Redefining Loading Protocols:Unveiling the Potential of AnyTime Loading

In his lecture, Dr. Platt challenged traditional dental implant loading practices. He questioned the long-standing protocols established by Dr. Branemark and Dr. Albrektsson, which dictate waiting 3 to 6 months before loading an implant. Dr. Platt argued against this conventional approach, advocating for immediate and early loading to better meet patient needs.Dr. Platt emphasized that traditional guidelines are based on the assumption that necrotic bone around implants needs time to become vital again. However, he questioned why necrotic bone is present at all, urging a re-evaluation of surgical techniques to prevent this issue and adhere to the Hippocratic Oath of "Doing no harm." Here counted his own experience, stating that he was able to chew on an implant within three weeks,challenging the necessity of waiting periods for osseointegration.

The lecture highlighted a large meta-analysis by ITI and Straumann, which revealed high success rates (97.8% for immediate loading and 98% for early loading) without significant differences between maxillary and mandibular implants or across various insertion torques and ISQ values. Dr. Platt criticized the reluctance of implant companies to explore loading within the first eight weeks, attributing it to fear of failure and adherence to tradition.

Dr. Platt introduced Neobiotech's concept of"AnyTime Loading," proposing that immediate loading can occur within the first week, early loading between one and twelve weeks, and conventional loading from three to six months.He argued that eliminating bone trauma during surgery and using precise drilling and proper torque can maintain and increase bone-implant contact, thereby avoiding the stability dip that traditionally occurs.

The key to successful AnyTime Loading, according to Dr. Platt, lies in the meticulous preparation of the osteotomy, appropriate insertion torque, and avoiding lateral forces on the crowns. He concluded by expressing confidence in the AnyTime Loading protocol, supported by his personal and professional experiences, and encouraged colleagues to embrace this innovative approach to improve patient outcomes.

Unraveling the Stability Dip: How to Eliminate Bone Trauma

Dr. Alves began by discussing the various causes of implant failure, noting that it can result from patient-related factors, implant design issues, or surgical techniques. This presentation focused on"over-compression of the bone and overheating"as key factors affecting bone healing and implant success.

He emphasized the importance of "primary stability" to avoid fibro-integration and implant loss. Stability is influenced by bone quality,implant design, length, diameter, and surgical technique. The formation of necrotic bone around the implant osteotomy is a critical issue,influenced by the extent of bone trauma.

Thermal damage to bone cells starts at 50°C, with alkaline phosphatase denaturing at 56°C. Dr. Alves highlighted the "critical threshold for bone necrosis at 47°C for 1 minute." Overheating can lead to severe consequences like hyperemia, protein degeneration, osteocyte death, osteoclasis, and bone necrosis. He presented clinical cases linking bone necrosis to implant placement, particularly in denser bone (D1 bone),where symptoms of implant failure due to overheating include pain, inflammation, fistulas, radiolucent areas, and implant mobility.Dr. Alves reviewed research on bone heating,noting that many studies are in vitro or animal based with varying quality and biases. He listed factors affecting overheating, including bone density, cortical thickness, drill diameter, material,wear, pressure, and speed. He recommended"intermittent drilling with a pumping motion" for better cooling and debris removal, though there is no consensus on the best irrigation technique,and the temperature of the saline is also important.

Drill design also impacts temperature increase,with conical drills and certain fluted drills potentially being more efficient. Studies suggest that drills should be used within a range of 30-50 uses to remain effective. Dr. Alves warned that“bone compression over a certain threshold can cause deformation, fractures, ischemia, and necrosis."

He compared high torque and low torque during implant placement, explaining that high torque can cause bone cracks and necrosis, whereas lower torque allows better bone formation.Studies show "good survival rates for implants placed with low insertion torque," indicating that high insertion torques are not a guarantee for successful osseointegration. Dr. Alves advised clinicians to "avoid overstressing the bone during implant surgery" and suggested that future implant systems should focus on optimized drill protocols and macro designs to derive stability from trabecular bone rather than merely compressing the cortical layer.In conclusion, Dr. Alves reiterated that overheating and high insertion torque compromise bone regenerative capacity and mechanical properties. He stressed that"mechanical stability should consider bone quality and intended loading protocol."The clinical implications of his lecture highlight the importance of maintaining bone health during implant procedures, using careful surgical techniques, and appropriate drilling protocols to avoid thermal and compressive bone trauma,emphasizing lower insertion torque for better long-term implant success. By focusing on these points, clinicians can enhance their practices to achieve better implant outcomes and reduce the risk of bone trauma and implant failure.

