world conference 2005 nobel biocare scientific...

Nobel Biocare

scientific summary

World Conference 2005

NOBEL BIOCARE WORLD CONFERENCE NOBEL BIOCARE WORLD CONFERENCE NOBEL BIOCARE WORLD CONFERENCE NOBEL BIOCARE WORLD CONFERENCE NOBELBIOCARE WORLD CONFERENCE

2

impressumIntro “Feeling Groovy” 4

Opening Session 6Ms Heliane Canepa

Arena Program – Monday

Hosts of the dayDr. Brien Lang, USA, Dr. Patrik, Australia

Introduction of the Scientific Program 9Dr. Brien Lang, USA

Forty Years of Implant HistoryMs. Heliane Canepa and Prof. Per-Ingvar Brånemark 10

C&B&I™ Significance Today and Tomorrow in One’s Dental Practice 13Dr. Gordon Christensen, USA

The best Solution for Your Patients 13Dr. Brien Lang, USA

TiUnite™ Biomaterial, Soft Tissue Integration™

and Immediate Function™ 14 Dr. Roland Glauser, SwitzerlandDr. Peter Schüpbach, Switzerland

Partial Edentulous Therapy Using NobelGuide™, Implants and Procera® 14Dr. Brent Allan, Australia

Single and Multiple Tooth Replacement Using NobelDirect® and Procera® 15Dr. Tom Balshi, USA

Expert Presentations 16Dr. Mick Dragoo, USADr. David Gelb, USADr. Guido Heydecke, GermanyDr. Glen Liddelow, AustraliaDr. Carlos Moura Guedes, PortugalDr. Peter Moy, USA

Implant-Retained Overdentures 16Dr. Regina Mericske-Stern, Switzerland

NobelGuide™ with the All-on-4 Concept 17Dr. Paulo Maló, Portugal

Totally Edentulous NobelGuide™ Surgery with the new Brånemark System® Zygoma Implant 18Dr. Chantal Malevez, Belgium

Expert Presentations 18Dr. Matts Andersson, SwedenDr. Carlos Aparicio, SpainDr. Edmond Bedrossian, USADr. Maha El Sayed, EgyptDr. Chris Marchack, USADr. Pär-Olov Östman, SwedenDr. Steve Parel, USADr. Daniel van Steenberghe, Belgium

contentPublished by teamwork media GmbH

Editors:

Dr. Jochen Burger, Germany

Dr. Johannes Heimann, Germany

Christina Riedmann-Pooch, Germany

Dr. Dr. Günter Wiesner, Austria

The statements and opinions in the summaries are solely those of the individual authors

and not of Nobel Biocare AB.® Copyright 2005 Nobel Biocare AB.

All Rights Reserved.

CARE WORLD CONFERENCE NOBEL BIOCARE WORLD CONFERENCE NOBELBIOCARE WORLD CONFERENCE

Arena Program – Thursday

Hosts of the dayDr. Ronald Goldstein, USA, Heliane Canepa, CH, Dr. Avishai Sadan, USA

Requirements for Ideal Esthetic Restorations 24Dr. Gerard Chiche, USA

Single and Multiple Units – Hard And Soft Tissue Management 25Dr. Patrick Palacci, France

NobelEsthetics™ and NobelRondo™: A Creative Concept 26Mr. Ernst Hegenbarth, Germany

The Use of the Procera® System for Single and Multiple Units on Implants and Natural Dentitions 26Dr. Mauro Fradeani, Italy

Expert Presentations 27Dr. Nitzan Bichacho, IsraelDr. Lesley David, CanadaDr. Eric Van Dooren, BelgiumDr. Iñaki Gamborena, SpainDr. Tidu Mankoo, Great BritainDr. Avishai Sadan, USA

A biological interface 28Dr. Eric Rompen, Belgium, Dr. Eric Van Dooren, Belgium, Dr. Bernard Touati, France

Platform switching powered by Procera® 28Dr. Iñaki Gamborena, Spain

Procera® Implant Bridge in Zirconia 29Dr. Paul Chang, USA, Mr Ernst Hegenbarth, Germany

The Bone Saving Implant 29Dr. Nitzan Bichacho, Israel

ZiUnite Implants 30Dr. Ralf Kohal, Germany

Bone Inductive Implants 30Dr. John Wozney, USA, Dr. Ulf Wikesjö, USA and Dr. Jan Hall, Sweden

Arena Program – Wednesday

Host of the dayDr. Jörg Strub, Germany

Single and Multiple Unit Replacements with NobelPerfect® Implants 19Dr. Massimo Simion, Italy

Optimum Eshtetics for Natural Teeth and Implants 20Dr. Jonathan Ferencz, USA

Live presentations of the morning 20

The Role of Dental Rehabilitation in an “Extreme Makeover” 22Dr. Sherri Worth , USA Dr. Harvey Zarem, USA

Expert Presentations 23Dr. Dario Adolfi, BrazilDr. Markus Blatz, USADr. Yves Budzynski, BelgiumDr. George Duello, USADr. Sonia Leziy, CanadaDr. Dr. Georg Watzek, Austria Dr. Peter Wöhrle, USADr. Masao Yamazaki, Japan


4

introPalm trees swaying in the hot desert wind, gleaming limousines gliding by, legendary crabcocktails, the blinking lights and buzz of the gambling casinos with their one-armed ban-dits, the sound of roulette balls and the constant pulse and throb of the sea of lights makethe heart of every visitor to Las Vegas beat faster. The MGM is one of the world’s best-knownhotels, linked in everyone’s mind with its lions whose great big roar opens just about everymovie coming from the USA, and with the gigantic Arena.

In the MGM Arena Las Vegas, Heliane Canepa and her team hosted a gigantic dental showrunning from 5 June to 10 June 2005, and involving the participation of high-profile speak-ers from all over the world as well as live video link-ups from locations around the globe.

“Dear Members of the Nobel Biocare family – it’s so good to see you all gathered here. Webid you a warm welcome to the Nobel Biocare World Conference”, was President and CEOHeliane Canepa’s greeting to conference participants. 173 top speakers from all over theworld, including 32 women, were invited to contribute to the conference programme. “Itwould be good to see even more women speakers. They are still somewhat underrepresent-ed”, said Ms Canepa.

She also focused on the issue of active audience participation in the conference programme.Members of the audience were free to put questions to the speakers and even to the sur-geons shown at work during the live video crosses at any time. She insisted that “this is theonly way to have a lively presentation, and to achieve progress.” The eight-member teamof moderators chaired by Dr. Brian Lang succeeded in presenting the Arena Programme inthe kind of professional, competent, lively and interactive manner that would appeal to anyaudience.

“We can already provide you today with the kind of products patients will be asking fortomorrow”, promised Ms Canepa. “In doing so, quality is our top priority. I am sure youhave all heard of the very first patient to receive a titanium implant, some 40 years ago, Mr.Gösta Larsson. And by the way, the second recipient was a taxi driver – not just any taxi driv-er, but the very one who was driving Mr Larsson to the clinic that day. Can there be betteradvertising than this?”

feeling groovy


5

Among all the product innovations presented throughout the spacious exhibition hall, theGroovy implants made the biggest impact by far. However, Ms Canepa had an even biggersurprise in store for the conference participants, and for an entire afternoon she presentedall the latest innovations emerging from the research division, demonstrating that dentists,dental technicians and patients have a lot to look forward to. The future remains excitingindeed!

And so 6,000 conference participants found themselves enthralled around the clock – therewas something for everyone, no matter what their specialization: perhaps on the jet-lagprogramme starting at 3 am, with simultaneous interpretation in all major languages pro-vided by more than 40 interpreters, or in a more traditional mode, in a diverse range ofhands-on seminars in classrooms. The offer was so varied that there is no way we couldreport on the focus sessions and hands-on courses here in any detail – we could fill severalbooks. Every single one of the presenters made an important contribution toward makingthe event a success and supplemented the main programme with detailed and highlyknowledgeable comments. The conference clearly benefited from the intense, personal andvivid dialogue between participants and presenters embedded in a sophisticated frame-work. It comes as no surprise, then, that the focus sessions were considered one of the mainattractions of the World Conference. And for those who had always wanted to have confer-ence papers presented to them while reclining in the comfort of their hotel bedroom – noproblem at all, as Channels 27 and 28 were non-stop putting on some decent fare onimplantology.

After all, Nobel Biocare had spared neither expense nor effort to ensure that everythingwent without a hitch: equipment rolled into Las Vegas on board no fewer than 123 trucks,a television crew was on hand, a radio studio had been set up, and more than six millionbrochures had been printed by three different printing companies. The evening pro-gramme with the cheerfully grumpy Bill Cosby was also first rate. An absolute winner wasthe American closing party featuring five-time Grammy award winner Donna Summer. Allin all: the Nobel Biocare World Congress was groovy all round.


6

nobel biocare world conference–2005

Heliane Canepa

Las Vegas, Nevada is the premier location in North America for meetings and conferenceswhose content and appeal attract international audiences. Global participants and audienceshave always enjoyed the top of the range convention facilities, the great food and entertain-ment, not to mention the fantastic weather. The MGM Grand hotel and casino is by far themost spectacular and best-known facility in Las Vegas. Its gigantic “Grand Garden Arena” canseat 15,000 people and it has a large all-purpose convention center that is second to none.This site provided the setting for Ms. Heliane Canepa, President and CEO of Nobel Biocare,and her staff to host the gigantic Nobel Biocare World Conference 2005 from June 5ththrough June 10th. The program was organized in multiple venues with continuing educa-tion within science and clinical patient care as the major emphasis of the meeting. By usingsatellite transmission, no less than seven live surgeries from different locations were showedduring the conference.

In this scientific Summary of the World Conference, the focus lies with the day-time ScientificProgram held in the Grand Garden Arena, including live surgery, presentations and relatedpanel discussions. Other presentations and learning activities such as the Pre-Conferenceworkshops, the Focus Sessions, the Jet-Lag program and the German and Japanese Programsare not referred to in this publication.

Nobel Biocare “New Vision” – Ms. Heliane Canepa, President and CEO Nobel Biocare

The opening session began with a spirit of excitement as fast-paced music and multipleaction scenes were displayed on six large screens surrounding an elevated stage located inthe centre of the MGM Arena. The appearance of Ms. Heliane Canepa centre-stage, Presidentand CEO for Nobel Biocare as the house lights came up brought the Arena to life.

