clinical articles • management advice • practice profiles • technology reviews November/December 2013 – Vol No PROMOTING EXCELLENCE IN IMPLANTOLOGY Corporate profile Planmeca Collagen plug application in extraction sockets Drs Jon B Suzuki and Diana Bronstein Pride Institute “Best of Class” special awards tribute Corporate insight ZEST Anchors Hard tissues Drs William C Martin, Emma Lewis, and Dean Morton Practice profile Dr Yong-Han Koo The most innovative 3D technology available today… Ask For It By Name See the inside back cover to learn more about why the ProMax offers the ideal 3D imaging solution for your practice PAYING SUBSCRIBERS EARN 24 CONTINUING EDUCATION CREDITS PER YEAR! PLANMECA ProMax® 3D WHEN THE OSTEOTOMY MUST BE NARROW - SO MUST YOUR IMPLANT CHOICE Choose the LOCATOR® Overdenture Implant System 2.5mm Cuff Heights 4mm 2.4mm Diameters 2.9mm included with each Implant It’s a fact – denture patients commonly have narrow ridges and will require bone grafting before standard implants can be placed Many of these patients will decline grafting due to the additional treatment time or cost For these patients, the new narrow diameter LOCATOR Overdenture Implant (LODI) System may be the perfect fit Make LODI your new go-to implant for overdenture patients with narrow ridges or limited finances and stop turning away patients who decline grafting Your referrals will love that LODI features all the benefits of the LOCATOR Attachment system that they prefer, and that all of the restorative components are included Discover the benefits that LODI can bring to your practice today by visiting www.zestanchors.com/LODI/31 or calling 855.868.LODI (5634) ©2013 ZEST Anchors LLC All rights reserved ZEST and LOCATOR are registered trademarks of ZEST IP Holdings, LLC EDITORIAL ADVISORS Steve Barter BDS, MSurgDent RCS Anthony Bendkowski BDS, LDS RCS, MFGDP, DipDSed, DPDS, MsurgDent Philip Bennett BDS, LDS RCS, FICOI Stephen Byfield BDS, MFGDP, FICD Sanjay Chopra BDS Andrew Dawood BDS, MSc, MRD RCS Professor Nikolaos Donos DDS, MS, PhD Abid Faqir BDS, MFDS RCS, MSc (MedSci) Koray Feran BDS, MSC, LDS RCS, FDS RCS Philip Freiburger BDS, MFGDP (UK) Jeffrey Ganeles, DMD, FACD Mark Hamburger BDS, BChD Mark Haswell BDS, MSc Gareth Jenkins BDS, FDS RCS, MScD Stephen Jones BDS, MSc, MGDS RCS, MRD RCS Gregori M Kurtzman, DDS Jonathan Lack DDS, CertPerio, FCDS Samuel Lee, DDS David Little DDS Andrew Moore BDS, Dip Imp Dent RCS Ara Nazarian DDS Ken Nicholson BDS, MSc Michael R Norton BDS, FDS RCS(ed) Rob Oretti BDS, MGDS RCS Christopher Orr BDS, BSc Fazeela Khan-Osborne BDS, LDS RCS, BSc, MSc Jay B Reznick DMD, MD Nigel Saynor BDS Malcolm Schaller BDS Ashok Sethi BDS, DGDP, MGDS RCS, DUI Harry Shiers BDS, MSc, MGDS, MFDS Harris Sidelsky BDS, LDS RCS, MSc Paul Tipton BDS, MSc, DGDP(UK) Clive Waterman BDS, MDc, DGDP (UK) Peter Young BDS, PhD Brian T Young DDS, MS CE QUALITY ASSURANCE ADVISORY BOARD Dr Alexandra Day BDS, VT Julian English BA (Hons), editorial director FMC Dr Paul Langmaid CBE, BDS, ex chief dental officer to the Government for Wales Dr Ellis Paul BDS, LDS, FFGDP (UK), FICD, editor-in-chief Private Dentistry Dr Chris Potts BDS, DGDP (UK), business advisor and ex-head of Boots Dental, BUPA Dentalcover, Virgin Dr Harry Shiers BDS, MSc (implant surgery), MGDS, MFDS, Harley St referral implant surgeon PUBLISHER | Lisa Moler Email: lmoler@medmarkaz.com Tel: (480) 403-1505 MANAGING EDITOR | Mali Schantz-Feld Email: mali@medmarkaz.com Tel: (727) 515-5118 ASSISTANT EDITOR | Kay Harwell Fernández Email: kay@medmarkaz.com Tel: (386) 212-0413 EDITORIAL ASSISTANT | Mandi Gross Email: mandi@medmarkaz.com Tel: (727) 393-3394 DIRECTOR OF SALES | Michelle Manning Email: michelle@medmarkaz.com Tel: (480) 621-8955 NATIONAL SALES/MARKETING MANAGER Drew Thornley Email: drew@medmarkaz.com Tel: (619) 459-9595 PRODUCTION MANAGER/CLIENT RELATIONS Adrienne Good Email: agood@medmarkaz.com Tel: (623) 340-4373 PRODUCTION ASST./SUBSCRIPTION COORD Lauren Peyton Email: lauren@medmarkaz.com Tel: (480) 621-8955 MedMark, LLC 15720 N Greenway-Hayden Loop #9 Scottsdale, AZ 85260 Tel: (480) 621-8955 Fax: (480) 629-4002 Toll-free: (866) 579-9496 Web: www.implantpracticeus.com SUBSCRIPTION RATES year (6 issues) years (18 issues) $99 $239 © FMC 2013 All rights reserved FMC is part of the specialist publishing group Springer Science+Business Media The publisher’s written consent must be obtained before any part of this publication may be reproduced in any form whatsoever, including photocopies and information retrieval systems While every care has been taken in the preparation of this magazine, the publisher cannot be held responsible for the accuracy of the information printed herein, or in any consequence arising from it The views expressed herein are those of the author(s) and not necessarily the opinion of either Implant Practice or the publisher Volume Number Three reasons why cone beam imaging is good for your practice C one beam imaging is a relatively new technology, which has firmly established itself in clinical dentistry since its introduction into the U.S dental marketplace in 2001 With cone beam imaging, the X-ray energy emitted from the device is divergent, forming a cone-shaped beam During a cone beam scan, more than 500 images are obtained while the patient remains stationary, and the scanner rotates around the patient’s head The resulting images, which are interpreted by computer software, are threedimensional, and it is the third dimension that allows for a world of difference in dental diagnosis and treatment planning The three-dimensional images generated by a cone beam scan can be manipulated by sophisticated computer software for a wide variety of applications, including implant diagnosis and treatment planning, orthodontic diagnosis, detailed evaluation of the temporomandibular joints, examination of the patient’s airway, endodontic diagnosis, evaluation of impactions, and assessment of maxillary and mandibular pathology, along with numerous other diagnostic purposes For both general practitioners and specialists, cone beam technology deserves serious consideration for incorporation into everyday practice Reason No 1: The standard in diagnosis and treatment planning has been raised With the availability of the third dimension in diagnosis, it quickly becomes apparent that two-dimensional images present the clinician with severe limitations Because of its superior ability to view anatomical structures in their precise location with remarkable detail, the bar has been raised significantly when it comes to dental diagnosis For example, when evaluating an impacted third molar, a two-dimensional film superimposes all structures, and it is virtually impossible to distinguish exactly where any given tooth sits anatomically in relation to its surrounding structures The third dimension made available by cone beam imaging allows the clinician to precisely plan a surgical approach that will avoid damage to surrounding structures and facilitate a safe surgical outcome Reason No 2: Implant treatment planning is driven by the prosthetic needs of the patient Implant patients seek treatment because they are missing teeth, not because of a desire for implants In asking for implants, a patient’s true desire is to replace teeth that are missing Today in 2013, our patient expectations are high They expect teeth that will look good, feel good, allow them to eat comfortably, and which will be relatively free of maintenance This can only be accomplished when implant treatment is prosthetically driven The third dimension provided by cone beam imaging allows for a true prosthetically driven implant placement Reason number 3: Significant