PERIOIMPLANT Program

This concept has proven to be highly successful, with 91,7% success rate for the All-on-4 surgical protocol in the mandible (up to 18 years follow-up) and a 93,9% success rate for the All-on-4 surgical protocol maxillary techniques (up to 13 years follow-up).

The success of the technique and the continue follow-up of our treatments, have brought in numerous of challenges, which we have to overcome in a daily practice.

Through innovation, along with continuous clinical and scientific research, it has been possible to establish protocols on:

• how to address an edentulous maxilla according to the amount of bone available
• how to achieve good primary stability and how much is enough
• how to overcome the lost of implants
• how to be more predictable from planning to final result
• customised maintenance programs according to peri-implant risk factors
• new implant surfaces and abutments surfaces, which enhance Mucointegration
• what to do when complications occur and how to resolve them

–     when and how to resolve complications with zygoma implants, pterygoid implants and other specific implants.

The search to overcome our daily complications and challenges will continue to be our mission in order to find the solutions, as the All-on-4 ® concept has increased the quality of life for thousands of patients worldwide.

This is primarily due to the difficulty of the surgical procedure and its potential complications. However, it has been demonstrated that successful clinical outcomes can be predictably achievable when strict protocols are followed.

The detailed understanding of clinical anatomy should guide the clinician when managing the soft tissue flaps in an attempt to securely close the flaps to achieve optimal healing environment of the graft. Graft immobilizations, the optimal use of graft materials are essential in achieving bone formation even in a distance from the bony walls. This presentation will summarize the essential steps of ridge augmentation and gives an insight how a clinician can learn these demanding procedures.

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Learning objectives:

1. Understand the surgical anatomy of the floor of the mouth
2. Learn the surgical principles of ridge augmentation surgery
3. Learn the tension free closure of the flaps after vertical ridge augmentation
4. Learn soft tissue reconstructions after ridge augmentation

Krenimo od finalnog rješenja: Kako povezati Smile Design s interdisciplinarnom rehabilitacijom osmijeha
dr. Ivan Ćatović

Danas se iznimno veliki naglasak pridaje estetici u svim područjima života. Poznati je utjecaj osmijeha na samopouzdanje, osobnu i poslovnu kvalitetu života. Uspješnost oralne rehabilitacije ne ovisi samo o zadovoljavanju biološkog i funkcionalnog aspekta, već se na prvo mjesto stavlja estetski rezultat. Najbolji način za postizanje visokoestetskih rezultata u kompleksnim interdisciplinarnim rehabilitacijama je temeljito 3D planiranje fokusirajući se na lice kao cjelinu. Kako savladati glavne izazove pri rehabilitaciji osmijeha i koliko je uistinu važan smile design? Na koji način integrirati smile design i orofacijalne principe kojima moramo vladati pri rehabilitaciji multidisciplinarnih slučajeva? Zašto je važno fokusirati se na cijelo lice pri planiranju terapije i na koji nam način moderna tehnologija pomaže u postizanju finalnog rezultata prirodnog izgleda neovisno radi li se o rehabilitaciji potpuno ozubljenih čeljusti, djelomičnim ili potpunim bezubostima?

U predavanju će se prikazati mogućnosti i značenje moderne sveobuhvatne stomatologije, koji su trendovi i koristi u svakodnevnoj praksi te zašto je potrebno primjenjivati ta načela. Kako realizirati predvidljivu, bržu i efikasniju egzekuciju rehabilitacije osmijeha korištenjem digitalnih rješenja u planiranju, kirurškoj i protetskoj fazi sa naglaskom na implantološka rješenja.

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FP1-FP2-FP3 prosthetics
From a Single Tooth Replacement to a Full Arch Rehabilitation
dr. Damir Jelušić

Today’s dental world revolves around implants; teeth are preserved, edentulous patients desire fixed solutions, and patients’ wishes are effectiveness, aesthetics, and function. Is it possible to harmoniously combine the treatment of bone loss, immediacy, and aesthetics?

Tooth extraction introduces patients to the world of dental implants. The most effective way to replace a tooth after extraction is immediate implant placement. This approach has many advantages such as saving time, being effective, and offering biological benefits. The most important biological benefits include preserving and preventing post-extraction bone loss, as well as maintaining, or even better, enhancing the soft tissue profile. Considering FP1, FP2, or FP3 prosthetic designs is about balancing the degree of hard and soft tissue retraction with standard tooth dimensions.

