EDI - BdiZ

ISSN 1862-2879
Issue 2/2010 Vol. 6
EDI Journal
European Journal for
Dental Implantologists
TOPIC
Maxillary and Mandibular
Full-Arch Rehabilitation:
A Complex Case
»EDI News: Coming up: 14 th BDIZ EDI Symposium in Munich · Interview with Professor
Joachim E. Zöller on Challenges in Oral Implantology · 14 th BDIZ EDI European Committee
Meeting in Cologne · 4 th Mediterranean Symposium in Belek/Antalya »European Law:
ECJ: Economic Incentives to Promote the Description of Low-Cost Medicinal Products
are Legal »Case Studies: Comparative Investigation of Various Implant Surfaces by
SEM Analysis · Vestibuloplasty: New Indications for an Old Technique? · Maxillary and
Mandibular Full-Arch Rehabilitation: A Complex Case · »Product Studies: Bone Platform
Switching · Pre-Implantological Bone Block Osteosynthesis

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If you don’t already know
Bavaria and Munich –
come and get to know
it now! I would like to
invite you to the “me -
tro polis with a heart” on
the banks of the river
Isar on 15 and 16 October 2010. As you can imagine, it was not
primarily the interesting museums and the unique Bavarian
spirit that prompted me to issue this invitation. Rather, it
was that on these two days, BDIZ EDI is going to address the
challenges awaiting oral implantologists and their teams now
and over the next few years.
This issue of the EDI Journal contains the complete schedule
of events for this notable symposium – and I can promise you
that you will not be lacking in anything: Reliable information
by eminent healthcare experts explaining to you in which
direction the fee schedule discussion is developing and what
the legal and political framework for your dental office will be
in the future. And there will be top-notch continuing dental
education – as usual you can trust Prof Joachim E. Zöller to
select a highly qualified and balanced team of expert speakers.
Talking about challenges in oral implantology means moving
the focus away from the successes and breathtaking pictures
and taking a more scrutinizing look instead. This time we are
also going to show the problems and the failures, offering tips
and tricks for the pre-insertion stages to prevent complications
before they can manifest themselves, and helpful advice for
dealing with problems that nevertheless occur.
By popular request, BDIZ EDI will again be holding this event
in the exclusive atmosphere of the five-star Sofitel Munich Bayer -
post. More than 400 attendees had enjoyed themselves there
last year, and we hope to equal, if not exceed, this mark in 2010.
So we will be holding our symposium in the middle of the
city again, offering you a special treat right at the beginning: A
“getting-ready-for-success” training for the entire dental team
with former first-league handball player Jörg Löhr, today a
much sought-after motivational coach who has inspired the
managers and staff of many major companies in Germany.
I myself was at one of his coaching sessions at one point, and
I can assure you: After only two hours, you and your team will
be highly motivated and set on taking active steps, or at least
looking at things from a new angle.
It’s the Right Mix
that Counts!
Determination and a thirst for action are two of the attri -
butes that characterize members of the free professions anyway.
Unfortunately, our tedious daily struggle with laws, rules
and regulations – not to mention the eternal fights with reimbursement
agents – will often cause us to lose our drive. Time,
then, to revive it!
With just the right dose of motivation, you will be ready
to meet the challenges of the fee schedule discussions at
the Health Politics Forum. Our team of experts and decision-makers
will update you on current issues in healthcare
politics.
Here, too, a healthy mix of theory and practice is the road to
success. And with this, I am actually giving away a secret, the
secret of the BDIZ EDI philosophy: A healthy mix of theory and
practice is what the BDIZ founding father, the late Prof Egon
Brinkmann kept demanding almost ad nauseam. We are continuing
along the path he outlined for us: The mix of theory
and practice is reflected in the daily work of BDIZ EDI. Proof
of this are the annual Guideline of the European Consensus
Conference held under the auspices of BDIZ EDI, as well as
the BDIZ EDI symposia – which becomes particularly obvious
when you look at the second part of the event, the scientific
programme. So what, exactly, are the challenges we are facing
in daily clinical practice? How do I avoid complications, including
major ones such as nerve damage? How do I tackle surgical
and prosthetic problems – more specifically: What do I
do if the nerve already appears to be damaged? How do I
proceed during a sinus lift? And what about subsequent coverage?
What is the key to success in bone augmentation?
What pre-existing conditions must I take into account, and
what medications are actually helpful? What are the benefits
of drilling stents and 3D planning and surgery? How do
I design, process and insert ceramic restorations to avoid
fractures and chipping?
In our daily practice it is important to forestall complications,
to master problems and to avoid failures. And this can in fact
be done successfully. Come to Munich and see for yourself!
Attend the congress, bring your team – and make sure you set
aside a few hours to enjoy the city and its splendours!
Sincerely,
Christian Berger, Kempten/Germany
President of BDIZ EDI
EDI
Editorial
3

4 EDI
Table of Content
EDI News
Mastering Challenges in Everyday Practice
14 th BDIZ EDI Symposium in Munich,
15/16 October 2010 8
The Time of Breathtaking Pictures is over
Interview with Prof Joachim E. Zöller on
challenges in oral implantology 22
European Curriculum under Development
14 th BDIZ EDI European Committee meeting
in Cologne 26
4 th Mediterranean Symposium: See Turkey and
Learn Something
Successful BDIZ EDI continuing-education week
in Belek/Antalya 28
Top-level Implantological Training
12 th BDIZ EDI Curriculum Implantology to start
in November 2010 34
Successful Exam Candidate in Cologne
EDA Expert in Implantology 37
Upcoming EDA Expert in Implantology
Certification Exam
Munich, 17 October 2010 37
International Expert Symposium for Regenerative
Methods in Medicine and Dentistry
Visiting Fuerteventura for the 20 th time 38
BDIZ EDI in Barcelona
14 th Dentsply Friadent World Symposium 39
International Congress for Maxillofacial Surgery
Belgrade, 27 to 29 October 2010 40
18 th International SEI Convention in Spain
Seville, 25 to 27 November 2010 40
Europe Ticker 42
European Law
ECJ: Economic Incentives to Promote the
Description of Low-Cost Medicinal Products
are Legal 46
Page 78: Pre-implantological bone block osteosynthesis.
Case Studies
Surprises in the Land of Microns
Comparative investigation of various implant
surfaces by SEM analysis 50
New Indications for an Old Technique?
Neugebauer on vestibuloplasty 55
Maxillary and Mandibular Full-Arch Rehabilitation:
A Complex Case
Well-organized teamwork: Periodontology,
implantology, prosthodontics 58
Marketing and Other Types of “Mad Cow Disease”
Neugebauer et al on augmentation materials 70
Product Studies
Bone Platform Switching
3D finite element analysis comparing standard
and reverse conical neck implants 72
Functional Innovations
Pre-implantological bone block osteosynthesis 76
Business & Events
Success is...
14 th Dentsply Friadent World Symposium 80
The Conversation of Geneva
ITI World Symposium 2010 84
For the Patient’s Benefit
Osteology Symposium Baden-Baden 2010 86
6 th Mozo-Grau Update Congress on Implantology 90
International Osteology Symposium, Cannes,
April 14 to 16, 2011 91
Straumann Launches Digital Solutions Platform 92
Materialise Dental NV Collaborates with
Cefla Dental Group and QR srl 93
Twenty Years of Omnia 94
Dr Berthold Reusch Takes over 95
News and Views
Editorial: It’s the Right Mix that Counts! 3
Imprint 6
Product Reports 96
Product News 100
Calendar of Events 106
Publishers Corner 106

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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 Hakan Özyuvaci, Istanbul
Prof Dr Georgios Romanos, Rochester MDT Luc and Patrick Rutten, Tessenderlo
Dr Henry and Maurice Salama, Atlanta Dr Ashok Sethi, London
Ralf Suckert, Fuchstal Prof Dr Dr Joachim Zöller, Cologne
All case reports and scientific documentations are peer reviewed by the international editorial board
of “teamwork – Journal of Multidisciplinary Collaboration in Restorative Dentistry“
Project Management
& Advertising:
Marianne Steinbeck, MS Media Service, Badstraße 5, D-83714 Miesbach,
Phone +49 8025 5785, Fax +49 8025 5583, ms@msmedia.de, www.msmedia.de
Publishers: teamwork media Verlags GmbH, Hauptstr. 1, D-86925 Fuchstal
Phone +49 8243 9692-11, Fax +49 8243 9692-22
service@teamwork-media.de, www.teamwork-media.de
Layout: Sigrid Eisenlauer; teamwork media GmbH
Printing: J. Gotteswinter GmbH; Munich
Publication Dates: March, June, September, December
Subscription Rates: Annual subscription: Germany € 40.- including shipping and VAT. All other countries € 58.- including shipping. Subscription
payments must be made in advance. Ordering: in written form only to the publisher. Cancellation deadlines:
in written form only, 8 weeks prior to end of subscription year. Subscription is governed by German law. Past issues
are available. Complaints regarding nonreceipt of issues will be accepted up to 3 months after date of publication.
Current advertising rate list No. 1, from 1/01/05
ISSN 1862-2879
Payments: to teamwork media GmbH;
Raiffeisenbank Fuchstal BRC 733 698 54 Account No.100 416746
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
manuscripts the publisher has the right to publish, translate, permit reproduction, electronically store in databases, produce
reprints, photocopies and microcopies. No responsibility shall be taken for unsolicited books and manuscripts. Articles
bearing symbols other than of the editorial department or which are distinguished by the name of the authors represent
the opinion of the afore-mentioned, and do not have to comply with the views of BDIZ EDI or teamwork media
GmbH. Responsibility for such articles shall be borne by the author. All information, results etc. contained in this publication
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
specially labeled items shall not be borne by the editorial department.
Copyright: teamwork media GmbH . Legal Venue: Munich

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EDI
EDI News
An old adage says that the early bird catches the
worm. With so many different options, choosing the
right activity from the pre-congress programme may
be a challenge in its own right. If you attend the
CBCT course on radiation protection in dentistry,
you will be among the first up and around on Friday.
The course hopes to duplicate last year’s success,
with more than 100 dentists attending. Part 1 will
run from 7:30 am to 12:30 pm on Friday and from
6:00 pm to 7:00 pm on Saturday. Part 2 and the
final examination will take place on 5 March 2011,
at the 6 th BDIZ EDI Expert Symposium in Cologne.
If you do not require the CBCT course, you may
choose between three different industry workshops:
bredent medical, Sirona Dental and Camlog are all
ready to meet the challenges of oral implantology in
their own way.
Training for success
14 th BDIZ EDI Symposium in
Munich, 15/16 October 2010
Mastering
Challenges
in Everyday
Practice
Munich, the Bavarian metropolis that styles itself “cosmopolitan city with a heart”, will soon catch the attention of clinical
dental implantologists for the second year in a row. The 14 th BDIZ EDI Symposium, to be held at the Sofitel Munich Bayerpost
on 15 and 16 October 2010, will address topics of interest to the entire dental team. As in 2009, BDIZ EDI is expecting more
than 400 attendees. The motto of the symposium will be “Mastering Challenges”.
Course in radiation protection
Starting at 10 o’clock on Friday, BDIZ EDI will offer
an absolute novelty for the dental office – that is,
the entire dental team: Former professional handball
player and star motivational coach Jörg Löhr from
Augsburg will present dentists and assistants a number
of important facets of successful office management.
Löhr is one of the most popular coaches in Germany,
inspiring Top 100 companies such as carmaker
BMW, Germany’s mighty automobile association
ADAC and Bundesliga football team Eintracht Frankfurt.
After the lunch break, dental assistants will
branch off to their own programme.
For dentists, a top-notch panel of speakers hosted
by BDIZ EDI President Christian Berger will try to
answer the question “Quo vadis, GOZ?” at the Health-
On Friday, 15 October and Saturday, 16 October, BDIZ will be offering another CBCT course (Part 1) in radiation
protection in dentistry covering advanced technical aspects of digital cone-beam computed tomography, also
called digital volume tomography or DVT. This special course has been approved by the Chambers of Dentists
of the state of North Rhine-Westphalia and Bavaria and is a prerequisite for gaining approval operating a CBCT
unit. Approval requires, in addition to the theoretical expertise acquired within the framework of the Munich
course (Part 1) and by attending the presentations at the Munich symposium, a three-month practical training
period after the course. This practical training will be offered at the University of Cologne in small groups by
individual appointment. Part 2 of the course and the final examination will take place on 5 March 2011 at the
6 th BDIZ EDI Expert Symposium in Cologne. More information: www.bdizedi.org

The Sofitel
Munich Bayerpost
will be the
venue of the
14 th BDIZ EDI
Symposium.
care Politics Forum, including renowned experts on
the German healthcare scene. (GOZ is the German
standard fee schedule for dentists, applicable to private
patients, including patients with private health
insurance.) Prof Johann Eekhoff will present an analysis
of the status quo in healthcare, while Dr Thomas
Drabinski of the Institute for Micro-Data Analysis
(IfMDA) in Kiel will explain what the so-called small
flat-rate health insurance premium (“kleine Gesundheitsprämie”)
will mean for dentists. Peter Knüpper,
attorney and Managing Director of the Bavarian
Chamber of Dentists, will explore whether dental
care can continue to be funded by statutory health
insurance. Wolfgang Reif of the Bavarian State Committee
for private health insurance will be addressing
the issue of future remuneration models for dental
services from the point of view of private health
insurers. Michael Schwarz, President of the Bavarian
Chamber of Dentists, will show how HOZ (which is
the German Dental Association’s fee schedule) can
be implemented in the dental office. This part of the
Hot Sax Club
symposium will conclude with Dr Thomas Ratajczak
answering the quo vadis question. This year’s welcoming
address will be given by Dr Wolfgang Heu -
bisch, BDIZ EDI member and Bavarian State Minister
of Science, Research and Art.
The “Prime Minister” is coming!
Friday night’s highlight is likely to be the performance
by political satirist Wolfgang Krebs parodying
former Bavarian prime minister Edmund Stoiber at
the BDIZ EDI gala night. “Edmund Stoiber” is bent on
explaining the world to oral implantologists. At the
request of many members and attendees, the fivecourse
gala dinner and musical entertainment will
once again be held at the Lenbach – not in the
restaurant’s dining room this time, but in the tapestry
room. Also like last year, the four saxophone players
of the Hot Sax Club will play to their heart’s
desire, and again you may look forward to beholding
them in their constantly changing, breathtakingly
glamorous wardrobe. BDIZ EDI President Christian
Berger will be awarding the 2010 BDIZ EDI Medal of
Honour to a highly deserving implantologist, who is
also a speaker at the scientific sessions. (But that is
all we are ready to give away at this time!)
B as in Brodbeck to Z as in Zöller
EDI
EDI News
After a glamourous evening and night, it will be “back
to business” on Saturday. What do the challenges in
oral implantology consist of today? This will be the
focus of the scientific programme at the 14 th BDIZ EDI
Symposium. If you want to read up on the topic
ahead of time, you should not miss the interview
Annual General Meeting
The Hot Sax Club is an all-female jazz quartet whose members will be
performing familiar jazz tunes on their saxophones – acoustic saxophones,
no amplifiers. These could be catchy tunes from the 1920s like
Charleston or Entertainer, or melodies from the Glenn Miller era such as
In the Mood or Summertime – or more contemporary arrangements
such as The Pink Panther or Don't worry, be happy.
This year’s Annual General Meeting of BDIZ EDI
will take place at the Sofitel Munich Bayerpost
hotel on Saturday, 16 October 2009 between
12:15 pm and 2:00 pm. Conspicuous signs will
guide participants to the appropriate room.
9

Institute
The Eduardo Anitua Institute (Vitoria, Spain)
is one of the outstanding international
training centres in the fields of implantology
and oral rehabilitation. Supported by most
modern medical and audiovisual technologies
you experience advanced training on highest
level, scientific and practice oriented.
The centre includes an auditorium for 74
persons, several seminar rooms and an
additional training room for practical
exercises.
Advanced Training
The desired live-surgery courses of Dr. Eduardo
Anitua are offered several times per year. The
capabilities of the attendants get improved in the
most important areas of implantology by livesurgeries,
practice oriented lectures and handson
exercises.
For further information
please contact:
BTI Biotechnology Institute
San Antonio 15 - 5º
01005 Vitoria (ALAVA) • SPAIN
BTI
Training Center
www.eduardoanitua.com
Tel.: (34) 945 149 202
Fax: (34) 945 154 909
export@bti-implant.es

Extrashort implants
5-year retrospective study with
BTI short implants (99.2 % success
rate):
Anitua E, Orive G, Aguirre JJ, Andía I. 5 year clinical
evaluation of short dental implants placed in posterior
areas: a retrospective study. J Periodontology 2008;
79: 42-48.
0.5 mm.
Biotechnology Institute
San Antonio 15 - 5º
01005 Vitoria (ALAVA)
SPAIN
Tel.: (34) 945 149 202
Fax: (34) 945 154 909
export@bti-implant.es
LEADING INNOVATION
1.5 mm.
4 mm.
5.5 mm.
0.5 mm.
L: 5.5 mm. L: 6.5 mm. L: 7.5 mm. L: 8.5 mm.
1.5 mm.
5 mm.
Ø mm.: 2.5 3 3.3 3.5 3.75 3.3 3.5 3.75 4 4.25 4 4.5 5 5.5 4.5 5 5.5 6
6.5 mm.
These implants have 1,5 mm from the platform to the first thread. If we place them in a supracrestal way
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Predictability and biosafety of BTI Dental Implants.
Anitua E, Orive G, Aguirre JJ, Andía I. Clinical outcome of immediately loaded BTI dental implants: a 5-year retrospective study.
J Peridontology 2008;79:1168-1176.
Retrospective study with 5787 BTI Dentals Implants in 1060 patients (99.2 % of success).
Anitua E, Orive G, Aguirre JJ, Andía I. 5-year clinical experience with BTI Dental Implants: risk factors for implant failure.
J Clin Periodontol 2008;35:724-732.
BTI of North America
1730 Walton Road
Suite 110
Blue Bell, PA 19422-1802 US
Tel: (1) 215 646-4067
Fax: (1) 215 646-4066
info@bti-implant.us
BTI Deutschland GmbH.
Mannheimer Str. 17
75179 Pforzheim
GERMANY
Tel: (49) 7231 428060
Fax: (49) 7231 4280615
info@bti-implant.de
BTI Implant Italia Srl.
Piazzale Piola n.1
20131 Milano
ITALY
Tel.: (39) 02 70605067
Fax: (39) 02 70639876
bti.italia@bti-implant.it
BTI de México
Lope de Vega 117, 701-702
11570 Col. Chapultepec Morales
México DF • MEXICO
Tel.: (52) 55 52502964
Fax: (52) 55 55319327
bti.mexico@bti-implant.com
BTI Portugal
R. Pedro Homem de Melo
55 S/6.03
4150-000 Porto • PORTUGAL
Tel: (351) 22 618 97 91
Fax: (351) 22 610 59 21
bti.portugal@sapo.pt
www.bti-implant.com / www.prgf.org

12
EDI
EDI News
with Prof Joachim E. Zöller, Scientific Director of the
programme and BDIZ EDI Vice President, in the EDI
News section of this issue. The “Challenges” topic
complements the range of issues that had been discussed
earlier this year at the Expert Symposium in
Cologne. But even if you did not attend Cologne, the
programme of the 14 th BDIZ EDI Symposium will offer
valuable advice for your clinical practice and assist
you in dealing with complications.
The panel of speakers includes experienced
implantologists who are not afraid to discuss complications
and failures. The initial presentation by
Dr Jörg Neugebauer (Cologne) will try to answer the
question whether medications can influence implantological
success. Next, Dr Achim Nickenig (Cologne)
will address the technique of template-guided
implant insertion; Prof Rolf Ewers (Vienna) will elaborate
on principles of guided surgery. Dr Stefan Reinhardt
(Münster) will present the various bone augmentation
options, and Prof Peter Tetsch (Münster)
will evaluate the sinus lift. Dr Frank Kistler (Landsberg)
will demonstrate the immediate placement
of implants without augmentation. Prof Germán
Gómez-Román (Tübingen) will inquire into what
parameters determine success in the aesthetic zone.
Dr Arndt Happe (Münster) will focus on the difficult
issue of soft-tissue management. Before looking
more closely at the materials, Prof Antonio Felino
(Porto) is planning to emphasize the importance of
bone-preserving surgical techniques for subsequent
implantation procedures. Prof Peter Pospiech (Bad
Homburg) will tackle the issue of ceramic chippings,
!
Please register via fax
+49 228 9359-246
or by mail
BDIZ EDI Geschäftsstelle Bonn
An der Esche 2
D-53111 Bonn
trying to investigate whether chipping is a problem
in prosthodontics or a problem in material technology.
Dr Urs Brodbeck (Zürich) is also going to look at allceramic
restorations and tries to answer the question
whether everything really is simple without metal.
“Managing complications in oral implantology
requires a thorough understanding of the biological
situation and many years of clinical experience”,
wrote Prof Joachim E. Zöller in his preface to the
programme of the 14 th BDIZ EDI Symposium. These
experienced practitioners and representatives of the
academic world will share their knowledge with the
attendees of the Munich event.
AWU
Registration
Symposium und CBCT course
Members/assistant members of BDIZ EDI: €700 (after 1 August: €790)
Non-members: €1,300 (after 1 August: €1,390)
Symposium only
Members of BDIZ EDI: €320 (after 1 August: €390) Non-members: €390 (after 1 August: €460)
Assistants/students: €260 (after 1 August: €310)
Programme for dental assistants
€120 (after 1 August: €160)
(The conference fee is not subject to VAT.)
Gala Night: ______ tickets @ €95 p.p. (incl. VAT) = € __________
I will be attending the General Meeting.
Family name and given name
Street address
Postal code and city
Contact/Phone/E-Mail
Date and signature
Hotel reservations
BDIZ EDI has secured a contingent of Superior
rooms at the Sofitel Munich Bayerpost hotel for
the participants of the symposium. Participants
are requested to make their own reservations,
mentioning “BDIZ EDI” at the time of booking:
Sofitel Munich Bayerpost
Bayerstraße 12, 80335 München, Germany
Phone: +49 89 59948-3000
Fax: +49 89 59948-1000
h5413@sofitel.com
Superior room per night, including breakfast
€ 165.00

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14
EDI
EDI News
Friday, 15 October, 10:00 am
Getting Ready for Success with Jörg Löhr
Jörg Löhr Erfolgstraining, founded in 1995, is considered the leading provider of seminars on success, motivation and personality
in the German-speaking area. This company, owned by “Europe’s most sought-after success and personality coach”, claims as
its mission to support people in all wakes of life in developing their full potential.
Löhr’s coaching clients include top athletes and
national sports teams as well as well-known business
corporations such as Allianz, Arcor, BASF, BMW,
IBM, Daimler, Deutsche Telekom, L’Oréal, Oracle, SAP
and numerous major German financial institutions.
In recent years, Jörg Löhr has received several
awards for his ability to combine the transfer of solid
knowledge with his talent to inspire. In 2006, he was
accepted into the Speakers’ Hall of Fame in recognition
of his lifetime achievements. As an athlete, he
had played on the national handball team 94 times,
Friday, 15 October, 9:00 pm
winning the European and German cups and multiple
German championships.
He was a business consultant, owns several companies
and is a bestselling author. Today he is considered
one of the foremost speakers in Europe.
Jörg Löhr has made the methodology he developed,
and his own motivation and inspiration, the
focus of his own professional life. His seminars invariably
incorporate the most recent research, the results
of which he disseminates not only as a speaker but
also as a lecturer at the University of Augsburg.
“Edmund Stoiber”: Explaining the World
to Oral Implantologists
The much-parodied former prime minister of Bavaria, Edmund Stoiber, as impersonated by political satirist Wolfgang Krebs,
will be talking to the people, as impersonated by the attendees of the BDIZ EDI Symposium. Krebs, born in 1966, performed
on stage for the first time when he was only five years old. During his school years, he was active in student and local theatre
groups. Since 1988 Krebs has been performing, on and off, as a speaker in various radio plays.
Having attended comprehensive acting workshops in
Berlin and in London, where he obtained his actor’s
licence, Wolfgang Krebs has been present on Bavarian
TV, impersonating the Bavarian prime minister
ostensibly commenting aspects of a popular satirical
show – and not only him, but also other well-known
figures in regional politics, including the current
holder of the Bavarian prime minister office, Horst
Seehofer.
Wolfgang Krebs’ satirical stage performances have
also been highly acclaimed, as have his impersonations
of a mail carrier-cum-voice imitator claiming
to present greetings from Chancellor Angela Merkel
and other well-known people in German public life.
He gained the attention of a broader public when
he went so far as to impersonate Edmund Stoiber in
mock interviews to the German national press in the
context of the 2005 coalition talks.
He is also the author of a children’s book entitled
Star journeys: seven dream journeys for children and
the patron of a project called Secret Matter Porcupine,
a violence prevention programme for children
and adolescents founded in 1998 by fellow actor
Olaf Krätke.
Jörg Löhr
Wolfgang Krebs

