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# 3:2Volume 3. Issue 2. 2000BoneThe Golden Tissue WorthBuilding and PreservingDon’t Waste Bone – Use it! . 3Implant Surfaces & Bone Formation . 10Bone Augmentation . 6Education Program . 13Inform Your Patient . 8Product News . 14

PublisherThe Astra Tech Insight is published anddistributed world-wide by Astra Tech AB,P.O. Box 14, S-431 21 Mölndal, Sweden.Astra Tech is a company in the AstraZenecaGroup.Editor-in-chiefMia Jensen, DDSClinical Information Manager, Astra Tech ABAssociate editorAnders Holmén, DDSMedical Director, Astra Tech ABContact usEditors can be reached at the above addressand at Pleasemail your questions, opinions and thoughts onthe Astra Tech InsightSubscriptionContact your local office or the Astra Techmain office directly on the above mentionedaddress.TranslationsAstra Tech Insight is translated to severallanguages, such as French, Spanish, Italian,Russian, Danish and Japanese.CopyrightAll rights reserved, including that of translationinto other languages. No part of this publication may be reproduced or transmitted in anyform or by any means, electronic or mechanical, including photocopying, recording or anyinformation storage or retrieval system, without permission in writing from Astra Tech AB.Editorial contentAlthough great care has been taken incompiling and checking the information givenin this publication to ensure it is accurate, thepublisher shall not be held responsible for thecontinued currency of the information or forany errors, omissions or inaccuracies in thispublication.The opinions expressed in this publication arenot necessary those of the publisher or editorin-chief.Submitted material will be stored electronicallyfor the possibility of publication on theInternet, reprints and in other manners.Editorial content developed in conjunctionwith Adis International Limited, Chowley OakLane, Tattenhall, Chester, CH3 9GA, UK.LayoutLayout developed with assistance of theadvertising agency Explicit & Partners,Gothenburg, Sweden.PrintingPrinted in Sweden by Typografia Olsén AB.ContentsDon t Waste Bone – Use it! . 3Product information on Astra Tech s new disposablebone collecting device, BoneTrap .Augmentation of Local AlveolarRidge Defects . 4Clinical experience of augmentation with BoneTrap .Prospective Clinical Study onBone Augmentation . 6Summary of clinical study on how bone chips collectedwith BoneTrap covered exposed implant threads.Inform Your Patient and PromoteYour Clinic . 8New patient information material that can promotethe individual clinic is now available.Single Tooth Implants – A Five YearProspective Study . 9Summary of scientific study on 15 Astra Tech STimplants with a follow-up period of 5 years.Implant Surfaces and Bone Formation . 10Article on basic bone biology and factors influencingbone formation on implant surfaces.Welcome to the Astra Tech ImplantEducation Program . 13A new comprehensive education program is nowbeing introduced with a large variety of courseson different levels.Product News . 14Presenting a new manual, “Creating Passive Fit”,Polishing Protectors and two new Depth Gauges.Calendar of Events . 16Cover: Astra Tech Fixture ST in poliarized light.2I NSIGHT #3:2

BONE TRAPBoneTrap is a device for easy and efficient harvesting of bone particles duringSPECIAL TOPICimplant surgery. It is single-use and sterile with no need for cleaning or re-steril-Björn LarssonInternational Product Manager, DentalAstra Tech ABization. With BoneTrap, bone that otherwise might be wasted can be collected.The BoneTrap is an easy way to ensure that autogenous bone is always available.Don’t Waste Bone – Use it!The clinical need for bone augmentationProfessor Dan Lundgren in theEasy to useBone augmenting procedures haveDepartment of Biomaterials/HandicapResearch at Göteborg University,BoneTrap can be easily attached tobecome widely used in implanttreatment. The aim of augmentation isto create predictable function andesthetics in cases with insufficientbone quantity. Management of suchcompromised situations is a challengeand has resulted in a number ofclinical protocols involving augmentation techniques and procedures,ranging from minor augmentation oflocalized defects to major augmentation procedures involving on-lay,distractions and sinus lifts. In almostall these cases there is a need for bonematerial or bone substitutes.Sweden. The present design isapproved as a medical device by theyour suction system using a dispos–able tube for which adapters aresupplied to fit different tube diameters.FDA and European authorities.Product descriptionNo clogging of the filterThe BoneTrap is manufactured inThe filter is designed to ensureplastic (polypropylene and oroglass),has a maximum volume of 0.8 cc (ml)efficient harvesting of small boneparticles and ensure a constantflowduring suction until full.Additionally, the filterdesign eliminatesclogging, a commonand is provided in boxes of 10 units.Each BoneTrap pack includes: casingwith filter, nozzle, adapters and aplunger.occurrence with other bonecollecting instruments.Even though extensive researchduring the last decade has focused ondeveloping alternative materials,autogenous bone is still regarded asthe ideal material for bone augmentation. Currently several devices forcollection of bone particles are available but being fully or partiallyreusable they tend to becomeexpensive. They also demand thoroughcleaning and sterilization to avoidbacteria and organic material transferbetween patients. The central issue isthe need for simple, reliable methodsto harvest bone whilst minimizingtrauma to the patient.BoneTrap – the ultimate bone collectorBoneTrap has been developed by Single-use and sterileThe BoneTrap is a disposable system and thus the risk of inter-patient contaminationis eliminated as is the need for extra handling, cleaning and sterilization effortsassociated with reusable systems. The BoneTrap is packed in peel-open envelopesand is sterilized by radiation. EfficientThe amount of bone that can be harvested (0.8 ml) is sufficient to manage thelocalized defects that is a clinical reality of many implant cases. If available,additional bone can be collected with the same BoneTrap as needed.INSIGHT #3:23