She began, “Dear Nobel Biocare family it’s so good that you’re here. Welcome to the WorldConference from Nobel Biocare 2005. The conference 2003 was a great success and now weare back again. I told you then that we will keep you in a constant state of amazement, andthe challenge from 2003 was to exceed your expectations for this year’s World Conference.We had to do something MORE, something NEW, and thus the Scientific ProgramCommittee has developed an amazing program for 2005 – the best ever! A program that isfun, interesting and modern - and one where the interaction with YOU will play an impor-tant role.”

“We are proud to have one hundred seventy-three (173) of the most well-known lecturers inthe world - the crème de la crème of our profession, and I am especially proud to have noless than 32 females in the speaker list. This is very close to my heart and I want women tobe more visible on stage. About fifty percent (50%) of practicing dentists are women and Idon’t see them enough. But at Nobel, We Walk The Talk and you should know that this is justthe beginning!”

“The times are over where you just sit and listen to presentations, where you don’t move andyou just watch the speakers. We want YOU to participate, and working TOGETHER has alwaysproven to be the best recipe for success!”

Opening Session – Ms Heliane Canepa, Dr. Brien Lang, USA

forty years of dental implantology – FINAL


7

Aren

a Pro

gram

Dr. Peter Boy Andresen, Niebüll, Germany: “We attended theentire week at the Nobel Biocare World Congress in Las Vegas.Personally, I was greatly interested not only in the presentationsbut also in talking to Nobel Biocare executives, thus being able toobtain accessories and additional information on the Nobel Guided

System, which we will be working with in the future – the fifth dental office inthe world to do so, by the way. We are ready to go!”

Dr Jolanta Andresen, Niebüll, Germany: “I really enjoyed the good quality ofthe programmes and the nice atmosphere. We basically went to Las Vegas toattend the congress, but then we met a lot of friends here.”

“You should know that you are in the best profession with a great potential and future. Peopletoday want to look good, and beautiful teeth are an important part of that. We know that thepatients are looking around to find the right solutions for their problems - no matter how oldthey are. That is confirmed by the fact that today we have between 5000 – 10,000 peopleon our website, every day, and they want to have Beautiful Teeth Now! In other words, asquickly as possible and without walking out of the practice looking like a hamster! YOUR taskis to provide the right solutions for these patients, and OUR task is to provide you with theright tools to do that. You decide – we provide!”

“In order to make it possible for you to meet the requirements of these patients, we havedefined our key strategic objectives: Easy Esthetics™, Soft Tissue Integration™ and ImmediateFunction™! All based on the biomaterial TiUnite™.

“Do you know that we have published 37 studies on TiUnite™ and over 60 studies onImmediate Function™? During this conference you will be presented with new findings andeven more documentation for its extraordinary performance also in soft tissue integration,thereby supporting long-term esthetics.

“In the immediate Function area we are taking the next step by the introduction of groovy.A small groove with a huge effect!”

“To make these solutions more accessible, predictable and efficient, we are also introducingthe new concept for guided surgery, NobelGuide™. You will hear a lot more about this dur-ing the conference.”

“But there is no future without history, and I am very proud of celebrating the 40 yearanniversary of the first patient treated by Professor P-I Brånemark. His name is Gösta Larssonand he is the living evidence for the functionality of dental implants, and the second patient,Sven Johansson, is the taxi driver who picked up Gösta Larsson and brought him to the trainstation after his treatment. This is the first proof of one happy patient telling another aboutimplant treatment.”

“Professor Brånemark created a scientific and innovative atmosphere 40 years ago, and weare continuing on this path by having a close cooperation between inventors and industry.We have some excellent examples these past many years. Procera® developed by Dr. MattsAndersson, NobelPerfect® developed and improved even further by Dr. Peter Wöhrle,NobelDirect® a product developed and enhanced under the guidance of Dr. Mick Dragoo,


8

Maria Angeles Sanchez Garces, MD/DDS, Spain: "It´s the second time for meto join a Nobel Biocare Congress and I´m here to learn, to get informationsabout the latest inventions and also discuss with collegues and to meet friends.I´m familiar with most of the techniques shown in the Live-surgerys onMonday, but the surgery done by the Belgian surgeon Chantelle Malevez was

really outstanding. Of course I´m glad and proud that my team won the third prizein the "Poster Competition."

NobelRondo™ our own ceramic solution developed by Mr. Ernst Hegenbarth, and at thismeeting we are proud to introduced the new NobelSpeedy™, a new implant system tried anddeveloped in cooperation with Dr. Paulo Maló. And of course, all of these prominent dentalprofessionals are here with us today, sharing their expertise and experience in the arena pro-gram and focus sessions during this exciting week. And it is out of this cooperation that wecan present to you no less than 560 new products that are launched at this meeting.”

“Back in 2001, I said that we would be a one-stop shop for high esthetic dental solutions, andtoday we are! Like I said before - We walk the talk. From implants to the perfect esthetic out-come, today we provide complete solutions, even including the dental porcelain! We haveproven to you that our innovations are based on both REAL experience, REAL science andREAL genius. On Thursday afternoon I will tell you more - much more - about the excitingfuture ahead of us. Because already today we have to think about what the patient will wanttomorrow. And the needs are the same all over the world.“

“At this conference we have no less than 74 countries represented! It’s unheard of, but againthis is Nobel. Being global means that we provide translations into 9 different languages dur-ing this conference. We have 40 translators working for us at this conference, just like theUnited Nations, and in order to make this happen, we had to establish our own radio stationhere at the MGM Grand. It has taken 12,000 working hours just to set up the arena. Twenty-two (22) trucks were needed to get the equipment to Las Vegas. Ninety-two (92) computershave been used just to set up the AV system with over 450 km of cable. We even have a TVcrew at each of the 8 locations in 7 countries for live transmission! So you can see, we havetruly come a long way to make all of this happen. But then again, I said that this years con-ference was going to be something out of the ordinary!”

“To support the conference, we even have two TV channels at the MGM Grand! On channel27 we broadcast what is happening in the arena, and on channel 28 we have on-going prod-uct presentations and information about all the new products! And instead of sleeping, youcan join me in the arena for the jet lag sessions between 3 am and 6 am in the morning. Hereyou can meet a mixture of experienced clinicians and new and upcoming exciting lecturers.It’s something I wouldn’t want to miss for the world!”

Ms. Heliane Canepa closed her opening speech by encourage the audience to try out theaudience response system which was frequently used throughout the conference. Whenasked the question what gender the audience were, it turned out that there were 70% males,27% females and 3% who were not really sure. But like Ms. Canepa concluded, this resultmay change if the question was asked again after the conference because as we all knowwhat happens in Vegas stays in Vegas.

http://www.dental-online-college.com/nb/canepa1


9

Aren

a Pro

gram

Dr. Brien Lang

Introduction of the Scientific Program – Dr. Brien R. Lang

Ms. Heliane Canepa welcomed Dr. Lang to the arena stage, who began, “Thank you Heliane.This is the day that we have all waited for, and as you might well know these kinds of proj-ect take a great deal of time to organize. This project was started well over one year ago andI was especially fortunate to have a group of wonderful individuals from around the world onmy program committee. So let me take a few moments and introduce them to you. FromBrazil, Dr. Dario Adolfi, from the United States Dr. Ronald Goldstein, from down underDr. Patrick Henry, Australia, from Japan, Dr. Shohei Kasugai, and from Germany, Dr. JörgStrub. Two other members of the committee you will meet later as they provide you with livesurgery demonstrations, Dr. Paulo Maló, from Portugal and Dr. Chantal Malevez, fromBelgium. I want to personally acknowledge their contributions in the development of the con-ference and to thank them for their efforts. Thank you!”

“Throughout the arena program a panel of experts on stage will be very interactive not onlywith the speakers on stage but also those clinicians who will be demonstrating procedures foryou from remote sites. This format was developed by the committee to be quite unique anddifferent from any other meeting you may have attended in the world. The arena programthat we are going to experience this morning, will introduce you to the “best solutions foryour patient” in a way that has never been done before at a dental meeting. As the programsare presented, our panel members will have the opportunity to interact with our clinicianswho are in distant locations but also interact with speakers that are addressing you from thearena stage. That is quite unique and quite different, for a speaker on stage giving a presen-tation to be interrupted by a question from the moderator or panel member. It should be veryinteresting and I hope I get off this stage without incident.”

“The other programs that were listed by Heliane should also be of interest to you. The FocusSessions program, all-day on Tuesday, will present in greater detail many of the presentationsintroduced here in the arena program so that you can begin to experience these procedureson Monday morning next week in your practices. Some of the focus session program will bevideotaped and be re-played here in the arena area on Wednesday afternoon.”

“The Jet-Lag program is a favourite of mine. When the committee begin to think about ourfriends and colleagues that come across two time zones, we realized they are going to gethere and be awake at 3:00 am in the morning. Gambling is not one of the favourite activi-ties that we do in dentistry and they are going to want to do something that is more excit-ing. We have a wonderful program put together for them, the Jet-Lag program. So those ofyou who are wide awake come on down here to the arena area, I think you will enjoy it thor-oughly.”

“Some of you have already experienced the pre-conference programs. Obviously, there willbe other programs and workshops that you can experience throughout the week. Ninety-sixposters were submitted for presentation and were reviewed by a committee headed byRonald Goldstein. These are absolutely fantastic posters. They will begin to be put up tomor-row morning. So as you walk around the arena, or are finding your way to the other parts ofthe convention centre, stop and look at these posters. Hands-on program are offeredthroughout the week. The special programs planned for the conference are phenomenal. Wehave an all-day German program and a one-half day Japanese program.”

forty years of dental implantology

arena programmemonday, 6 june 2005


10

“I think that Heliane is a little too modest in her description of the Thursday afternoon pro-gram. We have a program on Thursday afternoon that you must attend. It is the future, it isthe vision of this woman and her team as to where Nobel Biocare is going in the next five (5)to ten (10) years. There are things that you are going to see that no one else in the world hasever seen, that are so spectacular that you are going to leave here saying, that this is goingto change drastically the way I practice dentistry.”

