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					identity
EVIDENT SUCCESS   ®
                      3_03




in_sight
03_editorial

04_input
  04_Cone Focus


06_inside
  06_Evident Success


08_titanium
  08_Fascination Titanium II


12_international
  12_DeguDent Austria
  13_Living Tomorrow
  13_Partner Russia


14_ankylos
  14_Prof. Dr. C. R. P. Araujo: Cercon® abutment
  18_Dr. D. May: SynCone immediate loading
  24_Dr. G. E. Romanos: bone-implant interface
  28_Dr. J. Eifert: Free-end edentulism
  32_Dr. Dr. S. Berg: PepGen P-15 sinus graft
                                  ®




_contents
36_Cellplus
  36_Dr. G. Bayer: CELLplus in practice


40_pepgen
  40_PepGen P-15® Study Group


42_news
  42_FRIALOC ® / XIVE® TG CELLplus
  43_Complete set


44_eao

46_worldwide
  46_CELLplus goes USA
  47_ANKYLOS® goes USA
  48_Evian Evident Success
  49_FRIADENT Tour
  50_Hola XIVE®
  51_Centre of Excellence


52_imprint
                                                                                     _editorial




       PROGRESSIVE THREAD



       Dear Readers,



       Effective January 1, 2004, Dr. Werner Groll assumed overall management

       responsibility at DENTSPLY Friadent. After 30 years with FRIATEC AG and

       FRIADENT GmbH, Mr. Walter Hund decided to retire for health reasons at

       the end of 2003. Under his leadership, FRIADENT developed pioneering

       innovations that significantly influenced the field of implant dentistry.

       We wish him all the best for the future!




success_taper                                                                             _03




       This edition of iDENTity is dedicated to our ANKYLOS® implant system,

       which offers the optimum basis for long-term functional and esthetic

       restorations. The authors of our interesting articles and comprehensive

       case studies are focusing on the advantages, the easy handling and

       the developments of ANKYLOS®.


       In retrospect, the new FRIADENT® surface that we launched international-

       ly at the EAO in Vienna was definitely our highlight of the year 2003. And

       this was only the start! An article by Dr. Georg Bayer on page 36 describes

       the clinical application of this new generation implant surface.


       We also include reports on international events, new partnerships in

       Austria (page 12) as well as practical hints and important information on

       our products, FRIALIT®/XiVE® and PepGen P-15®.

       Enjoy reading!




       Lolita Keller / Editor

       identity@friadent.de
  _input




                                                                        cult_cone
                                                                        For more than 50 years,
                                                                        Campari Soda in the cone
                                                                        bottle. “Campari Light”,
                                                                        a shining memorial for
                                                                        this anniversary designed
                                                                        by the master of light,
                                                                        Ingo Maurer.
           tone_cone                                                    www.ingo-maurer.de
           Big commotion for small
           pegs: The sound of an
           orchestra can depend on
           this exact fitting –
                                                         2.3°
           small jacaranda cone.




_04        cone_focus                                                               8°


           F I R M , S E C U R E , T I G H T – S U C C E S S TA P E R

           THE ALL DECISIVE ANGLE




                                                                        cone_speed
                                                                        Acceleration, speed, curve
                                                                        forces, brake delays, cargo
                                                                                                      33°
                                                                        change-over, shaking
                                                                        race-courses:
                                                                        small cone – great success!
                                                      _input




gold_cone
One can’t be too sure.
Everything that is very
precious to us, is put under   cone_travels
lock and key – secured by      With this cone in your ear
the high-security cone of      you get everywhere:
the safe.                      Ear planes made for perfect
                               hearing during take-off and
                               landing.
            19°                www.sonicshop.de




                                          7°




                               cone_inside
                               Enlightment from above:
                               within the glassy dome of
                               the building of the Berlin
                               Reichstag sticks a gigantic
                               mirror-cone, directing the
                               sunlight right into the Plenary
                               Assembly Room of the German
                               Parliament´s Lower House.




                                cone_classics
                                Secure for everyday: from
                                the wash basin via the sink
                                to the bath – this cone is
                                watertight!




                                                             11°
           ANKYLOS® – a successful concept

           The ANKYLOS® system, which has been in clinical use since 1987, is noted for its unique design –

           the implant-abutment connection with progressive threads. Although this design principle

           appears unusual at first, it has clearly proven its superiority through years of clinical experience.

           This is based particularly on the high mechanical stability of the taper connection, which

           minimizes the possibility of screw or abutment loosening. The requirement for follow-up

           treatment is reduced, which makes the system even more economical. Due to its tapered design,

           primary stability is increased significantly and the peri-implant bone is extremely stable.

           Consequently, no resorption has been noted after restoration and loading, the volume of bone

           remaining stable at the implant level.




_06   evident_success
           The system opens the way for new solutions, particularly with regard to esthetics and stability of

           the papillae. Due to the taper connection a high degree of flexibility in aligning the prosthetic

           abutments is ensured; they are parallel in every case. These characteristics enable implementation

           of a unique immediate loading system, which allows the patient to leave the practice with restored

           implants after no more than two hours (SynCone concept). The articles by Prof. Dr. Araujo,

           Dr. Eifert, Dr. Dr. May and Dr. Romanos specifically focus on the advantages of the ANKYLOS®

           system that will be available with the new CELLplus surface in 2004. Let this somewhat different

           implant system fill you with enthusiasm and convince you!



           Together with our other systems, FRIALIT® / XiVE®, the FRIOS® products and PepGen P-15®, we

           offer a complete range of products for implant dentistry. Whatever your needs and interests are,

           we have the right answer for you. And of course, our experts are always ready to support you with

           our in-house or on-site service wherever you are. Worldwide, we will actively support you, our

           customers, in establishing and developing implant dentistry, as a future-oriented treatment option,

           by ensuring your and our long-term success. This corporate philosophy is also manifest in our

           slogan: “DENTSPLY Friadent – Evident Success®”.
                                                                                                          _inside




The success of our customers and their patients is our number one priority. This means doing much

more than just developing, marketing and supplying implants. It means taking action to advise and

support our customers in their daily business, during expansion and in advising patients.



■ New practitioner concepts: We make it easy for you, as a new practitioner in implant

dentistry, by assisting you in developing your own individual practice concepts. You receive

detailed information on implementing systems, targeted support in selecting suitable further

education events and practical tips for changing practice procedures.




■ Continuous education: We provide insight on the continuous education options and answers to

the questions: “What kind of professional training do I need, when and why?” We will help you find

the correct solution, so you can invest your time and money sensibly.

■ Patient information: Implant dentistry requires a lot of explanation and is a very sensitive area for

your patients. We offer clearly laid-out brochures and flyers with exactly the information that your

patients need to feel comfortable with their choice.



Last but not least, I would like to take this opportunity to express my appreciation to Mr. Walter

Hund for his decisive contribution to the success of FRIADENT GmbH over his 30-year career in the

field of implantology. Mr. Hund decided to retire for health reasons from his position in the company

management at the end of the year 2003. We are grateful for his untiring dedication to the welfare of

the company and wish him all the best for the future.

And now, enjoy reading the clinical and research reports on ANKYLOS®!




      Dr. Werner Groll
           F R O M S E M I - F I N I S H E D P R O D U C T T O T I TA N I U M R O D




_08   fascination_titanium II
           We accelerate, we are on time, we see better, we can monitor, control and

           assist – the wide range of applications for high-quality steel and titanium

           rods extends from the automobile industry through measurement and control

           technology, pneumatics, watches, jewelry and eyeglasses through to dental

           and medical technology.

           We published an introductory article on titanium in iDENTity 2/03.

           Now we would like to introduce the precision semi-finished product and

           take you on a tour behind the scenes at one of our most important certified

           suppliers: the ZAPP Group at the Ergste Westig GmbH steel works in

           Schwerte, Germany.

           The ZAPP Group, which can look back on more than 300 years of industrial

           and business tradition, now includes leading manufacturers in metal

           processing and materials technology. The Ergste Westig GmbH has plants

           in Schwerte and Unna and is one of the most important companies in this

           process industry with its cold rolling mills, drawing and hardening works.
_titanium




            Five hundred employees monitor a complete process around the clock.

            Experienced engineers ensure that only the best quality materials enter the

            modern high-precision production lines. The semi-finished products in their

            progress to titanium rods undergo the following processes before we receive

            them: finishing, drawing, straightening, marking, grinding and polishing.

            Every single step of the many different stages is exactly inspected and

            documented – in conformity with our claim of maintaining your safety with

            selected quality.

            The pure titanium is supplied in large rolls and runs through a complex

            finishing process. Any defects remaining from the hot rolling process are

            removed, yielding a rod that is practically free of defects right at the beginning.