EDI
EDI News
The programme on 15 and 16 October 2010
Introduction
Christian Berger
Prof Joachim E.
Zöller
Meeting challenges – this motto for our 14 th BDIZ EDI
Symposium in Munich is important for the dental
office – in terms of professionalism and in terms of
politics. The overall healthcare politics framework
will result in selective reimbursement agreements in
statutory and private health insurance alike. How
does our profession react to this and other challenges
associated with the various fee schedules?
Add to that the challenges we are facing in our professional
work. Reports about implantological successes
are one, shiny, side of the coin. What does the
other side look like? The 14 th BDIZ EDI Symposium in
Munich will help you find out. I am looking forward
to seeing you there!
Christian Berger, President BDIZ EDI
Managing complications in oral implantology
requires a thorough understanding of the biological
situation and many years of clinical experience. Experienced
practitioners and representatives of the academic
world want to share their knowledge with you.
The 4 th European Consensus Conference of BDIZ EDI
has made one important step in the right direction
by developing its clinical guidelines on complications.
In Munich we will add new dimensions to this
topic: we will be reviewing medications, immediate
placement procedures, soft-tissue management, bone
augmentation, sinus lifts and high-quality ceramic
restorations. Don’t miss Munich!
Prof Joachim E. Zöller, Scientific Director
BDIZ EDI would like to extend its sincere thanks to the
following sponsors:
Gold sponsor: Silver sponsors:
15

16
EDI
EDI News
Friday, 15 October 2010
Pre-congress Programme
7:30 am – 12:30 pm CBCT course CBCT course in radiation protection in dentistry (Part 1)
pursuant to Sect. 18a para. 1 of the German x-ray ordinance
Prof Joachim E. Zöller/Dr Jörg Neugebauer
8:00 am – 10:00 am Workshop 1 Preoperative planning and treatment of implantological and
bredent medical prosthodontic complete rehabilitation cases
Dr Michael Weiss, Ulm, Germany
8:00 am – 10:00 am Workshop 2 New avenues in fixed implant superstructures
Camlog Dr Martin Gollner, Bayreuth, Germany
8:00 am – 10:00 am Workshop 3 Cerec meets Galileos – simultaneous prosthetic and
Sirona Dental surgical implant planning
Dr Lutz Ritter
Friday, 15 October 2010
Getting Ready for Success in the Dental Office
for dentists and dental assistants
10:00 am – 10:05 am Welcome and introduction
Christian Berger, President BDIZ EDI
10:05 am – 12:15 pm Success and motivation for the dental office
Jörg Löhr, motivational trainer, Augsburg, Germany
12:15 pm – 1:00 pm Buffet lunch · Dental exhibition visit
Friday, 15 October 2010
Programme for Dental Assistants
“Getting ready for success in the dental office” is also a part of the programme for dental assistants.
1:00 pm – 2:00 pm Accounting problems – Dealing with health insurance funds
Dr Thomas Ratajczak, Sindelfingen, Germany
2:00 pm – 3:00 pm Advise, convince, inspire: Toward successful patient information
Dr Dirk Duddeck, Cologne, Germany
3:00 pm – 3:30 pm Break · Dental exhibition visit
3:30 pm – 4:30 pm Reprocessing surgical instruments
Marina Nörr-Müller, Munich, Germany
4:30 pm – 5:30 pm GOZ: Capitalizing on chances – avoiding errors
Dr Stefan Liepe, Hannover, Germany

18
EDI
EDI News
Friday, 15 October 2010
Quo Vadis, GOZ? Health Politics Forum
1:00 pm – 1:05 pm Welcome and introduction
Christian Berger, President BDIZ EDI
1:05 pm – 1:15 pm Welcoming address by the Bavarian State Minister of Science, Research and Art
Dr Wolfgang Heubisch, Munich, Germany
1:15 pm – 2:00 pm Whither healthcare policy?
Prof Johann Eekhoff, Institute of Economic Policy, University of Cologne, Germany
2:00 pm – 2:30 pm Financial viability of the German health insurance system
Dr Thomas Drabinski, Institute for Micro-Data Analysis (IfMDA), Kiel, Germany
2:30 pm – 3:00 pm Sufficient, appropriate, economical: Will dental care continue to be funded
by statutory health insurance?
Peter Knüpper, solicitor, Managing Director of the Bavarian Chamber of Dentists
3:00 pm – 3:15 pm Discussion
3:15 pm – 3.45 pm Break · Dental exhibition visit
3:45 pm – 4:15 pm Future funding for dental services: Selective agreements?
Wolfgang Reif, Member of the Board of the Bavarian State Committee
for private health insurance, Munich, Germany
4:15 pm – 4:45 pm Implementing the HOZ schedule of fees in the dental practice
Michael Schwarz, President, Bavarian Chamber of Dentists, Bernau, Germany
4:45 pm – 5:15 pm Quo vadis, GOZ?
Dr Thomas Ratajczak, specialist attorney for social law, specialist attorney for medical law,
BDIZ EDI legal adviser, Sindelfingen, Germany
5:45 pm – 6:00 pm Final discussion
Host: Christian Berger
Friday, 15 October 2010
Gala Night
8:00 pm Gala Night at the Lenbach
(Tapestry Room)
Dining, music and political satire
The gala night will take place at the Lenbach.

Nobel Biocare

20
EDI
EDI News
Saturday, 16 October 2010
Meeting Challenges in Oral Implantology –
Scientific Day
Note: Simultaneous interpretation of the scientific presentations will be available.
8:30 am – 8:45 am Welcome and introduction
Christian Berger, President BDIZ EDI
Prof Joachim E. Zöller, Scientific Director
8:45 am – 9:15 am Can medications influence implantological success?
Dr Jörg Neugebauer, Cologne, Germany
9:15 am – 9:45 am Template-guided implant insertion: What resources are required?
Dr Achim Nickenig, Cologne, Germany
9:45 am – 10:15 am Guided surgery: Prosthetic results by simple means
Prof Rolf Ewers, Vienna, Austria
10:15 am – 10:30 am Discussion
10:30 am – 11:00 am Break · Dental exhibition visit
11:00 am – 11:30 am Building bone – but how?
Dr Stefan Reinhardt, Münster, Germany
11:30 am – 12:00 noon Sinus floor elevation: More complications than benefits?
Prof Peter Tetsch, Münster, Germany
12:15 pm – 2:00 pm Break · Dental exhibition visit
BDIZ EDI General Meeting
2:00 pm – 2:30 pm Immediate placement of implants without augmentation: Successes and problems
Dr Frank Kistler, Landsberg, Germany
2:30 pm – 3:00 pm What parameters determine success in the aesthetic zone?
Prof Germán Gómez-Román, Tübingen, Germany
3:00 pm – 3:30 pm Surgical or prosthetic soft-tissue management?
Dr Arndt Happe, Münster, Germany
3:30 pm – 3:45 pm Discussion
3:45 pm – 4:15 pm Break · Dental exhibition visit
4:15 pm – 4:45 pm The importance of bone-preserving surgical techniques for subsequent implantation procedures
Prof Antonio Felino, Porto, Portugal
4:45 pm – 5:15 pm Ceramic chipping – A problem in prosthodontics or a problem in material technology?
Prof Peter Pospiech, Homburg, Germany
4:15 pm – 5:45 pm All-ceramics – Everything simply without metal
Dr Urs Brodbeck, Zürich, Switzerland
5:45 pm – 6:00 pm Final discussion
Host: Prof Joachim E. Zöller, Cologne, Germany
6:00 pm – 7:00 pm CBCT course, Part 1 (continued)
Prof Joachim E. Zöller/Dr Jörg Neugebauer

Keystone

22
EDI
EDI News
Interview with Prof Joachim E. Zöller on challenges in oral implantology
The Time of Breathtaking
Pictures is over
So far, oral implantology has mostly featured exciting cases, beautiful results and happy patients. But the times are changing –
they have to be. More and more patients opt for high-quality implant treatment – and the more patients are treated, the
more cases we see that do not end with the patient flashing that perfect smile. But who likes to talk about failures or about
intra operative or postoperative complications? BDIZ EDI will do so on 16 October 2010, at its 14 th Annual Symposium in Munich.
“Meeting challenges” is the motto – facing failures and complications. And the focus will naturally be on what can be done
to avoid those failures and complications. EDI Journal spoke with the scientific director of the symposium and BDIZ EDI Vice
President, Prof Joachim E. Zöller, Chairman of the Interdisciplinary Department for Oral Surgery and Implantology and of the
Department of Oral and Maxillofacial Plastic Surgery of the University of Cologne.
Professor Zöller, can you give us an overview of current
challenges in oral implantology?
We are witnessing a time of changes in oral
implantology. 3D diagnostics and, increasingly, CAD/
CAM technologies are gaining ground and will gradually
become standard, at least when it comes to
major locations. Progress is rapid, and universities are
increasingly tasked to provide the appropriate scientific
background and training. At the same time, we
are seeing a restructuring of the implant market,
where some smaller firms offering top-quality products
will continue to gain market share, which will
result in changes in price levels.
The BDIZ EDI Expert Symposium in Cologne in February
was the first to address the issue of failures and
complications. The Annual Symposium in Munich in
October will move in the same direction. You have
been responsible for the scientific programmes at
both these events. Why should someone who has
attended Cologne also attend Munich?
Avoiding failures and managing failures is an
important skill for any oral implantologist. We have
reached the point where many experienced speakers
are beginning to talk about their complications. Just
a few years ago, this was still a difficult thing to do.
Everybody just wanted to show off their breathtaking
pictures, which all of us have seen to saturation in
implantological journals. But looking at these pictures
no longer does anything for the experienced
implantologist. Only honest presentations that talk
about successes and problem cases alike will really
teach us something. This is what we were trying to
work on at the Expert Symposium in Cologne this
year, and we will continue in this direction at the
Annual Symposium in Munich in October.
Treatment providers must investigate whether their
patients are in fact eligible for the planned implant
therapy – ahead of time. How much influence can
systemic diseases have on the success or failure of
implant treatment?
This aspect has been insufficiently considered in
recent years. Our patients are getting older, and this
means they will be increasingly likely to suffer from
systemic diseases. This is our most important patient

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EDI
EDI News
group! Systemic diseases have serious repercussions for
the prognosis of implant treatments. I keep wondering
about results where implant success rates of more than
95 percent are claimed for edentulous patients. I would
like to ask the authors of those reports: Were all those
edentulous patients 18 years old? Or did you exclude all
older patients with concomitant diseases? Of course
this effect is particularly pronounced in patients for
whom bone augmentation has been planned. Yet in
these patients, the best augmentation procedure is the
one that is not implemented.
What influence does the choice of materials have –
the “right” implant or the “right” bone replacement
material?
An analysis of the patient population and a major
study we conducted have shown that, as long as the
appropriate protocols are observed, the materials
used have no significant influence on success rates.
Unfortunately, many oral implantologists have
become almost addicted to discussing materials here
and properties there. But patient selection, the physiology
of wound healing and, most of all, operator
skills are much more important.
Nerve injuries must be included among the serious treatment
errors. Is there any reliable method to avoid them?
Many experts have shown us that, while nerve
injury may be due to inferior surgical techniques, its
main cause will generally be inappropriate treatment
planning. Cases abound where the operator deviates
from the treatment plan intraoperatively because of
unpleasant surprises during implant insertion, such
as an insufficient supply of transversal bone. To avoid
augmentation, implants are frequently inserted too
deeply in these cases.
Your department performs sophisticated and demanding
procedures such as bone augmentation. At the
Expert Symposium, one of the speakers – Prof Khoury –
said that there is no augmentation without complication.
What will be your focus at the 14 th BDIZ EDI Annual
Symposium when it comes to bone augmentation?
Complications may occur during any type of augmentation
surgery. How frequent they are depends
both on the procedure and on the operator. The
greater the amount of allogenous material, the higher
the infection rate. It is therefore important to do
with as little alloplastic material as possible. At this
point, the transplantation of autogenous vital bone
is still the most valuable procedure from a biological
point of view, with the lowest infection rates.
What is the relative importance of immediate implant
insertion procedures today? The European Consensus
Conference 2006 had developed pertinent guidelines.
Have we had new insights regarding materials and
procedures since?
The “fad” of immediate insertion surgery has subsided
somewhat as more complications are seen –
as many operators have been disappointed to learn.
With the exception of the mandibular intraforaminal
region, the relevant criteria have not been firmly
established. I believe that immediate insertion is
rarely indicated for the average patient at this time.
I am sure these patients prefer safe, low-risk implant
procedures and will opt for the lengthier but more
successful treatment once properly informed.
Implantation and augmentation procedures often
compromise the soft tissues. What possibilities do we
have today to avoid complications in this area?
Next to augmentation and implantation, the
important third element of success is soft-tissue surgery.
The operator must determine whether a special
soft-tissue technique is required as early as during
reentry. If peri-implantitis manifests itself later,
vestibuloplasties will often fail to deliver the desired
result, and the peri-implantitis and the associated
bone loss will proceed. When exposing implants following
bone augmentation, special soft-tissue management
techniques are required. Apically repositioned
flaps play an important role. The flap, when
created correctly, will not only create a zone of periimplant
attached gingiva 2 to 3 mm in height, but
it will allow the operator to shape the vestibulum
again.
Well, that really arouses our curiosity as to the scientific
day in Munich. Professor Zöller, thank you very
much for this interview.
AWU

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26
EDI
EDI News
14 th BDIZ EDI European Committee meeting in Cologne
European Curriculum
under Development
European issues play an important role in the day-to-day work of BDIZ EDI. That the partner associations are
keenly interested in this work is underscored by their regular attendance at the BDIZ EDI European Committee
meetings. The topic in Cologne last February was the common European curriculum.
Participants this year included Prof Hakan Özyuvaci
(Istanbul) for Turkey, Dr Philip Bennett (Lyme Regis) for
our British partner association ADI, Prof Andrzej Wojtowicz
(Warsaw) and Dr Christoph Sliwowski for our
Polish partner association OSIS EDI, Prof Vitomir Kons -
tantinovic (Belgrade), Dr Zoran Marjanovic (Novi Sad)
and Dr Dusan Vasiljevic for our Serbia-Montenegro
partner association, Prof Bernhard Broos (Villach), who
represented Austrian implantologists, and Dr Peter A.
Ehrl (Berlin), who organizes the Greek-German Curriculum
for BDIZ EDI. On the part of BDIZ EDI itself, participants
included Christian Berger, Dr Detlef Hildebrand,
Dr Jörg Neugebauer and Dr Dirk Duddeck, Anita Wuttke,
Dr Thomas Ratajczak as secretary and Dr Stefan Liepe.
Ralf and Angelika Suckert were present in the capacity
of publishers for BDIZ EDI konkret and EDI Journal.
Qualification and comparability
The most important point on the agenda was the
European curriculum that the partner associations
want to join forces to initiate. The meeting discussed
suggestions by Dr Ehrl and Dr Neugebauer (who is the
organizer of the BDIZ EDI Curriculum Implantology).
Dr Neugebauer pointed out that even within Germany
there is a number of different curricula with considerable
variation with respect to the quality of the syllabus.
The BDIZ EDI curriculum is considered to be particularly
highly developed. BDIZ EDI President Christian
Berger thanked both speakers and pointed out the
importance of reaching comparable standards for the
curriculum throughout all the different countries. Each
of the partner organizations is now tasked to evaluate,
on a national level, what additional modules could be
helpful to ensure comparable entry skills and qualifications
throughout Europe. The committee members
then discussed the current status of curriculum development,
which differs considerably across different
countries. The committee agreed that qualified pre-
senters and a comparable syllabus both within participating
countries and on a European level are a
prerequisite for creating a European curriculum.
Individual countries
Dr Phil Bennett outlined the new e-learning program
that the British ADI had initiated, teaching implantological
basics to prospective implant dentists. Prof
Andrzej Wojtowicz announced an international twoday
symposium of Polish oral and maxillofacial surgeons
in May and a broad-based multi-country Eastern
European symposium in 2011. Prof Vitomir Konstantinovic
reported on developments in oral implantology in
Serbia. The Serbian association of oral and maxillofacial
surgeons will be holding a major symposium in Belgrade
in the autumn of 2010. Konstantinovic asked for
BDIZ EDI support in the shape of the delegation of
qualified speakers. He also suggested organizing major
multicenter studies using uniform study protocols
throughout Europe.
Toward the end of the meeting, Ralf Suckert gave
an overview of e-learning and e-journals at teamwork
media – not least with iPads in mind, which are
expected to become very popular in the near future.
AWU
The outlines of the European curriculum are beginning to take shape. Representatives
of seven countries engaged in highly constructive discussions.

28
EDI
EDI News
Successful BDIZ EDI continuing-education week in Belek/Antalya
4 th Mediterranean Symposium:
See Turkey and Learn Something
The BDIZ EDI Mediterranean Symposium has become a small but highly appreciated event for implant dentists in Europe offering
top-notch training under the auspices of the association – and that far beyond Germany’s borders. Following Montenegro (2007),
Crete (2008) and Vouliagméni (2009), this year’s one-week BDIZ EDI continuing-education event was held in May under the
motto of “Avoiding Treatment Errors – Managing Complications” on the “Turkish Riviera” at Belek.
Twelve speakers and fourteen presentations on a
single day left little time to enjoy the sun, the
beach and the sea, the international golf courses
or the comfort of a luxury hotel built in the style of
a Moorish castle. Nevertheless, neither the Turkish
nor the German attendees felt they were missing
anything – the one-day symposium and workshops,
interpreted simultaneously, simply had too
A job well done: BDIZ EDI Presidents Prof Joachim E. Zöller
and Christian Berger with Prof Hakan Özyuvaci (centre).
The Kempinski Hotel The Dome was built in the style of a
Moorish castle.
much to offer. The two scientific directors of the
continuing-education week, Prof Joachim E. Zöller
(Cologne) and Prof Hakan Özyuvaci (Istanbul), had
fine-tuned the programme together, arriving at a
delicate composition of topics focusing on complications
in oral implantology, including restorative
issues and sidelines such as mathematics or
anaesthesia.
Before the symposium: Taking a look at the venue,
the Karatay ballroom.

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30
EDI
EDI News
Prof Joachim E. Zöller Prof Hakan Özyuvaci Özcan Yildirim Hilal Kuday
Dr Kerem Dedeoglu Dr Serdar Yalcin Chris tian Berger Dr Atakan Elter
Looking beyond the dental fence
Prof Özyuvaci opened the proceedings by presenting
a classification of complications as preoperative,
intraoperative and postoperative. Some of his illustrations
showed dislocated implants within the maxillary
sinus. Prof Zöller also pointed out the interrelationship
between an aging patient population and
the rising incidence of concomitant systemic diseases.
In addition to local diagnostic findings, he
said, systemic afflictions must always be taken into
account by the treatment concept. His presentation
focused on the importance of the patient’s medical
history, general clinical findings and psychosocial
background in addition to the anatomical situation.
Everybody expects to come home from continuing
education with new ideas to be implemented in clinical
practice. The symposium paid special attention to
dental technology. Dental technician Özcan Yildirim
(Istanbul) explained how present-day dental laboratories
work and demonstrated the differences be -
tween conventional and CAD/CAM restorations in the
production phase. He concluded that the precision
of milled restorations is greater than that of cast
restorations when it comes to wide-span bridges.
Dental technician Hilal Kuday (Istanbul) emphasized
the importance of patient discussions and of paying
attention to the patient’s overall facial features
when introducing high-quality aesthetic anterior
restorations.
Dr Kerem Dedeoglu (Istanbul) spoke about the
importance of getting an accurate patient history,
presenting some case reports to demonstrate the
potential dramatic consequences of incomprehensible
clinical descriptions. Prof Serdar Yalcin (Istanbul)
pointed to possible complications, including implant
loss after immediate insertion, citing a significantly
higher rate of complications following immediate
implant insertion in inflamed regions. Christian Ber -
ger (Kempten) made the connection to endodontics,
referring to a number of clinical cases to demonstrate
that, given the current state of the art and the
currently available treatment options, an endodontically
treated tooth may well be the better implant.
Aesthetics and mathematics
What does aesthetic dentistry have to do with mathematics?
Quite a lot, Dr Atakan Elter (Istanbul) thinks.
Nature, human beings in general and the human

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EDI
EDI News
Prof Vitomir Konstantinovic Dr Holger Janssen Dr Jörg Karst
Dr Detlef Hildebrand
mouth in particular are governed by the golden ratio
linking the principles of symmetry and asymmetry.
The golden ratio, which has often been called the
divine proportion, is a mathematical constant that
can be derived from, and be used in, dental aesthetics.
For example, this constant phi (oI = 1,6180339887...)
can manifest itself in the relationship between the
length and the width of the tooth. Although the
golden ratio is an oft-cited topic in dental aesthetics,
the attendees in Belek were once again fascinated by
this irrational mathematical ratio that is considered
particularly harmonious and beautiful – whether in
architecture or in present-day dentistry.
Nerve injury and bone augmentation
From aesthetics, the focus returned to the depth of
the maxillary sinus – which is the realm of Prof Joa -
chim E. Zöller. In his second presentation he illustrated
the importance of a correct diagnosis before any
implantological procedure in order to prevent nerve
injury and enumerated the therapeutic guidelines to
be applied. A typical nerve injury he cited was the
damage sometimes caused by a casual injection.
Experience has shown that the inferior alveolar nerve
hardly ever ruptures – not even in the event of a
mandibular fracture. On the other hand, the nerve is
highly susceptible to damage by pointed or sharp
instruments, being more sensitive to pressure than to
tension. His advice was to “keep the tweezers away”.
Zöller also discussed augmentation and the associated
risks. He made clear that the use of autologous
bone material was the most valuable procedure from
a biological point of view. Bone replacement material
should be reserved for sinus lift procedures or collateral
augmentation of defects.
Meeting before the background of the Mediterranean scenery: Speakers, organizers and some participants meeting on the roof terrace of the
Kempinski Hotel The Dome in Belek to exchange impressions and ideas after a demanding symposium. Some of the people in this picture:
Christian Berger (front left), Prof Joachim E. Zöller (centre), Anita Wuttke (BDIZ EDI, European matters) and Prof Hakan Öyzuvaci; Dr Holger
Janssen (far right), Prof Vitomir Konstantinovic; Dr Jörg Karst and Dr Detlef Hildebrand (behind them, right).

