Food for the head, hands and soul

Søren Jepsen and Frank Schwarz presided over one of the first of the long-awaited major scientific congresses, the German National Osteology Symposium, in Baden-Baden on 6 and 7 May. Its latest event followed a tradition of over fifteen years and welcomed 200 participants from all over the country with a balanced mix of lectures and workshops in a great congress location. The shared joy of finally attending a full-scale live event again was written all over the faces of participants, speakers, and organisers alike.

Please all roll up your sleeves!

The well-attended two-day event offered a wide variety of theoretical as well as practical industry and Osteology Foundation workshops on the first day, some with intensive hands-on exercises. Renowned experts like Anton Sculean, Karin Jepsen, Alexander Volkmann, Markus Schlee, Shahram Ghanaati and Markus Tröltzsch transferred their in-depth knowledge to motivated participants, who were able to benefit fully from a direct exchange with the speakers in manageable group sizes.

 

Other highlights were the Research Forum including a poster competition, where the four best submitted poster abstracts were given the opportunity to be presented. Amely Hartmann and Sebastian Gaus were the happy winners of the Osteology Research Award including participation at one of the coveted Osteology Research Academies.

Besides this, a hands-on circle training was organised in the Young Forum for students and young dentists. The programme of the Young Forum has been developed by the National Osteology Group Germany. At three different work stations, Eik Schiegnitz, Tobias Fretwurst, Hendrik Naujokat, Ausra Ramauskaite and Raluca Cosgarea gave an introduction to techniques regarding extraction, implantology, GBR as well as soft tissue management - all procedures were practised directly on pig jaws.

The evening get-together was then used extensively, as were the congress breaks, both to visit the attractive industry exhibition and for the long-lost exchange among colleagues and other professionals.

Science is the basis for good daily practice

The second day of the congress turned out to be a real firework display of top-class lectures on the topics of regenerative perio surgery, the biologisation of biomaterials and the latest status of peri-implantitis treatment.

Anton Sculean started the symposium with strategies for regenerative therapy in vertical and furcation defects in Stage III periodontitis. Deep infra-bony defects associated with periodontal pockets are the classic indication for periodontal regenerative therapy. Additionally, different degrees of furcation involvement in molars and upper first premolars are a further indication for regenerative approaches as the furcation area remains difficult to maintain through instrumentation and oral hygiene. Therefore, the treatment aim must be the reconstruction of the defect, caused by periodontitis, namely to rebuild missing periodontal support. According to Sculean, the use of a collagen matrix helps to stabilise the blood coagulum and therefore supports the regenerative process and maintenance of the soft tissue. The collagen matrix also appears to act as a carrier for other bio-stabilising elements such as cell-growth stimulating proteins. He ended his lecture with the message not to simply fill up the defects, but to understand the regeneration process and support it accordingly.

Karin Jepsen followed with a lecture on combined regenerative surgical and orthodontic therapy for Stage IV periodontitis. Since tooth movement has no effect on periodontitis itself, orthodontic treatment is also indicated for this group of patients. Jepsen’s conclusions based on published clinical data were that orthodontic treatment should be started as early as four to six weeks after regenerative therapy, as this seems to support periodontal stabilisation in the long term. The related study was funded with an Advanced Researcher Grant by the Osteology Foundation.

Team Biologisation

Shahram Ghanaati then introduced the first of two very intriguing lectures on the biologisation of biomaterials. Biologisation with platelet-rich-fibrins (PRF) is indicated for biomaterials that do not elicit a foreign body reaction, which Ghanaati again classifies into three severity classes – mild, moderate and severe. According to him, PRF is not a volume-stabilising material, but rather promotes wound healing. He concluded the lecture with the clear future indication of PRF in extra-oral surgical areas.

Reinhard Gruber then continued with his extraordinarily entertaining lecture on the biologisation of particulate bone substitute materials. He validated the osteoconductive and osteogenetic properties of autologous bone with data from research, and showed that on the contrary, there is no robust evidence for cells from culture, bioreactors, bone marrow aspirate concentrates, bone morphogenetic proteins or PRF. However, autologous bone is superior to bone replacement material only in the early phase of bone formation. Later the difference becomes rather small.

An outlook into the near future

Following Gruber's lecture, Jan Derks gave an insight into the initial results of a large clinical trial funded by the Osteology Foundation. The study compared reconstructive periodontal therapy with and without the addition of biomaterial. He stated that in aesthetically demanding cases the addition of biomaterial seems to be useful. The first paper is in the process of submission and will be published soon.

Markus Schlee followed with a lecture on a new technology for the treatment of peri-implantitis. The procedure consists of complete biofilm removal of the implant surface while preserving the original surface structure and thus enabling re-osseointegration by applying galvo-electricity. The results of the in vitro and animal studies have all proven the efficacy of this implant cleaning technology and the first human study over six months has shown promising results.

Dissent as a virtue

A special treat was the last congress session, in which complex case situations on the two topics of horizontal and vertical ridge augmentation as well as borderline cases of tooth preservation were discussed not only by the presenting surgeons, but also by a panel of experts on stage and the audience in the hall.

 Ilja Mihatovic’s case was a large vertical defect combined with the necessity of implant placement. The experts on stage (Hendrik Naujokat, Tobias Fretwurst and Till Gerlach), together with the participants in the auditorium, suggested almost ten possible techniques to solve the case. Besides these clinical aspects, questions related to the extent to which an informed patient can or must be involved in clinical decision-making were also intensively discussed. There was no agreement on what would have been the objectively best technique in this case, and even the speaker himself admitted that in retrospect he would have used a different method than the one actually chosen to solve the case. Henrik Dommisch's case was a young patient with advanced aggressive periodontitis and diabetes. Bone loss was very pronounced in many tooth positions, but the patient wanted to keep his natural teeth. Again, the opinions of the expert panel (here Markus Schlee, Jan Derks and Anton Sculean) differed considerably. Whether absolute avoidance of implants due to a high risk of peri-implantitis or the placing of implants planned from the beginning, regenerative procedures were discussed in all scenarios. The speaker showed the patient status eight years after initial treatment, still with his natural teeth, but after many conservative periodontal steps there was now also a need for reconstructive measures.

Overall, the event was characterised by the professionalism familiar from Osteology Symposia, but this time rounded off by a constantly perceptible joy on the part of all participants to be able to take part again in such enriching opportunities for continuing education and human interaction. We would like to thank our local organisers as well as our industry partners for their invaluable support and look forward to more events of this kind in the future.

Take a look at our picture gallery on the BOX (free login required): box.osteology.org/Symposia/PublicSymposium