savings in terms of cost and radiation exposure Prior to the availability of cone beam imaging in dentistry, dentists often referred out their imaging needs to outpatient imaging centers or radiologists These required the patient to travel to a facility outside of the practice, with the financial cost of these images being far greater than that of in-office cone beam images The cost extends far beyond dollars – a CAT scan image delivers far greater radiation to the patient than a typical cone beam image Technology available to dentists today, such as Planmeca’s ProMax® 3D technologies, allows for adjusting the size of the volume to suit the specific area that is being studied Eugene Antenucci, DDS, is a general dentist who maintains a full-time private practice in Huntington, New York His state-of-the-art dental facility is also home to a continuing dental education training center for dentists, as well as a commercial dental laboratory His practice, Huntington Bay Dental, was distinguished as “Dental Practice of the Month” by Dental Economics in May 2003 and “Business of the Year” by the Huntington Chamber of Commerce for 2003 Dr Antenucci is a 1983 graduate of New York University College of Dentistry He was awarded his Fellowship in the Academy of General Dentistry in 1992, the American College of Dentists in 1999, and the International College of Dentists in 2005 Dr Antenucci is a certified CEREC Basic and Advanced Training Instructor, and has conducted training seminars throughout the United States He lectures internationally, conducting seminars in the clinical utilization of advanced technology in dentistry, as well as seminars in cosmetic dentistry, practice management, CEREC, and laser training Dr Antenucci serves on the Board of Benefactors of the Guide Dog Foundation and America’s Vet Dogs, and is also an active member of the National Italian American Foundation, serving as the New York Area Coordinator for the organization Dental equipment manufacturer Planmeca USA has retained Dr Antenucci as a spokesperson for its line of 3D imaging products and to advise the company on marketing, advertising, and continuing-education efforts Implant practice INTRODUCTION November/December 2013 - Volume Number TABLE OF CONTENTS Clinical Collagen plug application in Practice profile Dr Yong-Han Koo: Honesty, integrity, and precision Dr Koo strives to make a positive impact on his patients, colleagues, and staff Corporate profile Planmeca : innovative, upgradeable imaging technology ® Planmeca, a leader in dental imaging, stays in the forefront of technology as dentistry evolves extraction sockets Drs Jon B Suzuki and Diana Bronstein explore the efficacy of a collagen plug-in 14 Case study Stem cell block grafts Dr Paul Petrungaro delves into allogenic stem cell block grafts to facilitate reconstruction of localized/ severe ridge defects and reconstruct proper alveolar contours prior to dental implant placement 22 Ideal tissue management when immediate provisionalization is not appropriate Drs Robert L Holt and Bernard E Keough illustrate a specific type of implant management 26 Reflections on the Straumann® Tissue Level (TL) implant Dr Robert Margeas discusses a predictable and easy-to-use implant option 28 Corporate insight 10 ZEST Anchors Overdenture product innovations changing the lives of edentulous patients worldwide Implant practice Volume Number TABLE OF CONTENTS 60 Avoiding therapeutic failure Special section Step-by-step Pride Institute “Best of Class” special award tribute 32 Integrated implant technology – GALILEOS CEREC Integration (GCI) by Sirona 50 Continuing education Hard tissues Drs William C Martin, Emma Lewis, and Dean Morton examine adjacent implant restorations .42 The root of the matter Drs Mike Lloyd Hughes and Graham Stuart Roy look at the placement of a first dental implant as part of an inhouse implant mentoring program .46 Implant practice Product insight Practice management Materials matter Dr Paul A Fugazzotto offers advice on avoiding therapeutic failure that can affect the implant practice .60 VELscope® 52 Product profile Osstell ISQ 54 ACE Surgical – infinity Dental Implant Systems .56 Dental technology gets a new look with Henry Schein’s augmented reality app 58 On the horizon 3D at 38,000 feet Dr Justin Moody reflects on the benefits of cone beam 3D imaging .62 Materials & equipment .64 Volume Number Now available! Discover ™ ATLANTIS ISUS Patient satisfaction meets clinical benefits • Available for all major implant systems • Precise, tension-free fit In addition to ATLANTIS™ patient-specific abutments, the ATLANTIS™ ISUS solution includes a full range of implant suprastructures for partial- and full-arch restorations The range of standard and custom bars, bridges and hybrids allows for flexibility in supporting fixed and removable dental prostheses For more information, including a complete implant compatibility list, visit www.dentsplyimplants.com 79690-US-1307 © 2013 DENTSPLY International, Inc • Comprehensive 10-year warranty PRACTICE PROFILE Dr Yong-Han Koo Honesty, integrity, and precision What can you tell us about your background? I was born and raised in Seoul, South Korea, and moved to the U.S when I was 16 My father was an architect, and I had always been fascinated with structures and the engineering involved I was exposed to dentistry during my years in college at Washington University in St Louis and decided that this was the field I wanted to pursue Dentistry has the perfect combination that satisfies my curiosity in structural foundation and engineering, as well as the ability to make a positive impact on others’ lives I proceeded to obtain my DDS from Columbia University College of Dental Medicine and my oral and maxillofacial surgery residency training from Yale-New Haven Hospital After several years in an oral surgery group practice, I opened my solo practice in Wayland, Massachusetts Is your practice implants? limited to My practice is limited to oral and maxillofacial surgery with emphasis on 3D-guided implantology Why did you decide to focus on implantology? The dramatic impact that implants have on dental reconstruction and the individual’s quality of life is astounding We now have options that we could not have imagined years ago It is an exciting, ever-evolving field, and the importance of continuing education to stay abreast of current technology is crucial I am passionate about being innovative and seeking inspiration from everyone I work with I believe that continuing education should be utilized to improve the quality of life of not only the patients, but also the clinicians and all the staff involved To bring this vision into reality, I launched my study club, the Academy of 3D Connection in Osseo-Integration We had a successful, 2-day inaugural meeting this past May in Boston The main purpose of the academy is for all of us to appreciate the value of precision in dental implantology utilizing 3D CBCT from the Implant practice O.R suite at Wayland Oral Surgery diagnosis and treatment planning phase to the final surgical and prosthetic execution phase Through the academy, we also offer small-group, hands-on courses throughout the year Since I am also involved in clinical studies through Harvard School of Dental Medicine, my goal is to create a bridge between academics and the community clinicians, to bring in research results, and actively apply them to everyday practice that the clinicians can relate to How long have you been practicing, and what systems you use? I have been in practice since I finished my residency in 2007 I have used multiple systems over the years, and presently my preferences are Nobel Biocare® and