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Transcript
M AGA z I N E f O R C U S TO M E RS A N D PA R T N E RS O f S T R AU M A N N 1 I 2012
the straumann ®
regenerative system
Imprint starget – magazine for Customers and Partners of straumann i © straumann usa i 60 minuteman road i andover, ma 01810 i Phone 800/448 8168
Fax 978/747 2490 i Editors roberto gonzález i mildred Loewen i E-Mail [email protected] i Internet www.straumann.us/starget
Legal Notice exclusion of liability for articles by external authors: articles by external authors published in starget have been systematically assessed and carefully
selected by the publisher of starget (straumann usa). such articles in every case reflect the opinion of the author(s) concerned and therefore do not necessarily
coincide with the publisher’s opinion. nor does the publisher guarantee the completeness or accuracy and correctness of articles by external authors published in
starget. the information given in clinical case descriptions, in particular, cannot replace a dental assessment by an appropriately qualified dental specialist in an
individual case. any orientation to articles published in starget is therefore on the dentist’s responsibility. articles published in starget are protected by copyright
and may not be reused, in full or in part, without the express consent of the publisher and the author(s) concerned. straumann® and all other trademarks and logos are
registered trademarks of straumann usa and/or of its affiliates. third party corporate names and brand names that may be mentioned may be registered or otherwise
protected marks even if this is not specially indicated. the absence of such an indication shall not therefore be interpreted as allowing such a name to be freely used.
editorial
STARGET 1 I 12
A New Era in Oral Tissue
Regeneration
Dear Valued Customer,
It is my pleasure to introduce myself as the new head of Straumann North America,
and also to introduce this first installment of STARGET for 2012. The focus of this issue,
"The Straumann Regenerative System," is particularly significant for me as I come
to Straumann USA as the former Head of Straumann Global Regenerative Sales.
As you know, Straumann provides solutions for both tissue regeneration and GBR
including Emdogain™, BoneCeramic™, Straumann AlloGraft, and most recently
MembraGel ®, an innovative liquid membrane that can be precisely applied to the
surgical site.
You’ll find several interesting articles on tissue regeneration in this issue of
Andy Molnar
Straumann Executive Vice President
North America
STARGET: “Why Repair When You Can Regenerate?“ on page 6, “Redefining
the Membrane“ on page 12, and an interview with Prof. Dr. Christoph Hämmerle
on the innovation and distinctiveness of MembraGel on page 16. You’ll also see
an article on our Esthetic Case Book, which documents 11 cases illustrating the
dramatic results that can be achieved through Emdogain, on page 18.
Restorative dentistry has seen breakthroughs over the past few years. This STARGET
features articles on the latest development of Straumann CARES ® digital workflow.
We hope you will enjoy the clinical case on Straumann's screw-retained hybrid
solution from your peers, and an article based on the interviews with three key
opinion leaders on global trends in dentistry.
Enjoy this issue of STARGET and please let us know how we can continue to
improve upon it.
Sincerely,
Andy Molnar
Straumann Executive Vice President, North America
3
4
overvieW
STARGET 1 I 12
Overview
STARGET 1 I 2 0 1 2
6
The Straumann® Regenerative System
offers solutions for oral tissue regeneration
– ranging from conservative dentistry to
dental restoration. New to the portfolio:
Straumann
®
regenerative SyStem
28
Straumann® MembraGel®.
Straumann® CareS® digital SolutionS
Straumann, together with 3M™ ESPE™,
has introduced a streamlined digital
workflow that connects the Lava™ C.O.S.
Intra-Oral Scanner to the Straumann®
CARES® Digital Solutions platform.
Simply doing more
54
Global Trends – Where is the final
destination? We asked three prominent
dentists to give us their perspective
on things: Lyndon Cooper, Kenneth
Malament and Daniel Wismeijer.
Content
STARGET 1 I 12
CONT ENT
FOCAL POINT
STRAUMANN ® REGENERATIVE SYSTEM
STRAUMANN ® CARES ® DIGITAL SOLUTIONS
6
Why Repair When You Can Regenerate Instead?
12
Straumann MembraGel® – Re-Defining the Membrane
16
Interview with Christoph Hämmerle
18
An Esthetic Case Selection on Straumann Emdogain™
20
Straumann Allograft Portfolio Expands
22
Evaluating the Precision of Straumann® CARES® Guided Surgery
Based on a Clinical Case
RESTORATIVE
28
Digital Workflow
30
The Intraoral Workflow
32
3M™ ESPE™ Lava™ Ultimate Restorative
38
Interview with Mike Rynerson
43
Straumann® Anatomic IPS e.max® Abutment
45
Immediate Full Mouth Restoration Using Implant-Supported Fixed
Hybrid Prosthetics
SURGICAL
50
Updated SLActive® Scientific Evidence Brochure
ITI / EDUCATION
52
Straumann & Baylor University Launch the First Interdisciplinary
Digital Dentistry Course
SIMPLY DOING MORE
53
ITI Membership Tops 10,000
54
Global Trends
60
Straumann AID: Access to Implant Dentistry
64
Literature Alerts
67
Upcoming 2012 Education Events
5
6
STARGET 1 I 12
foCal point
STrAUMANN ® reGeNerATive SYSTeM
Why Repair When You Can Regenerate Instead?
The More Complex an Organism is, the Lesser the Capacity of its Body to Perform Regenerative
Processes
The biological process, or self-sufficient capability to restore deficient tissue is referred to as the ability
for regeneration. In contrast to repair, i.e., wound healing, whereby the original biological structure is
not fully rebuilt, the goal of regeneration is to completely restore the structure and function of tissue that
has been lost or injured. This ability has continuously diminished as creatures have evolved and the
complexity of these organisms has increased. Compared to the “champions” of regeneration, present
day cnidarians, which can re-grow severed extremities and internal organs that have been lost, this
capability in humans, without additional support, is limited to a few types of external tissue.
When the Body’s Own Healing Process “Overshoots its Target“
When a person’s tissue is injured, the body’s repair process, rather than regenerative process, begins.
Here, the body does not primarily attempt to restore the original state and function of the tissue,
but rather to close the wound as quickly as possible. This spontaneous healing process involves the
formation of connective tissues that penetrate deeply into the original tissue and also remove “good”
tissue in the process. During such a “radical” healing process, it is possible that even important functions
are permanently destroyed.
Regeneration Can be Guided with Medical Treatment
To prevent this type of overcompensation in the healing process wherever possible, strong antiinflammatory drugs are administered today, such as in cases of back injuries. This prevents this destructive
process from occurring, in turn making it possible to preserve part of the nerve tissue and mitigating
deficits such as paralyses. In medical terms, regeneration entails assisting desirable tissue formation
processes, and guiding and limiting the repair mechanisms involved in wound healing as to not impede
the regeneration of intact, functioning tissue.
foCal point
Fig. 1: The cnidarians (pictured here, a green anemone, anthopleura xanthogrammica) are equipped with astounding regenerative
capabilities that far surpass those of humans.
STARGET 1 I 12
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STARGET 1 I 12
Straumann® regenerative SyStem
The Insertion of Implants Requires Healthy Bone Tissue
Great advances in regeneration have been achieved in dentistry over that last 20 years. We can
now regenerate the bone tissue of the jaw, opening the door for implants as a treatment for replacing
teeth. This has required scientific evidence documenting the physiological processes involved in tissue
formation and the necessary aids for controlling these processes. Today, for example, we know that
lost or missing bone can only be regenerated by the body when the bone-forming cells can perform
their work undisturbed. Without external intervention, this process would have to compete with the rapid
natural wound repair mechanism, which would result in the growth of new connective tissue instead of
the desired bone tissue.
Fig. 2: The high porosity of Straumann® BoneCeramic™ (90 %) allows blood vessels and vital bone to vascularize into the material.
Regeneration Requires Matrices and Membranes
Today, one means of guiding the regeneration process requires two aids: a matrix and a membrane.
The matrix keeps the space available for the bone to grow while a membrane serves as a barrier to
prevent the connective tissue infiltration of the gingiva.
Straumann® regenerative SyStem
Various types of these matrices and membranes are used today for regenerative purposes. Some of
these “placeholders” remain in the body, integrated into the newly formed bone for the rest of the person’s
life. Applying membranes for this purpose is also quite complex and time-consuming. Straumann ®
MembraGel ® was developed to deal with the disadvantages of the types of membranes used in the
past. The time-consuming cutting and fitting of the membrane is unnecessary since MembraGel is
applied in liquid form and polymerizes to form a solid film in less than a minute. The resulting hydrogel
is biocompatible and completely biodegradable.
Periodontitis – The Greatest Threat to the Periodontium
For implantology, the regeneration of the periodontium is equally as important as the new formation
of bone, which is destroyed by periodontitis and can ultimately result in the loss of the tooth. Despite
numerous attempts to regenerate the destroyed tissue, a breakthrough to achieve complete tissue
reformation remains to be seen. Straumann ® Emdogain™ can be used in cases to undo some of this
destruction, making it possible to prevent loss of the tooth. Emdogain contains the key components
required for building up the cementum and periodontal ligament, important parts of the periodontium.
These elements, or proteins, tap into the body’s own natural ability to rebuild the surrounding tooth
structures, using nature’s help.
“Simply Doing More“ – During the Regeneration Process
Straumann’s successes in the field of regeneration are promising and we have yet to fully realize our
dreams. We are already working on further innovations to guide regenerative processes in an even
simpler and more effective manner. We are inspired by two great visions:
»
A matrix for bone augmentation that breaks down fully and can be used without requiring a
membrane.
»
Guided tissue regeneration that allows for complete preservation of the tooth.
Now making its first entrance into the dental market with Straumann MembraGel, we view PEG technology
as the foundation for achieving these goals. Beyond MembraGel, there are numerous combinations and
degrees of cross-linking these biocompatible hydrogels, which present an exciting range of possible
options. This innovative technology is only in the early phases of trials and development and has
enormous potential for the future.
STARGET 1 I 12
9
10
STARGET 1 I 12
Straumann® regenerative SyStem
The Straumann® Regenerative System: Everything from a Single Source
The Straumann® Regenerative System offers you a variety of solutions for oral tissue regeneration –
ranging from conservative dentistry to dental restoration. Our goal is to offer you a variety of predictable
and scientifically proven regenerative treatment solutions – all from a single source and in the tried and
tested quality that is Straumann’s hallmark.
Tissue Regeneration
By mimicking the natural process of odontosis,
Straumann® emdogain forms an insoluble,
three-dimensional
extracellular
matrix
that
remains on the root surface for 2 – 4 weeks
and enables a selective cell population,
proliferation and differentiation.
Bone Formation
Straumann® allograft is a wide range of
bone allograft solutions, allowing you the
flexibility to choose the treatment that’s right for
your case. Through a commercial partnership
with LifeNet Health®, Straumann’s allograft
options provide confidence in the safety of the
material you use to treat your patients.
Straumann® BoneCeramic™ is a fully synthetic
bone
substitute
material
with
excellent
morphology that promotes the new formation
of vital bone. It can be used for a series of
procedures used for dental bone regeneration.
Bone Healing
Straumann® membragel ® is a membrane
of the latest generation. It combines unique
material properties that have been developed
to promote undisturbed bone healing and to
simplify the surgical procedure.
STARGET 1 I 12
11
straumann® emdogain™
IS TRUE PERIODONTAL REGENERATION
IMPORTANT TO YOU?
Photos courtesy of Dr. G.
Zuchelli, Bologna, Italy
before
after
More than 100 clinical publications in peer-reviewed journals demonstrate
Straumann® Emdogain to be safe and effective in stimulating the formation of new
periodontal soft and hard tissue. These clinical studies involve more than
3000 defects in over 2500 patients.
Contact Straumann Customer Service at 800/448 8168 to learn more
about Straumann solutions or to locate a representative in your area.
www.straumann.us
-4
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5
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5,6
Tonetti MS, et al. Enamel matrix proteins in the regenerative therapy of deep intrabony defects.J Periodontol.
2002;29:317–325.
Froum SJ, et al. A comparative study utilizing open flap debridement with and without enamel matrix derivative in
the treatment of periodontal intrabony defects: A 12-month re-entry.J Periodontol. 2001;72:25–34.
Jepsen S, et al. A randomized clinical trial comparing enamel matrix derivative and membrane treatment of
buccal class II furcation involvement in mandibular molars. Part I: study design and results for primary outcomes.
