logo 18 • CAMLOG Partner Magazine • July 2018 11 SCIENCE / CLINICAL RESEARCH In addition to the selection for the oral presentations, the best case report, the best clinical study and the best preclinical research work were selected from all participating posters. The three winners each received a monetary prize with a value of € 2’000. The Poster Jury selected the posters, which will be published in International Poster Journal of Dentistry and Oral Medicine as well as on the Oral Reconstruction Foundation website. Members of the Poster jury: Prof. Pedro Nicolau, Prof. Fernando Guerra, Françoise Peters, Dr. Ben Derksen THE THREE WINNING POSTERS Category Pre-clinical Research Dr. Anders Henningsen Title: Influence 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. InfluenceofUV-light andnon-thermalplasma on rough titaniumsurfaces in vitro • UV-lightandNTP treatment didnotalter the surfacestructureor roughness parameters • UV light andNTPsignificantly increasedwettability on the titanium surfaces (P< 0.001,Fig. 2) • UV-lightandNTPsignificantlydecreased carbon remnants (P< 0.002,Fig.3) • NTPwasevenmoreeffective in carbon removal thanUV light (P=0.03,Fig.3) • UV light andNTPsignificantly increased cellattachment compared to thenon-treated disks (P<0.001,Fig.4) • NTP significantly increased cell proliferation (P = 0.002, Fig. 5) compared to the non-treated aswell as to the UV-treateddisks • NeitherNTPnorUV-light treatment resulted in cytotoxiceffects ORALRECONSTRUCTIONGLOBALSYMPOSIUM 2018 26.–28.APRIL2018 I ROTTERDAM,NETHERLANDS 1 Department ofOral andMaxillofacialSurgery,UniversityHospitalHamburg-Eppendorf,Hamburg,Germany 2 Division „RegenerativeOrofacialMedicine“,UniversityHospitalHamburg-Eppendorf,Hamburg,Germany 3 ImplantCompetenceCentrum,Munich,Germany 4 RMSFoundation,Bettlach,Switzerland 5 Department ofOralandMaxillofacialSurgery,GermanArmedForcesHospital,Hamburg,Germany SmeetsR.1,2,CacaciC.3,HeubergerR.4,HeinrichO. 1,Hartjen,P.1,HankenH.1,PrechtC.1,HenningsenA.1,5 Introduction andPurpose Various studies described positive effects of ultraviolet (UV) irradiation or non-thermal plasma (NTP) treatment on titanium and zirconia surfaces. The aim of this studywas to determine and compare the effects ofUV-light and non-thermal plasma treatment on rough titanium surfaces regarding the changes in wettability, surface chemistry as well as cell attachment and proliferation ofmurine osteoblast-like cells in vitro. Methods Results Conclusions Disclosure Contact: Prof.Dr.Dr.RalfSmeets DepartmentofOral andMaxillofacialSurgery DivisionofRegenerativeOrofacialMedicine UniversityHospitalHamburg-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 inwettability 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 aswell as the determinedadvantage ofNTP in vitroand in vivo. Fig. 1: Electronmicrograph 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 carbonategroups,OI :oxides;OII :OH-groups;OIII : adsorbedwater. * statistically significant differences • Sandblastedandacid-etched titaniumdisks (grade 4,Fig.1)weredivided into a non-treated control groupand twoexperimental groupseither treatedbyUV-light (0.05mW/cm2at λ=360 nmand 2mW/cm2 at λ= 250nm)orbyNTPofargon (24W; -0.5mbar) for12minuteseach • Wettabilitywas assessedusing dynamic contact anglemeasurement (SurtensUniversal,OEG,Germany) • X-ray photoelectron spectroscopy (XPS)analysiswas performed (KratosAxisNova,KratosAnalytical,UK) • Murineosteoblast-like cells (MC3T3-E1,SigmaAldrich,Germany)wereused for in vitro experiments • Cellattachmentwas assessedusing fluorescindiacetate /propium iodidestaining (live-dead-staining) after2, 24and72 hours and cytotoxicityassay (LDH) • Proliferationwasdetermined using an XTTassay 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 diskswere