significantly higher mean values of new bone height, area of bone formation, and bone-to-implant contact than corresponding SLA® implants.

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Fig. 1f: Higher magnification (x30) of fig. 1e

However, within the SLActive® groups, bone regeneration was significantly improved at submerged implants.5 Accordingly, it was concluded that SLActive® titanium implants supported bone regeneration in acute-type buccal dehiscence defects, and a submerged healing process further improved the healing outcome.5 A similar pattern of bone regeneration was also observed when Soft Tissue Level® implants with SLActiveâ were combined with different types of barrier membranes or bone substitutes.10,11 Blood vessels and the

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Figures 2a–l: Clinical outcome of guided bone regeneration at Straumann® Bone Level implants with SLActive® surface.

Fig. 2a: Clinical situation 6 weeks after extraction of teeth 12 and 22

Fig. 2b: Compromised implant site in region 012. The vestibular bone plate was almost completely resorbed.

Fig. 2c: The correct three-dimensional positioning of a Straumann® Bone Level Implant (Ø 4.1, SLActive® 10 mm) was associated with a large buccal dehiscencetype defect.

Fig. 2d: Guided bone regeneration using a collagen membrane and particulate natural bone mineral.

subsequently formed woven bone invaded the defect area in a coronal direction, primarily along the surface of SLActive® implants. Recently, the Straumann® Bone Level Implant was introduced as a two-part implant to support bone preservation for predictable esthetic results.12,13 Its specific macrodesign coupled with the SLActive® surface might provide a promising environment to support bone regeneration even at advanced defect sites as observed with Straumann® Soft Tissue Level implants with SLActive®. Accordingly, the aim of a very recent experimental pilot study performed in dogs was to assess the influence of the defect size on bone regeneration at Straumann® Bone Level implants with SLActive®. Standardized (width: 4 mm; depth: 1–2 mm) buccal dehiscence-type

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defects of different sizes (i.e. height: 7–8 mm; 8–9 mm; and 10 mm) were surgically created following implant site preparation in the lower jaws of dogs. After 4 weeks of submerged healing without the additional use of bone graft substitutes or barrier membranes, dissected blocks were processed for histomorphometrical analysis (i.e. coronal extent of newly formed bone in contact with the implant surface, area of new bone fill, percentage of bone-to-implant contact in the defect area, and percentage of linear defect fill). In general, wound healing was regarded as uneventful at all sites. There were no signs of any wound infections or dehiscences. Irrespective of the initial defect size, histomorphometrical analysis revealed a significant increase of all parameters investigated. The mean percentage

of linear defect fill varied between 54 and 65 %. In all specimens, the newly formed woven bone extended along the bottom of the defect in a coronal direction and showed close contact to the titanium surface (Figs. 1a–f). These values were within the range of the data reported for either non-submerged/ submerged Straumann® Soft Tissue or Bone Level implants with SLActive® (Table 1). In these studies, however, the defects had a moderate height of 4 mm. Based on these findings, it might be suggested that Bone Level® implants with SLActive® surface have a high potential to support bone regeneration even at advanced buccal dehiscence-type defects. Even though the surgical creation of standardized defects in dogs is a commonly used model to evaluate bone regenera-

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FOCAL POINT

Fig. 2e: Double layer technique to increase the stability of the barrier membrane.

Fig. 2f: Tension-free wound closure to ensure a submerged healing process.

tion at titanium implants, acute-type defects have a certain tendency to spontaneous healing. Accordingly, from a clinical point of view, the defect model employed in these animal studies on SLActive® implants may not reflect the biological situation encountered at chronic-type defects. So far, however, clinical experience suggests that a combination of Straumann® Bone Level implants with SLActive® and simultaneous guided bone regeneration provides a high level of predictability to support hard tissue formation even at advanced defect sites (Figs. 2a–l). These findings are also in agreement with the results obtained previously with Straumann® Soft Tissue Level implants with SLActive® surface.

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SLACTIVE®

Fig. 2g: Clinical situation after 4 months

Fig. 2h: Re-entry at 4 months revealed complete defect fill with newly formed hard tissue. The implant neck was homogeneously covered by a thick (2mm) layer of mineralized tissue.

Defect Heigth (Healing Period) Implant Type

SLActive®

SLA®

4 mm (2 weeks)4

Tissue Level

34.0 – 80.0 %

0.0 %

4 mm (4 weeks)

Tissue Level

69.5 – 96.1%

37.8 ± 49.1%

4 mm (4 weeks)14

Bone Level

48.2 – 99.1%

not included

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References 3 Schwarz F, Wieland M, Schwartz Z, Zhao G, Rupp F, Geis-Gerstorfer J, Schedle A, Broggini N, Bornstein MM, Buser D, Ferguson SJ, Becker J, Boyan BD, Cochran DL. Review: Potential of chemically modified hydrophilic surface characteristics to support tissue integration of titanium dental implants. J Biomed Mater Res B Appl Biomater 2008. 4 Schwarz F, Herten M, Sager M, Wieland M, Dard M, Becker J. Bone regeneration in dehiscence-type defects at chemically modified (SLActive®) and conventional SLA titanium implants: a pilot study in dogs. J Clin Periodontol 2007;34:78-86. 5 Schwarz F, Sager M, Ferrari D, Herten M, Wieland M, Becker J. Bone regeneration in dehiscence-type defects at non-submerged and submerged chemically modified (SLActive®) and conventional SLA titanium implants: an immunohistochemical study in dogs. J Clin Periodontol 2008;35:64-75.

Liu HM, Wang DL, Liu CY. Interactions between fibrin, collagen and endothelial cells in angiogenesis. Adv Exp Med Biol 1990;281:319-331. 7 Long MW, Robinson JA, Ashcraft EA, Mann KG. Regulation of human bone marrowderived osteoprogenitor cells by osteogenic growth factors. J Clin Invest 1995;95:881887. 8 Reilly TM, Seldes R, Luchetti W, Brighton CT. Similarities in the phenotypic expression of pericytes and bone cells. Clin Orthop 1998:95-103. 9 Rickard DJ, Kassem M, Hefferan TE, Sarkar G, Spelsberg TC, Riggs BL. Isolation and characterization of osteoblast precursor cells from human bone marrow. J Bone Miner Res 1996;11:312-324. 10 Schwarz F, Herten M, Ferrari D, Wieland M, Schmitz L, Engelhardt E, Becker J. Guided bone regeneration at dehiscence-type defects using biphasic hydroxyapatite + beta trical6

Table 1: Experimental animal studies reporting on the percentage of linear bone fill in dehiscencetype defects after 2–4 weeks of submerged healing.

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FOCAL POINT

Fig. 2i: Situation subsequent to careful removal of the crestal hard tissue bridge.

Fig. 2j: Adjustment of the healing abutment.

cium phosphate (BoneCeramic) or a collagencoated natural bone mineral (BioOss Collagen): an immunohistochemical study in dogs. Int J Oral Maxillofac Surg 2007;36:1198-1206. 11 Schwarz F, Rothamel D, Herten M, Wustefeld M, Sager M, Ferrari D, Becker J. Immunohistochemical characterization of guided bone regeneration at a dehiscence-type defect using different barrier membranes: an experimental study in dogs. Clin Oral Implants Res 2008;19:402-415. 12 Jung RE, Jones AA, Higginbottom FL, Wilson TG, Schoolfield J, Buser D, Hämmerle CH, Cochran DL. The influence of non-matching implant and abutment diameters on radiographic crestal bone levels in dogs. J Periodontol 2008;79:260-270. 13 Buser D, Halbritter S, Hart C, Bornstein MM, Grütter L, Chappuis V, Belser UC. Early Implant Placement with Simultaneous GBR Following Single-Tooth Extraction in the Esthetic Zone 12-Month Results of a Prospective Study with 20 Consecutive Patients. J Periodontol (in press). 14 Schwarz F, Ferrari, Sager M, Wieland M, Becker J. Comparative study on bone regeneration in dehiscence-type defects at chemically modified hydrophilic (SLActive®) or nanostructured (NanoTite®) titanium implants. An experimental study in dogs (study finished).

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Fig. 2k: Placement of an implant in region 022 (Straumann® Bone Level Implant, Ø 4.1, SLActive® 10mm) was also associated with the occurrence of a dehiscence-type defect. Note the small decortications prior to the GBR procedure.

PD Dr Frank Schwarz Education 1993–1998 Dental School, University of Saarland, Homburg/Germany February 2001 Dr med. dent. Thesis: “Periodontal treatment with an Er:YAG laser” November 2003 Postgraduate Degree Oral Surgery June 2005 Habilitation Priv. Doz. postdoctoral lecturer qualification

Fig. 2l: Reentry after 4 months of submerged healing also revealed complete defect fill with newly formed mineralized tissue exceeding and covering the implant neck.

Professional Experience January 1999–October 2000 Department of Periodontology and Operative Dentistry (Prof Dr E. Reich) University of Saarland, Homburg/Germany November 2000–March 2002 Research Associate Department of Oral and Maxillofacial Surgery (Prof Dr Dr M. Ehrenfeld) Ludwig Maximilian University, Munich/Germany since April 2002 Assistant Professor Department of Oral Surgery (Prof Dr J. Becker), Heinrich Heine University, Düsseldorf/ Germany

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FOCAL POINT

Prof Dr Jürgen Becker at the APDC.

Dr Frank Schwarz.

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The hands-on session at the Prince Philip Dental Hospital of the University of Hong Kong, one of the modules in the Speakers Development Program.

SLActive® goes East

Launch in South Korea and product clearance in the People’s Republic of China SLActive® was launched in South Korea in June 2009 and received the long-awaited approval by the regulatory authorities in the People’s Republic of China in September 2009. SLActive® Symposium in South Korea

Spotlight on SLActive® at the 31st APDC

The Straumann Symposium on SLActive® was held in Seoul, South Korea, on 8 May 2009 with the purpose to introduce SLActive® to the about 400 dental professionals. Key opinion leaders from Kyunghee and Yonsei Universities, and dental clinics attended in order to listen and to meet Dr Schwarz lecturing on SLActive®. The audience was impressed by the study results on the comparison of the surface properties between SLA® and SLActive® and also between SLActive® and competitors’ surfaces.

This year’s 31st Asia Pacific Dental Congress (APDC) was held in May 2009 in Hongkong SAR. At the seminar “Current concepts to improve osseointegration of titanium dental implants”, guest speakers Prof Jürgen Becker and Dr Frank Schwarz from the Heinrich Heine University in Düsseldorf (Germany) presented the latest scientific research results emphasizing the outstanding clinical benefits of SLActive®. Furthermore, Prof Urs Brägger from the University of Bern (Switzerland) and Prof Niklaus P. Lang from the University of Hong Kong SAR were lecturing

Regional speakers with Dr Frank Schwarz and Prof Niklaus Lang.

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about “The impact of CADCAM on dentists, dental technicians and patients” and “Periodontal care according to patient needs” respectively in the scientific program. SLActive® now available in 9 Asian countries Straumann’s premium implant surface is now available in 9 Asian countries: South Korea, Taiwan, Hong Kong, Singapore, Thailand, Malaysia, Indonesia and the Philippines. With the product clearance received for the People’s Republic of China in September 2009, clinicians and patients will benefit of SLActive® in a further country.

Presentation of the Straumann® Dental Implant System in Seoul, South Korea.

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SLACTIVE®

FOCAL POINT

1 million SLActive® implants sold

The success story of Straumann’s premium implant surface

tive

... e

nt s so ld!

Stra

c ® SLA ann

m illi o n i m

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21.12.2009 17:34:48 Uhr

FOCAL POINT

SLACTIVE®

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Innovation and development are the engine that drives progress in implant dentistry. However, only innovations that involve a genuine added value and enable the previous range of indications to be extended have the potential to become successfully established in practice. SLActive® from Straumann is an example of such added value.

Right from the start: clinically documented and setting standards Straumann® SLActive, the third generation hydrophilic implant surface, has been notably successful since it was introduced to the market at the EAO 2005 in Munich. From the start, SLActive® was able to convince the professional world as its outstanding features were already confirmed by numerous preclinical studies when it came on the market1. The advantages for users and patients, such as improved predictability and a shortened healing period of 3 to 4 weeks with a high success rate, were repeatedly con-

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firmed clinically. In numerous preclinical studies in which SLActive® was also compared in dehiscence models2 and as regards shear strength3, it proved to be significantly better compared to competitors’ surfaces.

of the Medicines Authority there in September 2009 and so is about to be introduced there (see also our report on page 9).

Awarded the “Medical Device Technology Award 2005“

The broad acceptance of SLActive® evinced by dentists and clinicians working in the area of implant dentistry is also apparent from the fact that Straumann now supplies one third of all implants sold with the SLActive® surface. A further major milestone in the SLActive® story was reached in September 2009 after the 1 millionth SLActive® implant to be sold was delivered.

Because of these features, SLActive® received the “Medical Device Technology Award“ in 2005, which is awarded every year by the international market research company Frost and Sullivan on the basis of an assessment by an independent expert committee for outstanding technological innovations and their exemplary introduction.

SLActive® – a decision for the health of your patients

Straumann® Dental Implant System: Überblick wissenschaftliche Forschung. Institut Straumann AG. 2 F. Schwarz, D. Ferrari, M. Wieland, M. Sager, J. Becker. An experimental study in dogs: Comparative study on bone regeneration in dehiscence-type defects at chemically modified hydrophilic (SLActive®) or nanostructured (NanoTite®) titanium implants. 3 J. Gottlow, S. Barkarmo, L. Sennerby: Eine biomechanische und histologische Studie an Kaninchen.

Gradual worldwide introduction From 2005 SLActive® was introduced gradually in different countries. Since June 2009 clinicians and patients in South Korea can now benefit from the advantages. In the People’s Republic of China SLActive® obtained the approval

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IPS E.MAX® CAD RESTORATIONS BY STRAUMANN® CADCAM

FOCAL POINT

IPS e.max® CAD restorations by Straumann® CADCAM The next step in the partnership with Ivoclar Vivadent AG: Straumann presents the IPS e.max® CAD restorations by Straumann® CADCAM – a highly esthetic solution for single tooth replacement and restoration

All-ceramic restorations for efficient esthetics Versatility for easy handling High-strength product designed for reliable restorations The IPS e.max® CAD is an innovative lithium-disilicate glass-ceramic from Ivoclar Vivadent AG, an established specialist in ceramic materials and final restorations. Efficient esthetics Currently not available in all countries 1

Wide range of translucencies and shades Optimal tooth design supported by etkon™_visual software (version 5.0 or higher)1 – e.g. Ivoclar Vivadent AG tooth database Efficient workflow for high-quality restorations Easy handling State-of-the-art software: user friendly and flexible applications Various processing techniques: staining or layering technique Flexible cementation: adhesive, self-adhesive or conventional Designed for reliable restorations High-strength material: final flexural strength of 360 ± 60MPa Certified industrial milling center applying cutting-edge technology for an outstanding quality

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FOCAL POINT

IPS E.MAX® CAD RESTORATIONS BY STRAUMANN® CADCAM

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Indications at a glance IPS e.max® CAD restorations by Straumann® CADCAM, made from lithium-disilicate glass ceramic, are used for final restorations on natural teeth or implant abutments. Strength, quality and durability combined with translucence and natural vitality are the distinguishing properties that make it a material of choice for highly esthetic results. With the IPS e.max® CAD restorations, Straumann® CADCAM offers an outstanding solution for: Full anatomic crowns using the staining technique (Low Translucency) Copings using the layering technique (Medium Opacity)

Processing technique TRANSLUCENCY LEVEL

LT Low Translucency MO Medium Opacity

Staining technique

Layering technique

• •

Indications Anterior crowns

Posterior crowns

•

•* *up to premolar

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IPS E.MAX® CAD RESTORATIONS BY STRAUMANN® CADCAM

FOCAL POINT

IPS e.max® lithium-disilicate glass-ceramic: excellent clinical performance Ivoclar Vivadent’s lithium-disilicate glass-ceramic is a significant progress for the dental industry. At the 39th Annual Session of the American Academy of Fixed Prosthodontics, P.C. Guess, R. Zavanelli, N. Silva, and V.P. Thompson (Researchers in the Department of Biomaterials and Biomimetics at the New York University College of Dentistry)2 presented the results of their study using the mouth-motion-simulator test to compare the durability of IPS e.max® CAD lithium-disilicate full anatomic crowns to veneered zirconium dioxide crowns (IPS e.max® ZirCAD/IPS e.max® Ceram). The NYU researchers replicated actual forces exerted in the human mouth to provide a more realistic assessment of how ceramic materials hold up to the chewing forces. The research found that approximately 90 % of veneered zirconium dioxide crowns (IPS e.max® ZirCAD/IPS e.max® Ceram) tested showed chip-off fractures by a force of 350N independent of the number of cycles. None of the IPS e.max® CAD lithium-disilicate full anatomic crowns showed fracture/chip through the lithium-disilicate crowns below 1,000 N and 1 million cycles. As a conclusion, IPS e.max® CAD lithium-disilicate full anatomic crowns demonstrated excellent in vitro performance relative to chipping or fracture in comparison to veneered zirconium dioxide crowns (IPS e.max® ZirCAD/IPS e.max® Ceram). Mouth Motion Fatigue and Durability Study Petra C Guess, Ricardo Zavanelli, Nelson Silva and Van P Thompson, New York University, March 2009

The Straumann® CADCAM Solution

The 5th generation of the etkon™_visual software features the IPS e.max® CAD restorations by Straumann® CADCAM.

In the Lab Completed framework

3D scan of the model and design of the restoration

Returned to the lab by logistic service

Scan data transmitted via Internet

Straumann® CADCAM Production Center Milling the framework

STEP 1: The dental laboratory scans the model. The etkon™ es1 scanner scans dies and models, acquiring jaw and die situation data. With 28,000 precise scanning points per second, the etkon™ es1 scanner is highly accurate.

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FOCAL POINT

IPS E.MAX® CAD RESTORATIONS BY STRAUMANN® CADCAM

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STEP 2: The IPS e.max® CAD restoration by Straumann® CADCAM is designed with etkon™_visual 5.03

Straumann® CADCAM offers a broad array of materials and an extensive application range.

Synthetic materials

polycon

Metals

coron

Ceramics

ticon

zerion

Please contact your regional Straumann Sales Point for information on availability in your country. 3

IPS e.max ® CAD

With the new module including the IPS e.max® CAD lithium-disilicate glass ceramic from Ivoclar Vivadent AG, copings as well as full anatomic crowns can be designed easily. The restoration design is further supported by various tooth databases, e.g. Ivoclar Vivadent SR Postaris and SR Vivodent.

To help the dental laboratory achieve an optimal restoration result, the etkon™_visual software supports the dental laboratory in producing a design of the IPS e.max® CAD restorations ordered from Straumann® CADCAM that fulfills the specific guidelines of the material. If the recommended minimum thickness is not respected, the dynamic minimum wall thickness control immediately signals the relevant areas to the user, so that the restoration design can be improved easily.

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IPS E.MAX® CAD RESTORATIONS BY STRAUMANN® CADCAM

FOCAL POINT

The software automatically places the restoration in the material blank. Users can select the position of the retention pin, as this one can be of critical importance for the further processing and finalization of the restoration.

