Nobel missing teeth survey presented at AO Annual Meeting

www.osseo.orgVolume 20, Number 2 • 2009A quarterly publication of the Academy of OsseointegrationIn This IssuePresident’s Message:How implant dentistry haschanged in 25 years! . . . . . . . .2Dr. Vincent Iaconosworn in as AO President . . . .3Director Profile:Dr. Jay Malmquist . . . . . . . . . .3Dr. Richard RounsavelleOF President for 2009-10 . . . .5Committee Profile:Amerian D. Sones, DMD, MS . .6Clinical Technique Feature:The extra-long implant driver: easyaccess for implant placement . .72009 Annual Meetingbreaks single meetingattendance record . . . . . . . .8-9Awards presented to six . . . . . .9Guest Editorial: Who shouldmanage catastrophic implantcomplications? . . . . . . . . . . . .11Guest Editorial: Who’s going tomanage your catastrophicimplant complications? Put thedriver back in the bag . . . . . .13Editor’s Editorial: Clearing theair about managingcomplications . . . . . . . . . . . .14Academy NewsAcademy of Osseointegration85 W. Algonquin Road, Suite 550Arlington Heights, IL 60005847/439-1919EditorJohn P. Schmitz, DDS, MS, PhDEditorial ConsultantsKevin T. McNally, DDSAlfonso Monarres, DDS, MSOender Solakoglu, DMD, MS, PhD© The Academy of Osseointegration. All rights reserved.Nobel missing teeth surveypresented at AO Annual MeetingBy Kevin T. McNally, DDS, Academy News Editorial ConsultantIn the summer of 2008, Nobel BiocareNorth America conducted a large survey(56,680 respondents)to better understandthe prevalence ofmissing teeth in U.S.adults, their attitudesand general awarenessof the impact of missingteeth, particularlyon their appearance.Nobel also surveyedawareness of the consequencesof missingteeth and awareness of dental implants.The results were presented as a poster presentationat the most recent AO meeting inSan Diego. The detailed report can be seenat www.usdentalsurvey.com/.A number of interesting observations canbe made from the data presented. Almostone-half of the U.S. population over 25 hasone or more missing teeth (third molarsand orthodontic extractions were notcounted). Probably not surprising, thosewith lower incomes have more missingteeth than those with higher incomes.However, 33% of those with incomes of$75,000 or more had missing teeth. Thepercentage of missing teeth was spreadfairly evenly across the states in a range of41% to 58%, with Arkansas, Montana,New Mexico, and Wyoming having thehighest percentage of people with missingteeth, while Minnesota andHawaii shared the lowest rate.Two areas of the survey stand out as sourcesof reflection for dentists. One is the valuethat people place on their smile and dentalappearance. While most of us know thatthis is an important area for our patients, itmay not be known that the survey showed itis the most important physical attribute,considered more important than hair,clothing, eyes, facial features, and physique.The second is that although 70% of allrespondents were aware of dental implants,and 80% of those with missing teeth wereaware of dental implants, they were almost…continued on page 5…continued on page 13The purpose of the Academy of Osseointegration is to advance the science and application of tissue replacement in oral and facial care.

President’s MessageHow implant dentistry has changed in 25 years!By Vincent J. Iacono, DMDI am honored to follow Drs. Steven Eckert and Steven Lewisas AO President and wish to thank the membership, AOBoard of Directors and staff for having the confidence in meto lead your Academy as it enters itssilver anniversary year. I accept thechallenges we face and pledge to domy best to lead this premier organizationin the world on implantology toachieve its goals and objectives in fulfillingits vision of advancing oralhealth and well being by disseminatingstate-of-the-art clinical and scientificknowledge of implant dentistry andDr. Vincent Iacono tissue engineering.Your Academy has just completed a most successful year underthe leadership of President Steven Lewis including the outstandingannual meeting in San Diego. AO’s ExecutiveDirector, Mr. Kevin Smith, reported that attendance set anall-time record of over 1,900. In addition, student attendancerepresented 402 of this total, which has established a new studentattendance record.The San Diego meeting has received kudos from speakers,attendees and our corporate sponsors. The successful SanDiego meeting has increased the efforts of Dr. Stuart Froumand his planning committee to develop a “ne plus ultra” programfor the AO’s silver anniversary meeting to be held March4-6, 2010 at the Walt Disney Dolphin Hotel in Orlando,Florida. The program, entitled “25 Years of Experience – TheFormula for Predictable Implant Success,” is sure to be awatershed event in implant education.At the outset, I would like to acknowledge my mentors, Drs.Paul Baer and Charles Berman. Through their guidance, Ibecame one of the first 50 periodontists to be trained byProfessor Ingvar Brånemark on osseointegrated dentalimplants. Indeed, it was an educational experience that literallychanged my professional career.It was through Uncle Charlie’s direction that I joined thethen-new Academy 25 years ago and performed my firstimplant surgery in 1985. I can still remember that case. Itincluded inserting five grade 1 commercially pure titaniumexternal hex machined 3.75mm diameter screws into pretappedand countersunk osteotomies in the anterior sextant ofa fully edentulous mandible of a 60-year old woman undergeneral anesthesia for a fixed/detachable denture.How matters have changed in 25 years! The awesome innovationsin surgery, prosthodontics, bone biology, materials scienceand informatics since then have been mesmerizing.Implant designs and surfaces have been modified to