WISSENSCHAFT / KLINISCHE FORSCHUNG logo 42 • das CAMLOG Partner-Magazin • Juli 2018 logo 42 • das CAMLOG Partner-Magazin • Juli 2018 10 11 Das globale Symposium ist immer eine großartige Gelegenheit, nicht nur die Wissenschaft allgemein zu fördern, sondern auch, um junge Wissenschaftler zu unterstützen und in der Forschung aktiven Zahnärzten eine Möglichkeit zu geben, ihre Arbeiten einem größeren Publikum zu präsentieren. Auch beim Oral Reconstruction Global Symposium 2018 in Rotterdam wurde großer Wert auf diese Tradition gelegt. In diesem Jahr boten der Forschungspreis, der Poster-Wettbewerb und der kurze Poster-Vortrag exzellente Gelegenheiten, dieses Ziel zu erreichen. WISSENSCHAFT / KLINISCHE FORSCHUNG FORSCHUNGSPREIS UND POSTER-WETTBEWERB Forschungspreis 2016/2017 Seitdem er 2008 ins Leben gerufen wurde, ist der Forschungspreis (Research Award) an junge, talentierte Wissenschaftler und anwendungsorientierte Kliniker, die sich auch dem Fortschritt der Wissenschaft widmen, vergeben worden. Auch in diesem Jahr war es für das Scienti c Evaluation Committee wieder eine schwierige Entscheidung, aus der Fülle an Themen und interessanten Veröffentlichungen aus verschiedenen Ländern die drei besten Publikationen auszuwählen. Bei der 5. Au age dieses Preises wurden die Gewinner im Rahmen des Oral Reconstruction Global Symposium – dem ehemaligen International CAMLOG Congress – ausgezeichnet. Professor Dr. Jürgen Becker, der frühere Präsident der Oral Reconstruction Foundation, führte den Vorsitz bei dieser Zeremonie. Der mit 10.000 Euro dotierte erste Preis ging an Frau Doktor Nicole Passia von der Klinik für Zahnärztliche Prothetik, Propädeutik und Werkstoffkunde an der Christian-Albrechts-Universität zu Kiel für ihre Publikation: “Survival and complications of single dental implants in the edentulous mandible following immediate or delayed loading: A randomized controlled clinical trial”. J Dent Res. 2018;97(2): 163-70. E-Publikation: 18. Oktober 2017 https://www.ncbi. nlm.nih.gov/pubmed/29045800 Doktor Tobias Fretwurst, von der Klinik für Mund-, Kiefer- und Gesichtschirurgie am zahnmedizinischen Zentrum des Universitätsklinikums in Freiburg, erhielt den zweiten Preis, der mit 6.000 Euro dotiert war. Seine Publikation hat den Titel: “The impact of force transmission on Narrow-Body dental implants made of commercially pure titanium and titanium zirconia alloy with a conical implant-abutment connection: an experimental pilot study” Int J Oral Maxillofac Implants 2016; 31: 1066-77. https://www.ncbi.nlm.nih.gov/ pubmed/27632261 Mit dem dritten Preis in Höhe von 4.000 Euro wurde Privatdozent Doktor Erhan Çömlekoğlu von der Abteilung für prothetische Zahnheilkunde an der Fakultät für Zahnmedizin der Ege Universität Bomova in Izmir (Türkei) ausgezeichnet. Stellvertretend für Dr. Çömlekoğlu, der nicht an der Feier teilnehmen konnte, nahm Privatdozentin Dr. Pinar Meric von derselben Universität den Preis entgegen, und zwar für die Publikation: “Immediate de nitive individualized abutments reduce peri-implant bone loss: a randomized controlled split-mouth study on 16 patients”. Clin Oral Investig. 2018; 22(1): 475-86. E-Publikation: 31. Mai 2017. https://www.ncbi.nlm.nih.gov/pubmed/28567530 Poster-Wettbewerb 2018 Für den Poster-Wettbewerb des Jahres 2018 wurden über 50 Poster von der Jury angenommen. Fünf davon wurden für einen Kurzvortrag im Rahmen der Sitzung am Freitagnachmittag ausgewählt. Der Vortrag ist eine hervorragende Gelegenheit, dem größeren Fachpublikum die Ergebnisse mehrjähriger Forschungsarbeiten vorzustellen. Die Redner präsentierten die Ergebnisse mehrerer klinischer Studien, und zwar: von drei prospektiven mit fünf bzw. drei jähriger Nachbeobachtung (PD. Dr. S. Rocha, PD. Dr. Dr. M. Moergel, Dr. L. Fierravanti), von einer retrospektiven