www.osseo.org

Dr. Tomas Albrektsson to receive 2014 Nobel Biocare BrånemarkOsseointegration Award

A quarterly publication of the Academy of OsseointegrationVolume 25, Number 1 • 2014

In This Issue

President’s Message: My goals as President: Grow AO membership, at home and abroad . . . . . . . .2

Member News: Drs. Cochran, Amet honored . . . . . . . . . . . .3

Take your meeting mobile . . .5

Four speakers confirmed for AO Charter Chapter meeting in India . . . . . . . . . . .6

AO launches Charter Chapter in Israel . . . . . . . . . . .6

Second AO UK chapter meeting held in London . . . . .7

AO’s New Product Showcasefeatures 12 companies . . . . . .7

Expert Dr. Franck Renouard offers opinions on “zombieimplant” questions . . . . . . . . .8

AO’s 2014 Summit Conference will create 3 deliverables . . . . . . . . . . . .10

First showings of AO Founders Video scheduled at Seattle . . . . . . . . . . . . . . .10

Academy News welcomes 4 new editors . . . . . . . . . . . .13

Editor’s Editorial: Here’s to longer telomeres . . . . . . . . . .4

Academy NewsAcademy of Osseointegration85 W. Algonquin Road, Suite 550Arlington Heights, IL 60005847/439-1919

EditorKevin T. McNally, DDS

Editorial ConsultantsEdward M. Amet, DDS, BS, MSDBruce K. Barr, DDSDaniel R. Cullum, DDSBarry R. Franzen, DDSLouis R. Guenin, BDS, LDS, RCSPaige Warren Miller, DDS

© The Academy of Osseointegration. All rights reserved.

Tomas Albrektsson, MD, PhD, ODhc,Gothenburg, Sweden, a close co-workerwith Dr. Per-Ingvar Brånemark in the

development ofosseointegrateddental implanttreatment in the1980s, is the sev-enth recipient ofthe Nobel BiocareBrånemarkOsseointegrationAward. The awardis given annually by

the Osseointegration Foundation (OF) tohonor an individual whose impact onimplant dentistry is exemplary in any or allof the Foundation’s mission categories:research, education, and charitable causes.

OF President Dr. Luis J. Fujimoto, NewYork, NY, will present the award Saturday,March 8, at the end of the Academy’sannual business meeting at the WashingtonState Convention Center in Seattle.

Previous Nobel Biocare BrånemarkOsseointegration Award honorees areProfessor Brånemark (the first honoree),Drs. Daniel Buser, William R. Laney andGeorge A. Zarb, and Professors Danielvan Steenberghe and Ulk Lekholm. The

award is made possible by a grant fromNobel Biocare. The selection processinvolves members of the OsseointegrationFoundation’s Titanium Society to proposedistinguished candidates from the field ofimplant dentistry.

“The Foundation is proud to present thisaward to such a deserving honoree. Dr.Tomas Albrektsson is one of the trailblaz-ers in our field. His record of leadership inimplant dentistry has been recognizedworldwide, with awards and honors inEurope, Asia, South America, and NorthAmerica,” says Dr. Fujimoto.

“The Nobel Biocare BrånemarkOsseointegration Award is the highesthonor bestowed by the Foundation. It isour pleasure to have this opportunity torecognize Dr. Albrektsson’s accomplish-ments as a leader, teacher, and researcherin the field,” Dr. Fujimoto adds.

Dr. Albrektsson, 68, was Professor andHead of the Department of HandicapResearch (now called Department ofBiomaterials), Department of ClinicalSciences, University of Gothenburg, from1986 to 2012. He is now visiting professorat Malmö Dental University.

…continued on page 13The purpose of the Academy of Osseointegration is to advance the science and application of tissue replacement in oral and facial care.

Dr. Tomas Albrektsson

…continued on page 5

It has been an honor and a privilege to serve as the Presidentof the Academy of Osseointegration this past year. I joinedthis organization 20 years ago and later volunteered to be on

the board, as I believed the AO wasthe premiere dental implant organiza-tion in the United States. I nowbelieve this to be true for not only theUnited States, but worldwide. Eventhough our organization started as asmall study club, it was based on tech-niques and technology from Europe,specifically Sweden. The AO hasalways sponsored one of the mostcomprehensive annual meetings on

dental implants and found the need to continually bring in topspeakers from around the world to accomplish this goal.

As our international membership has now grown to over 20%of our 6,000 members, we have been approached by otherinternational organizations to join with them in promotingexcellence in patient care withthe most recent evidenced-based techniques. The AO, aninternational organizationbased in the U.S., has had adifficult time determining howbest to accomplish this, whilemaintaining the excellence ofour annual meetings and notdiluting the value to our exist-ing members.

When I started my year asPresident, besides trying tomaintain the elite status of the AO and our Annual Meeting, Ihad two goals: to grow the AO membership at home andabroad. There have been many tiers to these efforts, includinghiring an outside PR firm and setting up new task forces andcommittees, but my main focus has been on expanding ouroutreach internationally and into the general dentistry popula-tion. While the AO started as a specialty organization advocat-ing the team approach to implant dentistry (and we willcontinue to do this), as times have changed and implant den-tistry has become a mainstream standard of care, the generaldental population has become an integral part of this team.Even if dental practitioners are not practicing implant den-tistry today, patients are constantly walking into their officesneeding follow-up or continued implant care. Everyone needsto understand how best to treat these patients and/or when torefer. This, of course, is the theme of our annual meeting:“Real Problems, Real Solutions,” which should provide essen-

tial information to all dentists, no matter what their level ofinvolvement.

One of the planks of our recent Strategic Plan is to find waysto recruit and retain general dentists who presently make upapproximately 15% of our membership. For this purpose, weestablished a General PractitionerRecruitment Task Force under the leadof Dr. Steven Rosenstein. We havealready and continue to sponsor sym-posia at other dental meetings whichcater more to the general practitioner,and look forward to playing an impor-tant role in the upcoming GreaterNew York Dental Implant Conference.Our hope is to present more basic andadvanced implant concepts, supportedby evidenced-based research, along with information impor-tant to those who have not had formal or advanced training insurgery, following the Academy of Osseointegration’s

Guidelines for the Provision ofDental Implants. This informa-tion, not readily available at ourannual meetings, can also beprovided at our Residency lec-ture programs and potentialRegional Meetings. As many ofour non-specialty trained den-tists are looking for certifica-tion, we have embellished theAO Fellowship program andare attempting to set up aMaster’s program as well.