J Periodontol. 2004; 75:1150–1160.
McGuire MK, et al. Evaluation of human recession defects treated with coronally advanced flaps and either enamel
matrix derivative or connective tissue. Part 1: comparison of clinical parameters.J Periodontol. 2003;74:1110–1125.
Sculean A, et al. Ten-year results following treatment of intra-bony defects with enamel matrix proteins and guided
tissue regeneration. J Clin Periodontol. 2008; 35:817-824.
Data on file (McGuire 10 year)
12
STARGET 1 I 12
Straumann® regenerative SyStem
STrAUMANN ® M eMbra G el ®
Re-Defining the Membrane
In 2010, Straumann introduced Straumann MembraGel, an advanced technology membrane that
is one of the most significant innovations in guided bone regeneration in recent history.
Created with PEG (polyethylene glycol) hydrogel technology, Straumann MembraGel is applied in
liquid form and molds to the defect. Shortly after application, the liquid components solidify, stabilizing
the bone graft and providing an effective barrier to tissue infiltration. Straumann MembraGel then
biodegrades over time. It is designed to achieve undisturbed bone regeneration, which is a prerequisite
for achieving ideal clinical and esthetic results.
“Straumann MembraGel is a key innovation in Guided Bone Regeneration. With the
PEG technology we are on the verge of something new, entering a new era in oral
tissue regeneration.“ Christoph Hämmerle, University of Zurich
Designed for Improving GBR Procedures
Straumann MembraGel provides effective support in bone formation for GBR (guided bone regeneration)
cases due to its optimized barrier properties. It facilitates undisturbed bone healing as a basis for the
optimal clinical outcome achieved by stabilization of the bone graft material. The precise and easy
application simplifies the surgical procedure.
Straumann® regenerative SyStem
Stabilization of the Bone Graft
The gel-like consistency of Straumann® MembraGel ® allows for precise application to the
surgical site and adaptation to various types
and sizes of bone defects.
Solidification and Stabilization
Once solidified in situ (20 – 50 seconds after
application),
Straumann®
MembraGel
is
designed to stabilize the underlying bone graft
to facilitate undisturbed bone regeneration.
Backed by Scientific Documentation
Straumann MembraGel is backed by preclinical1,2,3,4,5 and clinical 6 documentation including one- and
three-year follow-up data7 presented in 2010 and submitted for publication. The ongoing clinical
program with Straumann MembraGel includes over 40 centers and more than 200 patients in Europe
and North America.
Straumann® MembraGel Exclusive Education Program
Straumann® MembraGel was launched in conjunction with a well-received specialized education
program that provides in-depth information on pre-clinical and clinical evidence, hands-on product
training and the surgical techniques of this new application. Herbert Früh, Head of Business Unit
Regenerative at Straumann explained, “MembraGel has allowed Straumann to bring a brilliant idea to
STARGET 1 I 12
13
14
STARGET 1 I 12
Straumann® regenerative SyStem
fruition. It is an innovative technology that requires training. Customers’ initial experience is that it saves
time during intraoral application but it is different to handle. For this reason, it was the right decision to
combine the launch of the new product with an intensive education program.”
Availability
Straumann® MembraGel ® was introduced in Europe and North America toward the end of 2010, with
roll-outs to other markets planned in the future.
Hands-on workshop at a Straumann MembraGel education event.
1
Humber CC, Sándor GK, Davis JM et al. Bone healing with an in situ formed bioresorbable polyethylene glycol hydrogel mem-
brane in rabbit calvarial defects. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;109:372–384.
2
Jung RE, Lecloux G,
Rompen E et al. A feasibility study evaluating an in situ formed synthetic biodegradable membrane for guided bone regeneration
in dogs. Clin Oral Implants Res 2009;20:151–161.
3
Thoma DS, Halg G-A, Dard MM et al. Evaluation of a new biodegradable
membrane to prevent gingival ingrowth into mandibular bone defects in minipigs. Clin Oral Implants Res 2009;20:7–16.
4
Herten
M, Jung RE, Ferrari D et al. Biodegradation of different synthetic hydrogels made of polyethylene glycol hydrogel/RGD-peptide
Straumann® regenerative SyStem
PeG – The TechNOLOGY BehiNd STrAUMANN® MeMbraGel®
Straumann MembraGel is a synthetic, biodegradable in situ-formed membrane made of polyethylene
glycol (PEG) which forms a molecular network. The material is biocompatible, is applied in liquid form
and sets quickly. Due to its gel-like consistency, it can be applied to cover the exact shape of the defect
or augmented area and does not require cutting and trimming to shape before application – unlike
traditional GBR membranes.
What exactly is PEG, and what makes it suited to this purpose? PEG is a polymer (a large molecule
comprised of repeating structural units). It is produced through the reaction between ethylene oxide and
water or the organic compound ethylene glycol, which is often used as a precursor to polymer materials.
PEG is available in a wide range of molecular weights. The molecular weight also determines the
consistency of the material, which can vary greatly from waxy-solid to water-soluble liquid states. PEG
has a number of properties that are particularly desirable in a number of biological, pharmaceutical
and chemical applications: it is highly flexible, non-toxic and non-immunogenic. It is also hydrophilic,
meaning that its attachment to biomolecules can increase solubility and decrease aggregation of the
molecules.
Thanks to these very advantageous properties, PEG has been extensively used in many medical,
pharmaceutical and medical device applications. For instance, it is used as a spray-on adhesion barrier
and as a main ingredient in laxatives; as an agent for bowel irrigation prior to surgery or colonoscopy;
as an addition to protein medications to extend their effect and increase dosing intervals; and as a
carrier in various medications, such as soft capsules, ointments, tablets, and lubricants. Preliminary
research is also underway to investigate the potential of PEG as a component in many other exciting
applications, such as gene therapy, spinal cord injuries and the suppression of carcinogenesis. The
use of PEG as a customizable, liquid-applied membrane is therefore another milestone in a long line of
applications for this useful, versatile and extensively researched material.
modifications: an immunohistochemical study in rats. Clin Oral Implants Res 2009;20:116–125.
5
Jung RE, Zwahlen M, Weber FE
et al. Evaluation of an in situ formed hydrogel as a biodegradable membrane for guided bone regeneration. Clin Oral Implants Res
2006;17:426–433.
6
Jung RE, Hälg GA, Thoma DS, Hämmerle CHF. A randomized, controlled clinical trial to evaluate a new
membrane for guided bone regeneration around dental implants. Clin Oral Implants Res 2009;20:162–168.
7
Ramel C, Halg G,
Thoma D et al. A randomized clinical trial to evaluate a synthetic gel membrane for GBR around dental implants – 1- and 3-year
results. European Association for Osseointegration 19th Annual Scientific Meeting, Glasgow, UK, 6–9 October 2010; Abs 055.
STARGET 1 I 12
15
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STARGET 1 I 12
Straumann® regenerative SyStem
iNTerview
“Being Part of this Network is Something Truly Exciting –
Something We’ve Never Done in this Way Before.“
Andy Molnar, Straumann Executive Vice President, North America, interviews Professor Dr. Christoph Hämmerle of the University of Zurich about
Straumann® MembraGel ®.
professor Hämmerle, our company is introducing membragel by way of an
international education-based program. this is a product which has been longawaited in the market; so many people would like to get their hands on it as
Prof. Dr. Christoph Hämmerle
Chairman of the Department of Fixed and
Removable Prosthodontics and Dental Material
Science, University of Zurich/Switzerland.
soon as possible. What are your thoughts on this educational approach to the
launch?
I think it’s very important to use an educational approach. What we’re dealing
with here is a new technology, a new kind of membrane, a new way to apply
the membrane. There are a lot of differences from all the membranes we’ve had
before. I think it’s very important to launch the product in a well-structured way so
that we know what experience we can rely on. It’s also an opportunity to learn
about new things we need to become familiar with before we can use a new
technology like this successfully and predictably.
“We treated over thirty defects and had minimal complications.
Based on this experience and learning, we moved on to larger defects with a very good success rate once again.“ Christoph Hämmerle
i know you’re excited about membragel and the progress the product is making.
How would you describe your involvement from the start, from inception all the
way through the development of the project?
It has been very exciting for us. It’s really special to be there when the original
idea is born and then to participate in the development of a new product, which
is eventually able to solve problems and improve patient care. With all the sharing,
teaching, and feedback we’re getting from different people all over the world,
being part of this network is something really exciting, something we’ve never
done this way before. For this reason, we’re looking forward to continuing with the
Straumann® regenerative SyStem
STARGET 1 I 12
development of this scientific and educational network and
When we conducted our initial study, in which we used a
really benefiting from the process. I think it’s great!
collagen membrane as a control, we did not see any more
difficulties with the membrane using the new technology than
from our learning so far, what are the key points that we
with the membrane using the older technology. I think this was
need to pass on to our educators?
the case because we were careful to use small dehiscence
There are three key points. One is that you have to change
defects in non-esthetic areas. We treated over thirty defects
some of your surgical habits to adapt to the new technology,
and had minimal complications. Based on that experience
the new way to apply the membrane. The second is to adhere
and learning, we began to expand to larger defects, again,
to published surgical guidelines. And the third is to begin with
with very good success.
less complex cases until you have had around ten successful
cases, and then move on to more difficult cases.
Professor Hämmerle, thank you very much for your time.
It’s much appreciated.
“I think it’s very important to launch the product
in a well-structured way so that we know what
experience we can rely on.“ Christoph Hämmerle
Returning to the topic of changing habits, this is a new
technology, and there is a great temptation to use it in all
kinds of different ways because it is rather easy to use and
very new and exciting. We need to exercise restraint and
really adhere to new practices in aspects of our surgical
work.
The second point pertains to the surgical guidelines. We
have seen that the surgical guidelines are not always
followed accurately. Following the surgical guidelines could
improve the practical outcomes when it comes to using this
new product.
The third aspect is the size of the defects we tackle first.
17
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STARGET 1 I 12
Straumann® regenerative SyStem
GrOwTh iN receSSiON
An Esthetic Case Selection on Straumann ® Emdogain™
Clinicians have been predictably treating gingival recession with Straumann ®
Emdogain™ for years and talking about the beautiful smiles they gave back
to their patients – we gave them the chance to prove it.
The best cases from the 2009 “Growth in Recession” Esthetic Case Competition
were chosen by a renowned international jury to appear in Straumann’s Growth in
Recession Esthetic Case Book. This casebook, published in 2011, features eleven
cases presented together with the patients’ histories and images of each step to
facilitate a detailed understanding of the surgical procedures involved.
This valuable tool is complimentary to you with your next order of Straumann
Emdogain. Please reference order code “RECESSION” when placing your order.
Designed to help achieve excellent esthetic results
Esthetic Casebook: Straumann® Emdogain
The following clinicians contributed their Case reports to this publication:
p Brazil: Dr. Robert Carvalho da Silva, DDS, MS, PH.D. (co-authors: Dr. Julio
Cesar Joly, DDS, MS, PH.D., and Dr. Paulo Fernando Mesquita de Carvalho,
DDS, MS)
p USA: Dr. Robert Levine, DDS – Dr. Ken Akimoto, DDS, MSD – Dr. Mark I. Gutt,
DMD– Dr. Eunseok Eugene Oh, DDS (co-author: Dr. Vincent Iacono, DDS) – Dr.
Paul G. Luepke, DDS, MS
p Canada: Dr. Ira Paul Sy, DDS, MS, Dip. Periodontics
p Germany: Dr. med. dent. Andreas Hofmann, M.Sc. – Dr. Bjørn Greven (coauthor: Dr. Bernd Heinz)
p Spain: Dr. Ion Zabalegui, MD
Straumann® regenerative SyStem
STARGET 1 I 12
“BOTH THE SCIENTIFIC EVIDENCE AND MY PERSONAL ExPERIENCE
SUPPORT THAT WITH THE APPROPRIATE CASE STRAUMANN® EMDOGAIN™
SIGNIFICANTLY IMPROVES ROOT COVERAGE COMPARED TO THE
CORONALLY ADVANCED FLAP ALONE.”