provided byCamlogBiotechnologiesAG. The authors declare no conflictof interest. Fig. 4: Cell attachment of MC3T3-E1 cells after 2, 24 and 72 hoursof incubation. * statistically significant differences Category Clinical Research 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(Distanceimplantshoulder-firstbone contact) Distancebonecrestto contactpoint CONCLUSION " $ ! & % # $! $ ! ' Theeffectofone-timeabutmentplacementonmarginalbone levels andperi-implantsoft tissues:3yearsresults fromaprospective randomizedclinical trial INTRODUCTION -AIM Oneofthemaingoalsofcurrentimplantdentistryisnotonlytoachieveosseointegration,butalsotomaintainthelong-termstabilityofthesoftandhardperi-implant tissues.Themanipulationoftheimplanttoabutmentinterphasecomponentsmayinfluencethestabilityofthesurroundingtissues.Inexperimentalstudies(1)repeated dis-andreconnectionofprostheticcomponentscouldcompromisethemucosalbarrieraroundimplantsandresultedinanapicalshiftoftheconnectivetissueattachment andtheunderlyingbone.Thisexperimentalevidencepromptedthedevelopmentofthe“oneabutmentatone-time”protocolconsistingontheplacementofthedefinitive restorativeabutmentatthetimeofimplantsurgery.Thescientificevidenceonitsefficacywhenappliedtoimplantsplacedinhealedsitesis,however,unclear(2,3). Therefore,theaimofthisstudywastocomparetheeffectofplacingthedefinitiveabutmentatthetimeofimplantplacementversusatalaterstage,onthesoftandhard tissuechangesarounddentalimplants. Theoneabutment–onetimeconceptisassociatedwithlessmarginalbone loss.Furthermore,peri-implanttissuesstabilityseemstoendureinthelong term(3years). o STUDYDESIGN:Prospective,randomized,parallel,controlledclinicaltrial o TARGETPOPULATION: o SAMPLESIZECALCULATION Patientswithatleastonemissingtoothintheposterior maxillaormandible(positions4-7),willingtoreceive implantsupportedrestorations Meandifferenceof0.20mm Standarddeviationof0.157mm Powerof95% Levelof significanceof5% Dropoutsof10% 40patients Inclusion criteria Exclusion criteria Maleorfemale≥18yearsold Oneormoreadjacentmissingteethintheposteriormaxillaormandible(positions4-7) Naturaltoothmustbepresentmedialtotheimplantsite Opposingdentitionmustbenaturalorimplantsupportedfixedrestorations AdequatebonequalityandavailabilityforCamlogConelog®Screw-Lineimplants placementofdiameter3.8mmor4.3mm,andlengthsof9mm,11mm,or13mm. Patientswillingtoparticipateandattendtheplannedfollowupvisits SYSTEMIC:Uncontrolleddisorders,medicationinterferingbonemetabolism,physical handicaps,smokers>10cigs/dayortobaccochewers,alcoholismordrugabuse LOCAL:boneaugmentationonimplantsite<3monthsbefore,intraoralinfectionand inflammation,mucosaldiseases(i.e.Erosivelichenplanus),historyofimplantfailure, post-extractionsiteswith<6weekshealing,severebruxism. INTRA-SURGICAL:lackofprimarystabilityatsurgery,needforboneaugmentation procedures,inabilitytoplacetheimplantaccordingtotheprostheticrequirements CamlogConelogScrew-LineImplants Ø3.8–4.3mm Length9-11-13mm patients recruited 2excluded intrasurgically Testgroup:96.6% Controlgroup:100% NoSSD NoSSD NoSSD MATERIALANDMETHODS RESULTS Screening& Informed Consent SutureRemoval (1week) Impressions (6-12weeks) Loading (8-14weeks) 6Months Periapical x-ray Adverseevents ImplantPlacement& Randomization 12Months 36Months Adverseevents Periapical x ray /Clinical variables (QM,mPLI,mSBI) /Soft tissue parameters /Patient relatedoutcomes /Adverseevents SS increase inpapilla filling intragroup NoSSD intergroupatany timeand variable BONELEVELCHANGES CLINICALVARIABLES PAPILLAFILLING –JemtScore SS reductions intragroup NoSSD intergroupduring thewhole studyperiod SURVIVALRATES 98.3% patients 60 39 implants 41 patients 36 6months 56 implants patients 35 12months 55 implants patients 33 36months 52 implants A tendencyofgreaterbone losswasobserved in the controlgroup over time,beingonly statistically significantat6months. Between12monthsand36months,aslightbonegainwas observedinbothgroup. ADVERSEEVENTS Screw loosening:at impression (1:T),6months (3: 1C,2T),12months (2:1C,1T) VarioSRabutment fracture: (1:C) PATIENTSATISFACTION NoSSDintergroup during the whole studyperiod (1) Abrahamsson,I.,Berglundh,T.