With a swirl of languages and accents from around the world filling the lobby of the stately auditorium at New York’s Waldorf Astoria, the Nobel Biocare Global Symposium 2010 was certainly ready to live up to its name. Showcasing Nobel Biocare’s implant systems and featuring a panel of distinguished speakers from around the globe, the three day event got underway with a full slate of clinical and academic presentations focusing on immediate load implants for the morning and soft tissue management in the afternoon.
But before the panel of speakers took the stage, Nobel Biocare Scientific Committee Chairman Dr. Jonathan Ferencz opened the event reading a series of proclamations from New York Governor David Patterson and Mayor Michael Bloomberg welcoming the attendees and declaring this week as “Nobel Biocare Week” in New York. Next up Nobel BioCare CEO Domenico Scala presented the company’s first President’s Award to Dr. Burton Langer and reviewed the company’s history and goals, especially when it comes to the rapidly digitizing dental industry.
“Nobel Biocare is fully committed to staying at the forefront of the movement,” he said.
As a final introduction before the numerous panelists took the stage, Scala introduced a video featuring an interview with Dr. Per-Ingvar Brånemark, the originator of dental implantology who talked about how amazed he is at how far the science behind dental implants has come in the last fifty years, and how much there remains to be learned. Dr. Brånemark said cooperation between clinicians remains key to implant success, and he would like to see a closer relationship between dentists and medical doctors.
“My feeling it that dentistry and medicine is healthcare, and there is no separation between them,” he said.
As the day moved on to the presentations from the Global Symposium faculty it was announced that questions should be submitted via text message, and devices were handed out that allowed speakers to poll the audience about certain questions throughout the day. With these devices it was learned that 44 percent of attendees were oral surgeons or periodontists, 23 percent were general practitioners, 17 percent were prosthodontists, 10 percent lab technicians, with the remaining 6 percent falling into other categories.
Dr. Roland Glauser provided the keynote on immediate function implants, explaining that the key to success is controlling loads, not eliminating them. While presenting data showing that immediate load cases can be successful when bone quality meets the right criteria where there is a mix of dense bone to provide stability and soft bone to allow faster healing, he also asserted that implant design and surgical technique are key factors. Because implants lose a bit of their initial anchorage during the first few weeks after they are placed, immediate load cases that fail often do so in the first four to six weeks, however, Dr. Glauser said clinicians who understand the optimal conditions for immediate loading can be successful with them.
“Success had to be realized not only by implant survival, but also by maintaining soft tissue architechture,” he added.
While displaying a set of gorgeous microscopic images of organic tissues integrating implants, Dr. Peter Schüpbach used his time at the podium to cover osseointegration and how TiUnite implants are able to obtain stability faster than some other implant types. Next up Dr. Sonia Leziy discussed the indications for immediate load implants. The patient desire for these procedures is a big driving force, but technologies such as guided surgery are really what make imemdiate load cases far more achievable, she said. Another benefit she has seen by providing immediate load implants to her patients is better soft tissue results.
“It’s very clear how the implant placement plays a key role in guiding soft tissue development,” she said.
Of course not every speaker was boosting the immediate load concept. Dr. Langer used his time on stage to discuss how immediate function implants are not the best option for every case, especially when bone augmentation is needed. Dr. Peter Wöhrle continued along this line of thinking, saying that he does not see the controversy around immediate load cases because the factors that preclude immediate loading can be defined. The variables he covered were patient specific and different for single tooth and full arch cases, but mostly came down to having adequate bone to support the implants.
“Can we do it everyday? Yes. Can we do it every patient? No,” he said. “The key is to choose what treatment is right for the indication.”
After a break for lunch, Dr. Eric Rompen led off with the keynote address on soft tissue management around implants. While comparing how implants link with surrounding tissues with how natural teeth make their connections, he explained that while implants seek to mimic nature, they do not copy the process exactly. Because of this, the connection between an implant and surrounding tissue will always be somewhat fragile, and subject to disturbance by cement, impression materials or retraction cord. Because of this, preserving as much healthy gingival material around the implant site is a key to success.
While Dr. Torsten Jemt was tasked with breaking through the myths surrounding peri-implantitis diagnoses, he used his time on stage to explain how the science is still conflicted on how to accurately define the condition. Without a consensus definition, he said the debate on the topic will continue. While his speech was anticlimactic to some in the audience, the next two speakers presented far less disputed information. First Dr. Laureen Langer showed off 10 years of data on placement of TiUnite implants that showed off the success those implants have. Next Dr. Glauser returned to the stage to present his research findings that TiUnite implants maintain their stability over time.
After Dr. Tidu Mankoo presented about different implant design preference for different indications and his preferece for cemented implants in the anterior and screwed implants in the posterior region, Dr. Rompen returned to discuss the importance of biocampatibility in not just implants but also in abutments. A key to success is always having a tight connection throughout the implant to prevent bacterial infection and working in concert with the biology of the patient.
“Even with excellent implants, if we do not accept the biology of the soft tissue, we will not have success,” he said.
Dr. Bernard Touati used his time in front of the crowd to explain the advantages of screw retained implant designs. He touted their versatility and the ease of removing them, as well as the advantage of not having any cement near the implant itself. Because of this, Dr. Touati said screw retained designs are his top choice for anterior implant cases.
The event continues tomorrow with sessions on emerging technologies, edentulous patients and biomaterials.
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