DR. MICHAEL K. MCGUIRE, DDS
Treatment of recession defects with Straumann Emdogain
Courtesy of Dr. Paul G. Luepke, DDS, MSD
A referred 23-year-old female patient was presenting with multiple gingival recessions
(teeth #8 to #3). The prominent canine showed a Miller Class III recession, the
other teeth presented with Miller Class I recessions. The treatment procedure began
with a thorough cleaning and scaling of the exposed root surfaces with hand
and sonic instruments and was followed by a split thickness flap preparation of a
Dr. Paul G. Luepke, DDS, MS
Zucchelli-style flap (without vertical releasing incisions). A dissection into the vestibular
1996 Master’s degree in Periodontics, University
mucosa allowed for further mobilization.
of Texas at San Antonio Health Science Center, Tx,
USA • 1997 Diplomate of the American Board (EDTA) was applied for two minutes on the root surface.
of Periodontology • 2008 Assistant Professor of Subsequently, the surgical area was rinsed with sterile saline and Straumann®
Surgical Services Periodontics Division, Marquette
Emdogain™ was applied to the root surfaces. Connective tissue graft (CTG) was
University School of Dentistry in Milwaukee, WI,
harvested from the palate with the single incision technique. The graft was then
USA • 2009 Interim Department Chair of Surgical split. The CTG was fixed on the root surface and the flap coronally positioned and
Sciences at Marquette University School of Dentistry
fixed with sling sutures.
in Milwaukee, WI, USA
Straumann
®
PrefGel
®
Mechanical tooth cleaning in the surgical area was avoided during the first 4
weeks and a chlorhexidine solution was prescribed. Sutures were removed 10
days after surgery.
Initial situation
6 week follow-up
11 month follow-up
19
20
STARGET 1 I 12
Straumann® regenerative SyStem
ALLOGrAfT LiNe exPANSiON
Building A Foundation for Success with More Options –
Straumann AlloGraft Portfolio Expands
Straumann is pleased to expand the options available for you through our commercial partnership with
LifeNet Health,® allowing you the flexibility of choice when treating your patient. Processed with LifeNet
Health’s proprietary and patented Allowash xG ® technology, Straumann AlloGraft gives you confidence
that your graft is safe and effective.
Straumann AlloGraft C/C mix, Mineralized
Ground Cortical/Cancellous mix
A mix of the strength of cortical bone with the
structure of cancellous bone to support bony
ingrowth in one product
Straumann AlloGraft OCAN (top) and Straumann
AlloGraft GC (bottom), electron microscope
image, magnification 20x
Straumann AlloGraft OCAN 0.25 cc, Mineralized Ground Cancellous
Straumann AlloGraft GC 0.25 cc, Mineralized Ground Cortical
Straumann AlloGraft DGC 0.25 cc, Demineralized Ground Cortical
For smaller defects, when extensive grafting is not needed
Straumann AlloGraft OCAN (left), Straumann
AlloGraft GC (middle), Straumann AlloGraft DGC
(right), electron microscope image, magnification 20x
SIMPLIFy WITH CONFIDENCE
From crown to root, Straumann provides you with the
convenience of ordering solutions from one provider – all
from the scientifically driven company you know and trust.
STARGET 1 I 12
21
straumann® Cares® digitaL soLutions
SEAMLESS CONNECTIONS
Pave your way to success. Covering a full product range from temporary restorations to
esthetic crown and bridge restorations, Straumann® CARES® Digital Solutions is now featuring:
new generation scanner new cAd software
new applications leading range of materials
Straumann® CARES® Digital Solutions brings modern digital dentistry to dental professionals as a complete system –
reliable, precise, and dedicated to your needs.
intra-oraL sCan
guided surgery
us
CadCam
Please contact us at 800/448 8168. More information on www.straumann-cares-digital-solutions.com
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Straumann® CareS® digital SolutionS
STefANO STOreLLi, LeONArdO AMOrfiNi, MAUriziO cAMANdONA ANd eUGeNiO rOMeO
Evaluating the Precision of Straumann ® CARES ® Guided
Surgery Based on a Clinical Case
Introduction
The use of guided surgery is paving the way for the future of implant surgery. Softwarebased pre-operative planning differs considerably from traditional planning with casts
and x-ray printouts. The following case report involves a restoration for a partially
edentulous woman with a fixed prosthesis preceded by pre-operative planning
with the Straumann® Guided Surgery System using coDiagnostix™ (software) and
gonyx™ (scan and surgical template fabrication device).
Dr. Stefano Storelli
Graduation in Dentistry and Dental Prosthetics at the
Patient History
University of Milan/Italy. PhD in Implant Dentistry.
An 87-year-old Caucasian woman referred to our clinic, asked for a solution for her
Postgraduate in Oral Surgery (class of 2012).
faulty fixed bridge which was causing pain and difficulty in eating. She had never
Lecturer at the Department of Implant Prosthetics at
worn a removable prosthesis and was willing to do anything possible to keep her
the University of Milan. Author of various national
fixed dentition. The patient suffered from an unspecified choreia with symptoms of
and international publications and collaboration on
involuntary movements, and was on aspirin treatment for her high blood pressure.
various transcriptions. ITI and SIO member. Private
Despite these restrictions, she was in a good physical and mental health.
practice in Milan.
Clinically, the following situation was diagnosed: (1) a faulty fixed bridge (7 to
12), still anchored on the left side, where an old implant was still in use, (2) two
Fig. 1
Fig. 2
Fig. 3
Fig. 4
Straumann® CareS® digital SolutionS
STARGET 1 I 12
remaining teeth (8 and 11) which were fractured, and (3) a resorption on site 8
and a fracture of 11 revealed by the OPG as well as the inclination of the distal
implant placed in 12 (figs. 1 – 3). Under these circumstances the clinician decided
to remove the bridge and to restore the patient with a removable prosthesis.
After a couple of weeks the patient stated that it was impossible for her to wear
the temporary denture and she returned to the dental practice several times due
to fractures to the prosthesis. Therefore, it became apparent that a removable
Dr. Leonardo Amorfini
restoration was not suitable for this patient and that an implant solution had to
Graduation in Dentistry and Dental Prosthetics at the
be taken into consideration. Since minimally invasive surgery was intended, the
University of Milan/Italy. Author of various national
clinician opted for a guided implant insertion in the post-extractive sites.
and international publications and collaboration
on various transcriptions. ITI, AO, SICOI and SIO
Treatment Planning
member. Private practice in Gallarate (VA).
A mock-up of the future teeth was evaluated, followed by the preparation of the
diagnostic template with the Straumann ® gonyx table. The plate was attached
to the barium teeth and the three titanium pins were placed according to the
manufacturer’s instructions (figs. 4, 5). The diagnostic guide was tested for
Fig. 5
Fig. 6
Fig. 7
Fig. 8
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STARGET 1 I 12
Straumann® CareS® digital SolutionS
stability in the mouth of the patient before performing the Cone Beam CT scan
(fig. 6). The CT showed a remarkable resorption on site 8 and confirmed the
inclination of the implant placed in 12. Therefore, the implant to be placed
immediately in position 8 was moved to 7 and a miniflap was raised. The
implant in position 11 had to deal with the position on the other implant.
The
final
treatment
on
3
decided
implants
upon
in
was
a
positions
fixed
implant
7-11-12.
The
supported
Dental Technician Maurizio Camandona
prosthesis
Teacher of post-graduate courses in dental implant
coDiagnostix™ software was used to plan the treatment (figs. 7, 8). The
technologies at the University of Milan.
implant positions were defined in the software and the resulting template plan
Author and co-Author of professional articles and
was sent to the lab. The implant in position 7 was planned to be a Roxolid ®
reference books. Private practice in Lomazzo
implant with small diameter (Straumann ® Bone Level implant, NC Ø 3.3 mm,
(Como)/Italy, specialized in implant prosthetics,
SLActive ® 12.0 mm); for the implant in 11, a Straumann ® Bone Level implant
ceramics and state-of-the-art technologies (CADCAM
(RC Ø 4.1 mm, SLActive 12.0 mm) was chosen.
etc.). Speaker at national congresses on the topics
listed above.
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Straumann ®
Straumann® CareS® digital SolutionS
STARGET 1 I 12
It was possible to identify the implant in 12 as a CoreVent1 Ø 4.0 mm
implant placed about 15 years ago and, after some research, some prosthetic
component of the respective implant manufacturer was found that was
compatible with the internal connection to this implant. After drilling the holes
into the scan template according to the template plan, the lab provided the
surgical guide (figs. 9 – 11).
Surgical Procedure
Prof. Eugenio Romeo
The two teeth were removed together with the granulation tissue around the
Graduation in Medicine and Surgery in 1984 at the
root of tooth 8 under local anesthesia. The considerable resorption needed to
University of Milan/Italy. Director of the Department
be treated with regenerative material (bovine bone substitute material covered
of Implant Prosthetics at the University of Milan since
by a resorbable collagen membrane) to avoid major alteration of the contour.
1992. Associate Professor since 2005. Author
The surgical guide was placed on the remaining teeth and on the healing
of various educational books and national and
cap of the distal implant (fig. 12). The surgical procedure was performed
international publications. Chairman of the Advanced
according to the surgical plan. The implant in position 7 was positioned after
Oral Implantology course at the University of Milan.
raising a mini-flap and by using the extra-long drill (Ø 2.8 mm) through the
ITI fellow.
Ø 2.8 mm sleeve (figs. 13, 14).
Fig. 13
Fig. 14
Fig. 15
Fig. 16
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Straumann® CareS® digital SolutionS
The implant was positioned after the guide had been removed, since the implant, having a diameter of 3.3 mm, cannot
be inserted through the Ø 2.8 mm sleeve. The implant in position 11 was placed after using the extra-long drill series
(Ø 2.2/2.8/3.5 mm) with the 1 mm reduction handle through the Ø 5 mm diameter sleeve (figs. 15, 16). The implant
was positioned through the surgical guide. Transmucosal healing caps were positioned and the bone substitute material
was inserted into the extraction sockets. Both sites were covered with the resorbable collagen membrane.
Final Prostheses and Follow-up
After 6 weeks, the OPG showed correct healing with no radiolucencies (fig. 17). Clinically, the implants sounded
correct and were stable (fig. 18). The healing abutments were removed and screw-retained transfer parts were placed
Fig. 17
Fig. 18
Fig. 19
Fig. 20
Fig. 21
Fig. 22
Fig. 23
Fig. 24
Fig. 25
Straumann® CareS® digital SolutionS
in order to take the impression. The three impression copings were splinted
with a bridge of acrylic resin that had been prepared a few days before (figs.
21, 22). The three abutments were placed in position (fig. 22) and the metalceramic prosthesis (fig. 24) was cemented with a removable cement (fig. 23).
After one month of loading, no complications were registered or stated by
the patient. By comparing the values obtained by computer planning with the
x-ray taken after implant placement (figs. 19, 20), the precision of the system
became visible, with the postextractive implant being about 1 mm deeper than
planned and without much variability in the other dimensions.
Conclusion
The use of computer-guided implant placement allowed expanded treatment
options and a fast, minimal invasive surgery for a patient who was not able to
withstand long procedures. Producing the guide in such a manner is efficient
and it fits well on natural teeth because it has been customized on the patient's
impressions. The implant placement in the case reported here demonstrates the
reliability of the Straumann ® Guided Surgery system.
With software-based treatment planning, the implants could be placed in
the same practiced manner as with traditional techniques – but with higher
precision and peace of mind. However, the learning curve for software-based
planning should not be underestimated; in addition to familiarization with the
software, new surgical techniques have to be applied and the surgeon needs
to get accustomed to visualizing the surgical procedure through the software.
STARGET 1 I 12
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Straumann® CareS® digital SolutionS
diGiTAL wOrkfLOw
Seamlessly Connected with Straumann ® CARES ®
Digital Solutions
1. MULTiPLe dATA SOUrceS
Surgical planning
2. STrAUMANN ® cAreS ® viSUAL deSiGN
Straumann ® CARES ® Visual
Digital impression taking
Scan master model
Straumann ® CARES ®
Scan CS2
A digital workflow to thousands of scanners
CARES ® 7.0: the open standard software platform
Straumann, together with 3M ESPE, has introduced a
Straumann® CARES ® Visual 7.0 offers a wide range of
streamlined digital workflow that connects the Lava C.O.S.
benefits: the advantages of a flexible, open software
Intra-Oral Scanner to the Straumann® CARES® Digital Solutions
standard – through the Dental Wings Open Software
platform. Parallel to the Cadent iTero ® intraoral scanner,
(DWOS ®) software core – and the quality and predictability
dentists using the Lava C.O.S. scanner are now able to
of the validated workflow of Straumann ® CARES ® – through
transfer digital scan data of the patient’s oral geometry to
specific Straumann software applications. Powered by the
the dental lab using the Straumann® CARES ® system. The
combined resources of the partners, the CARES ® platform
CARES ® platform offers seamless connectivity to thousands
strives for the leading role in dentistry and provides you
of scanners in dental practices worldwide.
with access to future high-class developments of the digital
dental industry.
