Inside Dentistry
July 2013
Volume 9, Issue 7

Nobel Biocare Global Symposium Focuses on Implants

Designing for Life strives to improve outcomes with customized approaches, new biotechnologies, and skill development

A Global Symposium sponsored by Nobel Biocare focused on the possibilities of implant-based dentistry to help patients enjoy an improved quality of life.

“Designing for Life,” the innovative program held at the Waldorf Astoria Hotel in New York City, June 20 to 23, 2013, covered the entire treatment “journey” from presentation to follow-up. Shaped by Nobel Biocare’s scientific committee, chaired by Professor George Zarb, the program featured implant experts from all over the world who led a wide variety of presentations and programs, including Master Class and Hands-on sessions. There was also an Emerging Leaders session on June 21, and June 22 included sessions for Dental Technicians Day.

Day 1: Missing Anterior and Posterior Single Teeth

The symposium kicked off with an introductory morning session moderated by
George Zarb and William Becker. The speakers raised numerous concerns that continue to challenge the notion of a universal therapeutic application of implant therapy, including the effects of systemic interactions on osseointegration, an expanded understanding of the induced interface that results in osseointegration, and the ongoing need for better evidence supporting long-term treatment outcome results and maintenance protocols.

The objectives of this opening program were to offer clinicians an increased understanding of background considerations in the identification of patient treatment selection; provide an update on current views regarding implant surface characteristics that influence bone and soft tissue responses; and convey appreciation for the methodologies used to evaluate the efficacy of long-term treatment outcomes.

That afternoon, the main program, “Patient Journey 1–Missing Anterior and Posterior Single Teeth,” was moderated by Peter Wöhrle and Charles Goodacre. The first of four patient journeys, the session offered strategies for dealing with the demanding esthetic challenge posed by replacement of anterior single teeth, which is especially common in younger patients due to issues related to available soft and hard tissue morphology and the status of adjacent teeth.

Speakers discussed the need to determine the merits or shortcomings of selected implant placement sites—for example, taking into consideration the risk of restricted host bone dimensions in posterior sites. They also addressed the need to take advantage of the best treatment strategies and implant designs to ensure optimal treatment outcomes. The speakers urged clinicians to consider adjunctive use of digital planning tools and laboratory simulation of clinical results, and to consider proactive measures to avoid any surgical morbidity or treatment complications at any stage. The presentation further described reliable methods for achieving long-term esthetic and stable soft-tissue responses and the prosthesis maintenance requirements.

The first day also included six speaker-led Master Class sessions, and a special program, “Minimally Invasive Surgical Protocols,” was moderated by Armando Lopes.

Day 2: Missing Multiple Anterior Teeth

“Patient Journey 2–Missing Multiple Anterior Teeth”—moderated by Bernard Touati, Sascha Jovanovic, and Lesley David—made it clear that in replacing multiple anterior teeth, clinicians should recognize that the resultant 3-dimensional morphologic features of long-term residual ridge resorption are more likely to pose a challenging esthetic outcome. In addition, a more demanding surgical site preparation may be needed for patients who do not want cantilevered prosthetic teeth with simulated gingival replacement; and when there are generous smile lines and both anterior teeth and supporting tissue have been lost, the treatment demands for achieving the desired biocompatible, esthetic, and functional parameters may be challenging.

Later that day, the main program ses;sions included “On Enriching the Treatment Para;digm–Digital Solutions in Implant Dentistry (Digital Stream 1)” and “Reconstructive Surgery and Prosthodontic Solutions for Severe Cases.”

The first session on digital solutions was moderated by George Duello and John Brunski, and the second featured Luc Rutten and Egon Euwe. Acknowledging the major role played by rapidly evolving computer-driven treatment planning and CAD/CAM solutions, these sessions provided short presentations dealing with innovative digital clinical concepts and workflows for both dentists and dental technicians. Available tools and digital techniques that support optimal esthetic results were demonstrated and discussed. Speakers stressed the benefits of computer-based planning in the communication between the surgical specialist, restoring dentist, and laboratory technician, and detailed the merits of the CAD/CAM approach in prosthodontic rehabilitation. They also discussed the impact of digital workflows and new dental laboratory technologies on the dental practice.

