Tools and strategies for regenerative therapies

The National Osteology Symposia in Italy have earned a great reputation over the years. It’s no wonder that Turin was the place to be for anybody interested in Oral Tissue Regeneration in September 2018, when the Osteology Foundation organised its National Symposium for the fifth time in Italy and returned to the place where it held its first symposium in 2006.

Almost 1300 participants attended the congress on 27–29 September 2018 in the Lingotto Congress Centre in Turin. The Chairmen of the congress, Mario Roccuzzo, Mariano Sanz, and Istvan Urban, had put together an outstanding programme with renowned international experts as well as the who’s who of oral regenerative therapies in Italy.

Under the title “Long-term success: tools and strategies for regenerative therapies”, workshops, discussions, poster and oral presentations, as well as lectures by the experts took place, covering all aspects of oral tissue regeneration, providing practical aspects, as well as highlighting the latest results from research. In addition, a special course with lectures for dental hygienists took place as well.

Workshops and Clinical Tables

Three practical workshops held on day one by Raffaele Cavalcanti and Luigi Minenna, Dennis Cecchinato and Eriberto Bressan, and Mario Beretta and Filippo Fontana addressed various topics, such as soft tissue management around implants and teeth, the management of post-extraction sites, as well as prosthetically guided bone regeneration. In clinical round table discussions, participants could discuss different indications based on cases, and had the chance to discuss the treatment in small groups with the experts Diego Capri, Giorgio Pagni, Martina Stefanini, and Fabio Vignoletti.

Osteology Young Speaker Award

In the research session, which also took place on day one, six young researchers competed with their presentations for the Osteology Young Speaker Award 2018. Roberto Farina won the prize with an outstanding presentation, in which he showed the results from a randomised, controlled, multicentre study comparing the morbidity of lateral and transcrestal approaches for sinus flor elevation. A study that was also funded by the Osteology Foundation. Congratulations!

Main Programme

The main programme was opened on Friday morning by the three chairmen. The local chairman from Turin, Mario Roccuzzo, welcomed the participants to his home town, followed by Mariano Sanz, president of the Osteology Foundation, who briefly introduced the organisation.

In his scientific presentation after the opening, Mariano Sanz addressed under the title “light and shadow in oral tissue regeneration”, novel therapy methods, materials and technologies for periodontal and bone regeneration. He explained that, at present, xenografts are probably the most reliable materials, but, in the future, there might be a shift towards allografts or synthetic materials. Regarding growth factors, such as BMP, he mentioned that the right dosage is still not known. He indicated that cell therapies and 3D-printed scaffolds are looking very promising for the future.

Ronald E. Jung presented the outcome of the Osteology Consensus Meeting 2017 on the importance of peri-implant tissues. He explained the conclusions with a real clinical case. Using this example, he was able to directly show the clinical relevance of the consensus outcome. He explained that: 1) two adjacent implants should be placed with an inter-implant bone distance of 3-4 mm to optimise inter-implant mucosa fill; 2) the vertical distance from the bone of the interproximal contact point to the crestal bone level seems to affect the interproximal papilla height (there is no clear threshold); 3) lateral bone augmentation procedures help to maintain health and stability of peri-implant tissues, while residual defects increase the risk for peri-implant mucosal inflammation and progressive bone loss: and finally, 4) increase in keratinised tissue resulted in a greater improvement of bleeding indices and higher marginal bone levels. Increasing mucosal thickness resulted in significantly less marginal bone loss.

Leonardo Trombelli showed that simplified regenerative procedures (i.e. non-surgical therapy and single flap approach) offer optimal solutions to periodontal problems, but that they cannot always guarantee aesthetic outcomes that are satisfactory for the patient. He said that simplified regenerative procedures are the cheapest option and can be used in combination with biological agents to treat simple defects or defects in the non-aesthetic area. However, for more complex defects or defects in the aesthetic area, a combination of surgical procedures, biological agents and deproteinised bovine bone mineral (DBBM) is preferred, despite being the most expensive option.    

Matteo Chiapasco presented different options for the vertical augmentation of edentulous areas: short, tilted, zygoma implants, vertical guided bone regeneration (GBR), onlay bone grafting, interpositional bone grafts, distraction osteogenesis, and inferior alveolar nerve (IAN) transposition. He explained which of them to use in which situation. He stressed that patient factors need to be evaluated carefully for the treatment decision (e.g. age and clinical conditions, treatment area, value for money, patient compliance, etc.). He also showed the use of a customised 3D-printed titanium mesh, which is still a relatively new technology, and which can be used in different indications as an alternative to onlay grafts.

The final presentation on Saturday was held by Istvan Urban. He talked about the management of hard and soft tissues after bone augmentation procedures. He explained that large vestibular extensions tend to have 50% shrinkage and explained the use of soft-tissue strips to reduce shrinkage but also to improve the colour of the soft tissues.

Local chairman, Mario Roccuzzo, was very happy with the congress. On Saturday, when the congress was over, he said: “It was a great congress with great presentations. Thank you to all the speakers, the organisers and also the sponsors. I hope to see all of you again in Barcelona next year.”