My hope is that with better training the general dentist cantake a more active role within the implant team. At the sametime, we continue pursuing AO’s unique role in sponsoringconsensus conferences to provide critical insights into patientcare. Our next conference: “Current Best Evidence forMinimal Intervention in the Management of the EdentulousMaxilla,” will be in August of this year. Only in this mannercan we hope to provide the best in patient care at all levels.

Implant dentistry not only spans all levels of dental care, butall international borders as well. I have had the opportunity totravel around the world lecturing and attending conferences,and the knowledge and expertise in this field is in no way lim-ited to North America. As I mentioned earlier, the AO hasrealized we need to expand our influence internationally aswell, we just did not know how to proceed. I am excited that

President’s Message

My goals as President:grow AO membership, at home and abroadBy Stephen L. Wheeler, DDS

2

Dr. Stephen Wheeler

…continued on page 3

“The AO has always sponsoredone of the most comprehensiveannual meetings on dentalimplants and found the needto continually bring in topspeakers from around theworld to accomplish this goal.”

Dr. Steven Rosenstein

3

the AO Board approved several concepts put forth by ourGlobal Program Development Committee, aided by inputfrom some of our Corporate Sponsors, and we started imple-menting them two years ago.

We had our first International Charter Chapter meeting in2012 in London, England, chaired by Dr. Michael Norton,and now have had a follow-up meeting last year chaired by Dr. Steve Jacobs, both of which were extremely well receivedand resulted in a number of new AO members. By the timeyou read this article, I will have returned from Tel Aviv, Israelwhere I will have presented to their first Charter Chaptermeeting, chaired by Dr. Zvi Artzi. We also have a co-spon-sored program set up in January of 2015 with the DPU inPune, India through the efforts of Drs. D. Gopalakrishnanfrom Pune and George Romanos. Dr. Ryo Jimbo and hisstudy club in Japan are also working to set up another Chapter there.

On yet another international front, theAO has become a member of the FDIspecifically through the efforts of Dr.James Taylor. Under the leadership ofDr. Michael Norton and the GPDcommittee, a group of three interna-tional lecturers presented to a standingroom only crowd at the FDI WorldSymposium last August in Istanbul. Aswe begin to take a more active role inthis organization, we are planning another sponsored sympo-sium in India for the next World Symposium, which willhopefully help to build our relationship with DPU in Pune.

Alongside the international outreach above, I have been work-ing for three years on the first AO International Symposiumdedicated to a single international country or region. By farthe largest international membership in the AO comes fromour colleagues from the Pacific Rim, Japan leading the way.Even though our international attendance at the annual meet-ings is consistently around 20%, one of our biggest barriers islanguage. This makes it difficult for our international lecturers

to present comprehensively in a second or third language, andfor them to understand any significant part of the other pre-sentations during the rest of the meeting. Realizing that keyopinion leaders from many of these countries have importantinsights they could share with us, the concept to set aside afull half day symposium within the Annual Meeting for thesekey individuals to present in their native language was formed.

I have had several visits to Japan both for presentations andlive surgical demonstrations, and was happy to travel again toTokyo this past summer to represent the AO and promote ourAnnual Meeting and our International Symposium in Seattle,which will be dedicated to our Japanese colleagues. The O.J.study club based in Tokyo has been instrumental in assistingus in getting this put together. They, along with several otherstudy clubs and our five corporate sponsors (Biomet 3i,DENTSPLY Implants, Geistlich Pharma AG, NobelBiocare USA and Quintessence Publishing Co.) have rec-ommended speakers who have enthusiastically accepted thisopportunity. We are honored to have Dr. Yataro Komiyama,the head of the Brånemark Osseointegration Center in Japan,as our moderator. We will also be providing English toJapanese translation for our main podium presentations duringthe rest of the meeting. I am excited to see all of our effortsfinally come to fruition, and hope this symposium meets witha resounding success and becomes a model for future endeav-ors with both Japan and other international groups.

As I near the completion of my presidential term, I continueto be astonished at all that the AO has become, and extremelyexcited about where we are headed. I wish to thank the AOstaff, the AO Board of Directors, and all of the participants inour committees for their time and efforts to keep this organi-zation at the leading edge of our profession. I encourage oth-ers, who have not had the opportunity to stand shoulder toshoulder with the outstanding members of our organization,to participate on our committees, task forces, or the Board aswe continue to move forward. Thank you again for the oppor-tunity to serve as your president. I am honored to have hadthe opportunity to “stand on the shoulders” of the manyamazing individuals who have preceded me!

President's Message …continued from page 2

Dr. James Taylor

Member News

AAP honors Dr. Cochran; Dr. Amet receives‘Significant Sig’The American Academy of Periodontology (AAP) recog-nized AO Past President Dr. David L. Cochran, SanAntonio, TX, with its Distinguished Scientist Award.AAP cited Dr. Cochran for his contributions “as a schol-ar, educator and leader,” noting that he has authored 2books, 12 book chapters, and over 100 publications ondentistry, periodontology, and osseointegration.

Sigma Chi Fraternity has honored Dr. EDward M.Amet, Overland Park, KS, with its “Significant SigAward,” the International Fraternity’s highest recognitionfor achievement in a brother’s professional career andcivic endeavors.

Congratulations, Drs. Cochran and Amet!

5

Take your meeting mobileBy Terri Vargulich, Marketing and Communications Manager

Enhance your experience at this year’s Annual Meeting withthe upgraded AO 2014 Annual Meeting mobile app. The appis free and offers state-of-the-art features to plan and organizeyour meeting schedule and personal time in Seattle – all in thepalm of your hand!

