Tạp chí implant IPUS tháng 5& 6/2013 Vol 6 No3

clinical articles • management advice • practice profiles • technology reviews

PROMOTING EXCELLENCE IN IMPLANTOLOGY

Treatment planning
of implants in the
esthetic zone:
part 2
Drs. Sajid Jivraj,
Mamaly Reshad, and
Winston Chee

Incorporating
state-of-the-art
and science to
provide stability and
excellent esthetic
results in implant
dentistry
Dr. Robert C. Vogel

Practice profile

Dr. Bao-Thy Grant

Dr. Suheil M. Boutros

PAYING SUBSCRIBERS EARN 24
CONTINUING EDUCATION CREDITS
PER YEAR!

Corporate profile
Millennium Dental
Technologies, Inc.

*Data on file.

Minimally invasive
maxillary sinus lateral
approach (SLA): a series
of case reports

3D imaging for lower dose
than a 2D panoramic* is not magic… it’s

May/June 2013 – Vol 6 No 3

Learn more on page


clinical articles • management advice • practice profiles • technology reviews

PROMOTING EXCELLENCE IN IMPLANTOLOGY

Treatment planning
of implants in the
esthetic zone:
part 2
Drs. Sajid Jivraj,
Mamaly Reshad, and
Winston Chee

Incorporating
state-of-the-art
and science to
provide stability and
excellent esthetic
results in implant
dentistry
Dr. Robert C. Vogel

Practice profile

Dr. Bao-Thy Grant

Dr. Suheil M. Boutros

PAYING SUBSCRIBERS EARN 24
CONTINUING EDUCATION CREDITS
PER YEAR!

Corporate profile
Millennium Dental
Technologies, Inc.

*Data on file.

Minimally invasive
maxillary sinus lateral
approach (SLA): a series
of case reports

3D imaging for lower dose
than a 2D panoramic* is not magic… it’s

May/June 2013 – Vol 6 No 3

Learn more on page


clinical articles • management advice • practice profiles • technology reviews

PROMOTING EXCELLENCE IN IMPLANTOLOGY

Incorporating state-of-the-art
and science to provide stability
and excellent esthetic results in
implant dentistry
Dr. Robert C. Vogel

Minimally invasive maxillary
sinus lateral approach (SLA): a
series of case reports
Dr. Suheil M. Boutros

Treatment planning of implants
in the esthetic zone: part 2

Practice profile

Dr. Bao-Thy Grant

Drs. Sajid Jivraj, Mamaly Reshad, and
Winston Chee

3D imaging for lower dose
than a 2D panoramic* is not magic… it’s

May/June 2013 – Vol 6 No 3

Corporate profile
Millennium Dental Technologies, Inc.
*Data on file.

PAYING SUBSCRIBERS EARN 24
CONTINUING EDUCATION CREDITS
PER YEAR!

Learn more on page


clinical articles • management advice • practice profiles • technology reviews

PROMOTING EXCELLENCE IN IMPLANTOLOGY

Treatment planning
of implants in the
esthetic zone:
part 2
Drs. Sajid Jivraj,
Mamaly Reshad, and

Winston Chee

Incorporating
state-of-the-art
and science to
provide stability and
excellent esthetic
results in implant
dentistry
Dr. Robert C. Vogel

Practice profile

Dr. Bao-Thy Grant

Dr. Suheil M. Boutros

PAYING SUBSCRIBERS EARN 24
CONTINUING EDUCATION CREDITS
PER YEAR!

Corporate profile
Millennium Dental
Technologies, Inc.

*Data on file.

Minimally invasive
maxillary sinus lateral
approach (SLA): a series

of case reports

3D imaging for lower dose
than a 2D panoramic* is not magic… it’s

May/June 2013 – Vol 6 No 3

Learn more on page


Introducing the new LOCATOR® Overdenture Implant System (LODI), featuring
narrow diameter implants from the makers of the trusted LOCATOR A achment.
LODI is an ideal treatment alternative for the many patients with severe resorption,
resulting in very narrow ridges for implant placement. These edentulous patients
who are faced with the choice of bone gra ing may decline treatment due to
additional surgeries or financial reasons. LOCATOR Overdenture Implants may be
placed using a minimally invasive, flapless procedure with intuitive instrumentation.
The implants are made from strong Titanium Alloy and are designed to provide
primary stability when immediate loading is indicated.
Incorporating all of LOCATOR’s proven features, including its patented pivoting
technology, LODI has remarkable resiliency and exceptional durability, while
allowing for replacement of the a achment should wear occur throughout time.
The LOCATOR Overdenture Implant System now allows you to treat edentulous
patients with the minimum standard of care of an implant overdenture,* at a
reduced cost and with greater satisfaction.

2.5mm Cuff Heights 4mm

2.4mm

Diameters 2.9mm

Included with each implant

Stop turning away overdenture patients with narrow ridges just because they decline bone grafting!
Take a look at the LOCATOR Overdenture Implant System and call 1.855.868.LODI (5634)
or visit our new website at www.zestanchors.com/lodi/ip

* The McGill Consensus Statement on Overdentures. Montreal, Quebec, Canada. May 24-25 2002.
©2013 ZEST Anchors LLC. All rights reserved. ZEST and LOCATOR are registered trademarks of ZEST IP Holdings, LLC.