Once the design of the IPS e.max® CAD restoration by Straumann® CADCAM is finalized, the restoration can be ordered.

STEP 3: Milling of the IPS e.max® CAD restorations in the Straumann® CADCAM production centre

Thanks to its rigorous quality management system, continuous investment in its state-of-the-art production centers, as well as development of new technologies, the Straumann® CADCAM Solution is designed to deliver IPS e.max® CAD restorations of high quality.

STEP 4: Processing in the dental laboratory

The IPS e.max® CAD restorations by Straumann® CADCAM are delivered in their intermediate state (bluish color) to offer high versatility in the processing. Their final strength and esthetic are achieved after the crystallization and characterization process in the dental laboratory.

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FOCAL POINT

IPS E.MAX® CAD RESTORATIONS BY STRAUMANN® CADCAM

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IPS e.max® CAD crown by Straumann® CADCAM:

Restoration delivered by Straumann® CADCAM

Restoration delivered by the dental laboratory to the dental office

IPS e.max® CAD coping by Straumann® CADCAM:

Restoration delivered by Straumann® CADCAM

Restoration delivered by the dental laboratory to the dental office

1 million CADCAM elements sold since 2007 Straumann entered the tooth restoration market in 2007 through the acquisition of etkon, an emerging CADCAM company. With the global Straumann brand and presence the business has expanded rapidly and has now sold over a million elements. Straumann supplies CADCAM copings, crowns and bridges in a range of modern materials including

zerion™ (ceramic), ticon™ (titanium), coron™ (cobalt chrome), and polycon™ (polymer). The addition of IPS e.max® CAD lithium-disilicate glass ceramic enables the company to offer highly esthetic single tooth restorations in various shades and translucencies supporting further the success of the Straumann® CADCAM solution.

A comprehensive service with a full-range portfolio Straumann provides a comprehensive CADCAM service, including a full range of CADCAM dental prosthetics and related technology. The success of its system is built on innovative CAD software, high precision milling and powerful laser scanning technology. Easy to use, the etkon™_visual design software enables the dental technician to model prosthetics via computer. The data are then transmitted via

Straumann to a high-speed milling center, which produces the desired prosthetic component and sends it to the lab for coloring and finishing. Straumann® CADCAM offers a broad range of modern biocompatible, durable and esthetic materials, including state-of-the-art highly esthetic ceramics such as IPS e.max® CAD restorations by Straumann® CADCAM.

Meeting international technical standards Straumann® CADCAM is fully integrated and meets FDA and ISO Medical Device Directive (MDD)

STARGET_1_2010_en.indd 17

standards, endorsing the high quality, esthetics and precision for which Straumann is renowned.

21.12.2009 17:35:01 Uhr

18 STARGET 1 I 10

ROXOLID™

Roxolid™ – a new material designed for the specific needs of implant dentistry Implants are exposed to high forces and need to osseointegrate. To meet these constantly increasing demands in implant therapy, Straumann has developed a new and stronger metallic material with excellent osseointegration properties: Roxolid™, an alloy of Titanium and Zirconium which was specifically designed for the needs of implant dentistry. High strength and excellent osseointegration Roxolid™ is stronger than pure titanium1,2, the current material of choice for implants, and accommodates the chemically active surface SLActive®. The data gathered from laboratory tests and pre-clinical studies3,4 as well as the one-year results of two human studies5,6 have underlined its high strength and excellent osseointegration properties. The new material is used for Straumann implants with an endosteal diameter of 3.3 mm where

Due to their size, high loads are a critical factor for small diameter implants. Existing approaches offer different, but inadequate material solutions in order to meet these specific demands: pure titanium or Ti-6Al-4V and other Titanium alloys containing Aluminum.

Fig. 1: Schematic depiction of the fatigue test set-up

F 4

30°

1. Block in which the implant is fixed 2. Axes of the block 3. Implant/abudment/crown system 4. Block which creates cyclic force on the abudment F. Cyclic force on the system Bone recession of 3 mm is simulated

Bo tion

orp

Res

STARGET_1_2010_en.indd 18

More confidence and peace of mind with small diameter implants

Pure titanium is known for its biological compatibility, but its strength is limited. Therefore the clinical usage of pure titanium implants is restricted in specific cases. In order to overcome this strength issue Ti-6Al-4V alloys are used as well. These alloys show a better strength but they cannot accommodate a rough/hydrophilic surface (like SLA®/SLActive®), due to their metallic structure. The osseointegration of these alloys is compromised as documented in various studies7–10. Now, with the combination of the Roxolid™ material and Straumann’s

Biomechanical tests have been performed according to the ISO 14 801 norm. Within this norm, the longterm survival load of an implant abutment system is measured. The system is exposed to an angle of 30° to a cyclic load acting with the frequency of 15Hz. A worst case scenario is simulated where the implant has a bone recession of 3mm. For each load level 3 systems are tested. The fatigue strength of a system is the load where three systems survived at least 5 millions of load cycles without any damages.

exactly this combination – strength and osseointegration – is of highest importance.

1 2

21.12.2009 17:35:02 Uhr

ROXOLID™

STARGET 1 I 10 19

Norm ASTM F67 (states minimum tensile strength of annealed titanium), used for all Straumann titanium and Roxolid™ implants, data on file 2 Biomechanical tests performed according to ISO 14 801 (15 Hz in air, 5 million cycles survival) 3 Gottlow J et al. Preclinical data presented at the 23rd Annual meeting of the Academy of Osseointegration (AO), Boston, and at the 17th Annual Scientific Meeting of the European Association for Osseointegration (EAO), Warsaw 4 Thoma D et al‚ Evaluation of a new titanium-zirconium dental implant. A comparative radiographic study in the canine mandible, oral presentation at the 24th Annual meeting of the Academy of Osseointegration, San Diego 5 Stone P, oral presentation at the EAO 2009, Monaco 6 Al-Nawas B, oral presentation at the EAO 2009, Monaco 7 Wong M et al. J. Biomed Mater Res 1995;29: 1567–1575 8 Stenport VF, Johansson CB. Evaluations of bone tissue integration to pure and alloyed titanium implants. Clin Implant Dent Relat Res. 2008, 10:191-9 9 Johansson CB, Chong Hyun Han CH, Wennerberg A, Albrektsson T. A Quantitative Comparison of Machined Commercially Pure Titanium and Titanium-Aluminum-Vanadium Implants in Rabbit Bone. Int J Oral Maxillofac Implants 1998;13:315–321 10 Steinemann S. “Titanium – the materials of choice?” Periodontology 2000, Vol. 17, 1998, 7-21 11 Data on file 12 Data from 2138 referrals in a survey conducted by Prof Gerhard Riegl from the “Institute of Healthcare Management” in Augsburg, Germany (see also p. 55–57) 1

SLActive® surface, a new situation has been created. The new possibilities lead to more peace of mind for specific treatments where small diameter implants have to be used. Flexibility due to more treatment options: choose the implant you need, for the best solution possible When treating their patients, clinicians always want to make sure that they choose the best solution possible. This confidence is even more important when small diameter implants have to be used. With Roxolid™, the clinician can choose from different implant types (soft tissue level implants with tapered or with parallel walls and bone level implants) and a wide range of Straumanns’ prosthetic components.

Roxolid™ implants have been used for a wide range of treatment options in a non-interventional study11 where different clinical situations were treated with a variety of solutions. In this study, over 250 patients have been treated and over 430 implants documented. In many of these cases, Roxolid™ implants with small diameter were chosen due to their specific benefits. Over 40 % of these solutions could not be treated before with small diameter implants because the risks would have been too high – now, with Roxolid™ these new indication possibilities could be fully exhausted. Only 2 implant failures were reported to date.

Fatigue strength (N)

220

Fig. 2: Despite the smaller diameter, Roxolid™ implants show higher fatigue strength (long-term survival) compared with other implants/abutment. When testing the competitive systems all the others implants failed(*), whereas with the Roxolid™ Straumann® Bone Level Implant only the abutment fractured(**).

190 160 130 100

2.9

3.1

3.2 3.3 diameter (mm)

3.4

3.5

3.6

Astra Osseospeed® 3.0S and TiDesign™ Abutment* Astra Osseospeed® 3.5S and TiDesign™ Abutment* NobelActive™ 3.5 and Esthetic Abutment* NobelReplace™ and Esthetic Abutment 3.5* Straumann® Bone Level Roxolid™ and Straumann® Anatomic Abutment**

STARGET_1_2010_en.indd 19

21.12.2009 17:35:03 Uhr

20 STARGET 1 I 10

ROXOLID™

Treatment options with Roxolid™ Ø 3.3 mm implants

Clinical situation Fully edentulous

Implant solution 2 x 3.3 mm Roxolid™ implants or more

Prosthetic solution Fixed denture Removable denture

Prosthetic options Bar LOCATOR® Ball Anchor Magnets SynOcta®

Partially edentulous

2 x 3.3 mm Roxolid™ implants or more

2 single crowns for double tooth gap 2 or more unit bridge

Entire Straumann® Soft Tissue Level portfolio Entire Straumann® Bone Level portfolio

Single tooth

1 x 3.3 mm Roxolid™ implant

Screw retained crowns Cemented single crown

Entire Straumann® Soft Tissue Level portfolio Entire Straumann® Bone Level portfolio

As patients’ requirements become more complex, dentists strive to offer them the best solution possible. By meeting the patients’ needs, the dentists can differentiate their practice through the benefits provided by small diameter implants. They have many advantages such as the application of a minimal invasive surgery or the removal of only minimal bone in cases of an edentulous mandible. They are helpful when

the maximization of bone support and maintaining of the vascularity is required. Roxolid™ may offer also greater confidence when placing small diameter implants in patients who are sceptical towards implant treatment.

A market survey12 indicates that, out of all cases suitable, only 58 % are treated with implants. With the benefits offered by small diameter implants it is now possible to offer to the patients the implant solution they were looking for.

35 30

25 Patients

Increasing the patients’ acceptance by offering a comfortable implant treatment

20 15

10 5 0

referred cases

suitable cases

Fig. 3: Only 58 % of suitable cases lead into an implant-based therapy.

STARGET_1_2010_en.indd 20

21.12.2009 17:35:03 Uhr

ROXOLID™

A strong scientific program for strong scientific evidence It has always been Straumann’s matter of principle that products undergo a conscientious and

extended research process starting in the laboratories before they are launched. The last step on this way to marketability is clinical research. Roxolid™ went through a severe scientific program with two clinical

STARGET 1 I 10 21

studies at launch documenting the product with a 1-year follow-up. The entire clinical program for Roxolid™ includes over 400 patients which were treated with more than 500 Roxolid™ implants.

Overview of Roxolid™ lab tests and pre-clinical studies

Biomechanical tests

Internal

Model indication Hydropulse

Corrosion test comparing various biomaterials

EMPA

Material

Closed

Cell culture comparing the osteogenic and inflammory response of various biomaterials Measurements of osseointegration at 4 wks3

Internal

Cell

Closed

Magneten, Malmö

Mini pigs

Closed

Osseointegration at 2, 4 and 8 wks4 Removal torque measurements for different materials6 Early bone healing after 3d and 2wks Early healing behaviour comparing different materials: tissue morphology and osseointegration Pilot study of implant new material5

University San Antonio Magneten, Malmö University of Connecticut University of Berne

Fox hound

Closed

Rabbit

Closed

Mini pigs

On-going

Mini pigs

On-going

2 centers in UK

Part. Edentulous

8 centers in Europe over 50 centers in EU and US University of Cork

Full edentulous

22 patients 1 yr FU 91 patients 1 yr FU Over 250 patients Recruitment closed 20 patients in preparation

Zurich/Harvard

Part. Edentulous

University of Berne

Single tooth

Mayo Clinic

Various

Clinical studies

Animal trials

Laboratory/in vitro

Content

Multi Center Study comparing Roxolid™ vs. Ti6 Roxolid™ in the daily practice (NIS)6,11 Show reduced need of augmentation and measure quality of life of patients with hypodontia Comparison Roxolid™ 3.3 mm vs. Ti 4.1 mm Performance of Roxolid™ implants for single tooth replacement in narrow spaces Performance of Roxolid™ implants for the anterior region

Center(s)

Various Hypodontia

Status Closed (Figure 2)

40 patients Recruitment 40 patients Recruitment In preparation

For more information on Roxolid™ see also STARGET 1.2009, p. 4–18. www.straumann.com/starget

STARGET_1_2010_en.indd 21

21.12.2009 17:35:05 Uhr

22 STARGET 1 I 10

ROXOLIDâ&#x201E;˘

Reduced-diameter implants as a treatment alternative in risk patients to avoid augmentation procedures by Prof Dr Hannes P. Schierle, Dr Hans O. Werner, dentist Franziska Nagel

Fig. 1: Initial clinical situation.

Fig. 2: Initial radiographic situation.

New implant material for extended indication where bone supply is limited The ITI began very early on to make strict demands with regard to the diameter of implants for treating different indication classes. On the one hand, this gave the clinician a certain safety margin as regards the employed implant components but on the other hand, a restoration that complied with the ITI was often possible only after previous and sometimes complex augmentation. With the development of Roxolidâ&#x201E;˘, the new implant material, we are

STARGET_1_2010_en.indd 22

Fig. 3: OPG with X-ray gauge and drill template.

now able to treat even situations with a limited bone supply in unusual indications without comprehensive augmentation measures. Case description This case describes the treatment of a 52-year old patient with severe osteoporosis of the skeletal system, who was on a daily dose of 150 mg of Bonviva (oral bisphosphonate). She was not a smoker. Her wish was for a fixed dental prosthesis but this could not be met in the conventional prosthetic way

because of the abutment situation. Because of the previous history, apicectomies had been performed on teeth 24 and 26 and in conjunction with the final extraction of the teeth this had led to loss of the buccal layer of the alveolar process in this region. Harvesting of a bone block and other invasive measures to prepare the implant site were declined by the patient out of concern regarding complications because of her existing underlying disease and medication, and she also declined a two-stage procedure.

21.12.2009 17:35:05 Uhr

ROXOLID™

STARGET 1 I 10 23

Fig. 4: Available bone clinically. Fig. 5: Use of the Safescraper.

Fig. 6: Lateral bone window in region 26 for open sinus lift.

Fig. 7: Membrane pushed in on palatal side.

Fig. 8: Membrane only applied.

Findings

adequately restored prosthetically and conservatively. Teeth 16, 15 and 45 had had endodontic treatment. There were no occlusion problems and the functional parameters were in the normal range.

Treatment planning

The clinical and radiographic examination shows moderate generalized horizontal bone atrophy in the maxilla and mandible and atrophy of the alveolar process in the vertical dimension of region 26 with loss of the buccal layer at 24–25 (Figs. 1, 2). There was no increased tooth mobility and the probing depths were not in the pathological range. The patient’s oral hygiene at home could be classified as good and the reduced residual dentition was

STARGET_1_2010_en.indd 23

Diagnosis A saddle area in region 24–26, vertical alveolar ridge atrophy in region 26, bone deficit in the transverse direction in region 24–26 with deficit of the buccal layer at 24.

To restore the saddle area in region 24 to 26, an implant-borne bridge was planned with implants in positions 24 and 26. The treatment plant provided for sinus floor augmentation in region 26 via a facial approach. Teeth 24 and 26 had been removed approximately 12 weeks before the start of treatment. The residual bone supply was considered adequate to allow a single-stage procedure. Insertion of a reduced-diameter implant in region 24 was planned. This was intended to circumvent an

21.12.2009 17:35:06 Uhr

24 STARGET 1 I 10

Fig. 9: Tight suture closure.

References Barter S et al. Clinical results presented at the 17th annual scientific meeting of the European Association for Osseointegration (EAO), Warsaw, September 2008 Gottlow J et al. Preclinical data presented at the 23rd annual meeting of the Academy of Osseointegration (AO), Boston, February 2008, and at the 17th Annual Scientific Meeting of the European Association for Osseointegration (EAO), Warsaw, September 2008 Buser D, von Arx Th, ten Bruggenkate Ch, Weingart D. “Basic surgical principles with ITI implants” Clinical Oral Implants Research, Volume 11, Supplement 1, Blackwell Publishing, September 2000, pp. 59-68(10)

STARGET_1_2010_en.indd 24

ROXOLID™

Fig. 10: OPG for postoperative check.

Fig. 11: OPG after exposure of the implants and screwing in the gingiva former.

onlay bone graft in the form of a bone plug or extension graft in this region. The planning documentation consisted of study models, X-ray gauge and drill template, and orthopantomograph with X-ray gauge and drill template (Fig. 3). Surgical procedure The bony structures were first exposed through a ridge incision with a mesial relieving incision on the vestibular aspect, sparing the papilla distal to 23 and leaving it in situ (Fig. 4). The facial window for sinus augmentation was first dissected extensively with a bone scraper (Safescraper® twist), and the area of dissection was extended as far as the cranial regions of the zygomaticoalveolar crest (Fig. 5). The next step was preparation of the lateral window for sinus floor elevation with a spherical diamond bur. The site was prepared for sinus augmentation by dissecting off the schneiderian membrane in all

three spatial directions, first filling the space palatal to implant 26 with bone chips from the zygomaticoalveolar crest. With the drill template inserted, pilot holes were then drilled in regions 24 and 26. Because of the very spongy and soft type III bone quality, subsequent preparation of the implant bed was with osteotomes. An innovative bone level implant with a reduced diameter (Ø 3.3 mm, SLActive® 12 mm) made of titanium and zirconium (Roxolid™) was inserted in region 24. A Straumann® NC Bone Level Implant was inserted in region 26 (Ø 4.1 mm, SLActive® 10 mm). Following insertion there was a facial fenestration defect in region 24 (Figs. 7, 8). This defect was covered with a mixture of autologous bone chips and blood. The remaining bone chips were used together with a hemostyptic to reinforce the sinus floor (Figs. 6, 7).

Membrane for GBR technique An absorbable membrane was then applied to the facial bone defect in region 24 and the access window in region 26 for protection and to stabilize the position of the graft (Figs. 7, 8). The wound was closed with interrupted sutures. The postoperative OPG shows the positioning of the inserted implants, which corresponds with the optimal prosthetic position given by the drill template. Exposure After a healing period of about 10 weeks, the implants were exposed. The OPG after exposure shows very good peri-implant bone, especially crestally in the area of the implant shoulders (Fig. 11). Prosthetic restoration Prosthetic restoration took place after an interval of 2 weeks following exposure. Figs. 12 and 13

21.12.2009 17:35:07 Uhr

ROXOLIDâ&#x201E;˘

Fig. 12: Prosthetic restoration I.

Fig. 13: Prosthetic restoration II.

show the completed restoration 6 months after implant insertion.

tinues to be based on conditioning the hard and soft tissue structures with a view to the final prosthetic result. Deviation from this concept is possible in special cases in agreement with the patient and outside the esthetic area. However, in

Conclusion The ideal restoration with a fixed implant-borne dental prosthesis con-

Prof Dr H. P. Schierle

Dr H. O. Werner

Specialist in oral and maxillofacial surgery and plastic surgery

Specialist in oral and maxillofacial surgery

Oral surgery practice in Karlsruhe and Landau/Germany

Teaching contract at the Medical College Hannover/Germany

Continuing education consultant

STARGET 1 I 10 25

order to avoid compromises with regard to the long-term stability, the new Roxolidâ&#x201E;˘ implant material from Straumann represents an ideal addition to the StraumannÂŽ Dental Implant System.