FP1 prosthetic design means rehabilitation based on pure dental design in its standard dimensions, like crowns and bridges. FP2 designs look like periodontal crowns and bridges with tissue retractions. FP2 restorations always have longer teeth. FP3 design replaces not only the teeth but also the hard tissue component that is missing due to advanced bone resorption. In FP3 restorations, a flange of pink restorative material is mandatory. Such aesthetics is usually called white and pink aesthetics.

In this lecture, the biological principles of bone loss after tooth extraction will be discussed and presented, along with their consequences on our clinical approach. Where are the limits of immediate implant placement, and what are the prerequisites for safe and predictable implant placement in such an environment? Do we need bone substitutes, and can we restore the tooth or an entire arch on implants placed in an extraction socket? Through clinical cases, techniques, and procedures, we will present and discuss step-by-step methods for transitioning from single tooth replacement to full arch rehabilitation, and from anterior zone to posterior solutions.

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Protetski vođena implantologija i digitalna rješenja
dr. Zoran Kovač
uskoro više informacija

Pacijenti s parodontitisom – kako ih zapravo liječiti?

dr. Larisa Musić

Kako se ispravno i uspješno liječe pacijenti s parodontitisom? Koje instrumente koristiti, koje dodatne terapijske postupke i lijekove uključiti, kada postoji potreba za kirurških liječenjem parodontitisa, i kojom točno vrstom zahvata, te kada započeti i provoditi sve ostale dentalne terapijske postupke (ortodoncija, protetika, implantologija)?

Smjernice za liječenje niza različitih bolesti odavno su prisutne u medicini. U svijetu parodontologije 2020. i 2022. godine dogodila se svojevrsna revolucija – po prvi su put u povijesti europske parodontologije publicirane službene smjernice za liječenje pacijenata s parodontitisom svih stadija bolesti. Smjernice su namijenjene informiranju kliničara, zdravstvenih sustava, policy makera i javnosti o najučinkovitijim modalitetima liječenja, temeljenim na dostupnim znanstvenim spoznajama.

Cilj ovog predavanja jest da se predstavljanjem novih smjernica te pružanjem stručno i znanstveno utemeljenih informacija odgovori na gornja, i mnoga druga svakodnevna klinička pitanja o terapiji pacijenata s parodontitisom.

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Pacijenti s periimplantatnim bolestima – kako ih zapravo liječiti?

dr. Davor Kuiš

Statistički podaci su neumoljivi – svaki drugi pacijent s dentalnim implantatom razvit će periimplantatni mukozitis, a svaki četvrti periimplantitis. Povrh toga, liječenje je kompleksnije a ishodi nepredvidljiviji u odnosu na gingivitis i parodontitis.

Europska federacija za parodontologiju učinila je jedan od najvećih iskoraka u dijagnostici, prevenciji i liječenju periimplantatnih bolesti još 2017. godine s Klasifikacijom, a 2023. godine izdaje i Kliničke smjernice za prevenciju i liječenje periimplantatnih bolesti.

Cilj predavanja je prikazati preventivne i terapijske kliničke postupke temeljene na trenutno dostupnim znanstvenim dokazima koji bi se trebali provoditi tijekom planiranja i postavljanja dentalnih implantata, kao i u dugoročnom praćenju pacijenata kojima su zubi nadoknađeni dentalnim implantatima.

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Hrvatsko parodontološko društvo kao krovno parodontološko stručno društvo u Republici Hrvatskoj i nacionalni član Europske federacije za parodontologiju prevelo je Smjernice za liječenje parodontitisa od stadija I do IV i Smjernice za prevenciju i liječenje periimplantatnih bolesti te time započelo proces njihove implementacije. Diseminacija Smjernica u tiskanom obliku očekuje se do kraja 2024. godine.

State of the art grafting materials in bone regeneration
Dr. Laszlo Parkanyi

Bone grafting in implant dentistry has been a routine treatment modality to restore the resorbed jaw bone, as to prevent its resorption in a certain extent. At first, our only option was to use autologous bone, which is highly invasive for patients, moreover, technique sensitive and time consuming for the operator. Today bone substitutes are present and continuously evolving, to save time, make surgeries less invasive, and easier to perform! In this lecture we will be discussing the enhanced possibilities with the latest and most advanced bone grafting material on the market, demonstrated with clinical cases.

