m aga z I n e f o r c U S To m e rS a n d pa r T n e rS o f S T r aU m a n n 1 I 2013
STRAUMANN ® STANDARD
PLUS NARROW NECK
CROSSFIT® IMPLANT
Imprint STARGET – Magazine for Customers and Partners of Straumann I © Straumann USA I 60 Minuteman Road I Andover, MA 01810 I Phone 800/448 8168
Fax 978/747 2490 I Editors Roberto González I Mildred Loewen I Jillian Foley I E-Mail info.usa@straumann.com I Internet www.straumann.us/starget
Legal Notice Exclusion of liability for articles by external authors: articles by external authors published in STARGET have been systematically assessed and carefully
selected by the publisher of STARGET (Straumann USA). Such articles in every case reflect the opinion of the author(s) concerned and therefore do not necessarily
coincide with the publisher’s opinion. Nor does the publisher guarantee the completeness or accuracy and correctness of articles by external authors published in
STARGET. The information given in clinical case descriptions, in particular, cannot replace a dental assessment by an appropriately qualified dental specialist in an
individual case. Any orientation to articles published in STARGET is therefore on the dentist’s responsibility. Articles published in STARGET are protected by copyright
and may not be reused, in full or in part, without the express consent of the publisher and the author(s) concerned. Straumann® and all other trademarks and logos are
registered trademarks of Straumann USA and/or of its affiliates. Third party corporate names and brand names that may be mentioned may be registered or otherwise
protected marks even if this is not specially indicated. The absence of such an indication shall not therefore be interpreted as allowing such a name to be freely used.
STARGET 1 I 13
The Confident Soft Tissue Level Solution
for Treating Limited Space
Dear Straumann Customer,
I am excited to present this latest issue of STARGET, focusing on the Narrow Neck
CrossFit ® Implant – our soft tissue level solution for treating limited spaces. This
latest addition to the Straumann Dental Implant System offers a dependable and
flexible soft tissue level solution for treating narrow interdental spaces or situations
with limited bone.
The clinician interviews and clinical cases in this issue demonstrate how this next
generation Ø3.3 mm implant benefits you with its combination of the strength
of the Roxolid ® material, the excellent osseointegration and hydrophilicity of the
SLActive ® surface, and the self-guiding CrossFit ® connection.
Andy Molnar
Straumann Executive Vice President
North America
This issue also includes clinician interviews and clinical cases for Straumann
MembraGel ®, a review of the new Periodontal Treatment Guide, and a look at
how the new Straumann CARES Scan & Shape service gives dental laboratories
without a CADCAM system access to genuine Straumann® CARES ® customized
abutments.
Beyond just product articles, readers will get a preview the upcoming US ITI
Congress, a review of Straumann Education courses, and an overview of our new
digital tools for patient education – featuring the new Straumann Patient Education
App for iPad ®.
We always look forward to “Simply Doing More,” and I hope you find this issue
of STARGET a valuable update on our products, services, and education offerings
to help you achieve success.
Sincerely,
Andy Molnar
Straumann Executive Vice President, North America
iPad® is a registered trademark of Apple, Inc.
1
2
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Overview
STARG ET 1 I 2 0 1 3
4
Narrow Neck crossFit
The Straumann Standard Plus Narrow
Neck CrossFit ® Implant Line offers the
confident soft tissue level solution for
treating limited space – featuring the
Roxolid® material, SLActive® surface, and
CrossFit connection.
60
straumaNN cares scaN & shape service
Straumann CARES Scan & Shape
Service
allows
dental
laboratories
without a CADCAM System to access
genuine Straumann CARES® customized
abutments.
D i g i ta l pat i e N t e D u c at i o N
68
Featuring a new patient education app
and
in-office
animations,
Straumann
Digital Patient Education Tools provide
a
convenient,
modern
platform
to
communicate the benefits of dental
implants and regenerative treatment.
STARGET 1 I 13
C ONTE N T
STRAUMANN STANDARD PLUS NARROW
NECk CROSSFIT IMPLANT LINE
®
STRAUMANN ® REGENERATION SOLUTIONS
4
The Confident Soft Tissue Level Solution for Treating Limited Space
14
Interview with Giuliano Fragola Arnau, Spain
18
Clinical Case Report by Giuliano Fragola and Javier Perez Lopez
22
Interview with Fancisco Faoro, Straumann
24
Clinical Case Report by Mario Roccuzzo, Italy
28
An Interview with Anton Sculean, Switzerland, and David Cochran,
USA, on the “Straumann Periodontal Treatment Guide"
38
Interview on MembraGel with Frank Bröseler, Germany,
and Robert Miller, USA
STRAUMANN ® CARES ® GUIDED SURGERy
45
MembraGel Clinical Case by Frank Bröseler
50
Emdogain Clinical Case Report by Brian Huber, USA
54
Straumann Guided Surgery Case Study, Luca Cordaro, Italy,
and Vincenzo Mirisola di Toerresanto, Italy
STRAUMANN ® CARES ® DIGITAL SOLUTIONS
60
Straumann CARES Scan & Scape Service
INTERNATIONAL TEAM FOR IMPLANTOLOGy
64
ITI Congress North America - 2013 Preview
SIMPLy DOING MORE
66
Dental Implant Complications Symposium Review
68
New Digital Patient Education Tools
72
Literature Alerts
74
History of Straumann Exhibit
78
Upcoming Education Events
82
Indications, Contraindications, and Warnings
APPENDIX
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STrAUMANN ® STANDArD PLUS NArrOw NeCK CrOSSFiT ® iMPLANT LiNe
The Confident Soft Tissue Level Solution
for Treating Limited Space
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In 2009 Straumann® unveiled its innovative Roxolid® implant material, combining higher
tensile1 and fatigue2 strength with excellent osseointegration.
Since then, new possibilities have opened up for implant treatment. Based on past experiences
and the success of Roxolid, Straumann developed a new, small diameter implant system: the
Straumann Standard Plus Narrow Neck CrossFit ® (NNC) implant line. This new soft tissue level
solution offers a broad range of prosthetic applications for narrow interdental spaces and limited
bone availability and opens up new treatment options. The NNC implant combines proven
Ø3.5 mm
concepts with the latest technical innovations from Straumann: the soft tissue level implant philosophy,
SLActive® surface technology and Roxolid material.
1.8 mm
The Straumann Standard Plus Narrow Neck CrossFit ® Soft Tissue Level Implant (NNC)
– a small diameter implant
The NNC Implant is a small diameter implant with an endosteal diameter of 3.3 mm. As a
Straumann Standard Plus (SP) Soft Tissue Level implant, it has a machined neck of 1.8 mm in height.
The design of the implant collar offers integrated soft tissue management. In addition, it allows
plastic components to be snapped on to the implant shoulder for an abutment level impression
workflow. Featuring a soft tissue level design, the new implant facilitates soft tissue management
and can be placed in a one-step procedure that avoids a second surgical intervention. It thus
simplifies treatment and reduces the number of dental visits.
Ø3.3 mm
The NNC is indicated for the anterior and
pre-molar region and is available only in
the Roxolid® material featuring the SLActive ®
surface. Small diameter implants are not
recommended in the molar region
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PrOF. Dr. GiULiANO FrAGOLA ArNAU, MADriD, SPAiN. ORAL SURGEON
AND EXPERT TEAM MEMBER OF THE NNC DEVELOPMENT PROJECT
"The NNC implant offers improved prosthetic versatility compared to the Narrow Neck
implant, thus allowing for easier and predictable handling of esthetic challenges which
were difficult to solve with the existing Narrow Neck implant."
Self-guiding CrossFit ® Connection at soft tissue level
The Straumann® Narrow Neck CrossFit ® implant features a scientifically supported and intuitive
implant-abutment connection (CrossFit) that is self-guiding and enables simple abutment positioning. It is
designed to provide stability, allow clear-cut insertion with all components and protect against rotation.
It is specifically adapted for small diameter soft tissue level implants with a narrow prosthetic platform.
NNC offers a solution
Designed to increase patients’ acceptance of implant treatment, the NNC implant is a 3.3 mm diameter
implant that includes a narrow prosthetic platform. Its internal connection can be used for a wide range
of prosthetic options and treatment solutions in the upper and lower jaw where space is limited.
Improved treatment options for the Straumann Soft Tissue Level implant line1
Fig. 1 Narrow interdental space: a new Ø3.5 mm prosthetic
Fig. 2 Limited bone availability: the Ø3.3 mm implant from
platform at soft tissue level, offering the advantages of an
the Straumann ® Dental Implant System, designed to minimize the
internal connection.
need for bone grafting.
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Dr. MiChAeL GAhLerT AND PrOF. Dr. Dr. heiNz KNihA. ORAL MAXILLOFACIAL SURGEONS,
MUNICH, GERMANy
"The design and idea behind the Straumann® NNC implant type are perfectly balanced, particularly for narrow and reduced anatomical gap situations. In our practice, the NNC will become the soft tissue level implant of choice for the anterior
region of mandible and maxillary lateral incisors."
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Dr. SerGiO PiANO, GeNOA, iTALy. PROSTHODONTIST AND SURGEON,
ITI FELLOW, EXPERT TEAM MEMBER OF THE NNC DEVELOPMENT PROJECT
"From my point of view, the NNC’s excellent prosthetic flexibility, which allows the dentist
to compensate for implant positioning that is not completely axial, has proved to be a valuable feature, thus giving it a significant advantage over the currently used NN implant."
1. Confidence when placing small diameter implants
High tensile1 and fatigue2 strength and excellent osseointegration are two of the benefits resulting from
the combination of Roxolid ® material with SLActive ® surface technology. Data gathered from laboratory
tests and pre-clinical trials as well as a Roxolid multi-center study have underscored the benefits of this
combination.3,4,5
The Roxolid material allows the implant to withstand high loading forces1,2, which is a critical factor for the
success of a small diameter implant. Roxolid is stronger than pure titanium1 and is able to
accommodate the rough/hydrophilic SLActive surface. SLActive is designed to provide faster
osseointegration to enhance confidence in all treatments 6, reduced healing times from 6–8 weeks to
3–4 weeks7, and increased predictability in stability-critical treatment protocols.
1000
Tensile strength (MPa)
8
800
600
400
ASTM Titanium
Titanium gr. 4 cold worked
Fig. 3 Tensile strength of Roxolid® is superior to annealed and cold worked titanium1.
Roxolid®
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2. Wide range of treatment options
NNC is indicated for the anterior and pre-molar region†. Its broad prosthetic portfolio offers a wider
range of treatment options for patients compared to the Narrow Neck implant. Compared to the
external connection of the Narrow Neck implant, the internal, conical CrossFit ® Connection of the NNC
offers significant benefits in terms of angulation and height limitations. This flexibility allows the NNC to
still be used if the patient loses additional teeth and the restoration has to be modified. As it becomes
more challenging to meet patients’ expectations, dentists strive to offer solutions tailored to meet their
specific needs. With the Roxolid ® material and SLActive ® surface technology, Straumann allows dentists
the ability to vary their techniques thanks to the benefits provided by Straumann small diameter implants.
Screw-retained
Cement-retained
Single tooth
NNC Gold Abutment,
crown
NNC Solid Abutment
NNC Cementable Abutment,
straight
NNC Cementable Abutment,
angled
NNC Gold Abutment,
crown
Partially edentulous
NNC Gold Abutment,
bridge
NNC Solid Abutment
NNC Cementable Abutment,
straight
NNC Cementable Abutment,
angled
NNC Gold Abutment,
crown*
Prosthetic options with NNC
edentulous
Removable overdentures
Fixed overdentures
LOCATOR ®
NNC Gold Abutment,
bridge for screw-retained restorations
Fig. 4: NNC Prosthetic options for screw-retained and cement-retained restorations in a wide range of treatment options.
Placement of small diameter implants in the molar region is not recommended.
†
*for cemented bridge substructure
LocAtor ® is a registered trademark from Zest Anchors Inc., USA
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3. Simplicity in daily use
With clinically documented success stories over 10 years8, the Straumann® Soft Tissue Level titanium
implant line offers many advantages to clinicians and patients. Designed specifically for singlestage surgery to shorten treatment times, it gives patients great freedom and convenience. Soft tissue
management is simple thanks to the implant’s polished collar, which can also reduce the number of
patient visits. In addition, the handling of prosthetics is convenient and precise since the connection at
soft tissue level allows for easy access.
The higher tensile1 and fatigue2 strength of Roxolid ® made it possible to design a strong, small diameter
implant with the internal CrossFit ® Connection. A complete range of new prosthetic components has
been developed since the connection is specifically adapted to small diameter Straumann® Soft Tissue
Level implants. The conical design facilitates the ideal transmission of force and the CrossFit ® Connection
provides easy handling when positioning the components.
The NNC implant features a New Transfer Piece (NTP), which is pre-mounted onto the implant with a
snap-fit mechanism. After insertion of the implant, the new transfer piece can be detached by hand;
counter-maneuvering with the Straumann holding key is no longer necessary. If the implant needs to be
screwed in further, the NTP can simply be re-inserted. The NTP can also be used as an orientation pin
to indicate the implant position and angulation for the parallel placement of adjacent implants.
Fig. 5: The New Transfer Piece (NTP) stays in the implant and acts
Fig. 6: The NTP can be pulled out by hand or tweezers, no
as an orientation pin to indicate implant position and angulation.
counter-maneuver with holding key is needed.
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Dr.
hervé
BUATOiS,
GreNOBLe,
FrANCe
ORAL
SURGEON,
DDSI,
EXPERT TEAM MEMBER OF THE NNC DEVELOPMENT PROJECT
"The NNC is perfectly in line with the Straumann philosophy when it comes to soft tissue
level implant design, and allows for vertical implant placement following the biological
principles."
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Dr. rONALD e. JUNG, PD Dr. MeD. DeNT., PhD. ASSOCIATE PROFESSOR
AND VICE CHAIRMAN AT THE DENTISTRy CENTER OF THE UNIVERSITy OF ZURICH,
SWITZERLAND
"For me the NNC implant is the preferred solution for edentulous cases with very limited
horizontal alveolar bone availability. In combination with computer-guided surgery it
offers a minimally invasive approach."
Roxolid®
Titanium
Fig. 7 Histological analysis showing Roxolid® (left) and titanium (right) demonstrates a better bone in-growth behavior of Roxolid®
compared to pure titanium3.
Clinical experience with NNC
Beginning in February 2011, clinical experiences have been gained at ten centers across Europe. A
total of 54 implants were placed within indication and documented; 28 implants were used to restore
single tooth cases and 26 implants were used to support 13 bridge cases. The graphic below (Fig. 8)
shows the areas where the implants were placed and confirms that NNC was used in cases of space
limitations, especially in the lateral incisor region of the upper jaw and the central and lateral incisor
region of the lower jaw. Twenty implants were placed for pre-molars as well. “Narrow interdental
spaces” and “bone availability” were the reasons for choosing NNC in 69% of cases9 (Fig. 9).
3
6
2
1
8
9
6
2
5
3
3
1
1
4
Fig. 8: Distribution of the 54 implants placed by 10 centers across Europe during limited market release.
s t r a u m a N N ® s ta N D a r D p l u s N a r r o w N e c k c r o s s F i t ® i m p l a N t l i N e
Six clinical studies are planned in both Europe and North America to document how the NNC performs
for single tooth, partially edentulous and fully edentulous cases. With its complete portfolio of prosthetic
options, the NNC implant line is now available in Europe and North America, with other countries to
follow (registration approval pending).
Fig. 9: Reasons for choosing NNC as reported by centers participating in limited market release of NNC.9
3 % thick mucosa biotype
1 % cross bite
1 % bruxist
2 % post extraction placement
3 % esthetic reason
6 % thin mucosa biotype
15 % emergence profile
33 % bone availability
36 % narrow interdental spaces
Norm AStM F67 (states min. tensile strength of annealed titanium).
1
2
Data on file (compared to Straumann titanium implants).
3
Gottlow J, Dard M, Kjellson F, obrecht M, Sennerby L. Evaluation of a New titanium-Zirconium Dental Implant: A Biomechanical
and Histological comparative Study in the Mini Pig. clin Implant Dent relat res. 2010 Jun 25. Epub ahead of print.
4
Barter S et al. A pilot study to evaluate the success and survival rate of titanium-zirconium implants in partially edentulous patients:
results after 24 months of follow-up. clin oral Implants res. 2012 Jul;23(7):873-81. Epub ahead of print.
5
Müller F. Academy of osseointegration 26th Annual Meeting, Washington Dc, March 2011; oral presentation.
6
compared to SLA® in an animal model.
compared to SLA®.