mit bis zu 13-jähriger Nachbeobachtung (Dr. Y. Duan) sowie eines Fallberichts (Dr. T. Page). Neben der Auswahl für die mündlichen Vorträge wurden aus allen teilnehmenden Postern der beste Fallbericht, die beste klinische Studie und die beste präklinische Forschungsarbeit ausgewählt. Die drei Gewinner dieser Kategorien erhielten jeweils einen Geldpreis in Höhe von 2.000 Euro. Die Poster-Jury wählte zudem die Poster aus, die im International Poster Journal of Dentistry and Oral Medicine sowie auf der Website der Oral Reconstruction Foundation publiziert werden. Mitglieder der Poster-Jury: Prof. Dr. Pedro Nicolau, Prof. Dr. Fernando Guerra, Françoise Peters, Dr. Ben Derksen DIE DREI SIEGERPOSTER Kategorie Präklinische Forschung Dr. Dr. Anders Henningsen Title: In uence of UV-light and nonthermal plasma on rough titanium surfaces in vitro Co-authors: Smeets R, Cacaci C, Heuberger R, Heinrich O, Hartjen P, Hanken H, Precht C. Influence of UV-light and non-thermal plasma on rough titanium surfaces in vitro • UV-light and NTP treatment did not alter the surface structure or roughness parameters • UV light and NTP significantly increased wettability on the titanium surfaces (P < 0.001, Fig. 2) • UV-light and NTP significantly decreased carbon remnants (P < 0.002, Fig. 3) • NTP was even more effective in carbon removal than UV light (P = 0.03, Fig. 3) • UV light and NTP significantly increased cell attachment compared to the non-treated disks (P < 0.001, Fig. 4) • NTP significantly increased cell proliferation (P = 0.002, Fig. 5) compared to the non-treated as well as to the UV-treated disks • Neither NTP nor UV-light treatment resulted in cytotoxic effects ORAL RECONSTRUCTION GLOBAL SYMPOSIUM 2018 26. – 28. APRIL 2018 I ROTTERDAM, NETHERLANDS 1 Department of Oral and Maxillofacial Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany 2 Division „Regenerative Orofacial Medicine“, University Hospital Hamburg-Eppendorf, Hamburg, Germany 3 Implant Competence Centrum, Munich, Germany 4 RMS Foundation, Bettlach, Switzerland 5 Department of Oral and Maxillofacial Surgery, German Armed Forces Hospital, Hamburg, Germany Smeets R.1,2, Cacaci C.3, Heuberger R.4, Heinrich O. 1, Hartjen, P.1, Hanken H.1, Precht C.1, Henningsen A.1,5 Introduction and Purpose Various studies described positive effects of ultraviolet (UV) irradiation or non-thermal plasma (NTP) treatment on titanium and zirconia surfaces. The aim of this study was to determine and compare the effects of UV-light and non-thermal plasma treatment on rough titanium surfaces regarding the changes in wettability, surface chemistry as well as cell attachment and proliferation of murine osteoblast-like cells in vitro. Methods Results Conclusions Disclosure Contact: Prof. Dr. Dr. Ralf Smeets Department of Oral and Maxillofacial Surgery Division of Regenerative Orofacial Medicine University Hospital Hamburg-Eppendorf Email: r.smeets@uke.de Phone: +49 (0)40 – 741053259 Surface treatment by UV-light or NTP led to a significant reduction of carbon remnants and a significant increase in wettability on rough titanium surfaces. Both methods are able to increase the bioactive capacity of titanium surfaces in vitro with slight advantages for NTP in carbon removal and cell proliferation compared to UV-light. However, further studies are needed to confirm the identified effects as well as the determined advantage of NTP in vitro and in vivo. Fig. 1: Electron micrograph of a non-treated titanium disk Fig. 2: Drop shape analysis A) nontreated B) UV-light C) NTP Fig. 3: Surface composition of the disks. Mean concentration of the elements in at% and standard deviation. Ti: titanium; C: carbon; CC-O: carbon bound to oxygen; CCOOX: ester, carboxylic or carbonate groups, OI: oxides; OII: OH-groups; OIII: adsorbed