Franziska Nagel Specialist resident in oral surgery, Karlsruhe and Landau/Germany

Director of several postgraduate courses in oral surgery and implantology Continuing education consultant

STARGET_1_2010_en.indd 25

21.12.2009 17:35:08 Uhr

26 STARGET 1 I 10

PRODUCTS

EXPERT TEAM MEETING

Exchanging first experiences with the Straumann® Anatomic IPS e.max® Abutment August 27, 2009 in Basel at Straumann Headquarters

At the IDS 2009 in Cologne, Straumann introduced the Straumann® Anatomic IPS e.max® Abutment, the first product resulting of a strategic cooperation between Institut Straumann AG and Ivoclar Vivadent AG. To generate first clinical experiences and outcomes with this new product, Institut Straumann AG and Ivoclar Vivadent AG had jointly formed a European Expert Team at the beginning of 2009, composed of Dental Technicians and Prosthodontists. At the end of August, a part of the Expert Team met at Straumann Headquarters in Basel to exchange first experiences with the new abutment.

Gathering experiences with highly esthetic, prefabricated anatomic ceramic abutments The Straumann® Anatomic IPS e.max® Abutment is a standardized premium ZrO2 ceramic abutment, designed for high esthetics and strength. The abutment features a prepared mucosa margin for adaptation to natural soft tissue contour. Esthetic results are crucially determined by successful soft tissue management. The emergence profile of the Straumann® Anatomic IPS e.max® Abutment is in compliance with the Consistent Emergence Profiles™ of the Straumann® Bone

STARGET_1_2010_en.indd 26

Level Implant line. The implant-abutment connection of the Straumann® Anatomic IPS e.max® Abutment features the Straumann® CrossFit™ Connection. The Straumann® Anatomic IPS e.max® Abutment is available in 2 shades. It is indicated for cement-retained crowns and bridges via mesostructure, and for direct veneered screw-retained crowns. With the use of the Straumann® Anatomic IPS e.max® Abutment the restorative team can apply an anatomically formed, ZrO2 abutment and make first steps and experiences with highly esthetic, prefabricated anatomic ceramic abutments, which might build the basis for

21.12.2009 17:35:10 Uhr

PRODUCTS

STARGET 1 I 10 27

Participants (in alphabetical order): Prof U. Belser, Dr A. Boesch, PD Dr S. Eitner, D. Vinci, Dr J. Wittneben-Matter. Cases by: Prof U. Belser, V. Brosch, Dr P. Couto Viana, PD Dr S. Eitner, D. Vinci, Prof U. Brägger, A. Bruguera, Dr J. Fabrega, Dr R. di Felice, B. Heckendorn, M. Temperani, Dr J. Wittneben-Matter.

future use of advanced CADCAM ceramic technologies such as the Straumann® CADCAM System. The expert team The expert team for the practical testing and discussion of the Straumann® Anatomic IPS e.max® Abutment was formed on the initiatives of both Straumann and Ivoclar Vivadent AG. To get an extensive range of experiences on the broad application range of the Straumann® Anatomic IPS e.max® Abutment, the expert team was composed to represent a broad clinical and technical background. Several cases were presented at the Expert Team meeting at Straumann in Basel in August 2009. The presentations included a short overview of all cases the restorative team

STARGET_1_2010_en.indd 27

had completed and a detailed documentation of one case with main focus on the case planning and surgical operation as well as dental laboratory procedures and outcomes. Summary of the experiences shared and conclusions All presenters were greatly satisfied with the overall result of the restoration. The properties of the abutment and the material allow for a comfortable processing which was done in the dental lab in all the cases. The anatomically pre-shaped abutment in combination with the Straumann® Bone Level advantages enabled an efficient preparation procedure in the dental lab and a familiar, standardized restorative workflow. Both, screw retained and

cemented restorations have been reported (70 % screw-retained, 30 % cemented) but the result was identical: a highly esthetic dental prosthesis. The shaded MO1 colour was more frequently used (80 %) than the white MO0 (20 %). Thanks to the possibility to select between a white or natural shade colour in combination with the translucency of the material, esthetic was achieved. The Straumann® Anatomic IPS e.max® Abutment offers user and patients advantages like higher esthetics, efficiency and the certainty of predictable results. A selected case from the Expert Team with detailed information on the restorative process, including an IPS e.max® restoration, will be presented in STARGET 2.2010.

21.12.2009 17:35:15 Uhr

28 STARGET 1 I 10

PRODUCTS

Straumann速 Temporary Abutments Your solution for narrow spaces

With its narrow diameter, the new Straumann速 Temporary Abutment for the Straumann速 Bone Level Implant opens up more restoration possibilities for narrow interdental spaces. For crowns and bridges, screw or cement-retained in the anterior and posterior region.

Engaging abutments are used for Screw- or cement-retained temporary crowns Cement-retained temporary bridges

STARGET_1_2010_en.indd 28

Non-engaging abutments are used for Screw-retained temporary bridges

21.12.2009 17:35:16 Uhr

PRODUCTS

STARGET 1 I 10 29

PRODUCT INFORMATION Ø 3.2 mm

11mm

Ø 3.4 mm

11mm

The devices are provided non-sterile and are for single use only The abutment can be steam sterilised (134 °C/18 min) Material: Titanium alloy (TAN/Ti - 6Al - 7Nb) Product sold with screw Provisional restorations are to be placed out of occlusion Shortable up to 6 mm with usual tools and technique Yellow anodization on NC Abutments, no anodization on the RC Abutments Consistent Emergence Profile™ Reliable CrossFit™ Connection Easy lab and chair-side temporization Not grindable (no diameter reduction or emergence profile customisation possible)

Ø 4.5 mm

Ø 3.5 mm

NC & RC Temporary Abutments1 Art. No.

Article

Dimension

024.2371

NC Temporary Abutment, for crown

Ø 3.5 mm L 11.0 mm

024.2375

NC Temporary Abutment, for bridge

Ø 3.5 mm L 11.0 mm

024.4371

RC Temporary Abutment, for crown

Ø 4.5 mm L 11.0 mm

024.4375

RC Temporary Abutment, for bridge

Ø 4.5 mm L 11.0 mm

Not all products are available in all countries.

STARGET_1_2010_en.indd 29

21.12.2009 17:35:21 Uhr

30 STARGET 1 I 10

PRODUCTS

NEW PACKAGING CONCEPT/STRAUMANN® STORAGE SYSTEM PROSTHETICS

Be perfectly organized in your dental lab and practice New packaging for non-sterile packaged components When dealing with medical devices, both manufacturer and end user are facing specific challenges. In order to completely satisfy these requirements, we have improved our packaging for non-sterile products.

STARGET_1_2010_en.indd 30

The new blister packaging is stackable and fits perfectly with the new Storage System Prosthetics.

and, most importantly, again strives to satisfy the high demands of its customers.

In accordance to our motto “Simply Doing More,” our detailed product documentation on instruction leaflets will now be available in 10 languages, the packaging/ insert labels in 6 languages. Straumann thus addresses the language guidelines for medical devices by ensuring that their products are in compliance with international standards like EN 980 and ISO 15223

The benefits of this new concept are a better time management and less expenses in your dental lab or practice. Our new packaging offers you some significant advantages: Quick access to the right product Easier identification due to multi-language labels with pictograms Better control of your inventory

21.12.2009 17:35:23 Uhr

PRODUCTS

STARGET 1 I 10 31

For an even greater increase in efficient organizing, you may also want to consider the “Straumann® Storage System Prosthetics”.

Product details L/W/H: 22.6/28/24.8 cm The “Straumann® Storage System Prosthetics” is delivered with its 3 standard drawers. Extra components can be ordered additionally according to your personal needs. Product availability Please ask your Straumann Sales Representative on the availability of the “Straumann® Storage System Prosthetics” in your country. He will be happy to make you an offer.

STARGET_1_2010_en.indd 31

21.12.2009 17:35:24 Uhr

32 STARGET 1 I 10

PRODUCTS

INFORMATION

Expert opinion on the study by Holger Zipprich et al.1 Institut Straumann AG has obtained an independent expert opinion from the Dental Faculty Bonn on the study by Dipl. Ing. Holger Zipprich et al.

Zipprich et al., Erfassung, Ursachen und Folgen von Mikrobewegungen am Implantat-Abutment-Interface (Detection, causes and consequences of micro-movements at the implant-abutment interface). Implantologie 2007; 15 (1): 31–46. 1

Prof. Dr.rer.nat. Dipl.Phys. Christoph Bourauel and Dr.rer.nat. Dipl.Math. Ludger Keilig. 2

Hermann JS, Buser D, Schenk RK, Cochran DL. Crestal bone changes around titanium implants. A histometric evaluation of unloaded nonsubmerged and submerged implants in the canine mandible. J Periodontol 2000; 71: 1412-1424. 3

STARGET_1_2010_en.indd 32

Straumann attaches the greatest value to the scientifically grounded and clinical testing of all products and components of the Straumann® Dental Implant System. As a pioneer in the field of implant-supported restoration, Straumann accordingly has comprehensive long-term clinical data on dental implants and the corresponding prosthetic components. This applies particularly to the Straumann® Soft Tissue Level Implant line, which is among the most frequently employed systems tested in clinical practice worldwide. This implant line is valued by dentists especially because of the many years of clinical evidence and simplicity. The in vitro study by Holger Zipprich was published in 2007 only in the German journal “Implantolo-

gie” and since then it has been presented repeatedly at industry events. Interestingly, nothing can be found in professional journals about the corresponding scientific discussion with professionals on an international level of the methodology and results. Subject of the Zipprich study The in-vitro study in question by Holger Zipprich investigated the connection between implant and abutment. Because of the movements between implant and abutment measured in the one-off study design in some of the tested implant systems, the author suppose that the movements between the two components could have a micro-pump effect, which would lead indirectly to increased bone resorption around

the implant. These assumptions are astonishing and raise the question of why the authors in their evaluation did not discuss the clinical studies already available at that time, all the more as there are clinically well-founded and internationally confirmed long-term data (> 10 years) for the Straumann® Dental Implant System, which clearly call into question the findings of the Zipprich study (see box). In order to assess the relevance of the study scientifically, Straumann asked the Dental Faculty of Bonn University for an independent expert opinion on Zipprich’s study.

21.12.2009 17:35:26 Uhr

PRODUCTS

Conclusions of the Dental Faculty of Bonn University The two experts2, both with many years of experience in orthodontic biomechanics and implant and prosthetic biomechanics and materials science, came to the following conclusions in their critical assessment of the Zipprich study: Direct application of the in-vitro results of the study to clinical practice is inadmissible, as mentioned in the study. The study design deviates markedly from the standards (DIN/ ISO 14801) stipulated for testing dental implants. Because of the great clinical relevance of the topic, it is essential that the comparability (that is, a study design in accordance with the stipulated standards) can be guaranteed with further investigations.

STARGET_1_2010_en.indd 33

It is not clear to what extent the investing of the implants was in accordance with DIN/ISO 14801, which raises questions with regard to the application of load, in the case of both soft tissue level and bone level implants. The spatial resolution of the imaging method used in the study was 4 μm. In the study, a distinction is made between an undetectable gap and a gap of 0.1–4.0 μm. Through this, it is suggested that conclusions might be drawn about measurements with an accuracy of 0.1 μm. Corresponding interpretations as a result are inadmissible and produce false ideas in the reader. The study lacks completely a critical consideration of the extent to which the design of the crown, the cementing of the crown or other clinical framework conditions can have an

STARGET 1 I 10 33

influence on the movements between implant and abutment (gap size). In summary, the experts found that: “The clinical relevance of the presented results can therefore only be doubtful, especially as concerns a technical failure of the implant-abutment system or a possible tissue reaction suggested by the authors. Clear evidence of a connection between micro-gaps depending on the implant-abutment system and technical failure or a tissue reaction cannot be identified, especially as the authors themselves refer to the reports of success in the literature“. A copy of the expert opinion can be requested from Institut Straumann AG.

21.12.2009 17:35:27 Uhr

34 STARGET 1 I 10

PRODUCTS

Stabilization by the cemented crown

Biological width

Fig. 1: “Biological width“

Straumann draws the following conclusions from the discussion: In order to be able to make a scientifically objective statement, the authors have dealt too little with the way the investigated systems function.

Fig. 2: Straumann® Soft Tissue Level Implant with crown

Deducing results using measurements that are below the measurement accuracy of the study design is a scientifically dubious procedure. A well-founded assessment of the clinical function of implant systems requires much more that

production of a few interesting pictures. Scientific discussion of study results – as included in studies of the Straumann® Dental Implant System is the only correct way to a clinically relevant assessment.

Clinical success with the Straumann® Soft Tissue Level Implant Biological width is respected: Compared with bone level implants, Straumann® Soft Tissue Level Implants have no connection and therefore no micro-gap at bone level. Depending on the implant type, the connection is located between 1.8 and 2.8 mm from the bone level and respects the so-called biological distance3. (Figure 1) Reduced lever forces in the region of the implant-abutment connection: Because the connection is sited 1.8 or 2.8 mm higher, depending on the implant, than with a bone level implant, the abutment is shortened by the same difference. Due to the shorted abutments, the level forces acting at the level of the connection are lower than in the case of a bone level implant. Connection inside the restoration: With Straumann® Soft Tissue Level Implants the connection between abutment and implant is inside the restoration (see Figure 2), whereas with a bone level implant the connection is not covered by the restoration. Stabilization by the prosthesis: The connection of the Straumann Soft Tissue Level Implants is gripped and stabilized by cemented prosthetic crowns and bridges sitting directly on the implant. Clinical experience: The Straumann® Soft Tissue Level Implant system is based on over 20 years of clinical experience in implant-based restorations.

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PRODUCTS

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Straumann® Bone Level Implant launched in Brazil The official launch of the Straumann® Bone Level Implant in Brazil was celebrated at the national congress “Osseointegration – 20 Years of the Brazilian Experience” on September 3–5 in São Paulo with over 3,000 guests.

Impressions from the congress “Osseointegration – 20 Years of the Brazilian Experience” in São Paulo.

Brazil is one of the world’s largest markets for many segments of the esthetic health care sector, both medical and dental. Therefore, the launch of the Straumann® Bone Level Implant line will close an important gap for local implantologists.

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Straumann Brazil gave their target groups an opportunity for early experience through a series of lectures throughout Brazil. The “Science and Esthetic” tour, which started in September, is a road show that was developed by five leading experts of the Straumann® Dental Implant System (Professors

Alessandro Januário, Julio Joly, Mauricio Araújo, Pedro Tortamano and Waldemar Polido) and aims to provide key information to Brazilian dental professionals on implant selection criteria, supported with solid scientific background and local clinical cases.

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CLINICAL CASES

Synergies for clinical success with an osteoconductive implant surface and bone replacement graft, a novel implant-abutment connection and meticulous occlusal therapy by Barry P. Levin, DMD

Initial situation The patient, a 69 year old female with a non-contributory medical history, presented for a comprehensive periodontal and implant consultation in March of 2008. were the patientâ&#x20AC;&#x2122;s chief complaints (Figs. 1, 2).

Her maxillary molar teeth had been missing for over 5 years after previous periodontal therapy was performed. Her remaining maxillary dentition demonstrated significant periodontal attachment loss and moderate posterior pocketing. Mobility and esthetic compromise

The decision was made to extract the remaining maxillary teeth and place 6 implants to support a fixed restoration.

Fig. 3: Site #4

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A digital CT scan was taken to assess available bone volume and density and assist in implant selection. The cross-sectional slices were also used to verify the probability of vertical placement and screw retention of the provisional prosthesis prior to the start of treatment (Figs. 3â&#x20AC;&#x201C;10).

Fig. 4: Site #6

Fig. 5: Site #8

Fig. 6: Site #9

Fig. 7: Site #11

Fig. 8: Site #13

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Lab procedure Prior to the patient’s surgical appointment, the restorative dentist obtained study models and an occlusal registration. From these models, a modified maxillary denture and clear acrylic surgical guide were fabricated (Figs. 11–13). Surgical procedure The stent was utilized to position 6 Straumann® Bone Level Implants with SLActive® surface in the second bicuspid, canine and central incisor locations bilaterally. An implant surface with high surface energy has been demonstrated

in animal and human studies to achieve an accelerated rate of osseointegration. This provides a shorter healing period during which the patient must demonstrate compliance with a very soft diet. In approximately 3–4 weeks, the patient may begin gradually incorporating a more normal dietary intake. With machined surfaces or more traditional roughened surfaces, the time to achieve osseointegration may be significantly longer (3–6 months).

Following minor flap reflection, all 12 maxillary teeth were carefully removed, with great attention to preserving the thin alveolar bone (Fig. 14). Six Straumann® RC Bone Level implants (Ø 4.1 mm/ SLActive® 12.0 mm) were placed according to the standard protocol, all achieving primary stabilization (Figs. 15, 16).

Fig. 9: Panoramic radiograph.

Fig. 10: Axial CT view of maxilla.

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The voids between the implant bodies and residual socket walls were obturated with Straumann®

Figs. 11–13: Lab procedure

Figs. 14–16: Surgial procedure

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BoneCeramic (SBC) of a 500– 1,000 micron particle size. The choice of SBC for the graft material was based on its osteoconductive and space-maintaining properties, necessary for the long-term support of the hard and soft peri-implant tissues. The degradability of bone ceramic is a desired property, allowing for gradual substitution of the graft with vital bone, capable of achieving osseointegration. The biphasic calcium phosphate material provides space maintenance because of the 60 % HA content, while the 40 % beta-tricalcium phosphate is rapidly degraded and replaced with host bone. The long-term support of the peri-implant soft tissue is crucial. A graft with a rapid resorption rate could lead

to collapse of the ridge following extraction with subsequent recession. This may compromise the health of the peri-implant tissues. Animal studies have demonstrated that surgically created dehiscences can be regenerated when Straumann Bone Ceramic is applied against an SLActive® surface. This combination of an implant surface with a high surface energy and macro- and micro-roughened surface and an osteoconductive graft may prove to be ideal. Six Straumann® RC Multi-Base Abutments (GH 2.5 mm, Ø 4.5 mm) were tightened to the implants at 35 ncm (Figs. 17, 18). Modified Straumann® RC Temporary Copings (for Multi-Base Abutment,

Figs. 21–24: Baseline radiographs

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straight, Ø 4.5 mm) were affixed to the Multi-Base Abutments, and incorporated into the modified denture via bis-acryl and acrylic materials (Figs. 19, 20). The soft tissues were sutured with an absorbable monofilament suture (Monocryl; Ethicon). The flanges were removed from the temporary prosthesis, the cantilever extensions shortened to one tooth length and the tissue surfaces were polished to reduce plaque retention and inflammation. The provisional hybrid denture was attached and tightened after careful occlusal equilibration to assure group function and balanced occlusion. This remained in situ for approximately 8 weeks (Figs. 25, 26).

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During this healing period, the patient was advised to maintain a very soft diet, with particular caution during the first 3 post-operative weeks, to minimize excessive forces on the implants and facilitate osseointegration. At the 8-week review, all implants were immobile and the peri-implant soft tissues were considered to be healthy and free of frank inflammation. The Multi-Base Abutment level impressions were taken and a screw-retained, fixed partial denture (hybrid prosthesis) was delivered about 4 months post-surgery.