EDITORIAL ADVISORS
Steve Barter BDS, MSurgDent RCS
Anthony Bendkowski BDS, LDS RCS, MFGDP, DipDSed, DPDS,
MsurgDent
Philip Bennett BDS, LDS RCS, FICOI
Stephen Byfield BDS, MFGDP, FICD
Sanjay Chopra BDS
Andrew Dawood BDS, MSc, MRD RCS
Professor Nikolaos Donos DDS, MS, PhD
Abid Faqir BDS, MFDS RCS, MSc (MedSci)
Koray Feran BDS, MSC, LDS RCS, FDS RCS
Philip Freiburger BDS, MFGDP (UK)
Jeffrey Ganeles, DMD, FACD
Mark Hamburger BDS, BChD
Mark Haswell BDS, MSc
Gareth Jenkins BDS, FDS RCS, MScD
Stephen Jones BDS, MSc, MGDS RCS, MRD RCS
Gregori M. Kurtzman, DDS

Jonathan Lack DDS, CertPerio, FCDS
Samuel Lee, DDS
David Little DDS
Andrew Moore BDS, Dip Imp Dent RCS
Ara Nazarian DDS
Ken Nicholson BDS, MSc
Michael R. Norton BDS, FDS RCS(ed)
Rob Oretti BDS, MGDS RCS
Christopher Orr BDS, BSc
Fazeela Khan-Osborne BDS, LDS RCS, BSc, MSc
Jay B. Reznick DMD, MD
Nigel Saynor BDS
Malcolm Schaller BDS
Ashok Sethi BDS, DGDP, MGDS RCS, DUI
Harry Shiers BDS, MSc, MGDS, MFDS
Harris Sidelsky BDS, LDS RCS, MSc
Paul Tipton BDS, MSc, DGDP(UK)
Clive Waterman BDS, MDc, DGDP (UK)
Peter Young BDS, PhD
Brian T. Young DDS, MS

PUBLISHER
Lisa Moler


Email:
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Mali Schantz-Feld

Email:
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taken in the preparation of this magazine, the publisher cannot
be held responsible for the accuracy of the information printed
herein, or in any consequence arising from it. The views
expressed herein are those of the author(s) and not necessarily
the opinion of either Implant Practice or the publisher.

Volume 6 Number 3

Strides in surgical and restorative technology

I

t is a great time to practice implant dentistry due to all of the surgical and restorative
technology available to us as clinicians.

Surgically, we now have materials and growth factors that allow us to put the bone
and soft tissue in an optimal position and in a predictable manner to help maximize
positive restoration outcomes. We are able to design the final prosthesis from the ideal
incisal edge backwards, without being limited by the initial tissues present.

Visually, the digital revolution affords us the ability to use CT scans, 3D images,
and treatment planning software for precise placement. When a complete and accurate
picture of the individual patient is available, a lot of the guesswork is removed, and
precision is possible. With 3D imaging, dentists have the capability of virtual surgery and
placement to bolster confidence and solidify the treatment plan before picking up the
scalpel. Radiation levels can also potentially be minimized by imaging equipment that
allows adjustable settings for exposure time. Additionally, treatment planning software
uses the latest technology to help keep the process streamlined and organized while also
offering state-of-the-art treatment options to patients.

Technologically, the many applications of computer software in the dental office
allow maximized patient comfort and minimized clinician aggravation. I recently got a
digital impression scanner (iTero®). It allows me to take a digital impression of the implant,
replacing the goopy-mouth, old-style impressions. Patients love it. It is pretty slick, and
clinicians enjoy that it saves them an impression appointment with the patient. It creates
a digital file; then a treatment plan can be formulated; then the file is sent wirelessly to the
lab. The lab can now fabricate a restoration solely from that digital file without ever having
to pour up a stone model. The digital file is much more precise as there is no margin of

error from material shrinkage, etc. It also allows for a faster turnaround time at the lab. In
my practice, in less than a week the crown is back. Similar treatment planning software as
is used by the CT scanner can now design abutments and crowns if desired.

Globally, it is easier than ever to share ideas with implant dentists both nationally
and internationally. Breakthroughs are no longer locked to a geographic location or
specific publication. Information sharing is faster than ever, and questions can be posted
to peers and answered virtually instantly. In the digital age, sharing files and radiographs
with referring colleagues and specialists can be accomplished with the click of a mouse
securely and quickly.

Responsible use of technology is a must for patient safety and treatment success.
Continuing education such as webinars, journals such as Implant Practice US,
congresses and seminars, as well as educational venues, such as the Rocky Mountain
Dental Institute, where I lecture, are all valuable tools to learn about the technologies that
are available and how to use them safely and effectively in this fast-paced, competitive
dental world.

Though some of the newer technologies are still in their infancies, I think that they
too will become a great part of future progress. When I lecture for continuing education
classes, I stress the importance of integrating technology into implant dentistry because it
is exciting to be on the cutting edge (no pun intended) of implant dentistry today as these
new methods grow in popularity, prevalence, and precision.

Lewis C. Cummings, DDS, MS
Kingwood Periodontics and Implant Dentistry, Kingwood, Texas
Center for Advanced Dental Education, Dallas, Texas
Rocky Mountain Dental Institute, Denver, Colorado

Implant practice 1

INTRODUCTION

May/June 2013 - Volume 6 Number 3


TABLE OF CONTENTS

Case study
Incorporating state-of-the-art
and science to provide stability
and excellent esthetic results in

Practice profile

6

Dr. Bao-Thy Grant: Living life, loving family, and practicing with
passion
It takes dedication and motivation to maintain a balance between a growing
practice and a growing family.

implant dentistry
Dr. Robert C. Vogel illustrates how a
patient with limited buccal bone and
interadicular space benefitted
from a narrow diameter implant... 16
Late implantation in an
anatomical medial diastema
Drs. Nikolaos Papagiannoulis and