            It is then cold-formed through multiple annealing stages until it has reached a

            strength value that can be reproduced at any time. This ensures a uniformly

            high quality.




            After finishing, the wire begins its journey to become the “perfect” rod.

            The wire rod runs from the uncoiler, which is what this roll is called,

            to the drawing bench. There it is reduced to the exact dimension specified

            by DENTSPLY Friadent. The titanium wire is pulled through the die with

            complex and coordinated movements of the drawing sledges and

            straightened. Specially trained and experienced technicians closely watch

            the quality of the material on the monitor of the integrated rod surface

            testing system.

            The rods must be cut into precise lengths without crushing the ends.

            This is done by “flying shears” in the direction of the rods.
                                                                                                                      _11



How important this work is, becomes clear at our Mannheim production facili-

ties: If the rods were crushed, they would rattle around in the lathes. After

straightening, the product is ready for the next stage where the surface is ground

and polished. The rods are fed into the pregrinding machine from a bundle

loader, which delivers the rods one by one to the intake rollers from the rod

bundle. Sensors monitor and ensure that every rod is captured by the grinding

machine. The finished, ground and polished rods are finally discharged from the

machine and immediately packed into shipping cases to protect them from              Next issue:
                                                                                     From the titanium rod to the implant.
damage. There is nothing to remind the observer of the original material now.



Final result? We, at DENTSPLY Friadent receive polished titanium rods of

excellent quality.




We express our gratitude for the illustrations to:
Kronos Titan GmbH & Co. KG, Leverkusen
Deutsche Titan GmbH, Essen
Stahlwerk Ergste Westig GmbH / Henning Christoph / Das Bildarchiv
      The implant dental team     A new partnership in the DENTSPLY group of companies has given us a new
      at the EAO:                 drive. Effective January 1, 2004, the team from FRIADENT-SCHÜTZE with the
      Petra Kolinsky, Christian   FRIALIT®-2 / XiVE® and the team from DeguDent with the ANKYLOS® implant
      Weilguni, Michael Fuchs,    system were combined into the new “DENTSPLY Friadent Implantats Division”
      Jacob Zwaanswijk,           of DeguDent Austria Handels GmbH in Vienna under the management of
      Wilhelm Leitgeb,
                                  Jacob Zwaanswijk. This makes us the leading dental implant company in
      Ferdinand Mayer, Robert
                                  Austria. Even before the integration was completed, we made our successful
      Dedl, Helga Hansmann,
                                  debut at the EAO in the Vienna Hofburg, where we first introduced our new
      Norbert Landsgesell,
      Beate Bruckner, Christian
                                  CELLplus implant surface.
      Markovits, Heinz Moser      Customer service is very important to us; this is why our seven marketing
                                  employees will now be covering smaller regions. This enables us to provide
                                  you with more intensive and personal service. Our internal teams will also be
                                  reinforced so we can further improve our range of services and provide a more
                                  effective and smoother flow of information to you and your patients.
                                  Within the international DENTSPLY group, DeguDent Austria will concentrate
                                  on product and system solutions for clinicians and dental laboratories.
                                  We place particular emphasis on integrated system solutions and product
                                  concepts that can ensure high-quality, unified service.




_12   degudent_austria



                                  DeguDent customers benefit from our years of experience in technology and
                                  materials, particularly in the area of implants, noble metals, dental alloys
                                  and ceramics. The quality and compatibility of our products is backed by
                                  multi-year clinical studies.

                                  This initial basis is unique and also ideal for you, because we offer solutions
                                  from one single source from the implant right to the prosthetic restoration.
                                  For example, the esthetic implant restoration with the ANKYLOS® Cercon
                                  Balance abutment coping of zirconium oxide matches optimally with the
                                  Cercon porcelain crown. Our experts also assist the surgeon, dentist and
                                  dental technician to work together, making it easier for you to meet your
                                  patients’ expectations.
                                                                                                                                    _international

living_tomorrow
Into the future as a guest of DENTSPLY Friadent
Who has not already dreamed of the benefits of the high-tech world of
tomorrow? The refrigerator that sends off the shopping list by e-mail while
you are at work in your practice. And the robot lawn mower cutting the
grass automatically. All just a dream? Not at “Living Tomorrow” in Vilvoorde
in Belgium. The house of the future is open for inspection.


On September 27, 2003, “Living Tomorrow” was the site of the Belgian
DENTSPLY Friadent Symposium. The new manager, Aarnaud Schiettekatte,
and his team presented FRIADENT products for the implant dentistry of the
future in this futuristic background. The main topics were XiVE® implants
with the new growth-activating CELLplus microstructure, the implant surface
of the next generation, and PepGen P-15®, the bone regeneration material
of the future, which has been clinically proven to enhance cellular activity
and bone formation. DENTSPLY Friadent is the future of implant dentistry
today – this was the impression that the approximately 90 participants took
with them from the presentation at “Living Tomorrow”.                          The Belgian DENTSPLY Friadent team:
                                                                               Kris Gielens, manager Aarnaud Schiettekatte, Nathalie
                                                                               Geerts, Vera Goes and Christine Smet (left to right)




partner_russia                                                                     D E N T S P LY F R I A D E N T K I C K - O F F
                                                                                                                                              _13



                                                                                   D I ST R I B U TO R M E E T I N G I N RU S S I A




                                                                                   The teams from Stomus, Status, Simko and Satellite.



It has taken us a long time to find the right point-of-contact for the
Russian market. Our new partners Stomus, Status, Simko and Satellite
have now enabled us to service the entire country. After discussing
and specifying the partners’ strategies, the foundation was laid with
new product material about XiVE® / FRIALIT® and ANKYLOS® in Russian,
web site, product registration, first advertising campaign in the most
important dental journals and on-site employee training. The products
were introduced at the “Dental Salon” trade fair in Moscow in
September 2003.
To support our dental partners Stomus, Status, Simko and Satellite
Dr. Dr. Gregor Hundeshagen and his team from Dessau/Germany visited
St. Petersburg in November. During the International Congress
Dr. Dr. Gregor Hundeshagen gave a lecture about “Osteoplasty prior to
implant placement”. The benefits of the ANKYLOS ® implant system
were demonstrated in several live surgeries by Dr. Dr. G. Hundeshagen
                                                                                   Professional training with Dr. Dr. Gregor Hundeshagen
in the Stomus Clinic. Dr. Britta Hundeshagen lectured about the
                                                                                   in Russia
prosthetic aspects with round-table discussions and hands-on training
for the dental technicians. A new chapter has been opened for
DENTSPLY Friadent in Russia and will be continued with events on XiVE ®
in Moscow.
 _ankylos




_14
            ankylos ®_Cercon abutment
                 At present, translucency and opalescence are         The “X technique” (picture on the left) is a
                 desirable qualities for esthetic ceramic restora-    simple procedure that can be used to place the
                 tions. Implant dentistry has been dealing with       implant in the esthetically correct position.
                 the challenge to produce such type of restora-       State-of-the-art dentistry requires that
                 tions because there are always visible metallic      implants have the proper amount of buccal
                 components underneath the restorations. The          bone in order to obtain a nice soft tissue
                 evolution of new ceramic materials has opened        contour. The adequate esthetic position of
                 new opportunities to the dental field. Ceramic       an implant can be determined by drawing an
                 crowns and bridgework components have been           “X” connecting the buccal right papilla to the
                 introduced to the field of implant prosthodon-       left lingual one and vice versa. A suture sling
                 tics and are now routinely used for multiple         can be used to help find out the precise loca-
                 situations to enhance the esthetic result.           tion. Subcrestal positioning of the implant is
                 With the introduction of zirconium ANKYLOS®          important and creates the possibility of a
                 Cercon abutments, DENTSPLY Friadent has set          natural emergence profile aligning the
                 new trends in esthetic implant rehabilitation.       differences between the diameter of the
                 For the first time in dentistry, it is possible to   implant and the adequate diameter of the
                 offer metal-free units in full extension with        emerging restoration.
                 the advantage of connecting them directly to
                 the original titanium implant via a hermetically     Reopening of an ANKYLOS® implant is
                 tight connection. One of the multiple require-       performed very conservatively. Small healing
                 ments for an esthetic implant restoration is the     components are used for three to six weeks
                 precise location of the implant.                     prior to mechanical stimulation of the delicate
                                                                                                                                _ankylos




C L I N I C A L C O N S I D E R AT I O N S O N E S T H E T I C Z I R C O N I U M I M P L A N T C O M P O N E N T S :