This new app is available for all smart phone and tablet for-mats, and an HTML5 version is available for desktop use.Simply enter this link: http://www.tripbuilder.com/ao2014into your phone or tablet browser. This link will automatically detect your device type and take you to the right place to download the app. Or just snap the QR code and download the app now.

With the 2014 mobile app, attendees can:

• Preview all sessions and events by clicking the Schedule iconand see detailed information including locations, descrip-tions and speakers.

• Use interactive floor plans for easy exhibitor/booth locationand navigation around the convention center and exhibithall.

• Search for specific speakers to confirm time and location oftheir sessions.

• Review the complete listing of Poster PresentationAbstracts.

• Search for exhibitor by name or booth number and viewtheir website.

• Search destination information about Seattle, such as recom-mended restaurants, local attractions, and weather statistics.

• Add items to your personal MyShow lists, which include apersonalized schedule, contacts, exhibitor booths, notes andSeattle city information.

• Use the Show Daily and Social Media icons to catch up onthe latest news from the meeting and to easily interact onboth AO social media channels, Facebook and Twitter.

• Receive instant alerts to all updates to the meeting program,sessions and events, as they occur!

The AO 2014 Annual Meeting mobile app is supported by agrant from Zimmer Dental.

Dr. Albrektsson is Editor-in-Chief of Applied OsseointegrationResearch, a scientific monograph. He is editor of 10 scientificbooks and member of the editorial board of 8 internationalscientific journals. He holds several patents in the field of bio-materials and is author of about 675 abstracts, reviews and sci-entific papers on bone grafts, vital microscopy of bone,experimental implants, oral and craniofacial reconstructions,and orthopedic implants. One of his papers was honored asbest paper of the year 2000 in the International Journal of Oral& Maxillofacial Implants (IJOMI).

He has been supervisor or co-supervisor of 45 PhD theses andhas given more than 1,000 invited lectures to professionalaudiences worldwide.

The identification and nomination of the Nobel BiocareBrånemark Osseointegration Award recipient is by the members of the Titanium Society, a special category of donor membership created to help the Foundation achieve its goals. Recipients of the award are then selected by a com-

mittee comprised of the president and immediate past presi-dent of both the Academy and the OF and Dr. Brånemark,for whom the award is named.

All Titanium Society members and a guest of their choice areinvited to attend the Annual Titanium Society BreakfastMeeting, Saturday, March 8, at 7:00 a.m., where Dr.Albrektsson will give an exclusive presentation for TitaniumSociety members and their guests.

Positions are still available in the Titanium Society, which islimited to supporters who have pledged $10,000 total in pastand future contributions over a four-year period. TheTitanium Society’s membership is limited to 100. Anyoneinterested in becoming a Titanium Society member may find adownloadable membership application on the OF section ofthe Academy’s website (www.osseo.org) or by contacting theAcademy’s Executive Office at 847-439-1919, or by email at academy@osseo.org.

Nobel Biocare Brånemark Osseointegration Award …continued from page 1

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AO news from around the globe

AO launched the Charter Chapter program in Israel with ameeting February 20 at the new Royal Beach Hotel in Tel

Aviv. The meeting was organized byIsraeli AO Ambassador Dr. Zvi Artzi,Tel Aviv.

Keynote speaker was AO President Dr.Stephen L. Wheeler, Encinitas, CA,who lectured on “TechnologicalAdvances: Safety & Predictability.” Dr.Zvi Laster, Tiberias, Israel, spoke on“Biomechanics & Periimplantitis.”

The meeting opened with a cocktailreception, followed by the presentations, and concluded withbeverages and refreshments.

“In order to spread the good name of AO and to attract newmembers, we asked that each member bring at least oneguest,” Dr. Artzi says. It is hoped the meeting attracted anumber of guests who will sign up for AO membership.

In his presentation, Dr. Wheeler discussed how implants havedramatically changed patient care and how changes in tech-niques and technology now allow us to achieve more pre-dictable and aesthetic results. His lecture responds to thequestions, “How do we sift through the promotions and hypeand how can we decide what is safe and predictable for ourpatients?”

Dr. Wheeler included a brief historical tour of where implantdentistry has come to better understand the past to help usexplore the future. “We live and practice in an exciting timewith phenomenal ways to restore our patients’ smiles bothfunctionally and esthetically,” he says.

“The AO is uniquely positioned as an organization, with nodirect ties to any specialty or corporation, to sift through themarketing and truly evaluate techniques and technologies thatare safe and predictable through evidence-based research. It isthis knowledge that allows us to effectively provide the besttreatment outcomes for our patients,” he adds.

Four speakers have been confirmed for the first meeting ofAO’s Charter Chapter in Pune, India, scheduled for early in2015, announced Global ProgramDevelopment Committee Chair Dr.Michael R. Norton, London,England, UK. The four speakers andtheir topics are:• Dr. Georgios E. Romanos, StonyBrook, NY (periodontist), immediateimplant therapy;

• Dr. Fernando Rojas Viscaya(prosthodontist), location, Spain,treatment planning, focusing onrestoratively driven implant dentistry;

• Dr. Hugo de Bruyn (periodontist), Ghent, Belgium, over-denture therapy, with results from long-standing and exten-sive clinical trials;

• Dr. Michael Norton (oral and maxillofacial surgeon), decon-tamination of the ailing implant and reparative therapies.

“We look forward to the interaction with speakers from India,promoting the country and the new opportunities we seethere,” Dr. Norton says.

The meeting will be held in the Dr. D. Y. Patil Vidyapeeth(DPU) University, Pune, a facility on the west side of India,

which fulfills AO’s expectations for teaching, research anddevelopment. According to the mission of the DPU, its goal isto contribute to the socioeconomic and ethical development ofthe nation by providing high quality education through insti-tutions that have dedicated faculty and state-of-the-art infra-structure, and are capable of developing competentprofessionals and liberal-minded citizens.

