Dental Implants: Treatment Planning . - Faculty Of Dentistry
Dental Implants:Treatment Planning Decision MakingJANUARY 24, 2017RESEARCH DAY 2017Tenth Anniversary1
Advancing oral health throughoutstanding education, research,and community service.TABLE OF CONTENTS17Research SupportersDental Implant Case18Graduate Research OpportunitiesResearch Day Schedule21Postgraduate Opportunities6Message from the Director of Research22Research Clusters7Presenters28Notes12Poster Abstracts31UBC Dentistry Graduate/Postgraduate Studies23Message from the Dean45
MESSAGE FROM THE DEANResearch Day 2017The 10th UBC Dentistry Research Day returns to a topic thatcontinues to grow in importance in clinical dentistry. The useof dental implants to replace missing teeth is increasing at arapid pace. Implant placement and restoration has becomepart of the practice repertoire of a continually expandingnumber of both general dentists and dental specialists. Thefirst UBC Dentistry Research Day featured research andclinical applications related to dental implants. The field hasadvanced rapidly in the past 10 years. This Research Day willhighlight the most recent developments in dental implantsand provide a look at what will be happening in the future.Until relatively recently, there were only a very limitednumber of ways to replace missing teeth. The ability to placea dental implant directly into the bone of the mandible ormaxilla and use the implant as an abutment for a restorationhas transformed how restorative dentistry is practiced. Thereis new information related to the types of pathology that canoccur at the implant–bone junction and the mechanisms thatinflammation can play to disrupt osseous integration leadingto implant failure. The opportunity to place and restore animplant on the same day has resulted in new approaches totreatment plan patients with missing teeth. Implants havebecome an important part of clinical dentistry. Learning whereit has come in the past 10 years will also provide some ideasabout where it will be going in the future.Enjoy the day, and I hope you acquire new information relatedto the clinical applications of dental implants and the scientificresearch that supports their use. The educational programs atUBC Dentistry all provide considerable theory and practice inthe use of dental implants. These presentations will offer someinsight into the future of dental implants.Thank you for your participation.Charles F. Shuler, DMD, PhDProfessor and Dean, UBC Faculty of Dentistry3
ORAL HISTORY An eleven-year-old presented with non-centred midlines, a congenital absence of themaxillary right lateral incisor, and a small maxillary left lateral incisor. There is an anteriorcrossbite, minimal attached gingiva on the labial surface of the lower incisors, ectopiccanines, and a family history of Class 3 malocclusion (Figure 1). Decisions were madeto prepare this patient for future implant placement for the missing lateral incisor (Figure2). A three-stage treatment plan was developed. The first stage involved anterior crossbitecorrection, which resulted in improvement of the lower incisor attached gingiva; alsoguidance of the ectopic canines to the correct position was employed. The canine positionwas improved to enhance bone in the future implant site (Figure 2). The second stageinvolved full fixed orthodontic appliances to prepare the patient for future implant placement.As this stage of treatment was done, the orthodontist worked with the implant surgeon andthe restorative dentist to ensure that the needs of future implant placement and restorativecare were met (Figure 3). The third stage of treatment was performed some 12 years after thepatient first presented, and was delayed until the cessation of all facial growth. This involvedimplant placement and final restoration, not only of the missing incisor but also of the smallcontralateral incisor (Figure 4).Figure 1[Case courtesy of Dr. David B. Kennedy]Learning Objectives:At the end of the day, participants are expected to be able to: Discuss treatment planning decisions that enhance successful implant placement. Identify clinical considerations that enhance immediate anterior implant success. Describe surgical treatment approaches to develop implant-recipient sites. Recognize the prosthodontic considerations needed to enhance implant rehabilitation. Explain non-surgical treatment approaches for the management of implant-associated biofilms. Describe surgical treatment approaches to manage failing implants. Identify factors affecting long-term implant stability.Figure 24Figure 3Figure 4
