EDI - European Association of Dental Implantologists

ISSN 1862-2879
Issue 3/2008 Vol. 4
EDI Journal
European Journal for
Dental Implantologists
TOPIC
Gap Sealing
Two gold medals
for BDIZ EDI member
at the Beijing olympics.
Read more on page 53!
Overview of sealing options to prevent
periimplantitis
»EDI News: 12 th BDIZ EDI Symposium – Fit for the Future · First Curriculum Implantology
in Greece · Promodentis 2008 – a Balkan Attraction · First White Paper on Implantology in
Spain · History of the Scientific Recognition of Oral Implantology »European Law: European
Commission Intends to Provide Legal Certainty for Patients’ Rights in Cross-border
Healthcare · Prohibition of Age Discrimination »Case Studies: The Key to Success »Product
Studies: Platform Switching · Practice Success with Telescopic Crowns · Gap Sealing · Soft-tissue
Healing Around Surface-roughened One-piece Implants · Immediate Placement and Loading

In 2009, Germany will be
coming down with a
monster that will benefit
practically nobody and be
a royal pain for most – the
Federal Health Fund. A
giant bureaucracy will be
born that no other European
country has in quite
the same form and to quite the same extent. We are talking about
one of the most far-reaching social reforms of the post-WW2 era
that will affect more people than the current pension discussion in
Germany. Even before its arrival, this Federal Health Fund is spreading
horror amongst members of the health professions, employers
and employees, health insurers, voters and even amongst many
politicians who – at the very last moment, it would seem – have
realized that the Fund has long since become a symbol for a glaring
anachronism: Ulla Schmidt, the Federal Minister for Health,
may be speaking of increased competition within the German
health care system, but what she really means is nationalization,
just like in socialist countries. Firmly by her side: Chancellor Angela
Merkel, who despite resistance across the country is unwilling to
give up on this unspeakable “healthcare reform”, which has nothing
good in store for the 71 million people affected and which will
bring, in addition to pronounced increases in premiums, a noticeable
reduction in the quality of medical care throughout the country,
as experts have warned. To say nothing of the pecuniary losses
within entire regions or of the reductions in income for physicians
and dentists.
In October, a uniform premium will be determined for statutory
health insurance that will probably amount to almost 16 percent
of most employees’ gross pay and, consequently, mean higher cost
both for them and for their employers, who are picking up almost
half of the tab. Throughout the country, physicians and other medical
personnel have been taking to the streets – 20,000 joined the
protest demonstrations held in Munich’s Olympic Stadium in June
alone. But any attempts to stop the monster appear to be too late:
The Federal Health Fund, the coming centralized collecting institution
for all healthcare premiums, has already taken up its work
with 95 employees.
In Bavaria, the second most populous German state, voters are
expected to turn out in droves against the ruling conservative
party in September to punish it for its links to the Berlin coalition
who introduced the Fund. Christa Stewens, Bavarian State Minister
of Labour and Social Welfare, had voiced her reservations against
the Fund from the beginning, but all this brought her was reprimands
from the Chancellor. Her ministry in Munich is therefore
trying very hard to distance itself from the monster that originated
in Berlin (see also the interview on page 42).
Die Zeit, a renowned German weekly, has recently reported on
the negative attitudes even among statutory health insurers,
using the company health insurance fund of Audi, the car manufacturer,
as an example. At present, the premium for their quarter
million insurance contracts is 13.1 percent of gross pay, which is
comparatively low. Now it seems as if everybody will have to pay
an extra 350 euros a year – and that on top of rising energy prices,
an increase that makes everybody’s blood boil, especially since the
ruling coalition in Berlin had originally promised to reduce nonwage
labour costs in Germany, in part by reducing health insurance
premiums.
The cost of the bureaucracy will also increase. The statutory
health insurers will have to reinvent the way they collect their premiums
– a logistical tour de force. At present, employers withhold
the employee’s share of the premiums from wages and forward it
to health insurers along with their own share. Because the health
insurers will be able, and often forced, to charge supplementary
premiums in the future, they must provide for collecting these premiums,
generating individual accounts for all policyholders. One
health insurer alone stated that this accounting changeover cost
them 40 million euros. The current government actually inherited
the idea of the Health Fund from its predecessor, the “Red/Green”
government in power until 2005. The Social Democrats had set out
to force private health insurers to pay substantial amounts of
money to bail out some of the less fortunate statutory health
insurers. The Christian Democrats, by contrast, wanted to introduce
flat per-capita premiums that were independent of policyholders’
incomes and not co-financed by employers. But in the
end, neither of these ideas was realized. Today, many politicians
might wish to close their eyes and see if their own Federal Health
Fund maybe simply goes away. But burying your head in the sand
no longer works – the masses of those who are affected will take
care of that. The health insurers themselves. Physicians and medical
personnel. And the voters, who will be seeing plenty of headlines
shouting out the news of rising premiums and of chaos and
turmoil in those organizations they depend on for their health.
The year 2009 will see federal elections and millions of policyholders
of statutory health insurers will be witnessing “quite
annoying things”, as Die Zeit predicts by way of genteel understatement.
The voters might be the only ones that can make the
government back away from its plans – for a while anyway.
Sincerely,
Christian Berger, Kempten/Germany
President of BDIZ EDI
EDI
Editorial
Germans are Turning
away in Horror
3

4 EDI
Table of Content
EDI News
Dental Medicine in Focus – Fit for the Future
12 th BDIZ EDI Symposium/Hesse Dentists’ Congress 8
A Greek-German Joint Venture
Pilot project: Curriculum Implantology in Greece 14
Motivated to their Fingertips
Attendants of the first Greek Curriculum
Implantology 17
Promodentis 2008 – a Balkan Attraction
Dental trade show and congress in Novi Sad 18
First White Paper on Implantology in Spain 21
History of the Scientific Recognition of Oral
Implantology
Foreword 22
Committed to our Tradition – Looking Back on
the History of the BDIZ EDI 24
Looking Back and Looking Forward 30
The Tübingen Implant 36
Federal Health Fund: “Dispose of it Properly!”
Interview with Christa Stewens 42
Are we Threatened by a New Wave of Regulations?
European Commission to strengthen
patients’ rights 46
18 th Expert Symposium University and
Clinical Practice
Fuerteventura 2008 50
Quintessenz-TV: Online Video Library 52
Implantologist Wins Two Gold Medals
BDIZ EDI congratulates Hinrich Peter Romeike 53
Europe-Ticker 54
European Law
European Commission Intends to Provide Legal
Certainty for Patients’ Rights in Cross-border
Healthcare 58
Prohibition of Age Discrimination 62
Case Studies
The Key to Success
Anterior maxilla reconstructed with autogenous
calvarial bone block grafts restored with dental
implants 64
Product Studies
Platform Switching
Clinical and biomechanical outcomes 72
Practice Success with Telescopic Crowns
Prosthodontic reconstruction of the edentulous
maxilla with a removable denture 78
Gap Sealing
Overview of sealing options to prevent periimplantitis
84
Soft-tissue Healing Around Surface-roughened
One-piece Implants 88
Immediate Placement and Loading
A basis for predictable esthetic transitional
contour 92
Business & Events
Making New Discoveries
Astra Tech World Congress 2008 96
Groundbreaking Technology
BioHorizons Global Symposium 2008 98
CARS 2008, Barcelona 99
EAO 17 th Annual Scientific Meeting, Warsaw 100
The camlog foundation Research Award
2008/2009 101
SimPlant Academy World Conference on
3D Digital Dentistry 102
An Investment to the Future 104
Camlog Invests in the Future of its
Wimsheim Site 105
News and Views
Editorial: Germans are Turning away in Horror 3
Imprint 6
Product Reports 106
Product News 114
Calendar of Events 122
Publishers Corner 122

6
EDI
Imprint
EDI
European Journal for Dental Implantologists
a BDIZ EDI publication
published by teamwork media GmbH, Fuchstal
Association: The European Journal for Dental Implantologists (EDI)
is published in cooperation with BDIZ EDI
Publisher Board
Members:
Christian Berger
Prof Dr Dr Joachim E. Zöller
Dr Detlef Hildebrand, Dr Thomas Ratajczak
Editor in Chief: Ralf Suckert, r.suckert@teamwork-media.de
Editors: Anita Wuttke, Phone +49 89 72069-888, wuttke@bdizedi.org
Simone Stark, Phone +49 8243 9692-34, s.stark@teamwork-media.de
Scientific Board: Prof Dr Alberico Benedicenti, Genoa Dr Marco Degidi, Bologna
Dr Eric van Dooren, Antwerp Prof Dr Rolf Ewers, Vienna
Prof Dr Antonio Felino, Porto PD Dr Jens Fischer, Bern
Dr Roland Glauser, Zurich Prof Dr Dr Ingrid Grunert, Innsbruck
Dr Detlef Hildebrand, Berlin Dr Axel Kirsch, Filderstadt
Prof Dr Ulrich Lotzmann, Marburg Prof Dr Edward Lynch, Belfast
Dr Konrad Meyenberg, Zurich Prof Dr Georg Nentwig, Frankfurt
Dr Jörg Neugebauer, Cologne Prof Dr Georgios Romanos, Rochester
MDT Luc and Patrick Rutten, Tessenderlo Dr Henry and Maurice Salama, Atlanta
Dr Ashok Sethi, London
Prof Dr Dr Joachim Zöller, Cologne
Ralf Suckert, Fuchstal
All case reports and scientific documentations are peer reviewed by the international editorial board
of “teamwork – Journal of Multidisciplinary Collaboration in Restorative Dentistry“
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& Advertising:
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Copyright and
Publishing Rights:
All rights reserved. The magazine and all articles and illustrations therein are protected by copyright. Any utilization
without the prior consent of editor and publisher is inadmissible and liable to prosecution. No part of this publication
may be produced or transmitted in any form or by any means, electronic or mechanical including by photocopy, recording,
or information storage and retrieval system without permission in writing from the publisher. With acceptance of
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bearing symbols other than of the editorial department or which are distinguished by the name of the authors represent
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are produced by the authors with best intentions and are carefully checked by the authors and the publisher. All
cases of liability arising from inaccurate or faulty information are excluded. Responsibility for advertisements and other
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Copyright: teamwork media GmbH . Legal Venue: Munich

8
EDI
EDI News
12 th BDIZ EDI Symposium/Hesse Dentists’ Congress, Frankfurt
Dental Medicine in Focus –
Fit for the Future
The title of this year’s BDIZ EDI symposium should be taken quite literally: Fit for the Future – when it comes to the German
standard fee schedule for dentists, GOZ. BDIZ EDI is aiming to prepare symposium attendants for working with the new GOZ.
And there is an innovation this year: For the first time, BDIZ EDI holds its annual symposium jointly with the Hesse Chamber of
Dentists. The 12 th BDIZ EDI Symposium and Hesse Dentists’ Congress (Hessischer Zahnärztetag) will take place at the Congress
Center of Messe Frankfurt on 7 and 8 November 2008 – very much in line with the BDIZ EDI tradition, addressing health-care
policy, legal and accounting matters and offering a comprehensive scientific program.
The imminent introduction of the new standard fee
schedule is probably the topic currently most discussed
among German dentists. Originally planned
for 1 January 2008, the Federal Ministry of Health is
now proposing a starting date of 1 January 2009, but
even this starting date may be difficult to realize.
Nevertheless, GOZ is certain to take effect some time
next year. Unfortunately, looking at the second GOZ
draft currently circulated by the Ministry, hopes are
slim for the new fee schedule to achieve more than
shuffling around a bunch of already existing items.
GOZ in daily practice
On the whole, it must be stated that, while dentistry
has made enormous progress in many fields during
the past 20 years, the GOZ draft does not really take
this into account. The only thing we will get is a re -
organization of GOZ that is “volume neutral”. Moreover,
fears are justified that GOZ, which applies to private
contract for dental service, will be made to conform
more closely to the much-denounced BEMA, a
catalogue of service point values that is applicable to
patients covered by statutory health insurance. For
these reasons, an entire day during the symposium is
dedicated to GOZ alone. What does GOZ 2009 actually
say? How is it structured and – most importantly –
what will its effects be? These topics will be discussed
by a round of experts consisting of Dr Rataj -
czak, Dr Sobek, Dr Winzen and Dr Brodmann, on the
morning of 7 November.
Highly practical aspects will be addressed on the
afternoon of the same day. Clinical cases from perio -
dontology, restorative dentistry and oral implantology
will be presented, followed by discussions of the
corresponding accounting issues pursuant to GOZ
2009 and HOZ (which is the German Dental Association’s
fee schedule). These sessions and the subsequent
discussion will be hosted by the respective
president of the Hesse Chamber of Dentists and BDIZ
EDI, Dr Michael Frank and Christian Berger. For a list of
speakers, please consult the following program.
Annual General Meeting
This year’s Annual General Meeting of BDIZ EDI
will take place at the Congress Center of Messe
Frankfurt on 7 November 2008 between 12:30 pm
and 2 pm. Conspicuous signs will guide participants
to the appropriate room.
Pure science
The scientific program on Saturday, 8 November
2008 will be very much in line with the motto of the
symposium, Fit for the Future. Clinical concepts for
the dental office will be presented in the morning,

EDA Testing
starting with a discussion of parallels between general
medicine and dentistry (Prof Gerlach, Frankfurt)
and the diagnosis of diseases of the oral mucosa
(Prof Wagner, Mainz). After that, several speakers will
present their own treatment concepts: on current
restorative treatment options (Prof Mehl, Zürich), on
current issues in endodontics (Dr Zehnder, Zürich)
and on microbiological diagnostic concepts in perio -
dontal therapy (Dr Ehmke, Münster). The morning
segment concludes with a summary by BDIZ EDI vice
president Prof Joachim E. Zöller (University of Cologne)
and a discussion of the presentations held during the
morning.
The afternoon segment is dedicated entirely to oral
implantology, featuring two highly interesting com-
As previously, the 12 th BDIZ EDI Symposium offers the perfect
opportunity to take the certification exam for EDA Expert in
Implantology (European Dental Association). Interested dentists
should learn more about the admission requirements available
at www.bdizedi.org/Education or by contacting the BDIZ EDI office
in Bonn. Registration forms and admission requirement information
are also available via e-mail from office-bonn@bdizedi.org.
parisons: “Dialogue on correct implant prosthetics –
restorative dentist and dental surgeon” (Dr Hildebrand,
Berlin) and “Dialogue on correct implant
surgery – dental surgeon and restorative dentist”
(Dr Neugebauer, Köln). These dialogues will then lead
to a discussion in which members of the audience
are welcome to participate.
The highlight of the day, and its culmination, will
be a live implant restoration session. Dr Paul Weigl
(Frankfurt) will be presenting a correct course of
implant and restorative treatment, step by step, from
bite registration to insertion. The final discussion will
be hosted by Christian Berger and Dr Michael Frank.
Workshops and dental exhibition
EDI
EDI News
Participants of the two-day symposium will have an
opportunity to register for one of the traditional four
workshops held under the auspices of the dental
industry on Friday morning between 9 am and noon.
A visit to the dental exhibition is highly recommended
during the breaks on Saturday. The program for
the 12 th BDIZ EDI Symposium can be found in the following
section.
9

10
EDI
EDI News
Friday, 7 November 2008
“Fit for Future”: GOZ 2009
GOZ Forum 2009
9:00 AM – noon Introduction: The GOZ-Forum
Dr M. Frank, Lampertheim
C. Berger, Kempten
GOZ 2009: Content – Structure – Consequences
Dr J.M. Sobek, Hamm
Dr O. Winzen, Frankfurt
Dr G. Brodmann, Bad Dürkheim
Dr T. Ratajczak, Sindelfingen
12:30 – 2:00 PM BDIZ EDI General Meeting
GOZ in daily practice
2:00 – 2:15 PM Welcoming address
C. Berger
Dr M. Frank
2:15 – 2:45 PM The perio case – clinical aspects
Dr B. Ehmke, Münster
2:45 – 3:15 PM The perio case: Billing according to GOZ 2009/HOZ
Dr O. Winzen, Frankfurt
3:15 – 3.45 PM Break
3:45 – 4:15 PM The prosthetic case – clinical aspects
Dr D. Hildebrand, Berlin
4:15 – 4:45 PM The prosthetic case: Billing according to GOZ 2009/HOZ
Dr J.M. Sobek, Hamm
4:45 – 5:15 PM The implant case – clinical aspects
Professor J.E. Zöller, Cologne
5:15 – 5:45 PM The implant case: Billing according to GOZ 2009/HOZ
Dr Christian Foitzik, Darmstadt
5:45 PM Discussion and summary
Dr M. Frank
C. Berger
6:30 PM Get-together party in the Congress Foyer
8:00 PM Social event for participants
Friday, 7 November 2008
Pre-congress Workshops
9:00 AM – noon Workshop 1 Microbiological diagnostics in periodontal therapy
Gaba Dr P.M. Jervøe-Storm
9:00 AM – noon Workshop 2 Regeneration techniques using stem cells
Geistlich N.N.
9:00 AM – noon Workshop 3 Natural aesthetics in anterior reconstructions made easy
American Dental Systems Dr H. Klinge
9:00 AM – noon Workshop 4
N.N.
Implantology

12
EDI
EDI News
Saturday, 8 November 2008
“Fit for Future”: Scientific Program
Fax to:
+49 228 9359 246
or mail to
BDIZ EDI Geschäftsstelle Bonn
An der Esche 2
53111 Bonn
Germany
Clinical concepts for practitioners (chair: Professor J.E. Zöller)
9:00 – 9:15 AM Welcoming address
Dr M. Frank, Lampertheim
C. Berger, Kempten
9:15 – 9:45 AM The future is chronic: Parallels between general medicine and dentistry
Professor F.M. Gerlach, MPH, Frankfurt
9:45 – 10:15 AM Oral medicine: Diagnosing diseases of the oral mucosa
Professor W. Wagner, Mainz
10:15 – 10:45 AM Break · Dental exhibition visit
10:45 – 11:15 AM Current concepts in restorative treatment
Professor A. Mehl, Zürich
11:15 – 11:45 AM Current concepts in endodontics
Dr M. Zehnder, Zürich
11.15 AM – 12:15 PM Microbiological diagnostic concepts in periodontal therapy
Dr B. Ehmke, Münster
12.15 – 12:30 PM Discussion of the morning presentations
Professor J.E. Zöller, Cologne
12:30 – 2:00 PM Break · Dental exhibition visit
Implantology – from the planning stage to the prosthetic result (chair: Dr M. Frank)
2:00 – 2:30 PM Dialog on correct implant prosthetics – Restorative dentist and dental surgeon
Dr D. Hildebrand, Berlin
2:30 – 2:45 PM Discussion
Dr C. Foitzik, Darmstadt
2:45 – 3:15 PM Dialog on correct implant surgery – Dental surgeon and restorative dentist
Professor J.E. Zöller, Cologne
3:15 – 3:30 PM Discussion
Dr M. Frank
3:30 – 4:00 PM Break · Dental exhibition visit
Live implant restoration session
4:00 – 5:00 PM Correct implant restorations
Step-by-step: From bite registration to insertion
Dr P. Weigl, Frankfurt
5:00 PM Final discussion
Dr M. Frank
C. Berger
Please register the following persons for the 12th BDIZ EDI Symposium (Frankfurt, 7/8 November 2008).
I understand that the registration is binding.
Please complete or tick as appropriate
Family name —————————————————— Title ————— Given name ————————————————
Street address —————————————————— Postal code/City —————————————————————
Phone (home phone if necessary) —————— Fax ————————— E-mail ——————————————————–
–––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––
Office seal
Please enter my order for ____ tickets
for the evening program on 7 November.
I will be attending the General Meeting.
BDIZ EDI would like to refer you to its Terms and Conditions for the 12 th
BDIZ EDI Symposium. For rates and the symposium program, please visit
www.bdizedi.org.
Dentist/physician
Member BDIZ EDI
Non-member
assistant
Workshop to attend (please choose one):
1 2 3 4
(Available only for congress registrants)
Date/Signature ———————————————––––––——————————

14
EDI
EDI News
Pilot project: Curriculum Implantology in Greece
A Greek-German Joint Venture
The first Curriculum Implantology in Greece, jointly
arranged by the BDIZ EDI and the University of Cologne,
was successfully concluded in the Greek capital of
Athens in July this year. The 26 graduates received their
certificates from BDIZ EDI president Christian Berger
personally in a solemn ceremony at the Parthenon
Hotel. But whilst the BDIZ EDI assisted the Greek side in
getting started, there was certainly no intention simply
to implement the German setup one-to-one. While
preserving the guidelines laid down in the curriculum of
the Consensus Conference on Dental Implantology, the
concept implemented gave special regard to the
specifics of the Greek environment. The driving force
behind the scenes was Dr Peter Ehrl from Berlin.
This first series of courses had been kicked off on
28 October 2007 and was completed by 26 graduates
with an intensive session on infection control in the
operating theatre on 12 July 2008. During this time,
the Greek dentists completed 124 hours of training.
Within the framework of the individual continuingeducation
modules, the participants also visited the
clinic of Dr Ehrl in Berlin and the dental office of BDIZ
EDI secretary general Dr Detlef Hildebrand to sit in on
live surgery performed by the pros. The tremendous
The city of contrasts: Old Athens and new Athens.
The Acropolis, high above the roofs of Athens.
number of applications for the Curriculum shows
how interested the Greek dentists are in dental
implantology. Curriculum 2 has been going on for several
months now, while Curriculum 3 has just started.
From idea to implementation
Everything started when BDIZ EDI and Yannis Roussis
of the Greek dental publisher Omnipress took contact
during a session of the BDIZ EDI European Committee
in Munich in 2006. At the time, Roussis was
looking to open up opportunities for Greek dentists
to embark on studies in innovative fields, such as
dental implantology, in their own country. BDIZ EDI
had promised support. The chance came, and was
seized immediately, when Dr Peter Ehrl held a presentation
on implantology in Athens and was contacted
by Yannis Roussis. Within half a year, Dr Ehrl and the
BDIZ EDI developed a complete concept, including a
timeline and a line-up of speakers, which included
Dr Efstratios Papazoglou, a young Greek dentist who
had both studied and taught in the US and who was
now to be responsible for the implementation of the
Curriculum in his home country. Omnipress was
responsible for organizing the individual modules in
Athens; Dr Ehrl organized the one-week practical
module in Berlin, where the participants engaged in

16
EDI
EDI News
hands-on studies at the clinic of Dr Ehrl and at the
dental offices of Dr Hildebrand and Dr Steffen Köhler.
Many of the participants placed their first implants
during the Curriculum. Dr Ehrl had given them two
specific tasks to complete: one task included the
placement of a single-tooth implant, complete with
photographic case documentation and a presentation
before the group, and the second task included
the placement of implants in an edentulous jaw, also
with documentation and presentation. Each case
was comprehensively discussed in the group.
Greek-German team of presenters
The implementation of this first Curriculum worked
beautifully, with praise due to its architects, Dr Peter
A. Ehrl of Berlin and Dr Efstratios Papazoglou of
Athens. The team they had assembled cooperated
across national boundaries in an easy and uncomplicated
manner. The Greek speakers were Dr Ioannis
Fakitsas, Dr Giorgos Goumenos, Dr Syridon Karatzas,
Dr Konstantin Lagios, Dr Efstratios Papazoglou, Dr Stavros
Pelekanos, Dr Nick Petrou and Dr Nick Raptis. The German
speakers were Dr Peter A. Ehrl, Christian Berger,
Dr Detlef Hildebrand, Dr Steffen Köhler and Professor
Joachim E. Zöller.
Conclusions
Looking back on this successful pilot project, Dr Ehrl
could not help but be satisfied. The goal had not been
“to impose German structures on other countries but
to create European structures that are accessible to
all countries”. This also happens to be the objective
that BDIZ EDI pursues – and it would be great if we
gave a chance to implantological associations in
Europe to build similar structures where this is
desired. BDIZ EDI is ready to help.
Graduates
Dr Stavros Bletsas
Dr Ioannis Triantafyllou
Dr Georgios Kontorinis
Dr Spyros Danias
Dr Paraskevi Margellou
Dr Christiana Constantinou
Dr Iliana Gkevreki
Dr Georgios Vasilopoulos
Dr Ioannis Tzikopoulos
Dr Harilaos Pashardis
Dr Georgios Magouliotis
Dr Vasilios Gogos
Highly motivated and attentive participants – until the very last day.
Successful graduates of the first Greek Curriculum Implantology and their teachers.
Dr Nikolaos Michalopoulos
Dr Christina Kagelari
Dr Dimitrios Kristallis
Dr Ilias Liakouras
Dr Aikaterini Gkova
Dr Panagiotis Dedes
Dr Vasiliki Papavasileiou
Dr Konstantinos Kyriopoulos
Dr Mersini Tourvali
Dr Konstantinos Dellis
Dr Vasilious Vasiloudes
Dr Theodora Karakousoglou
Dr Ioannis Diamantopoulos
Our first implant:
These two young
dentists will go a
long way!

Attendants of the first Greek Curriculum Implantology
Motivated to their Fingertips
The high level of motivation on the part of the twenty-six
participants of the first Greek Curriculum Implantology –
some of whom had actually placed their very first implant
during the Curriculum – was impressive even for lecturer
Dr Peter Ehrl from Berlin. “We have learned something from
you as well”, he said as he took leave from his students of
this first Curriculum.
We would like to present one of these highly motivated dentists:
Dr Vasilis Vasiloudes from Cyprus, who studied dentistry in Freiburg,
Germany 20 years ago, then returned to his home country after
graduation to open his own practice. Ten years ago he started getting
involved in oral implantology. “That was the right decision to
make”, he says today. Having mastered periodontology, he wanted
to be active in the surgical field, placing implants and directing the
restorative process. His small office in Nicosia, with a single treatment
room and two assistants, is growing thanks to the increasing
EDI
EDI News
demand for implantological treatments.
He is planning to add a
second treatment room soon: „This
course has given me plenty of selfconfidence!”
By way of confirmation,
he recounts that he had placed a
hundred implants in five years.
Meanwhile, he places at least that
many in a single year.
The Cypriot dentist plans to attend
more continued-education events in Dr Vasilis Vasiloudes
the field of dental im plantology. He is
considering the certification exam for EDA Expert in Implantology
(European Dental Association), which requires many years of prior
experience and the placement of a large number of implants and
implant-supported restorations every year. Despite being a father
of three, he is willing to travel long distances to attend continuingeducation
events, as his participation at the Curriculum has shown
– he had to fly from Nicosia to Athens every week to attend.
17

18
EDI
EDI News
Dental trade show and congress in Novi Sad
Promodentis 2008 –
a Balkan Attraction
June 2008 saw the fifth incarnation of Promodentis – Novi Sad, the dental trade show with its integrated
congress for dentists and dental technicians that has become known far beyond the limits of the Balkans,
presenting innovations in the technical as well as in the dental scientific and practical fields.
For three days, 34 experts from Serbia, Germany,
Romania, Italy, Slovenia, the Serbian constituent
republic of Bosnia-Herzegovina and Macedonia presented
clinical cases and technical innovations from
dentistry and dental technology. The 650 congress
participants were able to sample an overview of
dental developments in Europe, at the same time
demonstrating that the field of dental implantology
is looming in the Balkans.
Meeting point on the Danube
With its 350,000 inhabitants, Novi Sad (“New Garden”)
is Serbia’s second-largest city, which has long
since emerged from the shadows of Serbia’s capital
Belgrade, which is only 70 km away. In addition to the
annual Promodentis event, the inter national Pro -
medika trade show has been held for 16 years now –
a trade show where protagonists of medicine meet
the pharmaceutical industry. Despite its historically
young age – it was founded at the end of the 17 th century
– Novi Sad can look back on a turbulent history
(see box). The city was founded as a meeting point for
traders and craftsmen under the protection of the
Petrovaradin fortress, located on the other side of the
Danube River. Today, the city is a focal point for innovative
medical, pharmaceutical and dental technology.
Fruitful cooperation
Politicians and academic representatives of the medical
and dental faculties of several Balkan universities
had followed the invitation to participate at Promodentis
2008. The congress was organized by the Serbian
medical society DLVSLD, founded in 1872, by the
Serbian Association of dental technicians and by the
partner association of BDIZ EDI, the implantological
society UOI-SCG-EDI.
Germany was represented by BDIZ EDI president
Christian Berger. This was the second time that Berger
attended Promodentis Novi Sad as the personal
guest of UOI-SCG-EDI president Dr Dusan Vasiljevic.
He spoke on “Decisions: preserve or implant?” The
presentation also addressed unresolved questions in
dental implantology: Can peri-implantitis be prevented?
How can peri-implantitis be treated, and what
effect does this treatment have on the prognosis of
the implant? The cooperation of the two partner
Dr Branislav Kardasevic
and Dr Dusan Vasiljevic.
Meeting at Promodentis,
Novi Sad: Congress
visitors.