improvethe kinetics and degree of osseointegration. Implant abutmentinterfaces have been redesigned to facilitate restorations andnew surgical procedures have been developed for soft and hardtissue augmentation that optimize implant function andesthetics. The new technologies in imaging and computersoftware for the treatment planning, surgical guiding, andrestoring of implants have essentially changed how we practiceimplant dentistry today.In recognition of our ever-changing discipline, your Academywill continue to enhance its educational initiatives on the AOWebsite, expand regional events for postdoctoral students andresidents, explore the feasibility of developing educationalstandards for implantology, and continue its international outreachefforts. These activities will raise the bar for the provisionof implant services throughout the world and enhance theclinical outcomes for our patients.Two tangible outcomes of our educational initiatives include ahands-on workshop during the AO’s 25th annual meeting anda scientific workshop to commemorate the AO’s silveranniversary. The Hands-On Workshop Committee, under theleadership of Drs. Stephen Wallace and Stephen Parel, isdeveloping an all-day workshop on Wednesday, March 3, 2010on computer based imaging, treatment planning, implantsurgery, and restoration of dental implants. As attendance willbe limited for this highly valued educational experience, besure to register early!The planning for the Academy’s 25th anniversary event wascrystallized with the recommendation that the AO would holda workshop in the summer of 2010 with the theme,“Challenges for the Future in Implant Dentistry.” TheWorkshop will include two principal areas, each having severalrelated subtopics, as follows:1. Bioengineering for Soft and Hard Tissuea. Biologics – Growth and Differentiation Factors/Scaffoldsb. Stem Cell Researchc. Nanotechnologyd. Emerging Surgical Technologies2. Appropriate Measures ofClinical Outcomes for Implant Therapya. Patient Specific Outcome Measuresb. Clinical Specific Outcome MeasuresThe Planning Committee consists of Drs. Peter Moy andmyself, as Co-Chairs, Tara Aghaloo, Neel Bhatavadekar,David Cochran, Steven Eckert, Brian Mealey, ThomasOates, Eleni Roumanas, Clark Stanford, and Ulf Wikesjo.The Committee is in the process of finalizing the selection ofcontent experts and participants. The Workshop is tentativelyscheduled for August 5-8, 2010 at the Oak Brook HillsMarriott Resort in Oak Brook, Illinois.…continued on page 132

Dr. Vincent Iacono sworn in as AO PresidentDr. Vincent J. Iacono, Stony Brook,NY, was sworn in as 2009-10 AOPresident during the Academy’s annualBusiness Meeting in San Diego.Newly elected members of the AOBoard of Directors with Dr. Iacono are:• Dr. Peter K. Moy, Los Angeles, CA,President-elect;• Dr. Kenneth F. Hinds, LagunaNiguel, CA, Vice President;• Dr. Stephen L. Wheeler, Encinitas,CA, Secretary;• Dr. Jay P. Malmquist, Portland, OR,Director.AO President: Dr. Vincent IaconoDr. Iacono is Distinguished ServiceProfessor and Chairman, Departmentof Periodontology, School of DentalMedicine, Stony Brook University. Heis also Director of the school’sAdvanced Education Program inPeriodontics, and Associate Dean ofPostgraduate Programs.Dr. Iacono co-chaired the Academy’slandmark 2006 Workshop on the State ofthe Science of Implant Dentistry. He hasserved on the Board of Directors since2000, including terms as AO Presidentelect,Vice President and Secretary. Dr.Iacono had been active on many AOcommittees and also served on theOsseointegration Foundation Board ofDirectors. In addition, Dr. Iacono is pastPresident of the American Academy ofPeriodontology (AAP).Dr. Peter MoyAO President-elect: Dr. Peter MoyDr. Moy is Director of Implant Dentistryat UCLA and Associate Professor ofClinicalDentistry at theUCLA School ofDentistry. He isVisitingProfessor, FourthMilitary MedicalUniversity, Xi’an,China, and operatesa privatepractice focusingprimarily in the areas of osseointegratedimplants and reconstruction of severelyatrophic ridges.An Academy Fellow, Dr. Moy isAssociate Editor of the InternationalJournal of Oral and Maxillofacial Implants(IJOMI), AO’s official journal. He previouslyserved as AO Vice President andTreasurer, chaired the organization’sMembership Committee, and served onthe Research Committee and Ad HocCommittee on Practice Management.AO Vice President:Dr. Kenneth HindsDr. Hinds operates a private practiceemphasizing comprehensive, estheticand implantdentistry, andis a VisitingLecturer(RestorativeDentistry)at UCLA.An AO Fellow,Dr. HindsDr. Kenneth Hinds served as AOSecretary,chaired the Academy’s ScientificProgram Committee for its 2005Annual Meeting in Orlando, FL, andserved as Annual Meeting Chair for the2006 meeting in Seattle, WA.AO Secretary: Dr. Stephen WheelerDr. Wheeler’s private practice is basedin Encinitas, CA, where he provides afull scope of oral, maxillofacial and dentalimplant surgery. One of the firstdoctors in the U.S. to begin titaniumdental implant placement in the mid-1980s, he went on to establish theRancho Santa Fe Dental ImplantDentistry Club as a forum for implantdentistry training and education.…continued on page 11Director’s ProfileCommanding officer encouraged Dr. Jay Malmquist’s dental careerAcademy Director Dr. Jay Malmquist,Portland, OR, credits the influence ofhis former U.S. Army commanding officerfor setting him on the path to a successful30-year career as an oral andmaxillofacial surgeon.Following graduation from theUniversity of Oregon Dental School,Dr. Malmquist completed an Armyrotating internship at Fort Jackson, SC.There, he was inspired by ColonelWilliam Bond’s integrity, leadership andprofessionalism.