T H E A N K Y LO S® C E RCO N B A L A N C E A B U TM E N T



C A R L O S R . P. A R A U J O , D R . O D O N T. , M C O D O N T. , D E P A R T M E N T O F P R O S T H O D O N T I C S ,

U N I V E R S I T Y O F S Ã O PAU LO , S C H O O L O F D E N T I ST RY O F B AU RU , B R A Z I L

M A R I A A N G É L I C A R E H D E R A R A U J O , S P E C I A L I S T I N I M P L A N T S U R G E R Y, M A S T E R S T U D E N T,

F E D E R A L U N I V E R S I T Y O F S A N TA C ATA R I N A C E P I D , F L O R I A N Ó P O L I S , B R A Z I L




_1                                                 _2                                                 _3




connective soft tissue. The literature reports          abutment is partially prepared by the technician.
that connective tissue needs more maturation            However, it is preferable to do the final custo-
time before being mechanically stimulated.              mization directly in the patient’s mouth due to
Esthetic healing components can now be used             its extreme delicacy (figs. 5 a, b, c). Grinding of
to mould adequate soft tissue contours (fig. 1).        the zirconium abutment is perfectly possible
The availability of standard abutments (fig. 2)         and safe yet some material characteristics
might help the clinician at this point to start         must to be considered. Zirconium must only
using the provisional crown (fig. 3).                   be ground under an adequate irrigation other-
The comprehension of advanced contouring                wise, flaws and cracks may occur. Abutment
techniques is mandatory to develop the proper           preparation must result in a correct subgingival
provisional contour, to study future esthetic           extension of the buccal margin. In addition,
results, and to produce an adequate environ-            some preparation may be necessary at the
ment for the impression.                                subgingival abutment section.
The impression technique and the master cast
provide a replica of the soft tissue contour for        Adequate concavities at this part of the abut-
the dental technician. The technician can select        ment can be created with a round bur (fig. 6).
the adequate zirconium abutment and start its           This simple procedure can change the position
customization before sending it to the dentist.         of the natural gingival margin easily. A more
Figures 4 a, b depict the esthetic contour              coronal positioning of the gingival margin
obtained via the provisional crown and its              may be achieved by additional grinding, while
reproduction by an artificial gingiva as a              a little more convexity might place it more
regular laboratory technique. The zirconium             apically.
 _ankylos




_4a           _4b                             _5a                         _5b                      _5c




                    One always has to consider the fact that zirco-         The Cercon system allows for production of a
                    nium abutment surfaces need to be finished              coping with mechanical characteristics that
                    and polished. This procedure recovers the ori-          resemble the metal ones very closely .
                    ginal resistance of zirconium and sometimes             The double-scan-technique can reproduce the
                    may even improve it. So regular rubber wheels           wax-up of the inner as well as of the outer
                    and felt devices can be used to bring back              surface (fig. 7 a, b). Esthetically full-ceramic
_16
                    luster and shine to the zirconium surface. After        crowns can now be used in conjunction with
                    the abutment has been completed in the                  the zirconium abutment reproducing natural
                    patient’s mouth, it is sent back to the laboratory.     translucency, excellent color, opalescence and
                    The lab technician positions it back on the             still maintaining a very good resistance.
                    model cast and, taking advantage of the new
                    metal-free units, produces a full-ceramic               After fabrication of the crown, the dental
                    crown. The new CAD CAM technologies make                technician provides an acrylic matrix or a
                    it possible nowadays to fabricate a very                template which will help the clinician to place
                    resistant, but also a very esthetic translucent         the abutment in the patient’s mouth precisely
                    crown. Due to the fact that state-of-the-art            (fig. 8 a, b). The conical or tapered characteri-
                    implant dentistry requires that an esthetic             stics of the ANKYLOS® system, which have
                    implant is placed in a more lingual position            been scientifically and clinically proven over
                    in order to have a thicker buccal plate and a           the past 15 years, can now be used with its
                    more stable soft tissue margin, sometimes it is         full range of advantages together with the
                    difficult to have adequate occlusal clearance at        possibility of reproducing perfectly natural
                    the lingual aspect.                                     teeth.




_6          _7a                        _7b                           _8a                                 _8b
                                                                                                     _ankylos




Zirconium Cercon Balance abutments can            Due to the pro-active cell adhesion, an
                                                                                                          _17
now be connected to ANKYLOS® implants             accelerated cell spreading and activation is
providing long-term bone support and over-        initiated with rapid osteoblast differentiation
laying esthetic stability of the soft tissue.     and accelerated bone formation.
However, even greater possibilities will open
up in the future. Besides the taper connection,   Consequently, the beautiful esthetic results
different behavior characteristics of bone        will come together with the faster healing
growth on the implant have been observed.         of the peri-implant bone, diminishing the treat-
The new FRIADENT CELLplus surface is starting     ment time by still guaranteeing wonderful
to establish itself as the latest scientific      esthetics.
achievement to change the behavior of osteo-
blasts allowing them to dock into the micropits
of the new surface. Consequently, the
bone-to-implant contact is enhanced in a
much faster way than before. The cellular
extensions of osteoblasts (filopodia) find
ideal retention with multiple contacts in the
CELLplus microstructure.




                                                              Prof. Dr. Carlos
                                                              dos Reis P. de Araujo
                                                              Maria Angélica Rehder Araujo
                                                              Rua Alfredo Ruiz, 1239
                                                              BAURU-SP-BRAZIL
                                                              17040-350
                                                              carlos@fob.usp.br
 _ankylos




_18         syncone_immediate loading
                    I M M E D I AT E L O A D I N G W I T H

                    T H E A N K Y LO S ® S Y N CO N E CO N C E P T

                    D R . D I T T M A R M AY



                    Implant prosthodontic rehabilitation with a fixed single-tooth or bridge

                    replacement is now considered a routine procedure given suitable anatomical

                    prerequisites. The retention and support of complete or partial dentures by

                    implant superstructures are also no longer a problem. If one follows recent

                    scientific publications and conferences, it becomes clear that the latter

                    indications are now the focus of practice and science that cannot be over-

                    looked. Bar constructions on two or four interforaminally placed implants

                    are considered standard anchors for complete mandibular overdentures.

                    Ball-and-socket attachments are also recommended and should not be

                    overlooked. However, telescopic connections offer better stability for

                    complete overdentures.
                                                                                 _ankylos




Implants can also be easily used to compensate the loss of strategic abut-

ment teeth. Telescopic abutments and also the well-known retentions with

ball and socket are frequently used as superstructures with this indication.

It is also no longer a problem to anchor partial or complete overdentures over

implants for a successful rehabilitation with full chewing function.

An important point of discussion at present is the time of implant loading.

More than 20 years ago Ledermann showed the successful delivery of a

prosthesis immediately after surgery in the edentulous mandible on four

interforaminally placed implants primarily splinted with a bar. All other

known retention and support elements are only occasionally the subject of

reports related to immediate loading.




                                                                                      _19




The ANKYLOS® SynCone concept was developed more than five years ago for

immediate loading and restoration of the edentulous mandible. Four inter-

foraminally placed ANKYLOS® implants are secondarily splinted with the

prosthesis via tapered crowns. The innovation of this system is the use of

prefabricated tapered abutments and SynCone caps with an inclination angle

of 4°, which are positioned accordingly immediately after implant placement

(figs. 1 - 5). The great advantage of this is that the primary restoration

can be carried out without requiring expensive assistance from a dental

laboratory. The resulting reduction in the time required means that the

patient can leave the practice during the anesthetic phase.
 _ankylos




                      A detailed description of the surgical-prosthetic procedure for the SynCone

                      concept would take up more space than is available for this article. The time

                      of implant placement will also not be discussed. In principle, the ANKYLOS®

                      implant is well suited for immediate implant placement. It ensures very high

                      primary stability due to its progressive special thread. This article will

                      concentrate on describing clinical examples taking into consideration the

                      range of indications for this system.
_20




            _1   _2                _3                                      _4



                      The experience and results of many years with close examination of the

                      standard pre-operative criteria have demonstrated that immediate restoration

                      in the partially edentulous mandible and maxilla and in the fully edentulous

                      mandible can be very successful with SynCone.



                      The edentulous mandible

                      After simultaneous placement of four ANKYLOS® implants, the taper abutment

                      is seated taking into consideration the soft tissue thickness. Depending on

                      the time of extraction, the edentulous mandible may already be showing

                      signs of atrophy, and simultaneous preparation of the implant site may no

                      longer be possible. The resulting different implant axis inclination can be

                      corrected with the 15° angled abutment to allow parallel insertion of the four

                      tapered crowns polymerized in the prosthesis. The abutment, in the internal

                      cone, is adjusted until it is parallel to the adjacent abutments. The parallel

                      gauges available in the system are used for a visual check (figs. 4 - 11).
                                                                                                            _ankylos




After tightening the clamping screw in the tapered coping to a torque of 15 Ncm a

saliva-proof wound closure is accomplished. A few weeks after surgery a fixed,

non-irritating collar of connective tissue is formed above the implant shoulder in

the region of the reduced-diameter neck of the taper abutment (fig. 6).

