Program Guide
Table of Contents Corporate Sponsors
The Academy of Osseointegration acknowledges the following companies for their generous support of its 2021 Annual Meeting:
Corporate Forum presentations can be accessed in each company’s virtual exhibit booth.
2 Table of Contents
Page Page Board of Directors, Past Presidents & Staff...... 4 Live Sessions (continued) Greetings from the President ...... 5 Annual Business Meeting...... 47 Continuing Education...... 7 Closing Symposium: Special Announcements...... 9 The Future of Implant Practice Models ...... 48 Award Recipients...... 11 On-Demand Sessions Corporate Forums...... 16 Coffee and Controversies...... 50 Schedule At-A-Glance...... 26 Young Clinicians’ Session...... 53 Live Sessions TEAM Program...... 55 Opening Symposium: Game Changers...... 27 Laboratory Technician Program...... 57 Surgical Track: Oral Clinical Research Session...... 59 Thinking Outside of the Box – Part 1...... 32 Oral Scientific Research Session...... 60 Prosthetic Track: Technology Disruptors – Part 1. . . 33 Clinical Innovations Session...... 61 Esthetics...... 34 AO Research Award Recipients Session ...... 62 Complications...... 36 Oral Clinical Abstracts...... 63 Surgical Track: Oral Scientific Abstracts ...... 67 Thinking Outside of the Box – Part 2...... 37 Clinical Innovations Abstracts ...... 71 Prosthetic Track: Technology Disruptors – Part 2. . . 38 E-poster Abstracts ...... 78 Surgical Complications – Part 1...... 39 Oral Abstract and E-poster Author Index . . . . . 130 Risk Management – Part 1 ...... 41 Speaker Disclosures ...... 133 Surgical Complications – Part 2...... 43 Exhibits...... 136 Risk Management – Part 2 ...... 45
Annual Meeting Program Committee E . Dwayne Karateew, DDS, Chair; Clark Stanford, DDS, PhD, MHA; Jay Malmquist, DMD; Craig Misch, DDS, MDS; Tara Aghaloo, DDS, MD, PhD; German Gallucci, DMD, PhD; Lars Hansson, CDT; and Robert Vogel, DDS
Future Meeting Dates 2022 2023 2024 2025 February 24 — 26 March 16 — 18 March 7 — 9 March 27 — 29 San Diego, CA Phoenix, AZ Charlotte, NC Seattle, WA
3 Academy of Osseointegration
2020 — 2021 Board of Directors Clark M . Stanford, DDS, PhD, MHA . . . . President Joesph P . Fiorellini, DMD, DMSc . . . . . Director Tara L . Aghaloo, DDS, MD, PhD . . . President-Elect Jeffrey Ganeles, DMD ...... Director Amerian D . Sones, DMD, MS . . . . . Vice-President Joseph Y .K . Kan, DDS, MS ...... Director Hom-Lay Wang, DDS, MSD, PhD . . . . . Secretary Robert R . Lemke, DDS, MD ...... Director Joerg Neugebauer, DDS, PhD ...... Treasurer Lambert J . Stumpel, DDS ...... Director Jay P . Malmquist, DMD ...... Past-President Robert C . Vogel, DDS ...... Director Kevin P . Smith, MA, MBA . . . . Executive Director Past Presidents William R . Laney, DMD, MS ...... 1986-1988 Marjorie K . Jeffcoat, DMD ...... 2004-2005 Paul H .J . Krogh, DDS ...... 1988-1989 Richard K . Rounsavelle, DDS . . . . . 2005-2006. Gerald Barrack, DDS ...... 1989-1990 Edward B . Sevetz, Jr ., DMD ...... 2006-2007 Irving B . Stern, DDS ...... 1990-1991 Steven E . Eckert, DDS, MS ...... 2007-2008 Charles L . Berman, DDS ...... 1991-1992 Steven G . Lewis, DMD ...... 2008-2009 Daniel Y . Sullivan, DDS ...... 1992-1993 Vincent J . Iacono, DMD ...... 2009-2010 Thomas A . Collins, DDS, MS ...... 1993-1994 Peter K . Moy, DMD ...... 2010-2011 Stephen M . Parel, DDS ...... 1994-1995 Kenneth F . Hinds, DDS ...... 2011-2012 Michael S . Block, DMD ...... 1995-1996 David L . Cochran, DDS, MS, PhD . . . . . 2012-2013 Edwin S . Rosenberg, DMD, BDS . . . . . 1996-1997 Stephen L . Wheeler, DDS ...... 2013-2014 Gerald N . Graser, DMD, MS ...... 1997-1998 Joseph E . Gian-Grasso, DMD ...... 2014-2015 Bejan Iranpour, DDS ...... 1998-1999 Russell D . Nishimura, DDS ...... 2015-2016 Abraham Ingber, DDS ...... 1999-2000 Alan S . Pollack, DDS ...... 2016-2017 Melvin S . Schwarz, DDS, MScD . . . . 2000-2001. Michael R . Norton, BDS, FDS, RCS(Ed) . . 2017-2018 Dayn C . Boitet, DDS ...... 2001-2002 James C . Taylor, DMD, MA ...... 2018-2019 James H . Doundoulakis, DMD, MS . . . . 2002-2003 Jay P . Malmquist, DMD ...... 2019-2020 Clarence C . Lindquist, DDS ...... 2003-2004 Staff The Academy of Osseointegration Executive Staff is here to serve you . Please feel free to contact the staff with your questions or concerns at (800) 656-7736 or (847) 439-1919; fax: (847) 427-9656; or e-mail: academy@osseo .org . Executive Director ...... Kevin Smith, MBA...... ext . 287...... kevinsmith@osseo .org Associate Executive Director...... Mike Slawny ...... ext . 298. . . . . mikeslawny@osseo .org Chief Financial Officer...... Kevin Bragaw ...... ext . 286. . . . . kevinbragaw@osseo .org Director of Meetings and Conventions . . . Gina Seegers ...... ext . 276. . . . . ginaseegers@osseo .org Director of Education ...... Kim Scroggs...... ext . 288. . . . . kimscroggs@osseo .org Director of Membership Services...... Karla Kaschub...... ext . 282. . . . . karlakaschub@osseo .org Director of Registration...... Truman Adcock. . . . . ext . 308. . . .. trumanadcock@osseo .org Director of Exhibits ...... Jean Foellmer...... ext . 278. . . . . jeanfoellmer@osseo .org Director of Finance ...... Sarah Adcock ...... ext . 304. . . . . sarahadcock@osseo .org Director of Information Technology . . . . . Jeff Kiva...... ext . 279...... jeffkiva@osseo .org Marketing Communications Manager . . . . Terri Vargulich...... ext . 307. . . . . terrivargulich@osseo .org Media and Public Relations Manager. . . . William Wille...... ext . 318. . . . . williamwille@osseo .org Membership Manager...... Amanda Wiff...... ext . 312. . . . . amandawiff@osseo .org Administrative Assistant ...... Cherie Seyller...... ext . 270. . . . . cherieseyller@osseo .org Sponsorship Coordinator...... Miriam Standish...... ext . 299. . . . miriamstandish@osseo .org Registration and Exhibits Assistant. . . . . Kelly Burns...... ext . 284...... kellyburns@osseo .org
4 Table of Contents Greetings from the President
Welcome to the Academy of Osseointegration’s 2021 Virtual Annual Meeting! We are so glad you have joined us here in our virtual convention center for this year’s meeting titled “Game Changers ”. I want to thank you along with all of our corporate sponsors for participating in the Academy’s first ever virtual meeting . Dr . Stanford Over the years, Academy members and attendees of our in-person meetings have come to expect a dynamic, high-quality educational experience . This year, although virtual, will be no exception . Dr . Dwayne Karateew and his Program Committee have assembled top-notch presenters to contribute to this spectacular scientific meeting . Kicking off our Opening Symposium will be Dr . Catherine Mohr, President of the Intuitive Foundation . the manufacturer of the daVinci Surgical Robot . Dr . Mohr will provide her keynote address on “New Frontiers in Robotic Surgery” and demonstrate how the latest technology will impact the future delivery of medicine . The opening day program will be rounded out with presentations from Drs . Pravin Patel, Mitra Sadrameli, Sonia Leziy, Michael Miloro and Dr . Miguel Stanley . The afternoon will culminate with a presentation by Dr . Allan Radaic, recipient of the AO-sponsored 2019 IADR Award . On Saturday, we will be offering our widely popular Surgical Track and Prosthetic Track sessions along with sessions on Esthetics in the morning and Complications in the afternoon . As you make your way through our schedule over the next few days, I invite you to check out the Auditorium for the complete program line up so you can plan your schedule accordingly . With both live and on-demand viewing options…there is no need to worry about having to choose between which high-quality presentations you want to see . On Sunday, please ensure your clocks reflect the time change from Standard Time to Daylight Savings Time . And remember, the times of our presentations are all listed in Eastern Time . Sunday’s schedule includes Surgical Complications, moderated by the always dynamic Dr . Michael Norton, as well as Risk Management, which I will be moderating . I encourage you to visit the Networking Lounge to connect with your colleagues, the Virtual Exhibit Hall to chat one-on-one with industry representatives and view the latest research presented in our E-posters area and dozens of other abstracts throughout the meeting . If there is more than one presentation running concurrently which you want to sit in on, remember all sessions will be recorded and available within 12 hours . However, if you would like to participate in the live Q&A, be sure to tune into the session as it is being presented live . Between sessions, make your way into the virtual Exhibit Hall to visit our industry sponsors and view some of the many E-posters that are available . This year, many of the E-posters also feature a short video by the presenters to help supplement their research . Also be sure to check out our On-Demand sessions, which includes a full lineup of more than 20 pre-recorded presentations . These short topical sessions include our new Coffee and Controversies … continued on next page 5 Table of Contents Greetings from the President presentations, the Young Clinicians’ session, our TEAM and Laboratory Technician Programs along with our abstract sessions that include Clinical Innovations, Oral Research and AO Award Recipient presentations . These are available for viewing any time throughout the meeting . Finally, don’t forget to stop by the Networking Lounge when you have a few minutes . That is where you’ll find opportunities to connect with your peers and participate in some of the fun and games which are offered throughout the meeting . Plan to join us Sunday afternoon at 2:00 pm for the Annual Business Meeting, which includes recognition of various accomplishments and award by your colleagues…the Academy’s financial report…and the election of our new Officers and Directors . Following the Annual Business Meeting will be our Closing Symposium, where the panel will debate The Future of Implant Practice Models . Thank you again for joining us for this incredible event and hope you enjoy the Academy’s 2021 Virtual Annual Meeting . Best regards, Clark M. Stanford, DDS, PhD, MHA President
6 Table of Contents Continuing Education
Educational Objectives courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry . The goal of this year’s Annual Meeting is Concerns or complaints about a CE provider may to provide attendees with the most current be directed to the provider or to the Commission information based on what has been learned for of Continuing Education Provider Recognition at obtaining predictable results in implant therapy . ada .org/cerp . The overall objective is to evaluate clinical, technological and biological breakthroughs This continuing education activity has been made in implant dentistry . These advances will planned and implemented in accordance with be explored relative to their influences on clinical the standards of ADA Continuing Education practice . Recognition Program (CERP) . Our aim is to provide a comprehensive program, The Academy of Osseointegration designates this including addressing current challenges and activity for 56 continuing education credits. solutions in both restorative and surgical Credit is awarded and based on actual number techniques currently in use today, including of contact hours, excluding Corporate Forum pre- surgical and prosthodontic treatment planning, sentations, breaks, meals and registration periods . maintaining implant success, team management, Attendees may claim fewer hours in accordance and solving implant complications . Information will with their actual attendance (CE credits are earned be presented on team treatment collaborations, by attending all scientific sessions except for the treatment options for edentulous patients and Corporate Forum presentations) . what the future holds in implant dentistry . The formal continuing education program for The ultimate goal is to provide the attendee the Academy of Osseointegration is accepted by information on the most predictable and proven the Academy of General Dentistry (Recognition techniques to integrate into clinical practice to #145608) for Fellowship/Mastership credit . The improve patient care . current term of acceptance extends from 5/1/2018 — 6/30/2022 . Target Audience The Academy of Osseointegration is also a This program is targeted toward everyone who recognized continuing education provider for the has an interest in implant dentistry . This includes: Dental Board of California (R 3090) . students in training programs; dentists with limited experience and specialists with extensive training The Academy of Osseointegration is the in implant dentistry; auxiliary staff, including sole provider of continuing education and is hygienists, assistants and laboratory personnel . responsible for the program content and faculty The educational method for this program is lecture selection . The Academy assures that all continuing and self-mediated learning . No credit is available education presentations are independent of for the Corporate Forum sessions . commercial influences . In addition, the Academy of Osseointegration Continuing Education Credit ensures that the scientific basis for clinical and The Academy of technical CE content is presented in each course Osseointegration through a peer-reviewed process . Speakers are is an ADA CERP Recognized Provider . ADA CERP also required to provide an assessment of the is a service of the American Dental Association to benefits and risks associated with any clinical assist dental professionals in identifying quality recommendations or treatment options presented providers of continuing dental education . ADA as well as provide references whenever possible . CERP does not approve or endorse individual
7 Table of Contents Continuing Education
Online Evaluation, Credit Claim and Continuing Education Verification For your convenience, the Academy uses an 2) Click the “Claim Credit” button . online evaluation and credit claiming system 3) Log in using your last name and AO ID for the Annual Meeting . This system allows number which can be found in your meeting registrants to complete evaluations and claim confirmation email . credit for sessions attended . After completing an overall meeting evaluation, you will be able to 4) Complete the evaluations . save and/or print your Letter of Verification . You may complete your evaluations and claim credit 5) You will be required to complete and pass a anytime before June 14, 2021; however, we short quiz prior to receiving your CE letter . strongly urge you do this sooner rather than later! 6) Claim your credit for the sessions you A downloadable CE Tracking Form is included in attended . all attendees’ briefcases to help keep track of the 7) Click the “Submit Credits Claimed ”. sessions you attended so you can complete your evaluations and claim credit at the conclusion of Please complete the evaluation and credit the meeting . claiming by June 14, 2021 . No Continuing Education Credit will be awarded after June 14th . How to log into the evaluation and credit claiming system: If you have any questions please contact the AO office at (847) 439-1919 following the meeting . 1) Go to s6.goeshow.com/ao/annual/2021/ session_evaluation.cfm .
8 Table of Contents Special Announcements
Disclaimer Leaderboard Competition The primary purpose of the AO Annual Meeting is Throughout the meeting, attendees can collect educational . Information, as well as technologies, points to qualify for valuable prizes . After products and/or services discussed, are intended to logging in to the virtual meeting platform, click inform attendees about the knowledge, techniques on the trophy icon on the upper right corner of and experiences of specialists who are willing to your screen to display the leaderboard . You’ll share such information with colleagues . A diversity automatically earn tokens and points by visiting of professional opinions exist in the specialty and various booths in the exhibit hall and participating the views of the AO disclaims any and all liability in other meeting activities . Check the leaderboard for damages to any individual attending this throughout the weekend to see who’s winning! conference and for all claims which may result from Gift cards will be awarded to top scorers . All the use of information, technologies, products and/ players with scores over a certain threshold (other or services discussed at the conference . than top score winners) will be entered into a raffle for additional prizes . All tokens/points must Attendees are cautioned about the potential risks be collected by 5:00 pm EDT on Sunday, March of using limited knowledge when incorporating 14 . Complete contest rules will be available in the techniques and procedures into their practices, Networking Lounge and in the Virtual Briefcase . especially when the course has not provided them with supervised clinical experience in the technique or procedure to ensure that attendees Meeting Sessions and Recordings have attained competence . To access all the educational sessions, click on Moreover, the Academy of Osseointegration Auditorium when you enter the Lobby of the ensures that the scientific basis for clinical and Virtual Platform . From there you will have a choice technical content is presented in each course of accessing Live or On-Demand sessions . through a peer-review process . Speakers are The “Live” sessions are the programs presented also required to provide an assessment of the March 12 – 14, with either live or pre-recorded benefits and risks associated with any clinical presentations that include a live interactive chat . recommendations or treatment options presented The “On-Demand” sessions are all pre-recorded as well as provide references whenever possible . and can be viewed at any time .
E-poster Presentations Most of the “Live” sessions will be recorded and available approximately 12 hours after the live E-posters are accessible anytime through the event . The Virtual Platform, along with all of the meeting platform and online at osseo.org and recorded presentations, will be accessible until https://epostersonline.com/osseo2021 . December 31, 2021 . CE credit, however, is only available until June 14, 2021 . Foundation Donor List Social Media… The Osseointegration Foundation is proud to recognize those individuals who have generously Be part of the conversation via #AO21Virtual to contributed to the Foundation over the last ten follow Annual Meeting related posts and share years . A list of donors can be found in the OF your experiences on Instagram and Twitter Booth in the Virtual Exhibit Hall . @AcademyOsseo; Like us on Facebook, follow us on Linkedin and subscribe to our YouTube channel @Academy of Osseointegration .
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9 Table of Contents Special Announcements
Speaker Disclosures question following their presentation . Questions that do not get addressed can be sent to As required by the Continuing Education [email protected] . Please include the Recognition Program (CERP) under the auspices name of the presenter in your email . E-poster of the American Dental Association and in presenters will have an email address posted accordance with the Academy of Osseointegration on their individual e-poster page for e-poster policy, every effort has been made to encourage related questions . the faculty to disclose any commercial relationships or personal benefits associated with their presentation . The disclosures provided do Virtual Exhibit Hall not imply that the information is biased or of The Virtual Exhibit Hall will open Friday, March lesser quality . Attendees of this meeting should be 12 . At least 25 technical and scientific exhibitors aware of the factors in interpreting the program will display their latest products in the Virtual contents and evaluation recommendations . Exhibit Hall throughout the meeting . The Academy Moreover, views of the faculty do not reflect the appreciates the support of its exhibitors and urges opinions of the Academy of Osseointegration . all registrants to visit the displays . Plus, collect Speaker Disclosures can be found on pages tokens for the Leaderboard Competition to qualify 132-134 . to win great prizes! You will be able to view videos, company Speaker Questions information and interact with exhibitor personnel via text or video chat . Exhibits will be accessible All of the “Live” sessions will have a live interactive until December 31, 2021 . Q&A where you can ask any of the presenters a
Questions not addressed can be sent to [email protected].
10 Award Recipients
All Award presentations will be offered in the AO Research Award Recipients Session in the On-Demand section of the virtual platform.
2021 Osseointegration Foundation Applied Science Research Grant Presentation
The Effect of Osteoporosis on Osseointegration and Bone Regeneration Elena Calciolari, DDS, MS(Perio), PhD Osteoporosis is a common systemic skeletal disease characterized by a decrease in bone mass and micro architectural changes in bone . It is biologically plausible that the alterations in bone metabolism associated with osteoporosis might also impair the bone regenerative process and multiple levels, as well as bone healing around dental implants and negatively affect their osseointegration . This lecture will present data on the current evidence on the effect of osteoporosis on bone regeneration and osseointegration and it will introduce the possibility of using “omics” technologies to identify signalling pathways negatively affected by osteoporosis . Moroever, it will introduce preliminary data from an exploratory pilot study that investigated the use of proteins expressed in saliva and PICF (including exosomes) to predict different clinically relevant implant-related outcomes in a population of osteoporotic patients receiving a dental implant .
2020 Osseointegration Foundation Applied Science Research Grant Presentation
Using Digital Implant Planning in Assessing Outcomes of Maxillary Sinus Augmentation Procedures: A Retrospective Study Irina Dragan, DDS, MS The aim of this retrospective study was to use digital implant planning and assess radiographic outcomes of maxillary sinus augmentation procedures (ideal bone graft, excess bone graft, and insufficient bone graft) in reference to three-dimensional prosthetic- driven implant placement . The majority of the outcomes highlight an excess in bone grafting during the maxillary sinus elevation . The implant digital planning prior to maxillary sinus elevation can facilitate a better understanding of the expected clinical result . With the use of technology, we can leverage not only reviewing the anatomy of the sinus but quantifying the precise amount of bone graft needed for an adequate site development for future implant placement . This can be achieved only by the collaboration of the interdisciplinary team (surgical-restorative), thus having a direct impact on the patient care: time of healing and the cost of the procedure .
… continued on next page 11 Table of Contents Award Recipients
2021 Basic Science Research Grant Presentation
A Novel Growth Factor-free Adhesive Hydrogel Delivery System for Enhanced Bone Tissue Engineering Applications Sahar Ansari, MSc, PhD In the U .S ., over a million bone reconstructive procedures are performed due to injury, surgical removal of diseased tissue or congenital defects, representing substantial morbidity, pain and disability toll on society . Furthermore, this induces major social and economic hurdles, as bone regeneration therapies represent a cost of more than $2 .5 billion in the U .S . each year alone . To treat patients, clinicians are often faced with a challenging task of harvesting and grafting in order to recreate the necessary tissue architecture and function . These complex procedures commonly fail to deliver consistent benefits and often result in complications . Thus, a new paradigm for the treatment of damaged bone tissue is needed that can provide effective, and long-term therapy for most patients . Delivery of mesenchymal stromal cells (MSCs) such as gingival mesenchymal stem cells (GMSCs) presents an advantageous therapeutic option for bone tissue engineering, due to the accelerated tissue repairing rates . However, the major drawbacks of the current cell-laden biomaterials for cell delivery applications are low adhesion to the surrounding tissues, lack of suitable mechanical strength, uncontrolled degradation rate, and absence of tissue regenerative properties . In this research project, we developed an adhesive osteoconductive hydrogel delivery system with the ability to direct human gingival mesenchymal stem cells (GMSCs) toward osteogenesis . The hydrogel biomaterial contains bioceramic microparticles with bone regeneration capacity . We have shown that our engineered adhesive biocomposite are highly osteoconductive, osteoinductive, and able to promote osteogenesis and downregulate osteoclastogenesis in vivo . This accomplishment has been a paradigm shift in engineering bone tissues towards their use in treating maxillofacial and skeletal bone defects and disorders to provide an effective and innovative treatment modality for bone regenerative therapies .
12 Table of Contents Award Recipients
2020 Basic Science Research Grant Presentation
Effect of Drilling Preparation on the Cortical Bone Around Implants Subjected to Immediate Mechanical Load Michele Stocchero, DDS, PhD When implants are subjected to immediate load, the bone-implant interface is challenged . The implant anchorage is expected to withstand such load and implant primary stability is considered as a pre-requisite for a successful immediate loading protocol . A commonly used strategy to increase the initial implant stability is undersized preparation . This procedure, however, may generate excessive pressure and a major extent of remodelling, which could decrease the implant stability during the healing phase . Contrarily, implants placed with a non-undersized preparation observe an eventual increase of stability with time, but on the other hand they may not exhibit sufficient primary stability . With this in vivo experiment we simulated immediate occlusal load to implants placed after two different drilling protocols . Thanks to this methodology we evaluated the implant osseointegration and implant stability after five weeks of loading .
2021 William R. Laney Award Presentation
The Effect of Crown-to-Implant Ratio on the Clinical Outcomes of Dental Implants: A Systematic Review Andrea Ravida, DDS, MS The purpose of this study was to investigate the effect of C/I ratio (clinical and anatomical) on implant survival, marginal bone loss, and prosthetic complications . Systematic electronic and manual search was conducted to include clinical trials with a minimum follow-up of 1 year . In total, 15 articles were included in the final analysis . Linear regression analysis did not reveal a significant correlation between anatomical C/I ratios and survival rate, marginal bone loss, or prosthetic complications . Similarly, no significant correlation was observed in the articles providing the clinical C/I ratios . In conclusion, increased C/I ratio does not seem to be directly related with increased marginal bone loss and does not represent a biomechanical risk factor for the stability of the prosthesis and for the survival of dental implants .
Supported by a grant from Quintessence Publishing Co., Inc.
13 Table of Contents Award Recipients
2020 William R. Laney Award Presentation
The Effect of Moderately Controlled Type 2 Diabetes on Dental Implant Survival and Peri-implant Bone Loss: A Long-Term Retrospective Study Zeev Ormianer, DMD Diabetes mellitus (DM) is a metabolic disorder, a part of a group of metabolic diseases which influences the patient’s healthstatus . A common complication that is associated with DM, especially DM type 2 (DMT2), is advanced periodontal disease . The prevalence of the periodontal disease is much higher in patients with DMT2 than people without the disease . In addition, the loss of periodontal attachment and alveolar bone starts in early stages of life in such patients compared to general population . One of the main diagnosis of DM is according to HbA1C values . HbA1C < 5 .7% is defined as normal and patients with 5 .7% Supported by a grant from Quintessence Publishing Co., Inc. 14 Table of Contents www.selenium-medical.com ǀ [email protected] Table of Contents Corporate Forums This collection of sessions offers a unique and significant opportunity to view the latest research and developments in the field of craniofacial implant technology . The Academy is offering 20 industry- hosted presentations featuring the latest implant technology . The Corporate Forum presentations were presented live prior to the Virtual Meeting. Recordings of each presentation can be found in the sponsoring company’s booth in the Virtual Exhibit Hall. The topics and presenters are selected by the participating companies without any input from the Academy of Osseointegration and Continuing Education credit will not be provided . Full Arch Immediate Implant Setting New Standards for Immediate Molar Reconstruction: Avoiding Complications Implant Placement and Improving Treatment Michael Pikos, DDS for Geriatric Patients This presentation will focus on the prevention, Daniel Spagnoli, DDS, MS, PhD recognition, and management of surgical Recent advancements in technology have led to complications associated with full arch immediate more options for implant therapy in the molar implant reconstruction cases . It will feature the region . Conventional implants in molar extraction importance of proper treatment planning along sockets may not provide adequate stability or with key principles that should be followed to require less than ideal orientation to gain stability . minimize both intraoperative and postoperative The purpose of this presentation is to describe complications . guidelines for placing conventional or wide Upon completion of this presentation, participants diameter implants in the molar region, while should be able to: 1) understand the importance of developing the ideal emergence for restoration . proper treatment planning for full arch immediate implant reconstruction cases; 2) understand key principles to follow to minimize and manage intraoperative complications; and 3) understand key principles to follow to minimize and manage postoperative complications . 16 Table of Contents Corporate Forums Inspiration TALKS with Dentsply Sirona Moderator: Lisa Thoms, DDS, MSD Let’s TALK Implants and Digital Workflows As digital technology becomes more pervasive in everyday practice, there is an increased demand to leverage it in an increasing number of clinical situations . Join these world class speakers for an engaging session focused on digital implant workflow solutions to help you achieve simplified, predictable and esthetic clinical outcomes . Leveraging the Primescan Intra-oral Scanner Think Differently About Full-arch for Delivery of Screw-Retained Digitally Restorations Designed, Implant-Supported Restorations Mark Ludlow, DMD, MS Treating the fully edentulous patient with dental Michael Norton, BDS, FDS, RCS(Ed) implants can be one of the most rewarding When most people discuss digital workflow, endeavors in clinical dentistry . At the same time, thoughts turn to planning and impression taking, it can be one of the most intimidating endeavors but the digital workflow is so much more . This from a treatment planning and execution presentation will not only focus on the invaluable perspective, especially when we try to leverage use of CBCT and digital planning media such all of our digital tools . In this presentation, we will as Simplant®, but also on the delivery of high- explore and simplify the principles that will lead end implant-supported restorations that benefit to both surgical and prosthetic success by utilizing from a digitally designed, site-specific, CAD/CAM our digital tools within every step of the process . Atlantis® abutment, supported by a new breed of dental implant, one whose fundamental design is conceived for a digital world . With its one- position only index, the Astra Tech Implant EV® is uniquely geared to benefit from digital impression acquisition, using the new Primescan® intra-oral scanner . Finally, we can begin to understand the true meaning of a digital workflow, which creates an implant-supported restoration entirely fabricated in the digital medium . 17 Table of Contents Corporate Forums Inspiration TALKS with Dentsply Sirona Moderator: Lisa Thoms, DDS, MSD Let’s TALK Regeneration The era of placing implants with disregard to esthetic outcomes is over . Patients are demanding function and esthetics . Treating sites with soft and hard tissue loss may be challenging but is often necessary to ensure a successful outcome and meet patient expectations . Please join us in this regenerative session where three world class experts will present cases and discuss different treatment options, including the importance of implant design, graft material selection and application . Tips for Improving Vertical Tissue Height Predictable Regeneration using OSSIX™ Using GBR Bone, A Sugar Cross-linked Ossifying Collagen Scaffold Bach Le, DDS, MD Matthew Fien, DDS This presentation will focus primarily on the In this session, Dr Fien will discuss the benefits principles of guided bone regeneration in implant and versatility of OSSIX™ Bone for a wide variety dentistry and provide some insight on how to of regenerative procedures . In addition, several predictably gain vertical tissue height in small cases will be presented that illustrate its superior to moderate size defects using GBR . A series handling and regenerative potential . of cases have been gathered to illustrate risk assessment and predictable management of various critical size defects . Enhancement of Ridge Contour with Absorbable Scaffolds Rodrigo Neiva, DDS, MS Deficiencies in ridge contour have a significant impact in implant esthetic outcomes . Hard and/or soft tissue grafts are commonly used to address this type of ridge defect . This presentation will demonstrate the potential of absorbable dual scaffolds for the management of ridge contour deficiencies . 18 Table of Contents Corporate Forums A New Solution for Customized Bone Digital Assisted Soft Tissue Sculpturing Regeneration for Complex Alveolar Ridge (DASS) Technique for Esthetically Driven Full Defects Arch Implant Restoration with Long-Lasting Mario Roccuzzo, DDS Clinical Performance One of the greatest challenges facing clinicians Alessandro Pozzi, DDS, MSc is to place implants in an ideal position in sites To introduce a novel digitally assisted and compromised by trauma, periodontal disease biologically driven surgical and prosthetic and/or severe infection, where significant bone technique to achieve the ideal soft and bone augmentation is necessary . Recent studies have tissue interface for full arch implant supported confirmed that implants, placed after vertical fixed dental prosthesis . DASS technique allows augmentation by means of Titanium Meshes the previsualization of the ideal soft and bone and followed by an adequate supportive care tissue interface and fabricate a CAD-CAM pink program, offer predictable long-term results . free interim prosthesis for immediate loading . This program will show that careful selection of The DASS technique is a predictable surgical a proper bone-grafting technique and soft tissue and prosthetic integrated digital workflow that augmentation can produce good functional and simplifies the achievement of a scalloped tissue esthetic results . Furthermore, a modern fully interface, re-establishing the mucosal dimension customized CAD/CAM technology to satisfy required for the protection of underlying bone patient-specific requirements regarding a planned while maintaining tissue health to guarantee bone augmentation will be presented . long term success . The surgical sculpturing and Upon completion of this presentation, participants maturation of the soft and bone tissue is driven should be able to: and enhanced by the xenogeneic collagen matrix • identify the situations where vertical bone grafting grafting properly positioned in order to achieve is indicated; a qualitative and quantitative solid interface . • learn how to easily obtain a contoured form- The xenogeneic collagen matrix and the interim stable titanium grid structure, for customized bone prosthesis are used as a biologic and prosthetic regeneration; scaffold to boost the soft tissue healing and • evaluate the most important steps for optimal use sculpturing in order to embrace and integrate a of the titanium meshes; pink free highly esthetic complete arch prosthesis . • determine the prognostic factors to reduce the risk Upon completion of this presentation, participants of complications . should be able to: 1) increase the surgical and prosthetic knowledge on the management of the soft tissue interface for pink free complete arch restorations with a digitally assisted protocol; 2) introducing disruptive digital innovations to better understanding the surgical and prosthetic requirements of each implant recipient sites in order to take the conduct a personalized decision making and re-configurate a flat into a scalloped soft tissue interface; 3) feel confidence and being able to re-establish the proper mucosal dimension for the protection of underlying bone while maintaining tissue health to guarantee long term success; and 4) understanding advanced surgical and prosthetic concept with a clinical case based step by step learning method . 19 Table of Contents Corporate Forums Tips and Tricks for Faster, More The Digital Immediate Loading Protocol Predictable Full Arch Cases with Teeth-In-A Day: Non-Guided Riad Almasri, DDS Treatment Protocol This lecture is intended for clinicians who are Samantha Siranli, DMD, PhD familiar with the NeoArch® concept, “immediate Our protocol for the digital immediate loading loading using dental implants for full arch cases ”. with terminal dentition cases includes the This presentation will showcase both photography extraction of all non-salvageable teeth, implant and videography tips and techniques used to placements, abutment placements and the facilitate easier and more predictable approaches, intraoral scan of the freshly placed abutments, how to achieve less surgery time and how to computer aided designs and milling . minimize post-op surgical and prosthetic issues . The information referred to the esthetics and Upon completion of this presentation, participants vertical dimension is gathered with merging should be able to: the extra-oral 3-D facial scans, 2-D photographs • provide a full-arch surgery in lesser time; and intra-oral scans prior to surgery . The day of • basic principles for a better full-arch surgery; extractions and implant surgery, abutments are scanned and initial designs are merged with • surgical protocol to minimize post-surgical anatomical landmarks . prosthetic complications; Upon completion of this presentation, participants • demonstrations . should be able to: • clinical step by step demonstration of the complete digital flaw; • merge the extra-oral facial scans and intra-oral scans for smile design and vertical dimension of occlusion prior to the surgery; • intra-oral scans of freshly placed abutments following implant placements; • merge the abutment scans to initial intra-oral scans; • computer aided design/computer aided milling; • finish up touches of milled PMMA prior to insertion the day of the surgery . 20 Table of Contents Corporate Forums A Biologically Driven Concept to Zirconia in Implant Dentistry – An Update Design the Emergence Profile Around Markus Blatz, DMD, PhD Dental Implants: Surgical and Prosthetic Zirconium dioxide (zirconia) has become a highly Considerations to Optimize Hard and Soft popular material for tooth- and implant-supported Tissue Integration restorations . Among the many advantages are Giacomo Fabbri, DMD the optical and physical properties and arguably even more so, the biological integration, which The emergence profile is a crucial factor to is especially important for dental implant facilitate favorable esthetic outcomes and restorations . In addition, CAD/CAM technologies maintain peri-implant health and stability . It should provide excellent accuracy and precision of fit . be evaluated not simply in terms of morphology However, there are still many questions related but as a clinical variable closely related to to the advantages but also limitations of zirconia, material properties, surface chemistry and clinical such as: can zirconia be used like a metal, is all approaches; in this way, it is possible to achieve a zirconia the same, what are the best protocols comprehensive planning of this critical factor that for zirconia veneering, what are the different can significantly influence the integration, stability types of zirconia and how to select them, how and preservation of bone and soft tissues . Soft about precision of fit, and what is the soft-tissue tissue integration and adherence onto prosthetic response? These questions become even more components represent paramount elements to important for long-span zirconia fixed dental preserve and protect bone from contamination prostheses . Among the most recent developments and infection . The lecture is conceived to present in this area is the new Nobel Procera Implant a prosthetic concept suggested as an operative bridge, which will be introduced . strategy to preserve peri-implant hard and soft tissue and achieve predictable prosthetic This presentation will provide an update on zirconia outcomes optimizing soft tissue integration . as it is applied in implant dentistry on single-unit restorations up to full-mouth reconstructions and A comprehensive evaluation of the emergence introduce new material options . profile around dental implants to achieve ideal soft tissues adherence branches out into three main topics that can be listed in: 1) material, including biocompatibility, decontamination and surface chemistry and quality; 2) morphology, considering the design in the critical and sub-critical area; and 3) clinical approach that included surgical and prosthetic aspects . 21 Table of Contents Corporate Forums 15 Unique Ways to Utilize a Set the Stage: Use of Deepithelialized Deepithelialized Dehydrated Amnion Dehydrated Amnion-Chorion Allograft Chorion Allograft to Simplify Your in Both Immediate and Staged Implant Armamentarium and Improve Clinical Placement Outcomes Robert Miller, DMD Matthew Fien, DDS Guided Bone Regeneration has become an A Purion® processed, deepithelialized dehydrated integral part of implant dentistry over the amnion-chorion allograft (Bioxclude®) is a versatile past three decades . This presentation will biomaterial with unique biologic and handling focus on the unique role Purion® processed characteristics . In this forum, Dr . Fien will present deepithelialized dehydrated amnion-chorion a multitude of cases that illustrate the many allograft (BioXclude®) plays in both simultaneous applications of this material and will review new dental implant placement as well as a staged handling instructions to simplify use of Bioxclude® approach . A comprehensive review of the in a plethora of clinical scenarios . The discussion allograft and a decision tree will be presented, will include the decision process for selecting allowing a seamless decision-making process a single versus double layer barrier technique, when evaluating the defect for simultaneous including anatomical considerations and best implant placement with predictable GBR . practices to achieve consistent and predictable Participants will gain a unique understanding of outcomes . a predictable approach to placement of dental implants in deficient sites with the long-term results demonstrating the overall efficacy of each Using Deepithelialized Dehydrated Amnion- methodology . Chorion Allograft for Minimally Invasive Dental Implant Surgery: A Collaborative Zygomatic and Pterygoid Implants for Full Discussion Arch Immediate Load Reconstruction with Deepithelialized Dehydrated Amnion- Daniel Cullum, DDS Chorion Allograft Adjunct Michael Block, DMD Dan Holtzclaw, DDS, MS The rise of placental tissue is forever changing This lecture will offer a comprehensive overview medicine and Snoasis Medical has pioneered of immediate load full arch reconstruction of this development for over 10 years . Its Purion® the atrophic maxilla, including pterygoid and processed, deepithelialized amnion-chorion zygomatic implant utilization, as well as lateral allograft (BioXclude®) delivers multiple sinus augmentation . Adjunctive use of amnion- extracellular matrix proteins, growth factors, and chorion allograft membrane (BioXclude®) in these cytokines to provide a barrier membrane that cases will testify to the versatility and unique enhances healing . These lectures will review handling advantages for every aspect of surgery, current evidence-based techniques for minimally including: Schneiderian membrane repair and invasive and open grafting immediate implant reinforcement, graft containment, as an adhesion surgery in conjunction with BioXclude . These barrier, and an overall carrier of growth factors procedures provide a simple and effective means and cytokines . The inherent antimicrobial and to reduce treatment timelines while improving anti-inflammatory nature of BioXclude adds predictability and patient satisfaction . to the numerous offered advantages in these applications . 22 Table of Contents Corporate Forums Straumann ImmediaXy: Business Impacts Zygomatic Implant Redesigned: of Full Arch Immediate Treatment Rationale and Biomechanical Principles Steven Bongard, DDS Edmond Bedrossian, DDS Now more than ever, it’s important to understand The evaluation of patients for immediate loading the business of implant dentistry, and this start who have with terminal dentition, especially in with understanding the dental needs of the the maxilla, may at times be challenging . The patient population you are treating . Patients presence of pneumatized sinuses limits the are more savvy and demand immediate results . surgical options for placement of implants for This session will identify techniques to help you posterior support . leverage new technologies that help provide As always, treatment planning begins with the immediate treatment therapies and drive patient “end in mind” . The Determination of the type of case acceptance . final prosthesis, whether a tooth only or a hybrid bridge is essential to guide the surgical team in planning the number as well as the distribution of the implants needed along the arch length . The Adoption of the “Zones of the Maxilla”, allows the surgical team to determine whether to use axil, tilted or the zygoma implant . In cases where the Zygoma or the Quad Zygoma is planned, the adoption of the “ZAGA Classification” allows the surgeon to evaluate the contour of the lateral wall of the maxillary sinus as well as the extent of palatal resorption of the maxillary alveolar ridge . In this presentation, an algorithm to ensure the ability to obtain initial stability of implants in the posterior maxilla will be discussed . The rational for the modification of the Zygoma implant and its application will also be reviewed . The New Straumann Round and Flat Zygomatic implants address the potential limitations that have been observed by experienced surgeons over the last two decades using zygoma implants . Join Dr . Edmond Bedrossian, one of the experts who helped to develop the Straumann Zygomatic System, in reviewing the treatment planning, prosthetic and the surgical principles of the new solution . 23 Table of Contents Corporate Forums Digital Workflow in Immediate Implant The Straumann Digital Workflow: Situations: In-house Versus Outsourcing Connected Solutions With the IOS Solutions Hunter Dawson, DMD, MSD William Martin, DMD, MS Digital implant workflows from guided surgery The replacement of a missing tooth or teeth in to restoration were at one time a novel idea patients with immediacy and esthetic demands and pieced together with various forms of has become a focal point in today’s implant disconnected technology . Now in a world practice . The utilization of evidenced-based where connectivity, efficiency, and consumer treatment protocols coupled with the integration experience drives oral healthcare, Straumann of digital technology in the planning, placement digital workflows will lead the way by providing and restoration of these implants have resulted streamlined and synergistic solutions . From in a streamlining of the treatment workflow, intra oral scanning to 3D-printing, the full digital with end efforts to reduce patient chair-time, workflow is now connected and integrated across increase predictability and overall success . The multiple platforms from the intraoral scanner pressure for the clinician to adopt this digital directly to the guided planning software . In this technology is evident, but it can often be met with discussion, Dr . Dawson will highlight the benefits resistance due to lack of knowledge or the cost to your practice and your patients that a seamless of incorporation . The aim of this presentation is digital workflow can create for your practice . to showcase the advantages of utilizing digital technology in the immediate implant situation and to offer a comparison between incorporation of digital technology via in-house or outsourcing workflows . 24 Table of Contents Corporate Forums 8 Year Results After Ridge Augmentation Guided Surgery: 3D Diagnosis, Planning with Customized Allograft Bone Blocks and Clinical Success for Both the Dentate Klaus-Kristian Würzler, MD, DMD and Edentulous Patient Patients with severe ridge atrophy who want Jason Kim, DDS, MDS to have an implant-supported restoration may This course has been designed to explore 3D benefit from individualized treatment protocols . diagnosis, planning, and clinical success . There Allogenic bone blocks as well as autogenous will be emphasis on planning single/multiple grafts are the materials of choice in many of units, and full arch immediate restorations using these cases . The success or failure of the grafting Implant Concierge’s digital workflow to create procedure is determined by the close contact of custom surgical guides and provisionalization . the graft to the recipient bone surface . Posterior guided surgery in the mandible along Customized Allograft Blocks are a crucial with a full arch case will be demonstrated along developmental step in block grafting . A custom with a discussion of how to anticipate and avoid block is produced using CAD/CAM technology complications and pitfalls . based on a CBCT/CT scan of the defect area . Program Objectives: The preoperative design and fabrication of the • Discuss CBCT Analysis and 3D Treatment Planning individual bone graft reduces the necessity to and Diagnosis . shape the graft during surgery . This optimization • Plan and Implement for Single/Multiple Units and of the procedure reduces the surgical time Full Arch Immediate Restorations significantly, leading to less complications . • Understand the workflow for your guided surgery This lecture focuses on the history and case with 3D planning and how to anticipate and experiences of allograft block grafting in avoid complications and pitfalls . dental surgery . Based on photo and video • Understand the digital workflow to create custom documentations, histological results and clinical surgical guides and provisionals through Implant evidence, it will be shown why customized Concierge . allograft bone blocks are a valuable alternative to autogenous bone grafts . Program Objectives: • To better understand allograft processing methods and their impact on post-grafting remodeling . • To better understand allograft bone block properties and surgical protocols . • To better understand the workflow of designing and milling customized bone blocks . • To better understand technical and anatomical limitations . 25 Table of Contents Schedule At-A-Glance All sessions are listed in Eastern Standard Time (EST). The following presentations will be streamed live at the times designated below. Friday, March 12 Don’t forget to 9:00 am — 3:15 pm change your clocks! Virtual Exhibit Hall Hours EST changes to EDT on 10:00 — 10:30 am Sunday, March 14th Welcome and Introductions 10:30 am —12:30 pm Opening Symposium: Game Changers – Part 1 Sunday, March 14 12:30 — 1:00 pm 10:00 am — 4:45 pm Break Virtual Exhibit Hall Hours 1:00 —3:15 pm 10:00 — 11:30 am Opening Symposium: Game Changers – Part 2 Surgical Complications – Part 1 10:00 — 11:30 am Saturday, March 13 Risk Management – Part 1 10:00 am — 3:00 pm 11:30 am — noon Virtual Exhibit Hall Hours Break 10:00 am — 12:15 pm Noon — 1:35 pm Surgical Track: Surgical Complications – Part 2 Thinking Outside of the Box – Part 1 Noon — 1:35 pm 10:00 am — 12:15 pm Risk Management – Part 2 Prosthetic Track: Technology Disruptors – Part 1 1:35 — 2:00 pm Break 10:00 am — 12:15 pm Esthetics 2:00 — 2:30 pm Annual Business Meeting 12:15 — 12:45 pm Break 2:30 — 4:45 pm Closing Symposium: 12:45 — 2:30 pm The Future of Implant Practice Models Complications 12:45 — 3:00 pm Surgical Track: Thinking Outside of the Box – Part 2 12:45 — 3:00 pm Prosthetic Track: Technology Disruptors – Part 2 All On-Demand presentations are available beginning at 9:00 am, Friday, March 12. 26 Table of Contents Opening Symposium Friday, March 12 10:00 — 10:30 am Welcome and Introductions Clark Stanford, DDS, PhD, MHA AO President E. Dwayne Karateew, DDS Annual Meeting Program Chair 10:30 am — 3:15 pm Opening Symposium: Game Changers – Part 1 Moderator: Clark Stanford, DDS, PhD, MHA Keynote Speaker 10:30 — 11:00 am New Frontiers in Robotic Surgery Catherine Mohr, MD, MS In her talk “New Frontiers in Robotic Surgery”, Dr . Mohr will take us on a journey through some of the history of medical technology, its impact on human health, and what that means for how we should think about developing and introducing new technologies into medicine and surgery on a global scale — especially in the context of a pandemic . From understanding the many ways to measure value, to exploring the new technologies coming down the pipe, Dr . Mohr will talk about how these new capabilities might affect both the practice of medicine as well as the way in which we teach the next generation of practitioners their surgical skills . Upon completion of this presentation, participants should be able to: 1) discuss the effect that medical technology has had on overall longevity; 2) explain the difference between infrastructure limited technology deployment, and fast deploying technologies; and 3) describe the implications of emerging technologies like robotics and A .I . on the practice and training of medicine . 11:00 — 11:15 am Live Q&A With Dr. Mohr HAVE A QUESTION? Click on the chat button to submit your question . 27 Table of Contents Opening Symposium Friday, March 12 Game Changers – Part 1 (continued) 11:15 — 11:45 am From Rocket Ships to Surgery: Precision, Accuracy and the Impact of Gaming Pravin Patel, MD For nearly half-a-century, reconstructing patients with craniofacial deformities has relied primarily on two-dimensional photographic images and radiographs . It was the surgeon’s eye and experience that integrated the two-dimensional records to generate the virtual three- dimensional image for surgical planning . In the last decade of the twentieth century, multi- dimensional visualization of the skeletal deformity became possible with the emergence of Computerized Tomography (CT) and Magnetic Resonance Imaging (MRI) . This allowed the surgeon the ability to visualize the complexity of the deformity but not the ability to simulate surgery . It is only within the last several years that rapid advances in computational software began to transform the pure visual imagery of CT/MRI to allow the surgical simulation to become a reality . Today, surgeons are beginning to have the tools to simulate various craniofacial skeletal osteotomy patterns and the ability to manipulate each of the bony elements . However, the limitation of true simulation has always been the inability to fully visualize the third dimension trapped within two-dimensional flat screen displays . Thus, surgeons relied on 3D printed models for tactile feedback and to visualize depth . With the recent introduction of immersive virtual reality, mixed augmented reality and haptic feedback, three-dimensional surgical simulation becomes a possibility with greater fidelity .This presentation will showcase the technology of the future, today . Upon completion of this presentation, participants should be able to: 1) explain the historical evolution of the role for simulation from the space program of the 1960’s to the role of ‘gaming’ for surgical training; 2) discuss virtual and augmented reality tools to improve the precision and accuracy for surgical navigation; and 3) recognize how to incorporate three-dimensional surgical simulation into practice . 11:45 am — 12:15 pm Exploring the Boundaries of Diagnostic Imaging Mitra Sadrameli, DMD, MS Artificial intelligence (A .I ). is fast becoming a staple of diagnostic imaging, with the potential to allow early detection of disease and diagnosis of pathology . A I. . models are being developed to automate prediction of disease risk, detection of abnormalities/pathologies, diagnosis of disease, and post-surgical evaluation to optimize routine care and diagnosis accuracy . This presentation will discuss the contributions and limitations of A .I . and which applications will make A .I . an indispensable tool for the radiologist . Upon completion of this presentation, participants should be able to: 1) describe areas where A .I . will contribute to diagnostic evaluation in radiology; 2) discuss limitations which will prevent A .I ’s. mass use in the near future; and 3) explain deep learning’s role in the efficacy of A I. . in radiology . 12:15 — 12:30 pm Live Q&A With Drs. Patel and Sadrameli HAVE A QUESTION? Click on the chat button to submit your question . 12:30 — 1:00 pm Break 28 Table of Contents Opening Symposium Friday, March 12 Opening Symposium: Game Changers – Part 2 Moderator: Clark Stanford, DDS, PhD, MHA 1:00 — 1:30 pm Periodontology: The Dynamics of This Discipline and Its Impact on Implantology Sonia Leziy, DDS The career of the periodontist is far from static, being influenced by medicine, technology, and contemporary research advances . Every facet of the periodontology and the scope of care that this encompasses is being impacted, from diagnosis, to planning and culminating in treatment execution . While many traditional non-surgical and surgical periodontal procedures still apply in clinical practice, these are evolving with improved disease recognition and documentation, refined diagnosis, better disease prevention approaches and through minimally invasive soft and hard tissue regenerative therapies to manage tissue loss . The results: our ability to mitigate disease and regenerate tissues is more predictable . This lecture will explore some of advances and directions that are shaping this dynamic career . Upon completion of this presentation, participants should be able to: 1) discuss patient-centered risk evaluation and how it impacts our treatment planning; 2) provide an overview of diagnosis and technology- intertwined to reduce subjectivity; and 3) explain how/why advanced minimally invasive surgical approaches will continue to improve outcomes and treatment acceptance . 1:30 — 2:00 pm Pushing the Boundaries of Grafting Technology: Neural Allograft Technology Michael Miloro, DMD, MD Nerve injuries may occur following dental implant placement but there is no consensus on treatment protocols, and, unfortunately, patient morbidity may significantly affect quality of life . Proper planning can mitigate the risk of nerve damage, but prompt diagnosis and management is required when nerve injury occurs . Both non-surgical and surgical options exist to treat these injuries, and current technological advances have allowed the use of a processed nerve allograft to repair the nerve with excellent outcomes . Upon completion of this presentation, participants should be able to: 1) recognize the risk factors for implant- related nerve injury; 2) describe the diagnosis and treatment options; and 3) discuss the nerve allograft treatment possibilities . 29 Table of Contents Opening Symposium Friday, March 12 Game Changers – Part 2 (continued) 2:00 — 2:30 pm Are Consumers and Technology Driving the Future of Implantology? Miguel Stanley, DDS There are many challenges dentists face every day . The general population want faster, better, cheaper, smarter options in everything, and dentistry is no exception . What are the ways in which technology is reshaping the way we see dentistry and education, and how might this change the world of dentistry? Are you finding it difficult to fuse dentistry with business? Do your patients not understand why using technology will improve quality of treatments? Find out what is the perfect formula for yourself and your business . Dentistry is not what you see on-line but what you have to deal with every day, and it changes from country to country, between age groups, etc . This is a lecture for students, new dentists and veteran practitioners that will help you be part of a bigger game . Upon completion of this presentation, participants should be able to: 1) discuss why it is important to embrace technology and bring it to our universe; 2) explain to patients the importance of using the best technologies and how it elevates the quality of treatments performed; and 3) describe how to introduce new technologies in your day-to-day workflow and how it helps save time and stress . 30 Table of Contents Opening Symposium Friday, March 12 Game Changers – Part 2 (continued) 2:30 — 3:00 pm 2020 IADR Award Recipient: Prevention of Peri-implantitis Using Nisin and Nisin- producer Probiotic – An In Vitro Study on Titanium Discs Allan Radaic, PhD Dental implants have become a popular and predictable treatment option for replacing missing teeth, but it also created biological complications . Among those complications, peri-implantitis is a plaque-associated pathological condition occurring in tissues around dental implants, characterized by inflammation in the peri-implant mucosa and subsequent progressive loss of supporting bone . The prevalence of peri-implantitis in between 28% and 56% of subjects and 12% and 43% of implants . Treatment of peri-implantitis focuses on the removal of the pathogenic biofilms that form on dental implant titanium surfaces, which trigger the host- immune response that leads to inflammation and bone loss around implants . These approaches are not always successful and are often unpredictable . Thus, novel treatment approaches are needed to help address this significant problem in implant dentistry . Recent studies have suggested that the peri-implantitis lesion has a microbiologic profile that is distinct from periodontitis and it does not fully correspond with disease severity . One potential approach is the use of probiotics and bacteriocins to help modulate the disease-associated dental implant biofilms . However, limited studies have examined their effects in the oral cavity, even though most of the probiotics are consumed orally . Among all the probiotic strains examined, the nisin-producing probiotic Lactococcus lactis and its bacteriocin nisin have exhibited significant potential for biomedical use in different areas of health . Previous studies from our workgroup demonstrated that Nisin prevents the planktonic growth of periodontal disease-related microorganisms, including Porphyromonas gingivalis, Prevotella intermedia, A . actinomycetemcomytans and Treponema denticola and that both Nisin and the probiotic, can modulate the oral bacteria by shifting the pathogen-spiked biofilm from a dysbiotic to a biotic system . Therefore, we hypothesized that nisin and the nisin-probiotic might also have beneficial effects in a peri-implantitis settings . In this presentation, we will discuss the current findings of the research so far . Upon completion of this presentation, participants should be able to: 1) evaluate and discuss the progress of the awarded research; 2) recognize probiotics and antimicrobial peptides as promising treatments for peri- implantitis; and 3) discuss the possibility of using probiotics and antimicrobial peptides for peri-implantitis . 3:00 — 3:15 pm Live Q&A With Drs. Leziy, Miloro, Stanley and Radaic HAVE A QUESTION? Click on the chat button to submit your question . 31 Table of Contents Surgical Track Saturday, March 13 10:00 am — 12:15 pm Thinking Outside of the Box – Part 1 Moderator: Peter Moy, DMD 10:00 — 11:00 am Point/Counterpoint: Flap Management in the Esthetic Zone Marius Steigmann, DDS, PhD Giovanni Zucchelli, DDS, PhD Flap management in the esthetic zone differs from flap management in the non-esthetic zone, hence it requires specific, well-determined approach according to their indication . Flap management for access and GBR, soft tissue maintenance or soft tissue correction has to be performed after precise diagnosis . To avoid soft tissue failures in the esthetic zone, a good understanding of the biology, reaction to trauma and healing patterns is absolutely necessary . As there are multiple options, this lecture will describe different modern opinions on flap design in the esthetic in a point-counterpoint discussion for an ideal soft tissue outcome . Upon completion of this presentation, participants should be able to: 1) discuss the importance of pre-surgical soft tissue assessment in the esthetic zone; 2) recognize the factors which make surgery in the esthetic zone predictable; and 3) explain different techniques used to correct soft tissue failures around implants . 11:00 am — noon Interdisciplinary Treatment Strategies for Alveolar Ridge Deficiencies in the Esthetic Zone Jim Janakievski, DDS, MSD Greggory Kinzer, DDS, MSD Planning treatment for patients with missing or compromised anterior teeth and implants can often be complex . A detailed examination will uncover many clinical and patient factors that will guide the collaborative strategies and techniques that are selected for each patient . These include augmentation protocols for ridge enhancement, prosthetic design unique to each patient and orthodontic space/site management . This presentation will focus on collaborative treatment options for patients with anterior alveolar ridge deficiencies and compromised esthetics . Upon completion of this presentation, participants should be able to: 1) explain how a compromised implant may affect the outcome; 2) describe how the alveolar and gingival architecture can be preserved or enhanced; and 3) recognize how a collaborative approach can assist in treating the implant patient . Noon — 12:15 pm Live Q&A With Drs. Steigmann, Zucchelli, Janakievski and Kinzer HAVE A QUESTION? Click on the chat button to submit your question . 