Vol.

3 Issue 1/2013

implants
the journal of

oral implantology

2013

| user report

Camlog case studies

| case report

Tapered implants and overdentures

| research

Single molar restoration

1.5H
CPD ours
Poin
ts

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Introducing the
The 3i T3 Implant* is designed to deliver
aesthetic results through tissue preservation.

Dear Reader,

Seal IntegrIty2,3

multI-level Surface
toPograPhy

_Hello and welcome to the latest issue of Implants! I hope you find it both interesting
and informative.
This week Ive been catching up on the recently published Cochrane review on the
impact of loading times on the success rates of implants (Esposito M, Grusovin MG,
Maghaireh H, Worthington HV. Interventions for replacing missing teeth: different times
for loading dental implants. Cochrane Database of Systematic Reviews 2013, Issue 3. Art.
No.: CD003878. DOI: 10.1002/14651858.CD003878.pub5). The researchers looked at a
number of Random Controlled Trials that looked at loading implants immediately, after
six weeks (early) and at three months (conventionally).

Integrated Platform
SwItchIng

preservation
BY DESIGN

According to the authors, Overall there was no convincing evidence of a clinically

important difference in prosthesis failure, implant failure, or bone loss associated with
different loading times of implants. This I find most interesting, as there are many who
would lean very heavily on the evidence that you should always wait three months before
loading and would be very reticent to change that view; or am I being unfair?

Contemporary hybrid surface design

with multi-level topography; mediablasted on the threaded region and
dual-acid etched on the collar region
Optimized aesthetics with as little as
0.37mm of bone recession1

If you would like to read the full review, go to http://onlinelibrary.wiley.com/

doi/10.1002/14651858.CD003878.pub5/full and let me know your thoughts.

Higher seal strength as compared to the

competitive average 2,3
Seal integrity test was performed by BIOMET 3i on December 2011.
Testing was done under testing standard ISO 14801.
Five (5) BIOMET 3i PREVAIL Implant Systems and five (5) of three
(3) competitors implant systems were tested. Bench test results are
not necessarily indicative of clinical performance.

Until next time

Lisa Townshend
Group Editor, Implants

Please contact your local BIOMET 3i

Sales Representative or visit us online at
www.biomet3i.com to learn more.

lisa@healthcare-learning.com

*The 3i T3 Implant is not yet available for sale in the U.S.

1. stman PO, Wennerberg A, Albrektsson T. Immediate Occlusal Loading Of Nanotite Prevail Implants: A
Prospective 1-Year Clinical And Radiographic Study. Clin Implant Dent Relat Res. 2010 Mar;12(1):39-47.
2. Lazzara R. Dental Implant System Design and the Potential Impact on Long-Term Aesthetics: A Review of the
3i T3 Tapered Implant. ART1193EU 3i T3 White Paper. BIOMET 3i, Palm Beach Gardens, Florida, USA.
3. Suttin Z, Towse R, Cruz J. A Novel Method for Assessing Implant-Abutment Connection Seal Robustness.
BIOMET 3i, Palm Beach Gardens, Florida, USA. Poster Presentation, Academy of Osseointegration,
27th Annual Meeting; March 2012;Phoenix, AZ. http://biomet3i.com/Pdf/Posters/Poster_Seal%20Study_ZS_
AO2012_no%20logo.pdf. Testing done by BIOMET 3i, Palm Beach Gardens, FL; n = 20.

Aforementioned have financial relationships with BIOMET 3i LLC resulting from speaking engagements, consulting engagements and other retained services.

PREVAIL is a registered trademark of BIOMET 3i LLC. 3i T3, 3i T3 Implant design, Preservation

By Design and Providing Solutions - One Patient At A Time are trademarks of BIOMET 3i LLC.
2012 BIOMET 3i LLC.

implants

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T3 60x255.indd 1

I 03
14/01/13 16:07

I content _ implants

page 11

page 9

32 Impression and registration for full-arch implant

dentures

I editorial
03 Dear Reader

_Gregory-George Zafiropoulos

_Lisa Townshend

I industry report

I news

38 Fixed full arch metal-free prosthesis on four

SHORT implants

_Mauro Marincola, Vincent Morgan, Angelo Pertuini,

06 News

I events

07 Speaker announced for CIC 2013

Stefano Lapucci

I product spotlight
43 Broaden your BioHorizons

_Maurice Salama

I case report
08 I mmediate loading with a Straumann Bone Level
Implant after a horizontal tooth fracture in the
aesthetic zone
_Albert Barroso

manufacturer news
44 Manufacturers news

I diary dates

I user report
11 Implantology The Camlog way
_Sunny Kaushal

48 2013/International/UK

I about the publisher

49 _ Guidelines for submission
50 _ Imprint

I case report
22

page 23

Immediate functional loading of the edentulous

mandible
_Suheil M Boutros

I research
26 Single molar restoration wide implant versus two

conventional
_Amr Azim, Amani Zaki, Mohamed El-Anwar

page 27

04 I implants

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page 33

page 38

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I news_ implants

Dental nurses to benefit from ADI training

_The Association of Dental Implantology Dental courage confidence in their ability to assist throughout
Nurses Courses have been developed in response to the implant procedures, allowing the clinician to focus on the
increased role played by dental nurses in supporting im- task in hand.
plant clinicians.
Dr Simon Wright, Director of Education at the ADI says,
Attendees begin with the Original Dental Nurses We feel it is crucial that dental nurses are highly trained
Course, which aims to increase the understanding of den- to ensure that implant patients receive expert treatment.
tal implantology to dental nurses. This course provides Clinicians are giving them more responsibility in many
dental nurses knowledge and confidence to support the dental practices and the ADI Dental Nurses Courses are
operator with surgical implant placement and subsequent the ideal way to help them develop their skills.
restorative appointments.
Both courses are priced at a competitive 150. The
Delegates who move onto the Advanced Dental Nurses Original course takes place on Saturday 28 September
Course have the chance to learn complex surgical nurs- 2013. The Advanced course takes place on and Saturday
ing techniques involved in implant placement including, 23 November 2013. Visit www.adi.org.uk/nurses_courses
sinus lifts, bone grafting, socket preservation and soft tis- or call the Association on 020 8487 5555.
sue augmentation. The course has been designed to en-

Established ridge-split procedure offers new

application in dental implant surgery
_Dental techniques to modify the alveolar ridge have
been around for many years, often as a means of support
for dentures. As dental implants have now become common procedures, so has pre-implant preparation of the
bone. The ridge-split procedure is one such method of widening and augmenting the alveolar ridge that is finding renewed interest.

the benefits.

Because of differences in bone density, the ridge-split

technique requires a single surgical stage in the maxilla, or
upper jaw, and a two-stage approach in the mandible. The
two stages of mandible surgery consist of corticotomy, a
bone-cutting procedure, followed by splitting and grafting
performed threefive weeks later. The staged approach of
The Journal of Oral Implantology presents a detailed de- the ridge-split procedure has shown a higher implant sucscription of the alveolar ridge-split procedure, supplemented cess rate and better buccal cortical bone preservation.
by photographs. The alveolar ridge is the bony ridge on both
A practitioners experience is an important component
the upper and lower jaws that contains the sockets of the
teeth. Establishing an alveolar ridge of proper dimensions of this technique. This form of surgery modifies the conhas become essential with the advent of root-form endos- figuration of the bone and is usually performed in a closed
seous dental implants, the most common type of implants. fashion and uses a tactile sense. The authors emphasise the
need for careful manipulation of the thin ridge, knowledge
The ridge-split procedure described in this article is a of precise surgical principles, and specialised training.
form of ridge widening or augmentation. In cases of narrow
Full text of the article, Horizontal Augmentation Through
alveolar ridges, it has proven to be consistently successful.
Use of this minimally invasive technique has many advan- the Ridge-Split Procedure: A Predictable Surgical Modality
tages in the pre-prosthetic stage of dental implants. Low in Implant Reconstruction, Journal of Oral Implantology,
risk of inferior alveolar nerve injury, less pain and swelling, Vol. 39, No.1, 2013, is available at www.joionline.org/doi/
and no need for a second surgical site as donor are among full/10.1563/AAID-JOI-D-12-00112.

06 I implants

1_ 2013

events_ CIC 2013

Speaker Announced for

Clinical Innovations Conference 2013
17th and 18th May 2013, Millennium Gloucester Hotel, London

_On 17th and

18th May 2013,
Healthcare Learning; Smile-on will
be presenting the
10th Clinical Innovations Conference, in conjunction with The Dental Directory and the
AOG. The widely anticipated event will
be held in the Millennium Gloucester
Hotel in Kensington, London, attracting
hundreds of dental professionals in their
quest to remain abreast of the very latest
developments in the industry.

Dr Shahdad will be speaking on behalf

of Straumann at the event, discussing
Beauty or the Beast? Tissue-level implants in aesthetic zone.
Osseo-integration of implants has
become a well established technique,
and the focus is now on achieving ideal
aesthetics, explains Dr Shahdad. Longterm maintenance of soft tissue aesthetics around implants is a challenge, and
we are only now coming to understand
it better. Factors that influence periimplant bone remodelling and timing of
implant placement have a profound affect on labial bone maintenance.