In “Reconstructive Surgery and Pros;tho;dontic Solutions for Severe Cases,” moderators Johan Wolfaardt and Shohei Kasugai led a discussion focused on how modern surgical advances, cellular engineering concepts, prosthodontic virtuosity, and advances in biomaterials and implant designs have been able to improve the lives of patients with congenital anomalies and severe tissue loss from trauma or oncologic surgical interventions.

An Emerging Leaders session moderated by Eric Rompen and Bernard Touati gave several up-and-coming dental leaders the opportunity to share the podium with seasoned colleagues for a discussion of “Tissue Volume at Anterior Implants: a Key to Esthetic Success.”

The three special programs in the morning included “Immediate Function and its Sci;entifically Documented Efficacy and Effectiveness,” Immediate Placement–Implant Placement in Fresh Extraction Sockets,” and “Soft-tissue Integrity and Associated Optimal Esthetic Outcomes.” The single afternoon session focused on “Benefits and Complications Associated with Fixed Implant Rehabilitation Using Graftless Solutions for the Edentulous Maxilla.”

The educational experience was rounded out by morning and afternoon Hands-On Sessions with a team of speakers from Nobel Biocare and Master Class sessions with individual speakers.

Day 3: Missing Multiple Posterior Teeth and Managing the Terminal/Failing Dentition

On the last full day of the symposium, morning and afternoon main programs continued the patient journey theme, with “Patient Journey 3—Missing Multiple Posterior Teeth” and “Patient Journey 4—Managing the Terminal/Failing Dentition: The Transition to Edentulism,” respectively.

The discussion of missing posterior teeth moderated by Stefan Holst and Eric Rompen noted the need to select adequate implant numbers and design features to achieve desired esthetic outcomes, but stressed the importance of their potential for dealing with sustained and prolonged loading demands. Presenters stressed the importance of sophisticated imaging of planned host bone sites to permit the selection of the most appropriate surgical protocol with or without grafting interventions, and taking advantage of pre-treatment information gleaned from articulator simulation of teeth arrangement and distribution in the context of occlusal analysis and individual patient behavior history (eg, parafunction).

“The Transition to Edentulism,” led by Peter Moy and Roland Glauser, focused on how protocols in implant therapy for edentulous patients have now evolved to provide both patient and dentist with additional versatile and optional solutions. This discussion included how to meet the ongoing functional and esthetic needs of edentulous patients and current approaches to making an optimal selection from diverse management strategies. Evaluation methods and treatment options for patients with terminal dentitions were described. The presenters also evaluated the rationale for fixed prostheses by exploiting the ankylotic-like induction of a healed implant/bone interface that permits angulating abutments to maximize the areas of osseointegrated surface contact by using longer, tilted implants—which is the basic premise that underscores the “All-On-4’’ treatment concept. Finally, the merits of the scientific evidence that supports immediate functional loading of both fixed and removable prostheses were analyzed.

In addition to the usual Master Class and Hands-on Sessions, there were three sessions for Dental Technician Day. Christian Coachman presented “Smile Design and Material Selection for White and Pink Esthetics Over Implants,” Patrick Rutten and Stefan Holst presented “New Restorative Solutions for Efficiency and Esthetics,” and Jean-Marc Etienne and Bernard Touati presented “Implants Esthetics in the Digital Age.”

Day 4: The Predicament of Edentulism

The final day featured a Post Symposium program on “The Predicament of Edentulism—How Viable and Universal is the Implant Solution?” Moderators George Zarb and Edmond Bedrossian and the assembled speakers presented the spectrum of management challenges that confront the profession when seeking to manage long-standing edentulism in particular. They emphasized the need to recognize the predicament of patients with long-standing edentulism and to be aware of both adaptive and maladaptive complete denture wearing experiences. They discussed both surgical morbidity risks and long-term prosthodontic maintenance challenges when providing implant therapy for such patients. Finally, the merits of abbreviated surgical protocols that recruit All-On-4 or overdenture approaches to achieve the desired optimal treatment objectives were demonstrated.

Beyond the Symposium

The Global Symposium’s numerous and diverse presentations, workshops, and master classes worked in tandem to enrich the attendees’ clinical vision of biotechnological creativity that offers scientifically robust and predictable treatment outcomes for partially and completely edentulous patients. Transferring this information to each individual patient’s treatment journey helps to enable clinicians to eclipse past achievements and achieve even better treatment outcomes.

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