i d e n t i t y | 0 �

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tissue_care

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contents02_ Contents and editorial information

03_Editorial

04_Tissue_Trends

06_ Tissue stability redefined

08_ The TissueCare Concept

12_The dot on the i

16_ Fascination: TissueCare Concept

38_ Management of hard and soft tissue

for retention of esthetics and function

42_ Find a hearing, call attention to yourself,

arouse emotions

48_ Practice marketing works!

52_ How we design success

58_Speed and perfection

60_ Young. Dynamic. And successful?

64 _ News in brief

66 _ “Hola españa”

70_ 13th DENTSPlY Friadent

World Symposium

74_iDENTity Special 2007 preview

75_Fax form

77_Events 2007/08

4 �4 � 4 84 87 07 00 40 4

Imprint

identity EvIdEnt SuccESS® Publisher: Friadent GmbH · P.O. Box 71 01 11 · 68221 Mannheim/Germany · tel.: +49 (0)621 43 02-010 · Fax: +49 (0)621 43 02-011 · Internet: www.friadent.de

editor in chief: nadine dusberger (Medical consulting Group/düsseldorf/Germany) editorial team: dr. Ricarda Jansen · Johannes Lerch · claudia Schillinger · vanessa voll · tanja Friedrich (Medical consulting Group)

Further collaborators of this issue: Eva-Maria Hübner · corinna Branding design and Layout: WEGA Werbeagentur · Mannheim/Germany Printer: Wörmann & Partner / Mannheim/Germany

Photo: Stefan Blume (S. 7, 42-46, 48-51, 63, 67-69) · Fotostudio Balsereit Köln (Portrait S. 47) · Günter Hoffmann Konz (Architektur S. 47) · Bilderberg (S. 70-73)

identity is published in German and English four times per year and adresses expert groups. Authors’ opinions do not necessarily represent those of the editors.

Some products or specific “indications for use” may not be cleared for use in all countries. Copyright: Friadent GmbH, Mannheim/Germany

Reprints and reproduction, even in part, on approval by the publisher only Circulation: 30,000 Subscription: free of charge – orders to identity@friadent.de

User notes: the instructions for use that we supply for every product are the final authority for the use of our products with the approved indications. Suggestions and reports

from users published in idEntity are intended for scientific discussion. It is possible that the applications and indications that are described are not scientifically accepted

or they are not recommended by us in our instructions for use. the therapist is solely responsible for selection of the treatment method in every individual case.

We cannot accept any liability for selection of an unsuitable treatment method. not for distribution in the united States of America. Some products may not be available in all countries.

Please contact your dEntSPLY Friadent representative to obtain up to date information on the product range and on availability.

22_ long-term esthetic stability

by retaining the structure

28_ Navigation to success

32_ Accurate prosthetics with

navigated implantology

33_ Computer-guided implant treatment

34_ Bone defect in the esthetic zone

as a result of trauma

I D E N T I T Y | 0 3

DEAR READER,

TissueCare … As we were preparing this edition we conducted a short survey of

implantologists to find out the associations and expectations of this term among

professionals. We encountered one quotation that many of you certainly know:

“The tissue is the issue, but the bone sets the tone.” Dr. Dietmar Weng of Starnberg

added: “But is the screw the clue?” This edition examines this question in detail.

Is the retaining screw really the key to long-term stability of soft tissue and bone,

i. e. to what DENTSPLY Friadent understands as TissueCare? Read on from page 8

to find the surprising answer to this question.

Some pages later the presenters of the TissueCare Roadshow describe what fascinates

them about TissueCare and how this concept influences their everyday work. We

talked to them during the first Roadshow in Cologne – and spent some time finding

out for you what it was like and whether you should also join the TissueCare Concept.

Your responses to the TissueCare Concept and the continuing controversy over platform

switching confirm how important you find this topic and above all how important the

smiles of your patients are to you. However, we also know that this is only part of the

everyday work in the dental practice. This issue will also give you a navigation guide

to success in implantology. You will find out what a challenge it is even for a company

like DENTSPLY Friadent to establish its own unique identity. We can only encourage

you to find your personal path to your own corporate identity and corporate design.

It is worth it, as shown in our examples on page 48.

Have you ever wondered what the zip fastener on the title page has to do with stable

bone and healthy soft tissue? Not much at first glance, but much more at the second.

Both sides meet harmoniously to make a whole. They have teeth. They are accepted

without a second thought. And with both professionals have discovered the functio-

nal secrets – and today concentrate fully on the esthetics …

The zip fastener does it well. It was originally developed in 1890 and patented in

1893, it became popular in the 1950s and since then has been continuously developed

for the fashion industry, particularly for appearance.

The story of implantology is similar. Originally the functional aspects were most

important, while today the emphasis is on recreating an authentic and natural smile

on the lips of your patients.

We hope that we have been equally successful with this edition and we hope you

enjoy your reading!

Nadine Dusberger

and the iDENTity editorial team

tissue_trendsForm follows function? Form follows fun?

Ingenious tissue brings visions in form …

BONE_STRUCTURE

Sit on synthetic bone tissue:

Osteogenetic Chair -

seat-tested and awarded

www.timothy-schreiber.com

BLOW_CAKE

Blow out candles, blow up lamps –

the latest LED technology makes the

common balloon into an ingenious light

www.kyouei-ltd.co.jp

CELL_STRUCTURE

“Genetics” instead of reinforced concrete –

with fl owing forms and organic structures

the Leonardo Glass Cube seems to grow

together with its environment

www.3deluxe.de

0 4 | I D E N T I T Y

SLEEP_LESS

Is your partner speaking while sleeping?

No need to worry. He is probably just up

to speed on communication terms: with

the communication pillow containing a

bluetooth connection to the cell phone.

www.urbantool.de

DRAWING_TIME

draw in the air with a fl ashlight painted,

digitized, materialized – the table is

complete. The chair. The lamp …

www.frontdesign.se

FLOATING_PARTICLES

Exhibited at the MOMA in New York, endless

prizes for design – new designer Marcel Wanders

fl oats with Zeppelin in designer spheres

www.fl os.com

I D E N T I T Y | 0 5

0 6 | I D E N T I T Y

tissue stability – redefined

DEAR READER,

The TissueCare Concept is currently on tour through seven

major European cities and we encourage you to “Join the

TissueCare Concept!” We are not just doing this because we

want to meet you personally at one of the events. We also

want to encourage you to join us, because our initiative will

be really successful only with you.

Some of you will certainly be wondering why we are making

such efforts about tissue stability. The answer is quite simple:

we are working for your success. For the success of your

practice and for what you are trying to do for your patients:

successful implantology.

TISSUE STABILITY: YESTERDAY, TODAY AND TOMORROW

Up to a few years ago success in implantology was defi ned by

implants being healed and remaining fi rmly anchored in the

bone or the ability to actually graft the required bone volume

at the prosthetically relevant position. Safe implantology

concentrated primarily on the lower jaw and anyone who

considered placing an implant in a region with low bone

volume was considered experimental. This was not a real

problem, because patients were happy if their “new teeth”

simply worked.

However, success in implantology today includes rehabilitation

of hard tissue and soft tissue, its permanent stability and

natural esthetics. This is refl ected in the literature, where the

esthetic result is in the foreground of interest, and also in the

fact that patients consider the function of their implantological

restoration as self-evident and judge the result primarily by

the esthetics. In our view an important factor is that conside-

ration of esthetics and the resulting implantological success

must not be restricted to the year after implant placement.

The success is perfect by your standards and those of your

patients only if bone and soft tissue are still stable after many

years and the esthetics is still harmonious and crown margins

are not visible.

PLATFORM SWITCHING: THE PHILOSOPHER'S STONE?

Platform switching is currently touted as the all-inclusive

success factor in combination with initial and long-term bone

and soft-tissue stability. This is why the market now has a

wide variety of attempts to integrate platform switching into

the various implant systems. Platform switching is described

as if it alone were the deciding factor for long-term tissue

stability – people frequently forget that this feature has been

available for exactly 20 years. However, a critical analysis of

I D E N T I T Y | 0 7

the available clinical data and insights from 20 years of clinical

experience has shown that platform switching in isolation

does not bring the desired success. In brief, the step is part of

the solution but in itself it is not the solution.

EXPERIENCE BRINGS OBLIGATIONS

As one of the leading companies in dental implantology, we

feel a responsibility to share our many years of clinical expe-

rience and the knowledge derived from this with you. This is

why we are touring Europe, this is why we are emphasizing

tissue stability. We encourage you to support our common

quest for permanent implantological success and for the

smiles of your patients.

Join the TissueCare Concept! We look forward to seeing you.

Yours sincerely

Dr. Werner Groll

0 8 | I D E N T I T Y

Long-term hard and soft tissue stability forms the basis for

perfect red-white esthetics. And at the same time it poses a

major problem for implant therapy. Sooner or later in many

cases a dish-shaped depression forms in the bone around the

implant. The overlying soft tissue follows the hard tissue –

forming unsightly gingival retractions. Even though the bone

is resorbed by only a few millimeters, it is precisely these

millimeters that make the difference between success or

failure of an implantology procedure for patients with low

bone volume to start with, thin gingiva or particularly high

esthetic requirements. Prosthetic complications can be

repaired – but the situation is different for complications with

hard or soft tissue. Such cases are where it is particularly

important to be able to be sure of the long-term stability of

hard and soft tissue. And to be able to trust that the signifi cant

factors will form a harmonious whole with the selected

implant system to work towards the common goal: tissue

stability. A wide range of implant systems are available to

implantologists today. They all have one thing in common:

they all claim to be the best.

But what must the dentist look for when selecting the implant

system? And what are the important factors that must work

together to provide real tissue stability?

the tissuecare conceptImportant factors for long-term stability of hard and sof t tissue

| The editorial team

I D E N T I T Y | 0 9

An important initial point to consider is the implant-abutment

connection. Micromovements between the implant and

abutment may irritate the surrounding tissues, resulting in

bone resorption around the shoulder of the implant. The fi rst

requirement for an implant system for esthetically critical

cases is therefore to form a mechanically stable and bacteria-

proof connection between the implant and the abutment

that has no micromovement. Some implant systems achieve

this by using an internal friction-locked and keyed tapered

connection. This connection forms a virtual single-component

implant, which ensures tissue stability and prosthetic

reliability from the start.

Implant patients are becoming younger. This means that

implants are under mechanical loading for much longer.

Prosthetic complications such as screws or abutments

coming loose are more likely. But nothing can move in a

friction-locked and keyed implant – and nothing can come

loose. This gives the implantologist not only prosthetic

reliability but also advantages with the prosthetic restoration

because of the virtual one-piece system. The solid implant-

abutment connection also allows transgingival healing

without esthetic compromise and with optimum soft-tissue

regeneration.

An implant with a fi xed connection does not have it: The

microgap. A microgap between implant and abutment

allows bacterial colonization. Chewing loads cause relative

movement between the implant and abutment, resulting in

a pumping effect. The resulting distribution of endotoxins

cause infection in the tissue at the interface level. The bone

responds with resorption below the implant-abutment con-

nection until the biological width has become established.

The potential for infection is reduced without the microgap

– and in combination with no micromovement it is completely

eliminated. Without microbial leakage of the implant lumen

there is no microbial colonization and without endotoxins no

potential for infection. For these reasons when dealing with

cases with low bone volume, thin gingiva or particularly high

esthetic demands the implantologist must look for connection

that is as bacteria-proof as possible and with as little gap as

possible when selecting the implant system. This will keep

the hard and soft tissue stable.

1_ 2_

1_X-ray image of the Ankylos implant-abutment connection before

starting the test (x-ray image: Holger Zipprich/Dr. Paul Weigl,

Frankfurt am Main/Germany)

2_X-ray image of the Ankylos implant-abutment connection after

1,000,000 load cycles (x-ray image: Holger Zipprich/Dr. Paul Weigl,

Frankfurt am Main/Germany)

A bacteria-proof friction-locked and keyed connection is only possible

with the tapered connection completely fl ush.

1_ 2_

1 0 | I D E N T I T Y

We have already noted two factors. But micromovement and

microgaps are not the only enemies of stable tissue. Possible

negative effects of the implant-abutment transition are also

reduced by moving this connection away from the peri-implant

tissue to prevent any irritation. This is done by displacing the

implant-abutment connection to the center by using an ab-

utment with a smaller diameter than that of the implant. This

displaces the biological width from the vertical to the horizon-

tal plane. This procedure is referred to as platform switching.

Platform switching is an important factor in tissue stability

– but only in combination with a connection design that

prevents micromovement and is bacteria-proof, which

we call platform shifting®.

The smaller abutment also provides more space for peri-

implant soft tissue and as a result improves the red esthetics.

However, red esthetics alone is generally not suffi cient,

particularly for the esthetically sensitive front-tooth region.

This is the area where the patient wants perfect white esthe-

tics, a tooth that appears as if nothing had ever happened.

The emergence profi le is the key in this case. The formation of

a natural emergence profi le often required subcrestal place-

ment of the implant to take full advantage of platform shifting.

However, for implants with a connection that allows micromo-

vements and a microgap this is a real “implant killer.”

The bone will remain stable in spite of subcrestal placement

of the implant only if there is absolutely no irritation, which

means a bacteria-proof and rigid connection design that also

eliminates irritation by using platform switching. This results

in a natural emergence profi le that also leaves additional

space for stable, thick soft tissue over the implant shoulder.

It is clear that this is not required in every case.

Even if there are implant systems that can be placed sub-

crestally, bone deposition above the connection level was

formerly not considered feasible because the microroughness

of the implant surface always ended below the implant

shoulder. Implant concepts that make use of tissue deposition

Platform switching is an important factor in tissue stability in its

interaction with a stable, bacteria-proof connection design (x-ray

image: Dr. Nigel Saynor, Stockport/UK)

Deposition of bone tissue on the face of the implant by subcrestal

placement (histology: Dr. Dietmar Weng, Starnberg/Germany)

I D E N T I T Y | 1 1

in the shoulder region of the implant simply extend the

growth-activating implant surface over the shoulder region

of the implant.

What happens then is demonstrated by the most recent studies.

Bone and connective tissue cells adhere to and spread faster

and more extensively on a microroughened implant shoulder

than on a machined surface. In combination with platform

switching, subcrestal placement and a connection design that

eliminates micromovements bone can even grow on the

horizontal shoulder surface and on the abutment. This

supports the overlying soft tissue and gives patients long-

term stability of esthetic results.

