International Bone Substitution and Augmentation Congress
Date: 13 October
Venue: G pavilon, Digital Dentristy Show
Presenters: Dr. Gáspár Lajos, Dr. Joseph Choukroun, Dr. Vasilena Ivanova, Prof. Ioannis Georgakopoulos, Dr. Ahmed Halim Ayoub, Dr. Hassan Maghaireh, Dr. Gianni Pertici, Dr. Eitan Mijiritsky
Dr. Gáspár Lajos, Dr. Ahmed Halim Ayoub, Dr. Eitan Mijiritsky
13 October, Friday
Dr. Lajos Gáspár
9:30 - 09:40
Dr. Joseph Choukroun
PRF technology and bone augmentation
9:40 - 10:10
The concept of PRF (Platelet Rich Fibrin) is based on the centrifugation of whole blood without anticoagulants. (J. Choukroun et al. 2001). At the end of the spin, a fibrin clot containing the majority of the platelets and white blood cells is obtained.
This fibrin clot called Platelet Riche Fibrin or PRF will release gradually and growth factors or cytokines in the site (VEGF, PDGF, TGF Beta, Thrombospondin)
The expected objective of these growth factors is to accelerate the soft tissue and bone healing.
Numerous international publications are available and demonstrate the effectiveness of PRF in many indications: oral surgery (implants, bone grafting, periodontal surgery, extractions, etc…), Orthopedic, cosmetic and dermatological surgery.
Today, the PRF is recognized around the world, from Nice to New York from Los Angeles to Shanghai, from Rangoon to Moscow, from Sao Paulo to Cape Town, Santiago to Zagreb…
Its effectiveness is definitely proven.
Dr. Lajos Gáspár
The importance of bone machining and bone augmentation in implantology
10:15 - 10:45
In the Gáspár Medical Center, experts examined primarily the combined application of BoneAlbumin and Magnetic Mallet. In this framework, there were socket preservation, bone splitting, lateral and vertical bone augmentation, rehabilitation of chin defects following cystectomy, and sinus lifts in the test groups.
Between 1 October, 2014 and 1 April, 2017, we applied magnetic mallet for 419 patients. Magnetic Mallet and BoneAlbumin combined application in 102 cases.
Among implants put in, there were 81 pieces of MIS, 103 pieces of Straumann, 565 pieces of SGS, 72 pieces of Paltop, 11 pieces of Bego Semados and three pieces of Denti in the program.
Following a six-month healing and ossification period, at the place of the BoneAlbumin grafting, from the newly formed bone we made a bone biopsy by bone trepan – as the first step of the preparation of the implant bed. We sent the material for histological examination.
We summarize the results of the BoneAlbumin and Magnetic Mallet application in the clinical practice.
In bone grafting in the fields of implantology and oral surgery, the application of BoneAlbumin opened up new avenues. Based on our experiences (in sinus lifting, augmentation following bone splitting, grafting process following extraction, augmentation, grafting bone losses, bone blocks, etc.), its behavior shows a transition between own implanted bone (autograft) and bone of human origin (allograft).
In clinical practice, based on our experiences, positive features have continuously been proven, so BoneAlbumin may represent a significant breakthrough in bone grafting processes of oral surgery, dentistry and implantology.
Dr. Vasilena Ivanova
Socket preservation with BoneAlbumin. Volumetric dimensional changes and histological events -Case report
10:50 - 11:20
After tooth loss, the alveolar bone undergoes a process of resorption and remodeling. Socket preservation is a surgical technique, which conserves the alveolar architecture and prevents hard and soft tissue collapse. This minimizes the necessity for future augmentation procedures. Recently a new bone allograft has been implemented in the surgical practice with promising results, regarding the tendency of overcoming the drawbacks of other grafting materials. The aim of this case report is to investigate dimensional volumetric changes and histological healing outcomes following tooth extraction and preservation of the socket with BoneAlbumin.
A 37-year old male patient with a non-restorable molar tooth is presented. Before administering the anesthetic a 3D scan was performed with the Trios intraoral scanner and a virtual study model is generated. After performing atraumatic extraction, a mucoperiosteal flap was elevated. A second scan on the alveolar bone is then performed. BoneAlbumin was prepared and placed into the socket and covered with PRF membrane. The mucoperiosteal flap was repositioned and sutured. After 4 months a mucoperiosteal flap was elevated and a 3D scan was performed with the Trios intraoral scanner. A bone was harvested with trephine bur for histological examination and a dental implant was placed.
The histological outcomes and the results obtained with the precise and non-invasive method of 3D scan show that BoneAlbumin can successfully be used for socket preservation procedures.
Allograft, BoneAlbumin, socket preservation, 3D intraoral scan
Prof. Ioannis Georgakopoulos
“Immediate Implant placement into the Sinus with Allograft and without Sinus Floor Elevation”
11:25 - 11:55
Aim: The rapid placement of implants and grafting in the sinus cavity by means of intentional perforation of the sinus membrane following a certain clinical protocol, without performing Sinus Floor Elevation (SFE).