20 EDI
EDI News
20
Christian Berger in a discussion with Vitomir Konstantinovic,
professor for oral and maxillofacial surgery and oral implantology
at the dental school of the University of Belgrade.
associations BDIZ EDI and UOI-SCG-EDI has yielded
very positive results. The membership of the Serbian
implantological association has increased markedly
over the past few years.
Conclusions
In addition to the technical and scientific presentations
by internationally renowned speakers, the congress
also offered 60 poster presentations selected
Novi Sad – “New Garden”
The city of Novi Sad was founded in the 17 th century
as a settlement of traders and craftsmen serving
or working at the close-by military fortress of
Petrovaradin in the nearby Southern Pannonian
plain. Protected by this fortress, a small settlement
was founded on the left bank of the Danube in
1694. The region had become part of the Austro-
Hungarian Empire shortly before, in 1687, after the
end of the Ottoman rule. In 1748, the citizens gave
their settlement its current name and, on payment
of a fee, obtained the status of a Free Royal City. In
this manner, Novi Sad became the hub of the
mainly agricultural Vojvodina region. The city was
particularly characterized by its multiethnic popu-
The dental fair.
and introduced by a jury consisting of three professors
representing different specializations within
dentistry. Both the organizers and the participants
considered Promodentis 2008 in Novi Sad a big success.
It is planned to continue the trade show and
congress tradition during the upcoming years. The
dental trade show 2008 had more than 50 exhibitors
and considerably more than 1,500 visitors. A big dental
symposium is being planned for 2009.
Dr Branislav Kardasevic
lation – its inhabitants were Serbs, Hungarians,
Germans, Jews, Slovaks, Ruthenians, Greeks, Armenians
and others. Following World War I and the
defeat of the Austro-Hungarian Empire, the region
became part of the Kingdom of Serbs, Croats, and
Slovenes, and later of Yugoslavia. Novi Sad became
the capital of the Danube Banovina province, later
known as Vojvodina. Because Novi Sad and environs
are, or were, the site of strategically important
bridges across the Danube River and of important
petrochemical plants, the city was the target of
NATO bombardments during the Kosovo war of
1999. Novi Sad was affected particularly badly, with
bombardments affecting administrative buildings
and TV stations in the city centre; the attack on the
oil refinery released immense amounts of poisonous
substances. The destruction of the bridges not
only resulted in a complete traffic breakdown, but
also in massive water supply problems. Today, Novi
Sad is predominantly known as a centre of Serbian
culture, which is sometimes jocularly dubbed “the
Serbian Athens”.
Miscellaneous sources

The Spanish Dental Implant Society (SEI) conducted prospective study
First White Paper
on Implantology
in Spain
Araceli Morales Sánchez, PhD, MD, DDS, President
of the Spanish Dental Implant Society (SEI)
The Spanish Dental Implant Society (Sociedad Española de
Implantes, SEI) has conducted a prospective study on dental
implantology in Spain. The interest in such a publication has
been considerable, given the enormous interest in dental
implants today – not only amongst dental practitioners, but
throughout the entire industry.
Spain appears to have the third highest number of dental
implants of any European country – although it is very difficult
to come up with precise figures. This White Paper, however, has
established some very interesting facts. Dental implantology
has significantly changed the way dental clinics work. Implant
treatment has become more widespread and is increasingly
considered the treatment of choice.
EDI
EDI News
Implant treatment is undoubtedly a highly satisfactory therapeutic
modality, offering great clinical benefits to patients and dentists
alike. However, concerns about risks and failures are statistically
greater amongst dental practitioners than normally admitted.
The success rates published in the scientific literature are at
odds with the perceptions generally held by dentists, who often
report that they are seriously worried. While they perceive
implantology as a safe and prestigious discipline offering great
convenience to patients, they acutely recognize the potential
complications at various stages of the treatment. These need to
be carefully assessed, for the sake of the patients as well as the
practitioners themselves. The realization that implants can fail
requires the profession to take a responsible stance in order to
find appropriate solutions.
While certain postgraduate implantological training courses
are considered excellent, university-level teaching of dental
implantology as a whole is generally perceived as inadequate.
Concerns have arisen over the excessive number of – not
always well-monitored – courses offered.
This first White Paper on implantology in Spain, to be published
and distributed on request by September, offers a
wealth of highly pertinent information, some predictable and
others surprising. The SEI will continue to follow up on the issues
raised in this White Paper in the future. In a highly volatile field,
data and observations can change rapidly, so this study will be a
blueprint for future publications.
We would like to take the opportunity to thank the dental
practitioners who participated in the investigation and the suppliers
who supported the project. Without their help, this project
would have been impossible to carry out.
21

EDI
EDI News
The Spanish Dental Implant Society (SEI)
conducted prospective study
First White Paper
on Implantology
in Spain
Araceli Morales Sánchez, PhD, MD, DDS,
President of the Spanish Dental Implant Society (SEI)
The Spanish Dental Implant Society (Sociedad Española de Implantes, SEI) has
conducted a prospective study on dental implantology in Spain. The interest
in such a publication has been considerable, given the enormous interest in
dental implants today – not only amongst dental practitioners, but through-
out the entire industry.
21
Spain appears to have the third highest number of dental implants of any
European country – although it is very difficult to come up with precise figures.
This White Paper, however, has established some very interesting facts.
Dental implantology has significantly changed the way dental clinics work.
Implant treatment has become more widespread and is increasingly considered
the treatment of choice.
Implant treatment is undoubtedly a highly satisfactory therapeutic modality,
offering great clinical benefits to patients and dentists alike. However, concerns
about risks and failures are statistically greater amongst dental practitioners than
normally admitted.
The success rates published in the scientific literature are at odds with the perceptions
generally held by dentists, who often report that they are seriously worried.
While they perceive implantology as a safe and prestigious discipline offering
great convenience to patients, they acutely recognize the potential complications
at various stages of the treatment. These need to be carefully assessed, for
the sake of the patients as well as the practitioners themselves. The realization
that implants can fail requires the profession to take a responsible stance in
order to find appropriate solutions.
While certain postgraduate implantological training courses are considered
excellent, university-level teaching of dental implantology as a whole is
generally perceived as inadequate. Concerns have arisen over the excessive
number of – not always well-monitored – courses offered.
This first White Paper on implantology in Spain, to be published and distributed
on request by September, offers a wealth of highly pertinent information,
some predictable and others surprising. The SEI will continue to follow
up on the issues raised in this White Paper in the future. In a highly volatile field,
data and observations can change rapidly, so this study will be a blueprint for
future publications.
We would like to take the opportunity to thank the dental practitioners who
participated in the investigation and the suppliers who supported the project.
Without their help, this project would have been impossible to carry out.

22
EDI
EDI News
Foreword
History of the Scientific
Recognition of Oral Implantology
When DGZMK, the German umbrella organization for dentistry and dental science, recognized oral implantology as a scientific
discipline on 24 September 1982, implantology had reached the – albeit highly preliminary – end of a long and stony path.
Today, many dental clinics are hard to imagine without implant dentistry. For most patients it is the restoration of choice; for
many dentists it is an innovative discipline still far from the end of its development.
The history of BDIZ EDI is the history of oral implantology.
BDIZ was founded in 1989 by clinical dentists
who, as the BDIZ Expert Manual on Implantology
states, “did not want to watch the development of
implantology in Germany from the sidelines. Increasing
squabbles concerning indications and payment and
reimbursement issues surrounding implantological
services had greatly displeased them. The lack of representation
in and by the dental professional bodies
was perceived as a serious deficiency. The evaluation
of implantological cases by dental experts unfamiliar
with the new field was also viewed most critically.”
Dr Hans-Jürgen Hartmann of Tutzing, co-founder of
BDIZ EDI and its president for many years, reports
about the history of the association in good times and
bad – while always striving to achieve free implantology
practiced by free dentists. Things take a less political
turn on page 30. Professor Joachim E. Zöller of the
University of Cologne, BDIZ EDI vice president, takes a
Janus view from the standpoint of a university teacher
and scientist, not only looking back to the first steps
and the difficulties we were facing but also taking a
glimpse at the future of oral implantology.
The famous Tübingen implant – who would be better
suited to report on it than its inventor? Read the
report by Willi Schulte, former professor and highly
decorated academic teacher, starting on page 36.
Content
Committed to our tradition – Looking
back on the history of the BDIZ EDI p. 24
Looking back and looking forward p. 30
The Tübingen implant p. 36

24
EDI
EDI News
History of the scientific recognition of oral implantology
Committed to our Tradition –
Looking Back on the History
of the BDIZ EDI
Dr Hans-Jürgen Hartmann, Founding member of the BDIZ EDI and
president of BDIZ EDI from 1993 to 2000
In the early 1980s, oral implantology increasingly had developed into a treatment modality that – as the recognition document
from 1982 described it – “... can be employed as a duly considered alternative to other treatment options...”. The first annual
congress of German dental implantologists at Garmisch in southern Bavaria marked the breakthrough for scientific oral
implantology. It was Professor Manfred Straßburg of the German Society of Dentistry and Oral Medicine (Deutsche Gesellschaft
für Zahn-, Mund- und Kieferheilkunde, DGZMK) who first pronounced this scientific recognition.
Oral implantology – developed in clinical dental practice
and predominantly utilized there – gave rise to heated
discussions between dentists in private practice and
their colleagues at the universities. The restorative and
surgical basics we had been taught at the universities
were challenged and modified by oral implantology. We
gained novel insights into masticatory function and the
integration of external artifacts into the bone, insights
that we would never have dreamed of at dental school.
Implantological topics
were not taken up kindly
As the debate was raging back and forth, the 1988vintage
dental fee schedule was the first to cover
certain implantological services. It became amply clear
at that point that oral implantology was on the verge
of becoming an economic factor in clinical dentistry.
As Professor Egon Brinkmann wrote in the first issue
of the BDIZ yearbook in 1991: “... developments in
implantology have displeased many dentists in private
practice who are active in the field... so that, consequently,
eighteen of them assembled in Frankfurt on
30 September 1989 to found the German Association
of Clinical Implantological Dentists as a necessary
and logical consequence of the situation.”
The foundation of the BDIZ was preceded by copious
conversations, discussions and – sometimes fiery –
debates. It was the managing director of SPK Feld-
mühle (later Cerasiv and then CeramTec), Hoch, who
together with Professor Brinkmann assembled a group
of kindred spirits to sound out the possibility of
founding an implantological association for dentists in
private practice. Ultimately, a number of fellow dentists
joined the ranks, mostly dentists who also worked as
consultants for SPK Feldmühle.
In those turbulent times, when the founding of the
association was noted, it was largely dismissed as yet
another implantological society. But this was a misunderstanding,
as the BDIZ did not intend to estab-
Dr Hans-Jürgen
Hartmann
The BDIZ founders (left to right): Dr Rüdiger Oeltermann, Dr Rolf Brandau, Dr Rolf
Briant, Bernd Hölscher, Dr Uwe Ryguschik-Ott, Dr Helmut B. Engels, Prof Egon Brink -
mann, Dr Hans-Joachim Habermehl, Dr Stephan Hausknecht, Dr Hans-Jürgen Hartmann,
Dr Werner Hotz, Dr Heiner Jacoby, Dr Ulrich Kümmerle, Dr Hans-Joachim Foet
and Dr Lothar Winkler.

26
EDI
EDI News
lish itself as another scientific society; rather, the goal
was to represent dentists’ political and legal interests.
These interests were hardly, if at all, looked after by
the scientific societies. Issues related to professional
law or to fee structures were left to the various State
Chambers of Dentists, as they didn’t have any room
within the self-image of the scientific societies.
Clear separation between
science and professional law
It was a time of changes. The large scientific societies,
GOI, AGI and DGZI, were talking mergers. Led by
Professor Hubertus Spiekermann, GOI and AGI were
united to form the German Society for Implantology
(Deutsche Gesellschaft für Implantologie, DGI) in 1994.
The small and closely intertwined group of leaders of
the various associations and societies has developed
trustful relationships, a good prerequisite for mergers
and cooperative ventures. A clear separation between
scientific aspects and legal aspects increased the
relative importance of the BDIZ, which continued
attracting new members.
For example, BDIZ was instrumental in reopening
the communication channels between maxillofacial
surgeons and oral surgeons, ultimately getting them
to return to one table and talk. The political environment
developed in the way that favoured the BDIZ,
with the result that the separation of responsibilities
– scientific and legal – was accepted and supported
by the scientific societies. BDIZ became the mouthpiece
of all oral implantologists in all matters concerning
professional law, insurance politics and fees
and fee schedules.
BDIZ provides an implantological
interpretation of the GOZ
The first implantological interpretation of the German
fee schedule for dentists, GOZ, was offered by the BDIZ
and ultimately accepted, to a great extent, by the
State Chambers of Dentists, even if not without many
rounds of discussions and attempts at persuasion. A
committee of experts was formed. Also, expert symposia
and lists of experts as well as information conferences
for lawyers were conceived and implemented
in collaboration with the Chambers of Dentists in order
to spread the implantological expertise. It was also
planned to collect expert opinions, legal decisions and
other pertinent documents. Lastly, it was proposed to
let member dentists contact legal counsel via the BDIZ
to resolve differences with insurance funds and companies
related to dental fee. This idea continues to be
an important one to the state, and the legal firm of
Ratajczak and partners has implemented the concepts
devised by the BDIZ board at the time.
The struggle by clinical implantologists to have this
services accepted within the framework of fee schedules
became more intense, and the fight against
insurance companies became harder. The Contract
Committee, a primary contact point for dentists seeking
fee-related information, was established; it soon
became an important part of the BDIZ’s consultancy
work for the benefit of all dentists.
Increasing polemics prompted the BDIZ board to
make the insurance companies join in an attempt to
arrive at a common interpretation of the fee schedule.
A practical solution was found after many rounds of
discussion, but unfortunately it never gained the
support of the Chambers of Dentists nor, ultimately,
of the insurance companies themselves, rendering
the labours of three years obsolete. But at any rate, the
discussions brought a measure of clarity regarding the
concepts embraced by private insurance companies,
concepts that were communicated to the members.
Implantological schedule of fees
The idea to develop a separate implantological schedule
of fees devised by experts had been born early. It was
ultimately relayed to Germany’s main body of dentists,
the German Dental Association (Bundeszahn ärzte kammer,
BZÄK) by the Baden-Württemberg Chamber of
Dentists and Dr Peter Kutruff. Working closely with the
legal firm of Ratajczak and partners, a managed-care
system with a consolidated schedule of fees for oral
implantology was devised, based not least on economic
necessities.
It was quickly noticed that implant quality was giving
dentists trouble. Implants or screws would fracture,
marginal fit was poor, allegedly matching parts would
not fit and so on. This realization caused the BDIZ to
install a Quality and Registration Committee that
worked with the Fraunhofer Institute in Freiburg to
define specific quality criteria for dental implants.
The various implant systems were to be tested, at
considerable effort, to test implants for quality under
comparable conditions using neutral test setups. It
did get to the point where the first actual tests were
performed. However, as the European Union was
introducing its CE mark at the same time, these landmark
efforts were unfortunately not continued. A
reaction to these developments was the foundation
of the Association of German Dental Manufacturers
(Verband der Deutschen Dental-Industrie, VDDI).
Prof Dr Dr
Hubertus
Spiekermann

28
EDI
EDI News
The BDIZ has never shied away from vehemently
and committedly enacting and defending its decisions,
arrived at in lengthy internal discussions,
against insurance companies, courts, manufacturers,
but also dentists in blatant violation of the law with
regard to fee or quality issues.
Focus of professional activities:
Oral implantology
Minimal implantological education activities in the
1980s and the resistance and delaying tactics on the
part of some universities with regard to implantological
curriculum necessitated a different education
and training approach. The underlying framework for
this was created in the early 1990s and integrated
into the work of the Committee for Postgraduate and
Continuing Education.
Parallel to this, the possibility was investigated to
organizationally link these education activities to the
State Chambers of Dentists, and it was even considered
to take to the courts if no support was forthcoming.
Oral implantology as a formal “focus of professional
activities” – a German concept denoting a
practical professional specialization – met with
resistance on the part of the Chambers until a court
broke the impasse in 2001. With the assistance of
selected dentists, who received discreet support, this
political decision had been fought all the way to the
highest court. It was an unfortunate fact that the
“focus of professional activities” concept was not to
the liking of the Chambers. It had been made amply
clear during the negotiations that the lawsuit would
be withdrawn in the event that the Chambers
acknowledged the focus of professional activities
status for oral implantology under the conditions
that prevail today. The Chambers felt themselves
under pressure and responded negatively.
The decision of the highest court provoked a storm
of a magnitude that we as initiators had not expected.
It must be admitted that the Chambers of Dentists
were right in some of their misgivings. On the other
hand, the Chambers themselves proposed and evaluated
so many different terms, titles, focus designations
and similar that the result was an unhealthy proliferation
in terms of both terminology and content, a
development which still continues today.
Once it became clear how the courts would view
the “focus of professional activities” discussion, BDIZ
took the initiative and started calling for a consensus
conference. The many excellent personal contacts with
other associations ultimately made it possible, after
many rounds of negotiation, to unite all scientific
societies, including the maxillofacial surgeons, within
that consensus conference, with the objective of a
common education, a common curriculum, a common
teaching staff and so on. The inflationary number of
congresses was seen just as critically as today. Their
number was to be reduced, cooperative efforts with

Prof Dr Egon
Brinkmann
manufacturers were to be undertaken, and, finally, a
level of harmonization was aspired with regard to
the issues addressed by the scientific societies.
The consensus conference had as its goal to speak
for all implantological associations, first with regard
to specialist training and later, if sufficient agreement
could be reached, with regard to legal as well as scientific
issues. The entire consensus conference was to be
placed under the auspices of the DGZMK – together
with all scientific and professional societies.
BDIZ had meanwhile grown to the point where it
became possible to engage in fruitful landmark discussions
with insurance companies and the State
Chambers of Dentists. It was our strength in numbers
more than anything else that brought this about.
The Bologna process in the European Union, court
decisions on the European level and the increasing
political importance of the European institutions
required a European reorientation on the part of
BDIZ, which added “European Association of Dental
Implantologists” (EDI) to its name. The term “scientific
society” was included in the BDIZ EDI statutes, putting
it on the same level as the other associations – but
still with the traditional political orientation.
So over the years, the small group of 18 dentists
became a fully-fledged association that lacks in nothing
an association needs: its own office, its publications
EDI
EDI News
BDIZ konkret and EDI Journal, PR activities, legal support
by a specialized legal adviser and not least annual
congresses that, in addition to matters of professional
law, now also cover scientific subjects. Recommen -
dations are being issued and international contacts
are being made to European scientific and political
associations.
As a founding member, current board member and
past president guiding the association between 1993
and 2000, I would like to take the opportunity to
thank our founder, Professor Egon Brinkmann, for his
support. Yet no single person made BDIZ EDI what it
is today – but the community of those who were
driven by the idea to get something done for the
benefit of implantological dentists in private practice.
Thanks are also due to Dr Helmut Engels for his tireless
support and I particularly want to point out that he
contributed personal resources to help BDIZ in times
of financial need.
We shied away from no argument. We were afraid
of no dispute to promote our common views. It is
clear that the air was not always free of tension, and
a tremendous amount of discussions was required. I
wish the new president and all those who come after
him the best of luck in his office. I would like to see
BDIZ EDI to continue its activities in the energetic
spirit of recent years, despite all resistance and all
political hardships, in order to fight for our common
goal: free implantology practiced by free dentists.
29

30
EDI
EDI News
History of the scientific recognition of oral implantology
Prof Joachim E. Zöller
Numerous dentists performing implant treatments
today had not even completed their professional
training back in 1982. They are hardly aware of the
pioneers who were active at the time, except maybe
from references in various publications. Some dentists
in Germany engaged in dental implantology as
early as 30 or 40 years ago. Professor Schulte was
instrumental in promoting recognition of dental
implantology by the scientific community. Professor
Schulte spearheaded the establishment of a dedicated
research institute at the University of Tübingen.
The results of a multicentre study involving twelve
German universities prepared the ground for dental
implantology becoming a certified discipline of dental
science in 1982. As a result, dentists offering
implant treatments were no longer deemed to use
an “unorthodox” approach. Instead, they were
regarded as offering their patients a treatment
modality that was acknowledged as state of the art,
both technologically and scientifically.
Aluminium oxide implants and TPS coating
Quite some things have changed in these 25 years.
Aluminium oxide implants were formerly produced
by Friedrichsfeld (today Friadent) or SPK Feldmühle
(whose successor systems are being distributed by
Dentaurum). In addition, the late 1980s saw the
emergence of the IMZ system, which became established
as one of the most popular systems. Designs
featuring an absorbing element to imitate natural
Looking Back and
Looking Forward
Professor Joachim E. Zöller
The German Society of Dentistry and Oral Medicine (Deutsche
Gesellschaft für Zahn-, Mund- und Kieferheilkunde, DGZMK) has tradi-
tionally issued reviews of current practice. The latest revision, Version
3.0 was published in 2005. This version number reveals that few
groundbreaking changes requiring documentation by scientific stan-
dards have occurred ever since the publication of reviews of current
practice was first introduced.
tooth mobility were advocated for a long time. More
than a million implants were based on this principle.
Meanwhile, studies have demonstrated that the use
of “wearing parts” is not essential to the development
and long-term preservation of highly stable
implant-bone interfaces. As a result, few superstructures
continue to be supported by mobile implant
designs.
The surface debate
With the introduction of the IMZ system, implant
surfaces treated with a titanium plasma spray (TPS)
started to be widely used. For the first time, a microtextured
implant surface was available offering predictable
success even in situations of reduced bone
quality. Today, however, we are struggling with a legacy
of peri-implantitis, as this kind of surface greatly
favoured the accumulation of bacteria and osteo -
blasts in its niches and crypts.
It was not until 15 years after these implants had
been recognized by the scientific community that
the initial success rates could be substantially
improved. Osseointegration was made predictable by
high-temperature etching and sandblasting of the
implant surfaces.
Other attempts at optimizing success in reduced
bone showed good initial results, but they were associated
with increased failure rates in the presence of
inflammation. As a result, few implant systems today
continue to rely on hydroxyapatite-coated surfaces.

32
EDI
EDI News
Immediate loading
vs. time-efficient treatment
Competition increased as other manufacturers
emerged. Much was made of the effectiveness of different
surface types in the ensuing campaigns. These
were designed to reach not only the dentists responsible
for treatment decisions, but marketing efforts were
also targeted directly at the patients. Today, the controversy
has largely abated. Surfaces treated by sandblasting
and high-temperature etching have become
something of a standard. Their use can be considered
the state of the art in the quest for osseointegration.
Any newly developed surfaces will have to stand the
test of time, which is not going to be easy given the
very high success rates already on record.
Competing manufacturers, but also implantologists,
have instead embarked on a race for shorter
healing periods and ways of offering patients the
benefits of immediate restoration. Extensive debates
about these issues are a relatively new phenomenon,
having started only five to seven years ago. Once
again, however, they are based on the efforts and
experience of dentists such as Dr Ledermann, who successfully
used a bar design for the immediate restoration
of implants 30 years ago. Some of the original
techniques have fallen into oblivion, either because
the system components available at the time would
not allow the spectrum of indications to be increased
or because the available implants did not have the
properties required for immediate restoration.
Furthermore, any expectations of immediately
restoring all implants have turned out to be over -
enthusiastic and are clearly being reconsidered today.
Reduced healing periods of six to eight weeks often do
not justify the extra effort that is required for immediate
restoration. Even temporary restorations can offer
good patient comfort today. Current scientific evidence
on the subject was summarized at the 1 st European
Consensus Conference of the BDIZ EDI in 2006.
Challenges in the maxillary
posterior segment
Continuous progress has been made over the past
25 years with regard to treatment options. The first
implants were placed in the maxillary anterior segment
(using the Tübingen implants for immediate
placement) or to support a bar in the mandible
(using titanium implants). These original indications
were followed by maxillary restorations supported by
implants, whose insertion was guided by the principle
of utilizing existing bone. Prosthetic handling
became extremely difficult when implants were
inserted in the tuberosity region. Some fellow den-
TPS-coated IMZ implant afflicted with peri-implantitis. A large bone defect is present
on the lingual aspect.
Polarized-light micrograph of an
osseointegrated implant. Note the
structure of collagen fibers.
Tübingen implant replacing tooth 12.
The radiograph was obtained three
years after prosthetic restoration.
tists lost faith in their manual skills. As augmentation
procedures became established, the era when only
the available bone was utilized gave way to a new era
of bone enhancement for implant placement.
Especially in the maxillary posterior region, sinus
floor elevation and augmentation have become an
established procedure recognized by the scientific community.
Surgical access is established by lateral fenestration
and elevation of the Schneiderian membrane.
Most authors have used essentially the same approach.
However, very different materials have been used for
sinus filling. Ancillary measures to support wound heal-

34
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Insertion of four XiVE-TG implants following augmentation with a free
bone graft harvested from the iliac crest. These implant surfaces are
preconditioned by sandblasting and high-temperature etching.
ing have also varied widely. Meanwhile, approaches
relying on platelet-rich plasma (RPR) in combination
with (autologous, allogeneic or xenogeneic) bone
replacement material have mostly given way to simpler
approaches using microporous bone substitutes based
on hydroxyapatite or tricalcium phosphate.
Augmentation for alveolar
ridge reconstruction
A whole range of augmentation techniques to treat
jaw defects have been developed over the past two
decades. Lateral defects can now be treated with
hardly any problems. Important procedures include
bone spreading, bone splitting or guided tissue
regeneration (GTR). New materials and membranes
for GTR are periodically introduced, but they have yet
to succeed in lowering the risks of infection and failure
in a significant way. When it comes to the treatment
of vertical defects, the highest success rates
have been obtained with autologous bone grafts
(usually harvested from mandibular bone) and by
vertical distraction osteogenesis.
Even advanced cases of bone resorption or bone
defects can today be restored to integrity. Extended
techniques of reconstruction are used for this purpose,
based on free bone grafts harvested from the
iliac crest. This technique has come to offer predictably
stable results and a low complication rate.
Patients must be prepared, however, to undergo
various surgical interventions that are associated
with individual morbidity. Alternatively, conservative
and cost-effective restorations can be achieved in
some patients, depending on individual conditions
and expectations, by using minimally invasive techniques
such as reduced-diameter implants.
Computer-assisted planning for six Templant implants in the maxilla,
using Galileos software (Sirona).
3D diagnostics and implementation
Three-dimensional diagnostics for computer-assisted
template fabrication has been greatly refined over the
past few years. Some systems have reached a level of
radiation exposure comparable to that incurred with
conventional x-ray films, while offering abundant
information on the entire facial skull. As a result, the
need for extensive mucoperiosteal flaps must be
reconsidered. What used to be a strict requirement is
no longer mandatory for implant placement. Patients
benefit from this development by considerably lower
levels of postoperative symptoms.
In this way, the original concept of implant planning
by “bone searching” has been revived. Care is
taken to utilize existing bone by deliberate angular
placement of implants. Implants inserted in this way
along anatomical structures have been shown to
offer good biochemical stability. Thanks to the large
prosthetic surface areas, only few implants are needed
to support fixed restorations.
Zirconia for implants
Furthermore, these past few years have seen a rediscovery
of ceramic materials for oral implants. Ceramics
are known to yield good results for conventional
prosthetic superstructures. Most manufacturers
have succeeded in offering all-ceramic abutments,
although the designs vary.
One-piece zirconia implants require pertinent
experience with the concept of immediate restoration.
Without protection by a temporary restoration,
successful osseointegration cannot be achieved. The
use of zirconia has significantly improved the
mechanical stability of ceramic implants as com-

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Osseointegrated whiteSky implant (bredent) prior to delivering the final
restoration.
pared to the formerly used alumina implants. Zirconia
also has more favourable aging properties. However,
these new ceramic implants are applied very differently
from the concept used in the early days of
scientific implantology. Highly experienced treatment
teams are required. Their members need to
understand the principles of bone-adaptive implant
bed preparation and of delivering a temporary
restoration (ideally at the end of surgery) for implant
stability. Current scientific evidence on this subject
was summarized at the 2 nd European Consensus Conference
of the BDIZ EDI in 2007.
Summary
To summarize, 25 years of scientific implantology in
Germany have been guided by the interaction of clinicians,
universities and industry. Not all ideas have
stood the test of time. Some of them failed despite
enthusiastic propagation and marketing. In a similar
vein, not all innovations presented in recent years
were entirely new. Some of them had been used previously
in some form or another. For the next 25 years,
we hope for gentle progress in oral implantology. The
range of treatment options available to implantologists
should ensure successful outcomes and patient
satisfaction. Future progress should be based on solid
and responsible product development. Dependable
scientific foundations should be established at universities
and available for application in daily clinical
practice.
35

36
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EDI News
History of the scientific recognition of oral implantology
The Tübingen Implant
Professor emeritus Willi Schulte
The recognition of oral implantology by the German scientific community – German Socie-
ty of Dentistry and Oral Medicine (Deutsche Gesellschaft für Zahn-, Mund- und Kiefer-
heilkunde, DGZMK) – was significantly promoted by the results of basic scientific and
applied research in Tübingen over the years 1973 to 1982. The true impetus for this activity
came from an opening-ceremony lecture at the 1972 DGZMK annual conference. Its topic,
“science and clinical practice”, was focused on oral implantology. Its conclusion was that
numerous empirical efforts were being made in clinical practice, creating an urgent need
for university-level research institutes to make scientific efforts toward establishing foun-
dations in implantology [DZZ 28.337 (1973)].
An opportunity arose in 1973 and 1974. The Tübingen
Institute for Dental Surgery and Periodontology,
headed by this author, established contact with
physicist Dr G. Heinke, who was then director of
research at Friedrichsfeld GmbH (later renamed Fria -
tec, today Friadent). German implantology is greatly
indebted to that man. No other name than his will be
mentioned in this article.
The Baden-Württemberg Ministry of Economic
Affairs had invited bids for a 5-year interdisciplinary
research program aiming to promote the state’s
ceramics industry with a view to creating jobs. Collaboration
between identified study groups was
required. Disciplines included dentistry, veterinary
medicine, material research and biometrics. Participation
of industry was also required. A completely
new product had to be developed. Titanium and aluminium
oxide ceramics had been used for endoprosthetic
applications. Some experience with their use
had also been collected in dental implantology. The
invitation for bids was embraced by this author.
The new paradigm
Back then, dental implant systems were used solely
to restore edentulous jaw segments. In the 1950s and
1960s, we gathered comprehensive experience in
pre-prosthetic surgery, aiming to eliminate the damage
inflicted by tissue-supported dentures. Frustration
had developed in face of dissatisfying long-term
results. It was our ambition to develop a completely
new implant system. The goal was
to prevent disuse atrophy of the
alveolar ridge following tooth loss
Willi Schulte, former professor and
with the possible consequence of
highly decorated academic teacher.
edentulous jaw segments. Achieving
this goal required continuous loading of the bone
by placing an implant either immediately after tooth
loss or soon thereafter. Another objective was that
the newly developed implant should be capable of
replacing single teeth even in adolescents, for example
after trauma-induced loss of anterior teeth. A randomized
study was planned to test implants that
were identical in shape but were fabricated from aluminium
oxide or titanium.
While the ministry accepted the new paradigm as worthy
of sponsoring, the use of titanium was rejected. The
following new requirements were added for approval:
• For application in humans, it had to be ensured
that no permanent damage was inflicted in the
event of treatment failure.
• Patients were not allowed to be charged any fees
for the duration of public sponsoring.
• The Tübingen institute was not allowed to employ
any other implant systems for the duration of
public sponsoring.
• Conventional techniques had to be employed for
the superstructures (e.g. tooth-supported restorations
or dowel crowns).
• The implant manufacturer was barred from introducing
the product on the market before five
years into the research program.