12:15 — 12:45 pm Break 32 Table of Contents Prosthetic Track Saturday, March 13 10:00 am — 12:15 pm Technology Disruptors – Part 1 Moderator: Carlo Ercoli, DDS 10:00 — 11:00 am What is the Next Frontier in Prosthetic Management? Evanthia Anadioti, DDS Lee Culp, CDT The recent unprecedented technological advancements in digital and implant dentistry have affected previously established treatment philosophies and modalities . This presentation illustrates the patient and prosthetic management for maxillary unsplinted implant overdentures . The evolution of this treatment option after assessment of patients’ quality of life and associated complications from recent clinical cohort publication will be presented . Upon completion of this presentation, participants should be able to: 1) discuss the quality of life of patients treated with unsplinted implant supported maxillary overdentures; 2) review step-by-step the surgical and restorative process of unsplinted implant supported maxillary overdentures; and 3) recognize potential complications that may occur with unsplinted implant supported maxillary overdentures . 11:00 am — noon Complex Implant-Prosthetic Rehabilitations Dean Morton, BDS, MS Michael Norton, BDS, FDS, RCS(Ed) Dr . Dean Morton will discuss a linear thought process focusing on effective data collection and treatment planning, designed to ensure predictable outcomes for patients with complex needs . This presentation will center on team decision- making when treatment options include maintenance of the dentition, extraction of teeth and various prosthetic alternatives . Dr . Michael Norton’s presentation will build on this theme by focusing on a rare case of a 19-year-old man suffering from Tricho-Dento-Osseous Syndrome, that falls way outside what could be considered “a normative baseline” for implant-based rehabilitation . With a natural dentition congenitally “failing” through malformation, disrupted eruption patterns and amelogenesis imperfecta, difficult decisions about tooth extraction and a plan for alveolar as well as dental rehabilitation push the boundaries of treatment to the limits . Upon completion of this presentation, participants should be able to: 1) describe what constitutes a complex reconstruction; 2) explain the thought processes required to visualize and externalize a clear and precise treatment plan, and 3) discuss the type of procedures and processes necessary to take a complex case through to a successful outcome . Noon — 12:15 pm Live Q&A With Drs. Anadioti, Morton, Norton and Mr. Culp HAVE A QUESTION? Click on the chat button to submit your question . 12:15 — 12:45 pm Break 33 Table of Contents Esthetics Saturday, March 13 10:00 am — 12:15 pm Esthetics Moderator: Jacinthe Paquette, DDS 10:00 — 10:30 am Taking Control Over Challenging Esthetic Cases Using the Power Trio: Ceramics, Implants and Veneers Victor Clavijo, DDS, MS, PhD With the popularization of dental implants for single to complex restorations, the importance of treatment planning has been emphasized . We are frequently challenged by malpositioned implants, loss of interdental papillae, soft tissue discoloration, and other problems . The connective zone between the restoration and the soft tissue is one of the most important aspects that will lead to an imperceptible esthetic oral rehabilitation . This lecture will highlight the treatment planning options for highly challenging and demanding esthetic cases by using pink ceramics, implants, and/or veneers along with analogic and digital workflown in order to improve esthetic outcomes . With the popularization of dental implants for single to complex restorations, the importance of treatment planning has been emphasized . We are frequently challenged by malpositioned implants, loss of interdental papillae, soft tissue discoloration, and other problems . The connective zone between the restoration and the soft tissue is one of the most important aspects that will lead to an imperceptible esthetic oral rehabilitation . Treatment planning options for highly challenging and demanding esthetic cases by using pink ceramics, implants, and/or veneers analogic and digital workflow in order to improve esthetic outcomes will be discussed . Upon completion of this presentation, participants should be able to: 1) discuss treatment planning options for highly challenging and demanding esthetic cases; 2) list the benefits of using pink ceramics, implants, and/or veneers; and 3) explain how digital workflow can improve esthetic outcomes . 10:30 — 11:00 am Fully Guided Full Arch Immediate Implant Reconstruction: 2021 Michael Pikos, DDS This clinically based presentation will focus on the integration of restorative, surgical and laboratory disciplines, combined with CBCT technology, to provide a seamless approach for fully guided full arch and full mouth immediate implant reconstruction for the terminal dentition and edentulous patient . This protocol includes placement of a prefabricated computer guided monolithic acrylic bar supported prosthesis for both edentulous and dentate arches . Clinical cases will be presented that will feature indications and protocol for this approach, as well as advantages over the conventional conversion denture protocol . Upon completion of this presentation, participants should be able to: 1) discuss the indications and protocol for fully guided full arch and full mouth immediate placement with a prefabricated monolithic acrylic bar supported provisional; 2) compare the advantages of this protocol over the conventional conversion denture protocol for full arch and full mouth implant reconstruction; and 3) recognize the limitations of this fully guided surgical and prosthetic protocol for full arch immediate implant reconstruction . 34 Table of Contents Esthetics Saturday, March 13 Esthetics (continued) Moderator: Jacinthe Paquette, DDS 11:00 am — noon The Total Face Approach (TFA) in Modern Implantology: A Novel Diagnostic/Therapeutic Algorithm Giovanna Perrotti, DDS Tiziano Testori, MD, DDS Choosing the most appropriate prosthesis type, like fixed prosthesis with custom abutments and crowns, hybrid prosthesis and overdenture, for complex implant cases is a clinical dilemma for most clinicians . Even though dedicated software facilitates implant planning in the available bone and the accuracy of the surgical phase, the choice of the appropriate treatment plan and future prosthesis type remains the less investigated side of the treatment . The Total Face Approach allows the clinician to rationally choose between different prosthetic designs based on anatomical, esthetic, functional and surgical parameters . Upon completion of this presentation, participants should be able to: 1) select the best type of prosthetic design according to the clinical patient situation; 2) plan the most appropriate surgical approach; and 3) avoid miscommunication with the patient . Noon — 12:15 pm Live Q&A With Drs. Clavijo, Pikos, Perrotti and Testori HAVE A QUESTION? Click on the chat button to submit your question . 12:30 — 1:00 pm Break 35 Table of Contents Complications Saturday, March 13 12:45 — 2:30 pm Complications Moderator: Jay Malmquist, DMD 12:45 — 1:15 pm Long-term Complications With Implant Dentistry Fereidoun Daftary, DDS This lecture discusses the long-term complications of implant supported restoration due to craniofacial changes and the alternative treatment options in aesthetic zone . Upon completion of this presentation, participants should be able to: 1) describe the elements contributing to craniofacial changes; 2) recognize the patients with a higher risk; and 3) explain the treatment alternative . 1:15 — 1:45 pm Inter-implant Papilla Management With Root Shield: What We Know, What We Do Not Know, and What We Think We Know Joseph Kan, DDS, MS Leaving a piece of root fragment (root shield) to maintain buccal and proximity tissue for esthetics has gathered lots of interests since it was first advocated in 2010 . To many, it is a standard of care, while many others consider it a risky treatment option . This presentation will discuss the authors experience of this procedure over the past decade . Upon completion of this presentation, participants should be able to: 1) discuss guidelines for root shield; 2) explain complications involved with root shield and how to manage them; and 3) determine whether root shield is a viable option . 1:45 — 2:15 pm Platform Switching: Promise or Panacea? Tomas Linkevičius, DDS, Dip Pros, PhD This lecture will focus on this special design feature of implants and lead through its influence on crestal bone stability . We will see if it is a panacea or maybe just a simple promise, difficult to keep . Upon completion of this presentation, participants should be able to: 1) review how the gingiva, teeth, and bone interface to harmoniously create idealized implant esthetics; 2) discuss the role that the position of the implant fixture and the characteristics of the abutment play in maintaining and idealizing soft tissue contours; and 3) utilize digital surgical modalities to optimize implant placement and digital restorative modalities to register provisional contours and seamlessly transfer them to final restorations . 2:15 — 2:30 pm Live Q&A With Drs. Daftary, Kan and Linkevičius HAVE A QUESTION? Click on the chat button to submit your question . 36 Table of Contents Surgical Track Saturday, March 13 12:45 — 3:00 pm Thinking Outside of the Box – Part 2 Moderator: Peter Moy, DMD 12:45 — 1:45 pm Conometric Concept Michael Block, DMD Marco Degidi, MD, DDS Short and long-term problems with implants commonly result from problems with cement excess in the adjacent tissues or screw loosening which can result in screw facture and inflammation from mobility . This friction fit solution eliminated these problems and creates a safe environment . This presentation will briefly illustrate the developmental history and then show multiple case examples of the technique . Data on retention of consecutive series of friction fit crowns will be shown . Upon completion of this presentation, participants should be able to: 1) compare the difference between friction fit and cementation of crowns to abutments; 2) recognize the importance of proper technique to have long standing retentive crowns on abutments; and 3) discuss the evidence base that establishes friction fit connections as a very healthy environment for implant restorations . 1:45 — 2:45 pm The Value of a Tooth: Orthodontic Techniques for Periodontal Success Daniel Berant, DMD Frank Celenza, DDS The advent and success of implantology continues to transform dentistry and the inclusion of implants as integral components in orthodontic mechanotherapy is a particularly interesting application . Historically, orthodontics has played a preparatory role to implant placement, by virtue of aligning teeth to permit proper spatial relations for implant placement, which occurs subsequently . More recently, orthodontic modalities designed to alter tissue morphology, both hard and soft, have begun to be realized . In these two ways, orthodontic site preparation for implant placement has become an important modality to consider . Perhaps even more interestingly, orthodontic techniques that actually employ implants for the purpose of anchorage can have a dramatic effect on previously unattainable possibilities and outcomes . Implant- enhanced orthodontics can be achieved by a variety of means but can be broken down to direct or indirect anchorage . Various devices and applications of these modalities exist and are expanding continually . The ultimate extension of this thinking will be when implants that are designed specifically for orthodontic purposes, never destined to be restored but rather explanted, are utilized strictly for orthodontic advantage . This technology exists presently, and the use of such devices promises to have dramatic impact on the practice of orthodontics, both in terms of new outcomes and the sequencing by which to achieve them . Upon completion of this presentation, participants should be able to: 1) explain the physiology of tooth movement; 2) describe the implementation of adjunctive orthodontic modalities for prosthetic benefit; and 3) discuss how orthodontics can interact with implants . 2:45 — 3:00 pm Live Q&A With Drs. Block, Degidi, Berant and Celenza HAVE A QUESTION? Click on the chat button to submit your question . 37 Table of Contents Prosthetic Track Saturday, March 13 12:45 — 3:00 pm Technology Disruptors – Part 2 Moderator: Carlo Ercoli, DDS 12:45 — 1:45 pm Novel Techniques to Maximize Anterior Esthetics Harold Baumgarten, DMD Stephen Chu, DMD, MSD, CDT Immediate tooth replacement therapy and treatment of extraction sockets with implants have become a mainstream treatment modality for single and multiple tooth sites in the esthetic zone . However, achieving primary stability relative to implant diameter and gap distance within the limits of a finite socket dimension is a delicate yet essential balance for survival and esthetics . In addition, esthetic risks and complications exist such as apical socket perforation, loss of labial plate thickness over time, and loss of the interdental papilla due to proximity issues with tooth-to- implant distance following placement . Solutions in treatment as well as innovations in implant design will be presented that reinforces the biologic principles in wound healing that ultimately enhances esthetic outcomes in modern day implantology . Upon completion of this presentation, participants should be able to: 1) discuss the implant risks and complications in the esthetic zone; 2) explain the biology behind circumferential bone volume for long term maintenance to prevent ridge collapse, recession, and papillae loss; and 3) describe the inverted body-shift concept in macro implant design . 1:45 — 2:45 pm Implant Prosthetic Predictability Todd Schoenbaum, DDS Chandur Wadhwani, MSD This program is intended to aid the clinician in identifying and preventing the most common complications of implant restorations . In order to maximize predictability one must recognize the potential challenges and limitations of various implant restoration modalities . Pre-treatment recognition of the various complications will ensure that clinician and patient alike will be satisfied with treatment outcomes . This lecture will address common complications such as: screw loosening, porcelain failure, debonding, peri-implantitis, open interproximal contacts, and occlusal changes . We will explain the science behind the complications and provide solutions and protocols to enhance success . Upon completion of this presentation, participants should be able to: 1) recognize the five most common challenges of implant restorations; 2) discuss the protocols and techniques to eliminate or minimize these issues; and 3) explain the treatment of the partially edentulous patient . 2:45 — 3:00 pm Live Q&A With Drs. Baumgarten ,Chu, Schoenbaum and Wadhwani HAVE A QUESTION? Click on the chat button to submit your question . 38 Table of Contents Surgical Complications Sunday, March 14 Don’t forget to change your clocks! EST changes to EDT on Sunday, March 14th 10:00 — 11:30 am Surgical Complications – Part 1 Moderator: Michael Norton, BDS, FDS, RCS(Ed) 10:00 — 10:25 am Is Peri-implant Mucositis and Peri-implantitis an Inevitable Outcome? Mario Roccuzzo, DDS As utilization of dental implants continues to rise, so does the incidence of complications . Regardless of common thinking, long-term maintenance of healthy peri-implant tissues constitutes a major challenge for every clinician . It should be clear by now, that patients should be informed about their risk profile, before treatment is initiated . On the other hand, biological complications, detected at an early stage, can be successfully treated by means of surface decontamination and/or regenerative surgery in a high percentage of cases . Upon completion of this presentation, participants should be able to: 1) establish effective measures to reduce the risk of complications; 2) recognize situations where peri-implant soft tissue augmentation is recommended; and 3) select the ideal peri-implant regenerative surgical treatment . 10:25 — 10:50 am Patient Factors Contributing to Surgical Complications and Implant Failure Bach Le, DDS, MD The predictability and long-term success rate of dental implants is well documented in the literature . Nevertheless, complications and failures do occur and can have a significant impact on overall treatment . Failing implants and the consequences of implant removal usually results in significant loss of hard and soft tissues and jeopardize efforts to achieve satisfactory function and esthetics . This lecture will discuss risk factors for treatment failures and treatment modalities to deal with dental implant failure . When an implant fails, a customized treatment plan should be provided for each patient depending on the relevant needs . Patients should be informed regarding all possible treatment options and that achieving an ideal result in the compromised site is sometimes elusive and in some cases, impossible . Upon completion of this presentation, participants should be able to: 1) identify risk factors associated with surgical complications; 2) explain the difference between patient-related versus site-related etiology for surgical complications and failures; and 3) describe treatment options to mitigate risks of surgical complications and failures . 39 Table of Contents Surgical Complications Sunday, March 14 Surgical Complications – Part 1 (continued) 10:50 — 11:15 am Autogenous Teeth for Alveolar Ridge Augmentation Frank Schwarz, DMD Pre-clinical and clinical data provide clear evidence that tooth roots reveal a structural and biological potential to serve as alternative autografts for localized ridge augmentation . In fact, dentin has a similar anorganic and organic composition as bone, features osteoconductive as well as osteoinductive properties and also gets involved in the bone remodeling process . This presentation will elucidate this new biological concept and focus on associated surgical procedures for current clinical applications . Upon completion of this presentation, participants should be able to: 1) discuss the biological background for using tooth roots for alveolar ridge augmentation; 2) select appropriate clinical indications and surgical protocols; and 3) evaluate the overall efficacy and safety of the procedure . 11:15 — 11:30 am Live Q&A With Drs. Roccuzzo, Le and Schwarz HAVE A QUESTION? Click on the chat button to submit your question . 40 Table of Contents Risk Management Sunday, March 14 10:00 — 11:30 am Risk Management – Part 1 Moderator: Tara Aghaloo, DDS, MD, PhD 10:00 — 10:25 am Risk Profiling of Patients Don Curtis, DMD This program will review how a Risk Assessment Questionnaire (RAQ) can be used to estimate cumulative risk for late-term biologic complications related to implants . In private practice settings where this risk assessment tool has been used, patient acceptance and clinician feedback have been positive . Several ongoing clinical validation studies of the risk assessment algorithm will be reviewed in the context of how treatment planning and patient compliance can be improved . The goal is fewer unanticipated surprises for the clinician and fewer unexplained surprises for the patient . Calculating aggregate risk for a health outcome allows risk to be stratified so that the unique risk profile of a patient is identified and managed . In medicine, there are hundreds of risk assessment questionnaires that are used to provide an estimate of aggregate risk for a health outcome . This is the basis of personalized medicine . The RAQ discussed includes a summary of 20 individual factors that can increase the risk for biologic complications in patients being treated with dental implants . It can serve as a checklist for the clinician, informed consent for the patient, and as a means by which to establish a patient-specific maintenance program . Upon completion of this presentation, participants should be able to: 1) identify how risk assessment can be helpful in treatment planning, providing informed consent, and providing a patient-specific maintenance plan; 2) identify some of the clinician-based risks that can limit success with dental implants; and 3) explain why a maintenance plan should be patient-specific, risk-based, age-appropriate and account for the type of prosthesis being fabricated . 10:25 — 10:50 am Minimizing Risk With Digital Planning and Dynamic Placement Michael Block, DMD Lack of appropriate treatment planning and malposition of implants at the time of placement increase liability as well as implant success . Risk assessment of failed implants often reveals lack of optimal placement . This session will highlight a time–efficient means to utilize digital technology easily, with the use of one software program, to determine the final restoration and implant placement in a time-efficient manner . Implant placement using dynamic systems allows for accurate and precise placement which decreases risk . Upon completion of this presentation, participants should be able to: 1) identify which pieces of equipment are needed to utilize digital planning and dynamic placement; 2) recognize how the digital methods are time- efficient for both the clinician and patient; and 3) explain how digital planning and dynamic placement increase accuracy and precision for implant placement, resulting in less risk . 41 Table of Contents Risk Management Sunday, March 14 Risk Management – Part 1 (continued) 10:50 — 11:15 am Risks and Pitfalls of Guided Implant Surgery Waldemar Polido, DDS, MS, PhD Surgical procedures with the goal of implant placement require a high degree of accuracy . Digital planning is part of everyday practice and guided implant surgery was developed in order to increase surgical accuracy . However, as its use becomes more widespread, understanding technological tools, and the clinical workflow are important steps to take optimal advantage of guided surgery . This presentation will review different indications for guided surgery, as well as potential pitfalls, and the important details that clinicians need to understand to reduce and avoid complications . Upon completion of this presentation, participants should be able to: 1) list the components of a digital workflow for guided implant surgery; 2) choose the correct digital pathway for a specific clinical situation; and 3) recognize potential pitfalls for guided implant surgery . 11:15 — 11:30 am Live Q&A With Drs. Curtis, Block and Polido HAVE A QUESTION? Click on the chat button to submit your question . 11:30 am — noon Break 42 Table of Contents Surgical Complications Sunday, March 14 Noon — 1:35 pm Surgical Complications – Part 2 Moderator: Michael Norton, BDS, FDS, RCS(Ed) Noon — 12:30 pm Cell Therapies Applied to Bone Regeneration Mariano Sanz, MD, DDS, PhD Bone regenerative interventions remain an important part of implant practice and the advent of bioengineering opportunities enhances the possibility to obtain more predictable outcomes . In this presentation, I shall present the background of using autologous mesenchymal cells for bone regeneration and convey my experience on the clinical use and results of applying adjunctive cell therapy to GBR approaches using synthetic biomaterials . Upon completion of this presentation, participants should be able to: 1) discuss the potential of cell therapies in bone regeneration interventions; 2) describe the process of harvesting and applying autologous mesenchymal cells; and 3) assess the results obtained after the application of a cell therapy as adjunctive to GBR in bone regeneration prior to implant placement . 12:30 — 12:55 pm Predicting and Averting Hard and Soft Tissue Complications Rodrigo Neiva, DDS New treatment options for hard and soft tissue development have been introduced to implant dentistry in recent years . The aim of this presentation is to discuss possible advantages, disadvantages, and realistic short- and long-term expectations of these new treatment modalities . Upon completion of this presentation, participants should be able to: 1) explain the rationale for new materials and techniques; 2) discuss the advantages and disadvantages of the new treatments; and 3) select materials based on material properties and features . 43 Surgical Complications Sunday, March 14 Surgical Complications – Part 2 12:55 — 1:20 pm New Biologic Challenges in Implant Dentistry J E. . Davies, BDS, PhD, DSc This presentation will focus on new emerging evidence of the important biologic processes that precede bone formation in the earliest phase of osseointegration . We are all familiar with the sinusoidal curve of secondary healing first conceptualized by Raghavendra et al in 2005, which includes an initial lag phase . We now know that two important events occur during this phase of healing: peri-implant angiogenesis and the ingress of the mesenchymal progenitors that will become, among other cells, osteoblasts . Both of these phenomena are profoundly influenced by implant surface design and provide the important foundation for the bone formation that follows . Understanding these biologic events can provide new targets to accelerate the early healing that is so important in clinical practice . Upon completion of this presentation, participants should be able to: 1) explain the important biologic processes that precede peri-implant bone formation; 2) discuss how these biologic phenomena are influenced by implant surface design; and 3) describe how these early events can accelerate secondary implant stability . 1:20 — 1:35 pm Live Q&A With Drs. Sanz, Neiva and Davies HAVE A QUESTION? Click on the chat button to submit your question . 1:35 – 2:00 pm Break 44 Table of Contents Risk Management Sunday, March 14 Noon — 1:35 pm Risk Management – Part 2 Moderator: Tara Aghaloo, DDS, MD, PhD Noon — 12:30 pm Understanding Risks Associated with Patients with Terminal Dentition Ricardo Mitrani, DDS, MSD For over a decade, the term “Terminal Dentition”, has unquestionably gained a lot of trac- tion in the dental community, and it implies that there is a need to remove a patient’s remaining dentition . Implant supported solutions for these patients have been around for quite some time but until this day, there seems to be confusion among dental practitioners as to what is the ideal prosthetic solution for these patients and what are the risks associ- ated with these prosthetic solutions . Upon completion of this presentation, participants should be able to: 1) review a treatment planning algorithm that allows the treating team to follow a linear thought process in assessing the remaining dentition; 2) discuss common complications associated with full arch implant supported solutions; and 3) improve communication among the treating team . 12:30 — 12:55 pm Optimal Digital Design for Restorative Contours Mark Ludlow, DMD, MS Nothing is more satisfying (and sometimes more elusive) than an absolutely perfect implant restoration that is indistinguishable from the surrounding natural teeth . In this presentation, we will look at what needs to come together to achieve ideal results from a surgical and restorative perspective and how digital tools can help us make these results predictable . Upon completion of this presentation, participants should be able to: 1) review how the gingiva, teeth, and bone interface to harmoniously create idealized implant esthetics; 2) discuss the role that the position of the implant fixture and the characteristics of the abutment play in maintaining and idealizing soft tissue contours; and 3) utilize digital surgical modalities to optimize implant placement and digital restorative modalities to register provisional contours and seamlessly transfer them to final restorations . 45 Table of Contents Risk Management Sunday, March 14 Risk Management – Part 2 (continued) 12:55 — 1:20 pm Influence of A.I. in the Digital Planning of Advanced Interdisciplinary Care German Gallucci, DMD, PhD During this lecture, clinical considerations and indications for dental implants will be ana- lyzed in the context of their direct application to esthetic implant-prosthetic rehabilitations . Risk assessment, treatment planning, surgical protocols and esthetic/prosthodontic rehabili- tations will be discussed in detail according to different clinical situations . Recommended planning steps and treatment procedures will be presented through scientific evidence . Modern implant-prosthetic restorations using different implant designs and digital technol- ogy call for a harmonious esthetic integration with the pre-existing environment . A scalloped gingival line with distinct papillae and free of any abrupt vertical differences in clinical crown length between anterior implants, is paramount . In this context, biologic considerations affecting normal peri-implant soft tissue integration will be discussed as a major esthetic parameter . Upon completion of this presentation, participants should be able to: 1) discuss current trends in esthetic implant dentistry; 2) assess associated risk factor for suitable treatment planning; and 3) widen treatment planning options using a selective approach . 1:20 — 1:35 pm Live Q&A With Drs. Mitrani, Ludlow and Gallucci HAVE A QUESTION? Click on the chat button to submit your question . 1:35 — 2:00 pm Break 46 Table of Contents Annual Business Meeting Sunday, March 14 2:00 — 2:30 pm Annual Business Meeting The Academy of Osseointegration’s Annual Business Meeting is open to all Active Members, Fellows and Life Members. AGENDA I. Call to Order — Clark M . Stanford, DDS, PhD, MHA II. Awards William R. Laney Award — Clark M . Stanford, DDS, PhD, MHA Best Presentation Awards — Clark M . Stanford, DDS, PhD, MHA Osseointegration Foundation Research Grants — Edward Marcus, DDS III. 2020 Financial Report — Clark M . Stanford, DDS, PhD, MHA IV. 2021 – 2022 Nominating Slate — Clark M . Stanford, DDS, PhD, MHA V. Presentation to Outgoing Board Member — Clark M . Stanford, DDS, PhD, MHA VI. Installation of New President — Clark M . Stanford, DDS, PhD, MHA VII. Presentation by Incoming President — Tara L . Aghaloo, DDS, MD, PhD VIII. Presentation to Retiring President — Tara L . Aghaloo, DDS, MD, PhD IX. Adjourn — Tara L . Aghaloo, DDS, MD, PhD 47 Table of Contents Closing Symposium Sunday, March 14 2:00 — 4:45 pm The Future of Implant Practice Models Moderator: Clark Stanford, DDS, PhD, MHA 2:30 — 3:00 pm The Generational Shift: Five Things Dentists Need to Know About the Changing Implant Patient Lyndon Cooper, DDS, PhD Our patients literally change beneath our dental implants and patient factors are emerging as key mediators of implant success . First, our patients are becoming more diverse . Secondly, our patients are becoming older . Third, the retention of teeth and their failing restorations increases local complexity of need and therapy . Forth, they present with greater and changing systemic health complexity . Finally, our patients have changing expectations . We need to acknowledge the impact of these factors that affect the success of our treatment and the expectations of our patients regarding our care . It is not enough to focus on the dental implant as the central factor in our continued professional success . Upon completion of this presentation, participants should be able to: 1) explain the impact of changing demographics on dental implant therapy; 2) discuss the key systemic and pharmacologic factors that negatively influence dental implant success; and 3) describe how changing patient expectations may color our treatment planning decisions that influence dental implant outcomes . 3:00 — 3:30 pm The Future of Implant Practice Models: Multi-specialty Practice: 40 Years in Retrospect Dennis Tarnow, DDS Paul Fletcher, DDS The multi-specialty private office has become an increasingly desirable practice model in recent years . Benefits such as eliminating miscommunication between offices, single office consults as opposed to the patient traveling between multiple offices, and the efficiencies of combined, sequential multidisciplinary procedures are readily achievable . In addition, collaboration between compatible individuals attuned to the same goals can be synergistic, and can produce an intellectually, emotionally, and financially fulfilling practice environment that can lead to long term professional satisfaction . Two members of a multidisciplinary group specialty practice, that has been in existence for more than 40 years, will discuss the obvious benefits, the not so obvious benefits, and the pitfalls to avoid in developing this practice model . Upon completion of this presentation, participants should be able to: 1) discuss the patient and doctor benefits of an interdisciplinary multi-practitioner practice; 2) explain the treatment efficiencies of an interactive multi-specialty office; and 3) describe the professional, intellectual, and lifestyle benefits of practicing in a multi- specialty environment . 48 Table of Contents Closing Symposium Sunday, March 14 The Future of Implant Practice Models (continued) 3:30 — 4:00 pm DSO Group Practice Models Offering Implant-only Solutions Theresa Wang, DDS, MS Over the last decade, Dental Support Organizations (DSOs) have become more prevalent and are projected for continued growth within the market of Dentistry . DSOs provide business management and support dental practices in their non-clinical operations . This lecture will cover the clinicians’ perspective in working with a DSO offering Implant-only solutions and discuss the advantages of partnering with a DSO . Upon completion of this presentation, participants should be able to: 1) recognize DSO trends in dentistry and identify the contributing factors to these trends; 2) identify how a dental implant practice can positively impact treatment outcomes and patient experience through working with a DSO; 3) recognize how a dental implant practice benefits from the support of a DSO in business management and leadership development; and 4) discuss unique opportunities to analyze data within a DSO Implant practice due to size and scale . 4:00 — 4:30 pm Solo Specialist Practitioner: Thriving in the COVID World Paul Fugazzotto, DDS Between the multi-specialty in house practices, restorative dentists doing everything themselves, corporate dentistry and adversarial relationships with insurance companies, it was already difficult enough to survive as a solo specialist practitioner . Now add the COVID pandemic, which has placed greater financial demands on all dentists, increased patient fear of visiting the dentist, and made patients less willing to be referred to “another” office for specialty care, and I don’t know how I will survive! I hear various permutations of the above from colleagues on an almost a daily basis . Fortunately, none of the above is true in today’s world . While a horrible world crisis which no one of sane mind welcomes, the pandemic has presented practitioners and patients alike a unique opportunity for self-reflection and reassessment of our value systems . The opportunity to remake our practices through rediscovery of our missions, and strengthening of communications with referring doctors and patients by combining well established and “cutting edge” approaches and technologies, is unmatched in my almost 40 years of private practice experience . We have a choice: become flotsam in a sea of change or lead our referring partners, our patients and ourselves to greater heights of therapeutic and practice success and overall health . Upon completion of this presentation, participants should be able to: 1) discuss the unique practice challenges of the COVID world; 2) recognize the opportunities to improve patient treatment outcomes in the COVID world; and 3) identify effective approaches for establishing a dialectic referral network in the COVID world . 4:30 — 4:45 pm Live Q&A With Drs. Cooper, Tarnow, Fletcher, Wang and Fugazzotto HAVE A QUESTION? Click on the chat button to submit your question . 49 Table of Contents On-Demand Sessions The On-Demand Sessions are pre-recorded and available for viewing at any time until December 31, 2021. CE credit will only be available until June 14, 2021. Coffee and Controversies New Guidelines for Successful Ridge Preservation Combined With Immediate Implant Placement Mauricio Araujo, DDS, MSc, PhD The management of the ridge alterations that takes place following tooth extraction is of great interest for implant dentistry . This presentation will describe a series of studies that used ridge preservation combined with immediate implant placement for achieving good esthetic outcome . It will be demonstrated that the anatomy of the alveolar process markedly influences the amount of post-extraction bone loss and clinical success . The surgical technique for ridge preservation, a clinical procedure that aims at preserving the ridge volume within the envelope existing at the time of extraction, and immediate implant placement will be described . Upon completion of this presentation, participants should be able to: 1) discuss the rational and scientific evidence for ridge preservation procedures; 2) describe the scientific evidence concerning the benefit of ridge preservation and immediate implant placement; and 3) explain the guidelines for a successful ridge preservation combined with immediate implant placement . Extending the Resorption Properties of PRF from Two Weeks to Four Months in 10 Minutes of Prep Time Richard Miron, DDS, MSc, PhD, DMD Platelet rich fibrin (PRF) has been widely utilized in implant dentistry primarily owing to its ability to favor soft tissue wound healing . While many have attempted to use PRF as a GBR barrier membrane, many remain disappointed by its rather quick resorption properties (two- three weeks) . From the lead Editor of Quintessence’s 2021 Textbook titled: “Understanding Platelet Rich Fibrin”, Dr . Richard Miron discusses a variety of methods to improve PRF in routine daily practice . One main discovery has been the ability to extend the resorption properties of PRF from two weeks to four months utilizing the Bio-Heat Technology . Within 10 minutes, membranes can be transformed towards a slow degrading fibrin mesh and utilized similarly to collagen membranes . Recent trends to minimize early implant failure will also be discussed with respect to biomaterial integration . Upon completion of this presentation, participants should be able to: 1) explain how to transform PRF membranes from two weeks resorption properties to four months; 2) discuss new advancements in bone grafting utilizing custom 3D bone grafts utilizing PRF; and 3) describe the number one cause of unexplained early implant failure and how to rapidly lower your number of lost implant cases . QUESTIONS FOR A SPEAKER? Questions for any speaker can be submitted to speakerquestions@osseo org. . 50 Table of Contents On-Demand Sessions Coffee and Controversies (continued) Zirconia Implants: An Alternative for Tooth Replacement Joan Pi-Anfruns, DMD Your patient is asking for a metal-free alternative for tooth replacement . How well equipped are you for treating patients who request this type of treatment? In dentistry today, ceramic materials are widely accepted in prosthetic reconstruction . Contrary to this, dental implants made from Zirconium-dioxide are not yet part of the standard treatment but can be an attractive alternative to titanium . This lecture will cover the scientific evidence and clinical applications of zirconia implants and will review the indications and contraindications for their use . Upon completion of this presentation, participants should be able to: 1) explain the science behind ceramic implants; 2) recognize the advantages and limitations of ceramic implants compared to titanium; and 3) describe how to incorporate ceramic implants in your practice and attract new patients . Metallosis: Myth or Reality? Tom Wilson, Jr ,. DDS, PA The number of implants suffering from peri-implant disease is increasing . There are continued questions concerning the etiology and treatment of these problems . This presentation will cover new data on these topics . The role of titanium found in soft tissues surrounding implants affected by these problems will be discussed . The effect of early and late colonizing bacteria on the implant surfaces and their role in the production of these foreign bodies will also be detailed . New therapeutic modalities will be discussed including appropriate methods for removing biofilm from infected implant surfaces and how these approaches may or may not result in new attachments to implant surfaces previously covered with biofilm . Upon completion of this presentation, participants should be able to: 1) discuss metallosis and peri-implant problems; 2) describe the possible role of titanium particles in the etiology of these problems; and 3) describe current approaches for treating these diseases . Opportunities, Evidence, and Controversies of Lasers in Peri-implantitis Treatment Georgios Romanos, DDS, PhD, DMD Peri-implantitis is a relatively common complication in implant dentistry . This presentation is focused on the use of lasers for implant surface decontamination . The lecture will provide the scientific basis and evidenced-based information about the long-term success of dental implants using the appropriate laser wavelength . Upon completion of this presentation, participants should be able to: 1) demonstrate the appropriate laser-implant interactions; 2) evaluate the best evidence for treatment of peri-implantitis; and 3) present long-term success after laser-assisted therapy . QUESTIONS FOR A SPEAKER? Questions for any speaker can be submitted to speakerquestions@osseo org. . 51 Table of Contents On-Demand Sessions Coffee and Controversies (continued) Is a Soft Diet Healthy for Your Patients? Understanding the Risks and the Benefits Reva Barewal DDS, MS Many people gradually migrate to a softer diet with loss of teeth, dental pain, or ill-fitting prosthetics . Dental implants are often the best solution we have to regain a regular diet . However, we all place our patients on a soft diet during the early healing period . But what is the psychosocial and physiological cost of a soft diet? How long should we place a person on a soft diet? How can we time our soft diet recommendations with patterns of osseointegration to reduce the burden for our patients? What are the categories within the soft diet that we need to know to effectively transition our patients back to a regular texture diet? Join Dr . Barewal as she explores how masticatory function impacts the swallow reflex, brain health, and food enjoyment for individuals and can become an integral part of the initial conversation with patients about dental implants . Novel transitional foods will be discussed that help reduce the burden of a soft diet, may improve soft texture compliance post-surgically and overall health outcomes . A downloadable soft diet regimen will be provided that can more effectively guide your patients on appropriate choices to maintain compliance and overall satisfaction . Upon completion of this presentation, participants should be able to: 1) define soft diets and the associated risks; 2) explain the consequence of a soft diet — short- and long-term — on nutrition, cognition, and psychosocial well-being; and 3) summarize the role of transitional foods in management of the soft diet during the post-implant healing period . Biological Assessment of Used Dental Implant Healing Abutments: Is Surface Detoxification a Realistic Expectation? Aniruddh Narvekar, BDS Once exposed to the oral environment, healing abutments become contaminated from several sources which may play a fundamental role in shaping the immune response in proximity to dental implants, Manufacturers recommend healing abutments are for single use . However, it is well known that clinicians re-use healing abutments following decontamination and sterilization methods available in clinical settings . This lecture will present the findings of a study evaluating four decontamination strategies, available in most clinical settings, to determine the extent to which biomaterial can be removed on used healing abutments and secondly to determine the degree to which decontaminated healing abutments trigger an inflammatory response in-vitro compared to unused sterile healing abutments . Upon completion of this presentation, participants should be able to: 1) discuss the current literature on the decontamination of used dental implant healing abutments; 2) recognize and evaluate the efficacy of four common decontamination strategies on removal of biomaterial from used dental implant healing abutments; and 3) explain the potential for re-used healing abutments to trigger an inflammatory response in-vitro compared to unused sterile healing abutments . QUESTIONS FOR A SPEAKER? Questions for any speaker can be submitted to speakerquestions@osseo org. . 52 Table of Contents On-Demand Sessions The On-Demand Sessions are pre-recorded and available for viewing at any time until December 31, 2021. CE credit will only be available until June 14, 2021. Young Clinicians’ Session Moderator: Jose Antonio Garcia Montemayor, DDS Paired Approach to Soft and Hard Tissue Complex for Anterior Immediate Implant Placement Michi Katafuchi, DDS, MSD, PhD Immediate implant placement after tooth extraction is an established method . Flapless implant placement has successfully been documented, especially in the esthetic zone . The question arises if the buccal plate lasts when it is thin, and a buccal bone concavity is present . This presentation will propose a technique, Paired Approach, that increases peri- implant tissue thickness for the crestal area of the immediate implant without opening a full thickness flap and accesses the bone concavity to augment the bone . This approach may contribute to maintaining esthetics, promoting peri-implant health and reducing the risks for peri- implantitis . Upon completion of this presentation, participants should be able to: 1) identify the clinical scenario to perform the Paired Approach technique for anterior immediate implant placement; 2) explain the step–by–step surgical procedure for the proposed Paired Approach; and 3) discuss complications related to Paired Approach . Multidisciplinary Treatment of Full-arch Rehabilitation for Class III Malocclusion Patients Ye Shi, DDS A patient’s dental classification and skeletal classifications may not always coincide and treatments will vary depending on the appropriate diagnosis . To treat severe Class III malocclusion, orthognathic surgery in conjunction with orthodontic therapy will be needed . Orthodontic therapy only can be utilized to camouflage mild to moderate Class III malocclusions . However, as teeth are extracted and the dentoalveolar resorption process begins, it becomes more challenging to restore the function and esthetics for the patient to that of their initial dental classification . Comprehensive and multidisciplinary treatment is imperative to have a favorable outcome for these mutilated Class III malocclusion patients . Patients that present with edentulous spaces can greatly benefit from dental implants and prostheses as tooth replacement is required . This lecture will discuss treatment modalities to deal with the mutilated Class III malocclusion patients for full-arch rehabilitation . It will address clinical guidelines to help clinicians to correctly diagnose these patients so that an appropriate treatment for Class III patients can be selected . Understanding the differences between skeletal, dental and mutilated dentition is imperative to successfully treat malocclusion patients and to reduce the risks of adverse treatments . Upon completion of this presentation, participants should be able to: 1) provide a brief overview on the etiology and diagnoses of skeletal and dental classifications and mutilated dentitions of varying severities; 2) identify possible solutions to treating the mutilated Class III patients; and 3) list the indications and contraindications for such treatments . QUESTIONS FOR A SPEAKER? Questions for any speaker can be submitted to speakerquestions@osseo org. . 53 Table of Contents On-Demand Sessions Young Clinicians’ Session (continued) Social Media: The New Standard in Dental Education? Wesley Mullins, DDS Jonathan Rogers, DMD Social media has taken the world by storm and has changed the way people acquire and consume information . We have seen a tremendous impact on dental education through the ready availability of photos, videos and opinions on how to best treat patients . Now, a clinician can easily be inundated with information from these outlets or individuals, some of whom claim that they are experts in various aspects of clinical treatment . We will discuss the effects of this phenomenon on dental education and explore the pros and cons of this new way to “learn ”. Is social media pushing our profession away from evidence-based decision making or is there a potential for this to help our profession and improve outcomes for our patients? Upon completion of this presentation, participants should be able to: 1) identify the current state of social media in implant dentistry and its impact on education; 2) describe the risk and benefits of social media as an educational platform; 3) explain ways we can leverage social media to improve standards in implant dentistry; and 4) discuss how social media could impact the future of implant dentistry . QUESTIONS FOR A SPEAKER? Questions for any speaker can be submitted to speakerquestions@osseo org. . 54 Table of Contents On-Demand Sessions The On-Demand Sessions are pre-recorded and available for viewing at any time until December 31, 2021. CE credit will only be available until June 14, 2021. TEAM Program Moderator: Robert Vogel, DDS Trust Transformed: Strategies for Leading Teams and Placing People Where They Shine Tracy Butler, CRDH, MFT Today’s dental practice requires more than clinical acumen . Influence is the currency of leadership and there are levels of leadership throughout the dental team . People are the lifeblood of your practice and people want to be lead, not managed . Even the most ironclad strategy can be exposed by an antagonizing culture . Learn how to identify the strengths of each individual on your team and put them where they shine . Everyone communicates yet few people truly connect . Gaining alignment through a shared vision and clearly defined clinical philosophy are fundamental to a high performing team . Join us for an informative presentation packed with step-by-step guides and tools to guide you along the invisible bridge to building and nurturing trust on your team . Upon completion of this presentation, participants should be able to: 1) describe the elements of the Inclusivity Model; 2) differentiate between hierarchy and idea meritocracy; 3) review Gallup 34 strengths evaluation and implementation; and 4) define your people, products and processes . Current Concepts in Hygiene Janis Spiliadis, CRDH Many things have changed for the dental professional in 2020 including the way our patients view health . Now is the perfect time to implement new technology and concepts that will help patients improve oral health and impact overall health . This course will discuss current technology and techniques for efficient and effective biofilm removal and concepts to increase patient compliance . Upon completion of this presentation, participants should be able to: 1) integrate biofilm removal techniques into clinical protocols; 2) review the science behind the new technology in biofilm removal; and 3) implement protocols to increase patient compliance . Digital Dentistry to Increase Precision and Productivity. Dinosaur to Digital Diva Sophie Garcia The most significant change in dentistry in the past 20 years is the introduction of digital technology . The question is how do we best use this technology to benefit our patients and our practice as well which technology is right for you? This presentation presents a real- world private practice road map to decide which technology is best for your situation, as well as step-by-step instructions on use and benefits of available systems with an emphasis on intra-oral scanners . You cannot afford to ignore or miss out on the overwhelming benefits of this technology to improve patient care and practice productivity . Upon completion of this presentation, participants should be able to: 1) discuss the benefits of available intra- oral scanners; 2) explain how digital technology can improve patient care and practice productivity; and 3) determine which technology is right for you . 55 Table of Contents On-Demand Sessions TEAM Program (continued) Solutions to Generational Friction Lisa Copeland, RDH, CSP, CVP The key to cultivating a passionate team is generational perception . The Generational Friction Factor is real and influencing the dynamics of your team’s success . Each generation, team and patients, measures everything against their own language, perceptions, and work value . Accord- ing to the U .S . Census Bureau the Gen Z cohort (age 4-early 20’s) are currently entering the work environment and becoming patients in your practice . Gen Z will change dentistry…so be the practice that’s ready for it . They are the first cohort that are digital natives, never knowing life without technology, and will move on if they don’t immediately see what they are looking for on your website and social media platforms . To bridge the divide and flourish, Lisa educates leaders and team members about the value of recognizing and addressing generational differences . Her 4-G Concept instructs audiences how to spot generational markers or signs, and then offers simple yet powerful ways to reduce or even eliminate friction points that are particularly damaging to the team, patients, and bottom line . Attendees will be given the tools that positively improve issues around patient scheduling, optimized care, and stagnant or declining production . How we communicate cross-generationally impacts our bottom line . Build a dental practice that speaks each generational language and meets their expectations now to guarantee future practice growth! Upon completion of this presentation, participants should be able to: 1) cultivate a generationally perceptive team; 2) enhance and build relationships of trust using customized language tactics; 3) recognize how disregarding generational stereotypes can create a better patient experience; and 4) explore how to attract new Gen Z patients and employees . Mastering Inter-office Communication to Improve Referrals. No Donuts Required Emilee Secondino Recognizing the fundamentals of proper referral/specialist communication and understanding how to effectively communicate is critical to ideal patient care and practice productivity . In the current environment, it is more important than ever to remain laser- focused in team interaction . This presentation will review these important aspects of referral management and communication with team members . Upon completion of this presentation, participants should be able to: 1) discuss the specific benefits of good communication among team members; 2) explain how to best manage referrals; and 3) effectively communicate with your team . Become the Go-to Office for Implant Referrals Robert Vogel, DDS This fast-moving presentation will cover state-of-the-art topics, tips and techniques in implant dentistry for the surgical practice to become indispensable to restorative dentists . This program stresses ideal interaction for simplification of even the most advanced implant cases to ensure long-term stability, predictability and productivity . Also discussed in depth, is streamlining inter-office communication to make the referral process stress-free for patients and staff . This presentation will also review the newest equipment, components and technologies that need to be incorporated into everyday use to stay viable in our new landscape . Upon completion of this presentation, participants should be able to: 1) explain how to become the go-to office for implant referrals; 2) implement team coordination for productivity and ideal care; and 3) discuss the importance and use of latest technologies . 56 Table of Contents On-Demand Sessions The On-Demand Sessions are pre-recorded and available for viewing at any time until December 31, 2021. CE credit will only be available until June 14, 2021. Laboratory Technician Program Moderator: Robert Vogel, DDS 3D Printing and Complex Cases Alejandro Lanis, DDS, MS CAD/CAM procedures and specially 3D printing are changing the way humans consume products and services . In our field, 3D printing is changing the way we diagnose, plan and execute our treatments, allowing to optimize our clinical procedures . In the following presentation, I will describe the alternatives in the use of 3D Printing for the treatment of complex oral rehabilitation cases . Upon completion of this presentation, participants should be able to: 1) describe the 3D printing workflow applied to implant dentistry; 2) analyze diverse alternatives of 3D printers and their specific use for oral devices fabrication; and 3) evaluate the use of different 3D printed surgical templates depending on the clinical situation . Milled Zirconium Restorations Alexander Wuensche, CDT, ZT Zirconia is without any doubt, one of the most important restorative materials of modern times in dentistry . Zirconia also is one of the most sensitive materials we are utilizing for dental restorations . If using a single unit crown or a full arch reconstruction, it is very important to know how to handle this material . This presentation will review the different available zirconia types and how to properly handle them in their fabrication . Upon completion of this presentation, participants should be able to: 1) describe how to plan zirconia restorations; 2) explain working the pre-sinter stage without scarifying the stability; and 3) discuss how to properly finish the sintered zirconia to an aesthetic and functional dental restoration . Optimizing Solid Monolithic Zirconia Solutions With Restorative and Implant Esthetics Pinhas Adar, CDT, MDT This presentation will address more effective methods of utilizing the latest CAD/CAM technology workflow and how to communicate esthetic smile design solutions through several tools such as digital workflow designs, Trial Pop In Smiles™, PMMA’s and temporary restorations . These new CAD/CAM technologies have made proper communication between the laboratory technician and the dentist not only very different but extremely crucial to achieve optimal outcomes and save precious chair time . In CAD/CAM technology, just as with ceramic powders, the skill level of the technician is critical . This presentation will cover the key points that make the difference between laboratories using digital solutions for Full Monolithic (no ceramic layering) Zirconium . The 20% that is still the “human” touch is what makes the difference . Effective communication tools for a consistent and predictable outcome with the zirconia implant supported hybrid will also be covered . Upon completion of this presentation, participants should be able to: 1) utilize the digital workflow as a planning tool for predictable outcomes; 2) implement new processes to lessen appointments, save time and ensure the final seat times are around 10 minutes for screw retained zirconia hybrids; and 3) avoid communication issues among laboratory, clinician and patient for predictable results . 57 Table of Contents On-Demand Sessions Laboratory Technician Program (continued) Techniques and Protocols from a Laboratory Perspective for Long-term Prognosis in Implant Dentistry Olivier Tric, MDT This presentation will discuss temporization techniques, implant supported single central and material selection . Upon completion of this presentation, participants should be able to: 1) discuss temporization techniques; 2) describe implant supported single central; and 3) explain material selection . Is Smile Design Under Control? Christian Coachman, DDS, CDT The importance of mastering how to consistently create adequate smile designs in harmony with faces is underrated in dentistry and the notion that this topic is under control is overrated . The aim of this lecture is to highlight the challenges, the evolution, and the important concepts to become a great smile designer and also how to use technology to streamline the process and deliver natural beautiful healthy smiles consistently . Upon completion of this presentation, participants should be able to: 1) describe the differences between artificial looking and natural looking smiles; 2) recognize the ideal smile and better evaluate the 3D soft and hard tissue defect; 3) outline the most important facial references to create a smile in harmony with faces; and 4) discuss the white and pink components of natural smile . Full Arch Treatment Planning: Getting Back to Basics Using Digital Technology to Facilitate Consistent Successful Treatment Brandon Dickerman, CDT Over the past few years Fixed Hybrid Implant Therapy has become increasingly popular and widely accepted . With CBCT scans, photography, IOS data acquisition, and guided surgery implant planning software, we have the ability to plan and execute successful full arch rehabilitation with ease . A cornerstone of successfully executing this treatment is proper case documentation and pre-surgical interdisciplinary planning . Upon completion of this presentation, participants should be able to: 1) explore fundamental treatment planning concepts that are keys to successful hybrid restorations; 2) determine restorative material choices for fixed hybrid restorations; and 3) discuss what makes a patient a good candidate for a hybrid, and more importantly who is not a good candidate . QUESTIONS FOR A SPEAKER? Questions for any speaker can be submitted to speakerquestions@osseo org. . 58 Table of Contents On-Demand Sessions The On-Demand Sessions are pre-recorded and available for viewing at any time until December 31, 2021. CE credit will only be available until June 14, 2021. Oral Clinical Abstract Session See pages 63-66 for Oral Clinical Research Abstracts. Moderator: James Gurley, DDS OC-1 Immediate Versus Early Versus Delayed OC-5 Early Peri-implant Bone Loss is a Risk Single Post-extractive Implants: Three Year Factor for Periimplantitis – Five-year Results From an RCT Prospective Randomized Controlled Split- M . Karaban*, C . Barausse, L . Bonifazi, mouth Clinical Trial M . Esposito, P . Felice R . Pessoa*, R . Sousa, L . Pereira, E . Emi, G . Oliveira, F . Bezerra, J . Sloten, W . Teughels, OC-2 4 mm Supershort Implants Compared M . Quirynen, M . Messora, R . Spin-Neto With Longer Implants Placed in Reconstructed Posterior Atrophic Jaws: OC-6 Factors Associated with Loss of Proximal Three Year Results from an RCT Contact Between Implant Supported Fixed P . Felice*, C . Barausse, M . Karaban, L . Bonifazi, Prosthesis and Adjacent Natural Teeth R . Pistilli, M . Esposito M . Gul*, K . Zafar, R . Ghafoor, F .R . Khan OC-3 Effect of the Buccal Gap Dimension OC-7 Long-term Outcomes of Full-arch Following Immediate Implant Placement Immediate Fixed Prostheses Supported on the Buccal Bone Wall by Two Axial and Two Tilted Implants: D .R . Dias*, R . Levine, P . Wang, M . Araujo Prospective Clinical Study With A Minimum Follow-up of 10 Years OC-4 3-mm-Narrow Implants Compared With D . Romeo*, E . Agliardi, E . Gherlone 4-mm-Diameter Implants in Horizontally Augmented Bone: One Year Results from OC-8 Zygomatic Implants Compared with an RCT Dental Implants Placed in Reconstructed C . Barausse*, L . Bonifazi, M . Karaban, R . Pistilli, Atrophic Maxillae: Three-year Results from M . Esposito, P . Felice an RCT L . Bonifazi*, C . Barausse, M . Karaban, R . Pistilli, A . Ferri, M . Esposito, P . Felice QUESTIONS FOR A SPEAKER? Questions for any speaker can be submitted to speakerquestions@osseo org. . *The first name listed is the presenter . The presenter may/may not be the primary author . 59 Table of Contents On-Demand Sessions The On-Demand Sessions are pre-recorded and available for viewing at any time until December 31, 2021. CE credit will only be available until June 14, 2021. Oral Scientific Abstract Session See pages 67-70 for Oral Scientific Research Abstracts. Moderator: James Gurley, DDS OS-1 Developing A Screening Platform for OS-5 Structural Immunoinformatic Vaccine Osteogenic Compounds with Human Design Using Sytems Biology Approach Runx2 Transcriptional Activity in for Peri-implantitis Mesenchymal Stem Cells P .K . Yadalam*, S . Thilagar, D . Arumuganainar K . Ma*, C . Bai, L . Wang OS-6 Gene-Gene Interaction Network Analysis OS-2 Effect of Guide Sleeve Material, Region of Acellular Cementum Formation and Number of Usage of Drills on the P .K . Yadalam*, D . Arumuganainar, A . Thyagaraj, Material Loss From Sleeves and Drills S . Thilagar Used in Surgical Guides G . Çakmak*, O . Ozan, E . Seker, B . Yilmaz OS-7 Effect of Cyclic Loading on Screw Joint Stability of Implants With Angled Screw OS-3 Accuracy of Different Complete-arch Channel Crowns Digital Scanning Techniques, Using A S . Mulla*, R . Seghi, W . Johnston, B . Yilmaz Combined Healing Abutment-scan Body System OS-8 Ionic Liquids as a New Generation of G . Çakmak*, H . Yilmaz, A . Treviño Santos, Multifunctional Dental Implant Coatings: A . Kokat A Biocompatibility Assessment in the Lewis Rat OS-4 Implant Abutment Profile Changes and its S .E . Wheelis*, C .C . Biguetti, A . Arteaga, Effect on Retentive Strength of an Implant S . Natarajan, J . El Allami, B . Lakkasetter Supported Prosthesis Chandrashekar, G P. . Garlet, D . Rodrigues J .C . Kwan*, N . Kwan QUESTIONS FOR A SPEAKER? Questions for any speaker can be submitted to speakerquestions@osseo org. . *The first name listed is the presenter . The presenter may/may not be the primary author . 