A selection of world-class speakers

My presentation at CIC 2013 will be
has been confirmed to attend this years
event, taking delegates to the very cut- based on current research findings, and
will aim to demonstrate and highlight
ting-edge of the profession.
the important surgical and restorative
One of these is Dr Shakeel Shahdad dimensions for predictably achieving
(pictured). Dr Shahdad is a registered spe- and maintaining aesthetically optimised
cialist in Restorative Dentistry, Periodon- implant restorations. Emphasis will be
tics, Prosthodontics and Endodontics, as placed on integration of biological prinwell as a consultant and Honorary Clini- ciples into planning and decision-makcal Senior Lecturer in Restorative Den- ing in aesthetic implant dentistry. I will
tistry at The Royal London Dental Hos- also present the arguments for Tissue or
pital and Queen Mary University, Barts Bone level, Immediate or Delayed placeand The London School of Medicine and ment._
Dentistry. In addition, Dr Shahdad is a
Fellow of the International Team for Imimplants
_contact
plantology (ITI) and a Diplomat of the British Society of Oral Implantology, all the For more information about Clinical Innovations
Conference 2013 and to book your place call 020
while running a multi-specialist referral 7400 8989, email info@healthcare-learning.com
or go to www.clinicalinnovations.co.uk
practice in the West End of London.

implants

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I 07

I case report_ aesthetic placement

Immediate loading with a Straumann

Bone Level Implant after a horizontal
tooth fracture in the aesthetic zone
Author_Albert Barroso

Fig. 1

Fig. 2

Fig. 3

_Patient history
A 38 year-old non-smoking woman, in
good general health and with high aesthetic demands, presented at our dental
office with mobility of tooth #12 (Fig 1).
After clinical and radiological examination a horizontal fracture near CEJ (cement enamel junction) was detected
(Figs 1-4). Clinical examination showed
class III mobility of the crown of #12.
Aesthetic parameters were not altered.
The buccal bone plate was not affected
(Fig 2). The patients plaque control was
adequate and no periodontal disease or
periapical infection was detected (Fig 4).
_Treatment planning
It was not possible to prepare the
tooth for restoration with a single crown
due to the absence of ferrule. The short
length of the root would lead to an unsatisfactory crown-root ratio in case
of orthodontic extrusion, and crown
lengthening was not indicated in this
case because of aesthetic concerns. For

08 I implants

1_ 2013

Fig. 4

these reasons tooth #12 was considered hopeless. According to the options
proposed by the ITI group in terms of
implant placement timing after tooth
extraction, the present situation would
correspond to the Type I classification.
Though the lip line is high, a mediumthick biotype, the lack of infection and
a width of 1mm or more of the buccal
bone wall (as revealed by computerised
tomography) permits placing the implant
immediately after tooth extraction.
_Surgical procedure
A very accurate root extraction was
performed to keep the buccal plate intact (Fig 5). After verifying the integrity of the socket walls, the implant bed
was prepared without flap elevation
(Fig 6). We know that this approach
- leaving the periostium attached to
the bone - minimises the remodelling
of the alveolar ridge. A Straumann
Bone Level Implant with SLActive surface (Fig 7) was palatally positioned.
The filling of the vestibular gap was

case report_ aesthetic placement

Fig. 5

Fig. 6

Fig. 9

Fig. 10

done with Straumann BoneCeramic

which helps to preserve the horizontal
dimension of the ridge and, to some
degree, the vertical dimension (Fig 8).
_Immediate temporary restoration
An immediate provisionalisation was
done by an adhesive-fixed provisional
with the crown of the recently extracted
tooth #12 used as a Maryland bridge.
Seven days after the extraction and
immediate implant placement the tissues around the zone look completely
healthy (Fig 9). This not only permitted
providing the patient with an immediate aesthetic fixed provisional but also
to maintain the adequate gingival architecture during the osseointegration
period.

Fig. 7

Fig. 8

Fig. 11

ture was already achieved by the adhesive immediate provisionalisation (Figs

10&11). At this time a Straumann NC
Cementable Abutment with a minimally invasive approach is connected
and screwed in at 20Ncm torque (Figs
12&13). By applying this protocol the
abutment will not be disconnected, allowing the soft tissue to accommodate
to the ideal apico-coronal position and
minimising its possible future recession.

With a periapical radiograph we

checked the adequate fit of the abutment to the implant connection and
confirmed maintaining of the mesial
and distal bone around the implant (Fig
14). The preparation of the definitive
abutment was done intraorally (Fig.15)
and after this the definitive impression was taken. A new provisional was
cemented to the definitive abutment
_Final restoration
to maintain adequate soft tissue aesAfter a healing period of six to seven thetics (Figs 16&17). A metal-ceramic
weeks an adequate gingival architec- crown was prepared by the laboratory
Fig. 12

Fig. 13

Fig. 14

Fig. 15

Fig. 16

implants

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I 09

I case report_ aesthetic placement

Fig. 18

Fig. 17

Fig. 20

Fig. 21

Fig. 19

Fig. 22

_Conclusion

Fig. 23

Patients nowadays demand less invasive surgery, the shortest healing time
possible and optimal aesthetic results.
Clinicians, on the other hand, are not
only looking to satisfy their patients
expectations, but also to obtain predictable long-term results. Both needs can
only be satisfied by performing accurate
planning followed by an adequate execution and by using implant designs and
biomaterials that minimise the remodel(Figs 18&19) and adapted to the mouth.
ling of the surrounding tissues._
Immediately after cementation, the interproximal areas were not fully filled by
soft tissue (Fig 20).
implants
_author info

Fig. 24

After some weeks, the integration of

the implant restoration to the neighbouring teeth and the soft tissue was
optimal (Fig 21). Aesthetic parameters
were achieved for medium and pronounced smiling of the patient (Figs
22&23). The CBCT taken two years after
rehabilitation shows the maintenance of
an adequate buccal bone width which
will ensure the correct position of the
soft tissues over time (Fig 24).

10 I implants

1_ 2013

Dr. Albert Barroso

Degree in dentistry and
Master in Implantology
from the Universitat Internacional de Catalunya/
Spain. Private practice
in Girona, specialised in
Implant Dentistry and Oral
Surgery. Lecturer at the
International Master Course in Oral Implantology
at the Universitat Internacional de Catalunya. ITI
Member.
www.clinicabarroso.com

user report_ Camlog

Implantology
The Camlog Way
Author_Sunny Kaushal
Fig. 1

_With well over a thousand implant

systems currently on the market there is
a lot of choice when it comes to picking the right one to put in your practice.
After extensive experience with a variety of systems dating back to the mid
1990s, I recently began placing Camlog
dental implants, developed by Dr. Axel
Kirsch. This was after seeing the system
being extensively used in Germany by
some of my colleagues. I could clearly
see the merits of the system along with
the final results being produced.
_Surgical
The system is well thought out and
has all of the features that most of the
widely used systems have. The surgical
kit is incredibly easy to use with a logical
colour coded drilling sequence. An attractive design feature is the incorporation of removable depth stops for all the
burs. These stops slide on and off easily,

Fig. 2

Fig. 3

making maintenance simple while fitting well to the bur shank. The profiling
drills are not end-cutting, so they will
follow the pilot hole closely.
The combination of these two features
acts as a failsafe, which is especially neat
for the inexperienced. I found from my
mentees, that this was a big plus in their
minds.
_Benefits at a glance
One surgical set for both implant types
Colour-coded instruments arranged in
the surgery set in logical order of use
Depth stops and laser markings for
safe and individual implant bed preparation
Special design of multiple-use drills
for atraumatic, efficient and accurate

implants

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I user report_ Camlog

Fig. 5

Fig. 4

acting on the connection are distributed

in an ideal manner. The abutment screws
Implant packaging includes cover are minimally loaded and only have a
holding function. Therefore, screw loosscrew for submerged healing
ening or screw fractures are practically
There are two implant types in the eliminated. Clinical results confirm these
outstanding properties. (Fig 1)
Camlog system:
preparation

CAMLOG Implants: The heart of the

CAMLOG Implant Systems is the innovative implant-to-abutment connection,
known as the Tube-in-Tube. The positive press fit of the highest precision and
anti-rotation stability allows the simple
and durable prosthetic rehabilitation of
single crowns and bridges as well as a
secure and lasting screw connection.

Tube-in-Tube connection Benefits at a glance

Precise, anti-rotational positive locking allows simple and durable
prosthetic connections
Three grooves (implant) and three
cams (abutment) enable clear, secure
and fast positioning of abutments

As a result of this positive press fit

and the specially designed cams of the Comparative studies with other
Tube-in-Tube connection, all forces well-known implant systems have demonstrated that the CAMLOG connection yields excellent results for fit and
accuracy

Fig. 6

CONELOG
Implants
The
CONELOG implant is equipped with a
conical (7.5) connection combined with
a three groove index system. This gives
all the benefits of the tried and tested
conical connection and is my personal
preference.
The CONELOG abutments are conical
apically and have three cams which slot
effortlessly in to the implant to form a

12 I implants

1_ 2013

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I user report_ Camlog

quality

Fig. 7

Scientifically documented, clinically

proven
The following case studies demonstrate the surgical and prosthetic flexibility of the Camlog system from clinicians who understand the need for a
reliable and user friendly system.
_Case Study 1
Dr Marcus Gambroudes BDS (U. Birm)
(Fig 2) is a principal dentist at Cape Road
positive connection. The abutment does Dental Practice & Implant Centre in Warnot cover the implant shoulder, thereby, wick and director of The Warwickshire
offering integrated platform switching. Oral Surgery Clinic, where he receives referrals for both simple and complex imConical Connection - Benefits at a plant cases.
glance
Marcus is a Committee Member of the
Association
of Dental Implantology (ADI)
Precise, self-locking anti-rotational
and an active member of the Internaconical implant/abutment connection
tional Team for Implantology (ITI)
Integrated platform switching
His main area of interest is in guided
surgery
and immediate load. He also
Proven CAMLOG indexing makes abutment positioning simple, fast and accu- works alongside Consultant Oral and
Maxillofacial Surgeon Mr Sat Parmar ofrate
fering treatment under general anaesthetic.
Accurate and tight microbial seal
This 67-year-old lady was referred to
me with a view to replacing her failing
Sand-blasted, acid etched Promote upper incisors with dental implants. This
was to include replacement of her upsurface for fast osseointegration
per right canine that was lost some time
Six weeks healing time in good bone ago and being replaced with a badly deImplant Surface - Benefits at a glance

Fig 9_Post-operative radiograph at

the time of cementation
Fig. 8

Fig. 9

14 I implants

1_ 2013

Fig. 10

user report_ Camlog

Fig. 11

Fig. 12
Fig. 13

signed cantilever bridge.