7
8
Fischer K, Stenberg t. Prospective 10-Year cohort Study Based on a randomized controlled trial (rct) on Implant-Supported Full-
Arch Maxillary Prostheses. Part 1: Sandblasted and Acid-Etched Implants and Mucosal tissue. clin Implant Dent relat res. 2012
Dec;14(6):808-15. Epub ahead of print.
9
Narrow Neck crossFit Market Acceptance test Final report oct. 2011. Straumann data on file.
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AN iNTerview wiTh Dr. GiULiANO FrAGOLA ArNAU
“Technological progress as I see it is developing solutions for
situations that were difficult to solve in the past.”
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Dr. Fragola from Madrid, Spain is a member of the Ex-
osseointegration1 and higher tensile2 and fatigue3 strengths.
pert Team and contributed feedback to the development
I am not aware of any other small diameter implants on the
of the new Narrow Neck CrossFit ® (NNC) implant system.
market that combine these technologies with the soft tissue
In this role, he was able to acquire firsthand experience
level philosophy. The combination of these features makes
with the NNC components during the Market Acceptance
it possible to replace teeth with a narrow ridge, something
Test in Europe that occurred prior to the official market
that is quite common in periodontal patients. Use of other
introduction.
methods in these cases may require bone grafts, which in
turn makes patients reluctant to undergo such treatments. The
Dr. Fragola, you had the opportunity to work with the
NNC covers the needs of these patients with restorations
Narrow Neck crossFit ® implant. From your point of view,
that are predictable from the surgical point of view and
what specific advantages do NNc implants have to offer?
esthetically satisfactory from the restorative point of view. All
The NNC closes a gap in the Straumann Dental Implant
of this may be achieved with fewer surgical procedures and
System, completing the family of Soft Tissue Level implants.
better management of the gingival treatments.
The flexibility offered by the internal CrossFit connection
in a small diameter implant allows for improved prosthetic
the
he NNc
NNc system comes with a new implant transfer piece,
flexibility in situations with divergent implants – something
which can be removed from the implant after insertion
that was impossible in the past using Straumann Narrow
without having to release a lock-nut. what was your
Neck (NN) implants. This new system benefits both clinical
experience with this tool?
professionals as well as lab technicians. The NN implant
The new transfer piece, which was specifically designed for
made it challenging to carry out the prosthodontic restoration
this implant, makes the clinical handling of this implant quite
because its external connection required more bone mass for
easy. It's very stable, and allows for the placement of the
ideal implant placement if restoration was to be performed
implant in the mouth with the desired torque, either manually
easily and predictably. The NNC implants offer a range of
or using a hand-piece. Once the implant is placed, removal
options that were not feasible with NN implants. These include
of the transfer piece from the implant is easy. It can be
multiple screw-retained restorations with bars or LOCATOR®
extracted by hand or with a pair of tweezers. In our clinical
systems, even in cases where there are discrepancies between
experience with cases of limited buccal openings, removal
the angle of the implants and the overdenture.
of the carrier is much easier and less traumatic for patients.
They benefit from not having to over-exert themselves when
Today, the NNC system combines the latest innovations
opening their mouth to remove the carrier in situations where
developed by Straumann. The endosseous design corresponds
the implant has been placed in the premolar regions, which
to the Straumann Bone Level implant, it has the SLActive surface
have a very narrow mesiodistal distance. On some occasions
and is made of the Roxolid material, thus creating an implant
it is hard to remove a conventional threaded carrier because
designed to offer a symbiosis of high primary stability, faster
there is no space for the holding key.
®
®
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profiles, without compromising the gingival stability of our
in terms of strength, do you feel comfortable placing a
treatments, separating the microgap from the osseous tissue
Ø3.3 mm straumann® soft tissue level implant with a
and reducing the microinfiltration risks.
narrow prosthetic platform and an internal connection?
Before Roxolid launched, I rarely used small-diameter implants,
what is your practical experience with NNc and what
and I only used them in cases where strength was not a
clinical situations do you see as warranting use of NNc
key factor. This alloy allows for more customized treatments,
implants?
and I am no longer worried about strength as long as the
I have been very satisfied with my practical experience. The
implant is placed for any of the cleared indications. Since
implant offers a wide range of treatment options which appear
its introduction, we have been working with Roxolid implants
in our day-to-day practice. The internal CrossFit connection
in the most complex situations and have not experienced
also makes the implant system versatile and complete from the
implant fractures. I feel extremely comfortable using these
restoration standpoint. We have carried out various treatments
implants in my daily practice and have had very acceptable
ranging from individual crowns in the anterosuperior and
clinical outcomes. Patients greatly value having the option of
anteroinferior region, restoration of complete anterior groups
a minimally invasive, esthetic treatment. For us, this reconfirms
in situations with limited bone availability, and narrow crests
the notion that GBR techniques should be reduced, since our
in patients who refused to undergo bone grafting procedures.
patients don't like them and this limits their acceptance.
The surgical outcomes have been optimal, with excellent
bone and gingival stability.
how important is it to have a narrow prosthetic platform
with an internal connection?
I believe that in standard situations the use of Bone Level
I have always used implants with an internal connection. The
Narrow CrossFit ® (NC) implants would be sufficient, but the
usage of implants with an external connection, as is the case
design of the Standard Plus NNC makes it my preferred
with Standard Plus NN, complicates my job significantly.
option for situations where there are greater hygiene risks,
NNC implants allow me to work with a submerged or
less soft tissue, and separating of the gap from the bone
semisubmerged technique, with multiple restorative options.
crest for non-submerged techniques. It is also satisfactory for
This makes my day-to-day decision-making process very
dentists who would prefer to continue using soft tissue level
easy. Today it is essential to have an internal connection
implants instead of bone level implants.
throughout the entire range of implants, whether narrow or
wide. The narrow platform also allows for a better adaptation
In many situations we must use techniques that increase bone
of the prosthetic restorations in areas where tissue volume
and gingival mass in order to achieve esthetically acceptable
is severely lacking. The availability of this type of platform
results, but this is not always welcomed by our patients. This
allows us to create harmonious and natural emergence
has created a need for implants with small diameters, which
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can be used in these situations in a routine, predictable manner and with a wide
range of restoration components – all of which are characteristics dentists and
patients have come to expect from the Straumann Dental Implant System.
For this reason, the specific indications for this implant include those requiring small
diameters and strength along with the polished emergence profiles to which users
of soft tissue level implants have grown accustomed.
Dr. Giuliano Fragola Arnau
Madrid-based practice dedicated exclusively to
“I believe the work in this field is heralding in a new age in which these
implantology. Degree in odontology from the Com-
types of new alloys will allow for increasingly stable structures with
plutense University of Madrid. Masters in Implantol-
smaller diameters.” Giuliano Fragola Arnau
ogy, Periodontology and Oral Rehabilitation.
Fellow, Speaker and Iberian Study Club Coordinator
of the ITI (International Team for Implantology).
Author of scientific articles.
what are the benefits of NNc for the patients?
NNC gives the surgeon a new element to resolve special situations. Patients benefit
from NNC implants by possibly avoiding complex, irritating and costly treatments
that take longer to perform. The effect is that patients perceive the treatment as less
invasive. Technological progress, as I see it, is developing solutions for situations
that were difficult to solve in the past. I believe the work in this field is heralding
in a new age in which these types of new alloys will allow for increasingly stable
structures with smaller diameters. The next step is to further develop technology by
manufacturing smaller components that can be used to solve even more potentially
complex situations.
Dr. Fragola, thank you for this interview.
LocAtor ® is a trademark of Zest Anchors, Inc, Escondido, cA
*
compared to SLA® in an animal model
1
2
Norm AStM F67 (States minimal tensile strength of annealed titanium)
3
Data on file.
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GiULiANO FrAGOLA ArNAU AND JAvier Pérez LóPez
R e po sitioning of an upp er r ig h t la t er a l in c is or us in g t h e
St r a um ann ® Standard P lus N a r r ow N ec k Cr os s F it ® Imp l an t
Background
occasional smoker and had good periodontal health; an
Male patient, age 46, showed a missing upper right lateral
anterior crossbite was observed, leading us to believe that
incisor (#7) at the consultation and requested a fixed,
these teeth were subjected to a visible occlusal load. This would
esthetic restoration. The patient wore a Maryland bridge
explain the frequent debonding of the Maryland bridge. Clinical
which repeatedly debonded due to a crossbite, making
and radiological examinations were carried out and no gingival
it uncomfortable to wear (Figs. 7). He brought a few older
or bone alterations were observed in the remaining teeth.
periapical and panoramic X-rays in which the presence
of a non-restorable root remnant could be observed. The
Treatment plan
patient reported that the tooth had been extracted previously
The plan was to place a small-diameter Straumann® Standard
due to the fracture of a post and core. After extraction,
Plus Narrow Neck CrossFit ® Implant (NNC, Ø3.3 mm, 10 mm
an implant was inserted immediately. This implant failed
SLActive ®, Roxolid ®) with a screw-retained Straumann® NNC
during the period of osseointegration and had to be removed
Gold Abutment. The patient’s Maryland bridge was used
(Figs. 3, 4).
as a temporary restoration until full osseointegration was
achieved. In a second step, a screw-retained provisional was
Diagnosis
made in order to create the emergence profile before the
The patient did not have any systemic diseases, was an
final restoration was placed.
Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
s t r a u m a N N ® s ta N D a r D p l u s N a r r o w N e c k c r o s s F i t ® i m p l a N t l i N e
STARGET 1 I 13
Surgical procedure
junction of the neighboring teeth, leaving it in the supracrestal
The NNC implant was positioned with a full thickness flap
position (Figs. 5 – 9).
that included the adjacent teeth, without vertical releasing
incisions. A wide bone crest was observed without hollows in
A 1.5 mm-high NNC closure screw was placed, and the site
the vestibular area but with a narrow mesiodistal space. The
was closed by suturing with simple 4/0 stitches. The patient’s
coronal area of the bone was carefully drilled and prepared
Maryland bridge was cemented to provide a provisional
for placing the implant in the bone. The shoulder of the
prosthesis (Figs. 10*, 11).
smooth neck was positioned 2 mm from the amelocemental
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13
Fig. 14
Fig. 15
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s t r a u m a N N ® s ta N D a r D p l u s N a r r o w N e c k c r o s s F i t ® i m p l a N t l i N e
After four weeks, we examined the patient and the 1.5 mm
Outcome and conclusions
NNC closure screw was replaced by a Ø3.0 mm NNC
Using small-diameter NNC implants helps to offer a
Healing Cap. Perfect integration of the soft and hard tissue
predictable restoration of small interdental spaces. The smooth
was observed (Fig. 12 – 13*).
neck is designed to ensure the restoration is reliable in terms of
soft tissue healing; the Roxolid® material and SLActive® surface
Restoration procedure
treatment give us the necessary performance in terms of
Impressions were taken seven days later to produce a
tensile1 and fatigue2 strength and osseointegration3.
working model and make a temporary screw-retained crown
with the NNC post for temporary restorations which would
NNC
be in place for two weeks (Figs. 14 – 19). Next, the final
technological innovation for the benefit of our patients. In
Customized NNC
this case, good results were achieved without the need for
Gold Abutment for crowns. A metal test was carried out to
additional procedures involving bone or soft tissue grafts. The
check the correct fit before completing the veneering of the
esthetic advantages are obvious: rapid soft and hard tissue
final restoration. The final step was to insert the screw with
integration. In this case, the number of procedures for the patient
35 Ncm and check the occlusion (Figs. 20 – 23).
was minimized, making it possible to reduce overall treatment
crown was made using a Straumann
®
implants
present
a
clear
case
demonstrating
time and achieve a stable, predictable treatment outcome in
six to seven weeks.
Fig. 16
Fig. 17
Fig. 18
Fig. 19
Fig. 20
Fig. 21
s t r a u m a N N ® s ta N D a r D p l u s N a r r o w N e c k c r o s s F i t ® i m p l a N t l i N e
Fig. 22
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21
Fig. 23
Dr. Giuliano Fragola Arnau
Madrid-based practice dedicated exclusively to
implantology. Degree in odontology from the Com-
*the closure screws and healing caps used in this case report are yellow color-coded – the final market
versions of these components are not color coded.
Norm AStM F67 (States minimal tensile strength of annealed titanium)
1
2
Data on file.
3
compared to SLA® in an animal model
plutense University of Madrid. Masters in Implantology, Periodontology and Oral Rehabilitation.
Fellow, Speaker and Iberian Study Club Coordinator
of the ITI (International Team for Implantology).
Author of scientific articles.
Javier Pérez López
Dental technician specialized in esthetic implant-supported restorations. Director of “Técnica Dental Studio VP” laboratory. ITI fellow. Consultation services
and collaboration in research projects into implants
and ceramic materials. Speaker on esthetics, implants
and ceramic materials.
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s t r a u m a N N ® s ta N D a r D p l u s N a r r o w N e c k c r o s s F i t ® i m p l a N t l i N e
AN iNTerview wiTh FrANCiSCO FAOrO
“The Narrow Neck CrossFit ® Connection (NNC) prosthetic
portfolio enables clinicians to expand their treatment options.”
what is behind the design concept of the new NNc implant?
Straumann benefits from a long, sustained development history. The Straumann® Soft Tissue Level implant
portfolio, with its straightforward surgical and tissue management protocols, covers many indications
in the oral cavity. In 2007, we launched the Straumann® Bone Level implant line. This was the first
time Straumann featured an internal connection that was also suitable for small diameter implants with
narrow platforms. The simplicity of the soft tissue level line and the scientifically supported Narrow
CrossFit ® connection from the bone level implant were excellent building blocks for a new product line.
how was it possible to develop a soft tissue level implant with an internal connection in combination
with such a small prosthetic platform?
Straumann is a pioneer of innovative solutions. In 2009 we launched Roxolid ®, a titanium-zirconium
alloy with excellent mechanical properties. The tensile1 and fatigue2 strength of Roxolid ® enabled our
team to develop an implant with a Ø3.3 mm endosseous diameter narrow prosthetic platform, without
compromising strength.
how strong is this new implant?
Initially, we planned to offer an improved implant design with an internal connection and an enhanced
prosthetic portfolio to cover the same indications as the Narrow Neck (NN) implant. The dynamic
fatigue tests performed during the development of NNC in accordance with relevant ISO standard
14801 demonstrated higher than expected fatigue strength. This made it possible to provide an implant
line that not only replaced single front teeth in the upper and lower jaw but can also be used for
restorations in the pre-molar region.
why was a crossFit ® connection chosen for a soft tissue level implant?
More than a decade of successful clinical history confirms that our regular- and large-diameter tissue
level implants work remarkably well with the internal synOcta ® connection. However, the mechanical
limitations of smaller-sized implants became obvious during the development of NNC. Since the launch
of the Straumann ® Bone Level line in 2007, we have sold more than 350,000 small-sized implants with
the internal Narrow CrossFit ® Connection. Given the mechanical benefits of the CrossFit connection
combined with high acceptance of the CrossFit design by our customers, the CrossFit connection was
an obvious choice for the NNC.
s t r a u m a N N ® s ta N D a r D p l u s N a r r o w N e c k c r o s s F i t ® i m p l a N t l i N e
STARGET 1 I 13
what were the technical challenges when developing the new transfer piece?
Achieving the balance between a design that provides secure transfer of the implant
from the packaging to the patient’s mouth, while still offering easy handling, was
the requirement to be met. In more technical terms, the transfer piece needed to
provide aspiration security, apply high rotational forces during insertion and remain
easy to remove after implant placement. The challenge was to find a reliable
and reproducible design to transmit high torque without damaging the internal
connection of the implant. The concept has been in clinical use with selected
Francisco Faoro
customers worldwide since the first quarter of 2011, and customer response has
Head of Product Development, Business Unit
been positive.
Surgical, Straumann AG, Switzerland
why is it so important to have an internal connection?
Small-sized implants are often used in esthetic cases. Internal connections offer
more flexibility for angulated prosthetic solutions. In addition, internal connections
facilitate restorations with screw-retained bridges.
what is the biggest difference compared with the prosthetic options of the Narrow
Neck implant?
With the internal abutment-implant connection, the NNC’s broad prosthetic
portfolio enables clinicians to expand their treatment options and offers increased
prosthetic flexibility compared the Narrow Neck implant. It offers screw-retained
and cement-retained restorations for single tooth and partially edentulous cases.
One engineering highlight from the newly developed prosthetic portfolio is the
angled cementable titanium options, which are designed with an outstanding slim
emergence profile to produce highly esthetic results. The NNC prosthetic platform
also offers removable and fixed overdenture options for full edentulous cases. The
availability of a LOCATOR® abutment for the NNC offers a new option for a tissue
level implant with narrow dimensions for the treatment of edentulous situations.
