Research

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EDITORIAL
Issue: 01/2017
Dear Readers, dear Colleagues,

Dear Readers,
dear Colleagues,

Even though the year 2017 is already a couple of weeks old, I would nevertheless like to take the opportunity to once again wish you the very best of health, luck and success. And at the same time I would like to thank all my peers for their excellent cooperative engagement and support.

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Issue: 02/2017
Patient’s Informed Consent – can a patient information and consent form or a software replace the physician-patient dialog?

Patient’s Informed Consent – can a patient information and consent form or a software replace the physician-patient dialog?

Of course, one can proceed on the assumption that the majority of colleagues aim at doing an excellent job and demonstrating a great deal of responsibility vis-à-vis their patients. From the viewpoint of the treating physician, it therefore seems to be to a certain extent difficult to understand which requirements we have to fulfil with regard to informing the patient. Dramatic judgements at courts are frequently mentioned in the scope of discussions at conferences in which, in some respects, absurd patient information is requested. And in addition thereto new laws governing patient’s rights are enacted, representing new challenges for us doctors and dentists. Some colleagues even feel themselves quasi criminalised. In particular, in the field of implantology, with the multitude of various different therapy alternatives and a frequently elective treatment, special significance is attributed to patient information. This is even more the case, as financial consequences can affect the patient personally.

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Issue: 03/2017
Implantology in studies – is training up-to-date?

Implantology in studies – is training up-to-date?

Whereas implantology in the past was above all performed by specialists with focus on surgery, the increasing demand and the expanded indication spectrum has led to a wider establishment of dental implants in day-to-day work at a dentist’s office. Clinicians are increasingly endeavouring to offer their patients a holistic treatment at the same time taking all aspects into consideration, ranging from planning implant positioning, via surgery to restorative procedures. Implantology is thus currently not seen as an area of expertise which is assigned exclusively to specialists. Future dentists should therefore possess certain competences in implantology allowing them to identify relevant indications, to provide patients with correct information and to treat such patients within the scope of their competences or to refer them to other specialists.

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FROM PRACTITIONER TO PRACTITIONER
Issue: 01/2017
Dental implant rehabilitation of a patient with Down syndrome – interdisciplinary workflow

Introduction: Implant-supported prosthetic restorations exhibit greater patient satisfaction compared to removable prosthetic restorations. Systemic diseases such as Down syndrome can affect the treatment planning and therapy. Typical oral manifestations of this syndrome include macroglossia, dysplasia of maxilla, malocclusion of the teeth, crossbite, shortened roots and anterior open bite.

Material and methods: This case report describes therapeutic treatments of implant surgery and prosthetic rehabilitation in a patient with Down syndrome using digital treatment concepts.

Results: A complex treatment with dental implants in combination with a prosthetic restoration can be successfully carried out at a Down syndrome patient.

Discussion: It has been shown in this case study, the digital workflow and in particular digital impressions can facilitate treatment procedures in compromised patients.

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Issue: 02/2017 - José Eduardo Maté Sánchez de Val - Ronny Gläser
Long-term analysis of bone stability with a platform-switched and flat-connection implant system – radiological analysis

Background: Dental implants have proven to be a predictable treatment for replacing missing teeth; with an extensive literature base and numerous studies supporting the safety of treatment. They have been introduced modifications protocols and implants to improve osseointegration; including surface topography, implant design, implant anatomy, connection, load time and load type. In all, the survival rates of long-term implant analysis are set at high values above 95%.

Aim: The aimwas to analyze from radiological analysis the stability of bone surrounding implants and complete the follow-up with long-term results.

Materials and methods: Standardized radiographs were taken at the implant placement day and at the moment of the restoration of the prosthesis, recall 1 year and long-term (7 years) by means of a one-position paralleling system. 60 implants (blueSKY, bredent medical GmbH Co. KG, Senden, Germany)have been inserted and after a subgingival healing period of 3 to 6 months have been restored with cemented metal ceramic and Zirconia single crowns. Radiological analysis was performed with image J software Wayne Rasbarnd, USA. Distances between platform to first bone contact were recorded.

Results: No implants were lost during the study period; no abnormal inflammation phenomena were observed that were not due to a peri-implant cicatrization process. The measured distance values between the implant platform and the first contact with the peri-implant bone have been recorded. For the initial moment of implant placement, an average distance of 0.23 ± 0.02 mm was found with a variation at 0.20 ± 0.04 at the time of connection of the prosthesis, and 0.31 ± 0.11 at the 1-year review. After 7 years the bone level has been found at 0.68 ± 0.03 mm from the platform to the first contact.

Conclusions: With the limitations of a clinical study in humans, it can be established that the combination of a platform switch technique with an adequate implant design and adequate attachments allows stabilization of the peri-implant tissues, minimizing the apical migration of the bone during a period of time analyzed in the long term, independent from the kind of connection.

Cited as: Sánchez de Val JEM, Gläser R: Long-term analysis of bone stability with a platform-switched and flat-connection implant system – radiological analysis. Z Zahnärztl Implantol 2017; 33: 143-151

DOI 10.3238/ZZI.2017.0143–0151

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ORIGINAL STUDY
Issue: 03/2017 - Max Seidemann - Rainer Haak - Constanze Olms
A pilot study for evaluating interfaces by OCT: loading of a Resin Nano Ceramic on one-piece ZrO2 implants

Introduction: The prosthetic treatment of one-piece ZrO2 implants is a challenge because of the scarce long-term data available. In order to achieve a physiological rehabilitation on rigid, one-piece implant systems, a certain resilience is desired according to the natural tooth. The best way to achieve this, is with the restoration and asuitable bonding procedure to secure a stable and durable bond. The aim of this study was to visualize changes at interfaces before and after dynamic loading of adhesively bonded Resin Nano Ceramic (RNC) crowns on one-piece ZrO2 implants by optical coherence tomography (OCT).

Material and Method: A total of 20 one-piece ZrO2 trialimplants were produced and 20crowns from LAVA Ultimate (LU, 3M ESPE, Seefeld, Germany) were made using CAD/CAM procedures. After tribochemical pretreatment (SB) of all crowns, as well as half of the implant abutments (CoJet, 30?m, 2bar), the crowns were bonded to the implants with Scotchbond Universal (SU) and RelyX Ultimate (RU) according to the manufacturer’s instructions. Subsequently, OCT images (Telesto II, Thorlabs GmbH) ofthe attached crowns were recorded before and after chewing simulation (CS, 1.2million cycles with 50N at 5–55 °C for 60sec each, SD Mechatronik GmbH). The changes in the signal lines visible in the OCT-B scans wereassessed visually as “indistinct”, “equal” or “more pronounced”.

Results: An evaluation of the visible changes to the signal lines in the OCT-B scan was performed according to a visual classification into “indistinct”, “equal” or “more pronounced”. For all samples in the OCT-B scan a signal was visible along the SU+RU/ZrO2 interface not only before, but also after the CS. This signal was “more pronounced” for non-SB before CS than for samples that received pretreatment (SB). The signal intensity on the SU+RU/ZrO2 interface did not increase after CS for non-SB, whereas in SB samples it was “more pronounced”. In the occlusal B-scans, a second signal line was visible only in non-SB test samples after dynamic loading.

Conclusion: The pilot study shows that non-invasive imaging of changes in RNC interfaces by OCT is possible and thereby additional visual information on the bond can be attained.

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