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Abstract

Principles and advantages of surgical protocol based on full arch implant insertion, immediate retention by means of a bar welded in mouth, immediate loading in proper occlusion. Case report on 10 screws, including pterygoid implants (Auriga protocol)
DENTAL TRIBUNE
The World’s Dental Newspaper Middle East & Africa Edition
March-April 2019 | No. 2, Vol. 9Published in dubai www.dental-tribune.me
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Minimally invasive root canal
shaping – A new protocol
IDS reaffirms its leading position as
global dental trade fair
Digitalisation of the gold
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By Dental Tribune International
COLOGNE, Germany: The International Dental
Show (IDS), which took place in Cologne from
12 to 16 March, fulfilled the high expectations
of the global industry and once again under-
lined its position as the leading trade fair. With
2,327 companies from 64 countries participat-
ing, this year’s event welcomed 20 more exhib-
itors compared with two years ago, as well as
160,000 trade visitors from 166 countries. The
overall number of visitors rose by 3.2 per cent
(about 5,000 more people) and the number of
foreign trade visitors by 6.0 per cent.
Gerald Böse, CEO of Koelnmesse, which stages
the show, said: “IDS is a trade fair in a class of
its own and always sets new benchmarks. It
manages to surpass the already excellent re-
sults of the previous event every time.” Both
visitors and exhibitors are impressed by IDS:
it is only here that one encounters supply and
demand of such an extent, quality and level of
internationality. “IDS is the undisputed lead-
ing global trade fair for the dental industry,” he
continued.
The official figures confirm the high level of in-
ternationality at IDS: 73 per cent of the exhibi-
tors and 62 per cent of the visitors came from
166 foreign countries, including Argentina,
Australia, Brazil, Canada, Chile, Egypt, Japan,
Korea, New Zealand, South Africa and the US.
Regarding the 6 per cent increase in foreign
visitors, IDS 2019 recorded significant growth
in the number of visitors from Asia (+23.1 per
cent), eastern Europe (+19.6 per cent), Africa
(+17.0 per cent), Central and South America
(+14.6 per cent) and North America (+5.3 per
cent) specifically.
An independent visitors’ survey reported that
the largest groups of visitors came from the
dental industry. Schools and universities were
strongly represented too. Almost 80 per cent
of those who completed the survey stated
they were satisfied or highly satisfied with the
range of exhibition offerings. More than 93 per
cent said that they would recommend visiting
IDS, and 70 per cent of the respondents were
already planning to visit the next IDS, in 2021.
Dr Markus Heibach, Executive Director of the
Association of the German Dental Industry,
which is involved in organising the event, was
also pleased with the outcome of the trade fair:
“The high level of satisfaction of our trade visi-
tors and exhibitors is for us impressive con-
firmation of our efforts to make our guests’
stay as pleasant and successful as possible by
offering them a cosmopolitan, hospitable and
perfect service.”
IDS offered the ideal business platform, es-
pecially for new companies on the dental
market seeking to establish themselves with
high-quality innovations, such as those for
improved digital workflows and additive pro-
duction, new prophylactic formulas and filling
materials, pioneering intra-oral scanners and
implant designs, as well as flexible workflows
for management of the laboratory.
The 39th IDS is scheduled to take place from
09 to 13 March 2021.
The 2019 International Dental Show exceeded the results of the previous event and the organisers attained
their goals of greater internationality and higher quality in supply and demand, boosting the satisfaction of
both exhibitors and attendees.
The 2019 International Dental Show exhibition
© Koelnmesse
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Dental Tribune Middle East & Africa Edition | 2/2019 6mCME
By Dr Luca Dal Carlo, Dr Franco Ros-
si, Dr Marco E. Pasqualini, Dr Mike
Shulman, Dr Michele Nardone, MD,
Dr Tomasz Grotowski and Dr Shel-
don Winkler
Intraoral welding was developed by
Pierluigi Mondani1 of Genoa, Italy,
in the 1970s to permanently connect
submerged implants and abutments
to a titanium wire or bar by means of
an electric current (Fig. 1). The cur-
rent is used to permanently fuse the
titanium to the abutments in milli-
seconds, so the heat generated does
not cause any pathology or patient
discomfort.
If possible the implants are placed
without flaps. The titanium wire or
bar is bent and aligned passively to
the contour of the labial and lingual
surfaces of the implants before ap-
plying the electric current to perma-
nently connect titanium implants.