Consequently, vestibuloplasty is not necessary. After the surgical phase the posi-

tioned tapered crowns are polymerized in the prepared prosthesis. The resin

hardens in the patient’s mouth in occlusal position.




                                                                                                                 _21

_5                             _6                                                 _7



After finishing and polishing the overdenture, which is now exclusively

implant-supported, is delivered. The secondary splinting of the implants is            Fig. 5
                                                                                       one week post-op
retained for two weeks, except for an interruption after one week for cleaning

the wound and to remove the sutures. Besides the mandatory antibiosis,                 Fig. 6
                                                                                       two weeks post-op
antiseptic mouthrinse and soft food only are recommended for this period.
                                                                                       Fig. 7
A new rotary, atraumatic, transgingival tissue punch is now available from             four weeks post-op
DENTSPLY Friadent, which also marks the cortical bone with a central milling

tool (figs. 5-7). In appropriate anatomical conditions, this punch developed by

Jesch of Vienna, can greatly reduce the time required for the surgery (fig. 8).



Replacing strategic abutment teeth

Bilateral support of partial overdentures is extremely important for their function.

The loss of a molar can be extremely significant for the life of the residual

dentition and result in significant problems with the chewing function.

Two ANKYLOS® implants can be immediately loaded here to replace the lost
                                                                                       _8
_ankylos




                 abutment teeth as immediate or delayed implant placement based on the

                 SynCone principle.

                 Under certain circumstances, assistance from a dental laboratory may be

                 required for preparing the partial prosthesis for the tapered crowns (figs. 9 - 15).




      _9   _10                _11                                    _12



           _13   The edentulous maxilla

                 Assessment of the bone quality and quantity is of course extremely important

                 for planning and use of SynCone in the maxilla. If the local bone condition is

                 such that there are no problems with implant site preparation and four or six

                 implants have sufficient primary stability, the experienced dentist can also

                 apply the SynCone immediate loading concept successfully in this region.
           _14   The anatomical conditions of the maxilla must be considered when aligning the

                 taper abutment in parallel. The palatal axial inclination of the implants placed

                 requires that the 15° and 22.5° angled coping be used almost exclusively

                 (figs. 16-19).



                 Conclusion
           _15
                 The ANKYLOS® SynCone system for immediate loading is noted for its

                 prefabricated components. As a result, time-consuming dental laboratory pro-

                 cedures become unnecessary. The total treatment costs are reduced as well as
the period required for treatment. The patient can leave the practice after

about two hours during the anesthetic phase. The implant-supported

prosthesis as a wound cover provides optimum permanent coverage of the
                                                                                                       Dr. med. Dittmar May
wounds for a week and reduces swelling and pain to a minimum.                                          Ernst-Becker-Str. 13
                                                                                                       44534 Lünen
                                                                                                       Germany
Delayed restoration of SynCone will be the subject of a second article.




                                                                                                                              _23




_16                             _17                                        _18



                                                                                                 _19


Cost savings with ANKYLOS® SynCone
Immediate interforaminal loading of four implants in the mandible

                                         Bar*                             SynCone


Dental fee**                              38 %                            37   %
Laboratory costs***                       38 %                             6   %
Material costs                            24 %                            19   %
Total                                    100 %                            62   %


Finished after                           > 8 hours                approx. 2 hours
Sessions until delivery                   2                               1



The fee varies greatly from dentist to dentist, while the relation between the various cost
blocks generally remains constant. For this reason, actual charges have not been used. The
total fee for the bar has been set at 100%, and all other values are calculated with reference
to that. While the share of the dentist’s fee with the bar is only 37%, at exactly the same
amount it rises to 60% if SynCone is used.

Short treatment time with high-quality connection components and a competitive price!




* Oval bar, without extensions, ** 2.3 times the standard rate, *** without overdenture
      Fig. above
      Histology of peri-implant bone
      around immediately loaded implants
      showing dense bone formation
      in the cervical and middle section.
      Staining: toluidine blue.
                                             B O N E - I M P L A N T I N T E R FA C E A R O U N D T I TA N I U M

                                             I M PL A N TS U N D E R D I FFE R E N T LOA D I N G CO N D I T I O N S .

                                             A H I S T O M O R P H O M E T R I C A L A N A LY S I S I N T H E M A C A C A

                                             FA S C I C U L A R I S M O N K E Y

                                             G . E . RO M A NO S , C . G . TO H , C . H . S I A R ,

                                             H . W I C H T, H . YA C O O B , G . H . N E N T W I G

                                             J P E R I O D O N TO L 2 0 0 3 ; 74 ( 10 ) : 1 4 8 3 - 1 4 9 0




_24   bone-implant_interface
                                             Introduction: Bone healing around titanium implants is dependent on

                                             implant-interface loading conditions. The aim of this study was to evaluate

                                             histomorphometrically bone response around unloaded, late and immediately

                                             loaded implants with a progressive thread design that were placed in the

                                             mandibular posterior region of monkeys.



                                             Methods: Nine adult monkeys (macaca fascicularis) were used in this study.

                                             After extraction of the second premolars, first and second molars in the

      Fig. below                             mandible, the bone was allowed to heal for a period of 3 months. Six 8 mm
      High magnification of the
      peri-implant soft tissue with thin     long, 3.5 mm diameter ANKYLOS® implants were placed according to the
      sulcus epithelium, ingrowing
                                             following protocol. In two of the monkeys, six implants were placed and left
      connective tissue and macrocellular
      formation. Apically, the ingrowth of   to heal submerged for 3 months (group A). In seven monkeys, 21 implants
      the epithelium is not deep. A dense
      fibrous tissue collar is surrounding   were placed in one side of the mandible and loaded after 3 months of
      the abutment in the cervical region.
                                             submerged healing (group B). The group B implants were loaded with
      Staining: toluidine blue.
                                             temporary resin bridges at the same time as another 21 implants were loaded
      _1   _2                                                     _3



            immediately (group C) after placement in the contralateral side of the

            mandibles of the same monkeys. The occlusion of groups B and C implants

            was checked for optimal relationship of the resin bridges that were replaced

            1 month later with metal bridges and loaded for a further period of 2 months.

            The group A animals were sacrificed after 3 months of submerged healing

            without loading; group B and C animals were sacrificed only after 3 months

            of implant loading. Specimens were examined histologically and histomor-

            phometrically.



            Results: All implants osseointegrated without presenting any gap in the

            metal-bone interface. Dense cortical bone was found in contact with the

            implant surfaces. Group A implants characteristically demonstrated cancel-
_26
            lous bone with loose connective tissue at the interface. Group B and C

            implants showed a thick cortical plate with extensive bone trabeculae

            formation. There was a significant difference in bone-to-implant contact

            (BIC) at the interface between the various loading conditions. No significant

            difference (p 0.05) was found between group B and C implants. There
                         ^




            was an increased area of bone (BA) within the threads as well as around the

            apices of group B and C implants.



            Conclusions: Implant loading might have stimulated increased bone

            formation at the interface and thus may be a key factor in influencing

            positive osseointegration. In addition, immediately loaded implants may

            osseointegrate in a similar manner as delayed loaded implants.




      _8    _9                                      _10
_4                       _5                                        _6                _7



Legends to Figures


Fig. 1: Non-loaded ANKYLOS® implants in the mandible: The implant has
osseointegrated. The loose bone structure, filled with fat spaces surrounds the
titanium surface. This is a sign of missing functional irritation.


Fig. 2: Surgical site: The abutments were connected to the implants and loaded
immediately.


Fig. 3: Immediately loaded ANKYLOS® implants after primary splinting with the
provisional crowns with occlusal contacts at the intercuspal position.


Fig. 4: Specimen of loaded implants from the mandible for histological
examination.


Fig. 5: Histological examination showing peri-implant new bone formation around
delayed loaded implants. The implants have osseointegrated.


Fig. 6: Histological examination of immediately loaded implants shows newly
formed bone at the titanium interface, specifically around the implants and the                                 _27
adjacent tooth (bone reaction due to functional loading).


Fig. 7: New bone formation around the immediately loaded ANKYLOS ® implants is
in close correlation with the implant surface.


