International Poster Journal of Dentistry and Oral Medicine, Supplement ORGS/2018

Introduction: Autologous bone grafts have osteogenic, osteoinductive and osteoconductive properties, and therefore are considered the "gold standard" in bone regeneration. However, there are some disadvantages, such as risk of infection at the donor site, a limited availability of the autologous bone and a high graft resorption. Dentin and bone are similar mineralized tissues in terms of chemical composition, though the dentin is a more effective graft material as it does not have as many disadvantages as the bone in such matter. The dentin is also rich in growth factors, which enhances bone formation and tissue repair. Objectives: To assess the utility of autologous dentin for: a) its efficiency as a graft material in implantology; b) preservation and augmentation of the alveolar ridge; c) the advantage of being an alternative to other bone graft materials. Methods: Article search was performed using PubMed, regarding the use of autologous dentin as a graft material, published between 2012 and 2017. The following words were used in two different searches: "autologous dentin" and "autogenous dentin" respectively. Inclusion criteria in the study: 1) Articles published between 2012 and 2017; 2) Articles in English; 3) Studies performed only in humans; 4) Studies that evaluate the use of dentin as a graft material; 5) Studies that assess the function of autologous dentin as a graft bone graft material in the oral cavity. Exclusion criteria: 1) Studies performed in animals; 2) Studies that used xenogenic or allogenic dentin; 3) Studies that did not assess the dentin as a graft material in the oral cavity; 4) Studies that used other dental tissues than dentin. Results: 17 articles were selected. Conclusions: Autologous dentin graft shows to be a viable alternative to autologous bone, having had stable results. Dentin has a similar chemical composition to bone, having also growth factors which give its osteogenic, osteoinductive and osteoconductive properties. Clinical Implications: The use of autologous dentin is efficient in the preservation and augmentation of the alveolar ridge and it reduces the morbidity coming from the unfavorable characteristics of autologous bone. Keywords: Autologous dentin, autogenous dentin, bone augmentation, bone regeneration, auto tooth-bone, graft material

Objectives: To evaluate the effect of different abutment-framework designs and different layering materials on the fracture strength of implant-supported zirconia-based single crowns following artificial aging. Materials and methods: Seventy ti-base abutments (Conelog 4.3-0.8mm, C2242.4308, Camlog® Implant, Basel, Switzerland) were screwed onto dental implants (Conelog 4.3-11mm, C1062.4311, Camlog® Implant, Basel, Switzerland). Abutment-implant complexes were randomly divided into seven groups (n = 10) according to the design of the zirconia abutment and framework (VITA YZ T, VITA Zahnfabrik, Germany) as follows: uniform-thickness zirconia abutment and uniform-thickness zirconia framework layered with feldspathic porcelain (Group 1); layered with indirect composite material (Group 2); uniform-thickness zirconia abutment and anatomic design zirconia framework layered with feldspathic porcelain (Group 3); layered with indirect composite material (Group 4); anatomic design zirconia abutment and anatomic design zirconia framework layered with feldspathic porcelain (Group 5); layered with indirect composite material (Group 6); uniform-thickness zirconia abutment and monolithic zirconia crown (Group 7). All fabricated zirconia abutments were cemented on ti-base abutments, and then all crowns were cemented on ti-base-zirconia abutment complexes. All specimens were exposed to 10,000 thermal cycles between 5°C and 55°C and then tested for fracture strength. The data were statistically analysed using 3-way ANOVA and Bonferroni-corrected t tests (p≤0.05). Results: The mean fracture strength values of groups were found to be statistically different with a ranking from highest to lowest as follows: Group 7 > Group 5 > Group 3 > Group 1 > Group 6 > Group 4 > Group 2 (p0.05). Anatomical abutment and framework designs showed significantly higher strength compared to uniform abutment and framework designs regardless of layering material (p0.05). Porcelain-layered groups had significantly higher fracture strength values in comparison to the groups layered with indirect composite (p0.05). Conclusions: A framework design with anatomical form supported by an anatomical abutment design increases fracture resistance in implant-supported zirconia-based restorations. Indirect composite material and porcelain perform similarly to layering materials on zirconia frameworks. Fabricating monolithic zirconia crown onto zirconia abutment may be recommended for higher strength. Keywords: ti-base, zirconia, implant-supported, layering material, framework

