Quintessence Publishing Blog

Nonsurgical Periodontal Therapy: Two Special Workshops at ISPRD 2019

Posted on April 9, 2019 by Michelle Hartman

Reading time: 6 minutes

Marisa Roncati, RDH, DDS

The main goal of the two workshops I am presenting at ISPRD 2019 is to demonstrate my modified nonsurgical treatment protocols, which are validated by my 35 years of clinical experience and published in numerous scientific articles and textbooks. In some cases, nonsurgical treatment may be the only approach possible—even following diagnosis of severe periodontal or peri-implant diseases—due to concomitant systemic pathologies, economic problems, and/or other complications. These workshops are designed to provide participants with concrete clinical indications for practical nonsurgical treatment options. Afterward, each clinician will be able to select the best therapeutic options for his or her own clinical reality, choosing from a comprehensive range of materials, techniques, protocols, strategies, and tips and tricks.

The clinical value of a hands-on course is absolutely superior to a lecture. In addition to practicing techniques and strategies and experimenting with different materials (without first having to buy them), the participants also have the opportunity to be guided by an expert as they learn to implement modified techniques. They will be able to ask me questions and interact with their colleagues to clear up doubts or to have their own treatment modalities confirmed.

In some cases, nonsurgical treatment may be the only approach possible due to concomitant systemic pathologies, economic problems, and/or other complications.

These courses are addressed to many different dental specialists. First, they are addressed to the dentist who believes that periodontology is essential in any dental treatment. They are also addressed to the clinician who knows the nonsurgical approach is always the first therapeutic phase and who acknowledges the advantages—both for the patient and for the dental practice—that these treatment modalities provide in increasing the percentage of clinical success in complex cases. The courses are also directed at the dentist who, while delegating certain aspects of prophylaxis to the dental hygienist, can identify methods and protocols to create profitable synergies. These courses will provide educational value for dentists who are experts in many other fields of dentistry, including surgical periodontology, but who want to expand and improve their knowledge regarding a nonsurgical approach so they can offer a less invasive treatment (at least initially).

These courses are also well suited to newly graduated dentists who are responsible for nonsurgical patient management in their clinics and who feel the topic of nonsurgical periodontology has not been sufficiently covered during their academic training. Many dentists around the world have to practice nonsurgical periodontology, especially in countries where the figure of the dental hygienist does not exist. While nonsurgical treatment has traditionally been given secondary importance compared with the patient’s other treatment needs, nonsurgical periodontal management is as essential as the patient’s motivation for homecare with regard to periodontal health. If the clinician believes the nonsurgical phase is as crucially important as the patient’s home care skills and can communicate that to the patient, thereby enlisting the patient as a treatment ally, then the clinician can positively influence all dental treatment outcomes.

Last but not least, these courses are addressed to dental hygienists who want to explore new techniques using the latest materials and technologies and who want to receive practical, simple, and effective advice for everyday clinical challenges. I look forward to meeting and interacting with each and every one of you who will attend!

Marisa Roncati, RDH, DDS
Nonsurgical Periodontal Therapy: Novel Modified Technique and New Protocols
and
Peri-implant Diseases: Nonsurgical Periodontal Approach
Two Half-Day Hands-On Workshops at ISPRD 2019
Register today at www.bostonperiomeeting.com

Dr Marisa Roncati presenting the scientific evidence behind nonsurgical periodontal therapy for patients with dental implants at Geistlich Pharma’s 2017 Symposium on Multidisciplinary Treatment Solutions for Peri-implantitis in Chicago, Illinois. Photo by James Foster for Geistlich Pharma.

Dr Marisa Roncati assists participants during her workshop on nonsurgical periodontal therapy at Geistlich Pharma’s 2017 Symposium on Multidisciplinary Treatment Solutions for Peri-implantitis in Chicago, Illinois.

On the Dental Hygienist’s Place at ISPRD

Shavonne R. Healy, MSDH, RDH, ICP

ISPRD is an important symposium for dental hygienists to attend because it will dramatically improve their clinical practice. Currently, dental hygiene programs lack comprehensive curriculum on implant dentistry. Dental implants are the standard of care for the replacement of teeth, and with worldwide concern about peri-implantitis and an emphasis on implant maintenance, I am pleading for the dental hygiene community to own the role we play and step up!

This year’s program includes two hands-on workshops presented by Dr Marisa Roncati that are especially relevant for dental hygienists. I first met Marisa at Geistlich Pharma’s 2017 Symposium on Multidisciplinary Treatment Solutions for Peri-implantitis in Chicago, Illinois. I flew from Washington, DC, specifically to attend her hands-on workshop on a nonsurgical approach to peri-implantitis. During her workshop, I was exposed to techniques and information that you never find at typical dental hygiene conferences. Marisa was intriguing to me for four reasons: (1) She is a dentist by way of dental hygiene, (2) she is a practicing clinician, (3) she published a textbook supporting advanced dental hygiene practices such as the use of a diode laser, and (4) she was presenting on a nonsurgical approach—music to my ears considering my patient population consists mainly of patients with advanced implant dentistry.

If you are that dental hygienist still stuck on titanium and plastic scalers, you have a responsibility to be here!