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Implementation and design
Some of these limitations were disadvantageous,
most importantly those concerning the planned randomized
study. However, it was still our goal to
secure public sponsoring, as the university budget
did not cover our need for human and technical
resources. A number of German institutions took
part in developing the “Tübingen implant”: the Institute
for Medical Biometrics in Tübingen; the Institute
of Pathology (and animal farm) at the University of
Heidelberg; the Fraunhofer Institute for Mechanics of
Materials in Freiburg, the Max Planck Institute for
Metal Research in Stuttgart; and the development
department of Friedrichsfeld GmbH in Mannheim.
In the 1960s, extensive investigations of periodontal
histology had been performed in Tübingen. Other studies
had focused on oral wound healing and specific
hematological reactions for bone regeneration. The
results of these studies went into the implant body
design. For a comprehensive overview of the research
program, the reader is referred to ZM 74 (19/20), 1981 and
Quint Int 15: 2267, 1984. Numerous references are offered
in these sources. Following basic anatomical studies,
plans for implant placement were originally confined to
specific jaw segments (sites 15 to 25, 34 to 44).
The transmucosal implant element was polished
to a high gloss. In addition to reducing plaque accumulation,
this surface treatment was intended to
ensure the organismic principle of ectodermal
integrity in the transmucosal area. In natural teeth,
this integrity is ensured by hemidesmosomal attachment
of the inner junctional epithelium to the
cementoenamel junction. However, lack of such
attachment can remain without consequences for
decades in the presence of recessions because the
epithelium will also become attached to the very
smooth mesodermal cementum.
Based on previous haematological findings about
blood-clot attachment, the enossal surface was blasted
with aluminium oxide particles. The resultant
microtexture was characterized by peaks and valleys
of 1 to 5 μm, causing the coagulation and attachment
of blood to aluminium oxide surfaces in a matter of
seconds. Connection was established down to the
molecular level, meeting the quintessential requirement
for speedy organization of endosteal tissue!
Both principles were implemented for the first
time and have since been adopted by almost all
implant manufacturers, most notably in recent systems.
Incidentally, the effect of surface roughness on
final strength really continues to be an open question.
This conclusion was drawn after we measured
the osseointegration of different implant systems in
vivo using the Periotest system.
The implant body was designed
as a conical step cylinder. This
shape was based on the consideration
that implants cannot – as
natural teeth can – introduce
loads into the cranial skeleton by
a push-pull transformation within
the periodontium. Most of
today’s implants are designed
with threads. However, the ethical
requirements defined by the state
ministry precluded the use of
threads, since they would have
involved bone loss in the event of
treatment failure. Rather than
threads, the implant body was
designed to feature lacunae, initially filling with
blood and later with bone. The gross surface (not
including the microstructure) was generally around
55 to 65 percent larger than the surface of a natural
root.
The results obtained in animal experiments were
so excellent that, as soon as 1978, the Tübingen/Heidelberg
group won the DGZMK award for
best performance of the year. Optimal results were
even obtained in clinical studies, despite entering
uncharted territory. A number of rules (frequently
disregarded or highly controversial ever since) were
considered essential. Care was taken to preserve the
marginal gingiva with its fibrous structure and inner
junctional epithelium, requiring careful handling of a
periotome to separate the periodontal ligament. Any
reduction of the facial alveolar wall and bony interdental
septa was strictly avoided. Instead, the
implant bed was palatally relocated (in relation to
the alveolar axis) and cranially deepened. Finally, an
undisturbed healing period of three months was
observed prior to loading the implants.
Excellent statistical results were also obtained. As a
result, another eleven universities agreed to take part
in the clinical studies. These collaborations started in
1977 and were followed up by annual symposia in
Tübingen.
After the phase of sponsoring by the Baden-Württemberg
State Ministry of Economic Affairs had
ended and Frialit-1 had been introduced in the
market, the German Research Society (Deutsche For -
schungs gesellschaft, DFG) created an opportunity
for the study groups to continue their work. The
research objectives were considerably broadened.
Led by the author, a dedicated research institute was
launched and maintained from 1984 to 1996. Being
the largest effort of its kind worldwide, this initiative
The Tübingen
implant.

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EDI News
produced over 500 interdisciplinary publications
and countless lectures. Among other findings, these
efforts revealed that aluminium oxide implants susceptible
to fatigue fracture after ten to 15 years in
service, thus defeating original assumptions concerning
their longevity. This realization led to the
development of Frialit-2 titanium implants with prefabricated
abutments (Z Zahnärztl Implantol 8: 77-
96, 1992). The dimensions used in the Frialit-1 system
were retained. Threads were now used, some of
them being extremely flat “bone-saving” designs.
They were introduced (when the limitations
imposed by the state ministry were no longer in
place) because sporadic cases of implant rejection
had routinely occurred with the original step cylinders,
due to the organizational pressure occurring in
the first ten days.
Outlook
The first English-language report on the Tübingen
implant was published in 1984. What followed was
an unprecedented surge of single-tooth implants
around the world. They have changed the face of
dentistry like no other development before. Nevertheless,
our own investigations and long-term follow-ups
(over more than 30 years) have revealed that
the highest levels of mucosal compatibility and lowest
rates of peri-implantitis are reached with ceramic
implants. This observation prompted our own study
group within the research institute to develop an
implant surface with a titanium enossal segment
and a ceramic transmucosal segment. Material
researchers developed a special procedure of welding
the ceramic material to the transmucosal “collar”.
Good results were obtained in animal studies. Unfortunately,
these efforts were abandoned when the
research institute was discontinued in 1996.
Even at the time, our study groups would discuss
the use of all-zirconia implants. Designs of this type
were considered a promising option. These have
meanwhile been introduced in the market. Our experience
clearly indicates that the future belongs to
one-piece zirconia implants placed in single-stage
procedures. Zirconia is considerably more fractureresistant
than aluminium oxide. No metal margins
(as with titanium implants) will become visible as the
gingiva undergoes physiological retraction (0.1 mm
per year). Any aesthetic effects of this development
are much less conspicuous with ceramics and can be
readily corrected by changing the superstructure,
even after 15 or 20 years of service. However, ceramic
implant designs should always meet one extremely
important requirement: their supragingival element
must be as flat as possible.
39

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EDI News
Interview with Christa Stewens, Bavarian State Minister of Labour
and Social Welfare, Family Affairs and Women
Federal Health Fund:
“Dispose of it Properly!”
There is hardly a day on which the Federal Health Fund, whose stated objective is to reconcile the differences and financial
clout of the various statutory health insurers, does not make the headlines. EDI Journal had already reported on this.
Federal Minister for Health Ulla Schmidt and Chancellor Angela Merkel stubbornly cling to the fund and its starting date
of 1 January 2009. But they appear to be the only ones. Bavaria, Germany’s largest state by area, will be electing a new state
parliament this autumn – and this election may show the federal government how little appreciation their Federal Health Fund
is getting. BDIZ EDI president Christian Berger talked to Christa Stewens, Bavarian State Minister of Labour and Social Welfare,
Family Affairs and Women, about the homework that Federal Minister for Health Ulla Schmidt still has to do.
Ms Stewens, your party – the Christian Social Union,
CSU, the regional Bavarian conservative party – has
approved the Federal Health Fund at a federal level.
Why do many within the CSU no longer stand by this
Great Coalition compromise?
We stand by what we have agreed on. But we also
expect the same from our coalition partner. This is
why we will look closely at whether what we agreed
on and what has been defined in the pertinent law is
being both respected and actually implemented. This
also includes the convergence clause, exactly as
defined by the law, but also the correct implementation
of the morbidity-based risk adjustment pool and
workable insolvency rules that eliminate any liability
on the part of the State of Bavaria. To this day, only
fragments of the expert opinion on the convergence
clause required by the law – which is supposed to
quantify the effects of the Federal Health Fund
before it is realized – have been completed. We cannot
accept that and we will not accept that.
Your ministry has tasked a committee of experts led
by Professor Udo Steiner, former judge at the Federal
Constitutional Court, to examine the situation of
physicians and dentists in private practice. What is
their objective, and when can we expect results?
This committee will investigate where and how we
can assist physicians and dentists in private practice.
This is a fairly tall order, because it is the federal government
that creates the legal framework for statutory
health insurance and, consequently, for all contractual
medical providers. The only way Bavaria can
exert its influence is indirectly, through Bundesrat,
the Second Chamber, on a federal level. The expert
committee will therefore mainly be looking for
potential solutions that can be implemented at the
Bavarian level. In addition to the professional fees of
Bavarian physicians, we are also talking about a new
generation of physicians and about ensuring adequate
access to general practitioners in rural areas.
The goal is to give recommendations for improving
the situation of Bavarian physicians in private practice,
especially general practitioners. A number of
suggestions will be published by this upcoming
autumn.
Christa Stewens:
Basic tariff may
constitute a
threat.

44
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Physicians and dentists fear that the Federal Health
Fund will indiscriminately level all fees across Germany,
and their representatives in Bavaria fear that
500 million euros may go missing from physicians’
fees and 280 million euros from dentists’ fees. According
to a draft expert opinion to be published shortly,
the “convergence brake” will not have the intended
effect. What are you going to tell the patients if the
quality of medical and dental care cannot be maintained
in 2008 and later?
The convergence clause is indispensable for maintaining
the high quality of medical care for all
patients in all States. Contrary to the conclusions of
the expert opinion commissioned by the federal government,
I do believe that this clause can be implemented
in a manner that is in conformance with the
law. We are working on it. However, there is currently
no one who can offer any serious estimates of what
the concrete effects of the Federal Health Fund will
be. This is one of the questions for which I have
demanded an answer ever since day one, but I still
have not received a reply from Ulla Schmidt.
The effects of the health reform must be viewed
separately from the effects of the reform of the fee
structure. The latter affects contract physicians, but
not contract dentists. It is true that the formula
defined in the law, with its uniform standard point
value, will result in a certain amount of levelling.
However, the valuation committee has yet to make a
number of important decisions, so that we do not
know today what the concrete effects will be. How -
ever, I will do my utmost to ensure that Bavarian
physicians, too, can enjoy reasonable fee increases.
The federal government is obliged to help. After all,
price increases affect everyone, including those who
live and work in Munich and other Bavarian cities.
What effects will the Federal Health Fund have on the
average dentists in private practice? What does it
mean for inpatient and outpatient care?
Any definitive assertions concerning the actual
effects of the Federal Health Fund would be pure
speculation today, because a number of important
parameters remain undefined. How much are the
premiums going to be? What diseases will be considered
for the risk adjustment pool? There is a lot of
homework that Ulla Schmidt still has to do.
The beginning of this year has seen the introduction
of the “basic tariff”. Has this step ushered in the
decline of private health insurance in Germany?
The base premium in private health insurance is a
result of the political compromise on health reform.
Keeping comprehensive private health insurance
alive was an important agenda for the Bavarian gov-
ernment. We were able to push through this
demand. The pending decision of the Federal Constitutional
Court on the complaint brought by the private
health insurers will tell us more.
Have you been able to allay fears that the basic
tariffs, which are intricately linked to the issue of
portability of aging provisions accumulated by private
health insurers on behalf of their policyholders,
might bleed the comprehensive private health insurance
tariffs dry?
The portability of aging provisions merits well-differentiated
reflection. I myself certainly felt that it
was time to act. The situation today is effectively that
no policyholder of a private health insurance company
can switch to another private health insurance
company, because their share of the aging provisions
is not transferable. Whether the solution we have
found is ideal is of course a matter of debate. I can
understand the fears that the basic tariff could
threaten the comprehensive tariffs. In addition, any
subsidies that may be required to support the basic
tariff may penalize policyholders who have signed up
and are paying for the comprehensive tariff. Whether
the courts will find this interference with mutually
agreed contractual agreements to be constitutional
remains to be seen.
The Bavarian State Government seems to have little
influence on the reigning coalition in Berlin when it
comes to the Federal Health Fund. If you had a wish,
what would you do with the fund?
Dispose of it properly!
Ms Stewens,
thank you very much for your comments.
Christian Berger:
Bleeding the
comprehensive
private health
insurance tariffs
dry?

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European Commission to strengthen patients’ rights
Are we Threatened by
a New Wave of Regulations?
Peter Knüpper, solicitor, Munich/Germany
The European Court of Justice (ECJ) has passed an
extensive body of legal decisions on this topic since
1998. In summary, the court has stated that healthcare
services are covered by the freedom to render
services, which is one of the four European fundamental
freedoms. The free movement of goods, persons,
capital and, not least, services have long been
taken for granted by most of us. Nevertheless, only
30 percent of all EU citizens know that they can
choose to obtain health services in other EU countries,
where the social security system in the patient’s
home country – whether run directly by the state or
in the form of an insurance system – has to reimburse
the patient if those services would have been
offered or reimbursed for in the home country.
No prior authorization required
for outpatient services
This is exactly what the draft Directive codifies, with
the result that EU citizens will no longer have to
approach the ECJ in Luxembourg in order to obtain
reimbursement but can confront their national
administrations or health insurance institutions
directly with the new Directive on patients’ rights. It
states, in unison with ECJ decisions, that outpatient
services do not require prior authorization. The same
is true of inpatient health services that require a
patient to be admitted overnight or that are included
on a list of specific diseases – unless “the financial
balance of the Social Security system” were threat-
The European Commission finally presented its proposal for a Directive to facilitate the application
of European patients' rights in relation to cross-border healthcare on 2 July 2008, as part of its
Renewed Social Agenda. The proposal is intended to respond to rapid changes in the social and eco-
nomic fields. It intends to promote citizens’ “social well-being” through a mixture of measures and
instruments while at the same time harmonizing and modernizing the existing political armamen-
tarium. The proposed Directive covers cross-border health services that patients may obtain outside
their home country – such as the hip joint surgery that a British patient had had performed in
France, bypassing the long waiting lists of the British National Health Service.
ened or the planning and rationalization carried out
in the hospital sector were “seriously undermined”
(Article 8 (3) of the draft guideline). The prior authorization
system must be limited to what is necessary
and proportionate to avoid such an impact and must
not constitute a means of arbitrary discrimination.
The Member States must act to improve the flow of
information concerning potential healthcare services
in other EU Member States.
The European Commission continues to uphold
the sole responsibility of the Member States for the
organization and delivery of health services and
medical care. The Directive also demands of the
Member States to respect the principles of universality,
access to quality care, equity and solidarity and
define observe clear standards for quality and safety
and health care. They also have to ensure that “mechanisms
are in place for ensuring that healthcare
providers are able to meet such standards, taking
into account international medical science and generally
recognized good medical practices”. In addition,
EU Member States are tasked to ensure that the
application of such standards in practice is regularly
monitored.
National contact points
Healthcare providers will have to “provide all relevant
information to enable patients to make an informed
choice, in particular on availability, prices and outcomes
of the healthcare provided”. This also includes

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information on professional liability insurance. National
contact points are called upon to provide, in close
cooperation with other national authorities, information
to patients, particularly on cross-border healthcare
and the “guarantees of quality and safety”. These contact
points are to help patients protect their rights and
seek appropriate redress in the event of harm.
In addition, the EU requires the Member States to
facilitate the development of European reference networks
intended to help realize the potential of European
cooperation regarding highly specialized healthcare
for patients and for healthcare systems from
innovations in medical science and health technologies.
In addition, the networks are intended to “help to
promote access to high quality and cost-effective
healthcare for all patients with a medical condition
requiring a particular concentration of resources or
expertise” and to promote the effective use of
resources by concentrating them where appropriate.
What does this mean? Will there be a European
policy of subsidies supporting centralized structures
within the EU, comparable with the agricultural sector?
Even if the objective were merely to provide
quality and safety references that assist member
states to “provide a full range of highly specialized
services of the highest quality”, it is easy to imagine
the type of regulatory machinery this would entail.
The same is true of the development and operation
of a network for health technology assessment,
which the European Commission wants to require of
the Member States. The requirement to collect statistical
data needed for monitoring purposes on the
provision of cross-border healthcare, the care provided,
its providers and patients, the cost and the outcomes
(!) and to provide them to the European Commission
on an annual basis already afford a glimpse
of the new bureaucracy about to be born.
Introduction of quality standards
It has been estimated that approximately one percent
of all Europeans currently obtain cross-border
health services, not including those who require
treatment on holidays or while working in a different
EU Member State. This cost is borne by the national
health care systems anyway, and the corresponding
rules go back to as far as 1971 (Regulation 1408/71/
EEC), as symbolized by the E 111 form or the European
health insurance card.
It appears doubtful that such comprehensive
requirements encased in a Directive, dealing with
issues as diverse as patient information, national
contact points, European reference centres, information
technology or statistics, should really be necessary.
However, Community institutions are given
broad discretion when it comes to applying a high
level of protection. Quite adroitly, the draft Directive
would require the Member States to introduce, e.g.,
certain quality standards, with the European Commission
restricting itself to “merely” issuing guidelines.
Obviously, the intention is to resolve the contradiction
between the sovereignty of the Member
States in the healthcare sector on one hand and the
common market strategy of the EU on the other – a
path that may be juridically feasible but may well
prove politically difficult.
Conclusions
The Patients’ Rights Directive not only determines
that patients may obtain cross-border inpatient and
outpatient medical (elective) services, largely without
prior authorization by the national administrations or
health insurance institutions in their home countries,
and that they may demand reimbursement for these
services from their home social security system.
If the proposed Directive were to be enacted by the
European Parliament, the national healthcare systems
would be increasingly harmonized, since the
Member States would be obliged to cooperate and to
implement EU healthcare to a larger extent than previously.
They would ultimately have to adapt their
healthcare policy to the European regime – subsidiarity
or no subsidiarity.
What seems to be so problematic is that Europe is
not moving in the direction of liberalization but
instead seems to seek redemption by regulation – in
a manner similar to the national healthcare systems.
This is just what we feared when the European Parliament
decided to exclude healthcare services from
the scope of the general Services Directive in 2006.
We can look forward to the discussions within the
European Parliament and the European Council over
the next few months regarding the European Commission’s
new approach to regulating healthcare
services. Should the Directive fail, the verdict by the
ECJ prevails: Free movement of services includes
healthcare services – no restrictions allowed.
Brussels

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Fuerteventura 2008
18 th Expert Symposium University
and Clinical Practice
Once again this year, the BDIZ EDI University and Clinical Expert Symposium will be held on Fuerteventura – jointly with the
International Interdisciplinary Symposium on Pain and Movement. In 2008, oral implantology and periodontology will be at
the focus of this one-week continuing-education event. Date: 25 October – 1 November 2008.
An intensive exchange of ideas in a personal environment,
hands-on workshops, a completely renovated
venue – all these will help us to concentrate on
important implantological issues. Being away from
your daily chores and close to the expert speakers –
this is what makes the Fuerteventura expert symposia
so special.
Date: 25 October – 1 November 2008
Registration at: www.schmerzsymposium.de
Travel and registration:
HOLIDAY LAND Reisebüro Garthe & Pflug
Ms Garthe
Triftstrasse 20
60528 Frankfurt
Germany
Phone +49 69 6773670
The following speakers have been signed up:
(Germany unless otherwise noted)
Dr Markus Baumeister, Dortmund
• Treatment planning for reduced-diameter implants
in the aesthetic zone
Christian Berger, Kempten
• Forensic aspects of treatment documentation
Dr Fred Bergmann, Viernheim
• What type of soft-tissue management for what situation?
Dr Andreas Braun, Bonn
• Antimicrobial photodynamic therapy (aPDT) in chronic periodontitis:
Results of an in-vivo study
Dr Christian Foitzik, Darmstadt
• Surgical complications – or complications caused by surgery
Dr Ernst Fuchs, Zürich, Switzerland
• Planning, function and restoration of the bioactive container
Dr Ulrich Fürst, Attnang-Puchheim
• Long-term results of minimally invasive peri-implantitis therapy
Dr Viktor E. Karapetian, Cologne
• Immediate loading with chairside ceramic crowns
Dr Julia Kenter-Berg, Cologne
• Dental low-level laser treatment – evidence-based medicine?
Dr Frank Kistler, Landsberg
• Aesthetics in oral implantology – just a matter of planning?
Dr Christian Köneke, Bremen
• Functional complications in implant therapy

EDI
EDI News
51
Dr Frank Kornmann, Oppenheim, and MDT Gerhard Stachulla, Augsburg
• Implant planning based on state-of-the-art 3D diagnostics
Dr Matthias Krysewski, Gronau
• Solo prophylaxis for dentists and physicians
Dr Thea Lingohr, Cologne
• Preventing jaw atrophy through socket preservation
Dr Daniel Rothamel, Cologne
• Clinical importance of growth factors – hocus-pocus or the way of
the future? Xenogeneic and allogeneic bone blocks – blessing or curse?
Prof Hubert Nentwig, Frankfurt
• Complications caused by minimized implant numbers
and implant dimensions
Dr Jörg Neugebauer, Cologne
• What information does 3D diagnostics provide in the therapy
of congenitally missing teeth?
Dr Stefan Reinhardt, Münster
• Planning bone transplants to avoid complications
Dr Bernhard Saneke, Wiesbaden
• Fewer complications in the dental office through better staff selection?
Dr Sebastian Schmidinger, Seefeld
• Extended diagnostics and its influence on treatment planning in 2008
Dr Jochen Tunkel, Bad Oeynhausen
• Implants at hard- and soft-tissue defects with special regard
to soft-tissue management
MDT Hartmut Scholz, Bonn
• Loose dentures and bar fractures – or stable optimized bar-supported
restorations
Prof Anton Sculean, Nijmegen, Netherlands
• PDT in non-surgical periodontal treatment
Dr Martin Scheer, Cologne
• What mucosal situation can still be considered non-pathological
in oral implant therapy?
Dr Marius Steigmann, Neckargemünd
• Soft-tissue management complications
Dr Helmut Steveling, Heidelberg
• 3D planning and implementation: Facilitate systems
Dr Achim Wöhrle, Knittlingen
• How to explain failure to patients
Prof Joachim E. Zöller, Cologne
• Trauma to the dentoalveolar nerve and its consequences

52
EDI
EDI News
New service for members
Quintessenz-TV:
Online Video Library
“Your guest at home”! Starting in October 2008, members of BDIZ EDI will be able to select, from an extensive visual library,
the works of a highly diverse group of authors on a wide range of topics related to dentistry. This gives all those who want to
do so the opportunity to gain new insights and to continue their education at home or at the office in a manner and at a speed
that suits them. To be able to present this service to its members, BDIZ EDI has entered into a cooperative agreement with the
international Quintessence Publishing group.
The comprehensive library of videos and presentations
currently covers more than 200 topics
from all fields of dentistry. This archive is a true
treasure trove – it spans the range from one of the
first dental documentary ever shot (showing Professor
Gysi in the year 1926 as he registers a Gothic
arch) all the way to the most recent presentations
of internal and external sinus floor elevation
procedures: Continuing education films are available
in full standard TV quality – and since 2007,
Quintessence has been producing all its material
in the state-of-the-art 16 : 9 HDTV format.
At the time of this writing, the relaunch of the
existing quintessenz.tv programme is under way.
Several new convenient user functions will soon
be available (see illustrations). Online tests accessible
through integrated links will allow users to
obtain continuing-education (CE) points according
to BZÄK and DGZMK criteria. 50 tests related to as
many videos are already available on request.
BDIZ EDI will be able to use the service without
any extra charge for an initial period of twelve
months. The only technical prerequisite is a highspeed
Internet connection to ensure the necessary
bandwidth. Within the next few weeks, BDIZ
EDI members will receive a separate letter of
introduction containing the access data to register
at quintessenz.tv.
1. Embedded video player, 2. Player controls, 3. Full-screen button,
4. About the video, 5. Category/subject selection,
6. Name of active category, 7. Video wall for video selection

BDIZ EDI congratulates Hinrich Peter Romeike
Implantologist Wins
Two Gold Medals
What does an oral implantologist have in common with an Olympic gold medal
winner? Characteristics such as willpower, precision, technical expertise, but also
social competence and the ability to work in a team. Hinrich Peter Romeike from
little Moholz in the far north of Germany has all these virtues. At the Olympic site
of Hong Kong he won equestrian gold in both Eventing Team and Eventing Individual
on August 12.
The victorious rider is not only a dentist and oral implantologist
in private practice in Rendsburg but also a member of BDIZ
EDI. The entire BDIZ EDI board extends its congratulations. Hinrich
Peter Romeike and his grey gelding Marius have shown an
exceptional performance and made unexpected but welcome
headlines for the dental profession – but they also demon-
EDI
EDI News
Hinrich Peter Romeike (right), winner of two gold
medals in eventing at the 2008 Olympics in Beijing,
in Eventing Team and Eventing Individual.
Back in his home town of Moholz, he received a
warm welcome. Schleswig-Holstein’s Prime Minister
Peter Harry Carstensen congratulated him
and his teammate Peter Thomsen (left) and conveyed
the greetings of his government.
strated team spirit in helping the entire German team win
Eventing Team Jumping gold.
The BDIZ EDI can be proud to have someone like him among
its members. Congratulations, Hinrich Peter Romeike!
53