Straumann® CareS® digital SolutionS
3. vArieTY Of MANUfAcTUriNG OPTiONS
VALIDATED STRAUMANN WORKFLOWS
STARGET 1 I 12
4. vArieTY Of PrOSTheTic OPTiONS
HIgH qUALITy RESTORATIONS
Straumann milling centers
For modern implant and restorative dentistry:
Customized Straumann ® CARES ® Abutments (Ti, ZrO2),
Straumann ® CARES ® Screw-retained bars and bridges
(CoCr, Ti)
Copings, crowns and bridges, inlays, onlays and veneers
Resin nano ceramic:
3M™ ESPE™ Lava™ Ultimate Restorative Ceramics: zerion®
(ZrO2), IPS e.max ® CAD, IPS Empress® CAD, VITA Mark II,
VITA TriLuxe
ExTERNAL WORKFLOWS
Via open STL format
Metals: ticon ® (Ti), coron ®, (CoCr)
Polymers: polyamide, polycon ® ae, polycon ® cast2
Straumann milling centers: specialists in prosthetics
A leading material and application range
Straumann has a strong and long-time expertise in CADCAM
The Straumann® CARES ® Digital Solutions portfolio provides
manufacturing
industrial-
a leading range of CADCAM materials and applications –
grade precision and quality. The high reliability of these
according to your needs of serving your customers’ requests
restorations is based on Straumann’s strategy of validated
and of working cost-effectively without compromising on
design software and manufacturing that are compatible
quality: from single-tooth restorations to 16-element bridges
with each other. Via the Straumann milling centers, design
and from well-known to innovative materials like the new
expertise is offered as a service for complex restorations
3M™ ESPE™ Lava™ Ultimate Restorative.
of
prosthetic
restorations
in
such as screw-retained bars and bridges, and as a scan
service for customized abutments1.
1
Scan service available in Germany only
2
burn out resin, not for clinical use
IPS Empress® and IPS e.max ® are registered trademarks of Ivoclar Vivadent AG, Liechtenstein. 3M™, ESPE™, Lava™ are trademarks of 3M or 3M ESPE AG.
Used under license in Canada.
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Straumann® CareS® digital SolutionS
The iNTrAOrAL wOrkfLOw
The Straumann Digital Workflow for Implant Restorations:
Designed to be Simple, Accurate and Efficient
The conventional prosthetic workflow using traditional impression taking, casting and waxing techniques
can lead to inconsistent impression quality due to human errors. This can result in poor clinical and
esthetic outcomes and time-consuming adjustments during seating. Digitalizing these processes can
improve this situation from both a professional and business perspective.
From the intra-oral scan to the final restoration
Straumann offers a new and complete digital workflow for implant restorations. Starting with an intra-oral
scan of the implant site, the customized Straumann® CARES ® Abutment or full contour crown is designed
to provide accuracy together with time and cost efficiency through the whole restorative procedure.
This kind of digital workflow for implant restorations eliminates cumbersome and time-consuming manual
steps in dental practice and in the laboratory. Digital impressions allow immediate quality control by
the dentist, and result in an excellent impression being sent to the laboratory. The workflow therefore
eliminates or reduces impression retakes and restoration remakes, ensuring that seating appointments
are efficient due to the excellent occlusion and contact-points of the restoration.
Straumann® CareS® digital SolutionS
deNTiST
Scan the scanbody directly on the implant
with iTero™ intra-oral scanning and send
the digital data to your partner laboratory.
LABOrATOrY
Design the customized Straumann® CARES®
Abutment in Straumann CARES Visual and
send data to the Straumann milling center
for production.
LABOrATOrY
Finalize the restoration using the highprecision Straumann® CARES ® Abutment,
iTero™ model, Straumann Repositionable
implant analog, and full contour crown.
deNTiST
Serve patient with high-quality customized
restoration designed to provide optimal
function and esthetics.
STARGET 1 I 12
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Straumann® CareS® digital SolutionS
3M™ eSPe™ LAvA™ ULTiMATe reSTOrATive
A New Dimension for Dental Materials
3M ESPE and Straumann have partnered up to offer a
to internal structures between 1 and 100 nanometers in di-
new CADCAM restorative material, 3M™ ESPE™ Lava™
mension, defining the nano world. In comparison, a human
Ultimate Restorative, through Straumann® CARES ® Digital
hair is about 200,000 nanometers in diameter, and a typical
Solutions. The material is based on Resin Nano Ceramic
virus is about 100 nanometers long, a size which is at the
(RNC) technology, defining a new material class that com-
outer boundaries of nanotechnology. As size is decreased to
bines the benefits of ceramic based on true nano techno-
nanoscale dimensions, physical properties, e.g., optical cha-
logy and highly cross-linked resin.1
racteristics, get altered, especially when size nears the molecular scale, meaning < 5 nm. These unique properties are in
Entering the field of nanotechnology
the focus when research starts its innovative work to achieve
The field of nanotechnology has expanded dramatically as
materials with greatest efficiencies. In the dental field, 3M™
nanostructured materials exhibit unique properties on the ma-
ESPE™ Lava™ Ultimate Restorative offers an advanced den-
croscale that offer high-potential technological benefits. Typi-
tal material designed and engineered to be tooth-like and to
cally, the critical properties of nanomaterials are attributable
deliver workflow advances.
Human hair: Ø 200,000 nm
1
Virus: Ø 100 nm
3M™, ESPE™, Lava™, Ultimate Restorative is available with release of Straumann® CARES ® Visual 6.2
Nano particle: Ø 1-100 nm
Straumann® CareS® digital SolutionS
STARGET 1 I 12
Straumann® CARES® Restoration made of 3M™ ESPE™ Lava™ Ultimate Restorative. Courtesy of 3M ESPE Ag.
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MATeriAL deScriPTiON
3M™ ESPE™ Lava™ Ultimate Restorative is a Resin Nano Ceramic containing approximately 79 %
surface-modified nanoceramic particles. The ceramic particles are made up of three different ceramic fillers
(of silica and zirconia) ranging between 4 and 20 nm that reinforce a highly cross-linked polymeric matrix.
The ceramic fillers are a combination of:
Silica filler: non-agglomerated/non-aggregated, 20 nm
Zirconia filler: non-agglomerated/non-aggregated 4 to 11 nm
Zirconia/silica cluster filler: aggregated, comprised of 20 nm silica and 4 to 11 nm zirconia particles
According to 3M ESPE
Bonded zirconia/silica nano particles clustered and surface treated in a proprietary process. Courtesy of 3M ESPE AG.
Straumann® CareS® digital SolutionS
rNc – A New MATeriAL cLASS
3M™ ESPE™ Lava™ Ultimate Restorative is a new CADCAM material based on Resin Nano Ceramic
(RNC) technology, which is defined as a new material class. RNCs consist of nano ceramic components
embedded in a highly cross-linked polymeric matrix. The true nanotechnology imparts excellent esthetics,
strength and wear resistance. Using RNC technology 3M™ ESPE™ Lava™ Ultimate Restorative is designed
to support a streamlined, flexible workflow.
»
Brilliant esthetics – Resin Nano Ceramic for lasting polish
The physical properties of 3M™ ESPE™ Lava™ Ultimate Restorative make this material very similar to
the natural translucency and fluorescence of the teeth in its behavior. The Straumann® CARES® Restorations
made of it have a glossy appearance when delivered. An easy polishing step taking less than 4 minutes
makes the restoration highly brilliant.
»
10-year limited warranty* – Designed to be durable for reliable restorations
The high flexural strength and fracture toughness of the 3M™ ESPE™ Lava™ Ultimate Restorative material
make it a strong one-piece restoration. It is not brittle, allowing for chipping-free restorations. The material
properties make it possible for the Straumann milling centers to produce thin and minimally invasive
restorations, which also open up new treatment possibilities.
» Maintains functional balance – Absorption of chewing forces and less wear to opposing enamel
The nanoceramic technology makes it very kind to the opposing tooth regarding abrasion. 3M™
ESPE™ Lava™ Ultimate Restorative absorbs chewing forces and brings a new quality to all single tooth
restorations.
iMPrOved wOrkfLOw ThrOUGh AdvANTAGeS iN PrePArATiON ANd hANdLiNG
The high efficiency of the workflow made possible with 3M™ ESPE™ Lava™ Ultimate Restorative is of
special interest for both dental labs and dental practices.
*If all the conditions of the Straumann Guarantee® are fulfilled and if the material is used in strict compliance with approved
indications and instructions for use of 3M™ ESPE™.
STARGET 1 I 12
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»
No further processing or firing
Once the Straumann ® CARES ® Restorations made of 3M™ ESPE™ Lava™ Ultimate Restorative are milled
and delivered to the dental professional – no firing is required before being seated. The restoration can
be polished, characterized with light-cured restoratives, and the anatomy can be changed by addingon or build-up. The abolition of the firing step specially emphasizes the new material category RNC of
3M™ ESPE™ Lava™ Restorative.
»
Easy adjustment. Adjustments and customizations can be carried out extra-orally or intra-orally with
light-cured composite, such as 3M™ Filtek™ Supreme xTE Universal Restorative / 3M™ Filtek™ Ultimate
Universal Restorative, for excellent esthetic match.
»
Benefits for dentists, dental labs and patients. Straumann® CARES ® restorations made of 3M™
ESPE™ Lava™ Ultimate Restorative deliver esthetics without the requirement of further processing steps.
They offer advantages across the dental workflow which are of true benefit to dentists, dental labs and
patients. 3M™ ESPE™ Lava™ Ultimate Restorative offers high control and efficiency.
STrAUMANN – SPeciALiST iN cAdcAM PrOSTheTicS
The new 3M™ ESPE™ Lava™ Ultimate Restorative is indicated for single tooth restorations and can only
be processed by using modern CADCAM technology. 3M ESPE and Straumann have partnered up
to offer 3M™ ESPE™ Lava™ Ultimate Restorative, through Straumann ® CARES ® Digital Solutions. The
backing of Straumann as a reliable provider supports the opportunities this material offers through highlevel milling expertise and qualitative prosthetic outcomes. New treatment options are possible using
3M™ ESPE™ Lava™ Ultimate Restorative via the Straumann milling centers – specialists in CADCAM
prosthetics.
For more detailed information on 3M™ ESPE™ LAVA™ Ultimate Restorative, please go to website http://solutions.3m.com/wps.
portal/3M/en_US/3M-ESPE-NA/dental-professionals/products/category/digital-materials/lava-ultimate/.
3M™, ESPE™, Lava™, Filtek™ are trademarks of 3M or 3M ESPE AG.
Straumann® CareS® digital SolutionS
STARGET 1 I 12
BeNefiTS fOr deNTiSTS, deNTAL LABS ANd PATieNTS
1. DATA DIgITALIzATION
4. PROCESSINg / POLISHINg
Multiple data sources with Straumann ® CARES ®
Digitalization of patient situation with various scanners, the
intraoral scanners iTero® or Lava™ C.O.S. and the Straumann®
CARES ® Scan CS2 desktop scanner.
No firing required after milling
An additional polish makes the restoration highly brilliant.
2. DESIgN
5. SEATINg
Validated workflow through Straumann CARES Visual
Quality and predictability of the validated workflow via the
specific Straumann software applications.
Easy adjustment
Adjustments and customizations can be carried out with lightcured composite.
3. PRODUCTION
6. PATIENT
Straumann CARES restorations in high Straumann quality
Thin and minimally invasive restorations made of 3M™
ESPE™ Lava™ Ultimate Restorative via the Straumann
milling centers.
Less wear to opposing enamel
3M™ ESPE™ Lava™ Ultimate is not brittle, allowing for chipping free restorations. It shows no abrasion or opposite tooth
damage.