Because of resources like the advanced clinical education at ISPRD and the cutting-edge, hands-on experience and guidance from Dr Marisa Roncati, I have been able to redefine the role of the dental hygienist in my practice as a clinician specifically designed and educated to treat patients with advanced implant dentistry. It has also impassioned me to seek and develop other opportunities for clinical dental hygienists to work intraprofessionally with other dental hygienists. Dental hygienists often get lost in the subgrouping of auxiliary staff at multidisciplinary symposia when—in all actuality—we are providers and clinicians, so why should we be separated from the doctors? It is crucial that dental hygienists engage with educational resources like this symposium and Marisa’s textbooks and hands-on workshops. Until dental hygiene programs provide such curriculum and resources and until the dental hygiene profession can orchestrate our own symposia with clinicians, researchers, and academicians all presenting and discussing cases, where else are you going to get such education? I’m looking forward to all of the information that I am going to learn at ISPRD 2019. Some of it will be revalidating the need to break boundaries in dental hygiene that limit our abilities to provide individualized patient-centered care, and some of it will be new information that will surely take my professional practice to the next level! If you are that dental hygienist still stuck on titanium and plastic scalers, you have a responsibility to be here!

Shavonne R. Healy, MSDH, RDH, ICP
President, District of Columbia Dental Hygienists’ Association
Register today at a special discounted rate for hygienists at www.bostonperiomeeting.com!

Shavonne R. Healy and Dr Marisa Roncati pose with a copy of Dr Roncati’s book Nonsurgical Periodontal Therapy: Indications, Limits, and Clinical Protocols with the Adjunctive Use of a Diode Laser (2017).

Posted in Announcement, Events, Implant Dentistry, Special Offer | Tagged dental hygiene, ISPRD 2019, marisa roncati, nonsurgical periodontal therapy, periodontology | Leave a comment

Quintessence Roundup: April

Posted on April 1, 2019 by Quintessence Publishing

Reading time: 15 minutes

Special Offer

Celebrate 70 Years of Quintessence!

Since its founding in 1949 in Berlin, Germany, the Quintessence Publishing name has come to represent a commitment to quality that is unsurpassed in the dental publishing world. For seven decades now, Quintessence has provided the latest scientific and clinical information in formats designed to meet the varying needs of the dental community. Dental practitioners, researchers, and students alike have all come to rely on Quintessence for timely articles, clearly written and superbly illustrated books, and cutting-edge symposia presented by world-renowned experts.

Our company would be nothing without the support of the dental community, so we invite you to celebrate this special anniversary with us! We are celebrating 70 years of Quintessence by offering up to 70% off select titles, making now the perfect time to update your library with the latest in dental literature. You can view the full list of discounted titles here. To take advantage of this offer, use discount code 70YEARS while ordering online or call (630)736-3600 to order by phone. This sale will end April 30, 2019, so hurry and place your order while this offer lasts!

This offer is only valid in North and South America.

New Titles in Books

Lit: The Simple Protocol for Dental Photography in the Age of Social Media

Miguel A. Ortiz

In the age of digital dentistry, dental providers are under increased pressure to demonstrate proficiency in dental photography for the purposes of documentation, shade matching, and laboratory communication. Expertise in this area is fast becoming part of the standard of care and also has added value for clinicians who are looking to market themselves online. This book is geared toward practitioners who want to master dental photography and build their social media presence. Written for visual learners, this book breaks down the fundamentals of dental photography by outlining the key concepts, equipment, and lighting as well as by introducing “The Simple Protocol”—the basic day-to-day intraoral protocol that shows how easily clinical photography can be incorporated into the clinical workflow. That is where most photography books end, but this author also explores advanced techniques and demonstrates how to achieve some of the most characteristic looks in artistic dental photography, including the glossy effect, chiaroscuro, chromaticity, and texture manipulation, as well as a simple setup for taking photographs in the dental laboratory. Finally, the author provides fresh insight into the ever-changing world of digital marketing and explains what you need to know to reach your market on social media.

248 pp; 357 illus; ©2019; ISBN 978-0-86715-802-1 (B8021); ~~$148~~ Special preorder price! $118
Available June 2019

Zero Bone Loss Concepts

Tomas Linkevičius

Bone loss is still a major issue that dentists encounter, but it is a complication that can be prevented. By combining clinical experience with peer-reviewed scientific evidence, the author of this book has put together a guide that any implant specialist will find invaluable to prevent bone loss in their patients. Different strategies are presented that can be used to achieve zero bone loss years after treatment. Because successful treatment depends on both the surgical and prosthetic components, the book is divided into two parts, each focusing in depth on what must be done in each phase to promote bone stability. Case presentations detail many types of clinical situations, implant choices, and prosthetic solutions, all backed by evidence-based clinical studies that have proven success.

304 pp (hardcover); 1,231 illus; ©2019; ISBN 978-0-86715-799-4 (B7994); ~~$198~~ Special preorder price! $158
Available June 2019

Implant Therapy: Clinical Approaches and Evidence of Success, Second Edition

Edited by Myron Nevins and Hom-Lay Wang

Since the publication of the first edition of this book 20 years ago, the landscape of implant dentistry has changed dramatically. Both the industry and patient demand have expanded exponentially, leaving the clinician with many decisions to make (and often as many questions to ask) regarding patient selection, surgical timing and techniques, implant types, and restorative approaches. This volume brings together the knowledge of the foremost leaders in implant dentistry, covering all aspects of the treatment process, from decision-making and treatment planning through imaging, surgical techniques, bone and soft tissue augmentation, multidisciplinary approaches, loading protocols, and finally strategies for preventing and treating complications and peri-implantitis as well as providing effective implant maintenance therapy. Filled with expert knowledge based on decades of research and clinical experience as well as abundant illustrations and clinical case presentations, this book is an indispensable resource for clinicians seeking to provide implant treatment at the highest standard of care.

