1,200 excited participants at the Oral Reconstruction Global Symposium in Rotterdam! The Oral Reconstruction (OR) Foundation hosted its Global Symposium in Rotterdam and paid homage to the Dutch King Willem-Alexander by hosting the meeting on his birthday, the “Koningsdag” on April 27th. For three days, Rotterdam was abuzz with 1,200 congress visitors who flocked into the trendy Dutch metropolis from 39 countries.
The World Symposium motto sounded as auspicious as the regal setting: “The future of the art of implant dentistry.” With this in mind, the scientific committee led by chairmen of the Symposium, Professor Dr. Irena Sailer and Dr. Ben Derksen, put together an attractive two-day main program of the latest focus issues: soft tissue management, digital workflow, restorative concepts especially for older patients, ceramic implants and much more. Twelve hands-on workshops plus a theoretical workshop in English, German and Spanish as well as two workshops with simultaneous interpretation into Chinese left nothing to be desired in deepening the topic of particular personal interest. The additional specialist symposium for dental assistants included important facets for the team. All told, 57 speakers, moderators and experts from 12 countries offered a very good mix of science and everyday clinical practice with enormous practical relevance. The World Symposium also showed distinction at the accompanying industry exhibition. Twenty-one companies presented their products and solutions for oral implantology and restorative dentistry.
"Functional" gingiva
In the first session of the scientific main program, internationally renowned speakers Professor Dr. Mariano Sanz, Professor Dr. Anton Sculean and Dr. Edward P. Allen acknowledged the importance of healthy peri-implant soft tissue for successful implants and demonstrated techniques for thickening and widening the gingiva with different grafts and tunnel/pouch techniques. For both implants and recession covers of natural roots, it is crucial to create a sufficiently broad band of keratinized gingiva. According to Edward P. Allen, this consists of both free and attached gingiva; he therefore suggested it is more appropriate to use the term “functional” gingiva.
The best of both worlds
How far has the digital workflow already advanced and how practical is the virtual impression? That was the topic of discussion during the second session with speakers Dr. Wiebe Derksen, Dr. Tabea Flügge and the team Dr. Peter Gehrke and dental technician Carsten Fischer. Both the moderator of these presentations, Professor Dr. Florian Beuer, and the speakers themselves agreed that digitization is a “game changer” which is rapidly progressing.
Although analogous steps are still needed to close the digital workflow, all speakers were motivated to get to grips with the new technologies. According to Wiebe Derksen, digital planning is very efficient and team-oriented thanks to the matching of scan and DVT data. He loves the design process and the exchange with the dental technician. In contrast, he considers 3D-printed models to lack precision and surface accuracy, which is why he relies on passivation models from the lab for large-scale reconstructions. Tabea Flügge echoed the same sentiment, stating that the precision of digital impressions decreases with an increasing range and number of implants. The scanner itself and the scan protocol have a significant impact on the accuracy of digital impressions of implants.
Standardized parts make no sense in a digital workflow, said Peter Gehrke and Carsten Fischer. In the past, they have also intensively interacted with various quality criteria of CAD/CAM reconstructions in their own studies such as precision and surface quality and very often rely on DEDICAM® manufacturing services. Despite the indispensable CAD/CAM technique, the dental technician still has to rework and refine the prosthetic restoration every time.
Trend towards early protocols
Professor Dr. Dr. Bilal Al-Nawas started the “Treatment concepts” session with an observation on the time of implantation. For him, however, an ideal implant position, sufficient primary stability and adequate augmentative measures are more important than the time of implantation. Whenever possible, he strives towards immediate or early implantation, since his patients benefit from a shorter treatment time and less extensive soft tissue augmentation. In cases of infected alveoli or the need for GBR measures, immediate implantation should not be carried out.
The trend towards earlier loading protocols was also touched on in Rotterdam when Dr. Kai Zwanzig and Christian Rähle (Director of Research and Development, CAMLOG) first presented the PROGRESSIVE-LINE implant design to the public. It is very suitable for soft bone and compromised implant beds and follows a standard surgical protocol without the use of special instruments. The design of the implant body (apical conical, cranial cylindrical) as well as the thread (sawtooth-like) allows for a broad range of indications and enables a safe insertion torque through a multi-stage drilling protocol in all bone types. The new PROGRESSIVE-LINE will be available from IDS 2019 in a CAMLOG® version (Tube-in-Tube® connection) and subsequently in a CONELOG® version (conical connection), says Rähle.