For this AO Indian Charter Chapter, the Global ProgramDevelopment committee is pleased to be working with theuniversity’s President Dr. P.D. Patil, Dr. K.B. Powar –Chancellor, Dr. P.N. Razdan – Vice Chancellor, as well as Dr. R.S. Dolas – Dean of the Dental College, who have madea commitment to host the AO in this first Indian Chartermeeting. Due to these activities, the AO will be promoted inIndia and participants of the local national dental societies,clinicians and researchers interested in oral implantology areexpected to attend.

Drs. Norton and Romanos have been working closely withDr. D. Gopalakrishnan, Head of the Dept. of Periodontologyand Director – Research and Collaborations at DPU, to createa liaison and formulate the program for this inaugural meeting.

The AO Board of Directors hopes that due to the AO outreachactivities in India, there will be greater opportunities for theeducation and practice of implant dentistry.

Dr. Michael Norton

Dr. Zvi Artzi

Four speakers confirmed for first AO CharterChapter meeting in India

AO launches Charter Chapter in Israel, with Feb. 20 meeting, organized by Dr. Zvi Artzi

7

Set in the heart of London’s bustling and prestigious WestEnd, the second meeting of the AO UK chapter took place atthe highly-decorative Savile Club, 69 Brooke Street.Introduced by its global ambassador for outreach, Dr. MichaelR. Norton, London, and reinforced by the chapter’s lead, Dr.Stephen L. Jacobs, Glasgow, Scotland, an emphasis wasplaced on the key features of forthcoming activities and eventsrelated to the AO, including the unique position that the UKcurrently holds—the first to have a second divisional chaptermeeting! The introduction of global chapters has been a newand developing AO concept: its aims are to facilitate core ideaswith structured and highly useful working meetings, whereclinicians can actively voice and discuss research and currenttreatment trends.

The guest speaker, Dr. Andrew Darwood, spoke on the mas-tery of imaging; importantly stating, “CBCT allows creativi-ty.” Topics covered included productivity, optimization,interpolation, noise reduction, intuitive extrapolation, andmost importantly, understanding and changing threshold val-ues. Can we really justify the exposures needed to see superioraccessory canals from mental foramina; neurovascular bundlesabove fractured central incisors; or root fractures in endodon-

tics? How much does it, or indeed, should it, affect our dailypractice and treatment planning?

Whilst CT scanning isn’t routine, Dr. Darwood makes it hardto argue against the routine use of this invaluable tool. Thesuggestion of surgical guides was generally agreed as not to beused in compromised situations but rather as a ‘practice-builder’ in thenon-compromised cases (aiding speed, ease, and running to timemargins). We were made aware of guided placement and thepotential for huge disasters if some sort of guidance for place-ment is not employed.

Dr. Darwood has certainly not reached his threshold. The 3Dprinting and reproduction of surgical guides can still lead toinaccuracies that do tend to matter when fitting guides ontoteeth and bone. Calibration is key (phantoms and software)and further tips were welcomed: rescanning with higher reso-lutions of the model itself, making a radiographic guide on themodel and transforming this into a surgical guide.

The session proved extremely valuable and interactive for con-cise and critical debate. All in all, it was an extremely usefuland worthwhile day.

Second AO UK chapter meeting held in LondonBy Drs. Ben Mather (BSc, BDS, MJDFRCS, DipIMPDentRCS) and Louis R. Guenin (BDS, LDS, RCS)

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AO’s New Product Showcase features 12 companiesAO’s New Product Showcase, an Annual Meeting featureintroduced in 2013, offers a unique opportunity to view thelatest products from 12 companies in an intimate social setting, allowing attendees to see demonstrations, view theproducts up close, and ask important questions.

The Showcase is complimentary to all meeting attendees andtheir registered guests.

Attendees can pick and choose which companies to visit andmay change rooms at any time. Stop by and visit the showcaseto see some of the latest products in the field of craniofacialimplant technology.

8

Expert Dr. Franck Renouard offers opinions onDr. Bruce Barr’s “zombie implant” questionsIn this text, Dr. Franck Renouard, Paris, France, is the second of a panel of experts to offer his opinions on questions posed in Academy NewsEditorial Consultant Dr. Bruce Barr’s article, “Zombie implants and the potions we use” (Volume 24, Number 1, 2013).

Before replying to these questions, I would like to make someimportant points to help ensure that my answers are viewed intheir proper context – that of myworking environment.

1. My work revolves exclusivelyaround dental surgery, and I placeimplants for a number of referralsfrom whom I receive patients.

2. These referrers vary widely in termsof their expertise and experience inthis particular field. Some of themare very involved in and very com-mitted to continuing education programs and courses. Forothers, implants are just one small aspect of their work.These individuals don’t want to spend much time on ongo-ing training. This means that sometimes restoration workdoes not always adhere to generally accepted minimumstandards of quality.

3. In France, by law, the profession of ‘dental hygienist’ is notrecognized (incredible but true!). This means that generaldental cleaning tasks are performed, or should be per-formed, by dentists. However, it is illegal under French lawfor a dentist to employ other dentists or to have more thanone dentist working for them. This makes it very difficult toensure that a given patient’s teeth receive systematic, ongo-ing care and attention when it comes to general teeth clean-ing work.

4. I asked my colleague, Dr. David Nisand, who practices inthe fields of both periodontology and implantology, to readover what I have written. I would like to thank him for thecorrections and clarifications he was able to make.

Question: If a 10 mm rough surface implant exhibited 2.5mm of bone loss with obvious inflammation in a relativelynon-esthetic area, do you treat this by nonsurgical, resec-tive, or regenerative surgery, and please describe your pro-tocol regarding time, technique, and materials?

Before doing anything else, I would have to carry out anassessment of the entire mouth area in order to ensure thatthere hasn’t been a recurrence of a previously-treated peri-odontal condition or disease.

If this turns out to be the case, these wider issues would haveto be dealt with before deciding on a specific course of actionto take regarding the implant.

The other important point I’d like to make is that the size ofthe implant, whether 7 mm or 15 mm, should not influenceyour decision-making process. Either you’re worried aboutthe infection getting worse and therefore you have to treat it,

or else you think that the situation is stable and you leavethings just as they are, even when you’re dealing with a short implant.