Straumann® I personally believe they have the best 3D-guided systems currently on the market What training undertaken? have you I am board certified through the American Board of Oral and Maxillofacial Surgery I regularly attend meetings with AAOMS, AO, and ITI, as well as numerous advanced courses both domestically and internationally I also teach through my academy, and I am also clinical faculty for the implant CE courses at Harvard School of Dental Medicine Teaching and lecturing opens up avenues that I may not have been aware of, and I always feel that I gain so much more knowledge Who has inspired you? By far, my late father and father-in-law My father owned his architectural/civil engineering firm, and my father-in-law was the head of a global Fortune 500 company Although neither one was in the healthcare industry, I learned the importance of honesty, integrity, precision, and the fact that “people” are the biggest assets in a business They both put tremendous emphasis on developing and supporting staff members, which I also aspire to always Patients come first, but our staff members must be happy and fulfilled in order to provide a great environment for the patients I was also very fortunate to undergo my oral and maxillofacial surgery training under the tutelage of the incomparable Dr John P Kelly I cannot forget my imaginary best friend, Steve Jobs, who reminded us that death renews the old, and our time on earth is truly limited It is our job to find the Volume Number PRACTICE PROFILE The staff at Wayland Oral Surgery unique talent that God has instilled in each and every one of us and to utilize it for the greater good What is the most satisfying aspect of your practice? The feedback we receive from our patients For instance, we received a letter from the mother of a 4-year-old-boy who told his classmates that he wants “to be like Dr Koo” so he can help people; we were also told by a Stage IV cancer patient’s wife that we provided “much more than oral surgery” for her husband and her family These are reminders that we are all part of each others’ lives and that we have a chance to inspire people through our profession Reception Area (above) Dr Koo at the Academy of 3D Connection in OsseoIntegration meeting (below) Sirona Galileos® Cone Beam CT scan with face scanner Sirona/SiCAT has a great 3D-guided system and technical support team, which have allowed us to incorporate unparalleled precision into not only implant placement, but to the pre-prosthetic surgical stage as well We also have the beta version of the NobelClinician™ I am also one of the key opinion leaders for Sirona, Nobel Biocare®, and Straumann® These opportunities allow us to be on the cutting edge of new technology and to be constantly involved in its development What has been your biggest challenge? Time management!! Professionally, what are you most proud of? What would you have become if you had not become a dentist? Connections and relationships we have built over the years with clinicians, staff, corporate partners, and patients With synergy and collaboration, we can make a significant difference Professional golfer Not that I am saying that I would have definitely made it, but I certainly would have tried my very best to become one! What you think is unique about your practice? We make a point to fully engage our patients, educate them on the technology available, and allow them to become active participants in their treatment planning process This enables them to grasp realistic expectations of their treatment, whether good or bad, prior to committing to any procedures Our practice was recently chosen as one of the five beta centers for the new What is the future of implants and dentistry? True digital integration from start to finish What are your top tips for maintaining a successful practice? Honesty, integrity, and professionalism, in that order I believe everything else will follow as long as we not lose sight of these qualities Also, to continue to inspire my staff to make a difference together as a team What advice would you give to budding implantologists? “You can’t treat what you can’t see.” Therefore, having the best diagnostic tools, as well as the ability to execute your plan accordingly with precision, is paramount Always listen to your patients, and not initiate treatment until they have a good understanding of the process involved Assemble an outstanding team of professionals who are truly committed to excellence in patient care Last but not least, as cliché as this sounds, treat all your patients as though they are your family members and present the most optimal plan What are your hobbies, and what you in your spare time? I love to travel with my family I am an avid golfer and also enjoy skiing during the long winters in the Northeast IP Top Ten Favorites God Family and friends Patients and staff Golf Starbucks Traveling Reviewing and learning from past complications Ketorolac Galileos with face scanner 10 Kimchi and sushi Volume Number Implant practice CORPORATE PROFILE Planmeca®: innovative, upgradeable imaging technology Company history Planmeca is the world’s largest privately held dental imaging company and one of the industry’s leading manufacturers of panoramic and cephalometric X-rays Over the past four decades, it has expanded its sales network in more than 100 countries worldwide Planmeca’s imaging units offer superior image quality, reduced radiation during routine procedures, easy upgradeabililty, and advanced, userfriendly imaging software Planmeca has been a leader in digital imaging and advanced computer-integrated dental care concepts for years and remains in the forefront of technology as the field of dentistry evolves Since the company’s establishment, Planmeca’s developers have worked closely with dentists and leading universities to anticipate future trends, using the data to design an advanced line of high-tech products From the introduction of the first microprocessor-controlled chair, to the development of the ProMax™ line of imaging units with SCARA (Selectively Compliant Articulated Robotic Arm) technology, Planmeca has always led the way with new technology The company’s goal is to supply dental professionals with the highest quality dental equipment that is uniquely designed for today’s modern, technologically advanced practice Patented SCARA technology What truly sets Planmeca apart from the competition is the company’s patented, exclusive SCARA technology This robotic arm, which comes standard on all ProMax units, enables free geometry based on image formation and can produce any movement pattern required The precise, free-flowing arm movements allow for a wide variety of imaging programs not possible with any other X-ray unit on the market; this allows the dental professional to take images based on diagnostic needs, not machine limitations Anatomically accurate extraoral bitewing program Planmeca’s ProMax Mid imaging units extraoral bitewing only with SCARA innovative program Implant practice S3, 3D, and 3D offer an exclusive program, possible technology This consistently opens interproximal contacts, eliminates patient positioning errors, and is more diagnostic than other intraoral modalities ProMax extraoral bitewings are ideal for a number of patients, from the elderly and those requiring periodontal work to those with claustrophobia, sensitive gag reflexes, or those in pain All of this comes in a true bitewing program that enhances clinical efficiency and takes less time and effort than a conventional intraoral bitewing Upgradeable innovation One of Planmeca’s greatest contributions to dental imaging is its innovative, upgradeable product platform — all