Fig. 8: New bone formation around immediately loaded ANKYLOS ® implants in the
posterior mandible: The Howship lacunae are filled with active cells (toluidine
blue).


Fig. 9: Cross section of the posterior mandible with immediately loaded implants.
The remodeled bone at the interface represents the formation of new, lamellar
bone, as a reaction to functional loading.


Fig. 10: Fluorescence marking of immediately loaded implants at the interface:
The yellow marking at the bone-to-implant interface is a proof of vital, new bone.


                                                                                          Priv. Doz. Dr. G.E. Romanos
                                                                                          ZZMK Frankfurt
                                                                                          Poliklinik für ZÄ Chirurgie
                                                                                          u. Implantologie
                                                                                          Theodor-Storm-Kai 7
                                                                                          D-60590 Frankfurt
                                                                                          Dr.G.E.Romanos@t-online.de
 _ankylos




                      R E S T O R AT I O N O F M A N D I B U L A R F R E E - E N D

                      E D E N T U LI SM W I T H A N K Y LO S® I M PL A N TS I N

                      REDUCED BONE VOLUME

                      D R . J O A C H I M E I F E R T, H A L L E , G E R M A N Y




_28         free-end_edentulism

                      Implant-supported reconstructions in the lateral dental region, particularly

                      free-end edentulism, make up about half of all implant placement cases in

                      practice. If the bone volume is sufficient, implant restoration in this region

                      generally presents no problems. Unfortunately, in this region of the jaw, both

                      in the maxilla and the mandible, dynamic atrophy of the alveolar bone often

                      occurs in correlation with tooth loss. As a result, the residual bone height

                      makes implant placement difficult and requires bone remodeling treatment.

                      The following techniques are now an option:



                      ■ Grafting treatment with autogenous bone grafts

                      ■ Bone grafting materials

                      ■ Distraction osteogenesis
_1                                     _2                                         _3




Vertical grafting of the dental arch and distraction osteogenesis are very        The x-ray image shows the
                                                                                  status after surgery. After ten
demanding procedures, which require a precise indication.                         days, the bone gap has been
                                                                                  widened to 11 mm.
Distraction osteogenesis improves the bone volume by 10 to 12 millimeters
                                                                                  The remaining teeth requiring
within three months. The great advantage of this method is the simultaneous       treatment were restored with
                                                                                  porcelain restorations and
extension of the covering soft tissue. It requires a sufficiently wide alveolar   metal-ceramic crowns –
                                                                                  as requested by the patient.
ridge. For distraction, a segmental osteotomy is conducted in the existing

residual bone after securing an adequate bone base. Subsequently, the two

bone halves are connected with a distractor and the mucous membrane is

sutured. After five to seven days the distraction begins with a set screw being

turned twice a day (approximately one millimeter). With appropriate instruc-

tion, the patient can also do this independently to the planned height.

The slow stretching of the bone fragments induces the formation of new bone

in the gap; the soft tissue grows to match at the same time. After this process

the distractor remains in situ for eight weeks. The implants can be placed

after removal of the distractor.
                    Case study

                    A 43-year old patient presented in the office desiring a fixed free-end

                    restoration in the mandible and simultaneous improvement of the esthetic

                    and functional situation of her teeth. The x-ray image (fig. 1) showed a

                    highly atrophied mandible after loss of teeth 36 and 37 and all wisdom
               _4
                    teeth. Some teeth had semi-permanent fillings.
               _5



                    The patient was not satisfied with the esthetic situation in the anterior

                    region. Because of the low residual bone height, a digital volume sectional

                    image was made for three-dimensional assessment of the bone (fig. 4).




      _9/_10
_30



                    A residual bone height of five millimeters could be measured over the inferior

                    alveolar nerve; the bone width was 10 millimeters. After detailed discussion

                    with the patient and an explanation of other options, distraction osteogenesis

                    was selected as the means of improving the bone volume.

               _6
                    Surgery was performed under intubation anesthesia (anesthetist:

                    Prof. Dr. Dr. Hidding, Director of the Clinic for Oral and Maxillofacial Surgery,

                    Bethesda Hospital, Mönchengladbach, Germany). Subsequently, the segmental

                    osteotomy was conducted after placement of the distractor (Martin)

                    (figs. 5 , 6 , 9) and the wound was sutured. The x-ray image (fig. 1) shows the

                    status after the surgical procedure.
               _7

                    The rest of the treatment was carried out in the office on an outpatient

                    basis. After one week, the patient started to turn the distractor twice a day,

                    corresponding to about one millimeter (fig. 8). After ten days, the bone gap

                    was widened to 11 millimeters (fig. 2). Three months later, the distractor was




               _8
removed in the office (fig. 11) and well-vascularized, wide bone with a

vertical height increase of 11 millimeters could be detected (fig. 10).

Four weeks later, ANKYLOS® implants B 11 and C 8 were placed (fig. 12).

According to Misch the bone quality could be classified into classes D I and

D II. For this reason, implant placement immediately after removal of the
                                                                                   11_
distractor would also have been an option. After a healing phase of three

months the metal-ceramic crowns on standard copings were placed in the

implants (figs. 3 , 13 , 14). The Periotest measurement yielded the value -4 for

implant 36 and -6 for implant 37. The remaining teeth that required treatment

were restored with porcelain and metal-ceramic crowns, a result that met the

patient’s desires and expectations.

                                                                                   12_

In conclusion, it can be noted that distraction osteogenesis is a very good

option where the bone volume in the lateral dental region of the mandible

is reduced. However, specific anatomical conditions are required.

When selecting patients, note that the patients must develop an appropriate

attitude to this type of treatment.
                                                                                         _31




                                                                                   13_




                                                                                   14_

                           Dr. Joachim Eifert
                           Leipziger Straße 85
                           06108 Halle
                           Germany
                           Praxis@dr-eifert.de




                                                                                   15_
  _ankylos




                  ONE-SESSION SINUS LIFT WITH PEPGEN P-15® OR

                  O STE O G R A F® / N A N D A N K Y LO S ® I M PL A N TS

                  D R . D R . S T E FA N B E R G




             pepgen p-15 _sinus lift        ®




                  After decades of consolidation, implant             The one-stage method generally requires a

                  dentistry is today well-established as a dental     minimum bone height of four to five milli-

                  specialty. We are now in a position to find new     meters to ensure that the implants can be

                  – expanded – indications. As a result, sinus        placed with sufficient primary stability. The

                  floor elevation is considered an obvious and        sinus floor elevation, particularly in the event

                  accepted procedure. This technique is used to       of multiple implant placements in this region,
_32
                  restore the atrophied lateral maxilla for           is conducted through a lateral window.

                  implant placement by elevating the floor of the

                  maxillary sinus.                                    Apart from the correct technique selection,

                                                                      suitable material is decisive for the success of

                  Various techniques are used depending on the        implant placement. With their proven progres-

                  volume of bone required. A detailed diagnosis       sive thread, ANKYLOS® implants offer high

                  in the planning phase – with input from the         primary stability, even in bone of reduced

                  patient – helps with the selection of the correct   quality. A large, multicenter study has been

                  procedure. This also clarifies whether a one or     able to demonstrate that the success rate of

                  two-stage procedure will be selected. The           placing ANKYLOS® implants in local bone does

                  one-stage procedure has some advantages.            not differ from the success rate of ANKYLOS®

                  The time required can be arranged more easily,      implants in augmented regions. Whether the

                  the surgical trauma is minimized, and the           implant is placed in the maxilla or mandible

                  improvement of the bone site is more cost-          does not change the probability of survival.

                  efficient with simultaneous implant placement.      Autogenous bone is still considered the gold

                  However, the anatomical conditions of the           standard when it comes to selecting the bone

                  specific case must also be considered.              grafting material.
                                                                                                              _ankylos




                      _1                                                       _2                        _3




It combines all the parameters required for       unlimited availability and minimum stress on

new bone formation. They include the bone-        the patient. Most bone replacement materials

inducing cells and their precursors and the       are physiologically passive, meaning that they

non-cellular components, such as BMPs, GFs        simply fill defects; they do not induce new

and other osteoinductive substances. Finally,     bone formation (osteoconductivity). In contrast

the autogenous bone not only forms a passive      to such substances the PepGen P-15® bone
                                                                                                                   _33
osteoconductive matrix but, with its organic      replacement material actively supports new

components, it acts as a physiological frame-     bone formation in a unique manner. A peptide

work for bone-inducing cells to bond and          of 15 amino acids is irreversibly bound to the

activate them. However, harvesting autogenous     surface of the hydroxyapatite granules.

