Fresh energy and new speakers
Reinventing oneself is definitely no easy task but, from time to time, a necessity. First off: the organizers of the 9th Young ITI Germany meeting managed this feat, resulting in fresh energy and new speakers for this unique event presented by the German Section of the ITI that can be summed up as overall very satisfactory: Many new faces, a new look – it was clear that things had changed. What had not changed, however are the classic Young ITI qualities: communication during and after the presentations, cooperation between colleagues, often heated discussions, the possibility to network and benefit from an exchange of opinions. More than 180 participants made intensive use of this option and experienced an outstanding continuing education event.There is no doubt, the Hamburg meeting represented a milestone for Young ITI – the relaunch of Young ITI version 2.0.
The speakers: Dr. Dr. Dr. Thomas Ziebart, (Marburg), Dr. Jochen Tunkel (Bad Oeynhausen), Dr. Anja Zembic (Zurich), PD Dr. Dr. Marcus O. Klein (Dusseldorf), Dr. Ulf Meisel (Nuremberg)
Could any German city other than Hamburg have been better suited as the location for the relaunch? According to the Chair of the German Section, Professor Dr. Dr. Johannes Kleinheinz, this Hanseatic city has always been known for its cosmopolitan and innovative approach. He continued that the aim was not to jettison the successful formula of the Young ITI meetings, but rather to adapt the congress to the expectations and needs of the younger generation of colleagues. The responsibility for carrying out this task belonged to Dr. Ulf Meisel’s planning team, which achieved magnificent results. The organizers of the Hamburg Young ITI meeting focused on seamless interdisciplinary cooperation between prosthodontists and surgeons as the basis for optimally safe, predictable and successful outcomes. The prosthodontic workflow for implants formed the focus of the congress, but active participation in discussion and hot debate – as particular features of the Young ITI – also had their place.
Education program: outstanding with its variety and the excellence of its speakers
After a Section Germany Study Club Directors meeting on the previous day, the continuing education day could be devoted fully to the Section’s membership, that is not only one of the strongest in terms of numbers, but is also a true asset to the unique global network of the International Team for Implantology – ITI. The recently launched “ITI Implantology curriculum” serves to support this claim and, along with the unique Young ITI format, yet another event will be joining these later this year that represents a first for the ITI: the German Section is launching its Online Symposium on October 23. Autologous transplants, their necessity and alternatives form the core of the discussions led by renowned lecturers.
Substantial membership growth
Hamburg, in the meantime, provided the stage for an exposition of this enterprising Section’s performance and various activities. This allowed its Chair, Professor Dr. Dr. Kleinheinz, to report on substantial membership growth within the Section as well as on its recent Fellow meeting in Eltville-Reinhartshausen. He focused on the German Section’s continuing education situation. And it was not without pride that Professor Kleinheinz outlined the relaunch of his Section’s continuing education program that, with its variety and the excellence of its speakers, need not shy comparison.
“There has been a distinct shift from classic print media to web-based online platforms.” Dr. Georg Bach, Communications Officer ITI Section Germany, Freiburg
ITI Curriculum and ITI Study Clubs
The demand for the curriculum launched in the previous year is now so great that two curricula are being run in parallel and an English version is being planned. A central pillar of the ITI are its Study Clubs that allow Fellows and Members to meet and exchange experiences within a relaxed atmosphere as well as to benefit from the incredible knowledge pool represented by its experts. In Germany, the Munich-based maxillofacial surgeon Professor Dr. Dr. Andreas Schlegel is responsible for the Study Clubs. While his initial years working in this area were marked by fast growth with the establishment of many new Study Clubs, the tempo has slowed considerably, in part, according to Schlegel, “as such a large number of Study Clubs must be nurtured and instilled with life.” A consequence of this rapid development is a massive increase in the number of people within the Section who are able to run these many events and meetings with the necessary professionalism. Schlegel draws a positive conclusion “The German Study Clubs are doing well!”