Norm AStM F67 (states min. tensile strength of annealed titanium).
1
2
Data on file.
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s t r a u m a N N ® s ta N D a r D p l u s N a r r o w N e c k c r o s s F i t ® i m p l a N t l i N e
MAriO rOCCUzzO
Congenitally missing maxillar y lateral incisors:
treatment option with the new Straumann ® NNC implant
In February 2010, a 42-year-old non-smoker with a
The patient, who teaches at a university, expressed the desire
congenitally missing upper right lateral incisor was referred
to maintain esthetics during treatment. For this reason, lingual
by her orthodontist for a consultation prior to orthodontic
orthodontics with the Incognito ® technique was used, with the
treatment (Fig.1).
aim of creating adequate mesio-distal space (Fig. 2). At the end
of the treatment, radiographic examination revealed sufficient
The various treatment options were presented: (i) to close the
mesio-distal space along the roots and normal interproximal
space with orthodontic treatment or to open the space to allow
bone level (Fig. 3). A space of almost 6 mm was measured
for prosthodontic replacement either with (ii) a fixed dental
with the caliper, which is insufficient for a standard implant
prosthesis or (iii) a single-tooth implant. Each of the approaches
diameter (Figs. 4, 5). A Ø3.3 mm fixture is preferred. The
could potentially compromise esthetics, periodontal health and
patient’s medical history turned up nothing significant, and she
function. A thorough interdisciplinary analysis was performed,
was in good general health. After onset of local anesthesia,
and the patient ultimately gave her informed consent for the
an intrasulcular incision was made one tooth mesially and one
single-tooth implant treatment option.
tooth distal to the gap.
Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
s t r a u m a N N ® s ta N D a r D p l u s N a r r o w N e c k c r o s s F i t ® i m p l a N t l i N e
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A full-thickness flap was elevated to expose the bone, and
The implant was placed with the edge of the SLActive® surface
sutures were used for retraction on the palatal aspect of the
approximating the alveolar bone crest leaving the machined
alveolar ridge. On the facial aspect, no vertical releasing
neck portion in the transmucosal area (Fig. 8). A healing screw
incision was made to avoid the risk of cicatrices and/or
was placed into the implant, and the flap was sutured. The
recessions. Initial drilling was limited to a Ø2.2 mm pilot drill
radiographic examination confirmed the correct positioning of
at 680 RPM to facilitate the use of osteotomes at the implant
the implant (Fig. 9).
sites (Fig. 6).
Three weeks after surgery, the peri-implant mucosa showed
The final osteotomy site was prepared using Straumann
no inflammation. The patient was then instructed to brush
osteotomes to preserve as much bone as possible. Screw taps
properly for optimal plaque control with limited risk of soft
were not used. A Straumann Standard Plus, Ø3.3 mm NNC,
tissue recession. An impression for the temporary restoration
SLActive 10 mm, Roxolid implant was placed as indicated
was taken (Fig. 10). Thanks to the SLActive ® surface properties,
in the manufacturer’s instructions. The Implant was manually
which promote faster oseointegration1, it was possible to
inserted without tapping to achieve primary stability. (Fig. 7)
place a screw-retained temporary restoration on the implant
®
®
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
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s t r a u m a N N ® s ta N D a r D p l u s N a r r o w N e c k c r o s s F i t ® i m p l a N t l i N e
four weeks after surgery. Minimal gingival contouring was performed to eliminate
excessive soft tissue (Fig. 11).
Temporary restoration was kept in place for six weeks (Fig. 12) to facilitate soft
tissue maturation so that impression could be taken under ideal final conditions.
(Figs. 13, 14). The slightly submucosal implant shoulder position is visible on the master
cast. This allows for a submucosal crown margin position. The implant shoulder region
Dr. Mario Rocuzzo, DMD
is accessible for later cement removal from the metal-ceramic crown (Figs. 15, 16).
Lecturer in Periodontology at the University of Siena/
The clinical situation prior to cementing confirms the positioning of the implant “as
Italy. Private practice limited to Periodontology and
shallow as possible, as deep as necessary” according to the principles of the third
Implantology in Torino/Italy. Extensive research in the
field of mucogingival surgery, bone regeneration, im-
ITI Consensus Conference (Fig. 17).
plant loading protocols and implants in periodontally
compromised patients. Active member of the Italian
Society of Periodontology and ITI Fellow.
The team’s work was made possible, thanks to the
cooperation of:
Dr. Riccardo Rizzo, Orthodontist
Moncalieri (TO), Italy.
Francesco Cataldi, Master Dental Technician
Torino, Italy.
Fig. 13
Fig. 14
Fig. 15
Fig. 16
s t r a u m a N N ® s ta N D a r D p l u s N a r r o w N e c k c r o s s F i t ® i m p l a N t l i N e
Eleven weeks after surgery, the gold abutment was tightened with a torque of
35 Ncm (Fig. 18), the final crown cemented (Fig. 19) and the x-ray taken (Fig. 20).
Probing depth is within the expected physiological limit both around the implant and
the adjacent teeth. Plaque control is satisfactory, no bleeding on probing is present,
all leading to pleasing esthetic results.
compared to SLA® in an animal model
1
Incognito™ is a registered trademark of 3M, Bad Essen, Germany
Fig. 17
Fig. 18
Fig. 19
Fig. 20
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s t r a u m a N N r e g e N e r at i o N s o l u t i o N s
PeriODONTAL TreATMeNT GUiDe
A teamwork approach to achieving excellent esthetic
outcomes with periodontal treatments
PERIODONTAL TREATMENT GUIDE
Straumann® Periodontal Treatment Guide
Teamwork for treating periodontal disease
Contact your Straumann Regenerative Territory
Manager for more information.
s t r a u m a N N r e g e N e r at i o N s o l u t i o N s
The
esthetic
restoration
multidisciplinary
requires
dental
process
approach.
often
Successful
to diagnosing and treating periodontal disease. Different
rehabilitation
approaches were discussed and a final consensus was
reached based on scientific and clinical proof. In 2011, a
methodologies to achieve an esthetic, functional, and
group of clinicians from North America, including periodontists,
healthy restorative-periodontal interface. This process
general dentists and dental hygienists met to discuss the
needs
European consensus to tailor it for the North American market.
defined
to
a
their
clearly
professionals
involves
STARGET 1 I 13
objectives
integrate
and
professional
collaboration on many levels.
This accord was translated into the “Periodontal Treatment
Both general dentists and periodontists diagnose and treat
Guide”, which comprises some of the aspects to consider
patients with the goal to help maintain a healthy restorative
when
and periodontal interface. Achieving good oral health
Information on what should be evaluated, treatment options
many times calls for a multidisciplinary approach. Many
and the connection to overall health is taken into account.
complex treatment plans often require co-management
The “Periodontal Treatment Guide” is a key tool to support the
and intercommunication between a general dentist and
dialogue between periodontists, general dentists and dental
periodontist to achieve good oral health, function, and
hygienists. In order to promote this dialogue, the Straumann
esthetics. Once periodontal health has been established,
Regenerative team works with clinicians to provide state-of-
restorative treatment can begin. Following the fundamentals
the-art periodontal treatment for patients through education
of collaborative patient care typically leads to better patient
events throughout the country. Professor Anton Sculean of the
outcomes and mutual success for the referring general dentist
University of Bern in Switzerland provides additional insight
and periodontist. Ongoing communication between both the
into the original development of the Guide. He is a member of
general dentist and periodontist is paramount for success, and
the group that developed the “Periodontal Treatment Guide”
the lines of communication need to be defined and remain
and shares his professional experience and provides his
open throughout treatment. In order for the general dentist and
insight into the Guide and periodontal treatment options. Dr.
periodontist to function as a cohesive team, both professionals
David Cochran of the University of Texas Health and Science
need to have a thorough understanding of the treatment
Center in San Antonio, Texas comments on the adaption of
modalities, processes, and desired treatment outcomes.
the Guide for the North American market.
Equally important to the collaborative relationship is shared
treatment philosophies.
Back in early 2010, a group of experienced and highly
renowned European periodontists and general dentists got
together in Berlin for a workshop to address issues related
evaluating
a
patient
for
periodontal
disease.
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s t r a u m a N N r e g e N e r at i o N s o l u t i o N s
AN iNTerview wiTh PrOFeSSOr ANTON SCULeAN AND Dr. DAviD COChrAN
“ The ul timate goal is to s ub s t a n t ia lly imp r ov e
t he quality of life of pa t ien t s . ”
professor sculean, what should be the approach to the
could you tell us what the purpose of the periodontal
treatment of periodontal diseases?
treatment guide is?
We know that the main causes of tooth loss are tooth decay
The objective is to provide the dental community with
and periodontitis. This is clear evidence of the importance of
a straightforward, evidence-based tool to facilitate the
properly diagnosing periodontal disease in the population at
diagnosis,
large. Treating periodontal disease is a battle that requires
treatment for periodontal diseases. Straumann united a
actions on different fronts. Disease identification occurs very
group of renowned European periodontists and general
often in a General Practitioner’s (GP) office; therefore gum
practitioners to discuss current treatment options and finally
disease awareness among GPs is crucial. Initial therapy is
reach a consensus regarding the diagnosis and treatment of
usually performed by GPs and complex cases are referred
periodontal disease. The group consisted of university-based
to periodontists. Furthermore, dental hygienists play an
periodontists, periodontists working in private practice and
important role in providing non-surgical treatment to patients,
general practitioners who were willing to join forces in order
identification of patients who might need further treatment
to develop a treatment guide for periodontal disease. The
and assuring compliance with the regular appointments
ultimate goal is to substantially improve the quality of life of
patients need in order to receive proper treatment. In short,
patients by offering the best possible periodontal care.
enhance
prognoses
and
support
proper
providing optimal periodontal care to a population is the
how do you think dentists could benefit from the periodontal
result of teamwork.
treatment guide in their practices?
The predictability and long term stability of the results of
The guide is meant to be consulted and used by dentists
periodontal treatment has been largely shown. In cases of
in their daily practice whenever necessary. I also consider
advanced periodontitis, tooth extraction is no longer the only
it a useful tool for seminars, study clubs and referral events
option. The literature shows that if you treat periodontitis, in
in order to disseminate periodontology awareness and
most cases you can keep previously diseased teeth for at
knowledge. It provides an opportunity for practitioners to
least 30 years. Success depends on proper diagnosis, and
share their unique talents and special interests within their
this is where guidelines such as the “Periodontal Treatment
dental community and scope of practice.
1
1
Guide” might be helpful.
what is the main tool used for diagnosing periodontal
disease?
“Success depends on proper diagnosis, and this is
The periodontal probe is still one of the most important tools.
where guidelines such as the “Periodontal Treatment
Probing depths of more than 6 mm with bleeding or pus
Guide” might be helpful.” Anton Sculean
and furcation clearly indicate major periodontal problems.
In these cases, an x-ray may be necessary to evaluate
s t r a u m a N N r e g e N e r at i o N s o l u t i o N s
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bone loss. These tools are present in most clinical practices.
indication. There are different surgical modalities and, if
The periodontal examination is very important and I do
indicated, we should consider performing regenerative
recommend it for elderly and young patients alike. Though
surgery, which aims to restore lost soft and hard tissue.
severe periodontal problems are rare in young patients, when
they are affected with periodontal disease, it can cause
tremendous bone loss, particularly in those young patients
“I make clear to my patients that losing their teeth
with aggressive periodontitis.
due to periodontal disease does not have to be part
of their life.” Anton Sculean
“It is absolutely crucial to consider systemic diseases, such as untreated diabetes or cardiovascular dis-
Do you use straumann® emdogain™ for regenerative
eases, as well as any medications that may interfere
surgery?
with a patient’s periodontal status.” Anton Sculean
yes I do. It is one of the most widely studied and documented
regenerative products and is featured in more than 400
scientific publications. Emdogain has been used clinically for
how can state-of-the-art periodontal treatment be provided?
almost 20 years. I use it when a patient presents with a pocket
Proper diagnosis is essential. After assessing the severity of the
depth of 6 mm or more and an intrabony defect deeper than
disease, it is extremely important to have the right treatment
3 mm. I also use it for mandibular buccal Class II furcations.
plan. We need to look at the patient in a holistic way.
In addition, I use Emdogain for recession treatment either
alone or in combination with connective tissue grafts. In all
It is absolutely crucial to consider systemic diseases, such
these cases, applying regenerative materials like Emdogain
as untreated diabetes or cardiovascular diseases, as well
is definitely an important treatment option. The goal here is
as any medications that may interfere with a patient’s
to enhance the formation of cementum, periodontal ligament
periodontal status. Periodontitis is an infectious disease
and bone by regenerative means, which results in improved*
caused by bacteria. Therefore, to treat it, the bacteria must
clinical outcomes2,3 and long-term prognosis.4
first be eliminated. At this stage, initial therapy consists of
improvement of oral hygiene as well as non-surgical therapy
with or without systemic antibiotics, depending on the severity
of the case. The effects of non-surgical treatment are usually
evaluated after 6 weeks to 3 months, at which time the need
for a surgical approach is determined. It is also critical to
determine the best surgical modality according to the given
*compared to coronally advanced flap alone or flap surgery alone
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s t r a u m a N N r e g e N e r at i o N s o l u t i o N s
Do you have any last thoughts for us?
The important message I would like to get across is that we have come a very long
way in our understanding of periodontal disease. We have developed strategies,
technologies and techniques to effectively treat the disease. I make clear to my
patients that losing their teeth due to periodontal disease does not have to be part
of their life. The “Periodontal Treatment Guide” will therefore provide additional
reinforcement for developing awareness and providing guidelines on state-of-theAnton Sculean, DMD, MS, PhD
art periodontal care for patients. As an educational tool used in situations like
is Professor and the Chairman of the Department of Peri-
referral events, it can also highlight the need for a multidisciplinary approach
odontology, University of Bern, Switzerland.
among GPs, dental hygienists and periodontists in order to provide the population
The following clinicians have also contributed their sci-
with state-of-the-art treatment alternatives.
entific knowledge to the Periodontal Treatment Guide (in
alphabetical order):
Dr. Frank Bröseler, Aachen, Germany
Prof. Dr. Nick Donos, London, United kingdom
Dr. Holger Janssen, Berlin, Germany
Dr. David Nisand, Paris, France
Dr. Mario Roccuzzo, Torino, Italy
Dr. Markus Schlee, Forchheim, Germany
Dr. Christina Tietmann, Aachen, Germany
Professor Sculean, thank you for this insightful and interesting interview.
s t r a u m a N N r e g e N e r at i o N s o l u t i o N s
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s t r a u m a N N r e g e N e r at i o N s o l u t i o N s
Dr. Cochran, after the development of the Periodontal Treatment Guide in
Europe, we also reviewed it for the North American market. Can you please
provide us with insight regarding the discussion and thoughts of the group
that participated?
An energetic group of hygienists, general dentists and periodontists came together to discuss the Periodontal Treatment Guide, established by our European
colleagues, and how that Guide might be applied in clinical practice in North
David Cochran, DDS, MS, PhD
America. Most of the North American group are in private practice, have lectured
Is Professor and the Chairman of the Department of Peri-
and published, and are recognized as experts in their field. The North American
odontology, The University of Texas Health Science Cen-
group’s consensus was that they wholeheartedly supported the concept and felt
ter at San Antonio.
The following clinicians have also contributed their sci-
that this was a valuable tool to have in clinical practice. The basis of the PerioPerio
dontal Treatment Guide is the correct diagnosis of the patient in regards to his/her
entific knowledge to the Periodontal Treatment Guide (in
periodontal condition and to know when referral to a periodontal specialist is warwar
alphabetical order):
ranted. That sounds very simple, but in the day-to-day hustle and bustle of clinical
Dr. Frank Bröseler, Aachen, Germany
Prof. Dr. Nick Donos, London, United kingdom
practice, it’s helpful to be reminded of the value of a comprehensive periodontal
examination and when to refer so the advantages of periodontal treatment can be
Dr. Holger Janssen, Berlin, Germany
most beneficial for the patient. Late referrals can often limit what options a patient
Dr. David Nisand, Paris, France
might have to achieve better oral health. In addition, the Periodontal Treatment
Dr. Mario Roccuzzo, Torino, Italy
Guide reviews some options for periodontal treatment including the regeneration
Dr. Markus Schlee, Forchheim, Germany
Dr. Christina Tietmann, Aachen, Germany
of the tissues surrounding the tooth lost due to the patient’s periodontal disease.