“I will now turn the podium back to Heliane who has a very special task to perform this morn-ing that I think you all will enjoy.”

www.dental-online-college.com/nb/lang1

Forty Years of Implant History – Ms. Heliane Canepa andProfessor Per-Ingvar Brånemark

As Ms. Canepa returned to centre-stage, the video on the six screens came to life with theappearance of Professor P-I Brånemark prepared to address the audience. Ms. Canepa began,“Good afternoon Professor Brånemark I’m so happy and proud that you took the time to bewith us on this live transmission from Göteborg. You are the father of modern implantology.You discovered osseointegration and that genius invention totally changed the life for millionsof people and the profession. Without you, we wouldn’t be here. Over two (2) million oralinvalidates have got their quality of life, function and esthetics back, based on over seven (7)million Brånemark system® fixtures. From the start Brånemark system® has been the gold stan-dard and is still in that position”

“The success of the company has been build on your inventions and we owe you a lot for allthe resistance and scepticism you had to fight in the early days, and for your persistence andyour wisdom to introduce the team approach in advanced training. I am proud that NobelBiocare is associated with your name. It was here when I came into the company, and it willalways be there.”

“I have also been following your work with osseointegration in other parts of the body. Weadmire your persistency from the start, and the fact that you are still breaking new ground.Professor Brånemark, here are 6000 people who want to celebrate with you the 40 anniver-sary and give you a big welcome.”

After an applause that did not want to end, Heliane finally continued, “However, there is nofuture without history, and now we would like to hear how it all started.”

To which Professor Brånemark responds, “All integrated friends, I would like to not talk aboutteeth, I would like to talk about what you indicated Heliane, namely invalids. If you loose atooth or you loose all your teeth you are an invalid, and I think I would like to starts with twoexamples, of this, which are related to the attempts that we started in Brazil.

Professor Brånemark presents patient pictures on the screen and continues:”The first case wasa cleft that was not treated correctly but was fixed with collaboration with a large number ofdifferent specialties, and then a year ago we treated another girl, a beauty queen from Riowho had a lymphoma and was irradiated and was unconscious for two months. We provid-ed her with fixtures and various prosthetic devices so she could communicate and appearwithout any fear and she was very please to have a kissable lip and to take care of her child.Later you will meet our pioneer patient Mr. Larsson, but first I would like to ask Dr. KenjiHiguchi, what he thinks about what we learned together and what we possible might havedone differently if we would have know from the beginning how difficult this would be. Canyou please give your comments now that we have over 40 years of follow-up, but also thatwe have seen many patients that not only have lost their teeth but also lost their personali-


11

Aren

a Pro

gram

ties? I believe that teeth are not so much in volume, but they become so important in theidentity of the human being.”

Dr. Higuchi responded, “I think it is remarkable that there can be 6000 people in the audi-ence and everybody in this particular audience is here for one particular reason and that rea-son is Professor Brånemark. It strikes me that each of you, including myself and most impor-tant including our patients, thank Dr. Brånemark for his continuous contributions to osseoin-tegration. As you know he continues to work very actively and he is not finished with his lifework yet.”

Dr. Higuchi continued, “I would like to turn this question around and ask Professor Brånemarkif 40 years ago when you were working so hard against all adds, did you have any ideas ofthe potential of your discovery and what it would mean to the profession of dentistry, medi-cine and to huge numbers of patient?”

Professor Brånemark replied, “The simple answer is no. We spent 10 years trying to under-stand bone and marrow and the interaction between them in different situation and with dif-ferent material. It so happened that we where working with patients with defects in the hand,and in the maxillofacial region. We also had a patient that we could not really take care ofand that was our pioneer patient Mr. Larsson.”

“The remarkable thing is even with these difficulties it has turned out quite well and it tooktwenty years until we have fixed prosthesis on the lower and upper jaw, but it worked.

“Mr. Larsson needed to have a full dentition, not only a lower but also an upper so he couldcommunicate and function, and that proves the importance of teeth. The intriguing thing isthat now, after all the procedures during the last 15 years, Mr. Larsson has had a good lifedespite some vascular problems. From the radiographic image you can see the technical dif-ficulties. But I have something very important to show you and tell you, something thatshows that mother nature has been very kind to us, and what you see there is the first fixtureI put in the year 1967 in the mandible, this one is very typical because I put this fixture intothe bone all the way down to the roof of the mandibular canal and then I stopped driving itin. If I would have been over ambitious then we would not be sitting here today, because Mr.Larsson would not have any sensation in the chin.”

“He has normal feeling all the time and he does not feel anything peculiar after the proce-dures which include Zygoma fixture. It took us 20 years before we could complete it, but itworked. Mother nature is a very peculiar woman because he was involved in an accident andhad very serious effect on his hearing and we provided him with a bone anchored hearingaid. Now he is sitting here provided with good hearing.”

“With osseointegrated fixture you can replace fingers, legs, and in fact you bring back notonly anatomy but also physiology, and I think this is a gift from mother nature, but also is aconsequence that the pioneer patient like Mr. Larsson participated willingly and understoodthat it took us twenty years to go from lower jaw to upper jaw but now we are there and heis enjoying it.”

“I would like now to ask Kenji Higuchi to report on what we have been doing for the last 25years.”

Dr. Higuchi continues, “Early this morning when we where talking informally about Mr.Larsson being here I made the comment to Professor Brånemark that the goal is to providedless surgery for patient and some of your work has been directed to that end such as provingthat four very small titanium components could support a full arch reconstruction.”

Professor Brånemark replies, “The requirements of meditated surgery I think is the key to thefuture in maxillofacial and also in hand surgery and the rest of the body. But please remem-


12

ber now and be very proud all of you that all of these applications had their origin from den-tistry. If we had not started with our pilot patient we would have never developed the otherapplications, so I believe that the precision in prosthesis is the sign of good reconstructivedentistry. That made it possible and that is why it is so important that we communicate allover the world, and it is my great pleasure now to also emphasize, that we are in Brazil nowbecause there are challenges and also to learn from our colleagues who have such an enor-mous knowledge on how to achieve integration and maintain integration and provide har-monious occlusion. If you walk with a bone cell or you chew with a bone cell it does not mat-ter as long as you exercise the bone cell.”

Dr. Higuchi asks: “How can we reach out and expand the application of osseointegration andimplant therapy for patients that are in the population that are not being treated?”

To this question Professor Brånemark replies: “We have established in Latin America a Globalcentre where it is now possible to provide 80% of the patient in need with rehabilitation pro-viding a third dentition without any cost to them, and that is based on donations, from dif-ferent quarters, and we should recognize and understand that teeth are much more impor-tant than anyone has believed. These patients are invalids and that will give us the opportu-nity - with your collaboration and many other collaborations – to teach and train others todo the same. I believe that this is an enormous effort, because I believe that no one shoulddie with their teeth in a glass of water.”

“A non -profit foundation has been created with a committed group of clinicians that wouldoffer clinical services for those individuals in need with no financial resources; research anddevelopment of new technologies and providing training for both the basic as well as verycomplex defects that we encounter on a day-to-day basis.

“I believe that when we work in health care, dentistry or medicine or any specialty we arehere to improve the quality of live of our fellow human beings, and we should share ourobservations on what works, and what does not work so others don't repeat our mistakes.

Let me finish by giving you two mantras. One mantra is the old one that we started 40 yearsago. How can you provided the best treatment for your Patients or the 5 “P” dogma –Persistence – Precision – Provides – Predictable - Prognosis, and this goes with medical or sur-gical procedure in the mouth or any other part of the body. In fact, there is no differencebetween teeth and feet from the philosophical aspect. Then we have the 4 “P” mantraProfessional - Provision of Procedures and Products, and I believe that, is what you are goingto enjoy now. I wish you and all your patients that you should have eternal peace and enjoy-ment in everything you do and also that you care for your patients and also you care for yourcolleague and also you try to find solutions when there is no solution. Your hand is the exten-sion of the brain, and there is no computer better than your brain.”

At the end of the interview Heliane Canepa announced that Nobel Biocare are supporting theProfessor Brånemark’s on-going work in Brazil, and donates a grand to the foundation thatwill make it possible to treat 400 patients until 2008*. She then thanked Professor Brånemarkand returned the program to the Moderator Dr. Lang who introduced the next speaker.

* The P-I Brånemark Institute, Bauru, Brazil is driven by a non-profit foundation and is carryingout treatments and education within the area of osseointegration. 80 % of the patients have tobe provided their treatment free of charge.

For donations, please contact Barbro Brånemark or Kenji Higuchi on either of the below e-mails:

[email protected]@spokaneoms.com


13

Dr. Brien Lang

Aren

a Pro

gramDr. Gordon

Christensen

Dr. Gordon Christensen, USA – C&B&I™ significance today andtomorrow in one´s dental practice

In this lecture, Dr. Gordon Christensen presented the audience with multiple-choice ques-tions that could also be answered immediately in an interactive manner. It turned out that theaudience was mainly composed of surgically oriented dentists. Dr. Christensen’s first questionwas: “Do you perform implant therapy providing both surgery and prosthodontic treatmentyourself?" This was confirmed by 48 percent of the audience. Presumably, this percentage isnot representative of clinicians at large but can be attributed to the make-up of the audiencein attendance at the conference. Very interesting was the last question, which was more of apolitical nature: “Should general dentists be encouraged to place implants?” This notion wassupported by 58 percent of the audience, while the other 42 percent did not support it. Theneed for implants is still enormous, given an estimated 40–50 million patients with edentu-lous mandibles in the United States alone.

In his lecture, Dr. Christensen presented a number of patient clinical histories in which inad-equate support of partial dentures could be optimized with implants. He emphasized theimportance of implant positioning in these cases. The implants should be placed such that afixed restoration can be inserted, if necessary, at a later time. One advantage of this strategyis that the financial burden will be reduced if the patient decides to have a fixed restorationsupported by multiple implants down the road. With treatment plans of this type, the chew-ing function can be immediately rehabilitated at lower cost.

www.dental-online-college.com/nb/christensen

Dr. Brien Lang, USA – The Best Solution for Your Patients

Dr. Brien Lang presented video interviews of patients worldwide who had been treated withimplants. All interviews were presented in their original languages with English subtitles. Thepatients were asked by their dentists in what way the implant therapy had changed their lives.All patients were invariably very satisfied with their implant-supported restorations. The reha-bilitation with fixed teeth instilled new self-confidence in those patients and improved theirquality of life. All patients concurred that they would recommended implant therapy or seeksuch treatment once again themselves. Dr. Lang elaborated on how the problems of implantplanning can be solved. The planning phase is essential for implant-based rehabilitations. Asystematic approach to treatment planning will facilitate the further stages of treatment. Thequestion invariably is how individual patient therapy can be solved. The way to arrive at asolution is through systematic implant planning.