The iSy® implant system offers immediate implantation and treatment concepts, according to Dr. Jan Klenke. Tooth extraction, implant insertion, soft tissue thickening and provisional restoration with the multifunctional cap on a preassembled implant base could all comfortably fit into just one session. The fact that transmucosal healing has no negative impact on the success of an implant was confirmed by studies and his own experiences. The implant is first “opened” according to the “one-shift” concept by removing the implant base for final restoration. It then looks very “clean,” making it an intelligent concept with biological and aesthetic benefits.
Ceramic implants – an alternative to titanium?
PD Dr. Daniel Thoma and the research group at the University of Zurich have long been engaged in comparative studies of titanium and zirconia implants and presented some of these studies and their results. Osseointegration and marginal bone preservation are the same for both implant materials in the comprehensive treatment. Overall, zirconia implants in the latest generation would have had a greater soft tissue volume compared to titanium implants. It also appears that zirconia implants are more suitable in cases of dehiscence to minimize bone loss and recession.
This research summary was a rough draft for the two next speakers, Dr. Vladimir Kokovic and Dr. Frank Maier, both of whom have already been intensively involved with the CERALOG® Implant System. Among other things, Vladimir Kokovic has thoroughly researched the primary stability of CERALOG® implants, in order as well to explore the possibility of immediate loading protocols. One of his studies showed initial ISQ values of just over 60, a drop in week 3 to levels around 54 and a rise in week 16 to around 64. In CERALOG®, he sees the possibility of immediate loading protocols in the mandibular lateral tooth region. Single-tooth reconstructions are the domain of the system. The benefits would be most effective in the anterior region because of the material and its dual surface texture of 1.6 μm enossal and 0.5 μm in the neck area for the transition zone. Vladimir Kokovic firmly believes in the future of ceramic implants. He also credits the very user-friendly and precisely positioned two-piece Hexalob implant as an example. Dr. Frank Maier also prefers it over the one-piece Monobloc implant. He considers the biological aspects of implant materials to be important (zirconium dioxide does not release ions, unlike titanium), but at the same time finds it appropriate to erase the stigma of alternative medicine and place ceramic implants on a broader scientific footing. That’s the reason he doesn’t condone ceramic drills, for example, as they have poor thermal conductivity and therefore pose a greater risk of heat necrosis.
Frank Maier comes from the Tübinger School and sees an indication for zirconia implants both in combination with PEEK abutments and zirconia abutments on single teeth and smaller bridges up to a maximum distance of five missing teeth. In one patient, he used a four-tooth bridge over three implants, which was treated once with PEEK abutments and once with zirconia abutments as a means of comparison. Both treatments were judged to be equivalent by the practitioner and the patient, but the patient ultimately chose zirconia abutments for biological reasons.
Restorative concepts
Older patients are increasingly the focus of demographic development in the dentist’s office. It requires concepts that account for the older population and, even better, that can ‘grow old together’ with the patients — in other words, concepts that avoid leaving elderly patients, with decreasing visual and motor skills, with unsolvable problems. It is therefore worth considering strategically just which restorative concept should be recommended to the elderly, agreed the speakers at this session, Dr. Luca Cordaro, Dr. Claudio Cacaci and Dr. Rémy Tanimura. Here, each patient’s individual situation is the top priority. Luca Cordaro advocated total restorations with several smaller bridges while including the remaining teeth whenever possible.
Claudio Cacaci and his co-authors introduced, about ten years ago, the Munich concept “A dental prosthesis for two stages of life”. This idea stands out, in that a fixed cemented restoration can be converted into a removable telescopic restoration. The functional elements required are 2° milled zirconia abutments on CAMLOG® implants and galvanic secondary parts. Even then, the concept was very convincing but also new. Today, Claudio Cacaci has 13- to 14-year-old cased of patients which prove it works exactly as intended and that it still serves its purpose through various age ranges. Cacaci insists regular follow-ups and professional dental hygiene are an integral part of the concept’s performance.
