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Tạp chí implant tháng 1-2 /2013 Vol 6 No1
clinical articles • management advice • practice profiles • technology reviews January/February 2013 – Vol No PROMOTING EXCELLENCE IN IMPLANTOLOGY Every picture tells a story: chlorhexidine conundrum Dr Eddie Scher SonicWeld Rx™ — A novel replacement for traditional titanium mesh in particulate bone grafting Dr Lewis Cummings Straumann’s 2013 Dental Implant Complications Symposium Clinical Case: All-on-4™ and NobelGuide™ in an atrophic mandible The Most Efficient Clinical Workflow in Dentistry SCAN Drs Paulo Malo, Armando Lopes, Mariana Nunes, André Rodrigues, Ana Ferro, and Miguel De Araújo Nobre Corporate profile PLAN BIOMET 3i PLACE RESTORE Learn more at Sirona3D.com PAYING SUBSCRIBERS EARN 24 CONTINUING EDUCATION CREDITS PER YEAR! Visit us at Chicago MidWinter Booth # 1625 EDITORIAL ADVISORS Steve Barter BDS, MSurgDent RCS Anthony Bendkowski BDS, LDS RCS, MFGDP, DipDSed, DPDS, MsurgDent Philip Bennett BDS, LDS RCS, FICOI Stephen Byfield BDS, MFGDP, FICD Sanjay Chopra BDS Andrew Dawood BDS, MSc, MRD RCS Professor Nikolaos Donos DDS, MS, PhD Abid Faqir BDS, MFDS RCS, MSc (MedSci) Koray Feran BDS, MSC, LDS RCS, FDS RCS Philip Freiburger BDS, MFGDP (UK) Jeffrey Ganeles, DMD, FACD Mark Hamburger BDS, BChD Mark Haswell BDS, MSc Gareth Jenkins BDS, FDS RCS, MScD Stephen Jones BDS, MSc, MGDS RCS, MRD RCS Gregori M Kurtzman, DDS Jonathan Lack DDS, CertPerio, FCDS Samuel Lee, DDS David Little DDS Andrew Moore BDS, Dip Imp Dent RCS Ara Nazarian DDS Ken Nicholson BDS, MSc Michael R Norton BDS, FDS RCS(ed) Rob Oretti BDS, MGDS RCS Christopher Orr BDS, BSc Fazeela Khan-Osborne BDS, LDS RCS, BSc, MSc Jay B Reznick DMD, MD Nigel Saynor BDS Malcolm Schaller BDS Ashok Sethi BDS, DGDP, MGDS RCS, DUI Harry Shiers BDS, MSc, MGDS, MFDS Harris Sidelsky BDS, LDS RCS, MSc Paul Tipton BDS, MSc, DGDP(UK) Clive Waterman BDS, MDc, DGDP (UK) Peter Young BDS, PhD Brian T Young DDS, MS PUBLISHER Lisa Moler Email: lmoler@medmarkaz.com Tel: (480) 403-1505 MANAGING EDITOR Mali Schantz-Feld Email: mali@medmarkaz.com Tel: (727) 515-5118 ASSISTANT EDITOR Kay Harwell Fernández Dear Readers: Happy 2013! It seems like only yesterday that we were busily preparing to welcome 2012, but in fact, so much has happened in the dental profession and in our publications, that the time has just flown by The positive momentum of the past year continues to propel us forward We are happy to note that this year brings a fresh, contemporary look for the magazines New design elements, an easy-to-read print style, and expanded page size are just a few of the exciting changes that you will find in this, and future issues Implant Practice US is growing and evolving to help you grow and evolve We strive to keep up with current implant trends and to keep our readers up-to-date on the latest techniques and technology in the specialty Our dentist-authors give of their time and expertise to share the methods that result in better dental care for patients We are always seeking out new ideas and innovation in our clinical, technology and continuing education articles, and case studies Our corporate profiles tell the stories of companies that facilitate innovation, and practice profiles share the insights and concepts that inspire practice excellence And, practice management columns spotlight ways to improve the business aspects of the dental office that can make lives easier for the staff and the boss! Besides our magazine, Implant Practice US also features a vital and continually changing website (www.medmarkaz.com/web) and e-newsletter with the latest industry news, articles, and information Our social media mavens keep the action going on Facebook, Twitter, and LinkedIn So whether you like to turn the pages or click the mouse, information can be in your lap or on your laptop! Publishing a thought-provoking, diverse magazine with such high standards is a difficult task, but our authors, peer reviewers, editorial advisory board, advertisers, and columnists make it a smooth and enjoyable process Our editors, sales and production staff, and I appreciate all of our authors and readers and value feedback as we continue to strive for excellence Please feel free to call or email – we’d love to hear from you Email: kay@medmarkaz.com PRODUCTION MANAGER/CLIENT RELATIONS Kim Murphy Email: kmurphy@medmarkaz.com January is a time for resolutions We strive to keep up the momentum so that we all can grow together in 2013 All the best, NATIONAL SALES/MARKETING MANAGER Drew Thornley Email: drew@medmarkaz.com Tel: (619) 459-9595 NATIONAL SALES REPRESENTATIVE Sharon Conti Email: sharon@medmarkaz.com Tel: (724) 496-6820 E-MEDIA MANAGER/GRAPHIC DESIGN Email: greg@medmarkaz.com Greg McGuire PRODUCTION ASST./SUBSCRIPTION COORDINATOR Email: lauren@medmarkaz.com Lauren Peyton MedMark, LLC 15720 N Greenway-Hayden Loop #9 Scottsdale, AZ 85260 Fax: (480) 629-4002 Tel: (480) 621-8955 Toll-free: (866) 579-9496 Web: www.endopracticeus.com SUBSCRIPTION RATES Individual subscription year (6 issues) years (18 issues) Lisa Moler Publisher $99 $239 © FMC 2013 All rights reserved FMC is part of the specialist publishing group Springer Science+Business Media The publisher’s written consent must be obtained before any part of this publication may be reproduced in any form whatsoever, including photocopies and information retrieval systems While every care has been taken in the preparation of this magazine, the publisher cannot be held responsible for the accuracy of the information printed herein, or in any consequence arising from it The views expressed herein are those of the author(s) and not necessarily the opinion of either Implant Practice or the publisher Volume Number Implant practice MEMO FROM THE PUBLISHER January/February 2013 - Volume Number Great Reasons to CONNECT with the ITI in Chicago What puzzle pieces are you missing in your practice? Attend the ITI Congress and complete your puzzle for a successful future row your practice revenue by attending Thursday’s Pre-Congress Practice Management G Forum and learn about: Money, How to Make it, How to Grow it & Case Acceptance Learn from top international experts and educators: • Urs Belser: University of Geneva, Switzerland • Daniel Buser: University of Bern, Switzerland • David Cochran: University of Texas San Antonio,USA • Jocelyne Feine: McGill University, Canada • Hans-Peter Weber: Tufts University, USA • and many more Connect and be a part of the largest dental Network; share best practices at the ITI Congress Party on Friday to benefit the NFED (National Foundation for Ectodermal Dysplasia) Elevate your skill in the Technology Pods with demonstrations taught by Key Opinion Leaders in the Technology Hall (Digital Dental Photography, LOCATOR® Techniques, Cementing on Dental Implants, Provisional Fabrication, Augmentation techniques and more ) ackle Complications – attend Saturday’s “Managing Puzzle Problems” Session and T approach complications with confidence The program will start with complications from the restorative and surgical aspects in the esthetic zone The International Team for Implantology (ITI) is a unique network that unites professionals around the world from every field of implant dentistry and related tissue regeneration Not a member? Sign up today to take advantage of the highest quality educational support and a wealth of benefits to enhance professional activities Find out how you can get a $200 discount on the ITI North America Congress fee www.iti.org/congressnorthamerica Do not wait, take advantage of the early bird rate which expires January 31st and