At the end of the lecture, Dr. Lang addressed the data on the needs of patients worldwidewho could be managed by implant therapy. The increase in life expectancy reported in vari-ous populations in the foreseeable future will mean that the demand for dental implants willcontinue to rise until 2020.

Dr. Lang suggested a systematic approach to solving the problems related to implant plan-ning, and emphasized that an implant-supported restoration should offer long-term stabilityand a pleasing esthetic outcome. From the patient’s viewpoint these restoration must be pro-vided with little time delay once the treatment is initiated. The procedures involved must belargely pain-free. It is equally important that patients can afford the treatment provided.

Dr. Lang emphasized that all these goals can be achieved with Nobel Biocare solutions. Usingexamples of patient therapy he demonstrated how effective the solutions involvingImmediate Function™, NobelGuide™ and NobelEsthetics™ solved their needs.

www.dental-online-college.com/nb/lang2


14

Dr. RolandGlauser

Dr. Dr. PeterSchüpbach

Dr. Brent Allan

Dr. Roland Glauser, Switzerland and Dr. Peter Schüpbach,Switzerland – TiUnite™ Biomaterial, Soft Tissue Integration™ andImmediate Function™

Dr. Roland Glauser introduced the topic of Immediate Function™ and the role of the TiUnite™

biomaterial in patient therapy using a video showing how a Nobel Biocare implant systemwas placed in the anterior segment of a mouth. He discussed how through the immediatefunction capabilities with this system the needs of the patient were satisfied. The design ofthe implant and the influence of the TiUnite™ material on its surface were major influences inachieving a level of stability in bone following placement that permitted immediate function.The esthetic appearance of the restoration was entirely convincing and the patient wasextremely pleased.

Dr. Peter Schüpbach presented breathtaking electron microphotographic images of theTiUnite™ biomaterial, in which almost every collagen fiber could be seen inserting into theporous surface. The novel Groovy was presented as well, and Dr. Schüpbach explained howthe lower surface of the external implant threads feature a groove. This groove exists on thelower surface of each thread turn for the entire implant length and is 110 µm wide and 70µm deep. The excellent design of the groove promotes additional new bone formation dur-ing healing. The presentation included micro-CT images demonstrating in excellent qualitythat this groove is indeed in contact with new bone as it forms on the surface of the implant.

Another feature of this implant design is that the TiUnite™ surface extends higher up on theimplant. Additional grooves were also demonstrated within the collar portion of the implant.The purpose of this new design is to facilitate greater stability to the implant following surgi-cal placement in that new bone grows quickly into the grooves. Of special interest during thispresentation by Dr. Schüpbach was the appearance of the collagen fibers in the soft tissuesadjacent to the TiUnite™ surface. The orientation of some of the fibers suggests that theirattachment to the TiUnite™ surface is similar to what one observes in natural teeth. Clearlyone could speculate that they were demonstrating evidence of Soft Tissue Integration™. Whilethey may not be called Sharpey's fibers they still revealed a similar soft tissue structure, whichis supported by the TiUnite™ biomaterial.

www.dental-online-college.com/nb/glauser

Live: Dr. Brent Allan, Australia – Partial edentulous therapyusing NobelGuide™, implants and Procera

The first surgical procedure to be featured live was from Perth, Australia at 2:20 a.m. localtime to bridge time zones between Las Vegas and Perth. Dr. Brent Allan was the surgeon incharge who demonstrated the use of the NobelGuide™ concept to facilitate the placement oftwo implants in the maxillary posterior area to support a 3-unit fixed Procera® Implant Bridge.The NobelGuide™ 3D planning software was merged with a CT scan of the patient's maxillato determine the placement of the implants and the fabrication of the posterior bridgerestoration. The surgical guide was position in the surgery site in the posterior maxilla and ananchor pin was used to secure it in place with the help of this special Procera® software, theimplant positions in the bony maxilla are determined. The planned design is then transferredto a Procera® centre where the surgical guide is fabricated, and the appropriate implants andother components are selected and sent back to the clinician.

With the three implant positions defined by the Procera® software, the Procera® ImplantBridge framework planned for the restoration can also be designed and produced for inser-tion at the time of the surgery and implant placement. In this way, it was possible to finalizethe Procera® Implant Bridge even before the implants were placed in the presented patient.


15

Aren

a Pro

gram

Dr. Tom Balshi

An anchor pin was used to secure the surgical guide in the posterior maxilla and the surgeryarea. With the positions of the implants clearly defined by the surgical guide, Dr. Allen wasable to perform the soft tissue entry and bone drilling sequence to prepare the site for plac-ing of the implants. The entire process of bone preparation and implant insertion was carriedon through specific drill ports located in the surgical guide. Thus it was not necessary toreflect a flap. After placing the 3 Brånemark Mark III Groovy implants, the anchor pin and thesurgical guide were removed. The previously finished Procera® Implant Bridge was screwed tothe implants using a special type of adjustable abutment. The abutments feature a conicalscrew that will expand in the process of tightening, thus compensating for any fit differencesat the abutment to implant interface. The surgery was completed by placing composite fill-ings into the screw access hole on the occlusal surface of the bridge and the adjustment ofthe occlusion. The surgery and restorative therapy was characterized by swift execution andlittle invasiveness.

www.dental-online-college.com/nb/allan

Live: Dr. Tom Balshi, USA – Single and Multiple ToothReplacement Using NobelDirect® and Procera®

In this live surgery, Dr. Balshi demonstrated the placement of two NobelDirect® implants inthe anterior maxillae in combination with a provisional fixed bridge to replace the missing lat-eral and central incisors. A NobelGuide™ surgical template was fabricated for directing thepositioning of the implants in the appropriate locations in the surgical site. Dr. Balshi beganby demonstrating the appropriate components for a flapless surgery. The surgical guide wasposition in the mouth and the various step-wise surgical drills were used in the guide cylin-ders to prepare the bone to receive the implants. The implants were screwed into place andthe guide was removed. Using dental drills the abutment part of the one-piece NobelDirect®

implants were slightly modified to receive a prefabricated provisional bridge. The bridge wasfitted onto the implants by relining with an autopolymerizing acrylic resin. After positioningthe bridge, the lingual surfaces of the bridge were adjusted to achieve the proper occlusalcontacts. Following the placement of the provisional bridge, the patient demonstrated excel-lent immediate function of the implants by enjoying a large fresh strawberry together withthe surgical team.

In a live interview, the patient expressed satisfaction with the function and esthetics of thenew implant and supported provisional restoration. Following the surgery, a question wasasked by the audience as to the potential for complications due to the introduction of epithe-lial debris through the surgical guide and into the bone during the surgery. In the followingpanel discussion, it turned out that such debris is not a problem thanks to the flaplessapproach. Due to the several incremental drilling steps for bone preparation, any epithelialdebris can be readily eliminated. Another question concerned the occlusal contacts devel-oped with the provisional bridge. Most panel members agreed that the canine guidedocclusal scheme was the most desirable.

The final point of the discussion by the panel members dealt with a question concerning theaugmentation material used in some situations with implant placement. While the gold stan-dard continues to be autogenous bone, this material is not always available in sufficientamounts. Freeze-dried bone allografts (FDBA) was pointed out as a very good alternative. Thismaterial is a very effective for augmentations, and it will be fully resorbed and replaced bynormal bone.

www.dental-online-college.com/nb/balshi


16

Dr. Patrik Henry

Dr. ReginaMericske-Stern

The afternoon program was moderated by Dr. Patrick Henry, from Australia. He had thepleasant task to introduce the live operations performed in various parts of the world, all ofwhich were performed by acknowledged clinicians. This second half-day of the MondayArena program offered the participants several stimulating hours full of professional enhance-ment. The first presentation was a surgical and restorative procedure performed by Dr. ReginaMericske-Stern in Switzerland.

Live: Dr. Regina Mericske-Stern, Switzerland – Implant retainedoverdentures

An implant retained mandibular complete denture was the treatment plan demonstrated byDr. Mericske-Stern. The retention elements for the complete denture were two small ballattachments positioned on the top of two surgically placed implants.

An acrylic resin surgical guide was manufactured from a cast of the lower jaw. Two smallmetal guide sleeves were positioned on the stone cast in the areas selected for implant place-ment from the orthopanograph and clinical examination. These guide sleeves were incorpo-rated in the guide during polymerization of the acrylic resin forming the structure of theguide. Verification of the proper placement of the guide sleeves in the selected surgical sitewas determined by making a second radiograph with the guide in position in the lower jaw.The first step in the live demonstration consisted of placement of the guide over the lowerjaw. Using a 2.0 mm bur positioned in the guide sleeve, a small opening was made throughthe soft tissue to mark the bone. The acrylic guide was then removed and metal guides forcutting the soft tissue were positioned in the initial openings created through the soft tissueto the level of the bone. A soft-tissue punch was used with these soft tissue guides to removea small plug of tissue for the flapless procedure. A small paralleling guide component waspositioned into the initial 2.0 mm bone marking hole cut in the jaw bone. A twist drill wasthen positioned in the adjacent bone opening and the opening was enlarged in preparationfor threading of the surgical site and placement of the implant. The paralleling guide wasswitched to the other bone opening hole and the procedure was repeated.

The bone openings were enlarged with twist drills and two regular platform NobelReplace®

Tapered Groovy implants 13 mm in length were threaded into the bone openings. Thisimplant design features a TiUnite™ biomaterial extending right to the top of the implant. Thepurpose of this design is to reduce bone resorption and to improve soft-tissue integration. In

Discussion by the expert panel on the arena stage

Dr. MickDragoo, USA

Dr. DavidGelb, USA

Dr. GuidoHeydecke,Germany

Dr. GlenLiddlelow,Australia

Dr. CarlosMouraGuedes,Portugal

Dr. PeterMoy, USA

the afternoon program was hosted by Dr. Patrik Henry, Australia


17

Aren

a Pro

gram

Dr. Paulo Maló

addition, these Groovy implants are designed to expedite osseointegration. Once the twoimplants were placed, abutments with a ball design on their top surface were screwed intothe implants. Two small pieces of rubber dam were fitted over the balls and positionedagainst the base of the abutments. Two retentive components were then fitted onto the ballsand the denture base was seated on the soft tissues and checked to assure that no interfer-ences existed between the retention elements positioned on the balls and the denture base.After adjusting the denture to assure a passive fit, an acrylic resin reline material was posi-tioned in the relieved areas of the denture base and it was seated over the lower ridge. Afterthe resin material hardened the denture was removed and checked to see that the retentioncomponents were adequately joined to the denture base. The occlusion was checked againstthe opposing upper denture and the treatment completed.