bone, which requires an additional surgical       This peptide is an exact match to the cell-

procedure at the donor site, generally involves   binding domains of the naturally occurring

increased morbidity and increased cost for        Type I collagen.

patients. In addition, the increased resorption

kinetics of autogenous bone, which often          A bond to these domains or similarly to the

requires a significant overcontouring of the      peptide P-15 is the signal for proliferation and

bone defect, are the main reasons for the         differentiation of bone-inducing cells. This

increasing use of bone replacement materials.     prerequisite is decisive for initializing the casca-

                                                  de of events that ultimately leads to new bone

All bone replacement materials must be            formation. The increased and immediately

measured against the gold standard. They          available cell binding points on PepGen P-15®

must have at least the bioactive potency of       can optimize cell binding, enabling the formation

autogenous bone in combination with an            of a large quantity of vital bone in a short time.
  _ankylos




                                         _4                    _5                        _6




             To fill large defects (sinus floor elevation)      Then the maxillary sinus was filled with a

             PepGen P-15® can be mixed with other hydro-        mixture of OSTEOGRAF® / N and PepGen P-15®

             xyapatite materials (OSTEOGRAF® / N; FRIOS®        in a ratio of 2:1. This compound was mixed with

             ALGIPORE®) in the ratio of 1:2 to reduce costs     blood. Then the bone cavity was finished with

             for the patient.                                   the tapered grinder to receive the implants

                                                                (fig. 4). The ANKYLOS® implants were placed
_34
             Material and Method                                subcrestally in accordance with the surgical

             The 46-year old patient presented with a tooth-    protocol to ensure undisturbed healing

             bound gap and a free-end situation in the          (figs. 5 and 6). Subsequently, the wound was

             maxilla (fig. 1). An implant restoration in the    closed with sutures (fig. 7).

             maxilla was planned with fabrication of a fixed    After a reduced healing time of five months

             overdenture (regions 16, 25, 26, 27). Because      the ANKYLOS® implants were uncovered

             of the reduced bone volume a sinus floor           with a laser. The referring dentist provided the

             elevation was necessary in both quadrants          prosthetic restoration (fig. 8).

             (fig. 2). The maxillary sinus was divided by

             strong septa. The residual height of the local     Result

             bone was sufficient for simultaneous place-        The clinical checks and the radiological images

             ment of the implants. Initially, the maxillary     showed that all implants were successfully

             sinus was exposed by an external access and        osseointegrated. The prosthetic rehabilitation

             the Schneiderian membrane was lifted (fig. 3).     could be implemented according to the

             The implant site was now prepared to the step      treatment plan. All implants were completely

             of the parallel-walled drill shaft hole.           loaded.
                                                                                       _ankylos




_7              _8                                  _9   _10




Discussion

Extended surgical techniques and selection

of the correct materials have been able to

significantly reduce the time required for

prosthetic rehabilitation of patients. As a

result, a second surgical procedure to harvest
                                                                                             _35
autogenous bone is no longer necessary. This

eliminates the associated increased morbidity

and expense for the patient. PepGen P-15®

can actively support the formation of new

bone. The large number of cell-binding peptides

on its surface combined with the activation of

the bone-inducing cells forms vital, high-quality

bone in a short time.



The ANKYLOS® implant with its progressive

thread ensures primary stability even in

difficult bone conditions and in grafted
                                                               Dr. med. Dr. med. dent. Stefan Berg
regions.                                                       Ebertplatz 2
                                                               50668 Köln/Germany
                                                               www.Dr.Dr.Berg@t-online.de
_cellplus




                      FRIADENT® CELLPLUS –

                      F R I A L I T ® - 2 W I T H N E W S U R FA C E –

                      A C A SE STUDY

                      D R . S T E F F E N K I S T L E R , D R . G E O R G B AY E R ,

                      DR. FRANK KISTLER, L ANDSBERG, GERMANY




_36         cellplus_practice
                      Both science and industry have dealt with the topic of surface structure of

                      titanium implants for years. Even though various parties seem to be

                      introducing “the” revolutionary surface over and over again, until now the

                      only scientific confirmation has been that artificially roughened surfaces

                      are superior in the healing phase to surfaces that have only been machined.

                      With reference to long-term stability no significant clinical differences among

                      the various surface characteristics have yet been established. However, in

                      vitro studies can clearly indicate that certain methods of surface conditioning

                      can yield significantly better and longer lasting results, particularly in the

                      initial phases during the healing and bone deposition processes. This is also

                      reflected over the long-term in the clinical success statistics of implants

                      manufactured with this type of treatment. The FRIALIT®-2 stepped screw has

                      had an artificially roughened surface since its introduction to the market,

                      and the long-term results confirm the value of this treatment. However, the

                      scientific developments over the past ten years must also be taken into

                      account. In experiments, the newly developed FRIADENT® CELLplus surface
demonstrates significantly improved values, particularly with initial adhesion

of osteoblasts. This makes it an excellent clinical means of achieving

safe healing of implants and a higher osseointegration rate under loading,

particularly in defective bone.

It should further increase the reliability of implant treatment, especially

in difficult anatomical regions. These are the regions that will always pose

a challenge to implant dentistry in the future.



The following case study demonstrates the surgical handling of

FRIALIT® CELLplus implants.

The 54-year old patient presented in our practice after the loss of teeth 21 to 23.

The case history and diagnosis showed that the loss had been caused by

years of osteitic processes in this region, which could never be properly treated,

with the final result that the only remaining option was to remove the teeth.




* FRIALIT® CELLplus study implants with TempBase, not normally available.
      The diagnosis indicated that the bone structure was likely to be defective,

      in spite of the favorable clinical situation. The implant region was completely

      uncovered after a palatally offset crestal incision. The very thin compact bone

      of the alveolar ridge and the strong tendency to bleeding were notable features

      in this case.




_38



      Implants were planned for regions 21 and 23, while region 22 was not

      selected as an implant region. An implant-supported bridge solution with a

      pontic at 22 was planned for the subsequent prosthetic phase to achieve a

      more esthetic and above all predictable result.



      The next steps were to determine the implant position and axis with a surgical

      template and then to prepare the implant site with the standard FRIALIT®-2

      stepped drills. Stepped drills, 15 mm long and 4,5 mm in diameter, were used

      at each site. The bone quality at both implant sites was between D III and D IV.

      When the implants with the new surface are removed from the package, the

      lighter color, which is similar to the HA-coated surfaces, is immediately

      obvious when compared to the old surface structure. While placing the

      implants into the prepared bone site, the strong affinity of the surface to

      fluids, in this case blood, becomes obvious. It is clear that four related

      properties have a direct influence on implant healing: the chemical composition

      of the surface, the surface energy, the surface roughness and the morphology.
                                                                                                            _cellplus




The high degree of microroughness of the implants could be noticed clinically

with an unexpectedly high torque and high primary stability of the implant in

defective bone. The FRIOS® Unit E recorded an insertion torque of more than

35 Ncm with both implants – a value that many authors consider sufficient for

immediate restoration of the implants.




                                                                                                                    _39



After placement of the implants, the labial bone deficit at implant 23 was

augmented with autogenous bone and covered with a collagen membrane.

After closure of the wound a removable provisional denture was delivered.

Because of the unusually high primary stability, uncovery of the implants,

the prosthetic restoration was planned as early as three to four months

after surgery.

The extent to which the new FRIADENT® CELLplus surface offers clinically

significant advantages compared to the old FRIADENT® DPS surface will be

demonstrated in long-term studies. The histological results of the in vitro and

in vivo studies and our own experience with the surgical treatment after

placing around 120 implants of the previous model are certainly very              Dental Practice
                                                                                  Dres. G. Bayer, F. Kistler,
promising. Therefore, we believe that, particularly in difficult situations,      S. Kistler, A. Elbertzhagen
                                                                                  Von-Kühlmann-Str.1
this new surface will offer a predictable and successful implant restoration
                                                                                  86899 Landsberg am Lech/Germany
for our patients.                                                                 steffenkistler@web.de




* FRIALIT® CELLplus study implants with TempBase, not normally available.
  _pepgen


                P E P G E N P - 1 5 ® S T U D Y G R O U P E S TA B L I S H E D I N M A N N H E I M

                PepGen P-15® is the only biomimetic bone replacement material in the

                world that actively supports and accelerates the formation of new bone.

                The synthetically manufactured peptides on the surface of the particles,

                which consist of 15 amino acids, correspond to the cell-binding domains

                found in natural Type I collagen. The mesenchymal osteoblast precursor cells

                bind to the synthetic peptides (P-15) as easily as to the analogous structures

                in the collagen. This biochemical stimulus brings about their differentiation

                and an increased proliferation rate. An increased number of contact points

                on the PepGen P-15® enables binding to an increased number of cells. This

                accelerates natural bone formation. Cell binding is therefore the prerequisite

                for osteogenesis.