Teaching surgical procedures to students is a challenging task. They combine a thorough knowledge of anatomical structures with operational techniques and require an understanding of the three-dimensional configuration. Seminars, lectures, or video tutorials have their strengths in deepening theoretical knowledge. Their unfortunate drawback is that they can only offer a two-dimensional perspective. Trainee surgeons or students need to obtain adequate powers of spatial perception before commencing surgical procedures. Dental implant placement does not require a special degree or training. After graduating from dental school the dentist can perform implant surgeries without passing through a specific training. Many predoctoral dental curricula, however, do not include implant dentistry. Furthermore, students often do not participate in surgical treatment and their approach to learning surgical techniques is limited to observing (Kihara et al., 2017). Present models for hands-on practice do not transfer clinical situations to the training lab and might therefore not be sufficient as preparation to actual surgical interventions (Li et al., 2011). Three-dimensional imaging renders a unique possibility to study patient anatomy prior to surgery. Recent advances in computer-aided design and 3D printing technology are the foundation to transfer anatomical images to haptic models for surgery simulation. The use of patient-specific models replicating hard and soft tissue configuration provide helpful information not only to the surgeon but also to the student (Nobis et al., 2014). Haptic models derived from three-dimensional imaging data are used to educate students on patient-individual anatomy and to prevent from intraoperative complications related to surgical technique. Additionally, haptic models may be used to discuss and train soft tissue handling prior to a surgical intervention. Until today, fabricating a realistic soft tissue layer is the challenge but new materials introduced in stereolithography might be able to overcome this limitation (Park et al., 2017). Combined hard and soft tissue models are a useful learning instrument and might therefore increase the efficiency and success of dental implant surgeries. The purpose of this poster is to present a protocol for dental implant education. It may provide helpful information to increase the confidence of the inexperienced student and to visualize surgical challenges to the experienced clinician. Keywords: dental training, surgical training, dental implant, image guided surgery, preoperative planning, haptic model, 3D printing

Digital Technologies have been in our lives since many years and they are used in all fields. They also provide us shorter workflow periods. The accuracy, precision and repeatability are great advantages. With digital dentistry tools, the implant treatments are planned from the final restoration to the implants. This reduces all the possible risks like wrong positioning and angulation of the implants. In this case report, Fully Digital Workflow will be presented from planning to the final restoration. Keywords: Implant, isy, camlog, guided surgery, cerec, cerec guide, tibase, monolithic zirconia, full arch, bridge

Function and esthetics are very important for all kinds of dental restorations. For a fixed implant restoration, the positions of the implants and the emergence profiles are very important to have a good result. CAD-CAM systems help us for planning, as well as preparing the guide for guided surgery and fabricating the final restoration. Digital Workflow for a monolithic zirconia bridge on six iSy implants is presented in this case report. Keywords: Implant, isy, camlog, guided surgery, cerec, cerec guide, tibase, monolithic zirconia, full arch, bridge

Aim: In this case, the treatment of a 41-year-old woman who suffered a traumatic loss of her maxillary incisors is described. Due to the loss of alveolar and gingival contour, two patientspecific allogenos milled bone blocks had to be transplanted. Materials and methods: Introduction A female patient, aged 41, was referred to our clinic for implant therapy after traumatic loss of her central incisors. Due to severe alveolar bone loss in the implant site, allogenous bone blocks had to be transplanted to fill the defect in the maxillary anterior region. Treatment Performed Therapy was performed in several stages. Stage 1. The patient was referred with an "flipper" as a replacement for her maxillary incisors. A cone beam tomography was necessary to evaluate the maxillary defect. Stage 2. patient customized allogenic bone blocks were grafted to the anterior maxilla for horizontal ridge augmentation. Stage 3. Six months after bone grafting, removal of bone fixation screws and guided placement of two implant in the lateral incisor region. Stage 4. Six months after implant placement, a second stage exposure and augmentation procedure and placement of two gingivaformers. Stage 5. two weeks later, provisional abutments with a custom Zirconia core based on a CAD- CAM Abutment were inserted and a provesional bridge was placed. Stage 6. One month later, final Zirconia abutments with a custom were inserted and a final bridge of Ceramic fused to Zirconia was placed. Discussion: Missing maxillary incisor sites often show horizontal as well as vertical atrophy, with inadequate conditions for implant placement. Therefore bone and soft tissue grafting is often necessary to develop the optimal site for implant placement. To select the appropriate surgical procedure for site development, a wax-up or even a provisional prosthesis can be helpful to assess the amount of bone and soft tissue deficiency. In this case patient customized allogenic bone blocks were used for two-stage alveolar ridge augmentation. Based on CT/CBCT scans, the bone blocks were virtually designed and in second stage milled from processed cancellous bone blocks originating from living human donors. Implants were placed six months after bone grafting surgery using a SMOP surgical guide, based on the initial augmentation planning in order to achieve correct three dimensional implant positioning. Conclusion: A surgical plan based on the prosthetic design and desires of the patient should be established after the evaluation of the existing hard and soft tissue. The planned implant procedure steps should be discussed with the patient regarding treatment time and treatment costs. Keywords: Implant treatment, aesthetic zone, SMOP, allogenous bone block, CAD-CAM abutment, zirconia abutment