54
EDI
EDI News
Belgium/ECJ: National prohibition against
dentists’ advertisements upheld
National regulations that restrict or prohibit advertisement
for dental services are not in violation of
Community law, according to a European Court of
Justice (ECJ) decision reported by the dental news
service zänd. The judgment had been prompted by
criminal proceedings against a Belgian dentist who
had advertised his laboratory and his dental clinic in
the yellow pages under his full name, something that
is prohibited under Belgian law. The advertisement
contained objective information such as a list of services
offered as well as the addresses, phone numbers
and opening hours of the two establishments. The
Belgian court that had submitted the question to the
ECJ held the opinion that advertising restrictions for
dentists might violate their freedom of competition
pursuant to Articles 10 and 81 of the Community
Treaty. “On the other hand, given the heterogeneity of
the liberal professions and the specificity of their
markets, one would have to examine closely whether
restrictions in a given market actually restrain competition,”
as the Free Association of German Dentists
(FVDZ) stated at its Brussels office. After all, the ECJ
had held that the prohibition did not restrain trade in
that the Belgian law is not covered by any of the provisions
of Articles 10 and 81 of the Community Treaty:
The case at hand did not demonstrate that the law
favoured a cordial agreement or supported, facilitated
or mandated a company decision. Neither had the
law in question lost its character as a legal norm by
virtue of the fact that Belgium had transferred
responsibility for economic decisions to certain private
institutions.
Source: Various media
Private health insurance in France:
Covering the deficit
The government of France intends to force private
health insurers to cover the deficits of the state-run
health-insurance system, which stands at four billion
euros. “If we do not act, this deficits will grow by
another two billion euros each year”, as Minister of
Health Roselyne Bachelot and Budget Minister Éric
Europe-Ticker
Woerth said in an interview with the French daily Le
Parisien. For this reason, the government intends to
tax the turnover of private supplementary health
insurance companies, which would contribute
“approximately one billion euros a year” toward eliminating
the deficit by the year 2011. But the French
government also wants to realize savings in other
areas: They want physicians to stop prescribing
“unnecessarily expensive drugs”, to reduce prices for
certain drugs and medical exams and to improve hospital
organization. Rather than letting the beneficiaries
of the state health-insurance system foot the bill,
the government would tax private health insurers, as
Minister of Health Bachelot explained. After all,
approximately eight percent of all French citizens – or
about four million people – are covered. But political
scientist Bruno Palier of the national research Institute
CNRS warned of unfairness in the French healthinsurance
system: “Those who can afford it will buy
the best supplementary insurance and, consequently,
the best treatment”, he said to Le Parisien.
Sources: Le Parisien/Deutsches Ärzteblatt
Cancer patients in the UK:
No money for drug treatment
The National Health Service (NHS) in the UK is experiencing
a shortage of funds to pay for life-extending
drugs. The affected patients suffer from kidney cancer,
and four life-extending drugs are involved. At up to
£ 35,000 per patient per year, the NHS considers that
the drugs do not offer value for money. Professor Peter
Littlejohns, clinical and public health director at the
National Institute for Clinical Excellence (NICE), called
this a difficult decision: “NHS resources are not limitless.”
He admitted that the drugs might prolong the
lives of renal cell carcinoma patients by up to half a
year, but without having any actual healing effect. If
these drugs (bevacizumab, sorafenib, sunitinib and
temsirolimus) were provided on the NHS, other
patients would lose out on treatments that are more
useful. Patient representatives denounced the NHS
plans because they would result in many cancer
patients dying faster.
Source: Ärzte-Zeitung

EDI
EDI News
Miniclinics in the US: Treatment at the supermarket
As Americans suffer from the effects of the real estate crisis and high oil
prices, instant medical treatment of common ailments is booming. Minute-
Clinic, a subsidiary of the major US drugstore chain CVS, had 70 clinics in
2006. In March 2008, the 500 th clinic was opened, with the 700 mark expected
to be reached by the end of the year. Representatives of the medical establishment
warn of quality problems, but the demand is skyrocketing. Given
the unability of politicians to solve its rampant problems, the US healthcare
system is on the brink of collapse. More than 47 million Americans are not
covered by health insurance. As many established practitioners continue to
be highly skeptical, the miniclinic idea is being imitated elsewhere. The
world-famous Mayo Clinic will be founding several of these supermarket
clinics by the end of 2008 in order to cash in on its legendary name.
Source: Various media
Health insurance in Austria: Imminent bankruptcy
A not insignificant number of Austrian health insurers are facing bankruptcy.
The promised temporary state relief in the amount of 150 million euros
once promised by the government will not be forthcoming following the
governing coalition’s demise. In any event, the subsidy would have alleviated,
not resolved the financial difficulties. The situation of the Vienna Regional
Health Fund (WGKK) is particularly critical because it is up to 543 million
euros in the red. The Vienna Chamber of Physicians does not believe that the
bankruptcy of the WGKK can be staved off until February 2009, but expects
it to happen as early as this upcoming September, as a spokesman said: “We
do not believe the WGKK will last until February”. As early as this autumn,
patients may be forced to pay for their doctor’s visits themselves. Practitioners
are being told to prepare for a situation without a contract: “We are asking
ourselves whether we will still receive our fees come autumn.”
Source: Various media
Revalidation in the UK: Morale is low in the medical camp
Half of all British medical practitioners reject the revalidation process they
have to undergo every five years in order to keep their licenses because this
requirement questions their professional qualification. Sixty-five percent of all
physicians are convinced that the new revalidation procedures will reduce
morale, according to a current TNS Healthcare survey. In a survey of more than
200 GPs across the UK, they found little support for the new procedure: ”71 percent
of the physicians believe it will reduce time with patients and almost twothirds
anticipate that it will be no more than a ‘tick box’ exercise. Almost half
are concerned revalidation will serve as a tool to weed out doctors viewed as
difficult to manage or uncooperative.” The new process – which will be drawn
up and piloted over the next 18 months – includes a system for re-licensing the
UK’s 150,000 physicians by testing their basic medical competence.
Source: Zahnärztlicher Nachrichtendienst (zänd)
55

58 EDI
European Law
Proposal for a directive on the application of patients’ rights
in cross-border healthcare presented by the European Commission on 2 July 2008
European Commission Intends to
Provide Legal Certainty for Patients’
Rights in Cross-border Healthcare
On 28 April 1998, the European Court of Justice (ECJ)
ruled that patients are entitled to receive not only
non-hospital medical services anywhere within the
European Community but also to be reimbursed for
their expenses by the statutory health insurers in
their own Member State without prior authorization.
Although the ECJ continues to rule in favour of
patients, many of them are not being reimbursed
and have to pay the cost themselves if they are
unwilling or unable to go to court. A survey 1 has
shown that 30 percent of the citizens of the European
Union are not aware of the possibility to receive
healthcare outside their Member State of affiliation.
This might be a reason why cross-border healthcare
amounts to only 1 percent of all healthcare spending
in the EU, i.e. € 10 billion.
The European Commission has initiated public
consultations to analyze the problems within crossborder
healthcare and to identify possible legal
instruments best qualified for each of the different
issues. The majority of the 280 contributors voted in
favour of cooperation on the part of the European
healthcare systems on a legislative as well as on a
practical level. Based on these contributions, the
Commission presented, on 2 July 2008, a proposal for
a directive to facilitate the application of European
patients’ rights in relation to cross-border healthcare.
The proposal intends to issue common guidelines to
the Member States to assure that patients’ rights will
be protected.
The Commission’s suggestion is a follows: Based
on the rulings of the ECJ, access to cross-border
healthcare is to be simplified and the system of preauthorization
reduced to a necessary level. Patients
are to be reimbursed for non-hospital as well as hospital
care without prior authorization. Exceptions can
only be granted within hospital care. A Member State
can require prior authorization for hospital care if it
provides evidence that the treatment, had it been
performed on its territory, would have been covered
by its social security system and that the consequent
outflow of patients seriously undermines or is likely
to seriously undermine the financial balance of its
social security system.
Member States in which a substantial percentage
of all patients receive treatment only after extended
waiting times fear the migration of these patients
and potential subsequent instability within their
own healthcare systems. Other Member States are
looking forward to providing treatment for these
patients from areas in the vicinity of their borders.
It should not be overlooked that the definition of
non-hospital and hospital care varies from Member
State to Member State. The proposal defines hospital
care as a benefit that at least requires a patient’s
overnight accommodation, unless the hospital care
concerns certain treatments yet to be listed by the
Commission. Whether all Member States will agree
to this definition is a moot point. If some Member
States have lower or different standards regarding
the overnight-accommodation rule, conflicts may
arise as these States are prevented from requiring
prior authorization.
A potential problem is that the commission plans
to draw up a list of specific treatments that are
regarded to constitute hospital care and thereby
being eligible for a prior authorization requirement,
irrespective of the mode of accommodation. This list
is to include healthcare modalities that require a
highly specialized and cost-intensive medical infrastructure
and medical equipment or healthcare
involving treatments presenting a particular risk to
the patient or the population. It is more than questionable
that the Member States will actually give up
their right to participate in drawing up this list.

60 EDI
European Law
Another challenge all Member States will be facing
is to create a mechanism to assign their healthcare
benefits a specific monetary value in order for
these benefits to become reimbursable. For this
mechanism to become transparent, it will have to
be based on objective, non-discriminatory criteria
announced in advance. If legal certainty is to be provided
in the real of cross-border healthcare, the
Member States will also have to find methods to
establish cross-border comparability of benefits and
pricing systems.
Furthermore, the proposal intends to reimburse an
insured person for the costs of treatment in a foreign
state up to the cost of the same or similar treatment
within their national healthcare system, i.e. the treatment
has to be part of the service offered to the
insured person in his or her own Member State. In
order to avoid letting the insured person derive a
financial advantage from healthcare provided in
another Member State, reimbursement is to be limited
to the actual cost of the healthcare received.
Article 6 of the proposal clarifies that only insured
persons are allowed to claim reimbursement for
cross-border healthcare. Article 4 defines the expression
“insured person” with a reference to Article 1 c of
Council Regulation (EC) No. 883/2004. The proposal
therewith distinguishes between “insured person”
and “family member” as mentioned in Article 1 f of
Council Regulation (EC) No. 883/2004 but not in the
proposal itself. This may create difficulties because,
for example, family members in Germany can be coinsured
and accordingly should be entitled to reimbursement
for cross-border healthcare as well. Considering
the proposal’s text, this could not be the
case.
In addition, Article 6 of the proposal states that the
claim for reimbursement has to be directed against
the Member State of affiliation and not its statutory
health insurer. It would be preferable not to obligate
the Member States themselves but to create an obligation
of the Member States to ensure reimbursement
by their statutory health insurers.
If reimbursement presupposes that the same or a
similar treatment is being offered and covered in the
insured person’s Member State, it is arguable if and
to what extent the attending physician is allowed to
deviate from the treatment course without the
insured losing his claim for reimbursement. As far as
the proposal is concerned, a patient has the right to
receive any medicinal product authorized for marketing
in the Member State where healthcare is provid-
ed, even if this product is not authorized in the Member
State of affiliation. The medicinal product only
has to be considered “an indispensable part of
obtaining effective treatment in another Member
State”. But if the medicinal product is in fact not
authorized in the patient’s Member State, it cannot
be part of any treatment there. In this case, the system
of reimbursement might lack a precondition:
“the same or similar” treatment offered and covered
in the Member State of affiliation. This will certainly
not become an issue regarding medicinal products
that only bear a different name and/or are provided
by different manufacturers while still containing the
same or a very similar effective substance. But the
question might arise in the context of medicinal
products as parts of a highly specialized treatment
that, in this form, is not available in every Member
State.
The proposal does not intend to modify the Member
States’ particular national healthcare system.
Member States can impose the same conditions and
criteria of eligibility on insured persons seeking
cross-border healthcare as they apply domestically –
as long as these conditions are neither discriminatory
nor an obstacle to freedom of movement of persons.
For example, many health insurers in Germany
now deduct between 7.5 and 10 percent of the reimbursement
for “increased administrative expenses”. It
seems questionable at least that this policy will survive
the coming directive.
To inform patients of possible cross-border healthcare
offerings, every Member State has to establish
so-called “national contact points”. These contact
points are to advise patients on the requirements of
cross-border healthcare, reimbursement systems
and liability questions.
The time and effort the Member States will have to
invest in establishing these contact points will be
substantial. The goal is to gather, summarize and
present all the different healthcare systems and their
legal foundations for a legal layperson, the patient.
The proposal also plans to commit all “healthcare
providers” – which includes physicians – “to provide
all relevant information to enable patients to make
an informed choice, in particular on availability,
prices and outcomes of the healthcare provided”. If
this is interpreted as a comparison of the costs of all
healthcare benefits, an intimate knowledge of the
different healthcare systems and their guidelines
regarding conditions of treatment and reimbursement
systems will be essential. But the attending
physician cannot be expected to know, for all 27

EDI 61
European Law
Member States, whether or not patients are eligible
for a certain benefit or if they can claim reimbursement
in their Member States.
Aside from the immense amount of time this
information requirement would consume, it certainly
cannot be a physician’s duty to advise patients of
the numerous requirements of cross-border healthcare.
If anything, this task should be performed by
the national contact points.
The European Commission also wants to establish
common guidelines concerning the quality and safety
of medical care and to increasingly assure the
Member States’ compliance with these guidelines.
The Commission’s intention is to motivate the Member
States to improve their standards of quality and
safety and to align themselves with the actual state
of medical science to match up the levels of provision
within the Member States. Germany has many years
of experience with such guidelines, which are almost
invariably out of date by the time they are enacted.
This problem will increase if guidelines are to be
developed for all Member States at the same time.
The proposed directive still has to be ratified by the
European Parliament and Council. As with the directive
on services, the European Parliament will probably
request various amendments. The directive might
therefore not be ratified before a new parliament is
elected in the summer of 2009.
Solicitor Nico Gottwald
Ratajczak & Partners
Berlin · Cologne · Essen · Freiburg
Meissen · Munich · Sindelfingen
Posener Straße 1
71065 Sindelfingen, Germany
1 Flash Eurobarometer Series #210, Cross-border
health services in the EU, Analytical report, conducted
by the Gallup Organization, Hungary upon the
request of the European Commission, the Health
and Consumer Protection Directorate-General (DG
SANCO), 2007.

62 EDI
European Law
EDI Journal 1/2008, 44 f. – Supplementary information
Prohibition of Age Discrimination
A submission by the Social Court (Sozialgericht) of
Dortmund, Germany has now given the European
Court of Justice (ECJ) an opportunity to continue
developing its series of rulings related to the prohibition
of age discrimination and to make a decision on
age limits for dentists.
As reported in EDI Journal 1/2008, 45, the Federal
Social Court (Bundessozialgericht) of Germany had
not deemed it necessary, when ruling on the legality
of a rule that generally bars physicians or dentists
aged 68 or above from engaging in outpatient treatment
covered by the statutory health insurance system,
to submit the issue to the ECJ to request a concrete
interpretation of Directive 2000/78/EC (the
anti-discrimination directive). This gap has now been
filled by the Social Court of Dortmund, which did not
adopt legal precedent established by the Federal
Social Court. Hence, the Social Court of Dortmund
decided on 28 June 2008 to request clarification from
the ECJ concerning the prohibition of age discrimination
based on European law as it applies to age limits
for dentists within the statutory health insurance
system (S 16 KA 117/07). The Social Court of Dortmund
held that the only justification for such an age limit
could be that, according to general life experience,
advancing age goes hand in hand with a reduction in
performance and that this might translate into a
hazard to patients. This was one of the reasons why
the Federal Constitutional Court (Bundesverfassungsgericht)
of Germany ruled age limits to be constitutional
in 1998; however, this ruling did not relate
to European law, especially as it preceded the antidiscrimination
directive. To obtain an opinion on
whether age limits for dentists within the statutory
health insurance system are compatible with the
anti-discrimination directive, the Social Court of
Dortmund took recourse to the ECJ, which is responsible
for interpreting the provisions of European law.
The Social Court of Dortmund specifically requested
the ECJ to rule on whether the European prohibition
against age discrimination precludes the concept of
a reduction in performance with increasing age, as
assumed by general life experience, as a justification
for enacting age limits.
It should be noted, however, that the idea that
general life experience proves that performance is
reduced with increasing age, as assumed by the
Social Court of Dortmund, has not been conclusively
proven. Rather, gerontological and other studies of
the influence of age on productivity have shown that
the age factor has only limited predictive value when
it comes to individual performance (cf. Eichenhofer,
Gesetzliche Altersgrenze im Vertrags(zahn)arztrecht:
Kann nach dem AGG alles beim Alten bleiben?, SGb
2007, 580, 582 with references in footnotes 25 and
26). It remains to be seen what position the ECJ will
take with regard to this “general life experience” and
whether it will accept this concept as justification for
age discrimination.
Solicitor Dr Berit Jaeger
Ratajczak & Partners
Berlin · Cologne · Essen · Freiburg ·
Meissen · Munich · Sindelfingen
Posener Straße 1
71065 Sindelfingen
Germany
§

64 EDI
Case Studies
Anterior maxilla reconstructed with autogenous calvarial bone block grafts
restored with dental implants placed in a flapless image-guided procedure and
immediately loaded with a prefabricated prosthesis – a case report
The Key to Success
Dr Guido Schiroli, MD, DDS, Genoa/Italy, Dr Alessandro Acocella, DDS, and Dr Giuseppe Spinelli,
MD, Florence/Italy
This study describes the use of image-guided implantological procedures in a complex case involving the rehabilitation of the
anterior maxilla. Trauma to the teeth and alveolar process in the maxillary anterior region may cause severe bone deficiencies,
resulting in ridge atrophy and maxillary retrognathism with loss of upper-lip support and undesirable changes of the interarch
space, occlusal plane or interarch relationship.
After bone augmentation with autogenous bone blocks harvested from the cranium, endosseous implants were immediately
loaded with a prefabricated splinted bridge using a flapless approach and image-guided surgery. The calvarial area provides
primary stability thanks to a cortical grafting procedure well suited for treating localized alveolar-ridge deficiencies, resulting
in a very low resorption rate and highly dense structure. Image-guided surgery is optimal for determining the correct implant
position and performing a safe flapless procedure. A pre-fabricated prosthesis using the Nobel Guide protocol was placed at
the time of surgery for immediate loading and splinting of the implants at the previously grafted site. After a standard
healing period, zirconia abutments were connected to the implants, which were then restored with metal-free aesthetic
single-tooth crowns.
Injury to the alveolar ridge of the anterior maxilla
often causes severe deficiencies in the horizontal and
vertical dimensions, leaving inadequate alveolar
bone volume for standard treatment with osseointegrated
implants. In addition, the lack of supporting
bone may cause changes in the inter-arch space,
occlusal plane and arch relationship, accompanied by
maxillary retrognathism and a loss of upper-lip support.
An adequate bone supply is a prerequisite for
good aesthetic and biomechanical results, especially
in the anterior maxilla. The reconstruction and augmentation
of severely resorbed maxillary alveolar
ridges for subsequent implant placement have
become predictable procedures today, with different
grafting materials and techniques being available
[1-12]. The combination of autogenous bone grafts
with osseointegrated implants to repair larger
defects requires bone material from extraoral donor
sites such as iliac crest or the calvarium [13-24]. Split
calvarial block grafts have shown very low resorption
rates, fast revascularization and good long-term
results [20-24]. Many authors suggest delaying the
insertion of implants for three to six months after
the augmentation procedure and to wait an addi-
tional three to six months before applying functional
load [22-24].
Submerged healing, a waiting period of three to six
months before applying a functional load and a surgical
re-entry procedure were long considered a prerequisite
for osseointegration according to the Brånemark
protocol [25]. There were reports that early loading
associated with macromovements induced the
formation of fibrous tissue between the implant surface
and the bone [26-30]. However, several studies
were carried out involving immediately loaded
implants in animals and in humans, attesting to the
viability of immediate loading with survival rates similar
to those for implants with delayed loading [31-52].
More recently, there have been reports that there is a
continuum of implant micromovements ranging
from safe to unsafe and that the threshold of unsafe
movements may be between 50 and 150 μm [53-55].
Micromovement below that threshold may be tolerated
by the bone/implant interface, whereas exceeding
the threshold may result in fibrous encapsulation
of the implants [53-55]. Good bone quality, primary
stability and rigid splinting of the fixtures seem to be
the key to success for immediate-loading protocols.

Fig. 1
Radiological
stent with
radiopaque
teeth derived
from provisional
restoration
shells.
Fig. 2
Adequate
exposure of the
donor site.
Fig. 3
Full-thickness
flap exposing
the recipient site
and the residual
alveolar crest.
There are very little data available in literature
regarding the immediate loading of implants inserted
in previously grafted sites. Kupeyan et al [56] treated
a patient with immediate loaded implants after
four months of graft healing in the posterior maxilla
using bone blocks harvested from the posterior iliac
crest. Chiapasco et al [57] described six cases of
patients treated with immediately loaded implantsupported
overdentures in severely atrophied
mandibles after reconstruction of multi-layered
autogenous calvarial grafts and reported a high
implant survival rate.
Predictable bone reconstruction, correct soft-tissue
management and correct planning of the implant
positions are needed to obtain good aesthetic
results, especially in the anterior maxilla.
Teeth-in-an-hour and the Nobel Guide concept
(Nobel Biocare AB, Gothenburg, Sweden) in combination
with Procera planning software program make it
possible to preview the suggested implant placement,
showing the exact positions and depths of the
implants before surgery and designing a custom surgical
template for implant placement via flapless
surgery and a definitive or temporary prosthesis to
be inserted immediately after surgery [58-62].
The concept described, with its minimally invasive
and simplified surgical procedures, reduces treatment
time and post-surgical discomfort [58-62].
Image-guided implantology results in more predictable
and accurate implant placement [86] and
optimized prosthetics [86].
To our knowledge, the case presented here is the first
case of severe post-traumatic localized atrophy of the
anterior maxilla treated with calvarial bone grafts, flapless
image-guided surgery and immediate loading.
Clinical case
EDI 65
Case Studies
A 23-year-old woman was referred to the Maxillofacial
Division of the Faculty of Medicine (Orthopedic-Traumatologic
Centre, Florence) because of traumatic loss
of her anterior maxillary teeth and alveolar process
after a motorcycle accident. Panoramic radiographs
and CT scans were performed to exclude the presence
of maxillofacial fractures. A provisional removable
prosthesis was provided. After five months, the
patient was recalled for a clinical follow-up and for
planning an implant-supported fixed restoration.
The clinical examination revealed severe bone loss
of the maxillary anterior alveolar ridge, the absence
of a labial sulcus and the loss of upper-lip support.
For adequate reconstructive planning and to
assess the residual bone, a CT scan was performed
out with a barium-filled radiological stent (Ivoclar
Vivadent) (Fig. 1), an exact duplicate of the provisional
restoration. The digital CT scan (Simplant, Materialise
NV, Belgium) showed a knife-edge ridge with
complete loss of the buccal plate, a vertical and horizontal
alveolar-ridge reduction and inadequate conditions
for a conventional implant.
To reconstruct the maxillary anterior alveolar-ridge
defect three-dimensionally, we decided to harvest
bone blocks from the calvarium because of their volume
stability.
The bone augmentation procedure was carried out
under general anaesthesia with rhinotracheal intubation.
The initial step involved designing and
reflecting the soft-tissue flap to permit adequate
exposure of the recipient site (Fig. 2). The base of the
incision must be wider than the crestal incision to
maintain maximum blood supply. Buccal and palatal
intrasulcular incisions were made around the adjacent
teeth, including vestibular divergent releasing
incisions to avoid the interdental papillae. A full
mucoperiosteal flap was raised on the facial and
palatal aspects and retracted (Fig. 3).

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The bone crest was curetted to remove all soft tissue.
While the CT scans provide an excellent image of
the defect, direct visualization is the only way to accurately
assess its horizontal and vertical dimensions
the amount of bone to be harvested from the donor
site. A limited incision in the parietal region revealed
the donor site. No hair needed to be shaved off.
The periosteum was incised and reflected and
bone grafts were outlined using a cutting bur with a
tip diameter of 1.5 mm parallel and about 5 cm away
from distant from the midline. Three rectangular
bone grafts 4 x 1 mm in size were designed at the
donor site. The head of the round bur was shifted
down to the diploe layer. The oozing of blood from
the excision site revealed penetration to the appropriate
anatomical level of the skull. The final step was
to use a curved osteotome to free the intended bone
grafts from the donor site, to avoid sourcing any
material from the inner table of the skull. Bleeding
from the diploe layer was controlled with bone wax
and the scalp wound was closed using double layer
vertical-mattress resorbable sutures.
The harvested bone was placed in a sterile physiologic
solution or in moist gauze to maintain as much
the vitality of the block as possible. The recipient bed
was prepared by perforating with a small, straight
fissure bur. This created bleeding channels in the
recipient bed, assisting the formation of neovasculature
from the palatal periosteum. Once the recipient
bed had been prepared, rotary instruments were
used to shape the blocks of donor bone to fit the
recipient bed as closely as possible. One block was
adapted and attached on the buccal aspect of the
alveolar ridge as a veneer graft, while a second block
was adapted to serve as an onlay graft and attached
to the first calvarial block. To secure the block grafts
in place, two titanium alloy screws per block, at least
1.5 mm in diameter, were used (Fig. 4).
The bone blocks were secured using the lag-screw
technique. With this technique, the hole that is
drilled through the graft is wider than the screw
thread. The bur used to drill the host bone should be
smaller than the diameter of the screw. When the
head of the screw is tightened against the block, the
graft is compressed onto the host bone surface. The
graft must remain immobile during healing.
Sharp edges of the bone blocks were rounded off
with large diamond burs. Gaps around the block
grafts were filled with bone chips harvested from the
donor site. Several authors have reported that resorption
can be reduced by covering the bone graft with
a barrier membrane. However, we believe that barrier
membranes are not necessary with calvarial block
bone grafts, which already show minimal resorption.
Once the graft is secured, closure of the soft-tissue
Fig. 4 Panoramic x-ray taken one month after the bone reconstruction: the retention
screws are in place.
Fig. 5 Histologic preparation of the external cortical layer
of the calvarial graft at implant placement. The picture
shows the typical compact osteonic structures of the calvarium,
with signs of active remodelling and new vascular
ingrowth. The vital bone containing osteocytes in the
inner core of the osteons surrounded lamellar non-vital
bone, suggesting that non-vital bone was recolonized by
blood vessels and osteogenic cells via the Haversian canals (original magnification
x 200; specimens stained with haematoxylin and eosin).
flap requires primary closure without tension. An
incision through the periosteum at the base of the
flap usually allows for tissue coverage. Vertical mattress
sutures (Vicryl 3-0) are used to resist any pull on
the wound edges.
The main complication associated with onlay bone
grafts is wound dehiscence with graft exposure. Postoperative
antibiotic and analgesic therapy was routinely
practiced for seven days. Patients were also
given chlorhexidine digluconate (0.2 %) for ten days,
and the sutures were removed after ten to twelve
days. No major complications or evident seromas
were detected at the donor site. After four months of
healing, the fixation screws were removed under
local anaesthesia, grafts were re-contoured, and the
flap was repositioned to restore an adequate amount
of attached gingiva for a better aesthetic result. During
this procedure, a bone biopsy was removed with
a trephine bur and processed for histological testing
to study the vitality, revascularization and remodelling
processes of the grafts (Fig. 5). The gingiva was
conditioned by modification of the artificial teeth of
the provisional restoration using composite resin.
After three months of soft-tissue healing, an acrylic
radiographic stent was prepared on the base of a
diagnostic wax-up of the missing teeth according to
the Nobel Guide computer-based planning protocol.
To facilitate the double CT scanning technique and

6 7 8
Fig. 6 Virtual treatment planning. The space between the implants has been
respected as described in the literature.
Fig. 7 Virtual treatment planning. The bone blocks cover and contain the implant bodies.
Fig. 8 Virtual treatment planning. The positions of the implants correspond to the
final restorations.
Fig. 10 Provisional restoration, fabricated prior to surgery.
Fig. 12 All implants are placed using the surgical guide and customized
fixture mounts.
subsequent matching of the two CT scans in the Procera
software, small holes filled with gutta-percha
were inserted in the radiographic guide as reference
points. The first CT scan was performed on the patient
the radiographic stent in place, while a second scan
was performed on the radiographic stent alone. The
resulting CT DICOM files were converted into a file
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Fig. 9 Stereolithographic surgical stent according to the
Nobel Guide system.
Fig. 11 The abutments are integrated into the provisionals.
format compatible with the Procera software. The
insertion of four Nobel Speedy Tapered implants
(Nobel Biocare AB, Gothenburg, Sweden) was planned
(Figs. 6 to 8), and a customized surgical template was
developed using a stereolithographic process (Fig. 9).
The surgical stent contained all the necessary information
for creating the stone model, on which a temporary
screw-retained prosthesis was fabricated prior
to surgery (Figs. 10 and 11). On the day of surgery the
surgical template was seated intraorally under local
anaesthesia and secured with the anchor pins, verifying
its correct position relative to the opposite arch. A
special drill was used to punch four holes in the
mucosa to access the bone. Low-speed, high-torque,
internally irrigated drills were used to prepare the
osteotomies via sequential cuttings through the surgical
template following the standard protocol of the
Nobel guide surgical kit. Finally, implants were placed
at a torque of 35 Ncm (Fig. 12).