UBC Dentistry Research Day 2017 (Tenth Anniversary)Dental Implants: Treatment Planning Decision MakingTuesday, January 24, 2017Alma Mater Society Student Nest, Great Hall8:00 — 8:30REGISTRATION & CONTINENTAL BREAKFAST8:30 — 8:40WELCOMEDr. Charles Shuler, Professor and Dean, UBC Faculty of DentistryINTRODUCTION & OVERVIEW OF THE DAYDr. Edward Putnins, Professor and Director of Research, Graduate & Postgraduate Studies, UBC Faculty of Dentistry8:40 — 9:15INTERDISCIPLINARY CARE: THE ORTHODONTIST’S ROLE IN PREPARING THE PATIENT FOR IMPLANTSDr. David Kennedy, Clinical Professor and Clinical Co-Director, Graduate Orthodontics, Department of Oral Health Sciences, UBC Faculty of Dentistry“What can the orthodontist do to prepare the patient for implants?”9:15 — 9:50RETROSPECTIVE ANALYSIS OF IMMEDIATE ANTERIOR IMPLANT THERAPYDr. Mark Kwon, Dental Clinician and Chair, BITES Institute Implant Training Centre, Burnaby, British Columbia“What clinical considerations guide immediate anterior implant placement?”9:50 — 10:25IMPLANT SITE DEVELOPMENTDr. Dimitrios Karastathis, Certified Specialist in Periodontics, Vancouver, British Columbia“Which techniques are currently available to aid in implant site development?”10:25 — 10:55COFFEE BREAK10:55 — 11:30LIMITING PROSTHODONTIC COMPLICATIONS THROUGH APPROPRIATE TREATMENT PLANNINGAND IDEAL IMPLANT PLACEMENTDr. Anthony McCullagh, Clinical Associate Professor, Department of Oral Health Sciences, UBC Faculty of Dentistry“Why is dental implant placement so crucial in ideal prosthodontic prosthesis design, limiting long-term complications, and improved treatment outcomes?”11:30 — 11:45RESEARCH POSTER AWARDS PRESENTATIONDr. Ravindra Shah, Associate Professor and Director, International Relations, UBC Faculty of DentistryUndergraduate & Graduate Students11:45 — 12:45LUNCH (BOX LUNCH PROVIDED) & RESEARCH POSTER VIEWINGPosters by undergraduate students, graduate students, postdoctoral fellows, research associates, visiting scientists, and faculty members12:45 — 1:20MECHANICAL MANAGEMENT OF BIOFILM FOR IMPLANT MAINTENANCEMs. Penny Hatzimanolakis, Clinical Associate Professor, Department of Oral Biological & Medical Sciences, UBC Faculty of Dentistry“Are we at a paradigm shift in the mechanical management of biofilm?”1:20 — 1:55APPROACHES IN THE TREATMENT OF FAILING IMPLANTSDr. George Giannelis, Assistant Professor and Director, Graduate Periodontics Program, Department of Oral Biological & Medical Sciences,UBC Faculty of Dentistry“How can we improve the prognosis of failing implants?”1:55 — 2:55AN ANALYSIS OF TREATMENT PROTOCOLS AND IMPLANT FAILURES FROM A PRIVATE PRACTICE DATASET OF UP TO9,000 IMPLANTS (KEYNOTE ADDRESS)Dr. David French, Certified Specialist in Periodontics, Calgary, Alberta“What is an expected outcome in private practice with various treatment protocols and various implant systems? Can sinus augmentation be simplifiedand at the same time improve outcomes? Is all bleeding at implants a risk indicator for bone loss?”2:55 — 3:10WRAP-UP & DISCUSSIONUBC Dentistry Thanks the Following Research Day 2017 Supporters:SILVER SPONSORSILVER SPONSORSILVER SPONSORSILVER EXHIBITORSILVER SPONSOR5