544 pp; 1,782 illus; ©2019; ISBN 978-0-86715-798-7 (B7987); ~~$328~~ Special preorder price! $265
Available June 2019

The Clinician’s Handbook for Dental Sleep Medicine

Ken Berley and Steve Carstensen

It has been estimated that 20 million Americans suffer from moderate to severe OSA, and at least one patient in five has mild OSA. The primary treatment prescribed by sleep physicians is CPAP, but patient compliance with this therapy is unacceptably low, between 25% and 50%. There is a significant opportunity for dentists to provide a viable alternative therapy—oral appliance therapy (OAT). OAT results in much better adherence to therapy than CPAP, and while OAT is not as efficacious as CPAP, this increased compliance results in comparable therapeutic results. Currently, a board-certified sleep physician is the only medical professional qualified to diagnose OSA and other sleep-related breathing disorders (SRBDs), so dentists must coordinate with a sleep physician to provide OAT. This book is the how-to guide, a gateway to a successful dental sleep medicine practice. Written by two experts in the field, it clearly delineates the dentist’s role in the treatment of SRBDs and gives practical advice for how to incorporate dental sleep medicine into an existing dental practice, not to mention how to work with sleep physicians to best support patient care. In addition to step-by-step instructions for examination, appliance selection, and follow-up care, complications of OAT, legal issues, and medical insurance and Medicare considerations are included to fully prepare the dentist for the journey into dental sleep medicine.

Read more about The Clinician’s Handbook for Dental Sleep Medicine here!

Obstructive Sleep Apnea: A Deadly Disease with a Dental Solution

Surgical Management of Maxillofacial Fractures

Yoh Sawatari

The facial skeleton is comprised of vertical and horizontal buttresses and the intersections they create; maxillofacial fractures occur when these buttresses sustain more force than they can withstand. The objective when managing these fractures is to reverse the damage that these buttresses sustained and restore appropriate facial dimensions. Not all fractures propagate in the same pattern, so surgeons must compartmentalize the face and define the character of the individual bones. This book approaches the face one bone at a time, outlining how to evaluate each type of fracture, the indications for surgery, the surgical management, and any complications. Specific protocols for clinical, radiographic, and CT assessment are included, as well as step-by-step approaches for surgical access and internal reduction and fixation. Isolated fractures are rare with maxillofacial trauma, and the author discusses how to sequence treatment for concomitant fractures to ensure the most successful outcome. This book is a must-have for any surgeon managing maxillofacial fractures.

Read more about Surgical Management of Maxillofacial Fractures here!

Architects of the Face: Rebuilding After Maxillofacial Trauma

Dental Anatomy and Morphology

Hilton Riquieri

This beautiful atlas conveys not only the practical knowledge of dental anatomy but also the art of sculpting it in wax. The ideal anatomy of each dental structure is described in detail and the waxing techniques are beautifully illustrated step by step for visual reference. The author demonstrates that for every morphologic feature there is an explanation in nature, assigning significance to every minute feature of dental morphology. Organized by tooth and arch, this book views morphology through a clinical lens and repeatedly draws connections between anatomical features and clinical concepts. The fundamental knowledge presented in this text is essential for improving waxing and sculpting techniques and will be useful for students and specialists alike.

Quintessence of Dental Technology 2019: Volume 42

Edited by Sillas Duarte, Jr

QDT 2019 presents a potpourri of original articles highlighting new techniques and novel approaches for creating beautiful smiles—both in form and function. Featured articles include an innovative procedure for predictably matching a veneer to an implant crown, a program for producing a personalized smile based on its visual identity, and the Plane System for virtual functional and esthetic analysis, diagnosis, and CAD/CAM fabrication. These are but a few of the pearls found in this year’s beautifully produced annual resource for the dental technician and restorative clinician.

Técnica de Alineadores Transparentes

Sandra Tai

Los alineadores transparentes son el futuro de la ortodoncia, pero la ortodoncia digital evoluciona tan rápidamente que es difícil estar al día. Este libro trata sobre el uso de alineadores transparentes desde una perspectiva de diagnóstico y planificación del tratamiento; también, discute cómo se aplican principios de biomecánica y anclaje en el uso de estas técnicas. Cada capítulo explica cómo usar alineadores transparentes para tratar una oclusión no óptima y enseña a los expertos a diseñar un tratamiento adecuado usando el software disponible, así como la manera de hacer el tratamiento clínico y terminarlo. Este manual clínico preparará a los ortodoncistas y estudiantes dentales a superar las expectativas del paciente con los aparatos ortodónticos más estéticos disponibles hoy en día.

Read more about Técnica de Alineadores Transparentes here!

Clear Aligner Technique: Bringing Orthodontic Treatment into the Digital Era

The Oral-Systemic Health Connection: A Guide to Patient Care, Second Edition

Edited by Michael Glick

As the oral-systemic health connection continues to be the focus of an overwhelming amount of scientific literature, it is important for dentists to stay informed in order to be a reliable source of information for their patients regarding both oral and overall health. This second edition of The Oral-Systemic Health Connection: A Guide to Patient Care explores the connections between oral infections and systemic diseases/conditions, incorporating feedback from scientists, practitioners, and policymakers. In addition to updated chapters about cardiovascular disease, diabetes, inflammation, and adverse pregnancy outcomes, authors have contributed new chapters about antibiotic prophylaxis, the genomic connection, common risk factors, and the economic impact of this connection. Because interpreting this research can be challenging, new chapters about causal frameworks and biostatistical assessment have been added, and specific clinical considerations for providing dental care to patients with certain conditions have been included in selected chapters. Besides providing readers with up-to-date information on the complex connection between oral and general health, this book prepares oral health care professionals to critically read and evaluate new research to ultimately benefit their patients’ overall health.