Final result Radiographically, there is a strong suggestion that minimal change had occurred from baseline, 5 weeks post-operatively (Figs. 27–30) and after 8 months of loading (Figs. 31–34). This can be attributed to a combination of factors. First, the horizontal off-set of the microgap, where the prosthetic abutments connect to the implant, shifts the biologic width approximately 0.4 mm from the bone crest. Second, the placement of an osteoconductive graft material, such as Straumann® Bone Ceramic (SBC) to obturate the horizontal defect (HDD) between the fixture and the residual socket walls was successful in maintaining the bone thickness necessary for long-term

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osseointegration and tissue support. Third, the Straumann SLActiveÂŽ surface served to maintain a high level of crestal bone to implant contact from the time of installation to the delivery of the final prosthesis. Fourth, the provisional FPD was allowed to remain in place for nearly two months, facilitating the maturation of the supra-crestal, soft tissue attachment to the implants before the start of restorative therapy.

Conclusion This case demonstrates the synergies of an implantâ&#x20AC;&#x2122;s osteoconductive surface, an osteoconductive bone replacement graft, a novel implant-abutment connection and meticulous occlusal therapy throughout the completion of care. Special thanks to Dr Len Fishman for the final restorative therapy.

Fig. 35: Final restoration

Fig. 36: Final restoration

Barry P. Levin, DMD Clinical Associate Professor at the Department of Periodontics of the University of Pennsylvania Diplomate of the American Board of Periodontology ITI Fellow

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Regeneration of a periodontal defect with Straumann® Emdogain and a Straumann® Soft Tissue Level Implant with SLActive® surface, in combination with Straumann® BoneCeramic by Dr Marlene Teo and Dr Joanne Uy

Patient history and findings A 38 year old Singaporean Chinese woman, non-smoker with no relevant medical history, was referred for replacement of tooth #14 (FDI) with an implant. It had been extracted 3 months previously by a general dentist due to a fractured root. She had no other complaints. At the clinical examination, it was noted that tooth #15 had a mobility of II with 5 mm probing depths on the mid and mesio-buccal aspects and a 6 mm probing depth on the disto-buccal aspect. There was initial caries on the distal aspect of #15. The rest of the probing depths in the mouth were within normal limits. The #14 implant site showed good bucco-lingual and mesio-distal width (Figs. 1, 2) with a slight bone concavity apically. The radiographic examination showed 40 % angular bone loss on the mesial and distal surface of #15 and a healing socket at #14. The sinus floor was more

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than 12 mm away from the crest of the ridge at #14 (Fig. 3). The intermaxillary relationship was normal. Treatment planning The patient was put through initial therapy with full mouth scaling, and localized scaling and root planing was done on tooth #15. Concentrated fluoride was applied on #15 in an attempt to remineralize the carious lesion. Oral hygiene was adequate 6 weeks after initial therapy but the localized probing depth of 6 mm on the distal aspect of #15 persisted with bleeding on probing. It was

thus decided that regeneration of #15 with Straumann® Emdogain would be done simultaneously when the implant at #14 was placed. Surgical procedure A full thickness flap was raised from #13 to #15. Only a buccal flap was reflected as the angular defect only affected the buccal surface of #15 and left the palatal surface intact. Granulation tissue was removed and #15 was root planed, leaving a

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narrow, 3.5 mm deep 3-wall intrabony defect on the buccal surface of #15 (Fig. 4).

an apical perforation of the buccal plate measuring 5 mm by 4 mm in diameter (Fig. 7).

When the surgical stent was placed at #14, it was noted that the crest of bone was only 1 mm from its future cervical margin (Fig. 5). Bone was removed from the crest (Fig. 6) to ensure that the implant would be seated at least 3 mm below the future cervical margin. Implant bed preparation was done according to the Straumann protocol and was restoratively driven, guided by the surgical stent (Fig. 6).

A Straumann® Soft Tissue Level Implant (Standard Plus, Ø 4.1 mm, SLActive 12 mm) was placed in the #14 site in a good restorative position and with good primary stability (Fig. 8). The Straumann SLActive® surface was chosen to enhance bone formation during GBR and also to speed up the osseointegration process for early loading. A Straumann® RN Healing Abutment was placed on the implant to allow transgingival healing.

As there was a slight buccal undercut, the final 3.5 mm drill resulted in

The buccal plate around the exposed implant threads was then

decorticated to enhance GBR (Fig. 9). Straumann® PrefGel was placed on tooth #15 for 2 minutes to treat the root surface, then rinsed off with saline. Straumann® BoneCeramic was hydrated with saline and placed on the exposed #14 implant threads and the decorticated area (Fig. 10). The bone graft area was covered with a resorbable collagen membrane (Fig. 11). Straumann® Emdogain was then mixed with the remaining Straumann® BoneCeramic. The exposed root surface of #15 was coated with Straumann® Emdogain (Fig. 12) and the Straumann® Emdogain/

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BoneCeramic mix was placed into the periodontal defect surrounding #15 (Fig. 13).

patient’s request as she was not bothered by the temporary edentulous space.

The flap was sutured with Vicryl 5/0 sutures and Straumann® Emdogain was syringed around the incision lines to enhance soft tissue healing (Fig. 14). The immediate post-operative X-ray shows good angulation of the implant (Fig. 15).

Due to personal reasons, the patient only came for the restorative procedure 5 months after surgery. By then, osseointegration was achieved and the soft tissue profile was ideal. The impression was made using the open tray technique. As the implant position was good, a Straumann® synOcta® Abutment (cementable) was used (Fig. 17).

One week later, the patient presented with good soft tissue healing with little inflammation (Fig. 16).

#15 distal was also restored with a composite filling as it appeared to be getting larger. On the day that the #14 final crown was issued, it was noted that the distal papilla had not filled in completely (Fig. 18). However, it was expected that the papilla would regenerate since the distance between the interdental bone crest and the contact point was less than 5mm1. Treatment Outcome The 20-month radiographic outcome shows stable bone height and increased radiopacity of bone around the SLActive® implant at #14 (Fig. 19), compared to the radiograph taken on the day of surgery (Fig. 15).

The patient healed uneventfully. No provisionalisation was done at the

The abutment was torqued down to 35 Ncm and the access hole covered. The final restoration was a metal-ceramic crown (Fig. 18). At this point, the carious lesion on

Prosthetic procedure

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Choquet V, Hermans M, Adriaenssens P, Daelemans P, Tarnow DP, Malevez C. Clinical and radiographic evaluation of the papilla level adjacent to singletooth dental implants. A retrospective study in the maxillary anterior region. J Periodontol. 2001 Oct;72(10):1364-71. 1

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There is also radiographic bone fill of the angular defect at #15 (Fig. 19). Clinically, the distal papilla of #14 has filled the interdental space and probing depths around #15 have decreased to 3 mm and below. Mobility of #15 is now within physiologic limits. The 3-year post-operative exam shows stability of the soft tissues (Fig. 20), much like what was found at the 20-month post-op exam. The soft tissue profile of #14 replicates that of natural teeth and is symmetrical with the teeth in the upper left quadrant (Fig. 21). No 3-year radiograph was done as the patient was possibly pregnant. Conclusions The placed implant with the Straumann SLActive速 surface shows good osseointegration and osteoconductivity. Straumann速 BoneCeramic may

also be placed on the exposed implant threads for Guided Bone Regeneration (GBR) and placed in the periodontal defect to act as a scaffold for regeneration. Importantly, this case demonstrates that it is possible to place an implant with the

Dr Marlene Teo

marlene_teo@hotmail.com

SLActive速 surface with simultaneous GBR and treat an adjacent tooth with Straumann速 Emdogain regeneration simultaneously. This reduced in this case the number of surgical procedures. Both procedures proved successful over the span of 3 years.

Dr Joanne Uy

rsdujn@nus.edu.sg

Specialist Periodontist in private practice, Singapore

Specialist Prosthodontist at the National University Hospital, Singapore

Diplomate of the American Board of Periodontology

Assistant Professor of Restorative Dentistry at the National University of Singapore

Adjunct Lecturer in Preventive Dentistry at the National University of Singapore Adjunct Assistant Professor at the University of North Carolina at Chapel Hill ITI Fellow

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QUALITY AND PRODUCT SAFETY

Why the Straumann® Dental Implant System is a “premium” solution What premium brands achieve and why cheap implants cannot be regarded as an option for the patient who wants value for money and peace of mind Smaller suppliers are increasingly present in the market for dental implants, with cheap implant products and an aggressive marketing that is targeted at price. Some of these companies would not even exist without premium suppliers. In this article, Institut Straumann AG would like to show what premium suppliers do to develop implant dentistry on a scientific foundation and continuously increase treatment safety, while suppliers of cheap implants are exclusively salesoriented organizations with a short-term outlook.

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Years of research, development, and testing precede the launch of a high-end product, such as the excellent implant surface Straumann SLActive® – with corresponding costs.

Price comparisons: SLActive® as an example It is not uncommon for low-price players to promote their products with price differences by comparing their products against the most expensive, high end premium solutions. For instance one cheap

manufacturer may compare the price of its undocumented, secondgeneration surface with the price of Straumann’s third-generation hydrophilic SLActive® surface. Endorsed by more than 25 and ongoing studies, SLActive® is one of the best investigated implant surfaces on the market1.

SLActive – were price comparisons become difficult SLA®

SLActive® New bone

Histological cross-sections show bone defect filled at 12 weeks after implant placement Straumann 7 February 2007

Results from preclinical studies presented by Becker J, Schwarz F (Heinrich-Heine University, Düsseldorf, Germany) at 15th Ann. Sci. Meeting of the EAO, Zurich, 2006

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The crucial factors of a premium implant solution

Straumann SLActive Scientific Studies Third Edition. 2009. 1

Without clinical substantiation, low price implants simply have no claim to equivalence. Even when it comes to simple design features and finish, the claim that a cheap implant is an equivalent alternative must be based on comparative long-term data to support it, which often is not the case. If a comparison is made between Straumann’s value option, the SLA® surface, and a cheap manufacturer, the difference in the overall cost of the treatment is negliglible. However, the Straumann solution offers great flexibility, for example in terms of prosthetic range and planning – with simple handling and workflow. These are just two of many elements in our value proposition, which, together with the following factors, explains why Straumann is a premium implant solution.

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Straumann not only invests in the development of dental implant technology but also in the research of pioneering new technologies such as Regeneration and CADCAM.

Cheap implants may not offer ďŹ&#x201A;exible solutions for technical matters. But making compromises is not worth even the cheapest price.

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Lasting quality and service

Higher risk of mechanical failure in look-alike implant systems

Look-alikes give the clinicians the impression that they are saving money but they donâ&#x20AC;&#x2122;t talk about the long-term consequences. As in other fields, the rule applies: saving money at the wrong end can become costly later. A recent comparative study conducted by the University of Connecticut reveals how quality standards between premium implants and look-alikes can differ (see text box). The consequences and costs that may result from the usage of such products should therefore be taken into consideration in advance.

A study reveals higher risk of mechanical failure in low-cost implant systems. The study tested the mechanical fracture limit of three Straumann clone implant systems (IHDE Dental, Bluesky Bio, Lifecore) compared with original Straumann products. The systems tested showed a significant higher risk of mechanical failure than the original Straumann implants.

Junghoon Yoo DDS, Robert Kelly DDS, MS, DMedSc: Comparison of fracture behaviour among different single stage implants under cyclic loading. Reconstructive Sciences, University of Connecticut Health Center. Poster presentation at the American College of Prosthodontics, San Diego 2009.

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Premium companies like Straumann offer a large variety of courses worldwide every year to meet the constantly growing education needs in implant dentistry.

An implant is more than a screw Not only should the dental implant perform functionally and be reliable, it should also last on a long-term basis â&#x20AC;&#x201C; which means that the bone and soft tissues around it need to be maintained. Comprehensive long-term clinical studies published in peer-reviewed journals and presented at international scientific meetings have always been important to Straumann and the StraumannÂŽ Dental Implant System is backed by ongoing studies assessing esthetic parameters over the long term. In 2004, an ongoing cohort study was presented at the 13th Scientific Meeting of the European Association of Osseointegration (EAO), which included 12-year data on esthetic parameters of Straumann implants2. Nine-year data were published in 20033. Some manufactur-

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ers of cheap implants were not even in the business then and still have no clinical program in place. The question of choice The implant itself makes up only a fraction of the overall treatment costs. The last thing a patient wants is to risk failure or jeopardize longterm outcome by trying to save one or two hundred francs. In a consumer market, people have a choice as to whether they purchase a premium or a cheap product. In dentistry, patients rarely get to choose which manufacturersâ&#x20AC;&#x2122; products are put into their mouths. So the patient is unable to make a qualified choice and has to rely on the prescriber to receive the best treatment and materials possible. Thus, if the supposed savings are put in relation to the overall costs of the treatment or

to the costs resulting from implants or abutments which do not work properly, it becomes evident that cheap implants are only supposedly cheaper than premium products. Clinical substantiation Furthermore, Straumann conducts thorough preclinical and clinical tests on its products prior to market introduction. The results of these studies are presented at international scientific congresses and in peer reviewed journals, endorsing the quality of the research. Straumann currently has 18 studies running in 139 centers in 17 countries and involving 2061 patients.

Belser UC. Longterm stability of esthetic implants. Clin Oral Implants Res 2004;15(4):xxiv. 3 Giannopoulu C et al.: Effect of intracrevicular restoration margins on peri-implant health: clinical, biochemical, and microbiologic findings around esthetic implants up to 9 years. J. Oral Maxillofac. Implants 18(2) 2003: 173-81. 4 e.g. Buser D in NZZ am Sonntag 2009 Number 21, p. 45. 2

Attention has been drawn to the lack of clinical evidence and longterm data to support cheap implant products4. A search for literature

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Close interaction with the customers to understand their requirements.

Look-alikes give the clinicians the impression to save money, but they don’t speak about the long-term consequences. Norm ASTM F67 (states minimum tensile strength of annealed titanium), used for all Straumann titanium and Roxolid™ implants, data on file 6 Gottlow J et al. Preclinical data presented at the 23rd Annual Meeting of the Academy of Osseointegration (AO), Boston, and at the 17th Annual Scientific Meeting of the European Association for Osseointegration (EAO), Warsaw. 5

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in PubMed, which includes 18 million citations from 5,000 journals in MEDLINE, and in Google Scholar has lead to the result that, for certain manufacturers, there are no peer-reviewed studies on implants at all in these two databases. The costs behind the development and scientific testing of a next-generation implant surface Straumann products are backed by clinical studies before they are launched. For example more than 1,400 implants had been documented in clinical trials before our new generation bone level implant range was put on the market. It took 4 years and cost approximately CHF 20 million for Straumann to develop and test the SLActive® surface technology prior to market introduction.

Roxolid™: clinical trials with more than 400 patients and 60 centers around the world In addition to thorough laboratory testing, clinical trials are currently in progress in more than 400 patients and 60 centers around the world to ensure that Straumann has independent data substantiating the safety, performance and benefits of our new high strength material, Roxolid™, before it reaches practitioners and patients. Further studies are planned. Based on current knowledge, Roxolid™ is stronger than pure titanium5 and preclinical results indicate that it has improved osseointegration properties compared to titanium6. Straumann’s hope is that Roxolid™ will lead to smaller diameter implants that may obviate the need for bone grafting and augmentation in some cases. If so, it could save patients considerable cost and discomfort. These are just two of many reasons why meaningful innovation and research are important. Indeed, in contrast to cheap implant suppliers, Straumann is researching new materials and technologies – such as guided implant surgery, regenerative materials or CADCAM prosthetics – to add further predictability, simplicity, esthetics and reliability to tooth replacement procedures.

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Peace of mind with premium solutions: they may appear expensive initially – but can patients really afford to the possible drawbacks of cheap alternatives?

Research and development at Straumann: still heading the list of priorities even in the recession Research and development are the basis for launching innovative products and therefore for the company’s future. Even in an economic rockbottom, this budget is not cut at Straumann. Expenditure in this connection in the first half of 2009 was over five per cent of turnover and thus more than in previous years. These investments are made available for basic research, both clinical and preclinical, which plays a central part in product development. Only when convincing scientific evidence has been produced with scientific studies that Straumann products are both safe and effective (and furthermore offer clinical advantages) are these introduced to the market. Straumann will also employ the necessary means in future to test new products and materials before and after market introduction. Scientifically grounded products – the best investment for doctor and patients The innovations of Straumann are a response to the needs of the steadily developing implant dentistry practice. As the Roxolid™ example shows, an innovative product can signify an

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expansion of the range of indications for the dentist working in implant dentistry, that is, the possibility of reaching new groups of patients in whom implant therapy was not possible previously for various reasons or would have involved risks. This expansion of the range of indications also signifies corresponding growth

for their practice. Straumann customers are among the first who will benefit directly from the innovative, scientifically founded products that are designed to last – the outcome of years of intensive and accordingly expensive research. Training and education: an important element in the marketing mix Basic training in implant dentistry now features in under- and postgraduate education. However, there is a huge need for further education, specialization and refresher courses to ensure that practizing dentists, technicians, nurses and other dental professionals are able to offer the latest standard of care to patients. Premium companies like Straumann offer a large variety of courses worldwide every year. These are a major contribution to raising treatment quality and enhancing the standard of patient care. Although

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course participants usually pay a course fee, the companies incur considerable costs for the organization, teaching materials etc. Direct access to the customers and intense communication Because Straumann sells directly to dentists and dental laboratories, a close interaction with the customers to understand their requirements is possible. In addition to providing important information on new products and techniques, Straumann offers networking and hotline services. Our customers thus have access to specialists who can help with irregularities and difficult cases. In conjunction with the ITI, broad opportunities for customers to train further and to develop new skills are offered.

The risk of obsolescence In times of economic uncertainty, smaller low-margin companies face greater challenges to survive than established players with large customer bases. Saving on an implant increases the patient’s exposure to having an unserviceable implant in the future. Thus, an important question patients should ask is: ‘Is the implant system guaranteed?’ The risk of mixing Cheap implants often do not offer flexible solutions for technical matters. But making compromises is not worth even the cheapest price. Several low cost manufacturers sell copycat components intended for use on premium brand implants instead of the more expensive original components. Here

again, there is no clinical evidence to support the claimed compatibility. There is no assurance of the same precision or material quality. Furthermore, the original manufacturer’s liability for the product is voided and the dentist is responsible for mixing systems. As soon as components are mixed the Straumann guarantee becomes void. The Straumann Guarantee Quality, education and accountability come at a price. Short-term savings can prove painful in the long term, and although premium solutions may appear expensive initially, they could well work out cheaper in the long run. The question is: can patients really afford to the drawbacks of cheap alternatives?