&Lindhe,J.(1997)Themucosalbarrierfollowingabutmentdis/reconnection.Anexperimentalstudyindogs.JournalofClinical Periodontology24:568–572. (2) Degidi,M.,Nardi,D.&Piattelli,A.(2011)Oneabutmentatonetime:non-removalofanimmediateabutmentanditseffectonbonehealing aroundsubcrestaltaperedimplants.ClinicalOralImplantsResearch22:1303–1307. (3) Grandi,T.,Guazzi,P.,Samarani,R.&Garuti,G.(2012)Immediatepositioningof definitiveabutmentsversusrepeatedabutmentreplacementsinimmediatelyloadedimplants:effectsonbonehealingatthe1-yearfollow-upofamulticentrerandomised controlledtrial.EuropeanJournalofOralImplantology5:9–16. SOFTTISSUESMARGIN mPLI mSBI PD Controlgroup Controlgroup Controlgroup Testgroup Testgroup Testgroup CLI IP Healing abutment VarioSR abutment Controlgroup Testgroup Controlgroup Testgroup Surgery -Loading 12Months -36Months 6Months -12Months Loading -6Months Loading -6Months Controlgroup Testgroup Controlgroup Testgroup Loading -12Months Loading -36Months Testgroup Controlgroup Middle Satisfied Very satisfied Clinical variables Presence/absence QueratinizedMucosa PD mSBI (Mombelli1987) mPLI (Mombelli1987) 6 sites/implant Periodontal probePCP-UNC 15 Papilla filling Papilla Index(Jemt1997) Softtissue margin CLT (Crown lenghttooth) CLI (Crown lenghtimplant) IP (Distancetop of papilla to incisaledge) Patientrelated outcomes Patientsatisfaction:comfort,appearance, masticatoryfunction, taste,overallsatisfaction 5 itemsscale: verydiscontented,discontented, fair, satisfied, verysatisfied Adverse events Nature and frequencyof occurrence Implantrelated/Non implantrelated PRIMARY SECONDARY 3 1 2 Category Case Report Dr. Roman Beniashvili Title: Management of extractions sites new approach for compromised conditions in the posterior maxilla Co-authors: Kern B. Clinic forOralSurgery,MaxillofacialSurgery and ImplantDentistry Results After a 3-month healing period, average vertical bone dimensionsmeasured 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 elevationwas reduced by 100% (7 vs. 0) [4]. 10 Camlog® - implantswith lengths from 11 - 13mmwere 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 weremechanically stable. Considering that theminimum 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 procedurewas 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 buccalwall.After a healing period of 3months, all 10 implantswere uncovered.No further soft tissue correctionswere needed, second stage surgerywas performed,minimally invasively, or justwith a small apicaly positioned flap.All implantswere restored. Single-crown restorations or fixed bridgeswere placed on all implants.Osseointegration and periimplant healthwere evaluated at the time of implant uncovering and after restoration using radiographs, clinical examination and stability tests (Periotest).All implantswere clinically stable at the time of uncovering and examination after restoration (Figs. 11 - 12). The Periotest valueswere between -8 and -2 (average: -5). Tagesklinik fürOralchirurgie,Mund-, Kiefer-,Gesichtschirurgie und ImplantologieDr. Roman Beniashvili und Prof.Dr.Dr. KonradWangerin, Schorndorf,Germany. www.dr-beniashvili.de Literatur 1.Araujo et al. (2008) Inluence of Bio-Oss Collagen onHealing of an Extraction Socket:An Experimental Study in theDog. International Journal of Periodontics and RestorativeDentistry 28: 123–135. 2.Weng et al. (2011)WelcheMassnahmen sind sinnvoll zum Strukturerhalt desAlveolarfortsatzes nach Zahnextraktion? European Journal ofOral Implantology 4: 123-130. 