Next-Generation Biomaterials for Bone & Periodontal Regeneration

Edited by Richard J. Miron and Yufeng Zhang

New and innovative biomaterials are being discovered or created in laboratories at an unprecedented rate, but many of them remain entirely foreign to practicing clinicians. This book addresses this gap in knowledge by summarizing some of the groundbreaking research performed to date on this topic and providing case examples of these biomaterials at work. The book begins with a review of the biologic background and applications of bone grafting materials utilized in dentistry. The principles of guided tissue and bone regeneration are covered in detail, including many recent advancements in barrier membrane technologies as well as use of platelet-rich fibrin and various growth factors, and many next-generation materials that will optimize future bone and periodontal regeneration are presented. The final chapter is designed to help clinicians select appropriate biomaterials for each specific regenerative protocol. Much like one implant size and shape cannot be utilized for every indication in implant dentistry, one bone grafting material, barrier membrane, or growth factor cannot maximize regenerative outcomes in all clinical situations. This textbook teaches clinicians how to utilize biomaterials in an appropriate, predictable, and evidence-based manner.

Next-Generation Biomaterials: What They Are, Why You Need to Know About Them, and Which Ones Should Intrigue You

The Sinus Bone Graft, Third Edition

Edited by Ole T. Jensen

As research proceeds on treatment of the resorbed posterior maxilla, new techniques and innovations continue to be adopted to solve this clinical problem. While the previous edition of this book provided detailed information on the types of grafting materials and procedures available at the time, this completely revised version looks to the future with new strategies for treatment, some of which avoid grafting altogether. This book not only reviews the time-tested lateral window approach for sinus elevation and grafting but also describes a variety of techniques to approach the sinus transcrestally with or without grafting material. One section of the book is devoted entirely to the different types of implants and implant placement techniques available, many of which are designed specifically to avoid sinus elevation. In addition to clinical case studies and descriptions of how to perform specific surgical procedures, this book includes discussions on the science of bone formation and how continued research brings us closer every day to the ultimate goal of using tissue engineering to completely regenerate new teeth.

Read more about The Sinus Bone Graft, Third Edition here!

Introducing The Sinus Bone Graft, Third Edition, edited by Ole T. Jensen

The Ortho-Perio Patient: Clinical Evidence & Therapeutic Guidelines

Edited by Theodore Eliades and Christos Katsaros

Although most orthodontic curricula provide courses on interdisciplinary orthodontic-periodontic treatment, there are still surprisingly few resources on the topic. Written by leading scholars in the field, this book provides a broad analysis of the topic from both the periodontal and orthodontic perspectives. The authors systematically analyze the scientific and clinical interactions of these specialties by reviewing all the available evidence and using case studies to demonstrate principles discussed in theory. The result is a text that outlines the treatment fundamentals and shows how to improve the therapeutic outcomes involving orthodontic-periodontic interventions.

3D Printing in Dentistry 2019/2020

Irfan Ahmad and Fahad Al-Harbi

The invention of 3D printing technology and its microprecision products are revolutionizing the way dentistry is practiced. However, as with any new technology, many clinicians are uncertain of where to start. The purpose of this book is to arm clinicians with what they need to know to incorporate 3D printing into daily practice. After a brief discussion of the evolution of 3D printing and the scientific credence behind it, the first section examines the fundamental concepts and the latest trends in digital dentistry, including intra-oral scanning, 3D printers, 3D materials, and CAD/CAM processes. The second half of the book presents clinical case studies that apply 3D printing to treat surgical, orthodontic, prosthodontic, restorative, and esthetic cases. These cases examine the benefits and limitations of 3D printing technology in density. This text is a must-have for dentists wanting to understand the future of dentistry.

Restauración con fluidas

Douglas A. Terry

Este libro contiene las distintas aplicaciones de los compuestos de resina fluidos de nueva generación y las presenta paso a paso. Los primeros capítulos tratan sobre su evolución y la ciencia que respalda el concepto de su diseño adhesivo y la técnica compuesta de resina inyectable. Los capítulos siguientes presentan casos en los que se recurre a su uso clínico, como restauraciones anteriores y posteriores, coronas pediátricas, adhesiones de restauraciones indirectas, desarrollo del sitio de póntico ovoide, eliminación de la sensibilidad en el cervical del diente, sellado inmediato de la dentina, reparación de dentadura fracturada, entre otros. Cada presentación de caso incluye los varios diseños de adhesivos preparativos, técnicas reconstituyentes, protocolos adhesivos y los procedimientos finales correspondientes. Con el uso de este material ampliará las opciones de tratamiento dental, la precisión y la predictibilidad, reduciendo el tiempo del paciente en su consultorio.

Read more about Restauración con fluidas here!

Flowable Composite Resins: Esthetics at Your Fingertips

Kratochvil’s Fundamentals of Removable Partial Dentures

Ting-Ling Chang, Daniela Orellana, and John Beumer III

In the 1960s, Professor F. J. Kratochvil recognized the importance of biomechanics in removable partial denture (RPD) design and used these principles to develop a new design philosophy. This “RPI system”—a clasp assembly consisting of a rest, a proximal plate, and an I-bar retainer—changed how clinicians approach partial denture design and is now used throughout the world. This textbook provides an overview of Kratochvil’s design philosophy and the basic principles of biomechanics it is based upon. Topics include components of RPDs and their functions, design sequences for maxillary and mandibular RPDs, and techniques for surveying and determining the most advantageous treatment position. A chapter dedicated to digital design and manufacturing of RPD frameworks highlights new technology in this emerging field. Additional topics include optimizing esthetic outcomes through attachments and rotational path RPDs as well as applying the RPI system to patients with maxillofacial defects. The authors provide illustrations of clinical cases throughout the book as well as an illustrated glossary of prosthodontic terminology. This textbook will prepare students and general practitioners to design and fabricate a biomechanically sound RPD framework for just about any dental configuration they encounter.