Disadvantages and risks you may encounter when using cheap implants: Lack of clinical studies insecurity in care Restricted implant and prosthetic portfolio restricted treatment options Costly fitting inefficient working Combination with Straumann products loss of Straumann Guarantee If problems occur unreliable or no practical onsite service Unexpected complications full responsibility passes to the dentist No guarantee for a long-term market presence of the supplier risk of no support for phased-out products

Your benefit when using Straumann products: The components of the Straumann® Dental Implant System are the result of more than 20 years of scientific research. Straumann implants and prosthetic components offer an individual variety of treatment options Straumann products are designed for perfectly fitting solutions Straumann gives a 10-year guarantee Straumann gives immediate onsite support in problem cases – a call suffices.

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“Quality and service come at a price”

An interview with Dr Sandro Matter, Head of Global Products at Straumann In an interview with the Swiss business magazine “Finanz und Wirtschaft”1 on the topic of “Cheap implant suppliers versus premium brands“ Sandro Matter made his position clear, listing the reasons why, from Straumann’s point of view, such suppliers will not be successful in the long term and talked about the trends that occupy the manufacturers.

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Mr. Matter, what are the arguments in favor of dental implants?

the entire product then has to be replaced.

When a tooth has to be replaced, the dentist chooses either a bridge or an implant. As regards durability, both implants and bridges come off equally well in a ten-year comparison. Extrapolated to twenty years, the implants have the advantage. This is because only minor technical repairs are needed for implants in this period. With bridges, the problems are usually much more serious;

Do these statements apply to all available dental implants?

Interview: Carla Palm; published in the Swiss “Finanz und Wirtschaft” No. 13 of 18 July 2009, reprinted with the kind permission of the author. 1

No, the comparison is based on clinical studies with premium implants from Switzerland and Sweden. How must scientific studies in implant dentistry be designed if they are to demonstrate the benefit?

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“You can’t compare apples with pears. Quality and service come at a price. If patients knew what is sometimes implanted, they would begin to ask questions.“

There are different levels of clinical studies. The most reliable are randomized, controlled multi-center studies, which today are very similar to studies in the pharma industry. In contrast, there are individual case descriptions, which report on the treatment of individual patients and are published by dentists. Naturally, there is an enormous difference between the two studies. I suppose especially in price? A multi-center study over five years costs up to 1 million Swiss francs. At the moment, Straumann has 21 clinical studies in the field, and 15 of them are multi-center studies. How can smaller suppliers sell implants without clinical proof of the safety of the products? These suppliers sell their implants on the basis of the fundamental requirements of our sector. These include the basic biocompatibility of the products, appropriate design, mechanical strength and the company’s quality system. The European Medical Device Directive does not yet demand any clinical evidence for the benefit of the implants. The companies are only checked through a quality audit by the listed sites.

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Is that not frustrating for a market leader like Straumann, which invests several million francs a year in research and development? From 2010 the regulations regarding the scope of the clinical evaluation for all dental implant suppliers will be intensified. Straumann products are already documented by clinical studies although this is not necessary according to the standards of the sector. However, this gives us an enormous advantage in the long term in surgical, esthetic and long-term comparisons. Nevertheless, the small suppliers must be vexatious for the market leaders. The small companies like to present themselves as Robin Hood and we big companies are the evil Sheriff of Nottingham. That is just so much PR noise and is not true. Just because an implant looks like a Straumann product, it is not equally good. The products differ considerably, ranging from the surface structure through service to the material. Cheap suppliers often use titanium alloys, which do not osseointegrate as well. In contrast, Straumann works with pure titanium and the new material Roxolid™.

The price differences are substantial. You can’t compare apples with pears. Quality and service come at a price. If patients knew what is sometimes implanted, they would begin to ask questions. For instance, when problems arise with implants that are no longer being manufactured. Let’s stay with the competition. How do you assess the subject of culturing human teeth from stem cells? Admittedly, that is a fascinating area of research. However, the benefit for the dental sector is in the very distant future. Cell-based treatments are currently still very expensive. An ordinary dental implant treatment costs about 4,000 Swiss francs today. On the other hand, patients would have to come up with many times that amount for a cultured stem cell solution; that is still pie in the sky.

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PRACTICE BENCHMARKING

Discover and develop unutilized potentials for your practice The Straumann initiatives “Center of Excellence Implantology“ and “Achieving success in a specialist team” Implant restorations represent a great future market in the dental sector.1 Any dentist working in implantology who wants to offer his patients outstanding implant treatment and become successfully established permanently in this future market must think about his own professional and material development. Straumann would like to support this process with an excellence initiative. Establishing leading quality features The two Straumann initiatives planned internationally for the start of 2010, “Center of Excellence Implantology“ (with the focus on patients) and “Achieving success in specialist team” (with the focus on referring colleagues) are intended

Structure of the benchmarking initiatives: by including the practice team, patients and competitors and comparing the different perspectives, a 360° view of the individual situation is obtained.

to assist participating Straumann customers to obtain new information about unutilized potentials and associated forward-looking practice strategies. The surveys will be conducted by the prestigious “Institute for Management in the Health Service“ in Augsburg under Professor Dr Gerhard F. Riegl (see box). The surveys will be used and pro-

Team survey Compares the practice team’s assessment with the perceptions of patients and referring doctors.

“Achieving success in a specialist team“ Satisfaction, expectations, wishes and potential for improvement in the collaboration with referring colleagues.

Practice team

Referring colleagues

Patients

Your practice

“Center of Excellence Implantology“ Satisfaction, expectations, wishes and potential for improvement in the treatment of patients.

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fessionally analyzed in compliance with data protection for all those involved. The aim of the survey is not to ask referring colleagues or patients about all of their wishes and then fulfill these but to establish the leading quality features of the cooperation and then employ this information profitably for one’s own practice.

See “Dental implant penetration in leading markets“, Straumann business report 2008 p. 21. www.straumann. com/gb2008 1

Colleague benchmarking

Learning through direct comparison with regional colleagues

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Friendliness and atmosphere – two of the factors of patient satisfaction.

“Achieving success in a specialist team“: how one is perceived by referring colleagues An exchange in the spirit of partnership about cooperation wishes and the satisfaction of referring dentists provides the surgeon working in implant dentistry with valuable hints on optimizing potential. This knowledge can be an essential key factor for the success of the practice. This is not only a matter of a quantitative increase in referred patients but also of building up long-term links to the referring colleagues and extending this network, since it is the referral of suitable and demanding cases for treatment that lays the foundation for success in implantology.

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“Achieving success in a specialist team“: As a specialist working in implant dentistry, have you ever asked yourself … … why the referring dentists entrust you in particular with their cases? … whether you know the needs and expectations of your referring colleagues? … how you can offer your referring colleagues more benefits with small changes? … what is the basic level of satisfaction of referring colleagues with the existing cooperation? … how and by what means can you make yourself and your practice stand out from other competitors? … where you are already outstanding or where improvements would be appropriate? … what made you so successful with referring colleagues and what can you do to develop this success further in the long term?

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“Center of Excellence Implantology“: how one is perceived by the patients One of the keys to determining an individual practice’s success formula is a professional patient survey.

For analyzing the actual situation, it is very instructive to compare the subjective perceptions of the patients with the perspective of the practice owner. One of the resulting pieces of information might be that it does not make economic

“Center of Excellence Implantology“: As a specialist working in implant dentistry, have you ever asked yourself …

… on what criteria your patients based their choice of your practice?

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sense to implement changes (that is, invest time and money), which are not even noticed by the patient or are classified as minor. The aim of this initiative is to be able to set up specific measures on the basis of the obtained data that will increase patient satisfaction and promote both interest in and knowledge of the possibilities of modern implant restorations in the patients.

… whether your patients are satisfied and would recommend you to others? … what are your patients’ information needs? … whether your practice team recognizes customer needs correctly? … what importance your patients attribute especially to the framework conditions of your practice which are not relevant to treatment (such as service, appointment management, friendliness, atmosphere and appearance)? … how great is the willingness among your patients for tax-deductible high-quality restorations?

Benchmarking: what is the best way to differentiate? The two Straumann initiatives at the same time represent easily conducted regional market research, the results of which can be used for further qualification considerations. From the anonymous comparison with other colleagues from the same region, participants find out what made colleagues successful and how they compare with them. A win-win situation for all involved The excellence initiative described here was already carried out suc-

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cessfully in this form by Straumann in 2008 in one market (Germany), with entirely positive feedback from all involved target groups. Ultimately, everyone benefits from such a survey: the referring dentist whose wishes are accepted systematically and may be implemented; the surgeon who can work toward more referrals and greater dentist satisfaction through targeted changes; and the patient who obtains optimal treatment due to the coordination between referring dentists and surgeon. Thus, the recipe for success for a surgical dental practice is: “If you help the referring dentist and patient to gain, you gain yourself“.

The “Institute for Management in the Health Service“ of Prof Dr rer. pol. Gerhard F. Riegl Straumann’s cooperation partner, the “Institute for Management in the Health Surface“ of Professor Gerhard Riegl in Augsburg has the expertise of over a million patient surveys in over 10,000 practices. In the dental sector alone, more than 40,000 patients have been surveyed in over 700 practices. Prof. Riegl’s Institute is therefore a leader in the area of dental patient surveys and is the optimum partner for Straumann. Prof. Riegl is regarded in Germany as the “expert in quality assurance in medicine“. He is the publisher and author of the first large bestseller image and marketing study for dentists and dental laboratories in German-speaking countries under the title: “The Dental Practice as a Center of Excellence“. www.prof-riegl.de

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LITERATURE ALERTS SELECTED LITERATURE OF RECENTLY PUBLISHED JOURNALS1 STRAUMANN® EMDOGAIN Alhezaimi K, Al-Shalan T, O’Neill R, Shapurian T, Naghshbandi J, Levi P Jr, Griffin T. Connective tissue-cementum regeneration: a new histologic regeneration following the use of enamel matrix derivative in dehiscence-type defects. A dog model. Int J Periodontics Restorative Dent 2009;29(4):425-433. A total of 30 dehiscences were created on the maxillary canines and second and fourth premolars of five dogs; Emdogain was applied in the test group, while no Emdogain was used in the controls. After 4 months, functional connective tissue fibers in regenerated cementum (mean amount 3.74 ± 0.43mm) was found at all Emdogain sites, but no cementum was formed in the control sites. Emdogain therefore effectively promotes new cementum and connective tissue formation.

1 The abstracts of the quoted articles are publicly available from the database PubMed (www.pubmed.gov). The complete articles can be ordered there for a fee.

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Cortellini P, Pini-Prato G, Nieri M, Tonetti MS. Minimally invasive surgical technique and enamel matrix derivative in intrabony defects: 2. factors associated with healing outcomes. Int J Periodontics Restorative Dent 2009;29(3):257-265. Minimally invasive surgical technique, performed using microsurgical instruments and an operating microscope, was used

to access 40 deep intrabony defects and apply Emdogain to the root surfaces. CAL gain after 1 year was 4.9 ± 1.7 mm, with > 4 mm gain in 70 % of the defects, and was significantly associated with the depth of the three-wall component, intraoperative bleeding tendency and its interaction with the initial amount of bone loss. Garrocho-Rangel A, Flores H, SilvaHerzog D, Hernandez-Sierra F, Mandeville P, Pozos-Guillen AJ. Efficacy of Emdogain versus calcium hydroxide in direct pulp capping of primary molars: a randomized controlled clinical trial. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009;107(5):733-738. A total of 90 primary molars were treated in a spilt-mouth design using Emdogain or selfhardening calcium hydroxide. Internal dentin absorption, gingival sinus tract, root external resorption, pain and pathologic mobility were no significantly different between the groups; only one treatment in each group was judged as a failure. The pulp capping techniques evaluated in this study can therefore be recommended on the basis of clinical and radiographic results.

STRAUMANN® DENTAL IMPLANT SYSTEM Cochran DL, Bosshardt DD, Grize L, Higginbottom FL, Jones AA, Jung RE, Wieland M, Dard M. Bone response to loaded implants with non-matching implant-abutment diameters in the canine mandible. J Periodontol 2009; 80(4):609-617. In five dogs, 12 Straumann BoneLevel Implants per animal were placed after extraction of all mandibular premolars and first molars; implants were placed at alveolar crest level or 1mm above or below. Implants were submerged on one side of the mandible, while healing abutments were exposed to the oral cavity on the other side, and crowns were placed after 2 months. After 6 months, change in alveolar bone was -0.34mm, -1.29mm and 0.04mm for implants placed at, below or above the crestal bone, respectively for submerged implants, and -0.38mm, 1.13mm and 0.19mm for non-submerged implants. There were no significant differences in bone contact between or within the groups. The bone loss observed for implants with non-matching implant-abutment diameters were significantly less than those reported for similar implants with matching implant-abutment diameters. Cochran DL, Nummikoski PV, Schoolfield JD, Jones AA, Oates TW. A

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prospective multicenter 5-year radiographic evaluation of crestal bone levels over time in 596 dental implants placed in 192 patients. J Periodontol 2009;80(5):725-733. A total of 596 solid screw or hollow cylinder TPS surfaced Straumann implants placed in 192 patients were evaluated radiographically at implant placement, prosthesis placement, after 6 months and each year up to 5 years. Significant remodeling was observed in the first 6 months (mean bone loss of 2.44 ± 1.20 mm). Mean bone loss from prosthesis placement to 1 year and from 1 year to 5 years was 0.22 ± 0.42 mm and 0.18 ± 0.88 mm, respectively; 86 % of the total bone loss over 5 years occurred by the time of prosthesis placement. The observed trends were the same when adjusted for implant design, implant length and type of restoration. There is therefore significant bone remodeling up to the time of final prosthesis placement, but minimal bone loss thereafter. Gallucci GO, Doughtie CB, Hwang JW, Fiorellini JP, Weber H-P. Five-year results of fixed implant-supported rehabilitations with distal cantilevers for the edentulous mandible. Clin Oral Implants Res 2009;20(6):601-607. Implant-supported mandibular hybrid prostheses with distal cantilever extensions on

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237 Straumann implants were placed in 45 patients, and biological, implant and prosthetic parameters evaluated from implant placement up to 5 years. Mean cantilever length was 15.6mm (range 6 to 21mm). There were no implant failures, and the prosthesis survival rate was 95.5%, with a treatment success rate of 86.7% (six patients did not meet the criteria for success). The majority of complications were technical (54/79), and most of these involved fracture of the acrylic teeth and base (20/54). Rehabilitation with mandibular hybrid cantilever prostheses on implants was therefore a reliable treatment. Göllner P, Jung BA, Kunkel M, Liechti T, Wehrbein H. Immediate vs. conventional loading of palatal implants in humans. Clin Oral Implants Res 2009;20(8):833-837. From 2000 to 2006, two independent groups of patients, requiring maximum anchorage, were treated using Straumann ortho implants. Group 1 (n=36) was subjected to immediate functional loading within the first 24h after insertion while group 2 (n=40) received conventional implant loading after 12 weeks. The magnitude of orthodontic forces ranged between 1 and 3N. Histological workup was performed for nearly the last third of palatal implants removed after treatment. All implants reached primary stability. However, 3/36 in group 1 and 1/40 in group 2

were lost. The remaining implants were clinically stable and no mobility was recognized. The median BIC rates were 76% in group 1 (n=10) and 84% in group 2 (n=12); the difference was not statistically significant.

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Selected literature of potential interest from recently published journals.

Mericske-Stern R, Probst D, Fahrländer F, Schellenberg M. Within-subject comparison of two rigid bar designs connecting two interforaminal implants: patients’ satisfaction and prosthetic results. Clin Implant Dent Relat Res 2009;11(3):228-237. Patients received an implant-supported overdenture in the mandible and were randomly allocated to two groups. Group A received a standard U-shaped bar (Dolder bar), AND in group B precision attachments were soldered distal to the bar copings. After 3 months, patients answered a questionnaire and the bar design was exchanged. After a period of another 3 months, the patients had to answer the same questions; then they had the choice to keep their preferred bar. Patients that entered the study with the attachment bar gave slightly better ratings to this type for four items. At the end of the 6-month comparison period, all but one patient wished to continue to wear the attachment bar. In vivo force measurements of maximum biting were similar in both bar designs, but exhibited significantly higher axial forces in the attachment bar.

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Selected literature of potential interest from recently published journals.

SIMPLY DOING MORE

Nedir R, Bischof M, Vazquez L, Nurdin N, Szmukler-Moncler S, Bernard J-P. Osteotome sinus floor elevation technique without grafting material: 3-year results of a prospective pilot study. Clin Oral Implants Res 2009;20(7):701-707. In 17 patients, 25 Straumann implants were placed (16 molars and nine premolars) using osteotome sinus floor elevation; 21 of the implants were 10 mm long, while the others were 6 mm and 8 mm long. The implants were placed in newly formed bone tissue. All implants met the survival criteria after 3 years. Mean endo-sinus bone gain was 3.1 ± 1.5 mm and mean crestal bone loss was 0.9 ± 0.8 mm. Residual protrusion length decreased from 4.9 ± 2.1 mm to 1.8 ± 2.1 mm. Osteotome sinus floor elevation was therefore sufficient to gain bone without graft material. Nedir R, Nurdin N, Szmukler-Moncler S, Bischof M. Placement of tapered implants using an osteotome sinus floor elevation technique without bone grafting: 1-year results. Int J Oral Maxillofac Implants 2009;24(4):727-733. Osteotome sinus floor elevation without bone grafting was performed in 32 patients and 54 Straumann Tapered Implants were placed in sites with a residual bone height

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of between 1 and 6 mm (mean height 3.8 ± 1.2 mm). All implants achieved primary stability and were loaded after a mean 4.2 ± 1.6 months. One-year implant survival and success rates were 100 % and 94.4 %, respectively, and mean bone gain was 2.5 ± 1.7 mm and the mean crestal bone loss was 0.2 ± 0.8 mm. Primary stability can therefore be achieved with tapered implants in the posterior maxilla without bone grafting. Pjetursson BE, Rast C, Brägger U, Schmidlin K, Zwahlen M, Lang NP. Maxillary sinus floor elevation using the (transalveolar) osteotome technique with or without grafting material. Part I: implant survival and patients’ perception. Clin Oral Implants Res 2009;20(7):667-676. A total of 252 Straumann implants were placed using a modified osteotome technique in 181 patients between 2000 and 2005. The implant survival rate was 97.4 % for a mean follow-up time of 3.2 years; survival rates were 91.3 % at sites with ≤ 4 mm residual bone height, 90 % for sites with 4–5 mm residual bone height and 100 % at sites with ≥ 5 mm residual bone height. The survival rate was only 47.6 % for 6 mm long implants, compared to 100 %, 98.7 % and 98.7 % for implants 12, 10 and 8 mm long, respectively. Over 90 % of patients expressed

satisfaction with the therapy, as measured by visual analog scale, and the cost of therapy was considered to be justified. Pjetursson BE, Ignjatovic D, Matuliene G, Brägger U, Schmidlin K, Lang NP. Transalveolar maxillary sinus floor elevation using osteotomes with or without grafting material. Part II: radiographic tissue remodeling. Clin Oral Implants Res 2009;20(7):677-683. A total of 252 Straumann implants were placed using a modified osteotome technique in 181 patients between 2000 and 2005. Deproteinized bovine bone was used as grafting material for 35 % of the implants, while no grafting material was used for the remaining implants. Mean residual bone height was 7.5 ± 2.2 mm (range 2 to 12.7 mm); the mean residual height at sites with and without grafting material was 6.4 mm and 8.1 mm, respectively; the difference was significant. Mean bone gain with grafting material was significantly greater (4.1 ± 2.4 mm compared to 1.7 ± 2.0 mm without grafting material). Substantial new bone gain was therefore observed with grafting material. Siciliano VI, Salvi GE, Matarasso S, Cafiero C, Blasi A, Lang NP. Soft tissue healing at immediate transmucosal

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implants placed into molar extraction sites with buccal self-contained dehiscences. A 12-month controlled clinical trial. Clin Oral Implants Res 2009;20(5):482-488. Straumann Tapered Effect (TE) implants were immediately placed in molar extraction sockets with buccal bone dehiscence in 15 patients, and peri-implant defects were treated by a guided bone regeneration technique. In addition, 15 tapered effect implants were placed in healed molar sites in 15 patients (control group). After 12 months, implant healing was uneventful in all cases, and there were no implant failures. Probing depth and CAL values were significantly higher around the test implants, indicating that immediate placement in molar extraction sites with wide and shallow dehiscences may result in less favorable outcomes. Zijderveld SA, Schulten EAJM, Aartman IHA, ten Bruggenkate CM. Long-term changes in graft height after maxillary sinus floor elevation with different grafting materials: radiographic evaluation with a minimum follow-up of 4.5 years. Clin Oral Implants Res 2009;20(7):691700. Maxillary sinus floor elevation was performed in 20 patients with either autogenous bone or -tricalcium phosphate; patients were examined radiographically at least five times in a 4-5-year period and measurements were taken for BIC distally at the second most posterior implant, halfway between this and the posterior implant, and 5 mm distally to the posterior implant. Vertical bone height was significantly reduced at all locations, with no significant differences between the groups. A reduction in millimeters per month was observed at all three locations, but there was no significant difference in height reduction for vertical bone height and graft height between the three locations.