EDI
EDI News
Prof Vitomir Konstantinovic (Belgrade) took the
audience “back to the surface” by presenting safe
treatment concepts in oral implantology, especially
the two-stage procedure. Dr Holger Janssen (Berlin)
explained in his presentation on the prevention of
prosthetic errors that the static concept of occlusion
is increasingly giving way to a dynamic and functional
concept where the teeth are being treated as sensitive
receptors for the brain.
General anaesthesia – yes or no?
The risks and benefits of general anaesthesia in the
context of dental surgery were the topic of anaesthesist
Dr Jörg Karst (Berlin). He explained that general
anaesthesia may be indicated for high-risk patients
and protracted procedures, as today’s anaesthetic
methods are becoming increasingly safer. Dr Detlef
Hildebrand (Berlin) presented guided surgery procedures,
the Robodent system and stent-guided instrument
navigation, showing that precise planning and
accurate implementation helps avoid complications.
Conclusion
In his closing message, Prof Zöller concluded that the
continuing-education week, which after the symposium
itself continued with industry workshops and
interactive training on complications, had reached a
very high level internationally: “We have seen excellent
presentations by Turkish and German speakers
that were characterized by a high level of scientific
expertise, beautifully complementing each other in
the issues they addressed and the conclusions they
arrived at.” BDIZ EDI President Christian Berger also
took positive stock of the event, thanking the Turkish
partner of BDIZ EDI, Prof Hakan Özyuvaci, and his
team for organizing it. Similar to the continuingeducation
week in Greece the previous year, this
year’s event on the Turkish Mediterranean coast was
characterized by a vivid exchange of ideas between
the speakers and the Turkish and German audience,
supporting the mission of BDIZ EDI of promoting
high standards of quality in oral implantology and
working for establishing uniform implantological
standards throughout Europe.
AWU
Thanking our sponsors
BDIZ EDI thanks its sponsors for their support of
its continuing-education event: Sirona Dental,
Geistlich Biomaterials, Dentsply Friadent, Camlog
and Straumann.
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34
EDI
EDI News
12 th BDIZ EDI Curriculum Implantology to start in November 2010
Top-level Implantological Training
“Practical exercises on human specimens and a relaxed and congenial atmosphere helped make this Curriculum a success.
The hands-on workshops were excellently prepared, and the content of the course was immensely better than that offered by
other providers.” These and similar observations were heard from attendees of the 11 th Curriculum Implantology, who had success-
fully mastered their first step on the way to Certified Expert in Oral Implantology status. Participants appreciated the agenda
itself, but also the selection of speakers and the fact that a significant part of the Curriculum consisted of practical exercises.
The organizers received special praise for fostering an atmosphere of open exchange of discussions, both within the group of
participants and with the speakers and presenters. No questions remained unanswered, and each speaker shared his or her
own personal views on a variety of topics covering the entire field of oral implantology.
The BDIZ EDI Curriculum Implantology appeals not
only to young dentists and to newcomers to oral
implantology, but the modular design of the Curriculum
makes it particularly interesting to dentists who
perform implant surgery only occasionally but want
to make sure their treatment rests on solid ground.
The Curriculum allows its successful graduates to
master even difficult indications and to address
potential complications successfully.
Important criteria
The BDIZ EDI Curriculum Implantology can look back
on a long history. Since the Curriculum series was
inaugurated in 2004, more than 270 attendees have
participated in the Curricula held in Cologne and on
Fuerteventura. But it is not the numbers alone that
indicate the success of these Curricula. In addition
to the Curriculum’s overall approach, which is scientifically
sound and at the same time eminently practical
in outlook, it is the modular design that attracts
many new members to this form of continuing edu-
”Practical exercises on human specimens and a relaxed
and congenial atmosphere helped make this Curriculum
a success.” (Dr W. Greeven)
”The hands-on workshops were excellently prepared,
and the content of the course was immensely better
than that offered by other providers.” (M. Mariusz)
“I particularly appreciated the many live operations
and the fact that many different speakers partici -
pated.” (Dr W. Rizza)
12 th Curriculum Implantology agenda
25/26 Nov 2010 1. Basics of oral implantology
21/22 Jan 2011 2. Treatment planning and diagnosis
21/22 Feb 2011 3. Surgical techniques
17/18 Mar 2011 4. Prosthetics
07/08 Apr 2011 5. Augmentation 1 – Regional bone augmentation
12/13 May 2011 6. Soft-tissue management
26/27 May 2011 7. Augmentation 2 – Remote autologous bone grafts
14/15 July 2011 8. Recall and complications
cation. Continuing-education modules successfully
completed with other organizations than BDIZ EDI
may be transferred to the Curriculum for credit –
saving time and money.
Practical training is an important aspect
Six years since its inception, the continuing-education
series entitled “Curriculum Implantology” finds
its proven overall concept unchanged. Quality beats
No questions
remain
unanswered.

36
EDI
EDI News
The BDIZ EDI Curricula are characterized by a considerable share of practical instruction.
quantity – open training sessions for a limited number
of participants in the Curriculum units and a
sizable percentage of practical instruction take
precedence over “accommodating the masses”.
Attendees particularly appreciate the surgical exercises
on human specimens that make for realistic
hands-on workshops. These practical units are an
integral part of the Curriculum. Human specimens
provided by the Anatomical Institute of the University
of Cologne are prepared for participants at different
stages and tissue levels. This promotes threedimensional
orientation, facilitating close study of
the various structures worthy of preservation. Participants
gain a greater understanding of the complications
that may accompany sinus lift procedures, helping
them avoid uncontrollable situations.
“The practical workshops train skills that support
sophisticated treatment approaches and facilitate
meaningful treatment in complex cases or in the
event of complications”, says Prof Joachim E. Zöller,
who, besides serving as Vice President of BDIZ EDI, is
the director of the Department of Oral, Maxillary and
Plastic Facial Surgery and the Interdisciplinary Clinic
for Oral Surgery and Implantology of the University
of Cologne and has been the scientific director of the
Curriculum Implantology of BDIZ EDI since its inauguration
in 2004. The team of instructors around
Zöller is supported by speakers who are dentists in
private practice, as the treatment concept practiced
at the University Hospital in Cologne cannot cover
the entire bandwidth of indications, patients and
dental offices. The Curricula strive to present the
entire range of possible implantological treatment
approaches, allowing the participants to decide
freely what treatment concept they deem best for
their own situation. The individual Curriculum building
blocks offered, for example, at the Expert Congress
on Fuerteventura, have magnetically attracted
participants. The reason is that sophisticated training
units in small groups with plenty of available time
are highly attractive. As Christian Berger explains the
concept: “A generous share of hands-on practical
exercises has been included, making it easy for beginners
to take the first steps and offering more experienced
dentists a way to enlarge their practical armamentarium.”
“What I particularly liked about the BDIZ EDI Curriculum
was of course the live surgery units but also the
congenial atmosphere and the high level of competence
exhibited by the speakers.” (I. Lell)
“Experienced colleagues reported on their own mistakes
and taught us how to avoid them.” (Dr K. Tolk)
“I felt very positive about the chronological structure
and the practical exercises. I can only recommend other
dentists to take this course.” (O. Becker)
The 12 th BDIZ EDI Curriculum Implantology will take
off on Thursday, 25 November 2010. A few vacancies
are still available. Details on the Curriculum can be
found online at www.bdizedi.org (select English and
click “Education“). For information by phone call please
call the BDIZ EDI office at +49 228 9359-244.
DUD
Contact Address
Dr Dirk U. Duddeck
Interdisciplinary Policlinic for Oral Surgery
and Implantology
Department of Oral and Maxillofacial Plastic Surgery
University of Cologne
Director: Professor Joachim E. Zöller
Kerpener Straße 32 · 50931 Köln · GERMANY
Phone: +49 221 478-4744 · Fax: -6721
dirk.duddeck@uk-koeln.de

EDA Expert in Implantology
EDI
EDI News
37
Successful Exam
Can didate in Cologne
Following the
presentation
and discussion of the case reports
submitted, the three-member
jury was impres sed with the candidate’s
qualifications.
If you, too, are interested in sitting
the certification exam for
EDA Expert in Implantology, you
On the occasion of the 5 th Expert Symposium, Dr
Michael Vogeler of Merzhausen, Germany, success -
fully passed the EDA Expert in Implantology certifi -
cation exam.
Munich, 17 October 2010
will find all the information you
need at the www.bdizedi.org
website (currently in German
only, click “Fortbildung”). The
members of the Cologne examination
board were Per Fossdal,
Christian Berger and Prof Joachim
E. Zöller. AWU
Upcoming EDA Ex pert
in Implantology
Certification Exam
The next certification exam will be held at the 14 th BDIZ EDI Symposium
in Munich at the Sofitel Munich Bayerpost on 17 October 2010.
Admission requirements for the
certification exam include:
• 250 EDA-recognized advanced
education/training hours in
various sub-disciplines of
implantology
• Submission of ten documented,
independently performed
im plan tological treatment
cases
• At least five years of professional
activity primarily in the
field of implantology
Specific experience and primary
activity in the field of implantology
must be documented by at
least 400 implants inserted and
150 implants restored within the
past five years. If you would like
to register for the certification
exam, you can receive the requisite
information and registration
documents from the BDIZ EDI
office in Bonn:
office-bonn@bdizedi.org.
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q-implant-marathon@trinon.com

38
EDI
EDI News
Visiting Fuerteventura for the 20 th time
International Expert Symposium
for Regenerative Methods in
Medicine and Dentistry
The 20 th International Expert Symposium for Regen-
erative Methods in Medicine and Dentistry will be
held at the Robinson Club Esquinzo Playa on Fuerte -
ventura from 26 October to 4 November 2010.
The realignment at last year’s symposium, with a
clear focus on dental issues and related general medical
treatment options, has been greeted with great
enthusiasm on the part of the attendees. An interesting
and diverse schedule consisting of presentations,
seminars and workshops with practical exercises
allowed speakers and trainers to effectively present –
and attendees to effectively digest – a broad range of
relevant topics.
Innovations and biomaterials
The focus for 2010 will be on “Biomaterials: Innovation
is not limited to the surgical field”. This focus
takes into account the exciting developments of
recent years, with various innovations in dental surgery
and prosthodontics opening up new treatment
options for patients. The use of exogenous materials
frequently allows the reconstruction of lost hard and
soft tissue, creating a wide range of treatment
adjuncts for different indications. Speakers will present
their favorite biomaterials for specific indications
and share their experiences, which in some cases
have been accumulated over decades.
An intensive exchange of thoughts and ideas is
facilitated by the very special networking atmosphere
outside the sessions themselves. The symposium
does not limit itself to presenting innovative
thought. Rather, its main strength is its personal
atmosphere that is highly conducive to interdisciplinary
discussion.
NEU
Speakers on Fuerteventura
MDT Stefan Adler, Landsberg/Lech
Christian Berger, Kempten
Dr Fred Bergmann, Viernheim
Dr Claudio Cacaci, Munich
Prof Rolf Ewers, Vienna
Dr Erni Fuchs, Thalwil
Dr Ulrich Fürst, Attnang
Dr Arndt Happe, Münster
Dr Viktor E. Karapetian, Cologne
Dr Frank Kistler, Landsberg/Lech
Dr Frank Kormann, Oppenheim
Dr Klaus Lotzkat, Hannover
Dr Thea Lingohr, Cologne
Dr Jörg Neugebauer, Cologne
Dr Christoph Niesel, Karlsruhe
Dr Stefan Reinhard, Münster
Dr Daniel Rothamel, Cologne
Gerhard Stachulla, Augsburg
Dr Gerhard Werling, Bellheim
Prof Joachim E. Zöller, Cologne

EDI
EDI News
14 th Dentsply Friadent World Symposium
BDIZ EDI in
Barcelona
The 14 th Dentsply Friadent World Symposium 2010 took place in
Dr Werner Groll, CEO and Vice President
of Dentsply Friadent, had
promised that the symposium
was going to present knowledge
and skills revolving around the
dental office. Getting dental
offices ready for the future – even
in economically difficult times –
was the objective of the Barcelona
event. One hundred renowned
speakers and a program and discussion
forums spanning a wide
range of topics implemented the
guidelines issued by the symposium’s
scientific directors, Prof
Heiner Weber (Tübingen), Dr Henry
Salama (Atlanta) and Prof Lim
39
Barcelona with 2,500 participants from all over the world attending.
BDIZ EDI had its own booth – and the two days were an all-around
success: Great networking, many international contacts and plenty
of new subscriptions for the EDI Journal. All the sample issues were
completely gone as early as halfway through the second day.
Kwong Cheung (Hongkong). The
hands-on workshops on augmentation
techniques and soft-tissue
management were completely
sold out.
The 14 th Dentsply Friadent
World Symposium was a huge
public forum for dentists from a
host of different countries. The
BDIZ EDI booth got inquiries from
the Middle East and from Asia as
well as from all parts of Europe
and the Americas – which goes to
show that an international multiday
meeting is a highly attractive
event.
AWU
BDIZ EDI and DGOI representatives in Barcelona – BDIZ EDI President Christian
Berger and DGOI President Dr Georg Bayer (right) with DGOI Secretary General
Karl-Heinz Glaser (left).
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40
EDI
EDI News
Belgrade, 27 to 29 October 2010
International Congress for
Maxillofacial Surgery
The International College for Oral Maxillo-Facial Surgery (ICMFS) will be holding its 25 th international annual
congress in Belgrade. This major event will be held jointly with the Serbian Association of Maxillofacial
Surgeons, addressing a broad range of topics presented by international speakers.
Attendees will have the opportunity to learn more
about current and future developments in maxillo -
facial surgery and its various fields such as traumatology,
oncology, reconstructive and plastic surgery,
distraction osteogenesis, craniofacial deformations,
implant surgery etc. In his online welcoming address,
Congress President Nebojsa Jovic explains that the
event is directed at international participants, which
is reflected by the list of keynote speakers that also
includes German speakers.
Seville, 25 to 27 November 2010
BDIZ EDI offers this major event in Belgrade its
moral and practical support in the form of a panel
of speakers. Contact between BDIZ EDI and ICMFS
has been established via Prof Vitomir Konstantinovic,
who is one of the organizers of the congress. Kons -
tantinovic is Professor for oral and maxillofacial surgery
at the University of Belgrade and has been a
presenter at several recent BDIZ EDI symposia. For
more information, please consult the ICMFS website
at www.icmfs2010.org. AWU
18 th International
SEI Convention in Spain
The Spanish Congress of Oral Implantologists (Sociedad Española de Implantes, SEI) will be holding its
25 th National and 18 th International Annual Convention in Seville, Spain, from 25 to 27 November 2010.
From the very beginning, SEI conventions have ad -
dressed interdisciplinary issues. For three days, inter -
national experts will be presenting clinical cases and
scientific and technical innovations. The convention
will be held at the Melia Lebreros hotel in Seville and
will be hosted by Dr Araceli Morales Sánchez, President
of SEI, which is a partner association of BDIZ EDI
and an affiliate of the ICOI. Additional support will
be provided by the Seville Chamber of Dentists and
local and regional government bodies.
Seville is not only a distinguished convention
venue – it is also famous for its rich history. Its enormous
cathedral, one of the biggest in the world, was
built on the site of Muslim Seville’s main mosque
between 1401 and 1507. One highlight of the cathedral’s
lavish interior is Christopher Columbus’ supposed
tomb inside the south entrance. On the banks
of the River Guadalquivir stands the Torre de Oro,
which is today one of Seville’s major landmarks. It
was originally built by the Moors as a way to block
access to the harbour by attaching a chain to it and
to the opposite river bank.
SEI expects a sizable turnout, expecting that this
top-class event will be an unforgettable experience
for all participants.
AWU
Prof Vitomir
Konstantinovic
Dr Araceli
Morales Sánchez

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42
EDI
EDI News
New British government: Cut this and
cut that – but not health expenses
The new British government must cut expenses.
Shortly after taking office, the British Conservative-
Liberal Democrat coalition government announced
its first concrete austerity measure to rehabilitate
the national budget. The cuts will affect “wasteful”
public spending on e.g. administration, travel,
consultants or IT programs, as Chancellor George
Osborne explained before a meeting of Conserva-
tive Party members. The in-year spending cuts will
amount to £6.25 billion. Osborne promised that
there would be no cuts in education, defence and
health. However, local governments will have to
reduce their expenses by more than £1 billion. Partner
companies of the affected departments will
be contacted soon to implement the cuts as quickly
as possible.
Source: Welt Online, Germany
Italy, Greece, Spain and Portugal:
Rome to cut health expenses
Italians will have to brace themselves for budget
cuts: To reduce the mounting public debt, the government
in Rome is taking drastic austerity measures,
saving 24 billion euros by 2012. The health sector will
be affected as well. In addition, payouts to the local
and regional governments will be reduced.
Europe Ticker
Another victim of the budget cuts will be the
publicly financed Institute for Studies and Economic
Analyses (ISAE), which has conducted surveys on
the business climate and on consumer confidence.
Its tasks will be taken over by the Italian Ministry of
Economy. At 115 percent of GDP, Italy caries the highest
debt burden among the 16 euro-zone countries,
although its budget deficit of 5.3 percent is still relatively
low compared to that of other countries.
With its austerity program, Italy now follows other
countries in the euro zone. Its move had been preced-
ed by Greece, which had enacted a drastic austerity
program in the amount of 30 billion euros against
fierce domestic resistance. Spain has presented an
austerity plan that provides for spending cuts of
50 billion euros over the next three years. France has
raised the statutory retirement age, while Portugal
has increased taxes. Germany will decide on budget
cuts in June.
Source: ZDF – German Television
Photo: panthermedia/Jörg Rüger

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44
EDI
EDI News
Austria: Healthcare – Afraid of cuts
Austrians are highly satisfied with their healthcare
system, but afraid that it might deteriorate over
the next few years. This is the core message of the
current Health Barometer Austria presented by
Minister of Health Alois Stöger (Social Democrats) in
early May. For the second time, 1000 Austrians were
asked their opinions on healthcare. Customer satisfaction
with healthcare continues to be high; at
62 percent, it is approximately on a par with the EU
average, according to Peter Filzmaier, the author of
the study. On the other hand, an equal proportion
(60 percent) of those surveyed fear a deterioration
of the system due to budget cuts.
In this situation, Stöger is not planning any major
cuts in the healthcare sector. He said that healthcare
fund reform was already in progress and that
drug cost inflation had been brought down from
six to eight percent to two percent today. Instead,
Stöger favours economic stimulus programs in the
healthcare sector; he said such programs “focus on
adding value and create crisis-proof jobs”. The survey
also revealed a high level of public expectations
in connection with the introduction of joint medical
practices planned for later this year. A majority of
those surveyed expect these to become a viable
alternative to hospital outpatient departments,
with shorter waiting times, longer opening hours
and a better choice of treatment providers as a
result.
Source: nachrichten.at, Austria
European Commission survey:
Europeans afraid of treatment errors
Europeans are afraid of adverse events while receiving
healthcare. Their overall opinion of their healthcare
systems, however, is positive.
One-third of all German respondents felt they
could be harmed by healthcare (both by hospital
and non-hospital care). Looking at the EU as a
whole, the corresponding figure is almost 50 percent.
The perceived possible causes include hospital-related
infections or incorrect, missed or delayed
diagnoses.
These were the results of a survey conducted for
the European Commission in autumn 2009. The
survey population included 26,663 people from all
27 EU member states, who were asked questions
related to patient safety and healthcare quality in
Europe. The results of the study were published in
mid-April. Trust in the healthcare system was lowest
in Greece, where 83 percent of those polled expect
treatment-related injury.
More than one-fifth of all EU citizens cite negative
experiences with medical care. The German
figures are actually above average, with 30 percent
citing negative experiences, although only onethird
of those affected had reported the incidents
in question.
Most of those surveyed do not know which institutions
or organizations are responsible for patient
safety. One-third believes that the responsibility lies
with the ministries of health, while 27 percent think
that healthcare providers (e.g. hospitals, physicians)
are responsible. Most of those who reported having
suffered treatment-related injury in their home
country or another EU member state expect that an
investigation into the case or financial compensation
would be the forms of redress. Three-quarters of the
Germans surveyed indicated that they were planning
to seek help from a lawyer for this purpose.
Yet with all that scepticism, an average 70 percent
of those surveyed consider the quality of healthcare
in Europe to be good. Top figures were achieved by
Belgium, with 97 percent, and Austria, with 95 percent.
At 86 percent, the German result is in the upper
third of the table. At the bottom of the list are Romania
and Greece, with only 25 percent.
In addition, one third of those surveyed believe
that healthcare in their own country is better than
in other EU member states. Here, too, Belgium and
Austria topped the list with 65 and 64 percent,
respectively. In Germany the corresponding figure is
54 percent.
The reason why the European Commission conducted
this survey is its effort to improve the quality
of medical care across the EU and to eliminate
inequalities. These efforts include the planned directives
on patient information rights and on prescription
drugs as well as a recommendation by the EU
ministers of health for improving patient safety.
Source: Ärzte-Zeitung, Germany

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46 EDI
European Law
ECJ: Economic Incentives
to Promote the
Description of Low-Cost
Medicinal Products are Legal
In its decision dated 22 April 2010 (C-62/09), the European
Court of Justice in Luxemburg (ECJ) has ruled
that a scheme by national public health authorities
offering financial incentives to medical practices to
prescribe low-cost medicinal products is compatible
with European law.
The background of the case: In England and Wales,
the National Health Service (NHS) is responsible for
providing a comprehensive health service, including
the procurement of medical drugs. If healthcare professionals
issue prescriptions to be funded by the
NHS, they must comply with its rules. To reduce the
costs of medicinal products, the NHS has introduced
financial incentive schemes to induce physicians to
prescribe for their patients specific named medicinal
products, thereby establishing a positive list of lowcost
medicinal products (statins, in the case at hand).
Physicians were to give preference to medicinal products
in the same therapeutic class, but not necessarily
containing the same active substances. The rules did
not exclude the possibility that another medicinal
product in the same therapeutic class might be better
suited to the treatment of a particular patient, so that
switching the prescribed medication to another based
on a different active substance in some cases might
have adverse consequences for the patient. The NHS
established therapeutic equivalence of medicinal
products in the same therapeutic class in accordance
with, inter alia, the guidelines of the National Institute
for Health and Clinical Excellence.
Financial incentives
Under the scheme, financial inducements are calculated
according to how certain targets are met. One
target is to increase the proportion of prescriptions
for a specific named medicinal product from the positive
list. Another target is to increase the number of
patients whose established medicinal product has
been changed in favour of a specific named medicinal
product from the list.
The Association of the British Pharmaceutical
Industry (ABPI), representing 70 pharmaceutical companies
operating in the United Kingdom, objected to
these financial incentives, voicing its concerns to the
British Ministry of Health and requiring an investigation,
especially in the light of Directive 2001/83/EC on
a community code relating to medicinal products for
human use. The Directive states, inter alia, that persons
qualified to prescribe medicinal products must
be able to carry out these functions objectively without
being influenced by direct or indirect financial
inducements. Where medicinal products are being
promoted, no premiums or other advantages in
money or in kind may be given, offered or promised
to persons qualified to prescribe or supply them,
unless they are inexpensive and relevant to the practice
of medicine or pharmacy, as Article 94 (1) of
Directive 2001/83/EC states.
Safeguarding of public health
an essential aim
The British Ministry of Health considered the NHS
incentive schemes to be legal, as in its opinion the
prohibition of incentives in Directive 2001/83/EC did
not apply to national public health authorities but
only to commercial organizations, whereupon the
ABPI brought an action before the High Court of
Justice (England and Wales). This court referred the
case to the ECJ for an interpretive ruling of Directive
2001/83/EC, asking whether a public body forming
part of a national public health service is precluded
by Article 94 (1) from offering financial incentives to
medical practices for prescribing a specific named
medicine.
During the ECJ proceedings, the European Commission
submitted, in support of the ABPI, that the
provision also applied to national authorities, precluding
the NHS from offering financial inducements
for the prescription of specific named medicinal prod -
ucts. The United Kingdom held an opposing view,