                The prerequisites for clinical success are experience and knowledge –

                apart from selection of the correct material!




_40         pepgen p-15 _study group           ®
                                                                                                               _pepgen


This is why the PepGen P-15® study group was established after the 10th

International FRIADENT Symposium in Mannheim. The international members

of the group, clinicians and practitioners met for the first time in Mannheim to

exchange experience and knowledge accumulated from clinical studies.



DENTSPLY Friadent is increasing its competence in bone regeneration with

this concentrated knowledge – for the benefit of all dentists and maxillofacial

surgeons involved in bone grafting. After an address of welcome from

Dr. Werner Groll (DENTSPLY Friadent General Manager), Dr. Jörg Neugebauer

(University of Cologne) started with a lecture on grafting in different indications.




Visiting Prof. Dr. Dr. A. Valentin (Mannheim) presented an overview of the pos-        Dr. Werner Groll,
                                                                                       Dr. Jörg Neugebauer,
sibilities of receptor engineering, which described the beginnings of a new era        Vis Prof. (Nippon Dental
in bone rehabilitation and its practical use today with PepGen P-15®.                  University Japan)
                                                                                       Dr. Dr. Andreas Valentin,
Dr. Jochen Weber (DENTSPLY Friadent) focused on the goals and possibilities            Dr. Jochen Weber

of a PepGen P-15® study group and offered preliminary views of future

developments.



Finally, new research results were outlined with respect to the behavior of

osteoblasts on the surfaces of various grafting materials. The significantly

increased adhesion of vital cells to the PepGen P-15® granules and their

biological potency was clearly demonstrated. The concluding discussion

extended long after the official end of the meeting. The experts were

unanimous in their opinion that this new product and its clinical possibilities

are very exciting. We are looking forward to the next meeting.
      _news


                           XI V E ® TG C E LLPLU S R E PL AC E S FR I A LO C ®



                           XiVE® TG CELLplus is now fully available with all the advantages of the

                           FRIALIT® / XiVE® platform concept. For this reason, DENTSPLY Friadent has

                           decided to stop production of the FRIALOC® implant line at the end of the year
                FRIALOC®
                screw      2003. “XiVE® TG CELLplus offers significant advantages compared to the well-

                           known FRIALOC® system,” says Werner Groll, General Manager responsible for

                           development. The movable abutments greatly extend the range of indications,

                           and a wider range of implant lengths and diameters give the user maximum

                           flexibility during surgery.

                           The unique FRIADENT® platform technology allows the same prosthetic

                           components and procedures to be used with the identical implant-abutment

                           connection, regardless of whether XiVE® CELLplus, XiVE® TG CELLplus or

                           FRIALIT® CELLplus is used in practice.




_42           frialoc ®_xive tg cellplus



                           Now that XiVE® TG is available with the new FRIADENT® CELLplus surface

                           since December 1, 2003 it has yet another advantage over the FRIALOC®

                           system. The company believes that there is no better concept for easy

                           and fast single and multiple implant restoration. DENTSPLY Friadent has

                           developed two very attractive offers for users who want to upgrade from

                           FRIALOC® to XiVE® TG.



                           Please contact your local DENTSPLY Friadent distributor for more information.
                                                                                                                         _news


SMALL BUT VERY EFFECTIVE



How to become a referring dentist? And what criteria does a referring

dentist use to select the best implant surgeon?



Both are well aware that implant dentistry defines the prosthetics of

the future. One small but important innovation makes it easy to start

out in implant prosthodontics and simplifies teamwork with surgical

colleagues: the Mini Prosthetic Set from DENTSPLY Friadent.



This compact set contains all the instruments that the dental specialist

needs for prosthetic restoration of implants in one compact, sterilizable

plastic tray, which means exactly three. The Mini Prosthetic Set is availa-

ble for ANKYLOS® and for both FRIALIT® and XiVE®. It contains the three

essential instruments for implant prosthetics.


                                                                              complete_set                                       _43




depending on the system.
                                                                               Article no. 31036165     Article no. 46 - 7000:
                                                                               ANKYLOS® Mini            FRIADENT®
The Mini Prosthetic Set makes it easy and economical to start out in           Prosthetic Set           Mini Prosthetic Set
                                                                               Contents: ANKYLOS®       (for FRIALIT® and XiVE®)
implant prosthetics with DENTSPLY Friadent. Even better, the prosthetic        prosthetic ratchet,      Contents:
                                                                               1.0 mm hex screwdriver   FRIADENT ratchet,
set gives maxillofacial surgeons their most convincing argument for
                                                                               and setup aid            0.9 and 1.22 mm hex
referring dentists to work with them to establish a successful and                                      screwdriver, short

profitable partnership for both sides. The Mini Prosthetic Set allows both

dentist and surgeon to concentrate on what is important – and to deliver

the optimum restoration for their implant patients. The Mini Prosthetic

Set for ANKYLOS® and for FRIALIT® / XiVE® will be available from February

2004. Order the Mini Prosthetic Set for your referring dentist – you don’t

need anything else to start out in implant prosthetics!
_eao


                    EAO 200 3 IN VIENNA

                    IN FOCUS: FRIADENT® CELLPLUS




       eao_vienna   The 12th annual EAO (European Association of Osseointegration) meeting was
                    held in Vienna from October 9 to 11, 2003. Around 1800 delegates from all
                    over the world traveled to the Vienna Hofburg to see the latest trends and
                    technologies in implant dentistry against the opulent background of the
                    former Habsburg empire. DENTSPLY Friadent, as a Founding Gold Sponsor of
                    the EAO, was also a sponsor of the congress in 2003.

                    FRIADENT® CELLplus – the next generation implant surface
                    This was the DENTSPLY Friadent slogan used to introduce the FRIADENT®
                    CELLplus surface innovation at an international event.
                    Numerous delegates to the congress took the opportunity to see live and in
                    3D the unique combination of properties in this new implant surface at the
                    DENTSPLY Friadent booth:

                    ■   Unique three-dimensional microdesign for optimum osseointegration
                    ■   Excellent wetting properties for maximum biocompatibility
                    ■   Increased cell adhesion for accelerated new bone formation
                    ■   Improved bone quality for predictable long-term success

                    The view through the 3D-glasses made it clear that the perfect interaction of
                    biology and engineering is the key to the innovations of the future. Natural
                    structures that can be imitated to yield valuable potential for optimizing the
                    design of the implant surface of tomorrow. These speculations have become
                                                                               _eao




reality with the FRIADENT® CELLplus surface. With its optimum synergy of
biological functional principles and leading-edge technology FRIADENT®
CELLplus imitates nature more closely than any other implant surface.
It offers implant dentistry new perspectives for accelerated implant therapy
and a maximum degree of safety in treatment.

FRIADENT® CELLplus – scientifically proven and clinically tested
Prof. Rachel Sammons (Birmingham) and Prof. A. Novaes (São Paulo)
presented comprehensive results of studies on the development of
the FRIADENT® CELLplus surface on scientific poster. During the DENTSPLY
Friadent workshop Dr. G. Romanos, PD Dr. Gómez-Román and Dr. S. Wheeler
discussed the results of initial practical experience with the new surface.
Pilot users Prof. A. Piatelli (Italy) and Dr. Shahvier Nooryezdan (India),
who both appeared as lecturers in the main program, also focused on the
positive evaluations of the innovative FRIADENT® CELLplus surface.


                                                                                      _45




FRIADENT® CELLplus – available now from DENTSPLY Friadent
The presentation of the CELLplus surface during the EAO congress was
also the official European launch of sales of the new generation of
surfaces on FRIADENT® implants.
The screw implants of the two product ranges will become available with
the new surface in all European markets over the following months under
the brand names FRIALIT® CELLplus and XiVE® CELLplus.
ANKYLOS® CELLplus implants will be available in 2004.

The advantage for you, our customer:
Effective immediately, DENTSPLY Friadent supplies its FRIALIT® and XiVE®
implants with the new growth-activating microstructured surface. The
FRIADENT® CELLplus implant surface (DENTSPLY Friadent, Mannheim,
Germany) enhances surface wettability, osteoblast recruitment, bone
quality and bone formation. It positively influences cell attachment and
improves bone apposition to implants – for an optimal treatment success
and shorter healing periods.
cellplus_goes usa
       The worldwide market launch of the new CELLplus
       implant surface started at the Annual Meeting of the
       American Association of Oral and Maxillofacial
       Surgeons (AAOMS) from September 10 to 13, 2003.