“Col. Bond was a natural leader; an iconin the eyes of the clinicians who servedunder him,” Dr. Malmquist recalls. “Hisattention to detail and professionaldemeanor had a profound impact inhelping me become the person I wantedto be. He encouraged me to pursue acareer in oral and maxillofacial surgery,something I probably would not haveconsidered without his guidance.”Dr. Jay Malmquist is very proud of his two sons,Michael (left) and Chris (right).During two years of active duty serviceas a General Dentistry Officer at theYuma Proving Grounds, Yuma, AZ, Dr.Malmquist achieved the rank of Captain.Following his discharge, he completedresidency training in oral and maxillofacialsurgery at Oregon Health ScienceUniversity. He established a privatepractice in Portland in 1977.In 1984, Dr. Malmquist was introducedto the concept of osseointegration duringa weeklong educational programheld at the University of Washington,one of four training centers establishedto disseminate information about thenew technique across North America.…continued on page 113

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Dr. Richard Rounsavelle OF President for 2009-10Dr. Richard RounsavelleDr. Richard K. Rounsavelle,Torrance, CA, has been elected 2009-10 President of the OsseointegrationFoundation, succeeding Dr. Fraya I.Karsh, New York, NY, who remainson the Board as Immediate PastPresident. Dr. Rounsavelle was AOPresident in 2006-07.Other officers elected during theFoundation’s meetings in San Diego are:Drs. James H. Doundoulakis, New York, NY, Vice President,and Jonathan H. Orenstein, Marlton, NJ, Secretary-Treasurer.AO’s Immediate Past President, Dr. Steven G. Lewis,Cincinnati, OH, joins the Board as Academy LiaisonDirector. Newly elected Foundation Directors are Drs.Clarence C. Lindquist, Washington, DC, and Kevin T.McNally, Culver City, CA.Continuing as OF Directors are Drs. Edward M. Amet,Overland Park, KS, and Luis J. Fujimoto, New York, NY.Two of the OF officers and directors are general practitioners,two periodontists, four prosthodontists, and one an oral andmaxillofacial surgeon.Nobel Survey …continued from page 1three times more likely to be treatedwith a fixed bridge to restore missingteeth. Forty percent of those with a fixedbridge were unaware that it was not apermanent solution.Another rather glaring finding was thatwhen treatment options were discussedwith these patients, dentists recommendedimplants just 14% of the time.Other options, such as fixed bridges andremovable dentures, were similarly recommended.A whopping 45% of thetime, nothing was discussed.While survey data may often be interpretedcritically, the general informationgathered can be useful for discussion.The Nobel survey certainly has pointedout potential weaknesses in our assumptionsabout patient attitudes and ourown consideration of implant replacementof missing natural teeth. AO membersalmost by definition perhaps don’tfit this data set, but if these data are correct,dentistry as a whole has some roomto grow in its discussion and recommendationof dental implants. Our patientscertainly seem to be ready.5

Committee Profile: Amerian D. Sones, DMD, MS20-year member, now active Committee Vice Chair,Dr. Sones shows residents advantages of AO membershipDr. Amerian D. Sones, Santa Maria,CA, has been a very active Vice Chairof AO’s Membership and AwardsCommittee.Under her leadership, the Committeehas sponsored four major events toshow California’s postgraduate residentsthe many advantages of Academymembership. Informational meetingsDr. Amerian Soneswere held last May and June for residentsat UCLA, USC, and Loma Linda University. Then, inJanuary, the Committee hosted an elegant evening receptionat the Los Angeles County Museum of Art. The events certainlycontributed to a record turnout of student registrants atthe Academy’s San Diego Annual Meeting.AO’s immediate past president, Dr. Steven G. Lewis,Cincinnati, OH, has enjoyed a long friendship with Dr. Sones,having first met her as a co-resident at UCLA in 1982. “She’svery serious and hardworking, but what makes her unique isthat she always has a great sense of humor,” Dr. Lewis says.AO’s president-elect, Dr. Peter K. Moy, Los Angeles, a colleaguewhose friendship with Dr. Sones also dates back 25years, when they were both UCLA residents, describes her asan “all around wonderful person.” Her energy and outgoing,friendly personality contributed greatly to the success of theevents for postgraduate residents, he believes.Dr. Moy also remembers Dr. Sones as a very effective memberof the UCLA School of Dentistry faculty. “She’s one of thebrightest people I know, and she’s able to take that knowledgeand transfer it with her hands. I’ve never seen anyone workbetter with her hands,” he says.Another colleague from her days on the UCLA faculty, Dr.Robert E. Garfield, Los Angeles, describes her as a “highlyskilled, extremely capable prosthodontist who’s very good withpatients.” Her energy and willingness to work contributed significantlyto the success of regional meetings he chaired severalyears ago to attract general dentists to the Academy’smembership, says Dr. Garfield. “When she’s on a committee,she gives it her all,” he says.Dr. Sones’ early involvement in the Academy began as aspeaker on the scientific program in Dallas, Texas in 1989, presentingone of the earliest papers on “Complications of DentalImplants.” She was involved in the first regional meetings theAcademy sponsored in southern California, and co-organizedthe first laboratory program sponsored by the Academy fordental laboratory technicians. At the request of Dr. WilliamLaney, Rio Verde, AZ, she was a contributing author on thetopic of “immediate loading of dental implants” for theInternational Journal of Oral and Maxillofacial Implants (IJOMI).After completing her dental