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48 EDI
European Law
supported in this by the Czech, Estonian, Spanish,
French and Netherlands governments. No other
Member State submitted an opinion.
According to the ECJ, the essential aim of Directive
2001/83/EC is to safeguard public health. This aim is
not endangered by a national public health authority
offering financial incentives for prescribing certain
medicinal products, as this very authority is the
one in charge of safeguarding public health, including
but not limited to evaluating the therapeutic
value of the medicinal products they authorize to be
marketed and the control of the public expenditure
for healthcare. Since the authority is pursuing noncommercial
aims, the NHS’ financial incentive
scheme cannot be regarded as falling within the
definition of commercial promotion of medicinal
products. As the ECJ phrased it: “In those circumstances,
it is permissible for those authorities, in the
exercise of the responsibilities which they assume,
to determine, on the basis of evaluations of the therapeutic
qualities of medicinal products by reference
to their cost for the public budget, whether, in order
to treat certain conditions, certain medicinal products
containing a given active substance are, from
the point of view of public finances, preferable to
other medicinal products containing a different
active substance, but falling within the same therapeutic
class.” Or in other words, the end justifies the
means.
ECJ: Objectivity of physicians
not compromised
The public health authorities should, however, not be
allowed to act entirely freely but should be subject to
some measure of control by the pharmaceutical
industry. The ECJ pointed to Council Directive
89/105/EEC of 21 December 1988 relating to the
transparency of measures regulating the prices of
medicinal products for human use and their inclusion
in the scope of national health insurance systems.
The ECJ considers the resulting legitimate
interests and rights of the pharmaceutical industry
to be adequately protected if the financial incentive
scheme implemented by the public authorities is
based on objective criteria and if the pharmaceutical
industry can verify this objectivity. The ECJ had
already taken the same stance in other cases (e.g. in
its decision of 2 April 2009, A. Menarini et al., C-
352/07). To allow this objectivity to be verified, not
only must the relevant scheme be made public, but
the evaluations establishing the therapeutic equivalence
of the active substances must also be made
available to healthcare professionals and profession-
als in the pharmaceutical industry. But this examination
of incentive schemes is likely to be possible only
for pharmaceutical companies (that do not benefit
from them). Individual physicians will most likely not
be in a position to do so, because they lack the necessary
time and, possibly, the requisite pharmacological
expertise.
Nor does the ECJ seem to believe that financial
incentives can compromise the objectivity of physicians,
which is also required by Directive 2001/83/EC.
Prescribing physicians are prevented by their code of
professional conduct to prescribe a given medicinal
product if it is not fitting for the treatment of
the patient, despite the existence of public financial
inducements for its prescription. In addition, all physicians
in England practice under the supervision of
the public health authorities, which are authorized to
provide them with recommendations relating to the
prescription of medicinal products, either directly or
indirectly by appointing professional organizations
to that effect. This, too, is not considered to infringe
on the physician’s objectivity.
In this last argument, the ECJ seems to consider a
financial incentive to be the same as a recommendation
by a public health authority. However, the
ECJ neglects that Recital 50 in the Preamble to
Directive 2001/83/EC explicitly and exclusively
addresses the prohibition of financial incentives.
Recommendations by a public health authority are
not covered by the Directive at all, because they are
certainly less binding on physicians and less likely
to influence them than financial incentives. European
legislators were apparently aware of this
when they passed the Directive; not so the ECJ.
Its expectations of the professional ethics of physicians’
actions seem to be quite high: The ECJ
assumes that physicians will critically evaluate the
determinations of therapeutic equivalence made by
the National Institute for Health and Clinical Excellence,
being influenced by financial incentives only
where this does not cause the patient any harm.
Especially in a chronically underfunded system as
the NHS, it will be very difficult for physicians to
resist the temptations of financial incentives in a
given situation.
Solicitor Dr Berit Jaeger
Ratajczak & Partners
Berlin · Cologne · Essen · Freiburg ·
Meissen · Munich · Sindelfingen
Posener Straße 1, 71065 Sindelfingen
Germany
www.RPmed.de

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50 EDI
Case Studies
Comparative investigation of various implant surfaces by SEM analysis
Surprises in the Land of Microns
Dr Dirk U. Duddeck, PD Dr Jörg Neugebauer, Dr Martin Scheer, Dr Franziska Möller,
Dr H. Mauricio Herrera and Professor Joachim E. Zöller, Cologne/Germany
Implant surface treatment to enlarge the bioactive surface is a clinically proven method and has been accepted by all manu-
facturers as the basis for successful osseointegration of their implants [1-4]. The present study, which had its origins in the work
of the Qualification and Registration Committee, demonstrates that contamination with organic compounds often cannot be
completely avoided when dental implants are manufactured on an industrial scale. All implants inspected exhibited residue
from the production process or from the handling of the implant blanks prior to sterile packaging of the implant, depending on
the production process used.
Correlation between surface morphology
and osseointegration
Since the mid-1970s, implant surfaces have been
modified by microstructuring and surface enlargement.
Numerous studies have shown that retentive,
i.e. rough and porous, titanium surfaces improve
adhesion and promote the production of a matrix
by the osteoblasts [5, 6]. The high initial success rates
of the first Brånemark fixtures were mainly due to
the fact that these only minimally roughened,
machined implants were inserted mainly into compact
mandibular bone rather than into augmented
bone or into maxillary bone with its significantly
lower bone density. Additive procedures such as titanium
plasma spray coating (TPS) or implant coating
with calcium phosphate ceramics were tried in
Fig. 1 Sandblasted and acid-etched surface topography,
x 10,000 (Templant, Medentis).
recent years but have not won general acceptance.
Today, surfaces are generally modified by subtractive
procedures such as sandblasting and/or surface
etching or by anodizing [7, 8].
The implant surface must support the process of
osseointegration, especially when using highly
sophisticated surgical augmenting techniques such
as those required in the highly atrophic maxilla. In
recent years, therefore, several working groups and
implant manufacturers have presented a multitude
of techniques for micromorphological structuring
of implant surfaces in order to improve success rates
[9-13]. Osteoblasts proliferation and differentiation at
the implant surface will to a large extent depend on
the microstructure of that surface [14]. To support the
apposition of osteoblast filopodia, the implant surface
should exhibit a porous structure with micropores
approximately 0.5 to 1 μm in diameter.
Additional micropores 3 to 5 μm in diameter allow
osteoblasts to cling tightly to these depressions.
Implant surfaces with a microstructure characterized
by a very rough surface and the uniform and homo -
genous porous structure (Fig. 1) yield the best results
in terms of osteoblast proliferation and differentiation
[15, 16].
Background
Scanner electron microscope (SEM) studies conducted
in recent years have shown that different surface
treatments for titanium performed during the industrial
implant production process not only influence
the surface characteristics of the implants but also
may leave traces on the implants themselves. The

Manufacturer Country Type Surface treatment
3i Implant Innovations United States Osseotite Certain Prevail Double-etched
Altatec Germany/Switzerland Camlog Sandblasted/etched
Anthogyr France Ossfit Sandblasted/etched
Astra Sweden OsseoSpeed Sandblasted/fluoride-modified
Bego Germany Semados Sandblasted (until 2008)
Bicon United States Bicon Uncoated Implant Sandblasted/etched
Bredent Germany blueSKY Sandblasted/etched
BTI Spain Interna Etched
Curasan Germany Revois Sandblasted/etched
Dentsply Friadent Germany XIVE S Plus Sandblasted/etched
Heraeus Germany IQ:Nect Anodized
International Defcon Group Spain Defcon TSA Double-etched
Konus Dental Implant Systems Germany Plus+ Implantat Etched
Medentis Germany Templant Sandblasted/etched
Neoss United Kingdom Neoss Implant Kit Bimodal Surface Double-sandblasted
Nobel Biocare Sweden Branemark MK III TiU Anodized
Nobel Biocare Sweden Branemark MK III RP Machined
Osstem Korea Georgeous Sandblasted/etched
Straumann Switzerland SLActive Sandblasted/etched
Straumann Switzerland Standard Plus Sandblasted/etched
Sweden Martina Italy Global ZirTi Sandblasted/etched
Thommen Switzerland SPI-Element Sandblasted/etched
Zimmer United States AdVent Sandblasted
Tab. 1 List of implants examined (sorted by manufacturer).
objective of the present study has been to detect and
identify process-related residue and handling-specific
contamination on various implant systems. In doing
so, generalized residue distributed across the entire
implant surface was to be distinguished from random
local contamination; in either case, the findings
were to be subjected to measurements and qualitative
and quantitative elemental analysis.
Materials and methods
A total of 23 different implant systems by 21 implant
manufacturers from nine countries were examined
under the scanning electron microscope (Tab. 1). The
EDI 51
Case Studies
production processes for the implant systems examined
differed with regard to fundamental aspects. In
addition to the sandblasted/acid-etched implants
popular today, acid-etched, sandblasted, anodized
and machined implants were included in the study.
The study protocol called for three distinct study
phases:
• The SEM material contrast image allowed conclusions
to be drawn on (1) the chemical nature of
the target material and (2) the distribution of different
materials across the depicted surface. Elements
with an atomic number lower than that of
titanium (and, hence, less electron backscattering)
appear darker in the material contrast image.

52 EDI
Case Studies
Figs. 2a to c Organic contamination seen in the material contrast image (Curasan Revois, x 20, x 100, x 250).
Fig. 2d Qualitative and quantitative elemental
analysis of the organic contamination.
• The qualitative and quantitative analysis of the
implant surfaces, the so-called energy-dispersive
x-ray spectroscopy (EDS), uses the x-rays emitted
by a sample to determine its elemental composition.
An areal analysis and one or more spot
analyses were performed for each implant.
• In the third and final phase of the study protocol,
those implants exhibiting interesting findings on
the material contrast image that were not only
local (handling-related) but distributed across
most of the implant surface (process-related)
were topographically surveyed to identify the
average area affected as a percentage of the
total area.
Results
None of the implants examined was without local
and/or generalized findings. The bandwidth of these
findings ranged from irregularities in surface topo -
graphy such as inexactly tapped threads (Nobel Bio-
care, Osstem), deposited titanium particles (Nobel
Biocare) and organic contamination such as carbon
particles on the surfaces of 18 of the implants examined,
all the way to regular generalized inorganic
residue traceable to the production process of nine of
the 23 implants. The EDS spot analyses of isolated
local contamination demonstrated the large number
of implicated chemical elements (Tab. 2).
Organic contamination
Spot measurements on the black areas clearly discernible
on the material contrast images (backscattered
electron/BSE images) showed carbon concentrations
of between 9 at. % and 84 at. %. The local
spots with high carbon concentrations differed in
size (30-100 μm), shape and penetration depth and
included flat and superficial (Figs. 2a to d) as well as
impressively extensive contamination areas (Fig. 3). In
addition, carbon-containing structures were found
that obviously had penetrated the titanium surface
Element C F Na Mg Al Si P S Cl K Ca
Min. at. % 9.2 4.3 2.3 0.2 1.12 1.4 1.9 0.7 0.7 1.3 0.4
Max. at. % 84.2 4.3 23.4 4.1 91.2 3.4 7.0 4.4 15.1 13.4 5.8
Number of implants 18 1 3 1 12 2 2 4 3 2 6
Tab. 2 Elements found in the EDS analysis.
Fig. 3 Heraeus IQ:Nect, x 332. Fig. 4 Straumann SLActive, x 606.

Fig. 5 Bicon Uncoated, x 145. Fig. 6 Altatec Camlog, x 21. Fig. 7a Straumann Standard, x 500.
Fig. 7b EDS analysis, Straumann Standard. Fig. 8a Bego Semados, x 1000. Fig. 8b EDS analysis, Bego Semados.
more deeply (Fig. 4). Among the carbon spots found
repeatedly and regularly, contamination of the outer
threads was particularly prominent. The presence
of organic compounds could be demonstrated both
parallel to the thread (Bicon, Thommen, Defcon)
(Fig. 5) and perpendicular to the thread (Altatec,
Dentsply Friadent) (Fig. 6).
Inorganic residue
For inorganic residue, a distinction must be made
between localized spots and generalized coverage of
the entire implant surface with process-related
residue such as Al 2 O 3 . For example, some sandblasted
and acid-etched implants exhibited pronounced
entrapments of Al 2 O 3 in the spot analysis (Figs. 7a
and b). One implant that had merely been sandblasted
with aluminium oxide (Figs. 8a and b) exhibited a
remarkably high percentage of 14.4% aluminium in
generalized Al 2 O 3 residue.
Generalized contamination with
lightweight elements
Nine implants regularly exhibited dark spots in the
material contrast image (BSE). These dark spots indicated
lighter elements that were quantified by
measurements at five points on the implant surfaces,
in terms of the relative percentage of the
implant surface made up of them. The resulting percentage
values were 0.2% to 23.8%. The descriptive
statistics using one-way ANOVA indicated a group of
six manufacturers for which the generalized contamination
amounted to 0.3% and 2.4%, with a low
level of scattering (Heraeus, 3i Implant Innovations,
Zimmer, Osstem, Sweden Martina and Medentis). By
contrast with the implants just named, the implants
made by Bicon, Altatec and Bego exhibited light elements
on a significantly higher percentage of the
surface (p < 0.01) (Fig. 9). Within this group, the Bicon
and Altatec implants differed significantly from
Bego implants, which exhibited light elements on a
significantly larger percentage of the surface. The
production process for this implant has since been
modified.
Discussion
EDI 53
Case Studies
Implant loss and especially loss of the periapical
implant/bone contact is invariably due to multiple
etiological factors [17-20]. For example, apical periimplant
lesions have been associated with an insufficient
local blood supply, vascular ischaemia, overheating
during the preparation of the implant bed or,
possibly, contamination of the implant surface [21].
There are few reports on the clinical relevance of
different types of contamination in connection with
apical peri-implant lesions. In a retrospective study
on 3,578 patients, cases of implant loss were documented
and evaluated over a period of ten years
(1996 to 2006) [22]. Implant loss occurred in 126
patients (3.5%). In 80% of the cases, implant loss

54 EDI
Case Studies
occurred before the implants were loaded. Once
iatrogenic factors such as surgical technique, peri -
operative contamination or occlusal trauma (17.5%),
insufficient bone quality (3%) and peri-implantitis
(1%) were excluded, 75% of the cases were left with
no obvious clinical reason for implant loss. Hence,
when examining the possible causes of implantological
failure, one possible cause – over and above
improper indications, surgical technique or patientspecific
clinical aspects – may be surface contamination.
Insufficient or missing osseointegration – especially
when observed radiologically in the apical
region of the implant – may be the result of an
undesirable histological reaction to extraneous
materials that prevent the formation of the biologically
inert titanium oxide layer.
Since the early 1990s, endosseous titanium
implants have been examined for residue [23] that
may be related to the manufacturing process or to
product-specific handling subsequent to the production
process [24]. Piattelli, Degidi and co-workers performed
an animal study that led them to the conclusion
that residual aluminium oxide particles on
implants have no impact on the osseointegration of
dental implants made of titanium [25].
Shibli, in a qualitative and quantitative elemental
analysis performed in 2005 that was comparable to
the present study, examined 21 non-osseointegrated
titanium implants in 16 patients [26]. Of these,
14 implants have been removed prior to loading, six
after loading and one due to encroachment on the
mandibular canal. Two implants in sterile packages
served as control group. Material contrast images
were taken and EDS elemental analyses performed
on all implants. Unlike the implants of the control
group, all explanted implants exhibited different
types of organic residue that manifested themselves
as differently sized dark spots on the implant surfaces.
The elements found on these implants included
carbon, oxygen, sodium, aluminium, calcium and
silicon. However, the author was unable to prove a
correlation between the contamination and the
implant loss, even though the elemental composition
of the residue on the lost implants differed from
that on the control implants.
Conclusion
The principal distinction must be made between (1)
the medium used in sandblasting (such as Al 2 O 3 ) and
possible residue from the etching process (such as
acid deposits below impacted aluminium oxide particles)
and (2) complex salts whose presence can be
inferred from the presence of phosphorus, sulphur,
chlorine and calcium. The latter may form in varying
Fig. 9 Multiple comparison of the surface percentages of light elements.
Additional studies
In a comprehensive follow-up study, numerous implants by other
manufacturers are currently being examined using the same study
protocol. The objective of that ongoing research is to obtain an
overview of the surface characteristics of as many implants on the
market as feasible. For the first time, this research will also include
zirconia implants, mini-implants and intermediate structures in the
SEM analyses.
compositions depending on the etching solutions
and cleansing bath used.
In addition, carbon residue may be indicative of
traces of handling particles whose provenance may
be rubber gloves or the industrial production process
itself. Residue originating from the conditioning of
the implant surface, whose presence can be
demonstrated in the majority of the implants examined
by a qualitative and quantitative elemental
analysis would appear almost unavoidable, but just
like the organic contamination derived from the handling
process, these do not appear to have any clinical
relevance at the concentrations found.
A list of references will be supplied by the editorial office on request.
Contact Address
Dr Dirk U. Duddeck
Interdisciplinary Policlinic for Oral Surgery
and Implantology
Department of Oral and Maxillofacial Plastic Surgery
University of Cologne
Director: Professor Joachim E. Zöller
Kerpener Straße 32 · 50931 Köln
GERMANY
Phone: +49 221 478-4744 · Fax: -6721
dirk.duddeck@uk-koeln.de

Neugebauer on vestibuloplasty
New Indications
for an Old Technique?
PD Dr Jörg Neugebauer, Dr Franziska Möller, Dr Georg Bayer and Prof Joachim E. Zöller,
Cologne/Germany
In the heyday of preprosthetic surgery, vestibuloplasty was considered one of the procedures to improve the function of
This treatment option is prone to recurrence since
fixation in the edentulous jaw is contingent on, and
can only be achieved by, the prosthetic restoration.
EDI 55
Case Studies
prosthetic restorations [1,2]. Elevating the alveolar crest in relative terms would create an opportunity to significantly improve
the function of complete dentures at least on a temporary basis [3-5]. Due to the high recurrence rate involved, a number of
modifications to basic vestibuloplasty were presented and, once again, were shown to bring about different outcomes [6].
Submucosal vestibuloplasty as described by Edlan Mecha is particularly noteworthy, as this technique can establish a relatively
well-shaped vestibulum through a local approach.
Missing
mucobuccal fold
after Le Fort I
osteotomy
(with scarring).
Extensive free
split-skin graft
(covering sites 16
through 26).
Healed graft
following
vestibuloplasty.
An alternative recommendation in this situation is to
widen the attached mucosa through a free mucosal
graft harvested from the palate or to attach a splitskin
graft from the thigh or buttock [7-9]. These procedures
are known to yield more predictable outcomes.
However, they also create problems in the
oral cavity – free mucosal grafts by being associated
with scar formation and split-skin grafts by inclusion
of skin structures [10]. Split-skin grafts in particular
involve the secondary effect of creating a moist
chamber associated with the development of C. albicans
underneath fixed dentures. The use of this procedure
should therefore remain confined to very specific
indications.
Why was the mucosal tissue lost?
Nevertheless, vestibuloplasty still remains a simple
way of widening the attached mucosa on implant
surfaces, notably when the procedure can be used
to correct prosthetic restorations that have been
inserted already. However, it is essential to consider
the reason why the attached mucosa was lost in the
first place. If a flattened mucobuccal fold has formed
after surgery (e.g. because the soft tissue had to be
mobilized for plastic coverage) adequate relocation
will be relatively simple. Loss of attached mucosa
may also occur if a bone substitute is placed for
vestibular augmentation. This situation will normally
render vestibuloplasty somewhat more difficult to
perform down the road, as the tissue structures are
altered by the foreign material.

56 EDI
Case Studies
Mobile mucosa following
restoration of implants.
Suturing the mucosa inside the newly
established mucobuccal fold.
Fixation of the gauze strip with a periodontal
dressing.
Clinical procedure
Mucosal incision for
vestibuloplasty.
Vestibuloplasty needs to start out by providing infiltration
anaesthesia, such that the individual tissue
layers are expanded as the local anaesthetic spreads
through them. This will greatly facilitate the subsequent
task of conducting a strictly mucosal prepara-
Exposure of the deepened mucobuccal fold.
Note the open wound area.
Epithelialized wound area following suture
removal ten days after surgery.
Preparation of the mucosal flap. Excision of the submucosal
connective tissue.
Placing a iodoform gauze strip on the exposed
wound area.
Follow-up examination eight months after
surgery.
tion. Mucosal flap preparation will be completed on
reaching the implant margin if there is no relation
between the flap and the connective tissue and no
tensile interaction between the tissue types.
An epiperiosteal preparation can be performed to
thin down the connective tissue structure. This will
dislodge the soft tissue, which previously caused the

EDI
Case Studies
“pump effect” in the peri-implant area, from the
periosteum. Finally, the mucosal flap is transposed
to the newly created mucobuccal fold. The mobilized
mucosa is secured to the periosteum using vertical
mattress sutures. The resultant exposed wound area
is usually covered with an in lay for disinfection (e.g.
iodoform gauze strips) and is then immobilized with
a periodontal dressing. This will ensure that the sulcus
(or the mucobuccal fold) can become widened by
secondary granulation.
Since a relatively deep position must be expected
depending on the width of the mucosal flap,
resorbable sutures should be used for fixation (as a
precaution if primary suture removal inside the sulcus
is not possible after ten days) to avoid inflammatory
reactions in the newly established sulcus.
Patients may need antibiotic coverage in the post -
operative course, depending on the individual risk of
morbidity. This requirement varies both with the
size of the vestibuloplasty and with general health
considerations. Generally speaking, healthy patients
in ASA physical status class 1 or 2 will not require
antibiotic coverage. As the free granulation area may
be relatively painful, information to this effect should
be offered to the patients. They may experience pain
notably when eating acidic food.
Discussion
Keratinized mucosa cannot be attained by vestibuloplasty
alone. Through a submucosally prepared
vestibuloplasty, it becomes possible to reduce the
mobile mucosa which may frequently lead to periimplantitis
via pump movements [11]. Reducing the
mucosal thickness to less than 4 mm will minimize
the risk of anaerobe accumulation. Both free mucosal
and split-skin grafts involve the use of a secondary
donor site [12], which normally will always involve
an extended phase of regeneration compared to the
primary surgical area.
In particular, a vestibuloplasty conducted as a secondary
procedure to optimize the peri-implant soft
tissue is an important tool to ensure long-term outcomes
in healthy patients, as they can either prevent or
limit the progression of an existing peri-implantitis.
A list of references will be supplied by the editorial office on request.
Contact Address
PD Dr Jörg Neugebauer
Interdisciplinary Clinic for Oral Surgery and Dental
Implantology, Department of Dentistry and Oral and
Maxillofacial Surgery of the University of Cologne
Kerpener Straße 32 . 50931 Köln · GERMANY
joerg.neugebauer@uk-koeln.de
57
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58 EDI
Case Studies
Well-organized teamwork: Periodontology, implantology, prosthodontics
Maxillary and Mandibular
Full-Arch Rehabilitation:
A Complex Case
Dr Jochen Frank, MSc, Aindling/Germany, Gerhard Stachulla, MDT, and Sandra Nodlbichler,
Bergen/Germany
Meticulous planning and intensive collaboration between the dentist and dental technician are an important prerequisite
for implantological success. This article presents a clinical case to demonstrate a systematic periodontological, implantological
and prosthodontic treatment approach for a full-arch rehabilitation.
The 47-year-old male patient presented with several
mobile teeth. His tooth mobility caused him pain and
limited him during meals. The patient also suffered
from extremely bad breath. He was aware that some
of his teeth might not be salvageable. However, he
considered a removable denture with palatal coverage
unacceptable; he urgently requested stable and
functional teeth.
Patient history
The patient’s general health was good. Pocket depths of
up to 12 mm were measured in the maxilla. A purulent
discharge occurred during probing. The teeth generally
exhibited Class III mobility. In the mandible, pocket
depths at teeth 36 to 33, 43 and 45 were between
4 and 9 mm, with the teeth exhibiting Class I mobility.
The patient suffered from an aggressive periodontitis.
Treatment planning
• In the mandible, extraction of teeth 37, 32 to 42 and
44 and a long-term provisional restoration spanning
teeth 33 to 45 via 43.
• In the maxilla, extraction of all teeth and provisionalization
with a complete denture.
• Closed periodontal therapy of the remaining
mandibular teeth plus administration of antibio -
tics (combination according to van Winkelhoff et
al., 1989) with regular follow-up sessions with a
dental hygienist.
• Insertion of five Camlog implants at sites 32, 42, 44,
46 and 47.
• Maxillary CT diagnostics using the Med3D system
and insertion of eight Camlog implants at sites 16,
15, 14, 12, 22, 24, 25, 26; provisionalization with four
provisional implants (IPI, Nobel Biocare) and a fixed
temporary bridge.
• Fixed maxillary and mandibular rehabilitation
comprising crowns and bridges.
Treatment
Provisionalization
Impressions were taken of the baseline situation, and
casts were poured and mounted in an adjustable
articulator (Fig. 1). The dental laboratory was tasked
with the wax-up, with particular attention to preserving
the vertical dimensions, and to analyzing
tooth lengths as well as overbite and overjet. This
anticipatory wax-up served as the foundation for all
subsequent prosthetic and, consequently, implantological
steps (backward planning). Teeth 33, 43 and
45 were prepared, and impressions were taken. Teeth
37 and 32 to 42 were extracted and provisionalized
using a temporary resin bridge (Tempron, GC Europe).
Two weeks later, deep scaling and root planing were
performed on the residual mandibular teeth. The day
before, the patient had started taking the Winkelhoff
antibiotic cocktail (500 mg amoxicillin and 400 mg
metronidazole three times a day for eight days) [1].
At the same appointment, the laboratory-produced
metal-reinforced provisional bridge from tooth 33 to 45
via 43 was inserted (Fig. 2), the maxillary teeth were extracted
and an immediate provisional denture provided.