The decision whether or not to treat the inflammation willdepend on the presence or otherwise of medical signs associat-ed with bone loss. If there are no visible clinical signs (in otherwords, the bone loss has been discovered by chance), it isadvisable to do nothing and to monitor the situation every 3months to begin with, then every 6 months later on. A strictpersonal oral hygiene regimen should be drawn up. Obviously,the patient has to respect this regimen for it to be effective.

If the bone loss is associated with inflammation and/or suppu-ration, preparations for a surgical procedure will be made.The patient will be put on an 8 to 10 day course of antibiotics.Then, a full-thickness flap elevation will have to be performed,followed by the removal of granulation tissue and the disinfec-tion or decontamination of the implant surface using an air-powered tooth polishing system and hydrogen peroxide. Ifthere is a bony defect with a proper anatomy – a fairly rareoccurrence – a bone substitute or an autogenous bone graftmay be used. However, the results are mixed. What’s more, wedo not have reproducible results from a large-scale sample ofpatients. Results can sometimes be quite spectacular, but wehave to acknowledge that we are unable to explain why thisprocedure works so well in some cases, whereas generallyspeaking, the procedure is considered successful if it simplystops any further bone loss.

NB: Normally probing pocket depth would be used in thedecision-making process. I haven’t mentioned it because it issometimes quite difficult to gather reliable pocket depth mea-surement around the implant. In fact, the emergence profile ofthe prosthesis very often makes it difficult to use the peri-odontal probe properly. In the best case scenario, peri-implantprobing would be possible with all implant-supported prosthe-ses. What’s more, in order to improve patient monitoring, itwould be advisable to perform a pocket depth measurementon the day that the implant-supported prosthesis is fitted. Thiscould then be used as a benchmark against which subsequentfollow-up examinations using the probe could be compared,providing us with an objective measure of the extent to whichpocket depth has grown as a result of an inflammation.

Question: If this same 10 mm implant had 50% bone loss, how do you most often treat it and what are yourusual results?

If the bone around an implant has lost 50% of its length, thesurgical and decontamination procedures described earlierwould be performed, with check-ups 6 and 12 months later.

…continued on page 9

Dr. Franck Renouard

9

Dr. Franck Renouard …continued from page 8

All too often, results are disappointing and the implants haveto be removed. Some implants are kept in place for a littlelonger, but most of the time, the removal of the implant isinevitable. Of course, we’re not very happy with this outcome,but when we ask experienced colleagues for their advice withregard to this private practice scenario, they frequently agreethat it would be their solution as well.

Question: Assuming you can satisfy a patient’s esthetic andfunction requirements, how often do you choose to buryan implant in an attempt to regenerate bone? How suc-cessful are you?

From a theoretical point of view, surgically burying theimplant would seem to be absolutely vital in order to achieveosseointegration for a second time with regard to an implantthat has been contaminated. However, this view is not backedup by the relevant scientific literature, which shows no dis-cernible difference in results between the buried and the non-submerged techniques.

From a clinical point of view, we must always bear in mindthat burying an implant for a second time in an environmentfrequently affected by inflamed tissue is a complex and unpre-dictable procedure.

When it’s possible to bury an implant a second time round,the use of resorbable membrane to cover bone filler materialdoes not give particularly impressive results. When it doeswork, sometimes the result is bone that is indistinguishablefrom native bone. However, most of the time the result ismore akin to ‘very dense, fibrous tissue’. Perhaps this will turninto bone later on? The best solution would be the systematicuse of nonresorbable membrane. However, the incidence ofcomplications and adverse events associated with this proce-dure is too high, especially in relation to patient esthetics. It’svery difficult to attain tension-free primary closure due to thefragility and inflammation of the mucous membrane.

Question: Assuming cement is an issue with observedimplantitis soon after the restorative phase, do you mostoften perform surgery to assure removal? How do youaddress costs with your patient and restorative dentist, if any?

The systematic use of cemented implant-supported prostheseshas always seemed somewhat incongruous. There are somecircumstances in which the cemented implant-supported pros-thesis is clearly the best solution, but we would encourage ourreferrers to use the screw-retained option wherever possible.

Sometimes, there is a failure to remove all of the residualexcess cement used in cement-retained prostheses. Generallyspeaking, you won’t have long to wait before seeing the conse-quences of this. After a few months, the patient returns, suf-fering from a gingival abscess. By this stage, surgery cannot beavoided, sometimes resulting in ugly tissue loss.

We have noticed very encouraging signs in terms of tissueresponse if the problem is treated at a very early stage.

However, sometimes the lesions cannot be repaired and wefind ourselves with a worsening case of peri-implantitis. To beperfectly honest, we have also noticed bone loss with screw-retained prostheses in cases where the screw was manuallytightened. Some dentists don’t ‘dare’ to tighten the abutmentscrew to the manufacturer’s recommended torque setting. Inthis case, it will only be a matter of time before it comes loose.If the patient delays coming to see the dentist, you may end upwith exactly the same problem as that caused by the presenceof excessive residual cement.

We will cover the cost of treating the soft tissue lesions andalso of replacing the implant if this turns out to be necessary.However, we do not treat any of the biomechanical complica-tions that may arise if the abutment screws come loose under acemented crown, especially if a screw-retained prosthesiscould have been fitted instead. Often the prosthesis has to bebroken before it can be removed. In this case, the patient’spractitioner must perform the relevant work as well as cover-ing the cost of that work.

Question: Although it has only been a few years to com-pare, have you formed an opinion on a difference betweenplatform switched and non-platform switched implantsregarding mucositis and peri-implantitis and/or bone loss?

We should firstly remember that there is very little formal sci-entific research demonstrating that platform switching has apositive impact in terms of the preservation of bone levels. Infact, the findings have sometimes been somewhat contradicto-ry, and it is still too soon for us to assess the usefulness of thisresearch. Conversely, when positive impacts have been noted,these have been minimal.

This is why it’s difficult to understand the enthusiasticresponse to the concept of platform switching. There’s a feel-ing that people are looking for a solution to a non-existentproblem.