training at the Tufts School ofDental Medicine, Boston, MA, in 1979, Dr. Sones served twoyears in the Indian Health Service as a general staff dentist atthe Sells Indian Health Dental Clinic, near Tucson, AZ. Herinterest in prosthodontics brought her to the UCLA School ofDentistry, where she completed a two-year residency inProsthodontics. She also completed a one-year residency inmaxillofacial prosthodontics and received a Masters of OralBiology in 1984.As a full-time faculty member in the Department of RemovableProsthodontics at UCLA, from 1984 to1987, she became interestedin Implant Prosthodontics and was co-organizer of theinitial Brånemark Training Center at UCLA. Since that time,she has remained very active in the area of implant prosthetics.She has lectured extensively throughout the United States ondental implant related topics and has provided numerous clinicalresidency programs, teaching the restorative aspects of dentalimplants to general dentists and dental specialists.In addition to AO, she is an active member of the AmericanCollege of Prosthodontics, the California Dental Association,the American Dental Association, and the Pacific CoastSociety for Prosthodontics. She has been in private practice inSanta Monica, California for 12 years and Westlake Village,California for 4 years. Since October 2000, she has maintaineda private practice of implant prosthodontics in Santa Maria,serving California’s beautiful central coast.Dr. Sones’ husband,Lawrence Wolinsky,PhD, D.M.D., isAssociate Dean ofthe UCLA, Schoolof Dentistry. Theyare the proud parentsof three youngadults: Julia, 23, aUCLA School ofArt andArchitecture graduate,Zachary, 19, asophomore atUniversity ofCalifornia, SantaThe Sones/Wolinsky family: Zachary, Julia, Andrew,and GusCruz, and Andrew, 17, a junior at Santa Ynez Valley UnionHigh school. A recent addition to her family is her 7-monthold“titanium colored” Weimeraner puppy, Gus.Dr. Sones is an avid runner, gardener, and bread and pie baker.Her recent baking endeavours won first place recognition forthree consecutive years in the Los Olivos Apple Pie Contest,during the annual town event, “A Day in the Country,”October 17, 2004, 2005, and 2006.6

Clinical Technique FeatureThe extra-long implant driver: easy access forimplant placement in the pterygomaxillary regionBy Satoshi Kato, DDS, and Michiko Kato, DDSA number of reports have described the surgical procedurefor placement of screw-type implants in the pterygomaxillaryregion and have revealed a good treatment outcome (1-5). Inmany cases,the implantsare inserted inan antero -lateral direction(Fig 1).However,it is not easyto deliver theimplant covercap, healingcap, and theDrs. Satoshi Kato and Michiko Katoabutmentscrew with thecommercially available implant driver, due to access problemsin this region.We developed an extra-long driver combining custom-madeand commercially available driver parts, using a custom-madedriver from NobelBiocare Japan K.K., Tokyo Japan(www.nobelbiocare.com). Commercially available driversinclude the Unigrip Driver, Nobel Biocare AB, Göteborg,Sweden) (Fig 2). Our extra-long implant driver consists of aconventional driver head attached to a 50 mm-long shaft. Ithas helped to shorten the chairside time in many of our cases.The long shaft driver makes it possible to manipulate thedriver head extra-orally by improving the visibility conditions(Fig 3). Furthermore, other instruments such as theHandpiece Zygoma 20:1 (Nobel Biocare AB, Göteborg,Sweden), can be used to place not only zygoma implants, butalso pterygomaxillary implants. Screw Post Removing PliersCurved Type (YDM Corporation/Yamaura, Tokyo Japan,Email ydm@ydm.co.jp, URL http://ydm.co.jp), can be used tosmoothly remove the guidance pins while making an immediateprovisional bridge (Fig 4).We have found that the extra-long implant driver mayimprove access for implant placements in the pterygomaxillaryregion, compared to the conventional commercially availableimplant drivers.References:1. Tulasne JF. Osseointegrated fixtures in the pterygoid region. InWorthington P, Brånemark PI,(eds). Advanced osseointegrationsurgery: Application in the maxillofacial region. Quintessence publishingco, inc. Illinois 1992:182-188.2. Bahat O. Osseointegrated Implants in the Maxillary Tuberosity:Report on 45 Consecutive Patients. Int J Oral Maxillofac Implants1992;7:459-467.3. Valeron JF, Velazquez JF, Placement of screw-type implants in thepterygomaxillary-pyramidal region: Surgical procedure and preliminaryresults. Int J Oral Maxillofac Implants 1997;12:814-819.4. Balshi TJ, Wolfinger GJ, Balshi SF. Analysis of 356 pterygo-maxillaryimplants in edentulous arches for fixed prothesis anchorage. Int JOral Maxillofac Implants 1999;14: 398-406.5. Valeron JF, Valeron PF. Long-term Results in Placement of Screw-Type Implants in the Pterygomaxillary-Pyramidal Region. Int J OralMaxillofac Implants 2007;22:195-200.Drs. Satoshi and Michiko Kato, operate a private practice, MedicalCorporation Meishinkai, Kato Dental Clinic, Implant Center,Osaka, Japan. Email: samurai@katosika.dental-net.jpFigure 1. The direction of implants inthe pterygomaxillary region.Figure 2. The extra-long implantdriver and three commer cially availableUnigrip drivers.Figure 3. The long shaft makes it easyto handle the driver head extra-orally.Figure 4. Handpiece zygoma (upper)and Screw post removing pliers curvedtype (lower).7