save $100 ITI Congress North America Chicago, USA April – 2013 Connectivity in Implant Dentistry: Putting the Pieces Together INTRODUCTION The best gift – education P erhaps the best gift I have ever given myself was the pursuit of education I remember the day I received my dental degree, knowing that a long journey was ahead I had a plan, and my goal was simple: I would take continuing education courses that interested me and lay the foundation for my future success It began with restorative treatment and included esthetics At the same time, my self-confidence in endodontics was lacking, and I committed years to that discipline Confident with the ability to heal and restore ailing teeth, I set my sights on surgery Unfortunately, dental school and residency could only prepare me so far I yearned to understand the finer points of saving teeth with periodontal surgery, and when unable, then to extract those teeth After 14 years of more education and honing my craft, I was awarded a Mastership in the Academy of General Dentistry Yet, even with that, I always knew there was one discipline in which I was lacking, and it was dental implants I wasn’t simply interested in learning the science of restoring dental implants I wanted much more I sat through many weekend-warrior implant courses, often with a hands-on component using dentoform style models But rubber and plastic models are a poor substitute for the real thing For me, the holy grail of dentistry was learning, understanding, and acquiring the wisdom to surgically place the implant in vivo I had always felt that all other fundamentals had to be acquired, and at that time, I believed those elements were in my repertoire With the groundwork laid out, and the foundation solid, I stood at the precipice, wanting to dive into the implant surgical arena What held me back was fear Fear of the unknown Fear of those anatomical structures that haunted me, leading me to believe that with one wrong move, I would violate the maxillary sinus, the mental foramen, or the inferior alveolar nerve I knew those areas well enough, and frankly, they scared me So, one day, I decided that it was time to overcome my anxiety and discover if those bugaboos were really a threat or just the primal fear they inject you with at the undergraduate level I needed big time education I sought something that was a commitment of time and funds, the two ingredients integral to any worthwhile venture For me personally, I discovered and developed this talent (and continue to so) in a “mini-residency.” Akin to the famed maxi-course, the location was Englewood, New Jersey, a 3-hour drive from my Baltimore home It was a 6-month commitment of bimonthly lectures, participation, and over-the-shoulder live placement And yes, there were lots of homework and tests My teacher and mentor, Dr John Minichetti, assembled an all-star cast of educators, and between his excellent teaching skills, guidance, and care, I began my journey I was thrilled when I learned not only the mechanics of implantology, but also all of the supporting pieces needed for success I relearned how to extract a tooth, this time ensuring that the event was as atraumatic as possible I discovered the art of bone grafting extraction sockets, and when they weren’t intact, then how to grow bone I even deprogrammed my fear of those once dreaded anatomical sites, learning how to correct them (the sinus lift) or avoid them (the mandibular nerves) Once the course was complete, I was sent back into my world to begin this wonderful and exciting journey Initially, I began cherry-picking my cases, staying within my comfort zone, and as my self-confidence grew, so did my treatment Today, I am a proud recipient of the Associate Fellowship in the American Academy of Implant Dentistry Yet, I am even more proud to be considered a kindred spirit with all of you, my fellow implantologists I look forward to continued discovery and collaboration in 2013! Ian E Shuman, DDS, MAGD Implant practice Volume Number You’re Saving Smiles They’ll Smile at the Savings! Learn More at hellospringstone.com Springstone Has No-Interest* Plans PLUS the Best Extended Plans Case Size 12 Month No-Interest Payment Our Extended Plan LOWEST Payment $5,000 $417 $102 60 mo @ 7.99% APR* $10,000 $834 $181 72 mo @ 8.99% APR $20,000 $1,667 $334 84 mo @ 9.99% APR $40,000 N/A $667 84 mo @ 9.99% APR * For plan details, please visit springstoneplan.com • • • Lowest monthly payment available Fixed rates as low as 3.99% APR* Extended plans from $2,000 – $40,000 TABLE OF CONTENTS Through the keyhole Dr Scott Marshall Blyer: An affinity for accessibility and approachability A strong medical and surgical background, dedication to customer service, and a penchant for “pushing the envelope” keeps this clinician’s practice immersed in innovation 10 Corporate profile Biomet 3i Sustainable esthetic treatment, comprehensive tissue management, accelerated therapy, and digitally-driven patient and practice management solutions 14 Clinical Every picture tells a story: chlorhexidine conundrum Dr Eddie Scher raises the alarm on the potentially dangerous effects of chlorhexidine digluconate mouthwash 20 Customized impression of an implant-supported fixed partial denture in the esthetic zone Dr David Furze and Mr Ashley Byrne describe a method in which all four maxillary incisors are replaced with an implant-supported fixed partial denture 22 Continuing education Case study Clinical Case: All-on-4™ and NobelGuide™ in an atrophic mandible Drs Paulo Malo, Armando Lopes, Mariana Nunes, André Rodrigues, Ana Ferro, and Miguel De Araújo Nobre explore an implant solution for extreme cases 28 SonicWeld Rx™ — A novel replacement for traditional titanium mesh in particulate bone grafting Dr Lewis Cummings discusses an improved method for particulate bone grafting 32 Secure bonding: implants and overdentures Dr Ludwig Hermeler demonstrates how to modify an existing overdenture for use with implants and secure it with direct intraoral adhesion 36 Implant practice Volume Number 79459-US-1208 © 2012 DENTSPLY International, Inc Abutments as individual as your patients Available for all major implant systems and in your choice of titanium, gold-shaded titanium and four shades of zirconia, ATLANTIS™ patient-specific ATLANTIS BioDesign Matrix™ The four features of the ATLANTIS BioDesign Matrix™ work together to support soft tissue management for ideal functional and esthetic result This is the true value of ATLANTIS™ for you and your patients CAD/CAM abutments help to eliminate the need for inventory management of stock components and simplify the restorative procedure ATLANTIS VAD™ Designed from the final tooth shape Natural Shape™ Shape and emergence profile based on individual patient anatomy Soft-tissue Adapt™ Optimal support for soft tissue sculpturing and adaptation to the finished crown Find out how ATLANTIS™ can bring simplicity and esthetics to your practice Just take an implant-level impression, send it to your laboratory and ask for ATLANTIS today Custom Connect™ Strong and stable fit – customized connection for all major implant systems 800-531-3481 • www.dentsplyimplants.com TABLE OF CONTENTS 44 Socket grafting made simple Research Event preview Early loading versus immediate Straumann’s 2013 Dental Implant loading: case examples Drs Alberto Maltagliati, Andrea Ottonello, Giulio Raffaghello, and Andrea Mascolo explore esthetics and function of early and immediate loading implants 40 Complications Symposium Providing Solutions for Your Practice 48 Industry news Practice management Know your liability as a business owner Dr Robert M Fleisher