Thus, the group was excited to help evaluate the Periodontal Treatment Guide to
make it more relevant in North America.
“We are all in the business of optimizing our patient’s oral health
and the periodontal-systemic associations reinforce the need for us as
clinicians to stress this to our patients for the benefit of their overall
health.” Dr. David Cochran
s t r a u m a N N r e g e N e r at i o N s o l u t i o N s
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STARGET 1 I 13
s t r a u m a N N r e g e N e r at i o N s o l u t i o N s
Building on what Professor Sculean said about the be-
How does Straumann Emdogain fit into the equation of
nefits of the Guide, how might a clinician implement the
periodontal therapy and the Guide?
Periodontal Treatment Guide in his or her own practice?
As mentioned before, the recognition and evaluation of a
The North American group felt that the Periodontal Treatment
patient’s periodontal condition through a comprehensive pe-
Guide would be particularly helpful for all the staff to re-
riodontal examination is paramount for every patient. Those
view regularly during staff meetings. This could occur weekly
periodontal lesions that have been identified in many cases
or monthly depending on what is done in each office. This
might benefit from regenerative periodontal therapy and may
Guide could serve as the basis of discussion for the staff
allow the patient to retain their teeth for many years. A major
and would also serve as a reminder to all the staff for the
advancement that has taken place in periodontal regenera-
need to do comprehensive periodontal examinations on not
tion therapy is the recognition that the addition of a rege-
only new patients to the practice but also on recall patients
nerative material, either alone or mixed with a bone graft
and patients on regular maintenance regimens. Virtually all
material, significantly enhances the outcomes of our regene-
patients have some form of periodontal disease ranging from
ration therapy. Emdogain is the most well studied regenera-
Gingivitis to Severe Periodontitis and all benefit from discus-
tive material approved by the Food and Drug Administration
sions about their periodontal condition. This is particularly
(FDA) for periodontal regeneration and has been shown to
true today with the recognition of this disease as a chronic
be effective in over 15 years of studies. Emdogain can be
inflammatory disease of aging and its possible association
used alone in smaller defects or combined with a number of
to other chronic inflammatory diseases of aging such as car-
other bone graft materials for larger defects and is currently
We are all in
the only regenerative material approved by the FDA to be
the business of optimizing our patient’s oral health and the
used with multiple graft materials for periodontal regenerati-
periodontal-systemic associations reinforce the need for us as
on. Thus, when a periodontal regenerative approach will be
clinicians to stress this to our patients for the benefit of their
taken, Emdogain is my first choice of material to help grow
overall health. The North American Group also felt that this
back the patient’s tissue lost due to their periodontal disease.
diovascular disease, diabetes and arthritis.
5
Periodontal Treatment Guide could be given to the referral
practices associated with the dentist’s office and that he/
Thank you very much for your thoughts regarding the de-
she should use it in their study club meetings and when the
velopment of the Guide, Dr. Cochran!
dentist/dental hygienist provided continuing education.
“When a periodontal regenerative approach will be
taken, Emdogain is my first choice of material to help
grow back the patient’s tissue lost due to their periodontal disease.” Dr. David Cochran
s t r a u m a N N r e g e N e r at i o N s o l u t i o N s
Holm-Pedersen P, Lang NP, Muller F. What are the longevities of teeth and oral implants? clin oral
1
Impl. res 18 (Suppl. 3), 2007, 15-19
2
Froum SJ, Weinberg MA, rosenberg E, tarnow D. A comparative study utilizing open flap debridment
with and without enamel matrix derivative in the treatment of periodontal intrabony defects: a 12-months
re-entry study. J Periodontol. 2001 Jan;72(1):25-34
3
cueva MA, Boltchi FE, Hallmon WW, Nunn ME, rivera-Hidalgo F, rees t. A comparative study of
coronally advanced flaps with and without the addition of Enamel matrix derivative in the treatment of
marginal tissue recession J Periodontol. 2004 Jul;75(7):949-56
4
Sculean A, Kiss A, Miliauskaite A, Schwarz F, Arweiler NB, Hannig M. ten-year results following
treatment of intra-bony defects with enamel matrix proteins and guided tissue regeneration. J clin
Periodontol 2008: Sep; 35(9):817-24
5
otome-corgel J, Pucher J, rethman, M, reynolds, M. State of the Science: chronic Periodontitis and
Systemic Health. J Evid Base Dent Pract 2012: SI: [20-28] 1532-3382
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s t r a u m a N N r e g e N e r at i o N s o l u t i o N s
AN iNTerview wiTh FrANK BröSeLer AND rOBerT MiLLer
“We are at the beginning of an impor tant development”
in a field that has recently been limited in new innovations,
straumann membragel provides a unique opportunity to
“What interested me from the start about this inno-
improve1 guided bone regeneration.
Dr. Frank Bröseler,
vative technology was the simplification of the surgi-
germany, and Dr. robert miller, Florida, usa, provide
cal procedure for certain indications.” Frank Bröseler
insights into their clinical use of straumann membragel and
its introduction in europe and North america.
Frequent and controversial topics include the “mechanical
stability” and “barrier function” of membranes. what is your
“We are at the beginning of an important develop-
opinion? how stable should a membrane be and what role
ment” Frank Bröseler
does resorption play?
Stabilization of the augmentation material is undoubtedly
important. Considered objectively, the very need for
Nowadays, the use of membranes is standard in bone
augmentation around an implant involves a risk for the long-
augmentation procedures in implant dentistry. as a practicing
term prognosis. I regard MembraGel as advantageous for
dentist working in surgery, where do you see a potential for
the simplicity with which stabilization can be achieved.
improving the conventional membranes available today?
New developments in research and biotechnology associated
The barrier ensures that the operation site is securely shielded
with GBR and GTR demonstrate a trend to simplify use and
from the epithelium. Apart from a membrane’s stability,
improve biocompatibility. From the literature and clinical
the barrier function is thus clearly an important property.
experience, however, we know that undesirable side effects
However, the procedure should not be reduced to the
still occur relatively often during wound healing. These
membrane alone. Ultimately, this is only an aid to getting
probably have something to do with biocompatibility and
back lost bone, optimizing the implant bed or building up
are seen as symptoms typically associated with inflammation
2
the alveolar ridge. I therefore see the membrane as an
and are often associated with dehiscence of the wound
important part of a greater whole. The desirable properties
closure1. Therefore, the clinician has a need to minimize these
of a membrane are ultimately dependent on the nature of
risks in clinical use. Furthermore, simplification of application
the defect. For example, a resorption period that the user
is desirable for many users. In my opinion, MembraGel
could vary according to the defect type would be of great
represents a good option in this regard and I think that we
benefit. For example, I need only a short period for socket
are at the start of an important development.
volume preservation. On the other hand, a barrier function for
several months is necessary for alveolar ridge augmentation,
whether vertical or horizontal.
s t r a u m a N N r e g e N e r at i o N s o l u t i o N s
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s t r a u m a N N r e g e N e r at i o N s o l u t i o N s
the occurrence of soft tissue dehiscence is a common complication in gBr. what
is the significance of membranes in this context? what experience have you had
with the various materials?
In the last 15 years, I have gathered experience with both nonresorbable and
with different resorbable membranes. As a treating dentist, it is important for me
to keep irritation in wound healing to a minimum. It is important in principle to
achieve primary wound closure and prevent exposure of the membrane. With
Dr. Frank Bröseler
some non-resorbable membranes, the rate of treatment failure corresponds to the
Dentist and dental technician. Certified specialist of the
frequency of membrane exposure1,3. Modern resorbable membranes tolerate this
German Academy for Periodontology (Deutsche Ge-
better in my experience and also according to the available data1,4. MembraGel
sellschaft für Parodontologie, DGP). 2006 winner of the
practitioner prize of the DGP: Regenerative periodontal
surgery. 2009 EFP prizewinner: Implantology with prior
is based on polyethylene glycol and during the postoperative period, I have
observed that clinical wound healing progresses slightly differently than with ePTFE
periodontal damage. Advisory committee member of
or collagen membranes. Getting used to this is quick as both the duration of the
dental journals, special interest in regenerative/recon-
healing process and the final result are similar to what we are accustomed to with
structive periodontology.
conventional collagen membranes. In my experience, I am able to achieve good
Publications on the topics of periodontology and
related areas, and on preventive dentistry.
integration of the augmented material and irritation-free epithelialization.
www.paro-aachen.de
“We are seeing rapid advancement in the area of periodontology and
implantology nowadays and I want to be able to offer my patients the
best of modern care in this respect.” Frank Bröseler
how long have you been using straumann® membragel ® and what was the
impetus for your decision to use this innovative technology?
I have been using MembraGel since the last quarter of 2010. What interested
me from the start about this innovative technology was the simplification of the
application. Moreover, I see a great potential for development in PEG technology
as a vehicle for biologically active substances. Last but not least, I am interested in
technical progress as such. Nowadays we are facing rapid advancement in the
area of periodontology and implantology and I want to be able to offer the best
modern care to my patients. When new technologies are introduced, this often
means that the user first has to adjust to changes.
s t r a u m a N N r e g e N e r at i o N s o l u t i o N s
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how has your practice adjusted to deal with a new membrane
in which indications have you so far used this product
technology and how has your surgical procedure changed?
and where do you see differences in this regard from
Not as much has changed due to the introduction of the
conventional membranes?
new procedure as one might assume. Regarding the surgical
Particularly for socket preservation, I see a potential for a simplified
procedure, I am not doing things very differently from before.
procedure compared with conventional methods, such as free
I ensure that the access flaps are not too small and that
mucosal grafts. I also obtain excellent results in the treatment
I have adequate visual control of where I am applying
of dehiscence defects. While I lack the experience clinically
MembraGel. Regardless of the material, the suture and
to comment on the use of MembraGel in ridge augmentation
flap technique is important and the clinician should always
procedures, what I have seen in animal studies suggest that there
pay great attention to this. My personal procedure consists
will be a good clinical prognosis in these indications as well.5
of obtaining a completely tension-free flap, which always
includes periosteal splitting. I use a maximum suture size
of 6-0 and preferably 7-0. I place interrupted sutures a bit
“I also hope or even expect that PEG technology
closer together than usual. With regard to simplified use,
can also serve in future as a vehicle for biologically
MembraGel offers advantages as it allows some steps to be
active substances.” Frank Bröseler
delegated. For instance, I task my assistant with preparing
the material for application. The majority of my surgical
procedures are microsurgical, which means that I am working
if you could look into the future, what would the ideal
with considerable optical magnification. I can continue to
membrane look like?
devote my concentration to the operation field while my
An ideal membrane would be quick to apply, very thin and
assistant hands me the ready-mixed MembraGel that I can
would exhibit good tissue tolerability while providing an
then apply directly to the site. With conventional membranes,
optimal barrier. Moreover, it would be possible for me to vary
naturally, an interruption is needed to cut the membrane to
the resorption time for specific defects. On the road to this
size individually. In this way, I was able to modify certain
goal, MembraGel and PEG technology will certainly play a
steps to optimize the treatment flow.
part. I also hope or even expect that PEG technology could
also serve as a vehicle for biologically active substances.
“Particularly for socket preservation, I see a potential for a simplified procedure compared with conventional methods, including free mucosal grafts.“
Frank Bröseler
Doctor Bröseler, thank you for this interview.
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s t r a u m a N N r e g e N e r at i o N s o l u t i o N s
Dr. miller, as we discussed with Dr. Bröseler, membranes have been in use
clinically for a number of years. tell us a little about your experience and about
the innovations you might like to see in the future.
Barrier membrane technology has come a long way since the use of Millepore and
ePTFE membranes for GTR and GBR. Early surgeries required a two stage approach
necessitating a second procedure to remove the non-resorbable membrane and
the use of screws and other devices to stabilize the membrane. This made the
Dr. Robert J. Miller
procedure more technique sensitive and time consuming. Patient acceptance was
Periodontist, private practice in Plantation, Florida. DDS
not always guaranteed, as the procedures were arduous and quite costly.
New york University College of Dentistry (1981). Certificate for Advanced Graduate Study in Periodontics,
Boston University (1996). Diplomate, American Board
of Oral Implantology, Fellow, International Team for
Collagen membranes were considered a major step forward as they were
resorbable and relatively easy to use. Their ability to stabilize a bone graft and
Implantology. Member of numerous professional organiza-
resist soft tissue compression has always been a deficiency forcing the clinician to
tions, including Academy of Periodontology, Academy of
“over-build” their grafts. These qualities make MembraGel an excellent choice in
Osseointegration, Pierre Fauchard Academy, and Ameri-
sites which require horizontal augmentation.
can Dental Association.
I believe the future of membrane technology rests in the ability of the material to
be used as a vehicle or a carrier to deliver growth factors. This would be a major
advantage as the membrane would no longer simply be a mechanical barrier to
prevent soft tissue ingrowth but participate in the regeneration of the osseous defect.
“This technology has a tremendous future and I am proud to be part
of it.“ Robert Miller
tell us a little more about the sites you have treated with straumann membragel
to date and where you see this innovative technology being most beneficial.
The greatest advantages of the product are found not only in its ability to stabilize
a bone graft but the fact that it is actually quite precise and easy to use. Once
the clinician is comfortable working with the hydrogel it can be used in a time
efficient and cost effective fashion. Ninety seconds after application the material
s t r a u m a N N r e g e N e r at i o N s o l u t i o N s
polymerizes and the case can be sutured. It is not unusual in cases which have
multiple extractions with simultaneous implant placement to find dehiscence or
gap-type lesions necessitating regeneration. The qualities of MembraGel make it
the membrane of choice in these situations.
straumann® membragel has been introduced in europe and North america
with a corresponding program of courses. can you provide us insight into your
experiences as a speaker and being involved with the product?
One of the more rewarding experiences that I have had in my career is being part
of the MembraGel Advisory Board and involved in the education-based launch.
I have had the opportunity to get to know many interesting people including the
biomedical engineers and surgeons involved in research and development. This
type of interaction has increased my knowledge of the subject while developing
relationships with the innovators of the field.
I derive a good deal of satisfaction from sharing experiences with the participants
in the courses. This interaction has led to many new friendships and a feeling
that I have contributed in some way to the growth of the field. The feedback that
we have received about the course curriculum is tremendous, as we talk about
successes and failures with the product in order to best understand how to use it
and the “watch outs” when treating patients. It also has been quite rewarding to
see first-hand how a product that started as a concept has grown to be a tool in
many surgeons armamentarium. This technology has a tremendous future and I am
proud to be part of it.
Thank you so much for your time, Dr. Miller.
Zitzmann NU, Naef r, Schärer P. resorbable Versus Nonresorbable Membranes in combination With Bio-oss for Guided Bone
1
regeneration. JoMI 1997 Vol. 12, No. 6 (844 - 852).
2
Buddy ratner. Biomaterials science: an introduction to materials in medicine. Elsevier Academic Press 2004, p.121.
3
Lorenzoni M, Pertl c, Polansky rA, Jakse N, Wegscheider WA. Evaluation of implants placed with barrier membranes.
clin. oral Impl. res, 13, 2002; 274–280.
4
Jung, r.E., Hälg, G.A., thoma, D.S., Hämmerle, c.H.F. (2009) A randomized, controlled clinical trial to evaluate a new membrane
for guided bone regeneration around dental implants. clin. oral Impl. res. 20: 162–168.
Schwarz F,Mihatovic I, Golubovic V, Hegewald A, Becker J. Influence of two barrier membranes on staged guided bone
5
regeneration and osseointegration of titanium implants in dogs: part 1. Augmentation using bone graft substitutes and autogenous
bone. clin. oral Impl. res. xx, 2011; 000–000. doi: 10.1111/j.1600-0501.2011.02187.x
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43
straumann® emdogain™
IS TRUE PERIODONTAL REGENERATION
IMPORTANT TO yOU?
Photos courtesy of
Dr. Paul Luepke
before treatment
11-months after treatment with
emdogain and ctg
More than 100 clinical publications in peer-reviewed journals demonstrate
Straumann® Emdogain to be safe and effective in stimulating the formation of new
periodontal soft and hard tissue. These clinical studies involve more than
3000 defects in over 2500 patients.
Contact Straumann Customer Service at 800/448 8168 to learn more
about Straumann solutions or to locate a representative in your area.
www.straumann.us
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a
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i
fit
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e xc e l l
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i
n
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L ongcomf o
s
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atien
L e ss p
1
2
3
4
5
6
5,6
Tonetti MS, et al. Enamel matrix proteins in the regenerative therapy of deep intrabony defects.J
defects. Periodontol.
2002;29:317–325.