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STRAUMANN® SLACTIVE Roccuzzo M, Wilson TG. A prospective study of 3 weeks’ loading of chemically modified titanium implants in the maxillary molar region: 1-year results. Int J Oral Maxillofac Implants 2009;24(1):65-72. Implant site preparation in 35 patients was performed using osteotomes, with minimal drilling, and Straumann® SLActive surface implants were subsequently placed in the maxillary molar area, with abutment connection and provisional restoration in occlusion after 3 weeks. Pain was reported for six patients after 3 weeks, so provisionalization was postponed for another 4 weeks. There were no implant failures or patient dropouts after 12 months, and there were no significant differences in clinical parameters between baseline and 12 months. Threeweek occlusal loading can therefore be successfully performed with SLActive® implants. Schätzle M, Männchen R, Balbach U, Hämmerle CHF, Toutenburg H, Jung RE. Stability change of chemically modified sandblasted/acid-etched titanium palatal implants. A randomized controlled clinical trial. Clin Oral Implants Res 2009;20(5):489-495. Straumann® Orthosystem palatal implants with either an SLA® or an SLActive® surface were placed in 40 patients. Resonance frequency analysis was performed at implant placement and up to 84 days later. There were no significant differences in implant stability between the groups at placement (ISQ 73.8 ± 5 and 72.7 ± 3.9 for SLA and SLActive, respectively). ISQ values decreased thereafter in both groups, increasing again after 28 days in the modified SLA group and after 35 days in the SLActive group, returning to baseline values after 42 and 63 days, respectively. Stability was significantly higher in the SLActive group after 12 weeks.

STRAUMANN® BONECERAMIC Jensen SS, Bornstein MM, Dard M, Bosshardt DD, Buser D. Comparative study of biphasic calcium phosphates with different HA/TCP ratios in mandibular bone defects. A long-term histomorphometric study in minipigs. J Biomed Mater Res B Appl Biomater 2009;90(1):171-181.

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Selected literature of potential interest from recently published journals.

Defects were prepared in the mandibles of 24 minipigs and treated with hydroxyapatite/ tricalcium phosphate in three different ratios (20/80, 60/40 and 80/20) compared to autogenous bone, deproteinized bovine bone mineral (DBBM) or coagulum as controls. Bone formation and filler degradation of HA/ TCP 20/80 was similar to autogenous bone, while HA/TCP 60/40 and 80/20 were similar to DBBM. For all three test materials, bone formation and filler degradation was inversely proportional to the HA/TCP ratio. At all time points (4, 13, 26 and 52 weeks), autogenous bone showed the highest fraction of filler surface covered with bone, while the fraction was higher for DBBM than HA/TCP 80/20 and 60/40 in the early healing phase. Schwarz F, Sager M, Ferrari D, Mihatovic I, Becker J. Influence of recombinant human platelet-derived growth factor on lateral ridge augmentation using biphasic calcium phosphate and guided bone regeneration: a histomorphometric study in dogs. J Periodontol 2009;80(8):1315-1323. Lateral ridge defects in eight dogs were treated with biphasic calcium phosphate plus collagen membrane, with or without recombinant human platelet-derived growth factor-BB (rhPDGF-BB) and assessed after 3 weeks. Comparable bone and blood vessel formation was observed in both groups, but greater transglutaminase II activity was observed in the rhPDGF-BB group, resulting in significantly higher mean augmented area and mineralized tissue.

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EDUCATION

STRAUMANN AND ITI

International education program at a high level â&#x20AC;&#x153;Simply doing moreâ&#x20AC;&#x153; applies to Straumann in education, too. In collaboration with the ITI and its fellows it offers a broad range of high-quality international training and continuing education courses on the most varied topics in implantology, prosthetics and oral tissue regeneration. This article gives a brief overview of some of these and indicates where you can obtain further information or register for one of the numerous events.

Transnational communication of knowledge For many years now, Straumann and the ITI (International Team for Implantology) have been highly successful in organizing international continuing education courses on different topics in the area of

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dental implantology and oral tissue regeneration. This international range is an ideal complement to the national courses available. It enables practitioners to extend their knowledge and professional network purposefully in a global context with top speakers and instructors.

From theory to practice with new information and modern equipment In order to ensure constantly high course quality, Straumann and the ITI rely on cooperation with experienced and internationally wellknown speakers and on courses

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EDUCATION

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Live-operation of Prof Daniel Buser at the University of Bern/Switzerland.

designed to cover all the relevant aspects of comprehensive and indepth continuing education. The contents of the events are characterized by a balanced mixture of scientific, medical and technical topics. The discussion of cases from clinical practice along with the latest evidence-based medical information for treating them successfully is supplemented optimally by live surgeries and practical exercises. This is an optimal way to communicate the translation of theory into practice and it offers the possibility of applying the acquired knowledge under expert instruction. Broad range of topics The spectrum of contents offered internationally and locally extends from courses on regenerative periodontal surgery, GBR, implant surgery and prosthetics to technical and scientific subjects such as the optimal use and integration of CADCAM in practice and the

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employment of implant-based treatment concepts with a view to optimal cost effectiveness for clinician and patient. Highlights with attractive framework programs This international continuing education program contains highlights that are impressive not only with regard to the contents and high scientific level: the “ITI Education Weeks“ at the universities of Bern, Stuttgart and Hong Kong, the successful “Icelandic Week“, which will take place for the third time in 2010, the cadaver course at the University of Vienna with its unique premises or the course on “Clinical Experience in Advanced Surgery“ in Brazil, which allows surgical techniques to be employed on patients directly. These events combine education at the highest level with a framework program that will provide their participants with lasting memories.

Modular concept in accordance with SAC guidelines The range of courses is modular and structured in accordance with the “SAC Classification in Implant Dentistry“1 guidelines. The treatment complexity of clinical cases and the associated treatment risks are classified into the three stages S (Straightforward), A (Advanced) and C (Complex).

A. Dawson, S. Chen, D. Buser, L. Cordaro, W.Martin, U. Belser. „The SAC Classification in Implant Dentistry“. Quintessence Publishing Co, 2009. ISBN 9781-85097-188-7. www.quintessenz.de, www.quintessence publishing.co.uk, www.quintpub.com. 1

You will find more information about the international and local courses on offer on the homepage of your regional Straumann branch, in the current international course brochure, also available through your regional Straumann partner, or at www.iti.org.

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EVENTS

ITI WORLD SYMPOSIUM 2010

“30 Years of Leadership and Credibility” 15 – 17 April 2010 in Geneva/Switzerland at the Palexpo Conference Center

A special year in ITI history As one of the biggest events in the implant dentistry calendar, the ITI World Symposium justly enjoys an excellent reputation thanks to its tradition of focusing on cutting-edge issues and providing clinicians with solid information as well as the opportunity for discussion with opinion leaders from all over the world. The upcoming ITI World Symposium in Geneva promises to fulfill expectations for an incisive and challenging scientific program coupled with a strong practice-oriented approach. 2010 is a special year for the ITI as it will be celebrating its 30th anniversary.

Further information, registration & accommodation: Internet: www.iti.org/worldsymposium2010 E-Mail: iti2010@interplan.de Phone: +49 89 5482 3462 Fax: +49 89 5482 3443

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From visionary pioneering work to a leading, international organization As an independent, multidisciplinary academic organization, the International Team for Implantology has grown from a small group of visionary pioneers in implant dentistry to a leading international organization with more than 6,000 Fellows and Members and national sections in 24 countries. The ITI’s mission: “to promote and disseminate knowledge on all aspects of implant dentistry and related tissue regeneration” lays particular emphasis on education to ensure that practitioners are able to deliver optimal treatment to their patients. Throughout its 30 years, the ITI has led the way in implant dentistry, taking scientific rigor as its touchstone, and this pervades every aspect of its professional activities, including its many

publications and events. The 2010 Symposium motto reflects this history: “30 Years of Leadership and Credibility.” Much informative and lively debate and incisive discussions guaranteed The faculty for the World Symposium is made up of leading thinkers and opinion leaders in the field of implant dentistry from all over the world and their presence promises much informative and lively debate and incisive discussion. The carefully balanced scientific program as well as the newly introduced pre-symposium courses and the program of social activities available ensure that the ITI World Symposium 2010 will be the implant dentistry event of 2010 and one that should not be missed under any circumstances.

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EVENTS

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INTERVIEW

“We want to give our participants a great educational experience” Geneva, a beautiful and historic city in the heart of Europe, is the ideal location for the ITI World Symposium. This choice was based on the excellent infrastructure offered by the Palexpo Conference Center, which will provide the best possible conditions for both participants and exhibitors. With its Riviera-like atmosphere, Geneva has a reputation for shopping, banking and elegance as well as being the center for a number of important, international organizations. The city nestles at the foot of the mountains while the lake spreads out its sparkling expanse in front of it before receding in the distance to the jagged line of snowy white peaks on the horizon that are the Alps. For more information visit www.geneva-tourism.ch

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An interview with Prof Dr Daniel Buser and Dr Stephen Chen on the ITI World Symposium 2010 in Geneva, Switzerland

Dr Chen, you are the ﬁrst Australian Chairman of the ITI World Symposium Scientiﬁc Program Committee. The symposium will be held in Geneva, Switzerland – a bit far from Australia. Why Geneva? Stephen Chen: We chose Geneva because it is a central location for most of our ITI Members and Fellows, and is easy to travel to. Geneva has outstanding infrastructure and exhibition facilities with excellent accommodation and quality hotels in the vicinity – and it is a beautiful and picturesque city. The other very important point is that 2010 marks the 30th anniversary of the ITI. Although the ITI is an international organization, it was founded in Switzerland and we would like to bring this event back to Switzerland to celebrate this 30th birthday in the ITI’s birthplace.

Prof Buser, as the new ITI President and as a member of the Scientific Program Committee, you were strongly involved in designing the program. The theme of the ITI World Symposium is “30 Years of Leadership and Credibility”. Can you explain to our readers what stands behind this claim? Daniel Buser: With this title we would like to reflect the leadership the ITI has provided in all these years. When you analyze the current state of implant dentistry and the milestones achieved, you can easily recognize that the ITI has had an impressive influence over the progress and the future development of implant therapy. That involves such topics as the non-submerged healing modality and the discussion on surface technologies and biologic width. All these aspects have been strongly influenced by the ITI.

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The title may not sound too modest novel procedures and how they but, in my opinion, it clearly reflects might fit into the practice of implant dentistry. The third day reflects a our pride. very important and growing area in implant dentistry: namely the recognition that complications are a OVERALL, IT IS A STRONG PROGRAM AND EVERY SESSION AND ALL THE SPEAKERS reality of daily practice. Therefore, ARE GOING TO PROVIDE US WITH THE BEST AND MOST UP-TO-DATE INFORMATION this day will be devoted to looking at the different aspects of complicaABOUT THE TOPICS THAT THEY HAVE BEEN ASSIGNED TO. Stephen Chen tions, from surgical and biologic to technical and, importantly, esthetic complications. So there is a natural progression through the three Dr Chen, what will be the main days which I think should be welltopics and especially the highreceived by the audience. Personlights of the upcoming sympoally, I have no favourites amongst sium? What will be your own the topics. Overall, it is a strong favourites among the presentaprogram and every session and all tions? the speakers are going to provide us with the best and most up-to-date Chen: The scientific program committee decided to structure the three information about the topics that they have been assigned to. days of the Symposium according to specific themes that reflect Prof Buser, who should attend the clinical practice. On the first day, ITI World Symposium? Is this event new clinical methods of diagnosis intended only for ITI Fellows and and treatment planning will be Members or Straumann users? presented and discussed. The second day is devoted to treatment procedures – not just proven treatment procedures but also new and

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Buser: In general, it is intended to attract dentists with an interest in implant dentistry. Of course we will see a high share of participants who are ITI Members and Fellows. But it certainly will be a very instructive experience for non-ITI participants, too. Dr Chen, the last ITI World Symposium in 2007 in New York City set a new record with about 3,000 participants. How many participants do you think will show up in Geneva, also considering these economically challenging times? Chen: I am very conﬁdent that we will exceed those numbers in Geneva. Much has been said about the current economic challenges and the global downturn but the truth of the matter is that dentists will always seek out quality in continuing education. If we put on a strong program, irrespective of the economic times, people will come from far and wide.

factor. And thirdly, the programs of ITI symposia have always been of an excellent quality which has led to a ﬁrst-class reputation that is recognized by the scientiﬁc community. Dr Chen, as a novelty, the ITI World Symposium will feature Pre-Symposium Courses? What is the intention behind these new events?

address two areas of implant dentistry in detail. The ﬁrst course is a bone grafting course for site development. The speakers will report on the latest techniques and procedures to augment a site prior to implant placement. The second course is a very interesting and topical one: it deals with soft tissue management and conditioning around implants with the focus on esthetics.

Chen: We want to give our participants a great educational experience. The Scientiﬁc Program Committee decided to hold two Pre-Symposium Courses that will

Dr Chen, Prof Buser, many thanks for the conversation. We wish you and your team a successful ITI World Symposium 2010 in Geneva, Switzerland.

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Prof Buser, you have attended and lectured at many congresses and symposia all over the world. What makes the ITI World Symposium unique? Buser: I see three reasons for the uniqueness of the ITI World Symposium. Firstly, we always have focused on two topics and discussed them very thoroughly. Secondly, it is a truly international conference. We had more than sixty nations represented at the last ITI World Symposium in New York in 2007 and I think that this strong international touch is an important

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Prof Dr Daniel Buser

Dr Stephen Chen

Prof Dr Daniel Buser is Professor and Chairman of the Department of Oral Surgery and Stomatology at the University of Bern, Switzerland. He has been an ITI Fellow since 1986 and a member of various committees, most recently Chairman of the Education Committee, as well as taking on numerous additional functions within the organization. Since August 2009, Daniel Buser has been President of the ITI.

Dr Chen is a specialist periodontist in private practice in Melbourne, Australia and Senior Fellow at the School of Dentistry, University of Melbourne. He graduated from the University of Malaya and obtained the MDSc degree from the University of Melbourne and FRACDS. Dr Chen is a Fellow of the ITI, Chairman of the Australasian ITI Section and also Chairman of the ITI Education Committee and Education Core Group.

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PRE-SYMPOSIUM COURSE 1

Soft tissue management and conditioning around implants in the esthetic zone. Wednesday, April 14, 2010

9:15 9:30 10:10 10:50 11:10 11:50 12:30 13:30 14:10 14:50 15:30

Lecture Welcome and introduction Chairmen: Luca Cordaro (ITA), Dean Morton (USA) Soft tissue conditions for peri-implant tissue health and optimum esthetics Ridge preservation: Does it affect soft tissues and esthetic outcome? Coffee break Soft tissue augmentation at the time of implant placement or at second surgery How do provisional restorations inﬂuence our esthetic outcome? Are they always needed? Lunch Artiﬁcial gingiva in the aesthetic zone: a defeat or the most predictable and durable aesthetic outcome? Soft tissue contouring in the provisional phase for multiple missing teeth. Different options with transmucosal or bone level implants Treatment of mucosal recession affecting implant restorations End of pre-symposium

Speakers

Mario Roccuzzo (ITA) Paolo Casentini (ITA) Anthony Sclar (USA) Daniel Thoma (SUI)

Francesca Vailati (SUI) Javier Fabrega (ESP) Rino Burkhardt (SUI)

PRE-SYMPOSIUM COURSE 2

Bone grafting for implant site development. 9:15 9:30 10:10 10:50 11:10 11:50 12:30 13:30 14:10 14:50 15:30

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Lecture Welcome and introduction Chairmen: Hideaki Katsuyama (JPN), Gerhard Wahl (GER) Dimensional and positional requirements of bone for optimum function and esthetics Harvesting of autologous bone – indications for selection of donor sites, morbidity and complications Coffee break Procedures for lateral and vertical augmentation of ridges using autogenous bone blocks Allografts and xenografts Lunch Sinus ﬂoor grafting using the lateral window technique Sinus ﬂoor grafting using the transalveolar technique Distraction osteogenesis End of pre-symposium

Speakers

James Ruskin (USA) Timothy Head (CAN)

Hendrik Terheyden (GER) Jürgen Becker (GER) Hideaki Katsuyama (JPN) Paul Fugazzotto (USA) Paul Rousseau (FRA)

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New Clinical Methods for Diagnosis and Treatment Planning. Thursday, April 15, 2010

9:00

Lecture Opening of the scientiﬁc meeting

9:15

Keynote Address: Pioneering a more sustainable future

12:00 12:30 13:00

Session 1: Computer-based diagnostic and planning tools for implant dentistry Moderators: Anthony Dickinson (AUS), Johannes Kleinheinz (GER) Improving the reliability of computerized reformatted radiological images Has cone beam CT made conventional CT obsolete? Coffee break From planning to surgery: a critique of guidance and navigation techniques Implant treatment planning software: an essential tool or gadgetry? Panel discussion Lunch

14:30 15:00 15:30 16:00 16:30

Session 2: The impact of new technologies on treatment planning Moderators: Tom Taylor (USA), Ray Williams (USA) Periodontal regenerative procedures in the era of implant dentistry Choosing the implant design: soft tissue level or bone level? New narrow body implants – expanded treatment opportunities? The SLActive surface – new promise for compromised sites? Panel discussion

17:00 17:25 17:50

Session 3: Limited Attendance Session (5 parallel presentations) Diagnosis and planning Moderator: Merete Aaboe (DEN) 3A Planning for patients with hypodontia and anodontia 3A CT evaluation – when, where and how? 3A Soft tissue visualization by CT