Marius Steigmann present a case
report that takes a minimally invasive
approach to soft tissue surgery... 18
Connective tissue grafting
Dr. Ken Akimoto presents a
pictorial approach to improving a
patient’s smile through soft-tissue
regeneration................................ 24
Case study: restoring form
and function with implants and

Corporate profile

12

Millennium Dental Technologies, Inc.
Built by clinicians with products designed for clinicians, Millennium continues to
operate with the key tenets of research, training, and five-star service.

veneers
Dr. Nilesh Parmar tackles a patient’s
neglected dentition to restore his
smile without resorting to the
“Hollywood” look ........................ 26
The basics and beyond with mini
dental implants
Dr. M. Dean Wright illustrates the
advantages of mini implants as a
denture stabilization option ......... 28

2 Implant practice

Volume 6 Number 3



TABLE OF CONTENTS

38

implants in the esthetic zone

Continuing
education
Management of the black triangle
around dental implants in the
esthetic zone: part 2
Dr. Scott Blyer explores management
and treatment of the black triangle
after it occurs................................32
Treatment planning of implants in
the esthetic zone: part 2
In the second part of the series, Drs.
Sajid Jivraj, Mamaly Reshad, and
Winston Chee explore how the facial
bony wall and the interproximal bone
affect implant placement................38

Technology
Minimally invasive maxillary sinus

lateral approach (SLA): a series of
case reports
Dr. Suheil M. Boutros opens the
window to a new method of sinus
lateral approach ............................46

Product profile

Diary.......................................62

IngeniOs synthetic bone grafting
products......................................54
Renovix™ Guided Healing Collagen
Membrane...................................56

Materials &
equipment .....................64

Introducing Roxolid® for All.......58

Industry news
Nobel Biocare announces new
opportunities for education and
patient care.................................44
4 Implant practice

Volume 6 Number 3


DENTSPLY Implants offers a

comprehensive line of implants,
including ASTRA TECH Implant
System™, ANKYLOS® and XiVE®,
digital technologies such as
ATLANTIS™ patient-specific
abutments, regenerative bone
products and professional
development programs.

We are dedicated to continuing the
tradition of DENTSPLY International,
the world leader in dentistry with
110 years of industry experience,
by providing high quality and
groundbreaking oral healthcare
solutions that create value for
dental professionals, and allows
for predictable and lasting implant
treatment outcomes, resulting in
enhanced quality of life for patients.

We invite you to join us on our journey to redefine implant dentistry.
For more information, visit www.dentsplyimplants.com.

Facilitate™
www.dentsplyimplants.com

79570-US-1212 © 2012 DENTSPLY International, Inc.

DENTSPLY Implants is the union of two successful

and innovative dental implant businesses:
DENTSPLY Friadent and Astra Tech Dental.


PRACTICE PROFILE

Dr. Bao-Thy Grant
Living life, loving family,
and practicing with passion
What can you tell us about your
background?
I am 37 years old and was born in Santa
Monica, California to Vietnamese parents.
My parents immigrated to the U.S. the
night before the fall of Saigon. My parents
are the core of my existence and taught me
how to love to the fullest. I have a younger
sister. I wanted to be a dentist since I was
in high school, but also wanted a business
degree, because I feel that it is a universal
degree and a very fundamental aspect of
any career. I graduated from the University
of Southern California (USC) with a BS
in Business while fulfilling all my science
prerequisites to apply to dental school.
While attending the USC School of
Dentistry, I became a work study student
in the orthodontic department, and was
introduced to oral maxillofacial surgery
(OMFS) and became absolutely fascinated

with the specialty — the rest is history! I
was determined to do what was required
to pursue a residency in OMFS. I attended
Montefiore Medical Center/Albert Einstein
College of Medicine, Bronx, New York for
my OMFS residency.

I have been practicing since 2008, and
predominately use Straumann®, followed
by Astra Tech, and NobelActive™, but I
base my decision on each particular case.

Is your practice
implants?

What
training
undertaken?

limited

to

No, I also specialize in OMFS with an
emphasis on multidisclipinary care.

Why did you decide to focus on
implantology?
I am not particularly fond of the terms
“implantologist” or “implantology,” because

my practice is not just about placing
implants in edentulous areas. I am an oral
healthcare provider who educates patients
on the option of having dental implants as
a part their treatment plan, depending on
each individual case. I instill information
in my patients to understand the inherent
value of dental implants as they relate to
improving the quality of life and long-term
oral function, but also to give them realistic
expectations of treatment outcomes and
risk factors as well.

6 Implant practice

How long have you been
practicing, and what systems do
you use?

have

you

While at Montefiore Medical Center/Albert
Einstein College of Medicine, I served as
the Chief Resident at Beth Israel Hospital,
Bronx Lebanon Hospital, Jersey City
Medical Center, Montefiore Hospital,
and Weiler Hospital. I was inducted as a
member of the Leo M. Davidoff Society for

outstanding achievement in the teaching
of medical students. I am the co-founder
and instructor of the Orange County
CPR Angels, teaching basic life support
to healthcare providers and the public.
I am also on staff at St. Joseph Hospital
of Orange and Children’s Hospital of
Orange County, an active delegate and
chair on the state and local organizations
for the California Dental Association, a
Diplomate of the American Board of Oral
and Maxillofacial Surgery, and a fellow
of the American Association of Oral and

Maxillofacial Surgeons. Currently, I serve
as the team oral surgeon to the Anaheim
Ducks NHL team. I have published articles
and CEs, and lectured on dental implants
and patients taking oral bisphosphonates.