From classic print media to web-based online platforms
In his function as Communications Officer, Dr. Georg Bach, reported on the Section’s presence in the media as well as providing an overview of what is coming soon. It should be noted that there has been a distinct shift from classic print media to web-based online platforms.
Young ITI Meeting
“Our Young ITI flagship is in full sail!” The maxillofacial surgeon and Section Chair Professor Dr. Dr. Johannes Kleinheinz welcomed the more than 180 participants of the 9th Young ITI meeting and together with Dr. Sascha Pieger then presented the ITI Online Academy. The ITI’s web-based educational platform was launched during the last ITI World Symposium in Geneva and has developed both swiftly and positively. In the Asia region in particular, the Online Academy has been accepted as the standard reference work for research and study for everything connected with implant dentistry. The many various possibilities as well as the broad-ranging offering met with the participants’ unqualified approval – for once, in Kleinheinz’ words, it was “the right offering for the right target group”.
Implants in medically compromised patients
The first presentation was made by Dr. Dr. Dr. Thomas Ziebart – a maxillofacial surgeon from Marburg – who talked about implants in medically compromised patients. Ziebart called for boundary value analysis of patients leading to risk avoidance and reduction. “Recognition of boundaries, that is what we need!” he reiterated. Along with patients taking oral anticoagulants, Ziebart also talked about patients with stents. The first take-home message was: “Bridging with heparin is no longer the state of the art.” In regard to diabetes, Ziebart anticipated double the current number of cases in the next decade. With diabetes, whose side effects include reduced bone formation along with increased bone loss, it is important that the disease be well controlled before implants can be installed.
Ziebart further commented on patients suffering from autoimmune diseases whose therapy calls for stringent diagnosis as well as peri-operative treatment with antibiotics. HIV patients benefit from a much better long-term prognosis when treated using antiretroviral therapies, however, higher rates of osteoporosis are typically observed. The success of oral implants is significantly lower with bone physiology disorders (resulting from bisphosphonates or radiation – particularly at 50 Gy or more). Thorough risk analysis must be carried out here and should an implant be under consideration, the insertion technique should be minimally invasive along with the possible use of implants with an activated surface.
Implants used in limited oral vestibular space
This highly relevant topic was selected by PD Dr. Dr. Marcus O. Klein (Dusseldorf). His show-stopping start: “I cannot take you directly to reduced-diameter implants. First we need to go through the basics!” said the PD, who has his own practice. There followed explanations regarding oral vestibular deficits and rules for insertion that must be strictly observed before Klein shifted to the actual subject of his presentation. He recommended reduced-diameter implants for medically compromised patients as this makes it possible to avoid invasive and stressful therapies, along with the less need for augmentation procedures when reduced-diameter implants are used. A possible side-benefit is increased protection against resorption in the form of a biological buffer. Klein clarified, however, that very high demands are placed on the implant system (ideally conical) and the alloys used. “These small diameter implants must be able to withstand greater stress than standard diameter implants. According to Klein, the use of alloys like Roxolid that show 20% higher fatigue strength can present a good alternative.
Prosthetic treatment planning – materials and methods
With his presentation Dr. Sascha Pieger (Hamburg) was playing on home territory. Having already proved his affinity for the digital world during his presentation on the Online Academy, he progressed seamlessly by showcasing the options available for digital diagnosis and therapy. Beginning with the intra-oral scan, to digital implant planning, the results of which lead to a drilling template, Pieger proved himself to be a clear fan of virtual CAD/CAM-supported implant dentistry. The broader range of possibilities offered by today’s scanners that have moved from the purely therapeutic tool (mold) through to a diagnostic therapeutic instrument permits the seamless and continuous use of digital processes from first contact with the patient through to insertion of the restoration. This results, according to Pieger, in the perfect implant.