60 Table of Contents On-Demand Sessions The On-Demand Sessions are pre-recorded and available for viewing at any time until December 31, 2021. CE credit will only be available until June 14, 2021. Clinical Innovations Session See pages 71-77 for Clinical Innovations Abstracts. Moderator: Robert Miller, DDS CI-1 Guided Workflow for Full Arch Surgery CI-8 A Modified Technique of Zygomatic and Digitally Driven Final Rehabilitation. Implant Placement: A Prospective Study Minimally Invasive Base Guide Seating with a Two-to-Five-Year Follow-Up to Support Accurate Diagnostic Latched T . Nguyen*, N . Vo Conversion Converted to Hybrid Prototyping CI-9 Digital Implant Planning Using Patient C . Rensburg*, M . Vrhovac, J .J . Marrano, Specific 3D printed Teeth for a Full Arch D .G . Van Aarde Rehabilitation With Sectional Implant Supported Fixed Partial Dentures CI-2 Comprehensive Peri-implant Tissue V . Sequeira*, M S. . Bryington, M . Agusto Evaluation with Ultrasonography and Cone-Beam Computed Tomography CI-10 In Vitro Assessment of a Novel Additive R . Siqueira*, K . Sinjab, Y . Pan, F . Soki, H . Chan, Manufactured Titanium Implant Abutment L . Kalman* O . Kripfgans CI-3 Accuracy of Haptic Robotic Guidance CI-11 Survey of Torque Limiting Devices (TLD)- A of Dental Implant Surgery for the Fully System to Validate, Calibrate and Improve Edentulous Arch Measurement C .P . Wadhwani* S .L . Bolding*, U .N . Reebye CI-4 Ridge Augmentation in Extremely Atrophic CI-12 A Novel Approach to Extraction Site Anterior Mandible With Custom Alveolar Decontamination With the Er,Cr:YSGG Ridge Splitting Technique Laser P . Desai* A . Barsoum*, M . Limão Oliveira, S .C . Cho, Z . Bagheri CI-13 A Novel Approach to Biofilm Removal by CI-5 3-D Implant Positioning: An Innovative the Er,Cr:YSGG Laser for Peri-implantitis Tool Treatment P . Desai* A . Barsoum*, M . Limão Oliveira, S .C . Cho CI-6 Intra-operative Efficiency of Dental CI-14 Employing Interim Surgical Endodontics Robotics for the Fully Edentulous Arch for Implant Site Preparation of Hopeless U .N . Reebye*, S .L . Bolding Teeth With Endodontic Treatment and Critical Size Defect Lesions CI-7 Histological Evaluation of rhBMP-2 in an M . Abou-Rass* Extraction Site Model in the Esthetic Zone A . Rossi*, T . Scheyer, M . McGuire QUESTIONS FOR A SPEAKER? Questions for any speaker can be submitted to speakerquestions@osseo org. . *The first name listed is the presenter . The presenter may/may not be the primary author . 61 Table of Contents On-Demand Sessions The On-Demand Sessions are pre-recorded and available for viewing at any time until December 31, 2021. CE credit will only be available until June 14, 2021. AO Research Award Recipients Session AO/OF Research Grant Presentations Moderator: David Kim, DDS, DMSc 2021 Osseointegration Foundation 2021 Basic Science Research Grant Applied Science Research Grant A Novel Growth Factor-free Adhesive The Effect of Osteoporosis on Hydrogel Delivery System for Osseointegration and Bone Enhanced Bone Tissue Engineering Regeneration Applications Elena Calciolari, DDS, MS(Perio), PhD Sahar Ansari, MSc, PhD 2020 Basic Science Research Grant 2020 Osseointegration Foundation Applied Science Research Grant Effect of Drilling Preparation on the Cortical Bone Around Implants Using Digital Implant Planning in Subjected to Immediate Mechanical Assessing Outcomes of Maxillary Load Sinus Augmentation Procedures: A Michele Stocchero, DDS, PhD Retrospective Study Irina Dragan, DDS, MS William R. Laney Award Presentations 2021 William R. Laney Award 2020 William R. Laney Award The Effect of Crown-to-Implant Ratio The Effect of Moderately Controlled on the Clinical Outcomes of Dental Type 2 Diabetes on Dental Implant Implants: A Systematic Review Survival and Peri-implant Bone Loss: A Long-Term Retrospective Study Andrea Ravida, DDS, MS Zeev Ormianer, DMD Supported by a grant from Supported by a grant from Quintessence Publishing Co., Inc. Quintessence Publishing Co., Inc. 62 Table of Contents Oral Clinical Abstracts Method: Forty patients with atrophic posterior mandibles hav- OC-1 ing 5 to 6 mm bone height above the mandibular canal and 40 Immediate Versus Early Versus Delayed Single Post- patients with atrophic maxillae having 4 to 5 mm bone height extractive Implants: Three Year Results From an RCT below the maxillary sinus were randomised to receive one to three M. Karaban*, C. Barausse, L. Bonifazi, M. Esposito, 4.0-mm-short implants or one to three implants of at least 10 mm P. Felice long in augmented bone. Mandibles were vertically reconstructed with the interpositional technique while maxillary sinuses were Introduction: Dental implants have been traditionally placed augmented via a lateral window. Four months later provisional in healed ridges, however in order to reduce rehabilitative times restorations were delivered and replaced after 4 months by defin- early and immediate implant placement procedures have been itive ones. Patients were followed up to 3 years. Outcome mea- proposed. However, there had been no Randomised Controlled sures were: prosthesis and implant failures, any complications, and clinical Trials (RCT) comparing these three differente approches. peri-implant marginal bone level changes. The aim of this study is to compare the clinical outcome of sin- Results: In mandibles, two implants from the augmentation gle implants placed immediately after tooth extraction with those group failed, versus two 4.0-mm-long implants from the short placed 6 weeks after extraction, and those placed 4 months after implant group. In maxillae, four short implants failed versus seven extraction and socket healing. long implants. Three prostheses on short implants failed versus Method: Two hundred and ten patients requiring one single eight prostheses at augmented sites. There were no statistically implant-supported crown to replace a tooth to be extracted were significant differences in implant failures (P = 0.159) or prosthesis randomised into 3 groups of 70 patients each to receive immedi- failures (P = 0.919). There were more patients affected by com- ate, early, or delayed post-extractive implants. Temporary crowns plications in the augmentation group (18 patients affected by 30 were delivered after 4 months, and were to be replaced by defin- complications versus 8 patients affected by 10 complications), but itive ones after another 4 months. Outcome measures were crown the difference was not statistically significant (P = 0.587). At 3 years and implant failures; complications; peri-implant marginal bone post-loading, average peri-implant bone loss was not statistically level changes; aesthetics, as assessed using the Pink Esthetic Score significant in mandibles (P = 0.568), but was significant in maxillae, (PES); and patient satisfaction, recorded by blinded assessors. with greater bone loss at short implants (P = 0.037). Patients were followed-up for 3 years. Conclusion: Three years after loading, 4 mm supershort implants Results: Five implants (9.2%) failed in the immediate, four (6.6%) achieved similar, if not better, results than longer implants in aug- in the early, and one (1.6%) in the delayed group (P = 0.282). Com- mented jaws, but were affected by fewer complications. Hence, plications affected eleven patients from the immediate group, 12 short implants may be preferable to bone augmentation, especially from the early, and eight from the delayed group (P = 0.596). Mean in mandibles, since the treatment is less invasive, faster, cheaper, peri-implant marginal bone loss was -0.33 mm at immediate, -0.43 and associated with less morbidity. However, 10-year post-loading mm at early, and -0.49 at delayed implants; (P <0.001); there were data will be necessary before making reliable recommendations. significant pairwise differences between immediate and early (P = 0.0391) and immediate and delayed implants (P = 0.0004). The mean overall PES were 12.25, 11.98 and 11.17 in the immediate, OC-3 early and delayed groups, respectively (P < 0.001); there were sig- Effect of the Buccal Gap Dimension Following nificant pairwise differences between immediate and delayed (P = Immediate Implant Placement on the Buccal Bone Wall 0.0006), and early and delayed implants (P = 0.0099). There were no significant differences in patient satisfaction regarding function D.R. Dias*, R. Levine, P. Wang, M. Araujo (P = 0.353) or aesthetics (P=0.531), and all patients would undergo Introduction: When considering immediate implant placement the same procedure again. (IIP), the effect of the gap dimension between the implant shoulder Conclusion: No statistically significant differences in failure, and the inner aspect of the buccal wall on bone remodeling is not complications or patient satisfaction were observed among groups, established in the literature. Thus, the aim of the present study was even though failures were more frequent in immediate and early to evaluate the effect of the buccal gap dimension on the newly implants. Bone loss was significantly lower at immediate implants, formed buccal bone following IIP. and aesthetic evaluation scores were higher for immediate and Method: Forty-one patients treated with 50 implants at the early implants. maxillary central incisor region were included in this retrospective cohort study. Following minimally invasive tooth extraction and IIP, the buccal gap was measured and filled with anorganic bovine OC-2 bone. After 5 ± 4 years in function, CBCT scans were obtained. 4 mm Supershort Implants Compared With Longer Implant sites were divided into 2 groups: wide gap (>2 mm; n=36) Implants Placed in Reconstructed Posterior Atrophic and narrow gap (≤2 mm; n=14). A calibrated examiner assessed Jaws: Three Year Results from an RCT the following measures: width of the buccal and palatal bone walls at the implant shoulder, 2, 4 and 6mm below; height of the buc- P. Felice*, C. Barausse, M. Karaban, L. Bonifazi, R. Pistilli, cal and palatal bone walls in relation to implant length (%); and M. Esposito the effect of implant diameter (narrow, regular or wide) on bone Introduction: In case of bone atrophy, clinicians are faced with dimension. Intergroup differences were analyzed using Mann-Whit- the dilemma of whether to attempt an augmentation procedure or ney U and Kruskal-Wallis tests. to place short implants. The aim of this study is to evaluate whether Results: The buccal bone width measured at implant shoulder, 4 mm supershort implants could be used as an alternative to bone 2, 4 and 6mm below was 1.5mm (±1), 1.8mm (±0.9), 1.7mm (±0.9) reconstruction with xenografts and placement of implants of length and 1.5mm (±1) in the wide group and 0.6mm (±0.8), 0.6mm (±0.5), at least 10 mm in posterior atrophic jaws. 0.4mm (±0.5) and 0.3mm (±0.5) in the narrow group, respectively. *The first name listed is the presenter. The presenter may/may not be the primary author. 63 Table of Contents Oral Clinical Abstracts There were significant differences between the wide and narrow mm of peri-implant bone, while augmentation patients lost 0.52 gap at all levels observed (p<0.05). The palatal bone width mea- mm. The difference in bone loss between the two groups was sta- sured at the four levels were, respectively, 1mm (±1.2), 1.7mm tistically significant (P = 0.0112). Five 3-mm group patients ver- (±0.8), 2.2mm (±0.9) and 2.8mm (±1.2) in the wide group and sus two augmentation group patients (P = 0.4205) and one 3-mm 1.1mm (±1.1), 1.9mm (±1.3), 2.7mm (±1.4) and 3.4mm (±1.7) in the group patient versus two augmentation group patients (P = 0.5900) narrow group, with no statistical differences between them at any were partially satisfied with function and aesthetics, respectively. All level. The buccal bone height corresponded to 99.1% (±25.6) of the patients would undergo the same procedure again. implant length in the wide group and 61.7% (±45.2) in the narrow Conclusion: One year after loading, patients treated with 3 group (p=0.003), while the palatal bone height was similar between mm-diameter implants exhibited better results than those receiv- both groups (approximately 100%; p=0.482). No statistical differ- ing horizontal augmentation. Three mm-diameter implants might ences in the buccal or palatal bone dimension were observed therefore be the preferable choice with respect to horizontal bone regarding implant diameter (p>0.05). augmentation, the treatment being less invasive, faster, cheaper, Conclusion: Within the limitations of this study, grafting of a > and associated with less morbidity and peri-implant marginal bone 2 mm-wide buccal gap following immediate implant placement loss; however, 10-year post-loading data will be necessary before played an important role on the buccal bone dimension, regardless reliable recommendations can be made. of the implant diameter. OC-5 Early Peri-implant Bone Loss is a Risk Factor for Periimplantitis – Five-year Prospective Randomized- Controlled Split-mouth Clinical Trial R. Pessoa*, R. Sousa, L. Pereira, E. Emi, G. Oliveira, F. Bezerra, J. Sloten, W. Teughels, M. Quirynen, M. Messora, R. Spin-Neto Introduction: The relative contribution of relevant aspects of implant design on initial periimplant bone remodeling, as well as the role of biological and biomechanical aspects as risk indicators for periimplantitis remain to be determined. The present study Relative frequency of the buccal bone width at the implant shoulder, 2, 4 evaluate clinical, bacteriological, and biomechanical parameters and 6mm below. related to peri-implant bone loss, comparing external hex (EH) and Morse-taper (MT) connections, threaded (Th) and non-threaded OC-4 (nTh) crestal modules and crestal module with and without (wT) 3-mm-Narrow Implants Compared With surface treatment. Method: Twelve patients received four custom made Ø 3.8 x 13 4-mm-Diameter Implants in Horizontally Augmented mm implants (MT Th, MT nTh, EH Th, MT Th wT), randomly placed Bone: One Year Results from an RCT based on a split-mouth design. Clinical parameters were evaluated C. Barausse*, L. Bonifazi, M. Karaban, R. Pistilli, at a 1, 3 and 5 years follow-up. Peri-implant bone loss was assessed M. Esposito, P. Felice on standardized digital peri-apical radiographs acquired at 1, 3, 6 Introduction: Clinicians are faced with the dilemma of whether months and 1, 3, and 5 years follow-up. Samples of the subgin- to attempt an horizontal augmentation procedure, or whether to gival microbiota were collected 3, 6 and 12 months after implant place narrow implants. The aim of this study is to evaluate the loading. DNA were extracted and used for the quantification of Tf, effectiveness of immediately loaded 3 mm-diameter implants as Aa, Pi and Fn. Further, 36 computer-tomographic based finite ele- an alternative to horizontal bone augmentation procedures to allow ment (FE) models were accomplished and relevant biomechanical placement of implants with a conventional diameter of 4 mm. aspects were eavluated. Method: Forty-five partially edentulous patients with 4-5 mm Results: After 5 years follow-up, the variation in periimplant of bone width in areas requiring one to three adjacent implants bone loss was different between all aspects of crestal module were randomised to receive 3.0 mm-diameter implants to be design (p<0.001), except for MT Th and MT Th wT (P=0.1672). ± ± loaded immediately or horizontal augmentation for placing, after Mean IT-FBIC was 0.48 0.70 mm for MT Th, 0.65 0.57 mm for ± ± 6 months of healing, 4 mm-diameter implants. Four mm-diame- MT Th wT, 0.99 0.29 mm for MT nTh, 1.66 0.83 mm for EH Th. All ter implants were restored using provisional prostheses, replaced clinical and microbiological parameters did not present significant after 4 months by definitive ones. Three mm-diameter implants differences. In FE analysis, a significantly higher peak of EQV strain µ were immediately loaded with definitive prostheses if the inser- (p<0.001) was found for EH Th (mean 3438.65 e). The MT nTh ± 3 tion torque was ≥ 35 Ncm. Patients were followed-up to 1 year. (mean 1.54 1.25 mm ) implant presented the highest bone volume Outcome measures were: prosthesis and implant failures, any com- affected by a shear stress above 5 MPa. Implants presenting intial plication, peri-implant marginal bone loss and patient satisfaction. peri-implant bone loss above 1 mm had a relative risk 3.66 higher Results: Two implants failed from the augmentation group (P of developing periimplantitis, after 5 years of function. = 0.2333) and neither patient was fitted with a prosthesis. Five Conclusion: The extension of initial bone remodeling is influ- patients with narrow-diameter implants were affected by six com- enced by varying the implant design. Clinical and microbiological plications versus 11 augmented patients with 12 complications, the conditions could not be demonstrated as responsible for early difference being statistically significant (P = 0.0477). One year after marginal bone loss. A singular loading transmission through dif- loading, patients with 3 mm-diameter implants lost on average 0.14 ferent crestal module designs to the periimplant bone could be *The first name listed is the presenter. The presenter may/may not be the primary author. 64 Table of Contents Oral Clinical Abstracts observed. Initial bone remodeling above 1mm is a risk factors for periimplantitis. OC-7 Long-term Outcomes of Full-arch Immediate Fixed Prostheses Supported by Two Axial and Two Tilted Implants: Prospective Clinical Study With a Minimum Follow-up of 10 Years D. Romeo*, E. Agliardi, E. Gherlone Introduction: Nowadays immediately loaded full-arch implant supported prostheses with axial and tilted implants represents a well established procedure with surgical and prosthetic advan- tages. However, long term-clinical data are still lacking. The aim of this prospective study was to report implant and prosthetic survival OC-6 rates of immediate fixed prostheses supported by two axial and Factors Associated With Loss of Proximal Contact two tilted implants and to assess patients’ quality of life after at least 10 years of function. Between Implant Supported Fixed Prosthesis and Method: From April 2004 to January 2009, 173 patients (92 Adjacent Natural Teeth male and 81 female, 62 smokers) received an immediate full pros- M. Gul*, K. Zafar, R. Ghafoor, F.R. Khan theses supported by two tilted implants that engages the anterior Introduction: Loss of proximal contact (LPC) between natural sinus wall and two axial anterior implants. Acrylic resin provisional teeth and implant supported prostheses leads to food impaction prostheses were delivered within 4 hours of implant placement and resulting in damage to healthy periodontium, initiation of caries definitive restorations were placed 4 to 6 months later. During fol- and unwanted tooth migration. The present study aims to deter- low-up appointments, plaque and bleeding indexes were scored, mine the frequency of LPC between implant-supported prosthesis periapical radiographs were obtained and patient satisfaction was and adjacent natural teeth and to investigate the factors associated recorded. Cumulative implant survival rate was assessed using the with it. Kaplan-Meier statistics. Method: Total of 46 patients supported by 72 implants were Results: A total of 692 implants was inserted (404 in the mandi- included in the study. Total of 123 proximal contacts were evalu- ble and 288 in the maxilla). One-hundred and one prostheses were ated and multiple patient and prosthesis related factors. Gener- immediately loaded in the mandible with a follow-up range of 138- alized estimation equation (GEE) was used to identify potential 195 months (mean value 159±14 months). Eleven implants failed in factors influencing proximal contact loss. P-value of ≤ 0.05 was 4 patients (3 male, 1 female, 4 non smokers) leading to an implant taken as statistically significant. cumulative survival rate (CSR) of 97.12%. Seventy-two prostheses Results: Out of total 123 proximal contacts 49.6% were lost and were delivered in the maxilla with a follow-up range of 138-195 77% of the lost contact were mesial. It increased over time assesses months (mean value 161±15 months). Eight failures occurred in by Kaplan Meier survival analysis. The first proximal contact was seven patients (1 male, 6 females, 3 smokers) with an implant CSR lost as early as 6 months and almost 50 % of the proximal con- of 97.13%. No significant difference in survival were reported in the tacts were lost at 24 months of follow-up. Univariate GEE analysis mandible and maxilla (Pearson’s chi square) per implant (P = 1.00) showed that mesial aspect of proximal contact, splinting of implant, and per patient (P = 0.13). No effect on gender (males vs females) parafunction, opposing dentition, food impaction, state of pros- (maxilla using Fisher’s exact test P = 0.055 and mandible P = 0.32) thesis, prosthesis unit, implant diameter and mean probing depth, or smoking habits (smokers vs NS) (maxilla P = 0.29 and mandible bleeding on probing and implant plaque index were as signifi- P = 0.18) were reported. Patients’ satisfaction in terms of function cant factors. Whereas, poor oral hygiene, mesial proximal contact and esthetics was very high thought the study. position, opposing artificial dentition, food impaction, mesial bone Conclusion: These long-term clinical data from a relatively large loss, splinted prosthesis and implant plaque index were significant sample size suggest that the present technique can be considered factors in multivariate GEE analysis. a viable treatment option for the immediate rehabilitation of both Conclusion: Loss of proximal contact is common in posterior mandible and maxilla. implant supported prosthesis. It increased over the follow-up time. There was a significant association between mesial site, artificial opposing dentition, splinting of implant prosthesis with increased prevalence of LPC. Food impaction and Lower alveolar bone sup- port were the commonly affected periodontal factors associated with loss of proximal contact. *The first name listed is the presenter. The presenter may/may not be the primary author. 65 Table of Contents Oral Clinical Abstracts OC-8 Zygomatic Implants Compared With Dental Implants Placed in Reconstructed Atrophic Maxillae: Three-year Results from an RCT L. Bonifazi*, C. Barausse, M. Karaban, R. Pistilli, A. Ferri, M. Esposito, P. Felice Introduction: In cases of extremely atrophic maxillae the thera- peutic options could be either to reconstruct the bone or to place zygomatic implants. The aim of this study is to compare the clinical outcomes of immediately loaded cross-arch maxillary prostheses supported by zygomatic implants versus conventional implants placed in augmented bone. Method: Seventy-one edentulous patients with severely atrophic maxillae were randomised to receive either zygomatic implants to be loaded immediately or xenograft followed by placement of dental implants. Outcome measures were: prosthesis, implant and augmentation failures, any complications, quality of life (OHIP-14), number of days with totally or partially impaired activity, time to function, and number of dental visits. Patients were followed up to 3 years after loading. Results: One augmentation procedure failed. Eight prosthe- ses failed in the augmentation group versus two prostheses in the zygomatic group, the difference being not statistically signif- icant (P = 0.082). Forty-two dental implants versus six zygomatic implants were lost, the difference being not statistically signif- icant (P = 0.052). Sixteen augmented patients were affected by 30 complications versus 29 zygomatic patients (55 complications), the difference being statistically significant (P = 0.007). The 3-year OHIP-14 score difference was not statistically significant (P = 0.624) as the difference in days of total infirmity (P = 0.692). Days of par- tial infirmity were 14.24 in the augmented group and 12.17 in the zygomatic group, the difference being statistically significant (P = 0.048). The mean number of days to functional prosthesis fit- ting were 444.32 in augmentation patients and 1.34 in zygomatic patients, the difference being statistically significant (P < 0.001). The difference in average number of dental appointments was not statistically significant (P = 0.213). Conclusion: Three-year post-loading data suggest that imme- diately loaded zygomatic implants are associated with fewer pros- thesis failures, implant failures and less time needed for functional loading as compared to augmentation procedures and conven- tionally loaded dental implants. Significantly more complications were reported for zygomatic implants; however, in the short-term, zygomatic implants could be a better rehabilitation strategy for severely atrophic maxillae. *The first name listed is the presenter. The presenter may/may not be the primary author. 66 Table of Contents Oral Scientific Abstracts metal (CoCr) guide sleeves in surgical guides and the drill during OS-1 the preparation of osteotomies at the premolar and molar regions. Developing A Screening Platform for Osteogenic Method: Three tooth-supported maxillary surgical guides that Compounds With Human Runx2 Transcriptional have guide sleeve holes in different sizes positioned in the first Activity in Mesenchymal Stem Cells premolar and second molar regions were prepared. Guide sleeves K. Ma*, C. Bai, L. Wang (diameters: 2.20 mm, 3.40 mm and 4.05 mm) were milled from zirconia (n=60) and CoCr (n=60) blocks. Before drilling, maxillary Introduction: While medications such as bisphosphonates have and mandibular typodont models and guides were inserted on been widely used for osteoporosis (OP), their adverse events, such mannequin head. A total of 12 titanium nitride coated stainless as Bisphosphonate-related Osteonecrosis of the Jaw (BRONJ), and steel twisted drills (n=6 per sleeve material) in different diameters poor compliance, remain obstacles during clinical practice. Recently, (2.00, 3.20, 3.85 mm) were used with corresponding sleeves during plant-based compounds including phytoestrogens have emerged drilling. To quantitatively analyze the material loss from drills and as effective and safe candidates for OP; however, screening sys- sleeves, a mass determination was done before and after drilling. tems with high efficiency and predictivity of osteogenic capacity The data were analyzed using multiple linear mixed effect models are yet to be determined. This is due mainly to the time-consuming (α=.05). nature of in vitro and in vivo osteogenic assay conducted with pri- Results: For sleeves, the material loss was found significantly mary osteoblasts or mesenchymal stem cells (MSCs), the progeni- associated with all factors; number of drill usage (P<.001), material tors of osteoblasts. Applying both the osteogenic capacity of MSC (P<.001), diameter (P≤.063), region (P=.008). Zirconia sleeves had and a promoter reporter assay for Runx2, the master osteogenesis significantly less material loss than metal sleeves (P<.001). Sleeves transcription factor, we developed a rapid and highly predictive in in molar region had significantly more material loss than sleeves vitro screening platform for osteogenic molecules including the in premolar region (P=.008). For drills, the material loss was signifi- above mentioned plant-based compounds. cantly associated with the number of usage (P<.001) and diameter. Method: In this study based on murine MSC line (C3H10T1/2) Mean material loss from sleeves and drills was significantly less transduced with human RUNX2-promoter luciferase reporter when number of usage increased (P<.001). (hRUNX2-luc), we tested the osteogenic capacity of 8 species of Conclusion: The material loss was lower when zirconia sleeves plant-derived compounds from a variety of taxonomic families, were used. All sleeves had increased material loss in the molar including flavonoids, polyphenolic compounds, alkaloids, and iso- region than the premolar region and with wider sleeve sizes than thiocyanates. The transduction of hRUNX2-luc was through daid- the narrowest. Material loss from the drill increased with the thick- zein, an osteogenic phytoestrogen, which was also selected as the est drill compared to the narrowest and decreased with usage. positive control. Canonical in vitro and in vivo osteogenesis assays Clinicians may prefer zirconia guide sleeves over metal sleeves in were performed using primary murine and human bone marrow surgical guides for smaller amount of material loss. MSCs (BMMSCs) to validate the accuracy of this novel screening platform. Results: This novel MSC/hRUNX2-luc screening platform enabled us to both shorten the screening process for osteogenic compounds from 4 weeks to less than 5 days, and to evaluate the relative osteogenic potency of all tested compounds. Predictive analyses revealed nearly absolute correlation between this MSC/ hRUNX2-luc reporter platform and canonical in vitro functional assays of mineralization using murine BMMSCs. Likewise, validation assays conducted with human BMMSCs for in vitro mineralization and in vivo osteogenesis also demonstrated nearly absolute cor- relation to this MSC/hRUNX2-luc reporter platform. Conclusion: This screening platform based on MSC/hRUNX2 reporters may accurately and rapidly evaluate the osteogenic capacity of a variety of therapeutic candidates, which could be applied to test new drugs for OP. OS-2 Zirconia guide sleeves and implant drills used. Effect of Guide Sleeve Material, Region and Number of Usage of Drills on the Material Loss From Sleeves and OS-3 Drills Used in Surgical Guides Accuracy of Different Complete-arch Digital Scanning G. Çakmak*, O. Ozan, E. Seker, B. Yilmaz Techniques, Using a Combined Healing Abutment-scan Introduction: How material loss is affected when different guide Body System sleeve materials and implant drills in different sizes are used in G. Çakmak*, H. Yilmaz, A. Treviño Santos, A. Kokat different regions in surgical guides is not well-known. Therefore, Introduction: The verification of the scan accuracy of novel tech- measuring the material loss from zirconia and metal sleeves can be niques that increase reference data points by modifying mucosa clinically beneficial to select the optimal sleeve material for surgical surfaces or by splinting scan bodies may be clinically beneficial to guides to minimize the amount of shaved material. The purpose select the optimal scan procedure in the completely edentulous of this study was to compare the material loss from zirconia and arches. The purpose of the study was to investigate the effects of 3 different complete-arch digital implant scanning techniques used *The first name listed is the presenter. The presenter may/may not be the primary author. 67 Table of Contents Oral Scientific Abstracts with a combined healing abutment-scan body (CHA-SB) system on the relationship of length and shape of an implant abutment and the accuracy (trueness and precision) and scan time. its effect on retentive strength of a cemented prosthesis. Method: A poly(methyl methacrylate) master model simulat- Method: Two different types of titanium abutments were used ing an edentulous maxilla was fabricated with 4 parallel dental in this study. The first group were regular 4° Tapered titanium implants. A CHA-SB system was attached to each implant. The abutment (TTA) connected to an implant with increasing abut- model surface was scanned using a blue light industrial scanner ment length by 1mm from 3mm to 8mm were used. The second to generate a master reference model standard tessellation lan- group were titanium hexagonal shaped abutments (THA) with a guage file (MRM-STL). Three different scanning techniques:1) con- fixed length of 3mm with 0,1,2,3 and 6 axial surfaces removed. ventional technique (CV) with unmodified master model, 2) scan Two groups of implant bridges were also tested with the abutments body splinting technique (SBS) using orthodontic elastic ligatures angled at 15° towards the vertical axis and 12mm apart. First group, and plastic splint materials, 3) land marking technique (LM) using two 15° TTAs with a 3mm height and the second group had two pyramid shaped glass-ceramic markers, were performed. Fourteen THAs with 3 axial surfaces removed. All samples were cemented consecutive digital scans were made by using an intraoral scanner with their corresponding metal prosthesis. All samples were sub- (IOS) for each technique, converted to STL file and superimposed jected to a pull-out test using a Material Testing machine. The max- on the MRM-STL. Trueness and precision were calculated for each imum retentive force were measured in Kgf. One-way ANOVA with technique. The scan time was also recorded. The data were ana- post-hoc Tukey HSD test was performed. lyzed with 1-way ANOVA and Tukey HSD tests (α=.05). Results: There was significant differences in retentive strength of Results: Different scanning techniques had significant effects on TTA samples when abutment length increased by 1mm from 3mm the trueness (distance and angular deviations) (P<.001) and scan to 8mm, 31.67±SD 4.10 Kgf to 67.61±SD 11.23 Kgf respectively, time (P=.002). SBS technique had significantly the lowest scan time [F(5,24)=20.46,p <0.001]. In THA samples with a fixed 3mm abut- (P≤.05). LM technique had significantly higher mean distance devi- ment length, there was no significant difference, p>0.05, when the ation than CV and SBS techniques (P<.001). CV technique had sig- 1st, 2nd, and 3rd adjacent axial surfaces were removed and retained nificantly higher mean angular deviation than SBS (P=.001) and LM 85% of its retentive strength 60±14.36 kgf when compared to an techniques (P=.004). For precision, different scanning techniques unmodified hexagonal shaped abutment. The retentive strength had only significant effect on the distance deviation (P<.001). LM was significantly different, p<0.05, for implant bridges cemented to technique had significantly higher mean distance deviation than THA and 15° TTA, 98.87±SD 13.85 and 43.85±SD 8.12, respectively. SBS and CV techniques (P<.001). Conclusion: Using traditional dental concepts of a TTA shape Conclusion: Different digital implant scanning techniques would have to be 3 times in length in order to have comparable resulted in differences on the trueness (distance and angular devi- retentive strength to the THA. For anterior restorations a short THA ations) and scan time and distance deviation for precision. One (3mm in height) can be used to allow more freedom in implant scanning technique was not superior to others when both trueness placement. Selective removal of three adjacent axial surfaces of and precision were considered. Use of scan body splinting tech- the THA provide more than twice the retentive strength than 15° nique led to significantly less scan time. TTA and provides an unimpeded common path of insertion for the splinted metal bridge. Retentive Strength Mean (in Kgf) of TTA and THA samples OS-5 Structural Immunoinformatic Vaccine Design Using OS-4 Sytems Biology Approach for Peri-implantitis Implant Abutment Profile Changes and Its Effect on P.K. Yadalam*, S. Thilagar, D. Arumuganainar Retentive Strength of an Implant Supported Prosthesis Introduction: Vaccines have reduced the morbidity of diseases J.C. Kwan*, N. Kwan in most infectious diseases, and many vaccines in dentistry met Introduction: Standard implant abutments used to support den- with great difficulty and limited success. Our current pandemics tal prosthesis commonly follow the shape of natural tooth abutment have shown the importance of vaccines to prevent oral infectious preparation. The strength of the cement, contact surface areas and diseases. The impact of high-throughput technologies, along with the geometry of this standard greatly affects the stability of the insilico and systems biology methods of data analysis, has enabled prosthesis during function. The objective of this study is to evaluate immunoinformaticians to interrogate all genomic data and gene *The first name listed is the presenter. The presenter may/may not be the primary author. 68 Table of Contents Oral Scientific Abstracts expression signatures with immune response to consider the entire of periodontal regeneration. The network analysis was performed system as a whole. This study uses immunoinformatics Reverse vac- to identify the specific ‘acellular cementum-related genes.’ Follow- cine approach in developing new vaccines for peri implant bacteria ing KEGG and GO analysis, a functional annotation for DEGs was especially p.gingivalis. performed using the GENE MANIA tool. P < 0.05 was considered Method: Structural vaccinology involves screening the statistically significant. Top 250 upregulated genes in acellular entire genome of p.gingivalis atcc33277 using insilico methods cementum formation were retrieved. Density-based clustering was approaches to find antigenicity and genes coded for proteins with done to recognize too dense hubs having a robust association with extracellular localization, signal peptides & B cell epitopes. Next, acellular cementum phenotype. the epitope peptide sequence was identified in Immune Epitope Results: Out of the 250 genes recognized, the top five ranked Database Analysis Resource with positive assays for linear epitopes. genes were evaluated. The average precision for identifying the Identified peptide sequences are validated using the STRING tool, ‘acellular cementum-related genes’ vary between 80-100%. The and the network was built and analyzed for hubs, shortest path, interaction network was further clustered based on the density of clustering coefficient. interactions, and regulatory hubs were recognized. Among the top Results: Using STRING tools number of nodes and edges were regulatory hubs, the genes RPLP0 (encodes a ribosomal protein 11 and 22, respectively, and the average node degree was 4 with that is a component of the 60S subunit), PPP1CB-co-expression a local clustering coefficient 0f 0.848. and PPI enrichment p-value: (control of chromatin structure and cell cycle progression during 0.00574 and PGN_1608 were found to a highly interactive hub. the transition from mitosis into interphase), LIAS (localizes in the Conclusion: Thus, using the systems biology approach, a highly mitochondrion and plays a vital role in alpha-(+)-lipoic acid syn- interactive hub PGN_1608 can be used as a vaccine target for thesis), NUBPL (encodes a member of the Mrp/NBP35 ATP-binding p.gingivalis and need further studies to check its potency. proteins family), TUBGCP4 (encodes gamma-tubulin complex pro- tein-4, which intiates nucleation and organization of microtubules) were determined to be pivotal and critical driver genes for pro- tein-coding for acellular cementum phenotype. Conclusion: The present study established a novel gene-gene-in- teraction network that enhances the prediction accuracy of detect- ing the ‘acellular cementum-related genes. OS-7 Effect of Cyclic Loading on Screw Joint Stability of Implants With Angled Screw Channel Crowns S. Mulla*, R. Seghi, W. Johnston, B. Yilmaz Introduction: Research is lacking as to how reverse torque values (RTVs) of nonaxially tightened implant crowns compare to axially tightened cement-retained crowns under long-term cyclic loading. The purposes of this study were to evaluate the ability of different 25° angled screw channel systems to apply target torque value on their screws, the effect of cyclic loading on their RTVs, and their survival compared to crowns cemented on 0° angled screw channel abutments. Method: A total of 28 implants were divided into 4 groups. Twenty-one angulated screw channel crowns were fabricated at OS-6 25° angle correction using angled Titanium (Ti) bases by 3 man- ufacturers DY, DE and ASC (n=7). The fourth group, UB, which Gene-Gene Interaction Network Analysis of Acellular served as control had cement-retained crowns with 25° angled Cementum Formation custom abutments that were cemented onto their respective Ti P.K. Yadalam*, D. Arumuganainar, A. Thyagaraj, bases (n=7). Implants were embedded in epoxy resin and torqued S. Thilagar to manufacturer recommended values. Initial torque values (ITV1) 1 Introduction: The tooth root is an essential and integral part of were recorded. After 24 hours, the screws’ RTVs (24hr-RTV ) were our dentition. Acellular cementum formation in the source is crucial recorded. Then, a new set of screws was used for each group and 2 for periodontal regeneration. A thorough understanding of how the initial torque values (ITV ) were recorded. Specimens were sub- the root is bioengineered/regenerated is of utmost importance jected to cyclic loading at 2 Hz for 5 million cycles under 200 N 2 in regenerative and developmental biology. Hence, this particular load and RTVs (RTV ) were recorded. ANOVA (α=.05) was used gene-gene interaction network was built to elucidate the various to compare differences in means of deviation of ITVs and means genes that play a vital role in the regeneration process so that the of RTVs followed by a Tukey-Kramer post hoc analysis. Preload 2 2 same can be isolated and utilized to attain periodontal acellular efficiency was calculated (RTV / ITV ) and a survival analysis was cementum regeneration performed. Method: In this work, a gene-gene-interaction network was con- Results: A significant difference in means of deviation of ITVs of structed using GEO2R(accession number-GSE2525), an interactive the 25° groups (DY, DE and ASC) was found when compared to UB online tool to identify DEGs from the human genome’s GEO series at 0°. ASC and DE had lower ITVs than UB (P<.001 & P=.003 for 1 2 1 2 involved in the formation of acellular cementum during the process ASC ITV & ITV , P<.001 & P=.006 for DE ITV & ITV ). A significant difference was found in mean RTVs both after 24 hours and after *The first name listed is the presenter. The presenter may/may not be the primary author. 69 Table of Contents Oral Scientific Abstracts cyclic loading among all groups (P<.001). A significant difference histology, histomorphometry and immunohistochemistry to track was found between mean RTVs before and after cyclic loading for healing parameters. each group (P<.001). Preload efficiency was 43.78% for DY, 46.83% Results: OM of epithelial mucosa from young males indicated for DE, 54.16% for ASC, and 48.46% for UB. Time-to-failure survival that IonL-Phe coated and uncoated implants demonstrated normal showed no significant difference among groups. clinical benchmarks of healing at 30 days: mature oral mucosa cov- Conclusion: DY delivered comparable ITVs to the target value ering the implant with the absence of clinical inflammation (redness at 25° similar to how UB delivered at 0°. ASC and DE scored lower and swelling). Preliminary histology and histomorphometric anal- ITVs than their target value compared to UB. DY which had a lower ysis indicated that 78.5% of uncoated implants were successfully manufacturer recommended torque value had lower RTVs com- osseointegrated (> 60 % bone to implant contact (BIC %) and 100% pared to other groups. Time-to-failure survival of all groups was of IonL-Phe coated samples were successfully osseointegrated at similar. 30 days. Interestingly, of the successfully osseointegrated samples, the average BIC% of uncoated samples was significantly higher (p<0.05), at 80.96 % ± 6.70, than the IonL-Phe coated samples, with 70.87% ± 7.14. Conclusion: Preliminary results indicate that the IonL-Phe coat- ings may maintain or improve the chances for the osseointegra- tive success of titanium in the maxillary diastema of rats. These results indicate that ionic liquid coatings are a potential strategy to improve future generations of dental implant surfaces. 25° angled screw channel solution groups vs 0° control group OS-8 Ionic Liquids as a New Generation of Multifunctional Dental Implant Coatings: A Biocompatibility Assessment in the Lewis Rat S.E. Wheelis*, C.C. Biguetti, A. Arteaga, S. Natarajan, J. El Allami, B. Lakkasetter Chandrashekar, G.P. Garlet, D. Rodrigues Introduction: Dicationic Imidazolum-based ionic liquids with amino acid anions (IonL) have been proposed as a multifunctional coating for dental implants, addressing multiple causes of failures while maintaining host cell compatibility in vitro. However, inves- tigation of the coating impact on titanium (Ti)-tissue interactions during the early healing of dental implants in the oral environment is necessary to understand the efficacy of this approach. This study Figure 1. OM of oral epithelial mucosa after 30 days of healing in young aims to evaluate overall effect of IonL-Phe, the IonL coating with males (left), Hislotogical overview of implant osseointegration in H&E (middle) the best combination of in vitro properties, on the early healing at 30 days, and detailed view of oral mucosa and bone in contact with coated and uncoated implants in H&E (right). Arrows indicated implant location, 1M is and overall success of Ti implants using a recently validated oral first molar, SB is supporting bone, NB is new bone, and * indicates artefacts from osseointegration (OO) model in rats. histological processing. Method: The OO involved placing a 0.76x2 mm cpTi screw in maxillary diastema of twenty 10 week old male and twenty 26 week old ovariectomized female Lewis rats’ maxilla to represent best- and worst- case scenarios for bone quality. Rats received 2 implants: 1 IonL-Phe coated and uncoated on either sides of the maxillae. Peri-implant tissue was evaluated 7 and 30 days using *The first name listed is the presenter. The presenter may/may not be the primary author. 70 Table of Contents Clinical Innovations Abstracts CI-1 CI-2 Guided Workflow for Full Arch Surgery and Digitally Comprehensive Peri-implant Tissue Evaluation Driven Final Rehabilitation. Minimally Invasive Base With Ultrasonography and Cone-Beam Computed Guide Seating to Support Accurate Diagnostic Latched Tomography Conversion Converted to Hybrid Prototyping R. Siqueira*, K. Sinjab, Y. Pan, F. Soki, H. Chan, C. Rensburg*, M. Vrhovac, J.J. Marrano, D.G. Van Aarde O. Kripfgans Introduction: Full arch guided surgery is used for implant place- Introduction: As is true in medicine, accurate and comprehen- ment and to set the VDO for a diagnostically driven healing pros- sive diagnosis of peri-implant diseases is the key leading to precise thesis. The purpose of this study is to show the efficiency a guided treatment and optimal outcomes. In addition to clinical examina- workflow with latched conversion brings to the surgical and restor- tions, various intraoral and extraoral radiographs have been applied ative process. The VDO is transferred from the occlusal table of to aid in accurate evaluation of peri-implant hard tissue. Although the pre-extracted arch to a bone base guide. Historically, guides cone-beam computed tomography is becoming a standard of care required invasive tissue reflection of the buccal and palatal areas. in implant therapy, concerns have been raised recently about its Utilizing a proprietary patent pending guided workflow, offers limitation in imaging peri-implant tissues due to artifacts. The aim less invasive and more efficient surgeries. The foundation guide is of present study was to demonstrate the complementary role of seated over buccal mucosa, stabilized by Tissue Depth Indicators ultrasound (US), for a comprehensive examination of peri-implant (TDI) to protect tissue. A secondary method of laying block grafts tissues in live humans. to seat Unilateral Key Fixation (UKF) guides is also part of this study. Method: Patients with ≥ 1 implant, a CBCT scan, an US scan, Method: 251 patients processed over a 14-month period 269 and clinical photographs taken during the open-bone surgery were arches 243 single arch 216 dentate & 27 edentulous 13 full mouth included. The crestal bone thickness (CBT) and facial bone level Due to the limited sample size of dual arch and the differences in (FBL) were measured on both modalities, and direct FBL measure- techniques in edentulous the study focused on 216 dentate single ments were also made on clinical images. The correlation plots arches Cases were evaluated in three categories: Tissue reflection were made to evaluate the measurement agreements between the to seating of base guide Temporary cylinders to prosthesis ready 3 methods. The squared correlation coefficient (R2) was calculated for delivery Tissue reflection to prosthesis delivered The surgical for FBL comparisons between the methods. A Bland-Altman plot group consisted of 97 clinicians with varying experience levels was used to evaluate the CBT differences between US and CBCT. Uncontrollable variables: surgical competence, tooth extraction Results: A total of 8 implants from 4 patients were identified. complications, bone reduction method, implant system used and Representative images of the mid-facial site of the implants with sedation techniques cross sectional CBCT view, B-mode US, color mode US and direct Results: The time required to seat the base-guide - averaged assessment are shown in Figure 1. US and direct FBL measure- 22 min, due to a smaller volume of tissue reflection and less peri- ments were highly correlated (r2=0.95), whereas CBCT correlated osteum cleanup. Efficiency in the process resulted in an average satisfactorily with the direct reading (r2=0.75). CBCT exceeded US conversion time of 35 min. The efficiency increases resulted in an CBT readings by 0.17 ± 0.23 mm but without statistical significance average surgery and conversion time of 154 minutes (p=0.10). The absolute CBT difference was less than 0.5 mm in 7 Conclusion: The reduced amount of tissue reflection required out of 8 implants. There was a downward trend of the CBCT devi- to seat the base-guide, positively influenced surgery time. The ation toward 0 mm when the CBT became thicker. CBCT tended proprietary method of “jack and plug” latching of the prosthesis to misdiagnose FBL in the presence of thin crestal bone. US blood allowed for a more efficient conversion process. This study showed flow imaging was successfully recorded and showed a wide range an increase in the predictability of setting the post surgical VDO among patients with different degrees of clinical inflammation. over traditional techniques. This allows the temporary prosthesis Conclusion: The preliminary findings of the present study sug- to be utilized as the first step in the record gathering process. This gests that CBCT and US can complement each other and poten- complete guided workflow greatly influences the efficiency of the tially improve the diagnostic capability of the peri-implant diseases. final prosthetic delivery. Additional US features, e.g. blood flow imaging, may be useful to estimate the extent and severity of inflammation and deserve future research. *The first name listed is the presenter. The presenter may/may not be the primary author. 71 Table of Contents Clinical Innovations Abstracts fiducial array was then removed, and the robotic patient tracker end effector was attached to the splint. Intraoperatively, the sur- geons maneuvered a handpiece attached to the robotic guidance arm, osteotomies were created with a haptically constrained hand- piece, and the implants were also placed with 3D haptic constraints according to the virtual plan. Post-operative CBCT scans allowed the evaluation of the deviations of the final implant placement rel- ative to the plan. Results: Three dual arch patients and two single arch patients resulted in 38 individual endosteal dental implants placed. Twen- ty-three implants were placed in the mandible and 15 in the max- illa. The global angular deviation averaged 2.56° ± 1.48 while the crown and the apex of the final placed implant showed an average deviation from the plan of 1.04mm ± 0.70 and 0.95mm ± 0.73, respectively. The signed depth deviation averaged 0.42mm ± 0.46 proud. No adverse events were reported. Conclusion: This inaugural clinical series of treating the fully edentulous patient using haptic robotic guidance proved safe and accurate. While further, longer term clinical studies are neces- sary to measure outcomes and to assess differences as compared to non-robotic implementations, in the near term it seems haptic robotic preparation confers additional intraoperative advantages over other techniques for fully edentulous arches. CI-4 Ridge Augmentation in Extremely Atrophic Anterior Mandible With Custom Alveolar Ridge Splitting Technique A. Barsoum*, M. Limão Oliveira, S.C. Cho, Z. Bagheri Introduction: The absence of vital structures coupled with the frequently encountered Type II/III bone quality makes the anterior Figure 1. Representative images of Implants 1-4 (i1-i4) examined with region of the mandible suitable for implant placement. Neverthe- CBCT, US in B-mode and Color-mode, and a clinical photo. The cross-sectional less, the thinning of the coronal region of the alveolar ridge is a B-mode US clearly demarcated the exposed implant surface (I), evidenced by common finding. Reduction of the ridge height until adequate the presence of threads, the bone crest (BC), the facial bone (FB), and the facial bone width is obtained for subsequent apical implant placement mucosa (FM). Soft tissue image and blood flow are visualized in the color mode US image information. (FM=facial mucosa; FB=facial bone; BC=bone crest; may be a non-grafting option, but it is associated with increased I=exposed implant surface) crown length, which can compromise aesthetics and access for hygiene. Alternatively, GBR or ridge splitting have been shown to be predictable methods for increasing horizonatal bone volumes in CI-3 the anterior mandible. Insufficient mesial - distal distance is another Accuracy of Haptic Robotic Guidance of Dental Implant concern for single mandibular incisor replacement. This problem Surgery for the Fully Edentulous Arch can be addressed by the subcrestal placement of a platform switch- ing implant, which has been shown to maintain bone level with S.L. Bolding*, U.N. Reebye 1mm clearance from adjacent teeth, narrow diameters implants can Introduction: Despite the advances and development of CBCT- also be used in such situations. The purpose of this presentation based planning software and fabricated static surgical guides for is demonstrate ridge augmentation in extremely atrophic anterior dental implant placement, there are several limitations that impact mandible with custom alveolar ridge splitting technique. their use during surgery as well as the accuracy of the implant Method: A 36 year old male presented to the Periodontics and placement. The purpose of this study is to report the accuracy of Implant Dentistry Department, New York University, New York. dental implant placement using haptic robotic guidance in the fully Requesting to restore the missing mandibular anterior dentition edentulous patient. that were inadevertly lost due to blunt trauma of the face. Upon Method: In a prospective, IRB approved study, 5 qualified examination the patients medical review was non contributory, the patients received dental implants to replace and restore all the site of interest was classified as a Seibert Class I having suffiecent teeth of either the maxilla and mandible or both. Each arch of the bone in the vertical dimension but lacking in the horizontal. On the maxilla and mandible was treated with a full-arch implant sup- day of surgery, 2 carpules of Lidocaine (1:100k epi) were delivered ported dentition using haptic robotic guidance. A virtual preop- via field infiltration. Cortical cuts were made using a trephine to erative restorative and surgical plan was created prior to surgery. the length of 13mm, the buccal segment was moved labially and On the day of surgery, an edentulous patient splint was affixed to the osteotomy prepared at 900rpm. Implant was placed simulata- the anterior maxilla or mandible using self-tapping bone screws. nously with the ridge split in a 2-stage surgery, the implants were A patient CBCT scan with the splint-mounted fiducial array was uncovered 4 months later. obtained and merged with the previously created virtual plan. The *The first name listed is the presenter. The presenter may/may not be the primary author. 72 Table of Contents Clinical Innovations Abstracts Results: At the time of uncovering implant platforms were cov- ered with bone and had suffiecent buccal bone of 2mm width. Implants were successfully Osseointegrated and the site did not require any additional bone grafting. Conclusion: Customized alveolar ridge split technique is a via- ble treatment option in extremely atrophic anterior mandible, a site that is difficult to augment due to pressure from the oral muscula- ture and tongue thrust during swallowing. CI-6 Intra-operative Efficiency of Dental Robotics for the Fully Edentulous Arch U.N. Reebye*, S.L. Bolding Introduction: The introduction of new technology in surgery often reduces efficiency and may be associated with a learning curve to reach time neutral. The use of a haptic robotics platform for the partially edentulous patient has recently been expanded to CI-5 include a bone-mounted splint for multiple implant placement for 3-D Implant Positioning: An Innovative Tool the fully edentulous patient. The aim of this study was to document A. Barsoum*, M. Limão Oliveira, S.C. Cho the efficiency of a new fully edentulous, multiple implant workflow. Introduction: Advancements in the understanding of bone Method: In a prospective clinical study, five adult patients who regeneration and soft tissue biology have helped propel implantol- qualified for and elected to have dental implants to restore full-arch ogy to the forefront of treatment options. To optimize and facilitate dentition were treated using haptic robotic guidance resulting in predictable outcomes, cone beam computer tomography (CBCT) 29 individual implant placements. A virtual preoperative restorative planned laboratory fabricated surgical guides have gained pop- and surgical plan was created and matched to a day-of-surgery ularity as they allow for the positioning of implants in the most CBCT scan utilizing an edentulous patient splint affixed to the ante- biologically sound housing. Thereby facilitating predictable pros- rior maxilla or mandible using self-tapping bone screws. During thetically driven restorations that are both aesthetic and easily surgery, the robotic arm guided the surgeon during both the oste- maintainable. However, no intraoperative changes to position, otomies and the implant placement. To evaluate the efficiency of angulation or any deviation from the predetermined plan can be this new robotic workflow, various time durations were recorded. made during the surgery when needed for example if the bone Results: Twenty-three implants were placed in the mandible (4 anatomy was different than what was visualized on the CBCT. The patients) and 6 in the maxilla (1 patient). Two of the 5 patients were purpose of this poster is to introduce a novel free hand device that considered candidates for and successfully provided with imme- would enable the surgeon to modify the implant positions in real diately loaded full-arch prostheses. The total time with the splint time, allowing parallelism of consecutive implants and live naviga- attached to the bone averaged 95.4±20.3 minutes (range: 60 to tion of the anatomy in search of the best possible bony housing 109). The edentulous patient splint affixation and removal times within the prosthetic envelope, giving more freedom to the oper- averaged 4.6±1.8 and 1.2±0.4 minutes, respectively. Surgical time ator to customize the plan when needed. per arch averaged 15.6±10.3 minutes for osteotomies and 5.6±3.2 Method: A magnetic motion sensor was attached to both an minutes for implant placement per arch. This equated to an aver- implant handpiece and a 3D printed replica of a patients mandib- age surgical time per site of 2.7 minutes per osteotomy and 1.0 ular arch. The sensors were then connected to a computer software minute per implant placement. that is used for virtual and augmented reality modeling software Conclusion: First cases using haptic robotic guidance in fully to emulate the motion of both the handpiece and the patients jaw edentulous patients were notable for brief procedural times, in real time. A 3D surface scanner was used to replicate the jaw compatibility with minimally invasive soft tissue management and precisely into the modeling software a stock .stl file was used for access to immediate loading of restorations for candidate patients. the handpiece. These results suggest quick integration of the robotic edentulous Results: The sensors were able to model and allow the dentist protocol into the digital practitioner’s clinical workflow and the to view motion in real time with an accuracy of 1mm and a lag ease of employing robotic guidance to enhance edentulous patient time of 0.09s. Such lag is unnoticeable to the naked eye. For the treatment. Additionally, there was no wait for surgical guide fab- duration of the test, 30 minutes, the tool was able to allow us to rication, and no physical guide impeding access or visualization. track the movements on the screen without any interference from the implant motor or the operatory. No direct line of sight was needed through the entire experiment. CI-7 Conclusion: Magnetic motion tracking is a viable tool to use Histological Evaluation of rhBMP-2 in an Extraction instead of optical motion tracking which is significantly more Site Model in the Esthetic Zone expensive, bulkier and needs a direct line of sight at all times. A. Rossi*, T. Scheyer, M. McGuire Introduction: The objective of this study was to conduct a his- tological analysis of rhBMP-2/ACS graft material at 5 months ±4 *The first name listed is the presenter. The presenter may/may not be the primary author. 73 Table of Contents Clinical Innovations Abstracts weeks post grafting of maxillary (nonmolar) extraction sockets. The purpose and clinical relevance of this study is to highlight an CI-8 evidence-based approach to material selection for extraction site A Modified Technique of Zygomatic Implant preservation and histological proof of principle of de novo bone Placement: A Prospective Study With a Two-to-Five- formation following ridge preservation with rhBMP-2/ACS Year Follow-Up Method: 16 subjects were enrolled for histological sampling. T. Nguyen*, N. Vo After extraction, the socket wall was debrided with a surgical curette and irrigated with normal saline. An assessment was then made Introduction: An alternative for rehabilitation of severely atro- to ensure that there was not greater than 2 mm of vertical bone phied maxilla is to utilize the support from the zygomatic bone. loss at the study site as measured from the mid-buccal crest of Zygomatic implant placement has several disadvantages, including bone on the adjacent teeth. The XX Small 0.7 mL rhBMP-2–soaked the risk of soft-tissue infection and the high rate of sinusitis. This absorbable collagen sponge was cut into strips and placed to fill study suggested a modified technique to prevent the risk and to the defect sites. A larger strip of material (Infuse sponge soaked evaluate the zygomatic implants and its effects in preventing the with BMP) was then placed over the entire treatment site. After 5 related complications. months of healing and at the time of dental implant insertion, biop- Method: This study included 22 patients (11 female, 11 male, sies were taken by using a 3mm diameter trephine drill to obtain a and the mean age was 56,3 years) with severely atrophic edentu- core of at least 8 to 10mm in length which was placed into formalin lous maxilla were installed with zygomatic implants using the mod- solution and shipped to the laboratory for processing. The biopsies ified technique. Three key points are included: (1) the zygomatic were fixed, decalcified, and embedded in paraffin. implant was placed toward the buccal wall of the maxillary sinus; Results: Vital bone formation was seen in all samples, with noted (2) autogenous block bone graft was utilized to reinforce the buccal signs of vascularity. Histomorphometric analysis determined the wall and to increase the stability of the implant head; (3) extended percentage of vital bone and percentage of connective tissue. sinus graft was performed to create an maximum bone coverage Mean percentage of vital bone observed 5 months ± 4 weeks after around implant. Implant-supported provisional prostheses were alveolar ridge preservation with rhBMP-2/ACS was 61.58 ± 14.49%. delivered immediately, except in seven cases in which the implants Mean percentage of connective tissue observed after alveolar did not reach initial stability (<35N/cm). ridge preservation with rhBMP-2/ACS in all 16 histological samples Results: A total of 65 zygomatic implants were installed in 22 was 38.42 ± 14.49%. patients, in conjunction with 44 conventional implants. All of the Conclusion: The current study examined histologic wound heal- implants exhibited good osseointegration along the entire length ing following extraction and ridge preservation using rhBMP-2 on of the implant. Besides, two cases presented complications. One a collagen sponge. Robust formation of new vital bone was seen, case exhibited a soft tissue infection with pus discharging after suggesting that this material is a viable option for ridge preser- one month wearing provisional prosthesis. The other case had vation. All patients were able to have immediate provisionals and an implantitis after four years. Both of two cases showed buccal final restorations placed on the dental implants. The human histo- bone resorption but no oroantral fistula, the sinus membrane logical proof of principle validates rhBMP-2/ACS as an excellent remained intact, and no sign of sinusitis. Overall, the survival rates material for that provides a high quantity and quality of vital bone of zygomatic and standard implants were both 100%. The zygo- in socket preservation and in the development of ideal sites for matic- implant-supported prostheses improved both functional and tooth replacement. esthetic aspects for the patients. The mean follow-up period was 37.9 months (range, 4−65 months). Percentage of Vital Bone and Connective Tissue in 16 Histological Conclusion: This study illustrates that zygomatic implant place- Samples of Extraction Site Bone Core Biopsies ment with the new modified technique using implant head on or near the alveolar bone, onlay bone block augmentation and extended sinus grafting approach simultaneously is a successful and important treatment option when rehabilitating the atrophic maxilla. This modified technique provides a high long-term success rate and prevents patients from complications. *This patient is an obvious outlier and the only demographic information is that the patient was greater than 55 years old and had a previous history of adult periodontitis. *The first name listed is the presenter. The presenter may/may not be the primary author. 