based on exclusive, patented SCARA technology Since it’s software-driven, SCARA technology enables limitless possibilities to upgrade existing equipment, allowing the new dentist on a smaller budget to grow while making only appropriate and necessary equipment investments For example, Planmeca products can be upgraded from a 2D panoramic X-ray to a combination of pan/ceph capabilities, which can be further upgraded to accommodate 3D imaging needs Whether it is the transformation of a film to a 3D unit, or the addition of a cephalometric arm, Planmeca offers solutions for every upgrade need This single piece of technology makes the ProMax the most versatile all-in-one X-ray unit available on the market Reduced radiation procedures for safer All Planmeca products are designed around the ALARA radiation principle (As Low As Reasonably Achievable) Through specially designed programs, such as horizontal and vertical segmenting, autofocus, and pediatric pans, dental professionals are able to provide their patients with excellent care without compromising their safety Horizontal and vertical segmenting options limit the exposure to diagnostic areas of interest By selecting these options, patient dosage can be reduced by up to 93%, which is highly advantageous when follow-up images are needed Autofocus automatically positions the focal layer using a low-dose scout image of the patient’s central incisors, and uses landmarks within the patient’s anatomy to calculate placement The result is a “The company’s goal is to supply dental professionals with the highest quality dental equipment that is uniquely designed for today’s modern, technologically advanced practice.” fast, diagnostic pan every time, which drastically reduces retakes caused by false positioning Pediatric programs further lower the dose by automatically selecting the narrow focal layer of young patients, adjusting the collimator, and reducing the area of exposure from the top and the sides This reduces the dosage area while still providing full diagnostic information Digital Perfection™: standard the new Building on the well-established all-in-one idea of integration, Planmeca introduced the Digital Perfection concept in 2011 Seamless integration of dental equipment and software creates efficient diagnostic tools, optimized workflow, and advanced infection control methods that result in a treatment environment where all equipment shares an open interface The company works worldwide with all aspects of the dental industry, including dental schools, dentists, and dental team members, as well as dealers, and uses the latest technologies to create the best products for dental offices and patients alike As a forerunner in digital imaging technology, Planmeca delivers complete dental solutions based on integrated hightech device and software options with exquisite design IP For more information, visit www.planmecausa.com This information Planmeca was provided by Volume Number PRODUCT INSIGHT T he VELscope Vx is LED Dental Inc.’s latest model release of the VELscope system The VELscope Vx is the most powerful FDA- and Health Canadaapproved tool to screen for oral cancer, a growing health-care issue around the world It is used by dentists to detect early stage oral cancer and pre-cancer, as well as other oral abnormalities such as viral, fungal, and bacterial infections that might otherwise go unseen The technology is the first to offer both cordless convenience and an optional digital camera and customized bracket that make it easy for dentists to photo-document suspicious lesions The VELscope Vx is: • cordless • compact • affordable – even for multiple operatories The VELscope’s distinctive bluespectrum light causes the soft tissues of the mouth to naturally fluoresce Healthy tissues fluoresce in distinctive patterns — patterns that are visibly disrupted by trauma or disease Using the VELscope, a wide variety of oral abnormalities can be discovered — often before they’re visible to the unassisted eye Discovering soft tissue abnormalities is particularly important in the fight against oral cancer Because the VELscope Vx assists in early detection, cancer can be caught before it has time to spread, potentially saving lives through less invasive, more effective treatment Used on a regular basis, the VELscope Vx helps dental professionals find a wide variety of soft-tissue abnormalities, allowing practices to aspire to an advanced level of patient care The VELscope Vx is: • completely safe • simple to use • no unpleasant rinses or stains • entire exam in about minutes Occasionally, the VELscope system plays a crucial role in saving lives IP The VELscope Vx is the most powerful FDA- and Health Canada-approved tool to screen for oral cancer, a growing health-care issue around the world This information was provided by LED Dental Inc 52 Implant practice Volume Number Own the New Piezosurgery ® for as low as *$276 per month! *On Approved Credit - US Dentists only - Special 3.98% Interest Arrangement with Highland Capital Corp PRODUCT PROFILE Osstell ISQ The ISQ Scale – a global standard ISQ (Implant Stability Quotient) is a measurement scale for use with the RFA (Resonance Frequency Analysis) method of determining implant stability and osseointegration, presented on a clinically useful scale of 1-100 ISQ The ISQ scale correlates perfectly with micromotion: the higher the ISQ, the more stable the implant Here is how the Osstell ISQ works and what it achieves The Osstell ISQ instrument stimulates a SmartPeg mounted on the implant by emitting magnetic pulses These cause the SmartPeg to resonate at certain frequencies depending on the stability of the implant This is a wireless, noninvasive, and completely objective technique The SmartPegs have been calibrated in such a way that they all show comparable values for the same degree of stability Diagnostics by Osstell personal commitment – a More than 20 years ago, two scientists shared the frustration of not being able to determine osseointegration in an accurate, objective, and consistent way – beyond their own dexterity and tactile skills The concept of Resonance Frequency Analysis was developed The company was formed in 1999, and today more than 9,000 clinicians all over the world use the Osstell ISQ All Osstell employees are personally committed to the worldwide adoption of our unique diagnostics solution and to the continuous growth of our company To succeed, we ensure that our customers receive the unrelenting support and service they deserve Osstell AB is based in Gothenburg, Sweden where we develop, manufacture, and market our products globally through distribution partners and direct representations Since 2007, the company has been a part of the Biolin Scientific group, which is a leading provider of analytical instruments for the nanoscale study of interfaces IP The SmartPeg™ is attached to the implant It screws effortlessly into the implant’s internal thread The hand-held probe stimulates the SmartPeg magnetically, without actually being connected to it – or even touching it – and the value is displayed in a second www.osstell.com Your guide to predictable surgical and restorative protocols This information was provided by Osstell AB 54 Implant practice Volume Number Visit Osstell at Booth 817 during the AAOMS Dental Implant Conference, December 5th-7th PRODUCT PROFILE ACE Surgical – infinity Dental Implant Systems TRI-CAM and INTERNAL HEX Implant Systems F or almost 50 years, ACE Surgical has been dedicated to dental surgical advancements We continue to develop and manufacture the highest quality, stateof-the-art products at competitive prices, while keeping customer service at the core