Read more about Kratochvil’s Fundamentals of Removable Partial Dentures here!

Kratochvil’s RPD Design Principles Five Decades Later: How Today’s Prosthodontists Continue to Build Upon His Legacy

Current Issues in Journals

Featured article: Connective Tissue Graft Stabilization by Subperiosteal Sling Suture for Periodontal Plastic Surgery Using the VISTA Approach
Jonathan H. Do

New Bone Formation Using an Extracted Tooth as a Biomaterial: A Case Report with Histologic Evidence
Daniele Cardaropoli, Myron Nevins, and Peter Schupbach

The Effect of Dental Implant Collar Design on Crestal Bone Loss at 1 Year After Implant Placement
Elizabeth Felts Randall, Ramzi V. Abou-Arraj, Nico Geurs, Russell Griffin, Michael Reddy, and Mia Geisinger

Invited Commentary: Is Osseointegration a Foreign Body Reaction?
John E. Davies

Development and Validation of the French Version of the Orofacial Esthetic Scale
Thi-Lan N’Guyen-Van, Nathan Moreau, and Adeline Braud

Implant Survival in the Posterior Partially Edentulous Arch—30 Years of Experience. Part IV: A Retro-Prospective Multivariable Regression Analysis on Implant Failures Related to Arch and Implant Surface
Torsten Jemt

Featured article: Ligature-Induced Peri-implant Bone Loss Around Loaded Zirconia and Titanium Implants
Stefan Roehling, Michael Gahlert, Simone Janner, Bo Meng, Henriette Woelfler, and David L. Cochran

Thematic abstract review: Oral Implants Made of Zirconia: An Update for 2019
Guy Huynh-Ba

TiO₂-Modified Zirconia Surface Improves Epithelial Cell Attachment
Sini Riivari, Khalil Shahramian, Ilkka Kangasniemi, Jaana Willberg, and Timo O. Närhi

Nortriptyline Compared to Amitriptyline for the Treatment of Persistent Masticatory Myofascial Pain
Yaron Haviv, Avraham Zini, Yair Sharav, Galit Almoznino, and Rafael Benoliel

Tooth Clenching Until Exhaustion Evokes Exercise-Induced Hypoalgesia in Healthy Persons and in Patients with Temporomandibular Disorders
Sarah Vaderlind Lanefelt, Mauricio Mélo-Gómez, Mariam Chizari, Mirna Krsek, Nikolaos Christidis, Eva Kosek, and Malin Ernberg

A Prediction Model for Types of Treatment Indicated for Patients with Temporomandibular Disorders
Naichuan Su, Corine M. Visscher, Arjen J. van Wijk, Frank Lobbezoo, and Geert J.M.G van der Heijden

Mandibular molar distalization with clear aligners in Class III patients
Kamy Malekian, Simone Parrini, Francesco Garino, Andrea Deregibus, and Tommaso Castroflorio

Temporary Anchorage Devices (TADs) and Invisalign: A combination that can be used to meet aesthetic expectations in the orthodontic treatment of adult patients
Andrea Eliseo and Gianluigi Fiorillo

Initial therapy of occlusion
Werner Schupp, Wolfgang Boisserée, Maria Tabancis, and Julia Funke

Dental Meetings Quintessence Will Attend in April

AAE19: Booth #3311
hosted by the American Association of Endodontists April 10–13 in Montreal, Canada

AACD 2019: Booth #911
hosted by the American Academy of Cosmetic Dentistry April 24–27 in San Diego, California

ITI Congress North America: Booth #201
hosted by the International Team for Implantology April 25–27 in San Francisco, California

Upcoming Quintessence Events

Posted in Books, Events, Journal of Oral & Facial Pain and Headache, Journals, Promotions, Roundup, Special Offer, The International Journal of Oral & Maxillofacial Implants, The International Journal of Periodontics & Restorative Dentistry, The International Journal of Prosthodontics, What's New | Leave a comment

The Evolution of Dentistry’s Most Innovative Symposium

Posted on March 25, 2019 by Michelle Hartman

Reading time: 7 minutes

The International Symposium on Periodontics & Restorative Dentistry (ISPRD) is regarded throughout the global dental community as one of the most important interdisciplinary dental symposia. Occurring every 3 years in Boston, Massachusetts, the symposium brings together world-renowned thought leaders from a number of disciplines. Speakers and attendees spend 4 days both exploring and expanding the boundaries of treatment possibilities. But how does ISPRD continue to grow and change to reflect the ever-evolving landscape of interdisciplinary dentistry, and what is it about this symposium that keeps attendees coming back every 3 years?

A Unique Vision

Today, the symposium is known for its three major tracks of education: periodontics, restorative dentistry, and implant dentistry. In an industry where interdisciplinary treatment is still a relatively recent development, ISPRD was one of the first symposia whose basis was founded in interdisciplinary dentistry. The reason for this is the symposium’s close connection to The International Journal of Periodontics & Restorative Dentistry (IJPRD), another first of its kind with regard to interdisciplinary treatment. The idea for ISPRD was first imagined by IJPRD co-editors-in-chief Gerald M. Kramer, DMD, and Myron Nevins, DDS, in 1981.

“The vision of the symposium occurred when I attended a Quintessence symposium in Japan,” Dr Nevins recalls. “Afterward, my partner Gerry Kramer and I met with Quintessence’s Publisher Horst-Wolfgang Haase and proposed the idea of having a symposium in the United States on periodontics and restorative dentistry.”

Myron Nevins, DDS (right) and Marc L. Nevins, DMD, MMSc (left), co-chairs of ISPRD 2019. Dr Myron Nevins has chaired every ISPRD since the symposium’s start in 1983.