Fig. 1
Baseline casts.
Fig. 2
Framework of
the provisional
metal-reinforced
mandibular
bridge.
Fig. 3
OPG with
markers for
mandibular
diagnostics.
Fig. 4
Mandibular
situation
before implant
placement.
Fig. 5
During mandi -
bular implant
placement, with
some of the
healing caps
already in place.
Fig. 6
Control radio -
graph following
mandibular im -
plant insertion.
Fig. 7
Barium
sulphate splint
for creating the
CT stent.
1 2
3 4
5 6
7
The overall aesthetic type of the patient was to be preserved,
although improvements in terms of closing
gaps were explicitly approved. Because the patient was
suffering from an untreated aggressive periodontitis, it
was decided not to place any implants immediately, as
the bacterial load would have posed a considerably increased
risk to the stability of the implants. Four to
eight weeks following extraction is considered the ideal
window for implantation. At this time, the soft tissue
will have healed sufficiently while the amount of bone
loss at the alveolar ridge will still be tolerable [2].
EDI 59
Case Studies
The surgical procedure
After six weeks, five Camlog implants were inserted
in the mandible at sites 32, 42, 44, 46 and 47 (Figs. 3
and 4). Only a general stent for orientation was
employed to position the implants, because the
bone supply was satisfactory and the favourable
location of the residual teeth provided additional
guidance for implant alignment. No bone augmentation
was required, so the implants immediately
received their healing caps and were allowed to heal
openly (Figs. 5 and 6).
The maxillary bone had been compromised by the
pre-existing periodontitis, which made CT diagnostics
a sensible idea. The provisional restoration was used as
the basis for aesthetic reconstruction, facilitating the
fabrication of a prosthodontic drilling stent and defining
tooth positions, tooth axes and, most importantly,
the implant emergence profile. The temporary maxillary
restoration was relined once the extraction wound
had healed and duplicated for the fabrication of the CT
stent that served to guide the Med3D system (Fig. 7).

60 EDI
Case Studies
8
10 11
Figs. 8 to 11 Implant planning using the Med3D system.
To prevent dislocation of the stent during the CT
scan, the patient visited the dental office prior to the
scan, where he received local anaesthesia and the
stent was secured to his palate with two microscrews
(Martin, 1,5 x 13 mm). After the scan, the
patient returned to the office for removal of the
stent. Extra holes have been provided in the stent
to allow a second round of local anaesthesia to be
administered.
The CT diagnosis was performed at the planning
centre using the Med3D system. Virtual implants
were placed by the oral implantologist, and the result
was stored on the system. The data required for adjusting
the positioner were printed on a data form
(Figs. 8 to 11). The data obtained were transferred to
the drilling stent using a hexapod (Figs. 12a and b).
This hexapod was freshly adjusted for each implant
9
site and sleeve (Fig. 13). The treatment provider received
a surgical plan containing information about
implant positions, diameters and lengths. This plan
facilitated a predictable surgical procedure with no
major surprises, affording the patient and dentist additional
safety and reducing risk.
By comparison, drilling sleeves in conventional
stents will result in serious deviations from the ideal
position (angular deviation > 5°, positional deviation
> 1 mm) in two thirds of all cases [4].
Eight months following the extraction of the maxillary
teeth, the eight implants were inserted with the
assistance of the drilling stent. To prevent interfering
soft tissue from being displaced or injured during the
consecutive drilling steps, the incision was made from
palatally of the drilling stents. Wound healing was

Figs. 12a and b
Fabricating the
drilling stent in
the laboratory.
Fig. 13
The data
obtained were
transferred using
the hexapod.
12a
12b
Fig. 14 Two weeks after implant insertion. Wound healing
with epitheliolysis.
therefore associated with an epitheliolysis at the
palatal wound margins (Fig. 14), although this did not
present a problem. Epitheliolysis is actually a rather
frequent occurrence if the incision in the mandible
has to deviate from the crestal course that would be
ideal from the point of view of wound healing. The
drilling stent with its double tubes (tube in tube) was
again attached to the palate using traction screws
(Fig. 15). Since the Camlog range does not include any
extra-long implant drills, Straumann ITI drills were
used for preparing the implant bed up to a diameter
13
Fig. 15 The drilling stent was attached to the palate.
EDI 61
Case Studies
of 3.5 mm. For the diameters of 3.8 mm and up, the
preparation was performed with Camlog drills without
the drilling stent. The drilling holes for the four
provisional implants were simply apertures without
sleeves and were designed so small that they accommodated
only the pre-drill. The CT diagnosis had
shown that a full-length provisional implant could not
be used, so that the provisional implant had already
been trimmed accordingly prior to the procedure and
was available as a sterile implant of the right length at
the time of the operation.

62 EDI
Case Studies
16
18 19
Direct bilateral sinus floor elevation procedures
were performed (Figs. 16 and 17). To save the patient
the ordeal of bone harvesting, xenogenous material
(Bio-Oss, Geistlich) was used for this augmentation
almost exclusively; only a very small amount of autologous
bone was collected during drilling and added to
the augmentation material. Even sinus floor augmentation
procedures conducted exclusively with Bio-Oss
have shown the same or even better healing rates or
survival rates than procedures using autologous bone
[5,6,8]. The lateral fenestration was closed with a
xenogenous collagen membrane (Bio-Gide, Geistlich).
Using the membrane promoted the formation of vital
bone and increased the chances for implant survival
[7]. All implants – definitive and provisional – could be
inserted as planned with the Med3D system (Figs. 18
and 19).
Closed healing was provided for the definitive implants.
The temporary denture was reworked into
a bridge at the laboratory and was fitted directly on
the temporary implants postoperatively. This required
tilting the implant heads at the locations provided to
17
achieve parallelism. To prevent the temporary implants
from being accidentally removed or loosened,
they had to be secured below the tilting hinge with
a pair of pliers before tilting. The sleeves to be incorporated
were placed over the implants; undercuts
were blocked out using boxing wax, and the resin
bridge that had been the temporary denture was polymerized
while in occlusion. Once the bridge had been
cleaned and excess material removed, the bridge was
inserted using a temporary cement (Temp Bond, Kerr)
and the occlusion checked and adjusted where needed
(Fig. 20).
Several factors guided the decision in favour of temporary
implants. One of them was that the patient
was unwilling to wear a complete denture during the
six-month healing period. Another reason was that
mechanical loading of the alveolar ridge promotes
crestal bone loss. Mechanical stress increases osteoclast
activity, especially during the initial healing
phase following extraction [3]. A possible alternative
solution would have been a provisional immediate
restoration for the four definitive anterior implants.
Fig. 16
Lateral axis
window for
the sinus
augmentation
procedure.
Fig. 17
Left maxilla
following
implant insertion
and sinus lift.
Fig. 18
Right maxilla
following implant
insertion and
sinus lift.
Fig. 19
Control radiograph
following maxillary
implant insertion.

Fig. 20
Cemented
long-term
provisional
on provisional
implants.
Fig. 21
Preparing for the
maxillary ...
Fig. 22
... and mandibular
impression.
Fig. 23
Maxillary
implant
impression.
Fig. 24
Mandibular
implant
impression.
21
23 24
However, we rejected this possibility because it would
have meant an additional risk for the definitive implants
and would, moreover, have been associated
with considerable additional cost. But the provisional
restoration has its disadvantages with regard to softtissue
support, aesthetics and phonetics. The distance
between the bridge and the alveolar ridge was 2 to
4 mm. There was a potential hazard of a collapsing
upper lip and undesirable wrinkles. If the upper lip is
short, it may expose the void during smiling or even
get caught in the gap. Because air may escape between
the bridge and the alveolar ridge, inflating the
vestibular area, some patients may experience a phonetic
challenge. Patients may find attempts to prevent
this very strenuous, and changes in pronunciation may
result. In the case presented here, the phonetic challenge
did exist, but it was accepted by the patient for
the duration of the provisional phase.
22
EDI 63
Case Studies
Final restoration
The maxillary implants were uncovered after seven
months. The patient surprisingly opted for a removable
bridge as definitive maxillary restoration, no
longer being deterred by the idea of having to
remove the bridge each day for oral hygiene. On the
contrary, the patient realized the advantages of
being able to clean the restoration while in plain
view. The patient chose a removable telescopic
bridge whose primary components were custom allceramic
abutments. Four weeks after re-entry, opentray
maxillary and mandibular Permadyne impressions
were taken (Figs. 21 to 24). A bite rim attached
with a screw to the implant outside 22 assisted in
determining the approximate centric position. The
vertical dimension found during the time the provisional
restoration was in place was verified with a
gauge.

64 EDI
Case Studies
Fig. 25 Copy-milled primary crowns as produced by the
Cercon milling unit.
Fig. 27 ... and the secondary copings produced by electroplating.
Fig. 29 Maxillary tertiary framework ...
The maxillary telescopes:
The dental technician waxed up the primary telescopes
on the Camlog Insert abutments. The wax-up
was copy-milled using the Cercon milling unit (Fig. 25)
and adhesively connected to the prepared titanium
abutments in the laboratory. The surface of the telescopes
was finished by wet grinding with a turbine
(Fig. 26). The secondary copings were electroplated
onto the finished primary crowns using the Degu-
Fig. 26 The all-ceramic primary crowns were milled individually ...
Fig. 28 Electroplated copings on the zirconia primary crowns.
Fig. 30 ... complete with jig and bite rim.
Dent Solaris electroplating unit (Figs. 27 and 28). The
tertiary structure was cast in a non-precious metal
(Figs. 29 and 30).
The mandibular restoration:
The combination of natural and implanted mandibular
abutments required a multiply segmented bridge
design. The framework was cast in the classical manner
using a high-gold bonding alloy (Figs. 31a and b).

Fig. 31a The mandibular frameworks.
EDI 65
Case Studies
Fig. 31b The finished maxillary and mandibular frameworks exhibit a
good fit.
Fig. 32 The maxillary provisional/travel denture. Fig. 33 Second mandibular provisional.
Fig. 34a Maxillary ceramic abutment try-in. Fig. 34b Control radiograph.
New provisionals were provided for both the maxilla
and the mandible (Figs. 32 and 33).
In-office try-in:
The ceramic abutments in the maxilla were tried
in, some of them in anaesthesia (Fig. 34a and b). Titanium
abutments were used in the mandible. The
definitive abutment margins were checked and any
corrections required were documented. A provisional
implant between sites 14 and 15 had to be removed,
because there was too little space. The provisional
bridge was relined in this region and supported by
the healing caps. This was followed by the important
aesthetic wax-up, into which the patient’s expectations
were duly incorporated. The vertical dimension
was once again verified based on the speaking
space.

66 EDI
Case Studies
Fig. 35 Once the abutments have been seated, the secondary components
were tried in ...
Fig. 37 Tertiary framework with anterior jig.
Fig. 38 Maxillary ... Fig. 39 ... and mandibular overimpression.
The prosthetic appointment:
In a single session, the provisional implants were re -
moved, the abutments were definitively inserted, the
electroplated telescopic crowns were tried in (Fig. 35)
and adhesively connected to the tertiary frame -
work in the mouth using AGCem (Wieland). In the
mandible, the abutments were inserted prior to bite
registration, and the frameworks were connected
using fine A-silicone impression material. The centric
relation was recorded in detail based on the tertiary
framework (Fig. 36). The vertical dimension was
Fig. 36 ... and the centric relation determined.
determined by an anterior jig (Fig. 37). Next, an overimpression
of the frameworks was taken using Permadyne
(Figs. 38 and 39).
At the end of this extended treatment session, the
patient received a maxillary resin bridge without
any metal reinforcements to serve as a travel denture
(Fig. 40), which also served as a provisional restoration
until the definitive restoration was inserted. This also
meant that the patient would never be without a
restoration even in the event that the definitive

Fig. 40 Maxillary travel denture and second provisional mandibular
bridge.
Fig. 42 Ceramic veneer for the mandibular anterior ... Fig. 43 ... and posterior regions.
44 45
Figs. 44 and 45 Wax try-in and remounting.
restoration required repairs, a precaution that is generally
highly appreciated. For reasons of stability, the
palate could not be left completely uncovered in this
case. A new provisional restoration with a shortened
span was inserted in the mandible (Fig. 41).
Fabrication of the definitive restorations:
At the laboratory, new master casts were poured
and remounted in the articulator in the newly determined
centric relation. The definitive restoration
could now be fabricated based on the results of the
EDI 67
Case Studies
Fig. 41 Everything has been prepared for the try-in of the maxillary
wax-up and the mandibular framework after the first firing.
aesthetic wax-up and the desires and phonetic
requirements of the patient. In the mandible, the
restoration was veneered using the Duceram Kiss
veneering ceramic by DeguDent (Figs. 42 and 43). The
maxillary framework was veneered with a light-polymerizing
material, Sinfony by Espe. The missing gingival
segments were added using Sinfony Gingiva.
The next step was the important try-in of the maxillary
wax-up and the mandibular framework after the
first firing, followed by remounting (Figs. 44 and 45).

68 EDI
Case Studies
46 47
48a
Figs. 48a and b All-ceramic primary crowns in the maxilla.
The final steps were the definitive cementing of the
mandibular restoration (Figs. 46 and 47), adaptation of
the travel denture to the new occlusal situation and
remounting of the definitive maxillary restoration,
which had been designed as a removable bridge that
lets the palate completely free (Figs. 48a to 50). The
entire treatment took 15 months to complete.
A list of references will be supplied by the editorial office on request.
48b
Fig. 46
Titanium abutments
in the
mandible prior to
segmentation.
Fig. 47
Cemented
mandibular
crowns and
bridges.
49a 49b Figs. 49a and b
The definitive
restoration
in situ.
Fig. 50
Final radiograph.
Contact Addresses
Dr Jochen Frank,
Master of Science for Oral Implantology (DGI)
Arnhofenerstr. 4 1/2 · 86447 Aindling · GERMANY
Frank.Pflumm@t-online.de
Dentallabor Stachulla
Gerhard Stachulla, MDT
Derchinger Str. 11 · 86444 Bergen · GERMANY
gerhard@stachulla.de

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70 EDI
Case Studies
Neugebauer et al on augmentation materials
Marketing and Other Types of
“Mad Cow Disease”
PD Dr Jörg Neugebauer, PD Dr Dr Daniel Rothamel and Prof Joachim E. Zöller, Cologne/Germany
For patients to be treated with implants and implant-supported restorations, a number of different medical devices are
required such that adequate treatment can be performed in line with current scientific evidence. Many products and suppliers
have become established in recent years. As a result, highly specific surgical techniques and materials are available today to
deal with a variety of different indications.
Notably in the highly competitive market of bone
substitutes, various marketing concepts are employed
in an attempt to acquire new customers or users.
This implies that the pertinent documentation – usually
supplied by the industry – needs to be critically
ap praised. Summaries that seemingly bring together
various sources from the literature may be linked to
other statements and recommendations that were
never made or, for that matter, never intended by the
original authors. Over the past few weeks, numerous
implant dentists have been faced with a message
(first launched through anonymous mailing) that
bone substitutes derived from bovine material must
be expected to carry risks. Procedures of this type,
they were told, should henceforth become safer and
simpler through the introduction of a new bone substitute
or a novel application. Once users had been
sensitized to this campaign by repeated mailings, the
product was introduced. It was marketed as similar
in structure to conventional bovine materials while
being manufactured by purely synthetic means.
Power of innovation
by product development
The past few years have seen powerful innovations
in dentistry. This has clearly been due to the potential
of product development offered by industry. Only a
limited number of implant systems, implant surfaces
and bone substitutes would today be available in
the absence of this industry base. However, the relatively
generous design of introducing medical de -
vices at the suppliers’ own responsibility within the
European Community should not be interpreted such
that marketing-driven efforts can be allowed to cast
doubt on any established products that have been
around for numerous years. Any users of medical
devices, and healthcare providers conducting followup
treatments, are required by law to report any
unexpected events or side-effects to their national
supervisory authority (e.g. the German Institute for
Drugs and Medical Devices). However, calling products
into question in an effort to be provocative will
give rise to uncertainty in the market, notably when
patients come across such information that was originally
intended for physicians. Many of them will lack
the scientific background to take these campaigns
for what they are, objectively speaking. Similar to
many other devices used in dentistry, products are
available not only from the market leader but also
from other manufacturers offering bone substitutes
with similar technologies.
Based on the current body of literature, it can be
stated that the clinical functionality of bovine bone
substitutes has been demonstrated in an evidencebased
fashion by animal experiments, clinical surveillance
studies and prospective studies for indications
related to both periodontology and implant dentistry
[1-4]. Data for this purpose have been collected and
published both in university settings and by experienced
implant dentists.
A theoretical risk that prion infection might occur
during grafting with bovine bone substitutes is open
to discussion [5-7]. However, different studies on this
issue have already been presented [8,9]. Decisions
based on cultural, ethnic or religious concerns are an
entirely different matter and should be left at the discretion
of individual users. In this way, the various
products can be presented to patients on the basis of
scientific validation, thus helping them to avoid any

Fig. 1a Bio-Oss – overview (40 x)
Fig. 1b Bio-Oss – detailed view (200 x)
Fig. 2a Cerabone – overview (40 x)
risks involved. In the English-speaking countries, allogeneic
materials are preferably used along with bo -
vine materials [10,11]. These allogeneic products have
also become more popular in continental Europe, so
far without any major discussions related to infection
[12].
Figures 1a to 3b illustrate biopsies of bovine xenogeneic
bone substitutes, obtained six months after
two-stage sinus floor elevation within the context of
oral implant treatments. Three materials are shown:
Bio-Oss (Geistlich Biomaterials, Wolhusen, Switzerland),
Cerabone (botiss dental GmbH, Berlin, Germany)
and Bego OSS (Bego Implants, Bremen, Germany).
All materials display a reliable degree of
osteoconductive effectiveness. Throughout the augmented
zone, individual granules are invaginated by
newly formed hard tissue and are cross-linked to
each other via hard-tissue bridges. The different
staining pattern of the granules results from the different
preparation technique to which the bovine
bone was subjected.
EU Commission Directive 2003/32/EC details the
legal specifications for the use of medical devices of
animal origin [13]. Regarding the safety of Bio-Oss, a
statement by the German Society for Dentistry and
Oral and Maxillofacial Surgery (DGZMK) is available
[14]. The safety of Cerabone and Bego OSS has been
Fig. 2b Cerabone – detailed view (200 x)
EDI 71
Case Studies
Fig. 3a Bego OSS – overview (40 x)
Fig. 3b Bego OSS – detailed view (200 x)
officially certified by the health authority of the German
state of Hesse [13,15].
It seems odd that a new product for which limited
scientific information is available should provide
more safety than xenogeneic materials that have
been well established for use in augmentative procedures
over several decades. It is precisely in regenerative
procedures that long-term treatment outcomes
will only be evident after several years. The claims
made by this manufacturer are even more surprising
when considering that very few scientific studies
have been published about other bone substitutes
offered by that company despite relatively long follow-up
periods. Apparently, the manufacturer in
question is marketing a new concept on the basis of
fear-mongering without offering validation of their
claims by pertinent scientific data.
A list of references will be supplied by the editorial office on request.
Contact Address
PD Dr Jörg Neugebauer
Interdisciplinary Clinic for Oral Surgery and Dental
Implantology, Department of Dentistry and Oral and
Maxillofacial Surgery of the University of Cologne
Kerpener Straße 32 . 50931 Köln · GERMANY
joerg.neugebauer@uk-koeln.de

72 EDI
Product Studies
3D finite element analysis comparing standard and reverse conical neck implants
Bone Platform Switching
Matteo Danza, MD 1 , Ilaria Zollino, MD 2 , Luigi Paracchini, Engineer 3 , Iole Vozza, DDS 4 ,
Guidi Riccardo, DDS 2 , and Francesco Carinci, MD 2
Biomechanical optimization is an important objective in the design of dental implants [1]. Finite element analysis (FEA) has become
an increasingly useful tool for predicting the biomechanical stress on an implant and the surrounding bone [2]. The components in
a dental implant-bone system are geometrically complex [2]. The use of FEA in implant biomechanics offers many advantages over
other methods when it comes to simulating the complexity of clinical situations [3]. FEA facilitates predictions of stress distribution
in the contact area between implant walls and cortical bone and between the apical aspect of the implants and trabecular bone [2].
Although the success rates of some implant systems have been high, implant failures do occur [4, 5].
To achieve stable osseointegration, high stress concentrations
in bone should be avoided because they
can induce severe resorption of the surrounding
bone, leading to gradual mobility and potentially to a
complete loss of the implant [6]. A key factor for the
implant success is the manner in which loads are
transferred to the surrounding bone [7]. It has long
been recognized that both the implant and the bone
should be loaded within a certain range for physiologic
homeostasis. Overload can cause bone resorption
or fatigue failure of the implant, whereas underloading
may lead to disuse atrophy and subsequent
bone loss [8, 9].
Factors that influence load transfer at the boneimplant
interface include the type of loading, the
bone-implant interface, implant geometry, the type
of restoration and the quality and quantity of the
surrounding bone [2]. Implant length, diameter and
shape, representing the implant geometry, can be
modified easily in the implant design, while the quality
and quantity of the cortical and cancellous bone
need to be assessed clinically and should influence
implant selection [2].
Analyzing the load transfer at the bone-implant
interface is an essential step in the overall load analysis
[10], and FEA has been widely used for the quantitative
evaluation of loads on implants and surrounding
bone.
In the present study, 3D FEA was used to examine
the biomechanical behaviour of two types of
implants differing only in emergence profile that
were subjected to static loading in contact with D1
and D4 bone tissue.
Materials and methods
The biomechanical behaviour of two different
implants (SPI and SFB, Alpha Bio Implant, Petach
Tikva, Israel) subjected to static loading in contact
with D1 and D4 bone tissue was evaluated in the
present study. The implants were 4.2 mm in diameter
and 13 mm in length, and the abutments were
straight. The implants were identical except for their
emergence profile: SPI has a straight profile, whereas
SFB has a tapered profile (Figs. 1a and b).
The volumes of the single implants and their differences
were calculated. The total volume of a SFB
implant is 219.94 mm 3 , while the volume of a SPI
implant is 225.51 mm 3 . The difference is 5.57 mm 3 .
Therefore, placing the SFB implant will save 5.57 mm 3
of crestal bone around the implant neck, with potential
beneficial effects on the bone-implant interface
and on the papilla.
FEA was used to determine the strain distribution
within peri-implant bone as a function of the different
profiles of the implant neck. Implant system,
bone type and the axial and transversal loads applied
to the different configurations had to be examined to
evaluate the biomechanical behaviour. The directions
of the axial and transversal loads when applied to
the top of the implant were evaluated. A double system
was analyzed: (a) FY strength along the Y axis at
200 N; (b) FZ strength applied along the Z axis at 140 N
(Fig. 2).
The mathematical models produced by FEA are
curves, surfaces and solids. Once drawn the systems
that were object of the study by CAD (Computer
1 Dental School, University
of Chieti, Italy
2 Maxillofacial
Surgery, University
of Ferrara, Italy
3 Private practice,
Milano, Italy
4 Dental School,
University of Rome
“La Sapienza”, Italy