Successful soft-tissue management
With striking case studies, Dr. Jochen Tunkel (Bad Oeynhausen) managed to explain how important successful soft-tissue management is to the success of augmentation, implant placement and uncovering. Tunkel is not only an oral surgeon but also a periodontologist. “With soft tissue, what you don’t do is far more important than what you do!” From this point of view, immediate insertion that avoids surgical incisions and flaps would be the ideal approach. However, according to Tunkel, flapless surgery is not the universal solution. “In addition, it always fails when there is too little bone to place an implant.” He then went on to define the basics of incisions for augmentation and placement of implants. The speaker’s explanations were supported by well documented case studies – among them one on tunnel technique according to Khoury.
Individualized abutments, how they should be used and their necessity
Following a mega trend of recent years, Dr. Ulf Meisel (Nuremberg) analyzed individualized abutments and defined how they should be used and their necessity. Meisel was also responsible for putting together the scientific program of the 9th Young ITI meeting. Meisel stated clearly “In choosing the right abutment, one is simply reproducing the decision that was taken when planning the positioning of the implant!” The areas influenced by an individualized abutment are the suprastructure, the emergence profile, the abutment-crown interface, the sub-gingival area and finally the intra-implant space. Based on his own analyses as well as the analysis of the relevant literature, Meisel called for the exclusive use of original abutments from the respective manufacturer.
Cemented versus screwed reconstructions on implants
At a time when cement-associated peri-implantitis is much discussed, this was the “hot” topic selected by Dr. Anja Zembic (Zurich) for her contribution to the scientific program. At the very beginning of her presentation, the Swiss lecturer stated “Regardless of the approach you use to retain the implant, it is primarily a question of implant positioning!” If the implant is positioned too far buccally, screw retention is not possible as the screw access holes would impinge on the esthetic area. Presenting the advantages and disadvantages of both procedures took up a sunstantial proportion of Zembic’ presentation. Special attention was paid to the dangers of cementitis – an infection caused by cement residues, which is attributed with a considerable influence on the generation of peri-implant lesions. However, after five years the survival rate values for cemented crowns were actually higher than for the screw option. For the implants themselves, the same success rates were attributed to both retention methods. However, cement-retained crowns come off significantly better than screw-retained crowns in terms of technical complications; they are also more advantageous in terms of cost. When looking at biologic complications for both crowns and bridges, however, the picture is reversed. The highest rates of risk are found with cement reconstructions “and your patients need to know this!” says Zembic.
Opportunities and benefits of recall
Oral surgeon Dr. Anne Bauersachs (Munich) talked about the opportunities and benefits of recall appointments and assigned great importance to this tool. Our colleague, who spent many years at the University of Erlangen, then worked in Professor Schlegel’s practice before establishing her own practice, made a very impressive connection between an increase in complications and failure by the patient to attend aftercare appointments. “Recall appointments are for more than just a check-up, recall appointments are there to maintain and even restore oral structures” said Bauersachs. The check-up/maintenance/restoration triad is extremely important in implant dentistry, on the one hand because of the many attendant risk factors that can influence the long-term success of implant treatment, and on the other because of the structural and anatomic factors that enable the development of peri-implant lesions. Bauersachs finished off her presentation with a series of practical tips for implementing a recall system in practices dealing with dental implants.
Professor Dr. Dr. Johannes Kleinheinz
“The aim is to adapt the congress to the expectations and needs of the younger generation of colleagues” Professor Dr. Dr. Johannes Kleinheinz, Chairman of the German ITI Section
A classic: the Young ITI debate!
The debate on a “hot” topic between acknowledged experts – traditionally placed at the end of a Young ITI meeting – is a time-honored item on the event agenda. The attraction of these heated and rather unconventional discussions has been recognized by many other event organizers and it has been widely copied, now to be found at many dental congresses. In Hamburg, the structure for the debate was defined by discussion of cases with the participation of Dr. Anjy Zembic, Dr. Sascha Pieger, Dr. Jochen Tunkel and – representing the founding team of Young ITI presenters – Professor Dr. Dr. Andreas Schlegel.
At the end of the day, the organizers of the Young ITI meeting were able to say with a strong degree of satisfaction: Young ITI Version 2.0 is not just up, it is also running!