1. Upper right canine with a root fractureand marginal bone resorption on thebuccal side.2. Alveola following careful extraction.3. Bone particles are collected duringpreparation of the implant site usingBoneTrap .4. After disconnection of the BoneTrap,a plunger is inserted and the collectedbone mixture pressed out.5. An Astra Tech 4.5 x 15-mmfixture ST has been installed. Note thedehiscence on the buccal side.6. Bone particles are mixed withblood and packed on and aroundthe implant.Augmentation of LocalAlveolar Ridge Defects4BONE TRAPFor the last three years, we have used BoneTrap , a disposable device for collect-CLINICAL REPORTing bone particles, to collect bone chips during drilling of implant sites. The boneDr Lars Rasmusson, DDS, PhDDepartment of Oral andMaxillofacial Surgery,Göteborg University, Swedenparticles have been used to augment alveolar defects and cover exposed implantthreads without the use of membranes. The following article presents a biologicalbackground to our clinical experiences with the BoneTrap device.Local alveolar ridge defectstissues and may result in inferioraugmentation and regeneration ofA prerequisite to successful, secureanchorage of oral implants is a suffi-mechanical stability of the implant.Moreover, localized bone defects andbone defects have been described inthe literature. The use of autogenouscient volume of healthy bone. Insituations where the dimensions of theexposed implant threads are oftenesthetically undesirable. It has beenbone grafts as well as bone substitute,guided bone regeneration (GBR),jaw bone are less than or equal tothose of the implant, implant installa-suggested therefore, that for a favorable outcome, there should be at leastand combinations of these techniqueshave been suggested.tion may not be possible, or may resultin parts of the implant not being1 mm of supporting bone at the lingual/palatal and facial aspects of the implant.The use of allografts, such as frozen,covered by bone. Exposed threads havebeen speculated to cause mechanicalBone augmentation techniquesfreeze dried, mineralized or demineralized bone are alternatives to auto-irritation of the surrounding softSeveral techniques for local bonegenous bone grafts in reconstructiveI NSIGHT #3:2

7. The same site after 6 months of healing. The bone graft is wellintegrated.8. Due to bone growth over the cover screw, bone has to beremoved before changing to abutment.oral and maxillofacial surgery. Bydefinition, an allograft is a substituteof stability, extent of soft tissueingrowth, presence of growth factorsfor an autogenous bone graft derivedfrom bone tissue of an individual ofand cell survival within the graft. It hasbeen concluded that a gentle surgicalthe same species and contains noviable cells. The principles of incorp-technique with a minimally traumatized graft showed a faster remodellingoration of allografts follow the sameprinciples as for the autogenous boneand a shorter revascularization timecompared to a traumatized graft.graft but the process takes place moreslowly due to absence of living boneBlood supply from the recipient bed iscrucial for graft repair as well as thecells. Fresh allografts can be expectedto have a higher osteoinductiveability of newly formed vessels topenetrate the graft.capability but are complicated to usefor immunological reactions. BovineThe revascularization process differsxenografts, are also complicated to usein reconstructive surgery as a result ofbetween cortical and cancellous bonegrafts due to their different morpho-strong immunological reactions. Ifsuch xenografts are used, all proteinslogies. Bone collected during preparation of implant sites in the mandiblemust be extracted. Xenografts cantherefore only be osteoconductive andwill contain more cortical bonecompared to bone collected from thewill be resorbed and replaced by newbone very slowly. The healing andmaxilla. Moreover, the vascular supplyfrom surrounding recipient boneincorporation processes of free autogenous bone grafts are influenceddiffers between maxilla and mandible.Hence, mandibular bone grafts can beby factors such as surgical technique,rate and extent of revascularization,expected to be incorporated and remodelled in a different way to maxillaryembryonic origin of the graft, degreebone grafts.BoneTrapSeveral devices for collection ofbone particles are available. Reuseableversions tend to be expensive anddemand thorough cleaning and sterilization to avoid transfer of bacteriaand organic material between patients.The BoneTrap is disposable, deliveredin a sterile package and consists of anouter and inner casing, a plunger anda nozzle, all in plastic. The device isconnected to a suction tube and anarrow assists correct assembly. Onlyblood and bone particles should becollected and suction of saliva shouldbe avoided. To facilitate this, a parallelsuction tube may be used. When thesuction capacity decreases, the casingis full and the device is disconnected.The plunger is inserted at the back ofthe casing and the bone particles cannow be pressed out and applied whereneeded. If necessary, this procedurecould easily be repeated.INSIGHT #3:25