MESSAGE FROM THE DIRECTOR OF RESEARCHThank you for attending and celebrating our Tenth AnniversaryUBC Dentistry Research Day.Our Annual Research Day began with the purpose ofintroducing students to the importance of research andthe critical role it plays in new knowledge and technologydevelopment to enhance patient care. The focus of our firstResearch Day in 2008 was on implants. Over the pastdecade, significant advances in implant design, recipientsite development, best maintenance practices, and thedevelopment of surgical approaches to dealing with failingimplants have all occurred. These are also examples of hownew understanding through research continues to advancedecision making and dental practice. I am delighted thatwe are returning to this exciting topic for our 10th ResearchDay anniversary.We begin our morning with four presentations from facultyand alumni. Collectively they will discuss how effective earlytreatment planning and surgical intervention can enhanceimplant site development. In addition, we will hear aboutclinical considerations of immediate implant placement andprosthodontic considerations that must be accounted for toensure long-term implant success. The afternoon talks willfocus on non-surgical implant maintenance and surgicaltreatment options that are available to clinicians to maintainimplant health and stability over time. We are delighted to6finish the day with Dr. David French, who will present thekeynote address on his long-term private practice experiencesin implant placement and their stability. I would like to expressour appreciation to all of the outstanding faculty, alumni, andour corporate supporters, who have all agreed to participateand support Research Day 2017.In addition, please do read through this research day programbooklet to see the other exciting research currently being doneby our faculty and students at the University of BritishColumbia. This book and day are made possible by the effortsof many people on the Research Day Organizing Committee.I would like to personally thank Ingrid Ellis, George Giannelis,Penny Hatzimanolakis, David Kennedy, Anthony McCullagh,Jane Merling, Kim Schultz, and Terry Wintonyk, who have allworked very hard to make this day a success.Do enjoy Research Day 2017.Edward E. Putnins, DMD, PhD, DipPerioProfessor and Director of Research,Graduate & Postgraduate Studies
PRESENTERSBIOGRAPHIES AND SYNOPSESDAVID KENNEDYMARK KWONDIMITRIOS KARASTATHISANTHONY MCCULLAGHPENNY HATZIMANOLAKISGEORGE GIANNELISDAVID FRENCH7
DAVID KENNEDY, BDS, MSD,FRCD(C)Dr. Kennedy has master’s degrees in bothPediatric Dentistry and Orthodontics. Heis the first Canadian to hold Fellowship inboth specialties, and is a Diplomate of theAmerican Boards of both PediatricDentistry and Orthodontics. He has servedas an examiner for the Royal College ofDentists of Canada and the AmericanBoards of Pediatric Dentistry andOrthodontics, and is a Past President of theRoyal College of Dentists of Canada. Dr.Kennedy has published over 50 articles,including chapters in textbooks and hisown textbook “Paediatric OperativeDentistry,” which was published in 4languages and in 4 editions. He has givenover 30 1–2 day courses and over 100lectures. He serves as a peer reviewer for 5dental journals and has received teachingawards at UBC for 5 consecutive years.INTERDISCIPLINARY CARE:THE ORTHODONTIST’S ROLE INPREPARING THE PATIENT FORIMPLANTSThis presentation will review theorthodontist’s role in interdisciplinary carefor patients who need an implant. Correctinterdisciplinary care requires theinterdisciplinary team to develop theappropriate treatment plan andcommunicate with each other and thepatient to enhance the final outcome.Specific emphasis will be placed on theappropriate treatment timing and the needfor collaboration because failure results inunfavourable patient outcomes. The needfor a “quarterback” on the interdisciplinaryteam will also be discussed so that theright treatment is done by the mostqualified operator at the best time in orderto enhance the outcome. A case of onepatient, who started treatment at age 11and completed treatment at age 23, will beused to demonstrate these principles.8MARK KWON, DMDDr. Kwon studied pharmaceuticalsciences and obtained his Doctor ofDental Medicine from UBC. He is afull-time clinician in his implant-onlypractice, Chrysalis Dental Centre (www.implantmagic.com) and focuses onvarious implant surgery, advanced