Let’s re-frame the question in a slightly different way: is aninitial crestal bone loss of 1 mm a risk factor over the long-term? I have 25 years of experience in this field, during whichI’ve placed multiple implants. I would not consider crestalbone remodeling to be a source of potential problems.

It does seem that this 1 mm of peri-implant bone loss hasrapidly become a commercial issue. How many lab animals, inparticular dogs, have been sacrificed on the altar of this sacro-sanct 1 mm of peri-implant bone? From a purely medicalpoint of view, this whole debate seems something of an irrele-vance. If we look at the figures for bone loss associated withvarious implant systems over the mid to long-term, there’s vir-tually nothing to separate them.

Furthermore, this issue arose out of studies of differentimplant systems in which one-stage procedures were com-pared with two-stage implant surgery procedures. Thisapproach isn’t exactly a model of scientific objectivity. If wesay that platform switching has a 0.5 mm effect on bone level,

…continued on page 11

10

Good progress is being made on the AO’s 2014 scientific sum-mit meeting, Co-Chair Dr. Clark M. Stanford, Iowa City, IA,reports. “We will be creating three key deliverables from the

summit,” Dr. Stanford says. Headed“Current Best Evidence for MinimalIntervention in the Management ofthe Edentulous Maxilla,” the summitwill be held in August 2014 in theChicago area.

The summit’s three key deliverables,according to Dr. Stanford, are:

Systematic reviews concerning out-comes related to management of the

pendulous maxilla. These reviews are based on work from fiveworking groups that address the following content areas: Roleof site development, implant design, imaging, advanced bio-logics, and prosthetic interventions.

From the set of systematic reviews, a set of clinical practiceguidelines are being crafted, with a ranking of the literaturesupport and an outline of further research that is needed.

The third key deliverable will be to then rank the degree ofexperience needed by the entire clinical team to implement

the clinical practice guidelines at the level of outcomes docu-mented in the literature.

The Academy has been active in sponsoring consensus confer-ences for many years. The planning committee has outlinedfive domain areas from conventional dentures to complexbone graft and implant supported prosthetics.

Co-Chair with Dr. Stanford is Dr. Ole T. Jensen, GreenwoodVillage, CO. Group chairs and the planning committeeinclude Drs. Tara L. Aghaloo, Los Angeles, CA, ThrishulAllereddy, Iowa City, IA, Gustavo Avila-Ortiz, Iowa City, IA,Lyndon F. Cooper, Chapel Hill, NC, Kent L. Knoerschild,Chicago, IL, Craig M. Misch, Sarasota, FL, Georgios E.Romanos, Stony Brook, NY, Daniel B. Spagnoli, NewOrleans, LA, and James C. Taylor, Ottawa, ON, Canada.

Attendance at the conference is by invitation only. The plan-ning committee has selected the participants for each of theworking groups that are presently investigating the literaturein preparation for the summit discussion.

Conclusions from this important meeting will be presented atthe AO Annual Meeting in San Francisco, CA, in 2015. Theywill later be published in the International Journal of Oral andMaxillofacial Implants (IJOMI).

AO’s 2014 Summit Conferencewill create 3 key deliverables

Dr. Clark Stanford

The Academy’s Founders Video documentary, “The FoundingHistory of the Academy of Osseointegration,” will be shownat various times and places throughout the Annual Meeting inSeattle. A full 20-minute version and abbreviated 1-2 minuteversions will be shown.

“The Board desired to record the history of the founding ofthe Academy while those who were involved were able to beinterviewed and explain how and why the Academy came intobeing,” says Dr. Alan S. Pollack, New York, NY, who is lead-ing the Founders Video Task Force, with Drs. Russell D.Nishimura, Westlake Village, CA, and Michael R. Norton,London, England. Dr. Norton serves as narrator of the video.

“We also wanted to trace the evolution and growth of theAcademy since its early days,” Dr. Pollack says. In 2008, AHistory of the Academy of Osseointegration, 1985-2007 was pub-lished. The Founders Video will add an oral history. It isbased on interviews recorded in two daylong sessions over thecourse of a year and a half.

“A lot of time and effort has gone into this video, and we hopethat everyone will take the time to view it during the course ofthe Annual Meeting in Seattle,” Dr. Pollack says. “Of course,

the full interviews with the Academy’s founders will also beavailable on the Academy website (www.osseo.org) for thoseinterested in learning more about the heady days whenProfessor Brånemark first introduced his revolutionary newconcept and systems,” he adds.

Dr. Pollacksays the videowill have manyuses. “It willalso be a mostappropriateaddition to theNew MemberBreakfast heldat each AnnualMeeting. “Wewill use the video in our public relations and post it on theAcademy’s Website, serving as the Academy’s living archives.We expect the video will also be useful for dental implantstudy clubs, dental schools, resident instruction, and residentrecruitment programs,” Dr. Pollack explains.

First showings of AO Founders VideoScheduled during Seattle Annual Meeting

Dr. Russell NishimuraDr. Alan Pollack

11

Dr. Franck Renouard …continued from page 9

the next question we have to ask ourselves is: Will this extra0.5 mm in bone level during the first 6 months following theprocedure reduce the risk of peri-implantitis? The reply isprobably negative. A 0.5 mm bone level is not the be-all andend-all when it comes to the pathogenesis of peri-implantitis.This is a very complex condition about which we have a greatdeal still to learn.

Will an extra 0.5 mm in bone level make a difference to theesthetics of the final result? We’re convinced that it won’t. Wedon’t believe that ‘bone sets the tone’ as far as the esthetics ofthe implant are concerned. In any case, not when we’re talkingabout a matter of one millimeter or even less.

Lastly, observations made in our dental practice would lead usto estimate that over the long-term, in almost 30% of theimplants that we look at (standard external hex cylinderimplants) we can see bone that is level with the implant-abut-ment junction. In fact, the bone level can even be above theimplant-abutment junction. Unfortunately, we still haven’tworked out how this happens.