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Fig. 13 The provisional restoration placed at the time of surgery.
Fig. 16 Orthopantomograph three months after implant
insertion. All implants are osseointegrated.
Fig. 18 Aesthetic results after the final restorations were
cemented.
The pre-fabricated temporary prosthesis was connected
to the implants (Fig. 13), and an x-ray control
was performed to assess the position of the
implants beneath the bone and the adaptation of
the prosthesis to the implants (Figs. 14 and 15). Oral
hygiene and postoperative home care instructions
were provided, and the patient was dismissed under
antibiotic and antiphlogistic therapy. Postoperative
pain, bleeding and oedemas were minimal thanks to
the flapless approach. After three months, an
orthopantomograph was taken (Fig. 16), and a clinical
check-up was performed after removal of the
temporary prosthesis (Fig. 17).
14 15
Fig. 17 Clinical view before taking the definitive impression.
Fig. 19 Lateral view showing a correct position of the
restoration and good lip support.
At three months and at subsequent monthly clinical
examinations, the prosthesis was removed to
ascertain implant mobility, absence of pain, paraesthesia,
peri-implant bleeding and infection with suppuration.
At three, six, twelve and 24 months, regular
orthopantomographs and intraoral radiographs were
obtained to detect radiolucent areas and to evaluate
the marginal bone loss around the implants.
At six months, the definitive restorations, consisting
of zirconia abutments and zirconia single crowns (Figs.
18 and 19) were inserted. There were no signs or symptoms
of pain or peri-implant infection during any of
the clinical or radiological examinations (Fig. 20).
Fig. 14
X-ray taken at
the time of
surgery.
Fig. 15
All provisional
abutments fit
the implant
platform.

Fig. 20
Orthopan -
tomograph
three months
after the delivery
of the definitive
restoration.
The crater-like peri-implant resorption pattern that
frequently develops after the first few months of
occlusal loading was not observed (see Fig. 18).
The patient was satisfied with the aesthetics, phonetics
and function of her restoration (see Figs. 19 and 20).
Discussion
Implant dentistry has expanded the indications for
fixed dental prosthetics even in the severely compromised
dentition. Nevertheless, several factors are
required to achieve optimal aesthetics and function
in the anterior maxilla, such as the presence of adequate
alveolar bone height and width and the quality
of bone itself. If these requirements are not met,
ideal implant placement cannot be achieved, jeopardizing
the clinical outcome. If osseous deficiencies
are adequately corrected using predictable ridge
augmentation techniques, this helps achieve prosthetically
ideal implants and a more natural soft-tissue
profile, which in turn facilitates favourable crown
anatomies and crown/implant length ratios and,
consequently, aesthetic results.
Several procedures have been proposed to achieve
alveolar ridge augmentation in partially edentulous
patients [1-12]. The use of allografts or bone chips in
combination with a barrier membrane is useful
where small bone defects, such as fenestrations or
dehiscences, are present around implants inserted in
post-extractive sites or where so-called self-spacemaking
bony defects are present. Major reconstruction
is needed for vertical and/or lateral augmentation
of the alveolar crest. The use of particulate autografts
or allografts covered by barrier membranes
seems to produce controversial results. Some authors
have reported that GBR technique is an effective procedure
both in staged approaches [1,63] and concurrently
with implant placement [64,65]. However, the
use of allografts results in poor bone quality, while
the use of semi-permeable barriers increases the cost
of the surgical procedure and presents a higher infection
risk due to wound dehiscence and membrane
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exposure [66,67]. Like Chiapasco [67], we prefer the
reconstruction of narrow ridges with autogenous
bone blocks without membrane in the case of
extended edentulous areas.
Autogenous bone is still the “gold standard” for
bone reconstruction because of its osteogenetic,
osteoinductive and osteoconductive properties. A
bone-block graft is preferred for this type of augmentation,
since it provides a source of osteogenic cells
as well as a rigid structure for mechanical support.
An advantage of monocortical or cortico-trabecular
bone-block grafts is better anatomical correspondence
and adaptability to alveolar ridges. Bone-block
grafts maintain their volume better than particulate
material [68], but the real advantage is that they
can be secured by screws, titanium miniplates or
implants. The anterior iliac crest as a donor site is preferred
by many authors because of the large quantity
and high quality of the available bone and also
because the harvesting techniques are simple.
Recently, some authors have suggested that iliac
crest bone results in an unacceptably high degree of
postoperative morbidity and resorption [69,70]. As a
result, the use of other donor areas such as the cranium
and mandible has been advocated [20-24, 71-78].
It was found that membranous bone grafts resulted
in higher survival rates and maintained their volume
to a significantly greater extent than endochondral
bone grafts [79,80], which may be related to the
more rapid vascularization of membranous bone [81].
Bone harvested from intraoral donor site and calvarial
bone seem to have better osteogenetic and osteoinductive
properties, related to higher concentrations of
bone morphogenetic proteins (BMP) and growth factors
that may result in a greater capacity for bone
repair and graft retention [82,83]. The pattern of onlay
bone-graft resorption seems to be primarily determined
by a graft’s microarchitecture (relative cortical
and cancellous composition) rather than by its embryologic
origin [84]. The calvarium primarily provides
cortical grafts that are well-suited for veneer or onlay
grafting of localized alveolar-ridge deficiencies, which
seems to be a highly predictable procedure associated
with a good long-term prognosis of implant-supported
rehabilitations [20-24, 71-78].
Advances in fixture design, new implant surfaces
and new surgical techniques have radically changed
the guidelines for clinical treatment with regard to
the best time for implant placement and loading after
grafting. Originally, the Brånemark surgical protocol
stipulated that dental implants were to be submerged
beneath the soft tissue at the time of implant
placement and allowed to heal for a minimum of
three months in the mandible and six months in the
maxilla to achieve osseointegration [25]. Patients

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were also required to refrain from wearing a denture
for at least two weeks after implant placement to
facilitate soft-tissue healing [25]. After the submerged
healing period, a second intervention to uncover the
implants was required. The original concern was that
any implant micromovement might lead to fibroustissue
encapsulation of the implant as a reparative
response to physical trauma, resulting in failure to
achieve osseointegration [53-55]. While the importance
of the contribution by Brånemark and coworkers
[25] should not be underestimated given the high
success rates and predictable results that have been
documented for more then 30 years, it is important to
note that delayed loading was an empirical principle
that had never been experimentally demonstrated.
The current trend is not to consider implant movement
per se as detrimental to osseointegration, but
rather to consider a threshold of acceptable micromovement.
It has been suggested that micromovement
of 150 μm or more is excessive and therefore
deleterious for osseointegration, while micromovement
of less of 50 μm seems to be tolerated [53-55].
During the 1970s, Ledermann [31] introduced the technique
of immediately splinting and loading four
transmucosal implants in the edentulous mandible
with a bar-supported overdenture. The underlying
theory was that rigid splinting of implants in the
dense bone of the mandibular symphysis would prevent
implant micromovement and allow effective
healing and osseointegration under immediate-loading
conditions. Since then, an increasing number of
publications on immediate loading have been published
citing high success rates in mandibular and
maxillary sites for single-tooth replacement, partial
fixed restorations and full-arch prostheses [31-52].
Most authors agree that good bone quality, primary
stability with insertion torques up to 35-40 Ncm
and rigid splinting of implants are important factors
for the long-term survival of implants [45]. Several
studies by Piattelli and coworkers [41-43] on both animals
and humans have demonstrated that not only
may immediate loading lead to successful osseointegration,
but it may also increase the quantity of bone
in direct contact with the implant surface.
The dense structure of cortical calvarial bone grafts
[21-24], which gives implants a high level of primary
stability, and the immediate rigid splinting of fixtures
with a screw-retained provisional restoration
allowed us to immediate load implants inserted in
previously grafted maxillary sites. The Teeth-in-an-
Hour concept along with the Procera 3D planning
software (Nobel Biocare AB, Gothenburg, Sweden)
allowed us to provide patients with fixed well-functioning
restorations on implants in a single one-hour
procedure. By using a custom template created from
the primary CT scan, the provisional teeth can be fabricated
before the implant procedure and inserted at
the same time the implants are placed [58-62]. This
system offers more accurate and safer positioning of
dental implants via flapless surgery, reducing postoperative
pain, oedema and bleeding [58-62].
Conclusions
The clinical results reported here have shown that
immediate loading is feasible even in grafted anterior
maxillary sites, shortening treatment times in
patients with bone defects.
The therapy is a clinical option even in correctly
diagnosed patients with inadequate bone structure,
provided that a proper reconstructive treatment plan
is made. Patients expect good aesthetic results as
much as they expect functional rehabilitation.
Implant treatment in the aesthetic zone following
injuries or the resection of a tumour present both
aesthetic and functional challenges and require the
use of the entire scientific, biological and technological
armamentarium, from diagnosis to final therapy.
An accurate CT scan showing the available bone
supply plus the correct identification of viable
implant positions using state-of-the-art diagnostic
software constitute an appropriate approach toward
a three-dimensional determination of the bone
quantity required for the implants and their superstructures.
Decisions related to harvesting, donor
sites and bone-block sizes can be made subsequent
to the virtual planning phase.
A computer driven approach seems to be a new
“gold standard” for implant placement, as it assists in
identifying the correct position of the implant and
prosthetic platform, respecting adjacent anatomical
structures and creating a correct emergence profile of
the final restorations. In addition, this clinical approach
offers an opportunity to perform a safe and accurate
flapless procedure with favourable outcomes.
The use of cortical multi-layered split calvarial bone
grafts with a very low resorption rate and highly dense
structure, high primary stability and rigid connection of
the implants and accurate computer-guided planning
and implant insertion are the keys to success. However,
more studies and randomized clinical trials are needed
to asses the predictability of the procedure.
Contact Address
Dr Alessandro Acocella
Via Dante da Castiglione, 16/A Cercina, Sesto Fiorentino,
Firenze, 5010, ITALY
Phone: +39 333 2317982 (cell.)
alessandroacocella@yahoo.it
A list of references
will be supplied by
the editorial office
on request.

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Clinical and biomechanical outcomes
Platform Switching
Xavier Vela-Nebot, MD, DDS, Xavier Rodríguez-Ciurana, MD, PhD
and Maribel Segalà-Torres, MD, DDS, Barcelona/Spain
After an implant is exposed to the oral environment, the biologic width is re-established and irreversible peri-implant bone loss
occurs. This article looks at the tissues involved in this process and the amount of bone loss involved. Platform switching is
proposed as a technique for reducing such bone resorption. The histological and biomechanical advantages of platform switching
in implant therapy are assessed.
Throughout the years, two-piece implants have
demonstrated their performance and versatility in
solving all types of functional and aesthetic problems.
Numerous authors recommend placing
implants adjacent to natural teeth with the platform
2 to 3 mm below the cementoenamel junction (Fig. 1),
i.e. at the same level as the crestal bone or even
below it, to minimize the risk of exposing the metal
of the implant collar or the abutment and to achieve
an adequate vertical dimension and an aesthetic
emergence profile [1]. Peri-implant bone loss has
been widely documented and quantified and is a
usual radiographic finding. It is common to find a
bone loss of 1.5 to 2.5 mm (Fig. 2) on the vertical axis
and 1.5 mm on the horizontal axis, relative to the
implant-abutment junction [2].
Bone remodelling around the implant has traditionally
been divided into three phases [3]:
- Healing (first twelve months). After the surgical
trauma related to drilling and implant insertion,
new bone forms around the immobile implant. In
this phase, the initial blood clot and the traumatized
bone form a new bony callus.
- Remodelling (from the time of loading until 18
months). The implant is exposed to the oral environment
and masticatory forces, and the crestal
bone is remodelled according to the magnitude,
direction, and frequency of the load. The amount of
bone loss observed and described in the literature
in these first two phases ranges from 1.5 to 2 mm.
- Stabilization (after 18 months). Stabilization is
achieved after about 18 months from implant
placement; it means that the forces acting on the
implant and the remodelling capacity of the bone
around it are in balance. After 18 months, lamellar
bone is considered to have formed around the
implant and true osseointegration is achieved.
Fig. 1 Vertical position of the implant platform relative to the neighbouring teeth.
Fig. 2 Common values of peri-implant bone loss.
Bone loss in this final phase has been estimated at
0.05 to 0.1 mm/year. This bone loss is similar to that
found around natural teeth. The concepts and values
indicated in the crestal bone remodelling and stabilization
phases are still accepted today.

Fig. 3
Biologic width:
components and
dimensions.
Most bone loss is observed in the healing phase.
This is where classical biomechanical theories are
hard-pressed to explain things such as: the differences
in bone development observed between onepiece
and two-piece implants; the absence of bone
loss when the implant is submerged and its appearance
immediately after placing healing screws, even
without loading; and the observation that the
repeated screwing and unscrewing motion of the
healing abutment leads to apical migration of the
epithelial attachment and results in re-establishment
of the bone level [4].
Better knowledge of tissue biology and the experience
and information gained in recent years with single-surgery
implants, same-day implants, immediate
loading, etc. have opened up new routes for understanding
the process of immediate or early bone
remodelling.
Peri-implant bone loss
We can therefore say today that peri-implant bone
loss in the healing phase:
- Does not seem to be related to implant shape and
occurs with both root-form and cylindrical
implants [5].
- Is not related to when the implant is inserted; it is
observed in both immediate and non-immediate
implant placement [6].
- Does not appear to be related to immediate
implant loading. Some authors state that loads
generating micro-motion of less than 120 microns
are even favourable for bone apposition [7].
- Is related to exposure of the implant to the oral
environment [8] and is observed after four to five
weeks both in two-stage implants, after uncovering
them, and in single-stage implants when communication
with the oral environment occurs
immediately after implant placement.
Following exposure of the implant to the oral environment,
tissue biology ensures the formation of
connective tissue and an epithelial covering, creating
a band of soft tissues that forms a functional unit
with a structural pattern. This is the biologic width
similar to that found in natural teeth [9].
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Fig. 4 (a) Band of inflammatory tissue surrounding the
implant-abutment interface in a cylindrical implant without
platform switching. (b) Re-establishment of the biologic width.
This biologic width is traditionally considered to
be composed of a sulcus of approximately 1 mm,
1 mm of junctional epithelium, and 1 mm of healthy
supra-periosteal connective tissue. The sum of
these three structures gives us the known 3 mm
biologic width whose function is defined by each of
its components (Fig. 3):
- The epithelial components (sulcus and junctional
epithelium) are the first defensive mechanisms for isolation
from the internal medium, acting as a barrier.
- The supra-periosteal connective tissue guarantees
defence, support, nutrition, and filling.
The biologic width thus maintains and ensures the
protection of the internal environment by creating a
tight seal around the implants to keep out external
mechanical and biological agents.
Numerous studies have related peri-implant bone
loss to the presence and location of the implantabutment
interface, stating that the more apical the
interface is to the alveolar crestal bone, the greater is
the bone loss [10]. It seems apparent that micromovement
[11] between the implant and restorative
components and, specially, bacterial colonization are
the main causes of bone loss [12].
When the implant is exposed to the oral environment
(Fig. 4), the defensive epithelial barrier is broken,
allowing bacteria to migrate and colonize the
implant-abutment interface. According to Callan and
co-workers, this occupation takes place in the first 25
days. The bacteria involved in the process are mainly
gram-negatives and anaerobes.
The release of collagenase by the bacteria triggers
the connective tissue defensive response, causing
increased vascular patency that facilitates chemotaxis
in defensive cells (polymorphonuclear cells,
plasma cells and macrophages) whose function is to
destroy bacteria. This means that a 1.1 mm band of
connective tissue around the implant-abutment
interface contains copious amounts of inflammatory
infiltrate [13].

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Fig. 5 Platform switching with a 5 mm diameter implant
and a 4.1 mm diameter abutment.
The bacterial lysis resulting from this defensive
action releases endotoxins and osteoclast-activating
factors and lowers the pH, which culminates in the
bone resorption we observe radiographically. Typically,
this bone loss is evident down to the first thread
on the implant. It is an attempt to keep the sterile
internal environment away from the inflammatory
area. Loss of peri-implant crestal bone height causes
movement of soft tissue as a block (what we call the
biologic width). At the same time, there is an epithelial
migration as the body attempts to isolate the irritant
apically.
This recessive process finishes when the epithelium
recovers its function as a barrier, bonding with
hemidesmosomes to the implant surface in the area
of the implant-abutment interface. Underneath,
there is 1 mm of supra-periosteal connective tissue
that preserves the defensive properties needed to
keep the internal environment sterile.
What we really see is that the dimensions of the
biologic width are being re-established (the sum of
these areas explains the common bone loss [14]).
Platform switching
In response to this scenario of major peri-implant
bone loss (which occurs irreversibly as all two-piece
implants are exposed to the oral environment), the
concept of platform switching was developed. Platform
switching consists in creating a discrepancy
between the diameter of the implant platform and
the diameter of the prosthetic abutment. This is
achieved by using implants with a 5-mm platform
and undersized abutments (4.1 mm). A horizontal distance
of 0.45 mm is thus created between the
implant-abutment interface and the peri-implant
tissues [15] (Fig. 5).
When such a configuration is exposed to the oral
environment, the normal reaction occurs: the contact
Fig. 6 Comparison of bone loss between implants (a) without platform switching
(control group) and (b) implants with platform switching (study group).
surfaces between implant and abutment are colonized
by gram-negative and anaerobic bacteria, and a
band of connective tissue is generated with large
amounts of inflammatory infiltrate around it. But the
modification of the platform keeps the implant-abutment
interface away from the peri-implant bone,
minimizing the colonization of the biologic width
and resulting in a statistically significant reduction in
bone loss: p < 0.0005 [15] (Fig. 6).
Radiographic analysis
The authors have worked with platform switching in
more than 1500 implant cases. The bone loss found
around these implants is similar to that described in
the literature [15], with bone loss in both the vertical
and horizontal axes significantly reduced. The figures
are as follows:
- In implants with a 5-mm platform fitted with abutments
of the same diameter (the usual method
without platform switching): The mean vertical
bone loss is 2 to 2.5 mm, and the horizontal bone
loss is 1.5 mm [15].
- In implants with a 5-mm platform fitted with
undersized abutments of 4.1 mm (applying the
concept of platform switching): Bone loss is up to
70 percent less, with an average of 0.76 mm for vertical
loss and 0.72 mm for horizontal loss [15].
- The concept of platform switching has been incorporated
in the coronal design of the Certain Prevail
implants (Biomet 3i, Palm Beach Gardens, Florida,
USA). The coronal dimensions of this implant are a
4.8-mm diameter platform which connects to a
4.1-mm abutment. This leaves a space of 0.35 mm
at the edge around the implant-abutment interface.
The Prevail implant platform also has a bevel
of 15º, which raises the interface 0.10 mm above
the collar. Taken as a whole, the effect is to move
the implant-abutment interface further from the

Fig. 7 Amounts of bone loss in (a) implants without platform switching,
(b) implants with platform switching and (c) Prevail implants.
Fig. 8
Biomechanical
behaviour of an
implant without
platform
switching.
Finite element
analysis.
Fig. 9
Biomechanical
behaviour of an
implant with
platform
switching.
Finite element
analysis.
Fig. 10
Variations in
crown/implant ratio.
(a) Initial situation
without platform
switching.
(b) Peri-implant
bone loss with platform
switching.
(c) Peri-implant
bone loss without
platform switching.
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peri-implant bone as done with 5 mm diameter
implants connecting with 4.1 mm abutments.
Worldwide multicentre clinical studies of this
implant have shown up to 80 percent reduction in
peri-implant bone loss, with average values of
0.65 mm on the vertical and the horizontal axis
[16] after three years of loading (Fig. 7).
Biomechanical and aesthetic considerations
The use of wide-platform implants is indicated for:
1. Improving resistance to occlusal forces. Using an
abutment with the same diameter as the implant
platform distributes the stress uniformly over the
entire implant-abutment contact surface. This is
especially important with wide-platform implants
and is with no doubt a biomechanical advantage,
even though it involves major peri-implant bone
loss, a significant biological disadvantage (Fig. 8).
2. Optimizing the emergence profile. Using implants
and abutments of the same diameter makes it easier
to match the emergence profile of implant-supported
restorations with that of natural teeth.
Platform switching involves using abutments with
a smaller diameter than that of the implant platform.
This limits the advantages of wide-diameter
implants that have matching-diameter abutments.
However, it results in better preservation of periimplant
bone:
1. Using the Prevail implant reduces the peri-implant
bone loss. This implies a better preservation of cortical
bone around the implant platform. Cortical
bone is ten times more resistant to stresses than
medullar bone, especially in front of the oblique
forces. The internal connection of these implants
increases the implant-abutment contact area.
Although the abutment support on the implant
platform is reduced, the stresses inside the
implant are uniformly and progressively distributed,
which makes the biomechanical behaviour
of the Prevail implant superior to that of wideplatform
implants and abutments of matching
diameter. Results of finite-element analysis confirm
this (Fig. 9). The creation of the biologic width
causes vertical peri-implant bone loss that alters
the initial crown/implant ratio and even inverts it,
creating an unfavourable situation that reduces
the long-term predictability of the restoration
(Fig. 10).
2. The literature on implant-supported restorations
has widely documented the two options for
achieving a good emergence profile: using a wideplatform
implant seated at the level of the crestal
bone or a narrow-platform implant submerged in

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Fig. 11 Recommended subcrestal seating of the implant with platform
switching to achieve a good emergence profile.
the crestal bone to compensate for the smaller
platform diameter. With platform switching,
undersized abutments are being used with a wideplatform
implant. The implant thus must be slightly
submerged (by approximately 1 mm) to obtain
the correct emergence profile. The Prevail implant
is designed to be seated below the crestal bone. Its
micro- and nanorough NanoTite surface extends
up to the implant collar, which improves the boneimplant
contact index (Fig. 11).
Conclusions
Using platform switching to increase the distance of
the implant-abutment interface from the crestal
bone minimizes the attack on the biologic width
caused by bacterial colonization. The result is
reduced peri-implant bone loss [15]. This provides several
obvious benefits:
1. Reducing bone loss increases the bone-implant
contact surface and enhances the area of the
implant available for osseointegration (Fig. 12).
2. The enhanced osseointegrated area is found mainly
on the cervical third of the implant. This is crucial
for preserving peri-implant cortical bone, because
this is the area that best withstands biting forces,
especially the oblique ones, and improves the
crown/implant length ratio. Platform switching
therefore improves the biomechanical properties
of implant-supported restorations and their longterm
predictability [17] (see Figs. 8 and 9).
3. Platform switching also helps retain peri-implant
crestal bone, thus providing good support for the
soft tissues. This is extremely important in anterior
restorations in which preserving the buccal plate
and maintaining the peri-implant crestal bone
determines gingival aesthetics and the health of the
implant-supported restorations (Figs. 13 and 14).
Fig. 12
Enhanced
osseointegrated
surface
(a) without
platform
switching and
(b) with platform
switching.
Fig. 13
Tooth 11 restored
with a Certain
Prevail implant
after three years
of follow-up.
Fig. 14
Tooth 15 restored
with a Certain
Prevail implant
after four years
of follow-up.
Note the excellent
preservation
of peri-implant
bone, guaranteeing
a good gingival
support.

References
77
[1] Buser D, Martin W, Belser UC. Optimizing esthetics for implant restorations
in the anterior maxilla: anatomic and surgical considerations. Int J Oral Maxillofac
Implants 2004;19(SUPPL):43-61.
[2] Tarnow DP, Cho SC, Wallace SS. The effect of inter-implant distance on the
height of inter-implant bone crest. J Periodontol 2000;71:546-549.
[3] Branemark PI, Zarb GA, Albrektsson B. Tissue-integrated prostheses:
osseointegration in clinical dentistry. Quintessence Publishing 1985.
[4] Abrahamson I, Berglundh T, Lindhe J. The mucosal barrier following abutment
dis/reconnection. An experimental study in dogs. J Clin Periodontol
1997;24:568-572.
[5] Daftary F. Dentoalveolar morphology: evaluation of natural root form
versus cylindrical implant fixtures. Pract Periodontics Aesthet Dent
1997;9(4):469-77.
[6] Araújo MG, Sukekava F, Wenström JL, Lindhe J. Ridge alterations following
implant placement in fresh extraction sockets: an experimental study in the
dog. Pract Periodontics Aesthet Dent 2000;12(9):817-824.
[7] Romanos G, Toh Ch G, Siar Ch H, Swaminathan D, Ong A H. Histologic and
histomorphometric evaluation of peri-implant bone subjected to immediate
loading: an experimental study with macaca fascicularis. Int J Oral Maxillofac
Implants 2002;17:44-51.
[8] Hermann J S, Cochran D L, Nummikoski P V. Crestal bone changes around
titanium implants. A radiographic evaluation of unloaded nonsubmerged and
submerged implants in the canine mandible. J Periodontol 1997;68:1117-30.
[9] Gargiulo AW, Wentz FM, Orban B. Dimensions and relations of the dentogingival
junction in humans. J Periodontol 1961;32:261-267.
[10] Hermann J S, Buser D, Schenk R K, Schoolfield J D, Cochran D L. Biologic
width around one- and two-piece titanium implants. A histometric evaluation
of unloaded nonsubmerged and submerged implants in the canine mandible.
Clin Oral Impl Res 2001;12:559-71.
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Product Studies
[11] King G N, Hermann J S, Schoolfield J D, Buser D, Cochran D L. Influence of
the size of the microgap on crestal bone levels in non-submerged dental
implants: a radiographic study in the canine mandible. J Periodontol
2002;10:1111-1117.
[12] Callan D P, Cobb C M, Williams K B. DNA probe identification of bacteria colonizing
internal surfaces of the implant-abutment interface: a preliminary
study. J Periodontol 2005;76:115-120.
[13] Berglundh T, Lindhe J, Ericsson I, Marinello C P, Liljenberg B. Soft tissue reactions
to the novo plaque formation at implants and teeth. An experimental
study in the dog. Clin Oral Implant Res 1992;3:1-8.
[14] Berglundh T, Lindhe J. Dimension of the peri-implant mucosa. Biological
width revisited. J Clin Periodontol 1996;23:971-3.
[15] Vela X, Rodríguez X, Rodado C, Segalà M. Benefits of an implant platform
modification technique to reduce crestal bone resorption. Implant Dent
2006;15(3):313-320.
[16] Calvo JL, Sáez MR, Pardo G, Muñoz E. Immediate provisionalization on a
new implant design for esthetic restoration and preserving crestal bone.
Implant Dent 2007;16(2):155-164.
[17] Kitamura E, Stegaroiu R, Nomura S, Miyakawa O. Biomechanical aspects of
marginal bone resorption around osseointegrated implants: considerations
based on a three-dimensional finite element analysis. Clin Oral Impl Res
2004;15;401-412.
Contact Address
Barcelona Osseointegration Research Group (BORG)
Sant Martí Nº 43
08470 Sant Celoni (Barcelona)
SPAIN
Phone: +34 619 284474
headquarters@borgroup.net

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Prosthodontic reconstruction of the edentulous maxilla with a removable denture
supported on six SynCone abutments
Practice Success with
Telescopic Crowns
Dr Krzysztof Chmielewski, Gdansk/Poland
In the past few years, implantology has developed successfully even under sometimes difficult conditions, for example in
Eastern and Southern European countries. This article shows how Dr Krzysztof Chmielewski performs implantology to a very
high standard in Poland and successfully places Ankylos implants.
The different treatment concepts and solutions in
the Ankylos implant system are very obvious. The
benefits derived from the design of the implant, its
TissueCare connection and platform-shifting are the
key to long-term success and provide the background
of the TissueCare Concept. Reconstruction of the
edentulous maxilla is a very common challenge for
us in meeting patient expectations and achieving
long-term stable results.
A removable denture supported by a bar or telescopic
crowns is one solution to give the older
patient a compromise between function, esthetics
and the highly important accessibility for hygiene.
Hygiene can be difficult in elderly patients with a full
arch implant-supported reconstruction of the maxilla
for whom even the use of dental floss between their
existing natural teeth is problematic. If I can propose
to the patient a treatment which will assist him in
routine oral hygiene and which is very comfortable
and also stable, one of my first choices is a removable
denture supported with Ankylos SynCone taper abutments.
The great advantage of this taper connection
is reliable friction and precision coming from the production
process. The first time I had an opportunity
of holding a SynCone abutment and Gold Cap in my
hands, I was amazed at how well the components fit
together and I had no doubt that they would work in
the mouth as well. To deal with different situations
the abutments come with two different taper conical
heads: 4 and 6 degrees.
The case presented in this article shows how
patient expectations regarding function, esthetics,
hygiene and reasonable treatment costs can be met
(Figs. 1 to 31).
A 62 year old female patient with an edentulous
maxilla and problems due to the mobility of her full
upper denture came to my practice seeking a solution
to her problem. After various treatment concepts
were explained, the patient decided on a removable
Fig. 1 OPG during planning with template in the mouth. Fig. 2 Full denture with drilling sleeves mounted.