Drilling and Placement Protocol for AnyTime Loading

In Prof. Galaktion Makhviladze's lecture on"Drilling and Placement Protocol for AnyTime Loading" at the 2024 Neobiotech World Symposium, he emphasized the critical steps for achieving successful implant placements. He highlighted the importance of understanding bone density and using the appropriate drilling protocols to ensure optimal primary stability.

Prof. Makhviladze stressed the need for "passive placement in hard bone and active placement in soft bone" to avoid bone trauma and ensure strong fixation. He explained that passive placement involves full-size drilling and tapping in hard bone to minimize over-compression and maximize bone-implant contact (BIC) rates. Active placement, on the other hand, utilizes the self compacting design of the CMI implant for soft bone, leveraging its unique threads and apex for enhanced stability.

He introduced the CMI fixation concept developed by Dr. Heo, which aims to achieve fixation from all parts of the implant—coronal (C fixation), middle (M-fixation), and apical (I fixation). This approach ensures comprehensive engagement with various bone densities,enhancing primary stability and supporting the AnyTime Loading protocol.

Prof. Makhviladze stressed the importance of detailed bone density documentation for AnyTime loading, which involves recording bone density at various implant depths and fixation areas to determine the optimal loading approach based on fixation sources and insertion torque values.The CMI fixation concept provides optimal primary stability by ensuring fixation from all implant parts and bone densities, resulting in enhanced BIC ratios compared to conventional methods (62% with CMI protocol versus 48% with crestal widening). Dr. Makhviladze concludes by indicating that Dr. Mongkol will demonstrate the practical application of the CMI fixation concept,highlighting its efficacy in maintaining stability throughout the healing phase and supporting the AnyTime Loading theory.

Validation of No Stability Dip through Assessment of Total Stability Change

Dr. Thaveeprungsiporn's lecture at the Neobiotech World Symposium delves into the intricacies of assessing stability changes during dental implant procedures, offering valuable insights drawn from clinical experience. Dr.Thaveeprungsiporn begins by introducing a novel approach to categorizing bone density: D1 and D2 for harder bone, and D3 and D4 for softer bone.Within each section, he further divides the bone into coronal (C), middle (M), and apex (I),providing a comprehensive framework for understanding bone density variation throughout the implant site.

He emphasizes the importance of tailoring drilling protocols based on these bone density classifications, advocating for passive preparation in hard bone to minimize trauma and active preparation in soft bone to ensure adequate fixation. By meticulously documenting bone density and drilling procedures, clinicians can better adapt their techniques to optimize stability and promote successful osseointegration.

Dr. Thaveeprungsiporn introduces the AnyCheck instrument as a valuable tool for stability assessment, which involves tapping the healing abutment to measure contact between the bone and implant surface. He highlights the significance of healing abutment height in this process, noting that a standard height of 4mm ensures consistent stability measurements and facilitates accurate assessment.Dr. Thaveeprungsiporn presents several clinical cases to illustrate the application of his drilling protocol and stability assessment techniques in real-world scenarios. He details the specific drilling and implant placement protocols tailored to different bone densities, emphasizing the need for meticulous technique and close monitoring of stability changes over time.By sharing his clinical experiences and outcomes,underscores the importance of adapting techniques based on individual patient characteristics for successful implant procedures.He challenges clinicians to rethink their approach to treatment planning and stability assessment,emphasizing the need for careful consideration of bone density and implant placement techniques to ensure optimal outcomes and long-term success.

CMI Implant: Optimal Design for AnyTime Loading and All on X

Dr. Cabrera delves into the concept of atrophy,explaining it as the physiological decrease in volume after surgical removal (hard and soft tissue changes). He analyzes the various challenges posed by atrophy in the selection of appropriate dental implant systems, highlighting the patient-specific factors such as previous surgeries and anatomical conditions that influence treatment plans.

Through the presentation of three clinical cases,Cabrera illustrates the application of CMI implants for immediate loading and aesthetic rehabilitation. He underscores the importance of anatomical analysis and patient-tailored treatment plans in achieving successful outcomes in implant dentistry.Dr. Cabrera addresses the challenges associated with treating infected sites and cystic lesions,emphasizing the significance of guided bone regeneration techniques for successful outcomes.He discusses various surgical approaches and their implications for restoring oral health and function.