The date of The First International Symposium on Periodontics & Restorative Dentistry was set for April 28–30, 1983, and the location was the Sheraton Hotel in Boston. Dr Nevins recalls how successful that first symposium was, which further validated the need for such a symposium. “We thought we would have between 700 and 800 attendees, so we came to the Sheraton Hotel prepared for that number. We were shocked when instead about 1,300 people arrived! That’s how it began, and we have many who have been to several of the symposia since, including a few who have been to every single one.”

The symposium would continue to grow attendance each year—changing venues twice to accommodate the larger numbers of both participants and speakers. But how does ISPRD continue to provide fresh value for returning attendees?

According to Dr Nevins, one way the symposium provides value is by scheduling the program for every 3 years rather than annually. “Nobody has enough new information every year to present something that people haven’t heard before. Certainly all aspects of this industry evolve, but not at the pace that allows you to organize as comprehensive a program as ISPRD. Portions of the program would become the ‘same old, same old,’ and the knowledge value to attendees would be greatly diminished. This way, I think the audience anticipates and expects that they will receive a refreshing review of what has happened since the last meeting as well as an exciting look at the present and future of these three major disciplines of dentistry.”

Ueli Grunder, DMD, presenting during ISPRD 2016.

Another way ISPRD has been designed to maximize value for participants is through its concurrent session schedule. The program has always included at least two concurrent daily sessions: one session focusing on issues related to periodontics and one focusing on restorative dentistry. Participants are free to attend the presentations on the topics that interest them the most, flowing freely between the sessions in an osmotic design that allows for maximal exchanging of information between two closely related disciplines. The program provides added value through special programming on topics that intersect with periodontal and restorative dentistry treatment: The inclusion of a half-day on adult orthodontic treatment has become a staple in the program since the 7th ISPRD in 2000.

Everyone practicing dentistry has something to benefit from at this symposium—something to refresh their thoughts or challenge their most cherished beliefs.
Myron Nevins, DDS

One major shift in the programming of ISPRD came with the rise of implant dentistry. At the first symposium in 1983, there was only one lecture that touched on implants; now, implant dentistry represents the third concurrent session. Under Dr Nevins’s leadership, the program is continually adapting to address dentistry’s most contemporary topics, including adding a session on digital dentistry to this year’s program. “Focusing the program on these three major disciplines and their intersections ensures that almost everyone practicing dentistry has something to benefit from at this symposium—something to refresh their thoughts or challenge their most cherished beliefs. The topics presented at this meeting represent what has emerged as today’s best therapeutics and, in many cases, very clear predictions to the future.”

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Magnifying Innovation

In addition to the new ideas, new materials, and new therapeutics presented in this year’s program, something else will be making its debut: the second edition of Implant Therapy: Clinical Approaches and Evidence of Success, edited by Drs Myron Nevins and Hom-Lay Wang. The book will touch on many of the same topics presented on at ISPRD 2019, and includes several ISPRD speakers as contributors. Dr Nevins reflects on the need to publish the new edition now.

“The first edition of Implant Therapy: Clinical Approaches and Evidence of Success (Quintessence, 1998) was very well received by the international dental community. It was published in multiple languages and introduced several new interdisciplinary therapies. It has been 20 years, and so much has changed in that time. Implants have changed, implant dentistry has changed, and we decided that an update was necessary. This second edition includes chapters written by many of the world’s authorities in implant treatment, and it addresses topics of implant therapy from a variety of perspectives—from a surgical point of view, a regenerative point of view, a tooth position point of view, and a restorative point of view. The book will magnify those concepts and better enable clinicians to provide implant treatment at the highest standard of care when they return to their practices.”

ISPRD 2019 attendees, whether new or returning, can expect this year’s program to shine light on the most exciting advances taking place around the world as many of dentistry’s greatest innovators share their best clinical efforts. With a dynamic schedule filled with fresh topics, innovative clinical solutions, and plenty of scientific evidence, ISPRD will continue in what is by now a familiar tradition of immersing clinicians in the new and unfamiliar.

Myron Nevins, DDS, is the coeditor-in-chief of The International Journal of Periodontics & Restorative Dentistry and an associate clinical professor of periodontology at the Harvard School of Dental Medicine. He also holds the appointment of clinical professor of periodontics at the University of Pennsylvania School of Dentistry and Temple University Kornberg School of Dentistry. Dr Nevins is a past president of the American Academy of Periodontology and a former director and chairman of the American Board of Periodontology, where his contributions have been recognized with the Gold Medal and the Master Clinician Awards. He maintains a private practice limited to periodontics and implantology in Swampscott, Massachusetts, and is the founder and president of Perio Imp Research, Inc.

Implant Therapy: Clinical Approaches and Evidence of Success, Second Edition

Edited by Myron Nevins and Hom-Lay Wang

544 pp; 1,782 illus; ©2019; ISBN 978-0-86715-798-7 (B7987); ~~$328~~ Special preorder price! $265
Available June 2019

Posted in Announcement, Books, Events | Tagged boston perio meeting, ISPRD, the international symposium of periodontics & restorative dentistry | Leave a comment

Architects of the Face: Rebuilding After Maxillofacial Trauma

Posted on March 8, 2019 by Michelle Hartman

Reading time: 11 minutes

The human body is a complex physical structure, capable of macro feats like walking in a stable, upright position and micro feats like writing or handling surgical instruments. And just like the frames of buildings—from small houses to looming skyscrapers—the architectural frame of our body influences the appearance and character of everything that is laid over it. Nowhere in the human body is this more apparent than in the face, which serves as the physical ambassador of our thoughts, our emotions, and our identities to the world around us. While the external soft tissue provides the details, the internal bony frame provides the character of the face through projections and contours of the skeleton and the symmetry of the presentation. So how do you restore that character after the bones of the face have been damaged by trauma?