Who has inspired you?
My parents. My dad taught me to have
a good work ethic, while my mom taught
me how to be respectful and kind to
others. Together, they taught me to have
compassion and humility.

Several oral and maxillofacial surgeons
have inspired me during different phases in
my life:

Dr. Alan Felsenfeld (a great mentor I
have known since I was in college) taught
me to have a voice in our dental profession,
to be active in organized dentistry, and to
always lead by example. He truly was an
integral part in my educational ambitions.

Drs. John Given, Ralph Buoncristiani
and Howard Park (I was an oral surgery
assistant in their office in college) taught me
all the fundamentals of caring for patients in
a private practice setting with compassion,
and how to run a practice efficiently and
treat your staff well. They gave me my first
exposure to a team approach.
Dr. Richard Kraut (my chairman/
Volume 6 Number 3



PRACTICE PROFILE
director in my OMFS residency) taught
me great work ethics and to practice with
integrity. No excuses; just get the job
done, and do it well!

Dr. Jeffery Pulver (my business partner
who sadly passed away in 2010) embodied
all of the attributes above; most of all taught

me to live life, love family, and practice oral
surgery daily with great passion.

What is the most satisfying aspect
of your practice?
The most satisfying aspects of my practice
are: first, the confidence that my staff
and I have to care for our patients with
compassion. It is incredible to meet and
get to know our patients first, and then to
educate them on their surgical needs so
that they are comfortable and certain of

the care that will be rendered. Also I enjoy
receiving the heartfelt handwritten notes
from our patients and referrals.

My staff and I cherish the moments
that we share with our patients who are
so grateful and appreciative of the care
that was rendered, as that is such an
emotionally rewarding part of this journey.

while at the same time enjoying a marriage
and raising my children with the help of
my amazing husband. This dream has
become a reality as I am experiencing a life
where I am a wife, mother, and an oral and
maxillofacial surgeon.

Professionally, what are you most
proud of?

We work hard each day to provide excellent
care without any compromise. We provide
an environment where our patients feel
confident of their care, know that we are
honest, and we also have a great sense of
humor, as laughter connects us as people.
Each patient is unique and has a different
story, so it is our objective to honor that
and make his/her experience unparalleled.
Many times when we connect with our
patients in such a profound way, we actually
learn from them. They share their stories,
and we create a bond that is meaningful. It
is not always about the surgery. It is about
connecting with people.

I am proud to be a part of such a great
specialty, doing what I love with passion
and grace. I was always motivated by a
desire to pay my own bills and to be an
independent woman who could stand on
my own two feet no matter what. I knew
the kind of woman I wanted to be — an
independent woman with my own career

What do you think is unique about
your practice?

What has been your biggest
challenge?
Balancing family and professional life is a
heartfelt journey.

8 Implant practice

Volume 6 Number 3


End-Tidal CO2 Monitoring
As standards of care increasingly include Capnography,
SAS is standing by with solutions for your practice.

Comprehensive vital signs monitors with ETC02

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ETC02 specific monitors

BCIđ Capnocheckđ II Hand-Held
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ãProvideswaveforms,numericvaluesandon-screen
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8400 • Capnograph,PulseOximeter
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8409 • PoleMountforCapnocheck®II

For more information call:
1.800.624.5926
or visit
www.southernanesthesia.com

OneSouthernCourt.WestColumbia,SC29169.p1800.624.5926f1.800.344.1237.www.southernanesthesia.com


PRACTICE PROFILE

What would you have become if
you had not become a dentist?
I would have been a chief executive officer
for a major corporation in the fashion
industry or a talk show host to empower
young boys and girls.

What is the future of implants and
dentistry?

Preventing the need for implants in the
first place. As an oral healthcare provider,
preventative dentistry is essential. Implants
have been extremely valuable; however,
more emphasis is needed regarding the
challenges of peri-implantitis.
We also should strive towards a
paradigm shift to do what truly is right
for patients among all oral healthcare
providers. In a society, our professional
name has been tarnished from practitioners
who have substituted doing what is
right for patients for the “almighty dollar”
(i.e., coupon dentistry, bait-and-switch
dentistry, etc.). This truly disheartens me.

What are your top tips for
maintaining
a
successful
practice?
• Accountability
• Stay ahead of new advances in the field
• Empower, educate, and take care of
your staff, as they are the gatekeepers
of your practice
• Do not be driven by profits
10 Implant practice

• Excellent patient care is critical

• Approach each work day with
excellence, as there is no room for error
when it comes to patient care

What advice would you give to
budding implantologists?
I am not fond of the term “implantologist.”
Every practitioner has a responsibility to
diagnose, educate, and treatment plan a
case in the best interests of their patients,
whether implants are involved or not.

What are your hobbies, and what
do you do in your spare time?
Family time with my husband and kids. I
love the experience of being a wife and
mom! I love eating! I enjoy cooking and
going out to great restaurants for a culinary
experience. I drink hot green tea at least
four times a day. I am also trying to learn
how to knit and play bridge. I admit, I am
an old soul trapped in a young body! IP

TOP 10 FAVORITES
In no particular order:
1. Green tea
2.i-CAT® CBCT scanner and Anatomage
treatment-planning software
3. Michael Bublé
4. Ski trip to Deer Valley in February and Hawaii

in August with my family
5. New Straumann® mount
6.INFUSE® rhBMP-2 bone graft
7. Cooking recipes from Thomas Keller’s Ad
Hoc at Home cookbook
8. Lounging under the sun while reading a
book or journal as the kids run around in the
backyard
9. A great periotome
10. Hearing and learning about someone’s life
stories and lessons. It makes me a better
person.

