DentalEdu

All about the last two days
Masterclass Implantologie 2024 - Module 3 - Prostho rules

Zero bone loss: possible only when proven biologic protocols are being respected. Note the slight bone growth even on the distal threads.

Respecting biology:

Every intervention into the oral system is an active disruption of the natural biologic and biochemical processes. Our job is to strive to respect these processes with anything we do. In dental implantology we insert an artificial product and expect the biology to adapt to it as well as to integrate it. The best evidence that the job is thoroughly and respectfully done is when the tissues respond like in the case posted, in which three years after insertion the soft tissue is as healthy as it can only get and with full consolidation of the papillae.
In our practice this is our daily reality.

Note: from left to right
pre-OP with a fistula / immediate after insertion / 3-years post-OP

If you fail to plan, yo uplan to fail:

Performing your due diligence prior to any intervention is of utmost importance. Not that it didn‘t matter before, but these days it is crucial. Obviously because if you deviate from your offered treatment plan, you most probably find yourself involved in long and expensive liability cases. But also, because planing prior to ex*****on makes your life much much more comfortable (and cheaper, if that is a viable point for you).

Surgical navigation offers a lot of help, security and reproducibility. It reduced surgery time, diminishes to a minimum potential complications, gives you ease of mind and last but not least raises your revenue.

If you are new to navigation or find yourself struggling with it, the learning curve is not horrifying. On the contrary. Succeeding in planing will make you happier. As it makes me, when I see this image.

Join our world.

Unsere Implantat-Kursserie mit Konstantinos Tokmakidis, Bastian Wessing und Oliver Hugo fängt für dieses Jahr im April an. Mit führenden Persönlichkeiten in Europa einen regen Austausch und persönliche Begleitung sichern ist noch möglich. Für alle Interessierten gibt es noch ein paar freie Plätze.

Inlay vs. overlay/crownlay vs. crown

When do you decide to go full coverage and when not? And when you do, how do you decide on the actual extension? Since today we have all the right tools at our disposal to bond restorations, friction is only rarely needed. So why overextend, if there is no further advantage? At the same time, when is it right (or wrong) to underextend?

One way (and to my opinion the state of the art) is a staged procedure. Removal of old fillings, decay etc. and reevaluation of the cavity and the tooth structure. In this case, had the tooth no cracks, a simple mod-inlay would suffice.

Do we need to fully embed cracks? There is not sufficient evidence to address this question conclusively. So, in need of a protocol, we rely on our experience. From a clinical perspective, our goal is to stop their advancement. For that, their enclosure will suffice.

How do you proceed?

Tilted Implants

First of all, there hasn't been a post for quite some time. We have been quite busy this year, with many projects and cases.

One apparently hot topic we got asked upon this year were tilted implants. Obviously they are utilized throughout the world, but the arised question remains: are they a good and solid treatment modality?

According to literature they are a viable option. The newest meta-analysis is from 2012 and favors bone stability around tilted implants on a short-term basis (1-year-results). On the contrary, the authors favor bone stability around straight implants on a long-termin basis (>1-year-results). Both results showed no sufficient statistical significance (

Changing smiles with as minimal sacrifice as possible. Is interdisciplinary treatment a viable option or more of a “world unknown to man”?

Dentistry did always have its ways to produce results, that can change the course of life on specific individuals. In the last 50 years or so, dentistry has indeed achieved some very serious advances. Surgical reconstructions, minimally invasive restorations, invisible orthodontics, chair-side dentistry. You name it. With every consecutive year a new option falls into our hands. Probably we are living in an age, where we should consider ourselves and our patients quite lucky for us being able to utiliize all this advancement and at the same time our patients to massively gain from them.

Slowing down at this point, there are some things that never changed. Whatever we do, it needs to be thoroughly planned. If one can perform a somewhat decent planing, then everything will eventually fall into place. Right? Exactly!

Going a step further (or actually back for that matter), we need to remind ourselves, what is our oath to our patients. To treat them the best possible way, with our best possible knowledge AND without inducing big or further trauma. To achieve this goal, we have different specialties with their designated tools. Their combination might sometimes offer just that expected combination.

In our case, a male patient in his thirties was seeking advice for his misformed laterals. After having visited several offices, he was presented with a comprehensive plan for his whole smile architecture. Being quite overwhelmed with the idea but at the same time quite open-minded, he decided to pursue that goal. A digital smile design was performed, pointing towards the steps needed to follow:
1. Orthodontic pre-treatment
2. Replacement of an non-restorable tooth
3. Reconstruction of the remaining front teeth

Within 18 months the wonder was fulfilled, getting the patient to a very happy state, while keeping as much of his sound dentition untouched.

Single-day-dentistry: how to salvage a tooth in one session.

This patient hasn't been to a dentist for quite some time. He has several problems, knows of them, and wants to address them one at a time due to tight budgeting. In this session the lower left molars were treated. 3.7 with a direct composite, 3.6 with a direct ceramic crown. The steps backwards:

Accuracy of guided surgery:

Guided surgery is THE way to go, when we are talking about serious implant dentistry. Over the decades, it presented itself with various names, the most famous of them being “backward planing”. Yes, it is not a myth, especially in recent years, where we can utilize many and different ways to bring bone to where it is prosthetically needed. And why is that? Simple: because patients never demand implants. Moreover they demand teeth.

I remember starting my career over 20 years ago, trying to position implants at their optimal spot. Having succeeded in that, reassured a smooth path to the goal later on. At the same time, I was getting referrals, where implants were positioned wherever possible, leaving me to tidy up a mess, thus making my life and even more the one of my technicians quite miserable. Not to forget the patients’ reactions when they got the bill, since more technical and technique sensitive operations were needed to make the expected restoration possible.

Doing your due diligence prior to any surgical intervention, putting it into a plan ( in our case in the form of a guide) and executing your surgery according to plan is a very giving way to operate. Your patients will thank you. Your team will thank you. YOUR BODY will thank you. Yes, it will, for reducing the stress levels. So, maybe you can see in this form of surgery a huge benefit for your own health as well.

How does guided surgery perform though? Over the last 15 years we had major successes and optimizations, mainly due to computing advances. We get better CTs with lower radiation, better software, more powerful software to work with. Based on this advancement, we get highly accurate results when performing guided surgery (Massuda et al. 2022).
As shown in this fresh case (from this week), the transfer of the planned virtual position into real life was perfect!

If you seek to up your game while making your life easier, our courses will support you in doing that. Join our community of many happy colleagues around the globe, that follow our methods. Join www.dentaledu.ch.