Identifying the Pieces of the Puzzle

Before you can begin to conceptualize how to put a face back together, you must first understand how it functions when whole.

“When attempting to understand facial fractures and their effect on appearance and function,” explains Yoh Sawatari, DDS, author of the new book Surgical Management of Maxillofacial Fractures, “the surgeon must begin by compartmentalizing the face and defining the character of the bones. The facial skeleton may be divided into three different regions: the frontal region, the midface, and the mandible. The facial bones can be further conceptualized and defined into two different types of architectural structures: dense rigid buttresses and laminar sheets. The buttresses are traditionally dense cortical pillars that provide stability and structure to the face. They are responsible for the contours and dimensions of the face as well as the support for the laminar bone and the entire soft tissue component of the face enveloping the facial skeleton.”

(a and b) Facial architecture: Vertical buttresses are struts, and horizontal buttresses are arcs.

The buttresses of the face are further divided into horizontal and vertical buttresses. Horizontal buttresses are characterized by dense bone and have an arcuate shape. From top to bottom, the four horizontal buttresses include (1) the supraorbital bar; (2) a bar at the infraorbital rims and zygomatic arches; (3) another comprising the cortex from the pterygoid plate to the floor of the nose across to the contralateral pterygoid plate; and (4) the inferior aspect of the mandible. The vertical buttresses are also comprised of dense cortical bone, but they occur in four pairs of columnar formations. The first pair of vertical buttresses occurs at the bilateral nasofrontal section extending along the piriform rim, the second at the zygomaticofrontal junction, the third at the pterygoid plates, and the final pair at the ramus of the mandible. Areas where the vertical and horizontal buttresses intersect with each other include at the maxillary buttress, the base of the piriform aperture, the nasofrontal junction, and the angle of the mandible.

“To understand fracture patterns,” Dr Sawatari explains, “it is important to understand the concept of these vertical and horizontal buttresses and the intersections they create. Based on the distribution of forces, the horizontal and vertical buttresses fracture in different ways. Because the majority of facial fractures develop from the application of force from an anterior-to-posterior vector, the way in which the facial bones fracture is somewhat predictable. When force is applied to the horizontal buttresses, due to the arcuate shape, the bone fractures with displacement of the anterior segment posteriorly (losing projection), and the posterior segments splay in a lateral dimension. On the other hand, when vertical buttresses fracture, the central section of the buttress also displaces in a posterior vector, and the vertical height is shortened. Understanding the differences between how these buttresses fracture allows the surgeon to understand the resultant deformities that are created from these facial fractures. The loss of projection of a naso-orbitoethmoidal (NOE), Le Fort, or zygomaticomaxillary complex (ZMC) fracture is due to fracture of a vertical buttress. On the other hand, the development of telecanthus, the widening of the zygomatic arch, and the widening of the posterior mandible from a symphysis fracture are due to fractures of a horizontal buttress.”

(a) All horizontal buttresses are arcs. (b) Force application to a horizontal buttress leads to decreased anterior projection and increased posterior transverse width.

(a) All vertical buttresses are struts. (b) Force application to a vertical buttress leads to decreased anterior projection and decreased vertical height.

The organization of Dr Sawatari’s book is based on these fracture patterns so that when surgeons are presented with a facial fracture, they can easily reference that specific chapter to review the knowledge necessary to appropriately manage that fracture.

“In order to effectively manage facial fractures,” he continues, “the objective is to reverse the damage that the buttresses sustained and restore appropriate facial dimensions. This translates to the uprighting of the vertical buttresses, the reduction of the posterior horizontal buttresses, and the restoration of anterior projection for both vertical and horizontal buttresses. Thus, generally all fractures of the face will require restoration of the anterior projection, restoration of the vertical height, and closure of the widened posterior dimensions of the face. The management of each fracture type is ultimately dependent on the location of the fracture, and the concept of fracture management is always the same: Use adjacent stable bone as a reference and bring unstable fractured segments to the stable references; this is reduction. Once the fractured segments are aligned and the preinjury position is established, fixation is used to stabilize the fracture to prevent collapse of the segments and allow for appropriate bony apposition for immobility and adequate healing. The stable references are invariably the vertical and horizontal buttresses of the face, and the fixation points for all facial fractures are traditionally the intersection of the vertical and horizontal buttresses.”

Once the structural basis of the face is understood, the concepts of traumatic injury can be applied to further predict the fracture patterns of the face, giving the surgeon a sense of what lies beneath before imaging confirms.

“Essentially all facial fractures are a combination of vertical and horizontal buttress fractures,” Dr Sawatari explains. “However, there are multiple factors that influence the incidence of each type. The first factor that determines the incidence of fractures is the location of the face that is struck, because any area of the face that projects more tends to be more susceptible to fracture. The nose is first, followed by the ZMC, and then the mandible. The second factor that dictates the incidence of fractures is the mechanism. The most common cause of facial fractures is assault, followed by falling and motor vehicle crashes. The third factor that influences fracture type is the amount of force applied to the face. The classic laws of physics are always at work when analyzing facial fractures. An assault by a fist is far different from an assault with a solid object, which is again very different from the force of a high-velocity motor vehicle crash to the face. The greater the force, the greater the damage inflicted, and the more fractures, the more comminution that the patient will likely develop from the injury.”

Understanding how the face breaks is far easier than having to put those pieces back together. Structural damage to important components of the frames of buildings or cars can compromise the entire unit by affecting the stability of the unit as a whole, and the face is no different. The responsibility of the maxillofacial surgeon lies in restoring stability to the facial unit by rebuilding each small piece, section by section, brick by brick, until the stability of the face as a whole has been restored.