Fig. 1a Straight neck of a SPI implant.
Fig. 2 FY and FZ strengths applied along Y and Z directions at
200 N and 140 N, respectively.
Aided Design), the FEA discretized solids composing
the system in many infinitesimal little elementary
solids defined finite elements. This resulted in a mesh
in which the single finite elements were connected
by nodes (Fig. 3). Once the solids, the mesh and the
projected loads (direction and intensity) were
defined, a definition of the chemical and physical
properties of materials was required. When performing
a biomechanical analysis of the materials under
low-intensity stress, it must be remembered that the
materials were considered to be homogeneous, linear
and isotropic. The FEA simulation assumed a linear
relationship between loads and deformations.
The portion of bone containing the implant was
delimited by joints on two sides, removing all degrees
of freedom within the system.
The pivot inside the bone tissue was delimited by
contact elements such as the connecting screw and
the abutment. The CAD 3-D mathematical models used
for FEA were implemented using a surface modeller
Fig. 1b Tapered neck of a SFB implant.
(Rhinoceros 4.0 – McNeel Europe, Barcelona, Spain)
and a solid modeller (Solid Works 2007 SP 2.2, Solid-
Works Corporation Headquarters, Concord, Massachusetts,
USA, both belonging to Windows XP Pro -
fessional SP1, Microsoft Corporation, Milano, Italy).
The discretization in finite elements and the FEA
were realized by NEiFusion 1.12 (Noran Engineering,
Inc., Westminster, California, USA).
Results
EDI 73
Product Studies
Fig. 3 Mesh formation where the single finite elements were
connected by nodes.
The results obtained with the FEA simulation showed
that the stress distribution of a tapered profile of an
implant neck at the abutment insertion area differed
from that of an implant with a straight neck at the
level of the bone. Stress in a bone matrix is commonly
determined according to von Mises’ theory. This
theory was used here in order to determine the distribution
of stresses at the bone-implant system interface
in two different bone classes (D1 and D4).

74 EDI
Product Studies
For the tapered-neck (SFB) implants, the load distribution
was more uniform; the strain tended to be
uniformly distributed inside the bone. By contrast
the load acting on a straight neck (SPI) implant tended
to confine the strain next to the external surface
of the implant, and it was not distributed inside the
bone (Figs. 4a to 5).
Table 1 reports the values of the loads applied to SPI
and SFB implants.
Discussion
Primary implant stability and bone density are considered
essential for achieving predictable osseo -
integration and the long-term clinical survival of
implants [11].
The long-term clinical performance of a dental
implant is dependent on the preservation of good
bone quality around the implant and a sound interface
between the bone and the biomaterial. Both are
governed by the stress and strain distribution within
the bone [2].
An effective way to ensure excellent clinical performance
is to use a biomechanically optimized
implant that provides a health stress-strain level as
required for normal bone resorption and deposition
4a 4b
4c 4d
Fig. 5 Different strain distributions in the peri-implant bone
around implants. In the SFB implant, the strain tends to
spread uniformly inside the bone. In SPI implants, the load
tends to confine the strain next to the external surface of
the implant, and it is not distributed within the bone.
at the implant site [12]. Implant features causing
excessively high or low stresses may contribute to
pathologic bone resorption or bone atrophy [8, 9].
Most efforts have been directed at optimizing the
geometry of the implants to maintain beneficial
stress levels at the bone-implant interface [13].
Implant geometry includes length, diameter and
shape. The optimum length and diameter necessary
Figs. 4a and b
Stress distribution
(von Mises) of
SPI implants in
D1 and D4 bone,
respectively.
Figs. 4c and d
Stress distribution
(von Mises) of
SFB implants in
D1 and D4 bone,
respectively.

Tab. 1
Values of the
loads applied
to SPI and SFB
implants.
Bone class Type of implant _ (MPa) _ (micro-strain)
D1 Tapered neck 97 5.4e-003
D4 Tapered neck 82 5.25e-003
D1 Straight neck 75 3.9e-003
D4 Straight neck 65 8.1e-003
for long-term success depend on the condition of
the bone – if the bone is normal, length and diameter
will not be significant factors for implant success,
but if the bone condition is poor, large diameters
are recommended, and short implants should be
avoided [5, 14].
Previous studies had mainly focused on the
mechanics of implant and abutment connections
and their impact on abutment mobility as well as on
the effect of implant shapes on stress distribution
within the bone.
The effect of the abutment type on stress distribution
within the bone under vertical and inclined
loads was investigated by Chun et al. [6] using FEA.
They found that the type of abutment used significantly
influences the stress distribution within the
bone because of different load-transfer mechanisms
and the differences in size of the contact areas
between the abutment and implant.
With regard to implant shape, theoretical analysis
implies that clinically, whenever possible, an optimized
– not necessarily larger – dental implant shape
should be used based on the specific morphological
limitations of the mandible [2].
Siegele and Soltesz [15] compared cylindrical, conical,
stepped, screw and hollow cylindrical implant
shapes exposed to physiologic stresses and examined
the stress concentrations at the site of implant
emergence from the bone using FEA. They demonstrated
that different implant shapes led to significant
variations in stress distribution within the bone
because implant surfaces with very small radii of
curvature (conical) or geometric discontinuities
(stepped) induced significantly higher stresses than
smoother shapes (cylindrical, screw-shaped).
Danza and Carinci [16] elaborated on the concept
of bone platform switching (BPS) obtained by using
dental fixtures with a reverse conical neck. BPS is an
internal bone ring in the coronal part of the implant
yielding more residual crestal bone around the
implant neck, with several advantages: reduced
mechanical stress in the crestal area of the alveolar
bone, repositioning of gingival papillae on the bone
EDI 75
Product Studies
ring and a proper vascularization to the hard tissue
even in cases of reduced inter-implant space.
Load transmissions and resultant stress distributions
at the bone-implant interface have been the subject of
several FEA studies. Some authors [17, 18] have drawn
attention to the fact that repeated loading and unloading
cycles result in alternating contact and separation
of components of the implant. Clinical findings of
screw-loosening and failure probably result from these
separation events and from elevated strains within the
screw. The other mechanism of screw loosening is related
to the fact that no surface is completely smooth.
Because of the microroughness of components, when
the screw interface is subjected to external loads,
micromovement occurs between the surfaces.
Design changes to avoid or reduce the incidence of
clinical problems and abutment screw failures by
improving the stress distribution of implant components
have been suggested in this FEA study.
Different strain distributions in the peri-implant
bone around implants with a tapered neck seem to
result in more bone activity with less crestal bone
resorption. Zero or near-zero strain, as observed in
implants with a straight neck (SPI), does not engage
the bone matrix adequately, which may lead to a
crestal bone resorption [19]. The strain values have
shown that in the straight-neck implant (SPI) a higher
propensity to deformation (higher micro-strain
values) in the apical portion was present, leading to
greater implant instability (see Tab. 1). Higher instability
of a straight implant causes more micromovement
at the interface, with a higher risk of fibrous
connective tissue formation at the interface [20].
A list of references can be found on www.teamwork-media.de
Contact Address
Professor Francesco Carinci, MD
Chair of Maxillofacial Surgery
Arcispedale S. Anna
Corso Giovecca 203 . 44100 Ferrara · ITALY
Phone/Fax: +39 0532 455582
crc@unife.it . www.carinci.org

76 EDI
Product Studies
Pre-implantological bone block osteosynthesis:
Functional Innovations
Dr Dr Andres Stricker, Constance/Germany
Enossal implantation has been established as a predictably reliable option for the treatment of edentulous patients. Aimed at
approximating complete remission, the implant should meet not only functional requirements, but also aesthetic expectations.
The demand that the implant should be perfectly positioned in all three dimensions marks the end of approaches that simply
use the available residual bone – and the beginning of prosthetically perfect implant positioning. Perfect implant positioning
very often requires bone augmentation, since bone deficits need to be addressed either before or during implant insertion.
For alveolar crests with advanced atrophy (less than
3 mm in width), simultaneous procedures can be
contraindicated because they significantly increase
implant failure rates. Here it would be preferable
to pursue a two-stage approach where, ideally, an
autologous bone graft from an appropriate donor
site is transferred to the deficient alveolar crest
region before embarking on implant surgery. After a
healing period of at least three months, the osseous
implant bed will be optimally integrated in three
dimensions, ready for perfect implant positioning. In
pre-implantological augmentation procedures there
is a clear tendency towards intraoral bone grafts harvested
from the retromolar region (or possibly from
the mental bone or the zygomaticoalveolar crest),
but away from extraoral grafts harvested from the
iliac crest. The congeneric origin and consequent
similar bone structure (due to the neuroectodermal
formation of the viscerocranium and the mandible)
make intraoral bone grafts the preferred solution,
especially with regard to their significantly better
absorption properties compared to extraoral iliac crest
grafts, where the bone originates from enchondral
ossification.
The criteria for successful healing and integration
of bone grafts are secure and predictable fixation and
tension-free suture closure. But soft-tissue management
(incision control, lobe design) deserves at least
as much attention as contouring and securing the
bone block. Both these factors are interdependent, as
excessive stress on the suture leads to dehiscence of
the soft parts, eventually resulting in the total or partial
loss of the graft. The results of secondary implant
insertion in partially integrated grafts tend to be aesthetically
less satisfactory. Therefore, solid fixation
and secure suturing are an absolutely prerequisite
for successful bone grafting. At the same time, the
insertion of the graft itself and its connection to
the atrophied residual bone should be as easy as
possible. The principles of functionally stable osteo -
synthesis, which also apply to bone grafting, have
been known for many years, even since before the
introduction of enossal implants. These principles
demand secure anchorage within the residual bone,
while avoiding excessive compression of the graft
at the transplant bed, which would entail the risk
of fracture and, consequently, partial absorption or
complete loss of the graft.
Fig. 1 Intraoral appearance indicating severe atrophy. Fig. 2 Intraoperative presentation of the atrophied alveolar crest.

78 EDI
Product Studies
Fig. 3 Fixation of the retromolar bone graft. Fig. 4 Presentation prior to suture closure.
Fig. 5 Intraoral appearance after two months. Fig. 6 Presentation of the well-healed bone graft after three
months.
Fig. 7 Secondary implant insertion three months after block
augmentation.
In most cases, a small countersinking groove is
reamed into the bone graft in the region of the sliding
hole using a round burr to minimize the stress on
the bone block graft at the level of the screw heads.
This used to be the only method available to prevent
the round screw from exerting excessive pressure
during insertion of the graft. Alternative procedures
without countersinking groove required the screw
head to be left protruding and secured above the
graft. For the surgeon, this situation presented the
following dilemma: If screw heads were not countersunk,
the soft-tissue treatment would be complicated
by the protruding screw heads exerting additional
Fig. 8 Implant reentry three months after insertion and six
months after augmentation.
pressure on the soft-tissue lobes. Taking neither
measure would have resulted in a failed bone graft,
because the screw head pressing on the graft would
cause stress cracking within the graft, resulting in
secondary absorption or failure, while the protruding
screw head accompanied by heavier suturing would
lead to suture dehiscence and, eventually, complete
loss of the graft. The most straightforward way to
resolve this was to cut a slight groove in the grafts
with a round burr, minimizing the pressure on the
graft and improving mucosal adaptation.
With the osteosynthesis screws developed and
supplied by Aesculap as part of their Ergoplant bone

2034-0906 © Directa AB
79 79
Fig. 9 iCAT volume tomography of the osseointegrated implant.
fixation sets, there is now a titanium screw that has
a very flat head but will still not shear off thanks to
the strong material it is made of. The flat screw head
minimizes the pressure on the bone graft without
requiring the precaution of countersinking with a
round burr. It also greatly simplifies soft-tissue management,
as there will be less tension on the sutures
caused by increased volume expansion. The micro -
thread of the screw allows quick fixation, with only a
few turns, even in very thin residual bone (Figs. 1 to 10).
Dentists all over the world are
using LUXATOR ® instruments
as the preferred method of
performing extractions.
Implantology starts at
the time of extraction!
Easier for the dentist and dramatically less
traumatic for patients and their dentition.
EDI 79
Product Studies
The innovative head design of the new bone fixation
screw together with its new microthread and its
very robust titanium alloy facilitate predictable and
successful osteosynthesis for securing bone grafts in
place. For the implantologist performing augmentations,
this means high-quality results through successful
and stable osteosynthesis by a simpler and
quicker procedure.
Contact Address
Dr Dr Andres Stricker
Wessenbergstr. 6
78462 Konstanz
GERMANY
Phone: +49 7531 917110
Fig. 10
Innovative
design of the
screw head.

80 EDI
Business & Events
14 th Dentsply Friadent
World Symposium
in Barcelona
Success is...
It was another congress of superlatives. 2,500 atten-
dees from more than 60 countries met in Barcelona
on 19 and 20 March 2010. A pulsating city, more
than 100 outstanding presentations and hands-on
workshops – only a few of the impressions the participants took home with them after two days of scientific
and technical deliberations. The scientific leaders were Prof Lim K. Cheung (Hong Kong), Dr Henry Salama
(Atlanta, USA) and Prof Heiner Weber (Tübingen, Germany).
“What we offer is not just implants. What we offer is
dental solutions, from apex to cusp.” These were the
words Dentsply Friadent Managing Director Dr Wer -
ner Groll used to illustrate the symposium’s motto,
“Focus on a Successful Practice”. But what is success?
Safe and clinically successful treatments are as much
a part of success as our knowledge about ongoing
developments in oral implantology. Various fora and
sessions offered first-hand information. In the
“Proven Applications and New Approaches” forum,
experienced practitioners presented practical treatment
approaches and innovative procedures. In the
“Today’s Progress for Tomorrow’s Practice” forum,
speakers representing the research side gave their
audience an impression of ongoing studies and scientifically
founded developments. Interdisciplinary
cooperation played a focal role at the congress. For
example, interfaces with endodontics, periodontology
or dental technology serve to link these disciplines
into a broad and holistic implantological concept.
So the “apex to cusp” motto that Dr Groll cited
in his opening address was thoroughly confirmed as
the congress went on.
Timing, aesthetics, treatment protocols
and risk management
Keynote lectures highlighted four important factors
of implantological success – timing, aesthetics, treatment
protocols and risk management – on the basis
of practical examples as well as against a scientific
background. In his opening presentation, Prof Dennis
Tarnow (USA) emphasized the points that are impor-
tant for long-term success: In potential immediateplacement
cases, extra attention should be paid to
the status of the soft tissues and the buccal wall of
the bone, which must be sufficiently well preserved.
Dr Peter Gehrke (Germany) made a case for general
and objective aesthetic parameters. More than
80 percent of all patients consider aesthetics an
important factor of success. Dr Marco Degidi and
Prof Adriano Piattelli (Italy) presented their “chamber”
constant. Under certain circumstances, as the
chamber video impressively demonstrated, a threedimensional
biological structure arises between
the implant shoulder and the abutment. Dr Sanjay
Sethi (United Kingdom) called for paying more
attention to the biological consequences of treatment
planning and to its financial consequences.
Prof Wilfried Wagner (Germany) listed a number of
anatomical, biological, aesthetic, surgical, prosthetic
and mechanical risk factors along with suitable
preventive measures.
The afternoon’s Expert Talk before a tremendously
interested public saw Dr Dietmar Weng, Dipl-Ing Holger
Zipprich, Dr Marco Degidi, Dr Tord M. Lundgren,
Prof Karl Andreas Schlegel and Prof Dennis Tarnow discuss
the Tissue Care concept and the importance of
primary stability. Given the different backgrounds of
the panellists, it soon became obvious that important
tendencies with regard to immediate loading
and aesthetic long-term success should be given a
closer and more differentiated look, requiring scientific
evidence and enlarging our existing knowledge
base. The Ankylos and Xive implant system support
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82 EDI
Business & Events
Prof Dennis Tarnow explaining the factors that are
important for long-term success.
two essential findings on long-term success by
ensuring tissue preservation and predictable primary
stability. The short introductory presentations by
Weng, Zipprich and Degidi gave rise to an interesting
discussion on the measurability and definition of two
relevant core aspects of clinical long-term success.
Biomaterials and implant design –
what will the future bring?
What new treatment options can we expect to see in
the future, from a scientific point of view? Prof Karl
Andreas Schlegel (Germany) believes that a biologically
controlled bone augmentation process will
become more important in the light of an aging
patient population. Dr Christopher McCulloch (Canada)
spoke on diabetes mellitus as an example of where
optimized implant surfaces will permit implant
treatment of patients for which it had previously
been contraindicated. Dr Tord M. Lundgren (USA)
showed how Ankylos implants can help avoid vertical
bone loss in selected cases. And Dr Paul Weigl
(Germany) demonstrated how short (8 mm) Ankylos
implants could make bone augmentation in the
posterior area dispensable.
In times when problems become ever more complex
and in which more and more materials and
methods are extant, specialization alone can be
counterproductive, as Dr Henry Salama (USA) and
Dr Bernhard Saneke (Germany) underscored in their
final presentation. Successful implant therapy requires
interdisciplinary cooperation and networks consisting
of experts from different fields. Cooperation is
the only way to leverage the immense potential of
modern technologies.
Teamwork approach, personal meetings
and hands-on workshops
“Oral implantology needs dental technology” was
the title of a separate forum – a title that would have
been equally descriptive of both days of the symposium.
It is rare that dental technologists play such an
important role at an implantological congress. As
usual, MDT Gerhard Stachulla confidentially moderated
the presentations, of which the joint presentation
by Carsten Fischer and Peter Gehrke may have
been the most memorable. In the hands-on workshops,
offered this year for the first time and
completely sold out, participants were able to
use anatomical preparations to learn more about
augmentation techniques (Dr Thomas Hanser) and
soft-tissue management (Dr Wolfram Hahn and
Dr Stephan Klotz) and get some training in guided
surgery using ExpertEase on real casts (Dr Fred
Bergmann).
The positive response on the part of the attendees
convincingly attested to the quality of the speakers
and the successful congress organization. Particularly
agreeable were the prevailing neutral point of view
and the independent nature of the information presented.
The Dentsply Friadent World Symposium is
an important implantological congress that has preserved
its informal fabric despite its considerable
size. Even before they left, many participants indicated
that they would be attending the next World Symposium,
which will be held in Hamburg on 16 and
17 March 2012.
Annett Kieschnick
The scientific directors (left to right): Dr Henry Salama (Atlanta, USA), Prof Heiner
Weber (Tübingen, Germany), Dr Werner Groll (Managing Director, Dentsply Friadent)
and Prof Lim K. Cheung (University of Hong Kong).

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84 EDI
Business & Events
ITI World Symposium 2010
The Conversation of Geneva
That the Swiss canton of Geneva is only small, made the ITI World Symposium seem only the bigger – the biggest and most
successful in the history of the International Team for Implantology to date. Even though the first half of 2010 was speckled
with congresses and conventions, dentists all over the world seem to be far from having enough of continuing education.
And so, visitors from 82 countries ended up travelling to the ITI World Symposium in Geneva in April. What they saw was a
congress of superlatives: almost 4,000 attendees, 113 speakers, an interesting and diverse schedule and, of course, the
30 th anniversary of the ITI.
The presentations were highly practical and were
delivered in a professional manner. Dr Thomas von
Arx (Berne, Switzerland) demonstrated his affinity
both to implantology and to architecture. In his wellstructured
presentation, he discussed the topic of
localized bone defects, especially in buccal alveolar
walls in the anterior region. The correct three-dimensional
placement of an implant requires a certain
amount of bone volume; however, this bone volume
will not always be available due to changes the alveolar
ridge has undergone following extractions,
infection, trauma or malformation. To keep the number
of surgical interventions as well as overall treatment
time and cost at a minimum, implant placement
should coincide, wherever possible, with the
GBR (guided bone regeneration) measures taken.
However, Dr von Arx strongly emphasized that certain
criteria must be fulfilled for a single-set procedure
to be successful. If primary implant stability
cannot be achieved or if the implant cannot be positioned
correctly, bone augmentation must precede
implant placement with a sufficient margin. Other
important criteria for treatment planning include
the healing potential of the implant site and the
patient’s general health.
“As simple as possible. But not simpler
than that.” (Albert Einstein)
Dr Franck Renouard (Paris, France) had a question for
the audience: “What is short, and what is not?” The
implantologist in private practice reported on his
clinical experience, highlighting treatment with
short implants in particular, which he regretted were
often still discussed mostly in terms of the disadvantages.
He cited a number of arguments in favour of
short implants, stressing that these implants may
have a routinely good biomechanical prognosis.
Recent publications have shown that in greatly atrophied
bony implant beds, short implants can be more
favorable than long implants in augmented bone. In
addition, short implants provided added therapeutic
ITI President
Prof Daniel
Buser (Berne,
Switzerland) was
impressed with
the well-filled
auditorium.