2009 Annual Meeting breaks single meeting attendAO’s first president and longtime IJOMI editor, Dr.William R. Laney, accepts the Nobel Biocare BrånemarkOsseointegration Award to honor an individual’s impacton implant dentistry.Attendance at the Academy’s San Diego AnnualMeeting broke the record for a single (not jointlysponsored) meeting, with 1,911 dentists (members,non-members, students, and faculty). In total,including auxiliary staff, lab techs, non-physicians,exhibitors, spouses and guests, the meeting drew3,667, also a single meeting record. Only thecollaborative meetings in Boston in 2003 and 2008have been bigger.Program Chair Dr. David L. Guichetaddresses the opening session.The posters attracted many viewers and provokedprofessional interaction.Their smiles show something clicked for this poster team.The audience is following every word of this scientificpresentation.Much of the Annual Meeting’s action took place in theexhibit area.Thank youfor your supportThe Academy of Osseointegrationthanks the following companies fortheir generous support of theAcademy’s 24th Annual meeting:• ACE Surgical Supply• Astra Tech Inc.• Bio-Horizons• BIOMET 3i• DENTSPLY Tulsa Dental Specialties• Keystone Dental• Medtronic• Neoss Inc.• Nobel Biocare• Osteohealth Company• Piezosurgery• Quintessence Publishing Co.• Straumann Company• Sybron Implant Solutions• Zimmer DentalPassing of the gavel from outgoing President Dr.Steven G. Lewis (left) to incoming President Dr.Vincent J. Iacono.First hands-on workshop to debutat Academy’s 2010 Annual MeetingA hands-on workshop that focuses oncomputer-guided treatment programswill take place in advance of theAcademy’s 2010 Annual Meeting inOrlando, FL, Hands-On WorkshopCommittee Chair Dr. Stephen S.Wallace, Waterbury, CT, reports.The pre-meeting program, to be heldWednesday, March 3, will offer a series ofconcurrent surgical and restorative workshops.Attendees will have opportunitiesto explore how 3-D imaging and navigationtechnology helps providers fabricatesurgical templates, generate final prosthesisand place implants more effectively aspart of the “team approach” concept.“Increasingly, 3-D imaging and computerizedsoftware programs are enhancingthe team approach to implant dentistryThere was time to make friends, renew friendships, and enjoy themeeting’s social side.by providing comprehensive treatmentplanning,” Dr. Wallace explains. “Thegoals of this session will be to give registrantsfirst-hand experience in the applicationof three-dimensional imaging andnavigation technology, and demonstratehow these systems aid in the diagnosisand treatment of patients.”The Hands-On Workshop Committeehas secured the support of Astra,BioHorizons, BioMet 3i, KeystoneDental and Nobel BioCare to provideequipment, supplies and speakers foreach session. Each presenter’s submittedprogram and educational objectives aresubject to approval by the Academy.More information on the hands-onworkshop will be featured in upcomingissues of Academy News.8

ance recordDr. Daniel Buser makes a point during hisopening symposium presentation.Awards presented to sixDr. Tiziano T. Testori (leftphoto, far left) accepts theWilliam R. Laney Awardfor best IJOMI article fromEditor Dr. Steven E. Eckert(center) and Dr. Laney.AO/OF Research GrantCommittee Chair Dr.James L. Robbins (rightphoto, right) presents theAO Research Grant toDr. Ajay K. Dhingra.President Dr. Steven G.Lewis presents the awardsfor best oral scientificresearch presentation toDr. Gustavo Mendonca(left) and for best oralclinical research presentationto Dr. Juan Ibanez(right).New electronic signage made it easier forattendees to find their way to programs.Poster presentation awardswent to Dr. YoungBumPark (left) for bestscientific poster andDr. Ilser Turkyilmaz(right) for best clinicalposter. Dr. Lewis makesthe presentations.Photographers are often drawn to the happiestpeople at the reception.AO President Dr. Steven Lewis shares a lightmoment with Dr. Sean Avera, Auburn, CA.An enthusiastic group of pre-meeting AO bikersjoined a Harley Bike Ride through San Diego’sback roads, following routes mapped by hostDr. Stephen Wheeler.Dr. Stephen Wheeler (fourth from right) played host again for post-meetinggolf at The Crosby Club at Rancho Sante Fe, followed by a cocktail reception athis nearby home.A social foursome (left to right): Allison Adams, of AstraTech,Valerie Sternberg-Smith, Craig Rodriguez, of AstraTech,and Jeffrey Cebula.Academy leaders aboard the ship CaliforniaPrincess for the President’s VIP Dinner cruise tothe Hotel del Coronado: Director Dr. Russell D.Nishimura (left) and Membership and AwardsCommittee Chair Dr. Luis J. Fujimoto.Incoming President Dr. Vincent J. Iacono (second from right)hosts Prof. Ludovico Sbordone (left), Chair of Implantology andPeriodontology at the University of Pisa in Italy, his wife,Patrizia, and Dr. Wayne Aldredge.9

Time to challenge old truthsAstra Tech Implant System – setting a new standardHow do you achieve optimal long-termtreatment outcomes for your patients? Thestandard norm regarding dental implanttreatment success from 1986 does not reflectwhat is possible to achieve today. There areno reasons why the clinician or the patientshould accept a marginal bone loss of up to1.5 millimeters based on a standard set 20years ago. It has been proven in study afterstudy that with the Astra Tech Implant Systemthe mean marginal bone level reduction is only0.3 millimeters over five years.01 year 2 years 3 years 5 yearsMean marginal bone level change (mm)- 0.2- 0.4- 0.6- 0.8-1.0-1.2-1.4Optimized marginal bonemaintenance with theAstra Tech Implant SystemV- 0.3Astra Tech Implant System level*-1.5 Standard norm**-1.6Time period (yrs)* Astra Tech Implant System level based on data from more than 40 published articles presentingradiological data; literature search April 2008** Standard norm according to:Albrektsson T., et al., Int J Oral Maxillofac Implants 1986;1(1):11-25Albrektsson T. and Zarb G.A., Int J Prosthodont 1993;6(2):95-105Roos J., et al., Int J Oral Maxillofac Implants 1997;12(4):504-514How much bone loss are you willing to accept?Visit www.astratechdental.com and vote in the marginalbone maintenance campaign andfind out more about the factsbehind the figures.USA, Astra Tech Inc. 590 Lincoln Street, Waltham, MA 02451, Tel: +1-800-531-3481. Fax: +1-781-890-6808, www.astratechdental.com