SUMMARY

Long-term bone stability and healthy soft tissue can be

established by taking the following fi ve factors into account

when selecting an implant system:

1. NO MICROMOVEMENT

2. BACTERIA-PROOF CONNECTION

3. PLATFORM SWITCHING

4. OPTIONAL SUBCRESTAL PLACEMENT

5. MICROROUGHNESS TO THE INTERFACE

You as an implantologist know better than any company how

important this is to patients with low bone volume, thin

gingiva and high esthetic demands. And one thing is certain:

only long-term tissue stability is genuine tissue stability, or

as it is called by DENTSPLY Friadent: TissueCare. ■

In a radiographic and histological animal study the implant shoulders

were placed 1.5 mm below the bone margin in accordance with an

esthetic indication in the front-tooth region to simulate the low

position of the implant-abutment connection in the region of the

bone support of the papillae.

Standardized x-ray images were taken at monthly intervals. In

addition to other results the peri-implant bone margin around the

tapered connection remained signifi cantly higher over the six months

of the study (top row) than with a blunt abutment connection with

an external hexagon (bottom row). (x-ray images: Dr. Dietmar Weng,

Starnberg/Germany)

1 2 | I D E N T I T Y

TissueCare Concept on tour!

I D E N T I T Y | 1 3

“Tissue stability – redefi ned” This was the slogan on the DENTSPLY Friadent invitation

to join well-known experts at the fi rst series of European events on retention of

bone and soft tissue in implantology. Arising from the experience that long-

term success of an implant depends directly on the long-term stability of bone and

soft tissue, lecturers with the TissueCare Roadshow are describing the success

factors for permanent results in seven European cities. The fi rst stop of the

roadshow was in Cologne, Germany, on September 7, and iDENTity was there.

About 200 people were present when Dr. Werner Groll, Managing Director, opened

the TissueCare Roadshow at 10:30 am on September 7 in the Maritim Hotel in

Cologne. In an entertaining speech he described the 20 years of success of

DENTSPLY Friadent in tissue stability. Here he touched on a controversial part of

the ongoing discussion: platform switching, which is currently being touted as the

only factor in bone stability. With over 20 years of experience in this area DENTSPLY

Friadent can clinically confi rm that much more is involved in keeping bone and soft

tissue permanently stable. The central reason for the roadshow is to bring these

facts to a wider public with the assistance of international experts.

The event examined two questions from very different points of view: what is the

key to initial and permanent tissue stability? And what are the advantages of the

TissueCare Concept for the implantologist? An international team of well-known

experts was assembled in Cologne to answer these questions and to present new

perspectives on long-term tissue stability and the resulting long-term implantology

success to the audience. The specialists described the details of the fi ve most

important success factors of the TissueCare Concept that they had confi rmed as

decisive for long-term tissue stability in their research: no micromovement,

bacteria-proof connection, platform switching, subcrestal placement, and micro-

roughness to the interface.

the dot on the iThe starting gun for the TissueCare Roadshow

has been f ired in Cologne, Germany

| The editorial team

An expert who has had more experience in this fi eld than most others set the pace

for the event: Professor Georg-H. Nentwig, Director of the Poliklinik für zahnärzt-

liche Chirurgie und Implantologie des ZZMK at the University of Frankfurt, Germany.

From his 20 years of clinical experience he noted that the geometry of the Ankylos

system has proven its worth in maintaining tissue stability from the start. “But

TissueCare is not just the implant system,” said Professor Nentwig, and he made

it clear that it is essential for the fi ve success factors of the TissueCare Concept to

work together for long-term stability.

Diplom-Ingenieur Holger Zipprich, also from the Poliklinik of the University of

Frankfurt, Department of Dental Prosthetics, also emphasized the combination

of the success factors, but in his presentation he placed most emphasis on

mechanical stability, which should be followed by the other factors. He reported

on his comparative studies of the relative movements at the connection point

between the implant and abutment components caused by different chewing

forces. Therefore, he considered the elimination of micromovement in combination

with the bacteria-proof connection as the foundation of the total concept on which

platform switching, subcrestal placement and microroughness are built. “What is

an “i” without the dot?” Holger Zipprich asked the audience and answered with

his conclusion: “You can read it, but it's not perfect.”

Dr. Paul Weigl, specialist in dental prosthetics at the University of Frankfurt,

continued Holger Zipprich's topic in his presentation. In practice the mechanical

stability of the implant means a solid and reliable anchorage in the bone. If an

implant design with maximum mechanical stability is available, shorter implants

can be used and this can make complex grafting procedures unnecessary for many

patients. Dr. Weigl summarized his experience as follows: “The TissueCare Concept

means prosthetics with long-term stability with less aftercare.”

Dr. Dietmar Weng, Starnberg, Germany, concentrated on the topic of the microgap:

“The microgap is no longer relevant if a two-component implant behaves micro-

biologically and micromechanically as a one-piece implant,” stated Dr. Weng with

reference to the signifi cance of a friction-locked and keyed tapered implant-abut-

ment connection. With a connection of this type implants can now be placed under

the bone margin even in esthetically relevant situations. Bone-damaging factors

such as micromovement and bacterial colonization can be easily eliminated with

the TissueCare Concept.

Dr. Nigel Saynor, Manchester, UK, demonstrated the daily benefi ts of the TissueCare

Concept to a practitioner: predictability and long-term stability of esthetic implant-

based reconstructions. And this means satisfi ed patients, who are the ultimate

reason for the success of a dental practice. In conclusion he reduced the Tissue-

Care Concept to a simple slogan: “Look after the three micros – micromovement,

microgap and microbiology. The TissueCare Concept is the combination of the

three micros.”

Prof. Georg-H. Nentwig

Dipl.-Ing. Holger Zipprich

Dr. Paul Weigl

Dr. Dietmar Weng

Dr. Nigel Saynor

(top down)

1 4 | I D E N T I T Y

I D E N T I T Y | 1 5

The audience was enthusiastic about the outstanding scientifi c quality of the

presentations. “We found it far more useful than we expected – the whole event

was very informative,” said doctors Annette and Michael Weber of Bad Homburg.

Dr. Christopher Schulze from the Regensburg region was very pleased with the

scientifi c information, “particularly because the discussion placed much greater

emphasis on the link between long-term bone retention and the overall resto-

ration. I found it an excellent idea, to bring the fi ve most important points into

one concept.” The general program was also well received – not surprising when

the organizers had put so much imagination into making the whole meeting an

unforgettable event with a varied evening program. The acrobat Trinity performed

breath-taking gymnastics above the diners during the gala dinner. After the dinner

musical entertainment was provided by The Magnets, the English vocal and beat

group, and later in the evening there was dancing with DJ Marcellus. “My husband

and I found the evening very exciting and successful,” said Agnes Quack of Kürten,

“beautiful music.” The organizers could hardly have wanted a better conclusion to

the fi rst roadshow event. “A successful start for our new concept,” said Dr. Groll,

and added: “We are already looking forward to the next six events.” ■

1 6 | I D E N T I T Y

What do you fi nd special about the TissueCare Concept? iDENTity asked the

presenters at the TissueCare Roadshow in Cologne, Germany, this question.

We wanted to know what is the background of the fascination of TissueCare and

how it infl uences the daily work of implantologists. You can read the presenters'

assessments of TissueCare here – but we are also interested in your experiences.

What do you fi nd special about TissueCare? How is it working in your dental

practice? Send us your thoughts by email to identity@friadent.de – the editors

are looking forward to hearing from you.

fascination: tissuecare concept| The editorial team

TissueCare Concept!

I D E N T I T Y | 1 7

PROF. DR. GEORG-H. NENTWIG, FRANKFURT, GERMANY

The concept of platform switching has become a key word, in

fact a fashionable term. But where does platform switching

take us if other important factors are ignored? The answer is:

nowhere. In isolation platform switching is quite useless.

After more than twenty years of experience with Ankylos I

can state that the TissueCare Concept includes precisely the

components that are essential for tissue retention and long-

term success with the suitable implant system. The concept

requires absolutely no micromovement. We also have no

microgap, and as a result no contamination. And then when

with subcrestal placement the forces are constantly trans-

ferred by a special thread, and in addition if thread is also

microroughened up to the implant shoulder, this all accelerates

bone healing – and all important requirements for an implant

system that preserves and stabilizes tissue have been met.

However, we must also consider that other factors such as sur-

gical skill, atraumatic treatment of tissues, correct preparation

Prof. Dr. Georg-H. Nentwig

Poliklinik für zahnärztliche Chirurgie

und Implantologie des ZZMK of the

University of Frankfurt

60590 Frankfurt am Main/Germany

g.h.nentwig@em.uni-frankfurt.de

speed and low trauma during removal of the periosteum are

just as important. Another important point in my experience

is also bone training to improve the implant site. This always

has good results regardless of the implant system.

Finally, we require the right prosthetics for success. Among

other requirements the prosthetic restoration must be designed

to take advantage of the emergence profi le. If the prostheticist

follows a few rules here, the result will be a success. Even if the

patient's oral hygiene is possibly not absolutely perfect – I can

say this emphatically from my over twenty years of experience.

When we retain tissue over the long term, as planned by the

TissueCare Concept, this will always benefi t the patient, who

is very grateful for a successful implant procedure. For the

positive reaction of patients is always the greatest compliment

for my work. If the patient at a follow-up examination says that

the implant-borne restoration feels like the former teeth or the

remaining natural teeth, I know that patient is really satisfi ed.

1 8 | I D E N T I T Y

DIPL.-ING. HOLGER ZIPPRICH, FRANKFURT, GERMANY

The goal of the TissueCare Concept is to retain the crestal

bone, which forms the basis for retaining the soft tissue. This

is only possible with a connection that has no micromovement

and is bacteria-proof. These two items are the foundation of

the TissueCare Concept. To dot the “i” there are three addi-

tional items: platform switching, subcrestal placement and

microroughness to the interface. In my opinion the sequence

of the fi ve items is the decisive factor.

Platform switching alone does not take us any further if the in-

terface allows ingress of bacteria and a connection of this type

is placed subcrestally. In contrast, over the long term it will be

more trouble than use. The sequence is the deciding factor and

here the elimination of micromovement and a bacteria-proof

connection are the foundation for the success of the restora-

tion. They are the “i” and the other factors are the dot without

which the “i” cannot exist. It is clear that – as stated by the

TissueCare Concept – the subcrestal placement, the micro-

roughness to the implant shoulder and the platform switching

are all important factors in supporting retention of the crestal

bone in borderline situations. But without prevention of

micromovement and ingress of bacteria – here the TissueCare

Concept is quite clear – the concept cannot be successful.

PROF. DR. GEORG ROMANOS, ROCHESTER, NY, USA

A study of macaque monkeys in 2003 confi rmed that imme-

diate loading appears to have a stimulating effect on the

formation of new bone at the interface and as a result a positive

infl uence on osseointegration. Since then we have been able

to demonstrate that the peri-implant bone is condensed

during the loading phase with endosseous dental implants.

In my opinion the TissueCare Concept unites the essential

prerequisites for bone stability and condensing and conse-

quently for successful healing even under immediate loading.

These factors extend far beyond platform switching. The

appropriate implant geometry, meaning a progressive thread,

is of primary importance. The implant surface also plays an

important role, because bone can only grow over the implant

shoulder if the surface is microroughened over the entire

interface. Primary stability at the implant site is essential,

and there must be no micromovement between the implant

and abutment. This also provides a bacteria-proof connection.

Finally, subcrestal implant positioning must be possible.

Platform switching is only one of the essential requirements

for successful immediate loading of implants and maintaining

a stable bone margin.

Prof. Dr. Georg Romanos

Professor of Clinical Dentistry

Director of the Unit of Laser Dentistry

Eastman Dental Center

University of Rochester

625 Elmwood Avenue

Rochester, 14620 NY/USA

Georgios_Romanos@urmc.rochester.edu

Dipl.-Ing. Holger Zipprich

Poliklinik für zahnärztliche Prothetik ,

Sektion Werkstoffkunde

Johann-Wolfgang-Goethe University

Frankfurt am Main/Germany

zipprich@em.uni-frankfurt.de

DR. PAUL WEIGL, FRANKFURT, GERMANY

The special feature of the TissueCare Concept is bone

retention in the vertical plane. This phenomenon has two

effects. One is that the soft tissue will most likely remain

stable and papillae will form. It is of course unquestionable

that papillae can also be formed in systems without TissueCare

in accordance with the Tarnow rules – but this is less likely

because of the greater extent of bone resorption. This may

not be so noticeable with single tooth implants. But with two

or three implants side by side the problem is more obvious –

here the two millimeters of bone resorption make the

decisive difference.

The TissueCare Concept also allows the use of shorter implants

with the same load capacity. This is due to the fact that bone

remains stable and the a priori calculated loss of two millimeters

when using other implant systems are not actually lost. This

is a decisive advantage for patients – a fi xed restoration is

possible without bone grafting even where the bone volume

is very critical.

This is actually the signifi cant point for the TissueCare

Concept: the advantage for the patient. I even notice this in

my daily work. More patients will accept implant therapy

that does not require membranes, grafting and extensive

adjuvant surgery. For the patient the fi nancial factor is not

really the most important factor. In my experience it is fear and

apprehension that drives the decision to have, for example, a

bridge. Implantology is elective treatment, and if we cannot

present patients with a clear advantage for implant treatment,

they will frequently – and quite rightly – select a different

treatment. Against this background the TissueCare Concept

gives us the opportunity to convince patients to select the

better therapy.

Dr. Paul Weigl

Poliklinik für zahnärztliche Chirurgie

und Implantologie des ZZMK of the

University of Frankfurt

60590 Frankfurt am Main/Germany

weigl@em.uni-frankfurt.de

TissueCare Concept!

I D E N T I T Y | 1 9

DR. DIETMAR WENG, STARNBERG, GERMANY

An implant system with a tapered connection has inherent

platform switching – a term that is currently very widespread.

However, tissues will not remain stable with platform

switching alone. This is why it is only one aspect of the

TissueCare Concept.

Platform switching alone does not establish micromechanical

stability or a bacteria-proof connection. The TissueCare

Concept shows us that, to achieve this, platform switching

only makes sense if bacterial ingress to the microgap and

micromechanical movement can be prevented at the same

time. These are the factors that damage the bone. There are

of course other factors that may cause bone resorption, but

prevention of micromovements and bacterial colonization are

the basic requirements for preventing the microgap effect

with correct handling.

Dr. Dietmar Weng

Practice for Dental Medicine

Böhm & Weng

Maximilianstraße 17

82319 Starnberg/Germany

dw@bwsta.de

The fi ve success factors of the TissueCare Concept are all part

of the Ankylos system. From a clinical point of view, it makes

it possible to place the implant subcrestally, because this can

prevent the induction of a peri-implant bone defect. Where

formerly bone remodeling seemed necessary may now be

unnecessary. And now a step further: the deep positioning of

the implant makes it easier for the dental technician to achieve

a good emergence profi le during continuing treatment when

the positioning is correct.

For me the real signifi cance of the TissueCare Concept is that

I can offer the patient implants with the comforting know-

ledge that I am offering a long-term prosthetic solution. I want

to be able to stand by my position after fi ve, ten or fi fteen

years and know what I can expect in the patient's mouth:

stable hard and soft tissue.