of our business Our team of industry-leading professionals has taken every detail into account — designing, engineering and manufacturing the infinity Dental Implant Systems Made in the USA, each infinity system allows you to place and restore our implants and prosthetics with confidence Resorbable Blast Media surface (RBM) All infinity Implants are treated with RBM technology, one of the most studied surface treatments in the industry.1 RBM is a surface treatment designed to roughen the exterior surface of an implant without leaving the residual embedded blast particles or debris in the treated substrate To achieve the desired roughening, a biocompatible material with a suitable hardened particle size is used and then subsequently dissolved from the surface with a defined passivation treatment The result is a rougher surface than the traditional acid-etch treatments, providing a greater surface area for osseointegration Secure connecting platform With the TRI-CAM or INTERNAL HEX designs, you will have the peace of mind that comes from a truly compatible system Both systems provide a locking internal connection interface, which makes attaching infinity prosthetics to the implant a more secure and precise fit every time Along with secure connecting prosthetics, each component is color-coded, delivering consistency and accuracy in matching components across the surgical, laboratory, and restorative phases Long-lasting precision surgical drills Every infinity surgical drill is manufactured from hardened, high-strength, corrosiveresistant surgical drilling materials The 56 Implant practice surgical drills are individually designed and sized allowing for the creation of an osteotomy that will match each individual implant’s geometry and assure an exact fit for implant placement Each drill has precise laser markings for accurate drill identification and implant depth drilling Complete package infinity Implants are packaged sterile with the cover screw included in an easy-toaccess, color-coded suspension chamber for easy recognition, removal, and transfer Every implant includes instructions for use and product labels required for labeling the patient record, lab orders, and the restorative practitioner’s documentation Implants available: TRI-CAM • popular implant lengths across each platform size — Ø3.5 mm, Ø4.3 mm, and Ø5.0 mm (implant cover screw included with each implant) • popular healing caps with varying collar widths and heights across each platform size — Ø3.5 mm, Ø4.3 mm, and Ø5.0 mm • Prosthetics included for every platform diameter: prepable abutments, UCLA abutments, closed and open tray transfers, implant analogs, and a full array of Locator® abutments and restorative components INTERNAL HEX • platform sizes with two implant diameter sizes o Ø3.5 mm platform — Ø3.7 mm and Ø4.1 mm implants x five popular implant lengths (implant cover screw included with each implant) o Ø4.5 mm platform — Ø4.7 mm and Ø5.1 mm implants x five popular implant lengths (implant cover screw included with each implant) • Six popular healing cap options with varying collar widths and heights across each platform size for the Ø3.5 mm and the Ø4.5 mm • Prosthetics included for every platform diameter: prepable abutments, UCLA abutments, closed and open tray transfers, implant analogs, and a full array of Locator abutments and restorative components Comprehensive lifetime warranty Our comprehensive lifetime warranty doesn’t stop at simply replacing implant components; it also addresses the potential for bone loss The infinity TRI-CAM and INTERNAL HEX Dental Implant Systems are committed to delivering superior value through a truly premium, compatible, dental implant solution at a very affordable price to both you and your patients IP This information was provided by ACE Surgical Reference Gonshor A, Goveia G, Sotirakis E A prospective, multicenter, 4-year study of the ACE Surgical resorbable blast media implant J Oral Implantol 2003;29(4):174-180 Volume Number VISIT US AT AAOMS Dental Implant Conference Booth #119 CERTIFIED PRE-OWNED CONE BEAM Eligible for IRS Section 179 Tax Deduction SUPER STORE! i-CAT Models 54,900* $ 57,900* 49,900* 44,900-$89,900* $ $ $ VATECH DUO GENDEX CB-500 KODAK 3D PLANMECA PROMAX 3D 69,900* $ SIRONA GALILEOS 69,900* $ Delivery Training Installation Warranty © Renew Digital, LLC 2013 *'Starting at' price listed Prices can vary based on product age and options Call 888.246.5611 or visit RenewDigital.com PRODUCT PROFILE Dental technology gets a new look with Henry Schein’s augmented reality app S ome technologies have become so routine to our daily lives that it’s hard to believe they didn’t exist 20 years ago Online banking first launched in 1994 Amazon opened its virtual doors in 1995 Text messaging became mainstream in 2001 Smartphones gained momentum and exploded in popularity with the introduction of the first Apple iPhone® in 2007 In just two decades, inventions that seemed impossibly futuristic have become practical, widely used tools One of the newest technologies still in its infancy, but already making a major impact, is augmented reality Henry Schein has long been an innovator and early adopter of cutting-edge technology, and once again, they lead the way and are embracing this exciting development Henry Schein Dental’s first interactive Equipment and Technology Catalog using augmented reality technology was released in October, and it literally changes the way doctors and their teams view dental products and services What is augmented reality? Augmented reality projects a virtual layer of interactive features on top of an actual physical environment, when viewed on the screen of a mobile phone or tablet Henry Schein’s catalog and other brochures give readers another world of options — a digital world — that is interconnected to the printed page they are reading Viewing the page through their device’s camera, they can launch interactive product descriptions and specifications, training videos, current promotional offers, and one-click buttons that connect them quickly to a sales representative It’s all done just by hovering over an augmented reality enhanced page with an iPad®, iPhone® or Android™ device loaded with the Henry Schein Xtra app Augmented reality can be difficult to explain in words, and its benefits can’t be grasped fully unless you see the technology yourself You will be amazed at how powerful and applicable it can be to your dental practice 58 Implant practice Test drive Henry Schein’s augmented reality app — It’s quite a ride If you have a mobile device, you can try augmented reality right now by scanning the page right next to this article Just go to the Apple App Store or Google Play and download the free augmented reality mobile app called Henry Schein Xtra Next, open the Henry Schein Xtra app and hover over the page with your device, being sure the entire page is displayed on your screen Your device will “scan” the page to find the augmented reality features, and then watch the ad come to life with an on-screen button that launches a video As you’ll see, augmented reality puts you in control of your browsing experience because you engage with items that matter most to you in an informative new way Plus augmented reality gives Henry Schein the opportunity to constantly update materials with new information, promotions, videos, and more so you always have the latest news at your fingertips Thanks to this new innovation, Henry Schein’s printed catalogs and brochures can remain a doctor’s go-to resource for what’s new in dental technology today, tomorrow and months from now Search for Henry Schein Xtra in the Apple App Store or Google Play to give