discusses how to mitigate general liability risks besides malpractice claims 54 Aribex acquired by the KaVo Step-By-Step BondBone® Socket grafting made simple .44 Product profile Aseptico Aseptico’s AEU-7000L-70V fiber optic motor system 46 Implant practice Group Aribex, the leader in portable X-ray technology, joins the KaVo Group’s portfolio of dental brands .50 Abstracts Treatment of peri-implant diseases: a compilation of systematic reviews Dr Maria Retzepi rounds up the current thinking on an increasingly important aspect of implant dentistry .52 Materials & equipment 56 Volume Number RESEARCH 233 implants, of which 110 were in the jaw and 123 were in the maxilla: 18 patients, eight male and 10 female, received early loading treatment; two patients were under 50 years old, seven were under 60 years old, and the last nine were under 70 years old Some patients presented systemic conditions: three were affected by heart disease, and one patient was affected by diabetes In this patients’ group, we had 10 totally edentulous patients and eight only one arch edentulous patients Thirteen patients, seven male and six female, received immediate load treatment; eight patients were under 60 years old and five were under 70 years old Two patients presented with heart disease In this patients’ group, we had eight totally edentulous patients and five only one arch edentulous patients For the patients selected, two kinds of implants were used: Intra-Lock® International (Boca Raton, FL) and Tekka In-Kone® (Brignais, FR/EU), with a length from to 13 mm One hundred and seven implants were fitted with the finished prosthesis with a cemented technique after 60-90 days (early loading); 126 implants were fitted with the finished prosthesis with screwed technique after 72 hours (immediate loading) The chosen technique was opercular and flapless, with the insertion of the implants at least mm under the crestal bone level, to avoid the conic reabsorption peri-implant process The impression was taken with the pick-up technique with polyvinyl siloxane (Identium® Kettenbach GmbH & Co KG., Eschenburg, Germany) In the following 36 hours, we tried on the structure Pick-up impression technique cemented The prosthesis in metal-ceramic was cemented after 72 hours from implant placement Autologous fibrin glue was used with PRF methodic to increase peri-implant connective tissue formation and manage inflammation and healing, and accelerate vascularization by the growth factors (i.e VEGF, PDGF) contained in the buffy coat All clinical cases have been monitored radiographically with the same machine 12 and 24 months after the loading date The same doctor monitored all the clinical cases performing a periodontal probe after 6, 12, 18, and 24 months with a totally edentulous maxilla and previous maxillary sinus augmentation before implant restoration, with three 3I™ implants with external hexagon supporting a mandibular overdenture It was decided that the best course of action was immediate loading with cemented technique adding five Intra-Lock CT mm implants and using the previous implants The technique chosen was the opercular one, flapless, with the insertion of the implants at least mm under the crestal bone level, to avoid the conic reabsorption peri-implant process The impression was taken with the pick-up technique with polyvinyl siloxane In the following 36 hours, the structure was tried on and cementation of the prosthesis in metal-ceramic took place 72 hours after surgery Case (Figures 2A-2F) A 45-year-old female patient was affected by chronical periodontitis The treatment involved immediate loading at the maxilla with eight Intra-Lock CT implants mm; we maintained first and second superior left molars for inter arch occlusal contacts The prosthetic technique included a posterior region flat-one bridge with composite filling with screwed technique, with the intercanine area in metal-ceramic Multiple extractions were performed with maintenance of vestibular and interproximal cortical, and insertion of six Tekka In-Kone implants, which we chose for the excellent esthetic profile given by the switch-platform that reduces prosthetic spaces, increasing the periimplant connective tissue Implant insertion mm under the cortical bone allows for peri-implant bone regeneration Pickup impression technique cemented The prosthetic restoration was in metal-ceramic cemented after 72 hours from implant placement Results After 18 months, we report a mm conical peri-implant reabsorption on six implants loaded after 72 hours in parafunctional patients, having natural teeth opposing prosthetic full-arch rehabilitations No reabsorption was noticed in patients with upper and lower full-arch restorations.11-12 Two implants in the maxilla (first left molar and first right molar in the same patient), both loaded after 72 hours (immediate Case Figure 2A: Fixture insertion: operculum Figure 2B: Immediately after surgery: taking impression Figure 2C: Impression: parallelism between fixtures Figure 2D: Abutment inserted immediately after surgery Figure 2E: Restoration cementation Figure 2F: OPG Case examples Case (Figures 1A-1F) A 60-year-old female patient presented 42 Implant practice Volume Number RESEARCH Table Table Table loading), failed Results confirmed an augmentation in short-term esthetics in the immediate loading technique within 24 months, with a physiological maintenance of the interimplant papilla and a good trophism of the periodontal tissues Every technique used needed a good mid- and long-term predictability and repeatability, and with both methods we can assure esthetics and function.13 Conclusions Finally, in our opinion, supported from the recorded data, the immediate loading technique (full-arch with screwed technique) represents the current “gold standard” in implant prosthetic restoration, because it reduces intraoperatory time and increases wound healing, in hard and soft tissues, with excellent patient compliance IP References Cochran DL, Morton D, Weber HP Consensus statements and recommended clinical procedures regarding loading protocols for endosseous dental implants Int J Oral Maxillofac Implants 2004:109-13 Balshi SF, Allen FD, Wolfinger GJ, Blashi TJ A resonance frequency analysis assessment of maxillary and mandibular immediately loaded implants Int J Oral Maxillofac Implants 2005;20(4):428-34 Nkenke E, Fenner M, Vairaktaris EG, Neukam FW, Radespiel-Tröger M Immediate versus delayed loading dental implants in the maxillae minipigs Part II: histomorphometric analysis Int J Oral Maxillofac Implants 2005;20(4):540-6 Grotowski T, Dal Carlo L, Garbaccio D Carico funzionale immediato di impianti a vite bicorticale di Garbaccio post-estrattivi immediati – studio multicentrico prospettico su 15 anni di esperienza impianto protesica Chrurgia Orale; 2007 Sabattini B Tecniche ricostruttive e rigenerative dei mascellari atrofici Torino: TU.E.OR.; 2007:298-301 Glauser R, Sennerby L, Meredith N, Rée A, Lundgren A, Gottlow J, Hämmerle CH Resonance frequency analysis implants subjected immediate or early functional occlusal loading Successful vs failing implants Clin Oral Implants Res 2004;15(4):428-34 Nkenke E, Fenner M Indications for immediate loading of implants and implant success Clin Oral Implants Res 2006;7(2):19-34 Lorenzon G Implantologia funzionale dalla osteointegrazione alla fisiointegrazione Martina; 2010:4-123 Grotowski T Syncrystallization - technique for joining dental implants Physical and clinical observation in 17-year old Magazyn Stomatologiczny (Polonia) 2007;6:58-69 10 Linkow L The Legends of Implant Dentistry New Delhi: Jaypee Brothers Medical