Volume 6 Number 3


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* For plan details, please visit springstoneplan.com.
** Based upon publicly available data as of 2/7/2013.

Call 800-630-1663
Visit hellospringstone.com


CORPORATE PROFILE

Millennium Dental Technologies, Inc.
Established in 1990 by clinicians, Robert H. Gregg II, DDS, and Delwin K. McCarthy, DDS, Millennium
Dental Technologies, Inc. is the longest lasting dental laser company. The founders continue to operate
the company with a shared vision and purpose: To create better clinical outcomes in periodontal disease
patients and to remain true to the guiding principle: “It’s all about the patient.”

H

eadquartered in Cerritos, California,
Millennium Dental Technologies Inc.
is the developer of the LANAP® protocol
for the treatment of gum disease and the
manufacturer of the PerioLase® MVP-7™
digital dental laser. Built by clinicians with
products designed for clinicians, Millennium
continues to operate with the key tenets of
research, training, and five-star service.

A foundation of research
Groundbreaking research in the early
1990s on Nd:YAG lasers caught the
attention of the founders of Millennium
Dental Technologies, Inc., Drs. Gregg and
McCarthy. Studies by TD Myers in 19891,
Midda, 19902; Tseng, 19913; Lin & Horton,
19924; Cobb, 19925; and Gold SI & Vilardi
in 19926 formed the foundation for spirited
clinical discussions as to the applications
of lasers in dentistry.

Drs. McCarthy and Gregg continued
research to test tissue interactions with
different lasers and operating parameters
— from surgical argons (515 nm), free
running Nd:YAG “neodymium YAG” (1064

nm), Ho:YAG “Holmium YAG” (2100 nm),
Er:YAG “Erbium YAG” (2940 nm) to
Continuous Wave (CW) carbon dioxide. A
curious thing happened. The researchers
noticed certain laser wavelengths — with
modified operating parameters not seen
in dental lasers at the time — interacted
with tissues in profoundly different ways
and produced profoundly different results
than what mere wavelength-specific tissue
interactions would predict.
These observations evolved into
the critical operating parameters of the
LANAP protocol – a surgical treatment for
periodontitis, using the free running pulsed
Nd:YAG laser – the PerioLase MVP-7.

12 Implant practice

It’s All About the Patient™
The LANAP protocol was developed to
meet the needs of periodontally challenged
patients who would not accept traditional
osseous surgery.
An original icon,
the “No Cut, No Sew, No Fear” logo,
provided patients a reassuring message by
alleviating fear.
The procedure combines the best
aspects of laser soft tissue surgery with

well-established principles of periodontal
disease management. The result is a
tissue-sparing, non-destructive surgery
with consistent, reproducible, positive
results. Other advantages include improved
hemostasis intraoperatively, and improved
patient comfort and acceptance.

Elite training – better for the
clinician, better for the patient
Critical to the success of any procedure is
the clinician’s ability to replicate results in
their own patients. Founders Drs. Gregg
and McCarthy passionately believe proper
training is vital to the clinician’s success
and the patient’s health. Five days of
exceptional training received through
the Institute of Advanced Laser Dentistry

(IALD) are mandatory inclusions into the
PerioLase® Periodontal Package®.
Over 30 clinical instructors oversee
live-patient training, with a 3:1 studentto-instructor ratio. Clinicians treat three
different patients with varying degrees
of periodontitis during their training. All
patients are provided by the IALD as part
of our comprehensive support and receive
1 year of complimentary follow-up care.
To date, Millennium and the IALD have
partnered to provide over $6.5 million in

free periodontal surgery for infection control
and follow-up care.

Clinical results guarantee
How can a company guarantee clinical
results? Clinical real-world experience! The
LANAP protocol was developed during
a decade-long process in a real-world
practice setting by clinicians for clinicians.
No other manufacturer, in any medical
or dental field, has ever guaranteed a
clinical outcome. Millennium guarantees
that the LANAP protocol will result in 50%
pocket reduction by regeneration versus
subtraction.

Volume 6 Number 3


The PerioLase MVP-7 was honored with the
Pride Institute “Best-of-Class” technology
award for the world’s first integration of
the Android™ based Samsung® tablet
display into a medical device, combining
advanced laser components with the latest
LCD display technology for an optimum
operating experience. This enables
clinicians’ immediate access to patient
treatment records at their fingertips, factory
pre-sets for common procedures as well

as continual product upgrades without the
purchase of new equipment — breaking
the paradigm of planned obsolescence
built into the manufacturing of capital
equipment within the dental industry and
making obsolescence obsolete.
As part of the clinician-centric
environment, it was important to ensure
the Android system is fully retro-compatible
with all existing units so current clinicians
are not forced into unnecessary product
upgrades.

New solutions for new problems peri-implantitis treatment
Being operated by wet-finger dentists has
given Millennium an appreciation for new
challenges in oral health care. The LAPiP
protocol was developed to effectively treat
the unique challenges of failing implants and
destroy perio pathogens and endotoxins.
The LAPiP protocol eliminates local
inflammatory response with consistent,
positive results in the regeneration of
alveolar bone. The protocol is part of the
training curriculum taught by the IALD.

Supporting the fight against gum
disease
Millennium is a proud supporter of the
Fight Gum Disease campaign – a literacy

campaign aimed at increasing public
awareness of the prevalence and dangers
of gum disease. Twenty-three U.S. state
governors and two Canadian provinces
have signed proclamations supporting
Gum Disease Awareness month. Helping
patients understand the systemic impact
of periodontitis truly supports Millennium’s
key principle of “It’s all about the patient.”