Supported research projects
The Scientific Working Group of the OR Foundation oversees the scientific research and related funding. It is represented by Professor Dr. Fernando Guerra, Professor Dr. Dr. Dr. Robert Sader, Dr. Alex Schär, Professor Dr. Thomas Taylor and Professor Dr. Dr. Wilfried Wagner.
The presentation of results from selected research projects was also a part of the Symposium’s main program. The research projects pertained to the following topics: 3D accuracy of the implant position with template-guided implant insertion (Dr. Sigmar Schnutenhaus), maxillary overdentures supported by two implants (Dr. Florian Kernen), dental implants in case of aggressive periodontitis (Asst. Prof. Dr. Pinar Gümüs), microscopic examinations of peri-implant soft tissue cell attachment to different abutment materials (Asst. Prof. Dr. Hanae Saito), and efficacy of home care and professional procedures in biofilm removal on various materials and surfaces (Dr. Gordon John).
Oral Reconstruction Foundation research awards
In addition, Professor Dr. Jürgen Becker and Professor Dr. Fernando Guerra conferred the three OR Foundation research awards which were nominated with € 10,000, € 6,000 and € 4,000. The awards went to Dr Nicole Passia (first place), Dr. Tobias Fretwurst (second place) and Ass. Professor M. Erhan Çömlekoğlu (third place).
The poster exhibition also received a great deal of attention and included 50 peer-reviewed posters from nine countries. The poster award of €2,000 each was awarded in three categories and to the following authors. The “Case report” category went to Dr. Roman Beniashvili, the “Clinical research” category went to Dr. Ludovica Fierravanti and the “Pre-clinical research” category went to Dr. Dr. Anders Henningsen.
Case presentations from the clinic
One of many highlights of the versatile scientific program was the final session moderated by Dr. Karl-Ludwig Ackermann and Prof. Dr. Thomas Taylor called “Problems, complications and failures – what can we learn from them?”, examining particularly challenging patient cases handled by Prof. Dr. Michael Stimmelmayr, Prof. Dr. Juan Blanco and Dr. Mario Beretta. The initial situations were presented by the respective practitioners who subsequently opened up a discussion of treatment options to an international panel of experts. In the end, the solution actually chosen was presented by the respective practitioner.
Transfer succeeded
The OR Foundation did not inherit a simple legacy with its Global Symposium. Since relaunching the CAMLOG Foundation to the Oral Reconstruction Foundation at the end of 2016, a new name had to be established for the biennial World Congress that could build on the great successes of the international CAMLOG congresses.
The Oral Reconstruction Global Symposium in Rotterdam has clearly demonstrated that the transfer was a big success. OR Foundation board members Professor Dr. Dr. Dr. Robert Sader (Chairman of the Board of Directors), Oscar Battegay (Legal Advisor), Professor Dr. Fernando Guerra, Prof. Dr. Irena Sailer, Prof. Dr. Mariano Sanz, Dr. Alex Schär (CEO), Prof. Dr. Thomas Taylor and Prof. Dr. Dr. Wilfried Wagner succeeded in seamlessly transferring the previous values and content to the new organization. The board is closely connected to the former chairman Prof. Dr. Jürgen Becker, who was expressly thanked for his merits.
CAMLOG is the “founding partner” of the new independent organization. During the press conference, member and delegate of the CAMLOG Board of Directors, Dr. René Willi, emphasized the close partnership between the OR Foundation and CAMLOG especially in the fields of research and education.
The OR Foundation’s mission is to promote patient oral health through science and education, to link scientists, practitioners and the industry. It was a common thread through the network of partners at the Oral Reconstruction Global Symposium – truly a tailor-made start in a regal setting!
So what’s next? Stay connected to the OR Foundation on your Smartphone! Reconnect with the online community “INSIGHTS Dental” at https://dental.insights.md/ on the Internet or on the mobile app (see the App Store or Play Store) that you are already familiar with from the Symposium. Create a personal profile. You’ll receive daily updates about everything worth knowing for the things that interest you. Talk to peers about up-to-date issues and take advantage of the latest publications from recognized experts in a rapidly evolving online community. Of course, you’ll also be provided with the latest information on the Oral Reconstruction Global Symposium 2020 in New York.
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