10:00 10:30 11:00 11:30

18:15 17:00 17:25 17:50 18:15 17:00 17:25 17:50 18:15 17:00 17:25 17:50 18:15

3A Anatomy as a risk factor Surgery Moderator: Christiaan ten Bruggenkate (NED) 3B Immediate implant placement in the esthetic zone 3B Ridge expansion – esthetic and surgical outcomes 3B Computer-guided implant placement 3B Replacement of hopless teeth in the esthetic zone Restorative procedures Moderator: Eiji Funakoshi (JPN) 3C Attachment systems for implant overdentures 3C Immediate loading of full-arch restorations 3C Immediate loading of two implant overdentures 3C Transitional appliances for immediate function of distally tilted implants Restorative procedures Moderator: Javier Fabrega (ESP) 3D Provisionals and soft tissue management 3D Abutment material and mucosal color 3D Cement vs. screw-retained restorations 3D Implants and orthodontics Outcomes Moderator: Philip Freiberger (GBR)

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Speakers Daniel Buser (SUI), Stephen T. Chen (AUS) Bertrand Piccard

William Scarfe (USA) Bernard Koong (AUS) Ronald Ernst Jung (SUI) Daniel Wismeijer (NED)

Nikos Donos (GBR) Christoph Hammerle (SUI) Paul Stone (GBR) Frank Schwarz (GER)

Nadine Brodala (USA) Robert A. Jafﬁn (USA) Alessandro Lourenço Januário (BRA) Andre van Zyl (RSA) Ken Akimoto (USA) Dehua Li (CHN) Ali Tahmaseb (NED) Farhad Boltchi (USA) Arne Boeckler (GER) Jeffrey Ganeles (USA) Geert Stoker (NED) Sergio Piano (ITA) Diego Bechelli (ARG) Diego Lops (ITA) John Lucas (AUS) Wolfgang Trumm (GER)

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17:00 17:25 17:50 18:15 18:40

3E 10-year outcome of SLA implants in the edentulous maxilla 3E Reduced diameter implants in the posterior maxilla 3E Soft tissue stability around immediately placed and restored implants 3E Esthetic outcomes with bone level implants End of day 1

Kerstin Fischer (SWE) João Garcez Filho (BRA) Pedro Tortamano Neto (BRA) Chris Evans (AUS)

New and Proven Treatment Procedures. Friday, April 16, 2010 Lecture

8:00

Session 4: Limited Attendance Session (5 parallel presentations) Risk factors Moderator: Alex Tsai (TPE) 4A Critical factors for esthetic stability 4A Risk markers for oral bisphosphonate-related osteonecrosis 4A Excess cement and peri-implant disease 4A Osteoporosis as a risk factor for implant failure Surgery Moderator: Juan Carlos García Lara (MEX) 4B Minimally invasive sinus lift procedures 4B Vertical augmentation of the atrophic posterior mandible 4B Vertical and lateral bone augmentation using biphasic calcium phosphate 4B Distraction osteogenesis in partially dentate patients Surgery Moderator: Gerrit Wyma (RSA) 4C Microvascular bone transfer for ridge augmentation 4C Piezoelectric bone surgery in implant dentistry 4C Prosthodontically-driven tissue engineering 4C Post-extraction implants and immediate loading Restorative procedures Moderator: Richard Leesungbok (KOR) 4D Occlusal reconstruction based on maxillofacial skeletal morphology 4D Combining pink acrylic and porcelain in the estetic zone 4D Prosthetic reconstruction of the resected mandible 4D Principles of Attachment Selection in Overdenture Treatment Outcomes Moderator: Timothy W. Head (CAN) 4E Immediate non-functional loading of implants in the posterior maxilla

8:25 8:50 9:15 9:40

4E Ridge preservation 4E After implant placement and loading – what then? 4E Immediately temporized implants in the esthetic zone Coffee break

8:00 8:25 8:50 9:15 8:00 8:25 8:50 9:15 8:00 8:25 8:50 9:15 8:00 8:25 8:50 9:15

10:00 10:30 11:00 11:30 12:00 12:30

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Session 5: Surgical procedures Moderators: Steve Barter (GBR), David Cochran (USA) Bone grafting for localized defects – simultaneous or staged? Sinus ﬂoor augmentation Short implants – what is short and what is not? Flapless surgery Panel discussion Lunch

Speakers

Akshay Kumar (USA) Yong-Dae Kwon (KOR) Thomas Wilson (USA) Cermal Ucer (GBR) Lars Ake Johansson (SWE) Waldemar Polido (BRA) Andres Stricker (GER) Eppo Wolvius (NED) Alexander Gaggl (AUT) Nathan Hodges (USA) George Sandor (CAN) Juan Blanco Carrión (ESP) Masaaki Hojo (JPN) Steven Present (USA) Robert Lee Schneider (USA) Siegfried Heckmann (GER) Jonathan Mark Korostoff (USA) Nikolaos Mardas (GBR) Per Nygaard-Ostby (NOR) Barry Levin (USA)

Thomas von Arx (SUI) Matteo Chiapasco (ITA) Franck Renouard (FRA) Stephen T. Chen (AUS)

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Lecture

14:00 14:30 15:00 15:30 16:00

16:30 18:30

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Speakers

Session 6: Treatment procedures – prosthetic and technical Moderators: Frauke Müller (SUI), Tony Dawson (AUS) Bone and tissue level implants – prosthetic implications From casting to CAD/CAM: navigating the technologic advances affecting clinicians today Evolution of loading protocols in oral implantology The technicians’ viewpoint – material and technical evolution in implant dentistry Panel discussion

Will Martin (USA) Brody Hildebrand (USA) German Gallucci (USA) Michel Magne (USA)

Session 7: ITI Research Competition Oral presentations (5 categories) (10 minutes speaking time, 2 minutes for questions + answers per presentation) End of day 2

Complications in Implant Dentistry or Dealing with Reality. Saturday, April 17, 2010 Lecture

9:00 9:30 10:00 10:30

Session 8: Surgical and biologic complications Moderators: Joseph Fiorellini (USA), Erik Hjørting-Hansen (DEN) Complications – introduction and overview Peri-operative complications – occurrence, prevention, and handling Biologic complications – prevention and management Coffee break

11:00 11:30 12:00 12:30 14:00

Session 9: Management of technical complications Moderators: Andrea Mombelli (SUI), Steven Eckert (USA) Technical complications – implant-related Technical complications – prosthesis-related Panel discussion Lunch ITI Award Ceremony

14:30 15:30

16:30 16:45

Speakers

Niklaus P. Lang (HKG) Simon Storgård Jensen (DEN) Giovanni E. Salvi (SUI)

Bjarni Elvar Pjetursson (ICE) Dean Morton (USA)

Session 10: Esthetic complications Moderators: Lisa Heitz-Mayﬁeld (AUS), Hans-Peter Weber (USA) Surgical and prosthodontic management of esthetic complications Daniel Buser and Urs Belser (SUI) Interactive case discussion Restorative Dentist – Frank Higginbottom (USA) Periodontist – Luca Cordaro (ITA) Maxillofacial Surgeon – Dieter Weingart (GER) Technician – Alwin Schönenberger (SUI) Closing remarks Daniel Buser (SUI) End of ITI World Symposium 2010

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“The Formula for Predictable Implant Success” – 25th Anniversary Annual Meeting of the Academy of Osseointegration 4–6 March 2010 in Orlando/Florida The Academy of Osseointegration (AO) is celebrating 25 Years of excellence in education and development of implant technology and clinical-surgical practice. Throughout the last quarter-century, the AO has come together to discover and share new ideas, approaches and technology that have guided dental implant arena into the 21st century. This year’s Annual Meeting continues the tradition of promoting professional excellence and fellowship in the beautiful city of Orlando in Florida.

Straumann at the AO

Join Straumann at booth #419 to learn about Straumann’s formula – innovation and scientific evidence – for predictable implant success. Experience Roxolid™ and Straumann guided surgery through hands-on at our booth.

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On Thursday, March 4, from 8:00 am–12:00 noon, Straumann will sponsor a Corporate Forum with lectures of five internationallyrenowned speakers.

Session 1A

Evolving treatment options in GBR – Evidence of todays techniques and future perspectives

Christoph Hämmerle DMD, Prof. Dr. Professor and Chairman of the Department of Fixed and Removable Prosthodontics and Dental Material Science, University of Zurich, Switzerland.

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Orlando The 2010 Annual Meeting of the AO will be held at the Walt Disney World Dolphin Resort® in Orlando, Florida. A recipient of the prestigious Meetings & Conventions Hall of Fame Award, the Walt Disney World Dolphin Resort® is a respected and recognized leader in the US convention resort arena. Ideally located in the heart of the Walt Disney World®, guests enjoy immediate access to all adjacent theme parks and attractions. Experience the exclusive Disney Differences, sophisticated guest rooms featuring Westin Heavenly Beds®, the luxurious Mandara Spa and 17 world-class restaurants and lounges. For more information visit: www.orlandoinfo.com and disneyworld.disney.go.com

For more information visit the AO website: www.osseo.org Session 1B

Roxolid™ – more treatment options in placing small diameter implants

Jan Gottlow DMD, PhD, Sweden

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Session 2A

Digital Interdisciplinary Implant Dentistry – Part I Session 2B

Digital Interdisciplinary Implant Dentistry – Part II

Frank L. Higginbottom DDS. Clinical Associate Professor, Department of Oral and Maxiollofacial Surgery and Pharmacology, Restorative Sciences and Graduate Prosthodontics, Baylor College of Dentistry; Clinical Associate Professor, Department of Periodontics, University of Texas San Antonio

Thomas G. Wilson, Jr. DDS, Diplomate, American Board of Periodontology, Clinical Associate Professor, Dental School, University of Texas at San Antonio, Baylor College of Dentistry

Jeff Singler CDT, Founder of Singler Dental Ceramics, Inc. with focus on complex restorative cases and implant restorations.

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14th Annual UAE International Dental Conference & Arab Dental Exhibition (AEEDC) 9–11 March 2010 at the International Convention & Exhibition Center in Dubai The AEEDC Conference is a key platform for exchanging knowledge and information among dental colleagues and experts in the Gulf, Middle East and North Africa regions. Over the 3-day conference and exhibition, 20,000 visitors are expected. The conference will cover numerous topics highlighting the advances in dentistry and many other dental techniques essential to dental practice and the satisfaction of the entire dental sector. A comprehensive scientific program is provided for the education and enhancement of dental practices. The scientific conference within the event will host international and regional experts around the globe to present a series of lectures and specialized courses based on the latest researches and clinical experiences.

Dubai In addition to an appealing business environment, Dubai has something to offer for everyone. For example perfect winter climate, superb beachside resorts, world class shopping, spectacular beaches, lush green parks, great facilities for a variety of sports and leisure activities. For centuries hospitality has been Dubai’s tradition, nowadays Dubai extends this welcome to holiday makers as well as business visitors, offering facilities of the highest international standards combined with the charm and adventure of Arabia – an exceptional blend of modern city and timeless desert. For more information visit www.dubaitourism.ae

STARGET_1_2010_en.indd 74

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STARGET 1 I 10 75

Straumann at the AEEDC

On Wednesday, March 9 in the scientific program, three speakers will present their experiences with the Straumann® Dental Implant System.

Reconstruction of the severely resorbed maxilla with a combination of sinus augmentation, onlay bone grafting, and implants for patients with Ectodermal Dysplasia

Bone Level implants and tissue level implants used in atrophic jaws – 2 different implant philosophies with 2 different treatment concepts

Small diameter implants – where advanced materials make a difference

Dr Joe Bassil

Dr Dr Frank Palm

Ass. Prof Dr Dr Bilal Al-Nawas

Private practice in Beirut/Lebanon

Specialist in oromaxillofacial surgery

Oral surgeon at the Lebanese Army Hospital in Beirut

Chief of the Oromaxillofacial Surgery Department at Klinikum Konstanz/ Germany

Chief of the Oralmaxillofacial Surgery Department at the University Hospital Mainz/Germany

Professor of implantology and oral surgery at the University of Pisa/Italy

ITI Fellow

Senior Lecturer at the Department of Oral Surgery of the Saint Joseph University in Beirut ITI Fellow

ITI Fellow

Also visit the Straumann booth and learn more about Straumann’s latest innovations, such as Straumann® Roxolid™ (see p. 18–25).

OVERVIEW Dates: Venue: Exhibition hours: Conference hours: Admission fees for conference:

Information and registration:

STARGET_1_2010_en.indd 75

AEEDC 2010 March 9–11, 2010 Dubai International Convention & Exhibition Center Tuesday – Thursday: 10:00 am–6:00 pm Refer to program for details USD $220 (before December 31, 2009) USD $270 (after December 31, 2009) (USD $435 (on site registration)) www.aeedc.com

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“Guidelines for the Practitioner” – 18th Annual Conference of the EAO 30 September – 3 October 2009 at the Grimaldi Forum in Monaco Official Roxolid™ launch The 18th Annual Conference of the European Association for Osseointegration, one of the world’s biggest and most important international meetings in implant dentistry, attracted over 3,000 dental professionals from 71 countries. Although the Mediterranean atmosphere of Monaco and the beautiful weather offered a lot of distraction, the scientific sessions were very well

STARGET_1_2010_en.indd 76

attended throughout the conference. Straumann officially launched its new innovative implant material Roxolid™ in the European market (see p. 18–21). Straumann Satellite Symposium In the Straumann Satellite Symposium, Prof Bilal Al-Nawas gave a lecture on Roxolid™ and in this connection presented the latest results from the various pre-clinical

and clinical studies and the benefits especially in cases of narrow bone ridges. His presentation and those of Dr David Schwab, Dr Luca Cordaro, Dr Ronald Jung and Dr Javier Fábrega can be reviewed online at www.straumann.com/ eao_monaco

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Preview: EAO 2010 in Glasgow The next EAO conference will be held in the historic city of Glasgow, Scotland (UK), 6 – 9 October 2010. Don’t miss the Straumann Satellite Symposium scheduled for Thursday, 7 October 2010 from 11:00 am to 1:00 pm. Should you wish to be kept informed about Straumann activities at the EAO Glasgow, please send an e-mail to events@straumann.com. For updated program information & registration, visit the ofﬁcial EAO website: www.eao.org

The “Armadillo”, part of SECC, the Scottish Exhibition & Conference Centre

STARGET_1_2010_en.indd 77

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EVENTS

2010 LAND COUNTRY

MEETING DATES

Argentina

July 21–23

Argentina

SHORT NAME CITY

WEBSITE

Argentinean Prostodontic Association

APA

Buenos Aires

www.aoa.org.ar

Aug. 4–7

22° Muestra del Comercio e Industria Dental Argentinia

Expodent

Buenos Aires

www.expodent.com.ar

Argentina

Sept. 23–26

ITI Argentina Congress

ITI

Buenos Aires

www.itiargentina2010. com.ar

Belgium

Sept. 14–18

20th Congress of the European Association for Cranio-Maxillo-Facial Surgery

EACMFS

Bruges

www.eacmfs2010.org

Belguim

Oct. 21–23

International Dental Equipment Exhibition DENTEX

Brussels

www.dentex.be

Brazil

Jan. 30– Feb. 3

Congresso Internacional de Odontologia São Paulo

CIOSP

São Paulo

www.ciosp.com.br

Brazil

June 17–19

IX Encontro Internacional da Academia Brasileira de Osseointegração

ABROSS

São Paulo

www.abross.org.br

Brazil

Sept. 2–5

Annual Congress of the FDI World Dental Federation

FDI

Salvador da Bahia

www.fdiworldental.org

Brazil

Sept. 23–25

ITI Brazil Congress

ITI

Campinas

www.itieducacao.org

Bulgaria

Jan. 29–30

3 International Congress of Bulgarian Association of Oral Implantology

BAOI

Sofia

info@ultradental.net

Canada

March 3–6

Joint meeting of the American and AADR, CADR Canadian Association for Dental Research

Washington, DC (USA)

www.iadr.org

Canada

April 15–17

Pacific Dental Conference

PDC

Vancouver

www.pdconf.com/cms2010

Canada

May 13–15

Ontario Dental Association Annual Meeting

ODA

Toronto

www.youroralhealth.ca

Canada

May 27–30

Canadian Academy of Periodontology Annual Meeting

CAP

Vancouver

www.cap-acp.ca

Canada

May 29–June 1

Journee Dentaires Internationales du Quebec

JDIQ

Montreal

www.ordredesdentistesdu quebec.qc.ca

Canada

Sept. 20–27

Canadian Association Oral & Maxillofacial Surgery Annual Meeting

CAOMS

Whistler

www.caoms.com

Canada

Oct. 13–14

Canadian Academy of Restorative Dentistry & Prosthodontics

CARDP

Calgary

www.cardp.ca

China

March 29– April 1

Dental South China Exhibition & Conference

Dental South China

Guangzhou

www.dentalsouthchina. com/en

China

June 9–12

Sino-Dental Exhibition

Sino-Dental

Beijing

www.sinodent.com.cn

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FULL MEETING NAME

Worldwide Key Dental Events Calendar

21.12.2009 17:36:22 Uhr

EVENTS

COUNTRY

MEETING DATES

China

Oct. 27–30

Denmark

SHORT NAME CITY

WEBSITE

13 China International Exhibition & Symposium on Dental Equipment, Technology & Products

DenTech China Shanghai

www.dentech.com.cn

April 15–17

Scandinavian Dental Fair

SCANDEFA

Copenhagen

www.scandefa.dk

Finland

March 20

Apollonia Symposium 2010

Apollonia

Tampere

www.apollonia.fi

Finland

Nov. 12–14

Finnish Dental Congress and Exhibition

Odontologi

Helsinki

www.apollonia.fi

France

Feb. 4–6

Dental Forum

Vincennes

www.dentalforum2010.com

France

Nov. 23–27

Congrès de l‘Association Dentaire Française

ADF

Paris

www.adfcongres.com

Germany

May 12–14

Jahrestagung der Arbeitsgemeinschaft Kieferchirurgie

AgKiefer

Bad Homburg

www.ag-kiefer.de

Germany

May 26–29

Jahrestagung der Deutschen Gesellschaft für MKG-Chirurgie

DGMKG

Munich

www.mkg-chirurgie.de

Germany

June 3–5

Jahrestagung der Arbeitsgemeinschaft Dentale Technologie

ADT

Stuttgart

www.ag-dentaletechnologie.de

Germany

Nov. 10–13

Deutscher Zahnärztetag

ZÄ-Tag

Frankfurt

www.dzaet.de

Germany

Nov. 24–27

Jahrestagung der Deutschen Gesellschaft für Implantologie

DGI

Hamburg

www.dgi-ev.de

Indonesia

April 29–May 1

Pertemuan Ilmiah dan Teknologi Gigi Kedokteran

PITEKGI

Jakarta

pitekgi.moestopo.ac.id

Ireland

May 12–15

Irish Dental Association Annual Conference

IDA

Galway

www.dentist.ie

Israel

Feb. 3–4

The Annual Meeting of the Israel Perio Periodontal and Osseintegration Society

Tel Aviv

www.perio.org.il

Italy

Feb. 5–6

Congresso Internazionale SIO

SIO

Rome

www.osteointegrazione.it

Italy

April 16–17

Meeting Mediterraneo AIOP SICOI

AIOP - SICOI

Riccione

www.sicoi.it

Italy

May 8

Corso di aggiornamento SIO – Alternative terapeutiche a confronto: rapporti costi-benefici