TissueCare Concept!

2 0 | I D E N T I T Y

I D E N T I T Y | 2 1

DR. NIGEL SAYNOR, STOCKPORT

Predictability, long term results, and the ability to look at a

patient in such a way that you can predict what you can achieve

and fulfi ll a patient’s expectations within these parameters –

that makes the TissueCare Concept special to me. The switching

of the platform alone is not enough. In fact, we need to look at

a difference within the connection, because this contributes to

stability of the crestal bone. We have to bare in mind the three

micros – micro movement, micro gap and micro biology – which

result in the necessity of the TissueCare Concept.

What we have is a conical connection which has rigidity almost

like a stealth or invisible connection – and the absence micro

fl ora. After prosthetic restoration we have a virtual one-piece

implant, consequently bone to growth occurs over the abut-

ment connection. This could be the Holy Grail; the goal we are

looking for. A new paradigm? defi nitely. Or maybe it’s an old

paradigm rediscovered.

Dr. Nigel Saynor

Bramcote Dental Practice and

Dental Implant Centre

3 Sydall Road, Bramhall/GB

Stockport, SK7 1AB

bramcote@enterprise.net

In any case, it infl uences my daily work. When a patient attends

my offi ce I can deliver an implant solution with confi dence for a

long term predictable aesthetic result. An implant is not a tooth,

it does not behave like a tooth. An implant is a prosthesis that

mimics the tooth. We need to achieve form and function, with

hard and soft tissue stability, and harmony and health. Above

all I want to exceed their expectations. ■

2 2 | I D E N T I T Y

long-term esthetic stability by retaining the structure| Dr. med. dent. Birgit Grubeanu-Block | Dr. med. dent. Daniel Grubeanu

2_Mucosa conditions 3_View of the alveolar arch of maxilla 4_Subcrestal placement of the

Ankylos implant

1_Preoperative situation

INTRODUCTION

Patients interested in implant therapy are particularly interested in an esthetic, friendly

and simply brilliant smile. Advanced dental technology is being used to make the visible

white components of the dental prosthesis more demanding esthetically. However,

a really natural appearance can only be achieved in combination with an emergence

profi le that is indistinguishable from the neighboring teeth. An essential condition for

acceptable peri-implant soft-tissue esthetics is therefore the retention of the structures

around the implant. But exactly how can bone and soft tissue remain stable over the

long term? And above all what factors must be taken into account for this?

BIOLOGICAL WIDTH, DENTOGINGIVAL COMPLEX OF TEETH AND IMPLANTS

The term “biological width” describes the dimension of certain periodontal and

peri-implant soft-tissue structures, the gingival sulcus, marginal epithelium and

supracrestal connective tissue. Because marginal epithelium and supracrestal

connective tissue can adhere to teeth and implants, this is referred to as epithelial

and connective-tissue attachment. The basic principle of the biological width is that

bone projecting into the oral cavity is always covered by periosteum, connective

I D E N T I T Y | 2 3

7_Membrane placed over Frios Algipore

as protection against resorption

8_Suture with fitted gingiva former,

open healing

5_Facial bone deficit 6_Grafting with autologous bone in

contact with the implant surface

tissue and epithelium (Tarnow et al. 2000). The epithelial and connective-tissue

attachment in this case has a specifi c thickness (dimension). Animal studies have

demonstrated that the thickness of the peri-implant soft tissues remains relatively

constant at 3 mm (Buser et al. 1992; Berglundh et al. 1996; Cochan et al. 1997;

Hermann et al. 2000; Todescan et al. 2002).

PERI-IMPLANT BONE RESORPTION

Possible causes for peri-implant bone resorption are among the following:

1. Surgical trauma during placement of implant and abutment (Brånemark et al.

1969; Adell et al. 1986; Cochran et al. 1997)

2. Positioning of the implant relative to the alveolar ridge with supracrestal, epicrestal

or subcrestal positioning of the microgap and/or the transition from smooth to

roughened implant surface (Hämmerle et al. 1996; Hermann et al. 1997; Davapanah

et al. 2000; Hermann et al. 2000a)

3. Biomechanical overloading of the bone with formation of microcracks (Adell et

al. 1986; Brånemark et al. 1977; Pilliar et al. 1991a; Quirynen et al. 1992; Tonetti &

Schmid 1994; Rangert et al. 1995; van Steenberghe et al. 1999) or lack of mechani-

cal coupling between implant and bone by a roughened implant surface or screw

threads (Wolff 1892; Cowin 1986; Pilliar et al. 1991a; al-Sayyed et al. 1994; Hämmerle

et al. 1996; Jung et al. 1996; Vaillancourt et al. 1996; Hansson 1999; Wiskott & Belser

1999; Hansson 2000b, 2000c)

4. Violation of the biological width by insuffi cient dimensioning of the peri-implant

mucosa (Berglundh & Lindhe 1996), microbial noxa (Tarnow et al. 1996) or mechanical

noxa (Abrahamson et al. 1997; Tarnow et al. 2000)

5. Type of connection between abutment and implant with varying width of microgap

and force transfer to the crestal bone (Abrahamson et al. 1999; Jansen et al. 1997;

Hansson 2000b)

2 4 | I D E N T I T Y

REQUIREMENTS FOR INTERDENTAL AND INTERIMPLANT PAPILLAE

The major factor in the presence of peri-implant papillae is the distance of the con-

tact point between bone and alveolar ridge. Tarnow et al. (1992) state that papillae

are always present or are most likely to form between restored teeth if the distance

from the cementum-enamel junction to the crestal bone is 3 mm and interproximally

the crown contact point is 5 mm to the interdental tooth tip. Other authors (Kois et al.

1994) have found that the probability of interdental papillary formation is particularly

high if this distance is 4 mm. The distances described by Tarnow et al. have been

defi ned for implants with an external implant-abutment connection.

MICROGAP

Two-component implant systems have a microgap between the abutment and the

implant body. The microgap is contaminated with oral bacteria after initial uncovery

and removal of the factory-installed retaining cover screw. If the implant is placed

too deep and the microgap is subcrestal, the bone is resorbed around the implant

by 1-2 mm over the fi rst year (Lamb 2004; Buser et al. 2005). This is caused by the

formation of a new biological width around the implant. A number of animal studies

have demonstrated that the bone resorption is greater the further the microgap is

apically (Hermann et al. 2000).

Bacteria-proof implant-abutment connections have signifi cantly less or no bone

resorption compared to other systems (Weng 2005).

STRUCTURE RETENTION AND SOFT-TISSUE ESTHETICS

In addition to the optimum three-dimensional placement of the implant, the

anatomical requirements of the neighboring teeth, the gingival biotype (Kan et

al. 2003), the gingival genotype, and the correct dimension of the implants, the

central problem of a predictable soft-tissue esthetics around implants appears

to be the microbially colonized and mechanically loaded microgap. The exis-

tence of a microgap between the implant and abutment or implant crown and the

surgical placement of the microgap in relation to the alveolar ridge are of critical

importance and have signifi cant biological and pathological consequences. The

position and dimension of soft and hard peri-implant tissue (esthetics) and the

degree of infectious reactions (peri-implantitis) are directly affected. In the case

10_Occlusal situation before taking

impression after three-month healing

11_Facial view 12_Impression making9_Situation with external suture

I D E N T I T Y | 2 5

16_Unfired crown try-in15_Cercon scaffold try-in13_Zirconium oxide abutment try-in

with seating instrument

14_Abutment try-in

of immediate implant placements in extraction alveoli the danger of a subcrestal

placement of the microgap is large, particularly interdentally, because the vertical

placement is oriented to the buccal height. If bone resorption occurs, the peri-im-

plant soft tissue loses its support and unwanted gingival recession occurs, which

over the long term results in unacceptable esthetic conditions.

The Ankylos implant system has a special position here. With the reduced-diameter

geometry of the implant-abutment connection with an integrated platform switch

the biological width is not violated in the horizontal dimension; and with their

bacteria-proof implant-abutment connection Ankylos implants can be placed

subcrestally without violating the vertical dimension of the biological width. The

peri-implant tissue is supported by bone and remains stable over the long term –

a guarantee of long-term esthetic success.

CASE STUDY

ASSESSMENT

The 23-year-old patient was primarily interested in having the single-tooth gap at

region 21 closed.

DIAGNOSIS

The patient did not suffer from any disease, her oral hygiene was acceptable. Status

after motor vehicle accident with multiple enamel fractures in the front of the maxilla.

TREATMENT PLAN

1. Hygiene phase, oral hygiene instruction and motivation

2. Evaluation of compliance

3. Implant placement in region 21 with open healing

4. Fabrication of a porcelain Cercon crown (Degudent, Hanau, Germany)

SURGICAL PROTOCOL

An Ankylos plus implant (DENTSPLY Friadent, Mannheim, Germany), diameter

4.5 mm, length 14 mm, was placed with primary stability in accordance with the

standard placement protocol. The implant shoulder was placed 1 mm subcrestally.

2 6 | I D E N T I T Y

22_After one month 23_After six months 24_12 months after cementing-in

18_Cemented-in crown 19_Facial view after cleaning 20_Status one week after cementing-in17_Unfired crown

21_ Three weeks after restoration

Small facial bone defi cits and fenestrations were augmented with autologous bone,

which was locally harvested with a bone scraper (Stoma/Germany). The bone

replacement material Frios Algipore (DENTSPLY Friadent, Mannheim/Germany) was

used as resorption protection for the grafted region and covered with a resorbable

collagen membrane. The implant healed uncovered to establish optimum soft-tissue

conditions.

HEALING TIME

Further treatment was delayed for four months to guarantee stress-free healing of

the implant. There were no complications with the healing process.

PROSTHETIC PROTOCOL

After four months an impression of implant 21 was taken with an open customized

tray. One week after the impression, the zirconium oxide abutment (DENTSPLY

Friadent, Mannheim/Germany) and the zirconium oxide crown (Degudent, Hanau-

Wolfgang/Germany) were test-fi t. After minor corrections the crown was fi nished

and permanently placed. There were no complications or loss of soft tissue over the

observation phase of over one year by now.

I D E N T I T Y | 2 7

26_18 months after cementing-in25_18 months after cementing-in

CONCLUSION

1. The Ankylos implant system simplifi es restorations in the esthetic zone because

the system with its TissueCare connection guarantees that the natural constant,

the “biological width”, is not violated, which means the friction-locked and

keyed, bacteria-proof tapered connection between the implant and abutment.

2. The surgical process is minimized, because subcrestal implant placement is

possible even in extraction alveoli and interimplant or interdental bone resorption

processes of 2 mm do not occur.

3. The spacing parameters described in studies are not obligatory for this type of

implant.

4. The thick soft-tissue collar formed by the special geometry of the implant-abut-

ment connection alters the “thin” gingival biotype positively and ensures additio-

nal long-term stability.

5. The open healing in the esthetic zone with a reduced-diameter healing cap allows

the soft-tissue conditions to stabilize.

6. A buccal resorption protection coating should be placed for long-term stability. ■

The dental technology work was supplied by:

Britz Zahntechnik dental laboratory, Trier/Germany

For literature and any enquiries please contact the authors

Dental Practice

Dr. Daniel Grubeanu und Dr. Birgit Grubeanu-Block

Theodor-Heuss-Allee 6 · 54292 Trier/ Germany

Tel. +49 651 25501 · Fax +49 651 22703

Zahntechnik Britz GmbH

Brühlstraße 27 · 54295 Trier/Germany

Tel. +49 651 146520 · Fax +49 651 149639

info@britz-zahntechnik.de

2 8 | I D E N T I T Y

navigation to success| Dr. Dr. Stef fen Hohl, Buxtehude/Germany

INTRODUCTION

The GPS (Global Positioning System) has become established

in everyday life almost unnoticed. Now drivers no longer need

to look at a road map if they don't know the way to their des-

tination. The destination is entered into the GPA or navigation

device, which then automatically calculates the route and the

probable time of arrival. Any possible complications such as

traffi c jams, road construction or accidents are automatically

taken into account.

GPS or navigation systems are now also available for implan-

tology to enable perfect positioning of implants.

But what are the advantages of computer-guided navigation

for the patient and the surgeon? Could navigated surgery

assist in explaining to the patient the possible problems of

an implant-surgery procedure beforehand? And most of all:

how can computer-guided navigation be integrated into the

surgical protocol with as little diffi culty as possible?

This article will answer those questions. The following case

studies were implemented with the SimPlant Pro 11.0 planning

program (Materialise Dental, Leuven/Belgium) and Surgi-

Guides as drill guides.

2_Planning screen in the SimPlant 11.0

program (Materialise) with a view of

the various scan planes of the Denta CT

3_3D reconstruction with implant

planning with reference to the scan

prosthesis

4_The SurgiGuide with drill holes and

drill for fixing crestal retaining screws

1_Scan prosthesis for mucosa-

supported SurgiGuide with four

drill holes in the planned implant

regions.

6_Drill guide fixed in the mouth 7_Friadent AuroBases with pattern resin

key placed immediately after transgingival

implant placement

8_The shaped prosthesis with galvanic

caps fabricated before surgery. They are

integrated at chairside

5_Panoramic x-ray image with

SurgiGuide in position

case 1

I D E N T I T Y | 2 9

MUCOSA-SUPPORTED SURGIGUIDE WITH IMMEDIATE

LOADING

Patient 1

The 66-year-old patient had problems with the poor adhesion

of her full denture in the mandible. In implantology consulta-

tion in our clinic the patient decided in favor of interforaminal

placement of four Xive implants (DENTSPLY Friadent, Mann-

heim/Germany), which could be implemented with a mucosa-

supported drill guide and transgingival implant placement.

The full denture for the mandible was fabricated before the

operation. The advantage of this procedure for the patient

is that the restoration could be completed immediately after

implant placement by using previously fabricated Friadent

AuroBases and galvanic caps. The implants were immediately

loaded in this case.

BONE-SUPPORTED SURGIGUIDE

Patient 2

The 72-year-old patient had an edentulous maxilla. The six

Xive implants were placed using a bone-supported drill guide.

To speed up fabrication of the denture impressions of the

implants were taken during the surgery with transfer copings.

After a three-month healing phase the Xive implants were

directly restored with Friadent CeraBases and galvanic caps.

The denture, which was fabricated before the operation, could

then be replaced by ceramic telescopic bridges.