ShAdeS AvAiLABLe
Eight shades available, four of which include high translucency
HIGH
Transluscency
LOW
Transluscency
A1
Courtesy of 3M ESPE AG
A2
A3
A3.5
B1
C2
D2
Bleach
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Straumann® CareS® digital SolutionS
iNTerview
Scanning 2.0: Digital Impression-Taking
with iTero™
Straumann® CareS® digital SolutionS
STARGET 1 I 12
An interview with Michael Rynerson, Straumann Global Head
Straumann implants. True to the motto of our digital portfolio
of iTero™ Sales, on the iTero™ intraoral scanning system.
“Seamless Connections,” Straumann will now take the next
step together with our customers. The new digital workflow
How do you view the market acceptance for a system such
is the basis for increasing efficiency and quality, and
as itero?
facilitates the cooperation between surgeons, dentists, and
Interest in digital impression-taking is truly tremendous. In
dental laboratories significantly. We view digitalization as
particular, we have experienced this at congresses where the
a pronounced added value for customers at every stage of
system is demonstrated live. Commercially, the iTero system
the workflow.
with its highly developed 3D technology has gained a leading
position in the USA. We also enjoy widespread interest from
dentists and dental laboratories across Europe, where we
“The role as a center of digital competence makes
have achieved a leading position in intraoral scanning in
the laboratory an important partner for the dentist.”
some markets. There are a number of good reasons for
Michael Rynerson
deciding in favor of iTero: user-friendliness, precision, and
efficiency – also in terms of time and costs. Of course there
is an emotional element too – many of our customers are
Can you explain digital workflow for implants in more detail?
passionate about adopting great new technologies for the
Following the recovery period, a scanbody is screwed onto
benefit of their patients.
the implant. The dentist scans the scanbody and the adjacent
teeth in sequence and immediately sees on the screen the
What role does itero play in the Straumann portfolio?
completed digital impression. The scanbody provides the
Intraoral scanning is an integral part of our digital portfolio
necessary data on the position of the implant in the scan.
because it is the most direct link between the restorative
Then the data is forwarded to the laboratory for the design of
dentist, the laboratory, and our CARES production centers.
the customized Straumann CARES abutment in CARES Visual.
Our focus is on solutions which enable our customers to offer
The laboratory sends the production data to Straumann
their patients the best possible treatment available on the
for fabrication of a CARES custom abutment, and orders a
market. The advantages of iTero make intraoral scanning a
precision-milled iTero™ model from an iTero Regional Milling
key technology in dentistry and, thus, of interest to all dental
Center. The laboratory orders a Straumann Repositional
professionals.
Implant Analog that fits into the iTero model.
are there any innovations especially for implantologists?
are dental laboratories also a target group for itero?
®
As an innovative company, Straumann has developed a
In most cases modern dental laboratories are already centers
complete digital workflow, from intraoral scans to Straumann
®
of competence for digital technology – with CADCAM
CARES ® copings and crowns, to customized abutments for
being a top subject for some time now. This role as a center
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Straumann® CareS® digital SolutionS
of digital competence makes the laboratory an important
What does the future hold in your opinion?
partner for the dentist. Thus, the iTero™ system also offers the
For me it is not a question of will the majority of dentists
dental laboratory new service opportunities. This is of special
work predominantly with intraoral scanners, but when will
value because cooperation is closely linked via the intraoral
this become reality. We have all seen a similar revolution
scan workflow.
in photography. Who still uses film cameras these days?
Popular smartphones are another good example of how
are there other possibilities for using itero as part of the
digital impression technology will evolve. iTero is comparable
digital workflow?
to smartphones in so far as it is a platform for a range of
We are presently uniting the various workflows to provide
dental services that can be expanded through the installation
optimum compatibility. For example, our surgical planning
of new software applications. If you will, iTero™ is an
software, the Straumann Guided Surgery System, combines
extremely precise digital 3D camera with which dentists can
the DVT and CT information on the bone situation to a 3D
already cover a wide range of restorative and orthodontic
image for implant planning. Even today, we can already
indications today. Future developments of the software and
combine such data sets with intraoral scanning information
connected services will generate added value. In short,
to provide better documentation on the bone, soft tissue and
if somebody purchases an iTero™ scanner today, they
tooth situation. This allows improved surgical and prosthetic
should have confidence that it will continue to gain in value
planning.
through software innovations. The system already generates
®
considerable added value, we are only really at the beginning
Cadent, the manufacturer of itero, is part of align
of this technology – the development potential for the next
technology as of april 2011. What are the implications?
few years is enormous. For example, in future one could well
Align Technology is a heavyweight in the orthodontic industry
imagine taking 3D “snapshots” of patients at their first visit
and includes invisalign™ in its portfolio, a well-known and
and after subsequent treatments. Thus, dentists could not only
widely used digital service for orthodontic treatments.
document tooth situations in a digital manner, but would be
Therefore Align truly understands digital dentistry, as well
better able to assess future developments in the patient’s oral
as knowing the needs of dental professionals, making them
condition. Today, dentistry is still very reactive in many cases
an ideal new home for the iTero™ technology. Furthermore,
– using digital tools dental professionals will be able to be
because Straumann is the exclusive distribution partner for
much more proactive.
iTero™ in Europe, and, since February of this year, also official
distribution partner for iTero™ in North America, Straumann is
one of the closest and most important partners of Align. Our
cooperation to date with Align has been superb and we are
enthusiastic about continuing our partnership.
Straumann® CareS® digital SolutionS
STARGET 1 I 12
iNTrA-OrAL ScAN viA iTero™
The highly advanced intraoral scanner iTero
utilizes parallel-confocal 3D imaging and is
thus 100 % powder-free and autofocus. Both
features allow the dentist to place the scanning
head directly on the teeth to take a series of
3D images which are combined into a precise
3D representation of the patient’s teeth. This
provides stable handling as well as high precision and is often more pleasant for the patients
than conventional methods. iTero guides the
treating professional from tooth to tooth, similar to an automobile navigation system. The
scanner is not only easy to operate, but also
inspires patients as they can follow every step
on the screen.
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DID yOU KNOW?
Straumann is the #1 dental implant system worldwide
reStorative
STARGET 1 I 12
ALL-cerAMic reSTOrATiONS
Straumann ® Anatomic IPS e.max ® Abutment
by Straumann ® and Ivoclar Vivadent ®
Combining Outstanding Properties – Now Available for NC
of a custom restoration in combination with the flexibility and
Straumann is the partner of choice for innovations in implant
predictability of a stock abutment.
and restorative dentistry. Ivoclar Vivadent is the established
specialist in ceramic materials and final restorations. The
High-end esthetics: all-ceramic zirconium dioxide (ZrO2)
synergy of technologies has resulted in a premium esthetic
material in two shades for natural-looking restorations.
solution: the Straumann Anatomic IPS e.max Abutment, now
Effectiveness: pre-shaped abutment, straight and angled
also available for Narrow CrossFit ® (NC).
design in two gingival heights for cost-efficient restoration.
Predictability: Straumann Anatomic IPS e.max Abutment –
Esthetics by Design
strong connection between the implant and the restoration.
Designed by Straumann and produced by Ivoclar Vivadent
Flexibility: modifiable abutment (chair-side and lab-side) for
to fit a range of patient needs, this abutment is specifically
screw-retained and cemented all-ceramic restorations.
intended for reliable use and esthetic results and offers great
flexibility in its application. It gives you the high-end esthetics
Now also available for Straumann® Narrow CrossFit ® (NC) Bone Level implants
Color: white (MO 0)
Article No.
022.2812
022.2814
022.2822
022.2824
022.2832
022.2834
022.2842
022.2844
GH 2 mm
GH 3.5 mm
GH 2 mm
GH 3.5 mm
Color: Shaded (MO 1)
Article No.
43
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STARGET 1 I 12
reStorative
Screw-retained full ceramic restorations
Cemented full ceramic restorations
»
»
individualized emergence profile
directly veneered
»
»
overpressed
cemented
The abutment serves as an excellent basis for cost-efficient
restorations for those clinicians looking to transition into the
all-ceramic world of dental restorations.
»
»
»
»
Different shades
Different gingival heights
Straight and angled
RC and NC
shaded (MO 1)
IPS e.max ® is a registered trademark of Ivoclar Vivadent AG, Liechtenstein.
white (MO 0)
reStorative
STARGET 1 I 12
cOrBiN PArTridGe ANd BreNT GArriSON
Immediate Full Mouth Restoration Using Implant-Supported
Fixed Hybrid Prosthetics
Initial Situation
maxilla using the implant planning software. Four Straumann®
A 49-year-old woman with an unremarkable medical history
Bone Level implants1 were planned for the maxilla and four
presented for a full mouth extraction. Severe periodontal
Straumann® Soft Tissue Level implants2 were planned for the
disease was present in addition to mobile teeth and noted
mandible (figs. 3, 4). The posterior implants in the areas
bone loss (figs. 1, 2). She indicated that she wanted to
of #14 and #25 were angled to avoid the sinus and still
have an implant-supported fixed prosthesis in order to avoid
provide for first molar occlusion in the final prosthesis. A
having to wear traditional dentures long term.
guided surgical stent was then ordered through the software
for the maxilla. The referring office supplied the immediate
Treatment Plan
denture prior to surgery. The patient was scheduled for surgery
A CT scan was performed and converted into implant
approximately one month after the second consultation to
planning software. Upon examination of the CT scan and
allow for creation of the stent and immediate dentures.
reconsultation with the patient, it was determined that four
implants in each arch would be placed to support a fixed
Surgical Procedure
prosthesis. Using the converted scan, the implant sizes and
The initial phase of the surgery involved removing all of the
locations were planned for both the mandible and the
existing teeth with the exception of the #38 and #48, due
Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
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46
STARGET 1 I 12
reStorative
to nerve involvement. The patient was sedated and the teeth were extracted as
atraumatically as possible. Once the teeth were removed, the maxillary arch was
exposed and the surgical stent was secured to the maxilla. The osteotomies were
performed through the guide using a Straumann® Guided Surgical Kit with a
final drill diameter of 3.5 mm (fig. 5). Stabilization pins were used to secure the
stent while other osteotomy sites were prepared. The four Straumann ® Bone Level
implants were then placed with primary stability using a hand piece at 35 Ncm
(fig. 6). Sutures were used for ridge closure in a continuous and interrupted fashion.
Corbin G. Partridge, DMD
Attention was then directed to the mandible, where osteotomies were performed
Oral and maxillofacial surgeon. Full-time private
in the areas of #36, #33, #43 and #46. The Standard Plus implants were placed
practice at Northeast Oral and Maxillofacial
in the anterior sites #33 and #43. The Regular Neck Tapered Effect implant
Surgery in Indianapolis, Indiana. He has published
was placed in the area of #36 and the Wide Neck Tapered Effect implant was
several papers in both the Journal of Oral and
placed in the area of #46 (fig. 7). All implants were placed with primary stability
Maxillofacial Surgery and the Journal of the Indiana
using a hand piece at 35 Ncm. No sutures were required as the mandibular ridge
Dental Association. He served in the U.S. Army as
was not exposed.
the Executive Officer of the Head and Neck Surgery
Team with the 47th Combat Support Hospital in
Mosul, Iraq during Operation “Iraqi Freedom“
2005 – 2007. He is an ITI member.
[email protected]
Fig. 7
Fig. 8
Fig. 9
Fig. 10
reStorative
STARGET 1 I 12
Prosthetic Procedure
Immediately after the implants were placed, impression posts were attached and
impressions of both arches were taken. After the impressions were taken, healing
caps were placed on all implants, the impressions and immediate dentures were
sent to the lab, and the patient left the office. Using the impressions, the lab
converted the immediate dentures into screw retained immediate prostheses, which
were heat cured overnight (figs. 8 – 10). The patient returned to the office the next
day for placement of the provisional prostheses. The healing caps were removed
Brent T. Garrison, DDS, MSD
and the appropriate abutments were placed. The maxillary prosthesis was placed
Oral and maxillofacial surgeon. Full-time private
over the abutments and attached using four screws, with the mandibular prosthesis
practice at Northeast Oral and Maxillofacial Surgery
fixed in a similar fashion (figs. 11, 12). The patient’s bite was adjusted using a
in Indianapolis, Indiana. He has published several
handpiece with a denture bur. Once the adjustments were finished and the patient
articles and given numerous presentations on all
was satisfied with her bite, a temporary filling material was placed in the screw
aspects of oral and maxillofacial surgery. He has
holes of the prostheses and final x-rays were taken (figs. 13 – 17). The patient was
served terms as President of the Great Lakes Society
given instructions for post-op hygiene and told not to chew for eight weeks to allow
of Oral and Maxillofacial Surgery, the Indiana
Society of Oral and Maxillofacial Surgeons and the
Indianapolis District Dental Society. He is Assistant
Clinical Professor of Oral and Maxillofacial Surgery
at the Indiana University Medical Center. He is an
ITI member.