Fig. 3
Incision on
the top of
the ridge.
Fig. 4
Drilling through
the template
with 2.0 mm
pilot drill to
mark the drilling
point on the top
of the bone.
Fig. 5
Implant sites
prepared.
Fig. 6
Ankylos implant
during placement
in the bone.
Grooves on the
implant carrier
help to submerge
the implant
correctly.
Fig. 7
Six Ankylos
implants in
final positions.
Fig. 8
After six months
of healing
re opening of the
implant sites and
placement of
sulcus formers.
Fig. 9
Impression three
weeks after
secondstage surgery.
Closed tray
transfer copings
were used.
Fig. 10
Master cast
after un screwing
of the transfer
copings.
3 4
5 6
7 8
9 10
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11 12
13 14
15
17 18
16
Fig. 11
15 degrees
angulated
SynCone abutment
with six
degree tape.
Fig. 12
To establish the
correct axis
between the
abutments dedicated
paralleling
pins are used.
Fig. 13
In the first
implant position
on the left side it
was necessary to
customize the
abutment.
Fig. 14
Prefabricated
gold caps placed
on abutments.
Fig. 15
The caps were
milled to reduce
the external size.
To improve adhesion,
the gold
caps were sand
blasted.
Fig. 16
Galvano secondary
cap placed in
the customized
abutment.
Fig. 17
The metal
construction
was additionally
covered with
opaquer.
Fig. 18
Try-in of the
construction on
the model.

Fig. 19
Before unscrewing
the abutments
acrylic
jigs were made.
Fig. 20
At every stage
the technician
uses a dynamometric
key.
Fig. 21
Placement of
the abutments
in the mouth.
Fig. 22
Abutments are
screw-retained
with 15 Ncm
force.
Figs. 23 and 24
Try-in of the
caps.
Fig. 25
Try-in of the
metal
construction.
Fig. 26
The construction
should be above
the level of the
soft tissue to
leave room for
acrylic resin.
19 20
21 22
23 24
25
26
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27 28
29 30
Fig. 31 Final result in the patient’s mouth.
denture supported on Ankylos SynCone taper crowns.
Before the surgery, planning took place with an OPG
and to obtain more information regarding the best
implant position I made a surgical template using an
acrylic denture with fixed drilling sleeves. The
patient’s next X-ray was taken with the template in
the mouth. On the OPG I could see the possible positions
for the implants. More than six sleeves were
used in the template to provide more options during
planning. The surgery was then performed, followed
by a six-month healing period. In the meantime, the
patient wore her existing denture as a temporary
restoration. Placing the Ankylos implants 1 mm below
the ridge produces less risk of accidental loading by
the temporary denture. After second-stage surgery
and healing of the soft tissue, an impression was
taken using the closed tray technique and sent to the
laboratory. On the master cast the technician chose
Fig. 27
SynCone Copings
are fixed to the
metal elements.
Fig. 28
Bite registration
with acrylic resin.
Fig. 29
Impression with
the frame.
Fig. 30
Veneering of the
construction with
acrylic resin.

angulated Ankylos SynCone abutments and placed
them in the optimum position to allow space for the
secondary telescopes. The implants were placed in the
maxilla with divergence between the left and right
sides due to the anatomic situation.
In five locations the technician used SynCone abutments
with 15 degree angulation and proper gingival
height, but in position 24 the 22.5 degree angulation
of the abutment was not sufficient to obtain the correct
axis. In this position, the technician customized
the abutment. Every customizing of a prefabricated
SynCone abutment creates another problem because
it is no longer possible to use prefabricated secondary
telescopic crowns (gold caps). In this case, we
decided to place a Galvano cap as the secondary telescope.
This solution fits well but friction is less predictable
over time compared with prefabricated elements.
From my experience, use of one Galvano
among five other prefabricated SynCone elements
has no influence on denture retention.
The next step for the technician was the preparation
of the metal frame. The goal of this frame is to
strengthen the denture, provide retention for acrylic
veneering and limit the palatal dimension. The external
size of the gold caps can be reduced by milling
Contact Address
Dr Krzysztof Chmielewski
Vice President of the Polish Academy
of Esthetic Dentistry
Implantology and Esthetic Dentistry Clinic
Member of the “Omega Gruppe”
Gdansk
POLAND
biuro@kgcdent.pl
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prior to creation of the metal frame. It also helps to
avoid a bulky internal metal construction of the denture.
For optimum fitting the gold caps should be
glued to the metal frame in the patient’s mouth.
After that I took an impression of the construction
with a custom tray to enable the technician to veneer
the frame with acrylic resin. The final result is very
satisfactory for the patient. The function and esthetics
give the patient’s life a new dimension. The construction
appears to be as rigid as a bridge. The
absence of movement, very stable position and
reduced size especially on the palatal side are common
with non-removable constructions but in this
case the patient has a further advantage: she can
remove the denture for cleaning purposes.

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Overview of sealing options to prevent peri-implantitis
caused by re-infection from assembled implants
Gap Sealing
Christian Krenkel, Salzburg/Austria
Peri-implantitis denotes inflammatory diseases of the hard and soft tissues around dental implants (Fig. 1). A variety of etiologic
factors come into play [1-5]. The list of causes was formerly led by overload situations, poor gingival conditions and excessive
plaque accumulation. Additional mechanisms were identified more recently, including re-infection from intra-implant spaces
[6]. The dental industry is currently undertaking a variety of efforts to eliminate or minimize this pathogenic factor.
The goal is to effectively seal any gaps between implants and superstructures, establishing a barrier that cannot be penetrated
by micro organisms.
Various recent studies have addressed the question
of how peri-implantitis can be prevented and treated
[7, 8]. Spurred by these investigations, ways of sealing
the internal spaces of assembled implants have
increasingly become a focus of attention. Intraimplant
gaps and cavities are not a recent discovery
but have always been known to exist in principle.
Numerous practitioners had criticized a putrid smell
that would emanate from implant sites on (deliberate
or incidental) re-entry. However, appropriate
steps to remedy this situation were rarely taken.
Moreover, manufacturers have consistently maintained
that existing implant-abutment interfaces are
safe from leakage. Authors of studies on peri-implantitis
first expressed suspicions that infections of hard
and soft tissue might be nourished by pathogen colonization
from inside implants [9, 10]. These suspicions
were not, however, supported by hard evidence.
Medications were introduced to treat soft-tissue diseases,
including PerioChip (Dexcel Pharma, Alzenau,
Germany) and Duraplant (Lege Artis Pharma, Dettenhausen,
Germany). They are designed to control
mucosal infections at the subgingival level by intrasulcular
administration. Their active ingredients may
well be effective, yet they presumably cannot resolve
these infections in a lasting fashion unless the
underlying cause is also eliminated.
Schmüdderich was the first to present an analysis
of intra-implant pathogen colonization based on
light and electron micrographs [6]. His studies resulted
in a highly innovative sealant characterized by
bactericidal activity in addition to sealing intraimplant
spaces. Schmüdderich’s paper and marketing
for the sealant have apparently set off a spark. The
fact that manufacturers have taken a substantial
interest in hermetic sealing between implants and
their superstructures became clear at the 2007 International
Dental Show (IDS) in Cologne, Germany.
Recent studies have corroborated the existence of
relationships between peri-implantitis and re-infection
from implants [7, 8]. They specifically pointed out
that intra-implant gaps and cavities are very large
from a microbiological viewpoint. Thus the dimensional
proportions are conducive to pathogen colonization.
Intra-implant gaps and cavities
Intra-implant spaces are in direct contact with the
oral cavity (and its microorganisms) via gaps along
the implant threads. Structural drawings of implant
manufacturers clearly demonstrate that gaps and
cavities are indeed present (Fig. 2a). Their presence is
also apparent from radiographs, since most current
implants are made of radiolucent titanium (Fig. 2b).
Those gaps are so large that they offer no resistance
to pathogen invasion. Figure 3 illustrates the
gap size of an implant-abutment interface. Documented
sizes range from 4 to 125 μm [11]. Figure 4 illustrates
the dimensions of various intraoral microorganisms
by way of comparison. Here the documented
range is 1 to 10 μm [12]. Capillary forces, known to be
inversely related to gap size, also come into play (Fig. 5).
These conditions are ideal for pathogen invasion
and intra-implant survival. Micromovements of the

Fig. 1
This implant at
site 36 exhibits
peri-implantitis
and a vertical
bone pocket
extending down
to the apex.
1 2b
2a
Fig. 2a Cross-sectional schematic representation
of an implant stack (implant, abutment
and restoration). Red areas indicate
the cavities left upon assembly.
Fig. 3 Scanning electron micrograph (SEM) of an implantabutment
interface. The marginal gaps are clearly visible.
abutment during mastication are another factor. They
are associated with a pump-suction effect that will
further promote exchange of media between the
intra-implant and peri-implant spaces [13].
Based on current data obtained by scanning electron
microscopy, it seems unlikely that manufacturers
can possibly minimize the gap situation to the
point of obtaining an effective seal against pathogen
invasion. Even the greatest manufacturing precision
cannot eliminate the need for interposing some
material to compensate for the surface roughness of
implants and abutments.
Current sealing techniques
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Product Studies
Fig. 2b Radiographic view of three implants with single-restoration abutments
and fixation screws. Dark shadows indicating the persisting cavities are readily
visible.
Fig. 4 Sizes of microorganisms compared to implant marginal
gaps. Intra-implant spaces remain unprotected, since
bacteria can move freely in and out of the cavities virtually
without meeting any resistance.
While ingenious attempts have been undertaken to
accomplish sealing, some of these approaches have
been less than plausible.
One dental manufacturer (m&k dental Jena, Kahla,
Germany) promises that implant-abutment interfaces

86 EDI
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Fig. 5 Capillary forces
are particularly strong
in narrow gaps. They
will contaminate the
intra-implant cavities
by actively drawing
(microbially charged)
fluids.
Fig. 6 Silicones are another option to seal the intraimplant
spaces.
can be hermetically sealed with a gold foil. Efforts like
this deserve credit for acknowledging that gaps are
present and that they do require sealing. The problem
should not, however, be addressed by establishing
contact between dissimilar metals. Various
authors have shown that this situation will result in
salivary electrolyte streams causing the metals to
corrode by ion migration [14, 15]. The proposed gold
seal will be rather short-lived, not least because an
extremely soft form of gold must be used as a
sealant to achieve the desired effect.
Another manufacturer (GDF, Rosbach, Germany)
has introduced a silicone material by the name of
ImplaSeal (Fig. 6). This self-hardening material works
much like sanitary silicone sealants. It is supplied in
plastic syringes along with several syringe tips. GDF’s
concept introduces another source of gap formation,
since the material is bound to contract during setting.
There are also hygienic issues: only the syringe
tips are replaced, while the syringe itself is reusable.
Schmüdderich’s study describing a new sealant has
been mentioned previously in this article. The product
was introduced in 2007 and is being distributed
by Hager & Werken (Duisburg, Germany) under the
trade name of GapSeal (Fig. 7). The usefulness of
GapSeal is supported by current publications [6, 7, 8]
and user reports [16]. The author’s own experience
confirms these findings. All concur in believing that
this product is currently the most effective sealant in
the market, thanks to its logical design in terms of
consistency (long-term softness), ingredients (highly
viscous silicone base and thymol), application (autoclavable
applicator) and sterility (sterile carpules for
single use). The material offers excellent positional
stability due to its high viscosity. Being highly resist-
ant to washing out, it can be used even under
cement-retained superstructures. All sterility requirements
are met. The kit supplied is convenient to use
and exhibits a good cost-benefit ratio. GapSeal has
been clinically tested for ten years, offering implantologists
the special advantage of having a well-documented
and reliable product at their disposal [8].
Summary and discussion
Fig. 7 GapSeal is a highly viscous material. A special
applicator is used to load the sealant into implant
cavities without air inclusions.
Treatment considerations have resulted in attempts
to prevent peri-implantitis by avoiding its causes. Reinfection
from intra-implant spaces is a key pathogenic
factor. Gaps along the implant-abutment interface
are the pathway of such re-infection. They create
a situation in which pathogens are directly exchanged
between the oral cavity and intra-implant cavities.
Efforts have been made to develop sealing techniques.
While some attempts have not been successful,
they should be given credit for acknowledging
that gaps and cavities do exist in assembled
implants. A variety of strategies have been used to
establish hermetic sealing against pathogens. This is
a logical goal, as existing conditions have previously
allowed bacteria to migrate into implants, where
they find a favourable environment for survival, such
that they will propagate and subsequently migrate
back into the oral cavity. Implant materials cannot by
themselves ensure an adequate seal, no matter how
carefully an implant system is manufactured. Consequently,
a highly viscous sealant needs to be interposed.
This material should offer maximum bactericidal
activity and resistance to aging. Peri-implantitis
– if only cases maintained by re-infection such as
those described in this article – could be successfully
avoided in this way. Now that the problem has
become apparent, it is expected that manufacturers

will press ahead with eliminating this disadvantage
of assembled implants. New products are going to be
offered that will expand the range of potential solutions.
GapSeal as a universal sealant has yielded the
best results so far.
References
Contact Address
Christian Krenkel, MD, DMD, PhD
Clinic of Oral and Maxillofacial Surgery
Paracelsus Medical University
Federal Medical Center Salzburg
Landesklinik Salzburg
Müllner Hauptstrasse 48
A-5020 Salzburg
AUSTRIA
Phone: +43 662 4482-3601
Fax: +43 662 4482-884
c.krenkel@salk.at
www.endodistraction.com
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[1] Albrektsson, T., Isidor, F.: Consensus report of session IV. In: Lang, N. P.,
Karring, T. (Hrsg). Proceedings of 1st European Workshop on Perio dontology.
London: Quintessence Publishing Co., Ltd. 1994 (365-369).
[2] Ratka-Krüger, P., Horodko, M., Mayer, M.: Ätiologie, Diagnostik, Therapie
und Prävention der Peri-implantitis. ZM 91, 23, 2001 (50-56).
[3] Spiekermann, H.: Peri-implantäre Krankheiten. In: Hrsg. Ratei tschak,
K. H., Wolf, H. F. Implantologie. Georg Thieme Verlag, Stuttgart,
New York 1994 (317-328).
[4] Marinello, C. P., Kundert, E., Andreoni, C.: Die Bedeutung der periimplantären
Nachsorge für Zahnarzt und Patient. Implantologie 1,
1993 (43-57).
[5] Günay, H., Bohnenkamp A.: Peri-implantäre Infektionen, Quintessenz
12, 2006 (1355-1369).
[6] Schmüdderich, W.: Entwicklung eines Materials für die Versie gelung
von Implantatinnenräumen zur Prophylaxe bakterieller Kontamination.
Diss. Med. Dent. Düsseldorf 2001.
[7] Fritzemeier, C. U.: GapSeal – ein Material zur Versiegelung von
Implantatinnenräumen. ZMK 23, 2007 (2-3).
[8] Fritzemeier, C. U., Schmüdderich, W.: Peri-implantitisprophylaxe
durch Versiegelung der Implantatinnenräume mit GapSeal. Im plantologie
15, 2007 (71-79).
[9] Kleisner, J., Marinello, C. P., Kundert, E., Lüthy, H.: Prävention bakte -
riel ler Kontamination von Implantatkomponenten in vivo durch
ein anzuwendendes Metronidazol – Gel. Dent Implantol 2, 4, 1998
(284-296).
[10] Buchmann, R.: Mikrobielle Infekte beseitigen, Überlastungen
verringern. Implantologie Journal 2, 2000 (48-62).
[11] Binon, P., Weir, D., Wantanabe, L., Walker, L.: Implant Component
Compatibility. In: Hrsg. Laney, W. R., Tolman, D. E.: Tissue Integration
in Oral, Orthopedic & Maxillofacial Reconstruction, Mayo Medical
Center Rochester, Minnesota, 1990.
[12] Otte, H.-J.: Leitfaden der medizinischen Mikrobiologie, Gustav
Fischer Verlag, Stuttgart, 1965.
[13] Zipprich, H., Weigl, P., Lange, B., Lauer, H.-C.: Erfassung, Ur sa chen
und Folgen von Mikrobewegungen am Implantat-Abutment-
Interface. Implantologie 15, 2007 (31-46).
[14] Battaini, P., Neve, T.: Verhältnis zwischen der elektrochemischen
Korrosion von Dentallegierungen und ihrer Kompatibilität mit dem
menschlichen Körper. Werksmitteilung der Fa. Rigatti Luchini,
Como 1994.
[15] Fritzemeier, C. U., Steffens, E.: Titan als neues Restaurationsmetall
in der Zahnärztlichen Prothetik und der Mund-, Kiefer- und
Plastischen Gesichtschirurgie. ZWR 101, 1992 (589-595).
[16] Sellmann, H.: „Dicht“ machen. dental:spiegel 27, 2007 (41-42).

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A clinical study on the soft-tissue healing capacity around the treated surfaces of
one-piece screw implants
Soft-tissue Healing Around
Surface-roughened One-piece
Implants
Prof Emanuel A. Bratu, Dr Olimpiu L. Karancsi and Dr Radu Sita, Timisoara/Romania
This study was performed to evaluate the soft-tissue healing capacity around the treated surfaces of
one-piece screw implants.
Materials and methods
The study comprised six patients, each of whom
received one or two fully surface-roughened one-piece
covered screw implants (MIS, Shlomi, Israel), 10 to 13 mm
in length and 3 mm in diameter, in different locations
within the mouth. The baseline examination evaluated
the patients’ medical history and smoking habit, and
included extraoral and intraoral clinical examinations
and Panoramic X-rays. The patients’ bone and soft-tissue
volume were also estimated. Only patients with a
sufficient bone supply were included. The minimum
requirements for implant insertion were 4 mm of bone
width and 11 mm of bone height. The surgical intervention
was performed under local anaesthesia (Ultracain
DS Forte, Aventis).
Surgical procedure
A crestal incision was performed and full mucoperiosteal
flaps were elevated at the insertion sites. The
bone was cleaned of periosteal tissue, and the
implant positions were marked with a round bur. A
2 mm pilot drill marked the depth and angulation of
the implant. A 2.8 mm enlargement drill was used for
the first 2 mm of depth in the cortical crestal bone.
The implants were inserted with a ratchet until the
threads were completely covered by bone. The post -
operative medication included antibiotics (Augmentin
1 g, SmithKline Beecham) for six days and analgesics
(Ketonal forte, 200 mg) for three days. Probing depths
around the implants were taken after suture (Silk, 4-0,
B. Braun). Periotest measurements taken after insertion
yielded values of between 2 and –4.
Follow-up
Patients were asked to return after three days. A decision
to perform immediate restoration or to allow
for a healing period was made depending on the
patients’ periotest values. One-half of the patients
(with negative periotest values) received provisional
restorations; the other half (with positive values) did
not. The immediate restorations were made of acrylic
resin and cemented with provisional Temp-Bond
cement (Kerr).
For the patients who waited three months, probing
depths were again measured after the healing period
and compared to those on the day of surgery. Both
patient groups received instructions in oral hygiene
and were told to eat only soft food for two weeks following
their visit. No implant was lost during the study
period. All patients presented with attached healed
gingiva around the implants. The group with provisional
restorations showed faster and better healing
compared with the group with no restorations.
Results
The six patients comprised four men and two women
with a mean age of 48 (37 to 60) years. All patients
presented with small edentulous areas rather than
extensive tooth loss. Probing depths varied between
2 and 4 mm at suturing, and between 1 and 2 mm
after three months. No bleeding was observed. There
were no significant differences between male and
female patients. Patients with thicker peri-implant tissue
had smaller probing depths than those with thinner
peri-implant tissue. It was attempted to obtain

Fig. 1
Oral status
at baseline.
Fig. 2
Panoramic X-ray
of the initial
status.
Fig. 3
Periotest
values after
insertion.
Fig. 4
Panoramic X-ray
of the initial
status.
Fig. 5
Probing depths
after suture
removal,
implant 22.
Fig. 6
Probing depths
after three months
with provisional
restoration in
place, implant 22.
Fig. 7
Probing depths
before cementing
the final restoration,
implant 24.
Fig. 8
Final restoration in
place.
Fig. 9
Panoramic X-ray
after final
restoration
setting.
Fig.10
One-piece
implant (UNO)
in Panoramic
X-ray.
Case 1
1 2
3 4
5 6
7 8
9 10
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90 EDI
Product Studies
Case 2
11 12
attached gingiva around the implants (without which
probing depth measurements would have made no
sense). This confirms the theory of attached keratinized
gingiva forming around implants.
Discussion
The present clinical study evaluated the stabilization
of the soft tissue around surface-roughened implants.
At the first examination following implant insertion,
probing depths were greater than after three months.
This is as expected based on the healing process of the
peri-implant tissues. Of clinical importance is the fact
that there was no irritation of the soft tissues around
the implants during the healing period. This suggests
that the gingiva recovers well and adheres on a rough
surface, whether or not a patient receives a provisional,
if certain preconditions are met.
Conclusion
The study has shown that if attached gingiva around
the implant can be obtained, there is no absolute
need for a polished implant neck to prevent periimplant
tissue irritation. Also, pocket depths correlate
Nr Age Sex Size Position Periotest
value
with the thickness of the mucosa – the thicker the
mucosa, the smaller the depth. However, if the gingiva
is not attached, plaque deposit problems can arise,
and implant failure becomes possible. Initial results
have been promising, but further investigation and
longer observation periods are needed in order to
make a definitive statement on this issue.
Probing depth
Insertion 3 months
1 45 F 3/13 36 -1 4 2
3/13 37 0 3 1,5
2 50 M 3/13 43 -3 3 1,5
3 47 M 3/10 12 +1 3,5 2
4 62 M 3/13 45 -4 4 2
5 51 M 3/10 22 +2 4 1,5
3/13 24 +1 3 2
6 37 F 3/10 14 0 3 1
13
Contact Address
M.I.S. Implant Technologies Ltd
P.O.Box 110, Shlomi 22832, ISRAEL
www.mis-implants.com
Fig. 11
Panoramic
X-ray at patient
presentation.
Fig. 12
Probing depths
after suturing,
implant 36.
Fig. 13
Panoramic
X-ray after
implant
insertion.

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A basis for predictable esthetic transitional contour
Immediate Placement and Loading
Fernando Rojas-Vizcaya, DDS, MS, Chapel Hill/USA
In this complex case, Astra Tech BioManagement Complex supported and preserved the esthetics and functional
results by maintaining marginal bone and healthy peri-implant tissues.
In cases like this, the starting point is always the
desired cervical contour for the new crown. If placing
the implant 3 mm from this contour, the desired biologic
width can be created. But it’s important to
remember that the stability of cervical buccal tissue
is the ultimate determinant of esthetics. This means
preserving this soft tissue architecture while also
ensuring optimum marginal bone levels. In this case,
the Astra Tech BioManagement Complex is the basis
for predictable esthetic transitional contour.
Complex case, predictable outcome
This complex case of immediate placement and
immediate loading in an edentulous maxilla demon-
Fig. 1 Cervical contour design for fully maxillary
rehabilitation – creation of the new
esthetic information.
Fig. 4 Surgical stent showing the new cervical
contour.
strates how the BioManagement Complex works in
practice (Figs. 1 to 21). Starting with the desired cervical
contour, the optimal implant three-dimensional
placement is created when using a 2 mm/3 mm depth
rule from the cervical contour of the planed crown
indicated by the surgical stent.
Creating the optimal space
Rather than simply placing implants in available bone,
the cervical surgical guide created from the wax-up
allowed the removal of bone where necessary to create
the optimal 3 mm space from the planned crown
in the area of implants and pontics – while leaving
osseous peaks to support the interdental papillae.
Fig. 2 Before extraction. Fig. 3 After non-traumatic extraction – ready
for immediate placement protocol.
Fig. 5 Implants are to be placed 3 mm from
the cervical contour and 2 mm palatal to it.
Fig. 6 Before placing the implants, bone needs
to be removed.

Fig. 7 Try-in of provisional restoration before
bone reduction – the cervical contour is in
contact with the bone.
Fig. 8 Bone is removed using the cervical contour
of the surgical stent as reference.
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Fig. 9 Try-in of provisional restoration after
bone reduction – bone is 3 mm from the
cervical contour of the planned crowns.
Fig. 10 Localization of the ideal three-dimensional implant position using the surgical stent. Fig. 11 Implants are placed and primary stability
is obtained. Osseous peaks are left to support
the interdental papillae.

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Fig. 12 Closure, after abutment placement –
ready for immediate loading.
Fig. 15 New soft tissue contour with mesial
and distal papillae between the implants.
Fig. 18 No black triangles can be seen after 1.5 years – maintenance of
function and esthetics.
The desired result
Once the desired architecture was established and
implants placed, the BioManagement Complex supported
and preserved the desired result. The provisional
restoration, that had established the transitional
contour, guided the soft tissue during the healing
process and created the interdental papilla.
With acknowledgement to:
Jorge Cid Yáñez, CDT, Lica Pirv, CDT.
Fig. 13 Provisional restoration after immediate
loading protocol.
Fig. 16 Maintenance of the initial esthetic
design in the final restoration-position of the
zenith and a natural balance of the gingival
level.
Fig. 19 Final result.
Figs. 20 and 21 Final results after a full upper arch rehabilitation – frontal and palatine view.
Contact Address
Astra Tech AB
Box 14 · 431 21 Mölndal
SWEDEN
Phone: +46 31 7763000
www.astratechdental.com
Fig. 14 Healthy soft tissue after twelve weeks –
interproximal papillae and space for ovate
pontics.
Fig. 17 Panoramic x-ray showing bone preservation
– note the interproximal bone that
supports the central papilla.