3_3D image with reconstructed dentition 4_Bone-supported SurgiGuide1_Scan prosthesis with 20 % barium

sulfate in the region of the planned

implant placements

2_SimPlant 11.0 planning screen on left,

with view of bone density around implant

13. The bone density here is D2

8_Friadent CeraBases with galvanic

caps

7_Xive plus implants placed in regions

13, 14, 15, 23, 24 and 25 using guide

5_Stereolithography cast of maxilla 6_SurgiGuide in position. The guide

remains in position without requiring

retaining screws

case 2

3 0 | I D E N T I T Y

TOOTH-SUPPORTED SURGIGUIDE

Patient 3

The 53-year-old patient presented at our dental practice with a

free-end edentulism in the left maxilla. We had removed teeth

25, 26 and 27 six weeks previously. The transfer impression of

the implants was taken at the time of implant placement. The

patient received an early loading porcelain prosthetic restoration

within only three months. (This accelerated the laboratory

processing and reduced the total treatment time). In addition,

with this protocol laboratory-fabricated temporary acrylate

crowns can be used when the implants are uncovered, a

procedure that enables perfect soft-tissue shaping.

DISCUSSION

As demonstrated by the case studies, the procedure can be

integrated into the treatment protocol without diffi culty. Every

one of the above patients received accurate information of the

individual treatment goal with the SimPlant planning software.

The SurgiGuides and drill guides, which were produced by

stereolithography, were fabricated with the highest degree of

industrial precision (Rosenfeld AL et al., 2006; Miller RJ, 2006).

The implant position is located three-dimensionally with the

highest possible accuracy and transferred to the oral cavity.

The patient and the surgical team are aware of any measures

required for optimizing the bone site beforehand and it can be

accurately viewed with the planning software. In SimPlant 11.0

osteotomy guides can be implemented for very precise osteo-

tomies and bone grafts. Distractors can also be accurately

placed using guides. The time required for surgery is reduced

and material consumption is reduced to a minimum with the

accurate prior planning. The bone-supported SurgiGuide

should be preferred for major implant-borne rehabilitations

(Ewers et al., 2005; Mischkowski et al., 2006). The accuracy

that can be achieved is now known around the world in specialist

circles. Even navigation during surgery using robots cannot

compete with the accuracy of bone drill guides (Mischkowski

et al., 2006). The mucosa-supported SurgiGuide is ideally

10_Ideally placed implants with Friadent

CeraBases in position

11_Friadent CeraBases and galvanic caps

in position

12_Telescoping saddle bridge on six

implants outside the oral cavity

9_Friadent CeraBases with galvanic

caps and tertiary structure

14_Telescoping saddle bridge on six

implants outside the oral cavity

15_Telescoping saddle bridge on six

implants in position

1_Scan prosthesis with barium sulfate in

the area of the planned implant region

13_Telescoping saddle bridge on six

implants outside the oral cavity

case 3

I D E N T I T Y | 3 1

used with interforaminal implant placement, which can be

combined with immediate loading situations (Casap et al.,

2005; Hoffmann et al., 2005; Siessegger et al., 2001;

Wittwer et al., 2006).

Computer navigation is now an essential component of

implantology. The variety of options makes computer-guided

implantology the most promising discipline in dentistry.

CONCLUSION

The SimPlant program provides implantology with an ideal

tool for planning the precise location of implants. This is

particularly interesting because the esthetics and function of

an implant-borne denture depend greatly on the position of

the implants in the jaw. Computer-guided and template-guided

implantology makes esthetic results possible that could only

rarely or never have been achieved with conventional protocols.

The highest degree of industrial accuracy can be achieved with

drill guides or SurgiGuides fabricated using laser stereo-

lithography and this enables accurate implementation of

pre-operative planning. Advantages such as reducing the time

required for surgery and reducing the material consumption

are additional advantages of computer navigation. ■

Literature on request to author

4_Tooth-supported SurrgiGuide on cast2_Scan prosthesis in position in

oral cavity with intermaxillary

occlusion stabilization

3_Patient supine in spiral CT (gantry tilt

0 degrees), head fixed for stabilization

9_Porcelain crowns cemented to

implants 24, 25 and 26

8_Uncovered Xive implants6_Cercon abutments in cast with

Chick

7_Cercon abutments in cast with Chick

and porcelain crowns in cast situation

5_SimPlant planning screen

Dr. Dr. Steffen Hohl

DIC Dental Implant Competence

Oral, Orthodontic, Plastic and

Maxillofacial Surgery

Implantology and Periodontology

Estetalstrasse 1 · 21614 Buxtehude/Germany

Tel. +49 4161 55990 · Fax +49 4161 559911

www.dr-hohl.de

Dr. Marcus Abboud

Rheinische-Friedrich-

Wilhelms-Universität

Polyklinik für

chirurgische ZMK

Welschnonnenstaße 17

53111 Bonn/Germany

ACCURATE PROSTHETICS WITH NAVIGATED IMPLANTOLOGY

Excellent implantological results are always a question of

the skill and experience of the surgeon. But beginners and

experts need the right tools to reach the optimum potential –

and in implantology today that means Guided Surgery,

particularly for demanding cases. With this technique of

CT-based surgery I can plan the procedure virtually before-

hand with the 3D planning program. And I can implement my

planning with absolute accuracy with the guide system.

This of course makes the work more accurate, safer and more

predictable, which can mean less time and less pain for the

patient. The great advantage in addition is that temporary

dentures can be fabricated before the operation. This is a

technology of the future, the harbinger of even more innovative

treatment concepts, such as virtual prosthetics planning and

its clinical implementation. ■

3 2 | I D E N T I T Y

Navigation is a hot topic in implantology. But what is the signifi cance

of Guided Surgery for clinical work in the dental surgery? iDENTity asked

Dr. Marcus Abboud of the Rheinische-Friedrich-Wilhelms University in

Bonn, Germany.

I D E N T I T Y | 3 3

The new planning software from DENTSPLY Friadent has been

developed together with Materialise Dental on the basis of the

market-leading SimPlant system.

The ExpertEase system supports the experienced dentist

(Expert) with an implant placement guide system and assists

in making implant placement more accurate and easier (Ease

of use). ExpertEase with its easily accessible side guide accesses

and a drill system that abandons the “third hand” offers

superior accuracy, safety and comfort compared to conventio-

nal systems. The open guide system, meaning that it is not tied

to one implant system, enables absolutely accurate and safe

drilling, even where space is restricted.

SATISFIED USERS, ACCURATE PLANNING AND

SUCCESSFUL TREATMENT

The best dental results are the basis and the key for a success-

ful implantology practice. ExpertEase, the new Guided Surgery

system, with 3D planning software, has been developed by

DENTSPLY Friadent and Materialise Dental on the basis of the

market-leading SimPlant system. It simplifi es treatment and

computer-guided implant treatment … … with ExpertEase by DENTSPLY Friadent simplif ies treatment and makes it more accurate

| The editorial team

makes surgical protocols less complicated. The new planning

program is ideal for experienced dentists and meets their

needs, confi rms Dr. Daniel Grubeanu, a practicing dentist in

Trier, Germany: “As a user of ExpertEase I am now able to

position the implants with absolute accuracy with prosthe-

tically determined virtual planning that I can offer maximum

anatomical and prosthetic safety and predictability. The time

required for surgery is reduced – the procedure is minimally

invasive with the aid of a fi tted guide with side accesses – a

great advantage for the patient and the dentist.”

IMPROVED SAFETY AND ACCURACY

ExpertEase is used for safer, more accurate and also patient-

friendly planning of implant positions in the jaw. The lateral

accesses in the guide make drilling more accurate, even where

space is restricted and access is diffi cult. The specially deve-

loped drills with attached guide sleeves and drill stop system

(sleeve on drill) can be operated with two hands, in contrast to

conventional systems. The minimally invasive procedure gua-

rantees optimum results and minimizes grafting procedures and

pain stress for patients. The accurate measurement of the bone

volume and the location of the ideal implant position – which

is done at the computer during planning – can reduce uncovery

procedures to a minimum. Users of the DENTSPLY Friadent

implant systems Ankylos, Xive and Frialit will fi nd their systems

preset under Favorites to give them fast access to their own

system. If required, the software, which is not bound to any one

implant system, can automatically select the perfect abutment

for a functional and esthetically optimum restoration. With the

accurate planning of all steps of the treatment the time required

and the cost for the patient can be accurately predicted. Expert-

Ease, introduced at the IDS as Excelldent, will be available on

the market at the beginning of 2008. ■

Drill guide Software

bone defect in the esthetic zone as a result of trauma Reconstruction and restoration with four Xive implants

| Dr. Gerald Peintinger | Klaus Antley | Andreas Wiesler

Multiple implant placement in the anterior maxilla is consi-

dered a complex and advanced rehabilitation. An exact analysis

of the initial situation and extensive prosthetic planning in

consultation with the dental technician in addition to imple-

mentation in the surgical procedure as close to one-to-one as

possible are essential for functional and esthetic success.

Implant-borne restoration of the single-tooth gap today is a

standard procedure, both in the surgical procedure and the

prosthetic procedure. For example, the harmonious esthetic

gingival margin can now be predicted relatively accurately.

However, as soon as multiple implants are restored side by

side, the variety of surgical and prosthetic concepts shows

that important questions like the type of temporary restora-

tion, the signifi cance of the gingiva phenotype, the choice of

open or closed healing and also the prosthetic restoration

protocol are still the subject of controversy.

The authors will discuss the advantages and disadvantages

of various surgical protocols for restoration of an anterior

edentulous gap using the following case of a 38-year-old

patient.

The patient lost four front teeth in a work accident at the

age of 25. After the accident the gap was restored with a

metal-ceramic bridge from 13 to 23 + 24. However, for un-

known reasons the bridge was made with three instead

of four links, which compromised the esthetics by displacing

the midline.

3 4 | I D E N T I T Y

I D E N T I T Y | 3 5

3_Removal of bone block from chin 4_Positioning block with the aid

of the drill guide

1_Labial view of initial situation 2_Seriously atrophied bone situation

before starting treatment

Tooth 14 was also affected by the accident and was restored

with a single-tooth crown at the time (Fig. 1). The situation

before removal of the old bridge construction, which was

adapted several times for use as a temporary denture and

gingiva former before the restoration was completed, is

shown in Figure 2.

The horizontal restoration was substantially less marked

than the vertical resorption, which caused the loss of the

complete labial dental arch. After a diagnostic wax-up it

was clear that an esthetically satisfactory reconstruction

would not be possible without grafting a bone block. After

planning on the cast with placement of prosthetic teeth in

orthognathic position with fabrication of a cuspid guide,

a drill guide was fabricated with light-cured plastic and

titanium drill sleeves. The placement of the implants and the

bone grafting were simulated on the cast.

After measuring the approximate size of the required bone

block with a Krekeler sliding caliper (Prof. Krekeler, Zepf),

the bone block was harvested from the chin (Fig. 3). In spite

of the somewhat greater postoperative pain and possib-

le risks the author prefers the chin as the donor region,

because the bone block harvested by this method shows the

harmonious dental arch margin immediately.

The thickness of the block can also be adjusted to a degree

simply by removing more or less excess spongiosa from the

monocortical block.

The wound on the chin was closed by the standard protocol

in which the bone defect was not covered or fi lled, a protocol

that experience shows allows the wound to heal generally

without problems.

The maxilla was opened with a strongly palatal retrograde

split fl ap, which was prepared just ventrally from the incisive

foramen as a full fl ap.

The buccal relief could be positioned more distally into the

vestibule to prevent a visible step in the region of the gingi-

val margin.

After positioning the drill guide and temporary alignment of

2 mm pilot drills according to the planned implant positions

the bone block was shaped to leave at least 1.5 mm of bone

to the buccal side of the future implant.

The bone block was fi xed in position with two osteosynthesis

screws (Mondeal) (Fig. 4).

3 6 | I D E N T I T Y

6_The sutured, retrograde prepared

split flap

7_Placing the Xive implants 8_Xive implants in position5_The shaped, screw-retained bone

block

10_Situation after electrotoming 11_Implant uncovery by punch in the

1st quadrant and flap formation in the

2nd quadrant

12_Temporary crowns placed imme-

diately after uncovery

9_Pontic impression of the gingiva

with the modified old bridge

After closure of the wound, the four-month healing period

started. Gingival conditioning was started after half this

period had elapsed. The links of the old bridge were built up

step by step with plastic in a pontic shape and cemented-

in again under pressure, which is detectable at the anemic

points (Fig. 9). The pontic impression was further reinforced

by electrotoming over the implant retaining screws (Fig. 10).

After the healing period the implants were uncovered. This

was done by two different methods for comparison. In the

fi rst quadrant the author uncovered the retaining screws

with a tissue punch and buccal stretching of the gingiva. In

the second quadrant the implants were uncovered by for-

ming a fl ap and buccal displacement along with recreation of

the papillae in a battlement shape (Fig. 11). The impression

was taken a week later. Temporary Signum Nano Hybrid

crowns (Heraeus, Hanau/Germany) were fabricated on

angled customized Cercon abutments (DENTSPLY Friadent,

Mannheim/Germany) in the laboratory (Fig. 12).

Autologous bonemeal, which was harvested from the chin

region with a bone aspirator (Quality Aspirators, Duncan-

ville, Texas) was used for the shaping (Fig. 5).

In this case the surgical site was closed without covering

with an additional membrane. The spit fl ap was about 5 mm

ventral of the fi rst transverse incision. The rest was gra-

nulated under an upper plate (Fig. 6). The old bridge was

temporarily cemented over it. The advantage of this incision

was that the mucosa cover was simple and did not cause any

detectable displacement of the mucogingival margin.

Uncovery was two months later. The osteosynthesis screws

were removed and four Xive implants (DENTSPLY Friadent,

Mannheim/Germany, D 3.8) were placed with the aid of a

drill guide (Fig. 7, 8). The surgeon considered the two-month

interval appropriate because at this point if it is necessary

to widen the alveolar ridge by splitting it this procedure is

very easy.

I D E N T I T Y | 3 7

After wearing the temporary crowns for two months, during

which the emergence profi le of the crowns was adjusted

several times to harmonize the gingival margin, the fi nal

restoration was delivered (Fig. 13). This reconstruction

was also based on modifi ed, angled Cercon abutments

(Fig. 14) and four zirconium oxide single-tooth crowns

(Friadent Cercon, DENTSPLY Friadent, Mannheim/Germany,

Cercon, Degudent, Hanau-Wolfgang/Germany). Teeth 13, 14,

23, 24 were also restored with zirconium oxide single-tooth

crowns (Fig. 15). The crowns were placed in accordance with

the previously fabricated wax-up. A great challenge at the

stage was changing the front from fi ve to six front teeth. The

Cercon ceramic Kiss veneering ceramic (Degudent, Hanau-

Wolfgang/Germany) was used for veneering the perfectly

colored Cercon frameworks. This provided an ideal basic

assortment.

Dr. Gerald Peintinger

Hauptstraße 47

8742 Obdach/A

Tel. +43 3578 3200

gerald.peintinger@aon.at

16_Natural fluorescence in the

incisors

15_Occlusal view of cemented-in crowns13_Front view of cemented-in

crowns

14_Angled customized zirconium oxide

crown abutments

IN CONCLUSION, we can be sure that the result was esthe-

tically good, even if not perfect. The author considers the

following factors responsible for the result not being 100 %:

1. Xive implant 21, which was placed slightly too far in the

buccal direction.