74 Table of Contents Clinical Innovations Abstracts in a rehabilitation opposing natural dentition. Described below is a technique utilizing a hybrid prototype consisting of customized 3D printed teeth with a conventional PMMA denture base to aid in implant planning. Method: Mounted diagnostic casts were obtained at the planned VDO. A diagnostic wax-up of the planned tooth position, form, occlusion and esthetics based on patient’s demands was completed, scanned and printed. The 3D printed teeth were then incorporated into a conventional denture base to fabricate a proto- type for try in. Using a dual scan protocol, the try in prototype was scanned and related to the edentulous arch for accurate implant planning and surgical guide fabrication using a digital implant planning software. The implants were placed using a guided sur- gical protocol. Post implant healing following the delayed loading protocol, the scanned file was used to fabricate a provisional 3D printed implant supported prosthesis to establish satisfactory soft tissue emergence prior to finalization of the prosthesis. Results: In case of full arch rehabilitation with sectional implant supported fixed partial dentures, soft tissue management can be challenging. Treatment planning is extremely crucial in achieving a superior and predictable esthetic outcome. Traditional workflow involves a diagnostic wax up using artificial denture teeth that is transferred to the patient’s mouth using a denture base to evalu- ate final tooth position, form, occlusion and subsequently aid in implant planning. Unlike denture teeth, a fixed wax up provides greater control over esthetic and functional parameters. Accurate transfer of this information to the patient’s mouth and clear delinea- tion of the planned cementoenamel junction, tooth form and posi- tion will dictate the number, size and position of the implants and facilitate a simple and streamlined implant planning workflow using accepted guidelines with predictable soft tissue management and a superior esthetic outcome. Conclusion: The technique allows straightforward implant plan- ning using appropriately sized and shaped teeth for the patient’s esthetic demands to achieve a predictable esthetic outcome. A, B, Intraoral images before and after six-month implant placement. C, D, E, F, Intraoral images showed the four zygomatic implants were placed toward the buccal wall of the maxillary sinus resulting in the implant heads were near or on the alveolar crest. Autogenous block bone graft was utilized to reinforce the buccal wall and to increase the stability of the implant head, extended sinus graft was performed to create an maximum bone coverage around implant head to consolidate along the implant. G, H, I, J, K, Radiographic study of the secondary phase of implant placement six months later with bar connecting Implant planning using patient specific 3D printed teeth the four zygomatic implants. G, Orthopantomographic view. H, I, J, K, CT slices showed the osseous integration surrounding all four zygomatic implants. CI-10 In Vitro Assessment of a Novel Additive Manufactured CI-9 Titanium Implant Abutment Digital Implant Planning Using Patient Specific 3D L. Kalman* printed teeth for A Full Arch Rehabilitation With Introduction: Dental implant temporization remains a clinical Sectional Implant Supported Fixed Partial Dentures challenge. A novel abutment simplifying the procedure was devel- V. Sequeira*, M.S. Bryington, M. Agusto oped, but conventional fabrication was costly and unpredictable. Introduction: Artificial denture teeth being prefabricated, can A workflow was developed to fabricate the novel abutment using be a poor representation of a patient’s natural dentition especially additive manufacturing. This in vitro investigation assessed the *The first name listed is the presenter. The presenter may/may not be the primary author. 75 Table of Contents Clinical Innovations Abstracts additive manufactured (AM) novel abutments to conventionally Results: Demographic Information 60% used the beam-type manufactured (CM) abutments. TLD, For age, 43% were more than 3 years old. Many used the Method: The AM abutments were fabricated in dental-grade device for more than one procedure, with the 45% used TLDs for titanium (Ti-6Al-4V) using Selective Laser Melting and were surgical implant placement, closely followed by placement of final post-processed. The CM abutments were milled and subsequently abutment (41%), Regarding the observation of screw loosening, laser welded manually. Pin strength of the abutments was assessed only 8 % of respondents reported that they had not seen this. Rec- using a universal loading machine. Torque was measured by tight- ognition Information 6% of the responses, had calibrated their TLD ening the AM and CM abutments into dental implants within arti- When asked about the beam position relative to the marker arm, ficial bone. 66% had the marker position correct as central mid-bar (Fig. 8). Of Results: Average pin strength was 364.4 N for the AM abut- the 371 respondents, only 14 % appeared to understand the term ments and 62.5 N for the CM abutments. Average torque was 49.9 preload. Usage Information Regarding the speed of activation of Ncm for the AM abutments and 62.9 Ncm for the CM abutments. either the toggle- or beam- type TLD, there were 422 responses AM abutment’s pin strength was higher than the CM abutments. with 58% not knowing if speed of activation affected torque deliv- CM abutments measured a higher torque than the AM abutments. ery. Only 5% correctly identified toggle-type TLD being affected Conclusion: Additive manufacturing with titanium using SLM by the speed of use. provided an alternative fabrication pathway of a novel implant Conclusion: There is a need for innovated products that can abutment. The AM approach was cost-effective, predictable, effi- assist the clinician and help educate him/ her to engineering pro- cient and demonstrated pin strength and torque suitable for tem- cesses that not only adhere to universal standards but improve porization procedures in implant dentistry. clinical efficiency. The system developed allows for most TLDS (electric, manual, beam and toggle types) to be verified in the office, reqularly and prior to use. The marker system described aids in reading torue measurement from TLDs. CI-12 A Novel Approach to Extraction Site Decontamination CI-11 With the Er,Cr:YSGG Laser Survey of Torque Limiting Devices (TLD)- A System to P. Desai* Validate, Calibrate and Improve Measurement Introduction: The Er,Cr:YSGG laser has a unique position on the electromagnetic spectrum: in that light energy can penetrate C.P. Wadhwani* 2.5um into the alveolar socket. This depth of penetration is the Introduction: Torque is used both during implant surgery and “goldilocks” depth of decontamination of alveolar pathogens applied both during implant surgical and measure preload for compared to other laser wavelengths in the preparation of the screw joint stability. Engineers are well trained in concepts related failed tooth socket for either socket preservation or an immediate to torque techniques. It is not known how dentistry has adopted implant. The decontaminated alveolar socket is key to the success- this knowledge with screw loosening complication rate of 4-12% full integration but also the longevity of the implant for the lifetime incidence. A survey was done related to : Screw mechanics, torque of the patient. We know that repeat implant replacements (Machtei limiting devices and how to employ these torque devices correctly. et al, Nelson et al) have higher and higher failure rates. There is This information was used to produce innovative system to reduce nothing available to clinicians to not only curettage the socket “non the risk of over- torque and under-torque. mechanically” but also deal with the epigenetics of the local socket Method: 428 dentists answered a 9 questionnaire survey from environment. A series of 10 cases with immediate success but also multiple countries 3 specific areas evaluated: 1. Demographical: longevity will be presented. torque limiting device used, Age, when used (surgery of prosthetic) Method: 1) full thickness flap with blade/laser sectioning the and observation of screw loosening. 2. Recognition: Calibration, granuloma away from the flap 2) atraumatic extraction of the reading measurements of the TLD, 3. Usag; Screw tightening pro- tooth (MINIE extraction) 3) laser settings changed to provide cor- tocols, effect of speed during actioning TLD. Data collection was ticoabrasion or ablative capability of all the granulomatous tags compared to industry standards. ISO 6789 1,2-2017 for screw fas- in the surrounding socket 4) once complete socket decontamina- tener protocols. tion completed, then a healthy clot forms with an elevated level of *The first name listed is the presenter. The presenter may/may not be the primary author. 76 Table of Contents Clinical Innovations Abstracts PDGF (Kesler et al) 5) GTR for socket grafting or immediate implant with GTR is performed 6) standard flap closure CI-14 Results: 10 cases will be presented with longevity and 100% Employing Interim Surgical Endodontics for Implant success rate with controlled ridge collapse due to resorption of Site Preparation of Hopeless Teeth With Endodontic the buccal plate Treatment and Critical Size Defect Lesions Conclusion: A novel approach to socket decontamination is M. Abou-Rass* presented to optimize removal of the granulation and infectious tissue tags with Er,Cr:YSGG laser as opposed to just surgical instru- Introduction: The Orthopedic literature defines Critical size mentation (ie scraping of the socket) which causing an increase in defects (CSD) as bone defects that exceed 10-15mm in width, inflammatory cascade, morbidity and risk of IAN paralysis (Froum). length, and depth with associated loss of > 50% of the site cor- The YSGG laser is incredibly safe and risk free to prepare the socket tical bone. Such pathologic defects develop in the Alveolar Bone for grafting or implant placement Process and Proper of teeth with pulpal and apical pathology caused by substandard endodontic treatment, tooth structure loss, and fractures. This Presentation shows how Implant Dentistry CI-13 clinicians can use their inherent surgical skills to perform Interim A Novel Approach to Biofilm Removal by the Surgical Endodontics for implant site preparation of teeth with CSD Er,Cr:YSGG Laser for Peri-implantitis Treatment lesions. The approach eliminates site infection, Preserves the alve- olar socket anatomic integrity, and promote native, dense bone P. Desai* regeneration without alveolar bone augmentation. Introduction: The key to successful regeneration of an ailing Method: The Interim Surgical Endodontic for cases with pre-ex- implant is early intervention while the defect is circumferential in isting endodontic treatment and CSD lesions is essentially a buc- nature (ie a 4 walled defect). The advantage to this is having com- cal diagnostic Endo-Perio surgery. The following guidelines deal plete containment of regenerative factors surrounded by alveolar with the endodontic aspects of the surgery. 1- Envelop flap with structure creating a stable, immobile blood clot and predictable intrasulcular, mucoperiosteal, horizontal incision encompassing the regeneration. The disadvantage is that we do not have a finessed hopeless tooth, and two adjacent teeth. The incision may extend access to the contaminated coronal aspect of the implant head mesial or distal as necessary to elevate the flap 3-5 mm apical to due to these same four boney walls. The Er,Cr:YSGG laser with the root end. 2- Indicated vertical incisions are made as needed its unique position on the electromagnetic spectrum, the water and placed away from the CSD boarders. 3- Complete root expo- spray”s ablative and photoacoustic capabilities with its 400 um sure, Lesion curettage, and hemorrhage control. 4- Examination diameter tips is superior to any chemico-mechanical products on for cracks, perforations, or fractures using transillumination and the market today to remove the contaminated smear layer without magnification. 5- Resection of the apical half of the involved root. heat or mechanical damage to the implant surface. 6- Root-end opening seal thru burnishing of apical Gutta-Percha or Method: 1) full thickness flap around the affected implant with cleaning the opening with ultrasonic and sealing and finishing with proper GBR/GTR flap technique using blade or Er,Cr:YSGG laser 2) Cavit. 7- Reposition, coapt, and suture the flap. 8- Periapical radio- removal of the circumferential granulation tissue around the head graphs taken 6-12 months post-operatively should confirm bone of the implant attached to flap by fileting away from healthy portion regeneration and schedule an implant placement appointment. of the flap 3) change settings on laser to implant surface settings Results: Endodontic-Based CSD lesions heal with 92%-97% pre- and circumferentially loosen the tags in a paintbrush technique dictability without bone augmentation procedures. away from the the implant 4) once the depth of the defect is iden- Conclusion: Interim Surgical Endodontics is an innovative tified, adjust tip length to 14mm if needed and keep same laser approach to temporarily(6-12month) use the hopeless tooth to: settings and in a circumferential manner remove the smear layer - Eliminate site infection, - Preserve the alveolar socket hard and moving in a 2mm/second velocity (similar to endodontic method- soft tissues - Promote the patient’s healing potential to regener- ology for canals - literature provided) 5) once this is completed to ate native dense bone without the need for augmentation. - Avoid satisfaction, a blood clot can be viewed wicking onto the cleaned Traumatic extraction of hopeless endodontically treated teeth - implant surfaced, where visible the implant”s contaminated surface Facilitates the placement of immediate implant will be shiny after oxide layer removal as well 6) once blood clot is visualized, then particulate bone and turtle neck shaped membrane can be grafted and sutured up 7) follow up photos and xrays 4 years after surgery Results: By using this novel approach to smear layer and biofilm removal a proven technique by Strever et al, Yamamoto et al., a non toxic, pathogen free implant surface allows regeneration to occur in a predictable fashion Conclusion: This novel approach to peri-implantitis treatment with the Er,Cr:YSGG laser allows removal of smear layer and thus, predictable regeneration in a previously inaccessible type I circum- ferental defect around an implant. No other techniques or tool allow this type of finesse and access to the contaminated implant surface. *The first name listed is the presenter. The presenter may/may not be the primary author. 77 Table of Contents E-poster Abstracts Purpose To introduce simplified technique to reduce the amount P1 of cement extruded during placement of cement retained implant Indirect Immediate Implant Provisionalization restoration. Technique for Preserving Soft Tissue Architecture in Method: After fabrication of implant cement retained cera- the Esthetic Zone mo-metal crowns, customized abutments were fabricated using L.F. Abdeen*, A. Papathanasiou, P. Papaspyridakos, polyvinyl siloxane material injected inside the crowns to take the shape of inner surface. After setting, the customized abutments A. Kostagianni were withdrawal using wooden picks. And then, temporary cements Introduction: This case report is illustrating the rationale and were placed inside the crowns, and placed the customized abut- treatment sequence of immediate implant placement and imme- ment and remove the cement. Finally, the custom abutments were diate provisionalization to ensure preservation of soft tissue archi- removed, and the crowns cemented inside the patient mouth. tecture in the anterior maxilla. Results: The technique shows reduced in amount of extruded Method: A 63 years old patient presented to replace her frac- cements. Also, favorable vertical displacement of the cements. tured maxillary center incisor. Upon comprehensive diagnosis, However, loss of retention was 25% of the crowns cemented. extraction of remaining root tip followed by immediate implant Conclusion: Using customized abutments showed reduced in placement and immediate loading was planned. A surgical guide amount of cement extruded. However, more studies need to eval- was fabricated and the final prosthetic plan included a ceramic uate this technique and other techniques. Loos of retention was veneer on #8 and a ceramic implant crown on #9. A flapless atrau- the most complication with such technique. matic extraction was performed and a bone-level Implant (4.1mm platform) was placed and torqued to 45 N/cm. Allograft bone graft was packed (Cortical/Cancellous mix) around the implant body to P3 maintain bone volume. An impression post was screwed intraorally Quantitative and Qualitative Assessment of Soft Tissue and a transfer index was fabricated using GC acrylic resin that was Maturation attached to the impression post and extended to the adjacent teeth. This index was used to transfer the implant position extra- B. Al Haydar*, S. Song, R. Eskow orally, by attaching an implant analogue on the impression post Introduction: Understanding the healing and maturation of the and embedding it on the initial maxillary model. A window was gingival unit following resective surgical procedures such as crown cut on the initial cast over tooth #9 and the implant analogue was lengthening and gingivectomy is essential. These biological events secured on the same position with stone. A titanium temporary will guide the treatment planning and sequencing process. abutment was coated with an opaquer and a screw retained pro- Method: Two crown lengthening cases involving osseous resec- visional crown was fabricated extraorally on the modified model. tion and two gingivectomy cases were followed for the purpose Critical and subcritical gingival contours were established to allow of evaluating soft tissue maturation. Pre-surgical and post-surgical for papilla growth and minimize facial gingival recession. The pro- documentation included quantitative measurements of probing visional was delivered less than 24 hours after the implant place- depth, supra-crestal attachment and qualitative assessment of tis- ment. At 4 months follow-up soft tissue contours were established. sue phenotype, color, texture and fullness. Once the various tissue Veneer preparation for #8 was performed over the mock-up and elements of the gingival unit are disturbed surgically, the end point implant emergence profile was captured with flowable composite of the maturation process was determined for each case by re-as- over the impression post. Impression was made using close tray sessing the quantitative and qualitative variables. Re-establishment technique and final restorations included an E.max Press Veneer for of these components for each of the cases at their appropriate #8 and a screw retained porcelain fused to 4Y-TZP zirconia crown dimensions maybe variable with restoration of soft tissue texture, for #9. color, and fullness. Results: At 6 months follow-up, ideal soft tissue contours were Results: The timeline of the healing and maturation processes established and maintained by combining immediate implant is influenced by the type of the resective procedure, tissue pheno- placement and an indirect immediate provisionalization technique. type, and patient’s biology. The speed and pattern of the soft tis- Conclusion: High patient satisfaction and esthetic outcome was sue maturation differed for each case. Comparison of the pre- and achieved under conventional workflow; the final prosthesis met the post-operative quantitative and qualitative characteristics served esthetic and functional expectations of the patient. as a means for determining the appropriate timeline for the restor- ative treatment phase. Conclusion: This case series of crown lengthening and gingivec- P2 tomy procedures emphasizes the importance of re-establishment Simplified Technique to Reduce the Amount of Cement of the supra-crestal attachment post-operatively. This determinant Extruded With Cement Retained Implant Restorations in conjunction with color, texture and fullness should be used as a guide for the timing of the initiation of the definitive restorative A.E. Alharbi* treatment. Introduction: As public demand increase for implant den- tistry, the ultimate goal is to restore the function and esthetics. So, implant supported fixed restoration is the best treatment modality to replace missing teeth. From 1980s to the early 1990s there was a strong preference for screw-retained restorations which subse- quently changed with the introduction of the cement retained. *The first name listed is the presenter. The presenter may/may not be the primary author. 78 Table of Contents E-poster Abstracts P5 Surgically Guided Implant Placement Using In-office 3D printed Resin Surgical Guide M. AlRubaie* Introduction: The implant-supported restorations have become a standard treatment option for edentulous and partially edentulous patients even in patients with severe bone atrophy and in locations previously considered unsuitable for implants. Computer-aided implant placement offers several advantages over the traditional approach, but deviations from the planned implant placement may pose significant risks, especially in the edentulous arch. In this case report, we show how we can make our own surgical guides using in-office 3D printers for highly accurate implant placement. Method: Two patients who needed 3 dental implants placement presented to Nova Southeastern University, Periodontology clinic for implant consult. CBCT and intra oral scans were taken. Den- tal implant planning software was used to make a digital wax-up, Crown lengthening case. This photo series exemplifies the observation of soft tissue maturation. plan the position of the dental implants and fabricate a surgical guide. Surgical guides were saved as 3D printing compatible file formats and guides were printed using 3D printer. Three-dimen- P4 sional guides were fabricated using FDA approved resin material. New Crestal Approach in Posterior Maxilla for Failed During surgery, sterile guide sleeves were placed with dimensions of outer diameter of 5.4mm and inner diameter of 4.2mm. PAs Implant Sites and/or panoramic images were taken to verify implant position and A. Alqarni*, D. Tsitsimelis, M. Bergamini, M. Sawada, proper placement of implants during surgery. I. Fernandez-Guallart, S.C. Cho Results: A total of 3 implants were placed accurately as planned to use the in-office 3D-printed guides. One of these three implants Introduction: Maxillary sinus augmentation has been exten- had a stent that did not seat fully without pressure. It was later sively documented as a reliable procedure for restoring bone in determined that one of the teeth where the guide sits on had pro- the severely resorbed posterior edentulous maxillary arch. This visional crown that was fabricated after the jaw scan was taken. procedure has been widely performed for gaining a predictable Necessary adjustments were done. No complications noted during increase in bone height, which is necessary for successful endos- surgeries. All implants placed with 40 NCM primary stability and seous dental implant placement in this area. In cases where the one implant needed simultaneous guided bone regeneration. maxillary artery is in close relationship with the maxillary lateral Implant placement show high accuracy when drilled and placed window, a crestal approach might be indicated. The purpose of through the surgical guide when compared to the pre-op implant this report is to present a new crestal approach in the posterior planning. maxilla for failed implant sites in severely atrophic ridges that have Conclusion: 3D in-office printed guides aid in the treatment undergone maxillary sinus augmentation. planning and also accurate positioning of implants surgically. Accu- Method: A 73 years old male patient presented for implant racy of casts, intra-oral scans, CBCTs, 3D printers, desktop scanners placement. Due to the extraction of the implant and due to a and resin quality used to fabricate guides can affect the accuracy consequent pneumatization of the maxillary sinus, sinus elevation of surgical guides. Current implant planning software and desktop was required to enhance the bone height. Through a radiological printers have opened the door to more accessible guided implant assessment with CBCT, it was determined the close proximity with surgeries in a very cost-effective manner. the maxillary artery. Hence, the strategic approach was to perform a new modified crestal approach to enhance bone height and width. Results: The recently introduced modified crestal approach technique was able to enhance the vertical bone of height and providing the simultaneous placement of implants with the sinus augmentation. At 6 months the patient was able to have a screw-re- tained implant restoration. Conclusion: Within the limitations of the current study, the recently introduced crestal approach technique represents a valid, predictable, and less invasive option that allows minimization of post-operative complications when maxillary sinus augmentation is needed. However, more research is needed to confirm the result of the current study. *The first name listed is the presenter. The presenter may/may not be the primary author. 79 Table of Contents E-poster Abstracts Method: A 61-year-old female patient was presented in Ashman P6 Department of Periodontology and Implant Dentistry with the chief Guided Bone Regeneration in Lower Anterior Using complaint of “I haven’t chewed on left side for years. This tooth Symphysis Block Graft: A Case Report has been moving for quite a while.” Intraoral examination showed M. AlRubaie* #19 (lower left mandibular first molar) with grade III mobility and #20 with grade II mobility. Lower left mandibular first molar was Introduction: Bone augmentation procedures have become extracted and a CBCT was obtained 2 months post-extraction. Scle- more predictable with the advancement of bone graft materials rotic bone and sequestrum was presented on the lingual surface along with different barrier membranes available in the market and of site #20. The lesion was radiographically suggestive of osteo- block grafts become less of a treatment of choice. This case study myelitis. A debridement procedure was planned. Six months post reports the predictability of bone augmentation procedure using debridement, the site was re-evaluated. There was vertical bone autogenous block graft harvested from the patient’s symphysis defect showing deficiency in bone height. Custom alveolar ridge region and how a complication risen during the procedure was splitting was done to improve the ridge topography. Implants were solved. placed, following by 3 months loading protocol. Patient was satis- Method: 40-year-old patient missing tooth #23 planned for fied with the outcome. implant placement had CBCT taken. Scan revealed 2mm width Results: Following debridement of the lesion, the site presented of bone available to place dental implant in prosthetically driven vertical and horizontal bone deficiency. The deficiency was man- location. Delayed implant approach was decided with subsequent aged by custom alveolar ridge splitting technique, resulting in clin- implant placement. Symphysis block graft was harvested just apical ical improvement of the site. The site was restored with implant to the defect area at tooth #23 using piezo surgical unit. During placements. Patient was satisfied. block graft fixation, block graft fractured. Bigger piece of the graft Conclusion: Ridge splitting is a viable technique to improve was oriented horizontally and coronally and rest of the defect was ridge topography in area with limited bone height. The deficiency filled with allograft. Collagen absorbable membrane was placed in buccal bone height was compensated by the lingual bone that over the area and tension free primary closure was achieved. was split using custom alveolar ridge splitting technique. Clinical Results: Healing was uneventful. Patient reported slight discom- gain in buccal bone height allows for subsequent implant resto- fort during the first 2 weeks of healing mainly from the donor site. ration. No loss of adjacent teeth vitality noted, and no alteration of chin facial contour observed. CBCT was taken at 4 months after surgery and bone width gain was 2.5mm allowing an implant placement. Conclusion: Guided bone regeneration using symphysis block graft is predictable procedure when done properly. Care must be taken when securing the block graft with bone fixation screw and leaving a safety distance of a minimum of 5mm from adjacent root apices and vital structures. P8 Digital Workflow in Double Full-arch Implant P7 Rehabilitation Implant Placement in Atrophic Posterior Mandible M. Baevsky*, Y. Kudara, K. Vazouras, P. Papaspyridakos With Osteomyelitis Introduction: The purpose of this case report is to present an T. Asvaplungprohm*, E.R. Lima, H. Talib, S.C. Cho innovative prosthodontic protocol, to reduce overall treatment time Introduction: Osteomyelitis is an inflammatory process most and complexity in double full-arch rehabilitation for edentulous prevalence in mandible which includes alveolar bone necrosis, patients via complete digital workflow. sclerosis and intraorally presented with exposed bone. The eti- Method: A 75-year old female presented with a chief complaint ologies are associated with odontogenic infection, systemic dis- of poor retention and stability of her complete dentures with con- ease, medications such as chemotherapeutic agent, steroids and sequent discomfort and inability to chew. After comprehensive bisphosphonates. This case report presents a 61-year-old female diagnostic work-up, new interim complete dentures restoring patient from incidental finding of osteomyelitic lesion at lower left function and esthetics were made prior to digital implant planning. mandibular area, management of the lesion, custom alveolar ridge After digital planning, template-guided implant placement proto- splitting to improve severe ridge deficiency and restoration on the col with the “All-on-6” concept was used for both the maxilla and site with implants. mandible. Six dental implants were placed, followed by immedi- ate loading with the conversion prosthesis, providing the patient *The first name listed is the presenter. The presenter may/may not be the primary author. 80 Table of Contents E-poster Abstracts with immediate function. After 2 months of uneventful healing and after confirmation of osseointegration, a novel 3-visit protocol from implant impression to definitive prosthesis insertion was imple- mented. At the first visit, intraoral digital impressions, fabrication of verification jig and interocclusal records were obtained on the same visit. An innovative double digital scanning (DDS) technique facilitated the accurate superimposition of STL files from digital impressions for the fabrication of the prosthesis prototype with a complete digital workflow. During the second clinical visit, the prosthesis PMMA prototypes try-in were performed and minor adjustments were made. The third visit included the insertion of the definitive monolithic zirconia prostheses. Results: The patient was satisfied with the esthetic and func- tional outcome and was enrolled on a 6-month recall program. Conclusion: Complete digital workflow was made feasible with an innovative DDS technique that facilitated the accurate superim- position of STL files from digital impressions for the fabrication of the prosthesis prototypes in a cast-free approach. P10 Accuracy of 3D Printed Casts from Digital Implant P9 Scans Versus Stone Casts from Conventional A Novel Extraoral Digital Application for Intraoral Impressions: A Comparative Study in the Anterior Scanners for Implant Hybrid Restorations Maxilla C. Banh* A. Banjar*, A. Kostagianni, Y. Chen, A. Papathanasiou, Introduction: The implant industry has long utilized guided M. Finkelman, P. Papaspyridakos surgery to expedite surgical procedures for implant placement in hybrid restorations and the latest trend has been prefabricating Introduction: Intraoral Scanners (IOS) can offer a complete dig- the temporary as well. This technology has worked well to reduce ital workflow without the need for a physical cast. However, some morbidity, increase implant stability, and in general create a more complex prosthodontic procedures, especially in the anterior max- predictable restorative result. However, this solution only address illa, may still require physical casts. This is an in-vitro study compar- the surgical aspect of the process; the restorative process is still ing the accuracy of 3D printed casts, generated from digital implant mostly analog and consists of the following steps which are nor- scans using IOS, to stone casts made of conventional impressions. mally individual appointments: initial impression, verification jig, Method: A maxillary master cast with partially edentulous ante- wax rim and bite, framework try in, wax tooth try in, and finally the rior area with two implants (Regular CrossFit, Straumann) was fabri- final delivery of the restoration. The following method only records cated. Stone casts (n=10) which served as a control, were fabricated an intraoral scanner and 30 seconds of time to completely elimi- after conventional impressions using the splinted open-tray impres- nate at least three of those appointments. sion technique. Twenty digital impressions were taken using a white light IOS (TRIOS, 3shape) and Standard Tesselation Language (STL) Method: The central problem to restoring a hybrid is not the complexity of the steps. The verification jig is no more complex files were obtained.CANCELLED Based on the STL files, digital light processing than that used for an implant fixed partial denture and the wax (Varseo S) and stereolithographic (Form 2) 3D printers were used rim is no more complex than that used for complete dentures. to print casts (n=10 from each 3D printer). The master cast and all In this case the patient was edentulous and four implants were casts generated from each group were digitized using the same placed. The existing denture was converted at the time of surgery IOS. The STL files obtained were superimposed on the master cast using temporary cylinders for multi-unit abutments. Before the tem- STL file (reference STL) to evaluate the 3D accuracy with inspection porary was delivered, a 360 degree scan of the temporary was software using the root mean square value (RMS). µ taken using the intraoral scanner. Care must be taken to capture Results: The mean RMS error was 85.9 m (SD = 30.2) for µ all surfaces including the entire screw access hole. This scan can the conventional group, 89.5 m (SD = 55.1) for the Varseo S µ be 3D printed to create a working duplicate of the temporary that group, and 111.8 m (SD = 26.1) for the Form 2 printer group. is in the patient’s mouth with functional screw access holes. At the The assumption of normality was assessed using Shapiro-Wilk test laboratory the technician can screw analogs onto this duplicate to and was significant (p < 0.05 in both 3D printed cast groups). The pour both a soft tissue model and a working analog model that is independent-samples Kruskal-Wallis test revealed a significant dif- already verified to be accurate. By combining a bite taken during ference (p = 0.018). Post-hoc testing via Dunn’s test with Bonferroni surgery this duplicate can also be used to mount the case, effec- correction showed a significant difference between Varseo S and tively eliminating three restorative visits. Form 2 printers (p = 0.009). Within the limitations of this in vitro study, the casts Results: The records that can be extrapolated from the dupli- Conclusion: cated temporary exceed the accuracy of those from analog meth- generated from the Varseo S 3D printer had better 3D accuracy ods. than Form 2 3D printer. Both the Varseo S group and the conven- tional stone cast groups had similar 3D accuracy. Conclusion: This simple 360 degree scan of the temporary effectively eliminates at least three restorative appointments and is a more accurate, predictable method of record taking. *The first name listed is the presenter. The presenter may/may not be the primary author. 81 Table of Contents E-poster Abstracts 3D information can be extracted from computerized tomography. P11 The purpose of this presentation is to evaluate and discuss limita- Implant Rehabilitation in the Anterior Maxilla Utilizing tions of intraoral periapical radiography for the measurement of the Root Submergence Technique and Digital posterior maxillary alveolar bone height and discuss the use of Workflow information obtained by means of 3D computerized tomography A. Banjar*, A. Kostagianni, A. Papathanasiou, to help plan implant placement. Method: Clinical data in this study was obtained from the P. Papaspyridakos Implant Database (ID) at New York University College of Dentistry Introduction: The purpose of this case-report is to describe a (NYUCD). The data set was extracted as de-identified information. technique for ridge preservation and soft tissue development while The ID is certified by the Office of Quality Assurance at New York utilizing a complete digital workflow in implant rehabilitation for University College of Dentistry. This study is in compliance with the the anterior maxilla. Health Insurance Portability and Accountability Act (HIPAA) require- Method: A 24-year old female patient presented for rehabili- ments. Thirty five sites with both periapical and CBCT images of the tation of her missing lateral incisors in the anterior maxilla, after posterior region were compared especially the anatomical relation- completing her orthodontic treatment. During the comprehensive ship of the maxillary crest to the sinus floor was assessed with both examination it was determined that both her central incisors pre- modalities. The values recorded from the CBCT were used as the sented with mobility, significant root resorption and unfavorable standard to which PA was subtracted from. long-term prognosis. The treatment plan included an implant-sup- Results: Difference in measurements were consistently seen ported Fixed Dental Prosthesis (FDP) with implants placed on #7 when the remaining crestal height was measured on periapical and #10 while submerging the roots of #8 and #9 to preserve radiographs and CBCT images. When the threshold was set to the ridge volume and the soft tissue architecture. A CBCT was 1mm, the discrepancy observed was 34% in 12 sites. Periapical obtained and digital implant planning was utilized to fabricate radiographs overestimated the measurements 66% of the time in a stereolithographic surgical template. Implants were placed on 23 sites. The average discrepancy was 0.75mm and ranged from sites #7 and #10 and teeth #8 and #9 were prepared to hold a -1.69 to +2.1mm when PA minusCBCT distance measurements fixed tooth supported provisional with cantilevers on the laterals. were calculated. After 3 months of healing, the two centrals were endodontically Conclusion: CBCT imaging is a valuable adjunct in radio-ana- nd treated and a 2 stage surgery for the implants followed. On this tomical and radio-diagnostic observations in the posterior maxilla appointment, #8 and #9 were submerged 3 mm below the soft region. Furthermore, CBCT measurements were shown in the cur- tissue and a screw-retained provisional prosthesis was attached on rent study to be more accurate in assessing the remaining crestal the implants for soft tissue conditioning lasted for six months. Sub- ridge height apical to the sinus membrane when compared to PA sequently, the triple scan technique was used in order to transfer radiographs. More research is necessary to verify the findings in the emergence profile and pontic design digitally, by scanning the the current study. implant provisional prosthesis both intraorally and extraorally, and taking intraoral digital impression with scan bodies placed on the implants. The 3 Standard Tessellation Language (STL) files derived from the triple digital scanning were imported in a CAD software and superimposed into one master file that contained all the infor- mation from the implant 3-D position, prosthesis contours as well as the transmucosal part of the peri-implant soft tissues and pontic. Subsequently, a monolithic 4Y-TZP zirconia screw-retained FDP was fabricated. Results: The complete digital workflow reduced the treatment time while reproducing the ideal contours of the provisional implant prosthesis. High esthetic result was achieved and patients’ expectations were met. Conclusion: This treatment approach can efficiently preserve the ridge volume and facilitate the maintenance and development of ideal soft tissue contours. P12 The Accuracy of Cone Beam Computed Tomography Versus Periapical Radiography Measurements When P13 Planning Placement of Implants in the Posterior Maxilla Screw Stability of CAD-CAM Titanium and Zirconia – A Retrospective Study Abutments on Implants With Different Internal Conical A. Barsoum*, T. Kakumoto, S.J. Froum Connections Introduction: Intraoral periapical radiography is the technique G. Çakmak*, B. Batak, B. Yilmaz, W. Johnston commonly used for measuring the remaining crestal bone height Introduction: Limited information is available regarding the when treatment planning implants in the maxillary posterior region. removal torque values (RTVs) of screws of different abutment A major drawback of conventional radiographs is that a 3-dimen- materials when used with different internal conical connections. sional (3D) entity is compressed and superimposed on itself into The purpose of this study was to evaluate the effect of implant type a 2-dimensional (2D) image which is often distorted. Conversely, *The first name listed is the presenter. The presenter may/may not be the primary author. 82 Table of Contents E-poster Abstracts and abutment material (zirconia; Zr and titanium; Ti) on the RTVs of Conclusion: CHX and PDV have superior antibacterial proper- abutment screws after cyclic loading. ties, but significantly reduced HGF proliferation at higher concen- Method: OsseoSpeed EV (EV) and OsseoSpeed TX (TX) trations. AO was bacteriostatic at lower dilution but was highly toxic implants (n=10) were clamped in resin dies. Zr and Ti (N=20) cus- to HGFs. HAG revealed significant bacteriostatic activity at lower tom abutments were fabricated, hand tightened on implants and dilution and demonstrated no detrimental effects on HGF’s. This then torqued to 20 Ncm for TX and 25 Ncm for EV implants as favorable property of HAG towards fibroblasts may enhance heal- recommended by the manufacturer. The abutments were cycli- ing. The results of our study may be extrapolated for developing cally loaded by using a sequentially increased loading protocol; a post-surgical protocol for treating periodontal and peri-implant 2-million cycles under 100 N, 3-million cycles under 200 N, and soft and hard tissue deficiencies 2-million cycles under 300 N loads with 2 Hz. After 7 million cycles, RTVs (Ncm) were measured using a torque gauge. The data were analyzed with ANOVA by using the restricted maximum likelihood estimation method. The Tukey-Kramer adjustment was used for any significant interaction of implant-abutment pairs (α=.05). Results: Two TX implants, 1 with Ti and 1 with Zr abutment, frac- tured during cyclic loading and discarded for statistical analysis. Only implant type had a significant effect on the RTVs (P<.001). Screws of Ti abutments on EV implants had significantly higher RTVs than the screws of Ti (P=.003) and Zr (P=.005) abutments on TX implants. Conclusion: Implant type significantly affected the RTVs. Screws of Ti abutments on OsseoSpeed EV implants had higher RTVs than the screws of Ti and Zr abutments on OsseoSpeed TX implants. P15 RTVs were similar for Zr and Ti abutment screws within each implant Influence of Print Angulation, Layer Thickness, type. RTVs were higher than the initial torque values for all groups. and Post-processing to the Dimension of Stereolithographic Implant Surgical Guides P14 S. Bencharit*, N. Dalal, A.A. Abdulmajeed, G. Deeb, Antibacterial Efficacies and Effects on Human Gingival R. Ammoun Fibroblasts of Four Antibacterial Agents Introduction: Stereolithographic (SLA) 3D printers allows fab- C. Batra*, M. Alalshaikh, R. Gregory, L.J. Windsor, rication of implant surgical guides with laser polymerization in a S. Blanchard, Y. Hamada small layer incremental manner that initially polymerize the resin to create an implant guide. After printing, the printed implant guide is Introduction: Chlorhexidine (CHX) is considered the gold stan- post-processed through a series of alcohol rinsing and then furthur dard anti- bacterial agent; however it leads to a reduction in human polymerized with ultraviolet light and increase temperature. This gingival fibroblast (HGF) proliferation. The aim of our study was to study aimed to examine the effects of different printed layers, print- compare the anti-bacterial efficacies of 0.12% CHX, 10% Povidone ing angulations, and post-processiong methods to the dimension Iodine (PVD), Homeopathic antiseptic gel (HAG) and Antioxidant of implant surgical guides. gel (AO) on Streptococcus mutans (S.m), Streptococcus sanguis Method: The study was divided into two parts; Part 1 to examine (S.s), Fusobacterium nucleatum (F.n) and Porphyromonas gingivalis the printing layer thickness and printing angulation, and Part 2 to (P.g) with and without nicotine and evaluate the cytotoxic effects examine the two post-processing methods. The original standard on HGFs tessellation language (STL) implant guide was printed using an SLA Method: S.m, S.s, P. g and F.n were incubated with serial dilu- 3D printer, for Part 1, at 50 and 100 µm layer thickness and at 0°, tions of anti-bacterial agents in their respective culture media (with 45°, and 90° angulation (6 groups total and n = 10 each group); and without 2 mg/ml of nicotine). Minimum inhibitory and mini- for Part 2, a total of 20 implant surgical guides were printed and mum bactericidal concentrations (MIC/MBC) were calculated using divided into 2 group (Part 2A and Part 2B; n =10 each group). For a spectrophotometer (595 nm) and blood agar plates, respectively. Part 2A, ten printed guides were postprocessed using an auto- Confocal microscopy was also performed. A water-soluble tetra- mated method. For Part 2B, ten guides were postprocessed using zolium-1 (WST-1) assay was used to measure proliferation of HGFs a series of hand washing in combination with ultrasonics. The guide and a lactate dehydrogenase (LDH) assay to measure cytotoxicity was then scanned using cone beam computed tomography and on HGFs. Positive and negative controls were maintained. then superimposed onto the original designed STL file. t-test and Results: CHX and PVD significantly inhibited the growth of all F-test as well as ANOVA followed by a post hoc t-test were used to bacterial species (p<0.05) at all dilutions. Confocal imaging demon- determine statistical significant differences (α = 0.05). strated high degree of lysed bacteria. AO and HAG inhibited the th Results: For Part 1, the overall intaglio surface discrepancies growth of all bacterial species up to only 1/4 dilution. Low degree (µm) printed at 0°, 45°, and 90° were 55.07 ± 1.36, 52.39 ± 2.09, of lysed bacteria were observed on confocal images. No significant and 61.02 ± 15.96 for 50 µm layer; and 98.38 ± 10.55, 84.47 ± differences were noted between nicotine and no nicotine group for 10.61, and 90.26 ± 5 for 100 µm layer with statistically significant any of the agents. Exposure to higher dilution (<0.00012%) CHX differences for both t-test and F-test, p < 0.001. The maximal guide did not significantly (p<0.05) affect HGF proliferation. PVD at 1, tube linear and angular deviations (µm) were statistical different 0.1, 0.01 and 0.001% significantly (p<0.05) affected cell prolifera- in all group (ANOVA, p <0.05). For Part 2, there was a statistical tion and was toxic at 1% and 0.1%. AO affected HGF proliferation difference between the means of the two methods for the overall, and was toxic at all the dilutions (p<0.05). HAG did not affect HGF proliferation and demonstrated no significant cytotoxicity (p>0.05) *The first name listed is the presenter. The presenter may/may not be the primary author. 83 Table of Contents E-poster Abstracts intaglio, and cameo positive and negative discrepancies (t-test, p limited spaces. Freehand implant surgeries may require additional < 0.001). prosthetic components with higher costs and more chair time due Conclusion: Printing implant guides at 50 µm layer has the least to the inaccuracies in regards to placement. For dental implant dimensional intaglio deviations and tube angular deviations in all placement with the X-Guide system learning curve was established angulations of printing. Using hand washing with ultrasonics shows to be between 11 and 20 cases. more consistent guide dimension than the automated method. Conclusion: When compared to freehand implant placement, the X-guide dynamic navigation system was found to be superior. It was also found to be similar to static surgical guides but promising particularly for the training of inexperienced practitioners. Figure 1 demonstrates the process of implant guide fabrication and analysis of guide dimension P16 Comparison Between the X-Guide Dynamic Navigation System and Static Surgical Guides- A Literature Review A. Benghiac*, N. Fleisher Figure 1.A. X-Guide dynamic navigation system. B. Static surgical guide. Introduction: The vast majority of implants are placed freehand or without a conventional laboratory-made guide which can lead to significant errors and additional costs and chair time. Ideal dental P17 implant positioning requires prosthetically planned implant place- Histological Findings Eight Weeks Following ment. Guided surgery allows the practitioner to place the implants Customized Alveolar Ridge Splitting Technique accordingly. However, most dentists who use this technique, use static guides. Static guides offer many advantages they are also M. Bergamini*, T. Li, M. Leung, Y. Yu, S.C. Cho limited in terms of indications. The aims of this study were (a) to Introduction: Following tooth extraction, different techniques compare the differences between the X-Guide dynamic naviga- have been introduced when replacement is planned with a dental tion system (X-Nav Technologies, LLC, Lansdale, PA), static sur- implant. A conventional approach consisting in waiting 3-4 months, gical guides and freehand dental implant placement in terms of immediate implant placement (IIP), IIP and immediate provisional- advantages and disadvantages, (b) to assess whether the former ization (IIPIP) and early implant placement (EIP). When the ridge is superior to the other two methods, (c) to establish the learning is deficient, guided bone regeneration (GBR) with simultaneous curve for the X-Guide system. implant placement can also be performed. The recent introduction Method: A Google Scholar literature review was performed of the Customized Alveolar Ridge Splitting (CARS) technique can using the MESH terms “X-Nav”, “X-Guide”, “dynamic navigation”, help to avoid many of these problems. The purpose of this case “static surgical guide” and “freehand implant surgery” and 8 sci- report is to demonstrate the step by step surgical and restorative entific journal articles published between 2016 and 2020 were procedure for the CARS technique and present histological data selected. The articles included both clinical case presentations and of the new bone generated utilizing this technique. in vitro model- based studies. Method: A 26-year-old patient presented at the NYU College of Results: Among the advantages of X-Guide, the literature Dentistry with a questionable maxillary left central incisor 12 years cites the following: it allows for same day scanning, planning and following a traumatic injury. The tooth was diagnosed as hope- implant surgery and for real-time changes of the treatment plan less and an atraumatic extraction was performed. Bone sounding and guidance during the surgery. It provides the operator with confirmed an insufficient buccal plate of bone for IIP or IIPIP. Five complete visualization of the entire surgical field. It allows prosthet- weeks following tooth extraction, CARS technique was performed. ically-driven implant placement. The disadvantages are a learning The trephine was then used fwith a customized guide was used to curve and the initial cost of the device. The advantages of static engage the cut from the trephine and move the segment buccally. surgical guide are that it allows for flapless surgeries and for the A green stick fracture was created leaving the segment still con- creation of provisionals prior to the surgery. The disadvantages are nected to the underlying bone. Eight weeks after the CARS tech- a learning curve and limited visualizatio. Also, it cannot be used in nique, an implant was placed and while performing the osteotomy, *The first name listed is the presenter. The presenter may/may not be the primary author. 84 Table of Contents E-poster Abstracts a bone core was harvested with a 2.0mm trephine bur and sent for that normally lead to wound healing by means of bone apposition histological analysis. do not take place and fibrous scar tissue is formed. Results: Sections showed multiple fragments of tissue com- Method: A 49-year-old male patient who presented a 5x10 mm posed of residual bone and new bone surrounding the bone graft implant placed 6 months ago in zone of tooth 46. Patient is currently material. enrolled in a periodontal supportive therapy because of recurrent Conclusion: This case report demonstrates the step-by-step sur- biofilm-associated gingivitis. Clinical examination revealed implant gical and restorative procedure for the CARS technique used and platform exposure and implant cover screw loss. Periimplant tis- presents histological data of new bone created utilizing this proce- sues were evaluated: probing depth ≤ 3 mm and no bleeding on dure. Histological findings from this case support the biologically probe. Radiographic exam showed about 2 mm of crestal bone based theory of new bone formation at 8 weeks after performing loss. Clinical observation suggested mobility and patient claimed the CARS technique. pain when vertical forces were applied through the impression cop- ing. Surgical phase of treatment plan consisted on counter torque explantation of existing implant. Explantation socket was carefully P18 curetted to remove granulation tissue. Immediate placement of a Fully Digital Workflow for Anterior Implant 5x11.5 mm implant following recommended drilling sequence by Rehabilitation the manufacturer, inserted with 35 N at least achieving primary sta- A. Bokhary*, A. Papathanasiou, A. Kostagianni bility. Surgical site was sutured using 4-0 braided non-absorbable figure-of-eight technique with hemostatic sponge placed to aid in The purpose of this case-report is to present a Introduction: hemostasis. Oral analgesic and a chlorhexidine 0.12% mouth rinse complete digital workflow to restore two missing maxillary central were prescribed during the healing period. incisors. The digital workflow was applied from the implant place- Results: At one week follow up visit, surgical site was clinically ment, through the provisional and definitive implant prosthesis healthy according to time evolution and sutures were removed, the design and fabrication. patient reported no postoperative complications. At one month A 25-year old male patient presented for rehabilitation Method: follow up, clinically the soft tissue of implant site was completely of his maxillary missing central incisors and fractured (Class I frac- healed. ture limited to enamel only) lateral incisors. A Treatment plan was Conclusion: Early implant failure has many risk factors; it can- conducted that included implant supported crowns on #8 and #9 not be considered only one of them as the main cause of failure. and porcelain veneers on # 7 and #10. A mock-up was performed It has been described surgical trauma, bone volume and quality and scanned using an Intra-Oral Scanner to acquire Standard Tes- as the most important risk factors for early implant failures. Also, sellation Language (STL) files. A CBCT was followed and a digital implant length is related, larger implants increase the surface area implant planning software was utilized to fabricate a stereolitho- of bone-implant contact for the immediate replacement of non-in- graphic surgical template. Implants were placed on sides #8 and tegrated implants. Spontaneous early exposure of submerged #9. Primary stability was not adequate for immediate provisional- implants could affect uneventful healing and osseointegration fol- ization. Tooth whitening was performed resulting to an A1 shade lowing implant insertion. Implant insertion below the crestal bone and after 3 months of healing, a 2nd stage surgery was done. Scan reduces cortical bone support and may result in less spontaneous bodies were placed intraorally and an implant-level digital impres- exposure. The primary criteria for assessing implant quality or sion was taken. A milled screw- retained PMMA interim prosthesis health are pain and mobility. The presence of either one greatly was designed with a CAD software and attached on the implants. compromises the implant and removal usually is indicated. Following tissue conditioning for 3 months, teeth #7 and 10 were prepared for veneers. In order to transfer the emergence profile design digitally, the provisional implant-supported prosthesis was P20 digitally scanned both intraorally and extraorally. Additionally, an Thermal Effects of 445nm Irradiation on Titanium and implant-level digital impression was taken. The 3 STL files derived Ceramic Implants from the triple digital scanning were imported in Exocad software and superimposed into one file that contained all the informa- L. Calce*, M. Hafeez, G. Romanos tion from the implant 3-D position, prosthesis contours and the Introduction: Lasers have been used in the management of transmucosal part of the peri-implant soft tissues. A monolithic peri-implantitis of titanium dental implants, but there is no evi- 4Y-TZP zirconia screw-retained fixed partial denture with porcelain dence about the thermal changes that occur within titanium and micro-layered on the facial, was fabricated for #8 and #9 and e.max ceramic implants during irradiation. The aim of this study was to veneers on #7 and #10. compare the thermal effects of a 445nm blue laser light on titanium Results: The complete digital workflow reduced treatment time and ceramic implants. while reproducing the ideal contours of the interim implant pros- Method: A titanium and ceramic dental implant were placed thesis. into an organic bovine bone analog, and a 3-wall intrabony defect Conclusion: High esthetic results were achieved and patient’s was created (3x5x6mm). Two thermocouples were used to record expectations were met. temperature changes at the coronal and apical implant portions. The tip of the 445nm diode laser was positioned parallel to the implant, and the defect was irradiated for 30 seconds at 2W in P19 continuous mode and pulsed mode. The temperature changes Early Complications Leading to Implant Failure were recorded, and a statistical comparison with the t-test was A.P. Cabadas Reyes*, V. Soto Sánchez conducted. Additionally, a digital microscope was used to capture morphological changes that occurred on the surface of the ceramic Introduction: This clinical case report aimed to evaluate biolog- implant. ical factors associated with early implant failure when mechanisms *The first name listed is the presenter. The presenter may/may not be the primary author. 85 Table of Contents E-poster Abstracts Results: The temperature changes that occurred on the coro- nal and apical portions of the titanium and ceramic implants are included in the table below. Overall, the titanium implant showed higher (P < 0.001) temperature changes at the coronal and apical levels in comparison to the ceramic implant, and the results were statistically significant. Conclusion: The titanium and ceramic implants reached critical threshold (10°C) within 30 seconds of irradiation, therefore, the 445nm blue laser light should be used with caution when treat- ing peri-implant defects in clinical settings, especially on titanium implants. Average Change in Temperature P21 The morphology of MC3T3-E1 cells with MCM Hydrogenated TiO2 Nanotubes Rregulate Osseointergration via Influencing Macrophage Polarization P22 X. Cao*, R. Lu, X. Wang, S. Chen Histological and Histomorphometric Evaluation of Introduction: We investigate a new material –the hydrogenated Human-retrieved Successfully Loaded Implants: A TiO2 nanotubes(H-TNT), which have superhydrophilic surface. Cadaveric Study H-TNT were prepared by anodic oxidation and hydrogenation to L. Chiou*, Y. Tanaka, J. Iwanaga, R. Tubbs, Y. Hamada investigate whether they can promote M2 polarization of macro- Introduction: Bone-to-implant contact (BIC) is the gold standard phage, so as to promote the proliferation and osteogenesis of to represent the degree of osseointegration. However, histologi- MC3T3-E1 cells cal evaluations of fully osseointegrated dental implants in human Method: TiO2 nanotubes (TNT) were prepared by anodic oxi- are barely published in the literature. Therefore, this study aimed dation as control group; H-TNT were prepared by anodic oxidation to analyze the BIC and bone area (BA) with functionally loaded and hydrogenation as experimental group; the smooth pure tita- implants from a human cadaver and to compare those differences nium sheets (Ti,) were used as blank control group. RAW264.7 cells between mandibular and maxillary arches. were incubated on the surface of three groups, and the secretion Method: Following the institutional board approval, a fresh-fro- of cytokines was detected by enzyme-linked immunosorbent assay. zen cadaver from a 88-year-old at death Caucasian female with After 24 hours culture, the supernatants in Ti, TNT, and H-TNT were 9 root form dental implants (5 in the maxillary and 4 in the man- harvested for the subsequent incubation of MC3T3-E1 cells. The dibular arch) was obtained. Each block was sectioned parallel to morphology of MC3T3-E1 cells were observed by fluorescence the long axis of the dental implants in the buccal-lingual (palatal) staining; cell adhesion and proliferation were measured with CCK- dimension. All specimens were stained with toluidine blue followed 8; the osteogenic differentiation were measured by ALP kit, Alizarin by basic fuchsin staining. The BIC was measured by dividing the red S staining and RT-PCR. total surface length of the implant surface in bone by the length Results: The results of enzyme-linked immunosorbent assay with actual direct bone-to-implant contact. The BA was calculated showed that the expressions of anti-inflammatory factors such as as the percentage of occupying bone area within each thread. IL-4 and IL-10 increased, and the expressions of pro-inflammatory Mean values of BIC and BA were recorded with the standard devi- factors such as TNF-α and IL-6 decreased in H-TNT group. After ations for each implant in the maxillary and mandibular arches. The indirect co-culture, fluorescence staining of MC3T3-E1 cells showed two-sample t-test was used to compare the maxillary and mandib- that the morphology of the cells in H-TNT group were more spread ular arches in BIC and BA. and elongated. CCK-8 detection revealed that the H-TNT group Results: A total of 9 implants were analyzed. Peri-implant mar- promoted the adhesion and proliferation of MC3T3-E1 cells. ALP ginal bone loss was found in all specimens. Intrabony defects were activity, alizarin red S staining, and RT-PCR demonstrated that the present in 4 maxillary implants while horizontal bone loss was H-TNT group promoted osteogenic differentiation of MC3T3-E1 noted in 5 mandibular implants and 1 maxillary implant. Higher cells. bone turnover was noted within the intrabony bone loss around Conclusion: The hydrogenated TiO2 nanotubes promoted M2 dental implants compared to the area with horizontal bone loss. polarization of macrophages, thereby promoting the proliferation The overall average of BIC was 79.31% ± 7.06%. The mean BIC and osteogenic differentiation of MC3T3-E1 cells. were 83.24% ± 4.34% (range: 76.49% to 87.65%) and 74.41% ± 7.07% (range: 69.39% to 84.89%) for maxillary and mandibular arches, respectively. The average of BA for all implants was 79.92% ± 7.98%. The mean BA for maxillary implants was 84.26% ± 6.24% (range: 77.04% to 93.94%), whereas the mean for mandibular implants was 74.49% ± 6.87% (range: 69.78% to 84.69%). There *The first name listed is the presenter. The presenter may/may not be the primary author. 86 Table of Contents E-poster Abstracts were no statistically significant differences between the two arches Conclusion: It’s possible to say that our results provide a posi- in BIC or BA (P>0.05). tive response to the photobiomodulatory effect of the irradiation Conclusion: This study revealed that the BIC and BA from func- with 980nm laser beam on the MC3T3-E1 pre-osteoblastic cell line tionally loaded implants were relatively high. In the same individual, (both with the standard handpiece and with flat-top handpiece). no significant differences were found between implants placed in We observe an increase of the osteoblastic proliferation and its the maxillary and mandibular arches. conseguent differentiation. We can also say that an increased cellu- lar vitality was observed in the cells treated with flat-top handpiece, showing a better efficacy versus the standard handpiece. Within the limits of our evaluation, our results suggest that the laser energy can provide a positive effect on the healing of the bone tissue and could be used in many different clinical area, in order to obtain a positive response in bone related dental procedure. Implants: #14 (left) and #22 (right): Intrabony defects were present in the #14 site whereas horizontal bone loss was found in the #22 site. A different staining pattern was observed in both sites. High bone-to-implant contact (BIC) was observed on both implants (mean BIC: 81.69% for #14 site; 71.79% for #22 site). P23 Laser Assisted Bone Regeneration – Bone Tissue Regeneration Through Photobiomodulation of 980 nm Diode Laser E. Colombo* P24 Introduction: Photobiomodulation is a clinical non-invasive easy application of the laser therapy; it can brings different effects to Accuracy of Intraoral Scan Based Versus Cast Scan the target tissue. Through a laser beam, with or without contact to Based Surgical Guides the tissue, it’s possible to stimulate the cellular metabolism. In our R.H. Dabbous*, M. Sabet, H.T. Mohammed clinical research we tested the photobiomodulation on bone tissue Introduction: The aim of this study was to compare the accuracy with a 980nm laser, with a standard handpiece and with a flat-top of implant placement using both intraoral scan based and cast scan handpiece, that can carry a more homogeneous beam, to evaluate based completely limiting surgical guide. how laser act on the healing of the bone tissue. Method: 20 implants divided equally into two groups, group Method: In our experimental setup we used pre-osteoblastic A implants inserted using intraoral scan based surgical guides cells from the mice calvaria (MC3T3-E1); the cells were put in a while group B implants inserted using cast scan based surgical medium to grow and feed with a serum in a standard enviroment. guides. A pre-operative CBCT was taken to determine the virtual They were divided then in 3 groups: standard handpiece, flat-top implant location regarding coronal, apical and angular positions, handpiece and control group. Each group was then irradiated at after implant placement, a postoperative CBCT was taken and the standard time interval: 1 - 3 - 5 time for week (60 sec) for 2 weeks. DDS-Pro computer software was used to match the pre and post- Then different analysis were carried out to evaluate the difference operative CBCT images, to compare angular, coronal, and apical in the metabolic situation of the cells. deviations of the virtual and the actual implants positions by super- Results: From our result we can see that all the parameters imposition with the post-operative CBCT. used were increased at the cellular level, showing an augmented Results: The mean angular deviations of the placed implants metabolis and cellular proliferation in the pre-osteoblastic cell. in-group A and B were 3.3° ± 0.51° and 2.9° ± 0.34° respectively. We observed the increase of different parameters such as Runx2, The mean coronal and apical deviations in distance between the Osterix and Dlx5 proteins, that stimulate the osteoblastic differen- planned and placed implants were 1.02 ± 0.07 mm and 1.26 ± 0.08 tiation, and also the increase of ALP, promoting the matrix miner- mm for Group A; 0.95 ± 0.08 mm and 1.13 ± 0.17 mm for Group B alization. respectively. Mean apical, coronal and angular deviations in Group *The first name listed is the presenter. The presenter may/may not be the primary author. 