Publishers (P) Ltd.; 2010.79-172 11 Jokstad A, Carr AB What is the effect on outcomes of time-to loading of fixed or removable prosthesis placed on implant(s)? Int J Oral Maxillofac Implants 2007;22(suppl):19-48 12 Diotallevi P, Moglioni E, Pezzuti E,Pierazzini A, Pasqualini ME, Floris P Correlazioni biomeccanicoradiologiche nel riassorbimento osseo perimplantare Studio comparativo su 47 soggetti DoctorOS 2007;18(2) 13 Klineberg I, Kingston D, Murray G The bases for using a particular occlusal design in tooth and implantborne reconstructions and complete dentures Clin Oral Implants Res 2007;18(3)151–167 Volume Number Implant practice 43 STEP-BY-STEP Socket grafting made simple BondBone® S ocket preservation has become a hot topic for specialists and general practitioners alike The amount of bone loss following extractions can be greatly reduced by placing bone graft material immediately post extraction BondBone® is a unique biphasic calcium sulfate bone augmentation material that can be used for this purpose as a stand-alone product The term “bi-phasic” refers to the combination of hemihydrate and dihydrate calcium sulfate particles in this product BondBone does not need a catalyst to set and will set in the presence of blood and saliva Once BondBone has been hydrated with sterile saline, the pre-set seed particles initiate the setting process The entire setting process takes 3-5 minutes to occur In bony defects larger than 10 mm, BondBone can be used as part of a composite graft This is done by mixing BondBone with a particulate graft material of the clinician’s choice at a ratio of 2:1 BondBone to particulate graft This allows the paste that is formed to become cementable in the site Depending on the particulate graft material used, the resorption time of the composite graft could be extended BondBone used alone has been shown to fully resorb within 3-4 months after placement Following extraction, the following steps should be followed in a simple socket preservation procedure using BondBone as a stand-alone product Follow normal post-extraction protocol, which includes fully debriding the socket of all granulation tissue This will ensure that good bone-to-product contact will be achieved BondBone begins to set immediately after the hydration process is started It will fully set within 2-3 minutes after hydration so it is important not to hydrate the BondBone until the graft site is fully prepared Prepare the BondBone in the driver in which it is packaged Remove the outer small tip, and place the tip of a long, sterile needle filled with sterile saline into the driver Holding the driver horizontally, slowly express the saline into the driver at a 1:1 ratio of saline to BondBone Continue until you see a couple of drops of saline drip out of the driver Remove the needle from the driver 44 Implant practice Slowly push down on the BondBone driver to express all of the excess liquid and to compress the BondBone in preparation for placement into the socket Push down until you feel resistance Volume Number STEP-BY-STEP Remove the second tip from the driver You will notice excess moisture at the opening of the driver Remove the excess moisture by gently blotting the end of the driver on a piece of sterile gauze Extrude the BondBone directly into the extraction socket Slightly overfill the socket just above the crest of the ridge Take dry gauze, and place it over the BondBone graft while applying pressure to the graft with your thumb This draws out any excess moisture from the graft Hydrate gauze with sterile saline, and place the gauze over the graft Have the patient bite down, and relax for minutes This will allow the graft to set completely and bond to the bone After the BondBone is set, cut and place a membrane of choice over the graft, and suture into place IP This information was provided by MIS Implants Technologies, Inc www.misimplants.com Phone: 866-797-1333 Email: service@misimplants.com Volume Number Implant practice 45 PRODUCT PROFILE Aseptico’s AEU-7000L-70V fiber optic motor system A ll Aseptico-branded products are built in the United States, fully regulatory compliant to U.S and international manufacturing and safety standards AEU-7000L-70V fiber optic motor system The AEU-7000L-70V fiber optic motor system is designed for many specialties, including implant, endo, restoration, and oral surgery Features include a powerful, 40K rpm, autoclavable micromotor with LED illumination An advanced handpiece calibration system automatically detects the properties of individual implant or endo contra angles for highly accurate speed, torque, and efficiency results at the time of treatment Adjustable torque up to 80 Ncm ensures compatibility with most implant systems available Dr Ara Nazarian, the director of the Reconstructive Dentistry Institute in Troy, Michigan, and noted lecturer says, “The AEU-7000 Aseptico motor with corresponding Mont Blanc handpiece has always performed exceptionally well.” He continues, “I have used the AEU-7000 for root canals, drilling for implants, leveling bone, augmentation procedures, and wisdom teeth removal Most importantly, when doing large cases, the last thing you want is your surgical motor not working properly I always rely on Aseptico motors for consistent reliability and superb performance.” The firm’s dedication to customer service is another advantage Dr Nazarian says, “Having the very best trained staff and service department, I have found that when I have had a question or needed any assistance when setting up my units, Aseptico fulfilled my needs beyond my expectations I am so pleased with my Aseptico AEU-7000 units that I recommend them to all my students at the Reconstructive Dentistry Institute as well as at my lectures at various dental societies and conferences.” Dr Paresh Patel, co-founder of the American Academy of Small-Diameter Implants and clinical instructor at the Reconstructive Dentistry Institute, has used the Aseptico AEU-7000 motor/ handpiece for years He says, “As a wetfingered dentist whose practice focuses 46 Implant practice on extractions, implant placement, and overdentures, the Aseptico unit is one thing I would not want to practice without.” He describes, “My old unit, from another manufacturer, became obsolete as newer versions were released With Aspetico’s upgradeable software, it is as easy as inserting a flash card into the unit to get the latest features activated.” For more control, Dr Patel’s preference is to place implants with the surgical motor He says, “With a push of the button on the foot pedal, I can switch from the implant drill speed preset to the implant placement mode preset This kind of efficiency reduces our chair time when placing multiple implants There are six fully programmable buttons The real advantage for our practice and patients is the ability to change the display name No longer I have to look at every part of the screen to see if the speed, torque, water flow, and other variables are correct If the display says ‘implant placement,’ I know all my individual preferences are set and ready for me to use This powerful unit has unbelievable torque when it comes to bone leveling or any oral surgery procedure With 80 Ncm available, smooth, chatter- and vibration-free bone shaping and cutting is possible.” “Once the implants are fully seated, the Aseptico motor is still going to be put to work,” says Dr Patel With the ability to handle just about any attachment, I am able to place a straight E-type nose cone on the motor, and relieve dentures, and create space for our overdenture housings with ease The need to step out of the operatory and into