Guided by aesthetic and functional considerations, Cabrera advocates for minimally invasive dental surgery as a cornerstone of modern implant dentistry. He emphasizes the importance of immediate loading concepts and patient comfort in achieving optimal results.

Dr. Cabrera highlights the importance of comprehensive treatment planning, including facial and intraoral analysis, to achieve optimal outcomes in implant dentistry. He discusses the role of anatomical buttresses for primary stability and the application of immediate loading concepts improving patient experiences (health, immediate function + aesthetics).He discusses the utilization of advanced surgical techniques such as osseodensification and zygomatic implants to address severe bone atrophy and ensure successful implant placement.Emphasizes the importance of continuous innovation and learning in advancing the field of implant dentistry.He emphasizes the importance of continuous innovation and learning in advancing the field of implant dentistry.Through detailed case presentations, Dr. Cabrera demonstrates the transformative impact of CM Iimplants on patient smiles, function, and confidence. He underscores the importance of follow-up care and patient education in ensuring long-term success and satisfaction.

From Fixation to Function: Understanding CMI Fixation for Optimal Loading

Prof. Paek began his lecture that CMI fixation refers to achieving coronal, middle, and apical fixation of implants. It ensures optimal stability for immediate or Anytime loading. Challenges such as sinus proximity or soft bone may limit achieving all three fixations, but Neobiotech’s system helps document bone density at the selevels, aiding in treatment planning.

For successful immediate or Anytime loading,controlling occlusal forces is crucial to prevent micromotion. Strategies include reducing cusp inclination, narrowing the occlusal table, providing wide centric freedom, and ensuring primary occlusal contacts are within the implant diameter. Maintaining a favorable crown-to implant ratio is also essential.

A case is presented where a failing bridge and tooth were replaced with immediate implant placement and loading. Successful outcomes were achieved through careful treatment planning, including provisional restorations, soft tissue management, and patient adherence to a soft diet during the initial healing period.

To prevent failures, provisional prostheses should be reinforced with metal frameworks, and permanent cementation should be used instead of temporary bonds. Literature supports these practices, emphasizing the need for flat cusps and narrow occlusal platforms to distribute forces evenly.Critical factors for successful Anytime loading include ideal implant positioning, increased implant surface area, avoiding cantilevers, and providing shallow anterior guidance. Using night guards and achieving implant-protected occlusion are paramount. Recommendations highlight controlling biomechanical forces and ensuring clinical stability.

For successful Anytime loading in different bone densities, obtain 40N/cm of insertion torque passively or 30-40N/cm actively. Ensure splinting of implants, use wider implants in posterior areas,and fabricate screw-type provisional prostheses.These guidelines maximize stability and success in immediate loading protocols.

Navigating Prosthetic Design for Successful Esthetic AnyTime Loading

Dr. Redemagni shared examples of esthetic and biologic failure implant cases due to poor planning, emphasizing that thorough case study is crucial to avoid errors. He highlighted that"function is not enough; I also want aesthetics,"underscoring that aesthetic considerations are integral to dentistry. He expressed a preference for immediate loading over delayed loading because it preserves bone, reduces treatment time, and minimizes patient discomfort. He disputed the notion that immediate loading compromises the parabola, asserting that with proper technique, both papilla and parabola can be maintained.

Introducing the concept of the "restorative emergence profile," Dr. Redemagni described the trans-mucosal prosthesis design from the implant neck to the free gingival margin. He explained that there are two main ideal designs: "concave"for immediate post-extractive loading and"convex" for delayed loading, each suited to different clinical scenarios. He emphasized the need for adequate tissue management, dividing the REP area into three zones: connective tissue, junctional epithelium,and sulcular epithelium. Tissue management involves selecting the appropriate design(concave or convex) based on tissue thickness and the need for grafting.

Dr. Redemagni shared clinical cases demonstrating the use of guided bone regeneration, connective tissue grafts, and dermal matrix. He highlighted the importance of starting with a concave design for immediate implants to allow space for tissue healing, and adjusting the provisional restoration over time. Summarizing his lecture, Dr. Redemagni reiterated that two designs are used for provisional restorations:concave for immediate loading and straight to convex for cases with sufficient soft tissue. He stressed that successful esthetic outcomes depend on meticulous planning, correct implant positioning, and careful tissue management.