87 Table of Contents E-poster Abstracts B were smaller than that of Group A although it did not reach a and may require soft tissue grafting procedures with unpredictable significant level (p > 0.05). The results of the present study found clinical outcomes. that the apical deviation between the planned and actual implant Method: Three sets of titanium surfaces (machined “M”, sand- position was 1.2 mm and 1.1 mm for group A and B respectively, blasted “SA” and sandblasted, large grit, acid-etched “SLA”) were appreciably less than the well-known standard “safety zone” of 2 prepared to model standard dental implant surfaces. Each of these mm away from vital structures surfaces were disinfected and cleaned of all contaminants through Conclusion: Both methods can be used in manufacturing sur- UV-ozone treatment at 27°C for 15 seconds. One set of surfaces gical guides, as difference in accuracy is statistically insignificant. were untreated (control), a second set was treated with EDTA (24%, 1 min, rinsed with saline), a third set was treated with glycine-airflow (1 min, rinsed with saline). Each surface was measured for wet- P25 tability with a contact angle goniometer using 36mg/ml albumin GFX-1: A New Osteoinductor Biomaterial in to model saliva. Two measurements were recorded for each sur- Implantology and Medicine face, giving a total of four angle measurements each to determine V.c. da Silva* their wettability. Statistical analysis was performed with ANOVA to compare the mean angle measurements between different sets of In current practice many types of biomaterials, Introduction: surfaces under each treatment approach. osteoconductors and osteoinductors are used to promote bone Results: The average contact angle for the M, SA and SLA sur- growth prior to the implant placement. As the use of autogenous faces were for untreated surfaces: 51.25±2.12, 88.57±3.20, and bone grafts is related to increase morbidity, allografts have contra- 65.85±5.00, respectively; for EDTA-treated surfaces: 18.58±1.20, dictory induction activity and ceramics, limited properties, a new 19.28±7.22 and 23.50±6.69, respectively and for glycine-air- bone inductor biomaterial named GFX-1, have been clinically uti- flow-treated surfaces: 10.81±3.41, 20.04±4.31 and 9.40±0.19, lized for more than 30 years. Based on this results in more than respectively. The lowest contact angles for all three surfaces were two thousand cases an experiment was concluded, utilizing this obtained following glycine-airflow treatment and the highest con- biomaterial also in medicine. The aim of this pré clinical study was tact angles were obtained from the untreated surfaces. Between to demonstrate the new bone formation on anterior cervical discec- the untreated groups, a difference in the contact angle was found tomy and fusion (ACDF) in pigs. In the USA alone, approximately between M/SLA or M/SA (p<0.0001) and SA/SLA (p<0.0003). four hundred thousand surgeries are performed annually for fusion Untreated surfaces had greater contact angle (p<0.0001) com- or arthrodesis in the various segments of the spinal column (verte- pared to the treated groups without significant differences between bral). Again, the time required for the regeneration and formation EDTA- and glycine-treated group (p=0.15). These results show that of a new bone in the intersomatic space is approximately one year. treating machined, sandblasted or SLA titanium surfaces with either This research work was carried out in partnership with UnB and EDTA or glycine airflow will increase the wettability of the surface UPIS, involving eight neurosurgeons and spine surgeons, as well to albumin, leading to a greater adhesive force between the two. as eight veterinarians and three dentists. Renowned profession- Conclusion: The largest increase in wettability was found using als from Brasília and researchers from the two teaching entities, glycine-airflow. This increased wettability demonstrates increased already mentioned, as well as from USP and UniCamp participated adhesive forces between albumin and treated titanium surfaces. in this work. This result could lead to increased adhesion between grafting Eighteen pigs, divided in three groups of six animals, Method: materials and titanium surface, increasing the effectiveness of soft was utilized. After the removal of the intersomatic discs between tissue grafting. C-4 and C-5 vertebrae, the gap was filled with a new osteoinductor biomaterial, given name GFX-1 (Growth Factor X-1), and the ani- mals was euthanized, one, two and three months after the begin- P27 ning of the experiment. After clinical analysis, X-ray and computer Management of an HIV Patient With a Dental Implant tomography (CT), the corresponding areas, was submitted to the Treatment anatomo pathologic, imuno histologic and micro CT exams, in order to evaluate the quantity and quality of the new bone formed. H.C. del Razo*, D.S. Soria Pérez Results: As a result, there was a new and viable bone formation Introduction: The infection caused by HIV is considered a public and spinal fusion, in all of the periods considered in this study. health problem. The virus progressively deteriorates the immune Conclusion: The bone formation was done in a very fast way, systems cells among the cells that are affected we find CD4+ T from one to three months of the beginning of the experiment. cells, Currently there are therapies that have reduced mortality, The clinical studies in humans will be briefly initiate, in order to improved quality of life and reduces the possibility of virus trans- demonstrate a substantial reduction time from approximately one mition. This treatment is called HAART In the past, dental treatment year to nearly two months. This oral presentation I will shed light for HIV patients was limited to emergency and selective treatment. on clinical selected cases, to illustrate the utilization of the GFX-1 Due to the advance in retroviral therapy, more complex dental in implantology expanding this knowledge to the medicine field. treatments have been allowed. Method: The absence of teeth can be due to various reasons, Araujo and Lindhe conducted a study where they demonstrated P26 the loss of 30% of the vestibular and lingual walls during the three Contact Angle Wettability Semi-quantitative months later a tooth extraction, which is reflected in a change in the Assessment After Titanium Surface Modification horizontal and vertical ridge direction, making it difficult to place R. Davis*, X. Zuo, W. Hou, M. Rafailovich, G. Romanos implants in an adequate position. These changes can be minimized by performing alveolus preservation procedureso reduce this phe- Following implant placement, gingival recession Introduction: nomenon, providing a site with ideal conditions for the placement and bone loss can lead to unfavorable functional and aesthetics of a dental implant. *The first name listed is the presenter. The presenter may/may not be the primary author. 88 Table of Contents E-poster Abstracts Results: An HIV positive 34 years old male patient, which is being treated, dental clinical evaluation along with auxiliary diag- P29 nostic aids, CBCT scan help us establish a periodontitis stage II A Novel Method for Immediate Implant Placement in grade B, RT 3 on tooth # 3 and RT2 on tooth # 2 with an unfa- Defective Fresh Extraction Sites vourable prosthetic and periodontal prognosis. We can also see an A. Elaskary*, Y. Gaweesh, M. Maebed, S. Cho, M. El angulated dental implant in tooth # 4, along with a screw retained Tantawi temporary crown. According to these dental clinical findings and the patients health status, a treatment plan is established. The Introduction: This study assessed a novel treatment protocol for screw retained temporary crown would be remove and replace immediate implant placement in defective fresh extraction sockets. with a cover screw. Teeth # 2 and # 3 are going to be extracted and Method: A single-arm clinical study was conducted including socket preservation with a mixture of a xenograft bovine bone and 12 fresh extraction sockets divided into two groups: those with allograft bone. An acellular dermal membrane is going to cover intact and those with a deficient facial plate of bone. Hopeless the bone graft. Six months after these procedures, dental implants teeth were atraumatically extracted, a vestibular access horizontal are going to be place. incision was made 3 to 4 mm apical to the mucogingival junction, Conclusion: Dental literature regarding implant management in a mucoperiosteal tunnel was created from the labial orifice of the HIV patients is scarce. Due to advances in surgical procedures, safe socket, a slowly resorbing membrane shield was stabilized under protocols can be established for both the operator and patient, the tunnel, implants were placed using a surgical guide, and a improving the patients quality of life. HIV patients who are under- subepithelial connective tissue graft was harvested and secured going medical treatment may be candidates for bone graft surger- over the membrane shield. Definitive restorations were delivered ies as well as dental implant placement. Thus the success rate of a at 3 months postoperatively. Cone beam computed tomography treatment that includes bone surgery and dental implants in an HIV (CBCT) scans were taken at baseline and after 6 and 13 months to patient would be similar to an apparently healthy patient. measure facial bone thickness and height. Pink esthetic score (PES) was recorded at 6 and 13 months. Results: At 6 months, the mean ± SD facial bone thickness was 1.88 ± 0.73 mm for sockets with intact P28 facial bone compared to 0.76 ± 0.42 at baseline and 2.34 ± 0.78 Zygomatic Implant Design Using High Strength Pure mm for sockets with deficient facial bone compared with 0 ± 0 at ± Titanium baseline, whereas at 13 months, the thickness was 1.84 0.74 and 2.18 ± 0.73 mm, respectively. The facial bone crest coincided with M. dos Santos*, L. Cumming the implant platform in sockets with an intact facial bone plate and Introduction: New surgical approaches (Stella & Warner 2000, those with a deficient facial bone plate at 6 months, whereas at 13 Aparicio 2011, Pellegrino et al. 2015) and characterised patient months, the distance for sockets with a deficient facial bone plate anatomy constraints result in standard zygomatic implant dimen- increased to 0.20 ± 0.13 mm. The mean PES at 6 and 13 months sions being unfavourable due to bulky, invasive designs. By utiliz- was 11.33 for both groups out of a maximum score of 14. ing new high strength commercially pure titanium with superior Results: The proposed technique provided a minimally invasive mechanical properties (fatigue and tensile strength), design of the treatment with predictable esthetic outcome allowing immediate implants has been optimized for less invasive, anatomically con- implant placement in sockets with intact and with deficient facial servative options. plates. Method: Using FEA analysis, fatigue testing and performance Conclusion: The proposed technique provided a minimally inva- results of narrow diameter zygomatic implants that have recently sive treatment with predictable esthetic outcome allowing imme- received 510K approval in the USA, the use of narrow diameter diate implant placement in sockets with intact and with deficient zygomatic implants for quad zygoma cases is compared to stan- facial plates. dard zygomatic implant placement in terms of stress and cantile- vers applied to the zygoma. Results: ThroughCANCELLED analysis and testing it is shown that application of the high strength commercially pure titanium results in the nar- row diameter zygomatic implant achieving fatigue strengths equal to or exceeding that of standard zygomatic implants. Additionally, the ability to place multiple narrow diameter zygomatic implants in the place of one standard zygomatic implant allows are improved load distribution within the zygoma. Conclusion: Narrow diameter zygomatic implants allow for the placement of multiple implants per zygoma even in the case of P30 a narrow zygoma, with quad case surgeries providing favourable Custom Alveolar Ridge Splitting Technique in Atrophic restoration positioning and load distribution. The material selec- Posterior Mandible Edentulous Sites tion ensures the narrow diameter zygomatic implant can withstand J.Y. Eriguel*, H. Kimm, P. Hengjeerajaras, J. Scolnick, occlusal loading conditions while minimising the bone volume S.C. Cho required for implantation. Introduction: The atrophic posterior mandible is often associ- ated with high components of cortical bone, reduced vascular sup- ply, superficial muscle attachment and lack of keratinized gingiva. These factors contribute to the difficulty in increasing alveolar bone width and height prior to dental implant placement. Currently, there are a number of techniques used to augment bony defects *The first name listed is the presenter. The presenter may/may not be the primary author. 89 Table of Contents E-poster Abstracts with limited degrees of success and predictability. Custom alveolar type IV-bone quality (Sawbones®), respectively. In each group, 20 ridge technique creates a site specific defect surrounded by bony implants were placed at bone level, the other 20 implants 1mm walls. This method converts an extraosseous defect into an intraos- supracrestal. The IS was evaluated using an Osstell®-device. Com- seous defect yielding a highly successful regenerative results. parison of IS between the A, B and C for all implant groups was Method: A 79-year-old male presented with a chief complaint performed using ANOVA and Bonferroni correction for multiple of an unstable removable denture extending to his right posterior comparisons for significance level as p<0.05. mandibular edentulous ridge. Due to anatomical and prosthetic Results: Implants had a better stability when they were placed limitations, the most viable treatment option presented to the by clinician A than C. Implants placed crestally showed differ- patient was a three-unit implant-supported prosthesis together with ences between clinicians (A/C-p=0.0016; B/C-p=0.0075) but not horizontal ridge augmentation. All risks and benefits of the treat- between A and B (p=0.4435). At supracrestal placement, IS for A/C ment were discussed with the patient and the patient understood was p<0.0001 and B/C-p=0.0001 and between A/B, p=0.2864. and agreed to start treatment. In type I-bone, greater stability was achieved for A compared to Results: Two bone level implants were placed in edentulous C (p=0.0016) or B compared to C (p<0.0001); however, in type sites #29 and #30 together with custom alveolar ridge split (CARS) IV-bone the comparison of stability showed p <0.0001 for groups, augmentation technique and restored with a screw-retained fixed A/B, B/C or A/C with best IS for A. In the different diameter groups, restoration. The patient presented uneventful healing upon fol- stability values in A/C and B/C showed p<0.0001. low-up and the implants were restored with a screw-retained fixed Conclusion: Overall, both master and moderate experienced restoration. The patient’s chief complaint was addressed; both surgeons presented increased stability on 6mm-implants com- functional and esthetic demands were achieved and the patient pared to the inexperienced resident. Expert clinician achieved was satisfied with treatment. better stability of short implants in type IV-bone quality. Conclusion: Custom alveolar ridge split technique has paved the way for more predictable results in gaining alveolar ridge width. The results of this case report demonstrate both success and repro- P32 ducibility. Proper case selection and treatment planning also play a Guided Surgery Accuracy for Implant Placement in the role in achieving patient satisfaction and optimal results. Posterior Area: Case Report D. Flores Posada* Introduction: Aim: To describe the accuracy and reproducibil- ity of implant guided surgery in the posterior zone. Introduction: Guided surgery provides a virtual surgical planning with the use of a specific software and a CBCT scan. The accuracy of the reported average deviation at the level of implant entry was 1.12 mm mea- sured in 1,530 implants. The maximum deviation was 4.5 mm, the reported average deviation at the tip of the implant was 1.39 mm, with a reported maximum deviation of 7.1 mm. The average angu- lar deviation was of 3.89 degrees as well as a reported maximum deviation of 21.16 degrees. A wide range of factors that may con- tribute to deviations from the planned implant position to the real implant position should be considered. Method: Methods: A 49-year-old patient presents with a 6-year history of Sjögren’s syndrome. The oral examination reveals a gin- gival thick-scalloped phenotype and absence of tooth #46. Accord- ing to Misch’s classification, a D1 cortical bone density with a value of 1394 HU was determined. Ridge deficiency was categorized as a Class I alveolar defect according to Seibert’s classification. An anatomical impression was taken to obtain a scanned image and, P31 subsequently, a STL file. With the aid of the CT scan both images Stability of 6mm-Implants Placed by Surgeons of are matched. A virtual planning for the surgical field was performed with the 3D software, which determined to place an implant with Varying Experience In-Vitro a diameter of 4.3 mm and a length of 10 mm. A rigid guide was N. Estrin*, A. Zusin, Y. Zhang, W. Hou, G. Romanos obtained from the virtual planning through rapid prototyping with Introduction: Short dental implants are usually placed to avoid stereolithography (SLA). During implant virtual planning it was vertical augmentations. However, surgical experience seems to be determined to perform bone regeneration simultaneous to implant fundamental especially in compromised bone qualities. The aim of placement. this study was to evaluate the importance of clinical experience on Results: Results: Surgical reproducibility is achieved from the implant stability (IS) of 6mm implants placed in vitro. virtual planning in terms of the accuracy. Deviation at the level of Method: 480 implants (BioHorizons®-Tapered, 6mm with diam- implant entry was 1 mm and at the tip of the implant was 1.45 mm. eters 4.6mm and 5.8mm) were utilized. All implants were placed The average angular deviation was of 3.90 degrees. by three clinicians (A, B, and C) with different surgical experience Conclusion: Conclusion: Guided surgery accuracy for implant levels. One master clinician (A); one third-year resident having placement is within the acceptable range in most of the clinical situ- experience of almost 100 implants (B); and one resident without ations. However, a safe distance of at least 2 mm must be respected. implant experience (C). Each surgeon prepared 40 osteotomies The reported survival rate for 1,941 implants placed with guided for each implant diameter in type I-bone and 40 osteotomies in surgery was 97.3% according to a review. A wide variety of factors *The first name listed is the presenter. The presenter may/may not be the primary author. 90 Table of Contents E-poster Abstracts may contribute to deviations in the implant real position and the implant final position. Such factors include mouth opening, guide sterilization and errors during model scanning and CT scanning. P35 Critical Assessment of Systematic Reviews and Meta- analyses on Non-Surgical Therapy for Treatment of Peri-implant Diseases A.M. Gaikwad*, A.A. Joshi Introduction: Systematic reviews involve a methodical and com- prehensive search strategy, performed to identify, investigate, and conclude the research finding thus facilitating the clinical deci- sion. However, systematic reviews are seldom executed precisely. Bar graph of AMSTAR checklist showing authors’ judgment on each item Numerous systematic reviews have been conducted to determine for included reviews. the efficacy of non-surgical therapy for peri-implant diseases. How- ever, there is dearth in evidence whether the published literatures were performed with a methodological rigor and the presented P36 recommendations are feasible to validate a clinical decision. There- The Impact of Gingival Phenotype and Keratinized fore, the current review was conducted to critically evaluate the Mucosa Width on Peri-implant Health and Patient methodology of published systematic reviews investigating the efficacy of non-surgical therapy for peri-implant diseases. Related Outcome Measures Method: A literature search for systematic reviews and J. Kahng*, A.S. Gharpure, J. Latimer, F. AlJofi, meta-analyses was performed in 3 electronic databases including D. Daubert Medline, Embase, and the Cochrane database up to August 31, Introduction: There is growing evidence on the role of kera- 2020. An additional search was accomplished from journals with tinized mucosa width (KMW) and gingival phenotype (P) around high impact factors in periodontics, oral maxillofacial surgery, and implants in maintaining health. This study focused on the long-term implant dentistry. Eligible reviews were screened and assessed. impact of KMW and P on peri-implant health based on clinical and Two review authors independently evaluated the quality assess- patient-centric factors. ment by using the ‘Assessment of Methodological quality of Sys- Method: 193 implants (mean follow-up 6.9 ±3.7 years) in 63 TemAtic Reviews’ (AMSTAR) and the checklist proposed by Glenny patients were examined for plaque index (PI), gingival index (GI), et al. The inter-reviewer agreement was assessed using cohens’ probing depths (PD), bleeding on probing (BoP), suppuration and kappa coefficients. Assessment of correlation between the AMSTAR radiographic bone loss (BL). KMW (distance from gingival margin and Glenny et al checklist was performed by using the Spearmans’ to MGJ) was measured mid facially at implant sites as inadequate correlation. (< 2 mm) and adequate (≥ 2 mm). Phenotype (P) was categorized as Results: A total of 15 systematic reviews and 12 meta-analyses thin (TnP) or thick (TkP) based on show through of the periodontal fulfilled the inclusion criteria and were evaluated. The AMSTAR probe through the tissues. A questionnaire assessed patient aware- checklist score ranged from 5 to 11 with a mean of 7.5 ± 1.8 ness of food impaction and pain/discomfort during homecare. whereas the Glenny et al checklist score ranged from 3 to 14 with GEE Linear and Log-linear Regression were used to compare the a mean of 9.7 ± 2.8. A Spearman correlation analysis between these groups. 2 tools reported a high correlation (r=0.91) that was statistically Results: TnP had a statistically higher prevalence of peri-implant significant (P<0.001). disease than TkP (mucositis 43% vs 33%; peri-implantitis 27% vs Conclusion: The current evidence of the methodology of 11%, total peri-implant disease 70% vs 44%; PR 1.76, 95% CI 1.25 published systematic reviews investigating the efficacy of NST - 2.48, P < .001*). <2 mm KMW had a statistically higher prevalence for peri-implant diseases presented a medium quality evidence. of peri-implant disease than ≥ 2 mm KMW (mucositis 47% vs 34%; Furthermore, high quality systematic reviews of randomized con- peri-implantitis 24% vs 17%, total peri-implant disease 71% vs 51%; trolled clinical trials involving the use of quality assessment check- PR 1.39, 95% CI 1.02 - 1.88, P = .04*). PI, GI, BL were higher in list are needed to substantiate the evidence for the efficacy NST implants with TnP and < 2mm KMW as compared to TkP and ≥ 2 for peri-implant diseases. mm KMW (P > .05). Mean PDs were deeper in TkP (P = .61) and ≥ 2 mm KMW (P < .001*) groups. Sites with TnP had greater food impaction than TkP (55% vs 33%, P = .09) and pain/discomfort (25% vs 5%, P = .04*). Sites with < 2mm KMW had higher food impaction (53% vs 40%, P = .19) and pain/discomfort (28% vs 10%, P = .03*). TnP was strongly associated with inadeqaute KMW (PR = 3.18, 95% CI: 1.69 – 6.04, P <0.001) Conclusion: Thin phenotype (PR 1.76) and inadequate KMW (PR 1.39) may be significant risk indicators for peri-implant disease with trends for higher GI and PI scores and BL. Sites with thin phe- notype (PR 3.7) and inadequate KMW (PR 2.37) had significantly higher patient-reported outcome measures such as pain/discom- fort during homecare and higher trends for food impaction. These *The first name listed is the presenter. The presenter may/may not be the primary author. 91 Table of Contents E-poster Abstracts findings support the role of thick phenotype and adequate KMW in (p=0.51). The mean LBT for central incisor, lateral incisor and canine the maintenance of peri-implant health and favourable patient-re- ranged from 0.5mm-0.8mm. ported outcome measures. Conclusion: The most frequent type of SRP of maxillary anterior teeth in a sample of Pakistani population is Class I which is most favorable for immediate implant placement. Furthermore, LBT of maxillary esthetic zone is mostly thin i.e. within the range of 0.5- 0.8 mm. Table 1: Comparison of Thin vs Thick Gingival Phenotype and Inadequate (< 2 mm) vs Adequate (≥ 2 mm) Keratinized Mucosa Width (KMW) on the basis of implant diagnosis, GI,PI, BL, PD and patient-reported outcome measures such as Food Impaction and Pain/Discomfort during homecare. P37 Evaluation Of Sagittal Root Position (SRP) and Labial Bone Thickness (LBT) In Anterior Maxilla For P38 Immediate Implant Placement: A CBCT Based Study Effect of Bone Grafting in Jump Gap on the Outcome S. Habib*, M. Motiwala, F.R. Khan of Immediate Implants in Anterior Maxilla: A Introduction: Immediate implant placement in the maxillary Systematic Review and Meta-Analysis esthetic zone is a highly challenging and technically demanding task. To achieve favorable esthetic results, proper case selection S. Habib*, K. Zafar, F.R. Khan and treatment planning is necessary. Variables like SRP and LBT of Introduction: Immediate implant placement in the anterior max- maxillary anterior teeth are of paramount importance for predict- illa requires stringent case selection and careful treatment planning able outcomes. The objective of this study was to evaluate the SRP to optimize functional and esthetic outcomes. Factors such as root and LBT of maxillary anterior teeth for immediate implant place- position, labial cortical plate thickness and extent of jumping gap ment using cone beam computed tomography (CBCT). should be taken into account. The aim of this systematic review was Method: A cross sectional study was done to include CBCT to study the effect of bone grafting in the jumping gap distance scans of patients fulfilling the inclusion criteria. The SRP of each on the outcome of immediately placed implants in anterior maxilla tooth (maxillary canine to canine) was evaluated in a sagittal sec- Method: Literature search was done in four major health sci- tion of a CBCT scan. The LBT of each tooth was measured per- ences databases i.e. MEDLINE, Dentistry & Oral Science, CINAHL pendicularly to the long axis of tooth at three sites i.e. P1, P2 and Plus and Cochrane Library. Inclusion criteria were RCTs and cohort P3. Descriptive statistics were reported for both SRP and LBT. Chi studies, that reported at least a follow-up of six months and having square test was employed to assess any association of SRP with an intact buccal cortical plate before implant placement. Primary tooth type, age and gender. outcome was radiographic bone loss in horizontal and vertical Results: Class I SRP was the most prevalent n=196/240(81.6%). dimensions whereas secondary outcomes were soft tissue param- Class III was the least frequent SRP n=1/240 (0.4%). The associa- eters. The risk of bias in the included studies was evaluated by tion between tooth type and SRP was statistically non-significant using Cochrane risk of bias tool. *The first name listed is the presenter. The presenter may/may not be the primary author. 92 Table of Contents E-poster Abstracts Results: Out of 108 studies, seven randomized control tri- als (RCTs) met our inclusion criteria. Out of seven studies, only P40 one study reported statistically significant bone loss in no graft- Effect of LED Curing Modes on Depth of Cure of ing group (p=0.001). Four studies showed some bone loss in no BulkFill Composite Resin grafting group but the difference was statistically non-significant Z. Haji*, R. Ghafoor (p≥0.05). The forest plot depicted slightly less bone loss in bone Introduction: Introduction: Over the years, composite resins grafting group but the difference was statistically non-significant have taken over the restorative dentistry by virtue of being aes- (p=0.50). Only three studies measured the jumping gap distance thetic, metal-free restorations with predictable longevity. Compos- before implant placement. ite resin monomers are photocured at a wavelength of 420-480 nm. Conclusion: Bone grafting in the jumping gap distance appears Various types of light curing units are used for photo polymeriza- to yield less bone loss among immediately placed implants in tion of composite of which LED are commonly used. LED Light has anterior maxilla (irrespective of the jumping distance). However, different curing modes with variable intensities that influence the in comparison to no bone grafting approach, the difference is not polymerization of the restorative material. Restoring deep cavities statistically significant. More randomized clinical trials with quantifi- has a greater risk of trapping air or contaminants, bond failure and cation of jumping gap distance and consideration of labial cortical placement difficulty resulting in a sub optimal restoration. There- plate thickness with longer follow-up periods are recommended fore, SDR BulkFill composite materials have been introduced to overcome these problems. However, bulk fill materials have con- flicting reports on their success. Hence, the purpose of this study is to evaluate the depth of cure in BulkFill composite resin polym- erized by constant, pulse and ramped LED curing modes. Method: After obtaining exemption from ethical review com- mittee of the institution, cylindrical 33 composite specimens 11 in each group with dimension of 8x4mm were made in preformed P39 Teflon mould. The composite material was polymerized using Light-emitting diode using one of the three modes: Group1 with Infrared Diode Laser Irradiation on Titanium Implants constant mode; Group 2 with pulse and Group 3 with ramped In Vitro: Thermal Effects mode. Once polymerized, each specimen was extruded from the M. Hafeez*, L. Calce, G. Romanos mould and using the ISO 4049 scrapping method, uncured resin Introduction: It has been demonstrated that diode lasers can was removed. Specimen lengths were measured with a Vernier be used for treatment of peri-implantitis without clear consensus calliper. Each specimen was measured thrice and the mean was on which wavelength is safest for clinical applications. The aim of taken as the depth-of-cure. The data was subjected to ANOVA and this study was to determine the thermal effects of infrared laser Tukey’s post hoc analysis. radiation on titanium implants. Results: The pulse, constant and ramped modes resulted in Method: An implant (3.5x11mm) was placed into a bovine bone depth of cure of SDR BulkFill composite of 2.88 ± 0.27mm, 2.92 ± block. A 3-wall intrabony defect was created to simulate peri-im- 0.29mm and 3.18 ± 0.26mm, respectively. The difference in depth plant defect. Two thermocouples were secured to the apical and of cure between pulse and ramped curing mode was statistically coronal surfaces in order to measure temperature changes (ΔT) significant (p<0.04). during irradiation. The defect was irradiated with different diode Conclusion: Maximum depth of cure of SDR Bulkfill composite lasers (fiber 300µm). While the laser tips were positioned paral- was achieved by ramped cure mode of LED unit followed by Con- lel to the implant, the defect was irradiated for 30 seconds at 2W stant and Pulse modes. in continuous (c.w.) and pulsed mode. Total ΔT was recorded. 20 laser irradiations were performed for each laser wavelength for assessment of the ΔT. Results: The ΔT in both thermocouples is presented in the Table. The 940nm- laser resulted in the lowest ΔT at the coronal level in comparison to the 810nm-, 970nm-, and 980nm-lasers (p < 0.0001). The 810nm-laser resulted in the highest ΔT (coronally) in c.w. (p < 0.0001). Considering the manufacturer settings utiliz- ing the pulsed mode, the 810nm had a higher ΔT in comparison to the 940nm (p < 0.0001) and 970nm (p < 0.001). There was no significant difference in ΔT (coronally) between the 970nm- and 980nm-lasers in c.w. mode (p=0.19). The implant surpassed the critical threshold of 10°C when irradiated with each of the lasers. P41 Within the limitations of this study, the 940nm-pulsed Conclusion: Alternative Ways to Facilitate Learning for Surgical diode laser appears to be the safest in terms of overheating risk during implant irradiation. Procedures T. Hamza*, I. Dragan, R. Conca Introduction: As the COVID-19 pandemic continues to limit human interaction, advancements in technology progress rapidly. During the past few months studies have shown a spike in the usage of mobile applications across many domains. In the field of *The first name listed is the presenter. The presenter may/may not be the primary author. 93 Table of Contents E-poster Abstracts medicine and dentistry, the use of a surgical simulator application channels due to facial angle of implant placement. An implant level has bridged the gap between didactic learning and clinical train- impression was taken to have custom PMMA provisionals fabri- ing. One surgical simulator which provides a unique platform for cated. The patient remained in PMMA provisionals for four months surgical training is Touch Surgery (TS) Application. This review high- until optimal gingival architecture and occlusion was achieved. Due lights the use of cognitive task analysis training in TS and the role to the use of the angled screw channel, all restorations were made of surgical simulators in continuing education courses for medical to be screw-retained. After interproximal contacts, occlusion, and and dental professionals. esthetics were verified, prosthetics screws were torqued to 35 Ncm. Method: It is well documented that simulators play a key role Access channels were sealed with teflon tape and composite. in the education of dentistry, but also other healthcare profession- Results: A partially edentulous maxilla was restored with single als. With the advent of sophisticated mobile technology, simula- and multi-unit implant restorations. An anatomical gingival archi- tors have become less costly and more accessible. Touch Surgery tecture was able to be achieved using anatomic provisionals. The is one such mobile application simulator. Cognitive task analysis result improved the patient’s ability for maintaining gingiva health (CTA) is the underlying methodology used in the Touch Surgery as well as esthetics. By utilizing angled screw channels, screw- app. Surgical procedures on Touch Surgery are created with lead- retained restorations were able to be fabricated to improve screw ing surgical experts in the field, using a CTA approach. This creates retrievability and eliminate chance of residual cement. a map of an operation. The medical visualization team layers this Conclusion: By utilizing custom anatomic provisionals in the onto a VR patient. Cognitive Task Analysis helps you unpack the esthetic zone, appropriate gingival contours can become predict- thought processes of experts, so you can teach them to others. CTA able. breaks a procedure into its cognitive steps, with particular focus on decision-making. Results: Meta-analytic research on instructional studies, where P43 CTA is used as part of the design of instruction, provide strong evi- Placement of Two Implants in the Jaw for Overdenture, dence for its benefits. One study analyzed 38 comparison studies Prosthetically Assisted Implantological Planning and reported an overall average post-training learning and per- D. Hernández*, V. Soto formance gain of about 46 % for CTA training when compared to In implantology there are different stages of diag- more traditional training design using expert-based task analysis. Introduction: nosis that help us to prevent future complications in the treatment. Research shows that the implementation of applications in peda- Dental implants have become the first choice in the treatment of gogy have improved knowledge retention, boosted confidence, partial/total edentulism; However, for this type of rehabilitation, a provided easier access to educational materials, and reduced levels diagnosis and a correct surgical and prosthetic treatment plan are of anxiety with learning. of the most importance to achieve long-term success. Conclusion: Simulation experiences can be realistic, highly A 63-year-old female patient has presented to the engaging, and immersive, such that users feel that they are per- Method: Advanced dentistry program of UNAM, to obtain a solution to forming on a live patient. It is increasingly important to maximize the mobility problem and poor retention with her total prosthe- preoperative learning and postoperative knowledge consolidation, ses. Intraoral exploration revealed total upper and lower acrylic as well as to provide educational tools that can be utilized outside prostheses, with an inadequate occlusion. When the prosthesis was of the hospital to allow surgical training to thrive. removed, an atrophic alveolar ridge was observed in the maxilla and mandible with a type 4 bone classification (Atwood). The lower P42 prosthesis that the patient already has in the mouth is duplicated to Achieving Esthetic Gingival Architecture and Implant have a radiographic guide for the planning and placement of the 2 implants, in order to visualize the prosthesis in the tomography Prosthetics Using Anatomic Provisionals and Angled which was performed in closed mouth and in DICOM format. The Screw Channels closed mouth tomography and the duplication of the prosthesis K.S. Hanser*, R. Blackwell, M. Omran, B. Gruender with barium sulfate are used to see the prosthetic space available Introduction: It’s been long known that the esthetics of implants and to visualize the canines in the prosthesis for implants place- is determined in large by creating appropriate tissue contours. Not ment in this area. In the software, planning was carried out with only do appropriate tissue contours contribute to esthetics but also 4.2x10mm implants and a permissive guide was made with the cleansiblity and maintenance of implants. This clinical case study same duplicate of the prosthesis. On the day of the surgical proce- demonstrates how appropriate tissue sculpting improves gingival dure, a full thickness flap was made, a plateau was made with drills health and esthetics. Peri-implantitis as a result of excess cement of low speed and the prosthetically assisted guide was placed to is also a large concern when restoring cement-retained implant have the reference on the site of 3.3 and 4.3 which helped us to restorations. This case also demonstrates the use of angle screw make the marking on the alveolar ridge, since we had the marking, channels so that the prosthetics may be screw-retained, eliminating the guide was removed and proceeded to perform all the drilling the possibility of residual cement causing peri- implantitis. protocol for implant insertion, finishing the drilling protocol, the Method: Patient was referred for prosthetic restoration of implants were inserted manually, in which we obtained a torque implants in sites #5, #6, #7, #10, #11 to replace missing teeth #5 - of 35N, cover screws were placed and sutured. #11. Patient presented with healing abutments on all implants. Gin- Results: The placement of 2 dental implants was achieved based gival tissue around implants was red, erythematous, and purulent on the planning and prosthetic guidance carried out through a due to prolonged use of a removable appliance. Treatment recom- software. The placement of the implants with the help of this pros- mended was to restore implants #5, #6, #11 with single unit mono- thetically assisted guide was a successful placement. lithic zirconia screw-retained crowns. Implants #7 - #10 would be Conclusion: Studies have shown that the use of implant place- restored as a screw-retained fixed partial denture replacing teeth ment guides results in the success of prosthetic treatment. #8, #9. Crowns #5, #6 would be fabricated using angled screw *The first name listed is the presenter. The presenter may/may not be the primary author. 94 Table of Contents E-poster Abstracts P44 P45 Effects of Selenium Nanoparticles on Osteoblastic Risks of Sinus Floor Elevation Complications and Differentiation and Antimicrobial Effects on Pathogen Contributing Factors During and After Sinus Floor of Peri-Implantitis Elevation: A Systematic Review and Meta-Analysis J. Hou*, Y. Tamura, H. Lu, Y. Takahashi, H. Nakata, Y. Hsu*, C. Lee, K. Choksi, M. Shih, P. Rosen S. Kuroda Introduction: Posterior maxillary reconstruction is challenging Introduction: Peri-implantitis is a major complication that threat- for implant therapy. The sinus floor elevation (SFE) runs a signif- ens the success of implant restoration through the destruction of icant complication rate even though it has been widely applied alveolar bone. Selenium Nanoparticles (SeNP) possess therapeutic and achieved high levels of dental implant survival. This system- properties exhibiting biological activities, low toxicity and excellent atic review aimed to investigate the risk of complications with SFE bioavailability. This study aims to measure the effect of different procedures, including sinus membrane perforation (SMP) and their SeNP concentrations achieving an optimal antimicrobial effect with associated factors. absence or negligible adverse effect for the potential implementa- Method: Electronic databases and hand searches were con- tion of Implant coatings. ducted to screen literature published from January 1960 to August Method: MC3T3 osteoblast precursor cell line and Porphyro- 2020. The selected studies had to report well-described SFE tech- monas gingivalis of the red complex bacteria were used to observe niques and complications during and post-SFE. Variables of interest the effect of SeNp. The SeNP concentrations (C-) evaluated con- included SFE techniques, SFE complications of all types, and the sisted of 2, 4, 8, 16, 32, 64, 128, 256, 512, 1024, and 2048 in ppm. number of SMP events. Pairwise and network meta-analyses were Control sample were medium with no presence of SeNP. The shape conducted to evaluate the associations between surgical tech- and size of the nanoparticle was examined. The experimental test, niques and SMP. The odds ratios of SMP between surgical tech- including Proliferation assay, ALP activity and Alizarin Red Staining, niques were calculated. The effects of variables, such as residual and Optical Density to CFU/mL for bacteria concentration density, ridge height (RRH), clinical settings, and premedication on odds were utilized to analyze the proliferation rate, osteogenic differen- ratios were also evaluated. tiation, and antimicrobial effects, respectively. Results: A total of 90 studies with a total of 5822 SFE proce- Results: TEM analysis showed the mean size of the particles dures were included in the meta-analysis. Different SFE techniques were in the ultrafine size of 80 nm. All concentrations showed no demonstrated distinct features of complications with varying rates. significant difference to control in proliferation rate in Day 3. As Lateral window sinus floor elevation (LSFE) techniques tended to time progressed from Day 3 to Day 5, C-128 to C-2048 presented have a higher risk of SMP than transcrestal sinus floor elevation with significant lower proliferation rate to that of control. ALP activ- (TSFE). The surgical technique with the lowest risk of SMP was ities in Day 3, 5 and 7, were significantly lower in C-128, C-256, reamer-mediated TSFE. Comparing LSFE techniques, the use of C-512, C-1024, and C-2048. Both Proliferation and ALP assay rotary bur showed the highest risk of SMP than LSFE using piezo- showed toxicity in C-128 and above. However, Alizarin Red staining electric surgery or alternative techniques. RRH, clinical setting, and only showed great calcium deposition in C-2, C-4, C-8, and C-16, premedication did not significantly affect the odds ratios of SMP while the start of inhibition begins at C-32 ppm. Bacterial density between surgical techniques (p>0.05). Management of SFE com- in a 4-day incubation period at control was 3.9 x 106 CFU/mL. C-32 plications is also summarized as a clinical guideline. and C-64 significantly decreased the bacterial density to 2.1 x 106 Conclusion: This review is the first pairwise and network CFU/mL and 2.0 x 106, respectively. meta-analyses comparing SMP risks between multiple SFE tech- Conclusion: Concentration from 2 ppm to 64 ppm showed the niques with the most extensive data pool. The results of the system- best results exhibiting no inhibition to proliferation rates and osteo- atic review demonstrated how features of complications varied in genic differentiation. However, 32 ppm seemed to start affecting LSFE and TSFE using different techniques with the inherent limita- the calcium deposition in mineralization. Antimicrobial effects are tions. TSFE had a lower risk of SMP than LSFE. Using TSFE, reamer significant in all ranges of concentration. Concentration ranging mediate technique, had a lower risk of SMP than osteotome or from 2 ppm to 64 ppm showed potential and should be further hydraulic TSFE. Using techniques other than rotary bur to outline investigated in animal studies. the window during LSFE may reduce the SMP risk. P46 Quad Zygomatic Implants and Immediate Loading for the Severely Atrophic Maxilla; A Case Report M. Imani Emadi*, R.J. Almasri, K. Azzouz Introduction: The zygomatic implant is another means to estab- lish posterior support in patients who lack remaining alveolar bone. the limited intraoperative visibility, the vicinity of critical anatomical structures, as well as the inherent intricacies of the curved zygo- matic bone, make this type of surgery a demanding procedure. Method: A 57-Year-old Hispanic female with no significant medical history presented to the private practice with this chief complaint; “My partials move when I eat; I need implants”. Upon a comprehensive oral exam and CBCT scan review, a diagnosis of a partially edentulous atrophic maxilla and mandible was concluded. *The first name listed is the presenter. The presenter may/may not be the primary author. 95 Table of Contents E-poster Abstracts Patient was presented with both grafted and graft-less options for absence by trained observers on two separate occasions. Inde- a fixed dental implant restoration. Patient decided to proceed with pendent t-tests were applied to compare remaining GP and time the graft-less approach/zygomatic implants after the pros and cons required to remove it among both groups. Chi-Square was applied of each treatment modality was discussed with her. Surgery was to determine the association of remaining GP w.r.t location in canal. performed under Intravenous (IV) sedation. Full thickness muco- Level of significance was kept at (P value < 0.01) periosteal flap was elevated with clear visualization of the maxil- Results: Mean remaining GP in PTN and PTUR file was 1.71 ± lary buttress, nasal aperture, and the zygomatic base. The surgical 2.1 and 2.01 ± 2.6 respectively. The mean time required to remove guide was placed to idealize the depth and implant prosthetic maximum GP was 2.58 ± 0.75 and 3.16 ± 0.91 in PTN and PTUR emergence. After placing four zygomatic implants and suturing the groups. The amount of GP and time required to remove maximum mucosa, the immediate processed dentures were tried in, utilizing root filling material among both groups were not were not signifi- the palatal seat for the Maxilla and occlusal record that was made cantly significant (p value > 0.01). However, PTN was found to be prior to surgery for the mandible. After picking up the temporary more efficient in removing coronal GP (P value < 0.01). cylinders in the mouth, the prosthesis was removed, and all bor- Conclusion: The results indicated that PTN and PTUR are equally ders, palate, and extensions consistent with a complete denture efficient in removing GP from the canals. PTN is more efficient in cut back. The prosthesis was returned to the patient’s mouth and removing GP from the coronal third of the root. occlusion was adjusted. Results: At the conclusion of the 6-month healing time, teeth Difference of Remaining gutta-percha and time taken to remove it in try-in was done to confirm esthetic, function and speech. Fabrica- PTN and PTUR tion of the definitive prosthesis was done utilizing the fully milled zirconia teeth. Patient reported improvements in self-esteem and quality of life compared with the time she was wearing the remov- able prostheses. Conclusion: Bilaterally placing zygomatic implants and imme- Independent sample t-test p-value ≤0.01 is significant diately loading the prosthesis is a predictable treatment option for the reconstruction of the severely atrophic maxilla. Advantages include fewer surgical procedures, shortened treatment time, pre- P48 dictable immediate load, no need for adjunct grafting and overall Effects of Cannabidiol on Cytokines from Cigarette a higher acceptance rate from patients’ prospective. Smoke Condensate- Treated Human Gingival Fibroblasts U. Janu*, W. Jack, S. Blanchard, V. John Introduction: Cannabis sativa, commonly known as marijuana, is the most frequently used illicit drug for recreational purposes. Can- nabidiol (CBD) is the major non-psychotropic constituent of Can- nabis, composing as much as 45-50% of Cannabis extracts. It has been suggested that the use of CBD might reduce inflammation as it occurs in Periodontitis. Tobacco is a significant risk factor for the development and progression of Periodontitis. Aim: To evaluate the effects of CBD on cytokine expression from cigarette smoke con- densate (CSC) treated human gingival fibroblasts (HGFs) in vitro. Method: To determine the highest non-toxic level of CBD that does not affect cell proliferation, the effects of CBD on HGFs cell 3-week post-op, frontal view proliferation and cytotoxicity were assessed using WST-1 and LDH assays at different CBD concentrations, respectively. HGFs were P47 then incubated for 72 hours in serum-free media with CBD (31.4 µ µ Comparative Evaluation of ProTaper Next File and g/mL), with CSC (100 g/mL), with CBD and CSC, or with neither. Conditioned media were collected and examined for changes in ProTaper Universal Retreatment File in Removal of cytokine expression using cytokine protein arrays. Gutta Percha: An In-Vitro Study Results: It was determined that 31.4 µg/mL of CBD was not S. Jamal*, Z. Haji, R. Ghafoor toxic to the cells and did not affect cell growth, while all the higher Introduction: The removal of old filling material and sealer from concentrations examined did. The effects of CSC+CBD combined canal is an important factor for adequate debridement in endodon- on IL-10 was determined to be synergistic (CSC+CBD was signifi- tic retreatment for which various types of nickel titanium (NiTi) cantly greater than the sum of the individual effects of CSC and rotary instruments have been introduced. This study will help us CBD, P-value 0.045). The effects of CSC+CBD combined were not find an efficient file system for endodontic retreatment for clinical significantly different from an additive effect for GRO a/b/g, GRO practice alpha (CXCL1), IL-3, IL-6, IL-8 (CXCL8), or MCP-1 (CCL2), all P-values Method: Sixty human single rooted straight canals were obtu- greater than 0.05. rated using standardized method to an apical ISO size X2, with Conclusion: CBD at 31.4 µg/mL or lower does not affect cell thermoplastic GP. Retreatment was performed with PTN and PTUR proliferation and was not toxic to HGFs. There was a synergistic files. Time for each method was noted. Standardized radiographs effect on HGFs with the combination of CSC+CBD on IL-10 protein were obtained and analyzed on Image J to evaluate remaining GP expression, an anti-inflammatory cytokine. It has been suggested in apical, middle and coronal thirds in order to score presence or that the use of CBD might reduce inflammation as it occurs in *The first name listed is the presenter. The presenter may/may not be the primary author. 96 Table of Contents E-poster Abstracts Periodontitis and Implant failure. Tobacco is a significant risk fac- Conclusion: Provisional crowns fabricated using Integrity tor for the development and progression of Periodontitis, as well showed greater marginal accuracy than Protemp 4 crowns. The as implant failure. This effect suggests that CBD could be of ther- buccal margin of the prepared abutment was the least marginally apeutic value for tobacco users that developed Periodontitis or accurate. Marginal accuracy is significantly affected by the type of have Implants. provisional material and the margins of the preparation. P50 Prosthetically Driven Dynamic Implant Navigation for Full Arch Rehabilitation J.P. Jones*, Z. Brown, C. Bergeron, C. Barboza, D. Perez Introduction: Implant position and adequate bone reduction are P49 crucial components for successful full-arch, implant-retained dental Comparison of Marginal Accuracy in Two Different rehabilitation. The purpose of this retrospective study is to assess Materials Used in Provisional Crown & Bridge – An the accuracy and workflow of dynamic implant navigation using In-vitro Experimental Study the X-Guide (X-Nav Technologies, Inc., Lansdale, Pennsylvania) for F. Javed*, A. Arif, F.R. Khan edentulous patients receiving full arch rehabilitation. Method: All patients that underwent the edentulous X-Guide Introduction: A temporary crown with a good marginal adap- navigation protocol between 2019-2020 at the University of Texas tation will maintain health of the periodontal tissues and allow Health at San Antonio were retrospectively analyzed. One surgeon for proper gingival contours, thereby facilitating impression and placed implants in either the maxilla or mandible of edentulous cementation procedures. Currently, there are various materials patients using the X-Guide E-clip. Post-operative cone-beam CT that can be used to fabricate temporary crowns, which makes it scans were obtained for all patients. Implants that were placed a challenge to find the right material that can effectively form an completely using the E-clip were assessed for platform deviation, accurate marginal seal. The objective of this study was to determine apex deviation, and angular deviation from the virtual plan. Primary the difference in the marginal accuracy at buccal, lingual, mesial outcome measures were implant accuracy from planned position and distal margins of temporary crowns fabricated with Protemp 4 versus actual position. Secondary outcome measures were work- versus Integrity crown and bridge material. flow of dynamic implant navigation, and success of prosthesis fab- Method: Two bisacryl based temporary crown material, Integrity rication. and Protemp 4, were used to fabricate twelve temporary crowns Results: After review, 4 patients and 18 implants were identified each using the direct method. A pre-operative polyvinyl siloxane as having full arch rehabilitation with the edentulous X-Guide navi- impression served as a template for temporary crown fabrication. gation protocol. All eighteen were standard dental implants. All of A right mandibular molar tooth on a typodont was prepared to the patients were reviewed within the study but 6 implants deviated receive a crown. The provisional crown material was syringed onto from the X-Guide navigation protocol during implant placement the template and allowed to cure following the manufacturer’s and were not included within the accuracy calculations. The mean instructions. All four surfaces of the crown were observed under deviation from planned to actual was 3.96 degrees angular devi- a stereomicroscope equipped with digital SLR camera at 25.6x ation, 2.2 mm mean apex deviation, and 2.2 mm mean platform magnification. Once focused, the image of each surface was cap- deviation. All patients had predictable prosthetic fabrication with tured and a photographic record maintained. An image process- accurate bone reduction, and implant projection through pros- ing software was used for measurement of marginal discrepancy. thesis. No patients had implant failures that prevented prosthesis Independent sample t-test was used to calculate the difference in fabrication. means between the two provisional materials. Marginal accuracy Conclusion: Dynamic implant navigation is an emerging tech- between four surfaces was assessed using one-way ANOVA with nology in implant placement and workflow only continues to Tukey HSD post hoc analysis. To check for interaction between the improve. This study features 4 patients with predictable and accu- material, surfaces and marginal discrepancy Factorial ANOVA was rate prosthesis driven full-arch rehabilitation. used. A p-value of <0.05 was considered significant. Results: Mean marginal discrepancy for provisional crowns fab- ricated with Protemp 4 and Integrity was 410 ± 222 μm and 319 ± 176 μm respectively. The marginal discrepancy between the two groups was statistically significant (p = 0.027) with buccal margin exhibiting the most discrepancy (p < 0.01). *The first name listed is the presenter. The presenter may/may not be the primary author. 97 Table of Contents E-poster Abstracts Summary of Implant Accurancy of this retrospective analysis was to show the effect of various can- cer treatment modalities on the clinical outcome of dental implants. Method: A retrospective cohort of patients within a regional ser- vice were selected to assess the survival of dental implants placed post cancer treatment between 2012-2020. The primary outcome measures were implant survival, and prosthesis survival. Second- ary factors recorded included types of cancer treatment received including the type and dosage of radiotherapy, the site and timing of dental implant placement as well as recording the outcomes associated with the restoration. Results: The sample consisted of 300 implants placed in head and neck cancer patients who had received post-operative radio- therapy. The average follow up time was 48 months. All of the patients were rehabilitated with a prosthesis. The majority of all the implants placed survived. Most of the patients had implants placed P51 in bone irradiated with more than 50 Grays. Within the cohort of The Clinical Predicament: Peri-implantitis or Squamous patients that had implant failures, oral hygiene and their previous medical history proved to be risk factors. It was noted that a major Cell Carcinoma? proportion of the prosthesis were over engineered to accommo- R. Gilhespy*, A.E. Karjikar, A.U. Alsaggaf, M.R. Fenlon, date for the oral environment of these cancer rehabilitated patients. G. Paolinelis Conclusion: The results of this study show that rehabilitation Introduction: Although peri-implantitis is quite prevalent, squa- with dental implants are a feasible option for head and neck cancer mous cell carcinoma dental adjacent to implants is an atypical patients however it is a clinicians role to be aware of the limitations finding. Recent years have marked several reports of this clinical due to the effects of the cancer treatment itself. Further clinical trial anomaly. They have overlapping clinical features and both present and systematic review are needed in this direction. with bone loss and associated loss of soft tissue support. The aim of this study is to identify the risk factors associated with squamous cell carcinoma around dental implants. P53 Method: As part of a bigger systematic literature search per- Esthetic Challenge for Restoring Facial Support in formed for ‘outcome of dental implants in Head and Neck can- Severe Bone Resorption Case cer patients”, the authors were able to separately identify papers K.H. Kim* including the keywords ‘dental implants’, ‘Squamous cell carcinoma’ Introduction: With failed implants and severe bone loss, it AND ‘Peri-implantitis’ for the purpose of this research. Only human was quite challenging to make the case successful and meet the studies and English articles were used for the purpose of this study. esthetic expectation. This case lists things we need to keep in mind Results: History of previous squamous cell carcinoma or other when we start the difficult patient cases. extra-oral cancer and pre-malignant lesions/conditions can be Method: A patient made a consultation appointment showing identified as additional risk factors to the baseline oral cancer risk severe bone resorption and failed implants. Implant fixtures were factors: tobacco and alcohol consumption. It is of interest to note bonded to the prostheses and she has been using the implants fix- that many of the cases were ‘de novo’ in origin. Unknown factors or ture attached dentures with over the counter denture glue. Gingiva habits may be synergistically involved in the development of cancer was quite irritated but she has been using that way for her social around the dental implant. function. First consultation day x-ray showed even one upside Conclusion: Although rare, it is the Clinicians role to be aware of down fixture. She did not even want to take out the denture in first the plausible risk factors associated with squamous cell carcinoma appointment. Later, she showed the presenter how she removed around dental implants. Early identification with appropriate man- the denture and that involved bleeding from forced removal. That agement is of prime importance. Prosthetic rehabilitation around put her in quite high infection risk and made her embarrassed and such implants should be carefully managed keeping in mind ease affected her social life negatively. of mucosal inspection and cleansibility. A certain degree of vigi- Results: Clinically, too much bone loss was present to plan any lance is needed when managing patients with existing risk factors. treatment options. Lower posterior ridge showed 1mm above Infe- rior alveolar nerve and upper front ridge has only 1-2mm thickness. P52 Bone loss happened all the way to nasal floor. Only possible area for implant placement was upper posterior and lower front. For Interplay of Different Cancer Treatments on Dental lower, three implants supported overdenture was planned and for Implants: Retrospective Analysis of 300 Implants upper, hybrid denture over six implants was discussed. Implant R. Gilhespy*, A.E. Karjikar, A.U. Alsaggaf, S. Haria, osseointegration was successful. When final case was presented, G. Paolinelis, M.R. Fenlon she brought her twenties photo and demanded the same appear- Introduction: Dental rehabilitation of head and neck oncology ance. Multiple times teeth try in was done and case was completed patients has always been a challenge to the clinician. The success but at the end, she complained about the result and she did not and complications of dental implants associated with the various pay full fee and left disappointed. treatments has always been a matter of debate. Dental implant Conclusion: As an implant clinician, we all are focused on how therapy have been shown to be a successful treatment modality in to regain the bone structure and get the fixtures successful. For the rehabilitation of head and neck oncology patients. The purpose these difficult cases, clinicians can be focused on how to resolve the infection and making prostheses stable but after the hard work, *The first name listed is the presenter. The presenter may/may not be the primary author. 