water. * statistically significant differences • Sandblasted and acid-etched titanium disks (grade 4, Fig. 1) were divided into a non-treated control group and two experimental groups either treated by UV-light (0.05 mW/cm2 at λ = 360 nm and 2 mW/cm2 at λ = 250 nm) or by NTP of argon (24W; -0.5 mbar) for 12 minutes each • Wettability was assessed using dynamic contact angle measurement (Surtens Universal, OEG, Germany) • X-ray photoelectron spectroscopy (XPS) analysis was performed (Kratos Axis Nova, Kratos Analytical, UK) • Murine osteoblast-like cells (MC3T3-E1, Sigma Aldrich, Germany) were used for in vitro experiments • Cell attachment was assessed using fluorescin diacetate / propium iodide staining (live-dead-staining) after 2, 24 and 72 hours and cytotoxicity assay (LDH) • Proliferation was determined using an XTT assay Fig. 5: Proliferation assay (XTT) after 48 hours of incubation. * statistically significant differences This research project was granted by the Oral Reconstruction Foundation (CF11501). The UV and NTP devices were provided free of charge by the manufacturers. Titanium disks were provided by Camlog Biotechnologies AG. The authors declare no conflict of interest. Fig. 4: Cell attachment of MC3T3-E1 cells after 2, 24 and 72 hours of incubation. * statistically significant differences Kategorie Klinische Forschung Dr. Ludovica Fierravanti Title: The effect of one-time abutment placement on marginal bone levels and peri-implant soft tissues: 3 years results from a prospective randomized clinical trial Co-authors: Ambrosio N, Molina A, Sanz I, Martin C, Blanco J, Sanz M. Radiographic assessment DIB(Distance implant shoulder - first bone contact) Distance bone crest to contact point CONCLUSION " $ ! & % # $ ! $ ! ' The effect of one-time abutment placement on marginal bone levels and peri-implant soft tissues: 3 years results from a prospective randomized clinical trial INTRODUCTION - AIM One of the main goals of current implant dentistry is not only to achieve osseointegration, but also to maintain the long-term stability of the soft and hard peri-implant tissues. The manipulation of the implant to abutment interphase components may influence the stability of the surrounding tissues. In experimental studies (1) repeated dis- and reconnection of prosthetic components could compromise the mucosal barrier around implants and resulted in an apical shift of the connective tissue attachment and the underlying bone. This experimental evidence prompted the development of the “one abutment at one-time” protocol consisting on the placement of the definitive restorative abutment at the time of implant surgery. The scientific evidence on its efficacy when applied to implants placed in healed sites is, however, unclear (2,3). Therefore, the aim of this study was to compare the effect of placing the definitive abutment at the time of implant placement versus at a later stage, on the soft and hard tissue changes around dental implants. The one abutment – one time concept is associated with less marginal bone loss. Furthermore, peri-implant tissues stability seems to endure in the long term (3 years). o STUDY DESIGN: Prospective, randomized, parallel, controlled clinical trial o TARGET POPULATION: o SAMPLE SIZE CALCULATION Patients with at least one missing tooth in the posterior maxilla or mandible (positions 4-7), willing to receive implant supported restorations Mean difference of 0.20mm Standard deviation of 0.157mm Power of 95% Level of significance of 5% Drop outs of 10% 40 patients Inclusion criteria Exclusion criteria Male or female ≥18 years old One or more adjacent missing teeth in the posterior maxilla or mandible (positions 4-7) Natural tooth must be present medial to the implant site Opposing dentition must be natural or