Dr Thomas von Arx
Dr Stephen Chen Prof Matteo Chiapasco
flexibility. So the question really is: “Why so much
treatment complexity?” Dr Renouard proposed to
redefine the concept of relative length as applied to
crowns and implants. His explanation sounds plausible:
Studies using the finite-element methods (FEM)
have shown that loads always concentrate on the
first three intraosseous millimetres of an implant.
Hence, longer implants will not necessarily tolerate
higher loads than shorter implants.
“Knowledge is good. But skills are better.”
(Emanuel Geibel)
In a highly informative presentation, Dr Stephen Chen
(Melbourne, Australia) presented the evidence for
flapless procedures in the anterior region, taking a
critical view of the growing enthusiasm for this therapeutic
method. He shed some light on a number of
recent clinical studies and performed a systematic
analysis of the literature. The advantages of minimally
invasive procedures with their benefits for the
patient and the low level of intraoperative bleeding
remain undisputed. But how about the claim that
procedures will be shorter? Or, to cite Dr Chen’s words
of warning: “If you do not fold back a flap, you will be
groping in the dark.” To find the exact position for the
implant in a flapless procedure, the bone must first be
probed meticulously and the anatomical structures
analyzed extensively. Dr Chen asked himself aloud
whether the surgery really takes less time that way.
He concluded that the flapless insertion of an implant
requires a lot of experience, presence of cortical bone,
a wide ridge and a fake gingival biotype. Flapless
insertion is attractive, even seductive, for well-known
and understandable reasons – but the technique has
its limits, which the surgeon must be aware of.
Prof Matteo Chiapasco (Milan, Italy) elaborated on
the reconstruction of deficient bone volume in the
posterior maxilla. His presentation gave an overview
of the current literature and offered reliable information
and sensible treatment standards for treating
the atrophied posterior jaw. One of the issues Prof
Chiapasco addressed was the surface texture of
implants, which was also the focus of the entire sym-
posium. Ever since ITI has presented its first evidence-based
recommendations for insertion times at
the 3 rd ITI Consensus Conference in 2003, implantologists
actually have a decision tree they can follow.
This year’s World Symposium only confirmed that
the opinion leaders in oral implantology continue to
agree on this issue.
This was just a small peek at a comprehensive
World Symposium programme, intended to demonstrate
that the ITI is eminently practical while building
on solid scientific foundations. The congress was
highly convincing and once again demonstrated how
important organizations such as the ITI are for dentistry.
Medical research requires independence, open
space and occasions for discussion.
Networking meets implantology
Congratulations! The International Team for Implantology
is celebrating its 30 th birthday this year. The
two most important initiators of this organization,
founded in 1980, were Prof André Schroeder (Berne,
Switzerland) and Dr Fritz Straumann (Waldenburg,
Switzerland). Its goal was, and is, to bring together
specialists and research experts in order to promote
the field of oral implantology. Today, this organization
can boast more than 8,000 members – and science,
idealism and the well-being of the patient continue
to be at the focus.
André Schroeder Research Award
EDI 85
Business & Events
At a ceremony on the occasion of the World Symposium
of the International Team for Implantology (ITI),
Beat Spalinger, President and CEO of Straumann,
presented the André Schroeder Research award to
Dr Maria Retzepi for her study entitled “The Effect of
Experimental Diabetes on Guided Bone Regeneration”,
in which she examined the effects of controlled
and uncontrolled diabetes on intracellular processes
and on cellular genetic profiles during the healing
process subsequent to guided bone regeneration.
With the World Symposium in Geneva, the Inter -
national Team for Implantology has made itself an
impressive birthday present, confirming the ITI
hypothesis that the need for evidence-based research
and implantological training and continuing education
is far from being fully satisfied. A great number of
satisfied attendees, top-notch presentations and interesting
discussions made this meeting and all-round
success – although a certain volcano on Iceland made
getting home a difficult task for not so few.
Annett Kieschnick

86 EDI
Business & Events
Osteology Symposium Baden-Baden 2010
For the Patient’s Benefit
The 3 rd National Symposium of the Osteology Foundation took place on 19 and 20 March 2010. More than 500 interested
dentists had assembled in Baden-Baden to learn more about which new concepts for the regeneration of hard and soft tissues
are of importance for clinical practice. We are looking at a minimally invasive future with less stress for the patient during
surgical interventions. To some extent, this development is already happening.
On Friday, 15 workshops forged a link between theory
and practice. On Saturday, the theme was further
expanded on in a series of scientific and clinical
presentations by internationally renowned speakers.
The most important innovation presented at the
3 rd Osteology Symposium is probably a collagen
matrix “straight from the blister pack”, currently
approved for covering recession areas. Depending
on the clinical baseline situation, the harvesting procedure
otherwise required for this indication may
become dispensable.
Current trends in soft-tissue replacement
Prof Mariano Sanz (Madrid, Spain) held a presentation
on options for soft-tissue regeneration and the
preservation of keratinized gingiva. He contrasted the
classic mucosal transplant with its alloplastic alternatives
including a human skin matrix from cadaver
donors and a soft-tissue replacement material based
on a 3D collagen matrix of porcine origin. According
to recent study results, the 3D collagen matrix is a
promising alternative to – or even superior to – the
classic mucosal transplant and the coronally repositioned
flap (Allen technique) in terms of inflammation,
recession and keratinized-mucosa gain. Advantage
cited was the significantly lower patient morbidity
that was owed to the absence of a separate
procedure for harvesting the connective-tissue transplant.
Prof Sanz believes that alloplastic soft-tissue
replacement will become a standard in oral reconstructive
surgery.
Prof Christoph Hämmerle (Zürich, Switzerland)
summarized the topic of socket management following
tooth extractions. He pointed out that not even
immediate placement of implants and fresh extraction
sockets can prevent bone loss. Introducing
bovine biomaterials into the socket, by contrast, preserves
soft tissue for subsequent plastic coverage. In
addition, there are more and more indications that
the contour of the alveolar ridge may be preserved
if a suitable technique is used. An ongoing study
performed by Prof Hämmerle’s Zürich workgroup
compares the clinical hard- and soft-tissue volumes
following socket or ridge preservation procedures.
Dr Markus Schlee (Forchheim, Germany) also
addressed the topic of future trends in soft-tissue
replacement, especially for recession coverage. Longterm
stability, he reported, is contingent on adequate
tissue thickness. Dr Schlee also mentioned that gingi-
Prof Jürgen Becker and... ... Prof Christoph Hämmerle
presided over the scientific
part of the symposium.
Most of the work -
shops included
hands-on exer -
cises on animal
preparations,
forging a good
link between
theory and
practice.

Implant Direct

88 EDI
Business & Events
val thickness is dependent on the apical base and
on the inclination of the tooth, where a predictable
result presupposes complete coverage of the transplant
or matrix introduced.
Prof Karl-Ludwig Ackermann (Filderstadt, Germany)
presented various clinical cases to demonstrate available
options in soft-tissue surgery in the aesthetic
zone, the relevant surgical techniques and their
chances and limits as a function of the prevailing
indication. Any surgical intervention constitutes an
intentional local trauma. Trauma-related postoperative
changes should therefore be invisible and not
limiting to the patient as well as ethically acceptable
in the light of the resulting benefits.
Novel concepts in bone regeneration
The second section of the day entitled “Novel concepts
in bone regeneration” was opened by Prof Rai -
ner Schmelzeisen (Freiburg, Germany) with a forwardlooking
discussion of the clinical state of the art in
bone marrow aspiration. In the light of the emerging
potential of stem cells retrieved from bone marrow
aspirate to be used in bone augmentation procedures,
his verdict was critical when it came to autologous
bone – until now considered the gold standard.
By obtaining stem cells from a conventional blood
sample, patient comfort could be improved compared
to the harvesting of autologous bone from a
separate donor site.
Dr Daniel Thoma (Zürich, Switzerland) reported on
the use of growth factors in localized bone regeneration,
citing a combination of rhBMP-2 or rhPDGF
(osteoinductive growth factors) with mechanically
stable osteoconductive grafts such as DBBM or allografts
as the most promising method. However, there
are as yet no clinical studies evaluating a combination
of rhBMP-2 and appropriate carrier materials –
especially when used to block transplants – in more
complex defect situations.
Successful peri-implantitis therapy
Prof Andrea Mombelli (Geneva, Switzerland) gave an
overview of diagnostic procedures for the prevention
of periodontitis and peri-implantitis, with special
attention to an evaluation of the diagnostic benefits
of the procedures presented.
An overview of therapeutic concepts and regenerative
periodontal therapy was given by Prof Anton
Sculean (Berne, Switzerland) who demanded human
histological evidence for the use of materials, especially
with regard to periodontal regeneration; this
evidence was still lacking for alloplastic materials
such as bioactive glass.
The 3 rd National Osteology Symposium was a success for everyone attending.
Based on in-depth science and exciting clinical data, top-notch presenters explained
concepts and treatment approaches.
The scientific program concluded with the presentation
by Dr Frank Schwarz (Düsseldorf, Germany) on
current approaches to peri-implantitis therapy as
employed at the dental clinic of the University of
Düsseldorf. The results showed that non-surgical
treatment approaches in periodontitis (laser or
curette) in combination with antibiotic therapy must
be considered ineffective in terms of long-term treatment
success due to a lack of new bone formation
and reossification. A classification of cases as low,
medium or high risk helps guide the choice of surgical
intervention performed, taking both systemic and
local factors into account. Implants are cleaned using
plastic curettes, cotton pellets and saline solution.
Subsequent treatment options, according to Schwarz,
include implantoplasty (for the supracrestal aspects
of the defect, present in approximately 80 percent
of all cases), augmentation (for the intraosseous
aspects of the defect), and additionally the use of the
laser (for supraosseous aspects of the defect greater
than 1 mm with buccal dehiscences or a circumferential
intraosseous bone defect).
The 3 rd National Symposium of the Osteology Foundation
showed the participants how to implement
the most recent scientific findings in clinical practice.
The more than 500 attendees at the congress itself
and the more than 300 participants of the workshops,
all of which were sold out, appreciated the
lively and relevant discussions and the very suitable
overall format.
Dr Barbara Paleska

90 EDI
Business & Events
1500 professionals at the Sixth Mozo-Grau Update Congress on Implantology
Update on Implantology
The 2010 Sixth Update Congress on Implantology
attracted over 1500 attendees from more than
ten countries to IFEMA Southern Auditorium in
Madrid, Spain, on 19 and 20 February.
Close to 50 expert presenters guided the attendees
through the main and research programmes.
Acknowledging that the best way to learn is to practise,
limited-attendance courses were organised on
implantology for newcomers as well as on sinus lifts
and bone grafts.
One focus of the main programme was on specialcare
patients, a highlight being the presentation by
Dr Rafael Martín-Granizo, President of the Spanish
Oral and Maxillofacial Surgery Society (SECOM), on
implant treatment for patients under bisphosphonate
medication – a highly topical issue.
Dr Miguel Peñarrocha, Director of the Department
of Oral Surgery of Valencia University, focused on
implant treatment for special-care patients with systemic
diseases.
Prof Carlos Navarro Vila, Director of the Department
of Oral and Maxillofacial Surgery at Complutense University
(Madrid), presented a study on oral rehabilitation
with a success rate of 92.9 percent osseointegrated
implants in oncologic patients treated at the
Department of Maxillofacial Surgery of the Gregorio
Marañón General University Hospital, where he heads
the Department of Maxillofacial Surgery.
Another segment of the main programme
addressed immediate loading. Dr Juan Antonio
Hueto, Titular Doctor at the Oral and Maxillofacial
Surgery Service at the Vall D´Hebró Hospital,
Barcelona, gave practical advice related to this field.
He also supervised a practical workshop on sinus
lifts.
The congress’s Scientific Committee commented
on the unprecedented attendance: “Mozo-Grau continues
to be one of the fastest-growing implant companies
in Spain. The presentations and attendance
are indicative of our interest in research, and we
would like to thank everyone for attending.”
The research programme – where universities, hospitals
and doctors could present the results of their
ongoing research with Mozo-Grau products – was a
remarkable success.
More than 1500
professionals
attended the
Sixth Mozo-Grau
Update Congress
on Implantology
in Madrid.
Course organized
for the surgical
assistant team.

EDI 91
Business & Events
International Osteology Symposium,
Cannes, April 14 to 16, 2011
Focussing on
Regenerative
Dentistry
The Osteology Symposium is the only international
congress series that focuses on the key subject of
regeneration. After successful conferences in Lucerne
and Monaco the next International Osteology Sympo-
sium will take place in Cannes on April 14 t0 16, 2011.
In line with the congress title, Clinical Excellence, Risk
Factors and Complications in Regenerative Dentistry,
experienced researchers and well-known practitioners
will discuss the latest clinical innovations,
research results and current treatment concepts.
The Pre-Symposium on Thursday will be entirely
practice-oriented. In different workshops the participants
will be able to broaden their theoretical and
practical knowledge in different fields of regenerative
dentistry (soft tissue management, concepts of
bone regeneration, advanced suturing techniques,
etc.).
The International Osteology Symposium in Cannes
will again link high-quality science with the de -
mands of dental practice on one of Europe’s most
beautiful coastlines.
More Information and Registration
Osteology Foundation
www.osteology-cannes.org

92 EDI
Business & Events
Straumann launches digital solutions platform
Connecting Dental
Professionals across Disciplines
At the Chicago Dental Society Midwinter Meeting, one of America’s largest dental exhibitions, Straumann
presented an array of integrated computer-based technologies that have been designed to increase confidence,
safety, precision and reliability in implant and restorative dentistry.
Under the new umbrella brand of ‘Straumann Digital
Solutions’, the company now offers state-of-theart
computer-guided surgery, intra-oral scanning,
and CAD/CAM prosthetics to specialists, general
dentists and dental laboratories in various markets
around the world. With these innovations in intraoral
scanning, CAD/CAM and computer guided surgery,
a complete Straumann tooth – from implant to
final crown – is now available from a single provider.
Straumann’s integrated state-of-the-art digital solutions
now support implant placement, restoration
and esthetic performance.
Gilbert Achermann, President and CEO, commented:
“Digitalization will impact all aspects of dentistry
as digital workflows supersede labor-intensive
manual processes, enhancing interfaces, shortening
treatment, reducing potential for error and
improving quality assurance. These benefits are
expected to translate into lower treatment costs,
added convenience and improved comfort for
patients. Straumann is committed to bringing the
new technologies to customers as part of an integrated
array of flexible, reliable solutions that are
designed to optimize workflows and enhance
patient care.”
A major drawback facing dental professionals
wishing to invest in digital applications is that
equipment, such as scanners, surgical guides etc.,
has to be sourced from a variety of manufacturers
without standardization, or is part of a closed system
offered exclusively by a single provider. Customers
therefore face being ‘locked in’ or having flexibility
without full assurance of connectivity, quality and
comprehensive support services. Straumann Digital
Solutions offer the flexibility of state-of-the-art systems
together with seamless connectivity to one of
the world’s leading implant, restoration and regenerative
systems, in addition to guaranteed Straumann
quality, service and network support.
Computer-guided surgery
The combined use of 3D imaging digital design software
to plan and execute precise implant placement
is an emerging trend. Using a computed tomographic
image of the patient’s jaw, the dental surgeon plans
the position, angulation and depth of the implant on
a computer using sophisticated planning software.
The data are then used to produce a plastic surgical
template that fits onto the patient’s teeth or gum.
The template incorporates sleeves that guide drills,
taps and profilers, designed for optimal implant
placement. Computer-guided surgery is designed to
offer the dentist a clear view of the bone condition,
the position of nerve and vascular structures, and the
final implant location. It simplifies the planning and
execution of complex procedures, which can reduce
the risk of surgical and prosthetic complications.
Straumann entered this exciting field in 2009
through the acquisition of the dental business of IVS
Solutions AG, a German company specializing in software
applications for computer-guided surgery,
including surgical template design and fabrication.
Straumann is rolling out the technology internationally,
announcing that it will be available in North
America in the course of this year.
In addition to the benefits of user-friendliness and
predictability, Straumann’s guided surgery system
offers ‘open-system’ flexibility as the templates can
be produced quickly and efficiently in local laboratories
rather than exclusively by a central supplier. Furthermore,
Straumann’s comprehensive instrument
kit can be used with any Cone Beam CT scanner and
can be used with other implant libraries.
Powerful intra-oral scanning
Straumann also announced that its CAD/CAM service
is now connected to Cadent’s iTero intra-oral scanning

system. Intra-oral scanning enables the dentist to create
a 3D image of the patient’s teeth using a digital
scanner inside the mouth. Replacing the slower conventional
process of impression-taking in the dental
practice and model casting in the laboratory, digital
intra-oral scanning is designed to deliver considerable
time and cost savings – as well as high precision – for
both the lab and the dental practice.
In addition to the data sharing-agreement that connects
the two companies’ systems, Straumann has
exclusive distribution rights for Cadent’s iTero scanning
system in Europe and offers European dentists leading
intra-oral scanning technology as part of its integrated
range of solutions. The iTero scanner is designed to be
easy to use and convenient because it eliminates prescan
coating of teeth.
Advanced CAD/CAM technology
Modern dental prosthetic inlays, onlays, crowns, and
bridges are best designed by computer (CAD) and
milled on computerized machines (CAM). This procedure
is considerably more efficient than traditional
processes and can be highly profitable for dental
laboratories. Central milling of CAM prosthetics on
industrial machines offers a high level of precision
and reliability. Straumann provides a comprehensive
CAD/CAM prod uct portfolio including scanners, soft-
Materialise Dental focuses on 3D Digital Dentistry,
offering a range of solutions for computer guided
dentistry. Its SimPlant software is compatible with all
implant brands and CT and cone-beam 3D scanners,
thus providing clinicians the opportunity to stay with
their own implant brands and scanning equipment.
The newly established cooperation between Materialise
Dental and Cefla Dental Group and QR srl
is non-exclusive and offers customers of the two latter
companies the possibility to have SimPlant Pro
pre-installed on the cone-beam workstations upon
EDI 93
Business & Events
ware and a full range of prosthetics in modern biocompatible,
durable and esthetic materials, including
polymer, metals and ceramics. Through its partnership
with Ivoclar Vivadent, Straumann also offers
high-performance glass ceramics for high-end
esthetic restorations that are designed to be indistinguishable
from natural teeth.
The new advanced CAD/CAM system includes a
new scanner, which will be capable of scanning solid
master, section-cut and antagonist models. One
small practical feature is an integrated web-camera
to facilitate a new level online service support.
Because design software is a key component in
CAD/CAM, Straumann regularly releases upgrades to
its installed scanner base. The latest ‘5.0 IO’ upgrade
includes a number of new features that improve
workflows and functionality.
Apart from the new scanning capabilities, software
and materials, Straumann will launch a number of
additional CAD/CAM features this year, including
veneers, inlays and onlays.
More Information
Institut Straumann AG
Peter Merian-Weg 12
CH-4052 Basel · SWITZERLAND
www.straumann.com
Materialise Dental NV collaborates with Cefla Dental Group and QR srl
Cooperation Established
Materialise Dental has established a cooperation with Cefla Dental Group and QR srl to pre-install SimPlant
Pro on their cone-beam 3D scanning equipment.
purchase of a NewTom (NewTom 9000, 3G, VGi) or
MyRay (SkyView) cone-beam 3D scanner.
More Information
Materialise Dental NV – Headquarters
Technologielaan 15
3001 Leuven
BELGIUM
Phone: +32 16 396620
simplant@materialise.be
www.materialisedental.com

94 EDI
Business & Events
Manufacturer of disposable medical devices celebrates anniversary
Twenty Years of Omnia
Omnia, the name of the resulting company – now
considered the market leader in Italy and throughout
Europe, represented in more than 40 countries – is
Latin for “everything” and reflects the company’s mission:
Everything is possible. The company has taken a
close look at the way surgical and implant dentists
work in order to identify the specific requirements of
sterile devices in dentistry.
“Back in the old days, treatment providers often
rejected extensive sterile precautions, feeling that
there is nothing much to be kept sterile in the mouth
anyway”, reports Alexander Keim, Sales Manager at
Omnia. It is true that the oral environment is fairly
tolerant of challenges, but today’s dental treatment
methods have reached a critical limit that not even
the proverbially good self-healing capacity of the
mouth can cope with.
A hospital’s operation theater is a completely different
setting from a dental surgery. While in an operation
theater, several assistants perform the necessary
preparatory steps in a controlled anteroom to
help prevent infection, both the treatment provider
and his or her assistant in the dental surgery generally
operate in an uncontrolled environment. “Some
of the precautions you can take are very simple. For
example, you can fold a wrapper such that an assistant
– who like everyone else has only two hands –
can open it without touching the sterile device
inside.”
At Omnia, consistent specialization has resulted
in an enormous accumulation of competence. The
cleanroom technology employed at the separate
production sites for non-wovens in Fidenza near
Parma and plastic products near Mantua matches
microchip production environments. A large number
of custom surgical sets is available, which makes for
a high degree of complexity in production. These custom
surgical sets are a unique characteristic of the
Many dental treatment providers attempt to prepare for their increasingly demanding surgical
procedures by selecting their surgical materials from among those in common use in hospitals –
which works, in a way, but certainly not too well. Then, twenty years ago, Lauro Cereoli in Italy
had an idea: He decided to apply medical standards to the dental environment and to take
a close look at the specifics of the dental surgery in terms of which product features can be
dispensed with and which features are very special and highly important.
Omnia range of products. They complement the
many standard dental sets developed by cooperation
with dental experts and opinion leaders – names like
Massimo Simion, Tiziano Testori, Ferdinando D’Avenia
and Mauro Labanca speak for themselves. Sets may
be customized for individual surgeries, treatment
providers or even procedures and will usually be
delivered in sterile condition within a record 30 days.
“This reduces the number of parts that end up being
discarded unused and simplifies the procurement
logistics. Each treatment provider can receive a surgical
set that is tailored to his or her treatment environment
and methods. The higher price paid for custom
solutions is more than made up for by better
economy and time savings”, says Alexander Keim.
“The introduction of consistent quality management
regime in dental offices throughout Germany will
make the cost situation much more transparent;
dentists are in for quite a few surprises in the field of
infection control and instrument reprocessing”,
Francesca Isi, Distribution Management at Omnia,
adds. “Those who attend our seminars usually quickly
realize the ergonomic and economical benefits
of custom surgical sets.” Omnia in bonum – all the
best – for the next twenty years!
STE
Alexander Keim,
Sales Manager,
and Francesca Isi,
Distribution
Management
at Omnia

New General Manager for Germany,
Austria and Switzerland
EDI 95
Business & Events
Dr Berthold Reusch
Takes over
Materialise Dental has appointed Dr Berthold Reusch as General
Manager for Germany, Austria and Switzerland. He brings over 17 years
of global marketing, sales, clinical and business management
experience in the field of dental materials and digital dentistry.
Most recently, Reusch worked for
the dental division of 3M Espe
where he was Director of Operations
for the digital imaging
device business which he successfully
developed outside the U.S.
From 2007 to 2009 he was a
member of the executive management
team of Brontes Technologies,
a 3M company based in
Boston, MA, building the digital
impressioning business in the U.S.
As General Manager at Materialise
Dental GmbH, Reusch and
his team will further develop the
SimPlant and SurgiGuide business
within the German, Austrian
and German-speaking Swiss
markets.
Reusch received his diploma
and PhD (Dr rer nat) in Physics
from the University of Tubingen,
Germany, and then went on to
receive his MBA, with an emphasis
on marketing and international
business management, from the
Business School at the Catholic
University of Eichstätt.
When asked about his new
position, Dr Berthold Reusch said,
“I’m very enthusiastic to join
Materialise Dental, an innovative
and technologically driven organ-
Dr Berthold Reusch
ization. I’m looking forward to
undertaking the challenging task
of heading my division and –
together with my team – offering
our customers the most innovative
and advanced products to
meet their computer-guided im -
plant dentistry needs.”
More Information
Materialise Dental NV –
Headquarters
Technologielaan 15
3001 Leuven
BELGIUM
Phone: +32 16 396620
simplant@materialise.be
www.materialisedental.com
SINUS
RETRACTORS
ACC. TO PROF. (NYU) DR. MED. DENT.
MANFRED LANG
Clinical Associate Professor
Department of Implant Dentistry, New York University
· retraction of the mucoperiosteal flap during
lateral sinus window preparation
· mucoseal flap is secured by the “shark-teeth”
· designed asymmetrically, right and left version
· also suitable for retraction in the
anterior region
· anatomical handle ensures only moderate
retraction force
· patent pending
Bodenseeallee 14-16
78333 Stockach Germany
Tel. +49 7771-64999-0
Fax +49 7771-64999-50
www.kohler-medizintechnik.de

96 EDI
Product Reports
Planmeca launches a 3D face photo system and a new 3D imaging field size
New Members for the
3D Imaging Product Family
To fulfil the most diverse diagnostic needs of today’s dental professionals, Planmeca’s recognised 3D imaging concept has
grown with two new products. Planmeca ProMax 3D ProFace is a CBVT imaging unit with integrated 3D face scan system,
a true 3D application of the future. Planmeca ProMax 3D Mid introduces an extended selection of 3D volume sizes combined
with traditional 2D panoramic and cephalometric imaging.
Both products are based on the acknowledged Planmeca
ProMax platform making future upgrades
extremely simple. Planmeca ProMax 3D ProFace, the
CBVT unit integrated face scan, produces a realistic
3D face photo in addition to traditional digital maxillofacial
radiography. Planmeca is the first to introduce
this type of concept. The lasers scan the facial
geometry and the digital cameras capture the
colour texture of the face. One scan generates both
a 3D photo and a CBVT volume, or if required solely a
3D photo, in which case no radiation is emitted.
3D photo visualises soft tissue in relation to dentin,
providing an effective follow-up tool for maxillofacial
operations. As Planmeca ProMax 3D ProFace acquires
both a CBVT image and 3D photo in a single scan, the
patient position, facial expression, and muscle position
remain unchanged, resulting in perfectly compatible
images. Operation preplanning, where the
medical professional may study the face anatomy in
detail, facilitates a careful operation and enhances
the aesthetic results.
Another novelty introduced is Planmeca ProMax
3D Mid offering an extended selection of volume
choices to optimise imaging areas according to specific
diagnostic tasks, all while complying Planmeca’s
strong commitment to the ALARA (as low as reasonably
achievable) principle to minimise radiation. With
Planmeca ProMax 3D Mid, an optimal volume size is
available for every application, e.g. for endodontics
requiring high resolution, for implantology requiring
images with a smaller field of view, and for orthodontics
requiring large image sizes – without compromising
the best practices of dentistry. It is also capable
of acquiring traditional panoramic and cephalometric
images.
The existing products in Planmeca’s 3D concept
are Planmeca ProMax 3D s, ideal for applications
where a smaller field of view is sufficient, Planmeca
ProMax 3D, for general 3D applications with a field
size covering the mandible and maxilla, and Planmeca
ProMax 3D Max offering field sizes from a single
tooth to the whole maxillofacial area.
More Information
Planmeca Oy
Asentajankatu 6
00880 Helsinki . FINLAND
Phone: +358 20 7795-500
www.planmeca.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.