Her medical history was clear and she
had a heavily restored dentition that
was otherwise well maintained. Her oral
hygiene was excellent. (Fig 3)

The laboratory produced four cast

abutments. These were milled parallel
and a five-unit fixed porcelain fused to
Following a full clinical and radiometal bridge was constructed as the degraphic examination I opted to extract
finitive restoration. This was cemented
all four incisors with immediate implant
in place to achieve an excellent final replacement. In this case, I chose to result. (Figs 8-10)
place each tooth with a dental implant.
Not something I would routinely do,
I have been placing and restoring
however, I was concerned about the
CAMLOG implants for several years with
long-term prognosis of some of her upgreat success, due to its precision and
per posterior teeth and this would give
simplicity in both the surgical and reme the option of creating a reduced
storative aspects. The system also offers
dental arch, with minimal future intercomplete versatility with terrific affordvention should the need arise.
ability, without compromise. CAMLOG
has well over 10 years history of use and
The sockets were thoroughly debrided
clinical studies to back it up. For my paand implant osteotomies were prepared
tients, I want to provide the best treatto engage the palatal shelf and ensure
ment and materials I can.
good primary stability (Fig 4). All four
sites were prepared to receive 3.8mm x
_Case Study 2
11mm Conelog Implants. The implants
were placed and covered with the cloAndrew Chandrapal BDS MFGDP(UK)
sure screw provided. Any local defects
DPDS(Bris) MClinDent(Pros) qualified
were augmented with Bio-Oss particles
from Birmingham University and rapidly
and a Bio-Guide membrane was used to
progressed to achieve further qualificastabilise the graft material. (Fig 5)
tions and training which form the basis
of his special interests, dental cosmetics,
The healing was uneventful and the
bonding rehabilitation and management
implants were uncovered after approxiof wear. Andrew works with eminent colmately 12 weeks. Large wide body healleagues in various disciplines of dening caps were inserted to commense
tistry to create smiles that not only look
site development. This was followed
naturally outstanding but also function
by open-tray pick-up impressions two
efficiently and comprehensively.
weeks later. (Figs 6&7)

implants

1_ 2013

I 15

I user report_ Camlog

Fig. 14

Fig. 15

Fig. 17

Fig. 16

Andrew has gained knowledge in all

aspects of restorative disciplines and
continues to update his knowledge with
international studies on a regular basis.
His interests and skills have led to a focus
on prosthodontic interfaces and composite bonding.

ite resin artistry. (Fig 11)

He is Chair of communications on the

Board of Directors for the British Academy of Cosmetic Dentistry and a longstanding member of the AACD, the International Team for Implantology, the
Association of Dental Implantology and
the British Society of Occlusal Studies.
He is also an educator to other dentists
and key opinion leader to the industry
within the disciplines of aesthetic dentistry, treatment planning and compos-

This lady was presented with advanced periodontal disease affecting all
her remaining teeth and was looking for
a fixed solution. The first stage in the
treatment process was to remove all the
remaining teeth and provide conventional upper and lower full dentures. (Fig 12)

All lab work for Andy Chandrapal is

credited to Allport and Vincent Dental
Laboratory. Monument Business Park,
Warpsgrove Lane, Chalgrove, Oxford.
OX44 7RW

Following a healing period of approximately three months the patients existing dentures were relined and duplicated to form radiographic stents. This was
done using a mixture of 10-15 per cent
Barium Sulphate in the base acrylic and
radiopaque teeth (SR Vivo TAC and SR
Ortho TAC by Ivoclar Vivadent). The patient was then referred to have CT scans
of both jaws. (Fig 13)
The digital data obtained from the
scans was then used to plan the positions of the Camlog implants and sent
to a specialist laboratory for surgical
drilling guides (Camlog Guide) to be
produced. There was sufficient bone for

16 I implants

1_ 2013

honigum.
Overcoming opposites.
Often times, compromises have to be made when developing impression materials. Because normally the rheological
properties of stability and good flow characteristics would
stand in each others way. DMGs Honigum overcomes these
contradictions. Thanks to its unique rheological active

2012
efe
2010 Pr

r r e d Pr o
d

ucts

matrix, Honigum yields highest ratings in both disciplines.

We are very pleased to see that even the noted test institute
The Dental Advisor values that fact: Among 50 VPS
Honigum received the best clinical ratings*
www.dmg-dental.com

I user report_ Camlog

situ for approximately six months before
being removed and impressions taken
for the definitive bridgework. Duralay
verification jigs were used to ensure the
accuracy of the impressions. (Fig 15)

Fig. 18

The definitive, screw retained, bridges were constructed from a milled bar
overlayed with acrylic. The patient was
delighted with the result. (Figs 16-18)

Fig. 19

Fig. 20

six implants in the upper jaw and four

interforaminal implants in the lower
(Camlog Guide Screw Line Implants,
Promote Plus). The laboratory also provided the provisional acrylic bridges to
immediately load the implants after
placement.
With the planning complete the patient returned for surgery. This was carried out under local anaesthetic, and involved securing the surgical guide with
small pre-determined screws followed
by preparation of the implant beds with
the corresponding guided drills. (Fig
14) The upper jaw was completed first,
followed by the lower. The provisional
acrylic bridges were then secured to the
implants.
The provisional bridges were left in

18 I implants

1_ 2013

The CAMOG system was introduced

to me around three-four years ago
when I found more and more indications
for finding a more economical solution
to restoring edentulous arches. After
looking into CAMLOG implants and their
restorative versatility together with the
simple system of placement I trained up
on CT guided implant placement and
found the guided CAMLOG implants to
be of perfect application to my needs.
I now use CAMLOG implants for most
of my surgical and restorative cases. My
laboratory technician based in California
is also very comfortable with the system
resulting in superior technical results
as well as the simplicity and versatility of placement. It appears to be a well
researched and documented system to
which I have found the product support
to also be very good.
_Case Study 3
Marc Northover (Fig 19) is considered to be one of the UKs leading Clinical Dental Technicians, where for the
last decade he has worked as an opinion leader on behalf of an international
dental organisation, offering master
classes and one-to-one mentoring to up
and coming Clinical Dental Technicians.
Marc regularly teaches on courses for
dental professions in the UK and abroad
on his chosen topic of complete dentures
and continues to work very closely with

user report_ Camlog

Fig. 22

Fig. 21

the UKs leading Dentists, Dental Technicians and Clinical Dental Technicians as
part of the network of Changing Faces
Denture Clinics.
Marc graduated from the Royal College of Surgeons, England in 2007 with
a Diploma in Clinical Dental Technology and was a founding advisory board
member of British Association of Clinical
Dental Technology and remains an active member today. Marcs professionalism, patient care and expertise were
recognised at the annual Dental Awards
2009 and 2010 where he was awarded
Clinical Dental Technician of the year for
two consecutive years.
He practices as a CDT at Changing
Faces Denture Clinic, Birmingham,
where working with Dental Practices
that share his vision, he offers the highest standards of care possible as part
of a multi-disciplinary team. Marc is a
regular delegate at international conferences and has a particular interest in the
role of dental implants to assist denture
stabilisation.

The patient had obvious on-going issues with her remaining teeth and was
referred to a colleague for a full examination. It was clear that all the remaining teeth needed to be extracted. This
was duly carried out and the patient
was constructed a set of transitional
full upper and lower dentures whilst her
mouth healed. This was a very positive
step forward for the patient however
she was still experiencing some difficulty retaining her new teeth, especially
the lower set.
After a lengthy discussion about her
options, she opted to proceed with implant supported over dentures. This traditionally constitutes a minimum of four
implants in the maxilla and two in the
mandible. This option would also allow
me to uncover the patients palate and
increase her taste and temperature perFig. 23

This delightful 56-year-old lady presented to me complaining that she

wasnt happy with the appearance of her
teeth and she couldnt tolerate wearing
dentures. She had had some teeth extracted a short time before and was given a set of immediate partial dentures
that were poorly fitting and causing a
lot of discomfort. (Fig 20)

implants

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I 19

I user report_ Camlog

Fig. 24

ception.

_About the author

Four Conelog Implants were placed

in the maxilla and two in the mandible.
This was followed by construction of
Even distribution of the maxillary im- a new set of implant retained overdenplants is essential to ensure adequate tures. (Figs 23&24)
retention and the distribution of occlusal forces.(Fig 21)
I have found working with the Camlog
company extremely refreshing as have
After a healing period of three months my colleagues. They are a fast moving
the implants were uncovered and Loca- and forward thinking set up who have
embraced the modern way of communiimplants
cation, back up and teaching. I find their
Sunny Kaushal BDS (U. Birm) Dip Imp Dent RCS (Eng) MSc (U.
on-line blog service Camlog Connect
Lond) is the principal dentist at Chic Teeth in Birmingham and has more
extremely useful. The platform demonthan 16 years experience in dental implant surgery and restoration. He
is also an implant surgeon at the Harley Street Oral Reconstruction Censtrates case studies from international
tre. He was an elected Committee Member of the Association of Dental
clinicians via videos, pictures and weImplantology (ADI) and member of the British Academy of Cosmetic
binars. There is also an excellent iPad/
Dentists. He is a graduate of the Royal College of Surgeons and gained a
Diploma in Implant Dentistry with an advanced certificate followed by an
iPhone App which makes all the inforMSc (ImpDent) with distinction from the University of London. Sunny has
mation required at your fingertips._
a special interest in implant-retained overdentures and is a lead implant
surgeon for changing faces denture clinics. He also has a passion for
teaching and is an ADI mentor as well as a tutor for the highly respected
Royal College of Surgeons of England. To compliment this, he actively
encourages referring dentists to get involved in the restorative process
and provides one to one training in all aspects of restoring implants.

20 I implants

1_ 2013

tor Attachments (Zest Anchors) were

torqued on. (Fig 22)

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I case report _ Immediate loading

Immediate functional loading of

the edentulous mandible
Tapered implants & overdentures
Author_Dr Suheil M. Boutros

Fig. 2

Fig. 1

Fig 1_Mandible at the time of

implant placement with moderate
bone resorption
Fig 2_Pre-op panoramic radiograph
Fig 3_Guiding pins at the time of
implant placement
Fig 4_Four tapered implants at
placement

Fig 5_Flap was sutured around the

locators using 4-0 vicryl suture
Fig 6_Panoramic radiograph
immediately after implant
placement
Fig 7_Occlusal view of the
processing rings
Fig 8_The processing rings were
picked up directly in the mouth
Fig. 5

_Abstract
The aim of this case report is to demonstrate the concept of immediate functional
loading in the mandible using unsplinted
implants to support a locator attachmentsupported overdenture.
The patient was treated by placing four
tapered implants in the anterior mandible.
The implants were immediately loaded using individual unsplinted locators to support a removable overdenture. The patient
was followed for 24 months. To date, none
of the implants has lost osseointegration.
The radiographic bone levels remain stable. The patient has been able to maintain
healthy soft tissue around all individual
implants and indicated that she is comfortable and is able to function well with
Fig. 6