Introduction: Guided surgery optimizes: the accuracy of implant placement in a more safe, predictable and efficient situation by using a flapless technique. Objectives: The aim is to present a multidisciplinary case report in a partially edentulous patient to whom a digital workflow has been applied, including the computer assisted implant planning and the placement with static guided surgery. Material and Methods: A 68-year-old male patient with a Kennedy class I in the maxilla and mandible was treated in the Master of Restorative Dentistry based in New Technologies of Complutense University (Madrid). After basic periodontal treatment, all the teeth except 3.4., 3.3 and 3.3. were extracted. SMOP Implant Planning System (Smop, Swissmeda, Zurich, Switzerland) was used to align and match CBCT (Cone Beam Computed Tomography) with the digital models obtained from 2 situations: the mouth after teeth extractions and from the diagnostic wax-up. The placement of ten Conelog Implants (Camlog, Biotechnologies AG, Switzerland) was planned according to the protocol for guided surgery. The surgical template was designed and printed to use a flapless procedure for implants placement. Patient's function and aesthetics were reestablished with provisional full-arch maxillary restoration. On the mandible, a tooth-supported PMMA (Poly Methyl Methacrylate) provisional restoration was cemented. After 6 months, the definitive zirconium oxide screw-retained prostheses were placed. Discussion: Digital implant planning and guided surgery demand more preoperative time for the dentist and could increase the cost of the treatment. However several studies suggest that guided surgery reduces post-surgical morbidity due to the possibility of performing flapless surgery , improves accuracy in implant placement, and increases the predictability of the prosthetic treatment. Results: The ten implants were predictably and satisfactorily placed, both from the patient's point of view and from the clinician. Function and aesthetics were reestablished as desired by the patient. Conclusions: Computer assisted implant planning and guided surgery may offer clinical advantages in terms of patient morbility, time, optimization of available bone and accuracy regarding implant position. Keywords: Guided implant surgery, digital workflow, flapless implant surgery, digital planning.

Aim: to present a case report of a prosthetically driven digital treatment planning and its subsequent execution, using the fully guided implant placement protocol, in a complex periodontal patient. Material and Methods: A 58-year old partially edentulous female patient was referred to the post-graduate clinic of Master of Periodontology program of Complutense University (Madrid, Spain) for periodontal and implants treatment. Her chief complaint was teeth mobility, in both upper and lower jaws. After a clinical and radiographic diagnosis, the strategic decision was made to extract all maxillary teeth due to the complex treatment plan with the goal to achieve functionally stable and esthetically pleasing results. The following treatment sequence was used: all maxillary teeth were extracted in a single session, with a fabrication of an immediate removable complete denture. No socket preservation was performed. 6 weeks after teeth extraction, a CBCT was obtained, and the dental stone model of the maxilla was optically scanned. Resulting DICOM and STL files were superimposed in the SMOP Implant Planning System (Smop, Swissmeda, Zurich, Switzerland). The placement of six Conelog implants (Camlog, Biotechnologies AG, Switzerland) was planned and the surgical guide was designed for the protocol of fully-guided implant placement. After printing the surgical guide, the metal guide sleeves were inserted in the corresponding locations, and the surgery performed. Four implants were placed according to the flapless implant placement protocol, and two implants were placed with a flap elevation and simultaneous sinus floor elevation. Six months after surgery, second stage surgery on two implants was performed, and a definitive full-arch restoration was fabricated. Conclusions: complex treatment planning using digital approach may facilitate the process of implants placement, making it more safe and predictable, and improve the long-term functional and esthetic result of the complex rehabilitation. Disclosure: Nothing to disclose. Keywords: Full arch, delayed implant, guided surgery

Patient 42 years old, healthy and fit had 11 extracted due to root fracture. In the same surgical time, an implant 4,3 - 13mm was placed with bone regeneration followed by an immediate loading with an acrylic provisional crown. Half year later, the provisional crown was replaced by a final zirconia crown. A follow up period of 4 years shows good aesthetics with stable hard and soft tissues. Keywords: Root fracture, immediate implant, immediate loading, bone regeneration, acrylic crown, zirconia crown.