Guest EditorialWho should manage catastrophic implant complications?By Barry P. Levin, DMD periodontistAs a periodontist, I agree 100% with theconcept of managing dental implantcomplications in the Volume 20, Number1 editorial in theAcademy News. Assomeone who hasalso trained withsome of the truepioneers inimplant surgicaltherapy, andsomeone whoDr. Barry Levinteaches dentalimplant surgeryat the University of Pennsylvania, I amalso concerned about the unfortunatedirection implant therapy has taken.These one-stop-shop implant offices arenot only compromising a patient’s wellbeing,but also making it more difficultfor those of us who consider ourselves“team players" to provide standard ofcare treatment. More often recently,patients are refusing implant treatment,because they have had "bad past experienceswith implants" or know someonewho has shared a similar complicationstory. The public has no way of knowingwho is qualified to place implants.General practitioners are still the “gatekeepers”to most dental patients. If theydiagnose a condition warranting implanttherapy, their patients count on them tonavigate them to the final destination. Ifthey aren’t given a choice of a surgicalspecialist to handle this component ofimplant therapy, they usually don't askfor a referral.Public awareness is key. The problemwe face as specialists is that of notoffending our restorative colleagues.However, this prevents and is divisive tobroad public awareness campaigns.As a fellow lecturer, I am certain that youcan relate to the dilemma of fieldingquestions from general practitioners andothers clearly trying to milk you for surgicaltips. This is very uncomfortable, aswe don’t wish to be offensive, disrespectful,or elitist. However, we have aresponsibility to our specialties, and Iwould never wish to be one of those specialistsmaking extra bucks by teachingsurgery to those unqualified to do so.Dr. Schmitz’ editorial was well read, andI thought everyone should know that itdid not fall on deaf ears.Director’s Profile …continued from page 3Led by Dr. Per-Ingvar Brånemark,Goteborg, Sweden, the program markedthe first exposure of the BrånemarkMethod in the Pacific Northwest region.“That program was a game-changer. Tothis day, it remains the most impressiveeducational experience I’ve ever been apart of,” Dr. Malmquist explains. “It wascompletely grounded in science andmade everyone who attended a believer.”Dr. Malmquist attended AO’s firstAnnual Meeting in New York City thefollowing year. A frequent AnnualMeeting attendee and presenter sincethen, he marvels at how the Academyhas developed into the leading organizationfor dental implant professionals.Newly Elected Officers …continued from page 3Dr. Wheeler chairs AO’s Ad HocCommittee on International Relations,and helped establish the AO DentalForum, accessible via the Academy’sWebsite, www.osseo.org. In addition,he chaired the Academy’s 2002 AnnualMeeting in Dallas, TX.AO Director: Dr. Jay MalmquistDr. Malmquist (see profile, page 3) is“The AO’s greatest strength lies in thetalents and expertise of its individualmembers. No other dental organizationenjoys such a cross-section of specialistswho are able to learn from each other ina non-competitive educational environment,”Dr. Malmquist says. “That diversityhas made the Annual Meeting thepremier educational forum for dentalimplant professionals. I consider it aprivilege to serve on the Board.”In addition to his Academy service, Dr.Malmquist served as an examiner withthe American Board of Oral andMaxillofacial Surgery for seven years.He spent eight years on the Board of theAmerican Association of Oral andProfessor of Oral and MaxillofacialSurgery at Oregon Health ScienceUniversity, Portland. He has maintaineda private practice in Portland for morethan 30 years.Academy Officers and Directors continuingtheir service on the Board ofDirectors are Drs. Steven G. Lewis,Cincinnati, OH (Past President);Maxillofacial Surgeons (AAOMS),including a term as its president.Away from the office, Dr. Malmquistenjoys “working in my yard, playing golfand traveling to the Oregon coast.” Heis very proud of his two sons, Chris andMichael. Both are graduates of theMilitary College of South Carolina (TheCitadel), and are following in theirfather’s career footsteps.Chris completed two tours of duty inthe Middle East with the Marine Corps,and is currently West Coast Manager fora major dental implant manufacturer.Michael is pursuing a Fellowship in Oraland Maxillofacial Surgery at BaylorUniversity, Dallas, TX.David L. Cochran, San Antonio, TX(Treasurer); and Directors JosephGian-Grasso, Philadelphia, PA;Frank L. Higginbottom, Dallas, TX;Russell D. Nishimura, WestlakeVillage, CA; Michael R. Norton,London, UK; Alan S. Pollack, NewYork, NY; and James Taylor, Ottawa,Ontario, Canada.11