Dr. Regina Mericske-Stern emphasized that the flapless protocol should be considered when-ever possible. It is less invasive and the post-surgical convalescence is uneventful. Followingthis live demonstration, the moderator presented the audience with the question: Is this flap-less procedure appropriate for this procedure? There were 53 percent Yes votes and 26 per-cent No votes. The remaining 21 percent evidently abstained. Another point of discussionwas whether overdentures should be supported by two or four implants. It was agreed thatfollow-up relinings are needed in the presence of two implants, while the follow-up require-ments may be less extensive with four implants.

www.dental-online-college.com/nb/mericskestern

Live: Dr. Paulo Maló, Portugal – NobelGuide™ with the All-on-4Concept

Dr. Paulo Maló, Portugal, demonstrated the All-on-4 concept live from Lisbon. Prior to start-ing the procedure, the audience was asked whether they were familiar with the All-on-4 pro-tocol. There were 55 percent yes responses, while 45 percent were not familiar with this con-cept at the time. The principle of All-on-4 is to support and retain the denture by the fourimplants, and to angle the two most posterior implants towards the posterior part of the ridgeto better distribute the support of the prosthesis by the bone. The live surgery planned forthe patient involved the placement of a fixed bridge supported by four implants to restorethe entire mandibular dentition. Once again, the treatment plan was developed using the CTscan merged with the NobelGuide™ software to determine the positions for implant place-ment, allowing for a flapless surgical approach. Postoperative pain and swelling can be great-ly reduced with this minimally invasive approach.

Four NobelSpeedy™ implants were inserted during the surgery, and the two most posteriorimplants were distally angulated. This recently developed implant design is available withinternal or external connection. The TiUnite™ surface on the exterior of the implant extendsall the way to the top of the implant, and their thread geometry lies in between the tradition-al Brånemark and the Replace® Tapered implant designs. Using the surgical guide stabilizedby three anchor pins, Dr. Maló demonstrated the placement of the implants using the appro-priate step drills to prepare the surgical sites. Implant placement was completed demonstrat-ing ease of placement using the guide. After removing the surgical guide, the abutment com-ponents were joined to the implants using abutment screws. The distal abutments had a spe-cial angulated design to orient it parallel to the other abutments. Finally, a prefabricated pro-visional restoration was screwed to the abutments. The entire procedure, with insertion of therestoration, took approximately 20 minutes.

After the procedure had been completed, the audience was presented with a question andwas asked to select one of five possible answers. The question was: which strategy do youprefer in the edentulous maxilla? The tally was 22 percent in favor of All-On-4, 28 percent in


18

Dr. ChantalMalevez

favor of 6 implants, and 14 percent in favor of 8 implants. Only 3 percent of the audiencewere convinced that more than 8 implants would be the right choice. By contrast, 34 percentthought that the treatment decision should be made on a case-by-case basis.

www.dental-online-college.com/nb/malo

Dr. Chantal Malavez, Belgium – Totally Edentulous NobelGuide™

Surgery with the new Brånemark System® Zygoma Implant

Dr. Chantal Malavez performed the last live surgery demonstration this afternoon. The treat-ment plan was to restore an edentulous maxilla using four implants in the anterior segmentand additional two posterior placed Brånemark System® Zygoma implants. The NobelGuide™

System is particularly useful for Zygoma implants due to the sensitivity of neighbouring struc-tures such as the eye socket. The Zygoma implants are inserted into the maxilla, through thesinus and into the Zygomatic bone. This requires the use of special instruments such as elon-gated drills that are designed with greater implant length, as well as special instruments toprotect the lower lip. The surgeons fingers are also used to palpate the Zygomatic bone forimplant insertion in addition to using the NobelGuide™ surgical template. Zygoma implantsare deemed contraindicated in the presence of maxillary sinusitis, but also in the presence ofinsufficient mouth opening, as the space requirements for the instrumentation insertionprocess are substantial due to the great length of the instruments used. Immediate loading ofZygoma implants requires an insertion torque of 50 Ncm. After all six implants had been suc-cessfully inserted, the fixed restoration was joined to the implants by screws. Using Zygomaimplants, a fixed prosthesis can be treatment planned even if the anterior bone volume isreduced to the extent of allowing only two implants to be placed. The reported success ratesfor Brånemark System® Zygoma implants are very high.

A question from the audience concerned fractures of Zygoma implants and how they shouldbe handled. Dr. Malevez recommended that the sinus should be opened and the implantremoved. However, no fractures of Zygoma implants have been reported to date.

www.dental-online-college.com/nb/malevez

Dr. MattsAndersson,Sweden

Dr. CarlosAparicio,Spain

Dr. EdmondBedrossian,USA

Dr. Maha ElSayed, Egypt

Dr. ChrisMarchack,USA

Dr. Pär-OlovÖstman,Sweden

Dr. SteveParel, USA

Dr. Daniel vanSteenberghe,Belgium

The following panel experts contributed to the discussion on thearena stage


19

On Wednesday morning, the moderator, Dr. Jörg Strub welcomed the audience to the thirdday of the conference and the Arena Program. He then introduced the international panelmembers for the day, coming from Brazil, Belgium, Japan, Austria, Canada and the USA.Alluding to the venue, which happened to be a well-known boxing arena, the tune “Let meentertain you” was played while the panel members were being welcomed to the arenastage. The first live demonstration of the day on the subject single and multiple tooth restora-tions supported by NobelPerfect® implants was introduced by the satellite connecting LasVegas to Dr. Massimo Simion in Milan, Italy.

Dr. Massimo Simion, Italy – Single and multiple unit replace-ments with NobelPerfect® implants

Dr. Simion introduced the patient, a young woman, who had lost her four maxillary anteri-or incisors as a result of aggressive periodontitis. He began by a discussion of this diseaseprocess and the importance of hard and soft tissue augmentation that was carried out on thepatient prior to this surgery appointment, as well CT scans to assist in the planning for thesurgical procedures.

Dr. Simion demonstrated how the CT-based planning is transferred to the patient’s mouthusing the NobelGuide™ surgical guide. The design of the guide involved a six unit restorationconsisting of both canines and the four incisors. Drilling guide openings had been created inthe areas of the lateral incisors for the initial drilling through the soft tissue for placement ofthe implants. Once these opening had been made, the guide would be modified for use as aprovisional restortion during the healing period. After placing the initial soft tissue openings,he removed the surgical guide and using a minimally invasive, flapless procedure he finisheddrilling the surgical sites. He then placed two NobelPerfect® Groovy implants in the positionsof the missing right and left maxillary lateral incisors that would support a fixed implant-sup-ported restoration. He did not place implants in the areas of the right and left central incisors.His experience in these kinds of surgery has resulted in better esthetic result when the centralincisors are replaced as pontics in the fixed restoration.

Following placement of the two implants, the provisional restoration was placed over tempo-rary abutments that had been positioned on the implants. The provisional was modified withacrylic resin to secure an accurate fit. Following the surgical placement of the two implants,he modified the surgical guide to be used as a provisional implant-supported bridge overtemporary abutments that had been positioned on the implants. The provisional was modi-fied with acrylic resin to secure an accurate fit. The provisional restoration would be relinedevery 20–30 days over a 6 month time period. Finally, Dr. Simion concluded by pointing outthat flapless surgery in conjunction with immediate restoration placement involves the adher-ence of the clinician to a strict set of criteria for patient selection. In his view, an adequatebone volume and primary implant stability demonstrated during implant placement in boneare required. A happy smile by the patient at the end of treatment attested to the successfulwork of the entire dental team, who were congratulated at the end of his live transmission byProfessor Strub to the tune Forza Italia.

www.dental-online-college.com/nb/simion

Aren

a Pro

gram

wednesday, 8 june 2005

Dr. MassimoSimion

the morning program was hosted by Prof Jörg Strub, Germany

Dr. Jörg Strub


20

Dr. Jonathan Ferencz, USA – Optimum Aesthetics for NaturalTeeth and Implants

Following a short video clip on the sights of Big Apple, the moderator introducedDr. Jonathan Ferencz in New York City as the clinician who would deliver the second livedemonstration for this morning session. Dr. Jonathan Ferencz presented to the audience a 41-year old woman with trauma-induced tooth loss in the anterior maxilla. Comprehensive pre-treatment and implant placement had already been completed for the patient. For thisdemonstration, Dr. Ferencz was now going to deliver definitive Procera® crown restorationsover implants and natural teeth in order to restore the maxillary right canine, lateral incisor,central incisor and left central incisor.

Dr. Ferencz initially focused attention on how one positions the zirconia abutments onto theimplants in the area of the right lateral incisor and left central incisor. He began by demon-strating on the master cast of the patient how the abutments had been oriented to theimplant analogs. He also showed how the definitive Procera® crowns created for the twoimplant-supported restorations and those for the two natural teeth fit onto the abutmentsand the natural tooth preparations. Maintenance of this fit and positioning orientation of thecrowns and the abutments as they existed on the master cast to the mouth was critical to thesuccess of the overall restoration of the anterior units.

He showed how a custom metal splint had been fabricated to fit onto the zirconium abut-ments and natural tooth dies in the master cast. This splint would be used to position theabutments onto the implants in the mouth in an accurate relationship so that the Procera®

crowns could be position onto the abutments and natural teeth in the same orientation asthey were on the master cast.

The metal splint was positioned onto the zirconia abutments and dies and the laboratoryscrews that were holding the abutments accurately onto the implant analogs and dies wereremoved. The splint and abutments positioned in the splint were removed from the mastercast and inserted over the tooth preparations and implants in the mouth. Abutment screwswere positioned in their screw access holes of the abutments and the screws were tightenedto the appropriate torque. The splint was then removed from the teeth and abutments. Aftertheir precision of fit was verified by obtaining individual x-ray films, the retaining screws werere-torqued to 35 Ncm. The single crown restorations were first tried in and were then deliv-ered with definitive resin cement. In the last step, Dr. Ferencz checked the static and dynam-ic occlusal relationships and made occlusal adjustments. At the end of treatment, he was ableto present the audience a happy patient with a pleasing smile and esthetic restorations.

www.dental-online-college.com/nb/ferencz

The live presentations of the morning clinicians provoked con-siderable discussion from the panel of experts on the arenastage.