2. The fl ap-shape of the implant uncovery in the 2nd qua-

drant with battlement-shaped recreation of the papillae.

If the attached gingiva is high and wide enough and the im-

plant is precisely in the correct position, uncovery by tissue

punch is defi nitely the most esthetically satisfactory choice.

However, the criteria must be checked before uncovery. ■

Andreas Wiesler (left)

und Klaus Antley

W & A Dentallabor

Kärntner Str. 448 · 8054 Graz/A

Tel. +43 316 287788

offi ce@dentallabor.cc

CASE 1

A 50-year-old patient, a healthy non-smoker with good oral

hygiene, was referred to our practice for an implant-borne

restoration to replace teeth 15 and 16. She had a hard-tissue

defect in the transverse region with no vertical bone defi cit,

therefore we prepared the following treatment plan:

management of hard and soft tissue for retention of esthetics and function| Dr. Jérôme Bouzats | Prof. Serge Armand

6_Removal of membrane 7_Placement of a Xive plus D 4.5 implant 8_Placement of a Xive plus D 3.8 implant5_GBR after 6 months

2_X-ray image, Denta scanner 3_Membrane anchored with tacks

(Frios Fixation Set)

4_X-ray image, Dental scanner,

before implant placement

1_Initial situation

1. Grafting of the transverse defect before implant placement

with guided bone regeneration (GBR) using a non-resorbable,

submerged membrane of expanded polytetrafl uoroethylene

(ePTFE) and titanium (Gore, Flagstaff, AZ/USA).

2. Removal of membrane after six months.

3. Placement of two Xive plus implants (DENTSPLY Friadent,

Mannheim/Germany) – D 3.8 and D 4.5; length 11 mm.

4. After two months: implant uncovery and implementation of

the Palacci technique.

5. Fabrication of two crowns for restoration of tooth 15 and 16

after a one-month healing phase.

3 8 | I D E N T I T Y

17_X-ray image after cementing in16_Final crown after cementing in14_Shaped soft tissue 15_Abutments

11_Apical displace-

ment procedure

13_Soft-tissue development9_Implant positions 10_Second-stage surgery, vertical

incision

12_Periosteal

suture

FIRST-STAGE SURGERY

The bone situation discovered during surgery confi rmed the

presurgical diagnosis (scanner) of an inadequate transverse

width at tooth 15 and 16. The defect was uncovered by folding

back a mucoperiosteal fl ap with vertical relief incisions leading

away from the GBR site. All residual granulation tissue had to

be carefully removed from the cortical bone.

A piece of corticospongiosa bone was removed in the distal

region. Then the position for the membrane was perforated

above the cortical bone. The membrane was shaped with

pliers and scissors to fi t the desired shape of the augmented

alveolar ridge and anchored with six titanium tacks (Frios

Fixation Set, DENTSPLY Friadent, Mannheim/Germany). It was

necessary to cut a periosteal incision at the base of the buccal

fl ap for soft-tissue adaptation without tension and link it to

the vertical relief incisions. We took care to prevent the ePTFE

membrane from coming into contact with the natural teeth.

The patient was prescribed amoxicillin (daily dosage 3 x 500

mg) and cortisone (daily dosage: 60 mg for three days) for a

week after the procedure. She also rinsed her mouth out with

0.12 percent chlorhexidine gluconate solution for three weeks.

After a healing period of three weeks the membrane was

covered with keratinized mucosa. We attributed this to the

fact that we displaced the mucogingival margin, the free

mucosa for protection of the membrane, in a coronal direction

during the procedure.

HEALING PHASE

No complications were encountered during the six-month

healing phase.

PLACEMENT OF THE IMPLANTS

The membrane was removed and two Xive plus implants

(diameter 4.5 and 3.8; length 11 mm) were placed with good

primary stability in the regenerated bone in one session.

SECOND-STAGE SURGERY

Eight weeks after placement the implants were uncovered

and then temporarily covered with gingiva formers. In this

particular case we decided to conduct an apical displacement

procedure in combination with the Palacci papillary regene-

ration technique.

I D E N T I T Y | 3 9

2_X-ray image of fracture 3_Root extraction with a periotome 4_Vertical defect1_Chronic infection in tooth 11 after

root fracture

6_Implant placement 7_Autogenous bone harvested with

the bone filter

8_Bone defect filled with autogenous

bone and covered with Bone Shield

membrane

5_Ideal vertical implant position

CASE 2

A 32-year-old patient was referred for an implant-borne resto-

ration of tooth 11 as a result of a chronic infection following a

root fracture which caused a defect at the facial cortical bone.

We decided to extract the fractured tooth and then immediate

placement of an implant in conjunction with guided bone

regeneration (GBR) with a non-resorbable titanium membrane

(Frios BoneShield, DENTSPLY Friadent, Mannheim/Germany).

SURGICAL PROTOCOL

After removal of the root with a minimally invasive procedure

we placed a Xive plus implant (D 4.5, L 15 mm) immediately

and harvested the bone chips resulting from the drilling

with a bone fi lter (Frios BoneCollector, DENTSPLY Friadent,

Mannheim/Germany). A Frios BoneShield was placed over the

implant and covered with free mucosa displayed in a coronal

direction.

HEALING PHASE

After a six-month healing period, the membrane was removed

and the implant uncovered. An impression was taken of the

implant shoulder, then the previously extracted natural crown

was fi xed to a temporary abutment (Friadent EsthetiCap,

DENTSPLY Friadent, Mannheim/Germany). This was an easy

way of retaining the emergence profi le of the natural tooth.

An impression was taken again after an interval of one month

to allow the mucosa to mature and the fi nal restoration was

fabricated.

DISCUSSION

One of the frequent complications encountered with GBR is

soft-tissue dehiscence. Tension in the fl ap may cause exposure

of the membrane. The result is premature surgical removal

of the membrane. Periosteal incisions can be used to ensure

coverage of the membrane without tension to prevent this

complication. This fl ap modifi cation establishes loose,

keratinized mucosa and papillary tissue around the implant.

A defi cit in keratinized mucosa and papillary tissue may cause

esthetic and functional problems. Limited loss of the mucosa

attachmentmay be encountered in such cases. In spite of the

possibility of complications GBR has great advantages. It is

less invasive than bone grafting with retaining screw fi xati-

on and is primarily used for horizontal augmentation

4 0 | I D E N T I T Y

I D E N T I T Y | 4 1

11_Temporary crown (previously

extracted and modified natural crown)

12_Final prosthetic restoration9_Membrane fixed with Frios tacks 10_Surgical wound closure after place-

ment of implant and membrane

of the alveolar ridge, including fenestration and dehiscence

defects (Dahlin et al., 1991). It is also described as an effective

procedure for treatment of peri-implant bone defects at the

time of placement of an implant. Bone substance regenerated

by GBR responds to functional loading exactly like the natural

jawbone (Buser et al., 1996).

However, for long-term reliable success of peri-implant

reconstructions as much attention to the esthetics as the

function is required, because both the regenerated bone and

the peri-implant soft tissue play an important role in the

natural appearance of a prosthetic restoration. ■

Literature on request to authors

Pr Serge Armand

Professor of the University

Doctor of Odontological Sciences

Doctor of Odontology

Faculty of Dental Surgery of Toulouse

3, rue des Maraichers · 31000 Toulouse/France

Dr Jérôme Bouzats

Diploma of the University in Periodontics

Diploma of the University in Implantology

Private Practice, Practice limited to Periodontics

and Implantology

6, rue Maison Suisse · 64200 Biarritz/France

Dr. Jérôme BouzatsProf. Serge Armand

Bayer, Kistler, Elbertshagen Practice for Dentistry, Landsberg am Lech/Germany

Tissue has an important role to play not only in implantology. Regardless of whether

they are natural or of synthetic fi bers – tissue is becoming increasingly important

in modern interior architecture. Why not in your practice or surgery? Peter Hübner,

interior designer and owner of formfest innenarchitektur & möbeldesign in Cologne,

Germany has been using tissue in interior design for years. iDENTity talked to him

about possible and unusual applications of a versatile material.

MR. HÜBNER, WHAT ROLE DOES TISSUE PLAY IN INTERIOR DESIGN?

Tissue is an exciting topic in interior design – textiles and technical tissue are

becoming increasingly important. The range of materials covered by the term tissue

is very wide and is growing steadily. In modern interior design textile tissue is

increasingly being replaced by technical tissue such as low fl ammability high-tech

fi bers with dirt-repelling coatings. Extremely robust surfaces offer options that were

formerly unthinkable. Whether it is fi rm or elastic, brilliantly colored, with innovative

structures or woven metal wires – tissue is now available for virtually any use. I have

been intensively involved with this topic for years and I can say that there are no

limits to creativity in this area.

f ind a hearing.call attention to yourself.arouse emotions.The role of tissue in practice design

| Tanja Friedrich

4 2 | I D E N T I T Y

I D E N T I T Y | 4 3

THAT SOUNDS VERY EXCITING – BUT HOW CAN WE USE THESE MODERN

MATERIALS EFFECTIVELY IN A PRACTICE OR SURGERY?

In brief: in many ways tailored to the situation. This means that the special needs

must be clarifi ed fi rst. We must fi rst make a distinction between the practice and

the surgery, because the requirements for areas where people spend longer time

are special. To simplify the matter it could be stated that the longer a patient spends

in a room the more homelike the atmosphere should be. And of course the different

functional areas of a practice or surgery must be distinguished. The most important

rule for treatment rooms is “form follows function.” This means that the material

selection is primarily determined by functional factors. Tissue can play an important

role here, for example as easily replaceable covers in hygiene-sensitive areas. Less

functional aspects become more important in waiting areas, rest areas and patient

rooms, where subjective feelings of well-being pose a challenge for interior design.

Clever use of tissue can contribute to a pleasant atmosphere.

ARE YOU THINKING PRIMARILY OF DECORATIVE USE OF MATERIALS IN

THIS CASE?

Not at all, experience shows that decorative elements used as coverings are only

conceptual errors. Interior design is more than decoration. Interior design is

interested in developing a functional, sensible and complete overall concept, which

is rounded off by the material and also the form and color, in which tactile elements

and other factors can be just as important as the visual component. Textiles are very

functional materials – it would be a great pity to reduce them to their decorative

character or their function as visual screening materials.

HOW DOES THE FUNCTIONAL IMPLEMENTATION OF TISSUE APPEAR IN THE

DENTAL PRACTICE?

As I have said, tissue is multifunctional. Many areas pose problems, such as those

Dr. Wytek & Partner Practice, Wittenbach/Germany

Dr. Wytek & Partner Practice, Wittenbach/Germany

arising from modern architecture. For example, the large areas of glass that are being

popular today create not only bright rooms fl ooded with light but also acoustic pro-

blems. This is where the sound-absorbing properties of textiles can be very effective.

CAN YOU GIVE US AN ACTUAL EX AMPLE?

The sound-absorbing effect of textiles can be very effective in practices with limited

space. Such as in the design of waiting areas that are close to treatment rooms

where noise is often generated. Noise damping is also useful in larger areas, such as

where the waiting area is subdivided into a multimedia area and a quiet reading area.

Just one idea for this could be a room divider of a semitransparent fabric that divides

the room into zones without reducing the sense of space. The fabric absorbs sound

and can also act as a screen for the monitor area. People who have no interest in the

multimedia are not disturbed. And the material has even more to offer: the fabric

can also be used as an advertising area showing the corporate logo of the practice in

large photoquality format. If the fabric, print, space and lighting concept are properly

coordinated, we have a bright, well-lit waiting area with your own advertising mate-

rial and harmonious room acoustics. I don't know of any other material that could be

better suited for this particular situation.

AN ATTRACTIVE IDEA FOR THE WAITING AREA, BUT WHAT ABOUT THE

TREATMENT ROOMS? ISN'T THE CONCEPT OF HYGIENE MUCH MORE

IMPORTANT HERE?

Yes, of course. Here the above-mentioned selection of material and surface is very

important. An incorrectly planned ventilation system can also become a problem in

areas where hygiene is important. Treatment rooms should have a spacious, functio-

nal and simple design, not just for ease of cleaning. This can also be applied more or

less to other areas of the practice where wellbeing should be more important than

the impression of sterility.

4 4 | I D E N T I T Y

I D E N T I T Y | 4 5

DOESN'T THAT CONTRADICT THE REQUIREMENT OF GIVING PATIENTS THE

IMPRESSION OF HYGIENE AS SOON AS THEY WALK INTO THE PRACTICE?

This is based on a common misapprehension. Clean is not simply “white and cold.”

Unfortunately this conception of hygienic requirements is far too common in waiting

and reception areas. It is exactly the color concept that is a decisive factor in es-

tablishing an attractive ambience. People associate white not only with cleanliness,

hygiene and sterility but also with cold, ice and snow. This means that “white” and

“not white” are not really the solution. A harmonious color concept takes emotions

aroused by colors into account and uses them has a positive effect on patients and

is also a motivating factor for people working in the dental offi ce. Incorrect and

randomly assembled color combinations not only give an unattractive appearance

but they can also trigger negative moods and irritation. In contrast a harmonious

color concept can improve the environment.

SHOULD WE BE A BIT MORE ADVENTUROUS WITH COLORS?

How much color is feasible depends primarily on the size of the space, the function

and how much time people spend there. The fi rst impression in the reception area

is often taken into account, while less attention is paid to the waiting room, even

though patients often spend much more time there.

WHAT ARE THE CLASSICAL PROBLEMS WHEN DESIGNING WAITING

ROOMS?

The basic problem is that waiting rooms are generally furnished but not designed.

One example that often comes up is chairs up against the wall that leave marks on

the wall. The most common solution is the classical timber strip that is screwed to

the wall at the height of the chair back. A functional but defi nitely not a designed

solution. Think in causes when designing a room. For example, why are chairs

necessary in the waiting room? There is a wide range of seating furniture from fi xed

Kielhorn and Kielhorn Dental Clinic, Öhringen/Germany

Dr. Wytek and Partner Dental Practice, Wittenbach/Germany

seating groups to armchairs and sofas that completely eliminate the problem of

contact with the walls. How comfortable and elegant they should be depends on

the waiting times in the practice and the type of patients. Another problem in the

waiting room is the magazines. A pile of popular magazines stacked in the corner is

not exactly a stylish greeting. A suitable range of magazines, newspapers and infor-

mation brochures should be selected and attractively presented to refl ect the image

of the practice. The waiting room is the best place for advertising the practice. Apart

from technical competence the best advertising is when patients feel relaxed in your

rooms. It is well worth thinking in terms of customer orientation in the waiting room.

ALL IN ALL, WHAT MAKES A SUCCESSFUL PRACTICE DESIGN?