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GBR with NOVAMag Membrane: New possibilities
dr. Marko Blašković

Guided bone regeneration is the best documented technique for alveolar bone regeneration. This surgical technique is characterized by the application of a membrane which has the purpose to exclude non-osteogenic cells from interfering with the bone regeneration process. Today, there are several different membranes developed for the guided bone regeneration technique on the market. All the membranes can be clustered into two different groups: resorbable and non-resorbable. Each group is characterized by their own advantages and disadvantages. Resorbable membranes are less demanding to use, they do not need to be removed from the surgical site and have a lower exposure rate. Despite that, they have some disadvantages, bad mechanical properties which can lead to bone graft dislocation and the loss of the surgical site. On the other hand, non-resorbable membranes possess better mechanical properties but have a higher exposure rate and require an additional surgical procedure to be removed from the surgical site.

To overcome some of the disadvantages of resorbable and non-resorbable membranes, a new type of membrane was developed. The new membrane possesses the advantages of both groups: it is resorbable and has improved mechanical characteristics comparable to non-resorbable titanium reinforced membranes.

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3D Bone Augmentation – Hard and Soft Tissue Considerations
dr. Andrej Kravanja

In bone augmentation procedures, there are both hard tissue and soft tissue perspectives that need to be considered to achieve a successful outcome. The focus of discussion will cover diagnostic tools, digital dentistry, the selection of the proper bone grafting materials and surgical techniques used for augmentation procedures. With the advancements in digital dentistry, the process of bone grafting has become more efficient and precise, leading to better outcomes for patients and more precise hard and soft tissue grafting procedures.

Soft tissue augmentation following bone augmentation procedures have a functional and esthetic role. Adequate soft tissue coverage is essential for protecting the underlying bone graft and maintaining long-term stability, while soft tissue contours and symmetry are important factors in achieving esthetics, a natural and harmonious appearance.

Overall, a comprehensive approach that considers both hard and soft tissue perspectives combined with digital workflow is essential for achieving successful outcomes in bone augmentation procedures in dentistry.

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Filozofija potpunih bezubosti
Različiti pristupi i koncepti u rješvanju problema bezubih čeljusti
Dr. Marko Krmpotić

Potpune bezubost, bilo kao dugogodišnje stanje ili terminalna denticija koja vodi gubitku svih zuba, česta su i zahtjevna problematika u svakodnevnoj praksi. Od prvog Branemarkovog dokumentiranog slučaja prije 65 godina pa do danas implantologija nudi različita rješenja i pristupe za ovaj prije svega veliki zdravstveni problem.

Dati će se povijesni razvoj terapijskih pristupa te trenutačna high-end dostignuća na tom planu:  pokrovne proteze na implantatima sa lokatorima i prečke, fiksni cementirani mostovi na 6 i 8 implantata, All-on-4 i  All-on-6 rješenja,  upotreba zigomatičnih, pterigoidnih, transinusnih i nazalnih implantata za potpunu bezubost u gornjoj čeljusti, FP1 mostovi, subperiostalni implantati.

Prezentirati će se suvremeni pristup ovoj problematici: operativni zahvat bez regeneracije kosti (free-hand ili guided), imedijatna funkcija (provizorij isti dan), fiksni mostovi na vijke (FP1, FP2 ili FP3) u analognom ili digitalnom protokolu, kao zlatni standard za efikasnu implantoprotetsku rehabilitaciju bezubih pacijenata.

Key focus areas include FP3 and FP1 techniques, providing step-by-step guidance on their implementation. The session will explore an extreme approach to full arches, with a detailed examination of the palatal approach and the strategic placement of implants in the pterygoid area. Emphasis will also be placed on soft tissue grafting and manipulation, as well as various augmentation and preservation techniques essential for optimal implant success. The role of guided surgery in improving accuracy and efficiency will be highlighted, ensuring attendees leave with a comprehensive understanding of contemporary full arch implantology.

The aim of the lecture will be to describe a mucogingival approach to immediate implant installation that allow performing this surgical treatment also in different clinical scenarios, such as:

• Unfavorable position of the soft tissue margin of the tooth to be extracted
• Unfavorable condition of the soft tissue margin of the adjacent teeth (presence of gingival recession or altered passive eruption)
• Loss of papillae height and thickness of the tooth to be extracted
• Unfavorable condition of the buccal bone wall
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Learning objectives

• Identify indications for immediate implant placement
• Learn how to use in the proper way the biomaterials for GBR
• Learn how to manage flap elevation and CTG

He will explain how to choose the right zirconia based on the clinical situation, how to properly prepare the teeth for the use of zirconia and intraoral scanner, and how to correctly cement the zirconia. The speaker will point out his approach to prosthetic treatment, from simple cases to more complex ones: practical advice and tricks and tips will be given to achieve accurate scans on both natural teeth and implants cases.