NBGC2010: Nobel Biocare Global Symposium 2010 Day Two

While the first day of the Nobel Biocare Global Symposium 2010 kept the focus on clinical topics related to implant procedures, day two got underway with the focus turned to the technology powering treatment planning for implant cases. The international panel of speakers stressed the importance of planning cases with three-dimensional imaging, and the morning sessions concluded with Dr. Eirik Salvesen from Stavanger, Norway previewing Nobel Biocare’s NobelClinician™ and NobelConnect™ software systems which are slated to roll out this fall.

But prior to Dr. Salvesen’s preview of the host company’s enhanced software systems, a slate of speakers were given the stage to discuss technologies shaping the future of dental implants beginning with a keynote address from Swiss posthodontics professor Dr. Joerg Strub who reviewed the various digital systems being used to improve implant treatments in both the United States and Europe. Beginning with the intraoral impression systems, Dr. Strub’s presentation encompassed digital articulation systems, digital shade selection systems, digital assessment and tooth configuration programs (including an iPhone app from Vita), and finally software to virtual manipulate all that data and plan the actual cases. Throughout his review, he stressed the importance of keeping up with technology and the benefits of 3D imaging systems.

“We all agree on the fact that the 2D planning image is out,” he said.

While reviewing the more than 10 virtual treatment planning software titles currently available, Dr. Strub said they all have powerful capabilities and it is up to the individual clinician to decide which one is best for his or her practice. However, as good as guided surgery planning may be, he added that solid training and a deep understand of the principles of the procedures is still necessary because they are not so accurate as to allow for “blind implant placement.” As he continued to discuss CAD/CAM technologies, Dr. Strub said he is encouraged by the fabrications of the digital light processing technology being marketed by envisionTEC. However, while all of those technologies are impressive, he said what he is most excited about is the future of all-in-one systems such as one by 3dMD that handle all aspects of digital dentistry.

Next up, Dr. Stefan Holst used his time to discuss how CAD/CAM systems are improving the predictability and success of implant cases. However, while he spoke in favor of the technology, Dr. Holst began by stressing that he remains skeptical of the accuracy of some of the technologies and prefers to work in closed architecture systems because they keep the entire design and production process within one company’s software and production technologies. Still, the available technologies are capable of producing very accurate abutments and the ability to mill implant overdenture bars from a block of monolithic material is invaluable. The more accurate production technologies available certainly make it easier to produce restorations that will last, but he added that the patient still plays a role in case success.

“Hygiene is one of the key aspects when it comes to the longevity of our full mouth restorations,” he said.

From here the lectures shifted focus to discuss developments in the materials arena, with Drs. Mauro Fradeani and Eric Van Dooren speaking about the benefits of working with Ivoclar Vivadent’s e.Max lithium disilicate. Dr. Fradeani explained that e.Max’s strength and versatility allow it to be used for full contour restorations that are thinner than those produced with other materials, thus allowing for minimally invasive prep designs. Dr. Van Dooren presented a case completed just last week where he had the CAD/CAM produced e.Max crowns produced by NobelProcera and sent to his lab technician in the blue phase so they could be customized with cutbacks and layering effects.

“If by CAD/CAM design we can have these crowns, the future is very bright,” he said.

Continuing on the materials discussion, Dr. Dianne Rakow presented data from her National Institutes of Health-funded studies on the strength qualities of materials. While stressing that fabrication techniques have great impact on the final strength of dental materials, Dr. Rakow reviewed the various testing procedures used to determine material strength. She explained that no single number can tell the full story of how strong a material actually is, while describing the ongoing efforts to create ways to test materials that will accurately imitate conditions crowns are put under when they are actually placed in a patient’s mouth.

The presentations then returned to the subject of guided surgery with Dr. Luc Gillot sharing data from a study he and some colleagues conducted as an attempt to gauge the accuracy of guided implant surgery. While it is easy to see how 3D imaging and treatment planning software make it easier to plan procedures that will place implants in sites with sufficient bone, it is hard to determine how the surgical guides impact the accuracy of the procedures themselves. To test this, he and his colleagues did a study where they tested guided and freehand implant placements on cadavers, and by measuring the results of the actual placements against scans showing the desired placements, they found the guided procedures to be two to three times more precise than the freehand procedures.

“If you are going to insist on one thing, you have to be very accurate when you place the guide,” he said.

Finally, to close out the session, Dr. Salvesen presented the new features of Nobel Biocare’s upcoming software release. Introducing NobelClinician as the updated version of NobelGuide, he explained that the new software keeps the focus on the esthetics and function of the final restoration and offers improved case planning and communication for both patient and clinician. The new software adds more workable views of scan data, improved diagnostic capabilities, easier review of the surgical templates and cross sectional views that make choosing implant placements an easier process.

“All in all, the user experience for the software is much better,” he said.

The NobelConnect system that will be launched as a part of NobelClinician is an online communication portal designed to increase communication and collaboration between clinicians, specialists and lab technicians, Dr. Salvesen said. The system provides a secure way for patient files to be uploaded to a site where selected colleagues are able to access and work with the file. It is designed to improve teamwork and make working remotely a far easier situation.

While these lectures provided some of the more interesting opinions and findings on the day, other sessions covered implant solutions for edentulous patients, clinical decision making and minimally invasive implant procedures. Additionally, attendees had opportunities to see hands on previews of the new Nobel Biocare software as well as the company’s implant systems, Vita’s shade matching technologies and material options from Ivoclar Vivadent and Noritake. On Saturday, the final day of the event will feature a lab technician forum and presentations on short and thin implant designs.

Nobel Biocare Global Symposium 2010 Day One

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.