22 I implants

1_ 2013

Fig. 3

Fig. 7

Fig. 4

her overdenture. This preliminary report

presents a case in which individual immediately functionally loaded unsplinted implants maintained osseointegration when
used to retain a removable locator overdenture.
_Introduction
Patients with an edentulous mandible
may not be able to consume a normally
textured diet. As they continue to lose
alveolar bone height, the dislodgement
pressure by the perioral musculature on
the prosthesis becomes greater than its retentive aspects. This can cause discomfort,
sores and trauma to the mental nerve. The
placement of endosseous implants into the
anterior mandible is an excellent therapy
for reconstruction. It helps to restore edenFig. 8

case report _ Immediate loading

Fig. 9

Fig. 10

Fig. 11

Fig. 12

tulous patients to a normally textured diet, complete denture that she had been wearnormal nutritional intake, better health ing for four years. The clinical and radioand improved self-confidence.13
graphic findings revealed slight to moderate mandibular ridge resorption with an
A locator-supported overdenture is a ill-fitting lower denture (Figs 1 & 2). The
well-documented modality of treatment. patient was given the option of placing
The conventional method of treatment is four implants to support her existing lower
to place the implants in a submerged two- denture. The treatment plan was accepted
stage approach. After allowing the implants and included an immediate functional
to osseointegrate for three months, the im- loading by using a locator attachmentplants are uncovered and the locators are supported mandibular overdenture.
delivered to support the overdenture. The
concept of immediate functional loading
_Surgical treatment
has been documented in the mandible and
the maxilla: implants are connected rigidly
At the surgical appointment, following
and immediately after placement to avoid the administration of local anaesthetic, a
micro-motions, which can have a negative mid-crestal incision was performed and a
impact on the osseointegration process.48 full-thickness flap was reflected. In addition, osteotomies were prepared in type II
A higher failure rate has been reported bone. Bone taps were used to countersink
in only very few reports in the literature the sites, after which four OSSEOTITE Taabout immediate functional loading of pered Certain implants (BIOMET 3i; 4 mm
individual implants to support a mandibu- in diameter, 13 mm in length) were placed
lar overdenture.9 This case report demon- with the handpiece and hand ratchet. The
strates the use of tapered implants in the implants were torqued to 35 N (Figs 3 & 4).
mandible to immediately load and support
_Prosthetic treatment
four separate implants by means of a locator-supported mandibular overdenture.
Immediately after implant surgery, the
_Patient presentation
mandibular denture was seated in the
patients mouth and adjusted to provide
A 55-year-old female patient without clearance in the area of the locator(s). Four
any medical contra-indication for implant locators (4 mm in length) were torqued
therapy presented with an ill-fitting, lower to 30 N (Figs 5 & 6). Following the suture
Fig. 13

Fig. 14

Fig. 15

Fig 9_Occlusal view of the locators

two weeks post-implant placement
Fig 10_Buccal view of the locators
two weeks post-implant placement
Fig 11_The processing rings
were removed ten weeks postplacement
Fig 12_The blue retention rings
were placed as the final rings

Fig 13_Occlusal view of the

overdenture in place at ten weeks
post-placement
Fig. 14_Buccal view of the
overdenture in place
Fig 15_Occlusal view of the locators
six months post-placement
Fig 16_Buccal view of the locators
six months post-placement

Fig. 16

implants

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I case report _ Immediate loading

Fig. 17

Fig. 18

Fig. 20

Fig. 19

Fig. 21

Figs 17-20_Retorquing the locators

to 30 N six months post-placement
Fig 21_Final panoramic radiograph
six months post-placement

achieved full integration. Currently, the patient is on a six-month recall to ensure the
proper maintenance of the implants and
the prosthesis. The last maintenance visit
was 24 months post-placement and all imof the flap with 4-0 vicryl, the process- plants have maintained healthy soft tissue
ing rings were placed over the locators and a stable bone level.
and were picked up directly in the mouth
using hard self-curing acrylic (Rebase II,
_Clinical relevance
Tokuyama; Figs 7&8). The patient was given post-operative instructions, including
With a higher demand by patients for
the use of 0.12 per cent chlorhexidine glu- immediate implant placement and loadconate (Peridex, Procter & Gamble) three ing, the use of tapered implants can help
times a day. She was furthermore pre- achieve quick, economic and predictable
scribed 500mg of amoxicillin (to be taken results without having to use a rigid (bar)
every six hours for seven days). The patient attachment, since they a provide high dewas then informed that the implant-sup- gree of primary stability._
ported overdenture was to be left in place
for 48 hours. Two days later, she was seen
Editorial note: A complete list of referfor a follow-up visit and the healing pro- ences is available from the publisher.
cess was uneventful. The black processing rings were switched to blue rings ten
weeks after the placement (Figs 914).
implants
_contact
_Follow-up and maintenance
Dr Suheil M. Boutros

After six months, the patient returned

for another follow-up visit and all four locators were torqued to 30 N (Figs 1521). It
was determined that all four implants had

24 I implants

1_ 2013

Periodontal Specialists of Grand Blanc

8185 Holly Road, Suite 19
Grand Blanc, MI 48439, USA
sboutros@umich.edu

THE NEW POWERHOUSE IN IMPLANT DENTISTRY

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I research_ Single molar restoration

Single molar restorationWide implant versus two

conventional
Author_Amr Abdel Azim, Dr Amani M. Zaki & Dr Mohamed I. El-Anwar, Egypt
Fig. 1

Fig. 2

Fig. 1_Load distribution during

mastication shows marked
increase in the molar and premolar
area23
Fig. 2_Occlusal view showing a
missing first molar. The mesio
distal width is very wide and
restoration couldnt compensate it
leaving a space distally
Fig. 3_Proximal cantilever shown
radiographic view of maxillary right
first molar on standard Brnemark
implant with standard abutment
(Nobel Biocare)1

26 I implants

1_ 2013

_The single-tooth restoration has become one of the most widely used procedures
in implant dentistry.1 In the posterior region
of the oral cavity, bone volume and density
are often compromised. Occlusal forces are
greater in this region and, with or without
parafunctional habits, can easily compromise
the stability of the restorations (Fig 1). 2, 3

Fig. 3

myriad of options in diameter, platform configurations and prosthetic connections. Many

of the newer systems for these restorations
are showing promising results in recent clinical trials.6-8 It has further been suggested by
Davarpanah and others,9 Balshi and others,2
English and others10 and Bahat and Handelsman11 that the use of multiple implants may
be the ideal solution for single-molar implant
The single-molar implant-supported res- restorations (Figs 4 b & c).
toration has historically presented a chalMost standard implants and their associlenge in terms of form and function. The mesiodistal dimensions of a molar exceed that ated prosthetic components, when used to
of most standard implants (3.75 to 4.0 mm), support a double implant molar restoration,
creating the possibility of functional overload will not fit in the space occupied by a molar
resulting in the failure of the retaining com- unless the space has been enlarged (12 mm
ponents or the failure of the implant (Figs 2 & or larger).4 Moscovitch suggests that the con3).4 Wider-diameter implants have a genuine cept of using two implants requires the availuse in smaller molar spaces (8.0 to 11.0 mm) ability of a strong and stable implant having
with a crestal width greater than or equal a minimum diameter of 3.5 mm. Additionally,
to 8mm (Fig 4 a).5 Clinical parameters gov- the associated prosthetic components should
erning the proposed restoration should be ideally not exceed this dimension.2
carefully assessed in light of the availability
Finite element analysis (FEA) is an engiof implants and components that provide a

research_ Single molar restoration

Fig. 4a

Fig. 4b

Fig. 4c

Fig. 6a

Fig. 6b

Fig. 5

neering method that allows investigators

to assess stresses and strains within a solid
body.10-13 FEA provides calculation of stresses and deformations of each element alone
and the net of all elements. A finite element
model is constructed by breaking a solid object into a number of discrete elements that
are connected at common nodal points. Each
element is assigned appropriate material
properties that correspond to the properties
of the structure to be modelled. Boundary
conditions are applied to the model to stimulate interactions with the environment.14 This
model allows simulated force application to
specific points in the system, and it provides
the resultant forces in the surrounding structures. FEA is particularly useful in the evaluation of dental prostheses supported by implants.13-16 Two models were subjected to FEA
study to compare between a wide implant
restoration versus the two implant restoration of lower first molar.

sions can be simply measured with their full

details.
On the other hand, crown is too complicated in its geometry therefore it was not
possible to draw it in three dimensions with
sufficient accuracy. Crown was modelled by
using three-dimensional scanner, Roland
MDX-15, to produce cloud of points or triangulations to be trimmed before using in any
other application.
The second phase of difficulty might appear for solving the engineering problem, is
importing and manipulating three parts one
scanned and two modelled or drawn parts
on a commercial FE package. Most of CAD/
CAM and graphics packages deal with parts
as shells (outer surface only). On the other
hand the stress analysis required in this study
is based on volume of different materials.3
Therefore set of operations like cutting vol-

Fig. 4a_Radiographic view of wide

implants used to restore missing
lower first molars.1, 24
Fig. 4b_Buccal view of 2 standard
20-degree abutments on 3.5 mm
Astra Tech implants for restoration
of
mandibular right first molar.1, 24
Fig. 4c_Radiographic view of the
restoration.1, 24
Fig. 5_Crown, implants and bone
assembled in a model (FEA
software).
Figs. 6a & b_Von Mises stress on
crown (a) wide implant;
(b) two implants.

Tab. 1_Material Properties.

_Material and Methods

Three different parts were modelled to
simulate the studied cases; the jaw bones,
implant/abutment assembly, and crown. Two
of these parts (jaw bone and implant/abutment) were drawn in three dimensions by
commercial general purpose CAD/CAM software AutoDesk Inventor version 8.0. These
parts are regular, symmetric, and its dimen-

implants

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I 27

I research_ Single molar restoration

Fig. 7a

Fig. 7b

Fig. 7a & b_Spongy bone deflection

in vertical direction (a) wide
implant;
(b) two implants.
Figs. 8a & b_Cortical bone
deflection
in vertical direction (a) wide
implant;
(b) two implants.

Tab. 2_Results

umes by the imported set of surfaces in addition to adding and subtracting volumes can
ensure obtaining three volumes representing
the jaw bone, implant/abutment assembly,
and crown.2 Bone was simulated as cylinder that consists of two parts. The inner part
represents the spongy bone (diameter 14mm
and height 22mm) that filling the internal
space of the other part (shell of 1 mm thickness) that represents cortical bone (diameter 16mm and height 24mm). Two implants
were modelled one of 3.7mm diameter and
the other of 6.0mm. The implants/abutment
design and geometry were taken from Zimmer dental catalogue (Fig 5).
Linear static analysis was performed. The
solid modelling and finite element analysis were performed on a personal computer
Intel Pentium IV, processor 2.8 GHz, 1.0 GB
RAM. The meshing software was ANSYS version 9.0 and the used element in meshing all
three dimensional model is eight nodes Brick
element (SOLID45), which has three degrees
of freedom (translations in the global direc-

Fig. 8a

tions). Listing of the used materials in this

analysis is found in Table 1. The two models
were subjected to 120 N vertical load equally
distributed (20 N on six points simulate the
occlusion; one on each cusp and one in the
central fossa). On the other hand, the base of
the cortical bone cylinder was fixed in all directions as a boundary condition.17-21
_Results and Discussion
Results of FEA showed a lot of details
about stresses and deformations in all parts
of the two models under the scope of this
study. Figures 6a & b showed a graphical
comparison between the crowns of the two
models which are safe under this range of
stresses (porcelain coating, gold crown, and
implants showed the same ranges of safety).
No critical difference can be noticed on these
parts of the system. All differences might be
found are due to differences in supporting
points and each part volume to absorb load
energy (equation 2).**
Generally a crown placed on two implants
is weaker than the same crown placed on
one implant. This fact is directly reflected on
porcelain coating and the two implants that
have more deflections. Comparing wide implant model with the two implants from the
geometrical point of view it is simply noted
that cross sectional area was reduced by 43.3
per cent while the side area increased by 6.5
per cent. Using one implant results as a reference in a detailed comparison between the
two models by using equation (1) resulted
in Table 2 for porcelain coating, gold crown,
implant(s), spongy and cortical bones respec-