bonegrafting, and full-mouth reconstructionincluding All-on-4 “Teeth-in-a-Day”procedures. Dr. Kwon is a founder of theBITES Institute, an implant centre thatfocuses on providing surgical andprosthetic training courses as well asmonthly study clubs to support theongoing needs of general dentistsproviding implant dentistry. He is wellknown throughout Canada for hisappearances on various esteemed dentalstages, including the Pacific DentalConference Live Stage in 2013, 2014,2015, and 2016, and continues to teachfellow practitioners the immediate implantsolutions that define his clinical workthroughout Canada and abroad.RETROSPECTIVE ANALYSIS OFIMMEDIATE ANTERIOR IMPLANTTHERAPY“Immediate implant solution” has alwaysbeen a popular topic. Patients are awareof it and in some instances demand it,especially for front teeth. It certainly hasbeen a debated topic amongst colleaguesover the past decade. Being able toprovide a patient with a new tooth in asingle surgical appointment is a highlyattractive solution: extraction of a failingtooth, placement of an implant, anddelivery of a provisional crown. Theconcept of immediate anterior implanttherapy and the evolution of clinicalapplications in both surgery andprosthetics over the past decade willbe highlighted.
DIMITRIOS KARASTATHIS, DMD,MSc, DipPerioDr. Karastathis graduated from theFaculty of Dentistry at the University ofBritish Columbia with a Diploma inPeriodontics in 2011 and currentlypractices as a full-time periodontist inVancouver, Canada. In addition, he is apart-time clinical faculty member in theUBC Graduate Periodontics program andlectures to numerous study clubs andconferences throughout British Columbia.IMPLANT SITE DEVELOPMENTImplant placement has become one of themost popular options when replacing amissing tooth. However, a site that is toreceive an implant must present with acertain amount of hard and soft tissues inorder to allow for a favourable long-termoutcome. This presentation will discussthe numerous methods available todevelop both hard and soft tissues before,during, and after implant placement.ANTHONY MCCULLAGH, BDS,MPhil, MFDSIre, FDS, MRD(Pros),RCSEdinDr. McCullagh is a full-time facultymember in the Division of Prosthodonticsand Dental Geriatrics at the UBC Facultyof Dentistry and is a member of activestaff in the Department of Dentistry atVancouver General Hospital. He currentlycoordinates the teaching of partialremovable dental prostheses and dentalimplant teaching for the UBC DMDprogram and the clinical module of theGraduate Prosthodontics Program.LIMITING PROSTHODONTICCOMPLICATIONS THROUGHAPPROPRIATE TREATMENTPLANNING AND IDEAL IMPLANTPLACEMENTSignificant maintenance issues can beassociated with large implant-supportedfixed reconstructions. Both biological andbiomechanical failure can compromise thelong-term success of restorations andnecessitate the need for repair orreplacement prostheses over time. Dentalimplant positioning should always berestoratively driven as failure or inabilityto position implants appropriately for thesupport of fixed restorations often resultsin compromises to prosthesis design andtreatment outcomes. Contemporaryprosthodontic maintenance protocols forimplant restorations will also be outlined.9
PENNY HATZIMANOLAKIS,DipDH, BDSc, MScMs. Hatzimanolakis completed herDiploma in Dental Hygiene (1994) atVancouver Community College prior tocompleting both a Bachelor of DentalScience (2004) and a Master of Science(2009) at the University of BritishColumbia. As a Clinical AssociateProfessor, she teaches in the DMD,DHDP, and Graduate Periodonticsprograms. Ms. Hatzimanolakis isactively involved in clinical research,continuing education at numerous studyclubs, and has published and coauthored in multiple peer-reviewedclinically relevant journals. As aclinician, she has practiced in aperiodontal/prosthetic specialty office inNorth Vancouver for the past 18 years.MECHANICAL MANAGEMENTOF BIOFILM FOR IMPLANTMAINTENANCEThe implant is osseointegrated. Theprosthetic is restored. Now what? Whatare the best options