the lab is no longer necessary A quick push on the foot pedal to activate another preset is all that is needed Adjustable torque to grind away metal is available with this unit.” Dr Patel notes that his assistant, Shannon, likes the easy-to-load irrigation pump when she is setting up for implant cases She points out that the built-in dynamometer calibrates the motor and each handpiece “So if you ask the motor to give you 1500 rpm at 40 Ncm, that is what you are ensured to get, and it will even tell you the efficiency,” she says “This is huge for us, as it lets me know if my handpiece is in need of offsite maintenance.” The LED illumination is also an advantage where the overhead light or head-mounted light has difficulty lighting up the surgical field The LED is built into the motor so no bulbs or cables are necessary The clinician can even control the intensity of the LED and save it to any preset “On a personal note,” says Dr Patel, “I am glad that Aesptico motors are manufactured in the U.S The ability to connect with highly trained staff by phone was most appreciated when I needed to set up my first unit years ago If you are looking to purchase a high quality American made motor, then you should consider the Aesptico AEU-7000 With the ability to handle implant, endo, oral surgery, and restorative attachments, you can have it all.” For information about Aseptico’s full range of motors, handpieces, and accessories, visit www.Aseptico.com, call 866-244-2954 or 425-487-3157, or e-mail info@aseptico.com This information was provided by Aseptico Volume Number Implant & Oral Surgery $ 4,995 LED Motor & Fiber Optic Implant Handpiece Works with Any Implant System on the Market AEU-7000L-70V & AHP-85MBFO-CX Other Packages Starting at $3,895 1.866.244.2954 www.aseptico.com Offer Expires March 29, 2013 Promo Code IP-0313 EVENT PREVIEW Straumann’s 2013 Dental Implant Complications Symposium Dental Implant Complications: Providing Solutions for Your Practice will be held on Friday, May 17, 2013 in San Francisco, California Images were provided by Alexander Mangold O n Friday, March 23, 2012, 400 dental professionals joined Straumann and the Center for Advanced Implant Training for the first annual Dental Implant Complications Symposium in New York City This event, highlighting Dr Stuart Froum’s book of the same title, featured nine top Key Opinion Leaders in the dental industry who spoke on a variety of topics including Medical-Legal Concerns, Treatment Planning, Peri-implantitis, Prosthetic Complications, Surgical Handling of Esthetic Implant Failure Complications, Soft Tissue Complications, and Sinus Complications In 2013, this highly-regarded event will be held on Friday, May 17 in San Francisco, California, with returning speakers as well as new field experts The much anticipated presenters are: Drs Stuart J Froum, Paul S Rosen, Ronald E Jung, Dean Morton, Kirk L Pasquinelli, Sang-Choon Cho, and moderater Ray C Williams The 2012 program attendees spoke highly of the presentations: Dr Jennifer Hirsch Doobrow noted, 48 Implant practice “Thank you for organizing an exceptional symposium I truly gained an invaluable wealth of knowledge and cannot thank you and the entire panel of speakers enough for sharing your pearls of wisdom with all in attendance.” Dr Jay Freedman concurred, “Course was amazing Engaging speakers and was able to apply things I learned the next day I was in my office! As a restorative dentist who works in the same office as my surgical team, I have always enjoyed learning the surgical end so that it can enhance my ability to communicate the complete treatment to patients during case presentations.” Dr Joseph E Gian-Grasso added his congratulations to the symposium team, along with his intention of learning more at the next session “I will certainly be in San Francisco next year.” Stuart J Froum, DDS, also shared his personal feedback about the Symposium: “The Second Annual Implant Complications Symposium, which will take place in San Francisco on May 17, 2013 promises to continue what the first symposium began This will be a program like the first, which will present the latest evidencebased information for the prevention and treatment of implant complications The latest techniques will be shown and discussed with examples of how to avoid common and uncommon pitfalls that can occur to anyone placing or restoring implants The speakers are ‘world class,’ and even the most experienced clinicians will come home with practical solutions to problems that may arise during and after treatment It’s a meeting you don’t want to miss.” Four hundred people attended the sold-out event in 2012, and there were more than 100 people on the waiting list, so those who are interested in attending in 2013 should register early Visit http://straumann.cvent.com/ DIC2013 for complete details and to register See the Straumann ad in Implant Practice US to receive $20 off your registration IP This information Straumann was provided by Volume Number INDUSTRY NEWS Aribex acquired by the KaVo Group Aribex, the leader in portable X-ray technology, joins the KaVo Group’s portfolio of dental brands I n November 2012, Aribex, a worldwide leader in portable and handheld X-ray products, was acquired by the KaVo Group, an affiliation of leading global dental equipment brands Aribex, best known for the NOMAD™ handheld and portable X-ray systems, will continue to be the center of excellence for the portable X-ray business Handheld and portable X-ray systems are the fastest growing segment in intraoral Xray systems, and Aribex’s innovative products are supported by strong patents, intellectual property, and a robust new product pipeline Aribex NOMAD X-ray systems are now used in clinical, remote, and mobile facilities throughout the world, from professional offices to humanitarian missions The NOMAD significantly decreases costs 50 Implant practice and provides hundreds of safe, high-quality images on a single battery charge “We are thrilled to be joining forces with the KaVo Group, a world class dental organization that shares common values and a passion for future success The KaVo Group combines over 500 years of dental experience with leading global brands and will certainly bolster Aribex’s ability to further accelerate the adoption of handheld X-ray technology,” says Ken Kaufman, President of Aribex The KaVo Group consists of marketleading brands such as KaVo, Gendex, DEXIS®, i-CAT®, Instrumentarium, SOREDEX, Pelton & Crane, and Marus With the acquisition of Aribex, the KaVo Group will reinforce its global imaging footprint and commitment to marketleading innovation “We enthusiastically welcome the Aribex team and look forward to further acceleration and expansion of the portable X-ray market,” says Henk van Duijnhoven, Senior Vice President, Dental “The synergies across our platform are immense from integrated R&D, advances in workflow, technology integration, and a passion to advance the quality of care that our health care providers deliver We also share a passion for serving our dealer partners with excellence.” IP This information was provided by the KaVo Group Volume Number DIO IMPLANT Total Implant Solution DIO Implant provides a perfect solution in any type of clinical case, and with a wide range of Implant line-up, it offers a perfect solution for both user's convenience and patient's conditions 디오임프란트 | 부산광역시 해운대 I Faster osseointegration Member of DENTSPLY Group I Clinically proven surgical protocol I Predictable and reliable results I Comprehensive line of implants to meet any Implant case design and planning 디오임프란트 | 부산광역시 Strategic Partner of