augmented reality a try today IP This information was provided by Henry Schein Dental Download the Henry Schein Xtra App Watch the Video Volume Number Customized Practice Solutions for ORAL SURGEONS Scan this page with the Henry Schein Xtra App for an interactive experience! Scan this page w Henry Schein Xt an interactive exp Office Design & Consultation From the Front Office to the Treatment Room and every touchpoint in between, Henry Schein has the solutions you need to connect all of your practice technologies to maximize the digital workflow resulting in greater efficiencies With your success in mind, let us help you determine which products and technologies will enhance patient care within your practice Our specialists have the experience and knowledge to assist and guide you in all of your equipment and technology choices Service, Repair & Installation Imaging Solutions Computer Solutions & Support Operatory Equipment Practice Management 1-800-645-6594 prompt #1 www.henryscheindental.com Contact your Henry Schein Sales Consultant to ask about equipment and technology to advance patient care in your practice PRACTICE MANAGEMENT Materials matter Dr Paul A Fugazzotto offers advice on avoiding therapeutic failure that can affect the implant practice Why would anyone want become a dentist today? to Patients don’t understand the merits of various therapies and quality care Patients accept treatment based upon their insurance coverage and allowances Competition between various specialists and/or specialists and “generalists” to perform specific therapies is increasing Encroachment upon private practitioners by corporate dental entities threatens to destroy the “cottage industry” of private practice Graduates are saddled with debt in the hundreds of thousands and the prospect of working for a corporation rather than maintaining their autonomy Why are people trying to get in to the profession? Doesn’t it make more sense to grab what you can and get out instead? This is the type of mewling that is all too often encountered at congresses, and when speaking with smaller groups when teaching courses to them I not understand, and certainly don’t endorse, such thinking Having maintained a full-time private practice specializing in periodontics and implant therapies for over 32 years, I can state categorically and with full conviction Dr Paul Fugazzotto received his DDS from New York University in 1979 and a certificate in advanced graduate studies in periodontology from Boston University in 1981 Since that time, Dr Fugazzotto has maintained a private practice in periodontics and implant therapy in Milton, Massachusetts Dr Fugazzotto has authored or co-authored over 80 articles in refereed scientific journals, as well as authoring a monograph entitled “Guided Tissue Regeneration: Maximizing Clinical Results” and three textbooks entitled Preparation of the Periodontium for Restorative Dentistry; Decision Making in Regenerative and Implant Therapies; and Periodontal Restorative Interrelationships: Maximizing Treatment Outcomes Dr Fugazzotto is an active member of many organizations, and is a fellow of the International Team of Implantology Dr Fugazzotto is Senior Editor of Implant Realities and the US ITI Study Club Coordinator He is a visiting lecturer at Harvard University and Tufts University School of Dental Medicine Dr Fugazzotto lectures nationally and internationally on a multitude of topics 60 Implant practice that we as clinicians are all fortunate to be practicing today • Our understanding of therapeutic potentials has never been greater • Available materials to actualize such potentials have never been better • The willingness of our non-periodontist colleagues to participate in these treatments is exciting • The public’s “dental IQ” for both basic and sophisticated care has never been higher I practice miles south of Boston, Massachusetts Boston has the highest number of periodontists per capita, and the second or third of restorative dentists, of any area in the United States This being said, my restorative colleagues, other dental specialists we work with, and I continue to experience significant practice growth and maturation Why? The answer is a multilevel, uncompromising commitment to excellence and interdisciplinary comprehensive care Such a commitment must begin with the clinician, permeate his or her staff, and govern every aspect of therapy from communication with the patient to diagnosis and treatment planning with cotherapists (including doctors, auxiliaries, and laboratory technicians) to therapeutic and material selection Setting up your office, and thus your practice, to embrace comprehensive care is too large a topic to be discussed in one editorial As a result, the focus will be upon some key aspects of the journey Future columns will deal with other pertinent considerations For example, the auxiliary staff of you and your therapeutic partners’ offices are crucial to the success of transformation into a comprehensive care practice Auxiliaries means everyone, from the front desk to hygienists to chairside assistants to support staff such as your digital media specialist It all begins with what you demand of yourself, both clinically, and from a practice management point of view Your greatest office expense is therapeutic failure As such, materials and treatment modalities must always be selected with this fact in mind It is especially tempting in today’s environment, when companies continually offer us the Volume Number placed, the cost over Brand X would be $140 per implant, for a total of $70,000 A 98.5 % success rate would result in 7.5 Straumann failures for the year The 95% success rate of Brand X would result in 25 failures for the year, yielding a difference of 17.5 more failures with Brand X Assuming an efficient practice that books hour for the implant surgery, a 10-minute postoperative visit, and a 10-minute X-ray visit prior to implant restoration for a total of hour and 20 minutes, and allowing each of these implants only 10 minutes to explain the problem and the need for retreatment to the patient, and only half of these implants to require any type of second surgical procedure such as a 20-minute doctor who, unbeknown to her, was given aftermarket screws by her laboratory Three of the four screws broke in the implants While I was able to retrieve them without damaging the implants, the patient left the doctor’s practice, taking her family with her (including her husband who was treatment planned for four implants and a palateless removable prosthesis retained by locator attachments) Did the “savings” of utilizing poorer screws prove to be worthwhile for this doctor? The same attitude of vision and uncompromising excellence must be applied to all aspects of our practices The way to address and conquer the concerns mentioned in this article is through the life and practice changing concepts Can such a philosophy as Comprehensive Interdisciplinary Care succeed and grow in a “regular” dental practice, while still allowing the dentist time to enjoy his or her life? The answer is a resounding yes appointment for a soft tissue plasty, the additional 17.5 failures equals a minimum of 31.97 hours of retreatment Utilizing a surgical fee of $2,250 per implant, which according to a recent survey is below the national average, these 31.97 hours equal $71,932 These calculations not take into account the damage done to my relationship with the patient, the potential loss of the patient both for active therapy, and as a practice emissary to her friends, the potential loss of a referring doctor as a long-term co-therapist, and the potential damage to my reputation When a moderately