The technique follows a strict sur-
gical and prosthodontic protocol,
which includes using a number of
implants as close as possible to the
number of teeth to be replaced,
achieving primary stability by en-
gaging both cortical plates (bicorti-
calism), immediate splinting of the
implants utilizing intraoral welding
and immediate insertion of a fixed
provisional prosthesis with satisfac-
tory occlusion. The technique pro-
vides for immediate loading and
does not jeopardize the integration
process.2
Although intraoral welding has been
used successfully in Europe, especial-
ly Italy, for many years, it has yet to
achieve everyday use in the United
States.
Members of the Italian affiliate of
the American Academy of Implant
Prosthodontics, NuovoGISI, have
long and successful experiences
with immediate loading of maxil-
lary implants connected together by
intraoral welding.2
By inserting the prosthesis with ad-
equate retention and stability the
same day as the surgery, patient
complaints and discomfort can be
avoided or substantially reduced.
The instantaneous stability that re-
sults from the splinting can reduce
the risk of failure during the heal-
ing period. Intraoral welding can
also eliminate errors and distortions
caused by unsatisfactory impres-
sion making, as the procedure is per-
formed directly in the mouth.
Intraoral welding can fulfil a great
need for business and socially active
persons, as the surgical and prostho-
dontic procedures are accomplished
on the same day. Patients can leave
the dental office with a stable, esthet-
ic and retentive prosthesis.
Fig. 1. Schematic drawing of Mondani intraoral solder unit
Fig. 3. Nonrestorable teeth visible after removal of the patient’s pros-
thesis
Fig. 5. Immediate stabilization of the eight implants and two
additional implants previously inserted in the posterior regions,
by welding each implant to a 1.5 mm supporting titanium bar
Fig. 7. Healthy gingiva was observed after 90 days
Fig. 8. Lower implants welded together intraorally
Fig. 2. Preoperative panoramic radiograph of 50-year-old cauca-
sian woman
Fig. 4. Eight titanium one-piece implants are inserted.
Fig. 6. Panoramic radiograph after 90 days suggests complete
integration
Fig. 10. Seven-year follow-up radiograph shows satisfactory pres-
ervation of bone surrounding all of the implants
Fig. 9. Three-tooth mandibular fixed prosthesis
Fig. 11. Intraoral photograph of the definitive prosthesis shows
healthy gingiva
ÿPage 7
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Intraoral welding and lingualised
(lingual contact) occlusion: a case report
mCME articles in Dental Tribune have been approved by:
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CAPP designates this activity for 1 CE Credits
Dental Tribune Middle East & Africa Edition | 2/2019 7
The flapless technique, first pro-
posed by Tramonte3, can be per-
formed when the bony crest is wide
and an adequate amount of attached
gingiva is present. The technique al-
lows for uneventful healing, a reduc-
tion of postsurgical inflammation
and only moderate inconvenience
for the patient, who can eat efficient-
ly the same day.
Provisional prosthesis and
tooth arrangement
During the surgical session a tem-
porary resin prosthesis is inserted.
Occlusal plane height must be cor-
rect. A lingualized (lingual contact)
scheme of occlusion is recommend-
ed. The upper anterior teeth are
best arranged without any vertical
overlap. The amount of horizontal
overlap is determined by the jaw re-
lationship. A vertical overlap for ap-
pearance can be used, provided that
an adequate horizontal overlap is in-
cluded to guard against interference
within the functional range.4
Lingualized (lingual contact)
occlusion
Lingualized (lingual contact) occlu-
sion maintains the esthetic and food
penetration advantages of anatomic
teeth while maintaining the me-
chanical freedom of nonanatomic
teeth. Among the advantages of a
lingualized occlusion are occlusal
forces centered over the ridge crest
in centric occlusion, masticatory
force is effectively transferred more
“lingual” to the ridges during work-
ing side excursions, the “mortar and
pestle” type of occlusion minimizes
the occlusal contact area provid-
ing for more efficient food bolus
penetration and elimination of the
precise intercuspation that can com-
plicate the arrangement of anatomic
denture teeth.
Lingualized occlusion also prevents
cheek biting by holding the buc-
cal mucosa off the food table by
eliminating occlusal contacts on the
maxillary buccal cusps, minimizes
occlusal disharmonies created from
errors in jaw relationships, denture
processing changes and settling of
the denture base, and simplifies set-
ting of denture teeth, balancing the
occlusion and any subsequent oc-
clusal adjustment procedures.5
Clinical report
A healthy 50-year-old caucasian
woman presented for treatment at
the office of one of the co-authors
(LDC) with a mobile, painful, 12-tooth
semiprecious alloy-ceramic fixed
prosthesis (Fig. 2). The prosthesis
was removed and all of the remain-
ing abutment teeth were found to
be nonrestorable with extraction in-
dicated (Fig. 3). After removal of the
retained teeth, eight titanium one-
piece implants were inserted in one
session (Fig. 4).