The most important factor is to consider your own corporate identity – the practice

design should refl ect the corporate philosophy as much as advertising material or a

web site. Here we fi nd the key to the optimum design: individuality. This means that

the practice design must conform to the overall general concept. System furniture

may be the right choice for many requirements. However, in your own area specially

designed furniture may be the better solution functionally or esthetically – one size

does not fi t all here. Customized solutions do not need to be more expensive. In any

case it makes no sense to purchase expensive designer furniture simply because it is

fashionable or everyone has it.

SO YOU WOULD SUGGEST AVOIDING TRENDS?

Trends are of course not bad per se, but because a practice is not renovated as

often as a fashion boutique long-term thinking is better. The use of multimedia is a

common topic today, and a lot can be done with it. However, it should not be over-

done and it is better to be discreet with the new technology. The times when people

would be impressed by a large fl at screen are past. In my opinion a separate area of

the waiting room where information for patients is provided on small elegant

4 6 | I D E N T I T Y

I D E N T I T Y | 4 7

Dipl.-Ing. Peter Hübner

formfest innenarchitektur & möbeldesign

Gereonswall 105 · 50670 Köln/Germany

Tel. +49 221 1307350 · Fax +49 221 1307351

huebner@formfest.com

exterior and interior architecture , Günter Hoffmann with Peter Hübner

monitors is better advertising. Another idea: not only business people appreciate

internet access. Of course it is important to ensure that other patients are not distur-

bed by this.

WHAT IS THE RIGHT WAY TO DESIGN A DENTAL PRACTICE?

There is certainly no general recommendation – rooms are as different as the people

who live and work in them. For this reason it is not worth imitating the designs of

colleagues or the competitors – not if you want to distinguish yourself from them.

My advice to implantologists: in the fi rst place start analyzing your special require-

ments, your individual competencies and areas of expertise, what impression you

want to make, what clientele you want to address. Think about what is important to

you, what you don't like about your current design, ask your staff what works well

and what does not. Most important of all: tell your interior designer all this. The

planner can only implement what you want when he knows what you want and need.

The essential prerequisite for good results is good communication between you and

the interior designer. ■

4 8 | I D E N T I T Y

practice marketing works!Don't miss the boat …

| The editorial team

Everyone is talking about marketing for the medical practice. A number of

marketing agencies have recognized the increasing demand and offer a wide

range of concepts for marketing medical services. DENTSPLY Friadent has been

offering stepps, a modular marketing program specially designed for the

implantology practice, for about one year now. We feel it's time to ask what

marketing can really do for you. iDENTity talked to Dr. Peter Bohmann,

implantologist in Kaiserslauten, Germany, about his experience with practice

marketing in general and with stepps in particular.

I D E N T I T Y | 4 9

CAN YOU GIVE US A BRIEF HISTORY OF YOUR PRACTICE?

We established the practice in Kaiserslauten in 1992. Eight years later we moved to

our current offi ce. Right from the start, 15 years ago, our slogan was “Everything white

and solid.” Our focus has always been on ceramic restorations and implant-borne

prosthetics. We have had our own laboratory since 1994 in which we have been using

CAD/CAM technology for some years now. Over the years we have been working

towards the establishment of a Circle of Excellence. Dr. Bleckmann is a specialist in

the treatment of periodontitis, Mr. Trautmann specializes in esthetic treatment and

endodontics and I specialize in implantology and prosthetics. We emphasize continu-

ing education of the team, such as training courses through the DGOI in prophylaxis or

implantology asssistance for dental assistants.

WHEN AND WHY DID YOU DECIDE YOU NEEDED PRACTICE MARKETING?

I have always been aware of practice marketing. The book Marketing for the medical

practice by Professor Riegl, published in 1988 in collaboration with specialists in the

industry such as DeguDent in Hanau, Germany, inspired me to follow my own strategy

from the start. When we moved our offi ce this gave us the opportunity to renew our

entire marketing concept. I worked together with the marketing specialists from

DENTSPLY Friadent – with excellent results.

HOW DID YOU GO ABOUT IT AND WHAT STEPS DID YOU TAKE?

First we looked at the existing situation: who we actually are, what makes us different

from other dental practices, what specifi c image do we want to establish in the eyes of

our patients? This is how we developed our corporate image. The result was a complete

renewal with a new logo, new colors for the offi ce and a new home page. We renewed

the complete practice design. We even developed a team uniform to match the corporate

image.

5 0 | I D E N T I T Y

WHAT EX ACTLY HAS CHANGED WITH STEPPS IN YOUR PRACTICE?

The appearance is completely different – starting from the paint on the walls to the

lighting to the signage. The central point of all changes was the individual require-

ments and needs of our patients, which is why we also offer new services, such as

a coffee machine and a water dispenser in the waiting area. They are small things

but still not standard equipment in many practices.

HAS ONLY COMMUNICATION TO THE OUTSIDE CHANGED OR HAVE THERE

BEEN CHANGES IN INTERNAL COMMUNICATIONS?

The changes in communication to the outside have had an indirect effect on internal

communications. First of all, employees now have a completely different attitude to the

practice. They have a strong team spirit, in fact they are really proud to belong to the

team. The concentration on our corporate identity and its emphasis in marketing have

given our employees a higher self-esteem and team spirit. The identifi cation with the

practice has increased. Apart from these indirect effects on internal communications,

we have also implemented measures such as regular team meetings and outings such

as river-rafting to reinforce the team spirit.

WHAT WAS THE REACTION OF YOUR PATIENTS?

Very positive. Our new measures reinforced patients' feeling that they are in the

right practice with the right specialist in every fi eld.

HAVE YOU INCREASED THE NUMBER OF TREATMENTS? WHICH MEANS,

HAS PRACTICE MARKETING BEEN PROFITABLE?

Marketing has been profi table for us in every way. In addition to high patient loyalty

and new patients, it has helped us to position ourselves well even in diffi cult times.

WHAT ADVICE WOULD YOU GIVE TO YOUR COLLEAGUES WHO ARE

STILL SKEPTICAL ABOUT PRACTICE MARKETING?

They should be careful not to miss the boat. The basic point is that with our

marketing activities we support patients in their decision for our practice.

But the colleagues should always be aware of the importance of professional

assistance in practice marketing. From our own experience I can say that

self-made marketing efforts can have good results. But one should always

bare in mind how time-consumming this is and therefore well rely on pro-

fessionals. ■

Praxis Dr. Peter Bohmann

and Colleagues

Stiftsplatz 5a

67655 Kaiserslautern/Germany

Tel. +49 631 66628

info@drbohmann.de

www.drbohmann.de

Dr. Peter Bohmann is a

prostheticist, DGOI-certifi ed

expert in implantology and

has a diploma from the ICOI.

I D E N T I T Y | 5 1

5 2 | I D E N T I T Y

how we design successNew DENTSPLY Friadent image

| The editorial team

I D E N T I T Y | 5 3

Successful start at IDS 2007 – the new DENTSPLY Friadent image

Success is … Corporate Design. It was under this title in the last issue that iDENTity

published an interview with Betina Hubrich, a corporate identity consultant and

owner of Corporate Design Management, a consultancy. She discussed the factors

that are important in establishing a professional image for the dental practice. This

issue is also interested in corporate design, this time with an exciting example.

DENTSPLY Friadent has been implementing a new corporate design since the IDS in

March 2007. How does an international company manage this task? Much the same

as the average dental implantologist in private practice …

ORIENTATION IN THE JUNGLE OF IMPLANTOLOGY

In October 2006 DENTSPLY Friadent decided to begin development of a corporate

communications scheme to establish a completely renewed corporate design. The

decision was made against the background of the rapid development in the fi eld,

which means that new products are continually coming on the market, the number

of suppliers of implantology systems and services is rapidly growing and the range

of products is becoming more and more complex. Mergers and acquisitions, in which

DENTSPLY Friadent is also involved, present companies with the challenge of main-

taining a clear image. In such a dynamic fi eld it is not easy for users of implantology

products and services to maintain an overview. In the face of these developments

DENTSPLY Friadent has decided to revise the company image completely. Marketing

Director Birgit Dillmann explains: “We have been a reliable partner in the implant

market for our customers for many years and with our implant and augmentation

products we offer not only a complete and high quality range of products but also

technologies that increase effi ciency and unique services. The challenge of making

this customer-oriented range of complete solutions more transparent for users and

presenting them in a unifi ed and memorable form in a globalized market with new

forms of communication requires the development of a new, tightly unifi ed image for

our company.”

5 4 | I D E N T I T Y

From precise color defi nitions

to the unifi ed font to the

customized paper design –

the consistent implementation

makes the new corporate

design really stand out

I D E N T I T Y | 5 5

THE START OF ALL THINGS IS … IDENTITY!

The new image is designed to communicate all products, technologies and services

all over the world clearly, in a unifi ed manner and uniquely. Right from the start

the goal was to support and communicate with customers so they can acquire the

desired information easily and without complications. But how can we achieve this?

The solution starts with questions. The questions that DENTSPLY Friadent asked

at the start of developing the corporate design are the same questions that every

implantologist should ask when deciding to establish a new image for the dental

practice. Who are we? What do we do? What is special about us? In brief: what is our

identity, our corporate identity?

QUESTIONS ABOUT QUESTIONS …

These and many other questions resulting from the initial questions were developed

initially by a core team of t hree employees. The answers were then examined by a

larger strategic team. The market and its demands and the special features of the

company as perceived by customers all over the world were analyzed in workshops,

values were developed and colors discussed – until a common direction could be

discerned. Who are we – DENTSPLY Friadent answers this question after customer

surveys and creative and analytical internal processes as follows: DENTSPLY

Friadent is a reliable partner in the success of the dental practice for current and

future customers – because DENTSPLY Friadent offers implantologically oriented

dentists all over the world the three decisive factors that make an implantology

practice successful from one source:

■ strong and well-known brands with clinical experience in implantology

and augmentation throughout the world

■ unique and innovative technologies from the world leader in the dental

market, DENTSPLY

■ successful patient acquisition by a complete service and practice success

program with unique marketing support.

DENTSPLY Friadent offers

customers the three decisive

factors that make a practice

successful as complete

solutions:

1_Strong brands

2_Unique and innovative

technologies

3_Successful patient

acquisition

1_

2_

3_

5 6 | I D E N T I T Y

IT'S ALL ABOUT PRODUCTS

“The process of establishing an identity is certainly the most diffi cult part of

developing a new corporate design, but it is essential for achieving a successful

result,” says Birgit Dillmann. “In the case of DENTSPLY Friadent the result was that

our primary interest with our new image is to make our customers aware of the

unique value of our implant systems and augmentation products. Ankylos. Xive,

Frialit, Frios and PepGen – they are our brands, and we want to make them known

and attractive throughout the world. The company should be more in the back-

ground but still be visible as a reliable partner and supplier of the products. We want

to make sure that everyone can see and feel the unique solutions that our products

represent, because the fi rst priority for the customer is to ask what can the product

do for me.”

The identity fi nding process in the workshops was therefore extended to the

products. What is special about Ankylos? Xive? What do users like about Frialit?

CREATIVE PROCESSES

Of course in the end there are innumerable questions and innumerable answers. But

how do we develop a corporate design from these answers, from the corporate identity?

“By translating the identity to a harmonious visual and verbal communication,”

says Betina Hubrich, independent corporate design expert, who was involved in the

comprehensive project. Over the following months employees worked together with

design experts from Mehler & Partner (Frankfurt) in creative workshops. Roland

Mehler, owner of the agency, was involved from the start and was present at all

workshops. He summarizes the creative process as follows: “We worked together on

image language, typography and color range – elements that underline the unity and

differentiation of the images of the various products.” The creative personnel based

their work on the previously developed identities and properties of the products and

the company. “This creative period was very exciting for us,” remembers Claudia

Schillinger, Senior Manager Marketing Operations & Services at DENTSPLY Friadent,

who was the internal coordinator of the corporate design project. She explains: “For

example, we did not just consider color samples but also questions of psychology

and the effect of colors – absolutely essential when you have understood that colors

can make a major contribution to giving brands a personality.”

I D E N T I T Y | 5 7

Understated corporate image –

branded products with their own

unique character: some brochures

in the new design

PAST, PRESENT, FUTURE –

THE NEW IMAGE OF DENTSPLY FRIADENT

And is everything new and different? Not really. The new appearance of DENTSPLY

Friadent is based on proven components – the best known and established logos

have been retained. All the fonts for the company brand DENTSPLY Friadent are new.

The layout is the promise to customers that all systems, technologies and services

are part of a complete package for implantologists – and part of a leading interna-

tional company that combines tradition, innovation and values in a unique manner.

All company communication media – brochures, catalogs, manuals, web site – will

have the same base color in future, dentine. This is a clear acknowledgement of the

company's understanding of esthetics in implantology. “Esthetics does not mean a

brilliant A1 smile in every case! We believe that nature should be in the foreground,

including natural tooth colors,” explains Birgit Dillmann. The marketing materials of

the unique technologies of the company, such as the Friadent plus surface, Friadent

Cercon, or ExpertEase, will have this color – just as stepps, the DENTSPLY Friadent

brand for success-oriented practice development instruments. The company color

underlines the unique character of DENTSPLY Friadent in implantology and also gives

the different brands space for differentiation. Separate colors have been selected for

the central range of products – the implant systems and augmentation brands – that

represent the product properties. Turquoise for Ankylos. red for Xive, yellow-orange

for Frialit, and matching green shades for augmentation. Users will be able to recognize

immediately the brand that they are using. Brochures for Ankylos, Xive, Frialit, Frios,

and PepGen and also the new DENTSPLY Friadent bibliographies were introduced at

IDS in March 2007. This is the introduction of the new literature system, which will

be implemented further in coming months in the form of new brochures, catalogues

and manuals. The web site will be online shortly, and from 2008 the new design will

be refl ected in the packaging to ensure that all systems and components will be

uniquely and clearly identifi able right through to the dentist's chair. More actions are

to follow – something to look forward to. ■

CORPORATE DESIGN – SOMETHING FOR YOUR DENTAL PRACTICE?

A unifi ed image is not just for an international company but also a signifi cant success

factor for the modern dental implantology practice. If you want to make changes, we

recommend a look at our range of services offered by stepps, our service brand. See

the demo version at www.stepps-direct.de for a way to develop your own corporate

design in just a few short steps. Contact us – we look forward to hearing from you.

5 8 | I D E N T I T Y

speed and perfectionA Xive boat conquers the seas

| Tanja Friedrich

I D E N T I T Y | 5 9

A length of 10 meters, crew weight of 512 kg, brilliant white

hull and sails – the Xive X-99 has been proudly presented at

major international regattas like the Kiel Week. The name

of the boat is not just taken from thin air. Helmsman Dr. Martin

Christiansen is a dedicated Xive user and is sailing to

success under the fl ag of the Xive implant system. iDENTity

spoke to him about the passion of sailing, the fascination

of implantology, and what connects the two: speed and

perfection.