We encourage you to show your support
at www.fightgumdisease.com, or on
Facebook and Twitter at #fightgumdisease.

Ongoing research
In the last 14 years, 268 positive patient
outcomes have been published in peerreviewed journals. In 2012, the results of
a long-term tooth survival study by Lloyd
Tilt, DDS, MS,7 were published as was a
second human histology study by Marc
Nevins, DMD, MMSc.8
Although the LANAP protocol
has been proven in multiple studies,
Millennium is still committed to acceptance
through research, willing to financially
support further research despite lack

Volume 6 Number 3 Implant practice 13

CORPORATE PROFILE

Best-in-class technology


CORPORATE PROFILE

References
1. Myers TD, Myers WD, Stone RM. First soft
tissue study utilizing a pulsed Nd:YAG dental
laser. Northwest Dent. 1989;68(2):14-17.
2. Midda M. Nd:YAG Subgingival Curettage.
Innovation et technologie en biologie et
medicine. Actes du deuxienne congre modial. L,
impact des lasers en sciences odontologiques.
Presentation; 1990; Paris, France.
3. Tseng P, Gilkeson CF, Pearlman B, Liew V. The
effect of Nd:YAG laser treatment on subgingival
calculus in vitro [abstract 62]. J Dent Res.
1991;70(4):657.

of government or industry funding. In
August of 2011, Millennium and the IALD
launched a university-based, five center,
six PI, prospective, longitudinal, calibrated,
multicenter clinical study comparing
LANAP to Modified-Widman to Scaling and
Root Planing, to coronal debridement. For
study details, visit www.clinicaltrials.gov
and search for “LANAP”.

Principles that withstand the test
of time
Millennium Dental Technologies stands
as the longest lasting laser company that
manufactures its own laser in the U.S., with
the same name, same management team,
the same laser, and the same product.
14 Implant practice

The focus of the founders, Drs. Gregg
and McCarthy, has never changed – to
do what’s right for the patient in making
a treatment available that achieves results
not routinely and widely available when
compared to existing treatments.
Doing the “right” thing — putting
patients before profits — has been the key
to success and longevity in the dental laser
and manufacturing industry.

For more information about Millennium
Dental Technologies, visit www.LANAP.
com or call 877-526-2759. IP

This information was provided
Millennium Dental Technologies.

by

4. Lin PP, Rosen S, Beck FM, Matsue M, Horton

JE. The effect of a pulsed ND:YAG laser on
periodontal pockets following subgingival
application [abstract 1548]; The effect of a
pulsed Nd:YAG laser on periodontal diseased
root surfaces: a SEM study [abstract 1546];
A comparative effect of the Nd:YAG laser
with root planing on subgingival anaerobes in
periodontal pockets [abstract 1547]. J Dent Res.
1992;71:299.
5. Cobb CM, McCawley TK, Killoy WJ. A
preliminary study on the effects of the Nd:YAG
laser on root surfaces and subgingival microflora
in vivo. J Periodontal. 1992;63(8):701-707.
6. Gold SJ, Vilardi MA. Effect of Nd:YAG laser
curettage on gingival crevicular tissues [abstract
1549]. J Dent Res. 1992;71:299.
7. Tilt LV. Effectiveness of LANAP over
time as measured by tooth loss. Gen Dent.
2012;60(2):143-146.
8. Nevins ML, Camelo M, Schupbach P, Kim SW,
Kim DM, Nevins M. Human clinical and histologic
evaluation of laser-assisted new attachment
procedure. Int J Periodontics Restorative Dent.
2012;32(5):497-507.

Volume 6 Number 3


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CASE STUDY

Incorporating state-of-the-art and science to provide

stability and excellent esthetic results in implant
dentistry
Dr. Robert C. Vogel illustrates how a patient with limited buccal bone and interradicular space benefitted
from a narrow diameter implant

I

ncorporating the latest developments in
implant dentistry into practice may result
in increased security and less aggressive
surgical techniques with long-term stability
and excellent esthetics. The case below
illustrates the use of a Straumann®
Roxolid® narrow diameter implant with
improved strength* and osseointegration
with prosthetic flexibility through the use of
a CAD/CAM zirconia abutment.

Limited buccal bone and interradicular
space necessitated the use of a narrow
diameter implant such as the Straumann
Bone Level Ø3.3mm Roxolid Implant.
The biologic advantage of a platform
shift allows for maintenance of crestal
bone levels and maintenance of the
soft tissue. The strength of this implant
(titanium alloyed with zirconium) allows for
increased thickness of the abutment at the
level of connection resulting in the ability
to use a CAD/CAM all zirconia abutment

not previously feasible with other small
diameter implants.
The use of a zirconia abutment in
the case presented here addresses the
high esthetic demands of a patient with a
high smile line, thin tissue type, and high
scalloped architecture. Combining the

Figure 1: Healthy 18-year-old female with congenitally
missing lateral incisor. Orthodontics was necessary to
correct severe root convergence of adjacent teeth

Figure 3: Esthetic evaluation of provisional restoration 3
weeks after insertion
Figures 4A and 4B: Straumann® CAD/CAD zirconia abutment for Bone Level Ø3.3mm Roxolid® Implant

