7ème Congrès International d'Implantologie Céramique

This day-long class will be divided into morning and afternoon sessions. The class is intended to provide sufficient theoretical and practical basis to qualify attendants to incorporate ozone in their practice. Dentists, dental office administrators, dentist assistants and hygienists are welcome as Dr. Zaremski specializes in training teams. Dr. Zaremski's evaluations in previous Ozone Master Classes courses have been consistently stellar.
During the morning session, Dr. Zaremski will discuss the history, science of medical ozone, as well as its dental and medical applications. He will also discuss the different ways of ozone administration. The sales and billing details of ozone administration will be discussed.
During the afternoon section of the course, Dr. Zaremski will lead a hands-on workshop that will teach the following skills:
1. Hands on demonstration of operating an ozone generator. Determination of concentration for different therapies.
2. Hands on application of ozone to models. Use of ozone trays.
3. Hands on injection into tissues.
4. Oxygen safety.
Specific clinical work will be discussed as it pertains to each of the above therapies. The course will provide opportunity for Q&A.

Dr. Hong will lead this cosmetic hands-on course where you will learn all the steps to perform autologous treatment including blood centrifuging, separating growth factors from the centrifuged blood and various techniques of injecting autologous growth factors. Emphasis will be placed on teaching the latest technology in obtaining CD34+ stem cells for cosmetic treatments using the Medifuge blood phase centrifuge. Dr. Hong will discuss various techniques, such as LPCGF, APAG, and ICF. In addition, attendants will learn how to use ozone to stimulate the healing power of stem cells - components in the platelet that initiate and regulate tissue repair. Stem cells help you grow new collagen and blood vessels, repair and regenerate damaged skin, and help slow the signs of aging.  Hence, autologous treatments provide excellent results in skin rejuvenation, wrinkle filling and hair regeneration, offering our patients a younger, fresher appearance.
Dr. Hong will demonstrate the procedure on a volunteer and opportunity will be given for all participants to practice the treatment.

Despite the increased effort to improve the quality of dental materials, on occasion, failures are still being experienced either in the form of debonding, delamination or fractures under clinical conditions in tooth- and implant-borne reconstructions. Renewal of such reconstructions is often accompanied by the associated loss of tooth tissue/restorative material. Although there is little published literature on the longevity of repairs, repair of a restoration is more cost beneficial than total replacement where appropriate. Experience indicates that adhesive technologies could be utilized either at baseline or during failure management thereby survival rate of dental restorations could be prolonged. In this lecture, the criteria for decision making with regard to repair versus replacement will be discussed and step-by-step procedures will be explained for clinical repair of various materials used for tooth- and implant-borne reconstructions.

When cell loses 40% of oxidation, cell starts to become anaerobic oxidation. Ozone increase oxidation in the cell, increase blood flow through capillary system and increase flexibility of cells. When the cell deprives of oxygen in, cell dies which in turn creates an infection. What our cell need oxygen from an adequate amount of blood supply and stem cell to grow a new cell and ozone provide both.
Why some of your implant fail? When you are facing challenges due to an insufficient healthy bone during implant procedure, ozone can save your life. In conventional dentistry, we prescribe antibiotics for any infection in the body. And often, pathogen become resistant to antibiotic therapy. Ozone can be very effective on eliminating infection even those that exhibit antibiotic resistant strains. We use ozone to arrest and reverse osteomyelitis, bisphosphonate-induced osteonecrosis stomatitis, herpetic lesions, sinus infections, neuralgia, pulpal hypersensitivity, enhance healing after an extraction, and resolving cavitation.

Man has tried since ever to replace missing teeth somehow using natural teeth, wood, alloys, and ceramics. All these materials had been used in several centuries for the construction of dentures. Attempts to implant dental fixtures in the jaws were made from the beginning of last century but only in the past forty years true teeth substitution could be made. This was due to the development achieved in biomaterials and to the development of the concept of osseointegration by the end of the 1970s. So far, pure titanium is the biomaterial currently used in dental fixtures with very good clinical outcomes. However, research are still in progress to limit the drawbacks of this technology because of the demand coming from the increasing number of patients complaining for sensitization to metals and caring of the aesthetic of their smile, then concerned about implanting titanium fixtures. Zirconia toughened ceramics are the effective answer to this demand: in clinical use as dental fixtures since 1980, zirconia underwent significant improvements since then. This presentation reviews the development of ceramic dental implants, the characteristics of zirconia, and some of the developments now in progress in the field of ceramic implantology.