[email protected]
Fig. 11
Fig. 12
Fig. 13
Fig. 14
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STARGET 1 I 12
48
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for proper integration, after which a limited soft-chew diet was recommended. This
is recommended due to the limited strength of the provisional prostheses, which
serve a more esthetic rather than functional purpose.
Outcome
The patient returned to the office for her one week check, and was healing
well. She will wear the provisional fixed prostheses for approximately six months,
allowing the ridges to form fully and heal. At this time, she will return to the office
for final impressions, which will be used by the laboratory to create the permanent
bar retained prostheses. Combining the milled bar-retained prostheses with the
splinted Straumann® SLActive ® implants will result in a strong and permanent
alternative to traditional dentures.
1
4x Straumann® Bone Level Implant RC Ø 4.1, 12 mm SLActive.
2
2x Standard Plus RN Ø 3.3, 12 mm
SLActive/1 x Tapered Effect WN Ø 4.8, 12 mm WN/1 x Tapered Effect RN Ø 4.1 x 10 mm)
Fig. 15
Fig. 17
Fig. 16
SurgiCal
STARGET 1 I 12
50
STrAUMANN ® SLa ctive ®
Updated SLActive Scientific Evidence Brochure
The Straumann SLActive implant surface offers confidence in all treatments thanks to its unique properties of hydrophilicity
and chemical activity, which help to accelerate the osseointegration process.1 The excellent osseoconductive properties of
the SLActive surface have been supported by numerous preclinical and clinical studies.
Now clinicians can access the updated SLActive Scientific Evidence Brochure to review some of the key scientific studies
supporting the SLActive implant surface. The newly available and updated version of the SLActive Scientific Evidence Brochure
features summaries of 14 preclinical and 7 clinical studies on SLActive. A few new clinical studies from this information-rich
brochure are highlighted below. If you wish to have an SLActive Scientific Evidence Brochure sent to you, please contact your
local Straumann territory manager or contact the Straumann Customer Service team at 800/448 8168.
A prospective study on 3 weeks loading of chemically modified
Early loading of nonsubmerged titanium implants with a
titanium implants in the maxillary molar region: 1-year results
chemically modified sand-blasted and acid-etched surface:
M. Roccuzzo, T.G. Wilson Int J Oral Maxillofac Implants 2009;24:65–72.
6-month results of a prospective case series study in the
posterior mandible focusing on peri-implant crestal bone
Abstract: SLActive
®
implants were placed in the posterior
changes and implant stability quotient (ISQ) values
maxilla, which tends to have lower bone density, and loaded
Bornstein MM, Hart CN, Halbritter SA, Morton D, Buser D.
after 3 weeks. Preliminary results suggest no complications
Clin Implant Dent Relat Res 2009;11(4):338-347.
and no early implant failures in this challenging indication.
Abstract: Forty patients received 56 SLActive ® implants,
Conclusions
„„
„„
which were functionally loaded after 3 weeks. Implant
Successful functional loading is possible in the maxillary
stability (ISQ) was measured at various time points for up
molar region after 3 weeks with SLActive implants
to 26 weeks and showed a steady increase from implant
Implant survival was 100 % after 12 months in low
placement to week 26.
density bone
„„
The procedure represents an important step toward faster
healing and increased treatment predictability
Conclusions
„„
Early loading with SLActive implants 3 weeks after placement in the posterior mandible has a low risk for early
failures
„„
1
Compared to SLA in an animal model
Definitive functional restoration after 3 weeks is possible
SurgiCal
STARGET 1 I 12
Early loading at 21 days of non-submerged titanium
A multicenter prospective ‘non-interventional’ study to
implants with a chemically modified sandblasted and
document the use of and success of Straumann ® SLActive
acid-etched surface: 3-year results of a prospective stu dy
implants in daily dental practice
in the posterior mandible
Luongo G, Oteri G. 24th Annual Meeting of the Academy of Osseointegration,
Bornstein MM, Wittneben J-G, Brägger U, Buser D. J Periodontol
February 26-28, San Diego, CA, USA; poster P220. J Oral Implantol 2010;
2010;81(6):809-818.
36(4):305-314.
Abstract: SLActive ® implants were placed in patients and
Abstract:
functionally loaded after 21 days; clinical and radiographic
conducted, in which 276 SLActive implants were placed and
parameters were evaluated for up to 36 months. No implants
documented in 218 patients according to situations where
were lost and clinical attachment levels and probing depths
implants would normally be placed. After 1 year the survival
were improved versus historical SLA
®
controls.
A
multicenter
non-interventional
study
was
and success rate was 98.2%, similar to that observed in
strictly controlled clinical trials.
Conclusions
„„
„„
Early loaded SLActive implants can achieve and maintain
Conclusions
successful tissue integration over 3 years
„„
The 1-year cumulative survival and success rate was 98.2%
The procedure offers rehabilitation with a definitive resto-
„„
All failed implants were associated with a simultaneous
ration after 3 weeks, increasing cost-effectiveness for the
patient
„„
sinus floor augmentation procedure
„„
The success rate of SLActive implants in daily practice is
Loading after 3 weeks can be recommended in defined
similar to that observed in formal clinical trials with strictly
clinical situations for standard sites without bone defects
controlled patient populations
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international team for implantology
Straumann & Baylor University Launch the
First Interdisciplinary Digital Dentistry Course
On July 29-30, 2011, twenty-four dental professionals braved the Dallas, Texas drought and 100+
degree temperatures to learn about the digital dentistry workflow at Baylor University’s College
of Dentistry.
Over the course of two days, the participants—comprised of clinicians and lab technicians—learned
about where the dental world is headed and how interdisciplinary digital dentistry will continue to play
a larger part in their practices and labs. The course, cosponsored by Straumann, was designed for
the interdisciplinary team (surgeon, restorative dentist and lab technician) to attend and learn about
the different digital technologies available to each member of the team, and to understand how each
team member and their technology plays a role in achieving optimal patient care and esthetic results.
Participants were exposed to all of the links in the digital dentistry chain, including Straumann Guided
Surgery Planning Software, the gonyx table, the iTero scanner, and the CS2 scanner.
It was a jam-packed two days, filled with lectures, case presentations and hands-on sessions.
Participants learned how to treatment plan implant cases with the Straumann Guided Surgery treatment
planning software and how a radiographic template and surgical guide can be made with precise
accuracy on a gonyx table. They also experienced firsthand how to take an intra-oral impression with
an iTero system and how to open an iTero file into the CS2 CADCAM scanner and design a coping,
abutment or crown.
It was an excellent course, and many of the attendees left excited to start incorporating digital dentistry
into their practices.
The advice from previous attendees is to register as a team- many who came alone said they wished
they had brought their interdisciplinary team members.
Baylor will host this course again July 27-28, 2012. If you are interested in learning more about
the Interdisciplinary Digital Dentistry Courses, please contact the Straumann Education Department at
800/448 8168 and press 5, or register on the Baylor CE website at: http://www.bcdce.com/courses/
course/category.php?id=2
international team for implantology
STARGET 1 I 12
ITI Membership Tops 10,000
Basel, Switzerland – The International Team for Implantology
strong demand by colleagues for evidence-based education
(ITI), a leading academic organization dedicated to the
and treatment guidelines that are delivered independently of
promotion of evidence-based education and research in the
commercial interests.“
field of implant dentistry, announced on October 17, 2011
that it had welcomed its 10,000th member. This achievement
“I heard about the ITI several years ago and since then traced
marks another milestone in the 31-year history of the ITI.
its activities,“ said Dr. Shand. “After attending several ITI
education courses in Melbourne and working with a number
This growth is due in large part to the recently launched
of esteemed ITI Fellows in Australia including Dr. Anthony
ITI Study Club concept, which has evoked an overwhelming
Dickinson and Dr. Stephen Chen, I was immediately drawn
response around the globe. Exceeding its own expectations,
to becoming a member of this global organization with its
the ITI to date has established more than 500 Study Clubs on
wealth of benefits that will significantly enhance both my
every continent. Free participation in ITI Study Clubs as part
professional activities and international perspectives.“
of the annual benefits package has proven to be a significant
membership value. ITI Study Clubs are characterized by an
Established in 1980 by a small group of visionary pioneers
approach to learning through presentations and interactive
led by Prof. Dr. André Schroeder and Dr. Fritz Straumann, the
discussion in relatively small groups at a local level. They
ITI has championed the cause of implant dentistry since the
represent an efficient platform from which to disseminate and
early days, playing a continuous role in its development to
exchange knowledge on the latest treatment approaches in
the present day. Today, the organization has a true global
implant dentistry.
presence through its 27 national or regional Sections. The
ITI takes a leading role all over the world in continuing
The 10,000th member of the ITI is Dr. Jocelyn Shand, a
dental education and the development of standard treatment
well respected Oral & Maxillofacial Surgeon from the Royal
methods to ensure reliable outcomes. In addition, the ITI is the
Children’s Hospital, University of Melbourne and President
largest non-governmental organization worldwide to award
of the Australian & New Zealand Association of Oral &
research grants in implant dentistry.
Maxillofacial Surgeons. She was welcomed personally by
the ITI President Prof. Dr. Daniel Buser and the leadership
The ITI welcomes all appropriately qualified professionals with
team of the ITI Section Australasia.
an interest in implant dentistry as members of the organization.
Membership of the ITI offers a wealth of benefits and the
“We are very pleased with the current membership
highest quality educational support as well as the opportunity
development and the opportunity to welcome our 10,000th
to meet likeminded professionals through the extensive event
member,“ said Prof. Buser. “The continued growth of the
schedule. Dental practitioners who are interested in finding
ITI, which is a result of the systematic implementation of our
out more or joining the ITI should go to www.iti.org.
strategic Vision 2017 developed in 2007, is a clear sign of the
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Simply doing more
deNTiSTrY ON The MOve
Global Trends – Setting the Pace of Innovation
and Progress in Dentistry
Simply doing more
Where are We Headed?
How will the world’s demographics, technologies and economies develop in the future? Will these
developments impact implantology, dentistry and the other related medical disciplines? The answers
to these questions determine how Straumann designs our products and services, and how we drive
innovations. Perhaps the most globally influential trend is the aging population and the attendant need
for health services, including restorative dentistry. Practices of the future will look different than those
of today.
In the Beginning, There Was Titanium
In the 1970s, the discovery of titanium’s osseointegrative properties and high compatibility with the
human body led to the development of dental implants for the replacement of lost teeth and anchoring
of prostheses. Key advantages of implants over conventional denture techniques allowed manufacturers
and specialized dentists to develop a new discipline of dentistry, which has since evolved into today’s
standard treatments with restorative dentistry.
The Excitement Continues
Nearly forty years after discovering the osseointegration of titanium, we are entering the next quantum
leap in dentistry: the digitalization of restorative dentistry. This will have tangible effects on the way
we look at various occupations and, in turn, how dental experts work together. New products and
innovations are constantly developed, potentially leading to new treatment opportunities.
STARGET interviewed three prestigious dental specialists on trends and new technologies in restorative
dentistry: lyndon Cooper, Kenneth malament and daniel Wismeijer.
STARGET 1 I 12
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Simply doing more
restorations on a metal frame? Zirconia? What if the patient
only has enough bone for 6 mm implants? Should we graft
LYNdON cOOPer
Stallings Distinguished Professor,
Professor & Chair, Dept. of
Prosthodontics; University
of North Carolina School of Dentistry
bone and place 8 mm or 10 mm implants, or is 6 mm enough?
I’m not suggesting there is only one answer, but together the
profession and industry can use evidence to determine which
therapies provide maximum return on patient investment with
a minimal number of interventions and components.
What about standards for products?
How can the implant industry serve its customers better?
One implant system rarely covers everything, so you may
Implant therapies are evolving rapidly, yet dentists with
need at least two different systems. There may be some value
mature practices learned little about implants in dental school
in diversity. However, I also see value in having evidence
10 years ago. The industry must continue to help educate
based standards and shared criteria that reflect clinical
dentists. There needs to be an ethical discussion between
outcomes. It would be good to have efficacy data for implants
the industry and the profession about standards in product
tested six to 12 months before a product is sold. The drug
testing, documentation and training. Finally, the industry truly
industry gathers data after the product has been introduced.
serves both patient and dentist by providing clinical data
That model might work for our very fast product evolution.
about the products. How many implants failed? We clinicians
care and need to know.