DENTSPLY 디오임프란트 | 부산광역시 해운대 Member of DENTSPLY Group USA Corp 서울영업본부 02-2274-2850 경인영업 강원 033-765-2809 대전 042-255- 디오임프란트 | 부산광역시 해운대 서울영업본부 02-2274-2850 경인영업 강원 033-765-2809 대전 042-255- Member of DENTSPLY Group 3540 Wilshire Blvd #1104 Los Angeles, CA 90010 Phone 213 365 2875 Fax 213 365 1595 www.dioimplant.com www.dio.co.kr ABSTRACTS Treatment of peri-implant diseases: a compilation of systematic reviews Dr Maria Retzepi rounds up the current thinking on an increasingly important aspect of implant dentistry Non-surgical therapy for the management of peri-implantitis: a systematic review Muthukuru M, Zainvi A, Esplugues EO, Flemmig TF (2012) Clinical Oral Implants Research 23(Suppl 6): 77-83 The aim of this systematic review was to evaluate the efficacy of non-surgical treatment modalities employed for the management of peri-implantitis The authors included randomized controlled clinical trials that assessed nonsurgical treatment of peri-implantitis with a minimum follow-up period of months Following application of the inclusion criteria, nine clinical studies were identified and included in this systematic review The use of Er:YAG laser treatment adjunctively to submucosal debridement has been reported to result in greater reduction in bleeding on probing scores compared to submucosal debridement with adjunctive submucosal irrigation with chlorhexidine digluconate Likewise, submucosal glycine powder air polishing has been demonstrated to reduce bleeding on probing scores to a greater extent than submucosal irrigation with chlorhexidine digluconate, when used as an adjunct to submucosal debridement with hand instruments No differences in terms of clinical effectiveness have been found when submucosal glycine powder air polishing was compared with Er:YAG laser treatment Locally delivered antibiotics (minocycline microspheres or doxycycline hyclate) as an adjunct to submucosal debridement have resulted in greater reduction in bleeding on probing scores and in probing pocket depths compared to submucosal debridement with adjunctive submucosal Maria Retzepi, DipDS, PhD, MSc, CertClinSpec(Perio), is a registered specialist in periodontics and honorary clinical lecturer in periodontology at the UCL Eastman Dental Institute She currently works in specialist private practice in central London, England 52 Implant practice irrigation with chlorhexidine digluconate It should be noted that no progressive peri-implant bone loss has been found following any of the assessed treatments over a maximum observation period of 12 months In addition, only two studies reported implant survival rates, which were 100% over a 6-month follow-up period The authors concluded that the available evidence neither supported nor refuted the clinical efficacy of submucosal debridement using curettes or ultrasonic scalers alone and that it was insufficient to indicate whether any of the assessed nonsurgical treatments arrested peri-implant bone loss It was therefore suggested that long-term randomized controlled trials are needed to assess the efficacy of non-surgical therapy on progressing peri-implant bone loss, on implant survival rates, as well as on measures of oral health-related quality of life Surgical therapy for the control of peri-implantitis Renvert S, Polyzois I, Claffey N (2012) Clinical Oral Implants Research 23(Suppl 6): 84-94 The aim of this systematic review was to evaluate the effectiveness of different surgical treatment modalities in the management of peri-implantitis The review was based on 26 clinical studies investigating surgical procedures for the treatment of peri-implantitis lesions with a minimum population of seven patients Overall, the authors suggested that there was marked heterogeneity with regards to the study designs and case definitions for peri-implantitis employed by the clinical trials included in this review, which limited the potential to generalize the reported results A case series and a controlled clinical trial have reported that the performance of access flap surgery with removal of granulation tissue and implant surface decontamination was successful in reducing the plaque index, the bleeding on probing, the suppuration and the probing depths, and in arresting the bone loss on 58% of affected implant sites over years Resective surgery alone or combined with implant surface modification (implantoplasty) has also demonstrated effectiveness in treating patients with periimplantitis although systemic Interestingly, antibiotics have been used adjunctively to surgical treatment in most studies, no trials have actually evaluated the additional benefit from systemic administration of antibiotics, and therefore, at present, there is no scientific evidence to support one approach over the other The clinical trials included in the present review have indicated overall that it is possible to obtain defect fill of peri-implantitis defects following surgical treatment with concomitant placement of autogenous bone or deproteinized bovine bone mineral However, the authors reported that, at present, there is no evidence to support that the placement of membranes adjunctively to bone grafting procedures provides any additional defect fill Two clinical studies have reported that the decontamination of the implant surfaces with a CO2 laser or Er:YAG laser, in combination with augmentive or resective procedures, constitutes an effective modality for treating peri-implantitis defects However, the adjunctive use of laser treatment has not demonstrated additional benefits and, as such, it is suggested that the use of lasers as an adjunct to surgical treatment needs to be further elucidated before any firm conclusions can be drawn Overall, the authors stated that surgical therapeutic modalities for the management of peri-implantitis constitute a predictable method for treating peri-implant disease, and that the obtained clinical outcomes can be retained long-term Systematic review of quality of reporting, outcome measurements, and methods to study Volume Number Graziani F, Figuero E, Herrera D (2012) Journal of Clinical Periodontology 39(Suppl 12): 224-244 The aim of this systematic review was to evaluate the quality of reporting and the methodology of clinical research on preventive and therapeutic approaches for the treatment of peri-implant diseases such as peri-implant mucositis and periimplantitis The authors conducted a search for randomized and controlled clinical trials reporting on preventive or therapeutic interventions in patients with periimplantitis or peri-mucositis The reporting and the methods were evaluated through an analysis of the risk of biases and quality score Following application of the inclusion criteria, 32 trials were included in this review Of these, seven focused on prevention, six Volume Number on therapeutic treatment of peri-mucositis, 10 on non-surgical treatment of periimplantitis, and nine on surgical treatment of peri-implantitis In terms of trials evaluating preventive treatment, the use of triclosan/copolymer mouthwash, and 1% chlorhexidine gel inside the internal part of the implant during abutment placement after months, was related with improved clinical and microbiological parameters Clinical studies evaluating topical application of chlorhexidine for the treatment of peri-mucositis have reported no adjunctive beneficial effect Furthermore, trials evaluating different plaque control regimes indicated a superior performance of an essential oils mouthrinse and of a triclosan/copolymer-containing toothpaste, when compared with a sodium fluoride toothpaste Regarding the non-surgical treatment of