98 Table of Contents E-poster Abstracts we might not be able to deliver what patient wants. Pretreatment full communication regarding esthetic demand should be fully dis- P55 cussed to achieve best result. Clinical Application of Custom Alveolar Ridge Splitting Technique in Posterior Single Implant Site H. Kimm*, J. Eriguel, M. Kang, S.C. Cho Introduction: Successful dental implant treatment depends on sufficient bone volume around the implant site. Insufficient in either vertical or horizontal bone volume could result in no stability of the implant negatively affecting the oseeointegration, thus giving bad prognosis of the implant treatment. Many techniques were proposed to reconstruct atrophic alveolar ridge for placement of implant such as distraction oseeogenesis, autogenous onlay graft, guided bone regeneration (GBR), or ridge split techniques. Although reconstruction of atrophic alveolar ridge is possible, the risks, biological complications, cost, and prolonged treatment time associated with bone augmentation procedures have led clini- cians to look for alternative treatment options. The purpose of this presentation is to introduce custom alveolar ride splitting (CARS) technique in atrophic posterior single implant site. From the CARS P54 technique, the risks and biological complications are much less Combined Surgical Treatment of MRONJ Patients With with shorter treatment time associated with the procedure. rhPTH Method: A 77 years old male patient who was looking for S. Kim*, W. Shin implants for his edentulous area had a first premolar site with insuf- ficient horizontal bone. The area was narrow between the adja- Introduction: Parathyroid hormone (PTH) is a hormone that reg- cent teeth and guided bone regeneration or autogenous block ulates calcium metabolism, mainly having catabolic and anabolic graft was unfavored for a single implant site. In this case presen- actions in bone. Continuous exposure to PTH can cause resorp- tation customized alveolar ridge splitting (CARS) was performed tion of bone, however, intermittent administration of PTH improves with a trephine bur and with simultaneous placement of a tapered bone micro-architecture, mineral density and strength. This action 3.3x10mm implant. enables PTH to be an appealing treatment for patients with oste- Results: Favorable gaining of horizontal ridge width at the oporosis. Many clinical studies have shown promising results with site and implant placement with successful osseointegration was PTH for treatment of MRONJ. In these cases, we have prescribed achieved. The implant was restored after uneventful healing and rhPTH to patients with osteonecrosis of jaw. followed up for 6 months. Method: Case I The first patient, an 83-year-old woman, was a Conclusion: Custom alveolar ridge splitting (CARS) is a viable patient with systemic diseases such as high blood pressure, arte- technique with minimal risk, shorter treatment time, and less trauma riosclerosis, and osteoporosis. Sequestrectomy of necrotic bone for the patient. This case shows the CARS technique is favored for was performed under sedation and bone morphogenic protein was a single implant site for successful horizontal augmentation and transplanted. Afterwards, the patient started Forsteo injection from implant placement. December 2019, and was injected until March 2020. No further bone necrosis was observed, and it remained without complaints of pain. Case II The second patient, a 70-year-old woman with osteoporosis, was admitted to the clinic for persistent pain after extraction of #34i and 35i implants. Sequestrectomy of necrotic bone was performed under general anesthesia and bone forma- tion-inducing protein with platelet-rich fibrin were transplanted into the bone rhPTH injection was prescribed as a discharge drug. Continuous follow-up was conducted and normal healing state was maintained. Results: Continuously produced parathyroid hormone stimu- lates osteoclasts to increase bone resorption, thereby increasing blood calcium. However, parathyroid hormone drugs used for the purpose of treating osteoporosis, because of their short half-life, are intermittent and a small amount of concentration is used. They show the effect of increasing bone production by osteoblasts. Accordingly, short-term use of PTH can be helpful in resolving MRONJ lesions by raising the level of scrutiny for BP therapy, which is currently widely used. Conclusion: It is now widely known that PTH assist in removing necrotic bone and accelerate healing in MRONJ patients, the opti- mal duration of the PTH treatment for MRONJ is another unsolved question. Therefore, continuous research is still required to evaluate the effectiveness of PTH for the treatment or prevention of MRONJ. *The first name listed is the presenter. The presenter may/may not be the primary author. 99 Table of Contents E-poster Abstracts P56 Simultaneous Implant Placement in the Posterior Atrophic Mandible Using Combined Techniques: A Case Report A. Lee*, J. Wu, F. Elgaddari Introduction: Dental implants have proven to be a successful treatment modality in the replacement of missing teeth. Optimal bone quantity, quality, and location are considered prerequisites for implant application. However, it is common for dentists to encounter patients with resorbed ridges, where the amount of available bone is deficient. For the purpose of mitigating these ridge defects, a variety of bone augmentation techniques have been developed to facilitate simultaneous or staged implant place- ment. These techniques have demonstrated predictable outcomes Alveolar ridge with simultaneous implant placement following ridge split when the biological principles of wound healing are followed. The and horizontal expansion. aim of this case report is to demonstrate the use of alveolar ridge split technique, osseodensification, and guided bone regeneration (GBR) with simultaneous implant placement in the severely atrophic P57 posterior mandible. Rotational Load Fatigue Performance of Titanium Method: A partially edentulous, 36-year-old female presented Versus Titanium-Zirconium Implant-Abutment with the chief complaint (CC) that she wanted “implants to replace Connections her missing lower teeth”. Clinical and CBCT analyses revealed a S. Leo*, M. Tan, F. Lee, S. Yee, K. Tan bilateral narrow posterior mandible, but no apparent pathology. Treatment options to address her CC were discussed in detail. Introduction: Titanium-Zirconium (Ti-Zr) alloy has been devel- Results: A ridge split procedure was initiated in the lower left oped to strengthen the implant body, but clinically relevant infor- quadrant using piezoelectric instrumentation. Horizontal expansion mation is still limited. The aim of this in vitro study was to compare was performed using a combination of osseodensification burs and the rotational load fatigue performance of narrow diameter sequential osteotomes. Implants #18 and 20 were placed simul- (3.3mm) and regular diameter (4.1mm) dental implants made with taneously with good primary stability. GBR was used to enhance CPTi-G4 and Ti-Zr. the buccal bone thickness around the implants. Cover screws were Method: Narrow diameter (N) and regular diameter (R) implants placed and tension-free primary closure was achieved. Healing was with CPTi-G4 (Ti) or Ti-Zr (Tz) materials were tested. This resulted uneventful during follow-up visits. Second stage surgery was per- in 4 test groups: NTi, NTz, RTi and RTz. 5 samples were made for formed after 6 months of healing. Implants #18 and 20 were uncov- each group (n=5). Abutments used were milled from titanium-alu- ered and ISQ readings were 86 and 73, respectively. Radiographs minum-niobium alloy abutment blanks. A rotational load fatigue taken at the second stage demonstrated stable crestal bone levels. machine applied a sinusoidally varying load at an angle of 45 This case report showed successful use of differ- degrees to produce an effective bending moment of 35 Ncm at a Conclusion: o ent surgical techniques to overcome a ridge deficiency and allow frequency of 14 Hz in air at 20 C. The number of cycles to failure simultaneous implant placement. Combining ridge split technique was recorded. The upper limit was set as 5 million cycles. Results using piezoelectric surgery, osseodensification, osteotomes, and were evaluated using ANOVA and Tukey’s post hoc tests. Failure GBR can be considered a predictable and effective method when locations and patterns were evaluated with SEM. approaching atrophic posterior mandibular sites. Regardless of the Results: All regular diameter test groups reached the upper limit technique, understanding the biology of wound healing, proper of 5 million cycles without failure. All narrow diameter test groups case selection, and careful treatment planning are critical in man- failed within the range of 402,530 cycles to 3,374,353 cycles. It aging ridge defects and implant surgery. could be observed that NTz showed a higher mean cycle count as compared to NTi. NTi group recorded 2 implant damage, 1 implant fracture, 5 abutment fractures and 4 screw fractures. NTz test group showed only abutment fracture at the level of implant platform, with no damage to the implant body. Significant difference was found between implants of different diameters. There was no sig- nificant difference between implants of different materials. Conclusion: Regular diameter implants performed significantly better than narrow diameter implants, regardless of material, while no significant difference in cyclic load to failure was found between groups of different alloys. All NTz failures were at the abutment only, without damage to the implant. This failure pattern can poten- tially be clinically advantageous in terms of retrieval and subse- quent replacement of a failed prosthesis. *The first name listed is the presenter. The presenter may/may not be the primary author. 100 Table of Contents E-poster Abstracts months post op, the patient came back with sensitivity and clini- P58 cally found a fistula tract with pus content. No presence of mobil- Custom Alveolar Ridge Splitting (CARS) Technique in ity, bleeding on probing, nor deep pockets were found with high Esthetic Zone in Atrophic Edentulous Maxilla – A Case stability of the implant more than 35 Ncm. Periapical radiography Series with gutta percha tracing lead to the apical of the implant site. T. Li*, E. Gonzales de la Torre, M. Bergamini, As a result, full thickness flap at the implant site was raised and found granulation tissue at the buccal aspect. Complete curettage A. Kadempour was achieve leaving a buccal dehiscence apically the implant. The Introduction: Dental implants have become a viable treatment implant was not compromised Bone material was used to fill in the for edentulous patients. However, the bone remodeling after tooth space and close with resorbable membrane to correct the bony extraction as well as the hard and soft tissue changes in patients defect. The implant was not compromised who have dentures for a long time result in challenging quantity Results: At a 3 month post op, the patient did not complain of of bone. Hard tissue augmentation procedures are thus required any sensitivity, and no signs of periapical radiolucency. The implant although it may be unpredictable and time-consuming for patients. was 100% successful without any clinically signs and symptoms. This case series presents custom alveolar ridge splitting technique Conclusion: This surgical procedure can be a possible option to used in extreme anterior maxilla to achieve a potentially less inva- allowed the healing of the site without compromising the implant sive and simpler augmentation procedure for subsequent implant and further complications. placement. Method: The clinical data was extracted from Implant Database at New York University College of Dentistry and a private practice in New York. All patient information was de-identified and this study is in compliance with the requirements of Health Insurance Portability and Accountability Act (HIPPA). In this case series, four cases of atrophic anterior maxillary ridge were treated with CARS technique and restored with implant prostheses. Results: In all cases maxillary ridges were increased in terms of horizontal volume and accommodate implants without complica- tions. The presented four cases were further successfully restored by implant prostheses, and until present date no failures or com- plaints were developed according to patients. Conclusion: Within the limitations of this case series, the custom alveolar ridge splitting technique may reduce surgical costs, time P60 and complications compared to traditional bone augmentations Critical Factors for Soft Tissue Volume in Implant and present as a simpler approach of ridge augmentation in ante- Dentistry rior esthetic area. More researches with longer follow-up time are M. Limão Oliveira*, A. Barsoum, K. Paranhos, S.C. Cho needed to determine the promising outcome of custom alveolar Introduction: Replacing missing teeth with dental implants ridge splitting technique. has become a viable solution for conventional fixed or remov- able prosthodontics. However, the application of the principles P59 of osteointegration to single missing tooth and partial edentulism has increased patient esthetic demands. An important aspect of Treatment of Fistula Tract After Imediate Implant the success criteria for dental implants in esthetic zone involves Placement and Inmediate Provisionalization: A Case the establishment of soft tissue contour with an intact interden- Report tal papilla and a gingival line that is harmonious with the gingival E.R. Lima*, T. Kukiratirat, T. Asvaplungprohm, M. Yacker, silhouette of the adjacent healthy dentition. Although numerous S.C. Cho methods have been proposed to regenerate papilla, due to com- promised blood supply and scar tissue formation, these techniques Introduction: Immediate implant placement and immediate pro- were reported to be unpredictable. The purpose of this presenta- visionalization (IIPIP) is becoming a more common treatment due tion is to demonstrate critical factors for soft tissue volume gaining to patient’s demands. However, it’s not always possible to perform in implant dentistry. this treatment due to tooth infection, lack of buccal bone or poor Method: N/A implant stability. There are different timings for implant placement Results: N/A after tooth extraction. It’s possible to do immediate placement if Conclusion: Implant placement in the anterior maxilla is still a all the requirements are present after the tooth extraction. If not, challenge for clinicians not only due to difficult management of early implant placement or delayed implant placement requiring hard tissue but also soft tissue volume. To have a successful implant soft and hard tissues healing should be performed. placement and restoration in the esthetic zone, the critical factors Method: A 63 year old female patient came to Implant Dentistry discussed in this presentation should be considered when treat- department of NYU for an implant placement on upper left first ment planning each case. premolar diagnosed with pulpal necrosis with asymptomatic apical periodontitis. An initial CBCT was taken and the implant placement was planned for IIPIP with flapless approach. On the surgical day, fresh extracted socket were evaluated and deep curettage was done to assure granulation tissue was remove prior to immedi- ate implant placement with immediate provisionalization. At a 4 *The first name listed is the presenter. The presenter may/may not be the primary author. 101 Table of Contents E-poster Abstracts total prosthesis. The patient presented typical sings of combination syndrome: bone loss in the anterior maxilla, papillary hyperplasia and overgrowth of the tuberosities. The plan treatment consist in place 4 implants in the maxilla 2 of 3.75x10 in canine areas and 2 of 4.2x10 in premolar areas with simultaneous guided bone regen- eration. For the surgical procedure, 2 full-thickness flaps were per- formed, regularization of alveolar ridge and the insertion of the 4 implants. The horizontal augmentation was carried out with a P61 mixture of xenograft and allograft and the use of cross-linked col- Heat and Sound Generation During Implant lagen membranes, which were fixed to the flap and a continuos Osteotomy When Using Different Types of Drills in surgete to close. Artificial and Bovine Bone Blocks Results: Due to the health emergency caused by the COVID-19, S. Limmeechokchai* a clinical follow-up was given for 4 months. A 10-month control tomography was performed, where loss of the bone graft from The purpose of this study was to compare heat Introduction: the vestibular area was observed in the implants in the canine and sound generated during implant osteotomy when different areas. The possible factors that could have affected the survival of types of drill were used in artificial bone and bovine bone blocks. the bone graft are: Systemic condition may have interfered with A total of 80 implant osteotomies were formed using Method: graft integration. Anatomical conditions did not allow placement 4 implant drilling systems; N1 (OsseoShaper) (Nobel), NobelActive in other areas without more complex approaches. The choice of (Nobel), V3 (MIS) and BLX (Straumann) in both artificial bone and bone substitutes and collagen membrane was carried out based bovine bone blocks. Thermocouple probes were used to record on the properties that each one would provide during their inte- temperature change at the depths of 5.0 mm and 13.0 mm of each gration. The stabilization of the biomaterials was achieved during implant osteotomy formed by the final drill. In addition, thermo- the surgery. This may have been compromised during the healing graphic images, drilling sound, and drilling time were recorded process interfered with the integration. Time could caused peri-im- and evaluated. Statistical analyses were performed at α = 0.05. plant bone loss by the absence of loads to the implants. Decisions The mean temperature changes as recorded by ther- Results: must be made to improve peri-implant conditions. Although, the mocouple probes and thermocamera were significantly lower in case will be retaken until the sanitary conditions allow the care of OsseoShaper than most other drill-bone combinations (p < .05). the patient and the conditions of the case are reassessed. The mean drilling times and sound generation for OsseoShaperw- Conclusion: Multiple factors must be considered to achieve suc- ere significantly higher and lower than most other drill-bone com- cess of guided bone regeneration, such as the surgical technique, binations (p < .05), respectively. primary wound closure, biomaterials stabilization during healing Minimal heat and sound generation can be Conclusion: process, consolidation and osseointegration time. expected when implant osteotomies are performed using Osse- oshaperat a low rotational speed (50 rpm) even without irrigation. However, extended drilling time is required. P63 Study on Periodontal Pathogen Adhesion and Cytotoxicity of Different Materials for Implant Prosthesis Screw Access Hole H. Lu*, J. Hou, Y. Tamura, Y. Takahashi, S. Kuroda, H. Nakata Introduction: In two-piece dental implant systems, progressive colonization of periodontopathogen bacteria has been found in the space between implant components associated with peri-im- plant bone loss. Cotton has been the most widely used material for the sealing of the screw access hole because of its easy access, manipulation, and retrieval. However, it is also a reservoir for bac- 4 Implants drilling system were included in this study teria. The purpose of this study is to undertake an evaluation of the cytotoxicity and bacterial adhesion of potential materials for the screw access hole. P62 Method: Cotton, Polytetrafluoroethylene (PTFE) Tape, Paraffin Clinical Considerations in the Horizontal Bone plastic film, Wax, Gutta Percha and Hydraulic temporary restorative Augmentation With Simultaneous Implants Placement (HTR) were the materials used for this study. An implant-abutment screw access hole was used to standardize the size of the materials. in the Rehabilitation of Atrophic Maxilla The materials were tested with mouse gingival epithelial cells (GE- J. López*, A. Hernández, H. Basulto 1) for the proliferation rate and cytotoxicity using Proliferation and Introduction: The horizontal bone augmentation with simulta- LDH assay, respectively. Porphyromonas gingivalis was used for neously implants placement is a predictable treatment for implant analysis of the pathogen adhesion to the materials. Hydrophobic- rehabilitation. However it’s essential to consider different factors for ity was determined by measuring the contact angle with Image J. the succes of the treatment. Results: The Proliferation assay results of PTFE, Paraffin film, and Method: A 68-year-old female is presented with a history of con- Wax showed no levels of toxicity compared to a control group of trolled type 2 Diabetes Mellitus, reports discomfort with her upper no material. There was a significant difference (P<0.01) for HTR and *The first name listed is the presenter. The presenter may/may not be the primary author. 102 Table of Contents E-poster Abstracts Gutta Percha indicating the lowest proliferation rate of the GE-1 and 1.0 for the three raters, respectively. The inter-rater reliability cells compared to any other materials. In consistency to the Prolif- was 0.66. The logistic regression was performed using RAQ score eration assay, LDH assay of HTR and Gutta Percha was significant as the predictor variable, and whether the implant has PBL as the higher (P<0.01) in comparison to control. Gutta Percha continued dependent variable. The odds ratio (OR) was 1.286 which means to show high levels of toxicity as the period progressed from 24 with each one point of increase of RAQ score, the risk of having PBL hours to 72 hours. Colony forming units per milliliter (CFU/mL) increased 28%. The ROC analysis revealed that the best cutoff value were counted to indicate the concentration of Porphyromonas gin- for optimal sensitivity and specificity was when the RAQ score was givalis adhered onto each material. Cotton showed a significantly 10.5 points, where sensitivity was 80.3% and specificity was 76.5%. higher concentration mean value of 4.4 x 105 CFU/mL. PTFE, Para- In addition, logistic regression showed that an OR of 6.799 for PBL film and Wax indicated with a significantly lower count of 520, 42, between each risk category, representing a risk of 6.799 times to and 180 CFU/mL, respectively. The contact angle of all materials have PBL when an implant was categorized in a higher risk level except cotton were between 90° and 110°. compared to the one in a lower risk level based on the RAQ score. Conclusion: PTFE, Paraffin, and Wax were significantly lower The AUC of ROC was 0.795, representing a high accuracy of the compared to Cotton, HTR and Gutta Percha in bacterial density, overall performance of the RAQ diagnostic test. with Paraffin film being the best. Additionally, no levels of toxicity Conclusion: The RAQ demonstrated good sensitivity and overall were present to the GE-1 cells. The potential use of PTFE, Paraffin high accuracy in diagnosing peri-implantitis. Larger scale prospec- film, and wax should be further investigated in clinical studies. tive clinical trials are needed to further validate the RAQ. P64 Validity of a Dental Implant Risk Assessment Tool: A Pilot Study Y. Luo*, M. Fonseca, R. Kao, A. Sharma, G. Lin, D. Curtis P65 Introduction: There is currently no validated tool to estimate a patient’s aggregate risk for peri-implantitis. The purpose of this Natural Tooth as a Surgical Guide for Immediate pilot study was to evaluate the validity of a recently published den- Implant Placement: Case Report tal implant Risk Assessment Questionnaire (RAQ). R.A. Martinez* Method: A retrospective chart review was conducted. Patients Introduction: Immediate implants have several advantages: with implants in function of 1 to 3 years were identified radiograph- less quantity of surgeries, shorter time treatment, less bone lose. ically as having minimal bone loss (MBL) or pathological bone loss However, the technique has certain complications and must con- (PBL). The RAQ includes 20 risk indicators potentially contributing templated the tooth morphology, the implant angulation, primary to peri-implantitis in 3 categories: patient history, clinical exam- stability, periodontal phenotype and the management of the soft ination and a clinician’s treatment decisions. The total RAQ score tissue. These considerations can consider the use of additional was calculated for each implant. According to the RAQ tool, the material and regeneration techniques. In the restorative field, the included implants were categorized into three risk levels: low risk immediate load and the prosthetic protocol must be viewed before (0-5 points), medium risk (6-10 points), and high risk (>10 points). the procedures and their trans and post-surgical variants. Data were analyzed using logistic regression. The RAQ sensitiv- Method: A 38-years-old female patient with systemic diagno- ity and specificity was evaluated using a receiver operating curve sis of hypertriglyceridemia under treatment, was treated in the (ROC) and accuracy estimated by evaluating area under the curve Advanced Restorative Dentistry postgraduate program. The intra- (AUC) analysis. oral exploration was observed the tooth 5 at the place of the first Results: In total, 63 patients with 168 implants were evaluated; upper right premolar for the orthodontic treatment, the crown of 39 patients with 102 implants in the MBL group and 24 patients the natural tooth was loosed for deep caries and the root rest has with 66 implants in the PBL group. The values of the weighted periodontal pocket and previously root canal treatment, non-re- Cohen’s kappa scores of the intra-rater reliability were 0.72, 0.59 storative tooth. The surgery planning is performed, the type and *The first name listed is the presenter. The presenter may/may not be the primary author. 103 Table of Contents E-poster Abstracts diameter por the implant (C1 MIS 3.75x11.5mm) was selected in of the flap with sutures was necessary; however, the use of HFG base to the tomography and wax up. extremely effective for fixing the tissues after surgery. Results: The surgical procedure was performed under local Results: Twenty to 30 days following surgery, a pink mucosa anesthesia, the milling protocol using the localization of the natural covered the surgical area, no signs of inflammation were appar- tooth. The wear within the canal to a length of 13mm, the reference ent. An X-ray examination revealed a progressive increase in bone was the cervical third of the root. All tooth was extraction and then density. Bone density became similar to that of the adjacent bone the implant was placement, the gaps was regenerated with xeno- at 7–9 months. A few fibrils and mononuclear cells and no visible graft and sutured with a collatape over the surgical site. inflammatory cells were confirmed by histology. Conclusion: The natural tooth as surgical guide for immediate Conclusion: It is not only able to replace and reconstitute miss- implant placement offers tridimensional orientation. Neverthe- ing parts of the skeleton but is also fully capable of carrying out less, this protocol not exempt the planification using tomography the mechanical functions of the reconstituted segments and, if as diagnosis tool in the placement of immediate, early and late necessary, can accept and support the implantation of prostheses. implants. A preparation of recipient-site is a fundamental step toward a suc- cessful grafting procedure. P67 The Effect of Digital Implant Analog Design on the Accuracy of Implant Analog Position in Additively Manufactured Digital Implant Models S.J. Mata*, B. Yilmaz, W. Johnston, L. Meirelles Introduction: Additively manufactured digital implant mod- els (DIM) fabricated by 3D-printing became more popular in the recent years. The influence of DIM analog design on the accuracy of implant analog positions on DIMs is still unclear and evidence is scarce. The object of this research in vitro study is to evaluate and compare the effect of DIM analog design and insertion on the accuracy of analog position of 3 different DIM designs compared to a conventional implant cast. Method: ACANCELLED master reference model with a conventional implant replica on site #13 was used. Conventional VPS impressions were P66 made and implant casts were obtained (Group A). Complete-arch Membrane-free Full Maxilla Reconstruction: digital scan of the MRM with an intraoral scan body (ISB) was made Preparation to Reconstruction using an IOS and a dental CAD software was used to create 3 dif- ferent DIM designs (Groups B, C, D). DIMs were printed on a CLIP A. Massina*, E. Marini, L. Marini, J. Kwon, K. Kim, S. Kim, 3D printer and DIM analogs were inserted (n=12). MRM and all D. Oh specimens were digitized on a laboratory scanner. A metrology Introduction: Hydroxyapatite (HA) is the main mineral compo- software was used to measure deviations between the MRM and nent of bone and teeth. HA is well known for its ability to promote specimens. Linear deviations were measured at x, y, z and 3D devia- bone formation. Homologous fibrin glue (HFG) is a non-cytotoxic, tion was calculated. Angular deviations at the BL and MD projection resorbable biological matrix that simulates the last stages of the planes were measured. ANOVA and Bonferroni corrected t-tests natural coagulation cascade. Grafts incorporation and maintenance were conducted for statistical analysis to determine the accuracy is complicated but essential for osseointegration and a successful of implant analog positions with alpha of 0.05. clinical outcome. Ideal surgical protocols for preparation of the Results: A highly statistically significant interaction was found recipient-site, especially infected site, and long-term stability with between main effects for linear and angular deviation of implant graft is introduced. analog position. Statistically significant differences for linear devi- Method: Recipient-site preparation is required to allow access ations were found between conventional implant casts and DIMs. to the underlying healthy bone, which is critical for the optimal BL deviation statistically significant differences were found between ossification of the HA-HFG complex. All necrotic and inflamed groups A and D (P <.05), B and D (P <.01), and A and B (P <.01). portions of both hard and soft tissues were removed. Removing AC deviation highly statistically significant differences were found these unhealthy tissues permits in situ plasmatic imbibition for between groups B and D, A and B, C and D (P <.01). BL angular the first 24–48 hours. Additional meticulous debridement of the deviation statistically significant differences were found between operative site was performed using a Beaver blade. During the groups B and C (P <.05), and B and D (P <.01). debridement, several lavages with 10% hydrogen peroxide (H2O2) Conclusion: The accuracy on analog position of DIMs was were performed. H2O2 provides not only a chemical effect but also affected by the design of digital implant analogs. Pressure fit DIM a mechanical cleansing effect. After each lavage with H2O2, the analogs showed higher accuracy than screw-retained DIM and con- site was re-washed with saline solution so that the bone and soft ventional analogs. The Nobel DIM analog showed higher position tissue were not overly exposed to the caustic action of the H2O2. accuracy than third-party DIM and conventional implant analogs. Granules were rapidly molded with HFG. Typically, 3–4 drops of Recommendations were made on critical design features for digital HFG is necessary to mold 100 mg of granules. After mixing, the implant analog accuracy. HA-HFG complex was placed. The working time of the mixture was 4-5 minutes before the glue was completely set. Primary closure *The first name listed is the presenter. The presenter may/may not be the primary author. 104 Table of Contents E-poster Abstracts counts and proportions of complexes were determined by DNA- DNA hybridization. The cytotoxicity of both substances was evalu- ated by cell viability (XTT assay) and clonogenic survival assay on CHO-K1 and MC3T3-E1 cells. Results: The first treatment scheme resulted in a significant reduction in metabolic activity of biofilm by means of 77% by HCOBc and CHX treatments versus negative control. The total count of 11 and 25 species were decreased by treatment with HCOBc and CHX respectively when compared with the group with- out treatment (p <0.05), highlighting a reduction in the levels of P. gingivalis, T. forsithya, P. intermedia and F. periodonticum. CHX sig- nificantly reduced the count of 10 microorganisms in comparison with the group treated with HCOBc (p <0.05). HCOBc and CHX sig- nificantly decreased the proportion of the pathogenic red complex when compared with control-treated biofilm, and HCOBc had even a greater effect on the red complex than CHX had (p ≤ 0.05). For the 2nd treatment scheme, HCOBc complex and CHX significantly decreased 61 and 72 % of metabolic activity of control biofilms and the counts of 27 and 26 species, respectively. HCOBc complex did not significantly affect the proportions of formed biofilms while CHX significantly reduced proportions of red, orange and yellow complexes. Both substances exhibited similar cytotoxicity results. Conclusion: These data suggested that HCOBc complex was as effective as chlorhexidine in reducing overall subgingival biofilm formation, and better than chlorhexidine in reducing red-complex bacterial proportions. Although HCOBc reduced the mature 6-day- old subgingival multispecies biofilms, it did not modify the propor- tions of bacterial complexes of the biofilms. Future in vivo studies are needed to validate these results. P69 The Effect of Different Soft-tissue Management Techniques in Alveolar Ridge Preservation – A Randomized Controlled Clinical Trial C. Mertens*, C. Papace, C. Buesch, J. Hoffmann Introduction: For alveolar ridge preservation, various treatment protocols are described. While most studies focus on the effect of the bone graft material, the aim of this study was to determine whether covering the grafted socket with either a combined epi- thelialized-subepithelial connective tissue graft (CECG) or a porcine Linear and angular deviations for DIM and conventional analogs collagen matrix (CM) had an influence on the soft- and hard tissue. Method: A total of 20 maxillary extraction sockets were grafted with an anorganic xenogenic bone graft and then randomly P68 assigned to either group A (CECG) or group B (CM). Subsequently, Antimicrobial Effect of Hydro-carbon-oxo-borate on a labial and palatal tunnels were dissected leaving the periosteum Multispecies Subgingival Periodontal Biofilm attached to the bone. Then the grafts were inserted. Measurements M.A. Melo*, T. Furtado Rocha, F. Coelho, T.S. Capote, of soft-tissue parameters were performed at tooth extraction (T0), implant insertion (T1) and second stage surgery (T2). S. Saska, J.M. Pingueiro, M. Faveri, B. Bueno-Silva, Results: A similar initial gingival thickness of 1.18 ± 0.56 mm J.A. Shibli (CECG) and 1.24 ± 0.50 mm (CM) could be measured at T0 (p Introduction: This study evaluated the effect of hydro-carbon- = 0.791). At T1 a thickness of 1.29 ± 0.26 mm (CECG) compared oxo-borate complex (HCOBc) on a multispecies subgingival bio- to 1.58 ± 0.6 mm (CM), could be documented (p = 0.199). At T2, film. a reduction in gingival thickness to 1.2 ± 0.32 mm (CECG) was Method: The subgingival biofilm with 32 species related to recorded, compared with 1.7 ± 1.06 mm (CM) without statistical periodontitis was formed in the Calgary Biofilm Device for 7 days. significance (p = 0.214). This means an overall increase in gingi- Two different therapeutic schemes were adopted: 1) treatment with val thickness from T0 to T2 of 0.02 ± 0.66 mm (CECG: p = 0.926) HCOBc, 0.12% chlorhexidine (CHX) and negative control group compared to 0.46 ± 0.89 mm (CM: p = 0.102). Thickening of soft (without treatment) from day 3 until day 6, two times a day for 1 tissue in the sense of biotype switching from thin to thick biotype min each time, totaling 8 treatments, and 2) a 24-hour treatment on was observed in 8 patients (CECG = 4 patients, KM = 4 patients). a biofilm grown for 6 days. After 7 days of formation, biofilm met- Keratinized soft-tissue was 3.91 ± 1.11 mm (CECG) and 4.76 ± 1.48 abolic activity was determined by colorimetry assay, and bacterial mm (CM) before extraction and 3.73 ± 0.90mm (CECG) and 4.13 *The first name listed is the presenter. The presenter may/may not be the primary author. 105 Table of Contents E-poster Abstracts mm ± 1.29 mm (CM) at implant follow-up. Mean peri-implant prob- Method: Case1: For reconstruction of facial hard tissue contour, ing depths were 3.15 ± 1.39 mm (CECG) and 3.41 ± 0.99 mm (CM). Autogenous block bone was harvested from chin and protected The difference was not significant (p= 0.7858). by demineralized bovine bone mineral (DBBM). After 4 months Conclusion: A comparable soft tissue thickness was observed in implants were inserted in a prosthetically driven position. During both groups after ridge preservation with either a collagen matrix second stage surgery, Accordion free gingival graft (FGG) was or a combined autologous connective tissue graft. Thus the type used to increase the width of keratinized mucosa (KM) and ves- of the analyzed graft did not seem to influence the outcome of tibular reconstruction. Case2: Autogenous semilunar shape bone alveolar ridge preservation. block was harvested from fresh extraction third molar socket. After preparation of a guide hole in incisor extraction socket, bone block was placed in the facial aspect of this socket. Simultaneously with P70 implant insertion, the block was pushed to the residual bone plate Rehabilitation of Severly Atrophic Alveolar Ridges and fixed without any screw. Then soft tissue was augmented using Using Autogenous Bone Block Grafts as Cortical a free connective tissue graft (CTG). Case3: For hard tissue recon- Tenting. (case series) struction, autogenous block bone was harvested from ramus and protected by DBBM. Implants were inserted after 4 months and S. Mohseni Salehimonfared*, M. Taheri then alloderm was used to prevent of flap advancement and for- Introduction: Dental implants reveal highly predictable results mation of shallow vestibule. for replacing missing teeth. Frequently, after tooth extraction, Results: Facial hard and soft tissue contours were reconstructed resorption of the alveolar ridge occurs which is sometimes so successfully. All implants were successfully osseointegrated with severe that precludes implant placement. This necessitates exten- good stability and minimum bone loss. Increase in attached kera- sive bone augmentation procedures, which are usually performed tinized mucosa with favorable color match was achieved in all in a staged protocol before implant insertion. Autogenous bone patients. Prosthetic rehabilitation was successful and all patients blocks and guided bone regeneration using bone substitutes and received type 1 fixed prosthesis. membranes are various successful methods to provide adequate Conclusion: Clinical results of autogenous grafts are reliable bone volume enabling implant insertion in a prosthetically driven and predictable for hard and soft tissue contours reconstruction. location. Corticocancellous bone grafts from intraoral donor sites (ramus Method: Reconstruction of alveolar ridges was performed using mandible and symphysis) provide sufficient bone volume to recon- autogenous bone blocks in combination with bone graft materials struct ridge deficiencies without permanent harvesting morbidities. and membranes in 12 cases with full or partial edentulism suffering Autogenous soft tissue grafts (conventional or Accordion FGG and from severe bone resorption. Bone blocks were harvested from CTG) are effective and successful treatments with optimal color intra-oral sources (chin or ramus), and fixated with screws. Particu- match for KM enhancement and vestibular reconstruction around late allogenic or xenogeneic bone substitutes were placed above implants. and in between the bone blocks. The blocks created space to contain bone graft materials, indeed. The autogenous and non-au- togenous bone grafts were covered with resorbable collagen mem- brane, which was fixated using tacks if needed. Results: The outcome of the bone graft procedure was success- ful in all cases. After a healing period of 4 to 6 months, depending on the defect size and the source type of the used bone substitute, the width of the alveolar ridge was significantly increased, facilitat- ing implant insertion with adequate bone circumferentially around it. Patients received 1 to 8 implants according to the planned treat- ment. Four to six months later, removable/ fixed prostheses were fabricated supported by the successfully osseointegrated implants. Conclusion: Due to their osteogenic properties combined with the ability to maintain the space, autogenous bone blocks have special advantages to reconstruct severely resorbed alveolar ridges. P72 P71 Laser Assited GMSC a Game Changer in Vertical Bone A Novel Technique to Reconstruct Tissue Convexity Loss Bone Graft Materials and Regenerative Medicine/ Around Implants in the Esthetic Zone dentistry Tissue Engineering S. Mohseni Salehimonfared*, F. Poorsafar, M. Taheri M.M. Moreno Delgado* Introduction: Among the various available materials for aug- Introduction: Dental laser photostimulation of 904 nm wave- mentation, only autogenous bone possesses osteoconductive, lenght in vitro and in vivo for gingival mesenchymal stem cells help osteoinductive, and osteogenic properties. It is still considered as in create vertical bone loss in teeth and dental implants strategic the “gold standard” in alveolar ridge augmentation prior to oral sites. The bone created clinically helps in the prognosis for keeping implantation. We present 3 cases with compromised buccal bone teeth or/and implants, along with the application of GMSC improv- plate that were reconstructed using autogenous block bone and ing general health medical conditions. autogenous soft tissue graft. Method: Laser assisted GMSC have been applied in 7 patients with vertical bone loss in teeth or strategic areas for placing *The first name listed is the presenter. The presenter may/may not be the primary author. 106 Table of Contents E-poster Abstracts implants. The biopsy of gingiva (in vivo) and the expansion of the human teeth and compared to TECs. Risk of Bias tool was used to cells (in vitro) is done with application of low laser 904 nm wave- evaluate the quality of included studies. Random effects frequentist length to help the speed of proliferation of cells in the laboratory network meta-analysis was performed, with mean difference (MD) and disinfect the samples .The laser assisted GMSC with 904 nm and 95% CI as the effect measure. Confidence in the documented wavelenght were included as biomaterial during bone grafting evidence was assessed through the newly fueled CINeMA frame- areas in teeth, or implant sites that needed vertical bone regen- work (Confidence in Network Meta-analysis) based on the GRADE eration, along with dicalcium sulfate (Augma™) particles of bone approach (Grading of Recommendations, Assessment, Develop- (cerabone™) and platelets rich in GF. ment and Evaluation). Results: All the clinical situations of vertical bone loss, treated Results: A total of 844 articles were obtained in the electronic with laser assisted GMSC 1x 10(6) on .5 CC saline solution and and hand search. After the application of the eligibility criteria, and biomaterials resulted in improvement of bone height with bone duplicate removal, fourteen studies were included in this systematic regeneration at each clinical situation site, demonstrated in post- review. In total, 10 studies (n = 466) were included in the network operative x rays. Healing height improvement depended on the metaanalysis for molars. The overall risk of bias was low to moder- defect presented resulting in 96% of new mature bone produc- ate. The result showed that when compared to intact tooth, greatest tion on the sites treated. Laser assisted GMCS were also applied reduction in fracture resistance was reported for TEC (MD -897.91, for medical conditions as IV transfusion or at body site where the 95%-CI,[1289.37; 506.45]). CEC showed least reduction in frac- patient referred a health condition (shoulder, elbow, feet, knees ture resistance (MD -32.85, 95%-CI, [-419.21; 353.51]). The pooled (prosthetic knee or arthrosis in natural knee), arthritic hands, hair mean difference from pairwise analysis of studies comparing Intact loss, face wrinkles and hearing loss). Two patients IV transfused vs TEC tooth was 897.91 MD (95%CI, 506.45;1289.37) and intact with 40 x 10 (6) cells laser assisted GMSC reported improvement vs CEC was 32.85 MD (95%CI, -353.51;419.21]. CEC presented on libido, at 78 y.o. and 74 y.o. the highest probabilities of being ranked the most effective access Conclusion: Laser assisted GMSC with 904nm laser wavelength, cavity design. Surface Under the Cumulative Ranking (SUCRA) for help in regeneration of vertical bone height improvement for teeth Intact tooth was (53% probability of being ranked as 1st), CEC (49% and/or strategic sites for implant placement. Laser assisted GMSC probability of being ranked as 2nd), Ninja (40.5% probability of have regeneration capacities in tissue engineering in dentistry and being ranked as 3rd), TAC (42% probability of being ranked as 4th), medical clinical applications. Clinical bone loss around teeth and/ TEC (84% probability of being ranked as 5th). Level of confidence or strategic implant sites treated with laser assisted GMSC may help varied from low to moderate across all formulated comparisons. the implantologist give a solution for other medical regenerative Conclusion: Overall, CEC was the most favorable access cavity clinical conditions. design when compared to other (TAC, TEC and NINJA) and TEC was the least favorable for fracture resistance; however the level of evidence was low to moderate. P75 Achieving Optimal Esthetic Results Using Custom Healing Abutments for Restorations Over Dental Implants S.A. Muntean*, M. Omran Introduction: To understand the benefits of using a custom heal- ing abutment as opposed to a standard healing abutment before delivering a final restoration over an implant, particularly in the anterior, and how to transfer the tissue contours to the laboratory. Method: Cases at Southern Illinois University- School of Den- tal Medicine, were and are being monitored while using standard healing abutments in the anterior region, as well as custom healing abutments. The tissue is sculpted using the custom healing abut- ments so that the final restoration will be able to emerge from the tissue with aesthetically pleasing outcomes, profile, and tissue sup- port. Anatomical impressions are taken using customized impres- P73 sion copings to transfer the mold to the dental laboratory, and Effect of Different Access Cavity Designs on Fracture allow for accurate fabrication and delivery of the final restoration. Toughness of Endodontically Treated Teeth- A Results: Patients felt more comfortable at delivery appointments when custom healing abutments were used, as the tissue was not Systematic Review and Network Meta-Analysis impinged upon as when a standard healing abutment is used. M.A. Motiwala*, M. Gul, R. Ghafoor Photographic evidence shows that the tissue could be sculpted to Introduction: Objective of this systematic review is to com- allow for a more aesthetically pleasing outcome and emergence pare the effect of different Endodontic Access Cavities on fracture profile upon final delivery. Patients were also more pleased to have toughness of extracted endodontically treated human teeth. a tooth like restoration versus a standard healing abutment. Being Method: An electronic literature search was performed within able to transfer the record of the custom healed tissue using a cus- databases as well as hand search was performed until September tom impression coping is also of importance to be able to allow the 2020. All included studies were in-vitro that evaluated the influence lab to make an appropriate restoration to the contours that have of CECs on fracture toughness in extracted endodontically treated been achieved, as well as to allow for a more precise delivery of *The first name listed is the presenter. The presenter may/may not be the primary author. 107 Table of Contents E-poster Abstracts the final restoration. According to previously published research, abundance of Lautropia was significantly lower in never smokers by having a custom healing abutment, emergence profile can be than subjects who reported a history of smoking or were currently generated to allow for the tissue to heal to how the final restoration using tobacco. Elevated proportions of Prevotella and Fusobacte- will look, and this can then be used as a guide for the laboratory rium were noted in mucositis sites and in levels of Lactobacillus technician to create an ideal final restoration. when comparing smoking status attributed to a current smoker. Conclusion: Within the parameters of the study, there are tre- Conclusion: Alterations of the physio-chemical properties of mendous benefits to the use of custom healing abutments not only the healing abutment represented by different implant systems for patient comfort and esthetics of the final restoration, but also suggest that these modifications may result in altered microbial for the dentist to deliver it, and the dental laboratory to fabricate composition. the most clinically accurate restoration. P78 Ridge Augmentation With Simultaneous Implant Placement Using Bone Ring Allograft M. Omran*, C. Hanser, R. Blackwell, B. Gruender Introduction: Dental Implant treatment usually needs bone augmentation to have a better surgical and restorative outcome. Guided bone regeneration (GBR) is a surgical procedure used to help in the regrowth of lost hard and soft tissues with the help of the barrier membrane. GBR often performed in two surgeries. The drawback of this procedure is that patient has to do 2 surgeries and treatment time is increased. This case report shows a less invasive technique by simultaneously doing GBR and implant placement using an allograft bone ring. The bone ring fixed and implant apical threads used to stabilize the implant. Method: Surgical treatment: The surgical treatment was per- Custom healing abutment for #12 position formed under local anesthesia. Mid crestal flap raised and oste- otomy was done on tooth # 12 using the planing drill. The bone ring was adjusted to the correct width of the osteotomy and then P76 verified the stability for the ring. The implant used in this case was Microbial Analysis of the Implant-Abutment Interface a 4x10mm implant and was placed 1-2mm subcrestal of the bone ring. Cover screw placed and Freeze-Dried bone allograft used L. Nguyen*, D. Bompolaki, J. Merritt, J. Katancik to graft around the bone ring. The barrier membrane adjusted Introduction: The progression of peri-implant diseases, spe- and adapted to the grafted site. Fixation cap placed to stabilize cifically peri- implantitis, share common features to periodontitis the membrane. The flap was sutured and primary closure was with a primary focus on the host response to the microbial bio- achieved. The patient was seen regularly for follow up. The un- film. The host immune response to bacterial insult is thought to covery surgery was performed after 6 months from the implant be the initiator of a cascade of events leading to inflammation placement. Prosthetic treatment: The patient came back for a fol- and marginal bone loss surrounding an implant. The aim of this low-up and Osseointegration check. No mobility nor pain detected pilot study is to gain an understanding of early bacterial coloni- when the healing abutment removed and placed back. The digi- zation at the implant-abutment interface. Comprehension of the tal impression was done by using CEREC Omnicam unite to scan nature of bacterial colonization at this location would allow for the scanning body. Screw retained crown milled. Crown polished, establishment of an optimal and evidence-based implant- abut- verified fit, interproximal contact, contour, occlusion, and esthetic. ment design. Results: 1 premolar was treated in this report. The mean inser- Method: Healing abutments were collected at the initiation of tion torque values for the implant was 40 Ncm. The definitive res- restorative therapy between 4-6 months following implant place- toration was a screw-retained crown. Short-term survival rate (13 ment. Implant site, system, height of the gingival collar, assessment months) was 100% for the implant placed of tissue health, time healing abutment was in place, periodon- Conclusion: The allograft ring can be used to repair both hor- tal diagnosis (current and past), and history of smoking were izontal and vertical ridge defects. This case study shows how the recorded. Characterization of microbial genera sampled from technique is safe and predictable. The use of bone ring graft with the healing abutment and implant platform was completed using simultaneous implant placement saved the patient from doing a DNA extraction, PCR amplification of the 16S rRNA genes, Illumina second surgery to place the implant. Also, the technique helped library preparation and sequencing, and bioinformatic analysis. saving treatment time and achieved higher patient satisfaction. Results: 36 healing abutments were collected from 30 study subjects. Implant systems included Straumann (20), AstraTech (10), Nobel (3), and Zimmer (3). 33 samples utilized a platform switched design, 32 exhibited no signs of mucositis, and 3 samples were obtained from sites with a gingival collar height of 5 mm or greater. There were no significant differences in many of the patient-based and implant-based parameters; however, there was statistical significance associated with the relative abundance of Lactoba- cillus when comparing Straumann and AstraTech implants. The *The first name listed is the presenter. The presenter may/may not be the primary author. 108 Table of Contents E-poster Abstracts of Dentistry (UTSD), between January 1, 2007 and July 1, 2020, P79 were extracted from the school’s AxiUm database and exported Denture Duplication Technique Using Intra Oral in standardized extraction worksheets. All periodontal conditions Scanning and 3D Printing: Copy of Implant Over were defined according to the 2017 Classification of Periodontal Denture and Peri-implant Diseases and Conditions. Y. Oyamada*, T. Kobayashi, H. Kihara, K. Takafuji, Results: The population consisted of 7,965 self-referred patients, comprising of 5.7% Asians, 14.95% African Americans, 24.7% H. Sato, H. Kondo Whites, and 20.35% Hispanic. The prevalence of gingivitis was Introduction: The duplication of complete dentures is applied 5.7% and periodontitis was for stage 1: 4.6%, stage 2: 18.6%, and in various ways as custom trays, occlusion rims, or treatment/tem- stage 3: 66.4%. Stage 3 periodontitis was significantly associated porary dentures. Recently, The denture fabrication is used a digi- with age of the patient, hypertension, rheumatoid arthritis, diabetes tal technique which intra/extra scanning of edentulous ridge and mellitus, arthritis, male gender, the use of clindamycin and ASA II. then milling or 3D printing of prosthetics. In this report, using an Significant associations were found independently with maximum intraoral scanner, the duplication of implant over denture could CAL, PD, and bleeding on probing. be performed without the need for any complicated processes, Conclusion: Stage 3 periodontitis was found to be the highest laboratory scanners, or advanced CAD software. overall and it was significantly associated amongst all with a history Method: This patient was treated with maxillary and mandible of hypertension, rheumatoid arthritis and diabetes. implant- supported removable prostheses after bone and muco- sal graft surgery before 2 years. However, peri-implant mucositis were occurred due to poor oral hygiene in mandible mucosa that complex shaped under the bar attachment. In June 2020, a second mucosal graft was performed in mandible mucosa. The original denture duplicated to use as treatment denture after surgery. In this duplication technique, after scanning the cameo and intaglio surfaces of the implant over denture using an intraoral scanner, the two images were superimposed on the interocclusal image. The linear gap between cameo and intaglio surfaces were filled on free downloadable CAD software. The superimposed image was subsequently used as data for fabricating the duplicate complete denture with a 3D printer. Results: The duplicate denture was modified by layering differ- Factors and associated p-values with stage III periodontitis. ent thicknesses of gingiva-shade composite resin in buccal cameo surfaces. The denture was slightly adjusted in occlusal and intaglio surfaces and replaced a self-cured resin from photo-cured resin P81 in intaglio surface that female parts of the bar attachment was The Role of Age and Gender in the Outcomes of Non- attached. surgical Periodontal Therapy Conclusion: This technique enables to simplify duplication of N. Soldatos*, K. Parsegian, A. Dugum, E. Ioannidou dentures in a shorter time compared to the conventional method, Introduction: Limited evidence has suggested that the out- and may potentially become a new method for denture duplica- comes of non-surgical periodontal therapy (NSPT) are not affected tion. by age and gender; however, common limitations of these studies include small size populations, various definitions and cutoffs of P80 periodontitis, and a lack of multivariate analysis for confounding factors. The goal of our study was to examine the role of age and Relationship Between Gingivitis, Periodontitis and gender in the prevalence of periodontitis and outcomes of NSPT. Systemic Health: A Retrospective Study in a University Method: This is a large-scale retrospective epidemiological Setting study that included adult (≥18 years) women and men who pre- N. Soldatos*, H. Qadri, K. Parsegian sented for NSPT and periodontal re-evaluation at the University of Introduction: Periodontal diseases are inflammatory human con- Texas School of Dentistry (UTSD) from January 1, 2007, to July 1, ditions associated with various local, systemic, and environmen- 2020. A total of 3125 patient records from the BigMouth Repos- tal risk and contributory factors. The prevalence of periodontitis itory were included in this study. For statistical analysis, we used among the general U.S. adult population reaches 42%, however the a hierarchical mixed-effects model to evaluate the age- and gen- periodontal characteristics of patients attending academic dental der-associated changes in CAL and PD as primary outcomes of settings are unknown. The goals of the present large-scale retro- periodontal treatment. spective epidemiological study that involved patients attending Results: At the baseline, for both CAL and PD, the differences academic dental clinics were to (i) characterize the prevalence of across gender, age, and disease severity groups were found sta- periodontal diseases and (ii) examine the association of periodon- tistically significant (P < 0.01). The most severe breakdown was tal diseases with local, systemic, and environmental factors. observed in the middle age category, whereas the number of Method: The Institutional Review Board (IRB) of the Univer- missing teeth was the greatest in old patients. We also observed sity of Texas Health Science Center at Houston (Houston, TX, a significant association between the extent of periodontal break- USA) reviewed all proposed experimental approach and granted down and type 2 diabetes mellitus (P < 0.001) but not hemodialysis the approval to conduct the study (protocol #HSC-DB-18-0663). and smoking (P > 0.05). At the re-evaluation, for both CAL and PD, De-identified data of patients attending dental clinics at the School the differences across gender, age, and disease severity groups *The first name listed is the presenter. The presenter may/may not be the primary author. 109 Table of Contents E-poster Abstracts were found statistically significant (P < 0.01). There were significant changes in PD related to the patient’s age and race but not gender. P83 Conclusion: The present study demonstrated that the age-, gen- A CBCT Analysis of Alveolar Housing in Maxillary der-, and race-associated outcomes of NSPT. These results suggest Premolars in Preparation for Immediate Implant that clinicians should consider age and gender as important deter- Placement minants of therapy success and develop patient-centered, person- M. Petroche* alized treatment protocols. Introduction: The aim of this study was to establish a classifica- tion system for use in immediate implant placement by examining P82 alveolar sockets in maxillary premolars and evaluation of the vary- Digital Workflow for Immediate Guided Implant ing morphologies using CBCT imaging. These measurements may Placement for Maxillary Overdenture. -A Case Report provide a simplified approach to assist in the clinical decision of an immediate implant placement. P. Pattachainapuvanon*, K. Vazouras, E. Antonellou Method: Selection criteria was patients ages 15-85 with exclu- Introduction: In most cases implant placement to support a sions applied for subjects with a history of dentoalveolar surgery maxillary overdenture is planned by using the existing denture in the maxillary arch. A total of 200 maxillary premolars were clas- and performing a dual scanning technique with markers in order sified by their root morphology as Type I (two-rooted premolar to superimpose and plan predictably. In cases of patients who with interradicular bone), II (fused roots with mesiodistal alveo- present with terminal dentition, a technique where the immediate lar constriction) or III (single blunted root with no interradicular denture can be scanned and used as a prototype in order to dig- bone). All premolars were also classified as buccal (<1mm of buc- itally plan and produce a surgical guide for accurate immediate cal bone), centered (equal width of buccal and palatal bone) or implant placement seems to be very predictable. This technique palatal (greater width of buccal versus palatal bone) in relation to is an alternative which minimizes the chance for bone loss after the alveolar housing. The internal angle formed between the long teeth extractions and shortens the waiting period for the final reha- axis of the crown and long axis of the palatal root was measured bilitation. for Type 1 maxillary first premolars (n=40), as well as interradicular Method: A 70-year-old male patient presented with maxillary septal bone height (ISBH) compromised dentition for implant consultation. A comprehen- Results: A Type 1 premolar socket is present in 32% of the sam- sive evaluation was performedand due to finances, it was decided pled maxillary first and second premolars. The incidence of Type 1 he would be restored with an implant supported overdenture. An root form in maxillary first premolars was 51%. Type 2 socket was immediate complete denture was initially fabricated at the ideal present in 29% of maxillary first premolars and type 3 socket was vertical dimension of occlusion. In order to shorten healing and present in 16% of maxillary first premolars. In the maxillary second treatment time, as well as minimize the risk of bone loss, immedi- premolar the incidence of a Type 3 root form was 89%. The internal ate implant placement was decided. Precise surgical planning was angle formed between the long axis of the crown versus the long very challenging and several technical issues had to be addressed axis of the palatal root was averaged at 11 ± 4.35°. The ISBH was to ensure accurate scanning of the immediate denture with the an average of 7 ± 1.6 mm. intraoral scanner. Subsequent superimposition of this STL file to Conclusion: Maxillary premolars present a clinical challenge for the DICOM file with concurrent evaluation of prosthetic space for immediate implant placement because of their variability in root prosthetically driven implant placement. A masking tape was cut morphology, anatomical landmarks and the availability of alveolar and placed on both the intaglio and cameo surface of the denture bone. Type I root form had the highest incidence at maxillary first to achieve an accurate scan of the denture and serve as a reference premolars sites and has the most alveolar bone available. The type for the successful superimposition. Four implants were placed, in III root form is most common in the maxillary second premolar site conjunction with cancellous bone granules, and resorbable bilayer and has the least amount of alveolar support for immediate implant collagen membrane. Second stage was performed 6 months later. placement. The angulation and alveolar bone support provided by Final prosthetic restoration was a maxillary acrylic overdenture with the palatal root in Type I root form maxillary first premolar sites may metal framewotk supported with four Locator attachments. provide the stability necessary for an immediate implant placed at Results: This treatment approach aided to plan digitally the an appropriate prosthetic position. immediate placement of implants to support a maxillary implant overdenture. Conclusion: The use of the immediate denture served to have proper prosthetically driven implant placement and adequate restorative space for the final rehabilitation. This technique seems to be a predictable alternative over conventional planning with two- stage approach which involve extractions first, healing and then planning for implants. *The first name listed is the presenter. The presenter may/may not be the primary author. 