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ePaper created 2016-09-30, 16:42:46 | version 1.38.0
opinion 25th EAO Annual Scientific Meeting 8 Osstell symposium: Experts discuss benefits of ISQ diagnostics in daily practice n Today, dentists are facing increas- ing challenges in implant treatment: the continual development of digital technology, a growing number of high-risk patients associated with the pursuit of shorter treatment times, and achieving consistently predicta- ble outcomes. At a scientific sympo- sium, held by Swedish dental manu- facturer Osstell as part of the 2016 EAO congress yesterday, experienced clinicians discussed how to address these challenges using implant stabil- ity quotient (ISQ) technology. “The aim of our annual sympo- sium is to provide an opportunity for dental professionals to learn about the use of ISQ diagnostics in every- day practice and to interactively dis- cuss the topic with experienced clini- cians,” commented Osstell CEO Jonas Ehinger. “At this year’s symposium, four well-known experts demon- strated how to monitor osseointegra- tion in various treatment scenarios in order to optimise treatment time and implant loading and accomplish pre- dictable results.” For more than 25 years, Osstell has been manufacturing instruments for analysing dental implant stability that help assess osseointegration through resonance frequency analy- sis (RFA). The method, developed by Prof. Neil Meredith from Australia and Prof. Peter Cawley from the UK, is currently the only objective and non-invasive means of measuring im- plant stability. Meredith, one of the speakers at yesterday’s symposium, elaborated on the scientific concept of RFA, the development of ISQ tech- nology over the last 25 years and the advantages of using ISQ measure- ment to enhance long-term clinical outcomes. “Osstell ISQ is the sixth generation of a 25-year-old instru- ment, and for me as the inventor, the evolution has been dramatic. It is one of the most sophisticated instru- ments in dentistry, and it is not only about the technology; it is also about the ability to use the data that gives us more and better information re- garding the treatment and diagnosis of our patients,” Meredith stated. Dr Marcus Dagnelid from Swe- den, who has been working with Oss- tell’s technology for almost 13 years, moderated the symposium and ex- plained how he implements the tech- nique in the treatment planning of his cases, presenting examples of guided surgery and immediate load- ing in the case of single-implant treat- ment. “From the point when an im- plant is placed, the degree of micro- mobility and the process of osseointe- gration can be monitored. This is es- pecially important in the demanding clinical situations that we are facing today, as we are treating more diffi- cult cases than in the past,” Dagnelid said. Moreover, he showed how the online service Osstell Connect ena- bles clinicians to connect several de- vices and share ISQ values between rooms, team members and dental pro- fessionals worldwide. Oral and maxillofacial surgeon Dr Jay Malmquist from the US dis- cussed how treatment protocols have changed with regard to implant load- ing. Presenting cases of immediate and early loading and grafting, he highlighted the importance of pri- mary stability in implant treatment and demonstrated how clinicians can use ISQ diagnostics to evaluate im- plant stability at each point of treat- ment. “Osstell’s technology helps re- assure the practitioner that an im- plant is secure for loading purposes, thereby enhancing predictability and treatment success,” Malmquist stated. “For patients undergoing a com- plex implant and prosthetic treat- ment, reducing treatment time and assuring a predictable outcome are still the most relevant factors,” ex- plained Dr Jörg Neugebauer from Germany. The implantologist and oral surgeon presented cases of short and angulated placed implants and pointed out that grafting procedures are still necessary even with the use of these. Therefore, determining heal- ing time after implant placement and loading time after second-stage sur- gery is essential for a safe treatment, he said. “With ISQ measurement, in- dividual determination of the differ- ent healing periods is possible, which leads to an optimum treatment time and allows management of high-risk patients,” Neugebauer explained. EAO congress visitors who wish to learn more about ISQ can visit the company’s booth S18 until Saturday. 7 that will show that we have come a long way. However, we are not there yet. There are still certain problems we have to deal with, problems in preci- sion, problems in combining all the tools needed for guided implant sur- gery and the limitations of these tools. For example, in order to plan the position of an implant and its su- perstructure exactly, we have to su- perimpose CBCT scans and intra-oral scans using software. Factors such as voxel size and the absence of clear landmarks by which to superimpose the different scans correctly can af- fect precision and cause deviations between the planned and the real- ised positions. I am not saying that free-hand surgery is more precise; however, the free-hand surgical ap- proach may in some cases be more rewarding, as at least then the prac- titioner knows what he or she can ex- pect and what his or her limitations are. So what can dentists do to better im- plement a digital workflow in im- plant treatment? Dentists have to know that they cannot blindly rely on the comput- er-guided approach. They still need to get their heads around the technol- ogy first and stay focused while us- ing it. Moreover, they have to accept that there is a learning curve and that computer-guided surgery will not work 100 per cent the first time it is applied. In my lecture, I will be discussing the variables that influ- ence the precision of the guided sur- gery workflow and what dentists are able to do to overcome associated problems. Primarily, they have to be- come comfortable with the different tools and software packages and gain experience in working with them. In the long run—and I think that we are not so far away from that now—computer-guided surgery is a treatment approach that will proba- bly be much more precise than plan- ning and placing implants without any guidance at all. How will digital technology further change implant dentistry in the fu- ture? One of the tools that I will be demonstrating during my presenta- tion is a dynamic navigation system that provides real-time guidance based on the patient’s CBCT scan. During surgery, the dentist sees the planned implant position on a screen while sensors track the drill and the patient’s jaw and the system provides visual and tactile feedback to ensure that the dentist drills exactly at the planned osteotomy site. Dynamic navigation systems like this one are the next step towards robotisation in implant dentistry. From there, it will not take much to develop a computer- steered robot arm that calculates whether the drill is in line with the planning and, supervised and han- dled by the dentist, drills the osteo- tomy. In various surgical disciplines, for example neurosurgery, operations are already being performed using ro- botic technologies, as they are able to perform much more precisely than the human hand alone. It is only a matter of time until these technolo- gies enter dentistry as well. 7 “Digital technologies are proving themselves in implant dentistry and I think that they are improving with time.” 5 Prof. Daniel Wismeijer will be presenting a paper titled “Hand-guided surgery versus guided sur- gery” on Friday, 30 September, during a session running from 3.30 p.m. to 5 p.m., in the Amphithéâ- tre Bleu at the Palais des Congrès de Paris. 5 From left: Dr Marcus Dagnelid, Dr Jay Malmquist, Dr Jörg Neugebauer, Prof. Neil Meredith.