Have we reached the limits in osseointegration?
We continue to improve the osseointegration potential of
implants, but we still must learn to identify high risk patients
“The industry must continue to help educate den-
and develop successful strategies for them. From a broader
tists. There needs to be an ethical discussion be-
perspective, our knowledge of how soft tissues integrate
tween the industry and the profession about stan-
with the abutment is very immature. We need new scientific
dards in product testing, documentation and train-
understanding so we can get healthy soft tissue integration
ing.“ Lyndon Cooper
that protects the underlying bone, stays free of inflammation
and looks natural.
Will dentistry develop standards of care?
is peri-implantitis a latent epidemic?
Simplification and standardization can improve the quality of
We don’t know; we don’t fully appreciate its incidence or
care. For example, what possibilities exist for an edentulous
prevalence. We must acknowledge its presence and dentists
maxilla – four, six or eight implants? Ceramic or acrylic
must evaluate implants regularly for inflammation and act
appropriately. Does the inflammation begin at the implant
Simply doing more
STARGET 1 I 12
surface, at the implant-abutment interface, or at the abutment
complex restoration of defects. These three developments
itself? The solutions could be very different.
really open the door for tremendous growth in implant
dentistry.
How has the economic crisis affected dentistry?
US laboratories are making fewer crowns and veneers, while
What will the relevance of prosthodontics be in the future?
removable and complete denture volume is less affected,
As we move to smarter, more capable technologies, we need
suggesting that people still need teeth but they have adopted
better understanding of how to create occlusion, form, color,
a cost-conscious attitude. The growth of implant sales has
and natural esthetic appearance within the whole mouth.
been slower since 2008. The growing debate about
These are the concerns of the specialty of prosthodontics,
nationalized healthcare in the US is fueling new discussion
and I am very confident in its future.
about access to dental care.
“Preventive dentistry is more successful than ever
before, but many people don’t go to a dentist regularly, and their mouths show the usual levels of
decay and periodontal problems.“ Kenneth Malament
keNNeTh MALAMeNT
Clinical Professor of Postdoctoral
Prosthodontics, Tufts School of Dental
Medicine, Boston
Will better prevention reduce the need for prosthodontics?
I don’t think so. Preventive dentistry is more successful than ever
before, but many people don’t go to a dentist regularly, and
their mouths show the usual levels of decay and periodontal
problems. Also, people are still affected by accidents
and disease. Dental restorations break and cause serious
problems. In my practice, I haven't seen any diminution of
What have been the most significant developments in
required care.
prosthodontics in the past two to three years?
Digital scanning equipment and software continues to improve.
are the products coming onto the market adequately tested?
Then, for the very first time a material, lithium disilicate, has
No. Look at the whole cosmetic dentistry concept, where people
shown no signs of breakage over 2½ years. This monolithic
were putting plastics on everything and considering it conventional
material can be CADCAM’d to full contour in one step,
and thorough and long-term successful dentistry. Bacteria grow
unlike the bilayer materials. Finally, bone grafting materials
on and within resinous materials, and can cause serious
and techniques have significantly improved, allowing more
breakdown when they attack tooth structure. Recent research
on how ceramic materials flex and fracture has completely
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Simply doing more
changed the way we understand the mechanics and strength
of ceramic materials. As we develop new materials, we must
dANieL wiSMeijer
understand and test them better.
Professor & Chairman, Dept. Oral
Function & Restorative Dentistry;
are high-end esthetics out of reach for the average patient?
Head, Oral Implantology & Prosthetic
Right now, access to great esthetics is limited by the supply of
Dentistry Section, Academic Center
great dentist/technician teams. As we move to smart systems,
for Dentistry, Amsterdam (ACTA)
the expertise of the best practitioners will be built into the
software. I think CADCAM dentistry will eventually drop the
price of dentistry, but I’m not sure when.
do you think all of dentistry is going to become digital?
A dentist’s work is two-fold: handicraft and oral medicine. It
will be a while before we digitize interaction with the patient,
“As we move to smart systems, the expertise of the
looking at the medical and psychological background,
best practitioners will be built into the software.“
diagnosis, and individual treatment design. On the handicraft
Kenneth Malament
side, digital radiography improves diagnostics and reduces
chemical
waste.
Starting
with
oral
scanning,
digital
articulators and planners will replace physical models,
What major advances do you expect in the near to mid
and the whole workflow will become digital, ending in
term?
CADCAM production. Once we get good light images of
Low-radiation, noninvasive CT scanning for all dental
the teeth, a machine will also produce the prosthesis in the
impressions while the patient sits in a chair. Spectrophotometric
right color.
color analysis will help design the whole mouth on a giant
computer monitor.
is digitalization the most important trend in dentistry now?
It’s where things are happening. Virtual implant planning
Has the economic crisis had an effect on prosthodontics?
is getting more precise, and computer manufacturing of
No. The companies that will win in the next 10 years are
prosthetics is getting simpler than the casting method. We
those that best integrate the technologies and educate
can design the treatment digitally (site, position, implant type,
dentists and technicians. The real explosion will come from
superstructure) and insert the implants plus superstructure
well-funded industrial giants who are very active players
in one treatment sequence with a fault margin of 40 μm
within the story.
– the width of the thinnest human hair. Everything is more
controllable, and if something doesn’t fit during the digital
design phase, we can correct it before it reaches the patient.
So the digital environment is going to be very important.
Simply doing more
STARGET 1 I 12
What do you see as the biggest risks in digital dentistry?
What sort of innovations can we expect in the next years?
We will become more dependent on commercial software.
Improved navigation, so the dentist can monitor inside the
Some jobs will be lost. In order to rely on machines and
bone and teeth as he or she works. Apparatuses that convert
software, the safety standard must be very high. And in order to
hand movements into very small precise machine movements
rely on internet communication, the transmission, security, format
will make micro treatment possible. Finally, I hope companies
and integrity of private medical information must be ensured.
agree on data standards, so all the machines and software
Finally, the machines are not cheap, and it may be a long time
can communicate with each other.
before we can deliver digital dentistry at a lower price.
How will technological changes affect current dentists?
Young graduates will want to practice digital dentistry. Mature
dentists close to retirement face the choice of investing in
new technologies to attract young dentists who will then buy
their practices, or continuing the old way and losing some
of their original investment. There is no choice in between. If
they want to stay in dentistry they will have to invest in new
technologies.
does digitalization get ample attention in dental education?
Students leaving ACTA in a few years will be used to working
with intra-oral scanning, cone beam CT scans, digital
planning, drill guides, and CADCAM. As they join practices,
they will show other dentists the new techniques. We are
lucky that our school is new and so are all the fittings. Many
other schools are looking at what we are doing, but it will
take them time to convert.
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Simply doing more
STrAUMANN Aid: AcceSS TO iMPLANT deNTiSTrY
A Meaningful Contribution to a Different Quality of Life
effecTive ANd PrAcTicAL cONTriBUTiONS
AcceSS TO deNTAL SOLUTiONS
TO SOcieTY
‘Straumann AID’ (Access to Implant Dentistry) is our structured
Providing high quality, safe, effective, and lasting solutions that
global program to assist patients who need implant treatment
restore dental function and enhance the quality of life is perhaps
but are unable to afford it. Through this program, we donate
the greatest contribution we can make to society. In 2009,
all the Straumann products necessary, relying on dentists in
around a million patients spread across 70 countries invested
the ITI network to provide the clinical services without charge.
in a Straumann dental solution, and we have simply done
more to make certain that it will meet their expectations for
SPONSOriNG deNTAL cAre ArOUNd The GLOBe
many years to come.
Our strategy for corporate sponsorship is to concentrate
primarily on charitable activities where we can have the
At the same time, many people around the world are unable to
greatest impact, based on our own competencies and the
benefit from dental care due to geographic and economic
collaboration of our partners. For this reason, we focus on
limitations. As a leader in our industry and as a responsible
dentistry-related programs that help people who do not have
corporate citizen, we believe we have a duty to help in
access to dental care or cannot afford implant dentistry.
a practical, meaningful way. Our aim is to ensure that our
contributions benefit not only the recipients but also, indirectly,
Basic dental care and oral hygiene programs
our other stakeholders.
We continued our tradition of sponsoring charitable missions
and activities that bring basic dental care and education
to the underprivileged. Our contributions in 2009 included
support for the following:
p SDI Secours Dentaire International, treating patients
in Tanzania
p A team of young dentists from the University of Connecticut
Health Center, School of Dental Medicine to provide dental
treatment and oral hygiene to underprivileged children
in Chile
p The ‘Hope for All’ project to sponsor the education of two
dental students in Cambodia
p A team of young dentists from the Dental Institute of
Basel University, to provide dental treatment to orphaned
children in Cambodia
Providing dental treatment and oral hygiene to underprivileged children.
Simply doing more
STARGET 1 I 12
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STARGET 1 I 12
p Three teams of young dentists from the Dental Institute of
Zurich University, to provide dental treatment to children
in the Dominican Republic, Guatemala and the Ukraine
p The Smile Charity Foundation/Korean Universities and
Schools of Dentistry, to improve the oral health of disabled
persons and to provide scholarships in Korea.
In each case the sponsorship goals were met. Thanks to the
assistance of our dental partners, these projects have been
an extremely efficient use of funding and have made a real
difference to hundreds of people, most of whom are children.
We intend to continue our global charitable activities with the
goal of providing access to dental treatment to disadvantaged
people. Although economic downturns frequently result in
reduced charitable giving, we plan to continue our Straumann
The joy of dentistry! One of several hundred children treated through dental
projects sponsored by Straumann.
AID program and to support the National Foundation for
Ectodermal Dysplasia (NFED) and other relief projects. We
will continue to focus our charitable sponsoring on fields
related to dentistry, where we feel we have most to offer and
where our involvement is appreciated by our stakeholders.
Ectodermal dysplasia
Ectodermal Dysplasia (ED) refers to a group of genetic
disorders characterized by abnormal development of the skin
Ectodermal dysplasia patients are typically stigmatized by severely malformed
or missing teeth in addition to other debilitating symptoms.
and associated structures. Patients typically have few teeth and
the teeth they do develop are usually severely malformed. On
average, each ED patient in the US faces dental charges of
$28,000. This is a considerable burden because more than
50% of patients are not covered by insurance. The NFED,
based in Mascoutah, Illinois, is committed to providing help
and hope to families around the globe who are affected by
this condition.
This picture demonstrates the tremendous difference that treatment can make.
STARGET 1 I 12
WE CONTINUE OUR TRADITION OF SPONSORING CHARITABLE
MISSIONS AND ACTIVITIES THAT BRING BASIC DENTAL CARE AND
EDUCATION TO THE UNDERPRIVILEGED.
Today, several thousand individuals affected by ED in more
than 65 countries receive services from the Foundation,
which has provided financial assistance and information, in
addition to connecting affected families with each other and
with practitioners.
Once patients reach adulthood, they can be treated with dental
implants, which make a significant difference. Straumann
provides free implants to ED patients, but these represent a
small portion of the overall treatment costs. We work with
the NFED to expand its network of dental professionals who
provide free services to ED patients; we also support the
foundation with financial aid.
Cleft lips and palates (Clefts)
Cleft lips and palates (clefts) are one of the most common
We contribute to dental relief projects to provide treatment and instruction on
oral hygiene to orphans.
major birth defects in developing countries and occur in
1 in 600 to 1000 births. Despite the fact that surgery is
straightforward, it is not widely available, with the result that
millions of children suffer from unoperated clefts. Although
the condition is not usually life-threatening, patients are
stigmatized by their appearance and have great difficulty
in eating and speaking. Straumann contributes to non-profit
organizations providing free surgery to children with clefts in
developing countries.
On-the-spot treatment in a Straumann-supported dental relief project in Gambia.