Froum SJ, et al. A comparative study utilizing open flap debridement with and without enamel matrix derivative in
the treatment of periodontal intrabony defects: A 12-month re-entry.J
re-entry. Periodontol. 2001;72:25–34.
Jepsen S, et al. A randomized clinical trial comparing enamel matrix derivative and membrane treatment of
buccal class II furcation involvement in mandibular molars. Part I: study design and results for primary outcomes.
J Periodontol. 2004; 75:1150–1160.
McGuire Mk,, et al. Evaluation of human recession defects treated with coronally advanced flaps and either enamel
matrix derivative or connective tissue. Part 1: comparison of clinical parameters.J
parameters. Periodontol. 2003;74:1110–1125.
Sculean A, et al. Ten-year results following treatment of intra-bony defects with enamel matrix proteins and guided
tissue regeneration. J clin
lin Periodontol. 2008; 35:817-824.
Data on file (McGuire 10 year)
s t r a u m a N N r e g e N e r at i o N s o l u t i o N s
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FrANK BröSeLer
Treatment of a dehiscence-type defect around a dental
implant with Straumann ® MembraGel ®
Summary
for each individual defect thus offers an improvement for GBR
This case report describes the treatment of a dehiscence-
procedures. Recently, a novel PEG-derived (polyethylene
type alveolar bone defect around a dental implant with GBR
glycol) membrane for use with GBR indications has become
(guided bone regeneration) where Straumann MembraGel is
available on the European and North American markets. After
used as a biodegradable barrier. This membrane simplifies
activation by mixing the four different precursors, the membrane
clinical handling compared to conventional membranes be-
is applied as liquid and forms a hydrogel within 90 seconds
cause it is applied as a liquid1.After application, the membra-
after being applied. The membrane undergoes hydrolytic
ne solidifies within 90 seconds. This effectively stabilizes the
degradation during the healing period. PEG has been
bone graft in order to provide stable bone and peri-implant
shown to be biocompatible 9 and has been studied in other
soft tissue conditions with a completely restored emergence
medical disciplines in the past, for example, as a sprayable
profile around the dental implant.
adhesion barrier 10 and in neurosurgery 11. Several preclinical
studies using different animal models have been conducted
Introduction
to evaluate the effectiveness of this membrane as a barrier in
Alveolar bone defects in the jaw can be successfully treated
GBR procedures 12,13,14. in addition, clinical data is available1.
using GBR techniques. The idea behind this treatment method
Because Straumann® MembraGel represents a completely new
is to use a resorbable or non-resorbable barrier to prevent
technology for usage in GBR procedures the surgical protocol
ingrowth of proliferating connective or soft tissue cells into the
for the augmentation procedure has to be modified slightly over
hard tissue defect and to create a space for bone tissue-derived
that of conventional membranes. This case report illustrates a
. Barrier membranes can be manufactured
feasible treatment protocol for this new membrane technology
from various natural or synthetic precursors. Today, the most
in the treatment of alveolar bone dehiscence around a bone
frequently used resorbable membranes in dentistry are made
level dental implant in combination with bone graft substitute
of collagen 4,5,6,7,8. These membranes are available in standard
material.
cells to grow
2,3
sizes and forms and need to be adapted to the patient’s
individual situation before or during use. The availability of
a biodegradable membrane that can be customized in-situ
Fig. 1
Fig. 2
Fig. 3
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s t r a u m a N N r e g e N e r at i o N s o l u t i o N s
Patient history
this reason, prior to the planned implant insertion, a ridge
The patient (female, 52 years old at time of implant surgery,
augmentation was performed using bovine-derived xenograft
overall in good health, non-smoker) had been treated for
and a collagen membrane (in January 2010). In November
chronic periodontitis and undergone maintenance therapy
2010, the patient was scheduled to undergo implant insertion
since 1994 (Fig. 1). Due to pulp necrosis resulting from caries,
(bone level) with a simultaneous augmentation of the alveolar
tooth #26 was treated endodontically in 1997. Because of
ridge dehiscence located on the coronal section to ensure a
periapical periodontitis, an apicoectomy was performed.
stable morphologic reconstruction of the alveolar region. For
Due to recurring CAP (Chronic Advanced Periodontitis), tooth
the esthetic outcome in this case, this was important because
#26 had to be extracted in 2009 (Figs. 2, 3).
the patient’s lower gums were visible when she spoke.
Initial situation
Surgical procedure
Due to the limited prognoses for a second apicoectomy, the
No antibiotics were used preoperatively since the patient
proposed prosthetic solution for the patient was an implant-
underwent periodontal care and preoperative testing for the
supported single crown. The patient agreed after having
prevalence of periopathogenic microbiota, with no indications
been informed about the prognostic factors and risks. During
of the micro organism above the detection limit. The surgery
wound healing after tooth extraction, typical horizontal and
was performed under local anesthesia. The horizontal incision
vertical alveolar bone loss was found at position #26. For
was made with a slightly lingual aspect, with two vertical
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
s t r a u m a N N r e g e N e r at i o N s o l u t i o N s
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releasing incisions, each 1 tooth distant in the mesial and
grafting material was dried with sterile gauze immediately
distal aspect of region #26. A full mucoperiosteal flap was
before application.
raised. This flap shape was chosen to achieve sufficient access
and visibility to the treatment site and to ensure optimal blood
The activated Straumann® MembraGel ® was applied to the
support after primary closure (Figs. 4, 5). The implant site was
defect site. Next, 1-1.5 mm of the augmented area was
prepared according to the standard protocol recommended
outlined and covered with the bone substitute material. In
by the manufacturer (Fig. 6). Immediately after preparing the
the crestal aspect, the membrane was placed by covering
site, the periosteum-releasing incision was made to achieve a
no more than approx. 1/3 of the implant screw surface.
tension-free closure of the GBR site later, which then prevents
Complete coverage of the cover screw was avoided. Care
heavy bleeding at time of membrane placement (Fig. 7). After
was taken to ensure that only a thin membrane layer was
the placement of the bone level implant, a dehiscence-type
applied during the procedure (Figs. 8, 9).
alveolar bone defect of approximately. 4 mm was present.
The defect was augmented with bone graft substitute material
After application, the membrane set in situ by gelation
which was slightly rehydrated in physiological saline prior
within 90 seconds. No further fixation of the membrane was
to use. Overbuilding was avoided during the augmentation
necessary, as the gel adhered sufficiently to the surrounding
procedure. In order to optimize the attachment of Straumann
host bone.
®
MembraGel to the recipient site, the host bone and the
Fig. 10
Fig. 11
Fig. 12
Fig. 13
Fig. 14
Fig. 15
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Healing was attempted with the implant in a submerged
After an unproblematic initial healing period (Fig. 11), the
position
released
sutures were removed 10 days after the implantation operation.
mucoperiosteal flap. The wound was closed with interrupted
The subsequent healing period was also normal (Figs. 12, 13).
sutures made of a 7-0 PVDF monofilament material (Fig. 10).
The soft tissue healing abutment was installed 4.5 months
after
tension-free
closure
of
the
following the operation. The final restoration was completed
Postoperative treatment
6 weeks later (Fig. 14). The FPD was designed as a cemented
The patient was instructed to rinse four times daily with a
alloy-ceramic crown on a custom-made abutment.
prepared aqueous 0.12% chlorhexidine solution. No analgesics
were prescribed; the patient was informed that NSAIDs could
The post-op clinical and radiological evaluation at 47 weeks
be used if necessary. The patient was also instructed to refrain
exhibited stable bone and peri-implant soft tissue conditions
from mechanical plaque removal in the area of surgery until time
(Fig. 15) with a fully restored emergence profile, particularly in
of suture removal. She was provided with a small removable
the horizontal aspect (Figs. 16, 17).
prosthesis pre-operatively for esthetic purposes. Care was taken
to ensure the “dental flipper” did not apply any pressure to the
wound, and the patient was instructed to remove the flipper
while sleeping.
Fig. 16
Fig. 17
s t r a u m a N N r e g e N e r at i o N s o l u t i o N s
Jung, r.E., Hälg, G.A., thoma, D.S., Hämmerle, c.H.F. (2009) A randomized, controlled clinical trial to evaluate a new membrane
1
for guided bone regeneration around dental implants. clin. oral Impl. res. 20: 162–168.
2
Gottlow, J., Nyman, S., Karring, t., Lindhe, J. (1984) New attachment formation as the result of controlled tissue regeneration.
Journal of clinical Periodontology 11: 494–503.
3
Nyman, S.r., Lang, N.P. (1994) Guided tissue regeneration and dental implants. Periodontology 2000 4: 109–118.
Zitzmann, N.U., Naef, r., Schärer, P. (1997) resorbable versus nonresorbable membranes in combination with Bio-oss for guided
4
bone regeneration. International Journal of oral & Maxillofacial Implants 12: 844–852.
5
Hämmerle, c.H.F., Lang, N.P. (2001) Single stage surgery combining transmucosal implant placement with guided bone
regeneration and bioresorbable materials. clinical oral Implants research 12: 9–18.
6
Jung, r.E., Glauser, r., Schärer, P., Hämmerle, c.H.F., Weber, F.E. (2003) the effect of rhBMP-2 on guided bone regeneration in
humans. A randomized, controlled clinical and histomorphometric study. clinical oral Implants research 14: 556–568.
Moses, o., Pitaru, S., Artzi, Z., Nemcovsky, c.E. (2005) Healing of dehiscence-type defects in implants placed together with
7
different barrier membranes: a comparative clinical study. clinical oral Implants research 16: 210–219.
tietmann, c., Bröseler, F. (2009) ridge Augmentation using bovine-derived Xenograft prior to Implant Placement in the Esthetic
8
Zone. Journal of clinical Periodontology 36 (Suppl. 9), 217 #683.
9
Working, P.K., Newman, M.S., Johnson, J., cornacoff, J.B. (1997) Safety of poly(ethylene glycol) and poly(ethylene glycol)
derivatives. In: Zalipsky SJ, Harris JM, editors. Poly(ethylene glycol), chemistry and Biological Applications. Washington Dc:
American chemical Society: 45–57.
10
Mettler, L., Audebert, A., Lehmann-Willenbrock, E., Schive, K., Jacobs, V.r. (2003) Prospective clinical trial of SprayGel as a
barrier to adhesion formation: an interim analysis. Journal of the American Association of Gynecologic Laparoscopists 10:
339–344.
cosgrove, G.r., Delashaw, J.B., Grotenhuis, J.A., tew, J.M., Van Loveren, H., Spetzler, r.F., Payner, t., rosseau, G., Shaffrey,
11
M.E., Hopkins, L.N., Byrne, r., Norbash, A. (2007) Safety and efficacy of a novel polyethylene glycol hydrogel sealant for
watertight dural repair. Journal of Neurosurgery 106(1): 52-58.
12
Jung, r.E., Zwahlen, r., Weber, F.E., Molenberg, A., van Lenthe,
G.H. & Hämmerle, c.H.F. (2006) Evaluation of an in situ formed synthetic hydrogel as a biodegradable membrane for guided
bone regeneration. clinical oral Implants research 17: 426–433.
13
Wechsler, S., Fehr, D., Molenberg, A., raeber, G., Schense, J.c.,Weber, F.E. (2007) A novel, tissue occlusive poly(ethylene glycol)
hydrogel material. Journal of Biomedical Materials research 85A: 285–292.
14
Schwarz, F., Mihatovic, I., Golubovic, V., Hegewald A., Becker, J. (2011) Influence of two barrier membranes on staged guided
bone regeneration and osseointegration of titanium implants in dogs: part 1. Augmentation using bone graft substitutes and auto
genous bone. clinical oral Implants research
esearch Apr. 25: doi: 10.1111/j.1600-0501.2011.02187.x
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BriAN hUBer
Successful Use of Coronally Repositioned Flap with
a Subepithelial Connective Tissue Graft Using
Straumann Emdogain™
Gingival recession is a common finding among patients and can lead to esthetic
concerns, thermal sensitivity and/or root caries.
Among the most common
etiologies is mechanical trauma from aggressively brushing with force in
combination with a thin gingival biotype susceptible to recession. Occlusal
trauma and frenum pull are considered co-factors in the recession process.
Indications for root coverage include increased root sensitivity, root caries,
Dr. Brian Huber
abrasions, preprosthetic coverage and esthetic concerns of the patient.
Member of International Team For Implantology (ITI)
Champlain Periodontal
South Burlington and Middlebury, VT
Various grafting techniques have been developed to address this problem,
including the transplantation of autogenous tissue in combination with a
coronally advanced flap, pedicle flaps, guided tissue regeneration, and the
use of allograft materials.
The goal of root coverage procedures is to gain complete root coverage and
to restore the lost anatomic structures on the root surface. From a histological
perspective, this includes new cementum, periodontal ligament and alveolar
bone. The periodontal ligament is regenerated for a functional and esthetic
result.
Successful repair of the defect must fulfill the following criteria: root
coverage to the cementoenamel junction with a pocket depth no greater than
3 mm, absence of bleeding upon probing, adequate attached tissue and color
blending with surrounding tissues.
Advances in technology have significantly improved the predictability of root
coverage procedures. The use of enamel matrix derived proteins (EMD) in a
polyglycol alginate (PGA) carrier in conjunction with a coronally repositioned
flap1,2 or with an autogenous subepithelial connective tissue graft have been
shown to be an effective treatment modality with reduced morbidity for patients.
EMD with PGA, commercially available as Straumann ® Emdogain, has been
shown to promote regeneration of periodontal tissues on previously denuded
root surfaces1,2 and provide a more natural-looking result.1 The technique allows
clinicians to treat gingival recession with predictable results.3
Additionally,
a full arch of multiple recession lesions can be treated in one appointment.
s t r a u m a N N r e g e N e r at i o N s o l u t i o N s
The following case report demonstrates the successful use of a coronally repositioned flap
with a subepithelial connective tissue graft and EMD with PGA (Straumann ® Emdogain™).
Case Report
A 50-year-old male presented with generalized Miller class II and III recession (Fig 1). Clinical
exam found an 8 mm overjet and 7 mm overbite with class II occlusion and general crowding
throughout. In the maxilla, #6 & #11 were most advanced with 8 mm recession and no attached
tissue. Elsewhere in this arch, there were areas of 3-4 mm gingival recession. The mandible was
quite advanced as well, with #22, 24, 27, 28, 29 & 30 most advanced (Fig 2). There was 6-7 mm
of recession with a minimum of 1 mm, and no attached tissue on teeth # 22-30. Although connective
tissue grafting is more predictable with Miller class I and II recession, we wanted to improve the
quality of the gingival tissue and cover as much of the root structure as possible. The treatment plan
was presented and the patient understood that additional grafting may be necessary to achieve
optimal root coverage and tissue health.
Two separate surgeries were performed, dividing the mouth into maxillary and mandibular arches.
Local anesthetic was delivered and the sites were prepared with a split thickness flap. Intrasulcular
incisions were made utilizing a 15C blade on the buccal aspect.
Where possible interdental
papillae were left untouched. Horizontal incisions mesial and distal to the defect were performed
at the approximate level of the cementoenamel junction.
There was significant elevation and
periosteal release of the recipient site and the flap was raised to a level that allowed free coronal
displacement. The root surfaces were planed with a back-action hoe (periodontal chisel) and treated
with Straumann ® PrefGel™ to condition the roots. The graft was harvested from the corresponding
side of the palate in the premolar and first molar area using parallel incisions (Fig 3). EMD in a PGA
Fig. 1
Fig. 2
Fig. 3
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s t r a u m a N N r e g e N e r at i o N s o l u t i o N s
carrier (Straumann Emdogain) was applied to the site. The
The patient was followed for one month during the initial
goal of using this material was to promote attachment and
healing (Fig 6 and 8) and returned to the office at 8 months
improve patient comfort. Emdogain was applied to all the
(Fig 7) and two years later to check the long term outcome
exposed root and bone surfaces. The graft was secured to
(Fig 9). The patient healed without concern and slight, less
the recipient site using 5.0 chromic gut sutures (Fig 4) and
than 1 mm recession remains on #8 & #9.
surgical adhesive (Fig 5).
tissue has been reintroduced leaving the teeth supported
Connective
and protected.
The patient was prescribed a five day dose pack of
Medrol prior to the procedure and arnica montana was
Conclusion
recommended to prevent inflammation and post-surgical
By adding Straumann Emdogain to the subepithelial
swelling. A 0.12% chlorhexidine digluconate mouthrinse
connective tissue graft and coronally advanced flap
was utilized post-surgery in lieu of brushing the surgical site
procedure, a patient who presents with extensive full-
for 14 days. The patient was instructed to take 600 mg
arch gingival recession can be treated predictably
ibuprofen every six hours and supplement pain control with
while minimizing the number of appointments needed.