28 I implants

1_ 2013

research_ Single molar restoration

tively.
Difference % = {One implant ResultTwo
implants Result}*100 / One implant Result
(1)
Spongy bone deformation and stresses
(Table 2) seems to be the same in the two
cases. Simple and fast conclusion can be taken that using one wide implant is equivalent
to using two conventional implants. On the
other hand a very important conclusion can
be exerted that, under axial loading, about
10 per cent increase in implant side area can
overcome reduction of implant cross section
area by 50 per cent. In other words, effectiveness of increasing implant side area might
be five times higher than the increasing of
implant cross section area on spongy bone
stress level under axial loading. Starting from
Figure 7 a & b, slight differences can be noticed on spongy bone between the two models results. The stresses on the spongy bone
are less by about five per cent in the two
implants model than the one wide diameter
implant. The exceptions are the relatively increase in maximum compressive stresses and
deformations of order 12 per cent and 0.3 per
cent respectively.
The bone is known to respond the best to
compressive and the least to shear stresses22,
so considering the difference in compressive
stresses less significant, the two implants
were found to have a better effect on spongy
bone. Contrarily, Figures 8a & b, showed better performance with cortical bone in case of
using one wide implant over using two implants, that, deformations in cortical bone are
less by 20 per cent while the stresses are less
by about 40 per cent. The stresses and displacements were significantly higher in the
two implant model due to having two close
holes, which results in weak area in-between.
_Conclusions
This study showed various results between

Fig. 9

Fig. 8b

cortical and spongy bone. It was expected

that the maximum stresses in the cortical
bone was placed in the weak area between
the two implants. In addition to be higher
than the case of using one wide implant. Although the middle part of spongy bone was
stressed to the same level in the two cases,
using two implants resulted in more volume
of the spongy bone absorbed the load energy** which led to reduction of stress concentration and rate of stress deterioration by
moving away from implants. That is considered better distribution of stresses from the
mechanics point of view, which may result in
longer lifetime. Porcelain coating showed less
stress in case of two implants, longer life for
the brittle coating material is expected.

Fig. 9_Strain energy = area under

stress strain curve.

Contrarily more stresses were found on

the gold crown placed on two implants due
to its volume reduction (less material under
the same load). This is clearly seen in increasing stresses on the two implants, that
more load effect was transferred through
the weak crown to the two implants. That
showed maximum stresses in the area under
the crown, while the wide implant showed
maximum stresses at its tip. Looking to energy** absorption and stress concentration
on whole system starting from coating to
cortical and spongy bone, although the stress
levels found was too low and far from cracking danger, the following conclusions can
be pointed out; the total results favour the
two implants in spongy bone and the wide
implant in the cortical layer, but the alveolar
bone consists of spongy bone surrounded by
a layer of cortical bone. Its also well known
that according to the degree of bone density

implants

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I 29

I research_ Single molar restoration

the alveolar bone is classified to D1,2,3,4 23 in
a descending order.
So, provided that the edentulous space
after the molar extraction permits, its recommended in the harder bone quality (D1,2)
to use one wide diameter implant and in the
softer bone (D3,4) quality two average sized
implants. Therefore more detailed study to
compromise between the two implants size/
design and intermediate space can put this
stress values in safe, acceptable, and controllable region under higher levels of loading.

Fig. 10_Equation 2 (stress energy).

Fig. 10

30 I implants

1_ 2013

The three main stresses compressive, tensile, shear and the equivalent stresses in addition to the vertical deformity and the total
deformities were considered in the comparison between the two models. The results were
obtained as percentages using the wide implant as a reference. The spongy bone showed
about five per cent less stresses in the two
implants model than the one wide diameter
implant. The exceptions are the relatively increase in maximum compressive stresses and
deformations of order 12 per cent and 0.3 per
cent respectively.

** The area under the __-__ curve up to a

given value of strain is the total mechanical
The stresses and displacements on the
energy per unit volume consumed by the ma- cortical bone are higher in the two implant
terial in straining it to that value (Fig. 9). This is model due to having two close holes, which
easily shown as follows in equation 2:
results in weak area in-between. The spongy
bone response to the two implants was found
_Summary
to be better considering the stress distribution (energy absorbed by spongy bone**).
Restoration of single molar using implants Therefore, it was concluded that, using the
encounters many problems; mesio-distal wide diameter implant or two average ones
cantilever due to very wide occlusal table is as a solution depends on the case primarily.
the most prominent. An increased occlusal Provided that the available bone width is sufforce posteriorly worsens the problem and ficient mesio distally and bucco-lingual, the
increases failures. To overcome the overload, choice will depend on the type of bone. The
the use of wide diameter implants or two harder D1,2 types having harder bone qualregular sized implants were suggested. The ity and thicker cortical plates are more convenient to the wide implant choice. The D3,4
types consist of more spongy and less cortical
bone, are more suitable to the two implant
solution._
aim of this study was to verify the best solution that has the best effect on alveolar bone
Editorial note: A complete list of references
under distributed vertical loading. Therefore, is available from the author.
a virtual experiment using Finite Element _contact
implants
Analysis was done using ANSYS version 9. A
simplified simulation of spongy and cortical Prof. Amr Abdel Azim
bones of the jaw as two co-axial cylinders Professor, Faculty of Dentistry, Cairo University
drazim@link.net
was utilised. Full detailed with high accuracy
simulation for implant, crown, and coating Dr Amani M. Zaki
was implemented. The comparison included GBOI. 2009, Egypt
different types of stresses and deformations amani.m.zaki@gmail.com
of both wide implant and two regular im- Dr Mohamed I. El-Anwar
plants under the same boundary conditions Researcher, Mechanical Engineering Department,
National Research Center, Egypt
and load application.
anwar_eg@yahoo.com

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component matching

I research_ Impression and registration

Impression and registration for full-arch implant

dentures
Author_Prof. Gregory-George Zafiropoulos

Fig.1a

are often challenging and time-consuming

tasks.1

Fig.1b

Fig. 1a_Full denture in situ

Fig. 1b_Duplicate (DentDu)
of the interim denture

Fig. 1c_Trial of the DentDu

Fig. 2a_Placement of the DentDu
in the articulator
Fig. 2b_Pick-up impression system
On the left: titanium impression post
(placed on the implant)
On the right: plastic impression
sleeve (will be left in the impression)
Fig.1c

_Usually, a full denture is delivered following tooth extraction or implant insertion

of a fully edentulous arch. A denture is usually used until the final restoration is performed. A well-designed full denture should
fulfill the following criteria: 1) correct vertical height and maxilla-mandibular relationship; 2) accurate occlusion; 3) appropriate
choice of teeth with regard to shape, length,
width and position; 4) adequate lip support, and 5) proper function and aesthetics
to meet the patients expectations. The final
restoration should fulfill or surpass these
requirements. Obtaining a correct impression and accurately evaluating the interocclusal relationship (e.g., interocclusal distance, occlusal recording and determination
of the exact position of the placed implants)
Fig.2a

32 I implants

1_ 2013

The aim of the current report is to present

an impression and registration technique
that allows the transfer of the interocclusal relationship, occlusal recording and aesthetics that were initially applied to produce
a full denture as a template for the reconstruction of the final full-arch implant.
_Materials and Methods
Following multiple extraction of a nonsalvageable rest dentition and the placement of six dental implants in positions #4,
#5, #6, #11, #12, #13, a full denture was
fabricated. After the extraction sites had
healed and denture sores were eliminated,
the function and aesthetics of the denture
was optimised. If necessary, angulations,
shape and colour of the denture teeth and
the shape of the denture base were corFig.2b

research_ Impression and registration

Fig.3a

Fig.3c

Fig.3b

rected (Fig 1a). The resulting denture was

used by the patient until the final restoration was delivered. For the final restoration
of the maxilla, an implant-retained denture
with telescopic crowns as attachments was
planned.
After the implant was uncovered, the denture was modified to allow sufficient space
for the healing abutments. A duplicate of
the denture (DentDu) was made out of clear
resin (Paladur, Heraeus, Hanau, Germany,
Fig 1b). A trial of the DentDu was performed
and minor occlusal discrepancies were corrected (Fig. 1c). Bite records were taken in
centric occlusion with modelling resin (pattern resin, GC, Alsip, IL; Fig. 1c), using the
casts of the original denture. Afterwards,
the DentDu was placed in an articulator and
a controlling of the occlusion was made (Fig
2a) with the bite records. A pickup transfer
system consisting of a titanium impression
post and a plastic impression sleeve was
employed (Dentegris, Duisburg, Germany,
Fig 2b). The DentDu was carefully modified
by creating internal clearance in the area of
the implants so that it could be applied as
an individualised custom tray. This permitted it to be fully seated when the impression
posts were in place. Impressions were generated by a polyether material (Impregum,
3M ESPE, St. Paul, MI). During this process,
the DentDu was kept in centric occlusion
using the bite records (Fig 3a).

material (Fig 3b). A master cast was then

fabricated and articulated with the help of
the bite records (Fig 3c, Figs 4a & 4b).
Customisable abutments (Dentegris)
were taken to fabricate the implant abutments. Parallelism, angulation, position
and shape of the implant abutments were
determined using a silicon key fabricated
from a matrix of C-silicone (Zeta - labor,
Zhermack SpA, Badia Polesine, Italy, Fig 5).
The dentist and the dental technician
relied on two alternatives for customised
abutments selection: 1) UCLA customisable abutments (UCLA, Dentegris) for casting with a gold alloy (for example, Portadur
P4, Au 68.50 per cent, Wieland, Pforzheim,
Germany, Fig 6a) or 2) platinum - iridium
custoiable abutments (PTIR, Dentegris) forFig. 4a

Fig. 5

Fig. 3a_Taking the impression with

the DentDu. The bite records were
used to determine the exact position.
Fig. 3b_Fabrication
of the master cast
Fig. 3c_Placement of the cast
into the articulator using
the bite registrations

Fig. 4a_Master cast

Fig. 4b_The master cast is placed
into the articulator
Fig. 5_The customized implant
abutments are fabricated using
a matrix of C-silicone
Fig. 6a_Gold customized abutments
Fig. 6b_Chromium cobalt (CrCo)
customized abutments

Fig. 4b

Fig. 6a

Fig. 6b

The titanium impression posts were connected with the implant analogues and with
the plastic impression sleeves (Dentegris),
which were embedded in the impression

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I research_ Impression and registration

Fig. 6c

Fig. 7a

Fig. 7b

Fig. 7c

Fig. 6c_Electroformed gold copings.