Dr. Peter Wöhrle from the USA, inventor of the NobelPerfect® system explained the mostimportant intraoral and extraoral factors in treatment planning to achieve harmony betweenwhite and pink esthetics along with normal phonetics. He focused specifically on implant posi-tioning and interproximal distances required in the anterior segment to obtain predictableesthetic results. To ensure that the papillae are fully preserved, interproximal distances shouldnot exceed 5 mm between implants and natural teeth, or 3.4 mm between adjacentimplants.

Dr. JonathanFerencz


21

Dr. Wöhrle also commented on the characteristics of the patient presented by Dr. Ferencz anddiscussed alternative treatment options. Aside from the selected strategy, he also suggestedconsideration of the option of restoring the anterior segment with a conventional fixed bridgespanning the right canine to the right central incisor without the use of implants. He alsooffered the option of extracting the right central incisor and inserting an implant-supportedfixed bridge spanning from the right lateral incisor to the left central incisor. Another optionwould have been to deliver single-tooth restorations with an additional implant at the rightcentral incisor. Ultimately, Dr. Wöhrle would have based his treatment decision on whetheror not the patient favored a tooth-by-tooth restoration.

Dr. Georg Watzek from Austria, a specialist in bone augmentation described his approach tohard-tissue augmentation in the anterior segment of the dental arch. He discussed theoptions of autogenous bone grafting, for example using a bone scraper or advanced piezosystems, and emphasized the importance of sufficient blood supply to the graft, no matter ifa bone substitute, autogenous bone or a mixture is used. He recommends perforating thecortical bone wall accommodating the graft. In a case report similar to the one presented byProfessor Simion, he demonstrated the use of bone blocks covered by a resorbable mem-brane for augmentation. Professor Watzek emphasized the need for correct implant position-ing in the anterior segment and recommended using the palatal bone wall as a reference toobtain an adequate width of tissue on the facial side in addition to good primary stability. Hepointed out that primary stability as determined by the insertion torque was another impor-tant factor influencing the decision on whether to use immediate loading.

Dr. Sonia Leziy from Canada discussed manipulations of the soft-tissue structures to optimizeimplant esthetics. She illustrated several patient reports in which connective tissue grafts wereused to render thin gingival biotypes thick, and also, for example, to create better contoursalong the alveolar ridge.

Dr. Masao Yamazaki from Japan elaborated on ways to optimize the gingival margin aroundimplants, demonstrating how soft-tissue structures can be shaped with the help of provision-al composite restorations. He presented a patient in which he had utilized this technique inthe maxillary anterior segment, thereby achieving excellent pink esthetics.

Dr. Masao Yamazaki and Dr. Sonia Leziy both talk about soft-tissue shaping with the help ofcustomized temporary restorations prior to the definitive prosthetic phase. Both speakers illus-trated their point with impressive patient reports.

Dr. George Duello from the USA presented several patients from his office demonstratingthat this strategy can also be utilized with good results in partially and edentulous jaws. Healso presented patients in which surgically placed implants were subjected to immediatefunction with provisional prosthetics.

Dr. George Duello also stressed the need for patient compliance in selecting the type ofceramic. Since zirconium oxide favors bacterial effects, good long-term results can only beachieved in the presence of good oral hygiene.

Dr. Yves Budzynski from Belgium talked about the prosthetic implications of theNobelPerfect® system. He illustrated the special requirements of using a scalloped implantsystem, starting with implant placement at the right central incisor through fabricating aProcera® Abutment in zirconium, up to tightening the abutment to the recommendedtorque of 35 Ncm.

Dr. Yves Budzynski also presented a study on the 5-year-survival of ceramic restorations ascompared to porcelain-fused-to-metal and titanium restorations. The survival rates for alu-minium oxide were 97.7 percent in single crowns and 93 percent in multi-unit restorations,

Aren

a Pro

gram


22

which was almost identical to the rates obtained with porcelain-fused-to-metal (97 / 96 per-cent) and titanium (95 / 97.8 percent) restorations. According to Dr. Budzynski, the dataavailable for zirconium oxide were too sparse to be included in the comparison, althoughmulti-unit restorations made from zirconium oxide have been shown to involve a 3-year sur-vival rate of 94.5 percent.

Dr. Markus Blatz from the USA, was the last panel speaker who summarized the long-termresults obtained with the system in a total of 33 studies involving follow-ups of more than 5years. The success rates of both the implants and the associated restorations were higher than90 percent.

Dr. Markus Blatz also gave an overview of currently used ceramic systems. He first distin-guished between glass-based feldspathic materials and high-strength ceramics such as alu-minium oxide and zirconium oxide. The former are used in the esthetic zone and for veneer-ing, while the latter are mainly used for build-ups and as die materials. Dr. Blatz then dis-cussed the differences between zirconium oxide and aluminium oxide. Zirconium oxide ischaracterized by smaller particles, shows a tetra-gonal structure, and has the ability to closeinternal cracks on its own. Zirconium offers good esthetics and maximum strength, while alu-minium oxide, being more translucent, offers good strength and maximum esthetics. Finally,Dr. Blatz discussed the implications of cementation for all-ceramic restorations, presenting astudy in which the effects of cementation on the fracture strength and marginal seal ofProcera® crowns were investigated. In that study, the best fracture strength was obtained withPanavia®, while composite-reinforced glass ionomer cements had superior properties in termsof marginal seal. As a practical recommendation, Dr. Blatz suggested that high-performanceceramics of great strength should first be sandblasted, followed by silanization and finally becemented with Panavia®. However, the use of these materials is not necessarily confined toadhesive techniques.

The Role of Dental Rehabilitation in an “Extreme Makeover”

The third and final part of Wednesday’s Arena Program addressed the role of dental rehabil-itation in very complex situations. The organizers had invited Dr. Sherri Worth, who is theleading cosmetic and reconstructive dentist of the American TV show The Swan, andDr. Harvey Zarem, a plastic and reconstructive surgeon who is the leading surgeon of theshow Extreme Makeover on ABC.

After some introductory video clips showing scenes from the The Swan, which is a very pop-ular show with over 15 million viewers, Dr. Worth related some of her experiences andimpressions to her participation on the show. Some of her patients had received very exten-sive dental and facial treatment in a very short time, the aim being to turn “ugly ducks intoswans.” Dr. Worth used the expression smile transformation to describe the therapy provid-ed the participants on the show. Collaborating with plastic surgeons and dental technicians,she was able to give back radiating smiles to numerous participants who were patients on theSwan, who had been unhappy with their appearance and dental situation.

Dr. Worth presented a young but already edentulous patient who presented to the camera asmile showing a very appealing fixed restoration following implant therapy and prostheticrehabilitation. Dr. Worth emphasized the positive effects of such sweeping changes made topatients’ faces on their body awareness and self-image. She encouraged the audience to col-laborate more closely with plastic surgeons to achieve similar results. For example, correctiveelongation of the upper lip can produce more esthetic results in the treatment of “gummysmiles” than periodontal surgery alone.

Dr Harvey Zarem

Dr. Sherri Worth


23

Dr. Harvey Zarem is the chief surgeon of a similar show on the U.S. TV network ABC calledExtreme Makeover. In his presentation, he first discussed criteria for patient selection when-ever one provides extreme reconstructive surgery to change ones physique and outwardappearance. Candidates have to be open-minded and need to have an interesting personalhistory. Based on video scenes from Extreme Makeover, he demonstrated the approach ofplastic-reconstructive surgeons, documenting the first conversation with the patient, thebaseline oral situation, and all treatment steps that follow, including the final result.

In the second part of his presentation, he discussed ways to handle difficult patients. In hisexperience, misinformation through the Internet has been a major factor in this connection.He explained what he considered to be significant signs indicating to the experienced sur-geon that treatment of these specific patients should be refused. Among other things, herefrains from treating patients who can only afford surgery after saving up money for a longtime, since there is always a risk that some follow-up treatments may become necessary, andthese procedures cannot be performed because the patient has very limited remaining fundsto cover the costs of these procedures. He also refuses to treat patients with unclear or exag-gerated expectations.

Finally, Dr. Zarem discussed problems of fashion and commercialization associated with thegrowing run on plastic-esthetic surgery. However, he encouraged the audience by saying thathere is also good news. Since the public is today better informed, the general acceptance ofplastic surgical measures is rising. In addition, surgical techniques are becoming ever morereliable and safer thanks to ongoing technological advancements.

Dr. Strub closed the morning program by thanking all who participated for their contribu-tions.

www.dental-online-college.com/nb/zarem

Aren

a Pro

gram

Dr. DarioAdolfi, Brazil

Dr. MarkusBlatz, USA

Dr. YvesBudzynski,Belgium

Dr. GeorgeDuello, USA

Dr. SoniaLeziy, Canada

Dr. Dr. GeorgWatzek,Austria

Dr. PeterWöhrle,USA

Dr. MasaoYamazaki,Japan

The following panel experts contributed to the discussion onthe arena stage


24

On Thursday morning, Dr. Ronald Goldstein served as the morning moderator. He beganthe program by introducing the panel of experts that would interact with the speakers andalso discuss interesting topics related to the subject schedule for this arena session.

Dr. Gerard Chiche, USA – Requirements for Ideal EstheticRestoration

The first presentation addressed the various requirements and strategies to optimize theesthetic results of the Procera® system. The presentation ranged from veneers to single-toothand multi-unit restorations. Dr. Gerard Chiche presented various examples to illustrate hissolutions and strategies to ensure that his patients are satisfied with the esthetic appearanceof their restorations. He divided his presentation into five parts.

In part 1, Dr. Chiche presented a study by M J Friedmann (1998) demonstrating the longevi-ty of veneer restorations. Over a follow-up period of 15 years, the success rate was 93 per-cent. To minimize any potential for veneer losses, flexural forces should be reduced and theoral preparation margin minimized. Furthermore, fifth-generation adhesives should be used,and the adhesive should be allowed to harden completely before subjecting the restorationto functional forces.

In part 2, he presented a number of patients illustrating how veneers can be used to maskdiscolorations. In the presence of intense discoloration, available options include internal orexternal bleaching, window preparation (in the presence of gray discoloration), enhancingthe opacity of the ceramic, and deeper hard-tissue reduction on the vestibular tooth surface.

In part 3, Dr. Chiche explained the various cementation techniques for all-ceramic systems.