So, to sum up, we would say that we’re on a hiding tonowhere if we think we can solve or understand a biologicalissue (i.e., peri-implant bone levels) by adopting a purelymechanical approach, that is, platform switching.

Question: How much of bone loss around implants doyou attribute to patient individuality, and how much tobrand design specifics? Do you find particular brandsmore problematic than others and, if so, do you care torelate those?

This question links up with the previous one. We are con-vinced that tissue response to implants is inextricably connect-ed to the patient’s individual biological make-up. But to whatextent exactly? As yet, it’s not possible to say. However, wehave seen so many situations where multiple errors and riskfactors came into play—implants placed too close to teeth,misfit at the implant-prosthesis interface, patient not takingsufficient care of their oral hygiene, etc.—without the slightestnegative impact being noted. Conversely, other patientsreceived the very best medical care yet still developed peri-implant diseases.

We’re beginning to identify general factors that could play acontributory part in the development of these diseases. Forinstance, patients affected by allergies and patients with lowvitamin D levels are more susceptible to infections. These arepotentially very interesting avenues of research.

Question: Is there a set percentage of bone loss withinflammation, even though the implant may be stable,where you decide it is better to remove the implant andplace another?

First of all, whether the implant is stable or not is irrelevantwhen it comes to making the decision to keep or to removethe implant—apart from the rare cases where there is simplyno solution to the situation. For example, there may have been

so much bone lost that it would be impossible to place anotherimplant following removal of the existing implant. In this case,it would be best to put off the implant’s removal for as long aspossible and simply try to look after the implant as best youcan. If, despite one or even two surgical interventions, thecondition in question is getting worse, then the implant willhave to be removed. This is when you have to pluck up thecourage to tackle this challenge, not to mention face thepatient (!). Sticking your head in the sand in an effort to putoff the evil hour by performing subgingival irrigation orapplying other ‘band-aid’ solutions will only make the situa-tion even more difficult or even impossible when the timecomes to remove the implant.

Question: Do you feel keratinized tissue is an importantfactor in peri-implantitis and, if so, do you add it and when?

The word ‘stable’ would need to be added to this question.Seemingly the presence of stable keratinized tissue is an excellent barricade to the development of peri-implantitis,although in the course of our work we have also come across a fair number of examples that would appear to refutethis hypothesis.

However, we have to recognize that it’s not always easy eitherto convince patients to go through with this kind of procedureor to actually perform it (for example, when you have to workwith severe posterior mandibular residual ridge resorption).

In the light of these difficulties, it’s important to make sureyou conserve as much keratinized tissue as possible during thetooth extraction and gingival incision stages prior to the place-ment of implants.

Question: For what percentage of the implants you place doyou participate in the maintenance at least once a year?

As stated at the outset, given that the profession of ‘dentalhygienist’ is not recognized in France, I think that fewer than10% of patients we look at have their teeth professionallycleaned on a regular basis. We try to concentrate our effortson the most pressing cases.

Bonus Question! Would you care to share any observation,technique, advice, or other information our members mightfind helpful for treating mucositis and peri-implantitis?

Nowadays, treating mucositis isn’t particularly problematic aslong as the etiological factors are identifiable and treatable.However, treating peri-implantitis remains extremely chal-lenging and the long-term success rate for treatment is low.Prevention remains the best cure for these two conditions. Ithas to be said that a contributory factor in the occurrence ofperi-implant inflammation or infection is the incorrect posi-tioning of implants. The same can be said of crown emergenceprofiles that make it difficult for the patient to look after theirrestoration properly.

…continued on page 13

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13

Academy News welcomes 4 new editorsThe Academy News Committee is proud to add four new mem-bers to its ranks of contributors. You will see their names andfaces in upcoming issues of the News, and we welcome themon the News team.

First is Dr. Harriet K. McGraw, ageneral practice dentist in HarborSprings, Michigan. A graduate of theUniversity of Michigan, she finds thatadvanced continuing education hasbeen a key factor in her approach tocomplex restorative treatment. She is afounding member of the NorthernDental Network, an interdisciplinarystudy club, and serves on her localdental society board currently as PastPresident as well as the Michigan State committee on peerreview. She and her husband, Vaughn, a periodontist and alsoan AO member, share a passion for the great outdoors andtravel whenever time permits.

Dr. Navid Rahmani, periodontist,moved to the United States at the ageof eight years old and attended under-graduate college at NYU, then matric-ulated from dental school at StonyBrook. He credits AO Past PresidentDr. Vincent J. Iacono, Stony Brook,NY, for his interest in periodonticsand implant surgery. He practices inNew York City and teaches at NewYork Hospital of Queens, working withthe Prosthodontic Resident Program. He was recently marriedand is now the proud father of a baby boy. He states, “I enjoyevery day waking up and coming to work to treat my patientsand going home to my beautiful family.”

Dr. Archie A. Jones, periodontist, hails from Boerne, Texas,just outside San Antonio, where he practices. He is a fulltime

faculty member and Director ofPredoctoral Periodontics at theUniversity of Texas Health ScienceCenter at San Antonio. He is marriedto Elizabeth and enjoys photography,travel, and music. A member of theAcademy of Osseointegration since2005, he has been active on theMembership Committee for severalyears. As an educator, his contributionsfrom an academic perspective will bemost welcome.

Dr. Robert L. Schneider, Iowa City,IA, is the Director of MaxillofacialProsthodontics at the University ofIowa Hospitals and Clinics, HospitalDentistry Institute. He received hisDDS degree from the University ofSouthern California and spent fiveyears in general practice in Arizonabefore earning his MS and certificatein prosthodontics from The Universityof Iowa. He has published extensively in the prosthodontic lit-erature and is very active in many prosthodontic and dentallaboratory organizations. In fact, he is one of only three indi-viduals who have received an Honorary CDT from theNational Association of Dental Laboratories for his many con-tributions to the dental technology field. We are privileged tohave Dr. Schneider on the Academy News team.