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Astra Tech World Congress 2008
Making New Discoveries
The second Astra Tech World Congress at Gaylord National Resort in Washington, DC
is over and it was yet another success. “Get inspired” and “Making new discoveries”
were the overall messages of a congress that delivered four days of high-class presen-
tations, discussions, hands-on demonstrations, and awe-inspiring entertainment.
In his opening speech at the world congress, the President
and CEO of Astra Tech, Peter Selley, made a point
about the importance of scientific documentation in
regard to innovations and new discoveries in implant
dentistry, as it is not enough to design, invent and
market a product, it also has to be documented and
proven safe before it is placed in a patient. Innovation
and competitiveness in implant dentistry must never
put the safety and the well-being of the patient at risk.
From the very beginning, the development of the
Astra Tech Implant System was built on a very serious
approach to scientific documentation and patient
safety, in combination with curiosity, courage, determination
and search for excellence. Groundbreaking
innovations are the cornerstones of the Astra Tech
BioManagement Complex – Conical Seal Design,
MicroThread, OsseoSpeed and Connective Contour.
Exhibition archipelago
The exhibition area, spread out over 6,800 square
meters, provided an ocean of knowledge, where it
was possible to go deep beneath the surface and
study all the facts, details and specifics of what Astra
Tech Dental can offer. The delegates could cruise
between the islands of their interests and needs: Scientific
island, Surgical island, Restorative island, and
Training & Education island. By offering product
news, scientific documentation, one-on-one demonstrations,
hands-on training, and Speakers’ Corner
presentations, all visitors were able to make new discoveries
in the exhibition archipelago.
New products
The official launch of Atlantis, the CAD/CAM solution
for cement-retained, patient-specific abutments,
took place at the congress. By utilizing the Atlantis
VAD (Virtual Abutment Design) software, the abutments
are individually designed from the final tooth
shape. The result is an abutment
with outstanding
function and esthetics.
Two new OsseoSpeed
implants were also introduced
at the congress. One is a
short implant ideal for cases
with limited vertical bone height,
that also helps reduce the need for
bone augmentation. The other new
implant, OsseoSpeed 3.0 S, is one of the
few two-piece implant solutions on the
market today that is optimal for cases with limited
horizontal space.
Diary of a congress delegate
WEDNESDAY, JUNE 4 The congress kicked off today.
The nice weather all of a sudden turned into a spectacular
thunderstorm, like inauguration fireworks! The
afternoon started with sixteen pre-congress presentations
that welcomed over 500 attendees. The lectures
and hands-on program offered something for everyone,
from those new to implant dentistry to those
interested in more advanced techniques. There were
also programs in Spanish, Italian, French and Scandinavian
languages. Meanwhile, the poster authors were
busy posting their work – more than 138 posters participated
in the poster competition. It was a great start of
the congress and I’m looking forward to the remaining
three days of 131 internationally renowned researchers
speaking on issues of implant dentistry.
THURSDAY, JUNE 5 Finally, the international dental
community assembled for the Grand Opening. Performing
artists started the morning in a very inspiring
way, followed by the President and CEO of Astra Tech,
Peter Selley, officially opening the congress. Eight
world-renowned speakers presented during the
morning session, moderated by the chairman of the
Peter Selley
Jan Lindhe
Tomas
Albrekt sson

Scientific Committee, Professor Jan Lindhe. The session
covered topics in implant dentistry ranging from the
edentulous patient and oral infection and inflammation
as a risk factor, to special needs patients, treatment
planning, patient quality of life, and the future
of implant dentistry. For example, Professor Lindhe
emphasized the importance of implant design for the
preservation of soft tissue. Another highlight was
Professor Tomas Albrektsson’s presentation
“Implants in dentistry – history and future,” in
which he suggested that it is time to reconsider
the 1986 standard for marginal bone levels
with regard to implant success.
The afternoon featured three parallel sessions.
It was hard to choose between them,
but I managed to listen to parts of all three
sessions. The surgical session discussed
pharmacological issues in implant dentistry,
treatment planning protocols, minor soft tissue
procedures, sinus grafting and solutions
for challenging situations, while the restorative
session addressed provisionals, abutment
selection, cemented restorations, and screwretained
restorations. The focus of the third session,
„Unlimited possibilities in implant dentistry”,
was implant research, diagnostic technology, and
CAD/CAM and restorative solutions.
After a full day of in-depth learning, I attended an
unforgettable evening at the Smithsonian American
Art Museum and the National Portrait Gallery in
downtown Washington, DC. The theme of the
evening, “Making new discoveries through art,” gave
the scientific content of the morning and afternoon
the best possible ending. Great day!
FRIDAY, JUNE 6 The congress continued in high gear
this morning with “A Good Morning with Astra Tech,”
an innovative and fun morning show where six
speakers discussed controversies in immediate placement
and loading, inter-implant distance, digital
implant dentistry today and tomorrow, and the psychosocial
factors affecting the treatment outcomes
of maxillofacial conditions. Rich with live music, news
breaks and a dynamic talk show format, the morning
presentations set the stage for another inspirational
day. The lecture by Professor Rhonda Jacob from the
Department of Neck and Head Surgery at the University
of Texas M.D. Anderson Cancer Center, called
“Implants in the rehabilitation of head and neck cancer
patients – a hope for the future” truly embodied
the true meaning of the expression “quality of life”
for this vulnerable patient group. The morning session
ended with an intense and interesting panel discussion
lead by the two moderators Dr Michael Norton,
UK, and Dr Sverker Toreskog, Sweden.
After lunch it was time for seven parallel sessions.
The topics ranged from “Advanced technology in support
of implant therapy” and “Implants moving
towards a standard of care” to “Prevention and management
of complications” and “Frontline research in
implantology.”
After such a busy day, it was great to sit down for
an evening of “Making new discoveries through
music, song and dance.” Dinner and a three-act performance
unified the international audience with a
montage of orchestral, musical and dance styles.
SATURDAY, JUNE 7 The morning begun with a session
called “Esthetics and the future” in which six speakers
spoke on how biology dictates and implant components
and clinical management support natural esthetic
results. The session covered many different aspects of
the topic, from the fresh extraction socket to the longterm
success of the esthetically restored patient.
The winner of the Astra Tech Scientific Award was
also presented during this session – Professor John
Brunski of the Rensselaer Polytechnic Institute of Troy,
New York. Much of his work is focused on the properties
of the bone-implant interface and reliable models
for predicting implant loading and stress-strain
conditions at interfaces.
A Good Morning with Astra Tech.
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Business & Events
Let’s not forget the winners of the poster competition.
Dr Gustavo Mendonca of Brazil won in the
Research category, with Dr Ahmad Hamdan of France as
runner-up. In the Clinical application category, Dr Jenni
Rissanen, Finland, took home first prize, while Dr Hans
Bystedt, Sweden, walked away with second prize.
Professor Lindhe and Professor Albrektsson, two brilliant
minds and legends in their field, delivered the
closing remarks in an inspiring and very humorous
way. A great ending to a congress that delivered 131
internationally renowned speakers and scientists in
the extensive scientific program, 138 exciting and
inspiring posters, sixteen pre-congress courses, four
exhibition islands, three Speakers’ Corners, five award
winners, and delegates from 37 countries.

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BioHorizons Global Symposium 2008
Groundbreaking Technology
The 2008 BioHorizons Global Symposium drew more than 1,000 attendees from 42 countries to San Diego, California for
a three-day scientific program on today’s most important implant and tissue regeneration topics. Each clinician-moderated
session featured a panel discussion of audience-submitted questions that kept participants fully engaged in the program.
Members of the scientific panel and moderators
included Drs Carl E. Misch, Michael A. Pikos, Maurice
Salama and Michael Reddy. Featured presenters
included Drs Edward P. Allen, Stuart Froum, Michael
McCracken, Craig Misch, Myron Nevins, and Marius
Steigmann.
The keynote session featured presentations on the
ground-breaking Laser-Lok microchannels, BioHorizons’
proprietary surface treatment now offered on
Tapered Internal, Single-stage and Internal implants.
Dr Jack Ricci from NYU presented 15 years of in vitro,
animal and human studies conducted at leading universities
around the world on this precision-engineered
surface. Dr Myron Nevins from Harvard University
presented results from his landmark study:
Human Histological Evidence of a Connective Tissue
Attachment to a Dental Implant.* In this study, Laser-
Lok was shown to attract a physical connective tissue
attachment to a predetermined zone on the implant
while inhibiting epithelial downgrowth and preserving
coronal bone levels. Dr Nevins also showed Laser-
Lok implants placed up to nine-years post-op with
little to no bone loss.
BioHorizons and Dental Technologies, Inc. (DTI) also
announced a new Restoration-to-Implant Lifetime
Warranty covering implants, abutments and restorations
when fabricated by a participating DTI Laboratory.
This unique offer, made possible by the recent
merger of BioHorizons and DTI, brings incredible
value and practice building potential to the entire
implant team.
R. Steven Boggan, President and CEO, said in
regard to the unprecedented attendance: “Bio-
Horizons continues to be one of the fastest growing
implant companies in the industry because of
unique offerings like Laser-Lok and our Lifetime
Warranty program. The Global Symposium presentations
and attendance are indicative of our grow-
ing momentum that stems from science-based
design and synergies with high-tech partners
such as DTI.”
BioHorizons will present the 2009 Global Symposium
from April 30 to May 2, 2009, in Chicago, Illinois.
Attendance will be limited, and another sell-out is
expected, so please register early to ensure your
spot.
* International Journal of Periodontics & Restorative
Dentistry, Vol. 28, #2, April 2008.
More Information
BioHorizons
www.biohorizons.com
Myron Nevins,
DDS
Michael A. Pikos,
DDS

The home of
Gaudí.
CARS 2008
exhibition.
CARS 2008 in Barcelona
Bridging the Gap between
Diagnostics and Computer
Science
The CARS Congress is the most important international
forum for applied advanced information technology in
radiology and surgery. It covers a wide spectrum from
radiological imaging and management (PACS) to computer
science and engineering applications in surgery
(planning, simulation, navigation, robotics etc). Along
with the 22 nd International Congress and Exhibition, CARS
covered a wide range of topics: medical imaging, cardiovascular
imaging, maxillofacial computer imaging,
image processing and image display, telemedicine and
e-health, computer-aided diagnosis, computer-assisted
radiation therapy, surgical navigation, surgical robotics
and instrumentation, surgical simulation and education,
computer assisted orthopaedic and spinal surgery, computer-assisted
head and neck surgery, image-guided
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Business & Events
The International Congress of CARS (Computer-Assisted Radiology and Surgery) “aims to provide a forum to close
the gap between diagnostic and interventional radiology, surgery and computer science and to encourage inter-
disciplinary research and development activities in an international environment”, says the organizer of CARS 2008
in Barcelona, Dr Heinz U. Lemke, Professor for Computer-Assisted Surgery at the University of Leipzig, Germany.
neurosurgery and minimally invasive cardiovascular and
thoraco-abdominal surgery and not least maxillofacial
imaging. From June 25 to 28, CARS 2008 was the meeting
point for international experts, providing balanced
and in-depth information on new diagnostic and therapeutic
procedures including results from multidisciplinary
research and development efforts, treatment
providers’ experiences, patient outcomes, economic and
management considerations and well as scientific
results of medical validation. To make the new technologies
available to medical and health care specialists, the
scientific committee headed by CARS president Dr Javier
Herrero Jover had decided to extend the program with a
Clinical Day. This day turned out to be an educative event
where experts from radiological and surgical specialities
presented advanced IT applications in the diagnosis and
therapy of highly relevant clinical topics.
The 14 th Computed Maxillofacial Imaging Congress
chaired by Dr Allan G Farman (USA) showed what is possible
today in maxillofacial surgery, dentistry and dental
implantology. Speakers from the Universities of Cologne
and Hannover (Germany) covered the accuracy of a
newly developed integrated system for dental implant
planning (Dreiseidler) and the biomechanical effects of
surgical assisted rapid maxillary expansion by bone
anchored intraoral distraction device: a three-dimensional
finite element analysis (Hassfeld and co-workers).
Renowned speakers from the US gave lectures on contrasting
aspects of orbital floor fractures in the setting of
zygomaticomaxillary complex injuries versus isolated
orbital injury (Marcus and coworkers, University of
Durham, and Follmar and coworkers, University of Baltimore).
At the end, the international party of CARS 2008
allowed participants to catch a glimpse of tomorrow’s
service robots in surgery and medicine.

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EAO 17 th Annual Scientific Meeting, Warsaw, 18 – 20 September 2008
Clinical Advances and
Predictability with Oral Implants
The European Association for Osseointegration (EAO) will hold its 17 th Annual Scientific Meeting
at the PKIN Congress Centre in Warsaw, Poland, from 18 to 20 September 2008.
This year the congress will be co-chaired by Dr David
Harris and Dr Andrzej Wojtowicz. The 2008 EAO
meeting has been organized in collaboration with
the National Polish Implantology Association (OSIS).
Based on the statistics of the previous congress,
this year’s meeting, themed ‘Clinical Advances and
Predictability with Oral Implants’, is expected to welcome
about 3,000 experts from around the world to
share knowledge and experience in the field of
implant dentistry. The scientific programme will
mainly focus on topics like bio-active surfaces, medical
impairment, oncology, bisphosphonates, extra
oral cases, biomedical imaging, digital planning and
transfer to clinical procedures, navigation and guided
implant placement, gero-implantology, quality of life,
simplified treatment protocol, long-term management,
and treatment in the aesthetic zone.
By ensuring exciting three days with worldrenowned
speakers presenting recent advances on
highly relevant scientific and clinical topics in
osseointegration, the Warsaw Meeting will allow
researchers and clinicians to get state-of-the-art
information on all the different aspects using
osseointegrated implants in dentistry.
More Information
European Association for Osseointegration
www.eao.org

Foundation awards prize to young scientists
The camlog foundation
Research Award 2008/2009
Participants will have from the middle of 2008 to the
end of 2009 to prepare their research papers, which
are to be submitted to the camlog foundation after
their publication in a recognized scientific journal.
The research underlying the expected exceptional
scientific papers must have been conducted in one of
the countries in which Camlog Biotechnologies AG,
Basel, is represented by its products and services. The
papers may be written in either English or German.
The papers to be submitted are to relate to one of the
following three areas:
- Conceptual approaches for sustainable results
in implant dentistry
- Concepts for optimum red-white esthetics
- Convincing long-term results
The papers will be judged and assessed by the scientific
jury, consisting of five members of the Foundation
board and the Scientific Board of the camlog
foundation. The winner of the camlog foundation
Research Award 2008/2009 will have the opportunity
of presenting his or her paper to a larger audience at
the International Camlog Congress 2010, where
entries will also be invited for the camlog foundation
Research Award 2010/2011. Conditions of entry and
the entry form on which entries must be made can be
downloaded from http://www.camlogfoundation.org/.
The camlog foundation is a foundation established
by scientists under Swiss law. It engages in targeted
supporting of gifted young scientists, promotion of
basic and applied research, and continuing training
and education to promote progress in implant dentistry
and related fields to serve the patient. As part
of its scientific mission, the camlog foundation has
assumed patronage of the International Camlog
Congresses, which take place every two years.
The World of
Dental Edutainment
EDI 101
Business & Events
During the International Camlog Congress held in May 2008 in Basel, the President of the camlog foundation, Prof Rolf Ewers,
Vienna, announced and invited entries for the camlog foundation Research Award 2008/2009, which offers prizes of
CHF 10,000 for the winner, CHF 6,000 for the runner up and CHF 4,000 for the third place. Entries are invited from committed
specialists aged under 45 years working in universities, hospitals and surgeries.
More Information
camlog foundation
Margarethenstrasse 38 . CH-4053 Basel . SWITZERLAND
Phone: +41 61 56541-14
foundation@camlog.com . www.camlogfoundation.org
www.dental-online-community.com
The free continuing-education platform
for dentists and dental technicians

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SimPlant Academy World Conference on 3D Digital Dentistry
Successful Outcome
On Friday 30 and Saturday 31 May 2008, clinicians and laboratory technicians from 35 different countries came to Vienna to
participate in Materialise Dental’s 7 th edition of its SimPlant Academy World Conference on computer guided dentistry.
Set in the comfortable surroundings of the Hilton, clinicians attended intensive SimPlant software training sessions, hands-on
workshops and various lectures by key opinion leaders.
The SimPlant Academy World Conference kicked off
on Friday morning 30 May with two corporate fora,
one dedicated to Friadent’s ExpertEase and the other
to Biomet 3i’s Navigator technology. Ashok Sethi, BDS,
spoke for the former sponsor and Michael Block,
DMD, acted as a speaker for the second sponsor Biomet
3i. Other sponsors that were also represented at
the SimPlant Academy World Conference were Astra
Tech Dental (Facilitate), DeguDent, KaVo, Morita,
NewTom and Planmeca.
The corporate fora in the morning were followed by
a number of intensive SimPlant software training sessions,
which were designed for all levels of users and
were appreciated by many of the participants. On this
occasion, Materialise Dental took the opportunity to
introduce SimPlant 12, their latest software version.
During the afternoon sessions, interactive workshops
provided a terrific practical insight in the whole
process from scanning and planning to guided
implant placement, to the ultimate Immediate Smile.
Delegates got answers on questions such as “how is a
scan prosthesis made” and “what are the differences
between CT & CBCT scanners and what are the
requirements for a good scan”. Several CBCT scanners
were demonstrated by the respective manufacturers.
Treatment planning skills were practiced with real
patient cases and practical sessions with all of Materialise
Dental’s partners’ surgical kits combined with
genuine SAFE SurgiGuide drill guides taught how surprises
can be eliminated when drilling and placing
implants. SimPlant 12 now also offers the Next Innovation
SurgiGuide drill guide preview, allowing dentists
to customize a SurgiGuide according to their preferences.
And thanks to FastTrack planning, delivery time
of SurgiGuide drill guides is significantly reduced.
The Friday training sessions and workshops were
finally concluded with an exquisite dinner at the
Palais Pallavicini, a beautiful classical style palace
which was constructed in the eighteenth century and
is situated in the center of Vienna. The comfortable
and relaxed setting invited Materialise Dental and
its guests to reflect on an intensive but fruitful day.
Key opinion leaders sharing their
thoughts on 3D Digital Dentistry
Whereas the first day was dedicated to interactive
software training sessions and workshops, impressive
lectures by various key opinion leaders marked
the second day of the World Conference in Vienna.
Moderator Dr Elmar Frank, Director of the SimPlant
Academy in German-speaking countries, guided the
audience and lecturers through a series of four different
themes. The first round of lectures touched the
subject of the interdisciplinary approach of 3D Digital
Dentistry. Professor Ignace Naert and Professor Marc
Quirynen from the K.U.Leuven, Belgium, held a tandem
presentation on “3D Digital Dentistry to optimize
patient care”. A second tandem presentation on “The
interaction between an orthodontist and an oral maxillofacial
surgeon in an orthognathic surgery: a case
planning with SimPlant OMS, 3D Dento-Facial-Planner,”
was held by Dr Herman de Jonghe from The
Netherlands and Dr Nico Vrijens from Belgium.
The second round of lectures was all about widening
the scope with regard to virtual bone augmentation.
George Mandelaris, DDS, MS, talked about “Sinus floor
augmentation in the atrophic maxilla: a novel
approach using guided surgery with and without
Interactive workshops
provided a
terrific practical
insight in the
whole process from
scanning and planning
to guided
implant placement,
to the ultimate
Immediate Smile.

Dr Dr Steffen Hohl
lecturing on “High
end restorations –
predictability
through virtual
planning.”
EDI 103
Business & Events
simultaneous implant placement”, and Dr Andreas
Kullmann touched the subject of “Bone augmentation
based on advanced 3D printing technology”.
The third round of lectures was about predictable
esthetic planning. Dr Dr Steffen Hohl from Germany
held a lecture about “High end restorations – predictability
through virtual planning”, while Ashok
Sethi, BDS, presented his lecture on “Aesthetics: predicting
improved outcomes with better imaging
modalities and guided surgery”.
In the final round of lectures, two other experts went
deeper into the subject of facilitating the decision making
process for immediate loading through virtual
imaging. Dr Frank Spiegelberg from Germany talked
about “Immediate Smile following implant placement
in immediate extraction sites”, and Michael Block, DMD,
from the United States provided the icing on the cake
by lecturing on “Immediate provisionalisation in partially
edentulous cases – how to avoid complications”.
In between the different lectures, speakers from
universities and private practices in Austria, France,
Germany, Italy and Turkey presented their innovative
abstracts which had been selected by the scientific
committee. The key opinion leaders that made up
this scientific committee were Scott Ganz, DMD, Professor
Ignace Naert, Michael R. Norton, BDS, Ashok
Sethi, BDS, Professor Alberto Sicilia and Professor
Werner Zechner. Prior to the World Conference, they
had the strenuous task of selecting six top abstracts
pertaining to not only research topics involving computer
guided dentistry with SimPlant but also to the
description of extraordinary patient cases which had
been treated with the aid of SimPlant technology.
At the SimPlant Academy World Conference, Materialise
Dental also took the opportunity to inform
participants about their worldwide training schedule.
In addition to these regular trainings, the company
will hold its next clinical course and company visit
on 3 and 4 October at its headquarters in Belgium.
More Information
Materialise Dental HQ
www.simplantacademy.org

104 EDI
Business & Events
Planmeca’s equipment and software integration concept will be adopted
in Denmark
An Investment to the Future
Planmeca Oy introduced technologically pioneering dental equipment and software integration based on learning environment
for dental education in 2006. Since then the system has successfully been implemented to top-ranking dental schools such as
the Baltimore College of Dental Surgery, University of Maryland Dental School (UMB) and the Faculty of Dentistry at the
University of British Columbia (UBC). Now Planmeca supplies the system to the School of Dentistry, University of Copenhagen
and the Aarhus School of Dentistry also including dental hygienist and dental technician education in both institutions.
The agreement amounts to approximately 9.5 million euros.
Planmeca supplies the School of Dentistry, University
of Copenhagen and the Aarhus School of Dentistry
with 396 digital dental units, 50 digital simulation
workstations, and 600 ultrasonic scalers with LED
light. Planmeca’s solution features a centralised
waterline cleaning system and a centralised suction
hose cleaning system. These features are tailored
especially to fulfil rigorous hygiene demands of large
university clinics.
Moreover, the delivery includes a software solution
that links digital dental units to the information network
enabling remote monitoring, maintenance, and
management of the dental units and instruments.
The intelligent solution preindicates maintenance
routines of the unit, which is highly useful in large
facilities. Networking also enables automatic storage
of unit and instrument specific data, providing a data
pool for student performance evaluation, quality
assurance, and research purposes.
“Our references make Planmeca a reliable partner
in such extensive projects that require profound
understanding of clinical workflow as well as special
University of Copenhagen
equipment maintenance needs of a large institution,”
states Tuomas Lokki, Vice President, Marketing
and Sales.
The delivery is one of the largest investments to
dental care in Scandinavia. The first deliveries took
place in August 2008. The entire project will be completed
in 2010.
More Information
Planmeca Oy
Asentajankatu 6
00880 Helsinki
FINLAND
Phone: +358 20 7795 500
www.planmeca.com
Already installed
units at the
University of
Maryland, USA.

Camlog Invests
in the Future of
its Wimsheim Site
The symbolic first sod was turned on 5 May to mark the start of a signifi-
cant extension to Altatec- und Camlog Vertriebs GmbH’s existing produc-
tion and office facilities in Wimsheim, Germany, which opened in 2004.
Completion of the new buildings and the start of production are sched-
uled for June 2009.
The square extension is modular in
concept and will double the effective
area from its present 7,500 square
meters after only four years. In
addition to the expansion of the
production, logistics and office space
made necessary by the company’s
The symbolic first sod was turned on 5 May.
remarkable success, the Camlog
group also has other targets in its
sights. The most important of these
are consistently expanding production
in accordance with technical
cybernetic considerations, a
perceptible increase in production
intensity and the ongoing organizational
expansion and adaptation
to the new dimensions into which
the internationally successful Camlog
Group has now grown. One
hundred new jobs are scheduled
to be created in Wimsheim in the
next three years.
EDI 105
Business & Events
Jürg Eichenberger, Chief Executive
Officer of Camlog Biotechno -
logies AG, stresses that by making
these extensive investments, the
globally operating dental im plant
manufacturer is also making a
clear statement: Camlog is com-
mitting to the long term at
Wimsheim and is thus firmly
declaring its belief in Germany as
a location and in the ‘Made in
Germany’ stamp of quality.
More Information
Camlog Biotechnologies AG
Margarethenstrasse 38
CH-4053 Basel
SWITZERLAND
Phone: +41 61 56541-00
info@camlog.com
www.camlog.com

106 EDI
Product Reports
Natix by Tigran Technologies
More Stable Implants
with Titanium Granules
A new material for supporting bone in-growth around dental implants provides increased stability and is
easy to apply. These promising results are the outcome of clinical trials of the material when it is used to treat
peri-implantitis and in sinus lifts.
At the EAO Congress in Warsaw, on 18–20 September
2008, the Swedish medical company Tigran Technologies
is presenting the results from ongoing clinical
trials of Natix – a new, promising material for dental
use. The material consists of irregular titanium
granules that have been optimized in terms of porosity,
shape and size, forming the basis for a conducive
environment for bone in-growth.
Peri-implantitis: Peri-implantitis treated with white titanium
granules. No membrane was used in this case.
Courtesy of Doctor Caspar Wohlfahrt at the University of
Oslo, Norway.
Promising results for the treatment
of peri-implantitis
Peri-implantitis is a growing problem, and currently
there is no widely established method for supporting
bone in-growth around implants. Caspar Wohlfahrt, a
specialist in periodontology at the University of Oslo’s
Institute of Clinical Dentistry, is leading the clinical
studies. He recently concluded a pilot study of ten
patients, in which the possibility of using Tigran’s
porous titanium granules – Natix – in the treatment of
peri-implantitis was examined; this study has been
submitted for publishing. Caspar Wohlfahrt, who is presenting
the results at the EAO Congress, is impressed
by the material’s characteristics. Histology from two
patients shows bone in-growth next to, through and
between the granules and into the implant.
“We demonstrated well-osseointegrated titanium
granules and in addition the re-osseointegration of
the implants affected by peri-implantitis – that is,
new bone directly next to the affected implant surface
without fibrous encapsulation between the
bone and implant. This is one of the first times reosseointegration
has been proven in a clinical study
when using a bone substitute as a method of treatment,”
says Caspar Wohlfahrt.
Sinus lift: Three-year follow-up. The patient was followed for three years after the
abutment operation. The clinical and X-ray examinations show very good results
with healthy gingival margin and a stable marginal bone level. No membrane was
used in this case. Courtesy of Associate Professor Hans Bystedt, Stockholm, Sweden.

Increased stability for sinus lifts
EDI 107
Product Reports
Results from the recently published study “Porous
Titanium Granules Used as Osteoconductive Material
for Sinus Floor Augmentation: A Clinic Pilot Study”
demonstrate the clear benefits of the material. Associate
Professor Hans Bystedt, who previously worked
as the head of the Department of Oral and Maxillo -
facial Surgery at Sweden’s Karolinska University Hospital,
is leading the clinical-trial programme and is
hopeful about future use of Natix in sinus lifts. The
first time Hans Bystedt used Natix for bone regeneration
was for a sinus lift in 2003, and now he has treated
approximately 40 patients with Natix.
“The method works especially well for direct installations
when the implant is being put in at the same
time as a sinus lift is being done. The advantage of
treating with Natix is that you get stability straightaway
when you install the implant. Natix is easy to
apply, and there have been no infections.”
Both Caspar Wohlfahrt’s and Hans Bystedt’s experiences
with Natix indicate that the material is easy
to handle. It is easy to place in bone defects and
get the material to lie stable. A blood clot forms
extremely quickly around the granules, which leads
to a stable graft.
More Information
Tigran Technologies AB
Medeon Science Park
20512 Malmö
SWEDEN
Phone: +46 40 650-1665
info@tigran.se
www.tigran.se
The product information produced here editorially is based on information
provided by the manufacturer and has not been checked by the editor
for its accuracy.

108 EDI
Product Reports
The easy-to-use “two-in-one” solution is well suited
for practitioners seeking a more robust diagnostic
tool, especially implantologists or general practitioners
placing implants. The system’s userfriendly
design and intuitive software interface
enable it to be easily implemented in a dental practice,
with a footprint similar to that of a traditional
panoramic unit.
The power of 3D made easy
KODAK 9000 3D System by Carestream Health
Low-dose Threedimensional
Imaging
Carestream Health, Inc., the exclusive manufacturer of KODAK Dental Systems, introduced the KODAK
9000 3D Extraoral Imaging System. It enables dental professionals to obtain localized, low-doses three-
dimensional (3D) images as well as panoramic examinations at an affordable price – making the power
and utility of 3D technology available to most dental professionals.
Three-dimensional digital imaging provides highly
detailed images that show actual representations of
the patient’s anatomy that can be viewed from any
direction. Using this modality, anatomical depth and
relationships between individual features can be precisely
identified and measured for more accurate
diagnoses and treatment.
However in the past, 3D imaging has typically
been complex, expensive to implement, and often
only performed by radiologists. Moreover, radiation
dose associated with 3D imaging technology were
relatively high. With the introduction of the KODAK
9000 3D System, 3D diagnoses are now available to
most dental practices. The system’s localized field of
view limits irradiation to the region of interest and
shows an area of approximately three to six teeth in
extraordinary detail, resulting in increased image
accuracy and more detail per tooth. The 3D volume
acquired can be used for any implant treatments,
including both single and multiple site implant
planning. The voxel (VOlume piXEL), which represents
a quantity of 3D data similar to a pixel representation
in 2D data, features an edge size (or minimum
slice thickness) of 0.076 mm – providing 3D
images that are among the highest resolution in
the industry.
3D exams available on-site
Having 3D exams on-site helps dental professionals
provide quicker and more accurate diagnoses, and
reduce the number of visits and the treatment time
required significantly. Three-dimensional images
allow implantologists to assess precise bone volume
and quality, to identify anatomical obstacles, take 1:1
measurements and to plan implants using KODAK 3D
Imaging Module – all without having to send the
patient to another imaging facility.
KODAK 3D Imaging Module
comes standard with the Kodak
9000 3D System enabling simple
and efficient manipulation of 3D
exams, including an implant planning
module that will simulate
implant placement, take measurements
(both distances and
angles), and locate the mandibular
canal. The high-resolution images and reduced
radiation exposure of the KODAK 9000 3D System
also benefit other dental applications, including
endodontics, surgery, impaction, periapical lesion
assessment and TMJ assessment.
The KODAK 9000 3D System is available for sale. A
version of the unit including an optional cephalometric
module will be available starting October.
More Information
KODAK Dental Systems – Carestream Health
Phone: +800 4567 7654 (Western Europe)
Phone: +49 1805 274-010 (Eastern Europe & other countries)
europedental@cshdental.com
www.my90003d.com
The product information produced here editorially is based on information
provided by the manufacturer and has not been checked by the editor
for its accuracy.
Implant planning
module.