currently availableto help disrupt biofilm and maintain“sulcus” health? Does the currentevidence support lasers, hand or powerinstrumentation, antiseptics, or are we ata paradigm shift in effective mechanicalbiofilm management? During the pastfew years in North America and for over10 years in Europe, indications for theuse of air-pressured mechanical biofilmdisruption technology with the use oflow-abrasive powders for bothsupragingival (airflow) and subgingival(perioflow) biofilm removal have beendeveloped. This evidence-informedreview will explore the airflowmechanism and its clinical applicationfor biofilm management on healthy anddiseased implants.10GEORGE GIANNELIS, DDS, MSc,DipPerio, FRCD(C), DABPDr. Giannelis obtained his Doctor ofDental Surgery degree with distinctionfrom the Aristotle University ofThessaloniki (Greece). He continued hispostgraduate education at the Universityof British Columbia (UBC) to specializein Periodontics. He was awarded the“McAnulty Memorial Prize in GraduatePeriodontics” for outstanding overallperformance in the graduate program andthe “Nobel Biocare Achievement Prize”for outstanding theoretical performanceand excellence in implant surgery.Dr. Giannelis works at UBC as anAssistant Professor in the Division ofPeriodontics and he is the Director of theGraduate Periodontics Program. He is aFellow of the Royal College of Dentists ofCanada and a Diplomate of the AmericanBoard of Periodontology.APPROACHES IN THETREATMENT OF FAILINGIMPLANTSDespite the current knowledge andadvances in the dental implant industryand the high implant success rates thatare consistently reported in the literature,peri-implant disease (peri-implantmucositis and peri-implantitis) stilloccurs. Debate continues as to theetiology of the problem, but it is clearthat early diagnosis and early interventionare the key factors in the managementof peri-implant disease. The treatmentprotocols for peri-implant disease varyfrom non-surgical therapy to surgicalregenerative and resective approachesor even implant removal. The advantagesand challenges of each therapeuticapproach will be reviewed based onthe current literature.
KEYNOTE ADDRESSDAVID FRENCH, BSc, DDS,DipPerioDr. French graduated first-in-classfrom the School of Dentistry at theUniversity of Alberta in 1991 andthen received his specialty degreein Periodontics from the Faculty ofDentistry at the University of BritishColumbia. He has maintained afull-time private practice in Calgaryfocused on surgical implant dentistry.Dr. French is a Fellow of theInternational Team for Implantologyand a member the American Academyof Periodontology, EuropeanAssociation for Osseointegration,and the AO Foundation. He is apublished author with an emphasis onthe retrospective analysis of clinicalimplant dentistry outcomes.AN ANALYSIS OF TREATMENTPROTOCOLS AND IMPLANTFAILURES FROM A PRIVATEPRACTICE DATASET OF UP TO9,000 IMPLANTSReview of retrospective publications:· Straumann survival and bonescore analysis· Zirconia abutment· Osteotome-mediated sinus lift successand novel classificationEvaluation of 9,000 implants forpatterns of failure and identificationof risk:· Definition of failure: relative versusabsolute failure· Implant-related risks: size, type, anddesign; tapered versus straight; andplatform shift versus flat top· Patient-related risks: habits,medications, and conditions· Prosthetic-related risks: timing,loading, titanium versus zirconia, andgeneric components· Surgical-related risks: timing,bone grafts, socket grafts, andsinus management· Planning-related risks: diagnosis,case selection, planning, anddifficulty assessment11
POSTER ABSTRACTSPoster Competition JudgesDR. RAVINDRA SHAH (Chair)DR. MAHA AL-S
Boards of Pediatric Dentistry and Orthodontics, and is a Past President of the Royal College of Dentists of Canada. Dr. Kennedy has published over 50 articles, including chapters in textbooks and his own textbook “Paediatric Operative Dentistry,” which was published in 4 languages and in 4 editions. He has given
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