Figs. 7a & b_The customized
abutments are mounted on the
implants using a transfer key.
Fig. 7c_Electroformed gold
copings in situ.

Figs. 8a & b_Brial of the mock-up.

Fig. 8c_Temporary fixed
denture in situ
Fig. 8a

casting with a chromium cobalt (CrCo) alloy placed over the electroformed copings and
(for example, Ankatit, Anka Guss, Waldas- the occlusion was checked with the bite rechaff, Germany, Fig. 6b).
cords (Figs. 8a & b). A final impression with
a polyether impression material (Impregum,
After casting, the customised implant 3M ESPE) was taken with electroformed
abutments were grinded, polished and copings. The mock-up was further set up
served as the basis for the fabrication of and used for the fabrication of a new (final)
electroformed puregold copings with a master cast. After the impression was taken,
thickness of 0.25 mm (AGC Galvanogold, the TFD was fixed on the implant abutments
Au > 99.9 per cent, Wieland, Fig. 6c).2-4 The using temporary cement (TempBond, Kerr,
framework was then constructed via CAD/ Orange, CA).
CAM.
It was then left in place until the delivery
To ensure proper functioning of the of the final restoration (Fig 8c).
framework, a plastic mock-up and a temporary fixed denture (TFD) were milled (ZENOThe new master cast was articulated with
PMMA, Wieland). The customised implant the help of the gold copings and the mockabutments, the electroformed copings, the up. The metal framework was milled (here:
mock-up and the TFD were delivered by the Titanium Zenotec TI, Wieland, Fig. 9a). The
dental laboratory for the next clinical ses- veneering of the superstructure was made
sion.
using a light-cured indirect ceramic polymer (Ceramage, SHOFU, Menlo Park, CA,
The abutments were transferred, posi- Figs. 9ad). The electroformed gold copings
tioned on the implants and torqued to 35 were fixed in the metal framework using a
Nm using a resin transfer key (pattern resin, self-curing compomer cement (AGC Cem,
GC; Figs 7a & b). From this point on, the cus- Wieland, Fig 10).
tomised abutments remained fixed in order
The above-described procedures can be
to avoid any possible inaccuracies. The elec- also performed in cases in which a fixed
troformed copings were placed on the im- denture was planned for the rehabilitation
plant abutments (Fig. 7c). The mock-up was of the full-arch (Figs 11a&b, Figs 12ac) and
Fig. 8b

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Fig. 8c

research_ Impression and registration

Fig. 9b

Fig. 9a

Fig. 10

Fig. 9c

Fig. 9d

in cases where part of the natural dentition

is periodontally stable and can be applied
as abutments. In these cases, the immediate full denture can be designed as a cover
denture. From this cover denture, a DentDu
could be fabricated and further used as described above (Figs 13ac).
Porcelain is a possible material for veneering of fixed-denture frameworks. If
the angulation of the implants does not
allow for taking impressions in the abovedescribed way and an open-tray impression
is preferable, fenestrations can be fabricated
into the DentDu (Fig 14).
_Discussion
The reconstruction of the fully edentulous arch with implant-retained dentures
necessitates thorough planning and a precise and passive fit of the suprastructure. A
previous study demonstrated that a passive
fit between the implant superstructure and
the underlying abutments is essential for
the long-term success of the implant prosFig. 11a

thesis.5 To achieve a passive fit, an accurate

positioning of the implant replicas in the
master cast must be assured. The impression
technique and the splinting of the implant
copings are factors which may contribute
to errors in the final positioning of the implant analogues, thus leading to inaccuracies in the fit of the final superstructure.5-10
Furthermore, the angulation or proximity of
the implants may inhibit proper seating of
the impression copings and/or caps, which
may also have a detrimental effect on the
registration of the implant position.11

Figs. 9ad_Final telescopic crown

retained implant denture, palatal;
(a), anterior teeth (b), right side (c),
left side (d).
Fig. 10_Placement of the
electroformed copings
into the frame.

The precise recording of the maxillomandibular, eg interocclusal, relationship is

a prerequisite for achieving proper occlusion and a successful treatment outcome.1,10
The initially delivered denture allowed for
the correction of the interocclusal relationship, tooth shape and colour and angulations during the entire healing period. In this
way, the patient was able to acclimatise to
the function and aesthetics of the denture.
In the method described in this report, an
accurate impression and recording of the
Fig. 11b

Figs. 11a & b_A case of fixed

implant retained denture for the
maxilla full-arch rehabilitation: trial
of the mock-up (a) and the milled
temporary fixed denture is placed on
the abutments (b).

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I research_ Impression and registration

Fig. 12a

Fig. 12b

Fig. 12c

Fig. 13a

Fig. 13b

Fig. 13c

Figs 12ac_A case of fixed-implant

retained denture for the maxilla
full-arch rehabilitation, right site (a),
anterior area (b), left site (c).
Figs. 13ac_Impression of a case
with natural dentition (teeth #11 and
#12) and implants. Master cast
in the articulator with a duplicate
of the over-denture in place (b).
Gold copings fixed on the remaining
teeth #11 and #12 and customised
implant abutments mounted on the
implants (both of them served as
primary telescopes (c).
Fig. 14_DentDu modified for opentray impression technique.
Fig. 14

impression can be taken by the first DentDu;

the second DentDu is used for the remaining steps. Customised abutments are applied instead of a bar, galvano copings allow
a precise transfer coping, and secondary
telescopes as well as different technologies
are employed for the transfer of implant
positions and for the construction of the
If an open-tray impression is preferred, superstructure.
only minor changes to the procedure are
necessary. This method is based on a preCustomised implant abutments allows
12
vious publication. In cases such as this, it for better angulations and shape, for imis advisable to fabricate two DentDus. The proved occlusal force transmission from the
crown to the implant and the bone, and also
for facilitating the fabrication of an aesthetically pleasing implant-supported denture.
Ways in which abutment design contributes
to improved aesthetics include changes in
the location of the crown and changes in
the dimension and/or form of the restorative platform.
full denture was achieved by using a duplicate as a custom tray for the impression.
Therefore, it was not necessary to repeat all
the steps usually needed for recording the
interocclusal relationship, eg wax-up, etc.,
at the time of the fabrication of the final
restoration.

Additionally, features of the abutment

design contribute to the health and dimensional stability of the soft tissue. Current
attempts to objectively define implantrestoration aesthetics have focused on periimplant mucosal parameters.13,14 The introduction of the UCLA abutment provided
a custom solution for implant restorations.
This direct-to-implant restoration con-

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research_ Impression and registration

cept provided adaptability. Through waxing

and casting, the height, diameter and angulations can be addressed in order to provide a wide range of clinical solutions for
problems associated with limited interocclusal distance, interproximal distance, implant angulations and related soft tissue
responses.15
The customised implant abutments
served as primary telescopes, and the
electroformed copings served as secondary telescopes in cases where a removable
denture with telescopic crowns was used as
the attachment. Electroformed gold copings
are associated with several advantages, in
conjunction with both removable and fixed
restorations. The galvano-forming and electroforming process yielded a precisely-fitted
secondary coping for the implant abutment
with a gap of only 1230m. The gold electroformed coping saves space and is made
of high-quality material.2-4 Using gold copings for the impression allows for the exact transfer of the form, angulations and
position of the inserted customised implant
abutments.
With the help of the milled mock-up,
the future fit of the CAD/CAM fabricated
framework can be evaluated and necessary changes in the shape of the restoration
and occlusion can be made. Making these
changes on the mock-up was easier and
less time consuming than making them on
the metal framework itself, and it was then
possible to transfer them directly to the final framework. Furthermore, the mock-up
almost splinted the electroformed gold
copings during the impression, allowing for
the exact transfer of the abutment position.
At the same time, the vertical height and
interocclusal relationship were recorded.
The delivery of a milled temporary restoration permitted a slow and non-progressive
loading of the implants, which then leads
to bone remodeling.16 Abutments were left
in place after mounting. Combined with the

fabrication of a new cast, this further decreased the risk of inaccuracies during the
transfer process.
_Conclusion
The method described here can be used
for fullarch restorations with both fixed and
removable implant supported dentures. Accurate impressions can be accomplished
and occlusion, vertical dimensions, as well
as implant positions can be transferred
while facilitating the full-arch restoration
process. In addition, this technique resulted
in a reduction of the required chair time.
Disadvantages of this technique lie in the
fact that the quality of laboratory technicians work meets higher demands than
usual, and that the clinician also needs to
acquire some additional skills. Further disadvantages of this method include the
need for a highly qualified technical lab and
higher technical costs relative to those associated with prefabricated titan implant
abutments.
To date, this method has not been applied
in conjunction with immediate implant
loading. However, dentists and patients
have come to expect this level of rehabilitative accuracy, precision, long-term success
and aesthetics._
Editorial note: A complete list of references is available from the publisher.

_contact

implants

Prof. Gregory-George Zafiropoulos

Blaues Haus
Sternstr. 61
40479 Dsseldorf, Germany
zafiropoulos@prof-zafiropoulos.de
www.prof-zafiropoulos.de

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I industry report _ Full arch rehabilitation

Fixed full arch metalfree prosthesis on four

SHORT implants
Author_Prof. Mauro Marincola, Dr Vincent J. Morgan, Angelo Perpetuini & Stefano Lapucci

_The concept of having only four

SHORT implants for the support of a fixed
full arch non-metallic prosthesis (Trinia),
a CAD/CAM fiber reinforced resin, was first
executed in 2010. The clinically based results
performed in three different implant dentistry centres are showing clinical success
because of Trinias inherent mechanical and
clinical properties. Another factor were the
360 degrees of universal abutment positioning provided by the Implants Locking Taper
connection (Bicon), which gives the opportunity to use the Trinia prosthesis to orient
and seat the abutments in the well of the implants. The Trinia framework may be covered
with either customised poly-ceramic indirect
composite material or by conventional denture teeth and resin.