Materials & Methods: 18 patients with age range between 39-68 (7-female, 11-male), in which upper jaw rehabilitation needed to be performed with non-removable prosthesis. The option of placing a total of 28 implants (17 left and 11 right on sinuses sides) was offered to the patients. All of them have been informed regarding the clinical procedure and a written consent was signed. This study has undergone an ethics review from Patras University. According to the proposed clinical protocol, all implants were placed in a flapless approach and entered each sinus cavities with intentional perforation of the Schneiderian membrane. The combined employment of concentrated growth factors (CGF & stem-cells-CD34+) and OrthoSera allograft within the osteotomy site and by means of implant immersion, was made in such a manner that the sinus can adapt to the new conditions forming new bone around the implants without the need to perform an SFA procedure.
Results: CBCT scans showed new bone formation around the implants by means of textural image analysis. None of all patients’ sinuses presented any signs of infection. Implant Stability Quotient values ranged between 63 and 71 proving high implant strength. Histologic analysis showed alternate layers between non-Mineralized Tissue and Vital Bone.
Conclusions: IPG Technique promising results demonstrate that it can be considered as a reliable alternative to the SFE (Sinus Floor Elevation) procedure.
Dr. Ahmed Halim Ayoub
“Novel approach for optimizing Esthetic results”
11:55 - 12:40
High patient expectations have made esthetics a major requirement of treatment plans, especially in compromised esthetic situations. Although new restorative materials have highly improved predictability, soft and hard tissue management play a fundamental role when working in esthetic areas.Preservation of the natural soft and hard tissue architecture is the main objective.These proposed techniques illustrate the importance of soft and hard tissue management in highly esthetic compromised areas. The bone albumin simnifically improves the overall outcome of the implant treatment in esthetic zone.
Dr. Hassan Maghaireh
“Achieving Ultimate Aesthetics in Implant Dentistry: predictable guided bone regeneration in the anterior region”
15:00 - 15:30
The need to place implants in the anterior area to replace compromised or missing teeth requires some very important evaluations, correct four dimensional placement in addition to the required adjunctive bone and soft tissue management. In fact, if the therapy is not correctly carried out, there is a high risk of not getting a satisfactory aesthetic result because of unexpected recessions of the gingival margins and the formation of black triangles between the teeth, due to apical migrations of the interdental papillae. The use of bone regeneration techniques and the correct soft tissue management in addition to the correct insertion of the implants guarantee, when used by careful hands, a significant reduction of this risk, with predictable aesthetic results both in cases of substitution of a single tooth, and also in cases of rehabilitation of the complete anterior part. Furthermore, correct prosthetic management of peri-implant soft tissue can help in optimization of the layout and outline of the new implant restoration(s), maintaining a suitable natural look of the pink and the white aesthetics of the implant restoration in the aesthetic zone. This lecture will present clinical strategies based on unto date evidence based practice aiming to achieve a dental implant restorations offering perfect harmony with the surrounding teeth, soft and hard tissue. Learning Objectives
• Diagnosis and treatment planning for GBR and Ridge Augmentation with implants
• Anatomical considerations to guided bone regeneration
• Selection criteria for appropriate type bone graft and membrane selection
• Clinical tips for predictable guided bone regeneration
• The use of 3D imaging in GBR procedures
• Management of complications and post-operative care
Dr. Gianni Pertici
“Innovative graft for bone regeneration”
15:35 - 16:05
Bovine bone xenografts, made by hydroxyapatite (HA), were coated with poly (L-lactide-co-ε-caprolactone) (PLCL) and RGD-containing collagen fragments in order to increase mechanical properties, hydrophilicity, cell adhesion and osteogenicity, with the purpose of developing a novel composite material for bone tissue engineering. Scaffold microstructure was investigated in vitro via Environmental Scanning Electronic Microscopy (ESEM) analysis and micro tomography, while mechanical properties were investigated by means compression tests. In addition, cell attachment and growth within the three-dimensional scaffold inner structure were validated using human osteosarcoma cell lines (SAOS-2 and MG-63). Standard ISO in vivo biocompatibility studies were carried out on model animals, while bone regenerations in humans were performed to assess the efficacy of the product. The fabricated bone graft exhibited regular microstructure similar to healthy cortical non-ultracompact bone with an average of 27% open porosity and an adequately rigid structure, which ensures a better osteointegration once implanted. All results underline that this scaffold promotes bone regeneration and show interesting clinical outcome.
Dr. Eitan Mijiritsky
“The Total Digital Planning Concept-A Restoration_ Driven Implant Placement”
16:10 - 16:40
The most important phase in a complex implant case preparation is a precise pre-operative diagnosis and understanding of the treatment aims and the case limitations. With the aid of digital planning of the case through digital modelling and softwares, the clinician can predict anatomic conditions and occlusal limitations. It allows the clinician to transfer the planned 3-D implant position from the software into the surgical field, to plan in advance the restored teeth in respect to the occlusal relasionship and to the optimal implant position, to produce in advance a Cad/Cam provisional restoration and to decide regarding the surgical and prosthodontic protocols to choose such as late vs. immediate loading following a conventional flap vs. flap-less implant surgery. But what about the precision of the available intraoral scanners in oral implantology? Are we there yet? During the presentation the relevant and most updated literature and actual conclusions will be presented with few complex clinical cases.
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