NobelActive TMTaking a new direction in implants.Dual-function prostheticconnectionBuilt-in Platform ShiftingBone-condensing propertyHigh initial stability,even in compromisedbone situationsAdjustable implant orientationfor optimal final placement10 YEARS WITHTIUNITE® SURFACENew data confirmlong-term stability.NobelActive equally satisfies surgicaland restorative clinical goals.NobelActive thread design progressivelycondenses bone with each turnduring insertion, which is designed toenhance initial stability. The sharp apexand cutting blades allow surgical cliniciansto adjust implant orientation foroptimal positioning of the prostheticconnection. Restorative cliniciansbenefit by a versatile and secure internalconical prosthetic connection withbuilt-in Platform Shifting upon whichthey can produce excellent estheticresults. Based on customer feedbackand market demands for NobelActive,the product assortment has beenexpanded – dental professionals willnow enjoy even greater flexi bility inprosthetic and implant selection.Nobel Biocare is the world leaderin innovative evidence-based dentalsolutions.For more information, contact aNobel Biocare Representative at800 322 5001 or visit our website.www.nobelbiocare.com/nobelactiveNobel Biocare USA, LLC. 22715 Savi Ranch Parkway, Yorba Linda, CA 92887; Phone 714 282 4800; Toll free 800 993 8100;Tech. support 888 725 7100; Fax 714 282 9023Nobel Biocare Canada, Inc. 9133 Leslie Street, Unit 100, Richmond Hill, ON L4B 4N1; Phone 905 762 3500; Toll free 800 939 9394; Fax 800 900 4243© Nobel Biocare 2009. All rights reserved. www.nobelbiocare.com

Guest EditorialWho’s going to manage your catastrophic implantcomplications? Put the driver back in the bagBy Barry R. Franzen, DDS prosthodontistI don’t golf much anymore. It’s too hardto manage my complications. I evenbought a $450driver that wasguaranteed tocure any ailmentknown to JoeDuffer, but itonly accentuatedeverything thatwas wrong in theDr. Barry Franzenfirst place.Lessons, practice?Not part of the thought process.When the other members of my foursomestarted to run for cover as myslices headed back to the tee box, I knewit was time to put it back in the bag.Management of complications solved!I have been involved with implantssince 1982. Now we see more and more“non-surgeons” placing and restoringtheir own fixtures. I personally fall intothat category, as a prosthodontist placingmany of my own fixtures. I hadbeen in the implant game for over 17years and had been seeing fewer implantreferrals, because the surgeons weredoing those cases with the general practitionersI helped educate. I was seeingsignificant amounts of surgical production“leaking out the door” for the casesI was restoring.So I started thinking: I’ve been drillingPara posts successfully to within 0.2mmfor decades in a medium that doesn’t heal.I have a good baseline knowledge of thesurgical aspect, and I get my Christmastree straight every year, even when mywife helps. Wouldn’t that lost surgicalproduction look better in my pocket?Did I just run out, buy a drilling unitand start planting fixtures? No, it was adeliberate process that involved morethan a weekend course and then off tothe races. I was like Bill Murray in themovie “What About Bob?” Baby steps,baby steps. It was an evolution of knowingone’s limitations, seeking the knowledge,expanding the knowledge, andgaining experience.This awareness was not only in theplacement and restoration, but also inthe problems that may arise. Slowly andsteadily, this expanded to a point where Ihandle more difficult cases by myself. Ifthere is anything that I feel is beyondmy limitations, I refer those cases to thesurgeons with whom I have had a relationshipfor so many years. Misery doeslove company!So who is going to manage my catastrophicimplant complications? Theprosthetic end of it is not a problem. Iam way down that learning curve. Andthere isn’t a week that goes by thatsomeone isn’t calling with a prostheticissue with which I am asked to help.Granted, a prosthodontist placingimplants doesn’t cast a very big shadowin the surgery world, but a lot of goodwillis generated when I do retrieve thatbroken abutment screw for a surgeonand his general practitioner referral.There is even more goodwill when thegeneral dentist is doing both.Surgical complications are another issue.While few and far between, when I needhelp, I expect and rely on my surgeons.They do so willingly, because they knowI have reciprocated in the past and willcontinue to do so in the future. The onetime in the past ten years I did need helpwas an incredible combination of badluck and misaligned planets. I didn’tthink twice about calling for helpbecause I am already way ahead on thefavor “chit sheet.”So surgeons are starting to feel the pinchas more “non-surgeons” place implantsbefore taking baby steps. Do I detect justa bit of animosity when they may be askedto help clean up someone else’s mess?When it comes to catastrophic failures,the prosthodontist community hashelped in the bailout since day one. Andwe sit like a faithful lab waiting for thatbone of a referral that might be thrownour way as a reward. Maybe we are justnot self-confident enough to say, “Youbroke it. You bought it.” Or perhaps webetter understand that the whole essenceof being a specialist is the ability andwillingness to make the complex routine.To those brother “non-surgeons” placingimplants I say, “Do your homeworkand know your limitations.” Just don’tstab the lifeboat that may save you whenyou are in over your head. Keep a relationshipwith a “real” surgeon for casesthat are out of your comfort zone.For those who don’t know their limitations,I say, “Come on in, the water iswarm!” Personally, I’d keep the clubs inthe bag that get me in trouble but somepeople just can’t resist. Helping out onthose cases just adds to my knowledgebase on my third implant learningcurve, rescue!I sincerely like my Rube Goldberg alterego. I would invite my surgeon colleaguesto get in touch with theirs.Even if DRIMPLNTR deserves to godown in flames, his patient is worthy ofyour expertise. I guarantee you willhave a hitch in your giddy-up all daylong, especially when you pull a rabbitout of someone else’s hat!President’s Message…continued from page 2Regardless of the initiatives to beimplemented, your Board will befiscally responsible in these terribleeconomic times. In this regard, I amconvening a strategic planning sessionin conjunction with the next AOBoard meeting in June 2009 that willupdate our strategic plan to includegoals and objectives that reflect theAO’s vision in a cost-effective manner.As AO President, I look forward toworking with my fellow Officers andBoard Members to serve you, themembership, using the philosophy ofthe 3Cs – “Communication,Cooperation and Collaboration” tofulfill the AO vision. For we will bejudged not by our ideas, actions, orefforts, but by our tangible results.13