implant supported fixed restorations Adequate bone quality and availability for Camlog Conelog ® Screw-Line implants placement of diameter 3.8mm or 4.3mm, and lengths of 9mm, 11mm, or 13 mm. Patients willing to participate and attend the planned follow up visits SYSTEMIC: Uncontrolled disorders, medication interfering bone metabolism, physical handicaps, smokers > 10 cigs/day or tobacco chewers, alcoholism or drug abuse LOCAL: bone augmentation on implant site < 3 months before, intraoral infection and inflammation, mucosal diseases (i.e. Erosive lichen planus), history of implant failure, post-extraction sites with < 6 weeks healing, severe bruxism. INTRA-SURGICAL: lack of primary stability at surgery, need for bone augmentation procedures, inability to place the implant according to the prosthetic requirements Camlog Conelog Screw-Line Implants Ø 3.8 – 4.3 mm Length 9-11-13 mm patients recruited 2 excluded intrasurgically Test group: 96.6% Control group: 100% No SSD No SSD No SSD MATERIAL AND METHODS RESULTS Screening & Informed Consent Suture Removal (1 week) Impressions (6-12 weeks) Loading (8-14 weeks) 6 Months Periapical x-ray Adverse events Implant Placement & Randomization 12 Months 36 Months Adverse events Periapical x ray / Clinical variables (QM, mPLI, mSBI) / Soft tissue parameters / Patient related outcomes / Adverse events SS increase in papilla filling intragroup No SSD intergroup at any time and variable BONE LEVEL CHANGES CLINICAL VARIABLES PAPILLA FILLING – Jemt Score SS reductions intragroup No SSD intergroup during the whole study period SURVIVAL RATES 98.3% patients 60 39 implants 41 patients 36 6 months 56 implants patients 35 12 months 55 implants patients 33 36 months 52 implants A tendency of greater bone loss was observed in the control group over time, being only statistically significant at 6 months. Between 12 months and 36 months, a slight bone gain was observed in both group. ADVERSE EVENTS Screw loosening: at impression (1: T), 6 months (3: 1C, 2T), 12 months (2: 1C, 1T) Vario SR abutment fracture: (1: C) PATIENT SATISFACTION No SSD intergroup during the whole study period (1) Abrahamsson, I., Berglundh, T. & Lindhe, J. (1997) The mucosal barrier following abutment dis/reconnection. An experimental study in dogs. Journal of Clinical Periodontology 24:568–572. (2) Degidi, M., Nardi, D. & Piattelli, A. (2011) One abutment at one time: non-removal of an immediate abutment and its effect on bone healing around subcrestal tapered implants. Clinical Oral Implants Research 22: 1303–1307. (3) Grandi, T., Guazzi, P., Samarani, R. & Garuti, G. (2012) Immediate positioning of definitive abutments versus repeated abutment replacements in immediately loaded implants: effects on bone healing at the 1-year follow-up of a multicentre randomised controlled trial. European Journal of Oral Implantology 5: 9–16. SOFT TISSUES MARGIN mPLI mSBI PD Control group Control group Control group Test group Test group Test group CLI IP Healing abutment Vario SR abutment Control group Test group Control group Test group Surgery - Loading 12 Months - 36 Months 6 Months - 12 Months Loading - 6 Months Loading - 6 Months Control group Test group Control group Test group Loading - 12 Months Loading - 36 Months Test group Control group Middle Satisfied Very satisfied Clinical variables Presence/absence Queratinized Mucosa PD mSBI (Mombelli 1987) mPLI (Mombelli 1987) 6 sites/implant Periodontal probe PCP-UNC 15 Papilla filling Papilla Index(Jemt 1997) Soft tissue margin CLT (Crown lenght tooth) CLI (Crown lenght implant) IP (Distance top of papilla to incisal edge) Patient related outcomes Patient satisfaction: comfort, appearance, masticatory function, taste, overall satisfaction 5 items scale: very discontented, discontented, fair, satisfied, very