Putting the Pieces Back Together

When facial fractures are reduced and fixated appropriately, both function and form are restored.
Yoh Sawatari, DDS

“The objective of facial fracture management is to restore the facial contours to their preinjury state,” Dr Sawatari states. “The management of facial fractures is like a jigsaw puzzle. You identify stable references of the facial skeleton, and unstable bone segments are brought to these stable references to rebuild the face. All of the pieces are there, and they should fit, but it is necessary to use references and sequencing to ensure that all of the fractured segments are rebuilt into the form they were before the traumatic event. By reducing fractures into their appropriate position, the fracture segments oftentimes lock right into place, and the unit becomes more stable than the individual pieces. Like a jigsaw puzzle, when the puzzle is not assembled, the pieces fall everywhere. However, when your jigsaw puzzle is completed, the pieces are interlocked and can be visualized and moved as a single unit. The interesting thing about the face is that when fractures are reduced and fixated appropriately, both function and form are restored. Because of this, facial fracture management does not present with much dilemma sacrificing one benefit for another—form versus function—because both are intertwined where facial fracture management is concerned.”

Panfacial fracture. (a) Frontal view. (b and c) Lateral views. (d) Submental view.

Bring unstable fragments to stable bony references and rebuild. Find a place to start, treat that area, then move on to the next.
Yoh Sawatari, DDS

When fractures are limited to one section of the face, it may be easy or obvious where the stable bony references lie for fixation after reduction. However, when there are multiple fractures or in the event of a panfacial fracture, many points of reference are lost, and the surgeon is faced with the challenge of finding a place to start. The surgeon must be able to prioritize and correctly sequence a treatment plan because the repair process is a cascading chain: identify a fracture, reduce, fixate, then connect the next puzzle piece. And when every surgical step relies on the success of all those before it, the surgeon must also be able to adapt quickly and accurately if things don’t go as planned. There is plenty of room for error, and the face is a pretty visible area to make a mistake in. But according to Dr Sawatari, there’s no reason to panic: just find a place to start, treat that area, then move on to the next.

“A case with multiple fractures is more difficult and time-consuming than a single fracture,” Dr Sawatari explains, “because there is greater variability in the positioning of the fractured segments. This increased variability requires greater exposure of bone and more attention to sequencing, and it presents an increased possibility of inaccuracy. The management of facial fractures is never straightforward or easy. However, the basic concept remains the same: Bring unstable fragments to stable bony references and rebuild.”

Sequencing of reduction and fixation for the panfacial fracture.

“One of my most memorable cases involved a young man who sustained severe facial fractures from an industrial accident with a pipe exploding into his face,” Dr Sawatari recalls. “He presented with severe soft tissue injuries, but he had also sustained multiple facial fractures involving both the mandible and zygoma. In this complex case, time was spent on first collecting data. After a thorough clinical examination was completed, we reviewed the CT scan at length. Axial and coronal cuts were reviewed, and the 3D reconstruction was thoroughly analyzed. We then developed a plan. The data established that the patient had a left subcondylar mandible fracture and a severely displaced and comminuted left orbito-zygomaticomaxillary complex fracture. Due to the severe comminution and displacement of the fractures, we determined that we would need to perform multiple surgical approaches to expose reliable stable points of reference. We then formulated a logical sequence of procedures based on the need to reestablish specific dimensions of the complex. The procedure was then executed based on the established plan. Although it was difficult, the procedure proceeded without any unexpected complexities. By thoroughly evaluating the patient and CT scan prior to the surgery, establishing stable reference points, evaluating the complexity of the case, identifying access incisions to be used, and sequencing the reduction/fixation, the management was efficient and resulted in an effective surgical outcome. This case was memorable due to the patient’s satisfaction and appreciation. The patient’s spirits were so positive even after sustaining such a severe, deforming traumatic injury. With successful evaluation and planning, we were able to execute a surgical treatment plan that resulted in an ideal functional and cosmetic outcome. The combination of the patient’s gracious personality and the successful outcome resulted in one of the most gratifying cases in my career.”

(a and c) Preoperative clinical presentation and 3D reconstruction. (b and d) Postoperative clinical presentation and 3D reconstruction.

In Surgical Management of Maxillofacial Fractures, Dr Sawatari facilitates the achievement of successful outcomes by compartmentalizing the face. By breaking the face down into smaller regions and addressing each fracture thoroughly—from clinical evaluation and treatment planning to surgical execution and postoperative assessment, start to finish—he makes the complex manageable. The logical sequencing necessary for facial fracture management is reflected in the logical sequencing of the book, making it a valuable and accessible reference for surgeons actively managing facial fractures. The structure of the book, as well as the writing, brings a necessary sense of order to an inherently chaotic event—traumatic injury—and imbues on it the logical sensibility of a surgeon’s thought process.

Yoh Sawatari, DDS After graduating from the University of Michigan School of Dentistry in 1995, Dr Sawatari joined the Public Health Service/Indian Health Service on the Navajo Reservation in Arizona. He worked as a general dentist for 5 years and received numerous commendations and awards and was promoted to Lieutenant Commander. He then completed his postdoctoral residency training in Oral and Maxillofacial Surgery at the University of Miami/Jackson Memorial Hospital Residency program. He then worked in private practice for 2 years before being recruited to return as faculty to the University of Miami, where he is currently an Associate Professor and the Director of Residency of the Oral and Maxillofacial Surgery program.

Surgical Management of Maxillofacial Fractures

Yoh Sawatari

This article was written by Caitlin Davis, Quintessence Publishing.

©2019 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY. NO PART MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER.