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MAGAzINE fOR CUSTOMERS AND PARTNERS Of STRAUMANN 1 I 2012 

the straumann ® 

regenerative system

Imprint starget – magazine for Customers and Partners of straumann i © straumann usa i 60 minuteman road i andover, ma 01810 i Phone 800/448 8168 

Fax 978/747 2490 i Editors roberto gonzález i mildred Loewen i E-Mail info.usa@straumann.com i Internet www.straumann.us/starget 

Legal Notice exclusion of liability for articles by external authors: articles by external authors published in starget have been systematically assessed and carefully 

selected by the publisher of starget (straumann usa). such articles in every case reflect the opinion of the author(s) concerned and therefore do not necessarily 

coincide with the publisher’s opinion. nor does the publisher guarantee the completeness or accuracy and correctness of articles by external authors published in 

starget. the information given in clinical case descriptions, in particular, cannot replace a dental assessment by an appropriately qualified dental specialist in an 

individual case. any orientation to articles published in starget is therefore on the dentist’s responsibility. articles published in starget are protected by copyright 

and may not be reused, in full or in part, without the express consent of the publisher and the author(s) concerned. straumann ® and all other trademarks and logos are 

registered trademarks of straumann usa and/or of its affiliates. third party corporate names and brand names that may be mentioned may be registered or otherwise 

protected marks even if this is not specially indicated. the absence of such an indication shall not therefore be interpreted as allowing such a name to be freely used.

editorial 

STARGET 1 I 12 

3 

A New Era in Oral Tissue 

Regeneration 

Dear Valued Customer, 

It is my pleasure to introduce myself as the new head of Straumann North America, 

and also to introduce this first installment of STARGET for 2012. The focus of this issue, 

"The Straumann Regenerative System," is particularly significant for me as I come 

to Straumann USA as the former Head of Straumann Global Regenerative Sales. 

As you know, Straumann provides solutions for both tissue regeneration and GBR 

including Emdogain, BoneCeramic, Straumann AlloGraft, and most recently 

MembraGel ® , an innovative liquid membrane that can be precisely applied to the 

surgical site. 

Andy Molnar 

Straumann Executive Vice President 

North America 

You’ll find several interesting articles on tissue regeneration in this issue of 

STARGET: “Why Repair When You Can Regenerate?“ on page 6, “Redefining 

the Membrane“ on page 12, and an interview with Prof. Dr. Christoph Hämmerle 

on the innovation and distinctiveness of MembraGel on page 16. You’ll also see 

an article on our Esthetic Case Book, which documents 11 cases illustrating the 

dramatic results that can be achieved through Emdogain, on page 18. 

Restorative dentistry has seen breakthroughs over the past few years. This STARGET 

features articles on the latest development of Straumann CARES ® digital workflow. 

We hope you will enjoy the clinical case on Straumann's screw-retained hybrid 

solution from your peers, and an article based on the interviews with three key 

opinion leaders on global trends in dentistry. 

Enjoy this issue of STARGET and please let us know how we can continue to 

improve upon it. 

Sincerely, 

Andy Molnar 

Straumann Executive Vice President, North America

4 STARGET 1 I 12 

overvieW 

Overview 


6 

The Straumann ® Regenerative System 

offers solutions for oral tissue regeneration 

– ranging from conservative dentistry to 

dental restoration. New to the portfolio: 

Straumann ® regenerative S y S tem 

Straumann ® MembraGel ® . 

28 

Straumann ® CareS ® digital S olutionS 

Straumann, together with 3M ESPE, 

has introduced a streamlined digital 

workflow that connects the Lava C.O.S. 

Intra-Oral Scanner to the Straumann ® 

CARES ® Digital Solutions platform. 

Simply doing more 

54 

Global Trends – Where is the final 

destination? We asked three prominent 

dentists to give us their perspective 

on things: Lyndon Cooper, Kenneth 

Malament and Daniel Wismeijer.

C ontent 


5 

CONTENT 

FOCAL POINT 6 Why Repair When You Can Regenerate Instead? 

STRAUMANN ® REGENERATIVE SYSTEM 12 Straumann MembraGel ® – Re-Defining the Membrane 

16 Interview with Christoph Hämmerle 

18 An Esthetic Case Selection on Straumann Emdogain 

20 Straumann Allograft Portfolio Expands 

STRAUMANN ® CARES ® DIGITAL SOLUTIONS 22 Evaluating the Precision of Straumann ® CARES ® Guided Surgery 

Based on a Clinical Case 

28 Digital Workflow 

30 The Intraoral Workflow 

32 3M ESPE Lava Ultimate Restorative 

38 Interview with Mike Rynerson 

RESTORATIVE 43 Straumann ® Anatomic IPS e.max ® Abutment 

45 Immediate Full Mouth Restoration Using Implant-Supported Fixed 

Hybrid Prosthetics 

SURGICAL 50 Updated SLActive ® Scientific Evidence Brochure 

ITI / EDUCATION 52 Straumann & Baylor University Launch the First Interdisciplinary 

Digital Dentistry Course 

53 ITI Membership Tops 10,000 

SIMPLY DOING MORE 54 Global Trends 

60 Straumann AID: Access to Implant Dentistry 

64 Literature Alerts 

67 Upcoming 2012 Education Events


foC al point 

STrAUMANN ® reGeNerATive SYSTeM 

Why Repair When You Can Regenerate Instead? 

The More Complex an Organism is, the Lesser the Capacity of its Body to Perform Regenerative 

Processes 

The biological process, or self-sufficient capability to restore deficient tissue is referred to as the ability 

for regeneration. In contrast to repair, i.e., wound healing, whereby the original biological structure is 

not fully rebuilt, the goal of regeneration is to completely restore the structure and function of tissue that 

has been lost or injured. This ability has continuously diminished as creatures have evolved and the 

complexity of these organisms has increased. Compared to the “champions” of regeneration, present 

day cnidarians, which can re-grow severed extremities and internal organs that have been lost, this 

capability in humans, without additional support, is limited to a few types of external tissue. 

When the Body’s Own Healing Process “Overshoots its Target“ 

When a person’s tissue is injured, the body’s repair process, rather than regenerative process, begins. 

Here, the body does not primarily attempt to restore the original state and function of the tissue, 

but rather to close the wound as quickly as possible. This spontaneous healing process involves the 

formation of connective tissues that penetrate deeply into the original tissue and also remove “good” 

tissue in the process. During such a “radical” healing process, it is possible that even important functions 

are permanently destroyed. 

Regeneration Can be Guided with Medical Treatment 

To prevent this type of overcompensation in the healing process wherever possible, strong antiinflammatory 

drugs are administered today, such as in cases of back injuries. This prevents this destructive 

process from occurring, in turn making it possible to preserve part of the nerve tissue and mitigating 

deficits such as paralyses. In medical terms, regeneration entails assisting desirable tissue formation 

processes, and guiding and limiting the repair mechanisms involved in wound healing as to not impede 

the regeneration of intact, functioning tissue.

foC al point 


7 

Fig. 1: The cnidarians (pictured here, a green anemone, anthopleura xanthogrammica) are equipped with astounding regenerative 

capabilities that far surpass those of humans.



The Insertion of Implants Requires Healthy Bone Tissue 

Great advances in regeneration have been achieved in dentistry over that last 20 years. We can 

now regenerate the bone tissue of the jaw, opening the door for implants as a treatment for replacing 

teeth. This has required scientific evidence documenting the physiological processes involved in tissue 

formation and the necessary aids for controlling these processes. Today, for example, we know that 

lost or missing bone can only be regenerated by the body when the bone-forming cells can perform 

their work undisturbed. Without external intervention, this process would have to compete with the rapid 

natural wound repair mechanism, which would result in the growth of new connective tissue instead of 

the desired bone tissue. 

Fig. 2: The high porosity of Straumann ® BoneCeramic (90 %) allows blood vessels and vital bone to vascularize into the material. 

Regeneration Requires Matrices and Membranes 

Today, one means of guiding the regeneration process requires two aids: a matrix and a membrane. 

The matrix keeps the space available for the bone to grow while a membrane serves as a barrier to 

prevent the connective tissue infiltration of the gingiva.



9 

Various types of these matrices and membranes are used today for regenerative purposes. Some of 

these “placeholders” remain in the body, integrated into the newly formed bone for the rest of the person’s 

life. Applying membranes for this purpose is also quite complex and time-consuming. Straumann ® 

MembraGel ® was developed to deal with the disadvantages of the types of membranes used in the 

past. The time-consuming cutting and fitting of the membrane is unnecessary since MembraGel is 

applied in liquid form and polymerizes to form a solid film in less than a minute. The resulting hydrogel 

is biocompatible and completely biodegradable. 

Periodontitis – The Greatest Threat to the Periodontium 

For implantology, the regeneration of the periodontium is equally as important as the new formation 

of bone, which is destroyed by periodontitis and can ultimately result in the loss of the tooth. Despite 

numerous attempts to regenerate the destroyed tissue, a breakthrough to achieve complete tissue 

reformation remains to be seen. Straumann ® Emdogain can be used in cases to undo some of this 

destruction, making it possible to prevent loss of the tooth. Emdogain contains the key components 

required for building up the cementum and periodontal ligament, important parts of the periodontium. 

These elements, or proteins, tap into the body’s own natural ability to rebuild the surrounding tooth 

structures, using nature’s help. 

“Simply Doing More“ – During the Regeneration Process 

Straumann’s successes in the field of regeneration are promising and we have yet to fully realize our 

dreams. We are already working on further innovations to guide regenerative processes in an even 

simpler and more effective manner. We are inspired by two great visions: 

» A matrix for bone augmentation that breaks down fully and can be used without requiring a 

membrane. 

» Guided tissue regeneration that allows for complete preservation of the tooth. 

Now making its first entrance into the dental market with Straumann MembraGel, we view PEG technology 

as the foundation for achieving these goals. Beyond MembraGel, there are numerous combinations and 

degrees of cross-linking these biocompatible hydrogels, which present an exciting range of possible 

options. This innovative technology is only in the early phases of trials and development and has 

enormous potential for the future.



The Straumann ® Regenerative System: Everything from a Single Source 

The Straumann ® Regenerative System offers you a variety of solutions for oral tissue regeneration – 

ranging from conservative dentistry to dental restoration. Our goal is to offer you a variety of predictable 

and scientifically proven regenerative treatment solutions – all from a single source and in the tried and 

tested quality that is Straumann’s hallmark. 

Tissue Regeneration 

By mimicking the natural process of odontosis, 

Straumann ® emdogain forms an insoluble, 

three-dimensional extracellular matrix that 

remains on the root surface for 2 – 4 weeks 

and enables a selective cell population, 

proliferation and differentiation. 

Bone Formation 

Straumann ® allograft is a wide range of 

bone allograft solutions, allowing you the 

flexibility to choose the treatment that’s right for 

your case. Through a commercial partnership 

with LifeNet Health ® , Straumann’s allograft 

options provide confidence in the safety of the 

material you use to treat your patients. 

Straumann ® BoneCeramic is a fully synthetic 

bone substitute material with excellent 

morphology that promotes the new formation 

of vital bone. It can be used for a series of 

procedures used for dental bone regeneration. 

Bone Healing 

Straumann ® membragel ® is a membrane 

of the latest generation. It combines unique 

material properties that have been developed 

to promote undisturbed bone healing and to 

simplify the surgical procedure.


11 

straumann ® emdogain 

IS TRUE PERIODONTAL REGENERATION 

IMPORTANT TO YOU? 

Photos courtesy of Dr. G. 

Zuchelli, Bologna, Italy 

before 

after 

More than 100 clinical publications in peer-reviewed journals demonstrate 

Straumann ® Emdogain to be safe and effective in stimulating the formation of new 

periodontal soft and hard tissue. These clinical studies involve more than 

3000 defects in over 2500 patients. 

Contact Straumann Customer Service at 800/448 8168 to learn more 

about Straumann solutions or to locate a representative in your area. 

www.straumann.us 

excellent clinical results 1-4 

Long-term clinical benefit 5,6 

Less patient discomfort 3 

1 

Tonetti MS, et al. Enamel matrix proteins in the regenerative therapy of deep intrabony defects.J Periodontol. 

2002;29:317–325. 

2 

Froum SJ, et al. A comparative study utilizing open flap debridement with and without enamel matrix derivative in 

the treatment of periodontal intrabony defects: A 12-month re-entry.J Periodontol. 2001;72:25–34. 

3 

Jepsen S, et al. A randomized clinical trial comparing enamel matrix derivative and membrane treatment of 

buccal class II furcation involvement in mandibular molars. Part I: study design and results for primary outcomes. 

J Periodontol. 2004; 75:1150 –1160. 

4 

McGuire MK, et al. Evaluation of human recession defects treated with coronally advanced flaps and either enamel 

matrix derivative or connective tissue. Part 1: comparison of clinical parameters.J Periodontol. 2003;74:1110 –1125. 

5 

Sculean A, et al. Ten-year results following treatment of intra-bony defects with enamel matrix proteins and guided 

tissue regeneration. J Clin Periodontol. 2008; 35:817-824. 

6 

Data on file (McGuire 10 year)



STrAUMANN ® MeMbraGel ® 

Re-Defining the Membrane 

In 2010, Straumann introduced Straumann MembraGel, an advanced technology membrane that 

is one of the most significant innovations in guided bone regeneration in recent history. 

Created with PEG (polyethylene glycol) hydrogel technology, Straumann MembraGel is applied in 

liquid form and molds to the defect. Shortly after application, the liquid components solidify, stabilizing 

the bone graft and providing an effective barrier to tissue infiltration. Straumann MembraGel then 

biodegrades over time. It is designed to achieve undisturbed bone regeneration, which is a prerequisite 

for achieving ideal clinical and esthetic results. 

“Straumann MembraGel is a key innovation in Guided Bone Regeneration. With the 

PEG technology we are on the verge of something new, entering a new era in oral 

tissue regeneration.“ Christoph Hämmerle, University of Zurich 

Designed for Improving GBR Procedures 

Straumann MembraGel provides effective support in bone formation for GBR (guided bone regeneration) 

cases due to its optimized barrier properties. It facilitates undisturbed bone healing as a basis for the 

optimal clinical outcome achieved by stabilization of the bone graft material. The precise and easy 

application simplifies the surgical procedure.



13 

Stabilization of the Bone Graft 

The gel-like consistency of Straumann ® MembraGel 

® allows for precise application to the 

surgical site and adaptation to various types 

and sizes of bone defects. 

Solidification and Stabilization 

Once solidified in situ (20 – 50 seconds after 

application), Straumann ® MembraGel is 

designed to stabilize the underlying bone graft 

to facilitate undisturbed bone regeneration. 

Backed by Scientific Documentation 

Straumann MembraGel is backed by preclinical 1,2,3,4,5 and clinical 6 documentation including one- and 

three-year follow-up data 7 presented in 2010 and submitted for publication. The ongoing clinical 

program with Straumann MembraGel includes over 40 centers and more than 200 patients in Europe 

and North America. 

Straumann ® MembraGel Exclusive Education Program 

Straumann ® MembraGel was launched in conjunction with a well-received specialized education 

program that provides in-depth information on pre-clinical and clinical evidence, hands-on product 

training and the surgical techniques of this new application. Herbert Früh, Head of Business Unit 

Regenerative at Straumann explained, “MembraGel has allowed Straumann to bring a brilliant idea to



fruition. It is an innovative technology that requires training. Customers’ initial experience is that it saves 

time during intraoral application but it is different to handle. For this reason, it was the right decision to 

combine the launch of the new product with an intensive education program.” 

Availability 

Straumann ® MembraGel ® was introduced in Europe and North America toward the end of 2010, with 

roll-outs to other markets planned in the future. 

Hands-on workshop at a Straumann MembraGel education event. 

1 

Humber CC, Sándor GK, Davis JM et al. Bone healing with an in situ formed bioresorbable polyethylene glycol hydrogel membrane 

in rabbit calvarial defects. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;109:372–384. Jung RE, Lecloux G, 

2 

Rompen E et al. A feasibility study evaluating an in situ formed synthetic biodegradable membrane for guided bone regeneration 

3 

in dogs. Clin Oral Implants Res 2009;20:151–161. Thoma DS, Halg G-A, Dard MM et al. Evaluation of a new biodegradable 

4 

membrane to prevent gingival ingrowth into mandibular bone defects in minipigs. Clin Oral Implants Res 2009;20:7–16. Herten 

M, Jung RE, Ferrari D et al. Biodegradation of different synthetic hydrogels made of polyethylene glycol hydrogel/RGD-peptide



15 

PeG – The TechNOLOGY BehiNd STrAUMANN ® MeMbraGel ® 

Straumann MembraGel is a synthetic, biodegradable in situ-formed membrane made of polyethylene 

glycol (PEG) which forms a molecular network. The material is biocompatible, is applied in liquid form 

and sets quickly. Due to its gel-like consistency, it can be applied to cover the exact shape of the defect 

or augmented area and does not require cutting and trimming to shape before application – unlike 

traditional GBR membranes. 

What exactly is PEG, and what makes it suited to this purpose? PEG is a polymer (a large molecule 

comprised of repeating structural units). It is produced through the reaction between ethylene oxide and 

water or the organic compound ethylene glycol, which is often used as a precursor to polymer materials. 

PEG is available in a wide range of molecular weights. The molecular weight also determines the 

consistency of the material, which can vary greatly from waxy-solid to water-soluble liquid states. PEG 

has a number of properties that are particularly desirable in a number of biological, pharmaceutical 

and chemical applications: it is highly flexible, non-toxic and non-immunogenic. It is also hydrophilic, 

meaning that its attachment to biomolecules can increase solubility and decrease aggregation of the 

molecules. 

Thanks to these very advantageous properties, PEG has been extensively used in many medical, 

pharmaceutical and medical device applications. For instance, it is used as a spray-on adhesion barrier 

and as a main ingredient in laxatives; as an agent for bowel irrigation prior to surgery or colonoscopy; 

as an addition to protein medications to extend their effect and increase dosing intervals; and as a 

carrier in various medications, such as soft capsules, ointments, tablets, and lubricants. Preliminary 

research is also underway to investigate the potential of PEG as a component in many other exciting 

applications, such as gene therapy, spinal cord injuries and the suppression of carcinogenesis. The 

use of PEG as a customizable, liquid-applied membrane is therefore another milestone in a long line of 

applications for this useful, versatile and extensively researched material. 

5 

modifications: an immunohistochemical study in rats. Clin Oral Implants Res 2009;20:116–125. Jung RE, Zwahlen M, Weber FE 

et al. Evaluation of an in situ formed hydrogel as a biodegradable membrane for guided bone regeneration. Clin Oral Implants Res 

6 

2006;17:426–433. Jung RE, Hälg GA, Thoma DS, Hämmerle CHF. A randomized, controlled clinical trial to evaluate a new 

7 

membrane for guided bone regeneration around dental implants. Clin Oral Implants Res 2009;20:162–168. Ramel C, Halg G, 

Thoma D et al. A randomized clinical trial to evaluate a synthetic gel membrane for GBR around dental implants – 1- and 3-year 

results. European Association for Osseointegration 19 th Annual Scientific Meeting, Glasgow, UK, 6–9 October 2010; Abs 055.



iNTerview 

“Being Part of this Network is Something Truly Exciting – 

Something We’ve Never Done in this Way Before.“ 

Andy Molnar, Straumann Executive Vice President, North America, interviews 

Professor Dr. Christoph Hämmerle of the University of Zurich about 

Straumann ® MembraGel ® . 

professor Hämmerle, our company is introducing membragel by way of an 

international education-based program. this is a product which has been longawaited 

in the market; so many people would like to get their hands on it as 

Prof. Dr. Christoph Hämmerle 

Chairman of the Department of Fixed and 

Removable Prosthodontics and Dental Material 

Science, University of Zurich/Switzerland. 

soon as possible. What are your thoughts on this educational approach to the 

launch? 

I think it’s very important to use an educational approach. What we’re dealing 

with here is a new technology, a new kind of membrane, a new way to apply 

the membrane. There are a lot of differences from all the membranes we’ve had 

before. I think it’s very important to launch the product in a well-structured way so 

that we know what experience we can rely on. It’s also an opportunity to learn 

about new things we need to become familiar with before we can use a new 

technology like this successfully and predictably. 

“We treated over thirty defects and had minimal complications. 

Based on this experience and learning, we moved on to larger defects 

with a very good success rate once again.“ Christoph Hämmerle 

i know you’re excited about membragel and the progress the product is making. 

How would you describe your involvement from the start, from inception all the 

way through the development of the project? 

It has been very exciting for us. It’s really special to be there when the original 

idea is born and then to participate in the development of a new product, which 

is eventually able to solve problems and improve patient care. With all the sharing, 

teaching, and feedback we’re getting from different people all over the world, 

being part of this network is something really exciting, something we’ve never 

done this way before. For this reason, we’re looking forward to continuing with the



17 

development of this scientific and educational network and 

really benefiting from the process. I think it’s great! 

from our learning so far, what are the key points that we 

need to pass on to our educators? 

There are three key points. One is that you have to change 

some of your surgical habits to adapt to the new technology, 

the new way to apply the membrane. The second is to adhere 

to published surgical guidelines. And the third is to begin with 

less complex cases until you have had around ten successful 

cases, and then move on to more difficult cases. 

When we conducted our initial study, in which we used a 

collagen membrane as a control, we did not see any more 

difficulties with the membrane using the new technology than 

with the membrane using the older technology. I think this was 

the case because we were careful to use small dehiscence 

defects in non-esthetic areas. We treated over thirty defects 

and had minimal complications. Based on that experience 

and learning, we began to expand to larger defects, again, 

with very good success. 

Professor Hämmerle, thank you very much for your time. 

It’s much appreciated. 

“I think it’s very important to launch the product 

in a well-structured way so that we know what 

experience we can rely on.“ Christoph Hämmerle 

Returning to the topic of changing habits, this is a new 

technology, and there is a great temptation to use it in all 

kinds of different ways because it is rather easy to use and 

very new and exciting. We need to exercise restraint and 

really adhere to new practices in aspects of our surgical 

work. 

The second point pertains to the surgical guidelines. We 

have seen that the surgical guidelines are not always 

followed accurately. Following the surgical guidelines could 

improve the practical outcomes when it comes to using this 

new product. 

The third aspect is the size of the defects we tackle first.



GrOwTh iN receSSiON 

An Esthetic Case Selection on Straumann ® Emdogain 

Clinicians have been predictably treating gingival recession with Straumann ® 

Emdogain for years and talking about the beautiful smiles they gave back 

to their patients – we gave them the chance to prove it. 

The best cases from the 2009 “Growth in Recession” Esthetic Case Competition 

were chosen by a renowned international jury to appear in Straumann’s Growth in 

Recession Esthetic Case Book. This casebook, published in 2011, features eleven 

cases presented together with the patients’ histories and images of each step to 

facilitate a detailed understanding of the surgical procedures involved. 

This valuable tool is complimentary to you with your next order of Straumann 

Emdogain. Please reference order code “RECESSION” when placing your order. 

Designed to help achieve excellent esthetic results 

Esthetic Casebook: Straumann ® Emdogain 

The following clinicians contributed their Case reports to this publication: 

p Brazil: Dr. Robert Carvalho da Silva, DDS, MS, PH.D. (co-authors: Dr. Julio 

Cesar Joly, DDS, MS, PH.D., and Dr. Paulo Fernando Mesquita de Carvalho, 

DDS, MS) 

p USA: Dr. Robert Levine, DDS – Dr. Ken Akimoto, DDS, MSD – Dr. Mark I. Gutt, 

DMD– Dr. Eunseok Eugene Oh, DDS (co-author: Dr. Vincent Iacono, DDS) – Dr. 

Paul G. Luepke, DDS, MS 

p Canada: Dr. Ira Paul Sy, DDS, MS, Dip. Periodontics 

p Germany: Dr. med. dent. Andreas Hofmann, M.Sc. – Dr. Bjørn Greven (coauthor: 

Dr. Bernd Heinz) 

p Spain: Dr. Ion Zabalegui, MD



19 

“BOTH THE SCIENTIFIC EVIDENCE AND MY PERSONAL ExPERIENCE 

SUPPORT THAT WITH THE APPROPRIATE CASE STRAUMANN ® EMDOGAIN 

SIGNIFICANTLY IMPROVES ROOT COVERAGE COMPARED TO THE 

CORONALLY ADVANCED FLAP ALONE.” 

DR. MICHAEL K. MCGUIRE, DDS 

Treatment of recession defects with Straumann Emdogain 

Courtesy of Dr. Paul G. Luepke, DDS, MSD 

A referred 23-year-old female patient was presenting with multiple gingival recessions 

(teeth #8 to #3). The prominent canine showed a Miller Class III recession, the 

other teeth presented with Miller Class I recessions. The treatment procedure began 

with a thorough cleaning and scaling of the exposed root surfaces with hand 

and sonic instruments and was followed by a split thickness flap preparation of a 

Zucchelli-style flap (without vertical releasing incisions). A dissection into the vestibular 

mucosa allowed for further mobilization. 

Dr. Paul G. Luepke, DDS, MS 

1996 Master’s degree in Periodontics, University 

of Texas at San Antonio Health Science Center, Tx, 

USA • 1997 Diplomate of the American Board 

Straumann ® PrefGel ® (EDTA) was applied for two minutes on the root surface. 

Subsequently, the surgical area was rinsed with sterile saline and Straumann ® 

Emdogain was applied to the root surfaces. Connective tissue graft (CTG) was 

harvested from the palate with the single incision technique. The graft was then 

split. The CTG was fixed on the root surface and the flap coronally positioned and 

fixed with sling sutures. 

of Periodontology • 2008 Assistant Professor of 

Surgical Services Periodontics Division, Marquette 

University School of Dentistry in Milwaukee, WI, 

USA • 2009 Interim Department Chair of Surgical 

Sciences at Marquette University School of Dentistry 

in Milwaukee, WI, USA 

Mechanical tooth cleaning in the surgical area was avoided during the first 4 

weeks and a chlorhexidine solution was prescribed. Sutures were removed 10 

days after surgery. 

Initial situation 

6 week follow-up 

11 month follow-up



ALLOGrAfT LiNe exPANSiON 

Building A Foundation for Success with More Options – 

Straumann AlloGraft Portfolio Expands 

Straumann is pleased to expand the options available for you through our commercial partnership with 

LifeNet Health, ® allowing you the flexibility of choice when treating your patient. Processed with LifeNet 

Health’s proprietary and patented Allowash xG ® technology, Straumann AlloGraft gives you confidence 

that your graft is safe and effective. 

Straumann AlloGraft C/C mix, Mineralized 

Ground Cortical/Cancellous mix 

A mix of the strength of cortical bone with the 

structure of cancellous bone to support bony 

ingrowth in one product 

Straumann AlloGraft OCAN (top) and Straumann 

AlloGraft GC (bottom), electron microscope 

image, magnification 20x 

Straumann AlloGraft OCAN 0.25 cc, Mineralized Ground Cancellous 

Straumann AlloGraft GC 0.25 cc, Mineralized Ground Cortical 

Straumann AlloGraft DGC 0.25 cc, Demineralized Ground Cortical 

For smaller defects, when extensive grafting is not needed 

Straumann AlloGraft OCAN (left), Straumann 

AlloGraft GC (middle), Straumann AlloGraft DGC 

(right), electron microscope image, magnification 20x 

SIMPLIFy WITH CONFIDENCE 

From crown to root, Straumann provides you with the 

convenience of ordering solutions from one provider – all 

from the scientifically driven company you know and trust.


21 

straumann ® Cares ® digitaL soLutions 

SEAMLESS CONNECTIONS 

Pave your way to success. Covering a full product range from temporary restorations to 

esthetic crown and bridge restorations, Straumann ® CARES ® Digital Solutions is now featuring: 

new generation scanner new cAd software 

new applications leading range of materials 

Straumann ® CARES ® Digital Solutions brings modern digital dentistry to dental professionals as a complete system – 

reliable, precise, and dedicated to your needs. 

intra-oraL sCan 

guided surgery 

CadCam 

Please contact us at 800/448 8168. More information on www.straumann-cares-digital-solutions.com


Straumann ® C areS ® digital S olutionS 

STefANO STOreLLi, LeONArdO AMOrfiNi, MAUriziO cAMANdONA ANd eUGeNiO rOMeO 

Evaluating the Precision of Straumann ® CARES ® Guided 

Surgery Based on a Clinical Case 

Introduction 

The use of guided surgery is paving the way for the future of implant surgery. Softwarebased 

pre-operative planning differs considerably from traditional planning with casts 

and x-ray printouts. The following case report involves a restoration for a partially 

edentulous woman with a fixed prosthesis preceded by pre-operative planning 

with the Straumann ® Guided Surgery System using coDiagnostix (software) and 

gonyx (scan and surgical template fabrication device). 

Dr. Stefano Storelli 

Graduation in Dentistry and Dental Prosthetics at the 

University of Milan/Italy. PhD in Implant Dentistry. 

Postgraduate in Oral Surgery (class of 2012). 

Lecturer at the Department of Implant Prosthetics at 

the University of Milan. Author of various national 

and international publications and collaboration on 

various transcriptions. ITI and SIO member. Private 

practice in Milan. 

Patient History 

An 87-year-old Caucasian woman referred to our clinic, asked for a solution for her 

faulty fixed bridge which was causing pain and difficulty in eating. She had never 

worn a removable prosthesis and was willing to do anything possible to keep her 

fixed dentition. The patient suffered from an unspecified choreia with symptoms of 

involuntary movements, and was on aspirin treatment for her high blood pressure. 

Despite these restrictions, she was in a good physical and mental health. 

Clinically, the following situation was diagnosed: (1) a faulty fixed bridge (7 to 

12), still anchored on the left side, where an old implant was still in use, (2) two 

Fig. 1 Fig. 2 

Fig. 3 

Fig. 4



23 

remaining teeth (8 and 11) which were fractured, and (3) a resorption on site 8 

and a fracture of 11 revealed by the OPG as well as the inclination of the distal 

implant placed in 12 (figs. 1 – 3). Under these circumstances the clinician decided 

to remove the bridge and to restore the patient with a removable prosthesis. 

After a couple of weeks the patient stated that it was impossible for her to wear 

the temporary denture and she returned to the dental practice several times due 

to fractures to the prosthesis. Therefore, it became apparent that a removable 

restoration was not suitable for this patient and that an implant solution had to 

be taken into consideration. Since minimally invasive surgery was intended, the 

clinician opted for a guided implant insertion in the post-extractive sites. 

Dr. Leonardo Amorfini 

Graduation in Dentistry and Dental Prosthetics at the 

University of Milan/Italy. Author of various national 

and international publications and collaboration 

on various transcriptions. ITI, AO, SICOI and SIO 

Treatment Planning 

member. Private practice in Gallarate (VA). 

A mock-up of the future teeth was evaluated, followed by the preparation of the 

diagnostic template with the Straumann ® gonyx table. The plate was attached 

to the barium teeth and the three titanium pins were placed according to the 

manufacturer’s instructions (figs. 4, 5). The diagnostic guide was tested for 

Fig. 5 Fig. 6 

Fig. 7 Fig. 8



stability in the mouth of the patient before performing the Cone Beam CT scan 

(fig. 6). The CT showed a remarkable resorption on site 8 and confirmed the 

inclination of the implant placed in 12. Therefore, the implant to be placed 

immediately in position 8 was moved to 7 and a miniflap was raised. The 

implant in position 11 had to deal with the position on the other implant. 

The final treatment decided upon was a fixed implant supported 

Dental Technician Maurizio Camandona 

Teacher of post-graduate courses in dental implant 

technologies at the University of Milan. 

Author and co-Author of professional articles and 

reference books. Private practice in Lomazzo 

(Como)/Italy, specialized in implant prosthetics, 

ceramics and state-of-the-art technologies (CADCAM 

prosthesis on 3 implants in positions 7-11-12. The Straumann ® 

coDiagnostix software was used to plan the treatment (figs. 7, 8). The 

implant positions were defined in the software and the resulting template plan 

was sent to the lab. The implant in position 7 was planned to be a Roxolid ® 

implant with small diameter (Straumann ® Bone Level implant, NC Ø 3.3 mm, 

SLActive ® 12.0 mm); for the implant in 11, a Straumann ® Bone Level implant 

(RC Ø 4.1 mm, SLActive 12.0 mm) was chosen. 

etc.). Speaker at national congresses on the topics 

listed above. 

Fig. 9 

Fig. 10 

Fig. 11 Fig. 12



25 

It was possible to identify the implant in 12 as a CoreVent1 Ø 4.0 mm 

implant placed about 15 years ago and, after some research, some prosthetic 

component of the respective implant manufacturer was found that was 

compatible with the internal connection to this implant. After drilling the holes 

into the scan template according to the template plan, the lab provided the 

surgical guide (figs. 9 – 11). 

Surgical Procedure 

The two teeth were removed together with the granulation tissue around the 

root of tooth 8 under local anesthesia. The considerable resorption needed to 

be treated with regenerative material (bovine bone substitute material covered 

by a resorbable collagen membrane) to avoid major alteration of the contour. 

The surgical guide was placed on the remaining teeth and on the healing 

cap of the distal implant (fig. 12). The surgical procedure was performed 

according to the surgical plan. The implant in position 7 was positioned after 

raising a mini-flap and by using the extra-long drill (Ø 2.8 mm) through the 

Prof. Eugenio Romeo 

Graduation in Medicine and Surgery in 1984 at the 

University of Milan/Italy. Director of the Department 

of Implant Prosthetics at the University of Milan since 

1992. Associate Professor since 2005. Author 

of various educational books and national and 

international publications. Chairman of the Advanced 

Oral Implantology course at the University of Milan. 

ITI fellow. 

Ø 2.8 mm sleeve (figs. 13, 14). 

Fig. 13 Fig. 14 

Fig. 15 

Fig. 16



The implant was positioned after the guide had been removed, since the implant, having a diameter of 3.3 mm, cannot 

be inserted through the Ø 2.8 mm sleeve. The implant in position 11 was placed after using the extra-long drill series 

(Ø 2.2/2.8/3.5 mm) with the 1 mm reduction handle through the Ø 5 mm diameter sleeve (figs. 15, 16). The implant 

was positioned through the surgical guide. Transmucosal healing caps were positioned and the bone substitute material 

was inserted into the extraction sockets. Both sites were covered with the resorbable collagen membrane. 

Final Prostheses and Follow-up 

After 6 weeks, the OPG showed correct healing with no radiolucencies (fig. 17). Clinically, the implants sounded 

correct and were stable (fig. 18). The healing abutments were removed and screw-retained transfer parts were placed 

Fig. 17 Fig. 18 

Fig. 19 

Fig. 20 

Fig. 21 

Fig. 22 

Fig. 23 Fig. 24 

Fig. 25



27 

in order to take the impression. The three impression copings were splinted 

with a bridge of acrylic resin that had been prepared a few days before (figs. 

21, 22). The three abutments were placed in position (fig. 22) and the metalceramic 

prosthesis (fig. 24) was cemented with a removable cement (fig. 23). 

After one month of loading, no complications were registered or stated by 

the patient. By comparing the values obtained by computer planning with the 

x-ray taken after implant placement (figs. 19, 20), the precision of the system 

became visible, with the postextractive implant being about 1 mm deeper than 

planned and without much variability in the other dimensions. 

Conclusion 

The use of computer-guided implant placement allowed expanded treatment 

options and a fast, minimal invasive surgery for a patient who was not able to 

withstand long procedures. Producing the guide in such a manner is efficient 

and it fits well on natural teeth because it has been customized on the patient's 

impressions. The implant placement in the case reported here demonstrates the 

reliability of the Straumann ® Guided Surgery system. 

With software-based treatment planning, the implants could be placed in 

the same practiced manner as with traditional techniques – but with higher 

precision and peace of mind. However, the learning curve for software-based 

planning should not be underestimated; in addition to familiarization with the 

software, new surgical techniques have to be applied and the surgeon needs 

to get accustomed to visualizing the surgical procedure through the software.



diGiTAL wOrkfLOw 

Seamlessly Connected with Straumann ® CARES ® 

Digital Solutions 

1. MULTiPLe dATA SOUrceS 2. STrAUMANN ® cAreS ® viSUAL deSiGN 

Surgical planning 

Straumann ® CARES ® Visual 

Digital impression taking 

Scan master model Straumann ® CARES ® 

Scan CS2 

A digital workflow to thousands of scanners 

Straumann, together with 3M ESPE, has introduced a 

streamlined digital workflow that connects the Lava C.O.S. 

Intra-Oral Scanner to the Straumann ® CARES ® Digital Solutions 

platform. Parallel to the Cadent iTero ® intraoral scanner, 

dentists using the Lava C.O.S. scanner are now able to 

transfer digital scan data of the patient’s oral geometry to 

the dental lab using the Straumann ® CARES ® system. The 

CARES ® platform offers seamless connectivity to thousands 

of scanners in dental practices worldwide. 

CARES ® 7.0: the open standard software platform 

Straumann ® CARES ® Visual 7.0 offers a wide range of 

benefits: the advantages of a flexible, open software 

standard – through the Dental Wings Open Software 

(DWOS ® ) software core – and the quality and predictability 

of the validated workflow of Straumann ® CARES ® – through 

specific Straumann software applications. Powered by the 

combined resources of the partners, the CARES ® platform 

strives for the leading role in dentistry and provides you 

with access to future high-class developments of the digital 

dental industry.



29 

3. vArieTY Of MANUfAcTUriNG OPTiONS 4. vArieTY Of PrOSTheTic OPTiONS 

VALIDATED STRAUMANN WORKFLOWS 

Straumann milling centers 

HIgH qUALITy RESTORATIONS 

For modern implant and restorative dentistry: 

Customized Straumann ® CARES ® Abutments (Ti, ZrO 2 

), 

Straumann ® CARES ® Screw-retained bars and bridges 

(CoCr, Ti) 

Copings, crowns and bridges, inlays, onlays and veneers 

Resin nano ceramic: 

3M ESPE Lava Ultimate Restorative Ceramics: zerion ® 

(ZrO 2 

), IPS e.max ® CAD, IPS Empress ® CAD, VITA Mark II, 

ExTERNAL WORKFLOWS 

Via open STL format 

VITA TriLuxe 

Metals: ticon ® (Ti), coron ® , (CoCr) 

Polymers: polyamide, polycon ® ae, polycon ® cast 2 

Straumann milling centers: specialists in prosthetics 

Straumann has a strong and long-time expertise in CADCAM 

manufacturing of prosthetic restorations in industrialgrade 

precision and quality. The high reliability of these 

restorations is based on Straumann’s strategy of validated 

design software and manufacturing that are compatible 

with each other. Via the Straumann milling centers, design 

expertise is offered as a service for complex restorations 

A leading material and application range 

The Straumann ® CARES ® Digital Solutions portfolio provides 

a leading range of CADCAM materials and applications – 

according to your needs of serving your customers’ requests 

and of working cost-effectively without compromising on 

quality: from single-tooth restorations to 16-element bridges 

and from well-known to innovative materials like the new 

3M ESPE Lava Ultimate Restorative. 

such as screw-retained bars and bridges, and as a scan 

service for customized abutments 1 . 

1 2 

Scan service available in Germany only burn out resin, not for clinical use 

IPS Empress ® and IPS e.max ® are registered trademarks of Ivoclar Vivadent AG, Liechtenstein. 3M, ESPE, Lava are trademarks of 3M or 3M ESPE AG. 

Used under license in Canada.



The iNTrAOrAL wOrkfLOw 

The Straumann Digital Workflow for Implant Restorations: 

Designed to be Simple, Accurate and Efficient 

The conventional prosthetic workflow using traditional impression taking, casting and waxing techniques 

can lead to inconsistent impression quality due to human errors. This can result in poor clinical and 

esthetic outcomes and time-consuming adjustments during seating. Digitalizing these processes can 

improve this situation from both a professional and business perspective. 

From the intra-oral scan to the final restoration 

Straumann offers a new and complete digital workflow for implant restorations. Starting with an intra-oral 

scan of the implant site, the customized Straumann ® CARES ® Abutment or full contour crown is designed 

to provide accuracy together with time and cost efficiency through the whole restorative procedure. 

This kind of digital workflow for implant restorations eliminates cumbersome and time-consuming manual 

steps in dental practice and in the laboratory. Digital impressions allow immediate quality control by 

the dentist, and result in an excellent impression being sent to the laboratory. The workflow therefore 

eliminates or reduces impression retakes and restoration remakes, ensuring that seating appointments 

are efficient due to the excellent occlusion and contact-points of the restoration.



31 

deNTiST 

Scan the scanbody directly on the implant 

with iTero intra-oral scanning and send 

the digital data to your partner laboratory. 

LABOrATOrY 

Design the customized Straumann ® CARES ® 

Abutment in Straumann CARES Visual and 

send data to the Straumann milling center 

for production. 

LABOrATOrY 

Finalize the restoration using the highprecision 

Straumann ® CARES ® Abutment, 

iTero model, Straumann Repositionable 

implant analog, and full contour crown. 

deNTiST 

Serve patient with high-quality customized 

restoration designed to provide optimal 

function and esthetics.

32 STARGET 1 I 12 Straumann ® C areS ® digital S olutionS 

3M eSPe LAvA ULTiMATe reSTOrATive 

A New Dimension for Dental Materials 

3M ESPE and Straumann have partnered up to offer a 

new CADCAM restorative material, 3M ESPE Lava 

Ultimate Restorative, through Straumann ® CARES ® Digital 

Solutions. The material is based on Resin Nano Ceramic 

(RNC) technology, defining a new material class that combines 

the benefits of ceramic based on true nano technology 

and highly cross-linked resin. 1 

Entering the field of nanotechnology 

The field of nanotechnology has expanded dramatically as 

nanostructured materials exhibit unique properties on the macroscale 

that offer high-potential technological benefits. Typically, 

the critical properties of nanomaterials are attributable 

to internal structures between 1 and 100 nanometers in dimension, 

defining the nano world. In comparison, a human 

hair is about 200,000 nanometers in diameter, and a typical 

virus is about 100 nanometers long, a size which is at the 

outer boundaries of nanotechnology. As size is decreased to 

nanoscale dimensions, physical properties, e.g., optical characteristics, 

get altered, especially when size nears the molecular 

scale, meaning < 5 nm. These unique properties are in 

the focus when research starts its innovative work to achieve 

materials with greatest efficiencies. In the dental field, 3M 

ESPE Lava Ultimate Restorative offers an advanced dental 

material designed and engineered to be tooth-like and to 

deliver workflow advances. 

Human hair: Ø 200,000 nm 

Virus: Ø 100 nm 

Nano particle: Ø 1-100 nm 

1 

3M, ESPE, Lava, Ultimate Restorative is available with release of Straumann ® CARES ® Visual 6.2



33 

Straumann ® CARES ® Restoration made of 3M ESPE Lava Ultimate Restorative. Courtesy of 3M ESPE Ag.



MATeriAL deScriPTiON 

3M ESPE Lava Ultimate Restorative is a Resin Nano Ceramic containing approximately 79 % 

surface-modified nanoceramic particles. The ceramic particles are made up of three different ceramic fillers 

(of silica and zirconia) ranging between 4 and 20 nm that reinforce a highly cross-linked polymeric matrix. 

The ceramic fillers are a combination of: 

Silica filler: non-agglomerated/non-aggregated, 20 nm 

Zirconia filler: non-agglomerated/non-aggregated 4 to 11 nm 

Zirconia/silica cluster filler: aggregated, comprised of 20 nm silica and 4 to 11 nm zirconia particles 

According to 3M ESPE 

Bonded zirconia/silica nano particles clustered and surface treated in a proprietary process. Courtesy of 3M ESPE AG.



35 

rNc – A New MATeriAL cLASS 

3M ESPE Lava Ultimate Restorative is a new CADCAM material based on Resin Nano Ceramic 

(RNC) technology, which is defined as a new material class. RNCs consist of nano ceramic components 

embedded in a highly cross-linked polymeric matrix. The true nanotechnology imparts excellent esthetics, 

strength and wear resistance. Using RNC technology 3M ESPE Lava Ultimate Restorative is designed 

to support a streamlined, flexible workflow. 

» Brilliant esthetics – Resin Nano Ceramic for lasting polish 

The physical properties of 3M ESPE Lava Ultimate Restorative make this material very similar to 

the natural translucency and fluorescence of the teeth in its behavior. The Straumann ® CARES ® Restorations 

made of it have a glossy appearance when delivered. An easy polishing step taking less than 4 minutes 

makes the restoration highly brilliant. 

» 10-year limited warranty* – Designed to be durable for reliable restorations 

The high flexural strength and fracture toughness of the 3M ESPE Lava Ultimate Restorative material 

make it a strong one-piece restoration. It is not brittle, allowing for chipping-free restorations. The material 

properties make it possible for the Straumann milling centers to produce thin and minimally invasive 

restorations, which also open up new treatment possibilities. 

» Maintains functional balance – Absorption of chewing forces and less wear to opposing enamel 

The nanoceramic technology makes it very kind to the opposing tooth regarding abrasion. 3M 

ESPE Lava Ultimate Restorative absorbs chewing forces and brings a new quality to all single tooth 

restorations. 

iMPrOved wOrkfLOw ThrOUGh AdvANTAGeS iN PrePArATiON ANd hANdLiNG 

The high efficiency of the workflow made possible with 3M ESPE Lava Ultimate Restorative is of 

special interest for both dental labs and dental practices. 

*If all the conditions of the Straumann Guarantee ® are fulfilled and if the material is used in strict compliance with approved 

indications and instructions for use of 3M ESPE.



» No further processing or firing 

Once the Straumann ® CARES ® Restorations made of 3M ESPE Lava Ultimate Restorative are milled 

and delivered to the dental professional – no firing is required before being seated. The restoration can 

be polished, characterized with light-cured restoratives, and the anatomy can be changed by addingon 

or build-up. The abolition of the firing step specially emphasizes the new material category RNC of 

3M ESPE Lava Restorative. 

» Easy adjustment. Adjustments and customizations can be carried out extra-orally or intra-orally with 

light-cured composite, such as 3M Filtek Supreme xTE Universal Restorative / 3M Filtek Ultimate 

Universal Restorative, for excellent esthetic match. 

» Benefits for dentists, dental labs and patients. Straumann ® CARES ® restorations made of 3M 

ESPE Lava Ultimate Restorative deliver esthetics without the requirement of further processing steps. 

They offer advantages across the dental workflow which are of true benefit to dentists, dental labs and 

patients. 3M ESPE Lava Ultimate Restorative offers high control and efficiency. 

STrAUMANN – SPeciALiST iN cAdcAM PrOSTheTicS 

The new 3M ESPE Lava Ultimate Restorative is indicated for single tooth restorations and can only 

be processed by using modern CADCAM technology. 3M ESPE and Straumann have partnered up 

to offer 3M ESPE Lava Ultimate Restorative, through Straumann ® CARES ® Digital Solutions. The 

backing of Straumann as a reliable provider supports the opportunities this material offers through highlevel 

milling expertise and qualitative prosthetic outcomes. New treatment options are possible using 

3M ESPE Lava Ultimate Restorative via the Straumann milling centers – specialists in CADCAM 

prosthetics. 

For more detailed information on 3M ESPE LAVA Ultimate Restorative, please go to website http://solutions.3m.com/wps. 

portal/3M/en_US/3M-ESPE-NA/dental-professionals/products/category/digital-materials/lava-ultimate/. 

3M, ESPE, Lava, Filtek are trademarks of 3M or 3M ESPE AG.



37 

BeNefiTS fOr deNTiSTS, deNTAL LABS ANd PATieNTS 

1. DATA DIgITALIzATION 4. PROCESSINg / POLISHINg 

Multiple data sources with Straumann ® CARES ® 

Digitalization of patient situation with various scanners, the 

intraoral scanners iTero ® or Lava C.O.S. and the Straumann ® 

CARES ® Scan CS2 desktop scanner. 

No firing required after milling 

An additional polish makes the restoration highly brilliant. 

2. DESIgN 5. SEATINg 

Validated workflow through Straumann CARES Visual 

Quality and predictability of the validated workflow via the 

specific Straumann software applications. 

Easy adjustment 

Adjustments and customizations can be carried out with lightcured 

composite. 

3. PRODUCTION 6. PATIENT 

Straumann CARES restorations in high Straumann quality 

Thin and minimally invasive restorations made of 3M 

ESPE Lava Ultimate Restorative via the Straumann 

milling centers. 

Less wear to opposing enamel 

3M ESPE Lava Ultimate is not brittle, allowing for chipping 

free restorations. It shows no abrasion or opposite tooth 

damage. 

ShAdeS AvAiLABLe 

Eight shades available, four of which include high translucency 

HIGH 

Transluscency 

LOW 

Transluscency 

Courtesy of 3M ESPE AG 

A1 A2 A3 A3.5 B1 C2 D2 Bleach



iNTerview 

Scanning 2.0: Digital Impression-Taking 

with iTero



39 

An interview with Michael Rynerson, Straumann Global Head 

of iTero Sales, on the iTero intraoral scanning system. 

How do you view the market acceptance for a system such 

as itero? 

Interest in digital impression-taking is truly tremendous. In 

particular, we have experienced this at congresses where the 

system is demonstrated live. Commercially, the iTero system 

with its highly developed 3D technology has gained a leading 

position in the USA. We also enjoy widespread interest from 

dentists and dental laboratories across Europe, where we 

have achieved a leading position in intraoral scanning in 

some markets. There are a number of good reasons for 

deciding in favor of iTero: user-friendliness, precision, and 

efficiency – also in terms of time and costs. Of course there 

is an emotional element too – many of our customers are 

passionate about adopting great new technologies for the 

benefit of their patients. 

What role does itero play in the Straumann portfolio? 

Intraoral scanning is an integral part of our digital portfolio 

because it is the most direct link between the restorative 

dentist, the laboratory, and our CARES ® production centers. 

Our focus is on solutions which enable our customers to offer 

their patients the best possible treatment available on the 

market. The advantages of iTero make intraoral scanning a 

key technology in dentistry and, thus, of interest to all dental 

professionals. 

Straumann implants. True to the motto of our digital portfolio 

“Seamless Connections,” Straumann will now take the next 

step together with our customers. The new digital workflow 

is the basis for increasing efficiency and quality, and 

facilitates the cooperation between surgeons, dentists, and 

dental laboratories significantly. We view digitalization as 

a pronounced added value for customers at every stage of 

the workflow. 

“The role as a center of digital competence makes 

the laboratory an important partner for the dentist.” 

Michael Rynerson 

Can you explain digital workflow for implants in more detail? 

Following the recovery period, a scanbody is screwed onto 

the implant. The dentist scans the scanbody and the adjacent 

teeth in sequence and immediately sees on the screen the 

completed digital impression. The scanbody provides the 

necessary data on the position of the implant in the scan. 

Then the data is forwarded to the laboratory for the design of 

the customized Straumann CARES abutment in CARES Visual. 

The laboratory sends the production data to Straumann 

for fabrication of a CARES custom abutment, and orders a 

precision-milled iTero model from an iTero Regional Milling 

Center. The laboratory orders a Straumann Repositional 

Implant Analog that fits into the iTero model. 

are there any innovations especially for implantologists? 

As an innovative company, Straumann has developed a 

complete digital workflow, from intraoral scans to Straumann ® 

CARES ® copings and crowns, to customized abutments for 

are dental laboratories also a target group for itero? 

In most cases modern dental laboratories are already centers 

of competence for digital technology – with CADCAM 

being a top subject for some time now. This role as a center



of digital competence makes the laboratory an important 

partner for the dentist. Thus, the iTero system also offers the 

dental laboratory new service opportunities. This is of special 

value because cooperation is closely linked via the intraoral 

scan workflow. 

are there other possibilities for using itero as part of the 

digital workflow? 

We are presently uniting the various workflows to provide 

optimum compatibility. For example, our surgical planning 

software, the Straumann ® Guided Surgery System, combines 

the DVT and CT information on the bone situation to a 3D 

image for implant planning. Even today, we can already 

combine such data sets with intraoral scanning information 

to provide better documentation on the bone, soft tissue and 

tooth situation. This allows improved surgical and prosthetic 

planning. 

Cadent, the manufacturer of itero, is part of align 

technology as of april 2011. What are the implications? 

Align Technology is a heavyweight in the orthodontic industry 

and includes invisalign in its portfolio, a well-known and 

widely used digital service for orthodontic treatments. 

Therefore Align truly understands digital dentistry, as well 

as knowing the needs of dental professionals, making them 

an ideal new home for the iTero technology. Furthermore, 

because Straumann is the exclusive distribution partner for 

iTero in Europe, and, since February of this year, also official 

distribution partner for iTero in North America, Straumann is 

one of the closest and most important partners of Align. Our 

cooperation to date with Align has been superb and we are 

enthusiastic about continuing our partnership. 

What does the future hold in your opinion? 

For me it is not a question of will the majority of dentists 

work predominantly with intraoral scanners, but when will 

this become reality. We have all seen a similar revolution 

in photography. Who still uses film cameras these days? 

Popular smartphones are another good example of how 

digital impression technology will evolve. iTero is comparable 

to smartphones in so far as it is a platform for a range of 

dental services that can be expanded through the installation 

of new software applications. If you will, iTero is an 

extremely precise digital 3D camera with which dentists can 

already cover a wide range of restorative and orthodontic 

indications today. Future developments of the software and 

connected services will generate added value. In short, 

if somebody purchases an iTero scanner today, they 

should have confidence that it will continue to gain in value 

through software innovations. The system already generates 

considerable added value, we are only really at the beginning 

of this technology – the development potential for the next 

few years is enormous. For example, in future one could well 

imagine taking 3D “snapshots” of patients at their first visit 

and after subsequent treatments. Thus, dentists could not only 

document tooth situations in a digital manner, but would be 

better able to assess future developments in the patient’s oral 

condition. Today, dentistry is still very reactive in many cases 

– using digital tools dental professionals will be able to be 

much more proactive.



41 

iNTrA-OrAL ScAN viA iTero 

The highly advanced intraoral scanner iTero 

utilizes parallel-confocal 3D imaging and is 

thus 100 % powder-free and autofocus. Both 

features allow the dentist to place the scanning 

head directly on the teeth to take a series of 

3D images which are combined into a precise 

3D representation of the patient’s teeth. This 

provides stable handling as well as high precision 

and is often more pleasant for the patients 

than conventional methods. iTero guides the 

treating professional from tooth to tooth, similar 

to an automobile navigation system. The 

scanner is not only easy to operate, but also 

inspires patients as they can follow every step 

on the screen.

DID yOU KNOW? 

Straumann is the #1 dental implant system worldwide

eS torative 


43 

ALL-cerAMic reSTOrATiONS 

Straumann ® Anatomic IPS e.max ® Abutment 

by Straumann ® and Ivoclar Vivadent ® 

Combining Outstanding Properties – Now Available for NC 

Straumann is the partner of choice for innovations in implant 

and restorative dentistry. Ivoclar Vivadent is the established 

specialist in ceramic materials and final restorations. The 

synergy of technologies has resulted in a premium esthetic 

solution: the Straumann Anatomic IPS e.max Abutment, now 

also available for Narrow CrossFit ® (NC). 

Esthetics by Design 

Designed by Straumann and produced by Ivoclar Vivadent 

to fit a range of patient needs, this abutment is specifically 

intended for reliable use and esthetic results and offers great 

flexibility in its application. It gives you the high-end esthetics 

of a custom restoration in combination with the flexibility and 

predictability of a stock abutment. 

High-end esthetics: all-ceramic zirconium dioxide (ZrO 2 ) 

material in two shades for natural-looking restorations. 

Effectiveness: pre-shaped abutment, straight and angled 

design in two gingival heights for cost-efficient restoration. 

Predictability: Straumann Anatomic IPS e.max Abutment – 

strong connection between the implant and the restoration. 

Flexibility: modifiable abutment (chair-side and lab-side) for 

screw-retained and cemented all-ceramic restorations. 

Now also available for Straumann ® Narrow CrossFit ® (NC) Bone Level implants 

Color: white (MO 0) 

Article No. 022.2812 022.2814 022.2822 022.2824 

Color: Shaded (MO 1) 

Article No. 022.2832 022.2834 022.2842 022.2844 

GH 2 mm GH 3.5 mm GH 2 mm GH 3.5 mm

» 

» 


reS torative 

Screw-retained full ceramic restorations 

Cemented full ceramic restorations 

» 

directly veneered 

individualized emergence profile 

» 

overpressed 

cemented 

The abutment serves as an excellent basis for cost-efficient 

restorations for those clinicians looking to transition into the 

all-ceramic world of dental restorations. 

» Different shades 

» Different gingival heights 

» Straight and angled 

» RC and NC 

shaded (MO 1) white (MO 0) 

IPS e.max ® is a registered trademark of Ivoclar Vivadent AG, Liechtenstein.

eS torative 


45 

cOrBiN PArTridGe ANd BreNT GArriSON 

Immediate Full Mouth Restoration Using Implant-Supported 

Fixed Hybrid Prosthetics 

Initial Situation 

A 49-year-old woman with an unremarkable medical history 

presented for a full mouth extraction. Severe periodontal 

disease was present in addition to mobile teeth and noted 

bone loss (figs. 1, 2). She indicated that she wanted to 

have an implant-supported fixed prosthesis in order to avoid 

having to wear traditional dentures long term. 

maxilla using the implant planning software. Four Straumann ® 

Bone Level implants 1 were planned for the maxilla and four 

Straumann ® Soft Tissue Level implants 2 were planned for the 

mandible (figs. 3, 4). The posterior implants in the areas 

of #14 and #25 were angled to avoid the sinus and still 

provide for first molar occlusion in the final prosthesis. A 

guided surgical stent was then ordered through the software 

for the maxilla. The referring office supplied the immediate 

Treatment Plan 

A CT scan was performed and converted into implant 

planning software. Upon examination of the CT scan and 

denture prior to surgery. The patient was scheduled for surgery 

approximately one month after the second consultation to 

allow for creation of the stent and immediate dentures. 

reconsultation with the patient, it was determined that four 

implants in each arch would be placed to support a fixed 

prosthesis. Using the converted scan, the implant sizes and 

locations were planned for both the mandible and the 

Surgical Procedure 

The initial phase of the surgery involved removing all of the 

existing teeth with the exception of the #38 and #48, due 

Fig. 1 Fig. 2 Fig. 3 

Fig. 4 Fig. 5 Fig. 6


reS torative 

to nerve involvement. The patient was sedated and the teeth were extracted as 

atraumatically as possible. Once the teeth were removed, the maxillary arch was 

exposed and the surgical stent was secured to the maxilla. The osteotomies were 

performed through the guide using a Straumann ® Guided Surgical Kit with a 

final drill diameter of 3.5 mm (fig. 5). Stabilization pins were used to secure the 

stent while other osteotomy sites were prepared. The four Straumann ® Bone Level 

implants were then placed with primary stability using a hand piece at 35 Ncm 

(fig. 6). Sutures were used for ridge closure in a continuous and interrupted fashion. 

Corbin G. Partridge, DMD 

Oral and maxillofacial surgeon. Full-time private 

practice at Northeast Oral and Maxillofacial 

Surgery in Indianapolis, Indiana. He has published 

several papers in both the Journal of Oral and 

Maxillofacial Surgery and the Journal of the Indiana 

Dental Association. He served in the U.S. Army as 

Attention was then directed to the mandible, where osteotomies were performed 

in the areas of #36, #33, #43 and #46. The Standard Plus implants were placed 

in the anterior sites #33 and #43. The Regular Neck Tapered Effect implant 

was placed in the area of #36 and the Wide Neck Tapered Effect implant was 

placed in the area of #46 (fig. 7). All implants were placed with primary stability 

using a hand piece at 35 Ncm. No sutures were required as the mandibular ridge 

was not exposed. 

the Executive Officer of the Head and Neck Surgery 

Team with the 47 th Combat Support Hospital in 

Mosul, Iraq during Operation “Iraqi Freedom“ 

2005 – 2007. He is an ITI member. 

cpartridge@neomsindy.com 

Fig. 7 Fig. 8 

Fig. 9 

Fig. 10

eS torative 


47 

Prosthetic Procedure 

Immediately after the implants were placed, impression posts were attached and 

impressions of both arches were taken. After the impressions were taken, healing 

caps were placed on all implants, the impressions and immediate dentures were 

sent to the lab, and the patient left the office. Using the impressions, the lab 

converted the immediate dentures into screw retained immediate prostheses, which 

were heat cured overnight (figs. 8 – 10). The patient returned to the office the next 

day for placement of the provisional prostheses. The healing caps were removed 

and the appropriate abutments were placed. The maxillary prosthesis was placed 

over the abutments and attached using four screws, with the mandibular prosthesis 

fixed in a similar fashion (figs. 11, 12). The patient’s bite was adjusted using a 

handpiece with a denture bur. Once the adjustments were finished and the patient 

was satisfied with her bite, a temporary filling material was placed in the screw 

holes of the prostheses and final x-rays were taken (figs. 13 – 17). The patient was 

given instructions for post-op hygiene and told not to chew for eight weeks to allow 

Brent T. Garrison, DDS, MSD 

Oral and maxillofacial surgeon. Full-time private 

practice at Northeast Oral and Maxillofacial Surgery 

in Indianapolis, Indiana. He has published several 

articles and given numerous presentations on all 

aspects of oral and maxillofacial surgery. He has 

served terms as President of the Great Lakes Society 

of Oral and Maxillofacial Surgery, the Indiana 

Society of Oral and Maxillofacial Surgeons and the 

Indianapolis District Dental Society. He is Assistant 

Clinical Professor of Oral and Maxillofacial Surgery 

at the Indiana University Medical Center. He is an 

ITI member. 

bgarrison@neomsindy.com 

Fig. 11 Fig. 12 

Fig. 13 Fig. 14


reS torative 

for proper integration, after which a limited soft-chew diet was recommended. This 

is recommended due to the limited strength of the provisional prostheses, which 

serve a more esthetic rather than functional purpose. 

Outcome 

The patient returned to the office for her one week check, and was healing 

well. She will wear the provisional fixed prostheses for approximately six months, 

allowing the ridges to form fully and heal. At this time, she will return to the office 

for final impressions, which will be used by the laboratory to create the permanent 

bar retained prostheses. Combining the milled bar-retained prostheses with the 

splinted Straumann ® SLActive ® implants will result in a strong and permanent 

alternative to traditional dentures. 

1 

4x Straumann ® Bone Level Implant RC Ø 4.1, 12 mm SLActive. 2 2x Standard Plus RN Ø 3.3, 12 mm 

SLActive/1 x Tapered Effect WN Ø 4.8, 12 mm WN/1 x Tapered Effect RN Ø 4.1 x 10 mm) 

Fig. 15 

Fig. 16 

Fig. 17


S urgiC al 

STrAUMANN ® SLactive ® 

Updated SLActive Scientific Evidence Brochure 

The Straumann SLActive implant surface offers confidence in all treatments thanks to its unique properties of hydrophilicity 

and chemical activity, which help to accelerate the osseointegration process. 1 The excellent osseoconductive properties of 

the SLActive surface have been supported by numerous preclinical and clinical studies. 

Now clinicians can access the updated SLActive Scientific Evidence Brochure to review some of the key scientific studies 

supporting the SLActive implant surface. The newly available and updated version of the SLActive Scientific Evidence Brochure 

features summaries of 14 preclinical and 7 clinical studies on SLActive. A few new clinical studies from this information-rich 

brochure are highlighted below. If you wish to have an SLActive Scientific Evidence Brochure sent to you, please contact your 

local Straumann territory manager or contact the Straumann Customer Service team at 800/448 8168. 

A prospective study on 3 weeks loading of chemically modified 

titanium implants in the maxillary molar region: 1-year results 

M. Roccuzzo, T.G. Wilson Int J Oral Maxillofac Implants 2009;24:65–72. 

Abstract: SLActive ® implants were placed in the posterior 

maxilla, which tends to have lower bone density, and loaded 

after 3 weeks. Preliminary results suggest no complications 

and no early implant failures in this challenging indication. 

Conclusions 

• Successful functional loading is possible in the maxillary 

molar region after 3 weeks with SLActive implants 

• Implant survival was 100 % after 12 months in low 

density bone 

• The procedure represents an important step toward faster 

healing and increased treatment predictability 

Early loading of nonsubmerged titanium implants with a 

chemically modified sand-blasted and acid-etched surface: 

6-month results of a prospective case series study in the 

posterior mandible focusing on peri-implant crestal bone 

changes and implant stability quotient (ISQ) values 

Bornstein MM, Hart CN, Halbritter SA, Morton D, Buser D. 

Clin Implant Dent Relat Res 2009;11(4):338-347. 

Abstract: Forty patients received 56 SLActive ® implants, 

which were functionally loaded after 3 weeks. Implant 

stability (ISQ) was measured at various time points for up 

to 26 weeks and showed a steady increase from implant 

placement to week 26. 

Conclusions 

• Early loading with SLActive implants 3 weeks after placement 

in the posterior mandible has a low risk for early 

failures 

• Definitive functional restoration after 3 weeks is possible 

1 

Compared to SLA in an animal model

S urgiC al 


51 

Early loading at 21 days of non-submerged titanium 

implants with a chemically modified sandblasted and 

acid-etched surface: 3-year results of a prospective stu dy 

in the posterior mandible 

Bornstein MM, Wittneben J-G, Brägger U, Buser D. J Periodontol 

2010;81(6):809-818. 

A multicenter prospective ‘non-interventional’ study to 

document the use of and success of Straumann ® SLActive 

implants in daily dental practice 

Luongo G, Oteri G. 24th Annual Meeting of the Academy of Osseointegration, 

February 26-28, San Diego, CA, USA; poster P220. J Oral Implantol 2010; 

36(4):305-314. 

Abstract: SLActive ® implants were placed in patients and 

functionally loaded after 21 days; clinical and radiographic 

parameters were evaluated for up to 36 months. No implants 

were lost and clinical attachment levels and probing depths 

were improved versus historical SLA ® controls. 

Conclusions 

• Early loaded SLActive implants can achieve and maintain 

successful tissue integration over 3 years 

• The procedure offers rehabilitation with a definitive restoration 

after 3 weeks, increasing cost-effectiveness for the 

patient 

• Loading after 3 weeks can be recommended in defined 

clinical situations for standard sites without bone defects 

Abstract: A multicenter non-interventional study was 

conducted, in which 276 SLActive implants were placed and 

documented in 218 patients according to situations where 

implants would normally be placed. After 1 year the survival 

and success rate was 98.2%, similar to that observed in 

strictly controlled clinical trials. 

Conclusions 

• The 1-year cumulative survival and success rate was 98.2% 

• All failed implants were associated with a simultaneous 

sinus floor augmentation procedure 

• The success rate of SLActive implants in daily practice is 

similar to that observed in formal clinical trials with strictly 

controlled patient populations


international team for implantology 

Straumann & Baylor University Launch the 

First Interdisciplinary Digital Dentistry Course 

On July 29-30, 2011, twenty-four dental professionals braved the Dallas, Texas drought and 100+ 

degree temperatures to learn about the digital dentistry workflow at Baylor University’s College 

of Dentistry. 

Over the course of two days, the participants—comprised of clinicians and lab technicians—learned 

about where the dental world is headed and how interdisciplinary digital dentistry will continue to play 

a larger part in their practices and labs. The course, cosponsored by Straumann, was designed for 

the interdisciplinary team (surgeon, restorative dentist and lab technician) to attend and learn about 

the different digital technologies available to each member of the team, and to understand how each 

team member and their technology plays a role in achieving optimal patient care and esthetic results. 

Participants were exposed to all of the links in the digital dentistry chain, including Straumann Guided 

Surgery Planning Software, the gonyx table, the iTero scanner, and the CS2 scanner. 

It was a jam-packed two days, filled with lectures, case presentations and hands-on sessions. 

Participants learned how to treatment plan implant cases with the Straumann Guided Surgery treatment 

planning software and how a radiographic template and surgical guide can be made with precise 

accuracy on a gonyx table. They also experienced firsthand how to take an intra-oral impression with 

an iTero system and how to open an iTero file into the CS2 CADCAM scanner and design a coping, 

abutment or crown. 

It was an excellent course, and many of the attendees left excited to start incorporating digital dentistry 

into their practices. 

The advice from previous attendees is to register as a team- many who came alone said they wished 

they had brought their interdisciplinary team members. 

Baylor will host this course again July 27-28, 2012. If you are interested in learning more about 

the Interdisciplinary Digital Dentistry Courses, please contact the Straumann Education Department at 

800/448 8168 and press 5, or register on the Baylor CE website at: http://www.bcdce.com/courses/ 

course/category.php?id=2

international team for implantology 


53 

ITI Membership Tops 10,000 

Basel, Switzerland – The International Team for Implantology 

(ITI), a leading academic organization dedicated to the 

promotion of evidence-based education and research in the 

field of implant dentistry, announced on October 17, 2011 

that it had welcomed its 10,000th member. This achievement 

marks another milestone in the 31-year history of the ITI. 

This growth is due in large part to the recently launched 

ITI Study Club concept, which has evoked an overwhelming 

response around the globe. Exceeding its own expectations, 

the ITI to date has established more than 500 Study Clubs on 

every continent. Free participation in ITI Study Clubs as part 

of the annual benefits package has proven to be a significant 

membership value. ITI Study Clubs are characterized by an 

approach to learning through presentations and interactive 

discussion in relatively small groups at a local level. They 

represent an efficient platform from which to disseminate and 

exchange knowledge on the latest treatment approaches in 

implant dentistry. 

The 10,000th member of the ITI is Dr. Jocelyn Shand, a 

well respected Oral & Maxillofacial Surgeon from the Royal 

Children’s Hospital, University of Melbourne and President 

of the Australian & New Zealand Association of Oral & 

Maxillofacial Surgeons. She was welcomed personally by 

the ITI President Prof. Dr. Daniel Buser and the leadership 

team of the ITI Section Australasia. 

“We are very pleased with the current membership 

development and the opportunity to welcome our 10,000th 

member,“ said Prof. Buser. “The continued growth of the 

ITI, which is a result of the systematic implementation of our 

strategic Vision 2017 developed in 2007, is a clear sign of the 

strong demand by colleagues for evidence-based education 

and treatment guidelines that are delivered independently of 

commercial interests.“ 

“I heard about the ITI several years ago and since then traced 

its activities,“ said Dr. Shand. “After attending several ITI 

education courses in Melbourne and working with a number 

of esteemed ITI Fellows in Australia including Dr. Anthony 

Dickinson and Dr. Stephen Chen, I was immediately drawn 

to becoming a member of this global organization with its 

wealth of benefits that will significantly enhance both my 

professional activities and international perspectives.“ 

Established in 1980 by a small group of visionary pioneers 

led by Prof. Dr. André Schroeder and Dr. Fritz Straumann, the 

ITI has championed the cause of implant dentistry since the 

early days, playing a continuous role in its development to 

the present day. Today, the organization has a true global 

presence through its 27 national or regional Sections. The 

ITI takes a leading role all over the world in continuing 

dental education and the development of standard treatment 

methods to ensure reliable outcomes. In addition, the ITI is the 

largest non-governmental organization worldwide to award 

research grants in implant dentistry. 

The ITI welcomes all appropriately qualified professionals with 

an interest in implant dentistry as members of the organization. 

Membership of the ITI offers a wealth of benefits and the 

highest quality educational support as well as the opportunity 

to meet likeminded professionals through the extensive event 

schedule. Dental practitioners who are interested in finding 

out more or joining the ITI should go to www.iti.org.



deNTiSTrY ON The MOve 

Global Trends – Setting the Pace of Innovation 

and Progress in Dentistry



55 

Where are We Headed? 

How will the world’s demographics, technologies and economies develop in the future? Will these 

developments impact implantology, dentistry and the other related medical disciplines? The answers 

to these questions determine how Straumann designs our products and services, and how we drive 

innovations. Perhaps the most globally influential trend is the aging population and the attendant need 

for health services, including restorative dentistry. Practices of the future will look different than those 

of today. 

In the Beginning, There Was Titanium 

In the 1970s, the discovery of titanium’s osseointegrative properties and high compatibility with the 

human body led to the development of dental implants for the replacement of lost teeth and anchoring 

of prostheses. Key advantages of implants over conventional denture techniques allowed manufacturers 

and specialized dentists to develop a new discipline of dentistry, which has since evolved into today’s 

standard treatments with restorative dentistry. 

The Excitement Continues 

Nearly forty years after discovering the osseointegration of titanium, we are entering the next quantum 

leap in dentistry: the digitalization of restorative dentistry. This will have tangible effects on the way 

we look at various occupations and, in turn, how dental experts work together. New products and 

innovations are constantly developed, potentially leading to new treatment opportunities. 