       It was not by chance that the USA were selected to
       introduce this innovative surface first. The conferences
       in the largest and most important implant market in
       the world are always attended by a large number of
       visitors which means, an enormous growth potential
       for DENTSPLY Friadent.


       To cover east and west, the CELLplus surface was
       presented again one week later at the American
       Academy of Periodontology (AAP) Meeting in San
       Francisco, California.


       DENTSPLY Friadent was represented with speakers in
       the main program at both events. Presentations at
       the exhibition stands also provided information on
       the growth-activating microstructure of FRIADENT®
       CELLplus to numerous delegates. The new FRIADENT®
       surface has been available on FRIALIT® and XiVE®
       implants in the USA since September 2003.
                                                                                                                _usa




American ANKYLOS® pilot users met for the first time at the DeguDent training

center in Hanau from 30 October to 1 November 2003. A total of 13 surgeons,

prosthodontists and dental technicians had the opportunity of spending

two days to study all details of the system. The team of leading lecturers

consisted of Prof. Dr. Nentwig, director of the Department for Dental Surgery

at the Frankfurt University Clinic, PD Dr. Michael Stiller, senior physician at the

Benjamin Franklin Hospital in Berlin and Dr. Nigel Saynor, implant specialist

from Manchester (UK). All features and options of this implant system were

presented under the direction of Dr. Werner Groll (DENTSPLY Friadent, General
                                                                                      ANKYLOS® pilot user
Manager) and with the support of Dr. Eduard Eisenmann, Pascale Grote and              meeting in the training
                                                                                      center at DeguDent in
Thomas Lange (all employees of DENTSPLY Friadent). The program ended with
                                                                                      Hanau
a live surgery and hands-on.




ankylos ®_goes usa                                                                                                     _47




There was, of course, time to relax after such an intensive and successful

meeting. The dinner in the exciting atmosphere of the world-famous Frankfurt

Tiger Palace was an event in every way.



The obviously content group returned to the US full of enthusiasm and praise

for the unique ANKYLOS® system and the first-class event – they were looking

forward to use the system in practice as soon as possible.
       _france




                                                 The Hotel Ermitage in Evian was the meeting place for the most

                                                 powerful people in the world at the World Economic Summit 2003.

                                                 On September 18 and 19, 2003, the exclusive hotel overlooking Lake

                                                 Geneva was the site of a unique symposium organized by FRIADENT

                                                 France.



                                                 About 100 delegates attended to hear the latest information and

                                                 practical examples of the application of the FRIADENT® systems

                                                 ANKYLOS® and FRIALIT® / XiVE® systems in presentations by

                                                 Dr. S. Altglas, Dr. A. Amiach, Dr. A. Benhamou, Dr. C. Chavrier,

                                                 Dr. P. Moheng, Dr. P. Missika and others.




_ 48             evian_evident success

                      Successful:
                      The competitors for the
                      DENTSPLY Friadent Golf
                      Trophy in the Royal Parc
                      at Evian




                                                 Dr. Dr. Andreas H. Valentin and Dr. Jochen Weber presented lectures on

                                                 PepGen P-15® during the conference. This bone regeneration material is

                                                 available now from FRIADENT France. Delegates were able to see the

                                                 clinical application of PepGen P-15® and the FRIADENT® implant systems

                                                 in a live surgery performed by Dr. Jean Maddaleno in his practice.

                                                 The alternative was to compete in a golf tournament before the impressi-

                                                 ve panorama of Evian.



                                                 The unanimous conclusion: Evident Success in Evian – a high-quality

                                                 event in a beautiful environment.
                                                                                                              _scandinavia/poland


NEW ACTIVITIES IN POL AND

Implant treatment is of more and more interest for patients and dentists

in Poland. Our first workshop with Priv.-Doz. Dr. German Gómez-Román

(University of Tübingen/Germany) in Kielce in November 2003 was com-

pletely sold out. Dr. Gómez lectured on the advantages of the FRIALIT®

system at the Quintessenz Congress Kielce in the main program and 86

dentists attended his evening workshop. Our new distributor in Poland

is ROWAX. The new team will be happy to provide the best possible

support to our customers.



For additional information please contact:

rawexdental@aol.com or dial: +48 43 8273023




                                          friadent ®_tour                                                                       _49



S E A RC H FO R E XC E LLE N C E – E ST H E T I C S A N D FU N C T I O N

This was the title of three one-day conferences held in September at Helsinki,

Gothenburg and Copenhagen. DENTSPLY Friadent was there for customers

with all available products and four well-known lecturers: Dr. B. Saneke,

Dr. G. Romanos, PD Dr. G. Gómez-Román and Dr. J. Weber. The feedback was

very good and planning for the next meetings is already under way.




                                                                                 On the road to success with our
                                                                                 customers in three Scandinavian
                                                                                 countries:
                                                                                 J. Bagby, FRIADENT Scandinavia,
                                                                                 Dr. G. Romanos, University of Frankfurt,
                                                                                 O. Schmidt, FRIADENT GmbH,
                                                                                 PD Dr. G. Gómez-Román, University of
                                                                                 Tübingen,
                                                                                 A. Wiberg, FRIADENT Scandinavia,
                                                                                 Dr. J. Weber, Mannheim (left to right)
                                                                                 and Dr. B. Saneke, Wiesbaden (front)
      _spain




                                          OFFICIAL MARKET INTRO DUCT ION IN SPAIN –
               TMV managing               A COMPLETE SUCCESS!
               director Jorge Suárez
               (right) with Prof. Abel
               Garcia (University of
               Santiago de Compostela).




                                          XiVE® and the new surface were officially introduced to the market

                                          together at the Holiday Inn Hotel in Madrid on October 18, 2003.




_50     hola_xive                         About 300 dentists from all over Spain responded to the invitation

                                          from TMV Medica, the Spanish distributor. In addition to the extremely

                                          interesting program of lectures, the delegates also had the option of

                                          getting acquainted with the system in detail at the information stands.



                                          The Spanish lecturers Dr. Julio Acero and Dr. Fernando Luengo shared

                                          their comprehensive clinical experience with the audience, as did

                                          Prof. F. Khoury, who not only spoke about working with XiVE® but also

                                          described options for improving local bone volume. The congress,

                                          Dr. Santiago Barona and Dr. Victor De Paz as chairmen, also included

                                          the latest insights into receptor engineering and the application of

                                          PepGen P-15® by Dr. A. Valentin, Visiting Prof. at Nippon University.

                                          All members of the audience were able to follow the lectures due to

                                          simultaneous interpretation into Spanish and English. The final event was

                                          the presentation of the new CELLplus surface, in which Dr. R. Jansen,

                                          placed particular emphasis on the scientific studies that were crucial to

                                          the development of the new DENTSPLY Friadent surface.

                                          The participants were not only enthusiastic about the topics and presen-

                                          tations but also praised the relaxed atmosphere and the excellent organi-

                                          zation, which made the event a complete success.
D E N TA L S Y M P O S I U M 2 0 0 3 :

D E N T S P LY I N D U B A I




Centre of_Excellence
The Dental Symposium 2003 in Dubai from September 11 to 15, 2003,

attracted 270 participants from all over the world following the invitation

of DENTSPLY Middle East and Africa. DENTSPLY Friadent presented the

ANKYLOS® and FRIALIT® / XiVE® implant systems in lectures and hands-

on sessions. FRIADENT presenters for novices and experienced users

included Dr. G. Bayer, Dr. Dr. S. Berg and Dr. Dr. D. Haessler.



But what would such an event be in the country where the stories from

the thousand and one nights contrast with the progress of the 21st

century without an appropriate side program. A jeep safari, camel rides

in the desert, a beach barbecue party and a dinner in the exclusive

Burj el Arab, the only 7-star hotel in the world, were all attractions

offered for the delegates and contributed to a relaxed atmosphere for

exchanging practical tips and experiences with implant dentistry.




imprint
iDENTity Evident Success® · Published: three times per year Publisher: FRIADENT GmbH · P.O. Box 71 01 11 · D-68221 Mannheim
Tel.: +49 (0) 621 43 02-13 62 · Fax: +49 (0) 621 43 02-23 62 · Internet: http: / / www.friadent.de Editorial team: Lolita Keller (editor-in-chief )
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Design and Layout: WEGA Werbeagentur / Mannheim Printer: Wörmann / Mannheim Photo: Title: Matthias Müller / Mannheim · Getty Images®
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Copyright: FRIADENT GmbH, Mannheim · Reprints and reproduction, even in part, on approval by the editor only
Subscription: free of charge – orders to identity@friadent.de
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