One of the practical workshops was given by Rino Burkhardt from Switzerland. He explained that being a good surgeon starts with factual knowledge and requires pronounced visual-spatial abilities and psychomotor skills (i.e. manual dexterity). The workshop focused on these skills and how to improve and regularly train them. The take home message from his workshop was, that expertise takes time to build and has to be maintained with regular and specific metric-based training. It should be the goal of instructors to first train students in basic technical skills, and only then focus on specific dental procedures.
In the other practical workshop, Bilal Al-Nawas from Germany presented advanced bone augmentation techniques for extrabony defects, and participants practiced interpositional bone grafting.
The third workshop was a video workshop by Daniel Buser from Switzerland, exclusively for the members of the National Osteology Group Brasil. He focused on prerequisites for successful implant placement, and different treatment strategies tailored to the initial situation and exact defect. He explained augmentative procedures in detail, using several surgical videos.
The main programme was opened by the Chairman Maurício Araújo, a Member of the Osteology Foundation Board. His welcome and introduction of the Osteology Foundation was followed by a presentation about the National Osteology Group and a look ahead to its 2nd annual meeting in November 2018 by its chairman João Batista Cesar Neto. The excellent programme with top-class Brazilian speakers as well as international speakers on the second day of the symposium was also very popular. All aspects of regenerative therapies were covered by the topics of the great presentations. The speakers covered periodontal topics and soft tissue regeneration as well as small and large bone defects and adressed concrete treatment proposals to be used by the practitioner in his practice. The audience showed their great interest by joining actively the discussions.
International renowned speakers
Speakers from around the world addressed all kinds of topics on oral tissue regeneration in the main programme of the congress, ranging from soft tissue augmentation techniques and implant placement to the treatment of large defects and maxillofacial bone regeneration case studies. The programme was concluded with some clinical case studies presented by Maurício Araújo, who discussed how to treat them together with the speakers.
Daniel Buser explained in his lecture that there are five pre-requisites for success in implant dentistry:
- An understanding of the biology
- Risk assessment and anamnesis
- Correct implant positioning
- Contour augmentation
- Primary wound closure
He explained that the threshold for the buccal bone thickness after tooth extraction is 1 mm, and below this, extensive resorption is expected, whereas the mean in the aesthetic zone is less than this, at 0.7 mm. With every wall that is missing, he said, the osteogenic potential is reduced. He then outlined various techniques for bone augmentation, and when to apply immediate, early and late implant placement. Furthermore, he talked about how every case needs careful planning before extraction, and that a CBCT is vital. He concluded that the primary objective must be an aesthetic outcome with long-term functioning.
Rino Burkhardt talked about wound stability, which is the key for uneventful healing. The structure of fibrin fibres are influenced by genetics and patient-specific factors, he explained, and this has an impact on the elasticity and bending rigidity of the blood clot. He showed that thin fibres have less elasticity and more bending rigidity, while thick fibres provide more space for vascularisation and collagen deposition, concluding that elastic clots are less prone to disruption, while rigid clots better protect the wound. He pointed out that the type of clot also influences scar formation, and therefore a balance is needed. He clarified that, around teeth, a blood clot is a prerequisite for attachment as it protects against downgrowth of epithelial cells and formation of a long epithelium. Burkhardt also talked about how, in self-contained defects, the blood clot is the critical factor, and biomaterials can only support it, as well as how flap and incision design may influence wound stability, with higher force on wound margins leading to a higher risk of scar formation. Therefore, he summarised, careful preparation and mobilisation is important to keep the tissue intact.
Bilal Al-Nawas presented a lecture on different augmentation techniques for major bone defects. He explained how non-contained defects, i.e. one-wall defects, are always critical and therefore difficult to treat, with a simple GBR used for three-wall defects not being sufficient in those cases.
He presented the following treatment algorithm for one-wall defects:
- Horizontal augmentation in maxilla: bone split, and in other cases: shell technique (with blocks of autogenous bone or xenograft)
- Vertical augmentation in mandible: sandwich
- For complex, non-contained defects: customised titanium mesh, or iliac crest graft.
The iliac crest graft is still the "working-horse", he explained, and plays an important role. He added that augmentation with particulated material is limited to 4-mm gain. He also discussed the promising and effective new customisable 3D-printed titanium meshes. These are filled with a particulate material, and need to be covered by a collagen membrane to reduce dehiscences. Unfortunately, they are not yet available in Brazil.
The success of the National Osteology Symposium Brazil would not have been possible without the support of the Chairmen, the local organisers, and also the sponsors and exhibitors. The Osteology Foundation wishes to thank them in particular, as well as the excellent speakers, moderators, and of course all the attendees.