Predoctoral implant dentistry curriculum survey: European dental schools

PURPOSE: In 2002 a survey of European dental schools was conducted. The purpose of the survey was to determine the curricular structure, teaching philosophies and materials used in predoctoral implant dentistry courses. MATERIALS AND METHODS: Fifty-six European dental schools were randomly selected from the Association for Dental Education in Europe representing 33 countries. A questionnaire was mailed to the predoctoral implant dentistry director/chairperson of the selected European dental schools. Of these, 40 schools returned the completed survey, resulting in a response rate of 71%. The mean, median and range of responses were computed where applicable. RESULTS: The results from this survey show that 80% of the responding schools required a course in implant dentistry. Between 1997 and 1999 over a third of responding schools (36%) incorporated a predoctoral implant dentistry course into their curriculum. Eighty-seven per cent of the schools have some prosthodontists teaching the course. Thirty-seven per cent of schools are offering a laboratory course in conjunction with the implant course. Sixty-three per cent of the schools are not restoring implant cases at the predoctoral level. However, 68% of schools reported students are required to be present during implant surgery. Ten per cent of schools require that the implant-related laboratory work be completed by the students. CONCLUSIONS: Predoctoral implant dentistry educational programmes vary from school to school. Yet a large percentage of schools agree on certain topics, including the importance of including implant education in predoctoral dental programmes.     

牙种植外科技术探讨

牙种植外科技术是牙种植学的重要组成部分之一，它直接关系到牙种植的成功与失败。本文结合几年来的临床实践，介绍了牙种植患者的术前评估、治疗设计，重点对于该手术的外科手术问题进行探讨。文章还对该手术的注意事项，如何保证正确的种植部位与方向，防止副损伤等问题介绍了作者的体会。     

A model study on flapless implant placement by clinicians with a different experience level in implant surgery

INTRODUCTION: Some implant companies advocate that flapless surgery is easy to perform and beneficial for aesthetics and patients morbidity. However, studies objectively analyzing the position in the bone of implants installed with this approach are lacking. This in vitro model study was performed to analyse deviations in position and inclination of implants placed with flapless surgery compared with the ideally planned position and to examine whether the outcome is affected by experience level. METHODS: Identical radio-opaque resin models were developed with a silicon lining mimicking the soft tissues and six edentulous single tooth spaces. Eighteen clinicians (six periodontists, six general dentists and six students) drilled four implant sites each (Straumann AG, Basel, Switzerland) with a flapless approach. Corresponding CT-scan images of the models were available. A virtual implant program (Simplant, Materialise NV, Leuven, Belgium) was used to plan the ideal position and to compare this with the implant angulation and position of the test implants. RESULTS: There were no significant differences between the experience groups for all parameters except for global deviations between dentist and students, angle deviations between dentists and students and horizontal deviations between specialists and students. In incisor sites, specialists and students deviated significantly more in global deviation and depth than dentists. In premolar and molar sites, there were no significant differences except for horizontal deviations between specialists and dentists in molar sites. As a consequence of the malpositioning, perforations were seen in 59.7% (43/72) of the implant occasions when the artificial mucosa was removed from the model. CONCLUSION: The three-dimensional location of implants installed with flapless approach differs significantly from the ideal, although neighbouring teeth were present and maximal radiographical information was available. Within the limitations of this in vitro model study it seems necessary to point out that these deviations would in a clinical situation lead to complications such as loss of implant stability, aesthetical and phonetical consequences. The outcome is not influenced by the level of experience with implant surgery. This points out that more precise measurements of soft tissue in situ or additional use of guiding systems are recommendable.     

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对患者进行种植修复时,上下颌骨种植区垂直向和(或)水平向骨质的吸收,无疑给医生提出了一个难题。为确保种植区符合种植条件,必要的剩余牙槽骨尤为重要。本文对近年来改善颌骨种植区骨量不足的外科手术技术及其研究进展进行综述,为临床操作提供帮助。     

Accuracy of a newly developed integrated system for dental implant planning

Objectives: To evaluate the accuracy of the first integrated system for cone-beam CT (CBCT) imaging, dental implant planning and surgical template-aided implant placement.
Materials and methods: On the basis of CBCT scans, a total of 54 implant positions were planned for 10 partially edentulous anatomical patient-equivalent models. Surgical guides were ordered from the manufacturer (SICAT). Two different types of guidance were assessed: for assessment of the SICAT system inherent accuracy vendor's titanium sleeves of 2 mm internal diameter and 5 mm length were utilized for pilot drills. The guide sleeves of the NobelGuide system were implemented for fully guided surgery and implant insertion. Deviations perpendicular to the implant axes at the crestal and apical end, as well as the angle deviations between the virtual planning data and the surgical results, were measured utilizing a follow-up CBCT investigation and referential marker-based registration.
Results: The SICAT system inherent mean deviation rates for the drilled pilot osteotomies were determined to be smaller than 500 μm even at the apical end. Mean angle deviations of 1.18° were determined. Utilizing the NobelGuide sleeve-in-sleeve system for fully guided implant insertion in combination with the investigated template technology enabled to insert dental implants with the same accuracy. Crestal deviations, in general, were significantly lower than the apical deviations.
Conclusion: Although hardly comparable due to different study designs and measurement strategies, the investigated SICAT system's inherent accuracy corresponds to the most favourable results for computer-aided surgery systems published so far. In combination with the NobelGuide surgical set for fully guided insertion, the same accuracy level could be maintained for implant positioning.     