STARGET interviewed three prestigious dental specialists on trends and new technologies in restorative 

dentistry: lyndon Cooper, Kenneth malament and daniel Wismeijer.



restorations on a metal frame? Zirconia? What if the patient 

only has enough bone for 6 mm implants? Should we graft 

LYNdON cOOPer 

Stallings Distinguished Professor, 

Professor & Chair, Dept. of 

Prosthodontics; University 

of North Carolina School of Dentistry 

bone and place 8 mm or 10 mm implants, or is 6 mm enough? 

I’m not suggesting there is only one answer, but together the 

profession and industry can use evidence to determine which 

therapies provide maximum return on patient investment with 

a minimal number of interventions and components. 

What about standards for products? 

How can the implant industry serve its customers better? 

Implant therapies are evolving rapidly, yet dentists with 

mature practices learned little about implants in dental school 

10 years ago. The industry must continue to help educate 

dentists. There needs to be an ethical discussion between 

the industry and the profession about standards in product 

testing, documentation and training. Finally, the industry truly 

serves both patient and dentist by providing clinical data 

about the products. How many implants failed? We clinicians 

care and need to know. 

“The industry must continue to help educate dentists. 

There needs to be an ethical discussion between 

the industry and the profession about standards 

in product testing, documentation and training.“ 

Lyndon Cooper 

One implant system rarely covers everything, so you may 

need at least two different systems. There may be some value 

in diversity. However, I also see value in having evidence 

based standards and shared criteria that reflect clinical 

outcomes. It would be good to have efficacy data for implants 

tested six to 12 months before a product is sold. The drug 

industry gathers data after the product has been introduced. 

That model might work for our very fast product evolution. 

Have we reached the limits in osseointegration? 

We continue to improve the osseointegration potential of 

implants, but we still must learn to identify high risk patients 

and develop successful strategies for them. From a broader 

perspective, our knowledge of how soft tissues integrate 

with the abutment is very immature. We need new scientific 

understanding so we can get healthy soft tissue integration 

that protects the underlying bone, stays free of inflammation 

and looks natural. 

Will dentistry develop standards of care? 

Simplification and standardization can improve the quality of 

care. For example, what possibilities exist for an edentulous 

maxilla – four, six or eight implants? Ceramic or acrylic 

is peri-implantitis a latent epidemic? 

We don’t know; we don’t fully appreciate its incidence or 

prevalence. We must acknowledge its presence and dentists 

must evaluate implants regularly for inflammation and act 

appropriately. Does the inflammation begin at the implant



57 

surface, at the implant-abutment interface, or at the abutment 

itself? The solutions could be very different. 

How has the economic crisis affected dentistry? 

US laboratories are making fewer crowns and veneers, while 

removable and complete denture volume is less affected, 

suggesting that people still need teeth but they have adopted 

a cost-conscious attitude. The growth of implant sales has 

been slower since 2008. The growing debate about 

nationalized healthcare in the US is fueling new discussion 

about access to dental care. 

complex restoration of defects. These three developments 

really open the door for tremendous growth in implant 

dentistry. 

What will the relevance of prosthodontics be in the future? 

As we move to smarter, more capable technologies, we need 

better understanding of how to create occlusion, form, color, 

and natural esthetic appearance within the whole mouth. 

These are the concerns of the specialty of prosthodontics, 

and I am very confident in its future. 

“Preventive dentistry is more successful than ever 

before, but many people don’t go to a dentist regularly, 

and their mouths show the usual levels of 

decay and periodontal problems.“ Kenneth Malament 

keNNeTh MALAMeNT 

Clinical Professor of Postdoctoral 

Prosthodontics, Tufts School of Dental 

Medicine, Boston 

What have been the most significant developments in 

prosthodontics in the past two to three years? 

Digital scanning equipment and software continues to improve. 

Then, for the very first time a material, lithium disilicate, has 

shown no signs of breakage over 2½ years. This monolithic 

material can be CADCAM’d to full contour in one step, 

unlike the bilayer materials. Finally, bone grafting materials 

and techniques have significantly improved, allowing more 

Will better prevention reduce the need for prosthodontics? 

I don’t think so. Preventive dentistry is more successful than ever 

before, but many people don’t go to a dentist regularly, and 

their mouths show the usual levels of decay and periodontal 

problems. Also, people are still affected by accidents 

and disease. Dental restorations break and cause serious 

problems. In my practice, I haven't seen any diminution of 

required care. 

are the products coming onto the market adequately tested? 

No. Look at the whole cosmetic dentistry concept, where people 

were putting plastics on everything and considering it conventional 

and thorough and long-term successful dentistry. Bacteria grow 

on and within resinous materials, and can cause serious 

breakdown when they attack tooth structure. Recent research 

on how ceramic materials flex and fracture has completely



changed the way we understand the mechanics and strength 

of ceramic materials. As we develop new materials, we must 

understand and test them better. 

are high-end esthetics out of reach for the average patient? 

Right now, access to great esthetics is limited by the supply of 

great dentist/technician teams. As we move to smart systems, 

the expertise of the best practitioners will be built into the 

software. I think CADCAM dentistry will eventually drop the 

price of dentistry, but I’m not sure when. 

“As we move to smart systems, the expertise of the 

best practitioners will be built into the software.“ 

Kenneth Malament 

What major advances do you expect in the near to mid 

term? 

Low-radiation, noninvasive CT scanning for all dental 

impressions while the patient sits in a chair. Spectrophotometric 

color analysis will help design the whole mouth on a giant 

computer monitor. 

Has the economic crisis had an effect on prosthodontics? 

No. The companies that will win in the next 10 years are 

those that best integrate the technologies and educate 

dentists and technicians. The real explosion will come from 

well-funded industrial giants who are very active players 

within the story. 

dANieL wiSMeijer 

Professor & Chairman, Dept. Oral 

Function & Restorative Dentistry; 

Head, Oral Implantology & Prosthetic 

Dentistry Section, Academic Center 

for Dentistry, Amsterdam (ACTA) 

do you think all of dentistry is going to become digital? 

A dentist’s work is two-fold: handicraft and oral medicine. It 

will be a while before we digitize interaction with the patient, 

looking at the medical and psychological background, 

diagnosis, and individual treatment design. On the handicraft 

side, digital radiography improves diagnostics and reduces 

chemical waste. Starting with oral scanning, digital 

articulators and planners will replace physical models, 

and the whole workflow will become digital, ending in 

CADCAM production. Once we get good light images of 

the teeth, a machine will also produce the prosthesis in the 

right color. 

is digitalization the most important trend in dentistry now? 

It’s where things are happening. Virtual implant planning 

is getting more precise, and computer manufacturing of 

prosthetics is getting simpler than the casting method. We 

can design the treatment digitally (site, position, implant type, 

superstructure) and insert the implants plus superstructure 

in one treatment sequence with a fault margin of 40 μm 

– the width of the thinnest human hair. Everything is more 

controllable, and if something doesn’t fit during the digital 

design phase, we can correct it before it reaches the patient. 

So the digital environment is going to be very important.



59 

What do you see as the biggest risks in digital dentistry? 

We will become more dependent on commercial software. 

Some jobs will be lost. In order to rely on machines and 

software, the safety standard must be very high. And in order to 

rely on internet communication, the transmission, security, format 

and integrity of private medical information must be ensured. 

Finally, the machines are not cheap, and it may be a long time 

before we can deliver digital dentistry at a lower price. 

What sort of innovations can we expect in the next years? 

Improved navigation, so the dentist can monitor inside the 

bone and teeth as he or she works. Apparatuses that convert 

hand movements into very small precise machine movements 

will make micro treatment possible. Finally, I hope companies 

agree on data standards, so all the machines and software 

can communicate with each other. 

How will technological changes affect current dentists? 

Young graduates will want to practice digital dentistry. Mature 

dentists close to retirement face the choice of investing in 

new technologies to attract young dentists who will then buy 

their practices, or continuing the old way and losing some 

of their original investment. There is no choice in between. If 

they want to stay in dentistry they will have to invest in new 

technologies. 

does digitalization get ample attention in dental education? 

Students leaving ACTA in a few years will be used to working 

with intra-oral scanning, cone beam CT scans, digital 

planning, drill guides, and CADCAM. As they join practices, 

they will show other dentists the new techniques. We are 

lucky that our school is new and so are all the fittings. Many 

other schools are looking at what we are doing, but it will 

take them time to convert.



STrAUMANN Aid: AcceSS TO iMPLANT deNTiSTrY 

A Meaningful Contribution to a Different Quality of Life 

effecTive ANd PrAcTicAL cONTriBUTiONS 

TO SOcieTY 

Providing high quality, safe, effective, and lasting solutions that 

restore dental function and enhance the quality of life is perhaps 

the greatest contribution we can make to society. In 2009, 

around a million patients spread across 70 countries invested 

in a Straumann dental solution, and we have simply done 

more to make certain that it will meet their expectations for 

many years to come. 

At the same time, many people around the world are unable to 

benefit from dental care due to geographic and economic 

limitations. As a leader in our industry and as a responsible 

corporate citizen, we believe we have a duty to help in 

a practical, meaningful way. Our aim is to ensure that our 

contributions benefit not only the recipients but also, indirectly, 

our other stakeholders. 

AcceSS TO deNTAL SOLUTiONS 

‘Straumann AID’ (Access to Implant Dentistry) is our structured 

global program to assist patients who need implant treatment 

but are unable to afford it. Through this program, we donate 

all the Straumann products necessary, relying on dentists in 

the ITI network to provide the clinical services without charge. 

SPONSOriNG deNTAL cAre ArOUNd The GLOBe 

Our strategy for corporate sponsorship is to concentrate 

primarily on charitable activities where we can have the 

greatest impact, based on our own competencies and the 

collaboration of our partners. For this reason, we focus on 

dentistry-related programs that help people who do not have 

access to dental care or cannot afford implant dentistry. 

Basic dental care and oral hygiene programs 

We continued our tradition of sponsoring charitable missions 

and activities that bring basic dental care and education 

to the underprivileged. Our contributions in 2009 included 

support for the following: 

p SDI Secours Dentaire International, treating patients 

in Tanzania 

p A team of young dentists from the University of Connecticut 

Health Center, School of Dental Medicine to provide dental 

treatment and oral hygiene to underprivileged children 

in Chile 

p The ‘Hope for All’ project to sponsor the education of two 

dental students in Cambodia 

p A team of young dentists from the Dental Institute of 

Basel University, to provide dental treatment to orphaned 

children in Cambodia 

Providing dental treatment and oral hygiene to underprivileged children.



61


p Three teams of young dentists from the Dental Institute of 

Zurich University, to provide dental treatment to children 

in the Dominican Republic, Guatemala and the Ukraine 

p The Smile Charity Foundation/Korean Universities and 

Schools of Dentistry, to improve the oral health of disabled 

persons and to provide scholarships in Korea. 

In each case the sponsorship goals were met. Thanks to the 

assistance of our dental partners, these projects have been 

an extremely efficient use of funding and have made a real 

difference to hundreds of people, most of whom are children. 

We intend to continue our global charitable activities with the 

goal of providing access to dental treatment to disadvantaged 

people. Although economic downturns frequently result in 

reduced charitable giving, we plan to continue our Straumann 

The joy of dentistry! One of several hundred children treated through dental 

projects sponsored by Straumann. 

AID program and to support the National Foundation for 

Ectodermal Dysplasia (NFED) and other relief projects. We 

will continue to focus our charitable sponsoring on fields 

related to dentistry, where we feel we have most to offer and 

where our involvement is appreciated by our stakeholders. 

Ectodermal dysplasia 

Ectodermal Dysplasia (ED) refers to a group of genetic 

disorders characterized by abnormal development of the skin 

Ectodermal dysplasia patients are typically stigmatized by severely malformed 

or missing teeth in addition to other debilitating symptoms. 

and associated structures. Patients typically have few teeth and 

the teeth they do develop are usually severely malformed. On 

average, each ED patient in the US faces dental charges of 

$28,000. This is a considerable burden because more than 

50% of patients are not covered by insurance. The NFED, 

based in Mascoutah, Illinois, is committed to providing help 

and hope to families around the globe who are affected by 

this condition. 

This picture demonstrates the tremendous difference that treatment can make.


63 

WE CONTINUE OUR TRADITION OF SPONSORING CHARITABLE 

MISSIONS AND ACTIVITIES THAT BRING BASIC DENTAL CARE AND 

EDUCATION TO THE UNDERPRIVILEGED. 