Fig 1

We want to show how short implants

have been successfully used to restore severely atrophic mandibles without the use of
difficult bone augmentation procedures and
complicated prosthetic suprastructures in
the past decade.
_Material and methods
Fig 2

Fig 3

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Fig 4

Bicon Dental implants (Bicon LLC, Boston,

MA, USA) were used for the reconstruction
of the case, combined with a CAD/CAM fiber reinforced resin framework (Trinia) and
conventional denture teeth and resin prosthesis. Bicon implants can be characterised
by their special macro-structure, including
a root-shaped design with wide fins called
plateaus, by a sloping shoulder and by a well
which holds the abutment post by means of
a Locking Taper connection.1
The plateaus are of particular importance
for the biomechanical performance, allowing
SHORT implants with a wide diameter to be
used in any position in the oral cavity. Their
insertion into the osteotomy, which has been
prepared using atraumatic drills rotating
at 50rpm, is executed by using mechanical
pressure. The countless micro-retentions created on the surface of the fine edges with the
walls of the osteotomy ensure primary stability of the implant in the implant site. Furthermore, the wide spaces between the plateaus
avoid vertical compression on the bone walls
and rapidly collect the clotted blood, allowing rapid bone formation without the clasFig 5

industry report _ Full arch rehabilitation

Fig 6

Fig 7

sic macrophagic and osteoclastic processes

of bone resorption taking place. Thus welldefined bone is formed, with haversian canals and blood vessels which enable continuous bone remodelling around the implant/
bone contact surface. This ensures stability of
the implant in any situation involving biomechanical stimulus.2

Fig 8

Fig 9

of pathogens around vital structures, crestal

bone, periosteum and epithelium. The result
would be bone resorption well below the
original crestal bone level.
Bicons locking taper is a design feature
ensuring crestal bone level maintenance
around an implant with a convergent sloping shoulder placed subcrestally.3 The Locking Taper is a precise connection formed by
cold welding out of two surfaces of the same
material which are brought into close contact with pressure. In this way, the oxidation
layers formed both on the abutment post
and on the surface of the implant well
are detached.4, 5 The prosthetic components
(one-piece titanium abutments made from
the same surgical grade titanium alloy as the
implants) ensure maximum mechanical resistance and optimum biocompatibility. The
subgingival hemispheric base geometry is ideal for the stability of periimplant connective
tissues.

The sloping shoulder is vitally important

for the preservation of crestal bone after
implant osseo - integration and for implant
function. The Bicon implant design offers
platform switching with a neck which converges from the widest diameter of the first
plateau, to 2 or 3mm towards the crestal
zone (converting crest module). In our patient, we used implants 5mm in diameter,
but the space taken up at crestal level is only
three mm. This ensures bone augmentation
above the neck, also because the implant is
seated at least one mm below the crest during the first surgical stage. This allows the
above structures, such as the crestal bone,
periosteum and epithelium, to grow around
The abutments are connected to the imthe hemispherical base of the abutment and plant well by means of a post, which is 2mm,
to give sufficient space for maintenance and 2.5mm or 3mm in diameter. Implants which
the growth of the papillae.
are 3.0mm and 3.5mm in diameter are suitable for 2mm posts, while implants of a diAnother important factor for obtaining ameter of 4.5mm, 5mm or 6mm match with
long term crestal bone stability is the bacte- abutments with a 3mm post. All of the abutrial seal within the connection between im- ment posts have diameters or emergence
plant and abutment. If crestal bone mainte- profiles of 3.5, 4.0, 5.0 or 6.5mm, suitable
nance and the formation of papillae can only for allowing a natural anatomical shape of
be achieved when the implant is placed in a
Fig 11
subcrestal position and by platform switching Fig 10
at the level of the implant neck, it is also true
that this situation can only be accomplished
if the connection is hermetically sealed from
bacterial infiltration. Without this feature, the
placement of a sub-crestal implant without a
bacterial seal would result in the rapid spread

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I industry report _ Full arch rehabilitation

the soft tissues. Abutment diameters are
therefore independent of implant diameters,
which means that any implant may host the
four different abutment emergence profiles.
The different emergence profiles start from
the 2mm, 2.5mm or 3mm posts, placed at
crestal bone level. The geometry of the abutments provides for platform switching even
at a prosthetic level, which is of vital importance in the organisation of the connecting
tissue and the epithelial layer.

Fig 12

prior to recording their position by making an implant level impression with any
conventional impression material (Fig 4).
Upon the removal of the full arch impression, green impression posts were removed
from the implant wells and inserted into an
implant analogue of the same colour before inserting them into their corresponding acrylic sleeves within the impression.
Prior to the pouring of a stone model, a
resilient acrylic was applied around the impression posts to simulate a soft tissue contour in the stone model. The stone model
was used for the fabrication of a wax bite
rim to record the occlusal registrations. After
articulation of the models, appropriate abutments with the largest practical hemispherical base were selected and inserted into their
corresponding implant analogues within the
stone model. Their prosthetic posts were then
milled parallel to one another (Fig 5).

The supraperiosteal space involved in the

shift from the connecting post diameter
(23mm) to the diameter of the abutment
hemisphere (36.5mm), allows a thicker and
denser connecting tissue to form, resulting
in the optimal preservation of the papilla. In
the following case, all the selected abutments
have a 3mm post, as they must connect to
the 3mm wells of the 5.0 x 6.0mm implants.
Abutment post heights, inclinations and diameters are selected in the laboratory in accordance with the position of the implants
The model with the milled abutments was
relative to the anatomy of the alveolar ridge. used to fabricate a light cured resin bar and
denture tooth set up for an intra-oral conTrinia is a CAD/CAM multidirectional fibre firmation of the arranged teeth. Once the
reinforced resin material, which despite its denture set-up had been clinically approved,
light weight is capable of withstanding oc- a facial occlusal silicone mask was initially
clusal forces.
formed over the denture wax set up. Prior to
forming the lingual silicone mask, indexing or
_Case report
alignment grooves were placed in the facial
occlusal mask. After fabrication of the lingual
A 52-year-old male patient, presenting mask, grooves were cut into the stone model
a severely compromised mandibular bone, to prevent the subsequent entrapment of air,
was treated with the placement of four short when acrylic was poured into the silicone
implants. Two SHORT implants (4.5 x 8mm) flask through anterior cut-away or aperture
were placed bilaterally at the canine region in the lingual mask. Prior to the removal of
and two ULTRA SHORT implants (4 x 5mm) the wax denture tooth set up from the stone
were bilaterally located at the first molar re- model, the facial lingual extent of the wax
gion (Fig 1). The implants were placed in a two- denture tooth set up on the alveolar ridge
stage surgery and they were uncovered after was marked on the stone model with a pencil.
a healing period of three months (Figs 2&3).
After the removal of the denture teeth
Clinically, the prosthetic treatment be- and wax from the resin bar, the teeth were
gan with an implant level transfer impres- cleaned and lingually roughened or modified
sion by inserting with only finger pressure a prior to being facially glued to the facial ocgreen impression post with its corresponding clusal silicone mask with cyanoacrylate glue.
acrylic sleeve into the 3.0mm implant well, An uneven thin application of clear resin was

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For further information and details of

upcoming UK courses please contact

I industry report _ Full arch rehabilitation

Fig 13

Fig 14

then applied to the cervical area of the teeth

on the mask to achieve an aesthetic stratification of the gingival denture resin. The
facial occlusal mask and the resin bar were
then repositioned on the model to confirm
the appropriateness of their contours relative
to each other and particularly to the cervical
gingival area of the intended teeth. If necessary, the resin bar may be modified by adding wax or by reducing it with a bur. Prior to
its being sprayed and digitally scanned, the
space between the resin bar and the ridge
area between the pencil lines on the model is
filled with a putty material, so that the milled
framework can be in contact with the soft
tissue of the edentulous ridge (Fig 6).
After the model with the milled abutments
and the resin bar were separately sprayed
and scanned, the Trinia fibre resin bar was
digitally designed on the computer with a
minimum thickness of 7.0mm throughout,
an abutment clearance of 30 microns for
cement and with a maximum cantilever extension of 21.0mm. If necessary, the milled
Trinia framework may have been judiciously
reduced manually.

A thin mix of denture resin was poured

into the silicone flask through the anterior
cutaway or aperture in the lingual mask. Final polymerisation was achieved while the
silicone flask and models were under hot
water, with an air pressure of three bars. After polymerisation, the Trinia prosthesis was
removed from its silicone flask, then finished and polished in a conventional manner.
Clinically, after the removal of the temporary
abutments from the implant wells, at least
two milled abutments were incompletely inserted into the prosthesis. If necessary, they
were stabilised with an application of Vaseline, prior to their being transported to the
mouth and inserted into the well of their implant (Fig 8). The loosely fitting abutment facilitated its insertion into the well of the implant (Fig 9). Once the abutment was initially
seated, the prosthesis was removed for the
definitive seating by tapping directly onto the
titanium abutment. This seating process was
continued until all of the abutments were definitively seated (Figs 10 to 12).
Alternatively, an abutment could have
been initially be loosely seated in the well of
the implant, prior to the prosthesis being used
to orient and seat the abutment in the well of
the implant. Final or temporary cementation
was achieved by first applying Vaseline over
the ridge area of the prosthesis to facilitate
the removal of any extraneous cement. Only
a minimum of cement was applied to the
bores in the Trinia framework before inserting
the prosthesis in the mouth. The extraneous
cement was blown away with an application
of air under the prosthesis. The occlusion was
evaluated and adjusted (Figs. 13 & 14)._

After cleaning the milled Trinia framework

with alcohol, it was placed onto the milled
abutments to evaluate and, if necessary, modify the marginal adaptation of the framework
to the abutments and to the alveolar ridge of
the model. The ridge side of the framework
should be convex without any concavities.
Editorial note: A complete list of references
Additionally, the Trinia framework was used is available from the publisher.
to confirm both the path of insertion of the
prosthesis and the sequence of insertion of
the milled abutments on the model. After the
implants
_contact
sequence and path of insertion were confirmed, the facial, occlusal and lingual masks Prof. Mauro Marincola
were repositioned on the model and attached Via dei Gracchi, 285 I-00192 Roma, Italy
mmarincola@gmail.com
together with cyanoacrylate glue (Fig 7).

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product spotlight _ Biohorizons

Broaden your
BioHorizons
Author_ Dr Maurice Salama

deep tissue without the need for additional

remodelling
Sculpted design for optimal soft tissue
contouring in a wide variety of collar heights
Retained abutment screw for one-handed
positioning and delivery of angled abutments,
using either .050 Hex or Unigrip drivers.