当代口腔种植修复技术新进展

口腔种植修复技术的发展与成熟极大地改变了口腔医学面貌,已成为当今修复牙齿缺失最常规、最有效的临床方法之一。该文旨在相关种植外科技术、种植修复技术、种植体材料、数字化口腔种植四个方面的新进展与新问题进行讨论。     

分置式可测量种植导板在多颗前牙即刻种植即刻修复中的应用

本文报道1例应用分置式可测量种植导板引导的即刻种植即刻修复技术,修复牙外伤所致的12—22牙缺失。术前根据咬合记录,在exoCAD软件中设计上部目标修复体空间轮廓位置,再通过口内和锥形束CT图像实测获得12—22牙位点近远中向、唇腭向和𬌗龈向分别在软硬组织水平的空间数据,在Bluesky Plan 4软件中设计比选4个正确种植位点,确认后设计并通过三维打印制作基于三向位置数值的可测量种植导板。术中使用3组可测量种植导板结合测量尺实测依次完成定点、半钻预备及轴向核查、全程预备及三向位置核查和种植体植入,之后再次实测核查种植位点。术后通过转移导板即刻戴入基于目标修复体空间和原天然牙穿龈形态设计、并于术前切削完成的临时修复体。经术后对比测量,种植入口点平均线性偏差为（0.57±0.17）mm,种植止点平均线性偏差为（0.82±0.27）mm,各植体平均角度偏差为（1.86±0.89）°,实现了12—22牙位点种植体的精准植入与同期的即刻修复。     

慢速法制备种植体窝洞原位取骨的临床疗效评价

目的:牙缺失后,牙槽骨存在不同程度的吸收,给后期的种植治疗造成不利的影响。由于自体骨是修复骨缺损的最佳植入材料,目前,临床上常用的种植体窝制备方法是在不同的种植体窝制备阶段使用不同的转速,且需要全程冲水以防止产生过热的温度,切屑的骨组织被水冲走而流失,如需要收集这部分自体骨需要特别的器械,效果却并不好。因此,我们对需要植骨的种植患者,通过用常规钻慢速法(<50rpm)制备种植体窝,制备过程中不冲水,收集自体骨。本研究评价常规钻慢速法制备种植体窝在产热,种植体骨整合等方面的影响以及收集的自体骨的临床应用疗效。材料和方法:52例患者接受种植治疗,共植入136颗种植体。其中ITI28颗,OSSTEM83颗,Anyklos25颗。常规法52颗,慢速法84颗。慢速法中44颗种植体窝制备完后用生理盐水冲洗种植体窝,40颗不冲洗。慢速法制备种植体窝过程中收集的自体骨以全部自体骨,人工骨粉与自体骨混合物及先在种植体表面填入自体骨再在自体骨表面覆盖人工骨粉的"三明治"技术三种不同的运用方法用于修复骨缺损。术后疗效评价包括临床观察和X线,全景片,CBCT等检查。结果:134颗植入种植体成功,60颗已行上部结构修复,74颗未行上部结构修复。术后拆线时观察130颗种植体伤口一期愈合(伤口无明显炎症,种植体无暴露),4颗种植体伤口有炎症但无种植体暴露。术后6～12月观察种植体无松动,术区软硬组织无炎症。X线检查种植体与骨结合良好,种植体颈部无明显骨吸收,与常规法无差异。有2颗种植体失败,一例种植体松动,一例种植体有暴露。收集的自体骨修复骨缺损效果良好,一例全部以自体骨修复骨缺损时效果不佳。结论:慢速法制备种植体窝的优点明显,不仅可以收集自体骨用来修复骨缺损或上颌窦提升,而且在疏松骨质的种植术中可以更好的控制方向和力量。收集的自体骨量:I类骨>II类骨>III类骨>IV类骨。常规钻慢速法制备种植体窝在产热,骨整合与常规法无明显差异。     

Using computer-guided implantology in flapless implant surgery of a maxilla: a clinical report

Summary  The current notion in implantology is to utilize techniques that can provide function, aesthetics and comfort with a minimally invasive surgical approach. The flapless implant surgery has been suggested to fulfil these requirements. Traditionally, the flapless implant surgery was performed by using a tissue punch technique, which may be potentially harmful because of the inherent blindness of the technique. Today, computer software programs and 3D radiographic techniques, such as CT technology, have been developed to provide the practitioner with precise implant placement planning. Although this sophisticated approach has many advantages, transferring this information to the surgical phase has only recently been developed. The purpose of this paper was to introduce a more predictable flapless approach for treatment of a patient's maxilla through principles of computer-assisted implantology.     