Tylenol 3 as needed.
Compared with previous treatment plans, this saves time
and cost for both the patient and the periodontal office. In
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
s t r a u m a N N r e g e N e r at i o N s o l u t i o N s
addition, Emdogain promotes the regeneration of the underlying support structures of the cementum,
periodontal ligament and alveolar bone, helping to achieve the ultimate goal of complete root
coverage and true regeneration.
Dr. Brian Huber received his dental degree from Northwestern University Dental School in Chicago,
IL, and completed a General Practice Residency at the Medical College of Ohio in Toledo. He
received his Certificate of Periodontics from the V.A. Medical Center simultaneously with his Master
of Science Degree from Marquette University Dental School in Milwaukee, WI. Currently he maintains
private periodontal practices in South Burlington, VT and Middlebury, VT. He is a member of many
professional organizations including the Academy of Osseointegration, the American Academy of
Periodontology, and is a member of the International Team for Implantology.
Special acknowledgement to Nicole Fortune for her help in drafting the article.
1
McGuire, MK & Nunn, M. Evaluation of human recession defects treated with coronally advanced flaps and either enamel matrix
derivative or connective tissue. Part 1: comparison of clinical parameters. J Periodontol 2003;74:1110-1125.
2
McGuire, MK & Nunn, M. Evaluation of human recession defects treated with coronally advanced flaps and either enamel matrix
derivative or connective tissue. Part 2: Histologic evaluation. J Periodontol 2003;74:1126-1135.
3
cairo, et al. treatment of gingival recession with coronally advanced flap procedures: a systematic review. J clin Periodontol.
2008;35(8):136-162.
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straumaNN® cares® guiDeD surgery
viNCeNzO MiriSOLA Di TOrreSANTO AND LUCA COrDArO
Surgical Implant Treatment
Planning For Complex Cases
Background
A 41-year-old woman with an edentulous maxilla and bilateral edentulous region
(kennedy Class I) in the mandible wanted removable restorations for both arches
(Figs. 1, 2).
Due to prosthetic constraints (reduced inter-arch distance and short upper lip
interfering with prosthetic flanges), a fixed implant-supported restoration was
Vincenzo Mirisola di Torresanto, DDS
suggested even though the edentulous maxilla and posterior mandible exhibited
Degree in Dentistry and Dental Prosthetics. Clinical
atrophy (Fig. 3).
researcher at the Department of Periodontology and
Prosthodontics at Eastman Dental Hospital in Rome, Italy.
Awarded the H.M. Goldman Prize by the Italian Society
Treatment plan
of Periodontology for his clinical research in 2007. Vari-
The following plan was developed to provide the most predictable surgical treatment
ous national and international publications and lectures.
possible for the patient.
ITI member and co-director of the ITI Study Club of Rome.
Private practice in Rome.
Maxilla: Conventional Procedure
Complex reconstruction with bilateral sinus lift and autogenous particulate bone
FiGS 4-12: MAxiLLA, CONveNTiONAL PrOCeDUre
Fig. 1
Fig. 2
Fig. 3
Fig. 4
straumaNN® cares® guiDeD surgery
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harvested from the chin and multiple bone block grafts harvested from the ramus;
four months after insertion of six implants and loading after an additional eight
weeks with an fixed dental prosthesis (FDP) (Figs. 4 – 12).
Mandible: Guided Surgery
The mandible exhibited severe horizontal and vertical atrophy in the lateral-posterior
region and the remaining frontal dentition (from canine to canine), which, even
if compromised, was considered maintainable after a periodontal non-surgical
Luca Cordaro, MD, DDS, PhD
phase. Bone-harvesting sites in the chin and retro-molar region had already been
Currently, Head of the Department of Periodontology
used for maxillary surgery.
and Prosthodontics at the Eastman Dental Hospital in
Italy. Private practice in Rome, Italy. Active member of
A guided surgical procedure was planned and proposed in order to offer the
the Italian Society of Osseointegration. Fellow of the ITI
and Chairman for the Italy chapter of the ITI, Chairman
patient the possibility for a less invasive surgical procedure. By visualizing the
of the Study Club Committee and member of the Board
available bone in 3D, guided surgery shows the potential for insertion of smaller
of Directors. Author and co-author of scientific papers
implants without requiring additional bone augmentation.
and literature, international lecturer. Dr. Cordaro’s professional interests are periodontology, implantology
and oral surgery, with a special focus on reconstructive
treatments for alveolar atrophies.
Fig. 5
Fig. 6
Fig. 7
Fig. 8
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straumaNN® cares® guiDeD surgery
Fabrication of templates and computer-assisted planning
The scan template was fabricated at the laboratory following the patient’s
master model and the guidelines of the Straumann® Guided Surgery System.
The initial template was fabricated with a suck-down technique and then filled
with radiopaque material. Next, the templiX™ reference plate with reference
pins was attached to the suck-down template and mounted on the gonyX™.
The completed scan appliance was worn by the patient and a CT scan was
performed. After the CT scan, the DICOM data was processed with the
coDiagnostiX™ software. The virtual planning strategy was to bypass the
anatomical structures and make use of all available bone by using a predictable
procedure that remained simple and affordable for the patient. The proposed
restoration was designed as a three-unit (18-21, 28 and 30), bilateral implantsupported FDP (Figs. 13, 14).
gonyX™: Device for surgical template fabrication
The decision was made to insert two implants on each side in the first premolar and
first molar positions. The 3D bone scan showed a reduced height and width in the
molar sites and reduced width in the premolar sites (Fig. 15).
Fig. 9
Fig. 10
Fig. 11
Fig. 12
straumaNN® cares® guiDeD surgery
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All implants were planned so as to maintain a distance of at least 2 mm from the alveolar nerve. Insertion of a Straumann®
Tissue Level Implant RN Ø3.3 mm SLActive ® 10 mm was planned for both premolar sites. However, despite the selection of
a reduced diameter implant, the virtual model of the inserted implant at 21 showed a marginal dehiscence (Fig. 16). For the
distal implants, a Straumann® Tissue Level Implant RN Ø4.1 mm SLActive ® 6 mm was planned for each side. Again, the virtual
model of the implant inserted on the patient’s right side showed a minor marginal dehiscence (Fig. 17).
The planning for the axial inclination of the implant was anatomically driven rather than prosthetically driven.
Using the abutment selection feature in coDiagnostiX™, it was determined that a 20° angulated abutment for the distal implants
would make it possible to achieve the required parallelism with the mesial implants.
Because of the dehiscences of the implants planned for 19 and 21, a traditional open flap procedure was chosen for the right
side, while a flapless approach was taken for the left side. Two Ø2.8 mm sleeves were inserted in the right side of the surgical
template; two Ø5.0 mm sleeves were inserted in the left side to prepare for the complete preparation of the site and for the
guided insertion of the implant (Fig. 18).
FiGS 13-30: GUiDeD SUrGery
Fig. 13
Fig. 14
Fig. 15
Fig. 16
Fig. 17
Fig. 18
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straumaNN® cares® guiDeD surgery
Surgical procedure
as required (Fig. 24). Implant site 19 was prepared with a
Bilateral local anesthesia was administered. The surgical
Ø3.5 mm drill, drilling freehand to a depth of 6 mm. Both
template was placed and carefully checked to ensure
right-side implants were inserted with the handpiece set with
stability before beginning the procedure. The mucotomy on
a torque of 35 Ncm and tightened manually. Similar to the
the left side was performed by inserting a Ø4.3 mm round
dehiscences seen in the virtual models of the implants, a
mucosa punch through the sleeves (Fig. 19).
vestibular dehiscence occurred in the case of both right side
implants: a GBR procedure with a bone substitute and a
Implant sites 28 and 30 were prepared using the drill
resorbable collagen membrane was performed around each
sequence generated by the coDiagnostiX software
implant (Figs. 25, 26). The flap was opened, repositioned
(Figs. 20 – 22). The implants were inserted with thehandpiece
and sutured around the healing abutment.
set with a force of 35 Ncm and tightened manually after
the template was removed. On the right side, a muco-
Prosthetic restoration
periostal flap with horizontal incision at the top of the ridge
The implants were observed two months after surgery and
and a distal vertical incision were made (Fig. 23). Both sites
showed stability accompanied by no inflammation or pain.
were drilled with a Ø2.8 mm drill (short for 19 and long
In addition, the radiographic evaluation showed successful
for 21) through the Ø2.8 mm sleeve, without a drill handle
healing of the bone without radiolucencies. A standard
Fig. 19
Fig. 20
Fig. 21
Fig. 22
Fig. 23
Fig. 24
straumaNN® cares® guiDeD surgery
prosthetic protocol was followed.
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To achieve the precise results, Straumann® Guided Implant
insertion is recommended. This case was treated with
Two cemented FDPs were planned: solid abutments for
Straumann® Soft Tissue Level Implants, according to the
both mesial implants and 20° B angulated abutments
routine protocol for lateral-posterior rehabilitations.
were selected based on the virtual models (Fig. 27). Two
porcelain-fused-to-metal triplicate FDPs were fabricated (28,
Combined with the ability to perform predictable flapless
29, 30 and 19, 20, 21) and fixed in place with temporary
procedures, one interesting application for the Straumann®
cement (Figs. 28, 29).
Guided Surgery System is the potential to bypass
anatomical structures. In carefully selected cases and in the
Conclusion
hands of experienced clinicians, visualization of the bone
In this case, the virtual planning models and the actual
morphology with the use of 3D treatment planning software
outcome (Fig. 30) demonstrated that the Straumann Guided
may reduce or eliminate the need for bone augmentation
Surgery System provides a high level of precision for the
and the associated treatment complications.
®
purposes of implant positioning.
Fig. 25
Fig. 26
Fig. 27
Fig. 28
Fig. 29
Fig. 30
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s t r a u m a N N ® c a r e s ® D i g i ta l s o l u t i o N s
Straumann ® CARES ® Scan & Shape Ser vice
The Choice is Yours
Dental laboratories now have an investment-free method to obtain genuine Straumann CARES
Customized Abutments. For dental labs not ready to invest in a CS2 scanner, Straumann CARES Scan &
Shape provides genuine Straumann CARES Customized Abutments directly from a model or wax-up abutment. This allows laboratories to expand their product portfolio by offering customers original Straumann
implant-abutment connections and The Straumann Guarantee ® for customized abutments.
Why Original Connections are Important
Offering genuine components to your referrals instead of look-alike components may be of great importance when it comes to long-term stability and the successful outcome of the restoration. Original
Straumann implant-abutment connections are designed to:
Provide optimal load distribution to reduce peak stresses
Minimize the infiltration of bacteria and contamination in microgaps
Provide optimal mechanical performance and long-term stability of the restoration
Provide ease of handling of the abutment and screw during the assembly process
s t r a u m a N N ® c a r e s ® D i g i ta l s o l u t i o N s
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Four Simple Steps to Straumann CARES Customized Abutments
The laboratory receives an Rx from the clinician for a customized abutment, and submits a master model or wax-up abutment
to Straumann, where our experienced CDTs digitally model the CAD abutment based on the technician’s design specification.
PROCESS OVERVIEW
FROM MODELS
PROCESS OVERVIEW
FROM WAX-UP ABUTMENTS
1. Customer
1. Customer
Call our Straumann technical support team at
Call our Straumann technical support team at
866/531 7365 to request an order form and to arrange
866/531 7365 for the order form and to arrange the
the pick-up service.
pick-up service.
2. Order
2. Order
Pack all items to be sent and the order form into the
Pack your wax-up abutment and order form into the box
shipping box provided. The package will be picked up by
provided. The package will be picked up by a courier.
a courier. y
you will be given a tracking number.
you will be given a tracking number.
y
3. Straumann
3. Straumann
your abutment is scanned and digitally modeled based on
y
The wax-up abutment is scanned. y
your abutment is
your requirements. After your approval, your abutment is
manufactured.
manufactured.
4. Delivery
4. Delivery
The abutment and the model are delivered to you for
The abutment is delivered to you for fabrication of the
fabrication of the final restoration.
final restoration.
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STRAUMANN® CARES® GUidEd SURGERy
Service and Support
When you choose Straumann, you enjoy the security and reliability of The Straumann Guarantee ® for
customized abutment restorations: a limited warranty* for 5 years on ceramic abutments, 10 years for
metal abutments. Our trained technical support team of CDTs is available to answer your questions at
any time.
What Customers Are Saying
Meeting customer needs is our priority. After receiving their first cases back from Straumann CARES
Scan & Shape, customers were raving about the quality and reliability of the service and product.
"I have the Atlantis experience to compare Scan & Shape to and it is as easy. The process
is easy and all the information great. The finished product is phenomenal, high quality.
The service is optimal. The communication between Straumann and our lab is great. They
are very easy to work with." Trudy Hornbacher, Lab Manager, Distinctive Dental Studio, IL
Don’t Delay – Try Your First Case Today!
It’s easy to get started – just call our Technical Support Team at 866/531 7365, Prompt #6 and you’ll
be on your way to genuine Straumann CARES Customized Abutments.
*Terms and conditions apply
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straumann ® Cares ®
sCan & sHaPe
A simple way to ORIGINAL Straumann® CARES® Customized Abutments for dental laboratories
On-demand CAD abutment service to help improve profitability
No capital investment required
Simplicity and high-quality products
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i N t e r N at i o N a l t e a m F o r i m p l a N t o l o g y
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ITI Congress Preview
Continuing education at the highest scientific level
The fellows and members of the North American Sections of the International Team for Implantology invite you to
attend the 2013 NA ITI Congress, taking place April 4 – 6, 2013 in Chicago, Illinois. The theme for the Congress is
“Connectivity in Implant Dentistry: Putting the Pieces Together.” This theme embraces the ideals of the ITI – the dissemination of clinically relevant, scientifically sound information in an environment of collaboration and cooperation.
Program Highlights
Pre-Congress - Straumann Practice Management Business Forum: Thursday, April 4, 2013 – www.straumann.us/iti
ITI Congress - “Connectivity in Implant Dentistry: Putting the Pieces Together”
Featured Topics
•
Surgical Track
•
Complications Track
•
Dental Implant Solutions
•
Restorative Track
•
Technology Pods
•
CAD/CAM
Poster Presentation
Implant-related poster presentations submitted by registered attendees are exhibited and judged by the ITI Scientific
Program Committee. The winner will receive free entry to the ITI World Symposium 2014 in Geneva, Switzerland!
Smile You’re Sense-Sational!
Charity event benefitting the National Foundation for Ectodermal Dysplasias
Technology Hall
Rotating sessions through “Tech Pod” stations,
Regional Leadership
exploring the latest advances in dentistry.
Dean Morton, ITI Section Chairman (USA)
Keynote Speakers
Urs Belser, University of Geneva (Switzerland)
Daniel Buser, University of Bern (Switzerland)
David Cochran, University of Texas (USA)
Frank Higginbottom, ITI Education Delegate (USA)
Tim Head, ITI Section Chairman (Canada)
Robert Carmichael, ITI Education Delegate (Canada)
Venue
Jocelyne Feine, McGill University (Canada)
Chicago Marriott Downtown Hotel, Chicago IL
Hans-Peter Weber, Tufts University (USA)
Register and learn more at
http://www.iti.org/congressnorthamerica/
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s i m p ly D o i N g m o r e
A “hiSTOriC“ PrOGrAM
Dental Implant Complications Symposium Review
On Friday, March 23, 2012, over 400 dental professionals
encountered in the modern dental practice. Topics covered
joined Straumann and the Center for Advanced Implant
included Medical-Legal Concerns, Treatment Planning, Peri-
Training for the Dental Implant Complications Symposium:
implantitis, Prosthetic Complications, Surgical Handling
Etiology, Prevention and Treatment program in New york
of Esthetic Implant Failure Complications, Soft Tissue
City. The event, in support of Dr. Stuart Froum’s book of
Complications, and Sinus Complications.
the same name, was held at the recently renovated New
york Historical Society and featured nine of the top key
Due to the popular subject and excellent speaker line up,
Opinion Leaders in the dental industry; Professor Daniel
the program sold out more than two months in advance of
Buser; Dr. Stuart Froum; Dr. Paul Rosen; Dr. William Martin;
the event date, and raised interest for next year’s program
Dr. Ron Nevins; Dr. kirk Pasquinelli; Dr. Stephen Wallace;
taking place in San Francisco on May 17, 2013.
Dr. Edwin Zinman; and Dr. Ray Williams.