robust situation is considered, in which the periodontist or oral surgeon places 1,000 fixtures a year, the cost to the practitioner of utilizing Brand X is even greater If you are a restorative dentist, you utilize a laboratory based on fee, or fit and esthetics? Do you want to spend excessive chair time “modifying” (i.e., attempting to fix) prostheses before inserting them, or to deliver a product that results in esthetic dissatisfaction? I recently worked with a restorative of excellence and interdisciplinary comprehensive care Does such a philosophy place unique demands upon the office and the therapists? Yes Time must be spent working up and discussing cases with each other and with the patient A commitment must be made to communicate clinical excellence However, there is no doubt that the patient and the treating clinicians all benefit Patient long-term oral health is maximized Both the restorative and surgical team members perform the types of therapies they have longed for, and experience dramatic increases in practice revenues Interdisciplinary comprehensive care represents a win-win-win scenario However, the key question is: Can such a philosophy as Comprehensive Interdisciplinary Care succeed and grow in a “regular” dental practice, while still allowing the dentist time to enjoy his or her life? The answer is a resounding yes Future columns will discuss in detail how to attain this goal, and the steps which must be taken in all aspects of the practice IP Volume Number Implant practice 61 PRACTICE MANAGEMENT newest miracles, which are “just as good as X, at a significantly reduced cost.” What does “just as good as” mean? As a periodontist, it is critical that the implant I utilize deliver the highest level of success possible Such success is not short-term, and should not be based upon corporate propaganda In addition, as a businessman, I must dig deeper than the price of purchasing a specific material to truly determine the cost to me I utilize an implant (Straumann SLActive®), which has demonstrated success rates of between 98.6 and 99% long-term (at least over years) in numerous independent or ITI blindly funded studies Note that I believe years should be the minimum study length considered This is not years mean time, but rather years minimum time for any implants to be considered and assessed I was recently approached and offered an implant with a reported 95% “success” rate, which I could purchase for $150 less per implant as an introductory offer! The problems with the data offered me included the following: Definitions of success versus survival were poorly defined: There is a great difference between successful implants (characterized by stable peri-implant bone circumferentially, healthy soft tissues, and esthetic satisfaction), and surviving implants (which may, for example, meet the criteria of Albrektsson, et al., and still demonstrate progressive buccal bone loss and/or esthetic dissatisfaction) Nevertheless, the terms “survival” and “success” are indiscriminately interchanged by many authors, clinicians, and corporate entities In assessment of my patients’ implant therapies, I define success as the criteria of Albrektsson, et al., plus stable crestal peri-implant bone circumferentially as determined by bone sounding, stable soft tissues with no signs of inflammation or recession, and no increasing probing depths circumferentially Many of the implants reported upon had been in function less than years All studies shown to me were company funded Ignoring all of my aforementioned concerns, lessening the number of implants placed to the relatively miniscule number of 500 implants per year, granting implant X a 95% survival rate, and reducing Straumann’s success rate to 98.5%, an objective analysis yields the following: If only 500 Straumann implants were ON THE HORIZON 3D at 38,000 feet Dr Justin Moody reflects on the benefits of cone beam 3D imaging F lying home from Boston today allowed me precious quiet time to reflect upon what I was able to learn during this weekend I was honored to speak at the 7th International Congress on 3D Dental Imaging with my colleagues, including Drs John Russo, Scott Ganz, Dan Cullum, and many others Having attended several of these events, I was excited to see and hear everyone talk about 3D imaging Personally, 3D imaging has changed the way I practice dentistry It is no longer acceptable to enter a surgery or any procedure with only a piece of the information needed As a speaker at this meeting, I had the luxury of listening to everyone and seeing how my perspective was in sync with those around me What I did not realize was that everyone had this extra sense of excitement, and this spring in their step about the positive direction that 3D image would make in their practices The common theme that I heard that made the 7th International Congress on 3D imaging so different was the ability to take quick, full volume scans with such low radiation levels We have always had our patients’ safety as our top priority, and that doesn’t ever change What has changed is that now we can acquire all the needed information safely and efficiently I can tell you firsthand that having the i-CAT® FLX CBCT machine (Imaging Sciences International) in my office has done just that With the new touchscreen monitor and ability to integrate with my dental practice software, the process of taking the scan to treatment planning is a matter .3D imaging has changed the way I practice dentistry It is no longer acceptable to enter a surgery or any procedure with only a piece of the information needed of just a few minutes Full volume scans at less than half the radiation of a digital pan, treatment planning software that is easy to navigate, and the confidence of knowing that you are providing your patient with the very best in dental treatment and diagnosis, all combine to create the “wow moment.” I encourage all of you to explore this amazing technology, and see how it can best fit into your practice It’s not about can you afford it, but rather can you afford not to have it? IP Image courtesy of Imaging Sciences International Dr Justin Moody is a Diplomate with the American Board of Oral Implantology and with the International Congress of Oral Implantologists, Fellow and Associate Fellow of the American Academy of Implant Dentistry, Adjunct Professor at the University of Nebraska Medical College, and Founder and Director of the Rocky Mountain Dental Institute He is an international speaker and is in private practice at The Dental Implant Center in Rapid City, South Dakota He can be reached at justin@rockymountaindentalinstitute com or at drjustinmoody.com 62 Implant practice Volume Number INDUSTRY NEWS The 6th Annual Ethics and Legal Aspects of Dentistry Conference The 6th Annual Ethics and Legal Aspects of Dentistry Conference sponsored by the American College of Legal Medicine will be held Friday and Saturday, February 28 – March 1, 2014, at the Westin Galleria in Dallas, TX Dentists attending the conference will be able to: learn more about legal issues in dentistry and understand the government’s role and the role of dental education, describe ethical, moral and diagnostic issues as they relate to the dental practice, evaluate risk management considerations, and identify issues relating to patient care, access to care and dental health care coverage, electronic record keeping, licensure issues, and the current landscape for malpractice and more For further information and registration, visit the ACLM website at www.aclm.org or contact Wendy Weiser at wendy@wjw.com or Dr Bruce Seidberg at bseidbergddsjd@me.com MATERIALS lllllllllllll & lllllllllllll