_Implant
company
BioHorizons
launched two new products at this years
The Tapered Plus implant system offers all
Dentistry Show in March.
the great benefits of BioHorizons highly successful Tapered Internal system designed for
Together with world renowned dentist Dr increased soft tissue volume.
Maurice Salama, Biohorizons presentation
centred on the benefits that the new MultiBoth systems offer optimised threadform
unit abutment and Tapered Plus implant can buttress thread engineered for superior stabring to both patients and clinicians.
bility over micro-threaded implants plus, for
restorative ease, the conical internal hex conThe Multi-unit abutment system enables nection is colour-coded for quick identificaplacement and restoration of multiple im- tion and component matching.
plants on a partially or fully edentulous maxilla or mandible supporting a provisional, In addition, Tapered Plus has:
fixed or, when indicated, immediately loaded A Laser-Lok treated bevelled collar for bone
full-arch prostheses.
and soft tissue attachment
Platform switching designed to increase
The system offers:
soft tissue volume around the implant con Straight and angled multi-unit abutments nection.
providing the greatest range of angulation
correction and maintaining the least lateral
Dr Salama also presented a few cases he
offset, delivering uncompromised strength, has performed using the new technology,
versatility and simplicity
highlighting especially the increased soft tis 45 conical connection featuring a self- sue volume for improved aesthetics._
centring 22.5 of angulation correction to
help ensure a passive prosthetic fit and extend
For further information, please call 01344
restorative flexibility to diverging implants 752560, email infouk@biohorizons.com or
Low profile abutment emergence pro- visit www.biohorizons.com.
files seat easily with implants in shallow or

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I manufacturers news
Bicon:
Simple Implantology for General Practice - with Live Surgery
Presented by: Dr Clive Debenham and Dr Geoffery Pullen
Training in Central London 6:30pm - 8:30pm
Bicon course programme compiles with GDC guidelines

Tuesday 11th June 2013

Cost: 150 (Refreshments provided)
To book your place and for information contact Sam Debenham on
Tel: 01473 829299 or Email: sdebenham@bicon.com
DMG UK:
Honigum - MixStar Heavy
Straumanns & Brnemarks material of choice

TUESDAY 19TH MARCH 2013

o book your place and for information contact Sam Debenham

on Tel: 01473 829299 Email: sdebenham@bicon.com

Honigum-MixStar Heavy is the material of choice, best fulfilling

the demands for precision and handling. Dr Nannmark says:
Honigum-MixStar Heavy ensures improvement and simplificaAPRIL
2013
tion ofTUESDAY
our prosthetic9TH
treatment.
In our
clinic, every patient is a
lifelong commitment where we take full responsibility of follow
up and long-term results.

To book your place and for information contact Sam Debenham

onFeaturing
Tel: 01473DMGs
829299patented
Email: sdebenham@bicon.com
Honigum Technology, Honigum-

Mixstar Heavy contains a unique microcrystalline wax matrix.

This rheologically active matrix combines with its unique Directed Flow characteristic to facilitate unprecedented flow even
in problem areas. Together they offer the benefits of exceptional
precision, exact margin reproduction, thixotropic non-dripping
consistency, easy removal, distortion free storage, neutral taste
and honey scent.
DMG UKs Honigum-MixStar Heavy has been selected by
Brnemark & Straumann as their material of choice for implant
impressions.
At the Brnemark Centre they treat every type of implant
case from simple single tooth to the most complex cases. They
continuously evaluate every stage of treatment in order to find
the optimal combination from osseointegration to optimal precision of the prosthetic reconstruction. Their conclusion is that

44 I implants

1_ 2013

Honigum-MixStar Heavy is designed for use in combination

with DMGs MixStar and MixStar-eMotion automatic mixing
units, and other similar machines.
For further information contact your local dental dealer or
DMG Dental Products (UK) Ltd on 01656 789401, fax 01656
360100, email info@dmg-dental.co.uk or visit www.dmg-dental.
com

OPG/CEP
from

39.99
ns

CBCT sca

from

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t reports

is
Radiolog
from

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referring to another practice...
- Lowest radiation and smallest eld of view
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Birmingham 2nd Floor, Varsity Medical Centre, 1a Alton Road, B29 7DU

I manufacturers news
Sirona
Digital X- Ray solutions
At the forefront of the rapid advances in digital dentistry, Sirona have
developed digital 2D and 3D X-Ray systems to provide precise treatment
planning.
GALILEOS and ORTHOPHOS XG 3D can offer comprehensive cone beam,
panorama and cephalometric X-ray programs to suit all disciplines within
dentistry.
Sirona is the only manufacturer worldwide which offers an integrated
concept consisting of 3D imaging as well as computer-aided implant planning
and implementation with both Galileos and the XG3D.
The ORTHOPHOS XG Family of panoramic imaging units are among the
best sellers in the industry. The systems wide range of functions, excellent
image quality and ease of use has impressed many users.
Contact details for further information:
Sirona Dental Systems 0845 071 5040
Info@sironadental.co.uk
GC Fuji TEMP LT
The first place-paste gloss-ionomer provisional luting cement
GC Fuji TEMP LT is
especially designed for
long-term temporary cementation. Thanks to its
balanced formulation, it
is very convenient during
application and provides a
stable retention whilst assuring the future safe removal of indirect restorations. Besides presenting optimized handling and physical properties, GC
Fuji TEMP LT counts on the well-known safety offered by glass ionomer
materials.

GC Fuji TEMP LT, all you need in temporary cement

Pleasant handling
no-runny consistency with low film thickness
easy to remove excess
Reliable retention
Long term security
No negative influence on final adhesive cementation
Secure retrievability
Safe removal of the restoration whenever needed
Easy clean up

These advantages combined with the safety offered by glass ionomers

make it the ideal choice for:
Long-term temporary cementation of all types of all-ceramic, resin,
acrylic and metal-based crowns and bridges, including try-on cementation
of long-span prosthetic appliances;

46 I implants

1_ 2013

Especially adapted to assure sufficient retention and retrievability of

crowns and bridges cemented on implant abutments.
GC Fuji TEMP LT comes in one single shade (Universal) and is presented in
paste pack cartridges to be used with the practical Paste Pack Dispenser from
GC. Removal of cemented prosthetic appliances is better performed with the
use of GC Pliers for better control of applied forces.
For further information please contact GC UK on (0044) 1908 218999 or
e-mail info@uk.gceurope.com
At United Smile Centres it is our mission to make your patients experience with us as pain-free and pleasant as possible. Because we specialise in
the Fixed Teeth in a Day technique, we have the most up to date facilities
to ensure that treatment is completed precisely and with the minimum of
fuss and discomfort.
Our team of highly qualified, dedicated clinicians are among the leading
dental surgeons working in the UK, and will use their wealth of experience
to quite literally transform your patients lives. At United Smile Centres we
always work closely with referring dentists for the best possible outcome. We
even provide you with the final restoration ready for YOU to fit.
To learn more about how patient implant referrals can benefit your practice, contact United Smile Centres today. For more information call United
Smile Centres on 0800 8 49 49 59, email info@unitedsmilecentres.co.uk, or
visit www.unitedsmilecentres.co.uk

Exceptional gum health requires a gentle touch

Take the pressure out of brushing, with Oral-B

93% OF patients reduced

their brushing FOrce in
1 mOnth using the OraL-b 5000
series eLectric tOOthbrush1
triple pressure control system:
1

internal sensor activates when patient

exceeds safe brushing force (>3n)

indicator lights flash, reminding

patient to reduce pressure

Brush reduces speed by 35% and

stops pulsation

Learn how Oral-b electric

toothbrushes provide a gentle
touch, at dentalcare.co.uk

Reference: 1. Janusz K et al. J Contemp Dent Pract. 2008;9(7):1-13.

2012 P&G

P13120.01

continuing the care that starts in your chair

I meetings _ diary dates

Diary Dates
Implant Events 2013
ADI Study Club UK
23rd April 2013
Wakefield
British Dental Conference and
Exhibition
25-27th April 2013
London
ADI Study Club UK
14th May 2013
London

48 I implants

1_ 2013

Clinical Innovations Conference

17-18th May 2013
London

ADI Study Club

10th June
Britannia Daresbury Park Hotel, Chester

ADI Study Club

21st May
Felbridge Hotel and Spa, East Grinstead

ADI Study Club

11th June
Ramada Hotel, Belfast

ADI Study Club

23rd May
Holiday Inn Hemel Hempstead

ADI Study Club

19th June
Novotel Newcastle Airport

ADI Study Club

5th June
Hilton Warwick, Warwick

BDTA Showcase
17-19 October
NEC, Birmingham

about the publisher _ imprint|

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Questions?
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Group Editor
Lisa Townshend
lisa@healthcarelearning.com

implants

1

_ 2013

I 49

I about the publisher _ imprint

implants
the journal of oral implantology
Group Editor
Lisa Townshend
lisa@healthcare-learning.com
020 7400 8979
Publisher
Joe Aspis
joe@healthcare-learning.com
020 7400 8969
Editorial Assistant
Angharad Jones
Angharad.jones@healthcare-learning.com
020 7400 8981
Sales Executive
Joe Ackah
joe.ackah@healthcare-learning.com
020 7400 8964

Editorial Board
Mr Amit Patel
BDS MSc MClinDent MFDS RCEd MRD RCSEng Specialist in
Periodontics & Implant Dentist Associate Specialist Birmingham
Dental Hospital
Professor Andrew Eder
BDS, MSc, MFGDP, MRD, FDS, FHEA Director of Education and
CPD, UCL Eastman Dental Institute

Dr Stuart Jacobs
BDS MSD (U Ind) in full time private practice

Dr Neel Kothari
BDS Principal and General Dental Practitioner

Shaun Howe
RDH Dental Hygienist

Design and Production

Ellen Sawle
ellen@healthcare-learning.com
020 7400 8970

Published by Dental Tribune UK Ltd

2013, Dental Tribune UK Ltd.
All rights reserved.

Dental Tribune UK Ltd makes every effort to report clinical information and manufacturers product news accurately, but cannot assume responsibility for the validity of product claims, or for
typographical errors. The publishers also do not assume responsibility for product names or claims, or statements made by advertisers. Opinions expressed by authors are their own and may
not reflect those of Dental Tribune UK.

implants_Copyright Regulations
_implants is published by Dental Tribune UK and will appear in 2013 with one issue every quarter. The magazine and all articles and illustrations
therein are protected by copyright. Any utilization without the prior consent of editor and publisher is inadmissible and liable to prosecution.
This applies in particular to duplicate copies, translations, microfilms, and storage and processing in electronic systems.
Reproductions, including extracts, may only be made with the permission of the publisher. Given no statement to the contrary, any
submissions to the editorial department are understood to be in agreement with a full or partial publishing of said submission. The editorial
department reserves the right to check all submitted articles for formal errors and factual authority, and to make amendments if necessary.
No responsibility shall be taken for unsolicited books and manuscripts. Articles bearing symbols other than that of the editorial department, or
which are distinguished by the name of the author, represent the opinion of the afore-mentioned, and do not have to comply with the views
of Dental Tribune UK. Responsibility for such articles shall be borne by the author. Responsibility for advertisements and other specially labeled
items shall not be borne by the editorial department. Likewise, no responsibility shall be assumed for information published about associations,
companies and commercial markets. All cases of consequential liability arising from inaccurate or faulty representation are excluded. General
terms and conditions apply, legal venue is London, UK.

50 I implants

1_ 2013

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roots

Down your canal... roots is the place to keep up with the latest developments in the endodontic arena. A combination of comment, studies, case
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