satisfied Adverse events Nature and frequencyof occurrence Implant related / Non implant related PRIMARY SECONDARY 3 1 2 Kategorie Fallbericht Dr. Roman Beniashvili Title: Management of extractions sites new approach for compromised conditions in the posterior maxilla Co-authors: Kern B. Clinic for Oral Surgery, Maxillofacial Surgery and Implant Dentistry Results After a 3-month healing period, average vertical bone dimensions measured 10.2mm (7.1mm – 13.8mm). In comparison with preoperative condition, an average increase of the primary sub-antral bone height of 3.4mm (1.2 – 7.6mm) was observed. The number of regions with vertical bone dimensions < 7mm was 0. According to this, the number of cases with an indication for an external sinus floor elevation was reduced by 100% (7 vs. 0) [4]. 10 Camlog® - implants with lengths from 11 - 13mm were placed, such as: one 3.8 x 11mm, one 4.3 x 11mm, two 5.0 x 11mm, three 6.0 x 11mm, two 4.3 x 13mm, and one 5.0 x 13mm implant (Figs. 8 - 10). All implants were mechanically stable. Considering that the minimum length of the implants was 11mm, implants were placed in combination with an osteotome sinus floor technique in 6 cases (60%). The average sub-antral bone height, prior to sinus floor elevation was 8,7mm (7.1 – 10.5mm). In no case (0%), the implant placement was performed utilizing a simultaneous conventional sinus floor elevation with lateral window and no additional vertical augmentation was indicated. In no case was a two-step procedure for sinus floor elevation necessary. An additional lateral augmentation procedure was performed in three cases (33.3%); in one case due to presence of a dehiscence and in 2 cases to prevent resorption of a thin buccal wall. After a healing period of 3 months, all 10 implants were uncovered. No further soft tissue corrections were needed, second stage surgery was performed, minimally invasively, or just with a small apicaly positioned flap. All implants were restored. Single-crown restorations or fixed bridges were placed on all implants. Osseointegration and periimplant health were evaluated at the time of implant uncovering and after restoration using radiographs, clinical examination and stability tests (Periotest). All implants were clinically stable at the time of uncovering and examination after restoration (Figs. 11 - 12). The Periotest values were between -8 and -2 (average: -5). Tagesklinik für Oralchirurgie, Mund-, Kiefer-, Gesichtschirurgie und Implantologie Dr. Roman Beniashvili und Prof. Dr. Dr. Konrad Wangerin, Schorndorf, Germany. www.dr-beniashvili.de Literatur 1. Araujo et al. (2008) Inluence of Bio-Oss Collagen on Healing of an Extraction Socket: An Experimental Study in the Dog. International Journal of Periodontics and Restorative Dentistry 28: 123–135. 2. Weng et al. (2011) Welche Massnahmen sind sinnvoll zum Strukturerhalt des Alveolarfortsatzes nach Zahnextraktion? European Journal of Oral Implantology 4: 123-130. 3. Fugazotto PA (1999) Sinus Floor Augmentation at the Time of Maxillary Molar Extraction: Technique and Report of Preliminary Results. International Journal of Oral and Maxillofacial Implants 14(4): 536-542. 4. Jensen SS, Katsuyama H Preoperative Assessment and Planning for Sinus Floor Elevation Procedures. ITI Treatment Guide Volume 5 - Sinus Floor Elevation Procedures. Management of Extractions Sites - A New Approach for Compromised Conditions in the Posterior Maxilla Roman Beniashvili, DDS, Dr. med dent, Bastian Kern, DDS, Dr. med. dent. Tagesklinik für Oralchirurgie, Mund-, Kiefer-, Gesichtschirurgie und Implantologie Dr. Roman Beniasshvili und Prof. Dr. Dr. Konrad Wangerin, Schorndorf, Germany Materials and Methods The described technique, wich is the modification of a technique described by Fugazotto [3] was performed