Mastering AnyTime Loading in the Sinus Area

In his lecture titled "Mastering AnyTime Loading in the Sinus Area" at the 2024 Neobiotech  World Symposium, Dr. Giuliano Garlini focused on the challenges and techniques of immediate loading in the maxillary sinus area, emphasizing the need for precise planning and technique to achieve optimal outcomes. He explained that in Italy, AnyTime loading typically means immediate function, as patients expect to leave the office with a new tooth the same day. However, the maxillary sinus area presents unique difficulties due to its bone quality and quantity.Dr. Garlini highlighted the importance of understanding the "CMI concept" and ensuring that both surgeons and prosthodontists are aware of the fixation achieved in each case. He referred to Dr. Heo's book on minimally invasive sinus surgery, which outlines 4 classifications based on the amount of remaining bone.

For "Class I" (10 mm or more of remaining bone),immediate post-extractive restoration is possible but challenging due to variations in bone density.In cases with D444 bone density, he advised delayed loading.

For "Class II" (engaging the apex of the implant into the inferior wall of the sinus), here commended using an S-reamer to create a controlled fracture in the sinus floor, ensuring stability for immediate loading. He shared a successful case study from 2014, demonstrating stability over time.

In "Class III" (3 to 7 mm of bone left), he emphasized careful evaluation using tools like AnyCheck to decide if immediate loading is feasible. He showcased cases where provisional restorations were used successfully, but also stressed caution in complex situations.careful consideration of bone density and stability. He recommended delayed loading for"sinus class IV" to achieve reliable outcomes.Throughout his lecture, Dr. Garlini underscored the importance of precise technique and patient specific planning to master AnyTime loading in the sinus area.

For "Class IV" (1 to 3 mm of bone left), he advised a crestal approach and recommended delayed loading to avoid risks and ensure success.Dr. Garlini concluded with guidelines for each sinus class, stressing that while "Class II" is ideal for immediate loading, other classes require

Successful AnyTime Loading on Fully Edentulous Jaw

In Prof. Richard's lecture, he discussed the successful AnyTime loading of implants for fully edentulous jaws, particularly focusing on elderly disabled patients. Highlighting the context of a super-aged society, he noted that Korea's average life expectancy had risen from 83 years in 2013 to 90 years by 2020, with projections of reaching 100years by 2030. This demographic shift necessitates a future direction in dentistry that emphasizes the importance of implants,removable prostheses, and fixed prostheses to maintain quality of life.

Prof. Richard outlined several critical considerations in implant treatment planning:determining who will perform the surgery and when, deciding between fixed, removable, or hybrid prostheses, identifying the optimal implant placement, the required number of implants, and whether to connect or segment them.Additionally, he stressed the importance of deciding the appropriate time for patients to begin chewing and establishing a follow-up routine. These factors are crucial, especially since edentulism, which affects eating and speaking, is considered a chronic condition managed by palliative rather than definitive treatment.

The core of his presentation revolved around the"Top-Down and Restoration-driven Treatment Planning" approach, which starts with the desired end result and works backward to ensure a precise and predictable outcome. This method involves critical decisions such as whether to use cross-arch splinting or segmented bridges and evaluating the number of implants needed for a full arch prosthetic solution.

He described his clinical practice of AnyTime loading, involving immediate dentures and provisional restorations that transition to final zirconia restorations after three months. Prof.Richard highlighted the advancements from traditional techniques to a smart digital workflow since 2016, utilizing CAD/CAM technology for more accurate prosthesis construction. This evolution has facilitated the use of monolithic zirconia prostheses, known for their superior properties and biocompatibility.

Prof. Richard emphasized that for elderly patients, fixed All-on-X restorations are strongly recommended, with at least six implants in the maxilla and four in the mandible to ensure effective outcomes. He noted that segmented designs might offer better structural durability and fracture prevention compared to one-unit long-span designs. He illustrated the clinical workflow for All-on-X, beginning with panoramic views and impressions, followed by the fabrication of immediate dentures and their duplication for CBCT with radio-opaque markers.Implant surgery is then conducted using computer-guided templates, leading to immediate provisional restorations and final impressions for definitive prostheses.Concluding his lecture, Prof. Richard stressed the importance of considering patient-specific factors,such as age, gender, and occupation, when planning treatments. He advocated for the use of Symposium Report 31 zirconia for its optimal properties and highlighted the significance of fixed-type restorations for elderly patients.