110 Table of Contents E-poster Abstracts Results: With having to juggle more things and in different ways, P84 burnout and stress are at an all-time high, reducing performance, Reconstruction of a Traumatic Maxillary Defect With a health, and morale. Scapular Flap and Dental Implants Conclusion: In this powerful presentation, Jessica gets you fired M. Pham* up by sharing the role resiliency plays to prevent and extinguish burnout, pinpointing your contributing factors to overwhelm, and Introduction: Scapular tip free flap (STFF) reconstruction most showing you how to handle stress to improve focus, performance, frequently occurs after oncologic resection. However, dental and quality care. implants are often not placed due to the misconception of their inadequate bone quantity and quality. The case of a patient with extensive comminuted injuries to the right maxilla, zygoma, and P86 orbital floor secondary to gun shot wound (GSW) is presented Ignite the Burned and Stressed Out: How Leadership here. The patient’s resulting maxillary defect was reconstructed with STFF and subsequent dental implant placement. Inspires the Disengaged Method: A 68-year-old male with comminuted Lefort I/II/III frac- J.L. Rector* tures as well as avulsion of all right maxillary teeth. The patient Introduction: Burnout and stress are at an all-time high. Employ- underwent right sided craniectomy as well as open reduction and ees feel overwhelmed, unappreciated, unrecognized, which internal fixation of his facial fractures. Although his orbital floor was decreases productivity, attitude, and performance. reconstructed with good projection of his zygoma, he was left with Method: As the #1 expense to organizations, burnout is an orga- what mimicked a right maxillectomy defect. nizational and leadership issue affecting morale and bottom-line Results: The patient presented with no buccal vestibule as well results. as right lip and cheek contracture. Due to the patient’s desire to Results: How much is burnout really costing you? Research not require an obturator, the decision was made to carry out recon- shows even the “best place to work for” Google has 53% burnout. struction with a STFF. He healed nicely, but had bulky vestibular Conclusion: Using her burnout research, Jessica shares how soft tissue that occluded with his mandibular ridge. This left him organizations can proactively anticipate burnout, teams can stop with deficient occlusal space for a fixed partial denture (FPD). Cone stress from spreading to other work and life areas, and how leaders beam computed topography (CBCT) was then obtained and uti- can ignite, motivate, and empower employees to build resilience, lized for virtual surgical planning (VSP). Three-dimensional printed create a thriving culture, and tackle uncertainty and challenges models and a surgical guide were printed from the CBCT. The without burnout. guide was also used to make markings for buccal bone reduction that would allow for seating of the FPD. Three 3.6x8mm implants were then placed along with soft tissue debulking. This was done P87 making sure at least 10 mm of occlusal clearance was present Ignite the Power of Confident Communication at all aspects of the ridge. The three implants were uncovered 9 J.L. Rector* months later and were found to have obtained osseointegration. Introduction: Companies lose over $11,000 a year per employee The patient was restored with an FPD, which the patient has func- due to poor communication. tioned well with. Method: How much money is your organization losing? Suc- Conclusion: Although the STFF has been described to recon- cessful communication spurs a dynamic team, stronger leadership, struct GSW and there is now increasing literature supporting and deeper connections. implant placement in the STFF, there has not been a case pre- Results: With all the different components of communication sented that combines the two methods. The STFF provided ade- plus the method of communication (virtual, text, email, phone, or quate facial projection and a maxillary ridge as reconstruction for in person), it’s easy to see how communication breaks down in the a defect that mimicked a hemimaxillectomy for our patient. Careful simplest of conversations. planning using VSP and soft tissue recontouring created the space Conclusion: To decrease this communication loss, Jessica shares needed for him to be rehabilitated with a FPD and avoid requiring the fundamental component of communication that most people an obturator. overlook which leads to conflict, misunderstandings, and stress. Discover how to converse with different personalities in other P85 departments, generations, or positions, improve your communi- Fire Up So You Don’t Burn or Stress Out: How to cation confidence to talk to anyone, anytime, and the single most important part of every conversation. Prevent, Break Through, and Extinguish Burnout (and the Power of Resiliency) J.L. Rector* P88 Introduction: Burnout and stress are like wildfires—spreading Fire Up Your Thinking: How to Manage Your Mental quickly and affecting everything in their path. Health Through Change, Uncertainty, and Challenges Method: With the increased stress, pressure, and expectations J.L. Rector* to do more with less, 79% of the workforce is burned out and even Introduction: When faced with challenges, fear, worry, and stress more stressed out. The World Health Organization recognizes burn- can easily take over. out as a workplace syndrome, but burnout isn’t just for the work- Method: So many changes happening in a short time can feel place anymore. overwhelming and paralyzing, keeping you from getting things done and engaging. *The first name listed is the presenter. The presenter may/may not be the primary author. 111 Table of Contents E-poster Abstracts Results: Your mental health is the fundamental foundation for leaning into uncertainty, embracing change, responding to chal- lenging and even performing every day activities. Conclusion: Explore Jessica’s impactful process to identify your thinking patterns, hijack your thoughts, and develop a sustaining mind wellness initiative for yourself and your team. P89 Custom Alveolar Ridge Splitting (CARS) Technique as a Predictable Horizontal Ridge Augmentation in the Atrophic Anterior Maxilla – A Case Series P90 N. Reis*, L. de Carle, M. Manasse, S.J. Froum, S.C. Cho Custom Alveolar Ridge Splitting (CARS) Technique as a Introduction: For successful implant placement, adequate bone Predictable Horizontal Ridge Augmentation Procedure width and height is needed. In cases of inadequate quantity of for Atrophic Ridges – Concept and Technique. bone, the bone volume can be increased by bone augmentation N. Reis*, L. de Carle, M. Manasse, S.J. Froum, S.C. Cho procedures. Several factors can affect bone regeneration, one of Introduction: Bone augmentation techniques are needed in those is the morphology of the defect at the implant site. A defect cases when there is inadequate bone volume for implant place- surrounded by bony walls (an intra-osseous defect) is known to ment. There are several techniques being used to increase alveo- yield a highly successful regeneration. The purpose of this case lar bone height and width. However, each of these has potential series is to present the step-by-step surgical procedure known as complications and limitations. The Custom Alveolar Ridge Splitting the CARS technique for maxillary anterior ridge augmentation for (CARS) technique is a new technique developed to augment the implant placement. bone width prior to implant placement. The purpose of this presen- Method: Clinical data in this study was obtained from the tation is to demonstrate the step-by-step of this novel technique. Implant Database (ID) at New York University College of Dentistry Method: The CARS technique procedure step-by-step can be (NYUCD). This data set was extracted as de-identified information performed in stages: First stage - initial drilling with the help of a from the routine treatment of patients at the Ashman Department guide is made, guide cylinder is placed into this first osteotomy, of Period ontology and Implant Dentistry at New York University and a trephine bur is used through the guide pin. If the segment is College of Dentistry. The ID was certified by the Office of Qual- stable, it is expanded and an implant placement can be attempted. ity Assurance at New York University College of Dentistry. This If it is not stable, reentry will be performed three to four weeks study is in compliance with the Health Insurance Portability and later. Second stage - a green stick fracture is created by the same Accountability Act (HIPAA) requirements. Sixteen consecutive cases trephine bur (or a small periosteal elevator or a small bone carrier) (22 implants in total) were selected in patients who desired dental and the splintted segment is moved buccally and wedged in the implants with a fixed prosthesis to replace their missing teeth in surrounding buccal plate of bone. If the splintted segment is stable, the anterior maxillary arch and had implants placed with the CARS implant placement can then be attempted. Otherwise, bone graft technique. material is placed to maintain the space. Third stage - three to four Results: In the sixteen cases followed, all implants were suc- weeks later, implant placement is performed. cessfully placed, restored (six to twenty-one months after implant Results: These technique was performed in several cases includ- placement), and were followed for twelve to twenty-four months ing anterior maxilla, anterior mandible, posterior maxilla and poste- after loading. In one case the segment was fractured, and success- rior mandible. All implants were successfully placed, restored and ful retreatment was completed two months later. This implant was followed-up. To date all implants have been functning well without successfully placed, restored (six months after implant placement), failures neither complications. and was followed for an additional twenty-four months after load- Conclusion: In conclusion, the CARS technique is simple, suc- ing. To date all twenty-two implants have functioned well with no cessful, and predictable, and may be used as another surgical treat- failures or complications. ment option for horizontal alveolar ridge augmentation in cases Conclusion: Within the limitation of this case series, it can be of atrophic alveolar ridges. The advantages of this technique are concluded that the CARS technique may present another option less invasive, less traumatic, less time consuming, less postopera- for horizontal alveolar ridge augmentation in the anterior maxilla tive discomfort and complications. The limitations of this technique in cases of atrophic alveolar ridges. Further research with a greater are technique sensitive, bone width of at least of 2 mm is needed number of patients and case-controlled comparison studies are and it doesn’t augment bone height. Further research is needed necessary to determine the success and advantages of the CARS to determine the success and advantages of the CARS technique technique compared to those conventionally used for horizontal compared to those conventionally used for horizontal ridge aug- ridge augmentation. mentation. *The first name listed is the presenter. The presenter may/may not be the primary author. 112 Table of Contents E-poster Abstracts P92 An Innovative Macro Hybrid Implant Design With Unique “Body-shift” Concept: Preliminary Results From Clinical Study H. Saito*, S. Chu, B. Levine, P. Östman, M. Nevins Introduction: An innovative hybrid implant design (Invertaâ, Southern Implants) featuring an implant “body-shift” in diameter, shape, and thread pattern combined into a single structure was developed to address implant placement in extraction sockets and P91 compromised sites (Figure 1). This designed is aimed at enhancing Esthetic Implant Restoration in Anterior Maxilla With labial plate dimension and tooth-implant distance while achieving consistent esthetic outcomes. Preclinical and clinical studies were Custom Alveolar Ridge Splitting Technique conducted to evaluate survival, primary stability, and esthetic param- M. Rodríguez Fernández*, M. Sawada, M. Natour, eters specifically, Pink Esthetic Score (PES). S.C. Cho Method: Preclinical Study: Eighteen implants were placed Introduction: Implant therapy has become an important option bilaterally into three foxhounds. Samples of soft and hard tissues for the restoration of edentulous areas of maxilla and mandible. surrounding the implants were retrieved to perform light micro- Successful placement of a dental implant requires adequate sur- scopic and histomorphometric analyses. Clinical study: The cases rounding bone. In cases where there is an inadequate quantity of were selected based on the criteria from the Inverta Registry. Sixty bone for implant placement, the bone volume can be increased by implants were placed in 24 patients, immediately post-extraction of bone augmentation. Despite all the advancements in bone regen- hopeless maxillary anterior teeth. and assessment was performed eration techniques the outcome in many cases is not highly pre- for implant survival, insertion torque value, PES, interproximal bone dictable. Similar to an extraction socket or maxillary sinus cavity, a crest width, distance and height were maintained at implant plat- defect surrounded by bony walls is called an intra-osseous defect. forms, mesial and distal. This type of defect is known to yield highly successful regeneration Results: The preclinical study showed no evidence of apical due to good blood supply and the graft being well contained. In pressure necrosis with consistent insertion torque values of 100 contrast, an extra-osseous defect with less bony walls are known Ncm on roughly three-quarters of the implants placed, due to the to be less predictable for bone augmentation. nature of apical portion of the extraction socket that possesses tra- Method: In this case report two patients with anterior atrophic becular bone. The selected cases from the clinical study confirmed maxilla wanted to replace the missing tooth with implants. In the the use of the body-shift design in compromised cases such as first case, two central incisors are missing. The patient had a hori- dentoalveolar dehiscence defects of the labial plate with consistent zontal bone deficiency for implant placement. CARS technique was esthetic outcomes measured by labial plate dimension, tooth-to- done in the central incisor area converting an extra-osseous defect implant distance, marginal bone levels, and PES. into an intra-osseous defect. Proceeding to the implant placement. Conclusion: Studies showed no evidence of apical pressure After the implants area placed in the desire position, guided bone necrosis with consistent insertion torque values of 100 Ncm on regeneration was performed with resorbable membrane. After 2 roughly three-quarters of the implants placed. The macro hybrid months provisional was delivered. In the second case left central implant geometry for this immediate tooth replacement protocol incisor was missing same procedure was done achieving esthetic provided excellent and stable two-year results relative to implant results and improving the labial bone contour. survival (100%), labial plate thickness on CBCT and PES. Results: CARS technique improved the bone deficiency in the labial contour achieving esthetics results in both cases. Conclusion: CARS procedures is a viable option for horizontal alveolar ridge augmentation in the anterior maxilla because it is simple, successful, predictable, minimizes patient morbidity and is more comfortable to the patient. CARS is a viable and predictable technique in treating anterior atrophic ridges with esthetics results. *The first name listed is the presenter. The presenter may/may not be the primary author. 113 Table of Contents E-poster Abstracts Results: The early data (from January 2019 to September 2020) was extracted from the Registry based upon the case type (e.g. immediate implant placement into postextraction sockets), 60 implants were placed in 57 patients. 90% of the implants replaced maxillary anterior teeth, 85% of the sites were D3-D4 bone quality and 60% of those sites were undersized osteotomy by 0.5–1.0 mm. Overall implant cumulative survival rate was 98%. Mean insertion torque was 61.03 (± 12.90) Ncm with a range 40–100 Ncm and ISQ value average 60.92 (± 7.73) Ncm. More than 93% of the cases had immediate provisional restorations placed at the time of the surgery. Conclusion: The results of this study indicate that the macro hybrid implant geometry provided stable early outcomes relative to implant survival, labial plate thickness via CBCT evaluations, tooth-to-implant distances immediately post- implant placement, PES. Interproximal bone crest width, distance, and heights were maintained at the implant platform with positive PES within the evaluated time period. P94 The Influence of Abutment Macro-design on Facial Peri-implant Tissue Dimensions for Guided Placed Implants at Healed Sites: One-year Cone Beam Computed Tomographic (CBCT) Findings from a RCCT I. Saleh*, T. Koutouzis, A. Ali Introduction: Aim of the study was to assess the facial peri-im- plant tissue dimensions for implants connected to either convex or concave final abutments with the use of CBCT. Method: Subjects with a single missing maxillary tooth received a pre-operative CBCT scan; a wax up was made for the missing tooth on a plaster model and, was scanned using digital scanner, Image showed that the implant design provides thicker buccal plate at 1 the obtained STL file was merged with the CBCT for implant plan- year following immediate placement. ning. Implants were placed 3-4mm subcrestally. Patients were ran- domly allocated to receive either a convex (Gp Cx) or concave (Gp Cv) titanium abutment on the day of the surgery. Both examiner and P93 subjects were not aware of the allocated treatment. Final crowns An Innovative Macro Hybrid Implant With a “Body- were delivered 3 months after surgery. - A CBCT was obtained shift” Design: Results From a Clinical Study Registry 1-year post surgery, and the following measurements were done on the buccal aspect of each implant: 1- first visible bone-to-implant H. Saito*, S. Chu, B. Levine, N. Egbert, M. Nevins contact (fBIC), implant shoulder (IS), bone crest (BC) and marginal Introduction: Recent preclinical and clinical studies on an inno- mucosal level (MML) 2- fBIC-IS, fBIC-MML, fBIC-BC, IS-MML, IS-BC vative macro hybrid implant design (Invertaâ, Southern Implants and BC-MML in a vertical linear plan. 3- Parallel to the implant utilizing a paradigm shift in biologic and esthetic thought has shoulder, 4 horizontal measurements were planned to see: Muco- been reported. This unique “body-shift” concept in diameter and sal thickness at level of implant shoulder (MT1), Mucosal thickness shape combines a tapered apical portion with a cylindrical coronal coronal to the level of bone crest (MT2), and Mucosal thickness at portion in a singular body design (Figure 1). This case series will the level of the mid-distance of BC-MML (MT3) and bone thickness showcase the implant survival, labial plate thickness via CBCT eval- at 1mm apical to BC (BT) -Soft tissue area coronal to the bone crest uations, tooth-to-implant distances, PES, and interproximal bone (AREA) and the peri-implant mucosa profile (PFL) were measured crest width, distanceCANCELLED and heights. on a different software. Method: The data has been extracted from the Inverta cohort Results: Twenty eight patients were initially recruited. One sub- research registry, a repository for clinical data of the patients ject from each group dropped the study(Gp Cv n=13, Gp Cx n=13). treated with Inverta implants (WIRB study# 1252367). The clinical No statistically significant difference was found for the vertical linear data is collected as de-identified information and has been used to measurements in terms of fBIC-IS, fBIC-MML, IS-MML, IS-BC and, identify efficacy and prospective research: 1. To determine survival BC-MML, or the horizontal linear measurements for MT1 and BT. and success rates of Inverta implants. To rapidly record and address No SSD was found between two groups for AREA and, PFL. A SSD adverse events and complications. 2. To evaluate primary stability was found between the two groups in terms of vertical peri-implant via insertion torque and/or ISQ measurements. 3. To evaluate radio- mucosa height (fBIC-MML), mucosal thickness coronal the level of graphic outcomes and correlate these findings with clinical esthetic BC (MT2) (r=0.52, p=0.006), supracrestal vertical soft tissue height parameters including labial plate dimension (LPD), tooth-to-implant (BC-MML) and mucosal thickness at IS (MT1) (r=0.54, p=0.004). distance (TID), marginal bone levels (MBL) and Pink Esthetic Score (Table 1) (PES). *The first name listed is the presenter. The presenter may/may not be the primary author. 114 Table of Contents E-poster Abstracts Conclusion: Subcrestally placed implants with concave abut- Results: Successful regeneration of bone volume with implant ments maintain greater peri-implant mucosa height and greater osseointegration with uneventful healing was achieved. The facial peri-implant mucosa thickness, compared to implants with implants were restored and followed up for 6 months without any convex abutments. complication. Conclusion: Customized alveolar ridge splitting (CARS) tech- Table 1. Soft Tissue Area (in mm2) coronal to the bone crest (AREA) nique with simultaneous lateral window sinus augmentation is a and the peri-implant mucosa profile (PFL) (in mm) viable treatment for maxilla area with limited horizontal and vertical bone volume. The case report shows how the overall treatment was less traumatic, more predictable, less complications, and shorter procedure time. *p<0.05 **p<0.05 Mann-Whitney U Test was done for all the parameters P95 Clinical Application of Custom Alveolar Ridge Splitting Technique With Simultaneous Lateral Window Sinus Augmentation P96 M. Sawada*, M. Bergamini, M. Rodríguez Fernández, Fully Exposed Connective Tissue Graft to Increase M.J. Bloom, S.C. Cho Keratinized Tissue for Multiple Sites: An Innovative Introduction: The placement of implants in maxillary posterior Technique and A Case Report can be challenging due to limited horizontal and vertical bone F. Shaya*, Y. Hsu, C. Herron volume. Limited bone volume is caused by rapid resorption of Introduction: Connective tissue grafts (CTG) have diverse appli- the alveolar ridge after tooth extraction, progressive pneumatiza- cations in the field of periodontics. The primary indications involve tion of the maxillary sinus, and limited bone height to the sinus root coverage in cases of gingival recession causing compromised to provide sufficient stability of the implants. Techniques such as esthetics and sensitivity. Traditionally, CTG are either fully-covered autogenous onlay graft and guided bone regeneration have been by the flap of the recipient site or left slightly partially-exposed. used to increase the limited bone volume in the area with sinus Compared with free gingival grafts (FGG), the amount of kerati- augmentation. However, there was limited degrees of success and nized tissue (KT) gained with CTG is limited. However, for anterior predictability with graft techniques, and prone to risk of compli- esthetics, color match becomes a concern when using FGG. This cations once combined with simultaneous sinus augmentation. case report shows the use of a fully-exposed connective tissue graft Maxillary sinus augmentation through lateral window is the most secured on a split-thickness recipient bed. documented technique that can provide increased vertical bone Method: A 31 year-old male patient presents with a chief com- volume available at the implant site with predictable prognosis. plaint of sensitivity associated with recession on tooth #24. Clini- Customized alveolar ridge splitting (CARS) technique can lower the cally, tooth #24 presents with 2 mm of recession with minimal KT risk of complications and shorten the procedure time for increased present on teeth #23-26. At the surgical appointment, a CTG was horizontal bone volume, which allows simultaneous sinus aug- harvested from the right maxillary tuberosity, measuring 10 mm in mentation for increased vertical bone volume. Also, with the CARS length, 7 mm in width, and 5 mm in thickness. The harvested tissue technique, the overall procedure becomes more predictable with was dissected in half but kept intact to result in a connective tissue favorable prognosis. graft with dimensions of 18 mm in length, 7 mm in width, 2.5 mm Method: A 61 years old female patient presented with partial in thickness, and a retained epithelial collar. A recipient bed was removable prosthesis in the maxilla looking for replacement of the prepared via split-thickness dissection in the lower anterior region missing teeth in the anterior maxilla and posterior premolar area. on the facial of teeth #23-26. The graft was then secured with 6-0 Custom alveolar ridge splitting combined with simultaneous max- polypropylene sutures with the epithelial collar facing facial and illary sinus augmentation using lateral window technique at the coronal of the recipient bed. site of maxillary left first and second premolar was performed in Results: During the healing period, the graft integrated well with order to enhance the facial bone contour. Subsequently, 4.1x10mm minimal sloughing or loss of tissue. The patient was brought for a and 3.3x10mm bone level tapered implants were placed simulta- 1-year follow-up to check on the final outcome. At 1 year, tooth neously at the edentulous sites. #24 presented with no residual recession. Furthermore, the zone of KT was increased with evident change in the tissue phenotype. *The first name listed is the presenter. The presenter may/may not be the primary author. 115 Table of Contents E-poster Abstracts Esthetically, the graft blended with the surrounding tissues without vertical releasing incisions were made on the facial. A full thickness having a different color or appearance, as FGG would. flap was then elevated to expose the implants. Cover screws were Conclusion: While FGG is the gold standard for augmenting replaced with healing abutments. Porcine derived XCM material the zone of keratinized tissues, this innovative technique allows a was manually compressed and condensed into balls ranging 6-7 fully-exposed stretching CTG to modify periodontal phenotype in mm in diameter and placed over the facial bone in areas of soft tis- multiple sites. The results at 1 year showed complete root coverage sue deficiency. A periosteal releasing incision was then made in the with increased zone of KT, as well as phenotype modification of the buccal flap to accommodate for the increase in volume from place- soft tissue with high esthetics and superior tissue blend compared ment of the XCM balls and to allow for tension-free flap closure. to FGG. Results: Our case series reported an average horizontal soft tissue volume gain of 4.33 mm. This finding is higher than results reported in other studies. The greater horizontal soft tissue vol- ume increase reported in our report compared to other studies that utilized porcine collagen matrix may be related to the dense compression of the XCM material into balls prior to placement. Conclusion: Soft-tissue augmentation is frequently needed to achieve an esthetic and stable result around implants in the esthetic zone. The use of XCM has been gaining popularity in peri-implant soft tissue augmentation, with results comparable to autogenous soft tissue graft while offering advantages, such as reduced surgical time, unlimited availability, avoidance of a secondary donor site, decreased post-surgical morbidity, and increased patient prefer- ence. The ball technique described provides a viable method for augmenting peri-implant soft tissue volume in the anterior maxilla using condensed XCM balls. Fig A: Initial presentation, Fig B-D: Harvested tuberosity tissue, Fig E: Prepared recipient site, Fig F: dissected connective tissue graft with retained P98 epithelial collar, Fig G: Graft secured on recipient bed, Fig H: 1-year follow-up Single Tooth Replacement In The Aesthetic Zone Utilizing Partial Extraction Therapy Concept: A Case P97 Series Peri-Implant Soft Tissue Augmentation Utilizing S.S. Shin*, W. Cheng, E. Fathi Condensed Xenogeneic Collagen Balls: Case Series Introduction: Single tooth replacement in the anterior maxilla is S. Sheng*, T. Mizuguchi, M. Salama, Y. Iwano, considered for many clinicians as one of the most challenging tasks E. Kitamura, S. Min in implant dentistry. Over the years, implant success has evolved from just attaining osseointegration into achieving a high aesthetic Augmentation of soft tissue deficiency is often Introduction: outcome. Different treatment options and techniques have been required for an esthetic outcome and long-term success of implant developed over the years to address this concern. Partial extraction therapy in the anterior maxillary region. Here, we present a case therapy (PET) is still considered to be controversial among aca- series on peri-implant soft tissue augmentation using condensed demicians and clinicians. However, in the past few years, there is xenogeneic collagen matrix (XCM) balls. This technique reduces an increase interest to validate the PET concept. Studies prove surgery time and avoids a secondary donor site compared to that successful osseointegration can be achieved. Also, the ridge autogenous connective tissue graft. A horizontal soft tissue volume dimension including hard and soft tissues can be maintained when increase ranging from 3-5 mm was observed post-surgically and PET is performed. In this presentation, three cases were successful maintained at later follow-ups. The ball technique described in this treated using PET. case series report offers a viable method for peri-implant soft tissue Method: Three different patients referred to the department of enhancement in the anterior maxillary region. Periodontology were treated with PET concept to replace a non-re- At second stage uncovery, crestal incision biased Method: storable single anterior tooth in the maxilla. Case 1: 70-year-old toward the palatal was made over the implant sites and oblique *The first name listed is the presenter. The presenter may/may not be the primary author. 116 Table of Contents E-poster Abstracts male tooth #7 Case 2: 40-year-old female tooth #9 Case 3: 77-year- descriptive statistics. The effect of maxillary vs mandibular arch as old male tooth #9 Treatment options were discussed in detail with well as between the placement of 4 vs 6 implants were analyzed each patient. In all cases, CBCT analysis was done prior to the to further understand whether these factors are associated with the surgery. PET concept as described by Gluckman et al. (2017) was accuracy of guided surgery. followed and performed. Results: 3-D deviations between the virtually planned and Results: Case 1: Healing abutment was placed following implant placed implants were found. The mean root-mean-square error placement. After 4 months of uneventful healing, the implant had (RMSE) between all 25 arches was found to be 0.199mm (SD an ISQ value of 75. The implant was restored with a temporary ±0.154). The mean RMSE between maxillary arches was 0.187mm crown before delivering the final restoration. At the 1 year fol- (SD ±0.151), and 0.214mm (SD ±0.163) between mandibles. The low-up, the gingival margin and buccal contour remained stable. deviations between the maxillary and mandibular arches were not Case 2: After extraction and immediate implant placement follow- significant (p > 0.05). The deviations between the arches with 4 vs ing PET technique, allograft was placed into the facial gap. The 6 implants were found to be significant (p < 0.05). implant was immediately provisionalized. Case 3: The same surgi- Conclusion: The 3-D deviations were found between the digitally cal steps were performed as the second case. However, following planned implants positions and the placed implants were found to implant placement a customized healing abutment was fabricated. be clinically acceptable and within reported threshold of discrep- Conclusion: Esthetic outcome is extremely important when deal- ancy. When comparing the implant 3-D deviations found between ing with single anterior tooth implant replacement. With careful and maxillary and mandibular arches, no statistically significant differ- specific case selection, PET concept can result in high esthetic out- ences were found. When comparing the implant 3-D deviations come and maintain the ridge dimension. In this case series, three between arches containing 4 implants and arches containing 6 cases were successfully treated using this technique. More studies implants, statistically significant differences were found, with lower with long term results will be needed to further validate and add to deviations in the group containing 4 implants. the body of scientific evidence supporting this treatment concept. P100 Complete Digital Workflow for Full-arch Maxillary Implant Rehabilitation E. Sicilia*, A. De Souza, K. Kang, K. Vazouras, Y. Kudara, P. Papaspyridakos Introduction: The purpose of this case report is to illustrate step-by-step a protocol for complete digital workflow for full-arch implant rehabilitation. Method: A 71-year old patient with an interim maxillary CD pre- sented for implant consultation at the Tufts PG Prosthodontic clinic. After diagnostic work-up, different options were discussed with the patient and she elected to proceed with maxillary fixed implant rehabilitation. New interim maxillary CD was made to satisfy esthet- ics, phonetics and OVD and subsequently used as a radiographic template. Dual CBCT scan was taken and the DICOM files were imported into digital planning software. Guided surgery was dig- itally planned and a mucosa-supported template was 3D printed. P99 Immediate loading was performed with a full arch interim prosthe- Digitally-Planned Guided Surgery in 25 Edentulous sis after the guided implant placement, by picking up intraorally Arches: Accuracy Outcomes the temporary abutments (conversion technique). After 2 months of uneventful healing, an double intraoral scan with the interim E. Sicilia*, D. Ben Yehuda, M. Finkelman, A. Muftu, prosthesis was taken, as well as a scan with the scan bodies. Both H. Weber, P. Papaspyridakos STLs were superimposed using adhesive markers in the palate as Introduction: The purpose of this study is to compare the 3-D reference using the Double Digital Scanning (DDS) technique. The deviations between the digitally planned and actually placed den- merged master file was used as a reference to manufacture a PMMA tal implants, in order to determine the accuracy of guided surgery. prototype after minor modifications were digitally performed with Method: The stone master casts of 25 fully edentulous arches CAD software. The PMMA was used as reference for the fabrication (14 maxillae and 11 mandibles) of patients treated with either 4 or of a full-arch implant-supported zirconia prosthesis. At the PMMA 6 implants (9 and 16 arches respectively) with guided surgery were prototype try-in, esthetics, phonetics, and occlusion were verified included in the present study. The stone casts generated from the and at the next visit, the definitive copy-milled zirconia prosthesis surgical templates (group one - test) used were digitally scanned was delivered. Clinically and radiographically acceptable fit was and digitized into Standard Tesselation (STL) files with a high pre- noted demonstrating the clinically satisfactory accuracy of the intra- cision reference scanner (Activity 880). For comparison, the stone oral digital impression, as well as the digital workflow followed for master casts derived from intraoral complete-arch impressions the design and manufacture of the definitive prosthesis. after implant placement (group two - control) were also digitized Results: The patient was satisfied with the esthetic and func- and the resultant STL files were superimposed to the test group. tional outcome and was enrolled on a 6-month recall program. A best-fit-alignment algorithm was used to quantify the 3-D devi- Conclusion: Complete digital workflow was made feasible ations present between the digitally planned vs placed implants. with an innovative DDS technique that facilitated the accurate The data were analyzed via a mixed-effects model (a = 0.05) and *The first name listed is the presenter. The presenter may/may not be the primary author. 117 Table of Contents E-poster Abstracts superimposition of STL files from digital impressions for the fabri- Conclusion: IP is associated with significantly lower perceived cation of the prosthesis prototypes in a cast-free approach. pain compared to EXT and MGS surgery. Analgesic consumption was generally parallel to pain perception. A considerable number of patients elected to control the post-surgical pain using over P101 the counter medication up to 72 hours. Periodontal/oral surgery Double Digital Scanning Technique for Full-arch procedures vary in the amount of perceived post-operative pain. Implant Rehabilitation Tailoring post-operative medications to the type of periodontal/oral E. Sicilia*, A. Alfagheli, M. Baevsky, Y. Chen, K. Vazouras, surgery performed will help prevent over prescribing of opioids. P. Papaspyridakos Introduction: The purpose of this case series is to report early P104 outcomes of a protocol for complete digital workflow in full-arch The Surgical Anatomy of The Greater Palatine Artery: A implant rehabilitation with zirconia prostheses. Human Cadaver Study Method: Three patients underwent full-mouth fixed implant rehabilitation with double full-arch, one-piece, minimally veneered N. Soldatos*, L. Herman, K. Font, S. Chandrasekaran, monolithic zirconia prostheses at the multi-unit abutment level. A C. Powell digital workflow was applied throughout all aspects of the treat- Introduction: The identification of the accurate location of the ment, from digital planning and template-guided implant place- greater palatine artery (GPA) can be challenging. The purpose of ment to digital impressions and CAD/CAM prosthodontics. Clinical the present cadaver study was to determine the location of GPA and radiographic outcomes are reported after up to 2-years of fol- from the cementoenamel junction (CEJ) of the maxillary canine to low-up. second molar teeth and to define its relationship with the palatal Results: After short-term 2-year observation time, implant and vault height (PVH) in Caucasian cadavers. prosthesis survival rates were 100%. Minor biologic complica- Method: The inclusion criteria were as follows: (i) each quad- tions such as peri-implant soft tissue recession was observed in rant had to have their canine through second molar (specimens all patients, while no technical complications were encountered. A with missing 1st premolars were excluded), and (ii) teeth were not digital workflow for double full-arch fixed implant rehabilitation in supraerupted or misaligned in the arch. If there were multiple miss- 4 appointments was implemented. ing teeth or unidentifiable CEJ’s, the specimens were excluded. Conclusion: Digital workflow can simplify the full-mouth implant The specimens consisted of 16 males (M) and 19 females (F) with rehabilitation with monolithic zirconia prostheses and predictably an age range of 53 to 98 (mean age: 75.5 years). The PVH was reduce chairside time and clinical appointments. The integration of measured vertically from the midpalatal suture to the level of the digital planning, intra oral scanners and CAD/CAM technology has CEJ of the maxillary first molars using a custom stent fabricated been key to the enhancement of clinical effectiveness. The use of for each specimen using 0.02 Raintree Essix material. The UNC 15 monolithic zirconia as the prosthetic material for double full-arch probe was placed in the center of the custom stent to measure the fixed implant rehabilitation, seems promising in the reduction of height of the palatal vault. Categorization of the PVH was as fol- treatment visits as well as the most frequent technical complication lows: shallow (S) (9 to 11mm), average (A) (12 to 14mm), and high of porcelain chipping/fracture. (H) (>15mm). Sectional cuts were made in the palate to visualize the artery and make measurements of the GPA’s distance from the CEJ of the corresponding teeth. P103 Results: The location of the GPA from the CEJ ranged from Evaluation of The Need to Prescribe Opioid a minimum of 8.7+ 2.1mm at the canine, to 14.5+1.3mm at the Medication to Control Post-surgical Pain of Different second molar (Table 1). The minimum distance of the GPA to the Periodontal/Oral Surgeries CEJ in different PVH, ranged from 6-12mm. There was a significant difference between male and female cadavers regarding the shal- N. Soldatos*, O. Al Bayati, K. Font, C. Powell low PVH. The PVH only, as independent variable had a significant Introduction: To determine the level of perceived pain after correlation with the location of GPA. There was no effect of age at different types of periodontal/oral surgical procedures, and differ- the location of the GPA. ences in patients’ selection of pain management protocol over the Conclusion: The majority of PVH in this cadaver study was high counter (OTC) versus opioid based on procedure type. (>15 mm), with the maximum distance of the GPA from the CEJ Method: Patients undergoing surgical procedures were asked to ranging between 10.0 mm (mean) at the canine to a 14.5 mm complete a pain questionnaire at four time points: 1) prior to sur- (mean) at the second molar in this vault type. The gender was gery 2) first dose of analgesic at home, 3) 24 hours post-operatively, identified as a significant factor regarding the location of the GPA, and 4) 72 hours post-operatively. The questionnaire consisted of especially on the shallow PVH. numerical and descriptive scales to describe the perceived pain. Results: 198 patients completed the questionnaire. Surgeries were categorized into five major categories: Bone Augmenta- tion Procedures (11% BAP) Teeth Extractions (26% EXT), Surgical Implant Placement (25% IP), Mucogingival Surgeries (21% MGS), and Pocket Elimination Procedures (17% PE). MGS and EXT were associated with significantly higher pain rate and pain severity. IP surgery was associated with significant less pain. There was a sta- tistically significant difference for taking any medication based on type of surgical procedure at 24 hours (p<0.05). *The first name listed is the presenter. The presenter may/may not be the primary author. 118 Table of Contents E-poster Abstracts Conclusion: In non-smokers, age did not affect the ability to isolate or expand aBMSCs nor did it have an impact on their growth kinetics in culture. However, in smokers the combined effects of smoking and age had a slightly negative effect on the ability to isolate aBMSCs and their growth kinetics in culture. Further studies evaluating the osteogenic potential and regeneration capacity of these cell populations are needed to continue to translate these findings toward clinical application for the regeneration of bone defects. Interaction plot of the logistic regression between age and smoking on the capacity to successfully isolate aBMSCs. Negative correlation between smoking and age. The odds of being able to predictably isolate aBMSCs decreases Cadaver measurements from GPA to the CEJ from maxillary canine to 2nd among smokers with age. The odds of isolating aBMSCs remains relatively molar showing the mean and standard deviations and the minimum distance constant with age among non-smokers. from the CEJ to GPA. P105 P106 The Effects of Age and Smoking on Alveolar Bone Angulated Screw Channel Solution With Increased Derived Stem Cell (aBMSC) Isolation and Growth Preload C. Sommer*, C. Cao, A. Dahlkemper, D. Kaigler A. Stuart-Smith* Introduction: Angulated Screw Channel Solutions have gained Introduction: Alveolar bone serves as a potent source of aBM- a reputation of being associated with “screw loosening” result- SCs, which can be used in cell therapies for the regeneration of ing from a decreased preload in the retaining screw due to the craniofacial bone defects. Developing stem cell therapies into clin- angulation. Further complications include interface distortion and ical application requires standardized techniques for isolating and that Angulated Screw Channel Solutions have low limits in terms growing aBMSCs. The goal of this project was to determine how of maximum achievable tightening torque of the retaining screw. systemic variables such as age and smoking affect the isolation and This is due to limited driver-screw interface engagement which is growth potential of aBMSCs. a consequence of screw channel angulation. This study aimed to Method: In this pilot study, a total of 58 alveolar bone samples propose a new Angulated Screw Channel Solution, utilising high were collected (0.2 cc - 1.0 cc) using a bone scraper during surgical strength materials and optimum dimensions, which can take up to procedures requiring bone removal from systemically healthy indi- 45 N.cm torque and hence generate significantly higher preload viduals between the ages of 20 and 90 years old. The sample col- than current solutions1 and preload equivalent to or greater than a lection included 21 current smokers. From these samples, aBMSC non-angulated screw channel at recommended torque. 1 Pitman J, populations were isolated and characterized through cell-surface Blackbeard G. The effect of angulation on the preload developed marker expression and growth kinetics. Multivariate linear regres- in a TiN coated retention screw driven by an omnidirectional TPA sion analysis was performed. driver from IPD. Proceedings of the 2017 Academy of Osseointe- Results: The ability to predictably isolate aBMSCs decreased gration Annual Meeting; 2017 Mar 16; Orlando, USA. with age among smokers. In alveolar bone samples from the smok- Preload measurements were recorded in titanium M2 ing group, there was a 100% success rate in isolating aBMSCs from Method: test screws during the application of input torques ranging from samples of younger patients compared to 50% success rate in 30-45 N.cm (in 5Ncm increments) using an optimally dimensioned isolating aBMSCs from older patients. Among non-smokers, the driver made of high strength stainless steel and torque gauge. At donor age did not significantly affect the ability to isolate aBMSCs. each input torque condition, the driver was angulated relative to Regardless of smoking status, cell surface marker expression was the screw axis at set positions between 0-20°, in increments of 10°, consistent among all age groups with > 99% of cells expressing using custom designed guide rings. At each angulation test condi- CD73, CD90 and CD105. Finally, while there existed pre-culture tion, the preload measurements were repeated 5 times with new differences in the cell compositions of the samples, after 72 hours screws being used each time. in culture these differences were not apparent in that regardless of On average, a 2% drop in the developed preload was smoking status or age, aBMSC populations had a fast proliferation Results: seen for the 10° angulation case and a 5% drop in the 20° angu- rate (mean population doubling time =1.36 days, SD=0.46 days) lation case. For all angulations tested, a higher tightening torque and a high stem-cell specific cell fraction of 19-27%. achieved a higher preload. The preload achieved at 45 N.cm for *The first name listed is the presenter. The presenter may/may not be the primary author. 119 Table of Contents E-poster Abstracts both the 10° angulation case and the 20° angulation case was 1.1 Conclusion: The use of osseodensification presents significant to 1.3 times greater than the preload achieved in a non-angulated advantages over traditional implant site preparation in three dif- screw channel (0° angulation) within the recommended torque ferent surgical protocols and should be implemented in every-day range of 32-40 N.cm. clinical practice for bone preservation, increased primary implant Conclusion: By utilising high strength materials and optimising stability and improved clinical results. the dimensions, a new Angulated Screw Channel Solution can take up to 45 N.cm torque and hence generates significantly higher pre-load than current solutions1 and 1.1 to 1.3 times greater than P108 a non-angulated screw channel at recommended torque. The Early Adhesion Effects of Human Gingival Fibroblasts (HGFs) on the Bovine Serum Albumin (BSA) Loaded Hydrogenated Titanium Nanotube (H2-TNTs) Surface Y. Sun* Introduction: The aim of the this study was to investigate the early adhesion effects of human gingival fibroblasts (HGFs) on the bovine serum albumin (BSA) loaded hydrogenated titanium nano- tube (H2-TNTs) surface. Method: 200μg,400μg,600μg BSA was loaded under vacuum on H2-TNTs samples which were synthesized by anodized oxida- tion and hydrogenation. The characteristics of the surfaces of H2- TNTs and BSA loaded H2-TNTs including topography, roughness, wettability, chemical structure and composition were performed P107 by scanning electron microscopy(SEM), atomic force microscopy, The Implementation of Osseodensification in Three water contact angle measurement, Raman spectrometer and Fou- Different Surgical Protocols rier transform infrared spectroscopy. HGFs were seeded on four N. Soldatos*, P. Stylianou, E. Umoh, N. Palanker sample groups: H2-TNTs(HTNT), air-TNTs(TNT), BSA-loaded H2- TNTs (BHTNT), BSA-loaded TNTs (BTNT). Cell adhesion and viability Introduction: The implementation of osseodensification in were evaluated by CCK-8 and live/dead staining at 0.5h, 1h, 3h, implant dentistry has been well established in literature. The use of 9h. Cell morphology was observed by scanning electron micros- three different osseodensification protocols are presented, which copy at 0.5h, 1h, 3h, 9h. Secretion and expression of FAK, integrin demonstrate the positive effects of dynamic bone instrumentation, and COL-1 were also evaluated at 0.5h, 1h, 3h, 9h to determine as well as, the simplification of more complex implant procedures. whether the surface and the loaded growth factors promoted the Method: Case 1: A 42-yr. old Hispanic female, ASA II, presented early adhesion of HGFs. All results were statistically analyzed using with missing teeth #23-26 and non-restorable teeth #22 and 27, analysis of variance (ANOVA) due to caries. A CBCT was taken, and the ridge width was mea- Results: The roughness was unchanged when BSA was loaded sured to be 3.50 mm at the crestal aspect, with the trabecular bone into nanotubes. Both H -TNTs and BSA-loaded H -TNTs presented measuring 2.23 mm. Using the osseodensification ridge split pro- 2 2 stable super-hydrophilic surface with water contact angle < 5°. The tocol, the ridge was split using the piezotome and then expanded adhesion and proliferation of HGFs on BSA-loaded H -TNTs were using the osseodensification burs. Teeth #22 and 27 were extracted 2 found to be significantly enhanced at the very early time point. atraumatically. Ridge augmentation of edentulous areas #22-27 was What’s more, the secretion and expression of FAK, integrin and then completed using FDBA and collagen membrane, and primary COL-1 were significantly increased in BSA-loaded H -TNTs group. closure was achieved. Case 2: A 75-yr. old African American female 2 Conclusion: The BSA-loaded H -TNTs surface could potentially ASA II, presented with hopeless prognosis of tooth #19. A CBCT 2 promote the early adhesion of HGFs compared with other groups. was taken and a surgical guide was generated through virtual plan- ning. The extraction of #19 was completed atraumatically, followed by implementation of the molar septum expansion protocol with the osseodensification burs, and a 5.0 x 13 mm implant was placed at 35 Ncm. The sockets were grafted using FDBA and covered with PTFE membrane to heal via secondary intention. Case 3: A 52-yr. white female, ASA II presented with missing #13-15. Implementa- tion of the osseodensification sinus lift protocols allowed for 3.0 - 8.0 mm sinus lift and implant placement of a 4.1 x 10 mm on #13 and 4.8 x 10 mm on #14 with a 35 Ncm torque value. Results: Case 1: An average of 3.0 mm increase in horizontal width was noted 6 moths post-operatively, with a 1.15 mm increase in trabecular bone width. Case 2: The implant was successfully osseointegrated at time of second stage surgery with good bone levels. Case 3: The implant was successfully osseointegrated at time of second stage surgery. The bone graft integrated well with the native bone, and the new sinus floor reformed at the apex of the implants. *The first name listed is the presenter. The presenter may/may not be the primary author. 120 Table of Contents E-poster Abstracts P109 P110 Effect of Static Magnetic Field on MC3T3-E1 Cells Evaluation of the Accuracy of Full-arch Intraoral Differentiation via TGF-β Pathway Scanning Method and Conventional Impression: An C. Supachatwong*, H. Nakata, Y. Tamura, S. Kuroda In-vitro Comparison Based on 3D Analysis and Dental Introduction: Introduction: Static magnetic force is proved to be Measurements. a safe way to achieve better ossification. However, the mechanism A.T. Sverzut*, K.L. Mendes, T.O. Gonçalves of using magnets are still unclear in cellular level. The purpose of Introduction: To evaluate and compare the accuracy of two this study was to evaluate the relevance of ossification by magnetic intraoral scanners with the traditional method of casting. β stimuli via TGF- pathways. Method: Full-arch impressions of a reference maxilla were per- Method: Method: MC3T3-E1 cells were cultured with or with- formed through casting and two intraoral scanners. The sample out neodymium magnets (30mT, 100mT and 250mT) placed under has a total of 135 repetitions. All digital files in .STL were imported the culture plate by adjusting the distance between culturing well into the program 3D software and compared separately to the ref- and the magnets. After 3, 5, 7 days of culture, cells were collected erence model to verify their reliability. To verify the precision, the to measure proliferation rate, toxicity, ALP and Von Kossa stain- models within the same group were overlapped and compared to ing at various magnetic field generated by neodymium magnets. The best magnetic field intensity for cell proliferation and staining each other using the same protocol with the 3D software. Finally, results was further studied to find the mRNA related to TGF-β path- to identify the accuracy, the intercanine and intermolar distances ways by qRT-PCR method. Data were calculated by student t-test of all models of the different groups were obtained and compared and fold changes of qRT-PCR. to the measurements of reference. Results: Results: Magnetic field of 250mT showed statistically Results: The qualitative analysis revealed variations, principally significant higher proliferation at 3, 7 days and higher ALP, Von in the posterior region of the dental arch and the precision is Kossa staining concentration by 10 days compare to other intensi- greater in the intraoral scanners when compared to the conven- ties. None of the magnetic field intensity in this study has toxicity. tional impression. The quantitative analysis showed that first scan- At 7 days of qRT-PCR on 250mT, ALP, Runx2, Osterix and OCN were ner do not present differences statistically significant compared to upregulated, and it is indicated that osteoblast differentiation was the reference, unlike second scanner and plaster models, however, upregulated as the result of upregulated BMPR1a, BMPR2, Smad1 these variations do not produce clinical significant deviations. The and Smad 3 at 3 and 5 days. BMPR1b was down regulated by 0.53 conventional impression exhibited the lowest accuracy and 0.6 fold by 3 and 5 days but upregulated by 1.2 fold at 7 days. Conclusion: Intraoral scanners are reliable and reproducible, with Conclusion: Conclusion: Magnetic field at proper intensity may results superior to those of conventional impressions. ACKNOWL- upregulate TGF-β pathway and result in enhancing osteoblastic EDGEMENTS This research was supported by grants from the São differentiation. Paulo Research Foundation (FAPESP, Brazil, 2018/18663-0). P111 Accuracy of the Osseointegrated Dental Implants Placement by a New Method for Obtaining Surgical Template for Flapless Guided Surgery. In-vitro Study A.T. Sverzut*, K.L. Mendes, J.V. Silva, P.Y. Noritomi, L. Asprino, M.d. Moraes Introduction: The essential aspects in the dental implants place- ment include the protection of all anatomical structures aiming the best aesthetic-functional result. The literature demonstrates that there are two ways of transfer the virtually position of the planned implant to clinical situation, the static through surgical templates (surgical guides) and the dynamics through surgical navigation. Method: The objective of this study is to validate a new method of obtaining a surgical template for flapless dental implant surgery using a intraoral scanner and additionally validate a new method of comparison of the accuracy of dental implants placement by digital transfer placed implants. Four dental implants will be placed by flapless surgery in polyurethane mandible with silicone gum simu- lation. Positioning of dental the implants will be achieved through the 3D software. The 3D STL prosthesis model will be obtained through tomography and scanning (by intraoral scanner) of the prosthesis. Results: The study is under development and will have the final results in November 2020, the authors would very much like to Figure 1: Results of proliferation, toxicity, total ALP and qRT-PCR of TGF-β present the results at the Academy of Osseointegration Annual markers. Meeting. *The first name listed is the presenter. The presenter may/may not be the primary author. 121 Table of Contents E-poster Abstracts Conclusion: It is expected that the new method of acquisition of the surgical template for installation of dental implants demon- strates a better accuracy mainly due to the decrease of variables to obtain them. ACKNOWLEDGEMENTS This research was supported by grants from the São Paulo Research Foundation (FAPESP, Brazil, 2018/18663-0) P112 Maxillary Tuberosity Bone Graft Y. Tan*, M. Dimaira, K. Green Introduction: Severe bone resorption can occur after tooth loss, which makes the site unamenable for implant placement. There are various techniques and bone grafting materials which can be employed to augment the planned implant site. Autogenous bone grafts have always been considered “the gold standard” due to their biocompatibility as well as their osteogenic potential to form new bone, which allografts, xenografts and alloplast materials lack. Common intra-oral donor sites for harvesting of block bone grafts include the ramus and the symphysis. The maxillary tuberosity has not been extensively used as a site for block bone graft harvests despite its lower associated morbidity, due to its expected poorer bone mineral density and hence bone quality. Method: A 71 year old male presented with the request for a dental implant to replace his missing maxillary right first molar, which was extracted about 10 months previously due to caries. Clinical and radiographic examination revealed clinical periodon- tal health on a reduced periodontium, and a prominent maxillary right tuberosity. The planned implant site presented with a defect measuring 5-6mm bucco-palatally, 5mm apico-coronally at the P113 mid-buccal aspect, and 10mm mesio-distally. A block bone graft Evaluation of Measurements Consistency With Various measuring 7mm by 11mm and 2mm in thickness was harvested CBCT settings in the Maxillary Teeth: Cadaveric Study from the crest of the maxillary right tuberosity and fixated at the Y. Tanaka*, K. Ferry, W. Lin, D. Vinicius, Y. Hamada planned implant site. Particulate bone graft was also harvested from Introduction: Field of view (FOV) and Voxel size need to be the maxillary right tuberosity and used to augment the planned adjusted based on the area of interests with cone-beam computed implant site. The bone grafted site was covered with a resorbable tomography (CBCT). The proper combination of FOV and exposure collagen membrane and allowed to heal for 4.5 months prior to parameters will maximize the benefits for patients and clinicians. re-entry for implant placement. However, there is no report to show the consistency of soft and Upon re-entry, the bone graft was well integrated. The Results: hard tissue measurements with variety of CBCT settings. bone fixation screw was removed and an implant measuring 4.8 by Method: A total of five maxillary anterior teeth segments were 12mm was placed and submerged. The submerged implant was obtained from cadavers. This study included three different CBCT allowed to heal for 4.5 months before a second stage uncovery setting including: Control (Voxel: 0.25mm, FOV:16x10cm), Test 1 surgery was performed. The implant stability quotient (ISQ) reading (Voxel: 0.4mm, FOV:16x10cm), and Test 2 (Voxel: 0.3mm, FOV: at the time of uncovery was 81, indicating high stability. Clinically, 23x17cm). All measurements were carried out at three different the implant was well integrated with a buccal bone thickness of points (P1: 3mm, P2: 5mm and P3: 7mm from a reference) on all approximately 2mm at the crest. There were no evident clinical or anterior teeth. A total of 90 sites were analyzed. Intraclass correla- radiographical signs of crestal bone loss. tion coefficients (ICC) and Bland-Altman plots were used to evalu- The maxillary tuberosity can be a safe and cost-ef- Conclusion: ate the observation-level agreement among three different CBCT fective alternative source for harvesting of autogenous block and settings. particulate bone grafts for alveolar ridge reconstruction prior to Results: None of the comparisons in all groups exceeded ICC implant placement. more than 0.9. Regarding the soft tissue thickness agreement, ICC including all measurements, revealed a relatively high agreement between C versus T1 (0.80), however other groups showed lower such as C versus T2 (0.62) and T1 versus T2 (0.74). In hard tissue assessment, none of ICC value with all measurements reached more than 0.8 (C versus T1 = 0.6, C versus T2 = 0.69, T1 versus T2 =0.75). The mean of buccal bone thickness decreased in two test groups (C: 0.52mm, T1: 0.36mm, T2: 0.39mm). There were statisti- cally significant differences between C versus T1 (p=0.002) and C versus T2 (p=0.001), however, there was no difference between T1 and T2 (p=0.508). The means of buccal bone thickness on canines *The first name listed is the presenter. The presenter may/may not be the primary author. 122 Table of Contents E-poster Abstracts and position P3 were significantly higher for Control than Test 1 Assessment of each 6 segments indicated a gradual increase of and 2. The mean of soft tissue thickness showed C: 0.87mm, T1: inaccuracy from anterior to posterior segments. 0.87mm, and T2: 0.91mm. These mean values were not significantly Conclusion: The present study suggests translocation as a prom- different between all groups (p>0.05). inent source of inaccuracy in complete arch digital impressions via Conclusion: This study showed that the consistency of three IOS. Comparison between scans with and without fiducial markers different CBCT settings were not reliable at the level of each indi- indicated such reference markers failed to aid in improved accu- vidual measurement. A larger voxel size and FOV did not have a racy. Trueness and precision were sub-optimal for both test scans. significant impact on the mean of the soft tissue thickness, but Error distribution pattern analysis indicated increased inaccuracy in significantly altered the mean buccal bone thickness. Therefore, posterior segments compared to anterior segments. each clinician needs to be aware the radiographic measures can be variable based on the different CBCT settings. A- top, TSC1 and RSC alignment; bottom, TSC2 and RSC alignment B- top, TSC1 inaccuracy in comparison to RSC; bottom, TSC2 inaccuracy in comparison to RSC C- magnified view of pre-correction posterior segment D- reduced inaccuracy following translational and rotational correction E- magnified view of post-correction posterior segment P115 Non-invasive Alternative for Uncovering Implants by P114 the Use of Soft Tissue Conformation Technique In vitro Study on Accuracy of Complete-Arch Intraoral A.C. Torres* Scans: The Contribution of Translocation Errors to Introduction: Anterior implant rehabilitation has become a real Overall Surface Inaccuracy challenge for Dentistry. Biological factors and the high aesthetic commitment have led the proposal of many techniques to achieve G. Tao*, P. Sim, S. Jackson, V. Lee, S. Song optimal and predictables results. Objective: To propose a non- Introduction: Digital impressions derived from intraoral scan invasive alternative for uncovering implants by the conformation (IOS) have shown deviations in trueness increases progressively of soft tissues technique. with the accumulation of scanned area. This error is generally rec- Method: A protocol was planned for uncovering an anterior ognized, but there is a lack of evidence to characterize the nature implant in a 26-years-old female patient, with thick gingival phe- of such inaccuracy. In the present study, a novel metric was utilized notype, by implementing the soft tissue conformation technique to identify the nature of inaccuracies by means of quantifying direc- based on the use of an ovoid pontic made by resin increments tional deviation. gradually towards the implant platform. Method: An edentulous stone cast was scanned on a labora- Results: In the traditional protocol for implants uncovery it is tory scanner as reference-scan-cast (RSC), and with an IOS as test- usually done through many surgical interventions which could scan-cast 1 (TSC1). 5 fiducial markers were positioned on the cast cause irreversible changes in the peri-implant tissues. The main and scanned with IOS as test-scan-cast 2 (TSC2). Test scans were requirement is to carry out a careful management of soft tissues repeated 45 times. All scans were processed to generate a stan- therefore it is of utmost importance while the implant platform dard tessellation language (STL) mesh. Region of interest (ROI) of 6 exposition for connect it to a restoration be as less traumatic as segments were determined from TSC1 and TSC2 with a 3-D model- possible. In the present case report, the conformation of the ovoid ing software. TSC1 and TSC2 were aligned to RSC utilizing iterative pontic was elaborated through the provisional and its gradual resin closest point (ICP) algorithm and a 3-D metrology software. In this increments contact with the closure screw was achieved and then initial alignment, the surface accuracy was evaluated. Following ini- replaced by a healing abutment thus avoiding a second surgical tial registration, each segment was translated and rotated to find intervention with a distance of 4 mm from the bone crest to the its own best-fit position in accordance with RSC. The translocation upper edge of the gingival margin. error was defined as the combined translational and angular dis- Conclusion: This technique could minimize the number of crepancy of each segment to reach its best-fit position. Surface surgical procedures performed during the second implantologi- deviation was visualized with a heatmap and numerically reported cal phase improving the conformation of the peri-implant tissues as mean, and standard deviation of pre- and post-correction root and promoting an adequate emergence profile whose final result mean square error (RMSE) for individual segments. depends on all the procedures carried out from the insertion of the Results: ΔRMSE for TSC1 was 70.3±17.2% (p=.000) with a implant to the placement of the definitive restoration. pre-correction RMSE absolute value (AV) of 80.7±58.0μm and post-correction RMSE (AV) of 16.7±5.5μm. ΔRMSE for TSC2 was 81.8±13.4% (p=.000) with a pre-correction RMSE (AV) of 113.6±71.6μm and post-correction RMSE (AV) of 14.7±12.0μm. *The first name listed is the presenter. The presenter may/may not be the primary author. 