These fall into two basic groups. Group A includes materials based on aluminum oxide andzirconium oxide. Since etching cannot be performed on these surfaces, a resin or glassionomer cement should to be used. Group B includes layering ceramics. Since these materi-als cannot be cemented, a bonding agent has to be used.

In part 4, Dr. Chiche discussed the high strength of aluminum oxide and zirconium oxideceramics. Multi-unit restorations made from zirconium oxide are so stable that frameworkfractures are no longer a realistic scenario. A number of points are essential to ensure optimalesthetic results with aluminum oxide and zirconium oxide materials:

1. Only patients with an adequate amount of occlusal space should be selected.2. The thickness of the zirconium oxide or aluminum oxide coping should be at least 0.4 mm.3. The vestibular tooth surface should be maximally reduced.

All three factors help compensate for the low translucency (15%) of these systems, so thatoptimal esthetics can be achieved.In part 5, Dr. Chiche discussed the differential transparen-cies of layering ceramics and zirconium oxide ceramics. Zirconium oxide has a translucencyof 15%, compared to 70% for built-up ceramic restorations.

Whether a ceramic build-up or a zirconium oxide material should be used for the restorationneeds to be decided on a patient-by-patient basis, Dr. Chiche related. Since the problem offramework fractures has been minimized by the introduction of zirconium oxide technology,the perspectives for the future are promising. At the end of his presentation, Dr. Chicheemphasized the importance of communication and collaboration with the ceramist in esthet-ic decision-making. Optimal aesthetic results can only be achieved through effective team-work.

www.dental-online-college.com/nb/chiche

thursday 9 june 2005

Dr. Ronald Goldstein

the morning program was hosted by Dr. Ronald Goldstein, USA

Dr. Gerard Chiche

25


Dr. Patrick Palacci, France – Single and multiple units – Hard andsoft tissue management

In this presentation, Dr. Palacci introduced his concepts of simplicity and reliability in esthet-ic implant therapy that has evolved since 1995 with regard to precise implant positioning aswell as bone and soft-tissue management. He updated the audience on the newest develop-ments in papilla management and demonstrated these techniques in combination with theProcera® system. He also presented a 15-year follow-up of patients who had received esthet-ic treatment in his practice.

Dr. Palacci presented two methods for classifications of diagnosis and treatment planning foresthetic rehabilitation following tooth loss.

First classification:

Class 1: One tooth lost, both papillae present.Class 2: One tooth lost, no papillae present.Class 3: One tooth lost, no papillae present, bone loss around the papilla.Class 4: Multiple teeth lost.

Second classification:

Class A: No vertical and horizontal resorption of the alveolar ridge.Class B: Mild vertical and horizontal resorption of the alveolar ridge.Class C: Moderate vertical or horizontal resorption of the alveolar ridge.Class D: Severe vertical or horizontal resorption of the alveolar ridge.

Based on this classification system, he presented a number of patient examples to illustratevarious treatment approaches. In class 1A patients, it is important that the implant is correct-ly positioned and its diameter is correctly selected. If both requirements are met, the inter-dental papilla will be preserved after restorative treatment.

In class 2B patients, soft-tissue augmentation is required in addition to correct positioning andimplant diameter selection. The augmentation is performed during implant placement orduring a secondary procedure, using a connective-tissue graft obtained from the palate as thedonor site. Another essential requirement for papilla formation between teeth and implantsis correct implant exposure, using small mesial and distal swing valves into the interproximalspace.

In class 3C patients, the first step must be to place an autogenous bone graft for augmenta-tion.

The implants are placed three months later, using the same protocol as in class 1A patientswithout additional soft-tissue augmentation. In class 4C patients, the first step must be toplace a bone graft for augmentation. The implants are placed three months later, using thesame protocol as in class 2B patients.

All these protocols include a submerged healing period of 2–4 months. Dr. Palacci’s experi-ence with this systematic approach in patient therapy includes a total of 7,000 implants thathave been placed since 1998. All patient reports he presented were documented over 15years and revealed stable bone and soft-tissue conditions. This conservative strategy has yield-ed wonderful esthetic outcomes, and the regenerated tissue structures have remained stablefor decades.

www.dental-online-college.com/nb/palacci

Aren

a Pro

gramDr. Patrick Palacci


26

MDT Ernst Hegenbarth, Germany – NobelEsthetics™ andNobelRondo™: A Creative Concept

In his presentation, Mr. Ernst Hegenbarth provided the background in the development oftwo new veneering materials along with the techniques used to meet the esthetic require-ments for designing restorations based on aluminium oxide and zirconium oxide ceramics.The NobelEsthetics™ concept is based on solid technology and material science, involvingexcellent ergonomics and offers a high degree of creativity.

NobelEsthetics™ includes all Nobel Biocare abutment versions available for esthetic restora-tions, including various titanium abutments but also Procera® abutments. NobelEsthetics™

offers customized solutions for all treatment indications.

NobelRondo™ is a new veneering system both for aluminium oxide and for zirconium oxideceramics substructures that are customarily used in NobelEsthetics™ restorations.

Mr. Hegenbarth illustrated the excellent material properties of NobelRondo™. Its flexuralstrength of 120 MPa significantly exceeds that of similar ceramic systems, thereby increasingthe longevity of the restorations. NobelRondo™ is also much more homogeneous and glass-like than other veneering systems. Furthermore, it is free of structural deficits. It also featuresa higher fracture resistance (by 20–30 percent) and a lower resistance to abrasion (by 42 per-cent) than other porcelain systems.

Mr. Hegenbarth reported that the system can be polished very well and features excellentvisual properties such as fluorescence, opalescence, translucency and a mother-of-pearl effect.

Aluminium oxide has a higher translucency than zirconium ceramics.

He described the simplicity of the NobelRondo™ circle system, which promotes an ergonom-ics arrangement. Also, several firing steps can be used to imitate nature without deterioratingthe material properties. Chipping of the layering ceramic from the zirconium oxide frame-work, as experienced with older systems, is no longer a problem with NobelRondo™. However,a sufficient layer thickness is required.

He presented several patient reports illustrating excellent esthetic results, involving follow-upperiods of up to 10 months. Individual shade selection and patient expectations are informa-tion that is essential to the ceramist to develop these restoration and achieve favorable results.

Mr. Hegenbarth is convinced that perfect esthetic outcomes can only be achieved by closecollaboration between the dentist and technician.

www.dental-online-college.com/nb/hegenbarth

Dr. Mauro Fradeani, Italy – The use of Procera® system for singleand multiple units on implants and natural dentitions

Dr. Mauro Fradeani shared with the audience his opinions on the use of metal-free ceramicmaterials and the excellent results they offer for veneers as well as for single-tooth and multi-unit restorations in the anterior part of the mouth. For the management of complex patienttreatment situations, it is essential that the restorative materials are selected together with theceramist. A decision must be made between two basic types of ceramic systems: silicon oxideceramics (feldspathic and glass ceramics) and high-strength ceramics (aluminium oxide andzirconium oxide ceramics). Silicon-based ceramics are highly translucent but offer lowerstrength. They are indicated for restorations in the anterior areas and for single-tooth recon-struction.

High-strength ceramics have a somewhat lower degree of translucency and are indicated inthe anterior and posterior segments of the mouth as well as for multi-unit restorations. Failure

MDT ErnstHegenbarth

Dr. MauroFradeani

27


of silicon-based ceramics will always be characterized by complete fracture. In high-strengthceramics fractures usually involve only the veneering material. According to Dr. Fradeani, thequestion of the cementing agent to use with high-strength ceramics is less important,although resin cements are preferable due to their superior properties. His preferred high-strength ceramic for anterior restorations is aluminium oxide, due to its higher translucencycompared to zirconium oxide ceramics.

However, since there had been no failures of multi-unit restorations made of zirconium oxideceramics over the past three years, this material holds the greatest potential for the future. Dr.Fradeani is convinced that zirconium oxide ceramics will replace the traditional gold or metalframework systems over the next few years and prevail as material of first choice for restora-tive purposes.

www.dental-online-college.com/nb/fradeani

The following panel experts contributed to the discussion on thearena stage

Aren

a Pro

gram

Christina Hendrika (CDT) and Johannes Beekhuis(CDT/Lab-Management), Apeldoorn, Netherlands: “Atthe Las Vegas conference we were most impressed bythe live surgeries. We came to Las Vegas to get to knowdifferent techniques and options in implantology. Afterthe daily programmes we also enjoyed Las Vegas.”

Dr. NitzanBichacho,Israel

Dr. LesleyDavid,Canada

Dr. Eric VanDooren,Belgium

Dr. Iñaki Gamborena,Spain

Dr. TiduMankoo,Great Britain

Dr. AvishaiSadan, USA


28

The afternoon program focused on Nobel Biocare’s immediate and long-term “Vision andAction Plan.” Ms Heliane Canepa, President and CEO of Nobel Biocare, with the help ofDr. Avishai Sadan introduced six teams of researchers and clinicians who introduced for thefirst time in public a number of new innovations supported by Nobel Biocare. TogetherHeliane Canepa and Avishai Sadan brought this final program of the conference that the audi-ence had awaited with great expectation to life; she and her brilliant far-sighted entrepre-neurial spirit, and he with his impressive manner of bringing out the best in the assembledspeakers.

Dr. Eric Rompen, Belgium, Dr. Eric Van Dooren, Belgium, Dr. Bernard Touati, France – A biological interface

The first team of researchers included Dr. Eric Rompen from Belgium, Dr. Bernard Touatifrom France and Dr. Eric Van Dooren also from Belgium. This first group presented a newabutment design whose purpose is to stabilize the soft tissue at the junction of the abutmentand implant interface. In their view, mucosal recessions in this area routinely occur in clinicalpractice as a result of the smooth abutment surface that does not necessarily encourage astrong attachment of the soft tissues to its surface.

Consequently, this team of researchers created a new abutment design featuring a half-rounded circular depression in the abutment just above the junction between the abutmentand the implant. This design feature has be instrumental in promoting the in-growth of con-nective tissue into the area of the circular depression, and thus resulting in a thickened con-nective tissue layer limiting the apical recession of the soft tissue.