利用数字化导板取出骨内折断种植体的临床效果研究

目的 研究利用数字化导板取出骨内折断种植体的临床效果.方法 选取2010年1月至2020年1月于中国医科大学附属口腔医院种植中心完成骨内折断种植体取出术患者11例行回顾性分析,其中利用数字化导板取出的患者5例(导板组),利用常规环钻取出的患者6例(常规组).比较两组的手术时间、种植体完整性、并发症发生情况及患者疼痛程度...     

Performance of six bone collectors designed for dental implant surgery

OBJECTIVES: The aim of this study was to perform an in vitro comparison of six bone collectors for harvesting of particulate bone. MATERIAL AND METHODS: Four commercially available bone collectors (Frios, Osseous Coagulum Trap, ACE Autografter, Bone Trap) and two custom-designed models were tested. Three different in vitro tests were performed to determine the harvesting capabilities of the collectors. In test I, a bovine mandible was drilled and the bone collectors were used to collect bone chips. The harvested bone volumes and dry weights were measured after harvesting. In test II, three dental implant sites were prepared in a bovine mandible. The bones from the implant osteotomies were collected, and bone volumes and dry weights were measured. In test III, 1 ml of bone chips was mixed with water, and suctioned through the bone collectors. The volumes of the bone chips retained were measured to determine the efficiency of each collector. RESULTS: The Osseous Coagulum Trap and the custom-made collectors were the most effective instruments in test I. The mean volumes ranged from 0.17 to 0.38 ml. In test II, the difference between the collectors was small and the bone volume ranged from 0.28 to 0.37 ml. In test III, the Bone Trap became blocked before the other collectors, and its bone procurement was therefore limited. CONCLUSION: Comparison of six different bone collectors in this in vitro study showed that all collectors are usable in clinical situations but their effectiveness varies.     

Patient-reported outcome measures compared to professional dental assessments of monolithic ZrO2 implant fixed dental prostheses in complete digital workflows: A double-blind crossover randomized controlled trial

Purpose

This double-blind randomized controlled trial analyzed patient-reported outcome measures in terms of subjective patient satisfaction compared to objective dental evaluation of prosthetic treatment with 3-unit monolithic zirconium dioxide implant fixed dental prostheses (iFDPs) in 3 digital workflows.

Material and methods

Twenty patients were restored with 3 iFDPs each on Straumann TL-implants with 2 completely digital workflows using different intraoral optical scanning systems with model-free fabrication of the restoration (Trios 3/3Shape [Test-1]; Virtuo Vivo/Straumann [Test-2]), and mixed analog-digital workflow with conventional impressions and digitized gypsum casts (Impregum/3M Espe [Control]). The order of impression-taking and the prosthetic try-in were randomly allocated. Sixty iFDPs were compared for patient satisfaction and dental evaluation using ANOVA.

Results

For iFDP evaluation, patients generally provided more favorable ratings than dental experts, regardless of the workflow. ANOVA revealed no significant difference for overall satisfaction when comparing Test-1, Test-2, or Control, either for patients (f-ratio: 0.13; p = 0.876) or dentist (f-ratio: 1.55: p = 0.221). Secondary, patients clearly favored the digital impression workflows over the conventional approach (f-ratio: 14.57; p < 0.001). Overall, the 3Shape workflow (Test-1) received the highest scores for all analyses.

Conclusions

The different digital workflows demonstrated minor influence on the subjective and objective evaluation of the monolithic zirconium dioxide iFDPs in nonesthetic regions; however, the dentist may significantly increase patient satisfaction by choosing intraoral scanning instead of conventional impressions. The dentist has to consider individual patients’ needs to fulfill their expectations for a personalized solution.     

Influence of implant positioning in extraction sockets on osseointegration: histomorphometric analyses in dogs

Aim: To evaluate the influence of implant positioning into extraction sockets on osseointegration. Material and methods: Implants were installed immediately into extraction sockets in the mandibles of six Labrador dogs. In the control sites, the implants were positioned in the center of the alveolus, while in the test sites, the implants were positioned 0.8 mm deeper and more lingually. After 4 months of healing, the resorptive patterns of the alveolar crest were evaluated histomorphometrically. Results: All implants were integrated in mineralized bone, mainly composed of mature lamellar bone. The alveolar crest underwent resorption at the control as well as at the test sites. After 4 months of healing, at the buccal aspects of the control and test sites, the location of the implant rough/smooth limit to the alveolar crest was 2±0.9 mm and 0.6±0.9 mm, respectively (P<0.05). At the lingual aspect, the bony crest was located 0.4 mm apically and 0.2 mm coronally to the implant rough/smooth limit at the control and test sites, respectively (NS). Conclusions: From a clinical point of view, implants installed into extraction sockets should be positioned approximately 1 mm deeper than the level of the buccal alveolar crest and in a lingual position in relation to the center of the alveolus in order to reduce or eliminate the exposure above the alveolar crest of the endosseous (rough) portion of the implant. To cite this article:
Caneva M, Salata LA, de Souza SS, Baffone G, Lang NP, Botticelli D. Influence of implant positioning in extraction sockets on osseointegration: histomorphometric analyses in dogs.
Clin. Oral Impl. Res. 21 , 2010; 43–49.