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STARGET 1 I 12
Simply doing more
LiTerATUre ALerTS
Selected Literature of Potential Interest from Recently
Published Journals
STRAUMANN ® EMDOGAIN TM
theses after 4 months. Clinical parameters were recorded
after 6, 12 and 24 months and radiographic bone level was
recorded after 2 years. Implant survival was 100 % for all sys-
Casarin RCV, Ribeiro Edel P, Nociti FH Jr, Sallum AW, Am-
tems. Plaque index and peri-implant inflammation scores were
brosano GMB, Sallum EA, Casati MZ. Enamel matrix de-
higher for the Brånemark implants in the first year. Marginal
rivative proteins for the treatment of proximal class II fur-
bone loss around ITI and Astra Tech implants was similar at 2
cation involvements: a prospective 24-month randomized
years (p > 0.05). The marginal bone loss around Branemark
clinical trial. J Clin Periodontol 2010;37(12):1100-1109.
implants was higher than Astra Tech implants (p < 0.05) but
A total of 12 patients with bilateral proximal furcation defects
similar to ITI implants at 2-year recall appointment (p > 0.05).
≥ 5 mm and bleeding on probing were treated with open
flap debridement and EDTA alone (control) or in combination
Nedir R, Nurdin N, Vazquez L, Szmukler-Moncler S,
with EMD (test). Clinical parameters were evaluated prior
Bischof M, Bernard J-P. Osteotome sinus floor elevation
to treatment and after 6, 12 and 24 months. No significant
technique without grafting: a 5-year prospective study. J
differences were observed after 24 months. Probing depth
Clin Periodontol 2010;37(11):1023-1028.
reduction was 1.9 ± 1.6 mm and 1.0 ± 1.3 mm in the test
Osteotome sinus floor elevation was performed without graft-
and control groups, respectively, and the gain in relative
ing in 17 patients (mean residual bone height 5.4 ± 2.3 mm)
horizontal clinical attachment level was 1.4 ± 0.9 mm and
and a total of 25 Straumann SLA® implants (10 mm in length)
0.7 ± 1.3 mm in the test and control groups, respectively.
were placed. Implant survival after 5 years was 100 % and
After 24 months, only five class II furcations remained in the
the mean increase in peri-implant bone was 3.2 ± 1.3 mm,
test group, compared to 10 in the control group (p < 0.05).
while implant protrusion into the sinus decreased from 4.9 ±
1.9 mm at baseline to 1.5 ± 0.9 mm. Mean crestal bone loss
STRAUMANN ® DENTAL IMPLANT SySTEM
was 0.8 ± 0.8 mm, which stabilized over 5 years; bone gain
after 1 year was noted at 20 implants. Grafting is therefore
not required for bone gain of at least 3 mm.
Bilhan H, Kutay O, Arat S, Çekici A, Cehreli MC. Astra
Tech, Branemark, and ITI implants in the rehabilitation
Bosshardt DD, Salvi GE, Huynh-Ba G, Ivanovski S, Donos
of partial edentulism: two-year results. Implant Dent
N, Lang NP. The role of bone debris in early healing ad-
2010;19(5):437-446.
jacent to hydrophilic and hydrophobic implant surfaces in
In 26 patients, Astra Tech implants (42), Brånemark implants
man. Clin Oral Implants Res 2011;22(4):357-364.
(36) and Straumann® implants (29) were placed; abutment
Straumann experimental implants (4.0 mm long and 2.8 mm
connection was performed for the Astra Tech and Brånemark
diameter) with either an SLA or SLActive surface were placed
implants after 3 months and all implants received fixed pros-
in the retromolar region in 28 volunteers and retrieved by
Simply doing more
STARGET 1 I 12
trephine after 7, 14, 28 and 42 days. All surfaces were par-
esthetic scores, with white esthetic scores being slightly su-
tially coated with bone debris and new bone formation was
perior. Mean crestal bone loss was 0.18 mm after 3 years;
observed after 7 days. New bone gradually increased over
bone loss from 0.5 to 1.0 mm was observed at only two
time while fractions of old bone, soft tissue and bone debris
implants, one of which showed minor recession of the facial
gradually decreased. New bone was higher with SLActive
mucosa (< 1 mm).
after 2 and 4 weeks. The change in bone debris:soft tissue
ratio changed significantly from 7 to 42 days for both SLAc-
Zupnik J, Kim SW, Ravens D, Karimbux N, Guze K. Factors
tive and SLA. The bone debris:soft tissue ratio suggested that
associated with dental implant survival: a 4-year retros-
bone debris had a significant influence on the initiation of
pective analysis. J Periodontol 2011;82:1390-1395.
bone deposition.
A retrospective chart review of patients at the Harvard School
of Dental Medicine (HSDM) who had one of two types of
Buser D, Wittneben J, Bornstein MM, Grütter L, Chappuis
rough-surface implants (group A: Straumann SLA®, group B:
V, Belser UC. Stability of contour augmentation and es-
Nobel TiUnite ®) placed by periodontology residents from
thetic outcomes of implant-supported single crowns in the
2003 to 2006 was performed. Demographic, health, and
esthetic zone: 3-year results of a prospective study with
implant data were collected and analyzed by multi-model
early implant placement postextraction. J Periodontol
analyses to determine failure rates and any factors that may
2011;82(3):342-349.
have increased the likelihood of an implant failure. The study
A total of 20 patients received implant-supported crowns on
cohort included 341 dental implants. The odds ratio for an
Straumann Bone Level implants in the esthetic zone, and clini-
implant failure was most clearly elevated for diabetes (2.59)
cal, radiologic, and esthetic parameters were recorded for
and implant surface group B (7.84), and male groups (4.01).
3 years follow-up. All implants were successfully osseointe-
There was no significant difference regarding the resident
grated and stable, with good peri-implant soft tissues after
experience. The success rate for HSDM periodontology resi-
3 years. Good results were obtained for the pink and white
dents was 96.48% during the 4-year study period.
65
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STARGET 1 I 12
Simply doing more
Cochran DL, Jackson JM, Bernard J-P, ten Bruggenkate
CM, Buser D, Taylor TD, Weingart D, Schoolfield JD, Jones
AA, Oates TW Jr. A 5-year prospective multicenter study
of early loaded titanium implants with a sandblasted
and acid-etched surface. Int J Oral Maxillofac Implants
2011;26(6):1324-1332.
A total of 439 implants were placed in 135 partially and fully
edentulous patients, with abutments connected after 6 weeks
in type II and III bone and after 12 weeks in type IV bone.
Evaluations were performed for up to 5 years, after which
the cumulative implant survival and success rates were 99.1%
and 98.8%, respectively; all implant failures were between
surgery and 1 year. SLA-surfaced implants can therefore be
loaded after 6 weeks in type II and III bone and maintain
high survival and success over 5 years.
Simply doing more
STARGET 1 I 12
STrAUMANN NOrTh AMericA edUcATiON cOUrSeS
Up coming 2 0 1 2 Educ a t ion Ev en t s
For more information on programs in the US contact the
March 30-21, 2012
Straumann US Education Department at 978/747 2553
The Art, Science and Business of Clinical Implant Practice
or [email protected] or visit us on the website:
las vegas, nv
www.straumann.us and click on the courses tab.
Lecturers: Dr. Paul Fugazzotto, Dr. Kanyon Keeney
For more information on programs in Canada contact the
April 20-21, 2012
Straumann Canada Department at 905/319 2900 or
The Art, Science and Business of Clinical Implant Practice
[email protected] or visit us on the website:
Washington, dC
www.straumann.ca.com and click on the courses tab.
Lecturers: Dr. Paul Fugazzotto, Dr. Kanyon Keeney
March 23, 2012
April 20-21, 2012
Dental Implant Complications Symposium: Etiology,
Digital Interdisciplinary Dentistry
Prevention & Treatment
louisville, Ky – university of louisville
new york, ny
Lecturers: Dr. Dean Morton, Dr. Jay Beagle, Travis Roy
Lecturers: Dr. Stuart Froum et. al.
Target Audience: Interdisciplinary Team consisting of
Target Audience: Dental Clinicians
Surgeon, Restorative Dentist and Lab Technician
Products: Implants
*must attend in a team
Registration: Straumann.cvent.com/event/march23
Product: SGS, CADCAM, Implants, Restorative Components
March 30-31, 2012
April 23, 2012
Digital Interdisciplinary Dentistry
"Are you Referring to Me?" Strategies for Marketing the
farmington, Ct – university of Connecticut
Oral and Maxillofacial Surgery Practice
Lecturers: Dr. Don Somerville, Dr. David Shafer
JaWS Society annual meeting
and Charlie Meneguzzo
Dr. David Schwab
Target Audience: Interdisciplinary Team consisting of
Surgeon, Restorative Dentist and Lab Technician
*must attend in a team
Product: SGS, CADCAM, Implants, Restorative Components
For more information on this program or to register:
http://smile.uthscsa.edu
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STARGET 1 I 12
Simply doing more
April 27-28, 2012
*must attend in a team
Understanding the Basics of Surgical and Restorative
Product: SGS, CADCAM, Implants, Restorative Components
Dental Implant Therapy
For more information on this program or to register:
detroit, mi – university of detroit mercy
http://www.bcdce.com/courses/course/category.php?id=2
Lecturers: Ahmad M. Fard DDS, MS and Anthony Neely,
DDS, PhD
August 5-12, 2012
Target Audience: Clinicians
Simplification and Predictability of Implant Dentistry
Products: Implants
alaska Cruise
For more information on this program or to register:
Lecturer: Dr. Robert Vogel
http://dental.udmercy.edu/ce
Target Audience: Entire Implant Team
Products: Implants
May 18, 2012
To register please go through www.kennedyseminars.com
Advanced Implant Surgery & Tissue Grafting
and click on “REGISTER NOW“
dallas, tX at Baylor university
Lecturer: Dr. Thomas Wilson
November 2-3, 2012
Temple University 2nd Annual Straumann Lecture –
May 19, 2012
Current Trends and Techniques in Planning and Restoring
Advanced Implant Surgery & Tissue Grafting –
Implants in the Esthetically Demanding Patient
Cadaver Course
philadelphia, pa
dallas, tX at Baylor university
Lecturer: Dr. Will Martin
Lecturers: Dr. Thomas Wilson and Dr. Jim Ruskin
December 14-15, 2012
June 4-8, 2011
Digital Interdisciplinary Dentistry
ITI Education Week
Baylor university, dallas, tX
Boston, ma
Lecturers: Dr. Frank Higginbottom and Dr. Thomas Wilson
Target Audience: Interdisciplinary Team consisting of
July 27-28, 2012
Surgeon, Restorative Dentist and Lab Technician
Digital Interdisciplinary Dentistry
*must attend in a team
Baylor university, dallas, tX
Product: SGS, CADCAM, Implants, Restorative Components
Lecturers: Dr. Frank Higginbottom and Dr. Thomas Wilson
For more information on this program or to register:
Target Audience: Interdisciplinary Team consisting of
http://www.bcdce.com/courses/course/category.php?id=2
Surgeon, Restorative Dentist and Lab Technician
Simply doing more
STARGET 1 I 12
ITI Education Week Boston – June 4-8, 2012
Comprehensive Implant Dentistry: From Treatment Plan to Clinical Implementation
69
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STARGET 1 I 12
WORLD-WIDE NEAR TO CUSTOMERS
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Distributors
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tel. +52/55 5282 6262
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straumann s.r.o.
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na Žertvách 2196
79111 Freiburg
Netherlands
Sweden
straumann gmbh austria
180 00 Prague 8
tel. +49/76 14 50 10
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straumann aB
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tel. +420/284 094 650
Fax +49/76 14 50 11 49
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tel. +31/30 60 46 611
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tel. +43/12 94 06 60
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straumann Ltd.
Fax +43/12 94 06 66
straumann Danmark aps
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tel. +47/23 35 44 88
tel. +1/800 448 8168
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tel. +32/27 90 10 00
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Fax +32/27 90 10 20
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20158 milano
tel. +39/02 39 32 831
Fax +39/02 39 32 8365
Fax +47/23 35 44 80
+1/978 747 2500
Fax +1/978 747 2490
GROWTH
IN RECESSION
This book, which presents 11 prominent clinical cases, is the product
of an international competition organized by Straumann. The objective
was to illustrate the esthetic results that can be achieved when using
Straumann® Emdogain in combination with conventional surgical
methods in the treatment of gingival recession. See page 18 of this
issue of STARGET for more information.
Please contact your local Straumann sales team member if you would
like to order a copy of this case book.
03/12 USLIT 395
AN ESTHETIC CASE SELECTION ON STRAUMANN ® EMDOGAIN