Immediate stabilization of the eight
implants and 2 additional implants
that were previously inserted in the
posterior regions was achieved by
welding (Acerboni Intraoral Weld-
ing Unit, Casargo, Italy) each implant
to a 1.5 mm supporting titanium
bar (Acerboni, Casargo, Italy), which
previously had been bent to fit pas-
sively on the palatal mucosa (Fig. 5).
A provisional resin prosthesis was
inserted, which provided an accept-
able vertical dimension and lingual
contact occlusion. Oral hygiene pro-
cedures were demonstrated to the
patient and reviewed at all future ap-
pointments.
After 90 days, a panoramic radio-
graph suggested complete integra-
tion (Fig. 6) and a healthy mucosa
was observed. (Fig. 7). The definitive
full-arch gold-ceramic maxillary
prosthesis was inserted, which great-
ly pleased the patient and her family.
In the lower arch, the right first and
second bicuspids were extracted and
implants placed in the first bicuspid
and first molar regions. The implants
were welded together intraorally
(Fig. 8), followed by the fabrication
and cementation of a three-tooth
fixed prosthesis (Fig. 9).
A 7-year follow-up radiograph (Fig.
10) shows satisfactory preserva-
tion of bone surrounding all of the
implants. An intraoral photograph
of the definitive prosthesis shows
healthy gingival tissue (Fig. 11).
References
1. Mondani PL, Mondani PM. The
Pierliugi Mondani intraoral electric
solder. Principles of development
and explanation of the solder using
syncrystallization. Riv Odontostom-
atol Implantoprotesi. 1982;4:28-32.
2. Rossi F, Pasqualini ME, Dal Carlo
L, Shulman M, Nardone M, Winkler
S. Immediate loading of maxillary
one-piece screw implants utilizing
intraoral welding: a case report. J Oral
Implantol (in press).
3. Tramonte, S. A further report on
intraosseous implants with im-
proved drive screws. J Oral Implant
Transplant Surg. 1965;11:35-37.
4. Winkler S, ed. Essentials of Com-
plete Denture Prosthodontics. 3rd
ed. Delhi, India: AITBS Publishers;
2015.
5. Lang BR, Lauciello FR, McGivney
GP, Winkler S. Contemporary Com-
plete Denture Occlusion, revision 4.
Amherst, NY: Ivoclar Vivadent, 2012.
Editorial note:
This article was originally published
in implants – the international maga-
zine C.E. of oral implantology, Issue
2/2015.
Dr. Luca Dal Carlo and Dr. Franco Rossi are
in private practice in Venice, Italy.
Page 6
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Dr. Marco E. Pasqualini is in private prac-
tice in Milan, Italy.
Dr. Mike Shulman is in private practice in
Clifton, N.J., and adjunct associate profes-
sor at the School of Oral Health Sciences,
Kingston, Jamaica.
Dr. Michele Nardone is with the Ministry
of Public Health, Rome, Italy.
Dr. Sheldon Winkler is adjunct professor at
Midwestern University College of Dental
Medicine, Glendale, Ariz., and School of
Oral Health Sciences, Kingston, Jamaica.
Dr. Tomasz Grotowski is in private practice
and professor at the School of Minimally
Invasive Implantology, Szczecin, Poland.
mCME
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Article
Full-text available
The edentulous maxilla can be reconstructed by one-piece implants welded together intraorally and immediately loaded with a provisional restoration. The technique described must follow a strict surgical and prosthodontic protocol which includes using a number of implants as close as possible to the number of teeth to be replaced, achieving primary stability by engaging both cortical plates (bicorticalism), immediate splinting of the implants utilizing intraoral welding, and immediate insertion of a fixed provisional prosthesis with satisfactory occlusion.
Contemporary Complete Denture Occlusion, revision 4
  • B R Lang
  • F R Lauciello
  • G P Mcgivney
  • S Winkler
Lang BR, Lauciello FR, McGivney GP, Winkler S. Contemporary Complete Denture Occlusion, revision 4. Amherst, NY: Ivoclar Vivadent, 2012.