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ADI Team Congress 2019 - Day 3 Write Up

Saturday Morning – 4th May

Changing Treatment Paradigms via Advances in Regeneration and Implant Design – Craig M Misch

Advocating short implants and a graftless approach to treatment rather than longer implants, vertical augmentation and increased patient morbidity. Craig stressed the need to embrace change, as long as comparable or better outcomes than the traditionally favoured techniques were achieved.

How shorter implants have evolved to more aggressive macro-characteristics from the parallel, minimally threaded original designs and thus purported reduced failures prior to loading. How despite a higher risk of failure (not rate), the latest designs with longer crown to implant ratios not only show no increase in failure, or marginal bone loss, but as the crown gets taller, the bone loss seems to reduce. Wolfe’s Law in action according to Craig.

Craig proceeded to show a historical case of titanium mesh based vertical augmentation in the posterior mandible with longer implants. It worked but he asked us to think about the reduced morbidity and complications today if he had used splinted 6mm implants instead. No vertical augmentation but still an adequate safety window to the superior border of the ID canal.

Sinus lifts with three times the complication rate according to a study by Thoma, Craig stated that with shorter implants, when a lift is still needed, less augmentation and volume is needed. Less of the implant is thus within graft and stability is higher as a result. Craig extolled the virtues of Densah burs and actually just using blood clot in the lift.

In the posterior mandible Craig doesn’t like guided due to inter-arch space but recommended sharp single use drill kits, short 6mm implants and he showed how he mesially transposed a ramus block graft to give adequate width for his suitably wide short implants in the molar region.

A self-acknowledged plug for a ribose cross-linked collagen membrane was combined with strong support for PRF to create both sticky bone for improved particulate handling and also for improved soft tissue healing. This was a presentation from a very accomplished clinician with scientific knowledge and research in spades. I use short implants routinely and I found myself in agreement with much of what Craig said here.

Hard and Soft Tissue Management for the Aesthetic Outcome Around Immediate Implants – Daniele Cardaropoli

The first case shown was historical and showed a poor aesthetic outcome. An upper anterior immediate case with a labially placed wide implant, a large flap disrupting periosteal blood supply and a bulky abutment leading to recession and a long tooth. As a statement of how we have progressed, it certainly made a clear point. Another historical case from 2003 showed far better results with a smaller diameter tissue level implant placed in a better 3D position coronally. Daniele used this to remind us of the basic biology of bundle bone resorption.

I found this lecture was pitched a little light for my tastes. Many references were from his new publication and whilst the standard of contemporaneous cases and photography was very high, it was only in the final case, showing how a stringent application of contemporary implant positioning, immediate loading, soft tissue management and duel zone grafting in a thin bone and tissue example could lead to exceptional results, that I got more of an understanding of where this lecture was going to. The combining of marginal gains through the rigorous application of contemporary techniques.

A Critical Look at Digital Treatment Protocols and Performance of CAD/CAM – David Guichet

Disruptive innovation leading to unanticipated transformative change. A feature of modern companies transposed to dentistry. Digitising the patient to allow geographically disparate specialists to consult on a case with all the information at their finger tips or mouse.

David showed us how his practice was utilising digital technology in both common and less familiar ways to become a leading centre for the digital dental revolution. A digital database of his whole practice worth of patients was soon to be a reality. Merged data sets with appropriate quality control of this merge, for CBCT, soft tissue scanning, facial scans and appropriate scan bodies attached to precision guided implant placements, leading to high quality reproducible outcomes.

David contrasted three methods of digital workflow by presenting three patient cases. From interrupted to full digital workflow with hybrid abutments and split files, titanium and zirconia hybrid abutments used with monolithic zirconia crowns. 1300 manufacturing folders with 1366 individual units from his practice showed 0.67% chipping. In contrast, zirconia full arch cases showed a 9.3% complication rate mainly where the abutments meet the superstructure. In house milled metal inserts and the intentional mis-angulation of distal abutments to reduce cantilevers were methods that David supported, to reduce these issues.

A super presentation to close three days of exceptional speakers. A truly world class opportunity for learning that confirmed my deep respect for the incredible team of the ADI.

Moderated Discussion – Nikolaos Donos; Craig M Misch; Daniele Cardaropoli; David Guichet

The final moderated discussion of this fabulous congress again sampled a selection of interesting questions from the audience and a couple of salient probing points from the session moderator, Nikolaus Donos. This was a fitting conclusion to the marvellous speakers’ contributions, prior to the ADI Poster Award, and close of session.

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