The event was enjoyed by all who attended and people
The one-day symposium provided a forum for these highly
are already waiting in anticipation for 2013 when this
renowned speakers to deliver informative and entertaining
highly regarded symposium returns.
presentations on common dental implant complications
MArK yOUr CALeNDArS
Dental Implant Complications Symposium 2013
Friday, May 17, 2013
San Francisco, CA
Learn from thought leaders on the latest innovations to
help you understand, treat, and prevent dental implant
complications in your own practice.
Speakers
Sang Choon Cho
kirk Pasquinelli
Stuart Froum
Paul Rosen
Dean Morton
Ray Williams
Information straumann.cvent.com/DIC2013
DID YOU kNOW?
roxolid® implants deliver more treatment options
Roxolid is designed for treatment of narrow interdental spaces.
#6 roxolid implant with
conical healing abutment
one-week post op
www.straumann.us
800/448 8168
Case courtesy of Dr. Mariano Polack and Dr. Joseph Arzadon
Case courtesy of Dr. Mariano Polack and Dr. Joseph Arzadon, Gainesville, VA
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New DiGiTAL PATieNT eDUCATiON TOOLS
S t raum ann P atient Educ a t ion A p p
With new digital patient education tools, Straumann aims to help customers improve patient education and communication, increase treatment acceptance, and reach new generations of dental
professionals and patients.
Straumann Patient Education App for iPad ®
Exclusively for Straumann customers, the Straumann Patient Education App offers a no-cost, interactive and
convenient platform to deliver patient education. This new app helps dental professionals demonstrate
the benefits of dental implant treatment, describe treatment options and procedures, and customize the
learning experience for each patient.
The Straumann Patient Education App is easy to navigate and includes animated treatment videos,
implant illustrations, FAQs, and an interactive treatment timeline. Additional features include a “draw”
function to describe unique situations and detail patient treatments, “print” and “email” sharing options,
and an “archive” for customized presentations.
Access
The full version of the Straumann Patient Education App is free for Straumann customers via the App
Store – search “Straumann” to find our apps. Once installed on your iPad ® and opened for the first
time, enter a Straumann customer number to ‘unlock’ the full content (this can be done on multiple iPads
if available to your practice).
As more and more dental professionals integrate the iPad into their offices, we are excited that the
Straumann Patient Education App lets our customers also leverage the iPad for patient education –
download it today!
Note: Please email patients@straumann.com for
technical support. currently, the Straumann Patient
Education App is available for iPad ® only.
s i m p ly D o i N g m o r e
UNLOCKiNG The iPAD
To ‘unlock’ the content, tap the padlock icon and enter your Straumann customer number. If you
cannot locate your customer number, contact Customer Service at 800/448 8168 or your local
Straumann representative.
Main dashboard
Treatment videos
Custom presentations
Draw function
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New DiGiTAL PATieNT eDUCATiON TOOLS
S t raum ann P atient Anima t ion Vid eos
Entertain and educate patients in your waiting rooms with our new patient animation DVD “Solutions
for a Healthy Smile.” The DVD’s animated videos highlight the benefits of Straumann Dental Implants,
Emdogain and CADCAM-based restorations, with patient-friendly images and easy-to-understand
information.
The DVD contains four main videos:
Film 1: Quality of life with dental implants
Film 2: Straumann Emdogain – Designed to treat and reverse gum disease and recession.
Film 3: CADCAM restorations – Beautiful smiles aided by state-of-the-art technology
Film 4: About Straumann – The #1 dental implant company worldwide
The DVD directory allows the entire video to be played in seamless playback, or just one of the
animations can be selected. Preview the videos by visiting the “image and video gallery” in our online
resource center at www.straumann.us, or order them directly through Straumann Customer Service at
800/448 8168 using article number USADV 039.
solutions for a HealtHy smile
PATIENT ANIMATION VIDEOS
PATIENT ANIMATION VIDEOS
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s i m p ly D o i N g m o r e
LiTerATUre ALerTS
S e l e ct ed literatu re of pot en t ia l in t er es t
fr o m recently published jour n a ls
weeks). Marginal bone loss was significantly lower at loa-
STRAUMANN ® SLACTIVE ®
ding for the SLActive implants (0.18 ± 0.05 mm versus 0.22
± 0.06 mm) and the RFA values were significantly higher for
Heberer S, kilic S, Hossamo J, Raguse J-D, Nelson k.
SLActive implants at loading than any other time point for
Rehabilitation of irradiated patients with modified and
both implant types. The SLActive implants therefore showed
conventional sandblasted acid-etched implants: prelimi-
greater stability and less bone loss at loading.
nary results of a split-mouth study. Clin Oral Impl Res.
2011;22(5):546-551.
Mamalis AA, Silvestros SS. Analysis of osteoblastic gene
A total of 20 patients received Straumann dental implants
expression in the early human mesenchymal stem cell re-
after ablative surgery and radio-chemotherapy for oral
sponse to a chemically modified implant surface: an in
cancer; 50 SLA and 52 SLActive implants were placed in a
vitro study. Clin Oral Impl Res. 2011;22(5):530-537.
split-mouth design with unloaded healing of 6 weeks in the
Cell attachment and proliferation of human mesenchymal
mandible (23 SLA, 24 SLActive) and 10 weeks in the maxilla
stem cells grown on titanium dics with smooth, SLA, or SLAc-
(27 SLA, 28 SLActive). Mean mesial and distal bone loss
tive surfaces were assessed after 3 and 24 h, and DNA
was 0.4 mm and 0.4 mm, respectively, for SLA implants and
gene expression was evaluated after 24 h. Cell attachment
0.3 mm and 0.3 mm, respectively, for SLActive implants. The
and proliferation were initially significantly reduced. Signifi-
implant success rates after an average observation period of
cant upregulation of 19 genes with the SLA surface and 27
14.4 months were 96% for SLA and 100% for SLActive. Both
genes with the SLActive surface were observed. These ge-
SLA and SLActive implants therefore showed high success in
nes controlled differentiation, signal transduction, cell cycle
irradiated patients.
regulation, angiogenesis, cell adhesion and the formation
®
of extracellular matrix and bone. Early osteoblastic differenkarabuda ZC, Abdel-Haq J, Arısan V. Stability, marginal
tiation genes were upregulated with SLActive, indicating a
bone loss and survival of standard and modified sand-
microenvironment that may enhance osseointegration.
blasted, acid-etched implants in bilateral edentulous
spaces: a prospective 15-month evaluation. Clin Oral Impl
Bayounis AMA, Alzoman HA, Jansen JA, Babay N. Healing
Res. 2011;22(8):840-849.
of peri-implant tissues after flapless and flapped implant
A total of 96 SLA and SLActive implants were placed in 22
installation. J Clin Periodontol. 2011;38(8):754-761.
patients, and implant stability by RFA was measured at surge-
A total of 30 Straumann SLActive implants were placed in 10
ry and after 1, 3 and 6 weeks. Panoramic x-rays were taken
dogs using three different surgical approaches; flapped, tis-
and implant stability measured at loading and the implants
sue punch flapless, or direct flapless. After 3 months, similar
were followed for 1 year. Implant survival was 100% for SLA
bone volumes and crestal bone levels were observed in all
and 97.91% for SLActive implants (one implant lost after 3
three groups, but first bone contact and percentage BIC were
s i m p ly D o i N g m o r e
STARGET 1 I 13
significantly lower with the punch flapless technique, and the
in the mandibles of nine dogs and subjected to submerged
barrier epithelium was significantly deeper around implants
healing. Radiographs were taken at placement and after
placed using this technique. The results indicated that implant
2, 4 and 8 weeks, and histologic and histomorphometric
placement can be performed using a flapless technique, but
measurements were performed. The mean bone change after
that a tissue punch wider than the implant diameter may ne-
8 weeks was a gain of 0.02 ± 0.33 mm and a loss of 0.09
gatively affect implant outcomes.
± 0.33 mm for Ti and TiZr implants, respectively, and the
mean first BIC was -0.06 ± 0.22 mm and 0.08 ± 0.30 mm
Marković A, ćolić S, Dražić R, Gaćić B, Todorović A, Stajćić Z.
at two weeks, respectively. Peak BIC was 83.4 + 5.9% at
Resonance frequency analysis as a reliable criterion for
4 weeks for Ti and 86.9 +6.8 % at 8 weeks for TiZr. No
early loading of sandblasted/acid-etched active surface
significant differences were found between the two groups at
implants placed by the osteotome sinus floor elevation tech-
any time point, indicating similar osseointegration between
nique. Int J Oral Maxillofac Implants. 2011;26(4):718-724.
the two implants.
Straumann Standard Plus SLActive implants were placed in
the posterior maxilla of 27 patients using the osteotome sinus
floor elevation technique. RFA was measured at surgery and
every week for 6 weeks, after which only implants with an
RFA value of ≥ 65 were loaded. Of 42 implants placed,
40 were loaded after 6 weeks (early loading), all of which
survived for up to 2 years with no clinical or radiographic
complications. Early loading is therefore suitable for SLActive
implants placed via the osteotome sinus floor elevation technique if adequate stability is confirmed.
STRAUMANN ® DENTAL IMPLANT SYSTEM
Thoma DS, Jones AA, Dard M, Grize L, Obrecht M, Cochran
DL. Tissue integration of a new titanium-zirconium dental
implant: a comparative histologic and radiographic study
in the canine. J Periodontol 2011;82(10):1453-1461.
Straumann Bone Level implants of either Ti or TiZr (Roxolid ®) (six
of each, both with the SLActive surface) were randomly placed
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s i m p ly D o i N g m o r e
STrAUMANN hiSTOry AND heriTAGe
Hist o r y of Straumann Exh ib it O p en s in A n d ov er
From a lasting influence in the renowned Swiss watch industry to a major role in the discovery of
osseointegration and understanding of human bone structure, to becoming a worldwide leading
dental solutions partner, Straumann has a strong history of innovation and quality. Our new “History
of Straumann” exhibit in our Andover, Massachusetts North American Headquarters celebrates this
heritage and tells the story of how Straumann became a leading dental implant company.
The “History of “Straumann” exhibit officially opened in November 2012 to a group of Straumann
customers and team members visiting our Andover facility. The exhibit self-guides Andover visitors through
the founding of Institute Straumann over 50 years ago, our pioneering innovations that revolutionized the
field of dental implants, and the development of our current-day solutions.
We invite you to visit our Andover facility not only to see this piece commemorating our history, but
also to take a guided tour of our state-of-the-art manufacturing facility and education center. Visitors
to Andover experience first-hand how Straumann quality, precision, and reliability that you trust in your
patient treatments are manufactured into every Straumann product.
s i m p ly D o i N g m o r e
STARGET 1 I 13
If you can’t make it to Andover, take a visual tour through the “History of Straumann” exhibit below.
Andy Molnar, Straumann North American Executive Vice President, officially opens the exhibit to a
group of PLATINUM customers and Straumann employees.
1954: Dr. Reinhard Straumann founds the Dr. Ing.
R. Straumann Research Institute AG, specializing
in materials testing and alloys for timing instruinstru
ments.
1930’s-1970’s: While recovering from a skijumping-related fracture, Dr. R. Straumann is the
first to recognize that the cortex of human bone
has a partly crystalline structure.
1974: Working with Dr. André Schroeder, StrauStrau
mann presents its first dental implants, including
the world’s first one-stage implant.
1989: The first US subsidiary is established.
1990: Dr. Thomas Straumann turns the company’s
focus to dental implants – marking the beginning
of Straumann as it is known today.
2003: Straumann acquires BIORA AB, and enters
the field of tissue regeneration through the launch
of Straumann Emdogain™.
2005: Straumann’s North American headquarters
in Andover, Massachusetts officially opens, boastboast
ing Straumann’s first implant manufacturing site
outside Switzerland.
2006: Straumann SLActive promotes faster osseoosseointegration and leads to earlier secondary stability
than the original SLA surface.
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s i m p ly D o i N g m o r e
2007: The Straumann Bone Level Implant with the
CrossFit® connection is launched.
2007: The acquisition of etkon AG enters Straumann into the crown & bridge industry and marks
our entry in the digital dentistry realm.
2010: Straumann CARES Digital Solutions simplisimpli
fies workflows and connects dental professionals
across disciplines.
Tomorrow: Vision 2020.
2009: Straumann introduces the Roxolid®
material, the first alloy of titanium and zirconium
designed specifically for dental implants.
s i m p ly D o i N g m o r e
June 17–21, 2013
ITI Education Week Boston
Comprehensive Implant Dentistry:
From Treatment Plan To Clinical
Implementation
THe ITI UnIVerSITY Program
The ITI – International Team for Implantology – is an independent academic
organization dedicated to advancing knowledge in the field of implant dentistry
and bringing this knowledge to a growing audience. The ITI’s educational
message and philosophy center on evidence-based treatment approaches that
predictably produce successful outcomes.
Introduced in 2009 as a new venture in ITI education, the ITI University Program
aims to enhance implant education worldwide by offering coordinated, high
quality continuing education courses in implant dentistry around the globe. The
premise behind the program is that continuing education in implant dentistry
and related fields is best delivered independently of commercial interests for
reasons of overall quality and credibility.
To find out more, go to www.iti.org/educationweek.
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STrAUMANN NOrTh AMeriCA eDUCATiON COUrSeS
Upco m ing 2 0 1 3 Edu cat ion Ev en t s
For more information on the programs in the US contact the
April 4-5, 2013
Straumann US Education Department at 978/747 2553
Maxi-Course
or education.us@straumann.com or visit us on the website:
loma linda university
www.straumann.us and click on the courses tab.
Loma Linda, CA
Speakers: Dr. Jaime Lozada, DMD, Dr. Mathew Kattadiyil, et al.
March 1-2, 2013
Register: http://www.llu.edu/dentistry/cde/maxicourses.page
The Art Science and Business of Clinical Implant Practice
institute for comprehensive implant therapy
April 4, 2013
Santa Monica, CA
Straumann Pre-Congress Practice Management Forum:
Speakers: Dr. Paul Fugazzotto, Dr. Kanyon Keeney, Dr. Bob Vogel
MONEY! How to Make it, How to keep it, How to Grow it
Register: www.theicit.com
Deborah Odell, MBA,
March 7-10, 2013
Clarity, Consistency and Congruency: How to Effectively
Comprehensive Implant Training Program in Implant
Convey them to Your Team
Dentistry
iti congress North america
georgia health sciences university/ aaiD
Chicago, IL
Atlanta, GA
Speaker: Sandy r. roth, Ph,D.
Speakers: Dr. Edward Mills, Dr. roman cibirka, et al.
Register: http://georgiamaxicourse.com/index.html
April 4-6, 2013
iti congress North america
March 14-15, 2013
Connectivity in Implant Dentistry: Putting the Pieces
Maxi-Course
Together
loma linda university
Chicago, IL
Loma Linda, CA
Speakers: Urs Belser, Daniel Buser, David cochran, Jocelyne
Speakers: Dr. Jaime Lozada, DMD, Dr. Mathew Kattadiyil, et al.
Feine, Hans-Peter Weber
Register: http://www.llu.edu/dentistry/cde/maxicourses.page
Register: www.iti.org/congressnorthamerica
March 22-23, 2013
April 11-13, 2013
The Art Science and Business of Clinical Implant Practice
Soft Tissue Grafting Around Teeth and Implants
institute for comprehensive implant therapy
institute for comprehensive implant therapy
Houston, TX
Milton, MA
Speakers: Dr. Paul Fugazzotto, Dr. Kanyon Keeney, Dr. Bob Vogel
Speakers: Dr. Paul Fugazzotto, Dr. Kanyon Keeney, Dr. Bob Vogel
Register: www.theicit.com
Register: www.theicit.com
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April 18-21, 2013
May 17, 2013
Comprehensive Implant Training Program in Implant
Dental Implant Complications Symposium:
Dentistry
Providing Solutions for Your Practice
georgia health sciences university/ aaiD
San Francisco, CA
Atlanta, GA
Speakers: Dr. Sang-choon cho, Dr. Dean Morton,
Speakers: Dr. Edward Mills, Dr. roman cibirka, et al.
Dr. ray Williams, Dr. Stuart Froum, Dr. Kirk Pasquinelli,
Register: http://georgiamaxicourse.com/index.html
Dr. ronald Jung, Dr. Paul rosen
Register: http://straumann.cvent.com/DIC2013
May 2-5, 2013
Comprehensive Implant Training Program in Implant
May 17-18
Dentistry
Digital Implant Dentistry
georgia health sciences university/ aaiD
2013 tufts university
Atlanta, GA
Boston, MA
Speakers: Dr. Edward Mills, Dr. roman cibirka, et al.