peri-implantitis, no additional benefits were found in a 6- to 12-month followup, with the use of different debridement approaches such as air abrasion, ultrasonic scaling or Er:Yag lasers in periimplantitis lesions However, a significant improvement on probing pocket depths has been consistently observed in clinical trials testing local application of antibiotics against scaling alone All trials evaluating the effectiveness of surgical treatment for peri-implantitis lesions reported some improvements of clinical conditions However, complete resolution of peri-implantitis has not been reported and, furthermore, significant differences among different surgical treatment modalities have not been reported by studies with a higher quality value The authors stated that, overall, the current literature on peri-mucositis and peri-implantitis prevention and treatment offers limited potential to extract clinically applicable information, and that the quality of methods and reporting guidelines in clinical methodology should be encouraged Implant practice 53 ABSTRACTS efficacy of preventive and therapeutic approaches to periimplant diseases PRACTICE MANAGEMENT Know your liability as a business owner Dr Robert M Fleisher discusses how to mitigate general liability risks besides malpractice claims A s small business owners, a category in which most of us as dentists fall, there are many rules and regulations we must follow One area of importance that is rarely discussed has to with our general liability to protect our patients, our staff, and our personal assets Let’s explore other areas of risk aside from malpractice claims that may help keep you out of trouble Innocent chores – major risk Many practitioners find it convenient to have an employee run chores for them These tasks range from making bank deposits to picking up supplies to transferring patient charts from one office to another Some utilize the services of their assistants, secretaries, and office managers rather often If possible, it is best to avoid any and all of these types of requests Here is a scenario involving an auto accident that takes place every day in one city or another all around the country Mary is riding to the bank to make your daily deposit when a dog runs into her path (hopefully she wasn’t texting) She veers off the street, onto the curb at the school bus stop where she kills three children, and four others are paralyzed to varying degrees; an unimaginable tragedy! The families will sue Mary, and since she was acting as your agent when the accident occurred, they will sue you as well and win Robert Fleisher, DMD, graduated from Temple University School of Dental Medicine in 1974 and received his certificate in endodontics from The University of Pennsylvania in 1976 He taught at Temple University and The University of Pennsylvania and is now a member of the Affiliate Attending Staff – Albert Einstein Medical Center, Philadelphia, Department of Dental Medicine, Division of Endodontics, Philadelphia, Pennsylvania Dr Fleisher is the founding partner of Endodontics Limited, P.C., one of the larger endodontic practices in the United States After retiring from practice, he now devotes his time to writing about practice management, aging and health issues, and fiction with a medical bent You can read about all of Dr Fleisher’s methods to improve bedside manner in his book Bedside Manner - How to Gain Your Patients’ Respect, Love & Loyalty www.bedsidemanner info Dr Fleisher can be reached at: drfleisher@bedsidemanner.info 54 Implant practice There is much temptation to use others to run chores, but try to them yourself if at all possible If an employee does have to run errands, make sure he/she has a valid license and automobile insurance of his/her own Make sure whoever runs chores for you is responsible, not driving under the influence or distracted by his/her cell phones You must make sure you have liability insurance as well since, as noted, you will be sued, too Purchasing an umbrella liability policy provides a large amount of coverage for little cost Your umbrella policy should be between and 10 million dollars Get as much coverage as you can reasonably afford to protect yourself as best as you can in an unreasonable climate Your umbrella policy is usually applicable to your home and offices as well, giving you an extra boost of protection against a lawsuit Personal liability While your homeowner’s and automobile insurance policies protect you from most personal injury claims, the bigger worries are the catastrophic claims that require the umbrella policy noted above People slip and fall all the time They often try to find Volume Number Vicarious liability Anyone who works for you can pose a threat by any and all of his/her actions This is called vicarious liability – liability incurred due to the actions of others These actions can include having your secretary or assistant making suggestions for managing postoperative pain to an associate who provides patient care The rationale for vicarious liability is based on the legal concept respondeat superior This model was developed many years ago and means that the master is responsible for the acts or omissions of the servant This states that you are responsible for the negligent actions of your staff members, including associates and possibly even independent contractors who offer services in your practice To reduce your liability, it is imperative to define and control all work-related procedures, and supervise all staff contractor However, remember you are going to be held responsible for any of your regular associates if the plaintiff can prove that you should have been aware of the poor quality of the associate’s work How hard is it to subpoena several charts of patients your associate worked on to show a pattern of poor quality? Get rid of anyone who doesn’t practice quality care Make sure you have vicarious liability insurance coverage Require a certificate of insurance from all professional employees, and make sure you check yearly that they have paid up policies You should be listed as an additional insured on their policy just as your associates should be listed as an additional insured on your policy Examine all educational credentials of any employees requiring licensure, and make sure they have valid licenses Check references on job applications to make sure they are legitimate Get Make sure you have a protocol in place to manage emergencies, whether it’s from a slip and fall, or a medical emergency related to patient care members Make sure you script exactly what you want your staff to tell patients regarding postoperative care and sequelae as well as any instructions you have auxiliary staff provide to patients Having written handout information is the best way to make sure you control instructions to patients, and it makes it much easier for your staff to learn the exact contents of the handouts This allows them to offer the same instructions verbally when queried by the patient A patient who sees your associate, the independent contractor, will likely sue you as well if a claim of malpractice arises unless you inform the patient of the independent status Without this notification, the patient has good reason to believe that the associate is an employee under the supervision of the owner of the practice, and therefore, making the owner liable for the actions of the associate A notification of the independent status of the associate, on the patient registration/ informed consent form that the patient signs, will help to reduce your vulnerability from the actions of the independent written permission to contact an