Current Advances
in Dental Implantology
Mozo Grau has successfully completed a multicentric prospective implant study,
underlining its continued support of scientific methods in dental implantology.
Following up on the previous “Multicentric retrospective
study of MG Osseous Implants” published in
2006, which monitored 1001 MG Osseous implants in
247 patients and showing an implant success rate of
97.8 percent after two years, Dr Serrano Caturla
(Barcelona, Spain) has now concluded a new multicentric
study on almost 1500 MG Osseous implants
from Mozo Grau, this time showing an implant success
rate of 98.2 percent after more than two years of
follow-up. In this study, the cases were prospectively
evaluated.
The design and development of the study was
supervised by Scientific Management in O&SS, a
Barcelona company specializing in such studies. The
study included MG Osseous self-tapping, titanium
implants and implants with RBM surface treatment.
Each participating dentist was asked to complete
detailed questionnaires to obtain detailed information
on every patient. Forty-nine cases of successful
implants were ultimately
excluded due
to insufficient questionnaire
responses, attesting
to the stringency of the
study.
These implants and patients continue
under periodical monitoring, and Dr Serrano would
like to extend the follow-up interval to a minimum of
five years, which would place this study among the
most extensive long-term studies
on implants.
In early 2008, based on this
information and experience, Mozo
Grau launched the MG InHex
implant with internal connector,
which shares the successful features
of the extensively studied
MG Osseous implant.
More Information
Mozo Grau
San Felipe Neri 2
47002 Valladolid
SPAIN
Phone: +34 983 211-312
sales@mozo-grau.com
www.mozo-grau.com
EDI 109
Product Reports

110 EDI
Product Reports
Orthopantomograph OP200 by
Instrumentarium Dental
All-in-one X-ray Unit
Instrumentarium Dental introduced new features in its Orthopantomograph. The new features of the
original Orthopantomograph OP200 are designed to make premium dental imaging easier and safer for the
patient – as well as to improve the productivity of dental practices.
Optimized Lateral Ceph is designed to minimize the
patient dose. The new Core Lateral Ceph imaging program
decreases the radiation up to 68 percent compared
to typical standard lateral ceph – yet with the
same proven image quality Orthopantomograph has
always been famous for. The starting point of the
scan is fully adjustable and therefore enables the
user to allow only the optimal area to be exposed.
Regardless of the reduced exposed area all typical
cephalometric tracing landmarks will be included in
the core view. For quick and easy intraoral bitewing
imaging Orthopantomograph OP200 is equipped
with a new imaging program that produces a clear
bitewing-like view of molar and premolar regions –
from 1 st premolar to 3 rd molar with one easy exposure.
This new feature offers a comfortable alternative for
patients with a strong gag reflex. Steady positioning
as a very important step towards successful imaging
is ensured with the new fully adjustable headrest. It
offers the strongest and steadiest head support
available and is height adjustable for improved suitability
for both child and adult patients.
Nowadays efficiency is everything. Orthopantomograph
improves the productivity of dental practices
with faster operations and carefully designed
automation. Quicker alignments and higher accuracy,
self adjusting fully automatic collimation and easier
unit installation make the unit even more efficient
than before. New OP200 D produces a standard highresolution
panoramic image in just 14,1 seconds. Lateral
ceph scan takes only 5,2 seconds with child patients
and 13,1 seconds with adults. In addition to these new
features, which are now standard in every new unit,
VT-Volumetric Tomography option expands the digital
Orthopantomograph into an advanced tool for
implantology. VT is an innovative digital tomography
imaging tool which enables accurate and reliable
measurements for implant site evaluation. VT produces
a stack of cross-sectional slices targeted only on
the region of interest. The reconstructed, wide volumetric
view offers 256 slices, from which the optimal
slice or any number of slices can be viewed and easily
navigated. Patient dose is kept low by exposing only
the selected region of interest. Orthopantomograph
OP200 combines premium quality panoramic,
cephalometric and volumetric tomography imaging
in a true all-in-one X-ray unit.
More Information
Instrumentarium Dental
Nahkelantie 160
P.O. Box 20, FI-04301 Tuusula
FINLAND
Phone +358 45 7882-2000
www.instrumentariumdental.com
www.vt-cube.com
The product information produced here editorially is based on information
provided by the manufacturer and has not been checked by the editor
for its accuracy.

112 EDI
Product Reports
Intralift by Satelec
Plug and Spray
The new Intralift method for the ultrasonic generator Piezotome and the ImplantCenter from Satelec (Acteon Group) now
enables dentists to lift the maxillary sinus membrane, by the crestal approach, gently and safely, and fill the new sinus space
with augmentation material – with less room for mistakes and low rupture risk, thanks to the five new TKW instruments.
Designed for ultrasonic drilling and Schneider membrane elevation by hydrodynamic effect, the augmentation material is then
inserted into the osteotomy and compacted. The Intralift procedure thus combines the safety, effectiveness and visibility of an
external sinus lift with the minimally-invasive internal sinus lift.
The scope for use of piezoelectric ultrasound technology
is constantly increasing. It is therefore not only
suitable for prophylaxis, endodontics and periodontics.
Oral surgeons can also benefit from the
adjustable frequency and the technically-ingenious
tips. With Intralift, Satelec has now introduced a
completely new, minimally-invasive operational
method for internal sinus elevation and bone augmentation.
Minimally-invasive procedure
The particularity of this procedure are the five specific
TKW instruments which enable the hydrodynamic
separation of the Schneider membrane, by means of
the modulated surgical mode and irrigation from the
ultrasonic generator. Here, the new ultrasound-based
Intralift method is not only the least invasive operational
procedure currently available, but it is also the
fastest and safest operational procedure for an internal
sinus lift and pre-implant bone augmentation.
Furthermore, it is just as effective as the classic lateral
window technique.
In the case of an upper residual bone height of less
than 5 mm, bone augmentation should be carried
out after raising the maxillary sinus membrane for
implant placement. According to the surgical protocol
for the Intralift, the new TKW1 to TKW4 diamond
instruments are to be implemented for a stepwise
bone preparation, taking into account bone density
and thickness. With a maximum diameter of 2.8 mm,
these tips make an exceptionally gentle cut into the
hard tissue only (selective incision), precisely and free
from bleeding. In this way they will create a microsurgical
access as in the keyhole technique, contrary
to an invasive, external sinus lift.
Hydrodynamic sinus lift
After the stepwise pilot drilling, the smooth TKW5
tip, with internal irrigation to the extremity of the tip,
is first inserted in the cavity to lift the Schneider
membrane by hydrodynamic effect. After the elevation,
the TKW5 can be used to insert a collagen fleece
as a protection against possible rupture of the sinus
membrane. The augmentation material is then carefully
moved cranially with the tip. If the material is
compacted strongly, the activation of this novel plugging
and trumpet instrument, with a low water flow
rate, will cause an automatic dispersion of the augmentation
material in the newly formed sinus cavity.
According to the “Plug and Spray” principle, new
material is now alternately inserted, compacted and
then spread using water pressure from the piezoelectrically-activated
TKW5 tip – until a safe primary stability
is achieved for the implant.
Reduced operational trauma
Besides the simple handling for the operator, the new
Intralift is also characterized by a comfortable and
stressless procedure for the patient. Thus the new
minimally-invasive sinus lift proce-
dure causes hardly any post-operative
swelling, pain or bleeding. The
shortened and improved bone regeneration
through piezo surgery is also
certain to convince both parties.
The Intralift TKW1 to TKW5 tips are
now available in a special Intralift
Kit (ref. F87336). They can be used
with both the high-performance
ultrasonic generator Piezotome as
well as the ImplantCenter.
More Information
Satelec-Acteon Equipment
17 avenue Gustave Eiffel
F-33708 Merignac
FRANCE
Phone: +33 556 340607
satelec@acteongroup.com
www.acteongroup.com
The product information produced here editorially
is based on information provided by the
manufacturer and has not been checked by
the editor for its accuracy.

114 EDI
Product News
Leone Exacone 360°
The anatomical abutments Exacone 360° have got
the ideal characteristics to facilitate the prosthetic
procedure both during the phase of choice and customizing
in the laboratory and in the following clinical
procedures.
The main innovation of the product, protected by
an international patent, is the realization of the apical
hexagon separated from the abutment: this
allows a free positioning to 360° on the model and
makes the correction of disparallelism easy by using
the anatomical form of the abutment to the utmost.
With the activation of the selfblocking
conic connection afterwards,
the abutment will join the
hexagon directed in the selected
position and it will drive the clinician
in the positioning on patient
with the maximum precision.
The anatomical abutments Exacone
360° are available straight or
angled at 15° or 25° to answer all
demands for prosthetic rehabilitation.
An indent on the angled
abutment allows the activation
of the connection by exerting a
coaxial force to the axis of the
implant. A special flat tip may
be joined to the multi-purpose
handle or contra-angle hand
piece assuring a stable support.
Zimmer Dental Instrument Kit System
Zimmer Dental Inc. has released the new and
improved Zimmer Instrument Kit System. With its
user-friendly layout and logical color-coding system,
it is designed to enable clinicians to get the most out
of the popular Tapered Screw Vent and Zimmer One-
Piece Implants.
The Zimmer Instrument Kit System is an easy to
learn, well organized product family that can be customized
to meet individual clinical needs and maximize
valuable time. A simple color coding system
enables clinicians to intuitively follow surgical sequences,
step-by-step. In addition, the Tapered Screw-
Vent Surgical Kit can be combined with an optional
Zimmer One-Piece Implant Module for streamlined
placement of all components of the renowned Tapered
Screw-Vent Implant System – thereby creating
a truly centralized, all-in-one kit.
Each Tapered Screw-Vent Surgical Kit includes instruments
needed to place any Tapered Screw-Vent
Implant, including the popular 4.1 mm line. All kit configurations
also leave extra storage space for additional
pieces. An accompanying Staging Block allows users
to place a selection of instruments
and implants needed for a procedure
within reach. A separate Zimmer
One-Piece Kit is also available
for new users who want to begin
their experience with Zimmer
Dental by treating tight interdental
spaces.
To help clinicians get the most
out of the Zimmer Instrument Kit
System, cleaning and sterilization
instructions for instruments and
Driva Drills as well as surgical
sequences are included in a handy
guide that comes with every kit.
Product:
Exacone 360° anatomical
abutments
Indication:
Anatomical abutments
Distribution:
Leone S.p.A.
Via P. a Quaracchi, 50
50019 Sesto Fiorentino (Fi)
ITALY
Phone: +39 055 3044-620
info@leone.it
www.leone.it
Product:
Zimmer Instrument Kit System
Indication:
Instrument kit system
Distribution:
Zimmer Dental Inc.
USA
Phone Germany: +49 761 15647-0
Phone Spain: +34 93 84605-43
Phone France: +33 1 451235-66
Phone Italy: +39 043 85555-73
Phone Israel: +972 3 612-4242
www.zimmerdental.com

In case of immediate implantation
there is a great risk to contaminate
the jaw bone with connective
tissue fibre of the soft tissue.
The new Aesculap Ergoplant
Immediate Implant Retractor
ensures a save implantation by
holding back the alveolar soft
tissue. Thereby working will be
safer, easier and more comfortable.
EDI 115
Product News
Aesculap
Ergoplant Immediate Implant Retractor
Product:
Ergoplant Immediate Implant
Retractor
Indication:
Implant retractor
Distribution:
Aesculap AG & CO KG
Am Aesculap-Platz
78352 Tuttlingen
GERMANY
Phone: +49 7461 95-2467
dental@aesculap.de
www.aesculap-dental.com

116 EDI
Product News
Kohdent Medizintechnik Trinovo
The Micro-Perio Instrument Set Trinovo provides
the dentist with essential instruments for perio -
dontic soft-tissue management and dental surgery.
They allow delicate ablation of interstitial papillae
and mucoperiosteal flaps without the risk of ripping,
which is always difficult to suture. Thanks
to the instruments’ efficient mode of operation,
which show a steadily continuous widening geometry,
every intrusion can be carried out with
extreme precision.
The instruments offer different working tips at
both ends. Through a combination of periosteal elevator
and gingiva retractor, the total number of
required instruments is lessened and, on the other
hand, influences
ergonomic
handling and rapid processing
during surgery. The
Trinovo grip guarantees comfortable
posture and instrument
handling during surgery. The
grip’s profile is also remarkable.
The geometry guarantees not
only effective instrument stabilisation,
but also offers the advantage
of being completely sterilisable
without having impedimental
retentive recesses.
Hirschmann Instruments
ART Plus and Implant Viewer
Hirschmann Instruments presents the dental
panoramic digital imaging system ART Plus made by
the Finnish company AJAT. The highlight of this unit
is its CdTe-CMOS sensor that converts x-rays directly
into electrical signals. ART Plus offers exceptional
image quality and some advanced and unique image
processing features such as the ability to select different
focal planes and convert them. The image area
can be enlarged without any loss in quality. Starting
immediately, Hirschmann Instruments will also market
AJAT’s retrofitting kits for converting panoramic
analogue imaging systems to benefit from state-ofthe-art
CdTe sensor technology, allowing the digitiza-
tion of legacy systems at competitive
prices.
The Implant Viewer by Anne Solutions,
also marketed by Hirsch -
mann Instruments, is an elegant
software solution for exporting reconstructed
DICOM axials to STL
files. DVT diagnostic centres and
dental radiologists can now pass
on the original 3D data to their
customers, which can use the
viewer software free of charge. The
viewer software facilitates multiplanar
representations of the selected
jaw region and allows implant
positions to be determined
and distances and angle measurements
to be applied.
Product:
Trinovo
Indication:
Micro-Perio instrument set
Distribution:
Kohdent Roland Kohler Medizintechnik
GmbH & Co. KG
Danningen 9
78579 Neunhausen
GERMANY
Phone: +49 7777 9395-30
info@kohler-medizintechnik.de
www.kohler-medizintechnik.de
Product:
ART Plus
Implant Viewer
Indication:
Dental panoramic digital imaging
system
Software for exporting reconstructed
DICOM axials to STL files
Distribution:
Hirschmann Instruments GmbH
Kramerstr. 17
82061 Neuried
GERMANY
Phone: +49 89 7592206
www.hirschmann-instruments.de

Mozo Grau
Abutments for Immediate Loading
In order to cover the latest
implantological techniques, such
as immediate loading, Mozo Grau
has launched a collection of new
abutments suitable for use when
an immediate aesthetic solution
is required by the patient before
the definitive prosthesis is delivered.
These components extend
the range of prosthetic options
when restoring MG Osseous and
MG InHex implants.
Designed jointly with experienced
clinical professionals, these
abutments have thinner walls,
which makes them suitable for
customization in the patient´s
mouth without presenting an
overheating hazard. Their special
surface facilitates cement adhesion
and improves the retention
of the provisional. To facilitate
adjustment, all Mozo Grau components
for immediate loading
are supplied with a plastic cap
that allows the cementation of
the provisional to the abutment.
This new range for use with
the immediate loading technique
includes castable and titanium
abutments for direct restorations
on implants and for trans epitelial
abutments such as the tapered
abutment. The tapered abutment
is recommended for immediate
loading in the mandible, allowing
the placement and removal of a
provisional without adversely
affecting the soft tissues. Its conical
design allows the provisional to be
perfectly adjusted to the implants
even in the presence of an axial
divergence of 10 to 30 degrees.
The precision of all abutments,
together with the self-locking
morse taper connection and the
internal double hex interlock of
the MG InHex implant, assure a
perfect passive fit of the provisionals
for single- and multipletooth
restorations.
Product:
Abutments for immediate loading
Indication:
Provisional for immediate loading
Distribution:
Mozo Grau
San Felipe Neri . 247002 Valladolid . SPAIN
Phone: +34 983 211-312
sales@mozo-grau.com . www.mozo-grau.com
EDI 117
Product News

118 EDI
Product News
Bicon SynthoGraft
SynthoGraft is a synthetic, biocompatible and
resorbable granular ceramic made of pure phase
Beta-Tricalcium Phosphate (Ca 3 (PO 4 ) 2 ) for oral and
maxillofacial bone regeneration or augmentation.
SynthoGraft was developed to create an augmentation
material that would perform to high levels of efficiency
in both rate and quality of regeneration. SynthoGraft
has a unique structure that provides stabili-
With the Piezon Master Surgery from EMS the Piezon
method is now also available in dental and oral surgery.
The method is based on piezoceramic ultrasound
waves which generate high-frequency, straight-line
oscillations. These vibrations increase the precision
and safety in surgical applications. Thus the ultrasound
drive enables micrometric incision in the range
of 60 to 200 micrometers, in which only a little bone
substance is lost. The ultrasound instruments cut only
hard tissue selectively; soft tissue remains conserved.
In addition, a largely bloodless operation field results
from the high-frequency vibrations with permanent
cooling thus thermal necroses are prevented.
Piezon Master Surgery can be used in periodontal,
oral and maxillary surgery as well as in implantology.
Distinct indications are osteotomy and osteoplasty,
extraction, root tip resection, cystectomy, gaining
bone blocks, sinus lift, nerve transposition, alveolar
ridge cleavage and harvesting autologous bone.
Operation using the touch board is especially simple
and hygienic: One can set both the power and the flow
rate of the isotonic solution by brushing one’s finger
over the recessed operating elements. The LED reacts to
ty, while its micro-porosity enables
rapid vascularisation and subsequent
resorption when mixed
with the patient’s own blood.
Several varieties of Beta-Tricalcium
Phosphate are now commercially
available, but their bone regenerating
capabilities are not
equal. These differences can affect
not only the rate and quality of
bone regeneration, but also the
rate of resorption and replacement
with autogenous bone during
the healing process.
Additionally, SynthoGraft offers
clinicians and patients the confidence
of knowing that they have a
completely synthetic bone graft
material, eliminating the inherent
risks associated with biologicallyderived
bone graft materials.
the stroke of the finger with a low
signal – even if your hand is in surgical
gloves and an additional protective
foil is used. Corners, joints
and gaps were dispensed with in
the design for the sake of hygiene.
Piezon Master Surgery is offered
as basic system with five
instruments for use in
implant preparations.
Optional systems for
tooth extraction, retrograde
root channel
preparation and operations
on the bone are
also available. All
systems contain
autoclavable
Combi torques
and a Steribox.
Product:
SynthoGraft
Indication:
Oral and maxillofacial bone
regeneration or augmentation
Distribution:
Bicon Europe, Ltd.
Phone: +353 61 303-494
www.synthograft.com
www.bicon.com
EMS Electro Medical Systems Piezon Master Surgery
Product:
Piezon Master Surgery
Indication:
Bone cutting using ultrasound
Distribution:
EMS Electro Medical Systems S.A.
Chemin de la Vuarpillière 31
CH-1260 Nyon
SWITZERLAND
Phone +41 22 9944700
welcome@ems-dent.com
www.ems-company.com

Implant Direct SwissPlant Implant
Product:
SwissPlant implant
Indication:
Dental implant system
Distribution:
Implant Direct Europe AG
Förrlibuckstrasse 150
8005 Zürich
SWITZERLAND
Phone: +41 848 345534
info-eu@implantdirect.com
www.implantdirect.eu
After the successful start of the
European business with its own
Spectra system and compatible
implant lines with other implant
manufacturers, Implant Direct is
expanding its product portfolio
with implants and prosthetic
parts that are compatible with
Straumann. The SwissPlant implant
is both surgically and prosthetically
compatible with Straumann
Standard/Standard Plus implants.
This gives Straumann users the
advantage of inserting SwissPlant
EDI 119
Product News
implants without purchasing another surgical kit.
The SwissPlant implants come with endosteal diameters
of 4.1 mm and 4.8 mm, and with implant
lengths of 8, 10, 12, 14 and 16 mm, all with the characteristic
blasted, micro-rough surface of Implant
Direct. The prosthetic platform includes the traditional
internal octagon of Straumann’s implant-prosthetic
connection. The implant has been improved to
include mini-threads in the upper implant body
reducing tensions in crestal bone, as well as double
lead threads in the appical area. Due to the microrough
surface of the implant neck it can be used for
one-stage or two-stage procedures, providing a maximum
of treatment flexibility. The implant comes in
an innovative All-In-One kit including prosthetic
components such as a cover screw, a healing cap, a
comfort cap, a transfer, and a straight abutment with
a significant price advantage.

120 EDI
Product News
Dr. Ihde Dental SSO Implants
More protection against early
implant loss and a consistently
high primary stability are the
most important advantages of
the new Dr. Ihde Dental SSO
implant surface. At the core of
this significant innovation there
is an ultra-thin NaCl coating. It
exerts a biocidal effect while
returning to the bone a fair share
of the mineral salt that is invariably
lost during preparation of
the implant bed.
Dr. Ihde Dental breaks new
ground when it comes to ensuring
primary implant success. To
date, it has not been possible to
avoid or compensate for the loss
of salt that occurs in the bone
Satelec Extraction Kit
The Extraction Kit is the latest addition to the range
of ultrasonic surgical tips from Satelec. Compatible
with Piezotome and ImplantCenter power generators,
this new kit of six tips has been especially developed
for extractions (total or partial): avulsions,
hemisections and root amputations. The Extraction
Kit presents many clinical advantages for the practitioner:
the slimness of these tips associated with
ultrasonic technology facilitates their access inside
the desmodontal space, and thanks to the selective
cut, the tips are inactive on soft tissue and sensitive
anatomical components. Without any inertia, the
regular to-and-fro movement decreases the risk of
lesions on adjacent teeth and roots. The use of this
kit will also provide benefit to patients who will experience
swift and less traumatic treatment that
respects the alveolar plate, as well as less post-operative
pain.
This kit, which is directed mainly towards general
practitioners and stomatologists, consists of five LC
tips and one Ninja tip. The LC tips are intended for syndesmotomies
and periradicular osteotomies. With differing
shapes and orientations, they address the morphological
constraints without damaging neighbouring
tissue and anatomical elements. Combined with
during implant-bed preparation – not even by using a
physiological saline solution or Ringer’s lactate for
irrigation. The Osmoactive surface proactively tackles
the salt-loss problem while at the same time creating
the best possible environment for osteoblasts to
develop. A recent study conducted at the University
of Würzburg, Germany (to be published shortly) has
shown that implants with an Osmoactive surface
have bactericidal properties yet do not inhibit
osteoblast growth – without requiring the use of
antibiotics or other unwanted chemicals.
Dr. Ihde Dental manufactures 16 crestal
and basal implant systems.
The product catalog is
available in German
and English.
the action of ultrasonic microoscillations,
they achieve, with
just a simple sweeping movement
around the tooth, detachment of
the periodontal ligament in order
to facilitate avulsion of the tooth
outside the alveolus. The Ninja
tip with double saw-tooth edges
was developed especially for hemisections
and root amputations.
This tip is also recommended for
sectioning impacted teeth. The
Ninja’s selective and accurate cut
allows the practitioner to achieve
faster and less invasive surgery.
Product:
SSO Implants with
Osmoactive Surface
Indication:
Dental implant
Distribution:
Dr. Ihde Dental AG
Lindenstrasse 68
8738 Uetliburg/SG
SWITZERLAND
Phone: +41 552 932-323
info@implant.com
www.implant.com
Product:
Extraction Kit
Indication:
Tips for extractions
Distribution:
Satelec-Acteon Equipment
17 avenue Gustave Eiffel
F-33708 Merignac
FRANCE
Phone: +33 556 340607
satelec@acteongroup.com
www.acteongroup.com

122 EDI
Calendar of Events
CALENDAR OF EVENTS
2008/2009 Event Location Date Details/Registration
September Swedental Stockholm, Sweden September 24-27,
2008
FDI Annual World Dental Congress
2008
Stockholm, Sweden September 24-27,
2008
October Dental Showcase 2008 London, England October 2-4,
2008
Dentex 2008 Brussels, Belgium October 16-18,
2008
Reunión de SEPES 2008 Zaragoza, Spain October 16-18,
2008
November 12 th BDIZ EDI Symposium Frankfurt/Main,
Germany
XXIV Congreso Nacional/
XVII Congreso Internacional de S.E.I.
November 7-8,
2008
Oviedo, Spain November 13-15,
2008
Congrès de l’ADF Paris, France November 25-29,
2008
February Chicago Dental Society Midwinter
Meeting
March 33 rd International Dental Show
(IDS) 2009
EDI – Information for Authors
EDI – the interdisciplinary journal for prosthetic dental implantology is
aimed at dentists (and technicians) interested in prosthetics implantology.
All contributions submitted should be focused on this aspect in content
and form. Suggested contributions may include:
. Case studies
. Original scientific research
. Overviews
Manuscript Submission
Submissions should include the following:
. two hard copies of the manuscript
. a disk copy of the manuscript,
. a complete set of illustrations
Original articles will be considered for publication only on the condition
that they have not been published elsewhere in part or in whole and are
not simultaneously under consideration elsewhere.
Manuscripts
Pages should be numbered consecutively, starting with the cover page.
The cover page should include the title of the manuscript and the name
and degree for all authors. Also included should be the full postal address,
telephone number, fax number, and electronic mail address of the contact
author. The second page should contain an abstract that summarizes the
article in approximately 100 words.
Manuscripts can be organized in a manner that best fits the specific goals
of the article, but should always include an introductory section, the body
of the article and a conclusion.
Figures and Tables
Each article should contain a minimum of 20 and a maximum of 50 origi -
nal color slides (35 mm) or digital photos, except in unusual circumstances.
The slides will be returned to the author after publication. Slides
should be numbered on the mount in the sequential numerical order in
which they appear in the text (Fig. 1, Fig. 2, etc.).
Chicago, USA February 26 - March 1,
2009
Cologne, Germany March 24-28,
2009
Editors Office: teamwork media GmbH . Hauptstr. 1 . 86925 Fuchstal/Germany
Phone: +49 8243 9692-0 . Fax: +49 8243. 9692-22 . E-mail: service@teamwork-media.de
Stockholm International Fairs
Phone: +46 8749 43-88
www.swedental.org
FDI World Dental Federation
congress@fdiworldental.org
www.fdiworldental.org
British Dental Trade Association
www.dentalshowcase.com
C.V. Dentex International S.C.
Phone: +32 2478 1441
www.dentex.be
SEPES – Sociedad Española de Prótesis
Estomatológica
Phone: +34 91 576-5340
www.sepes.org
BDIZ EDI
Phone: +49 228 9359-244
www.bdizedi.org
S.E.I. – Sociedad Española de Implantes
www.infomed.es/sei
Association Dentaire Française
Phone: +33 0158 221710
adf@adf.asso.fr
www.adfcongres.com
Chicago Dental Society (CDS)
Phone: +1 312 836-7300
www.cds.org
Koelnmesse GmbH
Phone: +49 180 577-3577
www.ids-cologne.de
Radiographs, charts, graphs, and drawn figures are also accepted.
Figure legends should be brief one or two-line descriptions of each figure,
typed on a separate sheet following the references. Legends should be
numbered in the same numerical order as the figures.
Tables should be typed on separate sheets and numbered consecutively,
according to citation in the text. The title of the table and its caption
should be on the same sheet as the table itself.
References
Each article should contain a minimum of 10 and a maximum of 30 references,
except in unusual circumstances. Citations in the body of the text
should be made in numerical order. The reference list should be typed on
a separate sheet and should provide complete bibliographical information
in the format exemplified below:
[1] Albrektsson, T.: A multicenter report on osseointegrated oral implants. J
Prosthet Dent 1988; 60, 75-82.
[2] Hildebrand, H. F., Veron, Chr., Martin, P.: Nickel, chromium, cobalt dental
alloys and allergic reactions: an overview. Biomaterials 10, 545-548, (1989)
[3] Johanson, B., Lucas, L., Lemons, J.: Corrosion of copper, nickel and gold
dental alloys: an in vitro and in vivo study. J Biomed Mater Res 23, 349,
(1989)
Review Process
Manuscripts will be reviewed by three members of the editorial board.
Authors are not informed of the identity of the reviewers and reviewers
are not provided with the identity of the author. The review cycle will be
completed within 60 days. Publication is expected within 9 months.
Page Charges and Reprints
There are no page charges. The publisher will cover all costs of production.
The journal will provide the primary author with 20 tear sheets and a free
copy of the journal issue in which the article appears.