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Nikos Mattheos

DDS, MASc, PhD

peri-implant mucosa dimensions and emergence profile: a guide for meticulous architects

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dental implants placed in fresh extraction sockets were first documented more than 25 years ago, so one might wonder why “immediacy” took so long time to mature into the mainstream implantology. The progress of a scientific protocol however, is rarely a straight line to implementation. Perceived breakthroughs are often followed by backlash and enthusiasm can be at times interchangeable with periods of caution. In the end, technology is also a major catalyst to help a vision make it safe to the mainstream practice.
How did immediacy develop from the first “immediate” implants into the current modern concept as a workflow? Let’s take a closer look into a long and winding road!

“Immediacy” revisited: beyond the extraction socket!

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dental implants placed in fresh extraction sockets were first documented more than 25 years ago, so one might wonder why “immediacy” took so long time to mature into the mainstream implantology. The progress of a scientific protocol however, is rarely a straight line to implementation. Perceived breakthroughs are often followed by backlash and enthusiasm can be at times interchangeable with periods of caution. In the end, technology is also a major catalyst to help a vision make it safe to the mainstream practice.
How did immediacy develop from the first “immediate” implants into the current modern concept as a workflow? Let’s take a closer look into a long and winding road!

Artificial Intelligence, Machine Learning and Implant Dentistry!

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With Artificial Intelligence entering every aspect of healthcare, the already increasingly digitized field of Implant Dentistry has become a testing ground for new tools. But what is in the core of this “artificial intelligence” revolution and how different is it really to what we have been doing so far in Implantology? In this article we discuss fundamentals of what machine learning is and is not, we will discuss the concepts of intelligence and artificial intelligence and applications in healthcare and implantology and we will see how these models are susceptible to mistakes just like every other tools developed for diagnostics

Implant Emergence Profile Demystified

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Is the implant emergence profile important for success of treatment? A wide mucosal emergence angle of the implant prosthesis can increase by as much as 30 times the risk for inflammation of the peri-implant tissue, as shown by a recent clinical study. It becomes therefore apparent that the prosthetic design of the implant supracrestal complex is critical for the long-term health of peri-implant tissue. Read more about the design features that are most important and the designs you need to follow when treatment planning with dental implants. Mucosal Emergence Angle, Deep Angle, Total Contour Angle

Not everything that glitters is artificial intelligence..!

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Artificial Intelligence starts when an algorithm becomes able to programme and re-programme itself, thus be able to perform tasks for which it was not originally programmed to do or could not be performed with it’s original code. This implies a software which can “experiment” and learn not only to improve it’s performance but also to perform new tasks. An AI algorithm is a piece of software that can demonstrate cognitive skills only shown by living beings.
To give you an analogy, let me use one of the first lessons we all learn in early childhood: do not touch a very hot item or you get burned. Now if you want to protect your algorithm from getting burned, you insert in the algorithm: “IF hot, DO NOT Touch”. This is algorithm. But you programme your algorithm to wander around, algorithm touches the stove, gets
burned and implements the line in its code “IF hot, DO NOT Touch”… this is Artificial Intelligence!

Is the future static or dynamic?

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Half a dozen major dynamic navigation systems focused in implant dentistry are now in the market, two of which are backed by leading implant manufacturers Straumann and Nobel Biocare. All systems use in principle the same optical tracking technology, but they each have its own proprietary design features which can impact ergonomics, accuracy, user experience, overall efficiency and cost effectiveness. The competition is going to be fierce and whether a clear winner is going to emerge in the end is up to everyone to speculate.
And while the masses will soon move into dynamic navigation, the early adopters are already documenting the rise of the robots! The marriage of the dynamic CAIS with the robotic arm has already borne fruit and the child is growing healthy and strong in two continents. Autonomous robotic implant systems are already in the market in US and China and although in an early stage of adoption, we see now the first peer-reviewed published results in the form of case series.

Static, dynamic or maybe both?

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In a recent randomised clinical trial static and dynamic computer assisted implant surgery were combined and used simultaneously while placing dental implants. The result was increased accuracy, even beyond the level that static or dynamic CAIS alone can offer. This can lead to even more precise surgeries, It comes however with an increased cost and time commitment.

How can you combine static and dynamic? Well that was not too difficult actually. In principle, you have to follow the workflow of the static, print the guide accordingly and then register and calibrate the guided surgery drills for the dynamic CAIS before the surgery. In the surgery the operator will place the surgical guide and continue with the drills as usual, only now with the visual aid of the correct angle and depth also displayed in real time.

Implant Surgery with map and compass!

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Have you ever thought why some people are fast to orientate with a map, while others tend to be always lost? Or, why some prefer to look at the navigation carefully once before driving, while others need to have it constantly in front of their eyes? And what does this all have to do with implant surgery? Today we will dissect a crucial skill for any implant surgeon, the spatial representation ability and we will discuss how to train and improve it for the benefit of your patients. Finally we have a small challenge to test your skills!

Tissue level versus bone level implants

Tissue Level versus Bone Level implants: Vol. 2 !

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In our first article 2 years ago we explored the difference between tissue level and bone level implants with regards to risk for peri-implantitis. In this article, we discuss deeper about the emergence profile in the light of new knowledge and we also extend to assess technical complications and potential implications of the implant connection. We will discusss the ocncept of Emergence profile and the “deep” emergence angle and we will investigate closer what were the reasons behind the early success of Tissue level implants, as well as their limitations.

The benefits of Computer Assisted Implant Surgery: Seeing beyond the Average!

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Static and Dynamic computer assisted implant surgery appear to deliver the same level of accuracy if we study the average deviation. But this is only half the truth. By analysing frequencies instead of the mean we could see some important differences and clinical implications, as it becomes obvious that both dynamic and static CAIS will deliver “plug and play” immediacy in 40% of the cases, as opposed to only 10% for freehand. If we extend to include the small modification group then we see CAIS serving successfully as much as 80% of the cases! Think of the time and resources saved, the logistics and the patient experience and you have already a major benefit of CAIS, certainly not described in the previously reported means. That is of course if you follow an immediacy procedure. With a conventional loading protocol, the benefit of CAIS is probably not that important in clinical terms.