NYU College of Dentistry
International Implantology Week
Implant Dentistry: An Evolving Field
NEW YORK -The implant dentistry field continues to
evolve. Almost every month, new tools are added to
the armamentarium, according to a speaker at the 2011
International Implantology Week hosted at New York
University College of Dentistry and sponsored by Zim-
mer Dental.
“Bone grafting materials, acellular dermis, and so
forth, these are all pieces of the puzzle,” Henry Salama,
DMD, former Director of the Implant Research Center
at the University of Pennsylvania, told the international
audience. “But it is important to remember, materials
are not the reason for your success. Certainly, good ma-
terials help a lot, but it is up to good technique.”
Dr. Salama encouraged clinicians to overlay a smile
on every x-ray, before beginning their work. He said to
carefully examine the lip line and how the implants will
look after placement. “Biotechnology, digital technol-
ogy, ceramic and adhesive technology—all of these only
work when the foundation is formed from an esthetic
position,” Dr. Salama said. “When the gums and the
lips are in harmony with the teeth.”
Keys to a Beautiful Smile
Dr. Salama explained that there are several key com-
ponents to keep in mind when designing a beautiful
smile, including:
• Balance of form
• Symmetry at the midline
• Gingival harmony
• Gingival relation to the upper lip
• Incisal edge relation to the lower lip
• Minimizing negative space so there are no shadows
in the smile.
Dr. Salama went on to say that some patients present
special challenges when considering these factors, includ-
ing labial defects, interproximal defects, and vertical com-
ponents, which he defined as type 2 and type 3 sites.“Once
you classify the site you are working in, you can overcome
problems with them,” Dr. Salama said. The way to classify
this, Dr. Salama said, is to start diagnostically.
“Always start with space management,” Dr. Salama
said. He presented a patient who needed extraction
of the posterior molars, but in this case, the clinician
placed implants and used them as “anchors to create
arch integrity,” he said. In this particular case, although
the teeth were a “loss,” he said the clinicians opted to
erupt the teeth to gain bone and soft tissue and allow
for mineralization. “A big advantage we found is when
you leave the root in and submerge it, the area will act
like an implant to the tooth site rather than implant to
pontic site,” Dr. Salama said.
When treating soft-tissue recession, Dr. Salama of-
fered this pearl: “Whenever we have a recession of soft
tissue, I approach it in a submerged fashion. There’s
a big tendency to shrink back, but it is much better to
do an advanced flap, and hide the tissue and keep it
submerged. You’ll be able to control position of tissue,
remove the bridge, and make a provisional restoration
from canine to canine.”
Dental Learning
Obtaining Thick Bone, Soft Tissue
Dr. Salama said there are 2 main reasons why an
implant procedure may fail: labial failures and inter-
proximal failures. He said the best way to avoid these
problems is obtaining adequate thickness of the bone
or soft-tissue. He said the third molar is a “great source
of tissue that doesn’t shrink. You can de-epithelialize it,
and obtain thickness in the anterior.”
Discussing which abutments to use, Dr. Salama cited
data from Jung and colleagues (2008) who examined
ceramic abutments and compared them with metal
abutments. That study concluded that with a mucosal
thickness of 2 mm or more, the eye did not “detect a
difference,” but with less thickness, the differences were
more noticeable. “When implants and teeth are going
to be reconstructed simultaneously, dentin-like ceramic
abutments may be preferred,” Dr. Salama said.
Unique Restorative Protocol Minimizes
Soft-Tissue Disturbance
Dr. Salama discussed how the process of plac-
ing abutments has evolved since when he first started
using meeting sponsor Zimmer Dental’s products in the
1990s. The session included highlights and clinical cases
demonstrating the use of Zimmer Contour Abutments
and restorative components to achieve immediate pro-
visionlization while the final restoration was fabricated.
He highlighted the clinical benefits of placing the abut-
ment at the time of surgery and never removing it so
that the initial gingival attachments to the abutment are
not disturbed due to repeated placement and removal
of healing abutments. He said the prefabricated copings
have enabled more intimate fits to the abutment mar-
gins and the premachined contours on the abutments
match the labial margins of the tissue. In addition to
using the snap-on abutment level, impression caps, Dr.
Salama urged clinicians to use an abutment they are
comfortable with, because all of this allows for a better
overall outcome.
Esthetics + Interface Development = Success
Keeping esthetics in mind is key to “creating success-
ful restorations,” Dr. Salama said, adding it is critical
to think about “interface development,” including look-
ing at the bone biology, labial plate, the relationship of
donor bone, and the interface between the implant and
the restorative therapy.
He added that CT-guided surgery is offering “excit-
ing” approaches to surgery, and offering clinicians the
option of combining technologies to “achieve the results
we and the patient are looking for.”—Colleen Platt
Henry Salama, DMD
Henry Salama, DMD, former Director of the Implant
Research Center at the University of Pennsylvania.
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