EQUIPMENT Straumann Roxolid® for All with the NEW Loxim™ transfer piece now available on tissue level implants The Straumann Roxolid® for All implant line featuring an advanced combination of the award-winning Roxolid® material and the SLActive® implant surface on all implant diameters is now available in Tissue Level with the NEW Loxim™ transfer piece for simplified handling Roxolid for All with the Loxim transfer piece is designed to provide clinicians with confidence in all cases, the flexibility of more treatment options, to help increasing patient acceptance of implant treatment, improved osseointegration properties,1 and efficient implant placement through simplified handling Loxim is a pre-mounted, self-retained transfer piece that offers clockwise and counter-clockwise rotations for one-step implant insertion With Loxim, the holding key is no longer required to remove the transfer piece, helping to make implant placement more efficient The Roxolid material and the SLActive surface technology each received the Frost & Sullivan Medical Device Technology of the Year Award This award, which recognizes excellence in technological innovation, is one of the Best Practices Awards bestowed by Frost & Sullivan, the global growth consulting company In 2005, the SLActive surface technology was noted as a “next generation dental implant surface technology,” and in 2009, the Roxolid material was noted as an “innovative high performance material for dental implants.” To learn more about Straumann, visit www.straumann.us Gottlow J, et al Evaluation of a new titanium-zirconium dental implant: a biomechanical and histological comparative study in the mini pig Clin Imp Dent Relat Res 2012 Aug;14(4):538-545 Zimmer Dental offers space-maintaining resorbable porcine membrane Zimmer Dental Inc., a leading provider of dental oral rehabilitation products and a subsidiary of Zimmer Holdings, Inc., has announced the availability of the CopiOs Extend™ Membrane — a biocompatible and resorbable, collagen-based membrane, derived from porcine dermis — for use in a variety of dental surgical procedures, including Guided Tissue Regeneration (GTR) and Guided Bone Regeneration (GBR) CopiOs Extend Membrane offers clinicians the synergy of space and time — promoting optimum resorption and space-maintaining conformance Lasting to months, the membrane’s extended resorption profile is designed to allow implant placement while subsequently providing ample time for unhindered regeneration In addition, CopiOs Extend Membrane has been designed to conform to the defect with enough structural integrity for necessary space creation Its cell occlusive nature allows nutrients to permeate while blocking epithelial cells, thereby creating an environment more suitable for successful GTR and GBR procedures, for example The biocompatible membrane is comprised of highly purified, intact dermis Supplied sterile, it can be implanted dry or slightly hydrated Once applied, the membrane is malleable and easy to reposition For more information call 800-854-7019, or visit www.zimmerdental.com Carestream Dental’s CS Solutions for CAD/ CAM restorations makes single-appointment restorations possible Carestream Dental announced that its new product line for CAD/CAM restorations, CS Solutions, is now available CS Solutions gives practitioners the ability to scan, design, mill, and place a restoration within their practice in just one appointment The product portfolio consists of an intraoral scanner, CBCT impression scanning system, restoration design software, a milling machine, and a hosted, Web-based platform created to share and manage restoration cases between dentists and laboratories The product line requires minimal training by offering a light guidance system during image capture, easy impression scanning, intuitive restoration design capabilities, and step-by-step milling instructions For more information, call 800-944-6365 or visit www.carestreamdental.com 64 Implant practice Volume Number The Ideal 3D Imaging Systems • Availability of multiple imaging modalities in one machine (3D, anatomically accurate extraoral bitewing program, panoramic, and cephalometric) • Versatile volume sizes (ø8 x cm, ø8 x 5cm, ø4 x 8cm, ø4 x cm, or ø14cm x 10.5cm x 8cm blended volumes) for a single impaction to full dentition, and beyond • Over 30+ Imaging Programs • Space saving - small footprint and compact design • Delivered with PLANMECA Romexis™ open architecture software for viewing, image enhancement, and treatment planning • Mac OS compatible and DICOM compliant Optional 2D SmartPan Panoramic and bitewing images are taken with the same flat panel sensor as the 3D images are taken, eliminating the risk of equipment damage and time constraints from switching sensors For a free in-office consultation, please call 1-855-245-2908 or visit us on the web at www.planmecausa.com PLANMECA® 3.0mm GoDirect® Implants 1-Piece Simplicity, 2-Piece Versatility Implant Direct’s 3.0mmD Overdenture Implants GoDirect Advantages vs Zest’s LODI Zest’s 2.9mmD LOCATOR® Overdenture Implant (“LODI”) Implant Design Options • Rounded apex for 28% greater surface area • Pointed apex for insertion with shorter drilling 4.85mm 1-Piece Implant Design 3.12mm Simplifies insertion with 87% greater strength (3.0mmD GoDirect vs 2.9mmD LODI) Implant Design Benefits • Micro-threads for reduced stress at crest • Longer grooves for self-tapping in dense bone Prosthetic Platform Compatible with Zest LOCATOR® as well as GPS® Internal and External Cap Attachment (see GPS advantages below) Prosthetic Versatility 1-Piece implant with internal threads accepts ball, multi-unit, custom-cast & GPS abutments vs Reduced Profile Height GoDirect 1-Piece design is up to 1.7mm lower providing more room for denture teeth Z All-in-1 Packaging: $175 includes implant, transfer, comfort cap, metal housing, black processing male, block-out spacer and GPS Internal cap attachment which provides vertical and rotational stress-breaking est’s Ad for its LOCATOR® Overdenture Implant (“LODI”) Claims “No More Compromise” but should just say “More Compromise.” 2 Under biting forces, the lateral walls of the GPS Internal liner flex outward - allowing the retentive ball to move downward into the internal cap 100% 73% GoDirect Offers More Implant For Your Money 28% greater surface area with GoDirect 3.0mm implants = Discover the GoDirect difference Reality Check Zest Customers Save $1751 by purchasing fewer implants 64% greater surface area with GoDirect 3.7mm implants = GPS® Internal Attachment eliminates the unhygienic gap on rotation and initially maintains 100% of its retention at 10° www.implantdirect.com | 888-649-6425 Savings based upon US list price for Zest LODI implant and impression coping Data on file LOCATOR® & LODI are registered trademarks and products of Zest Anchors Company The GoDirect™ and GPS™ Systems are neither authorized, endorsed nor sponsored by Zest Anchors Company Zest's LOCATOR® Dual Retention creates a gap on rotation and initially loses 27% of its retention at 10° ... lauren@medmarkaz.com Tel: (480) 62 1-8955 MedMark, LLC 15720 N Greenway-Hayden Loop #9 Scottsdale, AZ 85 260 Tel: (480) 62 1-8955 Fax: (480) 62 9-4002 Toll-free: ( 866 ) 579-94 96 Web: www.implantpracticeus.com... Periodontol 1992 ;63 (12):995-9 96 Tarnow DP, Cho SC, Wallace SS The effect of interimplant distance on the height of inter -implant bone crest J Periodontiol 2000;71(4):5 46- 549 Volume Number Implant practice... 10/22/2013 6: 02:02 PM Leading the industry in targeting the niche specialties of dentistry Contact Us 15720 North Greenway Hayden-Loop, Suite #9 Scottsdale, AZ 85 260 Phone: 866 -579-94 96 Fax: 480 -62 9-4002