applicant’s references, and have the applicant sign a release form authorizing former employers to provide references Call all the names on the reference list, not just the top ones Any question you ask a reference must abide by all non-discrimination laws It’s easy to be lazy about hiring, but the liability consequences can be enormous Do your homework! Protect yourself by employing these ideas They will help make you bulletproof to lawsuits Many people and lawyers are just waiting for the opportunity to file a claim Don’t let yourself remain vulnerable Most of all, consult with your lawyer and insurance agent to help you properly institute the ideas contained herein IP This article is an excerpt from Dr Fleisher’s soon to be published, From Waiting Room to Courtroom – How Doctors Can Avoid Being Sued Volume Number Implant practice 55 PRACTICE MANAGEMENT an excuse for their misfortune by blaming others and exaggerating the claim There are some protective measures that will keep your personal and business properties less risk-prone, and reduce the chance for a fall in the first place Tour your properties periodically to look for potential problems like defective pavements, potholes, loose carpeting, defective waiting room chairs, sharp edges, heavy objects on flimsy shelving, and any potential threats to the safety of visitors to your home and practice Parking lots should be well lit and properly paved with safe and easy access to your building Periodically have a serviceman check the stability of your overhead lights and X-ray equipment Equipment falling onto your patient can result in considerable damage and grief for all involved If you practice in a colder climate, make sure that icy conditions are managed appropriately with application of salt or sand, snow is removed in a timely manner, and any water that may result in slippery surfaces is attended to Assign someone on your staff to be in charge of safety, and make sure that he/she develops a list that documents that he/she is doing the inspections regularly Discuss your accident prevention program with your staff, and stress the importance of safety Make sure you have a protocol in place to manage emergencies, whether it’s from a slip and fall, or a medical emergency related to patient care Rather than running around in panic mode, each person should have a responsibility that allows for attending to the patient and a prompt call for emergency personnel During an emergency, it is not the time to run around looking for your emergency kit or checking the dates on the contents With a well-run emergency program in place, there should be no sign of panic, and most other patients in your office will not realize that an emergency has occurred until the ambulance pulls up to your door Having periodic emergency drills will allow you to handle most emergency problems in a professional and discreet manner The last thing you want is chaos, considering there will likely be several witnesses to what took place during an emergency You don’t want the plaintiff to show the jury how you were not prepared, and the resultant panic delayed timely and appropriate care resulting in further injury DEXIS connects with the all-new Dentrix Developer Program and with Dentrix® users MATERIALS lllllllllllll & lllllllllllll EQUIPMENT llllllllllllllllllllllllllllllllllllllllllllllllll DEXIS, LLC, whose premier product is the only digital X-ray system that fully integrates with Dentrix, is now a member of the Dentrix Developer Program, created for those companies that want to develop specific Dentrix G5 Connected applications Both the DEXIS® Digital Imaging System and the DEXIS® Integrator™ for DENTRIX® have also been accepted into the Dentrix MarketPlace program The Dentrix MarketPlace online portal provides a central location for users to easily review and select technologies that are associated with their Dentrix program and which ultimately enhance their practices The DEXIS Digital Imaging System with its award-winning Platinum Sensor and the feature rich DEXIS® Imaging Suite software provides clinicians with the best image quality, most comfortable sensor, and fastest workflow For more information on DEXIS Imaging Suite and the DEXIS® Platinum Sensor, and to learn about DEXIS imaging solutions, visit www.dexis.com PREAT Corporation introduces the new Hader Alignment Housing RGP signs license to produce Relax and Hydro armrests Dental professionals now have a choice between the popular Horix/Hader thin housings and the new knurled Hader Alignment Housings The alignment groove on top of the Alignment Housing provides an easy way to maintain clip alignment, assure that the clips have not rotated prior to processing, and maintain a parallel path of insertion/draw The Alignment Housings work with all retentions of Hader clips RGP has long been selling its articulating armrests, and under a newly signed license agreement, RGP owns the rights to manufacture the armrests According to Sales Manager, Jason DeCosta, “The Relax arm is a two-dimensional armrest that moves with you to accept the weight of your arm off your back, neck and shoulder It allows the user to hold a mirror or retract for long periods while alleviating the tension and strain usually associated with longer procedures The Hydro arm is a three-dimensional armrest designed to provide ‘full rangeof-motion’ for the dominant-instrument arm.” Visit RGP’s web site at: www.rgpdental.com; call: 800-5229695 x5534, or fax: 401-254-0157 For more information, or to place an order, contact www.preat com, 800-232-7732 The Wand® STA® All-Injection System Ideal for pediatric dentistry, endodontics, implant, and general dentistry, the Wand® STA® AllInjection System allows clinicians to gently, precisely, and quickly administer most injections (PDL, block, palatal, etc.) without the fear or anxiety of traditional syringes Single tooth injections eliminate numbness of the cheek, lips, or tongue for a more pleasant experience during and after the procedure Doctors can perform bilateral dentistry during a single visit! The Wand® STA® is made in the USA and provides real-time audio and visual guidance For more information, call 866-244-2954 or visit www.Aseptico com 56 Implant practice CareCreditSM announces free practice management CD featuring Dr Rhonda Savage CareCredit is offering a complimentary educational audio CD, Accountability = Energized Teams and Satisfied Patients, featuring Dr Rhonda Savage, chief operating officer of Miles Global, a practice management and consulting firm exclusively serving dentists In this audio program, Dr Rhonda Savage shares how accountability “done right” can improve communications, efficiency and help the practice run smoother Practices that currently accept CareCredit can request a copy of this complimentary audio CD by contacting their Practice Development Team at 800-859-9975 Practices that have yet to add CareCredit as a payment option can call 800-300-3046, ext 4519 to request their complimentary copy Volume Number ... Loop #9 Scottsdale, AZ 85 260 Fax: (480) 62 9-4002 Tel: (480) 62 1-8955 Toll-free: ( 866 ) 579-94 96 Web: www.endopracticeus.com SUBSCRIPTION RATES Individual subscription year (6 issues) years (18 issues)... 16 Implant practice Volume Number California Implant Institute is the world’s premier dental implant educator California Implant Institute offers a comprehensive fellowship program in oral implantology... Periodontol 1989 ;60 :65 5 -66 3 Assenza B, Piattelli M, Scarano A, Iezzi G, Petrone G, Piattelli A Localized ridge augmentation using titanium micromesh J Oral Implantol 2001;27 (6) :287-292 Malchiodi