The speakers used the term non-surgical connective tissue graft to describe this action of thesoft tissue in response to the abutment design. The mucosal seal that results from the designhas been determined to be 3 mm high, or an additional 1.0 mm that one sees with conven-tional abutments. In the teams view, the connective tissue is mechanically stabilized by thiscircular ring of connective tissue, thus minimizing and in some cases preventing soft-tissuerecession commonly found with the conventional abutment designs.

www.dental-online-college.com/nb/rompen-touati-vandooren

Dr. Iñaki Gamborena, Spain – Platform switching powered byProcera®

Dr. Iñaki Gamborena, from Spain, the next speaker on the program, presented a new abut-ment design concept that he and Nobel Biocare are pursuing called platform switching.Platform switching according to Dr. Gamborena created a design configuration between thecollar of the implant at the implant abutment interface whereby a step or depression is cre-ated at this connection area. The step is the direct result of using an abutment with a bear-ing surface platform that is smaller than the platform dimension of the implant itself. The stepthat is created by this platform switching provides yet another method to achieve a greaterthickness to the connective tissue circular ban that forms in this area during healing. Theincrease in the connective tissue can greatly minimize the downward migration of the epithe-lial tissues as a tissue recession response that is commonly found in this area with the currentjunctional abutment to implant configurations.

afternoon program hosted by Heliane Canepa and Dr. Avishai Sadan

Dr. Eric Rompen

Dr. Bernard Touati

Dr. Avishai Sadan

Ms Heliane Canepa

Dr. Iñaki Gamborena

Dr. Eric VanDooren

29


Dr. Paul Chang, USA, Mr. Ernst Hegenbarth, Germany – Procera® Implant Bridge in Zirconia

Dr. Paul Chang from USA and Mr. Ernst Hegenbarth a Dental Technician from Germany,presented the new Nobel Biocare one-piece implant framework fabricated in the zirconiaoxide material. What was most unique with this all-ceramic framework was that it emanateddirectly from the implant bearing surface. Equally significant was the advantage of combin-ing this framework with the new NobelRondo™ veneering porcelain to create an estheticresult that was spectacular. Dr. Chang illustrated how this technology had been used to cre-ate four Procera® Implant Bridges supported by implants for one of his patients who was total-ly edentulous. At each step in treatment that he illustrated, Dr. Sadan summarized for theaudience just exactly what was done from a technical standpoint because this technologywas completely new. After traditional implant level impression making and the creation of amaster cast, four wax patterns were made on the implants that provided the needed thick-ness and dimensions for three-unit bridge framework designs that also included soft tissuesupporting area replacing the missing residual ridge tissues in the maxillary arch. The waxpatterns were then duplicated in an acrylic resin material for scanning with the Procera® ForteScanner. Once scanned, the zirconia frameworks were produced by new technology devel-oped for making these one-piece fixture level frameworks. When the frameworks werereturned to Dr. Chang the precision of fit on the master cast implant analogs and the fit inthe oral environment demonstrate outstanding accuracy.

The next step in the treatment plan called upon the expertise of Mr. Hegenbarth in creatingthe contours and occlusal relationships needed to finalize the articulation with the opposingdentition. The creation of form and function in the appropriate shade with the esthetics tosatisfy the patients’ expectations was demonstrated. Mr. Hegenbarth walked Dr. Sadan andthe audience through each step using the NobelRondo™ veneering porcelain. The illustrationsdemonstrating this aspect of the treatment were outstanding and the lifelike end result wasexcellent.

www.dental-online-college.com/nb/chang-hegenbarth

Dr. Nitzan Bichacho, Israel – The Bone Saving Implant

Dr. Nitzan Bichacho from Israel, followed on the program with another new implant designthat his team of researchers and Nobel Biocare are developing. The new design consists of acompletely different thread configuration from the apical end of the implant up to the coro-nal portion, The implant has a conical design between the threads, which results in bettercontrol of the contact with bone during implant placement. This design allows intimate bonecontact to be maintained during its treading into the surgical site. This effect can only beachieved when an undersized implant surgical site has been prepared. Dr. Bichacho empha-sized that this system offers a high degree of bone condensation, excellent primary stability,and ease of implant placement. Furthermore, the implant can be reoriented during place-ment. Thanks to these factors, implant survival is very good. In a study involving 474 implantsover a follow-up period of 26 months, the survival rate was 98.3 percent. A great potentialfor the future can therefore be predicted.

www.dental-online-college.com/nb/bichacho

Aren

a Pro

gram

Dr. Paul Chang

Dr. NitzanBichacho

Mr. ErnstHegenbarth


30

Dr. Ralf Kohal, Germany – ZiUnite Implants

Dr. Ralf Kohal from Germany presented a new one-piece all-ceramic zirconium oxide implantbeing jointly developed and research with Nobel Biocare. This design features a ZiUnite sur-face instead of the conventional TiUnite™ surface, both characterized by similar depths of sur-face roughening. Dr. Kohal stated that the same degree of bone apposition was demonstrat-ed in animal experiments as on the TiUnite™ surface. ZiUnite is thus a very promising alterna-tive for restorations in the esthetic zone, although long-term data are not yet available.

www.dental-online-college.com/nb/kohal

Dr. John Wozney, USA, Dr. Ulf Wikesjö, USA and Dr. Jan Hall,Sweden - Bone Inductive Implants

Dr. John Wozney, Dr. Ulf Wikesjö and Dr. Jan Hall have been involved with bone researchsince 1997, specifically focusing on a bone morphogenetic protein material called BMP-2. Dr.Wozney provided a brief history of how this material was developed and is produced. Heemphasized that the material in question, its full designation being rhBMP-2, is the only sub-stance known globally to have osseoconductive properties. Basically this means that thismaterial on the surface of an implant will cause bone apposition in the implant to bone inter-face and may well be a deterient to bone resorption thereby minimizing if not eliminating thepotential for any resorption process to occur in the adjacent bone.

The members of this research team each presented various aspects of some of the research todate in which mandibular defects in animals were treated with a rhBMP-2 collagen sponge,resulting in complete reconstruction of the defect within 20 months. The early research effortswith this material has resulted in approval of rhBMP-2 in 2002 for clinical use in orthopedicapplications. A study involving primates has demonstrated impressively that surface treatmentof implants with rhBMP-2 induced bone growth. The implants were only inserted halfway intothe animals mandible, and then they were covered with mucosa and the surgical sites wereclosed with sutures. Histological microphotographs obtained after a few months revealed thatthe bone growth initiated by the presence of this material resulted in the implants were com-pletely covered with bone.

The team end their presentation by suggesting that this new material on the surface of den-tal implants may eliminate the need for any bone augmentation procedures to induce boneapposition onto implants in the future. Finally, they emphasized that ongoing research withthis material and formal approval for use with implants is in progress and its incorporationwith Nobel Biocare implants is expected within five years. This final presentation was a mostimpressive report of the vision and future short and long-term strategy of Nobel Biocare, andthe audience acknowledged the performance of Ms. Canepa and the speakers with a well-deserved applause.

www.dental-online-college.com/nb/wozney-wiekesjoe-hall

Ms Heliane Canepa, President and CEO of Nobel Biocare, closes the 2005 WorldConference

Ms. Heliane Canepa, acknowledged and thanked all of the participants to the WorldConference 2005 for their contributions. She thanked the audience for coming to this 2005conference and wished them a safe trip home and reminded them that the Nobel BiocareWorld Conference 2007 would be more spectacular and one that they would not want tomiss.

Dr. Ralf Kohal

Dr. Jan Hall

Dr. John Wozney

Dr. Ulf Wiekesjö

31


world conference –experience it onlineDid you miss out on the World Conference in Las Vegas? Or would you like towatch some presentations again? No problem: Nobel Biocare had a cameracrew from the online advanced training platform Dental Online College, DOC,on location. The camera crew recorded the entire proceedings in the Arena andon German Day, and they have now made the footage available on the Internet.This lets you beam yourself to Las Vegas at any time and re-live this excitingevent with its galaxy of experts again and again, simply by going towww.nobelbiocare.com and click on "world conference 2005", or by going towww.dental-online-college.de/nb.

The Dental Online College uses video-streaming technology, which basically means youwatch television on your computer screen. The difference is that you get to choose whichprogramme or which piece of video footage you want to watch. And even within each indi-vidual video clip, you can conveniently move forward and backward at will. You can alsopause the clips at any time, as well as repeat sequences of your choice at your leisure.

All contributions are arranged according to specialist categories. Alongside the videofootage of the speaker, the slide presentation accompanying the presentation is shown in asecond window. Each item in the table of contents can be accessed directly. Automaticallyinserted bookmarks mark the clips already viewed.

In terms of the technical requirements for using the Dental Online College, a PC with asound card, speakers and a DSL (broadband) Internet connection is all you need. The DOChome page even provides a quick online check whether your equipment meets these tech-nical requirements.

If this multimedia review has whetted your appetite, you can find direct links to the livefootage of individual conference presentations inside this report. The links are in the format“www.dental-online-college.de/nb/name-of-speaker). This means there is no need to wastetime with long searches: just click on the direct link and the show will get under way. Ofcourse, all the conference contributions can also be accessed via the Nobel Biocare website.

Dental Online College – currentlythe most advanced Internet plat-form in the field of dentistry

forty years of implant medicine

FrankfurtMarch 9–11

BaltimoreApril 1–3

Sun CityApril 9–11

MumbaiApril 21–23

MalmöApril 26–28

PhoenixMay 4–6

TokyoMay 19–21

ParisJune 14–16

SydneyAug 2–4

São PauloAug 16–18

Hong KongSep 3–5

MaastrichtSep 7–9

LondonSep 14–16

DresdenOct 19–21

RiminiOct 26–28

MontrealNov 2–4

BarcelonaNov 16–18

order your pre-program and register nowat www.nobelbiocare.com/worldtour

Where Do We Meet?

Nobel Biocare

World Tour™

2006Beautiful Teeth Now™

Coming to 17 major cities around the world, our World Tour offers three days focused on working together.

• Five Live Transmissions• Expert Presentations & Panel Discussions• Exciting Focus Sessions• Pre-Conference Program with Hands-on Sessions• Breath-taking Vision for the Future of C&B&I

Can you really afford to miss it?

1711

6 G

B 06

01 ©

Nob

el B

ioca

re S

ervi

ces

AG

, 20

06.

NO

BEL

BIO

CA

RE,

the

NO

BEL

BIO

CA

RE lo

goty

pe

and

all o

ther

tra

dem

arks

use

d in

thi

s do

cum

ent

are,

if n

othi

ng e

lse

is s

tate

d or

is e

vide

nt f

rom

the

con

text

in a

cer

tain

cas

e, t

rade

mar

ks o

f th

e N

obel

Bio

care

gro

up.

world conference 2005 nobel biocare scientific...

Documents