123 Table of Contents E-poster Abstracts P116 P117 Implant Placement Lateral to Inferior Alveolar Nerve in Digital Versus Conventional Implant Impressions: A Extremely Atrophic Posterior Mandible Systematic Review D. Tsitsimelis*, A. Alqarni, N. Reis, S.J. Froum, S.C. Cho K. Vazouras*, Y. Chen, E. Kotina, Z. Natto, K. Kang, Introduction: An atrophic posterior mandible is a challenge for P. Papaspyridakos a successful implant placement. Oftentimes, bone augmentation Introduction: Objective of the review was to systematically is indicated to achieve the desired bone volume for the implant review in vitro and clinical studies comparing quantitatively the placement. There have been developed numerous techniques to 3D accuracy (global implant deviations) of digital vs conventional increase the alveolar bone height and width. However, each one implant impressions for partially and completely edentulous of them has complications and limitations. An alternative treatment patients. for placing implant in posterior of an atrophic mandible is to place Method: To systematically review in vitro and clinical studies an implant lateral to inferior nerve (ILIAN). comparing quantitatively the 3D accuracy (global implant devia- Method: All clinical data in this study was obtained from the tions) of digital vs conventional implant impressions for partially Anonymous Implant Database (AID) at New York University Col- and completely edentulous patients. lege of Dentistry (NYUCD). This data set was extracted as de-iden- Results: The inclusion criteria were met by 9 in vitro and 1 clin- tified information from the routine treatment of patients at the ical study reporting on completely edentulous impressions, while Ashman Department of Periodontology and Implant Dentistry at 6 in vitro and 2 clinical studies reporting on partially edentulous NYUCD. The AID was certified by the Office of Quality Assurance impressions. Quantitative meta-analysis was performed for 5 com- of NYUCD. This database was given Internal Review Board (IRB) pletely edentulous and 6 partially edentulous studies. The studies approval and was in compliance with the Health Insurance Porta- exhibited high values for heterogeneity. A random effects model bility and Accountability Act (HIPAA) requirements. A total of 16 was conducted to estimate the effect size. Based on 5 in vitro stud- consecutive patients with atrophic posterior mandible that will ies on completely edentulous impressions, the mean 3D implant receive a single or multiple dental implants in the posterior area deviation between conventional and digital impressions was 8 μm will be included. Pre-operatively evaluation through clinical evalu- (95% CI: -53.56, 37.15) and the digital impressions had nominally ation and radiographic imaging through CBCT will be taken. After less deviation (P=0.72). Based on 1 clinical and 5 in vitro studies obtaining proper informed consent implant will be placed in the on partially edentulous impressions, the mean 3D implant deviation atrophic mandible in the space of the missing teeth. between conventional and digital impressions was 52 μm (95% Results: Of the 16 cases, in 4 cases implants were placed lateral CI: 6.30, 98.33) and the conventional impressions had nominally to IAN without need of bone augmentation procedures. In 1 case less deviation (P=0.03). Five in vitro and 2 clinical studies were not GBR was needed after implant placement lateral to IAN to cover included in the quantitative analysis due to heterogeneity in the a coronal buccal dehiscenece. In 6 cases the CARS technique was methodology. Implant angulation affected the accuracy in favor performed three weeks prior to the placement of the implants lat- of the partially edentulous conventional impressions whereas the eral to IAN. In 5 cases narrow diameter implants (1.8 to 2.4 mm) effect of different scanners was not statistically significant on the were placed 1-2 mm lateral to the IAN and served as a guide for completely edentulous impressions (P=0.82). the standard diameter implants placement. Of the 26 implants Conclusion: Digital scans appear to have comparable 3D placed lateral to the IAN in the posterior mandible in 16 patients, accuracy compared with conventional implant impressions based all successfully osseointegrated and were restored with splinted mainly on in vitro studies. However, clinical trials are recommended screw-retained restorations. to investigate the clinical accuracy of digital scans and digitally Conclusion: The ILIAN is a viable treatment option in patients fabricated interim or prototype prostheses, before digital implant of severely atrophic posterior edentulous mandibles for patients scans can be recommended for routine clinical use. who desired dental implants with a fixed prosthesis. The advan- tages include less trauma, surgical less time, implant placement without ridge augmentation (most of cases), and less postoperative P118 complications. Selective Responses of Human Gingival Fibroblasts to Superhydrophilic Hydrogenated TiO2 Nanotubes C. Wang*, X. Wang, R. Lu, S. Chen Introduction: Soft tissue integration is critical for the long- term retention of dental implants. In our previous work, a thermal hydrogenation technique was applied to modify anodized titanium dioxide nanotubes (TNTs), constructing a unique superhydrophilic nanostructure surface thus enhancing certain osteogenic proper- ties. However, the effects of the hydrogenated surface on soft-tissue cells remain unclear. The aim of the present study was to investigate Panoramic x-ray & CT scan of ILIAN. the bioactivities of human gingival fibroblasts (HGFs) on structured surfaces, which determine the early formation of soft tissue sealing. Method: Three groups were examined: commercially pure titanium (CpTi), anodized titanium dioxide nanotubes (air-TNT) and hydrogenated titanium dioxide nanotubes (H2-TNT). Char- acterization of the samples was performed. Subsequently, in vitro studies such as cell adhesion assays, cell morphology, *The first name listed is the presenter. The presenter may/may not be the primary author. 124 Table of Contents E-poster Abstracts immunocytochemistry, real time quantitative polymerase chain challenges. Connective tissue graft (CTG) placed under the buccal reaction and enzyme-linked immunosorbent assays were per- flap has been proposed to minimize soft tissue recession. No infor- formed to analyze the effects of the modified surfaces on the HGFs. mation is, however, available on the effect of CTG on the buccal Results: After anodization, TNTs were formed on titanium. Then, wall dimension. Thus, the aims of the study were to investigate hydrogenation ensured the H2-TNT surface was superhydrophilic the effect of CTG at immediate placement sites on (i) buccal bone with a contact angle of 3.5±0.8°. In vitro studies, cell adhesion on thickness and (ii) esthetic outcomes. the H2-TNT was significantly higher than that on the other groups Method: Twenty-six patients who had a single maxillary central (p < 0.001). HGFs on H2-TNT presented more filopodia at 1h and incisor tooth replaced by an immediate implant placement were displayed more extensively spread cytoplasm adhered intimately to included in this retrospective study. All surgeries were performed the surface with adhesion microstructures anchored and stretched by one experienced periodontist in a private practice setting. The into the nanotubes at 4h and 24h than those on air-TNT. More over, implant sites were divided into 2 groups in accordance to the cells on H2-TNT surfaces showed higher vinculin expression (immu- placement of the CTG, Group A: with CTG (n = 15) and Group nofluorescence) and more mature focal adhesions formed at the 2: without CTG (n = 11). At the final recall exams, intra-oral pho- periphery of the cells. At both 4h and 24 h, the HGFs on H2-TNT tography and CBCT scans were obtained. A calibrated examiner showed higher mRNA expression of focal adhesion kinase and inte- assessed the thickness of buccal plate at the implant shoulder and, grin β1 than air-TNT and CpTi (p each < 0.05). As for vinculin, there 2, 4 and 6 mm below on CBCT. Clinical esthetic assessment was is no significant difference between H2-TNT and air-TNT until 24 h conducted using the pink and white esthetic scores (PES/WES). (p < 0.05). Fibronectin and collagen I secretion from HGFs on the Mean values and standard deviations were obtained for each vari- H2-TNT surface were significantly higher than those of the other able, site and group. The differences between the groups were two groups after 4, 7days of incubation (p each < 0.05). analyzed with Mann-Whitney test. Conclusion: Our results revealed that a superhydrophilic nano- Results: Patients were followed for 1-15 years (mean 6.5 ± 4.3). structure modified by anodization and hydrogenation can improve The buccal bone thickness in Group A at the implant shoulder and, the bioactivity of HGFs and connective tissue regeneration. 2, 4, and 6 mm below were, respectively, 1.0±1.1 mm, 1.4±1.1 mm, 1.4±1.3 mm and 1.3±1.2 mm. The corresponding values in Group B were 0.7±1.0 mm, 0.8±1.1 mm, 0.7±1.0 mm and 0.9±0.9 mm. No significant differences were observed between the two groups. The mean Pink Esthetic Score (PES) in Group A was significantly higher than in Group B, 8.0±1.8 vs. 5.7±2.6 (p<0.05). The mean White Esthetic Score (WES) in Group A was 8.1±1.7 and in Group B, 6.3±2.4. There was no significant difference between the 2 Groups. The PES/WES was, however, significantly higher in Group A than in Group B, 16.1±2.7 vs. 12.0±4.5 (p<0.05). Conclusion: Within the limitations of this study, the use of CTG following immediate implant placement and socket graft promoted better soft tissue esthetics but failed to improve the dimension of the buccal bone wall. P120 Effect of Printing Parameteres on Flexural Properties of 3D Printed Polyether Ketone Ketone (PEKK) R. Wang* Introduction: Additive manufacturing (AM) becomes an import- ant mean for the fabrication of customized biomedical devices and P119 dental implants. Printing parameters are critical factors which affect Effect of Connective Tissue Graft on Buccal Bone properties of a printed material. The recent trends indicate that Dimension and Esthetics Following Immediate Implant PEKK has a potential to replace PEEK because of its advantages through 3D printing process. The objectives of this work was to Placement evaluate the effect of PEKK printing parameters on flexural prop- P. Wang*, D.R. Dias, R. Levine, M. Araujo erties via FDM method. The parameters were nozzle temperature, Introduction: Treatment of maxillary central incisors with layer thickness, build orientation, and infill density. immediate implant placement is a complex procedure. Soft tis- Method: PEKK samples were designed for 3D printing based sue esthetic complications and lack of buccal walls are the major on ISO #178 specification for 3-point bending test and printed *The first name listed is the presenter. The presenter may/may not be the primary author. 125 Table of Contents E-poster Abstracts with various parameters, such as, nozzle diameter, layer thickness Cancelle SP® process, which is directly related to osteoinductive and printing orientation. The build orientations were flat, upright potential of allografts. and on-edge printing directions. Five samples of each experimen- tal group were tested and the average value for each group was compared to other groups. Fractographic analysis was performed using scanning electron microscopy. Results: PEKK samples had lower fracture strain (6%-8%) printed a lower temperatures (345-365 C); and samples broke rapidly after reaching the peak bending stress with a short range of plastic deformation. at 375 C, the fracture strain went up to 10% with a longer plastic deformation curve. PEKK exhibits excellent flexural performance with a printing layer thickness of 0.1 mm. The flexural strength and modulus achieved in 100% infill density are 127.56 MPa and 2.72 GPa, which increase 30% and 34% compared with 85% infill density. The flexural strength of the flat orientation had a lower values compared to the on-edge orientation, while the specimens printed in upright significantly declined 39% than the on-edge ones. Fig.1 The ALP activity of the hMSCs at different time points in the presence of different mineralized/demineralized allografts. Conclusion: The most suitable nozzle temperature for PEKK is 375 C. The best layer thickness is 0.1 mm. the best flexural prop- erties are obtained by 100% infill printing. The flexural properties P122 of PEKK samples printed with on-edge orientation is superior to New Implant Abutment Design for Vertical other building orientations. This is mainly due to the different fail- ure modes of PEKK printed in various build orientation. Orthodontic Movement: A Case Report B. Wangsrimongkol*, B. Wangsrimongkol Introduction: The use of orthodontic movement has tradition- P121 ally been applied to treat malocclusions and to enhance the aes- Comparative Analysis of the Osteoinductive Potential thetic appearance of the dentition. Orthodontic therapy has also of Commercially Available Allografts: An In-vitro Study been used to alter the periodontal attachment for periodontal X. Wang*, O. Sanchez, E. Ajami, K. Kumar, H. Wen and restorative therapy. This ability to predictably alter the peri- odontium nonsurgically can dramatically improve the harmony and Introduction: Bone allografts are commonly used in reconstruc- dimensions of the hard and soft tissue topography of surrounding tive dental procedures. Various types of allografts are available in teeth, provided that inflammation is controlled. The purpose of this the market: mineralized, demineralized or combination thereof. case report is to introduce a new approach to reestablish a missing While mineralized allografts are only osteoconductive, the demin- papilla between a tooth and an implant, utilizing an implant as the eralized bone matrix (DBM) is claimed to be both osteoconduc- anchorage device for the orthodontic movement of the adjacent tive and osteoinductive. However, the degree of osteoinductivity of natural tooth. DBM products may differ based on their manufacturing process [1]. Method: A 68-year-old female presented at NYUCD. Patient’s The aim of this study is to investigate the osteoinductive potential chief complaint was the presence of black triangle between tooth of various mineralized/demineralized allografts obtained with dif- # 5 (previously placed dental implant) and #6 (natural tooth). The ferent manufacturing processes using Alkaline Phosphatase (ALP) periapical radiograph revealed an inferiorly placed implant in rela- activity assay. tion to the CEJ of adjacent tooth. When large vertical discrepancy Method: Three different mineralized/demineralized allografts exists between dental implant and natural tooth, it poses a greater were used. One allograft was processed via Tutoplast™ plus Can- risk of developing interproximal bone loss which resulted in large celle SP® technique (TC), while the other two were freeze-dried black triangle. The treatment option presented to patient was to (FD1, FD2). Human mesenchymal stem cells (hMSCs) were seeded use orthodontic forced eruption to gain more interproximal bone, in the well plates containing allografts. The ALP activity of total which ultimately reduces the size of the black triangle. In this study, cells in each well was measured by ALP Assay Kit (Abcam) at 7 and an implant supported crown was used as an absolute anchorage 14 days. Total protein was detected by Pierce™ Rapid Gold BCA device. The ISOM (Implant Supported Orthodontic Movement) Protein Assay Kit (Thermo Scientific) and was used to normalize attached on the implant supported crown is a device designed the data. The surface morphology of allografts was examined by specifically for this study to help achieve a more predictable intru- scanning electron microscopy (JEOL JSM 6460LV). sive and extrusive movement. Results: The ALP activity of hMSCs in the presence of TC was Results: The interproximal papillae between implant #5 and significantly higher than in the presence of FD1 and FD2 allografts tooth #6 had increased by 3 mm. Using Jemt papilla scale, the at 7 days (P<0.05). The ALP activity was increased with culture time interproximal papillae had changed from score 1 to score 2. for all the groups. At 14 days, the difference in the ALP activity Conclusion: One of the advantages of this device over other tra- between the TC and other two groups was more pronounced ditional orthodontic appliances is the minimal visibility of the appli- (p<0.01) (Fig.1). No major differences in the surface morphology ance by allowing for the adaptation of a provisional restoration of demineralized particulates were observed between the groups. partially covering the device. Despite the controversy regarding Conclusion: Within the limitations of this study, higher ALP activ- the biology after tooth intrusion and the lack of literature describ- ity of cells in the presence of TC is indicative of TC’s higher oste- ing intrusion next to an implant, the current technique may be uti- oinductive potential as compared to FD1 and FD2. This might due lized in the future as a predictable way of regenerating interdental to better preservation of native proteins during the Tutoplast™ and *The first name listed is the presenter. The presenter may/may not be the primary author. 126 Table of Contents E-poster Abstracts papillae. However, further research is required to determine if this bone around titanium implant may also affect contact osteogenesis, can become a predictable clinical procedure. this study tried to evaluate effect of BMP-2 on contact osteogenesis. Method: In this study, the rabbit tibia model was used, and Ti tubes were used to eliminate distance osteogenesis, minimizing P123 its effect on the biologic response to implant surface for distance Histological Observation of Effect of Collagen Cross- osteogenesis. The animal experiments were approved by the link Deficiency on Bone Augmentation IACUC of Cronex Co., Ltd., Hwaseong, Korea (CRONEX-IACUC: Y. Yamamoto*, M. Nagasawa, K. Hamaya, T. Zhang, 201805001). Four New Zealand white rabbits were used. The implants and tubes were inserted into the rabbit tibiae: To exclude K. Uoshima the effects of distance osteogenesis, the tubes were inserted into Introduction: The success of implant therapy should be directly the tibiae. Then, the implants were installed through the tubes: related to the surrounding bone bed. Bone augmentation might two implants and tubes for each tibia. Half of the implants served be necessary in several cases. Current gold standard of the aug- as control, and the others were placed with topical rhBMP-2 appli- mentation is auto bone transplantation and the bone could be col- cation (rhBMP-2 group). After 4 weeks of implantation, the rabbits lected from several sites. However, the fate of transplanted bone is were euthanized, and the undecalcified specimens were prepared reportedly not so optimistic in some cases. Moreover, in order to for histomorphometry. The independent t-test was used for statis- have a successful bone augmentation, a grafted bone as well as tical analysis. host bone should possess certain criteria such as healthy organic Results: After the in vivo surgery, one of the rabbits exhibited bone matrix. Collagen in bone has a cross-linked structure and complications and died at 16 days. The other three rabbits exhib- collagen cross-links(CCL) have a great influence on bone quality. ited no complications in terms of wound healing, implant expo- However, few studies have been investigated how bone quality sure, or other problems. Due to the inserted Ti tubes for isolating effects on the bone transplantation. Thus, the purpose of this study contact osteogenesis from distance osteogenesis, bone formation was to investigate the influences of CCL of both grafted bone and between the implants and inner surfaces of the Ti tubes was rela- recipient site bone on the success of bone augmentation. tively low, compared with that of the outer surfaces of the tubes. Method: Four weeks old male SD rats(n=37) were divided into The mean bone-to-implant contact (BIC) ratio was 20.6% for the control and test groups. Control and test groups were subdivided control group and was 47.1% for the rhBMP-2 group. rhBMP-2 sig- into donor groups (DG) and recipient groups (RG). Test groups nificantly increased the BIC ratios (P = 0.016). received 0.2% beta-aminopropionitrile (BAPN) in drinking water Conclusion: When minimizing the influence of distance osteo- for 4 weeks as CCL inhibitor. A 5mm diameter calvaria bone chips genesis, contact osteogenesis is affected by the addition of BMP- were harvested from DG and grafted on calvaria of RG. At 1, 2 2, that is an activator for bone healing and a substance from the and 4 weeks after surgery, rats were sacrificed, and the specimens existing bone. It is suggested that contact osteogenesis is a bone- were prepared from retrieved calvaria for decalcified histological driven process. sections. The specimens were stained with H&E for observation under light microscopy and histomorphometry. All the animal experiments were approved by the Institutional Animal Care and P125 Use Committee at Niigata University (#SA00726 and SA00727). A Case of a Two-part Implant for the Area of Occlusal Results: All transplanted bone chips were integrated with the Support – In Search of a More Efficient Treatment host bone. New bone formation was observed in part of the gap Method between grafted bone and recipient bone among all conditions at 1 week. At 4-week, filled 90% or more of the gap between grafted K. Yoshida* and recipient bone were filled by new-formed bone among all con- Introduction: Most missing tooth replacements rely on residual ditions. BAPN chips which were grafted on both control and BAPN teeth. Residual teeth are often devitalized teeth, and once broken, host tend to be resorbed actively at 2 weeks. On the other hands, they have a difficult course to repair. And, at the same time, many osteoclast like cells were still observed on normal bone chips which occlusal support areas may be lost at the same time In this case, grafted on BAPN host at 4 weeks. I am pleased to report that the implant placement and prosthesis Conclusion: Collagen cross-linked deficiency bone affected the was performed in two parts, as implant would result in the loss of bone augmentation in either cases of donor and recipient. occlusal support area. Method: The first visit was in April 2017. The patient came to the clinic with food stuck in the upper right corner. There was a P124 bridge fracture of the prosthetic and root fracture of the upper Effect of RhBMP-2 on Contact Osteogenesis: An in right anterior teeth. Removing 11 through 16 at once would sig- Vivo Study Using Rabbit Tibiae nificantly compromise the occlusal support zone, so we decided I. Yeo*, U. Kim to perform the missing prosthesis while maintaining the support zone, although it would take longer. Introduction: Osteogenesis around endosseous titanium(Ti) Results: (1) The upper right molar is left in place - 13 extru- implant divided into two distinct bone forming process. Contact sions. (2) Implant placement of the right anterior teeth ~11 and 13 osteogenesis is one of two bone forming process around endosse- (3) Implants of the right anterior teeth - provisional restorations ~ ous titanium (Ti) dental implants and the molecular mechanism of securing of occlusal support (4) Extraction of 15 and 16 teeth to contact osteogenesis is unclear. On an earlier study, newly formed implant placement (5) Prosthetic treatment of 15,16 (6) Prosthetic bone around dental titanium implant expressed BMP-2, which is an treatment for 11-16 + prosthetic treatment for 21-23 activator for bone healing and substance from existing bone. Under Conclusion: This time, the treatment period was two years. The the assumption that BMP-2 which was observed in newly formed treatment took a lot of time. I would appreciate it if many doctors could tell me if there is a more efficient treatment plan. *The first name listed is the presenter. The presenter may/may not be the primary author. 127 Table of Contents E-poster Abstracts P126 Radiographic Evaluation of Peri-implant Facial Bone Following Immediate Placement and Provisionalization With Customized Definite Abutment In Maxillary Anterior Single Implants. D. Yuan*, X. Wang, S. Chen Introduction: The marginal bone resorption after the immedi- ate implant placement were reported due to the dis/re-connec- tion of temporary abutment. The customized definite abutment was expected to maintain the soft tissue sealing undisturbed and reduced marginal bone resorption in maxillary anterior single implants. Method: 13 implants were immediately delivered after the teeth extraction. The customized definite abutments and provisionals were fabricated by using the CAD/CAM technique and immedi- ately connected into the implants. CBCT scans taken immediately after surgery (T0), 6 months (T1) and 12 months(T2). Vertical facial bone height (VBH) and Horizontal facial bone thickness (HBT) at 1,2,3,5,7,10,11.5,13mm apical to the implant platform were evaluated. Furthermore, the facial bone volume (BV) in different time points were also measured by Mimics Research and 3-matic Research. Results: The CBCT dimensional analysis showed a statistical sig- nificant difference in HBT changes in the period between T0 and T1 Figure 1. (a-j) The clinical procedure. (k-l) The volumetric analysis by. (m) Schematic of CBCT measurement. (n). Facial bone dimensional changes at at 1mm, 2mm, 5mm. And the HBT changes between T0 and T2 at different levels and volumetric changes in 6 months and 12 months 1mm, 2mm also reached significant difference. No significant differ- ence in the other levels. The VBH changes was -0.23mm in average between T0 and T1 and -0.55 between T0 and T2. No significant P127 difference between different time points. The volumetric analysis Analysis of Prosthetic Complications in Implant- showed facial bone volume changed significantly between T0 and retained Fixed Restoration: Longitudinal Study T2. No statistical differences were highlighted in the other periods. Conclusion: Immediate implant placement and provisonaliza- K. Zafar*, M. Gul, R. Ghafoor, F.R. Khan tion with customized definite abutment in maxillary anterior region Introduction: Dental implants are recognized as a predictable might be predictable within 12 months observation. The horizonal modality for replacing single or multiple missing teeth. Numerous bone thickness changes and volume changes were in reasonable studies have reported approximately 97% of the survival of dental ranges and the vertical facial bone height could be further main- implants after 5 years of its placement. Despite the high survival tained by using this technique. rate prosthetic complications frequently happen & are often under- reported. The objective of the study was to evaluate the prosthetic complications observed in the fixed prosthesis (single crowns and fixed partial dentures) supported by root-form implants with more than 6 months of follow up. Method: A single-arm longitudinal study was conducted on a total of 59 patients. Patients with age ranging from 18-70 years who received dental implants supported fixed prosthesis with a mini- mum follow up of 6 months were included. The prosthetic compli- cations such as screw loosening, chipping, decementation, implant loosening, abutment fracture, etc in implant-retained single crowns and fixed partial dentures were assessed through visual and clinical and radiographic examination. Data were analyzed using SPSS 20. The mean and standard deviation of a continuous variable and fre- quency distribution of categorical variables were also determined. Cox regression was applied to investigate the effect of possible risk factors upon the time a specified event takes to happen. P-value of ≤0.05 was taken as statistically significant. Results: A total of 95 implants in 59 patients; 26 (44.06%) females & 33 (55.93%) males were assessed. The mean age was 46.78±14.11. The mean prosthetic complication-free survival was 27.65±14.588 months. There were 64% of single crowns & 36% of fixed partial dentures. The mean mesial and distal bone loss was 1.19±0.69 & 1.12±0.60, respectively. The complication rate was *The first name listed is the presenter. The presenter may/may not be the primary author. 128 Table of Contents E-poster Abstracts reported to be 23% with the most common complication turned out to be screw loosening 15.8% followed by implant failure 3.2% and chipping (3.2%). Cox regression analysis showed crown height, implant diameter & method of prosthesis retention were signifi- cant risk factors for implant prosthetic complications (hazard ratio: HR=2.69, p 0.002; 5.51, p 0.032; 0.73, p 0.037, respectively). Other factors such as age, gender, bone graft, parafunction, & opposing dentition had no significant effect on implant prosthetic compli- cations. Conclusion: There was a tendency of more prosthetic compli- cations with increasing crown height, narrow diameter implants, & screw-retained prosthesis. P128 Surgical Considerations for New Implant Placement Following Inferior Alveolar Nerve Numbness L. de Carle*, N. Reis, T. Li, Z. Kaufman, S.C. Cho Introduction: The successful placement of dental implants can be expected when both systemic patient factors and local factors including bone height, width and quality are favorable. One of the limitations of placement of implants in the posterior mandible is compression of the Inferior Alveolar Nerve. The purpose of this case report is to present and discuss the treatment of a patient with complete parasthesia of lower left quadrant following implant placement into the inferior alveolar nerve canal. Method: A 67 year old male patient presented to the Implant Department at NYUCD with pain and parasthesia of left lower lip following implant placement in private practice 6 months prior. In the documented surgery implants #19 & #18 were removed uneventfully followed by placement of 4.1x8mm Straumann Bone Level implants to restore sensation in the lower left quadrant. Results: Succesful regeneration of sensation in lower left after removal of implants placed in close proximity to IAN. Successive implants were placed in the same sites and loaded after uneventful healing and followed up after 6 months. No parasthesia presented following subsequent implant placement Conclusion: Implants can be placed in the same vicinity as pre- viously placed implants that were removed due to nerve trauma using pristine bone and awareness of anatomic structures, with- out recurrent parasthesia. This is particularly important in helping patients achieve their goal of recovering form and function when it comes to replacing missing teeth. *The first name listed is the presenter. The presenter may/may not be the primary author. 129 Table of Contents Oral Abstract and E-poster Author Index Abdeen, L.F...... P1* Biguetti, C.C...... OS-8 del Razo, H.C...... P27* Abdulmajeed, A.A...... P15 Blackwell, R...... P42, P78 Desai, P...... CI-12*, CI-13* Abou-Rass, M...... CI-14* Blanchard, S...... P14, P48 Dias, D.R...... OC-3*, P119 Agliardi, E...... OC-7 Bloom, M.J...... P95 Dimaira, M...... P112 Agusto, M...... CI-9 Bokhary, A...... P18* dos Santos, M...... P28* Ajami, E...... P121 Bolding, S.L...... CI-3*, CI-6 Dragan, I...... P41 Al Bayati, O...... P103 Bompolaki, D...... P76 Dugum, A...... P81 Al Haydar, B...... P3* Bonifazi, L...... OC-1, OC-2, Egbert, N...... P93 Alalshaikh, M...... P14 OC-4, OC-8* El Allami, J...... OS-8 Alfagheli, A...... P101 Brown, Z...... P50 El Tantawi, M...... P29 Alharbi, A.E...... P2* Bryington, M.S...... CI-9 Elaskary, A...... P29* Ali, A...... P94 Bueno-Silva, B...... P68 Elgaddari, F...... P56 AlJofi, F...... P36 Buesch, C...... P69 Emi, E...... OC-5 Almasri, R.J...... P46 Cabadas Reyes, A.P...... P19* Eriguel, J...... P55 Alqarni, A...... P4*, P116 Çakmak, G. . . . . OS-2*, OS-3*, P13* Eriguel, J.Y...... P30* AlRubaie, M...... P5*, P6* Calce, L...... P20*, P39 Eskow, R...... P3 Alsaggaf, A.U...... P51, P52 Cao, C...... P105 Esposito, M...... OC-1, OC-2, Ammoun, R...... P15 Cao, X...... P21* OC-4, OC-8 Antonellou, E...... P82 Capote, T.S...... P68 Estrin, N...... P31* Araujo, M...... OC-3, P119 Chan, H...... CI-2 Fathi, E...... P98 Arif, A...... P49 Chandrasekaran, S...... P104 Faveri, M...... P68 Arteaga, A...... OS-8 Chen, S...... P21, P118, P126 Felice, P...... OC-1, OC-2*, OC-4, OC-8 Arumuganainar, D...... OS-5, OS-6 Chen, Y...... P10, P101, P117 Fenlon, M.R...... P51, P52 Asprino, L...... P111 Cheng, W...... P98 Fernandez-Guallart, I...... P4 Asvaplungprohm, T...... P7*, P59 Chiou, L...... P22* Ferri, A...... OC-8 Azzouz, K...... P46 Cho, S...... P29 Ferry, K...... P113 Baevsky, M...... P8*, P101 Cho, S.C. . . . .CI-4, CI-5, P4, P7, P17, P30, P55, P59, P60, P89, Finkelman, M...... P10, P99 Bagheri, Z...... CI-4 P90, P91, P95, P116, P128 Fleisher, N...... P16 Bai, C...... OS-1 Choksi, K...... P45 Flores Posada, D...... P32* Banh, C...... P9* Chu, S...... P92, P93 Fonseca, M...... P64 Banjar, A...... P10*, P11* Coelho, F...... P68 Font, K...... P103, P104 Barausse, C...... OC-1, OC-2, Colombo, E...... P23* OC-4*, OC-8 Froum, S.J. . . . . P12, P89, P90, P116 Conca, R...... P41 Barboza, C...... P50 Furtado Rocha, T...... P68 Cumming, L...... P28 Barsoum, A. . . .CI-4*, CI-5*, P12*, P60 Gaikwad, A.M...... P35* Curtis, D...... P64 Basulto, H...... P62 Garlet, G.P...... OS-8 da Silva, V.c...... P25* Batak, B...... P13 Gaweesh, Y...... P29 Dabbous, R.H...... P24* Batra, C...... P14* Ghafoor, R...... OC-6, P40, P47, Dahlkemper, A...... P105 P73, P127 Ben Yehuda, D...... P99 Dalal, N...... P15 Gharpure, A.S...... P36 Bencharit, S...... P15* Daubert, D...... P36 Gherlone, E...... OC-7 Benghiac, A...... P16* Davis, R...... P26* Gilhespy, R...... P51*, P52* Bergamini, M...... P4, P17*, P58, P95 de Carle, L...... P89, P90, P128* Gonçalves, T.O...... P110 Bergeron, C...... P50 De Souza, A...... P100 Gonzales de la Torre, E...... P58 Bezerra, F...... OC-5 Deeb, G...... P15 Green, K...... P112 130 Table of Contents Oral Abstract and E-poster Author Index Gregory, R...... P14 Katancik, J...... P76 Luo, Y...... P64* Gruender, B...... P42, P78 Kaufman, Z...... P128 Ma, K...... OS-1* Gul, M...... OC-6*, P73, P127 Khan, F.R...... OC-6, P37, P38, Maebed, M...... P29 Habib, S...... P37*, P38* P49, P127 Manasse, M...... P89, P90 Hafeez, M...... P20, P39* Kihara, H...... P79 Marini, E...... P66 Haji, Z...... P40*, P47 Kim, K...... P66 Marini, L...... P66 Hamada, Y...... P14, P22, P113 Kim, K.H...... P53* Marrano, J.J...... CI-1 Hamaya, K...... P123 Kim, S...... P54*, P66 Martinez, R.A...... P65* Hamza, T...... P41* Kim, U...... P124 Massina, A...... P66* Hanser, C...... P78 Kimm, H...... P30, P55* Mata, S.J...... P67* Hanser, K.S...... P42* Kitamura, E...... P97 McGuire, M...... CI-7 Haria, S...... P52 Kobayashi, T...... P79 Meirelles, L...... P67 Hengjeerajaras, P...... P30 Kokat, A...... OS-3 Melo, M.A...... P68* Herman, L...... P104 Kondo, H...... P79 Mendes, K.L...... P110, P111 Hernández, A...... P62 Kostagianni, A. . . . P1, P10, P11, P18 Merritt, J...... P76 Hernández, D...... P43* Kotina, E...... P117 Mertens, C...... P69* Herron, C...... P96 Koutouzis, T...... P94 Messora, M...... OC-5 Hoffmann, J...... P69 Kripfgans, O...... CI-2 Min, S...... P97 Hou, J...... P44*, P63 Kudara, Y...... P8, P100 Mizuguchi, T...... P97 Hou, W...... P26, P31 Kukiratirat, T...... P59 Mohammed, H.T...... P24 Hsu, Y...... P45*, P96 Kumar, K...... P121 Mohseni Salehimonfared, S. . P70*, P71* Imani Emadi, M...... P46* Kuroda, S...... P44, P63, P109 Moraes, M.d...... P111 Ioannidou, E...... P81 Kwan, J.C...... OS-4* Moreno Delgado, M.M...... P72* Iwanaga, J...... P22 Kwan, N...... OS-4 Motiwala, M...... P37 Iwano, Y...... P97 Kwon, J...... P66 Motiwala, M.A...... P73* Jack, W...... P48 Lakkasetter Chandrashekar, B. . . OS-8 Muftu, A...... P99 Jackson, S...... P114 Latimer, J...... P36 Mulla, S...... OS-7* Jamal, S...... P47* Lee, A...... P56* Muntean, S.A...... P75* Janu, U...... P48* Lee, C...... P45 Nagasawa, M...... P123 Javed, F...... P49* Lee, F...... P57 Nakata, H...... P44, P63, P109 John, V...... P48 Lee, V...... P114 Natarajan, S...... OS-8 Johnston, W...... OS-7, P13, P67 Leo, S...... P57* Natour, M...... P91 Jones, J.P...... P50* Leung, M...... P17 Natto, Z...... P117 Joshi, A.A...... P35 Levine, B...... P92, P93 Nevins, M...... P92, P93 Kadempour, A...... P58 Levine, R...... OC-3, P119 Nguyen, L...... P76* Kahng, J...... P36* Li, T...... P17, P58*, P128 Nguyen, T...... CI-8* Kaigler, D...... P105 Lima, E.R...... P7, P59* Noritomi, P.Y...... P111 Kakumoto, T...... P12 Limão Oliveira, M. . . .CI-4, CI-5, P60* Oh, D...... P66 Kalman, L...... CI-10* Limmeechokchai, S...... P61* Oliveira, G...... OC-5 Kang, K...... P100, P117 Lin, G...... P64 Omran, M...... P42, P75, P78* Kang, M...... P55 Lin, W...... P113 Östman, P...... P92 Kao, R...... P64 López, J...... P62* Oyamada, Y...... P79* Karaban, M. . OC-1*, OC-2, OC-4, OC-8 Lu, H...... P44, P63* Ozan, O...... OS-2 Karjikar, A.E...... P51, P52 Lu, R...... P21, P118 Palanker, N...... P107 131 Table of Contents Oral Abstract and E-poster Author Index Pan, Y...... CI-2 Scolnick, J...... P30 Thyagaraj, A...... OS-6 Paolinelis, G...... P51, P52 Seghi, R...... OS-7 Torres, A.C...... P115* Papace, C...... P69 Seker, E...... OS-2 Treviño Santos, A...... OS-3 Papaspyridakos, P...... P1, P8, Sequeira, V...... CI-9* Tsitsimelis, D...... P4, P116* P10, P11, P99, Sharma, A...... P64 Tubbs, R...... P22 P100, P101, P117 Shaya, F...... P96* Umoh, E...... P107 Papathanasiou, A. . . P1, P10, P11, P18 Sheng, S...... P97* Uoshima, K...... P123 Paranhos, K...... P60 Shibli, J.A...... P68 Van Aarde, D.G...... CI-1 Parsegian, K...... P80, P81 Shih, M...... P45 Vazouras, K...... P8, P82, P100, Pattachainapuvanon, P...... P82* Shin, S.S...... P98* P101, P117* Pereira, L...... OC-5 Shin, W...... P54 Vinicius, D...... P113 Perez, D...... P50 Sicilia, E...... P99*, P100*, P101* Vo, N...... CI-8 Pessoa, R...... OC-5* Silva, J.V...... P111 Vrhovac, M...... CI-1 Petroche, M...... P83* Sim, P...... P114 Wadhwani, C.P...... CI-11* Pham, M...... P84* Sinjab, K...... CI-2 Wang, C...... P118* Pingueiro, J.M...... P68 Siqueira, R...... CI-2* Wang, L...... OS-1 Pistilli, R...... OC-2, OC-4, Wang, P...... OC-3, P119* OC-8 Sloten, J...... OC-5 Wang, R...... P120* Poorsafar, F...... P71 Soki, F...... CI-2 Wang, X...... P21, P118, Powell, C...... P103, P104 Soldatos, N. . . . . P80*, P81*, P103*, P104*, P107* P121*, P126 Qadri, H...... P80 Sommer, C...... P105* Wangsrimongkol, B. . . . P122*, P122 Quirynen, M...... OC-5 Song, S...... P3, P114 Weber, H...... P99 Rafailovich, M...... P26 Soria Pérez, D.s...... P27 Wen, H...... P121 Rector, J.L...... P85*, P86*, Wheelis, S.E...... OS-8* P87*, P88* Soto Sánchez, V...... P19 Windsor, L.J...... P14 Reebye, U.N...... CI-3, CI-6* Soto, V...... P43 Wu, J...... P56 Reis, N...... P89*, P90*, Sousa, R...... OC-5 P116, P128 Spin-Neto, R...... OC-5 Yacker, M...... P59 Rensburg, C...... CI-1* Stuart-Smith, A...... P106* Yadalam, P.K...... OS-5*, OS-6* Rodrigues, D...... OS-8 Stylianou, P...... P107 Yamamoto, Y...... P123* Rodríguez Fernández, M. . . P91*, P95 Sun, Y...... P108* Yee, S...... P57 Romanos, G...... P20, P26, Supachatwong, C...... P109* Yeo, I...... P124* P31, P39 Sverzut, A.T...... P110*, P111* Yilmaz, B...... OS-2, OS-7, Romeo, D...... OC-7* P13, P67 Taheri, M...... P70, P71 Rosen, P...... P45 Yilmaz, H...... OS-3 Takafuji, K...... P79 Rossi, A...... CI-7* Yoshida, K...... P125* Takahashi, Y...... P44, P63 Sabet, M...... P24 Yu, Y...... P17 Talib, H...... P7 Saito, H...... P92*, P93* Yuan, D...... P126* Tamura, Y...... P44, P63, P109 Salama, M...... P97 Zafar, K...... OC-6, P38, Tan, K...... P57 P127* Saleh, I...... P94* Tan, M...... P57 Zhang, T...... P123 Sanchez, O...... P121 Tan, Y...... P112* Zhang, Y...... P31 Saska, S...... P68 Tanaka, Y...... P22, P113* Zuo, X...... P26 Sato, H...... P79 Tao, G...... P114* Zusin, A...... P31 Sawada, M...... P4, P91, P95* Teughels, W...... OC-5 Scheyer, T...... CI-7 Thilagar, S...... OS-5, OS-6 132 Table of Contents Speaker Disclosures As required by the Continuing Education Recognition Program (CERP) under the auspices of the American Dental Association and in accordance with the Academy of Osseointegration policy, every effort has been made to encourage speakers to disclose any commercial relationships or personal benefit, which may be associated with their presentations . This disclosure in no way implies that the information presented is biased or of lesser quality . Attendees of this meeting should be aware of these factors in interpreting the program contents and evaluating recommendations . Moreover, views of faculty do not necessarily reflect the opinions of the Academy of Osseointegration . Financial Disclosure Nature of Relationship(s) 1 — Speaker 2 — Honorarium 3 — Employment/Consulting Fee 4 — Performed Research 5 — Direct Support of Presentation The following speakers have disclosed commercial relationships: Mauricio Araujo, DDS, MSc, PhD Christian Coachman German Gallucci, DMD, PhD State University of Maringá Private Practice and Digital Smile Harvard University Rio de Janeiro, Brazil Design Residency Program Boston, MA Straumann1, Geistlich1234 Madrid, Spain Quintessence12, Straumann12, MIS12 Nemotech1234, Align1234, Modjaw1234, Reva Barewal, DDS, MS DSD1234, TekScan1234, The wand1234 Les Kalman Oregon Health and Science University Ontario, Canada Portland, OR Lyndon Cooper, DDS, PhD Research Driven, Inc 5. Dentsply12, Speech TherapyPD12, Taste University of Illinois at Chicago Joseph Kan, DDS, MS For Life34 Chicago, IL Dentsply Sirona124, BioHorizons124, Private Practice and Loma Linda Harold Baumgarten, DMD Ivoclar124 University Private Practice and University of Loma Linda, CA Pennsylvania Lisa Copeland, RDH, CSP, CVP Nobel Biocare123, Geistlich123, Philadelphia, PA Private Practice Straumann2, Dentium4, Osteohealth4 Zimmer Biomet123, Southern Park City, UT Michi Katafuchi, DDS, MSD, PhD Implants123, Argen123 Lighthouse12, ADHA12, Waterpik12, OraPharma12 Private Practice Michael Block, DMD Tacoma, WA Private Practice and Louisiana State Lee Culp, CDT Straumann1 University Private Practice Metairie, LA Cary, NC Bach Le, DDS, MD BioHorizons12, Dentsply12 Ivoclar1234, 3Shape1234, Carbon1234 Private Practice and University of Southern California Elena Calciolari, DDS, MS (Perio), PhD Don Curtis, DMD Los Angeles, CA Queen Mary University of London, University of California San Francisco BioHorizons12, Dentsply Sirona12, University of Parma San Francisco, CA Datum12 London, England, UK Colgate12, ADA3, Elseveir³ Sonia Leziy, DDS Straumann45, Geistlich4 Marco Degidi, MD, DDS Private Practice Stephen Chu, DMD, MSD, CDT Private Practice Vancouver, BC Private Practice and New York University Bologna, Italy Straumann1234, 3Shape2345 College of Dentistry Dentsply Sirona12 New York, NY Mark Ludlow, DMD, MS Brandon Dickerman, CDT BioHorizons1234, Southern Implants1234 Medical University of South Carolina Private Practice Charleston, SC Sharon, MA Dentsply Sirona124, Ivoclar Vivadent124, Straumann12 Henry Schein124, Elos Medtech14, 3Shape4, Colgate4 133 Table of Contents Speaker Disclosures Ricardo Mitrani, DDS, MSD Waldemar Polido, DDS, MS, PhD Marius Steigmann, DDS, PhD Spear Education and University of Indiana University School of Dentistry Private Practice Washington Indianapolis, IN Mannheim, Germany Mexico City, Mexico ITI12, Straumann124, Geistlich124, BioHorizons123, Botiss Dental3, Zest Ivoclar Vivadent123, Straumann123 Osteoscience Foundation12 Dental3 Michael Miloro, DMD, MD Alessandro Pozzi, DDS Michele Stocchero, DDS, PhD University of Illinois at Chicago Private Practice and University of Rome Private Practice and Malmö University, Chicago, IL Tor Vergata, Italy Augusta University, Sweden AxoGen, Inc123 Georgia, USA International Center Oral Castelgomberto, Italy Rehabilitation, Rome Italy Dentsply Sirona5 Richard Miron, DDS, MSc, PhD Rome, Italy Private Practice and University of Illinois NobelBiocare3, Align Technologies3 Dennis Tarnow, DDS at Chicago Columbia University Chicago, IL Allan Radaic, PhD New York, NY Process for PRF12, Intraspin12, University of California Zimmer Biomet12, Megagen12, BioHorizons12, Bio-PRF12, Straumann12 San Francisco, CA BioHorizons2, Southern Implants2, Phillips Oral Healthcare2, Sunstar Hiossen2, Keystone1234 Catherine Mohr, MD, MS Group4 Private Practice Tiziano Testori, MD, DDS, FICD Mountain View, CA Jonathan Rogers, DMD Private Practice and Galeazzi Institute, Intuitive Surgical1 Private Practice University of Milan Greenville, TN Como, Italy Wesley Mullins, DDS Dentsply Sirona2, Kettenbach LP2, 3M BioHorizons-Camlog12, Geistlich1, Private Practice and University of ESPE2, Argon Implants2 Nobel Biocare1, Straumann1, Dentsply Tennessee Sirona1 Knoxville, TN Mario Roccuzzo, DDS 3M ESPE12, Dental Crafters Network12, Private Practice and University of Torino Robert Vogel, DDS Astra Tech Dental12, Dentsply Sirona12, and University of Michigan Private Practice Argon Dental2 Torino, Italy Palm Beach Gardens, FL Straumann124, Geistlich124, Sunstar12, Straumann1234 Rodrigo Neiva, DDS, MS Regedent12 University of Pennsylvania Chandur Wadhwani, BDS, MSD St . Petersburg, FL Mariano Sanz, MD, DDS, PhD Private Practice Dentsply Sirona1234, Zimmer Biomet1234, Private Practice and University Bellevue, WA Datum Dental1234, Versah1234 Complutense of Madrid Nobel Biocare123, Keystone123, Madrid, Spain Neoss123, Astra123, Straumann123, Pravin Patel, MD Nobel Biocare124, Straumann124, Meissinger23 University of Illinois at Chicago Dentsply Sirona124, Geistlich124, Chicago, IL Dentium124, MIS124, CAMLOG4, Sweden Theresa Wang, DDS, MS ImmersiveTouch, Inc 3. & Martina Implants4, Sunstar4, Mozo & Private Practice Grau Implants4, Klockner Implants4 Chicago, IL Joan Pi-Anfruns, DMD Presentation will include off-label Dentsply Sirona1, ClearChoice3 Private Practice and University of discussion of cell therapies . California Los Angeles Xuesong Wang Los Angeles, CA Todd Schoenbaum, DDS West Palm Beach, FL Straumann124, BioHorizons124, University of California Los Angeles Zimmer Biomet3 Geistlich12, Z Systems12, Los Angeles, CA Tom Wilson, Jr., DDS Nobel Biocare12, BioHorizons12, Beverly Michael Pikos, DDS Private Practice Hills Dental Lab12 Private Practice Dallas, TX Trinity, FL Frank Schwarz, DMD Spear Education12, Straumann12 BioHorizons123, Osteogenics123, Goethe University Versah123, Carestream23, Piezosurgery2, Frankfurt, Germany Ellman2, Salvin Dental3, NDX3, Osteology Foundation124, Geistlich IntraLock3, Launchpad4 Biomaterials124, Straumann4, ITI4 134 Table of Contents Speaker Disclosures The following speakers have indicated they do not have any relevant financial relationships to disclose: Pinhas Adar, CDT, MDT Greggory Kinzer, DDS, MSD Mitra Sadrameli, DMD, MS Private Practice Private Practice and Spear Education Private Practice and University of Marietta, GA Seattle, WA Washington Chicago, IL Evanthia Anadioti, DDS Alejandro Lanis, DDS, MS University of Pennsylvania Private Practice and University of Emilee Secondino Philadelphia, PA Indiana School of Dentistry Private Practice Santiago, Chile West Palm Beach, FL Daniel Berant, DMD Private Practice Tomas Linkevičius, DDS, Dip Pros, PhD Ye Shi, DDS Vancouver, BC, Canada Private Practice and Vilnius University New York University Vilnius, Lithuania New York, NY Frank Celenza, DDS Private Practice Aniruddh Narvekar BDS, MS Janis Spiliadis, CRDH New York, NY University of Illinois at Chicago Private Practice Chicago, IL Naples, FL Victor Clavijo, DDS, MS, PhD Private Practice Thomas Nguyen, DMD, MSc Miguel Stanley, DDS Sao Paulo, Brazil Harvard University Private Practice Boston, MA Lisbon, Portugal Fereidoun Daftary, DDS Private Practice Michael Norton, BDS, FDS, RCS(Ed) Giovanni Zucchelli, DDS, PhD Calabasas, CA Private Practice Private Practice and University of London, England Bologna Paul Fletcher, DDS Bologna, Italy Private Practice and Stony Brook Pravin Patel, MD University University of Illinois at Chicago Stony Brook, NY Chicago, IL Paul Fugazzotto, DDS Giovanna Perrotti, DDS Private Practice Private Practice Milton, MA Como, Italy Antoanela Garbacea, DDS, MSD Georgios Romanos, DDS, PhD, DMD Private Practice and Loma Linda Stony Brook University University Stony Brook, NY Laguna Hills, CA Mariano Sanz, MD, DDS, PhD Sophie Garcia Private Practice and University of Private Practice Madrid Palm Beach Gardens, FL Madrid, Spain Academy of Osseointegration Speaker’s Personal Agenda Conduct Agreement The Academy of Osseointegration offers its members the highest quality of educational programs by providing eminent speakers with broad-ranging knowledge and expertise . The Academy recognizes that some speakers may have passionate agendas that are not necessarily pertinent to the topic of their AO approved presentations and it is for this reason that the Academy has developed a policy forbidding any speaker to convey, either directly or indirectly, his/her personal views on issues not relative to the selected topic of the presentation . Inflammatory, demeaning, deceptive and derogatory remarks relating to a person, product, company, organization, practice, etc . is in violation of the Academy’s lecture policy . Those in violation will be subject to sanctions posed by the AO Board of Directors that may include, but not limited to, removal from the program of future AO annual meetings and/or other related educational/scientific programs for a specified length of time and/or membership suspension and membership termination . 135 Table of Contents Exhibits View the latest technological advances in the field of implant dentistry in the Virtual Exhibit Hall . Don’t miss the latest products and services showcased by more than 25 exhibiting companies on display throughout the meeting . Be sure to visit the exhibits to see the newest products to enhance your practice and improve patient care . Virtual Exhibit Hall and Exhibit Disclaimer The Academy of Osseointegration (AO) established as part of its Annual Meeting, an Exhibit Hall to facilitate the sharing and dissemination of information regarding industry products and services . The exhibition is made available for information purposes . The participation of any exhibitor in the Exhibit Hall does not constitute an endorsement or representation of any kind regarding the qualifications, quality, expertise, capabilities, skill, message, value or competence of the exhibitor or of the exhibitor’s products or services . All information contained in the exhibits is provided by the individual exhibitors and has not been independently reviewed or verified by the Academy . The Academy of Osseointegration does not endorse Exhibit Hall products or services . By attending the AO Annual Meeting, you acknowledge and accept that AO has assumed no duty to review, investigate or otherwise approve and has not reviewed, investigated or otherwise approved the qualifications, quality, expertise, capabilities, skill, message, nature, value or competence of the exhibitor or of any product or service marketed by participants and exhibitors . AO specifically disclaims any liability for any damage to person or property arising out of your attendance at the Exhibit Hall and/or arising out of any exhibitor product or service . You further waive any and all claims, demands, actions or causes of action of any kind you may have directly or indirectly against AO of any of its directors, officers, employees, agents and other representatives resulting from, arising out of, or in any way related to your attendance at the Exhibit Hall and/or your use or reliance on any exhibitor product or service . AO Product/Service Endorsement Policy It is the policy of the Academy of Osseointegration not to endorse commercial products or services . 136 Table of Contents Exhibits AD Surgical Anatotemp 1296 Kifer Rd Ste 608 405 Niles Cortland Rd, SE Sunnyvale, CA 94086 Suite 202 Phone: (888) 841-8481 x1001 Warren, OH 44484 Website: http://www.ad-surgical.com Phone: (330) 609-0386 Contact Name: Mark Galvan Website: https://anatotemp.com/ Contact Email: [email protected] Contact Name: Terry B . Philibin We are the maker of the UNIFY Surgical Sutures! Contact Email: [email protected] Suture Materials including PTFE, Chromic Gut, PGA (Vicryl), The Anatotemp anatomic healing abutment has Silk, Prolene and much more . become a staple in providing an off-the-shelf solution Since the beginning, our mission has always been for creating ideal gingival emergence profile . We to offer surgical essentials, such as sutures, gloves, now introduce AnatotempSC, the second generation wound dressings, and drapes, at the best possible Anatotemp that is both an anatomic healing abutment prices to our colleagues so that they may enhance and a digital impression body . The digital dental productivity and profitability . implant workflow has become even easier saving four steps and one appointment utilizing the AnatotempSC . Academy of Osseointegration With the AnatotempSC there is no need to remove 85 W . Algonquin Road, Suite 550 the healing abutment and place an impression post Arlington Heights, IL 60005 or scan body . AnatotempSC does it all! AnatotempSC Phone: (847) 439-1919 works with many major dental implant systems . Website: http://www.osseo.org Contact Email: [email protected] BioHorizons AO is recognized as the premier association for 2300 Riverchase Center professionals interested in implant dentistry . It remains Birmingham, AL 35244 at the forefront of scientific advances in dental implant Phone: (205) 967-7880 and tissue replacement therapy and because its Website: http://www.biohorizons.com Contact Email: [email protected] membership is international, AO offers the unique advantage of sharing information on a worldwide The focus of BioHorizons on science, innovation and basis . The organization fosters the dissemination of service enables our customers to confidently use knowledge to all disciplines . The multidisciplinary our comprehensive portfolio of dental implants and make-up of the membership encourages dental biologics products making BioHorizons one of the professionals from all specialties, general fastest growing companies in the dental industry . practitioners, research scientists, academicians, BioHorizons helps customers restore smiles in 90 laboratory technicians and other ancillary personnel to markets throughout North America, Europe, South come together in a learning experience that provides America, Asia, Africa, and Australia . Our global a refreshing opportunity for an interdisciplinary network of professional representatives and our approach and promotes developments in tissue highly-trained customer care support team are well replacement therapies . equipped to meet the needs of patients and clinicians . Dentsply Sirona 590 Lincoln St Waltham, MA 02451 Phone: (800) 531-3481 Website: http://www.dentsplysirona.com Contact Name: Alison Adams Contact Email: [email protected] Dentsply Sirona Implants offers comprehensive solutions for all phases of implant therapy, including Ankylos®, Astra Tech Implant System®, and Xive® implant lines, Atlantis™ patient-specific solutions, Simplant® guided surgery, Symbios® regenerative solutions, and STEPPS™ professional and practice development programs – for better, safer, faster dental implant care . For more information on Dentsply Sirona Implants, visit dentsplysirona.com . 137 Table of Contents 2021 Annual Meeting Geistlich Biomaterials J. MORITA USA, INC. 902 Carnegie Center, Suite 360 9 Mason Princeton, NJ 08540 Irvine, CA 92618 Phone: (855) 799-5500 Phone: (949) 581-9600 Website: https://dental.geistlich-na.com/ Website: https://www.morita.com/usa Name: Ashley Hightower Contact Email: [email protected] Contact Email: [email protected] J . MORITA USA services North American dental Bone graft materials, membranes, and matrices . professionals on behalf of one of the world’s largest manufacturers and distributors, J . MORITA Hiossen Inc Corporation . The North American office was 270 Sylvan Ave, Ste 1130 established in 1964 and is headquartered in Irvine, Englewood Cliffs, NJ 07632 California . Product lines include 3D/pan/ceph Phone: (267) 759-7002 X-ray equipment, handpieces, apex locators, bone Website: http://www.hiossen.com regeneration, and impression materials . Contact Name: Martin Shin Contact Email: [email protected] Keystone Dental 154 Middlesex Turnpike Image Navigation Ltd. Burlington, MA 01803 301 Bridge Plaza North, Suite 301 Phone: (949) 344-5521 Fort Lee, NJ 07024 Website: http://www.keystonedental.com Phone: (646) 741-2103 ext . 702 Contact Name: Michael Martinek Website: http://image-navigation.com/igi Contact Email: [email protected] Contact Name: Lawrence Obstfeld Contact Email: [email protected], info@image- Keystone Dental is an oral healthcare company that navigation.net delivers advanced, easy-to-use implants, bio-materials and planning software for dental professionals IGI (Image Guided Implant Dentistry) is a focused on providing the most functional and most computerized image navigation system for placing aesthetically pleasing outcomes possible . dental implants . IGI utilizes dental surgeon’s 3D treatment plans to Maxxeus Dental direct targeted, precise placement of dental implants, 2900 College Dr in real-time, exactly where planned . Kettering, OH 45420 Phone: (800) 684-7783 Impladent Ltd Website: http://www.maxxeusdental.com 8690 188th Street Contact Name: Megan Merk Jamaica, NY 11423 Contact Email: [email protected] Phone: (718) 465-1810 The Trusted Experts in Regenerative Biologics, Website: http://www.impladentltd.com Maxxeus Dental is a brand of Community Tissue Contact Name: Zachary Adler Services, a leader in regenerative biologics . Maxxeus Contact Email: [email protected] Dental biologics have been available since 1990 Impladent Ltd offers affordable biomaterials featuring and provide safe and high quality options for the OsteoGen® Bone Grafting Plugs and Strips - one- best clinical outcome . With decades of expertise step solutions for socket/ridge preservation, as well in providing biologics to the dental market, we as OsteoGen® Bioactive Resorbable Calcium Apatite understand the needs of the implanting clinician . crystals, TriStar® Bone Graft Fixation Screw Kit, full line Because we focus exclusively on biologics, Maxxeus of human allografts and regenerative membranes . Dental can provide our customers and their patients the best regenerative biologics options available . 138 Table of Contents 2021 Annual Meeting Neodent Noris Medical USA 60 Minuteman Rd 7380 W Sahara Ave, Suite 150 Andover, MA 01810 Las Vegas, NV 89113 Phone: 800-448-8168 Phone: (702) 749-6364 Website: https://neodent.us Website: http://norismedical.com Contact Name: Angus McLean Contact Name: Andrea F . Contact Email: [email protected] Contact Email: [email protected] Neodent ® is a global brand available in more than Noris Medical is using state-of-the-art machinery 60 countries, with more than 1 6. million implants sold and CAD/CAM technologies in order to design and annually . With a legacy of more than 25 years focused optimize the manufacturing processes of advanced on ease of use, Neodent Dental Implant Systems prosthetic solutions made of commonly used materials focus on progressive treatment concepts, such as in the dental field such as titanium and zirconia . immediacy with modern and reliable solutions to enable therapy access and affordability for creating Osseointegration Foundation (OF) new smiles every day . 85 W . Algonquin Road, Ste 550 Founded by a dentist for dentists, with the purpose of Arlington Heights, IL 60005 changing the lives of patients, Neodent® is the second Phone: (847) 439-1919 largest dental implant company worldwide with a Website: http://www.osseo.org/osseointegration-foundation/ Contact Email: [email protected] proven record of clinical success and professional and patient satisfaction . The Osseointegration Foundation (OF) fosters the highest standards of research and education Neoss of practitioners, to enrich their patients’ lives and 21860 Burbank Blvd, #190 enhance their students’ knowledge and skills . Support Woodland Hills, CA 91367 of the OF is essential for the continuation of existing Phone: (818) 432-2600 research grant programs and to enable new programs Website: https://www.neoss.com/en-us to be launched . Contact Email: [email protected] Neoss offers innovative products that are intuitively Ritter Implants simple to use . Our products allow dental professionals 4310 West Avenue to provide reliable and cost-effective treatments to San Antonio, TX 78213 their patients with excellent long-term results . Leading Phone: (855) 807-8111 the market with ingenuity and integrity, we strive to Website: http://www.RitterImplants.com Contact Name: Basil Battah set new standards . In developing smart treatment Contact Email: [email protected] solutions and working closely with each practice, Neoss makes the complex less complicated . We call The Ritter Brand stands for high quality state-of-the- that Intelligent Simplicity . Call 866-626-3677 or go to art technology and thoughtful innovation made in www.neoss.com for more info. . Germany . We have a proud heritage of serving the global dental Nobel Biocare USA community since 1887 . It is our privilege to offer high 22715 Savi Ranch Pkwy quality products to ensure a predictable experience Yorba Linda, CA 92887 and to better serve the needs of your patients . Phone: (714) 282-4800 Ritter implants are supported by a lifetime guarantee, Website: http://www.nobelbiocare.com so you can remain confident, while remaining focused Contact Name: Adriana Aldridge on your ultimate goal of treating patients . Contact Email: [email protected] Does your dental implant provider give you the Our mission is to improve patient and clinician quality products and support you need to grow? of life . Learn how Nobel Biocare has the innovative products and knowledgeable team to support your periodontal practice at any stage of your career . There’s more to implants than titanium and we’d like to show you the possibilities . From single-tooth to full-arch, let’s discuss how Nobel Biocare can help your practice stand out from the crowd . 139 Table of Contents 2021 Annual Meeting Salvin Dental Specialties, Inc. Southern Implants North America 3450 Latrobe Dr 225 Chimney Corner Lane, Suite 3011 Charlotte, NC 28211 Jupiter, FL 33458 Phone: (800) 535-6566 Phone: (561) 472-0990 Website: http://www.salvin.com Website: https://southernimplants.com Contact Name: Greg Slayton Contact Email: [email protected] Contact Email: [email protected] Southern Implants is a leading provider of unique and Salvin Dental / Salvin Regenerative innovative Dental Implant Products with a focus on the “Everything For Your Implant Practice But advanced professional users who want more choices . The Implants®” Southern’ s expertise in research, development, and manufacturing of dental implants allows the Selenium America / Selenium Medical company to provide Innovative Treatment Solutions 6201 Fairview Road, Suite 200 that will reduce treatment times and improve patient Charlotte, NC 28210 outcomes . Phone: (704) 808-0970 The company was established in 1987 and is Website: https://www.selenium-medical.com/selenium- headquartered in South Africa with a global subsidiary surface-treatment/promotive-surface-treatment/ and distributor network Its. global network is Contact Name: Damien Uijttewaal dedicated and committed to providing high-level Contact Email: [email protected] technical support aiming to complement the clinicians’ SELENIUM MEDICAL, through its US subsidiary ability to deliver exemplified standards of care to their SELENIUM AMERICA Inc ,. is offering a wide range of patients and referral base . surface treatments, especially STARSURF, an etching process which improves the osseointegration of Straumann titanium implants by creating three different levels 60 Minuteman Rd of porosity at a macro, micro and nano scale . The Andover, MA 01810 associated white paper is available upon request . Phone: (800) 448-8168 Website: https://straumann.us Snoasis Medical, LLC Contact Name: Craig Kierst 651 Corporate Circle, Ste 118 Contact Email: [email protected] Golden, CO 80401 Straumann® – the world’s leading brand for confidence in Phone: (866) 521-8247 implantology and beyond . We stand for premium Swiss Website: http://www.snoasismedical.com quality, precision and innovation delivering confidence in Contact Name: Matt Burns dentistry, backed by the largest global scientific network . As Contact Email: [email protected] the global leader in implantology, we deliver cutting-edge innovations regarded as industry benchmarks and disruptive BioXclude Dehydrated Human Deepithelialized technological breakthroughs, supported by long-term Amnion-Chorion Membrane scientific evidence . We push the boundaries to enable the next generation of dental care . U.S. Army Recruiting Command 185 9th Calvary Regiment Avenue Bldg . 206 Fort Knox, KY 40121 Phone: (270) 832-5474 Website: http://www.goarmy.com Contact Name: Ina Tyler Contact Email: [email protected] There are more benefits to being part of the U S. . Army health care team than you think . Benefits that can advance your skills and knowledge, shape your perspective, and provide you a comfortable and rewarding lifestyle . Whether you choose the U S. . Army as your career or serve in the U S. . Army Reserve while maintaining your existing practice, you’ll enter as a commissioned Officer . The health care lifestyle will give you respect, responsibility and prestige that are afforded your rank . 140 Table of Contents 2021 Annual Meeting X-Nav Technologies, LLC Zimmer Biomet Dental 1555 Bustard Rd, Suite 75 4555 Riverside Drive Lansdale, PA 19446 Palm Beach Gardens, FL 33410 Phone: (267) 436-0420 Phone: (800) 342-5454 Website: http://www.x-navtech.com Website: http://www.zimmerbiometdental.com Contact Name: Michelle Jackson Contact Name: Customer Service Contact Email: [email protected] Contact Email: [email protected] X-Nav Technologies is the maker of the industry- Zimmer Biomet Dental is a leader in oral healthcare leading and evidence-based X-Guide® Dynamic 3D solutions . We are committed to helping clinicians Navigation system for more accurate implant surgery . achieve exceptional outcomes for their patients by This revolutionary system extends the capabilities continuing to provide state-of-the-art solutions, along of your cone beam imaging for simplified and more with exceptional customer service and technical accurate implant procedures . X-Guide delivers support . We offer comprehensive product portfolios, interactive, turn-by-turn guidance giving the ability world-class educational opportunities and responsive, to improve the precision and accuracy of implant personalized service . Your progress . Our promise® POSITION, ANGLE and DEPTH . New product advancements allow for complete Planning & Navigation for Full Arch Cases, Terminal Teeth, Edentulous, Dual Arch & Immediate Full Arch Cases . X-Guide delivers the only live, 360-degree single-view of implant position, drill movements and anatomy during surgery to confidently transfer your 3D treatment plan to the patient, with ease . With X-Nav, same-day guided surgery can be a reality for patients – and at just a fraction of the cost of traditional guides . www .X-NavTech com. Yomi by Neocis 2800 Biscayne Blvd ., Suite 600 Miami, FL 33137 Phone: (855) 963-6247 Website: http://www.yomirobot.com Contact Name: Cassie Hllberg Contact Email: [email protected] Neocis Inc . manufactures and markets robotic guidance systems for dental implant procedures . The company offers Yomi Robot-Assisted Dental Surgery for precise placement of dental implants . Yomi delivers physical guidance through the use of haptic robotic technology, which constrains the drill in position, orientation, and depth . This assistive technology leaves the surgeon in control at all times . 141 Table of Contents