Dental implants are highly successful at replacing missing teeth and restoring Oral-Health Related quality of life, yet a significant number of patients develop peri-implant mucositis and peri-implantitis. The definition of success for implants extends beyond merely implant survival; in addition to lack of mobility “success” encompasses the maintenance of health of the peri-implant tissues and supporting bone despite the constant microbial challenge in the oral environment.
It is well documented that the titanium dioxide (TiO2) passive layer is responsible for the biocompatibility of titanium dental implants and that weakening this layer leads to titanium dissolution and corrosion. Recent data support the implication of titanium corrosion as a factor in peri-implantitis and that certain oral taxa may cause bio-corrosion in vitro.
The presentation will present evidence of the prevalence and risk factors associated with peri-implantitis and the role of titanium as a modulator of the oral microbiome and host response. In addition, there is evidence that titanium corrosion products, and not the disease status, shape the peri-implant microbiome suggesting that dissolved titanium creates a unique niche in the oral cavity causing a shift of the composition of the peri-implant microbiome. Finally, the relationship between methylation levels, titanium particles, and peri-implantitis will be presented, demonstrating that Global DNA Methylation levels in the peri-implant crevicular fluid are greater in peri-implantitis cases when compared to controls, and independently associated to higher plaque-adjusted titanium quantities. In summary, these findings unveil the role of titanium as a dysregulator of peri-implant health, support the consideration of peri-implantitis as a distinct entity from periodontitis and highlight the importance of maintaining titanium surface biocompatibility during maintenance, and disease management.

It is a well known fact that titanium particles deriving from dental titanium implants (DTI) dissolve into the surrounding bone. Although titanium (Ti) is regarded as a compatible implant material, there are increased concern that the dissolved titanium particles induce inflammatory reactions around the implant. Specifically the inflammatory cytokine tumor necrosis factor alpha (TNF-α) is expressed in the peri-implant bone. The transition from TNF-α induced local inflammation following insertion of DTI surgery to a chronic stage of "silent inflammation" could be an overlooked cause of unexplained medical conditions. The signaling pathways involved in the induction of cytokine release were analyzed by multiplex analysis. We examined samples of jawbone (JB) for seven cytokines in two groups: Specimens from 14 patients were analyzed in areas of DTI for particle-mediated release of cytokines. Each of the adjacent to DTI tissue samples showed clinically fatty degenerated and osteonecrotic medullary changes (FDOJ) in the JB. Specimens from 19 patients were of healthy JB. In five cases we measured the concentration of dissolved Ti particles by spectrometry. Results: All DTI-FDOJ samples showed RANTES/CCL5 (R/C) as the only extremely overexpressed cytokine. DTI-FDOJ cohort showed a 30-fold mean overexpression of R/C as compared with a control cohort of 19 healthy JB samples. Concentration of dissolved Ti particles in DTI-FDOJ was 30 fold higher than an estimated maximum of 1.000 µg/kg. Discussion: As R/C is discussed in the literature as a possible contributor to inflammatory diseases, the lecture examines the question of whether common DTI may provoke the development of chronic inflammation in the jawbone in an impaired state of healing. Such changes in areas of the JB may lead to hyperactivated signaling pathways of TNF-a induced R/C overexpression, and result in unrecognized sources of silent inflammation. This may contribute to disease patterns like Rheumatic Arthritis, Multiple Sclerosis and other systemic-inflammatory diseases, which is widely discussed in scientific papers. From a systemic perspective, we recommend that more attention be paid to this cytokine cross-talk provoked by dissolved Ti particles from DTI in medicine and dentistry.

A correlation between plaque accumulation and progressive bone loss around implants has been reported in experimental and clinical studies. Plaque accumulation on implant surfaces or abutments induces an inflammatory reaction within the gingiva and alveolar mucosa in the same manner as around teeth. Peri-implantitis is a site-specific, plaque-induced infection leading to progressive bone loss. Different adhesion affinities of bacteria have been reported for different materials, such as titanium and ziconia. Plaque accumulation on implant surfaces or abutments induces an inflammatory reaction in the gingiva and alveolar mucosa just as around teeth. Surface characteristics of the components of the transgingival element, in addition to surface roughness, also seem to be extremely important in plaque formation and may be helpful in the prevention of peri-implant soft-tissue pathology. The purpose of this lecture is to characterize bacterial adhesion and bone healing on titanium and zirconia.