Aim: To compare the effect of placing the definitive abutment at the time of implant placement versus at a later stage, on the soft and hard tissue changes around dental implants. Materials and methods: Implants were placed in the posterior maxilla or mandible of partial edentulous patients and they were randomized to receive the definitive abutment at the moment of implant placement, or 6-12 weeks later. Radiographic assessment of vertical bone level changes (RBC) (primary outcome), clinical status of peri-implant tissues, changes in soft tissues margin, papilla filling and patient-related outcomes were assessed 6, 12 and 36 months after loading. Results: 60 implants were placed in 40 patients. In test group 9 single unit and 19 multiple unit were restored and in the control group 12 single and 19 multiple unit. 45.8% of the implants were placed in the maxilla and 54.2% in the mandible. Overall survival rate was of 98,3% at 36 months. A tendency of greater bone loss was observed in the control group over time, being only statistically significant at 6 months. However, between 12 months and 36 months, a slight greater bone gain was observed in booth group. At 36 months the bone loss was 0.94mm vs 0.49mm in control and test respectively. Periodontal clinical parameters (probing depth, plaque and bleeding) did not demonstrate significant differences between groups at any time point. A significant increase in papilla height was observed from loading to 36 months in both groups, with no differences between the groups. Regarding patient-related outcomes, no differences were between test and control. Conclusion: The one abutment - one time concept is associated with less marginal bone loss. Furthermore, peri-implant tissues stability seem to endure in the long term (3 years). Keywords: Marginal bone level, one-abutment one-time, implants

Background: Immediate implant placement has become an increasing treatment concept in daily practice. However, several factors have to be considered before tooth extraction in order to achieve functionally and esthetically satisfying results. One major prerequisite is primary stability. The challenge of immediate placement of an implant in premolar or molar sites is the implant bed preparation due to the presence of interradicular bone septa. Aim: This case report illustrates a step-by-step approach for the immediate placement of an implant in a premolar area in the upper jaw with pre-extractive implant bed preparation. Materials & Methods: A patient with a fractured and hopeless upper right first premolar presented in our clinic. All neighboring teeth were provided with intact fixed restorations. After clinical and radiographic analysis, a single crown implant restoration via immediate implant placement was planned. All drilling steps were performed directly through the remaining root, so that an optimal three-dimensional position of the implant could be achieved. After finishing the implant bed preparation, the remaining roots were carefully extracted in two parts. The socket walls were well conserved. After sounding of the height of the limbus alveolaris, the implant was placed with sufficient primary stability. The gap between the implant and socket walls was filled with bovine bone chips. A connective tissue graft was transplanted buccally via the envelope technique to stabilize gingival conditions. After a transgingival healing period of 4 months, the implant was provided with a CAD/CAM screw-retained implant restoration. Conclusions: From a clinical point of view, the concept of pre-extractive implant bed preparation allowed safe and precise positioning and angulation of an immediately placed implant. This is due to minimization of possible deflection of the osteotomy drills from the ridge of the bone septa. Therefore, the probability to achieve sufficient primary stability seems to be higher than in case of post-extraction implant bed preparation. Keywords: dental implants, immediate implant placement