D R . C H R I S T I A N S E N , YO U A R E N O T J U S T A N

E X P E R I E N C E D IMP L A N TO L O G I S T B U T A L S O A

PA SSIONATE SAILOR

Yes, for many years now. I sail the X-99 class as the helmsman

of a six-man crew. We are an experienced team of dedicated

sailors and sail regularly in competitions. I also sail with my

family and even in my profession my passion for sailing is

obvious. The manufacturing facility for regenerative dentistry

that I operate with Dr. Henrike Rolf has the short name of

mareZ …

… AND YOU SAIL A SPECIAL X-99 BOAT THAT CARRIES

THE XIVE LOGO …

… quite true. Our boat has the Xive logo, which we had put

on by a Danish shipyard. The crew members also wear sailing

jackets in the red Xive color and t-shirts with the logo.

WHEN AND HOW DID YOU GET THE IDEA OF CREATING

A XIVE BOAT? WHAT IS THE REASON FOR THIS?

I am an implantologist as is our foredeck hand, Dr. Henrike

Rolf. She is an oral surgeon and in our practice in Buxtehude

we both work with the Xive system. The idea of naming our

boat came to us together with DENTSPLY Friadent. A one-time

event was the original plan, but now it has become a sponsor

partnership.

WHAT DO YOU FIND SO SPECIAL ABOUT THE XIVE

IMPLANT SYSTEM THAT IT EVEN PLAYS A PART IN

YOUR LEISURE TIME?

Our slogan in the practice and on board is “Speed and

Perfection.” This is why we appreciate the properties of the

Xive system so much in our work. Particularly since the

Friadent plus implant surface has been introduced, which is

ideal for the formation of new bone and lasting stability.

Xive gives us a reduced healing period and the option of

immediate restoration. And with our CT and DVT-supported

treatment planning we are again with our slogan of “Speed

and Perfection.” The same applies to our crew on the water.

Often in a regatta there are only seconds between the winner

and the loser. The key is perfect preparation for the material

and in training. You can see that the spirit of Xive is in both

places.

HAS XIVE BROUGHT YOU LUCK IN COMPETITIONS?

You could say that. We were fi rst in the welcome race in this

year's Kiel Week. We are particularly proud of our result in the

world championship in Copenhagen in July – there we came

fourth of almost forty boats in the race.

THANK YOU, DR. CHRISTIANSEN, AND WE WISH YOU

ENOUGH WATER UNDER THE KEEL AT ALL TIMES. ■

Manufacture for regenerative Dentistry

Brüningstraße 11 · 21614 Buxtehude/Germany · Tel. +49 4161 749731

info@marez.de · www.marez.de

young. dynamic. and successful?One year of p3 – part-time at the 1st DENTSPLY Friadent

personal performance program

| The editorial team

The fi rst personal performance program – p3 in short – is in full swing. DENTSPLY

Friadent has invited participants to the p3 workshop three times already – another

three workshops in this series are already being planned. Halfway through iDENTity

took the opportunity of seeing how it was going and asked: has the development

program for young presenters met the expectations?

A BIT OF PRIDE can be detected when Dr. Ricarda Jansen, responsible for the

conception, organization and implementation of the personal performance program,

and her colleague Dr. Marcel Ender report on the fi rst workshop in the DENTSPLY

Friadent development program. They are proud to have created something new and

unique in implantology that meets a real need: “It is really a risk to offer a develop-

ment program over such a long period. But looking at the results so far we are sure

that the work has paid off and everyone will profi t from it,” says Dr. Ender.

A LOOK BACK at the recent events gives an idea of this exciting concept. Organization

for the six-part series of workshops started about a year ago, in September 2006,

in Tuscany (reported by iDENTity). Since this initial event the workshops have been

developed and conducted in collaboration with Ms. Zienterra of the Institute of Rhetoric

and Communication – a good initial decision in Dr. Jansen's opinion: “Ms. Zienterra is

an ideal leader. We certainly know the communication requirements in everyday work

in the practice and in our specialty, but we have only been able to translate them into

customized training courses with her as a professional in rhetoric and presentation.”

A central topic of the fi rst workshop was the basics of presentation and giving feed-

back. The following workshops built on this base.

1_“I – as the presenter“ –

Dr. Martin Oppermann

2_Dr. Insa Friedrich in a

customized training course –

Ms. Zienterra (right) knows

how it is done

6 0 | I D E N T I T Y

1_

2_

I D E N T I T Y | 6 1

AND HOW ARE THE PARTICIPANTS RECEIVING THE PROGRAM?

“We are excited by the enthusiasm and motivation of the group,” says Dr. Jansen

about the response to the workshop program. An important factor for the organizers

is the personal contacts with and among the participants: “The discussions about

cases and concepts, working with patients and ideas for practice development

are just as important for p3 as the development of communication abilities,” says

Dr. Ender. The background to this recipe for success is the idea of combining the

training workshop and event, which was the underlying factor for all events of the

p3 series.

IN JANUARY 2007 the participants met for the second workshop in Deidesheim,

Germany, in the Palatinate, a center for winemaking, to work on rhetorical training

and digital dental photography. Not only is the technique important on the podium

but the presentation must also be perfect, and the perfect presentation needs

pictures. DENTSPLY Friadent invited Dr. Wolfgang Bengel, one of the best know

presenters in this fi eld, to tell the participants about preparing successful photo-

graphic documentation of clinical cases. In the evenings the group relaxed with

the almost obligatory wine-tasting in the Reichsrat von Buhl winery and a cooking

course with Stefan Neugebauer of the “Schwarzer Hahn”.

He introduced the group to the secrets of gourmet cooking in an exclusive course.

The result was a fi ne menu that all the group could enjoy in the relaxed ambience

of the restaurant.

1_Haute cuisine – Dr. Christian

Mall learns about real life

2_Just enjoy: the results of the work

3_Young leaders: the p3 group

at the 3rd workshop in Bonn

1_ 2_

3_

AT THE THIRD WORKSHOP the participants were at the Institute for Rhetoric

and Communication at Bornheim near Bonn, where they continued their training

on “I – being the presenter“ and were able to concentrate on voice, presence and

impromptu speaking. A special feature was that the ten-minute presentations

prepared by every participant could be presented in a historical room – the Wa-

terworks in Bonn, still known to many as the temporary parliament building from

1982 to 1992. Not only the participants were impresses by the building: “It was

very impressive to work in these rooms that were the center of political life at one

stage,” says Dr. Ender, and Dr. Jansen adds: “The German eagle on the wall and

everything else – unchanged. That was really something special.” The meal after

the presentations also had style. It was held in the legendary canteen in the base-

ment of the Waterworks. “We were already somewhat awed and we wondered

where more decisions were made, upstairs in the parliament room or down here

in the canteen,” wondered Dr. Jansen. The fi nale of the third p3 workshop was a

relaxed barbecue in the grounds of the institute.

DR. JANSEN IS CONVINCED that the expectations of p3 have been more than

met halfway through the program: “The dynamics that the program has develo-

ped has even surprised us,” she said, and explained further: “The participants

have become very close and a network of young leaders has formed, who are

learning from one another and are profi ting from the p3 program as a team.

1_Speaking in the appropriate

atmosphere: the Waterworks

in Bonn

2_Voice, presence, impromptu

speaking – presented by Dr. Dr.

Andreas Pohl

3_“As it was then” – debating

under the German eagle with

Dr. Volker Rabald

6 2 | I D E N T I T Y

1_

2_

3_

I D E N T I T Y | 6 3

It is a real pleasure to work for this group and the p3 program.” And what is

happening now? The organizers have prepared something special again for the

next meeting in Switzerland – but no details are revealed yet. Dr. Enders has one

novelty to offer already: “All p3 participants will speak at the Symposium 2008

in Berlin as part of the young implantologists program.” And with a smile Dr. Enders

adds: “One thing is fairly certain – there will be another p3 program starting in

2008.” ■

AND WHAT ABOUT MSP?

Along with p3, the development program for young leaders, DENTSPLY Friadent

has also established a program to support well-known international leaders.

This involves intensive support of leaders, but direct exchange between

DENTSPLY Friadent and the leaders is also an important foundation stone of

the Master Speakers' Program (MSP). The fi rst MSP event, a meeting of all

involved to discuss strategies and innovations, took place last December in

the Hilton Hotel in Frankfurt. The response of the over 60 participants was over-

whelmingly positive. The combination of the presentation of new products and

ideas for the coming year with an interesting range of skills workshops was well

received by all participants. This idea will give birth to a tradition. The MSP event

will now always be in Frankfurt in December to look forward to the coming year

with the invited leaders.

1_Assembled expertise at the 1st

DENTSPLY Friadent MSP event

2_Listen to the music: leaders

meet in Frankfurt

3_Products, ideas, skills: DENTSPLY

Friadent talks to the experts

1_

2_ 3_

+++ news in brief +++

COMBINED DENTSPLY FRIADENT SCANDINAVIA APS OFFICE IN

COPENHAGEN

The two DENTSPLY Friadent subsidiaries in Roskilde in Denmark and Malmö in

Sweden have a shared offi ce in Copenhagen since July 1, 2007.

The Danish national Anne Eidorff was appointed as manager of the two subsidiaries

two years ago. “Now that the two organizations have grown together over this

period, we have decided to service the two markets from the same offi ce. This will

make us more effi cient and we will be able to supply our products from only one

source,” says DENTSPLY Friadent CEO Dr. Werner Groll. The experienced team

with fi ve fi eld representatives in Sweden and three in Denmark will remain

unchanged. Both subsidiaries have years of experience in the implant business

and with the merger they will both profi t from the experience of the other and

optimize their processes. The merger of the offi ces will simplify information

exchange and administration and open the way for more effi ciencies.

BOOK REVIEW

Bone Augmentation in Oral Implantology

Professor Dr. Fouad Khoury et al.

This new book by Fouad Khoury et al. deals with all current

methods for vertical and horizontal augmentation of the

maxillary and mandibular bone before implantation. This

comprehensive and up-to-date monograph covers topics

such as transplantation of intraoral and extraoral bone

material, bone augmentation techniques, the use of bio -

materials, and distraction osteogenesis. The authors

provide detailed instructions for application in surgery

and present signifi cant criteria for successful bone aug-

mentation. They also describe possible complications and

how to deal with them.

Bone Augmentation in Oral Implantology is a valuable

guide for every implantologist, oral surgeon and

maxillofacial surgeon.

The book is published in English

by Quintessence Publishing.

Khoury, Fouad/Antoun, Hadi/

Missika, Patrick:

Bone Augmentation in

Oral Implantology

Berlin: Quintessence

Publishing, 2006

448 pages with 1500 illustrations.

ISBN 978-1-85097-159-7

6 4 | I D E N T I T Y

I D E N T I T Y | 6 5

DENTSPLY FRIADENT: XIVE AWARDED US PATENT

The outstanding properties in combination with conden-

sing thread design and bone-specifi c preparation protocol

were decisive. The DENTSPLY Friadent Xive implant

system has now been patented in the USA by the United

States Patent and Trademark Offi ce.

Advanced primary stability in all bone classes

With the unique, bone-condensing thread and the fl exible

surgical preparation protocol of the Xive system the ideal

primary stability can be achieved even in soft bone. The

degree of bone condensation and the insertion torque during

placement of the Xive implant can be controlled by the depth of

the fi nal crestal drilling and an optional thread-tapping step.

The advantages of the system are clear even in cortical bone.

Implant placement is safe and atraumatic with the apical self-

tapping thread.

Additional highlights: Xive 3.0 and Xive TempBase

Xive 3.0 is the smallest two-component implant in the world.

Implants can now be placed in even the narrowest gaps. Xive

also offers other advantages. The premounted TempBase on

the implant allows immediate implant restoration with a fi xed,

esthetically attractive temporary denture in suitable cases.

This is the optimum solution for patients who have a busy life

and want their smile back quickly.

TURKISH DISTRIBUTOR BECOMES SUBSIDIARY

After the acquisition of the former Spanish distributor (see page 66), DENTSPLY

Friadent has also purchased its Turkish distributor, Saglik Dis Deposu. The contract

was signed in Turkey on September 25.

The acquisition will improve the company's position in the Turkish market.

The former proprietor, Albert Altaras, will become managing director of the

new subsidiary. This will ensure continuity for customers.

DENTSPLY Friadent is the market leader in Turkey with the Ankylos, Xive and

Frialit implant systems.

Albert Altaras

DFT Dis Hekimligi Urunleri A.S.

Sairnigar sokak

Halit Kehale Is Merkezi

No:4 Kat:2

34365 Nisantasi / Istanbul

Turkey

Tel. +90 212 224 7688

Fax +90 212 225 8099

6 6 | I D E N T I T Y

“hola españa”TMV Medica S.A. is now DENTSPLY Friadent Spain

| The editorial team

Jorge Suarez

Managing Director

DENTSPLY Friadent Spain

Marie Curie 19, Of. 1.7

28529 Rivas-Vaciamadrid

SPAIN

I D E N T I T Y | 6 7

What European country has the most cosmetic operations by population? It is one

of the most dynamic markets in Europe with very high and sustained growth rates:

Spain. Manufacturers of dental implants are very active in Spain, particularly the

local companies. DENTSPLY Friadent, a global player, has also had a presence

in Spain for some years. Now the Mannheim-based company has acquired its

Spanish representative, TMV Medica S.A. We talked to the DENTSPLY Friadent CEO,

Dr. Werner Groll, to fi nd out what this means for the Spanish market and for customers.

THE MANUFACTURER SWALLOWS THE REPRESENTATIVE –

DR. GROLL, PLEASE TELL US AGAIN HOW THIS HAPPENED.

DR. GROLL TMV became the exclusive dealer for Friadent products in 1999 and

since then has consistently expanded the business. However, in recent years the

market in Spain has become considerable more dynamic, which means that a

private company like TMV is fi nding it increasingly diffi cult to maintain its position in

the face of international competition. We came to a mutual agreement to purchase

the company. The advantage is that the structures and connections built up by

TMV with so much enthusiasm can now form the base from which DENTSPLY can

invest in the increasingly fast market growth. Jorge Suarez, the former CEO, will

continue to manage the business of the company, which will be renamed DENTSPLY

Friadent Spain on October 1, and will guarantee the company‘s continuity in the

Spanish market.

HOW WILL THE SPANISH COMPANY CHANGE AS A RESULT OF THE

CHANGE IN OWNERSHIP?

DR. GROLL As mentioned, TMV has already been very successful, so we do not

feel that it is necessary to make any basic changes in the organization. We will increase

the number of fi eld representatives signifi cantly and introduce a clear regional

structure. We will invest in the continuing education of our employees to improve

their ability to carry our mission to our customers and to make them more success-

ful. The integration of DENTSPLY Friadent Spain into our European organization

will mean new blood in the Spanish market.