Figure 5: Abutment and lithium disilacate (IPS e.max®)
crown ready for delivery shown on Bone Level NC (Narrow
CrossFit®) analog
Robert Vogel, DDS, graduated from the
Columbia University School of Dental and
Oral Surgery in New York City, New York;
upon graduation, he completed a combined
residency program in Miami, Florida at
Jackson Memorial Hospital, Mount Sinai Medical
Center, and Miami Children’s Hospital. He maintains
a full-time private practice in implant prosthetics and
reconstructive dentistry in Palm Beach Gardens,
Florida. He works closely as a team member with several
specialists providing implant-based comprehensive

treatment, as well as conducting clinical trials and
providing clinical advice to the dental attachment and
implant fields. Dr. Vogel has developed and collaborated
on the development of several prosthetic components
and techniques currently in use in implant dentistry. He
lectures internationally on implant dentistry, focusing on
simplification, confidence, and predictability of implant
prosthetics through ideal treatment planning and team
interaction. Dr. Vogel continues to publish scientific
articles on implant dentistry, and is a Fellow of the
International Team for Implantology (ITI).

16 Implant practice

Figure 2: Temporary abutment and provisional restoration
in place 6 weeks after implant placement for “provisional
guided tissue conditioning”

Figure 6: Delivery of final abutment to 35Ncm

Figure 8: Twenty-six-month
post-op radiograph noting
no change in bone levels
and stable implant/abutment
connection
Figure 7: Final restoration in place

SLActive® surface for reduced healing
times with a narrow diameter for decreased
grafting needs, along with a platform shift

design, all allow for more conservative
treatment in the difficult esthetic situation.
The ability to incorporate these biologic
and mechanical advantages with an all

zirconia CAD/CAM abutment allows for
precise angulation, emergence, and margin
placement with an esthetic advantage over
titanium or gold abutments. IP
*Norm ASTM F67 (states minimum tensile
strength of annealed titanium); data on file.
Volume 6 Number 3


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CASE STUDY

Late implantation in an anatomical medial diastema
Drs. Nikolaos Papagiannoulis and Marius Steigmann present a case report that takes a minimally invasive
approach to soft tissue surgery

D

uring the last decades, implantology
and guided bone and tissue
regeneration have made major steps in
improving osseointegration and soft tissue
esthetics. The conclusions reached by a
number of experienced clinicians now form
part of almost every surgical protocol.

Studies by Tarnow, et al., (2000) and
many specialized clinicians have shown
the optimal interimplant or implant-tooth
distance. They have also determined
the right distance between the proximal
contact and the bone lever as well as
the right geometry of the restorations in
order to achieve the best possible esthetic
outcome.

Many of these studies are more than
10 or 15 years old. During this time, implant
designs and surfaces have changed
considerably. Since modern biology
revealed the principles of osseointegration,
this topic no longer presents a problem.
Knowing how osseointegration works and
being able to predict the outcome – even
in cases of lateral augmentation, ridge
preservation, and severe defect treatment
– has moved the focus of modern
implantology to soft tissue esthetics.

The prime challenge today is the longterm esthetic result. These results depend
not only on osseointegration, but also on
the quality and amount of bone tissue
around the implant, and the amount and
treatment procedure of the soft tissue.
Factors such as the implant neck, proximal

contact to crestal bone, and the implantto-tooth distance have a major influence
on the esthetic outcome of a single tooth

Dr. Nikolaos Papagiannoulis is in private practice in
Germany. He graduated from the Dentistry School
in Eberhard-Karls University of Tubingen. He is
experienced with various implant systems, and in bone
regeneration and in sinus lifts, bone splitting, block
augmentation, prosthetic, and periodontal surgery.
Dr. Marius Steigmann is an adjunct associate professor
of oral and maxillofacial surgery at Boston University,
and honorary professor of the Carol Davila University
Bucharest. He is the continuing education assessor
for the International Academy of Oral Implantology.
Dr. Steigmann maintains a private practice in Germany
limited to esthetic and implant surgery.

18 Implant practice

Figures 1 and 2: Situation before implantation, with a bridge from UR2 to UL1 and tooth UR1 missing

Figure 3: Radiograph showing bone resorption

Figure 4: Soft tissue scarring

restoration.

Taking into account that new materials
and designs offer more possibilities,
surgeons today have to vary their protocols

and rethink some of the standards
established when there were only a few
implant designs and surfaces.
Such an occasion will be described
in this case report. Clinical and anatomical
findings lead us to an alternative protocol
and the choice of a specific implant design
surface.

Figure 5: Teeth UR2 and UL1 treated with composite

Case report
A 35-year-old patient presented with an
old and esthetically insufficient bridge in
the anterior maxilla. The clinical situation
showed a 15-year-old bridge from UR2
to UL1, while the right middle incisor was
missing after endodontic and surgical root
treatment (Figures 1 and 2). The bridge
was only vestibularly veneered, the teeth
too small, and the soft tissue was inflamed.
The soft tissue in the region of the missing
tooth was scarred, and the lip band was
transpositioned. The lateral bone loss was
massive but a logical result of the missing
tooth.
The control radiograph showed a
vertical bone loss of 2-4 mm. The bone
proximal to UL1 was intact, while the bone
proximal to UR2 had resorbed by almost 2

mm (Figure 3). Teeth UL1 and UR2 were
endodontically treated and sufficiently
filled.
We set the following goals for
treatment:
• A satisfied patient
• A long-term, esthetic outcome
• Correction of the scars
• Infection free

Treatment plan
1. Removal of the bridge UR2-UL1
2. Conservative treatment of UR2 and UL1
with composite reconstruction
3. Temporary bridge insertion
4. Implantation and guided bone regeneration (GBR)
5. Implant exposure and soft tissue plastic
6. Crown on UR2 and UL1
7. Forming of the papilla
8. Crown at UR1

Volume 6 Number 3


CASE STUDY
Figure 6: Exposing the bone 2 weeks later showed the
lateral defect

BONE GRAFTING SOLUTIONS

Introducing
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Figure 7: Insertion of tapered implant

Treatment
After professional tooth cleaning, the
old bridge was removed, and teeth UR2
and UL1 were treated with composite to
reconstruct the crown and gain stability for
the denture (Figures 4 and 5).