Background: A stable marginal bone and healthy peri-implant mucosa define the fundament for long-term stability of dental implants and both have impact on a satisfying esthetical and functional outcome. Apart from surgery, implant design and prosthetic parts have potential influence on these important outcome parameters. The CONELOG® SCREW-LINE implant by CAMLOG Biotechnologies AG offers a promising implant design with conical abutment connection and integrated platform shift. Aim: Evaluation of radiographic bone level changes from time of implant placement up to 60 months after prosthetic delivery by intraoral standardized x-rays in a prospective observational study. Secondary parameters were survival rate, performance of restorative components, nature and frequency of adverse events and the patient satisfaction. Material and Methods: Two to three implants of diameters 3.8 and 4.3 mm and lengths of 11 and 13 mm were inserted in the posterior mandible. Opposing dentition were natural teeth or fixed restorations. The implant shoulder was placed at bonelevel. Prosthetic delivery (loading) took place after 6-12 weeks in class I-III or 12-18 weeks in class IV bone. Peri-apical radiographs were taken after surgery and before and after abutment/crown placement. Routine clinical controls, photographs, and peri-apical radiographs were taken at 6, 12, 24, 36, 48 and 60 months after loading. Results: 52 implants were set in 24 patients. Mean age was 48.9 (SD ±13.8). Twenty patients received two, 4 had three neighbouring implants. Thirty-six implants in 17 patients could be followed over 60 months post loading. Seven patients (n=16 implants) dropped out during the course of the study. One patient withdrew consent, two patients died, three patients were lost to follow-up and one patient dropped out by implant failure after 16 months. Two implants got lost equivalent to a survival rate of 95.4%. Between insertion and loading mean bone loss was 0.5 mm (SD: ±0.4) and between loading and 6 months a bone gain of 0.1 mm (SD ± 0.4) was observed. A gain of 0.2 mm (SD: ±0.5) was reported after 24 months and this finding remained stable to the end of the study after 60 months: 0.2 mm (SD: ±0.6). Conclusions and clinical implications: The CONELOG® SCREW-LINE implant is safe and reliable for the partially edentulous patient in the distal mandible with a good performance regarding implant survival, esthetical outcome and bone stability over the course of the study. Keywords: dental implants, platform switch, mandible

A 79-year-old female patient wearing a 10-year-old implant fixed restoration presented with an increasing bone loss caused by a progressive peri-implantitis, and she requested a new implant fixed prosthesis because she was not able to get a conventional prostheses attached in her the edentulous mandible. The basic situation was marked by a major 3D bone defect in area 35 to 45. The inflammation and the occurred explantation left quite an ungentle and scar-penetrated soft tissue. Based on a DVT diagnostic, a customized YxossCBR^® titanium scaffoldwas constructed and the surgery performed (1. augmentation; 2. Implantation). Following the prosthetics were designed and incorporated (time interval in total of 9 months). The case aims to demonstrate a possible solution to move from a severe peri-implantitis to a complete restoration of the intraforaminal area using a new implant loaded prosthesis fixed in an edentulous mandible, under ambulant conditions. In addition, we will show an in house statistic about 27 implanted Yxoss meshes, including also failures and complications. Keywords: peri-implantitis, re-implantation, yxoss, bio oss

Background: The platform switching concept refers to the discrepancy between smaller diameter prosthetic abutments related to implant platform diameter. Clinically, the application of such components seems to reduce marginal bone resorption and to maintain soft tissue levels improving treatment outcomes and patient satisfaction. Up to this date the literature is sparse on long-term results deriving from well-designed randomized controlled trials evaluating the efficacy of platform switching versus platform matching. Aim: The purpose of this five-year prospective randomized multicenter study was to compare the clinical performance and peri-implants marginal bone levels of implants restored with platform switching (PS) or platform matching (PM) abutments. Materials and methods: The study enrolled adult patients missing two or more adjacent teeth in the posterior mandible mesially bounded by a natural tooth. Patients underwent open flap implant insertion and were randomly allocated to the PM or PS group, receiving the corresponding healing abutments. Loading was carried out after a healing period of 6-12 weeks (and for bone quality IV 12-18 weeks) with cemented crowns. Patients were followed annually for 5 years. Outcome measures were marginal bone level changes, implant survival and clinical parameters plaque index, sulcus bleeding index and pocket probing depth. Results: Thirty-three patients received 72 implants in the PM group and thirty-five patients received 74 implants in the PS group. Sixty patients attended the final appointment of the study, 31 had received PS components and 29 had received PM components with 65 and 63 implants respectively. Estimated mean difference in marginal bone levels of PS and PM restored implants was 0.28mm (95% CI: [0.06, 0.49], p=0.011), favouring the switching components. After 5 years the overall survival rate was 96.6% with no differences between groups (p=0.647). Conclusion: Patients requiring implant supported restorations in healed bounded or free end edentulous gaps of the mandible benefit from the use of PS prosthetic components from the surgical procedure onwards. Keywords: Dental Implant, platform switching, platform matching, bone level, marginal bone loss