Editor’s EditorialClearing the air about managing complicationsin implant surgeryBy John P. Schmitz, DDS, MS, PhD, Newsletter EditorMy last Academy News editorial (“Whathappens when implant placement turnscatastrophic? Do we need to call DirtyHarry?” Volume 20, Number 1, 2009)generated many emails and commentsto the Editor. The response was overwhelming,to say the least. It has takenme several weeks to begin to understandwhat it all means and to formulatea response. I received emails fromDr. John Schmitz my clinician friends, from former residentsI trained, from my former classmates,from former AO Presidents, and from people who justwalked up to me at the San Diego Annual Meeting and introducedthemselves.At first, I was going to try and address all the issues peoplehad raised. But as I began to collate a constructive response, Ifound that some of the rationale just wasn’t there. I wastempted to print several of the Letters to the Editor intact.However, I decided against this for two reasons. First, it wouldhave taken too much newsletter space. And second, I’m noteven sure that some of the members who wrote commentswould be comfortable having their letters published.The direction I have decided to take is to outline some of thecomments in the hope of clarifying my thoughts for the membershipand increasing understanding of what the AO is reallyabout. With this in mind, I will be the first to admit that noteveryone will be completely satisfied. That is the nature of ourdiverse membership. We must all understand that we comefrom diverse specialty memberships, and that the spirit of ourmembership should be education.However, in the spirit of allowing a voice to opposing viewpoints,I extended an offer to two AO members who emailedme comments (a prosthodontist, Dr. Barry R. Franzen, WestAllis, WI, and a periodontist, Dr. Barry P. Levin, Elkins Park,PA), to submit mini-editorials of their own. Their topic was:“Who will manage catastrophic implant complications?” Theirmini-editorials are published on Pages 13 and 11.As stated succinctly in the opening pages of our membershipdirectory, the Academy of Osseointegration (AO) is a multidisciplinary,international dental implant organization thatexists to bring together individuals of different backgrounds inorder to share experience and knowledge regarding dentalimplants. Members share the common goal of moving thefield of osseointegrated implants forward through clinical andevidence-based research and education. The AO has publishedGuidelines for the Provision of Dental Implants (2008) andhosted a 2006 Consensus Conference on the State of theScience on Implant Dentistry.Discussing implant complications and their management isimportant to moving the field of dental implant treatment forward.The AO regularly offers a session on complications atthe Annual Meeting. If a dentist doesn’t believe that managingcomplications is important, then the issue of patient safetymay not be high on his or her priority list. It should be.Managing complications is about managing patient safety.One member responded to my editorial by emailing that Ishould not go public in delineating other dentists’ shortcomings.Patient safety is embedded in the definition of the AO.However, there will always be isolated dentists who will feelthat complication management should be someone else’s problem.There are also some who will feel that they have the skillset to manage all dental implant complications, regardless ofhow little formal surgical training they received in their postgraduatepreparation.Let me conclude by summarizing my thoughts after all thisdiscourse. I must admit that most comments directed to mewere surprisingly supportive. Some of the opposing commentsseemed to come from members who misunderstood andtherefore misrepresented the intended message of my editorial.The editorial was about complications, not credentialing. Itwas about managing dental implant complications in the bestinterest of patient safety.In several emails, members conveyed a variety of reasons whythey began to surgically place their own implants. Several reasonswere advanced as justification for performing implantsurgery. However, the decision of a dentist to justify why he orshe performs such procedures was not the issue. The editorialwas about complications.I believe my editorial was misunderstood by many doctors,who thought it suggested, “General dentists should not placeimplants.” This was not my intended message. The messagewas how to manage complications (and indirectly patient safety).However, many doctors who place implants these daysdon’t recognize their own limitations.The AO Board is still determining the best way to assurepatient safety and maintain the high level of expertise and carein implant dentistry. The response to my editorial shows howimportant and how sensitive this issue can be. I support theBoard’s strategic planning efforts and remain confident thattheir actions will be in the best interest of implant dentistry.Readers who would like to comment or express a point of view on theeditorial are invited to write via e-mail to the editor atschmitzjp@hotmail.com. We will endeavor to publish pertinentcomments or views when space permits.14

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