A temporary bridge was inserted while
the soft tissue around UR2 and UL1 healed.
The implant was placed after 2 weeks.

Implant placement
Because of where the implant was to be
placed, we decided to use a tapered
implant with micro laser threads at the
implant neck. This design was chosen to
achieve maximum bone and soft tissue
integration with the implant surface, so that
the esthetic result satisfied both our own
and the patient’s expectations.

The SST medial to UL1 and UR2 was
less than 2 mm and allowed us to lift the

papilla on both sides. A split thickness
flap was performed. The exposed bone
showed a lateral defect and the need for
GBR to increase the bone level to at least
2.5 mm.

The form of the old bridge as well as
the clinically and radiologically-determined
anatomical bone geometry, and the
patient’s statement confirmed that the
patient had a diastema in her childhood.
This diastema was closed after losing
the tooth at UR1. Although the literature
recommends a distance of at least 1.5
mm from the neighboring tooth as optimal
for esthetic result, we decided to position
our implant 1.5 mm from tooth UR2 and
1.5 mm from the middle line, resulting in
a distance of 3 mm to UL1. Therefore,
we inserted a 3.8 mm diameter tapered
implant with internal hexagon. A length of
12 mm was chosen (Figures 6 and 7).

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GUIDOR® Matrix has not been clinically tested in pregnant women,
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Volume 6 Number 3 Implant practice 19


CASE STUDY

Figure 8: Augmentation of lateral defect with Cerabone

(0.5-1 mm)

Figure 9: Covering with Jason membrane and closure of
flap

Figure 11: Situation at 4 months postoperative with poor
position of distal papilla

Figure 12: The papilla was raised again

Figure 10: Postoperative control radiograph

The papilla was raised again. The gingival
former was removed, and a standard
abutment inserted. Without individualizing
the abutment, we changed the position
of the papilla, sutured it again, and fixed it
with a single suture to the keratinized gum
tissue. After fabricating a new temporary
bridge, a new appointment was scheduled
for 2 weeks later (Figures 11-13).

result (Figures 15-17).

Figure 13: Insertion of standard abutment and altering the
position of the papilla

Pre-prosthetic period
The lateral defect was treated with
autologous bone won with a bone trap,

human cancellous cortico-spongious bone
chips (Maxgraft®, Botiss), and bovine chips
of 0.5-1 mm diameter (Cerabone®, Botiss),
resulting in a double layer GBR material of
2.5 mm on the higher third of the implant.
The augmentation site was covered with
a porcine pericardium membrane (Jason®
membrane, Botiss) as a barrier to faster
growing soft tissue. The flap was closed
with only three 5-0 polyester sutures
(Figures 8-10).

We prescribed antibiotics for 4 days
and a 0.05% chlorhexidine solution for 1
week. The patient was recalled at 1, 2, 4,
10, and 16 weeks postoperatively.
The whole healing period passed
without any complications, membrane
exposures, or complaints from the patient.

Exposure
The implants were exposed 4 months
after placement. A simple mucoperiosteal
flap was raised, and a standard gingival
former inserted. The clinical situation
showed a fault position of the distal papilla.
20 Implant practice

After 2 weeks, the temporary bridge was
removed, and the soft tissue was examined.

The new situation showed sufficient bone
and soft tissue support, a new contour of
the anterior maxilla at the operation site,
and 3 mm of soft tissue above the implant
neck. The position of the distal papilla
was now perfect and guaranteed a good
esthetic outcome of the whole procedure.
At this appointment, we fitted the crowns
at UR2 and UL1, and started with the
manipulation of the mesial papilla.
Having the crown on tooth UL1
and enough soft tissue, we decided
on a conservative procedure using an
individualized abutment to form the mesial
papilla. The new temporary crown on UR1
was left for another 2 weeks (Figure 14).

Prosthetic period
The outcome was impressive. The mesial
papilla led to the crown of tooth UL1, we
observed no retraction of the soft tissue,
and the distal papilla was stable. The
impression followed as usual with a direct
transfer. The crown at UR1 was fabricated
and loaded after 2 weeks and a wax-up.
The patient was very satisfied with the

Results
Through minimally invasive procedures,
appropriate

planning
and
detailed
discussion with the patient, the following
results, important for the clinicians, were
achieved:
• Correction of the frenulum position
• Natural form of the mesial papilla
• Correction and natural form of the distal
papilla
• Correction of the quality and quantity of
bone and soft tissue
• Optimal hygiene situation
• Elimination of old scars at the operation
site
• Depression of new scar at the operation
site

Conclusion
Our primary aim in this case was a highly
esthetic result in a difficult and sensitive
region, while solving the patient’s problems
in as minimally invasive a way as possible.
The outcome was more than satisfactory,
resulting from good planning and the
knowledge of anatomy and biology of
implant surgery and GBR⁄GTR.
The way our bodies function has
not changed. What has changed is our
understanding of the biology. We know

how osseointegration works, and we
can treat with predictable results. The
procedure of the treatment is also the
result of our new understanding over the
last decades. This understanding can now
be used to manipulate and guide biology to
the direction we want.
Volume 6 Number 3