The restoration of a lost anterior tooth is the most difficult practice for the dentist to maintain aesthetic and functional integrity. In these areas, the shape, color and shading of the cords, interdental spaces, ridge topography, contacts with the opposing jaws, parafunctional habits and the aesthetic expectations of the patient should be taken into account when restoring. The single tooth defects of the upper jaw anterior region bring about functional, aesthetic and psychological problems. Although it may seem like a loss of one tooth, it is a condition that requires care and precision in treatment. Keywords: dental implants, immediate implantation, immediate loading, e-max prosthetics

Maxillary lateral hypodontia is the most common tooth missing after the third molar. There is a frequency of between 1% and 4% in the society. Diastema and asymmetrical appearance resulting in hypodontia result in aesthetic problems. Today's prosthetic approach includes innovative prosthetic materials in addition to minimum tooth preparation. For minimum preparations, laminated veneers are a very popular solution, and lithium disilicate material as a prosthetic material is aesthetically satisfying. Keywords: hypodontia, dental implant, free gingival graft, e-max veneer

Aim: The aim of this retrospective study is to report, in a period of 12 months, the radiologic marginal bone level outcome of patients treated with single tooth iSy implants when used in healed alveolar ridge with conventional loading protocol, in comparison with an immediate loading protocol in post-extraction sites. Materials and methods: 16 patients in need of a single-tooth replacement received iSy implants. In Group A 8 implants were placed in healed ridges, with transgingival healing using iSy healing cap and restored with delayed load and restoration, in Group B 8 implants were placed immediately into fresh extraction sockets without flap elevation and restored with immediate non functional loading by using a provisional crown bonded to the multifunctional cap and then snapped onto the implant base. The final restorations were made in all cases after 3 months from the surgery with a screw retained hybrid abutment crown (zirconia bonded to the titanium implant base). The Marginal bone level relative to the implant reference point was recorded at implant placement and after 12 months following surgery using intra-oral radiographs. Measurements were made on the mesial and distal sides of each implant. Results: The mean change in marginal bone loss (MBL) after 1year of implant placement was 0.31±0.22 mm in extraction sockets and 0.29±0.20 in healed ridges. Within all the limitations of this study, responses of local bone to immediately loaded iSy implants placed in extraction sockets or in healed ridges with delayed load were similar after one year. Immediate restoration technique by using iSy titanium implant base as abutment and with snapped multifunctional cap (without cement) placed in post-extraction single implants seems not to have influence on marginal bone around iSy implants as compared to conventional delayed surgery and loading in a period of one year. Keywords: Marginal bone loss, immediate load, conventional loading

After the resolution in terms of functionality of treatments with implants and surgical protocols, efforts have been focused on the esthetics of implant-bearing rehabilitations, owing to patient's demands, requiring thus wide-range technological and scientific investments. The zirconia used in dental implants has some properties comparable, even higher, to those of titanium. In terms of prosthetic rehabilitation, protocols using acrylic resin were gradually replaced by metal-ceramic protocols, and, following the popularity of metal-free reconstructions in dentistry, by all-zirconia protocols, with fore-teeth stratification, in the pursue of esthetic excellence. The clinical case was a patient of 43, totally upper edentulous for over 20 years. After complete pre-operative exams, we proceeded with planning the case and building the surgical stents. The placement of eight 10- or 12mm-long implants was planned according to the location of the remaining bone without using bone grafts. After 5 months, the implants were opened, and after 15 days, we started the prosthetic phase. Once the CERALOG abutments were used to choose the ideal positioning for each abutment, the laboratory produced a milled resin bar for the first try, before milling the zirconia (ZrO2) protocol bar. Another try-on and bite record was made for the ceramic stratification. The structure being finished, definite abutments were lodged in the patient's mouth with the torque that was recommended by the manufacture. The combination of technologies in Implantology and Prostheses was possible in this case, giving the patient not only her former function and esthetics but also the biocompatibility of zirconia both within the bone and outside the mouth, with excellent resistance, and incomparable prosthetic resolution. The CERALOG system of implants counts with all the necessary elements so that any type of prostheses upon implants be developed, ranging from one-piece dentures to a total protocol, as shown in this case of total rehabilitation. Keywords: zirconia implants, zirconia prostheses, flexibility