SIO

Bologna

www.osteointegrazione.it

Italy

Oct. 8–9

SICOI Congresso Nazionale

SICOI

Milan

www.sicoi.it

Japan

May 14–15

ICOI Japan Advanced Implant Symposium

ICOI

Yokohama

www.icoi.jp

Japan

June 12–13

The Academy of Clinical Dentistry

ACD

Tokyo

www.ago.ac

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FULL MEETING NAME

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80 STARGET 1 I 10

EVENTS

LAND COUNTRY

MEETING DATES

Japan

Sept. 17–19

Japanese Society of Oral Implantology

Japan

Oct. 8–10

Japan

SHORT NAME CITY

WEBSITE

JSOI

Sapporo

www.jsoi.org

Quintessence World Dental Show 2010 QU

Yokohama

www.quint-j.co.jp

Oct. 17–18

Japanese Society of Oral and Maxillofacial Surgeons

JSOMS

Chiba

www.jsoms.or.jp

Korea

March 28

Korean Academy of Oral & Maxillofacial Implantology

KAOMI

Seoul

www.implant.or.kr

Korea

April 9–11

Korean Academy of Prosthodontics

KAP

Seoul

www.kap.or.kr

Korea

May 28–29

Korean Academy of Periodontology – Spring Meeting

KPERIO

Seoul

www.kperio.org

Korea

June 25–27

Seoul International Dental Exhibition & Scientific Congress

SIDEX

Seoul

www.sidex.or.kr

Korea

Nov. 27–28

Korean Academy of Periodontology – Autumn Meeting

KPERIO

Seoul

www.kperio.org

Malaysia

Nov. 26–29

9th Asian Congress on Oral & Maxillofacial Surgery

ACOMS

Kuala Lumpur

www.acoms2010.org

Norway

Jan. 7–10

Vestlandsmøtet

VESTLANDSMØTET

Bergen

www.tannlegeforeningen.no

Norway

May 6–8

SFOMK Congress Oslo

NFOKOM

Oslo

www.kjevekirurgi.org

Norway

April 22–24

Midt Norge Møtet

MNM

Trondheim

www.tannlegeforeningen.no

Norway

Oct. 14–16

Nordental

NORDENTAL

Lillestrøm

www.tannlegeforeningen.no

Singapore

April 16–18

International Dental Exihibition and Meeting

IDEM

Singapore

www.idem-singapore.com

South Africa

July 9–10

University of Pretoria and the ITI – Latest Developments in Implant Dentistry

UP ITI 2010

Pretoria

www.itisouthafrica.org

South Africa

Oct. 29–Nov. 1

South African Dental Association International Dental Exhibition and Congress

SADA IDEC

Durban

www.sadaidec2010.co.za

Spain

March 11–13

11th Expodental

EXPODENTAL

Madrid

www.expodental.ifema.es

Spain

May 20–22

44th Reunión Española de la Sociedad Española de Periodoncia y Osteintegración

SEPA

Girona

www.sepa.es

Spain

July 14–17

88th General Session & Exhibition of the International Association for Dental Research

IADR

Barcelona

www.iadr.org

Sweden

Sept. 1–3

Annual Meeting of the Swedish Association of Oral and Maxillofacial Surgeons (KKFs årsmöte)

KKF

Uppsala

www.kkf.nu

Sweden

Sept. 15–17

Annual Meeting of the Swedish Society for Prosthodontics (Tylösandsdagarna)

SFOP

Halmstad

www.sfop.se

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EVENTS

COUNTRY

MEETING DATES

Sweden

Nov. 18–20

Switzerland

SHORT NAME CITY

WEBSITE

Swedental

Gothenburg

www.swedental.se

March 14–20

Oralchirurgie und Stomatologie für den Privatpraktiker

SSO

St. Moritz

www.fortbildungund erholung.ch

Switzerland

April 15–17

ITI World Symposium

ITI

Geneva

www.iti.org

Switzerland

May 27–29

DENTAL/SSO

Basel

www.dental2010.ch

Switzerland

July 18–24

Zahnerhaltung, Prävention und Kinderzahnmedizin für den Familienzahnarzt

SSO

St. Moritz

www.fortbildungund erholung.ch

Switzerland

Aug. 16–20

20th ITI Education Week Berne

ITI

Berne

www.iti.org/educationweek

Thailand

Dec. 1–3

Bangkok International Symposium of Implant Dentistry

BISD

Bangkok

www.implantdentistry thailand.org

Turkey

Jan. 13–14

Turkish Oral Implantology Congress

TOID

Istanbul

www.toid.info

Turkey

April 7–10

Istanbul Oral and Dental Health Apparatus and Equipment Exhibition

EXPODENTAL

Istanbul

www.cnr-idex.com

UAE

March 9–11

UAE International Dental Conference & Arab Dental Exhibition

AEEDC

Dubai

www.aeedc.com

March 5–6

The London Spring Symposium for Dental Technicians

DENTS

London

www.dentalexcellencetech. com

March 19–20

The Dentistry Show

NEC

Birmingham

www.thedentistryshow.co.uk

May 6–8

Dental Technology Show

DTS

Coventry

www.dla.org.uk

Oct. 6–9

19 Annual Scientific Meeting of the EAO European Association for Osseointegration

Glasgow

www.eao.org

USA

Jan. 27–31

Yankee Dental Congress

Yankee

New York, NY

www.yankeedental.com

USA

Feb. 25–27

Chicago Mid-Winter Meeting

Mid-Winter

Chicago, IL

www.cds.org

USA

March 3–6

Joint meeting of the American and AADR, CADR Canadian Association for Dental Research

Washington, DC www.iadr.org

USA

March 4–6

Academy of Osseointegration‘s Annual Meeting

Orlando, FL

www.osseo.org

USA

June 10–13

The 10th International Symposium on Periodontics & Restorative Dentistry

Quintessence

Boston, MA

www.quintpub.com

USA

Sept. 27–Oct. 2

American Association of Oral and Maxillofacial Surgery‘s Annual Meeting

AAOMS

Chicago, IL

www.aaoms.org

USA

Oct. 9–12

American Dental Association Annual Session

ADA

Orlando, FL

www.ada.org

USA

Oct. 30–Nov. 2

Academy of Periodontology‘s Annual Meeting

AAP

Honolulu, HI

www.perio.org

USA

Nov. 3–6

American College of Prosthodontic‘s Annual Meeting

ACP

Orlando, FL

www.prosthodontics.org

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FULL MEETING NAME

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STRAUMANN IBERIA

STARGET 1 I 10

GUIDED SURGERY WITH THE STRAUMANN® GUIDED SURGERY SYSTEM

Immediate guided maxillary loading with Straumann® Bone Level SLActive® implants Immediate mandibular loading with Straumann® Tissue Level SLActive® implants® Clinical history We present the case of a male patient aged 56 years who consulted us because of total upper and lower edentulism. The patient was wearing uncomfortable removable dentures. In the history, risk factors for restoration with dental implants were ruled

out (nonsmoker, no history of bruxism, no history of use of risk medications or of any disease). Physical examination showed a good bone level for implant placement and highly acceptable keratinized mucosa. The patient wished to replace his removable dentures with fixed prostheses (Figs. 1–4).

The orthopantomograph showed an adequate bone level at maxillary and mandibular level and also showed the presence of an embedded third molar with a follicular cyst which necessitated extraction and cyst excision (Fig. 5). It was decided to perform the extraction at a second session.

Figs. 1–5: Clinical and radiographic illustrations of the case.

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22.12.2009 15:54:41 Uhr

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STRAUMANN IBERIA

Treatment plan Given the excellent tissue conditions: width, height and keratinized mucosa, the possibility of performing guided surgery was considered. For this reason, a barium splint was designed which reproduced the ideal restoration conditions. The splint was fabricated with

A SAFE system (Materialise®) surgical splint was request (Fig. 10), designed especially to work with the Straumann® Guided Surgery system (Fig. 11). Together with the splint the drilling template for the Straumann® Guided Surgery system was received (Fig. 12). It was decided to carry out an imme-

Figs. 6–9: Illustrations of the study and planning of Straumann® Bone Level implants in the maxilla.

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barium splinted teeth (Ivoclar®) and a base made with a barium sulfate concentration of 10 %. With this splint a CT was performed which was processed using the Simplant program (Materialise®). Based on this study, it was planned to place 8 transmucosal Straumann® Bone Level implants with a diameter of 4.1 mm (Figs. 6–9).

diate screw-retained restoration with placement of the implants in the maxilla. In the mandible it was decided to place 6 Straumann® Tissue Level implants in the conventional way and to carry out immediate provisional restoration, after taking measurements.

22.12.2009 15:55:10 Uhr

STRAUMANN IBERIA

Surgical procedure Under local anesthesia and sedation the SAFE surgical splint was fixed with 1.6 mm internal fixation micro-screws (Mincro Osteoplac® system) 12 mm in length (Fig. 13). Using the Straumann® Guided Surgery system drilling template, 8 Straumann® Bone Level SLActive® 4.1 x 12 mm implants were placed in positions 17, 15, 13, 11, 21, 23, 25 and 26. Good primary stability was achieved with all of them and they were placed with an insertion torque greater than 35 N/ cm (Fig. 14). The depth of insertion was confirmed with a postoperative orthopantomograph which showed

that two implants had to be inserted two millimeters deeper. A good fit between the preformed prosthesis and the implant emergence was checked (Fig. 15). 6 Straumann® Tissue Level 4.1 x 12 mm implants were placed in the mandible in positions 42, 43, 46, 32, 33 and 36 using a conventional surgical splint (Figs. 16–17). In five of these a suitable insertion torque for an immediate screw-retained restoration was obtained (except for the implant in position 42, which was left unloaded). The postoperative orthopantomograph showed correct distribution of the implants in the maxilla and mandible (Fig. 18).

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STARGET 1 I 10

22.12.2009 15:55:29 Uhr

STARGET 1 I 10

STRAUMANN IBERIA

Restoration procedure After the implants were placed, the Bone Level abutments were placed (Figs. 19–20) so that the provisional upper denture could be screwed on to them (Fig. 21). Relining and adjustment were carried out, show-

ing very good adaptation between the provisional prosthesis and the abutments (Fig. 22). An hour after the conclusion of the procedure, the provisional upper prosthesis was screwed to the 8 implants stably and precisely (Fig. 23–26).

In the mandible, impressions were taken with the aim of screwing on the provisional restoration 24 hours after the procedure (Figs. 27–30).

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22.12.2009 15:55:52 Uhr

STRAUMANN IBERIA

STARGET 1 I 10

24 hours later, the provisional lower denture was placed on 5 of the 6 implants (Figs. 31–34).

Patient’s appearance 24 hours after the procedure (Figs. 35–36).

Initial clinical and radiographic situation with the removable dentures (Figs. 37–38), situation 24 hours after the procedure (Figs. 39–40) and situation 8 weeks later when the provisional dentures were replaced with the final prostheses (Figs. 41–42).

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22.12.2009 15:56:30 Uhr

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STRAUMANN IBERIA

Conclusions The advantages of computerguided surgical procedures have been published in the literature by authors such as Sarment and van Steenberghe. On the one hand, precise planning is achieved from the anatomical aspect. On the other hand, the possibility of having stereolithographic surgical splints allows a very exact approximation of the provisional restoration to be obtained. Transmucosal surgery provides excellent results in terms of speed and morbidity, with no postoperative inflammation and pain. The SLActive® surface provides greater security when placing an immediate provisional restoration so that it is very suitable in these procedures. The Straumann® Guided Surgery system offers the possibility of performing these guided surgery procedures with the majority of Straumann implants.

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Collaborators: Dr Jacobo Sanchez Mayoral, dentists and oral and maxillofacial surgeon, GBCOM Dr José Ignacio Iriarte Ortabe, oral and maxillofacial surgeon, GBCOM Dr Miguel Morey Más, oral and maxillofacial surgeon, GBCOM

Dr Jorge Caubet Biayna jcaubet@telefonica.net

Doctor of medicine and surgery Specialist in oral and maxillofacial surgery Professor of the University Master’s Degree in Implantology of the Balearic Islands Fellow of the European Board of Oral and Maxillofacial Surgery

Dr Bahzad Aghaei, dentist, Palma de Mallorca Dr Marina Muñoz, dentist, Palma de Mallorca Mr. Alberto Tomás, dental technician, Dentathlon, Palma de Mallorca Mr. Ignacio Barceló, dental technician, Dentathlon, Palma de Mallorca

ITI Fellow Private practice in implant dentistry and preprosthetic surgery, GBCOM (Balearic Oral Surgery and Maxillofacial Group), Palma de Mallorca

22.12.2009 15:57:10 Uhr

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22.12.2009 15:57:16 Uhr

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STRAUMANN IBERIA

REVIEW

SEPA â&#x20AC;&#x201C; Straumann meeting I The SEPA-Straumann meeting I took place on last June 12 and 13 in the headquarters of the COEC, Colegio Oficial de Odontologos y Estomatologos de CataluĂąa (Official College of Dentists and Stomatologists of Catalonia).

Professor Juan Blanco, Professor Daniel Buser

More than 170 people attended the talks given by two experts in implant dentistry, Professor Daniel Busel, chairman elect of the ITI, and Professor Juan Blanco, current chairman of SEPA. On Friday 12 June, Prof. Blanco explained the new SAC classification to the participants. This new classification represents an indispensable reference tool for

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clinicians when making decisions regarding what treatment to use. In addition, among other topics, Prof. Blanco explained the most recent loading protocols according to the last ITI Consensus that took place in Stuttgart. On Saturday 13 June, the topics discussed by Prof. D. Buser included the principal risks when choosing a specific treatment and

also the selection of biomaterials in cases requiring bone regeneration. Next year, SEPA and Straumann will again offer all clinicians the principal innovations in periodontal treatments. Here at Straumann, we would like to congratulate SEPA on its 50th anniversary.

22.12.2009 15:57:18 Uhr

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22.12.2009 15:57:31 Uhr

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STRAUMANN IBERIA

REVIEW

Straumann present at SEPA Las Palmas The 43rd annual meeting of SEPA, the Sociedad Española de Periodoncia y Osteointegración (Spanish Periodontal and Osseointegration Society), took place in the Alfredo Kraus Auditorium in Las Palmas, Gran Canarias, on 12, 13 and 14 November. Straumann as platinum sponsor of SEPA took part in the recent meeting with a 24 m2 stand located in the “Expoperio” exhibition of the auditorium, where Straumann had an opportunity to tell the professionals who attended the conference about the latest innovations in implant dentistry, tissue regeneration and CADCAM solutions, for instance, Roxolid™, the new and innovative material for small diameter implants, the Straumann IPS e.max® Anatomical Abutments, which is the latest innovation from Straumann for highly esthetic restorations, and the synthetic bone substitute Straumann BoneCeramic®.

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Straumann itself took part in the scientific program of the congress with a presentation on “Effective bony regeneration: experience with new materials” given by Prof. Luca Cordaro; in addition, Straumann sponsored the Clinical Commu-

nications competition, won by Dr Daniel Rodrigo, and the party that followed SEPA’s 50th anniversary gala dinner. Straumann would like to take this opportunity to congratulate SEPA again on its 50th anniversary.

22.12.2009 15:57:33 Uhr

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WORLD-WIDE NEAR TO CUSTOMERS

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Subsidiary companies Distributors

Switzerland Institut Straumann AG Peter Merian-Weg 12 4002 Basel Tel. +41/61 965 11 11 Fax +41/61 965 11 01

Brazil Straumann Brasil Ltda Rua Funchal 263 04551-060 São Paulo Tel. +55/11 30 89 66 83 Fax +55/11 30 89 66 84

Finland Straumann Oy Fredrikinkatu 48A 7 krs. 00100 Helsinki Tel. +358/96 94 28 77 Fax +358/96 94 06 95

Subsidiary companies:

Canada Straumann Canada Ltd. 4145 North Service Road Suite 303 Burlington/ON-L7L 6A3 Tel. +1/905 319 29 00 Fax +1/905 319 29 11

France Straumann France 3, rue de la Galmy - Chessy 77701 Marne-la-Vallée cedex 4 Tel. +33/164 17 30 00 Fax +33/164 17 30 10

Australia/New Zealand Straumann Pty. Ltd. 7 Gateway Court Port Melbourne 3207 Victoria Tel. +61/39 64 67 060 Fax +61/39 64 67 232 Austria/Hungary Straumann GmbH Austria Florido Tower Floridsdorfer Hauptstr. 1 1210 Wien Tel. +43/12 94 06 60 Fax +43/12 94 06 66 Belgium Straumann Belgicastraat 3 1930 Zaventem Tel. +32/27 90 10 00 Fax +32/27 90 10 20

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Czech Republic Straumann s.r.o. Na Žertvách 2196 180 00 Prague 8 Tel. +420/284 094 650 Fax +420/284 094 659 Denmark Straumann Danmark ApS Hundige Strandvej 178 2670 Greve Tel. +45/46 16 06 66 Fax +45/43 61 25 81

Germany Straumann GmbH Jechtinger Straße 9 79111 Freiburg Tel. +49/76 14 50 10 Fax +49/76 14 50 11 49

Japan Straumann Japan K.K. 3-231-3 Hamaderakoen-cho Nishi-ku, Sakai-Shi Osaka, Japan 592-8346 Tel. +81/722 64 18 82 Fax +81/722 64 18 24

South Korea Straumann South Korea (formerly: B.I. Trading Co. Ltd.) 1467-75, Seocho3 -Dong, Seocho-Gu, Seoul Tel. +82/72 265 8777 Fax +82/72 265 8797

Mexico Straumann México SA de CV Rubén Darío # 281 int. 1702 Piso 17 Col. Bosque de Chapultepec 11580 México DF. Tel. +52/55 5282 6262 Fax +52/55 5282 6289

Spain/Portugal Straumann S.A. Edificio Arroyo - A Avda. de Bruselas, 38 Planta 1 28108 Alcobendas (Madrid) Tel. +34/902 400 979 Fax +34/913 449 517

Netherlands Straumann B.V. Postbus 338 3400 AH IJsselstein Tel. +31/30 60 46 611 Fax +31/30 60 46 728

Sweden Straumann AB Fabriksgatan 13 41250 Göteborg Tel. +46/31 708 75 00 Fax +46/31 708 75 29

Great Britain Straumann Ltd. 3 Pegasus Place, Gatwick Road Crawley RH109AY, West Sussex Norway Tel. +44/12 93 65 12 30 Straumann AS Fax +44/12 93 65 12 39 P.O.Box 1751 Vika 0122 Oslo Italy Tel. +47/23 35 44 88 Straumann Italia s.r.l. Fax +47/23 35 44 80 Viale Bodio 37a 20158 Milano Tel. +39/02 39 32 831 Fax +39/02 39 32 8365

USA Straumann USA, LLC 60 Minuteman Road Andover, MA 01810 Tel. +1/800 448 8168 +1/978 747 2500 Fax +1/978 747 2490

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01/10 152.500 e

www.straumann.com

21.12.2009 17:36:29 Uhr