The choice of dental materials for implants is essentially limited to metals or ceramics: titanium and its alloys or zirconia. Whereas there is a large body of knowledge on both clinical and mechanical aspects related to metallic implants, our experience is more limited with regards to ceramic implants. Moreover, the current paradigm that wants to match the stiffness of the implant to that of the jawbone works against the ceramic materials.
This talk will first concentrate on the mechanical challenges of metallic implants, namely their fracture. The latter, while of a limited extent, is still a traumatic issue for the patient and a severe complication for the dentist.
The first point to be developed is that of fatigue failure of dental implants and how to identify it beyond any doubt.
Secondly, we will review the factors leading to fatigue cracking, with emphasis on the surface preparation treatment aimed at roughening it.
Next, a limited review of the fatigue performance of metallic implants in various fluid media will be presented.
Based on lessons learned from the three first points, we will identify the missing information about ceramic dental implants and their mechanical reliability.
A fourth point concerns mechanical and fatigue testing of dental implants, whether metallic or ceramic. Do we really learn anything about their fatigue properties by performing a very limited series of cyclic loading experiments? We will present here our random spectrum loading approach as a serious alternative to the existing procedures.
The fifth and last point to be presented concerns the “matched stiffness” paradigm, or the so-called stress-shielding considerations. Using the recently developed concept of failure envelopes, we will show that in fact, ceramic materials are excellent candidates for implant dentistry, and that the current paradigm of having a matched bone-implant stiffness is unsupported, so that the use of softer materials is not justified

The creation of an aesthetic smile with a gingival architecture in harmony with the adjacent dentition remains the final objective in dentistry. The challenge in Perio-Implantology is to manage the hard/soft tissue complex and to be as close as possible to the natural smile appearance of the patient in the aesthetic zone. The process of soft and hard tissue healing must be understood and incorporated into a carefully coordinated sequence of therapy.
The soft tissue aspect following implant treatment in the anterior zone called the “Pink Esthetic” is the most sensitive point and the one that presents the most challenges. Therefore, the preservation or the reconstruction of a natural esthetic gingival presents a major task in Implantology to achieve a perfect harmony between the PES and WES
The essential prerequisites to establish an optimal harmonious aesthetic result should always remain a precise, comprehensive biological and prosthetic diagnosis as well as the choice of the most conservative, appropriate, and least traumatic treatment for the patient and achieve a successful aesthetic outcome, always based on scientific evidence.
A major evolution in Perio-Implantology has taken place with less invasive surgery, more sophisticated approaches. The utilization of new bio-engineering materials, new strategies using Digital Flow, has modify the surgical approaches.

The aim of the present study was to evaluate the influence of accelerated aging on the tetragonal-to-monoclinic (t→m) phase transformation of five different commercially available zirconia dental implants and to determine its impact on the microstructural integrity and mechanical properties: flexural strength, Young's modulus, microhardness and fracture toughness. Zirconia dental implants were analyzed by focused ion beam (FIB), X-ray diffraction (XRD), scanning electron microscopy (SEM) and Raman spectroscopy. After the baseline analysis, the implants were aged at 134 °C and 2 bar pressure for 30 hours corresponding to 60 years invitro. Implants were tested for mechanical properties before and after accelerated aging process.
Y-TZP dental implants showed minimal increase in t→m phase transformation following accelerated aging. SEM and FIB analyses showed insignificant increase in depth of t-m transformation and surface changes following aging. Y-TZP ceramic implants did not suffer a decrease on flexural strength, Young's modulus, fracture toughness and microhardness following accelerated aging.

In this lecture the author highlights the combination of zirconia implants in conjunction with ultrasonic surgery and the use of L-PRF. Minimal invasive techniques like the Intralift, a transcrestal sinus grafting procedure in conjunction with L-PRF are displayed as well as high demanding esthetic cases and trouble management. The demand of patients with less treatment time, less post op complaints and downtime causes the necessarity to adapt surgical protocols towards these. Sinus grafting with no pain, no swelling and bleeding is not a fiction, even in “big cases” since reduction of flap size, small osteotomies and plasma concentrates give the benefital options to achieve this. Based on clinical experience and scientific back up the author draw a line between clinical application for the daily use and scientific data. In addition to that Marcel focus as well the extraoral esthetics and shows his techniques for natural appearance with Fillers and Botulinum Toxine

Zirconia dental implants are an exciting development in Implant Dentistry. Preliminary studies suggest zirconia implants induce less inflammation in the peri-implant tissues and promote a favorable epithelial attachment to the implant. They have a more natural appearance that may enhance esthetics, and contain no metal, making them ideal for patients who have metal sensitivities or prefer a metal-free option. Participants will become familiar with the science of zirconia implants
Participants will understand the indications and contraindications for use of zirconia implants, as well as patient selection