Aim: The aim of this study was to determine and compare the effects of UV light and non-thermal plasma (NTP) treatment on rough titanium surfaces regarding the changes in wettability, surface chemistry as well as cell attachment and proliferation of murine osteoblast-like cells in vitro. Materials and methods: Sandblasted and acid-etched titanium disks (grade 4) were divided into a non-treated control group and two experimental groups either treated by UV light (0.05 mW/cm2 at λ = 360 nm and 2 mW/cm2 at λ = 250 nm) or by NTP of argon (24W; -0.5 mbar) for 12 minutes each. Wettability was assessed using dynamic contact angle measurement and XPS analysis was performed. Murine osteoblast-like cells (MC3T3-E1) were used for in vitro experiments. Cell attachment was assessed using fluorescin diacetate / propium iodide staining (live-dead-staining) after 2, 24 and 72 hours. Proliferation was determined using an XTT assay. Results: UV light and NTP significantly increased wettability on the titanium surfaces (P 0.001). XPS analysis revealed a significant reduction of carbon remnants after treatment by either method (P 0.002). NTP was even more effective in carbon removal than UV light (P = 0.03). UV light and NTP significantly increased cell attachment compared to the non-treated disks (P 0.001) at any time. NTP led to a significant increased cell proliferation (P = 0.002) compared to the non-treated as well as to the UV-treated disks. Conclusion: UV light and NTP treatment can significantly improve wettability and reduce carbon remnants on rough titanium surfaces. Both methods are able to optimize surface conditions for osteoblast-like cells in vitro. However, further studies are needed to determine the extent of these effects in vivo. Keywords: dental implants, UV-light, non-thermal plasma, titanium, cell adhesion

Introduction: Since the beginning of oral rehabilitation with dental implants, it has been observed the need to develop alternative connection types to meet different prosthetic needs. Prosthodontic rehabilitation of implants using either internal or external connection is widely used today. The selection of the type of connection depends of a number of clinical characteristics that most adapt to each clinical situation. The dentist's knowledge of the advantages and disadvantages of each one is fundamental in order to properly customize each treatment. Objectives: This study consists of a literature review, whose objective is to describe the differences between internal and external connections. The clinical advantages and disadvantages of each connection types will be adressed. Methods of searching: Research was conducted in the database PubMed/Medline recent literature on the subject, using the words "Dental Implants Connection"; "Prosthodontic Rehabilitation"; "Internal Connection"; "External Connection" and "Internal Connection vs External Connection". Results: 15 articles were selected. Conclusions The literature reveals that for both types of connection, there is a high predictability of success rates. Biomechanically, advantages and disadvantages are observed in both connections, however the need to develop different types of platforms are recommended. The choice should be made based on the type of rehabilitation in progress. Keywords: Dental implants connection, prosthodontic rehabilitation, internal connection, external connection, internal connection vs external connection

Aim: The study aimed to assess the clinical results of a treatment protocol for performing both localized sinus augmentation and socket preservation at the time of maxillary molar and premolar extraction in cases with compromised residual bone heights. Materials and methods: 7 patients aged from 32 to 74 years old with existing severe attachment loss and hopeless teeth due to periodontal disease were enrolled in this study. The described technique was performed in 10 sockets following tooth extraction in the maxilla (7 molars and 3 premolars). After a healing period of three months cone beam computerized tomograms (CBCT) were taken, compared to preoperative radiographs, implants were inserted and followed up clinically and radiographically. Results: Compared to preoperative alveolar heights the average primary sub-antral bone height was increased by 3.4 mm. Through this technique, the number of cases with an indication for an conventional sinus floor elevation in conjunction with lateral window was reduced by 100% (7 vs. 0). 10 implants with lengths from 11-13 mm were placed. All implants could be placed primary stable. No further soft tissue corrections were needed. All implants were clinically stable and osseointegrated at the time of implant uncovering and follow up evaluation after loading. Disclosure: The described procedure verified that it improves the clinical condition for future implant placement in compromised initial situations, when distinct alveolar defects and reduced residual bone height are expected. Keywords: Implant, socket preservation, sinus floor augmentation, periodontitis

Management of defects of the jaw bone and consecutive implant placement is still a challenge in daily practice. Patient-specific titanium meshes are a promising tool to create optimal patient care. With this study, the surgical protocol was analyzed for feasibility and evaluated to identify risk factors concerning soft tissue healing according to a new classification for mesh exposure. Keywords: Titanium meshes, customized bone regeneration, dehiscences, implant placement