AND TO LOOK AT IT FROM THE OTHER DIRECTION –

WHAT DOES THE NEW SPANISH BRANCH MEAN FOR THE PARENT

COMPANY, DENTSPLY FRIADENT?

DR. GROLL Spain is the third largest market in Europe. This means that a strong

position in Spain is essential for a company that intends to be one of the leading

suppliers of implants in Europe. In addition to the increased penetration of our

products and treatment services based on Ankylos, Xive and Frialit, we will increase

our involvement with universities and opinion leaders.

6 8 | I D E N T I T Y

DENTISTS – WHAT DOES THE NEW DENTSPLY FRIADENT SPAIN MEAN

FOR CUSTOMERS? WHAT WILL REALLY CHANGE FOR THEM?

DR. GROLL We want to strengthen our position with dentists in the increasingly

competitive environment. The basis of this will be the previously noted increase in

personnel. We would like to almost double the number of fi eld representatives

by the fi rst quarter of 2008. This will enable us to offer qualitative and quantitative

support to more dentists. Our customers will become more successful with new

products like ExpertEase and our unique practice marketing concept stepps.

WHAT ACTIONS ARE PLANNED TO MAKE DENTSPLY FRIADENT SPAIN

BETTER KNOWN IN THE MARKET AND TO POSITION THE COMPANY?

DR. GROLL I would fi rst like to emphasize that we have many loyal customers in the

market, with whom we will continue to work as DENTSPLY Friadent Spain. Of course

we will restructure our public relations work, take a more active part in conferences

and improve our profi le with targeted actions. Our Internet presence will be available

in Spanish shortly with much more information in Spanish than ever before.

WILL WE MEET THE NEW DENTSPLY FRIADENT SPAIN AT THE EAO?

DR. GROLL Yes, we will be presenting DENTSPLY Friadent Spain in Barcelona for

the fi rst time in our new corporate design as part of DENTSPLY Friadent. The Spanish

subsidiary will also be there when we celebrate 20 years of clinical success of the

ANKYLOS implant system at the EAO on October 26 with transmission of a live

operation that will demonstrate ExpertEase, the new guided surgery system, scientifi c

presentations and a big birthday party.

THE FIRST BIG PRESENTATION WITH THE SUBSIDIARY IN SPAIN –

ARE MORE PLANNED TO INTRODUCE IT TO THE MARKET?

DR. GROLL Another event is planned, and that will be part of the TissueCare

Roadshow. We have developed the TissueCare Concept together with leading

Dr. Werner Groll

CEO, DENTSPLY Friadent,

Mannheim/Germany

I D E N T I T Y | 6 9

international experts and it is currently being presented throughout Europe in a total

of seven roadshow events where the experts present their insights into the topics of

bone and soft tissue retention in implantology. The fi nal event in this series will be

on February 8 next year at the Hotel Melia Castilla in Madrid. We also hope to be able

to meet Spanish implantologists at our international events outside Spain.

WHAT ARE THOSE EVENTS? WHEN AND WHERE CAN SPANISH

DENTISTS FIND THEM?

DR. GROLL Most important is of course the DENTSPLY Friadent World Symposium

on April 18 and 19, 2008, in Berlin. A large Spanish group will be attending and a

Spanish translation of the main program will be available for them. And then for

2008 other smaller meetings are also planned, which will certainly be of interest to

major Spanish customers. We are offering a conference at the University of Frankfurt

that will provide information on the latest in research and science and another day to

become acquainted with what actually goes on at one of the world leaders in implant

manufacturing, with special emphasis on the highly technical production processes.

THAT SOUNDS LIKE A LOT GOING ON.

DR. GROLL Yes, that is correct. But initiative and investment alone do not guarantee

success. The decisive factor is the people in the company who will be responsible for

the implementation. That is why I am so pleased to be able to rely on the experience

of Jorge Suarez and his team, who will be ensuring continuity in the Spanish market

after the change of management and under the new company name.

DR. GROLL, THANK YOU FOR THE INTERVIEW AND WE WISH YOU

SUCCESS WITH THE NEW SPANISH COMPANY. ■

13th dentsply friadent world symposiumThe centre of the implantologists' world is in Berlin in 2008

| The editorial team

The fall of the Berlin wall, the Love Parade, World Cup – Berlin is the exciting

metropolis in the new center of Europe, meeting place of people from all nations

and cultures. The world of implantology will meet at the 13th DENTSPLY Friadent

World Symposium in the Maritim Hotel on April 18-19, 2008, in the new center of

Berlin, just a few minutes from the busy Postdamer Platz. The new name of the

symposium describes it. Under the scientifi c direction of Dr. David Garber, USA,

Professor Adriano Piatelli, Italy, and Professor Lin Ye, China, this worldwide

celebration of implantology will offer more than 2000 national and international

delegates the opportunity to experience exciting innovations and practical

concepts at fi rst hand and to discuss their implementation into everyday practice.

7 0 | I D E N T I T Y

ALWAYS IN VIEW: YOUR SUCCESS

The slogan “Your practise success in focus” embodies the

promise of the event. Presentations on current topics in

implantology such as platform shifting or computer-guided

treatment plan ning, case studies of proven and new surgical

and prosthetic treatment concepts, and presentations of long-

term studies provide perspectives for successful expansion

of implantology in your own dental practice. Presentations by

international teams underline the importance of functioning

networks for success. A practice marketing session under the

descriptive

title of “A chamber of horrors: communication with the

practice team and patients” uses the Harry Potter novels to

present successful ways to communicate in the workplace in

an entertaining form.

Interactive panel discussions on “Periodontal therapy versus

implantology” and “Guided Surgery – genuine progress or

total hype“ will give delegates the opportunity to take an

active part in discussing controversial topics.

The symposium will end with the transmission of a live

operation with ExpertEase. Delegates will see in real time how

to achieve a perfect result with virtual treatment planning and

implant placement using innovative drill templates and a

simple drill system.

NEW THIS YEAR: LUNCH AND LEARN

Two parallel midday sessions are new this year. “East meets

West” on Friday presents exclusively lecturers from Eastern

Europe, who will describe some of the successes of implan-

tology. The “Young Implantologists' Forum,” presented by

the outstanding young implantologists from the DENTSPLY

Friadent p3 development program, will provide students and

potential implantologists valuable information and contacts

essential for a successful start in implantology. Saturday will

be “From the poster walk to the podium.” Selected poster

presenters will discuss their work in short presentations.

BEST INFORMED:

USER INFORMATION FROM THE SOURCE

As always, there will also be plenty of time to see and try out

the latest innovations from DENTSPLY Friadent. Meet DENTSPLY

Friadent product specialists and – new in the Expert Lounge –

I D E N T I T Y | 7 1

BOOK NOW:

YOUR TICKET TO SUCCESS

Register now for the 13th DENTSPLY Friadent World Symposium

and be there in April 2008 when the world revolves around

success in implantology. Immerse yourself in the life of Berlin

and take advantage of the unique atmosphere of the city for

encounters that will equip your practice for the future.

Take advantage of the early-bird rebate, register online now at

www.friadent.de

Use the fax form attached at the end to request the current

program of our symposium.

colleagues active in implantology from all over the world

and discuss the Ankylos, Xive and Frialit implant systems.

Try out computer-guided implant planning with ExpertEase

on the computer or surf the wave of success of the stepps

practice marketing platform. The Poster Walk, an exhibition

of scientifi c posters, is a popular method of presenting

and discussing your own treatment results. DENTSPLY

Friadent offers a prize for the best student poster, another

method of support for the younger generation of implanto-

logists and a way of transferring fresh ideas from universities

into daily practice.

PURE EXCITEMENT:

PARTY MOOD FOR ALL

Another highlight in Berlin will be the evening event in

one of the most unusual popular venues. “The Station”

is a former parcel post offi ce, the site of many prominent

events in Berlin life, such as the premiere of the new

James Bond, Daniel Craig, and it will offer an opportunity

to rest or dance after a long day at the conference. You

can enjoy food specialties such as a fi nger-food buffet and

the cocktail bar, enjoy artists and acrobats, listen to soul

singer Della Miles and “Szenario”, the cult band in the

world of dentistry with power violinist Christoph Broll and

an exciting performance by singer Sheila Gathright. ■

7 2 | I D E N T I T Y

Scientific chairs:

David Garber, DDS, USA; Prof. Ye Lin, MD, DDS, China; Prof. Adriano

Piatelli, MD, DDS, Italy.

Lecturers and hosts:

Dr. Marcus Abboud, D; Dr. Ata Anil, TR; Dr. Georg Bayer, D;

Dr. Anne Benhamou, F; Dr. Roman Beniashvili, D; Dr. Fred Bergmann, D;

Dr. Andre Büchter, D; Dr. Christian Buhtz, D; Renzo Casellini, MDT, USA;

Dr. Kryztof Chmielewski, PL; Dr. Martin Christiansen, D;

Marco Degidi, MD, DDS, I; Dr. Koray Feran, UK; Dr. Michael Ferchland, D;

Dr. Insa Friedrich, D; David Garber, DDS, USA; Dr. Peter Gehrke, D;

Prof. Dr. German Gómez-Román, D; Matija Gorjanc, SI;

Prof. Dr. Fouad Khoury, D; Jan Kielhorn, D; Dr. Gerd Körner, D;

Dr. Frank Kornmann, D; Dr. Stefanos Kourtis, GR;

Prof. Ye Lin, MD, DDS, CN; Dr. Arnd Lohmann, D; Dr. Christian Mall, D;

Prof. Dr. Georg-H. Nentwig, D; Dr. Martin Oppermann, D;

Dr. Armands Ozolins, LV; Dr. Dr. Andreas Pohl, D; Dr. Holger Psenicka, D;

Dr. Volker Rabald, D; Kathrin Rinke, D; Prof. Dr. George E. Romanos, USA;

Dr. Andreas Sahm, D; Henry Salama, DDS, USA;

Nigel Saynor, BDS, UK; Devorah Schwartz-Arad, DMD, PhD, IL;

Ashok Sethi, BDS, DGDP (UK), MDGSRCS (UK), DUI (Lille), FFDGP (UK), UK;

Peter Sochor, MDT, UK; Dr. Anthony Spencer, UK;

PD Dr. Dr. Michael Stiller, D; Dr. Takahiko Sugiyama, JP;

Prof. Dennis Tarnow, DDS, USA; Thomas Voeste, D;

Prof. Dr. Walther Wegscheider, A; Dr. Paul Weigl, D; Dr. Dietmar Weng, D;

Dr. Orcan Yüksel, D; Dipl.-Ing. Holger Zipprich, D;

Prof. Dr. Dr. Joachim Zöller, D.

We reserve the right to makes changes to the program

ATTENTION STUDENTS!

Students in the last semester pf prosthetic studies

who are already placing DENTSPLY Friadent implants

or performing prosthetic restorations are invited to

submit a scientifi c poster. If the poster is accepted

DENTSPLY Friadent will give you a free registration

for the symposium. The best student poster will

receive a prize – a continuing education course in

implantology.

Registration forms and detailed information at

www.friadent.de

www.visitberlin.de

I D E N T I T Y | 7 3

20 years of ankylosiDENTity special issue celebrating:

the iDENTity special issue will be published in october 2007.

7 4 | I D E N T I T Y

I D E N T I T Y | 7 5

Please send iDENTity regularly to

my address.

I would like an appointment with

my personal DENTSPLY Friadent

field representative.

yes, i want:

PERSONAL DETAILS

Name

Street

Area Code/City

Phone

email

Date/signature

JUST CUT OUT THE FORM AND FAX IT TO +49 (0) 211 516045-119 OR MAIL IT

INFORMATION ABOUT STEPPS

I am interested in stepps – please call me to make an appointment.

INFORMATION ABOUT TISSUECARE

Please send me:

the TissueCare brochure the current TissueCare Roadshow program

TissueNews in the print version TissueNews as pdf (please insert email address below)

PRODUCT INFORMATION

I am interested in more information about:

ExpertEase simplified surgery and the new Xive and Ankylos surgical trays

the new Frios Unit S/i the new Xive DVD

PATIENT MATERIALS

Please send me:

the new patient materials for Ankylos the new patient materials for Xive

the latest program for the Symposium

PUBLICATION IN IDENTITY

I am interested in submitting to iDENTity – please send me the authors guidelines.

FAX +49 (0) 211 516045-119

Medical Consulting Group

Tanja Friedrich

Mörsenbroicher Weg 200

40470 Düsseldorf/Germany

DENTSPLY FRIADENT TISSUECARE ROADSHOW OCTOBER 25-27, 2007

EAO – EUROPEAN SOCIETY FOR OSSEOINTEGRATION

BARCELONA/SPAIN

• Ankylos 20th Anniversary Show:

Future innovations based on long-term success:

Ankylos – Past, present, future

ExpertEase – Computer-guided implantology

Workshop with transmission of a live computer-guided

operation via satellite with Dr. Ashok Sethi, London, UK, and

live discussion of the Ankylos Expert Board (Dr. Nigel Saynor,

Stockport/UK, Prof. Dr. Georg E. Romanos, Rochester/USA,

Dr. Paul Weigl, Frankfurt am Main/Germany, and Dr. Dietmar

Weng, Starnberg/Germany)

• Ankylos 20th Anniversary Birthday-Party

Information: www.eao.org

NOVEMBER 29 – DECEMBER 1, 2007

4TH COMBINED CONFERENCE ÖGOCI, DGI, SGI

VIENNA/AUSTRIA

• DENTSPLY Friadent Workshop “Challenges in the present –

success in the future” with Dr. Thomas Hanser, Olsberg/

Germany, Jan Kielhorn, Öhringen/Germany, and

Prof. Dr. Georg E. Romanos, Rochester/USA

Information: www.oegoci.org

APRIL 18-19, 2008

13TH DENTSPLY FRIADENT WORLD SYMPOSIUM

BERLIN/GERMANY

• Register now and get the early-bird rebate!

Information: www.friadent.de

For current information on DENTSPLY Friadent activities at the

above conferences and additional even see www.FRIADENT.de

Join the TissueCare Concept – and experience how

experts present a new perspective in implantology:

• Prof. Dr. Georg-H. Nentwig, Frankfurt am Main/Germany

• Prof. Dr. Georg E. Romanos, Rochester/USA

• Dr. Dietmar Weng, Starnberg/Germany

• Dr. Peter Gehrke, Ludwigshafen/Germany

• Dr. Marcus Abboud, Bonn/Germany

• Dr. Paul Weigl, Frankfurt am Main/Germany

• Dr. Nigel Saynor, Stockport/UK

• Dipl.-Ing. Holger Zipprich, Frankfurt am Main/Germany

Information and registration: www.tissuecareconcept.de

NOVEMBER 23, 2007 LONDON/UK

JANUARY 24, 2008 NIZZA/FRANCE

FEBRUARY 8, 2008 MADRID/SPAIN

events 2007/08

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