in 10 sockets following tooth extraction (7 molars and 3 premolars) in 7 patients. All ten patients were female with an age ranged between 32 to 74 years. Tooth extraction was performed with special care minimizing trauma to the surrounding hard and soft tissues. Therefore, a sulcular incision was made around the tooth to preserve the approximal papilla structure. Preserving the interradicular bone and the buccal wall in case of molars and premolars with two roots, the tooth was trisected/bisected and the roots were gently removed individually (Figs. 1 - 3). Based on the radiographs and the existing clinical situation, a calibrated trephine bur was used, which was in sufficient dimension to include the complete interradicular septum and at least 50% of the extraction socket, but kept a minimum distance of 1.5 - 2 mm to adjacent teeth and 1mm to the buccal and palatal walls. Utilizing preoperative radiographs and measurements, a site was prepared using the trephine bur to within approximately 2 mm of the sinus floor (Figs. 4 - 5). In cases of premolars and molars without interradicular bone, and tapered roots, an appropriate dimension of the trephine bur, was selected to reach the socket walls 3 - 4 mm before the expected maxillary sinus floor. Osteotomes selected corresponding the diameter of the trephine preparation. The osteotomes were used under gentle force of a mallet, to a depth of 3 - 5mm. The residual socket was filled with a slowly resorbing, xenograft (Bio-Oss®) (Fig. 6). Because of the existence of the buccal wall, no membranes were used. In order to avoid to mobilize the mucogingival line coronally and to create a thick and adequate soft tissue, mucoperiostal flap elevation was not used for wound closure. Sockets were closed by free or connective gingival grafts / tissue grafts (palatal pedicle tissue) (Fig. 7). Disclosure The described procedure verified that it improves the clinical condition for future implant placement in compromised initial situations, when distinct alveolar defects and reduced residual bone height are expected. Fig. 1: initial clinical condition Introduction In unfavorable situations, like maxillary atrophy and/or distinct pneumatization of the maxillary sinus in combination with an attachment loss of the teeth due to advanced periodontal disease, leading to severe vertical bone loss, new therapeutic modalities are needed. Preservation or even improvement of the height and width of the alveolar ridge is essential in order to avoid or reduce the frequency and size of augmentation procedures [1,2]. The aim of the presented technique was to reduce the need of augmentation and avoid the sinus floor elevation or at least to provide treatment options for a onestage approach when at the time of tooth removal a deficit in the alveolar bone could already be expected and the need of a later sinus lift procedure was conceivable. Fig. 6: augmented Extraction sites Fig. 7: connective tissue graft (tunnel technique) Fig. 4: surgical technique Fig. 5: Osteotome Fig. 2: preoperative radiograph Fig. 8: radiograph 3-months postoperative Fig. 9: Implant placement Fig. 12: 4-year follow-up The authors declare no financial interest in any of the products mentioned herein. The authors mention their gratitude to dentist Horst Dieterich for the prosthodontics in the case herein. Fig. 3: Extraction sites Fig. 10: radiograph at the time of implant placement Fig. 11: Final Restauration v.l.n.r.: Prof. Dr. Jürgen Becker, Dr. Tobias Fretwurst, Dr. Nicole Passia, PD Dr. Pinar Meric in Vertretung für PD Dr. Erhan Çömlekoğlu, Prof. Dr. Fernando Guerra v.l.n.r.: Prof. Dr. Jürgen Becker, Dr. Ludovica Fierravanti, Dr. Dr. Anders Henningsen, Françoise Peters, Prof. Dr. Fernando Guerra
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