3.Fugazotto PA (1999) Sinus FloorAugmentation at theTime ofMaxillaryMolar Extraction:Technique and Report of Preliminary Results. International Journal ofOral andMaxillofacial Implants 14(4): 536-542. 4.Jensen SS, KatsuyamaH PreoperativeAssessment and Planning for Sinus Floor Elevation Procedures. ITI TreatmentGuide Volume 5 - Sinus Floor Elevation Procedures. Management of Extractions Sites -ANewApproach for CompromisedConditions in the PosteriorMaxilla Roman Beniashvili,DDS,Dr.med dent, Bastian Kern,DDS,Dr.med. dent. Tagesklinik fürOralchirurgie,Mund-, Kiefer-,Gesichtschirurgie und ImplantologieDr. Roman Beniasshvili und Prof.Dr.Dr. KonradWangerin, Schorndorf,Germany Materials andMethods The described technique,wich is themodification of a technique described by Fugazotto [3]was performed in 10 sockets following tooth extraction (7molars and 3 premolars) in 7 patients.All ten patients were femalewith an age ranged between 32 to 74 years. Tooth extractionwas performedwith special careminimizing trauma to the surrounding hard and soft tissues. Therefore, a sulcular incisionwas made around the tooth to preserve the approximal papilla structure. Preserving the interradicular bone and the buccalwall in case ofmolars and premolarswith two roots, the toothwas trisected/bisected and the rootswere gently removed individually (Figs. 1 - 3). Based on the radiographs and the existing clinical situation, a calibrated trephine burwas used,whichwas in sufficient dimension to include the complete interradicular septum and at least 50% of the extraction socket, but kept aminimum distance of 1.5 - 2mm to adjacent teeth and 1mm to the buccal and palatal walls. Utilizing preoperative radiographs andmeasurements, a sitewas prepared using the trephine bur towithin approximately 2mm of the sinus floor (Figs. 4 - 5). In cases of premolars andmolarswithout interradicular bone, and tapered roots, an appropriate dimension of the trephine bur,was selected to reach the socketwalls 3 - 4mm before the expectedmaxillary sinus floor.Osteotomes selected corresponding the diameter of the trephine preparation. The osteotomeswere used under gentle force of amallet, to a depth of 3 - 5mm. The residual socketwas filledwith a slowly resorbing, xenograft (Bio-Oss®) (Fig. 6). Because of the existence of the buccalwall, nomembraneswere used. In order to avoid tomobilize themucogingival line coronally and to create a thick and adequate soft tissue,mucoperiostal flap elevationwas not used forwound closure. Socketswere 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, likemaxillary atrophy and/or distinct pneumatization of themaxillary sinus in combinationwith an attachment loss of the teeth due to advanced periodontal disease, leading to severe vertical bone loss, new therapeuticmodalities are needed. Preservation or even improvement of the height andwidth 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 techniquewas to reduce the need of augmentation and avoid the sinus floor elevation or at least to provide treatment options for a onestage approachwhen at the time of tooth removal a deficit in the alveolar bone could already be expected and the need of a later sinus lift procedurewas conceivable. Fig. 6: augmentedExtraction 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 inanyof the productsmentioned herein.The authorsmention their gratitude to dentistHorstDieterich for theprosthodontics in the caseherein. Fig. 3:Extraction sites Fig. 10: radiograph at the time of implant placement Fig. 11:FinalRestauration from left to right: Prof. Jürgen Becker, Dr. Ludovica Fierravanti, Dr. Anders Henningsen, Françoise Peters, Prof. Fernando Guerra
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