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EDI Journal is the first and only European professional
journal of its kind, written for all clinicians with distinct
interest in dental implantology. This publication aims
at uniting European dentistry in a common effort, to
establish appropriate standards and to help open up
new markets.
The specific dental section of this periodical offers a
wealth of original work, case reports, scientific research
and other articles presented by authors from countries
all over Europe, all helping to make this top-quality
platform a truly international voice in the dental
profession. Product innovations are covered in depth.
And for the first time ever, dental implantologists are
offered exhaustive information on important ancillary
themes such as European standards, quality guidelines,
legal issues, questions of remuneration and professional
specialization.
Information on upcoming events of importance to dental
implantology and on training, continued education and
professional growth opportunities are also regular
features of EDI Journal.
EDI Journal
ISSN 1862-2879
European Journal for
Issue 1/2008 Vol. 4
Dental Implantologists
TOPIC
Implantation in the
Atrophied Jaw
Placing implants in atrophic jaws without
grafting procedures
»EDI News: European Consensus Conference: Guidelines on Peri-implantitis · BDIZ EDI
Expert Symposium on Peri-implantitis in Cologne · European Committee Meeting with
Focus on Postgraduate Education · Risk Management Topic at the Second Mediterranean
Symposium of BDIZ EDI on Crete · Dental Implantology in Turkey »European Law:
Prohibition of Age Discrimination »Case Studies: Implantation in the Atrophied Jaw ·
“A Completely New Feeling!” »Product Studies: Healthy and Stable · The Reverse Abutment ·
TINY Implants »Product Reports: Clinical Realities with Astra Tech BioManagement Complex
Journal

98 EDI
Product Reports
Porous titanium granules by Tigran
Successful
Dental Bone Regeneration
The following article presents different indications for Tigran porous titanium granules in dental bone
regeneration.
Sinus lift
A sinus lift makes it possible for edentulous patients
with insufficient mandibular bone volume to receive
dental implants. Tigran porous titanium granules are
placed at the sinus floor to promote new bone formation.
Sinus lifts can be completed in one or two steps.
With the one-step method, the implant is placed intrasurgically.
With the two-step method, new bone is first
generated at the sinus floor before inserting the
implant during a second procedure six to nine months
later. In both cases, the implant can normally be loaded
between three and six months after insertion.
1 2
3 4
Fig. 1 Five years after insertion of the dental prosthesis, the
fixture has become mobile, likely due to excess stress.
Fig. 2 The fixture is removed and the cavity of the fixture
widened and filled with titanium granules. A new fixture
is then screwed into place. At the same time, a sinus lift is
performed at site 14 and a new fixture installed.
Fig. 3 Clinical situation two years after delivery of the new
restoration.
Fig. 4 Radiograph two years after delivery of the new
restoration.
The study “Porous titanium granules used as osteo -
conductive material for sinus floor augmentation: a
clinical pilot study” by Hans Bystedt and Lars Rasmusson
shows that porous titanium granules effectively promote
bone regeneration in conjunction with implant
placement. Their study is followed up by an international
multicentre study aimed at showing that titanium
granules can trigger bone regeneration in connection
with immediate implant placement.
Filling alveolar sockets
An extraction often leads to local resorption of the
alveolar ridge – especially of the buccal bone sections.
This may lead to functional and aesthetic
problems with tooth- or implant-supported dental
prostheses.
Tigran has conducted a number of experiments on
animals showing that an extraction socket filled with
Tigran porous titanium granules will preserve the
volume of the alveolar ridge, resulting in a more predictable
implant treatment and an aesthetically
more attractive result. A study involving 60 patients,
begun in Israel in early 2010 under the direction of
Adi Lorean and Ziv Mazor, aims to show that the titanium
granules can also help preserve and regenerate
the bony walls of alveolar sockets.
5 6
7 8
Fig. 5 Extraction socket.
Fig. 6 Socket filled with titanium granules.
Fig. 7 Inserting an implant ten weeks after bone regeneration.
Fig. 8 Radiograph ten weeks postoperatively.

Peri-implantitis
EDI 99
Product Reports
Peri-implantitis results in bone loss around a dental
implant. If the condition is left untreated, there is an
imminent risk that the implant will become mobile
and require removal. In such cases, the jawbone must
be rebuilt before a new implant can be placed. This
takes a long time and is as demanding of the patient
as it is expensive.
Tigran is conducting a number of studies assessing
surgical treatment of bone defects caused by periimplantitis
using Tigran’s porous titanium granules.
One major field study led by Caspar Wohlfahrt is
expected to be submitted in 2010. Tigran has shown,
through human biopsies, that new bone can grow
in and around the titanium granules and help the
affected implant (re)-osseointegrate, restoring periimplant
bone volume.
9 10
11 12
13
Fig. 9 Pocket depth: 7 mm.
Fig. 10 Baseline radiograph.
Fig. 11 Bone defect after debridement.
Fig. 12 After mechanical and chemical decontamination
(H 2O 2, 3%) of the implant and perforation of the defect walls
to improve the blood supply, Tigran porous titanium granules
are inserted. After six months of healing, second-stage surgery
is performed and the crown reseated.
Fig. 13 Radiograph six months after loading.
More Information
Tigran Technologies AB
Medeon Science Park . 205 12 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.
Implant-retained
Dentures
Passive fi t
by using SAE spark erosion
Long-term osseointegration
20 years of
experience!
Latch open
Suprastructure latched to the bar
Latch closed
Naturally beautiful.
I am happy.
Clinical photographs:
Dr. E. Eisenmann,
Free University Berlin,
Benjamin Franklin Medical Center
Catalogue
Implant-retained Dentures
Dentist and Patient
information
including denturescost-estimates
Please order for free!
Rübeling Dental-Labor
Langener Landstr. 173 · 27580 Bremerhaven · Germany
Phone: +49 471 / 984 87-0 · Fax: +49 471 / 984 87-44
E-Mail: info@ruebeling.de · www.ruebeling.de
SAE DENTAL VERTRIEBS GMBH
Langener Landstr. 173 · 27580 Bremerhaven · Germany
Phone: +49 471 - 9 84 87 45 · Fax: +49 471 - 9 84 87 44
E-Mail: info@sae-dental.de · www.sae-dental.de

100 EDI
Product News
Zest Anchors
Locator Abutment Retaining Sleeve
The new Locator Abutment Retaining Sleeve slips
onto the driver end of a Locator Core Tool to hold a
Locator Implant Abutment while delivering it to the
implant site. This Retaining Sleeve makes it much
easier to deliver a Locator Abutment, and retains the
abutment while threading it into the implant.
The Locator Abutment Delivery Retaining Sleeves
can be autoclaved and are sold separately from the
Locator Core Tool in a 4 Pack or a discounted larger
quantity 20 Pack. The Locator Core Tool contains the
Male Removal Tool, Male Seating Tool, and Abutment
Driver for working with the Locator Attachment
System.
Nobel Biocare has expanded its popular Snappy
Abutment product portfolio with the addition of
taller abutment options. Starting immediately the
Snappy Abutment is available in 4.0 and 5.5 mm
abutment heights. Thanks to its profile and design,
the abutment permits clinical use without any modification.
In addition, the included snap-on impression
coping ensures simplified impression-taking.
The Snappy Abutment is an easy to use prosthetic
solution that is highly suitable for posterior restorations,
especially in partially edentulous jaws, and for
single-crown restorations with an implant. It ensures
optimal precision and in addition, all the prosthetic
components and individual elements required for
restoration are supplied in a single package.
Product:
Locator Abutment Delivery
Retaining Sleeve
Indication:
Abutment retaining sleeve
Distribution:
Zest Anchors, LLC
2061 Wineridge Place
Escondido, CA 92029
USA
Phone: +1 760 743-7744
www.zestanchors.com
Nobel Biocare Snappy Abutments 4.0 and 5.5
Thus, the Snappy Abutment provides
a cost-effective, time-saving
and highly functional prosthetic
solution.
The improved Snappy Abutment
package contains the final
abutment, the impression coping
used to take the impression, and
the temporary coping for fabricating
a provisional restoration. The
available components are designated
with the code 4 or 5-,
depending on the height of the
abutment used: the Snappy Abutment
4.0 or the Snappy Abutment
5.5. The Snappy Abutment
is available for all Nobel Biocare
implant systems, NobelReplace,
Brånemark, Nobel-
Active, and for all platform
diameters NP,
RP, WP, and 6.0.
Products:
Snappy Abutments 4.0 and 5.5
Indication:
Abutments for posterior restorations
Distribution:
Nobel Biocare Holding AG
P.O. Box
CH-8058 Zurich-Airport
SWITZERLAND
Phone: +41 43 2115320
info@nobelbiocare.com
www.nobelbiocare.com

Product:
Restorative Torque Wrench
Indication:
Torque wrench
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
Zimmer Dental Inc. has an -
nounced the availability of the
new Restorative Torque Wrench.
The adjustable tool offers en -
hanced precision and retentiveness
in a simple and intuitive
design – making it easier than
ever to confidently secure Zimmer
Dental’s “friction fit” components.
The Restorative Torque Wrench
replaces the previously offered
TW20 and TW30 models, thereby
reducing the number of required
instruments to one for optimum
simplicity and efficiency. The allin-one
wrench features a ratcheting
head, adjustable preset
torque levels which are indicated
EDI 101
Product News
Zimmer Dental
Restorative Torque Wrench
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on the handle with a visible gauge, and meets commonly
used international sterilization requirements.
By streamlining the implant restorative process
with a more user-friendly Torque Wrench design,
Zimmer Dental has again reinforced its commitment
to offering meaningful solutions to clinicians.
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102 EDI
Product News
Kohler Minvalux
It is possible nowadays to extract a tooth or a root
and place an implant immediately afterwards, provided
that the indications for this procedure are
observed. In such cases, it must be ensured that the
extraction is performed as atraumatically as possible.
For this, the surgeon must have suitable instruments
at his disposal. Minvalux instruments with a colourcoded
ergonomic Trinovo instrument handle have
a single working end and have especially been
designed for minimally invasive extraction surgery.
Leader Italia Tixos Implant
The Tixos implant line was developed in many years
of research in cooperation with major national and
international universities and research centres.
Tixos implants, manufactured by the exclusive and
original technique of titanium powder laser microfusion,
are designed in 3D: Around a very compact
core, an iso elastic surface is created that replicates
the spongious morphology of the bone – a structure
that is highly mimetic and accelerates bone
healing and promotes osseointegration, as demonstrated
in various in-vitro and in-vivo studies*. The
mechanical characteristics of these implants are
superior to those of traditional implants, while
their surface morphology promotes bone healing
and enhances the three-dimensional fibrin network
structure, cell adhesion and migration, the exchange
of fluids and nutritional elements and proper
vascularization to improve the organization of the
bone matrix.
The fine working tips are used
to divide the desmodontal fibres
of the tooth or root that is being
extracted without damaging the
bony socket walls. The instruments
with thicker working tips
are used for stronger roots
(canine, premolar or molar). The
slightly curved elevators are of
increasing diameter. For an optimal
effectiveness, with the least
possible trauma during dislocation
of the tooth or root, the
working ends have a very pointed
shape.
The two lancet-shaped instruments
can be introduced smoothly
into the space between the
bony socket walls and the
vestibular and oral approximal
surfaces of the tooth being
extracted.
The three-dimensional geometry
created by micro- and macrocavities
with well-defined sizes
and shapes, interconnected by micropores,
promotes bone formation.
*References available:
www.leaderitalia.it
Product:
Minvalux
Indication:
Minimally invasive extraction
surgery
Distribution:
Kohler Medizintechnik GmbH & Co. KG
Bodenseeallee 14-16
78333 Stockach
GERMANY
Phone: +49 7771 64999-0
info@kohler-medizintechnik.de
www.kohler-medizintechnik.de
Product:
Tixos implant
Indication:
Dental implant
Distribution:
Leader Italia srl
Via Aquileja 49
20092 Cinisello Balsamo (MI)
ITALY
Phone: +39 02 618651
export@leaderitalia.it
www.leaderitalia.it

103 103
Materialise Dental Universal SurgiGuide
Product:
Universal SurgiGuide
Indication:
Drill guidance
Distribution:
Materialise Dental NV –
Headquarters
Technologielaan 15
3001 Leuven
BELGIUM
Phone: +32 16 396620
simplant@materialise.be
www.materialisedental.com
Due to the success of Universal
SurgiGuide since its launch one
year ago, Materialise Dental has
recently expanded its range of
Universal SurgiGuide Drill Key
diameters to include 43 different
Drill Key diameters – 16 “Regular
Platform” drill diameters ranging
from 2.0 to 3.5 mm, and 27 “Wide
Platform” drill diameters ranging
from 2.0 to 4.6 mm. This expansion
of available drill diameters
allows for accurate guidance of
an even wider range of drills,
adding to the flexible nature of
the Universal SurgiGuide system.
A Universal SurgiGuide can be
used with any standard implant
surgery kit. The system is compat-
Since our beginnings, wwe
e ha have ve
alw always ays
been ffocused
ocused on
quality and innovation vation
toward
the battle ba ttle against
against
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and inf infections. ections
tions .
In the last 20 years, we have ensured d safety
and pr protection otection
tto
o yyou
ou and yyour
our patients patients,
with advanced and reliable products. TTools
ools that rrepresent
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the ideal ideal solution ffor
or who is
operating in dentistry, y,
implantology/oral
sur surgery gery
and general surgery. sur ger gery.
www.omniaspa.eu
OMNIA OMNIA S.p S.p.A.
Via F. Delnevo, 190 - 43036 Fidenza (PR) Italy
- Tel. Te el.
+39 0524 527453 - Fax
ax +39 0524 525230
VAT IT 01711860344 4 - R.E.A.
PR 173685 - CCompany
ompan y capital capital € 200.000,00
EDI 103
Product News
ible with all implant systems and provides for a
flexible drill sequence thanks to a set of Drill Keys
which is composed based on the clinician’s preferred
drill sequence. Additionally, any angle and any position
in the patient’s mouth can be reached thanks to a
special Universal SurgiGuide Handle.
With
Omnia sure
to t o be safe. saf safe.
© 2010 Materialise Dental

104 EDI
Product News
Kohler New Set of Retractors
The new sinus retractor by Kohler is a revolutionary
development. The end of the instrument is designed
asymmetrically, consequently there is an R-version
for right and an L-version for left. The sinus retractor
is also suitable for retraction in the anterior region,
therefore only these two instruments are necessary
for the complete upper jaw. Retraction of the
mucoperiosteal flap during lateral sinus window
preparation, lifting the sinus membrane and bone
augmentation with or without simultaneous
implant placement will be facilitated by the use of
Directa Luxator
Directa Luxator is a specially designed periodontal
ligament knife with a fine tapering blade that compresses
the alveolar bone, cuts the membrane and
gently eases the tooth from the socket. It was
invented and designed by a Swedish dentist.
The requirement for an atraumatic tooth extraction
has been much discussed recently. For best
treatment results, bone loss during extraction must
be minimized prior to implant treatment. The increasing
number of patients under anticoagulants –
often not allowed to interrupt their medication
even for a tooth extraction – requires extreme care
to avoid postoperative bleeding. Damage to the
tissues must also be minimized for improved local
haemostasis. Trauma for patients undergoing irradiation
or cytostatic treatment must be reduced to
diminish the risk of postoperative infection.
Avoiding unnecessary trauma when extracting
teeth is simplified considerably if the operation
this new instrument because the
mucosal flap will be secured by
the “shark-teeth”. It will therefore
no longer be necessary to press
the retractor firmly against the
jaw bone. Additionally, the shape
of the instrument end prevents
the instrument from sliding into
the sinus window and the
anatomical handle ensures that
the assistant needs only moderate
retraction force. This optimises
working efficiency according to
the slogan: optimised security,
simplicity and efficiency.
The newly designed cheek
retractors consisting of two side
and one front retractor make the
retractor set perfect. The sinus
retractors are indicated for the
upper jaw and the cheek retractors
can be used for upper and
lower jaw in equal measure.
is initiated or
accomplished with a
Directa Luxator to widen the
alveolus and loosen the perio -
dontal ligaments. The delicate
tip of Luxator Original can be inserted
deeply along the root, allowing
final tooth loosening and
removal with a minimal amount
of force.
Product:
New set of retractors according to
Professor (NYU) Manfred Lang,
Nuremberg, Germany
Indication:
Sinus and cheek retraction
Distribution:
Kohler Medizintechnik GmbH & Co. KG
Bodenseeallee 14-16
78333 Stockach
GERMANY
Phone: +49 7771 64999-0
info@kohler-medizintechnik.de
www.kohler-medizintechnik.de
Product:
Luxator
Indication:
Tooth extraction
Distribution:
Directa AB
P.O. Box 723
194 27 Upplands Väsby
SWEDEN
Phone: +46 8506 505-75
info@directadental.com
www.directadental.com

105
Soredex Digora Optime
Product:
Digora Optime
Indication:
Digital intraoral
imaging plate system
Distribution:
Soredex
Nahkelantie 160
P.O.Box 148
04301 Tuusula
FINLAND
Phone: +358 45 7882-2000
info@soredex.com
www.soredex.com
Soredex is introducing new features
to the Digora Optime digital
intraoral imaging plate system.
The Digora Optime is easy to use,
fast, provides excellent clinical
results and now even a new level
of hygiene and Comfort Occlusal
imaging.
The Opticlean concept sets a
new standard in hygiene in dental
radiology. It includes a smart and
automated internal ultraviolet
(UV) disinfection system that
inactivates harmful viruses and
bacteria on the plate transport
mechanism. This new feature provides
germicidal safety minimizing
the risk of cross-contamination
and protects the users of the
system. In addition, the Opticlean
hygiene concept provides effortless
end-to-end hygienic workflow
with touchless operation
and enhanced Optibag hygiene
bags. In the Digora Optime imaging
plate system there is never a
need to touch the re-usable imaging
plate during the imaging procedure.
Omnia Circular Scalpel
Product:
Circular scalpel
Indication:
Dental implantology
Distribution:
Omnia S.p.A
Via F. Delnevo 190
43036 Fidenza (PR) · ITALY
Phone: +39 0524 527453
info@omniaspa.eu
www.omniaspa.eu
The circular scalpel or soft-tissue
punch is used to precisely incise
the mucosal rim around the
implant. Omnia offers scalpels
with three different diameters
(4.1, 5.2, 6.2 mm) for easier adaptation
to major implants brands.
The disposable circular scalpel
causes less mucosal trauma than
traditional scalpels, since the incision
is limited to the dimensions
of the implant cap.
EDI 105
Product News
The Comfort Occlusal provides a pleasant imaging
procedure for the occlusal projection imaging, even
with pediatric patients. The optimized size and shape
of the Comfort Occlusal bite protector enables easy
positioning and shields the imaging plates effectively
from wear and damage.
The latest Digora Optime digital imaging plate system,
with the new version of the Digora for Windows
software, includes also several additional improvements,
like showing the patient name on the unit’s
display and drag-and-drop support to and from the
soft ware.

106 EDI
Calendar of Events
CALENDAR OF EVENTS
2010 Event Location Date Details/Registration
July 88 th General Session & Exhibition
of the International Association
for Dental Research (IADR)
August 8 th International Dental Ethics
and Law Congress
DGOI International Congress/
ICOI World Congress
September FDI Annual World Dental Congress
2010
Barcelona, Spain July 14 – 17, 2010 International Association for Dental
Research (IADR)
www.iadr.com
Helsinki, Finland August 18–20, 2010 International Dental Ethics and Law
Society
www.ideals.ac
Hamburg, Germany August 26–28, 2010 DGOI e.V.
Phone: +49 7251 618996-0
www.icoi-worldcongress-2010.com
Salvador da Bahia,
Brazil
September 2–5, 2010 FDI World Dental Federation
congress@fdiworldental.org
www.fdiworldental.org
October EAO Meeting 2010 Glasgow, Scotland October 6–9, 2010 Colloquium
Phone: +33 144 64-1515
www.eao.org
Reunión de SEPES 2010 Santander, Spain October 8–11, 2010 SEPES – Sociedad Española de Prótesis
Estomatológica
Phone: +34 91 576-5340
www.sepes.org
BDTA Dental Showcase 2010 London, England October 14–16, 2010 British Dental Trade Association
www.dentalshowcase.com
14 th BDIZ EDI Symposium Munich, Germany October 15–16, 2010 BDIZ EDI
Phone: +49 228 9359-244
www.bdizedi.org
November Future Trends in Implantology (FTI)
2010
Florence, Italy November 11–13, 2010 FTI Dental
Phone: +41 22 5330-948
www.ftidental.com
Swedental 2010 Gothenburg, Sweden November 18–20, 2010 Svenska Mässan
www.swedental.org
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.).
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
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.

The Planmeca ProMax concept offers a full range of imaging
volumes providing detailed information on patient anatomy.
The comprehensive Planmeca ProMax platform complies
with every need in dental radiology, offering digital
panoramic, cephalometric, and 3D imaging together with
advanced imaging software. At the heart of the concept
is the robotic SCARA technology: the unique robotic arm
enables any movement pattern required by existing or
future program, eliminating all imaging restrictions. With
the Planmeca ProMax concept superior maxillofacial
radiography can be performed with a single platform, today
and in the decades to come.
Perfect fi eld size for all needs
Planmeca Oy, Asentajankatu 6, 00880 Helsinki, Finland
tel. +358 20 7795 500, fax +358 20 7795 555
sales@planmeca.com, www.planmeca.com
Planmeca ProMax
all volume sizes