Speakers: Dr. H.P Weber, German Gallucci
Register: http://georgiamaxicourse.com/index.html
Straumann customers receive a 20% discount - contact
brian.piper@straumann.com for details
May 9-11, 2013
June 6-7, 2013
Maxi-Course
Maxi-Course
loma linda university
loma linda university
Loma Linda, CA
Loma Linda, CA
Speakers: Dr. Jaime Lozada, Dr. Mathew Kattadiyil, et al.
Speakers: Dr. Jaime Lozada, Dr. Mathew Kattadiyil, et al.
Register: http://www.llu.edu/dentistry/cde/maxicourses.page
Register: http://www.llu.edu/dentistry/cde/maxicourses.page
May 11, 2013
June 6-9, 2013
Implant Surgical Placement & Tissue Grafting Workshop:
Comprehensive Implant Training Program in Implant
A Hands-on Cadaver Course
Dentistry
Baylor university
georgia health sciences university/ aaiD
Dallas, TX
Atlanta, GA
Speakers: Dr. James D. ruskin, Dr. thomas G. Wilson
Speakers: Dr. Edward Mills, Dr. roman cibirka, et al.
Register: http://tissue-grafting.eventbrite.com
Register: http://georgiamaxicourse.com/index.html
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s i m p ly D o i N g m o r e
June 17-21, 2013
August 8-9, 2013
Comprehensive Implant Dentistry: From Treatment Plan
Maxi-Course
to Clinical Implementation
loma linda university
iti education week
Loma Linda, CA
Boston, MA
Speakers: Dr. Jaime Lozada, Dr. Mathew Kattadiyil, et al.
Speakers: German o. Gallucci, D.M.D.
Register: http://www.llu.edu/dentistry/cde/maxicourses.page
Hans-Peter Weber, D.M.D.
August 15-18, 2013
June 28-29, 2013
Comprehensive Implant Training Program in Implant
Digital Implant Dentistry: Imaging, Planning, Placement
Dentistry
and Restorations
georgia health sciences university/ aaiD
university of Florida
Atlanta, GA
Gainesville, FL
Speakers: Dr. Edward Mills, Dr. roman cibirka, et al.
Speakers: Dr. William Martin, Dr. James ruskin
Register: http://georgiamaxicourse.com/index.html
Straumann customers receive a 20% discount - contact
brian.piper@straumann.com for details
July 11-12, 2013
Maxi-Course
loma linda university
Loma Linda, CA
Speakers: Dr. Jaime Lozada, DMD, Dr. Mathew Kattadiyil, et al.
Register: http://www.llu.edu/dentistry/cde/maxicourses.page
July 18-21, 2013
Comprehensive Implant Training Program in Implant
Dentistry
georgia health sciences university/ aaiD
Atlanta, GA
Speakers: Dr. Edward Mills, Dr. roman cibirka,
ibirka, et al.
Register: http://georgiamaxicourse.com/index.html
s i m p ly D o i N g m o r e
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APPeNDix
Ind ica t ions/Contraindi c a t ion s /Wa r n in g s
These indications and contraindications pertain to the subject matter included in this 1 | 2013 edition of STARGET.
NARROW NECk CROSSFIT (NNC) Ø3.3 MM DENTAL IMPLANT SYSTEM
Indications for Use:
Straumann® dental implants are suitable for the treatment of oral endosteal implantation in the upper and lower jaw and for
the functional and esthetic oral rehabilitation of edentulous and partially dentate patients (unless specific indications and
limitations are present, as stated below). Straumann ® dental implants can also be used for immediate or early implantation
following extraction or loss of natural teeth. Implants can be placed with immediate function on single-tooth and/or multiple
tooth applications when good primary stability is achieved and with appropriate occlusal loading, to restore chewing
function. The prosthetic restorations used are single crowns, bridges and partial or full dentures, which are connected to the
implants by the corresponding elements (abutments). When placing implants in the posterior region, we recommend using only
large diameter implants. In cases of fully edentulous patients, 4 or more implants must be used in immediately loaded cases.
Specific indications for small diameter (Ø3.3 mm) implants:
Because of their reduced mechanical stability, small diameter implants are only used in cases with a low mechanical load.
Placement in the molar region is not recommended.
NNC IMPLANTS
Indications
Straumann® dental implants are suitable for the treatment of oral endosteal implantation in the upper and lower jaw and for
the functional and esthetic oral rehabilitation of edentulous and partially dentate patients. Straumann ® dental implants can
also be used for immediate or early implantation following extraction or loss of natural teeth. As a rule of thumb, always use
the largest possible implant diameter.
The prosthetic restorations used are single crowns, bridges and partial or full dentures, which are connected to the implants
through the corresponding components (abutments).
For details about the necessary bone volume, spacing between implants and distance from adjacent teeth, see the “Basic
Information” brochures as mentioned in the section “Further Information."
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STARGET 1 I 13
Specific Indications
Small Diameter Implants
Because of their reduced mechanical stability, small diameter implants (Ø3.3 mm) are only used in cases with a low
mechanical load. Ø3.3 mm implants are not recommended for molar region.
contraindications
Serious internal medical problems, bone metabolism disturbances, uncontrolled bleeding disorders, inadequate wound
healing capacity, not completed maxillary and mandibular growth, poor general state of health, uncooperative, unmotivated
patient, drug or alcohol abuse, psychoses, prolonged therapy-resistant functional disorders, xerostomia, weakened immune
system, illnesses requiring periodic use of steroids, uncontrollable endocrine disorders. Allergies or hypersensitivity to chemical
ingredients of materials used: titanium zirconium alloy
relative contraindications
Previously irradiated bone in head or neck area, diabetes mellitus, anticoagulation drugs/hemorrhagic diatheses, bruxism,
parafunctional habits, unfavorable anatomic bone conditions, tobacco abuse, untreated periodontal diseases, acute infection
of implant site, temporomandibular joint disorders, treatable pathologic diseases of the jaw and changes in the oral mucosa,
pregnancy, inadequate oral hygiene
Local contraindications
Inadequate bone volume and/or quality, local root remnants
STRAUMANN NARROW NECk CROSSFIT (NNC) GOLD ABUTMENT FOR CROWNS
Indications for Use:
Abutments are intended to be placed into dental implants to provide support for prosthetic reconstructions such as crowns,
bridges and overdentures.
contraindications
Allergies to materials used, which may include any or all of the following: Au, Pt, Pd, Ag, Cu, Zn, In, Ir.
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STARGET 1 I 13
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STRAUMANN NARROW NECk CROSSFIT (NNC) GOLD ABUTMENT FOR BRIDGES
Indications for Use:
Abutments are used in connection with the prosthetic restoration of Straumann dental implants. Abutments are intended to
be placed into dental implants to provide support for prosthetic reconstructions such as crowns, bridges and overdentures.
contraindications
Allergies to materials used, which may include any or all of the following: Gold (Au), Platinum (Pt), Palladium (Pd), Silver (Ag),
Copper (Cu), Zinc (Zn), Indium (In), Iridum (Ir).
STRAUMANN NARROW NECk CROSSFIT (NNC) TEMPORARY ABUTMENTS
Indications for Use:
The Straumann NNC Temporary Abutments are indicated for use in Straumann NNC Tissue Level Implants for temporary
restorations of single crowns and bridges for up to six months.
contraindications
Allergies or hypersensitivity to chemical ingredients of materials used: titanium (Ti), -titanium alloy (Ti-6Al-7Nb or TAN), PEEk,
and PMMA.
STRAUMANN NARROW NECk CROSSFIT (NNC) HEALING CAPS AND CLOSURE SCREWS
Indications for Use:
Straumann NNC Healing Caps and NNC Closure Screws are intended for use with the Straumann NNC Tissue Level Implant
system to protect the inner configuration of the implant. Healing Caps have a secondary function to maintain, stabilize and
form the soft tissue during the healing process.
contraindications
Contraindications for treatment with dental implants and allergies to materials used: Titan (Ti), titanium alloy (Ti-6Al-7Nb or
TAN), and PEEk.
DEVICE NAME: STRAUMANN NARROW NECk CROSSFIT (NNC) CEMENTABLE ABUTMENTS
Indications for Use:
Abutments are used in connection with the prosthetic restoration of Straumann dental implants. Abutments are intended to be
placed into dental implants to provide support for prosthetic reconstructions such as crowns and bridges.
Narrow Neck CrossFit Cementable Abutments are indicated for cement-retained single tooth and bridge restorations.
appeNDiX
STARGET 1 I 13
contraindications
Allergies or hypersensitivity to chemical ingredients of materials
used: titanium (Ti), titanium alloy (titanium-aluminum-niobium, or
TAN), PEEk (Polyetheretherketone), and PMMA (Polymethylmethacrylate).
STRAUMANN MEMBRAGEL
Indications for Use:
Straumann MembraGel is a biodegradable, synthetic, in situ forming hydrogel material. It is intended to aid in the regeneration
and integration of oral tissue components in guided bone regeneration procedures. This includes the surgical treatment of periimplant defects, bone defects, deficient alveolar ridges, and extraction sockets. Because MembraGel is not self-supporting,
it must be used in combination with a bone graft material in order to maintain space under the membrane.
contraindications
Straumann® MembraGel is contraindicated in clinical situations where dental surgery should not be performed.
Straumann® MembraGel should NOT be placed in infected sites. The practitioner should be confident that any active or
recent infection has been properly treated.
Warnings
Important warning for pregnant women and nursing mothers:
Straumann® MembraGel has not been tested in pregnant women.
Nursing mothers: It is not known whether degradation products of Straumann ® MembraGel are secreted in human milk.
Pediatric Use: Straumann® MembraGel is NOT intended for use in pediatric patients.
Precautions
Straumann® MembraGel must only be used by licensed practitioners properly trained in oral tissue regeneration using a
barrier membrane.
Straumann® MembraGel is designed for single patient use. Do NOT re-use or re-sterilize.
Straumann® MembraGel must NOT be used if the sterile packaging is opened or damaged.
Straumann® MembraGel is NOT self-supporting and must be used in combination with a bone graft material in order to
maintain space under the membrane.
Treatment outcome is dependent on operative technique and patient response. As with any surgical procedure, infection
is a risk. Use sterile intra-operative technique. Do NOT use at infected sites.
Straumann® MembraGel has NOT been clinically evaluated in non-submerged applications.
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The following complications are common with the surgical intervention with barrier membranes and therefore may not be
totally excluded: Soft tissue dehiscence, hematoma, pain, inflammation, increased sensitivity and redness.
Following the mixing instructions described above is essential for the performance of the product. Please read the
instructions carefully prior to surgery!
EMDOGAIN
Indications for Use
Emdogain is intended as an adjunct to periodontal surgery as a topical application onto exposed root surfaces. Emdogain
is indicated for the treatment of the following conditions:
Intrabony defects due to moderate or severe periodontitis
Mandibular degree II furcations with minimal interproximal bone loss
Gingival recession defects in conjunction with surgical coverage procedures such as the coronally advanced flap technique
Emdogain is also indicated for use in a minimally invasive surgical technique in esthetic zones to optimize tissue height for
intrabony defects only
In cases of wide defects or where soft tissue support is desired, Straumann® Emdogain can be used in conjunction with a
bone graft material.
contraindications
Emdogain should not be used in patients with disorders or conditions including, but not limited to the following: uncontrolled
diabetes or other uncontrolled systemic diseases, disorders or treatments that compromise wound healing, chronic high dose
steroid therapy, bone metabolic diseases, radiation or other immuno-oppressive therapy and infections or vascular impairment
at the surgical site.
Warnings
Immunological studies suggest that a small number of patients may become sensitized to Emdogain as a result of repeated
use. Please use caution in patients predisposed to allergic reactions and follow patients receiving repeated use closely.
Post-market experience has indicated that the sensitization adverse reaction rate is low. Required treatment has ranged
from no intervention needed to analgesics and/or antihistamines.
The safety and effectiveness of Emdogain has not been established in patients undergoing anticoagulant therapy. Careful
consideration should be given before using Emdogain for these patients.
Emdogain is intended for application around teeth only. Gain of tooth support occurs only to the level on the root surface
covered by the repositioned oral soft tissue. Therefore, Emdogain should be used in areas where there is adequate tissue
for root coverage. Emdogain should be used only after plaque and calculus have been removed from the diseased site.
WORLD-WIDE NEAR TO CUSTOMERS
Subsidiary companies
Distributors
HQ Switzerland
Brazil
Finland
Japan
South Korea
Institut Straumann AG
Straumann Brasil Ltda
Straumann Oy
Straumann Japan K.K.
Straumann South Korea
Peter Merian-Weg 12
Rua Funchal 263
Fredrikinkatu 48A 7 krs.
Sapia Tower 16F, 1-7-12
(formerly: B.I. Trading Co. Ltd.)
4002 Basel
04551-060 São Paulo
00100 Helsinki
Marunouchi, Chiyoda-ku,
1467-75, Seocho3 -Dong,
Tel. +41/61 965 11 11
Tel. +55/11 30 89 66 83
Tel. +358/96 94 28 77
Tokyo, 100-0005 Japan
Seocho-Gu, Seoul
Fax +41/61 965 11 01
Fax +55/11 30 89 66 84
Fax +358/96 94 06 95
Tel. +81/352 18 26 00
Tel. +82/72 265 8777
Fax +81/352 18 26 01
Fax +82/72 265 8797
Subsidiary companies:
Canada
France
Straumann Canada Ltd.
Straumann France
Mexico
Spain/Portugal
Australia/New Zealand
3115 Harvester Road
3, rue de la Galmy – Chessy
Straumann México SA de CV
Straumann S.A.
Straumann Pty. Ltd.
Suite 100
77701 Marne-la-Vallée cedex 4
Rubén Darío # 281 int. 1702
Edificio Arroyo - A
7 Gateway Court
Burlington/ON-L7N 3N8
Tel. +33/164 17 30 00
Piso 17
Avda. de Bruselas, 38
Port Melbourne 3207
Tel. +1/905 319 29 00
Fax +33/164 17 30 10
Col. Bosque de Chapultepec
Planta 1
Victoria
Fax +1/905 319 29 11
11580 México DF.
28108 Alcobendas (Madrid)
Germany
Tel. +52/55 5282 6262
Tel. +34/902 400 979
Czech Republic
Straumann GmbH
Fax +52/55 5282 6289
Fax +34/913 449 517
Straumann s.r.o.
Jechtinger Straße 9
Austria/Hungary
Na Žertvách 2196
79111 Freiburg
Netherlands
Sweden
Straumann GmbH Austria
180 00 Prague 8
Tel. +49/76 14 50 10
Straumann B.V.
Straumann AB
Florido Tower
Tel. +420/284 094 650
Fax +49/76 14 50 11 49
Postbus 338
Fabriksgatan 13
Floridsdorfer Hauptstr. 1
Fax +420/284 094 659
3400 AH IJsselstein
41250 Göteborg
Great Britain
Tel. +31/30 60 46 611
Tel. +46/31 708 75 00
Fax +31/30 60 46 728
Fax +46/31 708 75 29
Tel. +61/39 64 67 060
Fax +61/39 64 67 232
1210 Wien
Tel. +43/12 94 06 60
Denmark
Straumann Ltd.
Fax +43/12 94 06 66
Straumann Danmark ApS
3 Pegasus Place, Gatwick Road
Hundige Strandvej 178
Crawley RH109AY,
Norway
USA
Belgium
2670 Greve
West Sussex
Straumann AS
Straumann USA, LLC
Straumann
Tel. +45/46 16 06 66
Tel. +44/12 93 65 12 30
P.O.Box 1751 Vika
60 Minuteman Road
Belgicastraat 3
Fax +45/43 61 25 81
Fax +44/12 93 65 12 39
0122 Oslo
Andover, MA 01810
Tel. +47/23 35 44 88
Tel. +1/800 448 8168
1930 Zaventem
Tel. +32/27 90 10 00
Italy
Fax +32/27 90 10 20
Straumann Italia s.r.l.
Viale Bodio 37a
20158 Milano
Tel. +39/02 39 32 831
Fax +39/02 39 32 8365
Fax +47/23 35 44 80
+1/978 747 2500
Fax +1/978 747 2490
ConfidenCe in limited spaCe
STRAUMANN ® NARROW NECK CrossFit ®
The Straumann Soft Tissue Level solution to address space limitations
Confidence when placing small diameter implants
Wide range of treatment options
N
OSSEOIN
OF
TE
TION
RA
G
®
!* ·
D
N
AT
E RIA L STR E
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More information on www.straumann.us
*Fatique Strength according to ISO 14801 internal tests. Data on File (B679A/B567A)
03/13 USLIT 458
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Simplicity in daily use