It is a pleasure to introduce these new contributors to yourquarterly issues of the Academy News. They join returningmembers Drs. EDward M. Amet, Overland Park, KS(prosthodontist), Louis R. Guenin, London, England (generalpractice), Paige Warren Miller, New Bern, NC (general prac-tice), and Bruce K. Barr, Virginia Beach, VA (periodontist) inproducing the content that you enjoy in each issue. Welcome!

Dr. Harriet McGraw

Dr. Navid Rahmani

Dr. Archie Jones

Dr. Robert Schneider

Dr. Franck Renouard …continued from page 11

Correct three dimensional positioning of the implant is thekey factor in the prevention of peri-implantitis (and indeed ofother complications, whether biomechanical or esthetic innature). This would seem to be obvious, but like everythingthat is seemingly obvious, it’s a fact that we do well to remindourselves of from time to time.

It’s also important to ensure that there is a minimum of 2 mmbone thickness around the implant. In the past, as a conse-quence of wanting to follow our surgical guides to the letter,some implants were placed without leaving enough bone onthe vestibular side. In some cases, we have seen an inflamma-tion gradually develop in tandem with bone loss, firstly hori-zontal bone loss, then vertical bone loss.

Nowadays we would have no hesitation in adopting a ‘preven-tive’ approach, using biocompatible materials to augment thealveolar ridge and employing small-diameter dental implantswhich enable us to preserve a little more of the bone aroundthe implant.

Update member contact info atwww.osseo.orgDo we have your most current information for theMembership Directory? Members may update their contact information online at www.osseo.org, or send anemail to Barbara Hartmann, barbarahartmann@osseo.org.

14

I know you were as happy as I was tohear that we can now influence thelength of our telomeres. You know,those little bits of protein that sit onthe ends of our chromosomes. I amsure you remember from Genetics 101that these small caps of protein preventour chromosomes from fraying andsticking to one another that wouldotherwise bugger up the cell’s functionand make it behave badly. You may

also remember that each time a cell divides, the telomeres getshorter, ultimately leading to cell malfunction and death.Other than not being able to tie your shoes or remember yoursister-in-law’s name, shortening of our telomeres, a.k.a. aging,is as certain as that puzzled look on your face right about now.

Aside from the obvious maladies of humanity – cardiovasculardisease, cancer, diabetes, etc. – longer telomeres appear tomean living longer, and healthier. As you might imagine, astudy has been done to suggest that people can lengthen theirtelomeres, and this has begotten a number of companies who,for a fee, will give you the 411 on your telomeres. Fortunately,the way to promote longer telomeres is not all that difficult.Comically, the method is so last week as to be relegated to theback pages of the health and living section of your local blade:exercise regularly, eat right, lose extra weight, and reducestress. Duh!

Perhaps the benefit to this is to confirm our longstandingbelief that living a healthy lifestyle leverages our longevity.However, since some of our patients do not subscribe to thisphilosophy, we are faced with treating people in various stagesof decline and death, to put it bluntly. This is not a bad thing,since it is how many of us make a living. Personal interestaside, there is a noble undertaking in the healing of the sick,biblical almost. Indeed, it is this desire to heal and repair theravages of life that makes all of us in health care as dedicatedas we are.

The good news is that all of our efforts to help heal ourpatients have a bright future. Research, such as that mentionedabove, continues to delve deeper into our understanding of lifeand its processes. Aside from the obvious financial incentivesto discover and develop new treatment modalities, there seemsto be an instinct in many of us to venture into the unknown,as Captain Kirk of the Starship Enterprise is famous for say-ing, “To go where no man has gone before!”

Back down on Earth, we implant dentists are faced with thechallenge of treating those patients mentioned above who donot subscribe to the longer telomere theory. It is an unstated

suggestion that everybody should sooner or later get a dentalimplant. Think of those untold millions of edentulous spacesaround the world just waiting for the Starship Dentalprise toput implants where no implants have been before! But is thiswhat really drives us? Is it merely the mechanics of repair andrehabilitation that keeps us in the maelstrom of health care?

I would like to think that it is more likely a bit of that childlikewonder we share of the sheer complexity and magnificence ofthe world around us. The solving of a puzzle, the thought of anew idea, watching a spider spin a web without any govern-ment funding or a cell phone. It is this simple love of the mys-terious in our natural world that really keeps us in the game.The best part is that this passion is not merely linear with aslow advance to some point in the future. Our wonder curve isexponential, and the beauty is we will see things in our life-time that we have yet to imagine.

No better telling of that is our collective interest in and pas-sion for dental implantology. It is a terrific story, one thatHemingway or Steinbeck could only dream about. A humbleresearcher discovers, while studying one process, an entirelydifferent and wondrous phenomenon, osseointegration! Attemptsat replacing body parts (a.k.a. teeth) have been around sincethe Egyptians without success, and yet here little pieces oftitanium seem to work like a charm! What an incredible story!

Of course, this seminal discovery has followed the likes ofmany throughout the ages from Aristarchus to Zsigmondy andmany, many in between. You can count on many more. Andisn’t it this, the promise of the new and exciting discoveriesthat we by virtue of dumb luck, hard work and a few well-placed neurons are positioned to help our fellow travelers, ourpatients, to make a difference for a better life.

Our Academy of Osseointegration, I believe, reflects this sen-timent, maybe not in the by-laws or written committee assign-ments, but in the spirit of what draws its members fromaround the world to gather once a year and share their secretwonder about a few of the mysteries of life. It has been saidthat going through one door merely leads to several others onthe other side of the room. Here’s to many doors to come, andof course to longer telomeres!

The Editor’s Editorial is intended to contribute to the dialogue onissues important to implant dentists. The views expressed in the editorial do not necessarily reflect the policy of the Academy ofOsseointegration or its Board of Directors. Readers who would like tocomment or express a point of view on the editorial are invited towrite to the editor via email at ktmcnallydds@hotmail.com. We willendeavor to publish pertinent comments or views when space permits.

Editor’s Editorial

Here’s to longer telomeres,and exploring the mysteries of lifeBy Kevin T. McNally, DDS, Newsletter Editor

Dr. Kevin McNally

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BIOMET 3i TECHNOLOGY FORUM

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