Today, several thousand individuals affected by ED in more 

than 65 countries receive services from the Foundation, 

which has provided financial assistance and information, in 

addition to connecting affected families with each other and 

with practitioners. 

Once patients reach adulthood, they can be treated with dental 

implants, which make a significant difference. Straumann 

provides free implants to ED patients, but these represent a 

small portion of the overall treatment costs. We work with 

the NFED to expand its network of dental professionals who 

provide free services to ED patients; we also support the 

foundation with financial aid. 

Cleft lips and palates (Clefts) 

Cleft lips and palates (clefts) are one of the most common 

We contribute to dental relief projects to provide treatment and instruction on 

oral hygiene to orphans. 

major birth defects in developing countries and occur in 

1 in 600 to 1000 births. Despite the fact that surgery is 

straightforward, it is not widely available, with the result that 

millions of children suffer from unoperated clefts. Although 

the condition is not usually life-threatening, patients are 

stigmatized by their appearance and have great difficulty 

in eating and speaking. Straumann contributes to non-profit 

organizations providing free surgery to children with clefts in 

developing countries. 

On-the-spot treatment in a Straumann-supported dental relief project in Gambia.



LiTerATUre ALerTS 

Selected Literature of Potential Interest from Recently 

Published Journals 

STRAUMANN ® EMDOGAIN TM 

Casarin RCV, Ribeiro Edel P, Nociti FH Jr, Sallum AW, Ambrosano 

GMB, Sallum EA, Casati MZ. Enamel matrix derivative 

proteins for the treatment of proximal class II furcation 

involvements: a prospective 24-month randomized 

clinical trial. J Clin Periodontol 2010;37(12):1100-1109. 

A total of 12 patients with bilateral proximal furcation defects 

≥ 5 mm and bleeding on probing were treated with open 

flap debridement and EDTA alone (control) or in combination 

with EMD (test). Clinical parameters were evaluated prior 

to treatment and after 6, 12 and 24 months. No significant 

differences were observed after 24 months. Probing depth 

reduction was 1.9 ± 1.6 mm and 1.0 ± 1.3 mm in the test 

and control groups, respectively, and the gain in relative 

horizontal clinical attachment level was 1.4 ± 0.9 mm and 

0.7 ± 1.3 mm in the test and control groups, respectively. 

After 24 months, only five class II furcations remained in the 

test group, compared to 10 in the control group (p < 0.05). 

STRAUMANN ® DENTAL IMPLANT SySTEM 

Bilhan H, Kutay O, Arat S, Çekici A, Cehreli MC. Astra 

Tech, Branemark, and ITI implants in the rehabilitation 

of partial edentulism: two-year results. Implant Dent 

2010;19(5):437-446. 

In 26 patients, Astra Tech implants (42), Brånemark implants 

(36) and Straumann ® implants (29) were placed; abutment 

connection was performed for the Astra Tech and Brånemark 

implants after 3 months and all implants received fixed prostheses 

after 4 months. Clinical parameters were recorded 

after 6, 12 and 24 months and radiographic bone level was 

recorded after 2 years. Implant survival was 100 % for all systems. 

Plaque index and peri-implant inflammation scores were 

higher for the Brånemark implants in the first year. Marginal 

bone loss around ITI and Astra Tech implants was similar at 2 

years (p > 0.05). The marginal bone loss around Branemark 

implants was higher than Astra Tech implants (p < 0.05) but 

similar to ITI implants at 2-year recall appointment (p > 0.05). 

Nedir R, Nurdin N, Vazquez L, Szmukler-Moncler S, 

Bischof M, Bernard J-P. Osteotome sinus floor elevation 

technique without grafting: a 5-year prospective study. J 

Clin Periodontol 2010;37(11):1023-1028. 

Osteotome sinus floor elevation was performed without grafting 

in 17 patients (mean residual bone height 5.4 ± 2.3 mm) 

and a total of 25 Straumann SLA ® implants (10 mm in length) 

were placed. Implant survival after 5 years was 100 % and 

the mean increase in peri-implant bone was 3.2 ± 1.3 mm, 

while implant protrusion into the sinus decreased from 4.9 ± 

1.9 mm at baseline to 1.5 ± 0.9 mm. Mean crestal bone loss 

was 0.8 ± 0.8 mm, which stabilized over 5 years; bone gain 

after 1 year was noted at 20 implants. Grafting is therefore 

not required for bone gain of at least 3 mm. 

Bosshardt DD, Salvi GE, Huynh-Ba G, Ivanovski S, Donos 

N, Lang NP. The role of bone debris in early healing adjacent 

to hydrophilic and hydrophobic implant surfaces in 

man. Clin Oral Implants Res 2011;22(4):357-364. 

Straumann experimental implants (4.0 mm long and 2.8 mm 

diameter) with either an SLA or SLActive surface were placed 

in the retromolar region in 28 volunteers and retrieved by



65 

trephine after 7, 14, 28 and 42 days. All surfaces were partially 

coated with bone debris and new bone formation was 

observed after 7 days. New bone gradually increased over 

time while fractions of old bone, soft tissue and bone debris 

gradually decreased. New bone was higher with SLActive 

after 2 and 4 weeks. The change in bone debris:soft tissue 

ratio changed significantly from 7 to 42 days for both SLActive 

and SLA. The bone debris:soft tissue ratio suggested that 

bone debris had a significant influence on the initiation of 

bone deposition. 

Buser D, Wittneben J, Bornstein MM, Grütter L, Chappuis 

V, Belser UC. Stability of contour augmentation and esthetic 

outcomes of implant-supported single crowns in the 

esthetic zone: 3-year results of a prospective study with 

early implant placement postextraction. J Periodontol 

2011;82(3):342-349. 

A total of 20 patients received implant-supported crowns on 

Straumann Bone Level implants in the esthetic zone, and clinical, 

radiologic, and esthetic parameters were recorded for 

3 years follow-up. All implants were successfully osseointegrated 

and stable, with good peri-implant soft tissues after 

3 years. Good results were obtained for the pink and white 

esthetic scores, with white esthetic scores being slightly superior. 

Mean crestal bone loss was 0.18 mm after 3 years; 

bone loss from 0.5 to 1.0 mm was observed at only two 

implants, one of which showed minor recession of the facial 

mucosa (< 1 mm). 

Zupnik J, Kim SW, Ravens D, Karimbux N, Guze K. Factors 

associated with dental implant survival: a 4-year retrospective 

analysis. J Periodontol 2011;82:1390-1395. 

A retrospective chart review of patients at the Harvard School 

of Dental Medicine (HSDM) who had one of two types of 

rough-surface implants (group A: Straumann SLA ® , group B: 

Nobel TiUnite ® ) placed by periodontology residents from 

2003 to 2006 was performed. Demographic, health, and 

implant data were collected and analyzed by multi-model 

analyses to determine failure rates and any factors that may 

have increased the likelihood of an implant failure. The study 

cohort included 341 dental implants. The odds ratio for an 

implant failure was most clearly elevated for diabetes (2.59) 

and implant surface group B (7.84), and male groups (4.01). 

There was no significant difference regarding the resident 

experience. The success rate for HSDM periodontology residents 

was 96.48% during the 4-year study period.



Cochran DL, Jackson JM, Bernard J-P, ten Bruggenkate 

CM, Buser D, Taylor TD, Weingart D, Schoolfield JD, Jones 

AA, Oates TW Jr. A 5-year prospective multicenter study 

of early loaded titanium implants with a sandblasted 

and acid-etched surface. Int J Oral Maxillofac Implants 

2011;26(6):1324-1332. 

A total of 439 implants were placed in 135 partially and fully 

edentulous patients, with abutments connected after 6 weeks 

in type II and III bone and after 12 weeks in type IV bone. 

Evaluations were performed for up to 5 years, after which 

the cumulative implant survival and success rates were 99.1% 

and 98.8%, respectively; all implant failures were between 

surgery and 1 year. SLA-surfaced implants can therefore be 

loaded after 6 weeks in type II and III bone and maintain 

high survival and success over 5 years.



67 

STrAUMANN NOrTh AMericA edUcATiON cOUrSeS 

Upcoming 2012 Education Events 

For more information on programs in the US contact the 

Straumann US Education Department at 978/747 2553 

or education.us@straumann.com or visit us on the website: 

www.straumann.us and click on the courses tab. 

March 30-21, 2012 

The Art, Science and Business of Clinical Implant Practice 

las vegas, nv 

Lecturers: Dr. Paul Fugazzotto, Dr. Kanyon Keeney 

For more information on programs in Canada contact the 

Straumann Canada Department at 905/319 2900 or 

education.ca@straumann.com or visit us on the website: 

www.straumann.ca.com and click on the courses tab. 

April 20-21, 2012 

The Art, Science and Business of Clinical Implant Practice 

Washington, dC 

Lecturers: Dr. Paul Fugazzotto, Dr. Kanyon Keeney 

March 23, 2012 

Dental Implant Complications Symposium: Etiology, 

Prevention & Treatment 

new york, ny 

Lecturers: Dr. Stuart Froum et. al. 

Target Audience: Dental Clinicians 

Products: Implants 

Registration: Straumann.cvent.com/event/march23 

April 20-21, 2012 

Digital Interdisciplinary Dentistry 

louisville, Ky – university of louisville 

Lecturers: Dr. Dean Morton, Dr. Jay Beagle, Travis Roy 

Target Audience: Interdisciplinary Team consisting of 

Surgeon, Restorative Dentist and Lab Technician 

*must attend in a team 

Product: SGS, CADCAM, Implants, Restorative Components 

March 30-31, 2012 


farmington, Ct – university of Connecticut 

Lecturers: Dr. Don Somerville, Dr. David Shafer 

and Charlie Meneguzzo 





For more information on this program or to register: 

http://smile.uthscsa.edu 

April 23, 2012 

"Are you Referring to Me?" Strategies for Marketing the 

Oral and Maxillofacial Surgery Practice 

JaWS Society annual meeting 

Dr. David Schwab



April 27-28, 2012 

Understanding the Basics of Surgical and Restorative 

Dental Implant Therapy 

detroit, mi – university of detroit mercy 

Lecturers: Ahmad M. Fard DDS, MS and Anthony Neely, 

DDS, PhD 

Target Audience: Clinicians 



http://dental.udmercy.edu/ce 

May 18, 2012 

Advanced Implant Surgery & Tissue Grafting 

dallas, tX at Baylor university 

Lecturer: Dr. Thomas Wilson 

May 19, 2012 

Advanced Implant Surgery & Tissue Grafting – 

Cadaver Course 

dallas, tX at Baylor university 

Lecturers: Dr. Thomas Wilson and Dr. Jim Ruskin 

June 4-8, 2011 

ITI Education Week 

Boston, ma 

July 27-28, 2012 


Baylor university, dallas, tX 

Lecturers: Dr. Frank Higginbottom and Dr. Thomas Wilson 






http://www.bcdce.com/courses/course/category.php?id=2 

August 5-12, 2012 

Simplification and Predictability of Implant Dentistry 

alaska Cruise 

Lecturer: Dr. Robert Vogel 

Target Audience: Entire Implant Team 


To register please go through www.kennedyseminars.com 

and click on “REGISTER NOW“ 

November 2-3, 2012 

Temple University 2nd Annual Straumann Lecture – 

Current Trends and Techniques in Planning and Restoring 

Implants in the Esthetically Demanding Patient 

philadelphia, pa 

Lecturer: Dr. Will Martin 

December 14-15, 2012 


Baylor university, dallas, tX 

Lecturers: Dr. Frank Higginbottom and Dr. Thomas Wilson 






http://www.bcdce.com/courses/course/category.php?id=2



69 

ITI Education Week Boston – June 4-8, 2012 

Comprehensive Implant Dentistry: From Treatment Plan to Clinical Implementation

70 STARGET 1 I 12

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+1/978 747 2500 

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GROWTH 

IN RECESSION 

AN ESTHETIC CASE SELECTION ON STRAUMANN ® EMDOGAIN 

This book, which presents 11 prominent clinical cases, is the product 

of an international competition organized by Straumann. The objective 

was to illustrate the esthetic results that can be achieved when using 

Straumann ® Emdogain in combination with conventional surgical 

methods in the treatment of gingival recession. See page 18 of this 

issue of STARGET for more information. 

Please contact your local Straumann sales team member if you would 

like to order a copy of this case book. 

03/12 USLIT 395

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