Clinical Study onBone AugmentationBONE TRAPAt the Department of Oral and Maxillofacial Surgery, Mölndal Hospital,D O C U M E N TAT I O NSweden, a study has been performed to investigate the possibility of using boneDr Göran Widmark, DDS, PhDDepartment of Oral andMaxillofacial Surgery,Mölndal Hospital, Swedenchips, collected with the Astra Tech bone suction device, BoneTrap , to coverperioperatively exposed implant threads.Investigators Dr Göran Widmark and Dr Carl-Johan Ivanoff, explain how theyconducted the study.Dr Carl-Johan Ivanoff, DDS, PhDDepartment of Oral andMaxillofacial Surgery,Mölndal Hospital, Sweden“In 21 patients undergoing implanttreatment, exposed threads weremaxilla. Implants with exposedthreads were recorded photographic-What was the outcome? Was there anyvisible either as marginal dehiscencedefects or buccal fenestration defects atally. The exposed threads werecompletely covered with tightlyexposed implant threads?the time of implant installation. Duringdrilling of the implant sites, bone chipspacked bone chips and the periosteumand soft tissues were readjusted toIn 12 of the 21 implants we registeredcomplete bone coverage of the exposedwere collected with the BoneTrapdevice. The number of exposed threadscover the implants. Site evaluationwith respect to bone formation wasthreads, and in 6 sites there were onlyone or two threads that were notvaried between 4 and 14, and all butone implant was placed in the anteriorperformed 6 months later duringsecond-stage surgery.”completely covered. All sites showeddefinite improvement in coverage ofThe implant showing the buccal fenestration defect.6I NSIGHT #3:2bone regeneration on the previously“We obtained very successful results.The fenestration covered with bone chips.

exposed threads. The newly formedbone covering the previously exposedthreads appeared to be similar to thesurrounding bone, with a hard surfaceInstructions for usethat could withstand probing. Meanbone gain was calculated as percentagegain (remaining threads/initial threads)and was found to be 81% in the siteswith marginal defects and 82% in thesites with fenestration defects.”Did you treat the harvested bone in any1. Attach BoneTrap to theordinary suction tube.2. Collect bone whiledrilling.3. Empty BoneTrap anddeposit the collected bonematerial at the intended site.special way?“No, we followed the directions fromthe manufacturer. In order not tocontaminate the bone chips an addi-Furthermore, the use of autogenousshown that little or no bone regenera-tional suction device should ideally beused for evacuation of saliva. Thebone eliminates the risk of diseasetransmission that may be associatedtion occurs at exposed implant threads.We were able to prove that, by usingharvested bone was thus mixed with asmall amount of blood before it waswith bone substitution materials.”bone chips collected with the BoneTrapdevice, it is possible to achieve a fairlytightly packed into the defects and thesoft tissue was readapted.”What are the indications for coveringexposed threads?substantial amount of bone regeneration at perioperatively exposed implant“Bone augmentation of exposedthreads may increase implant stability,threads. However, how the newlyformed bone responds to functional“Compared to guided bone regenera-create a favorable situation for the softtissue and hence optimize esthetics.”loading remains unclear. The BoneTrapis also useful in other applications, fortion using membranes, autogenousbone collected with the BoneTrapDo you find this a valuable treatment thatexample bone harvesting from themandible in conjunction with differentdevice may decrease infection risk andserve as a cost-efficient alternative tomight be widely used in the future?augmentation procedures.”membranes and/or bone this study it has been previouslyAre there any advantages to augmentationwith autogenous bone?“Yes, even if we had no control groupSummaryTo investigate the coverage of exposed implant threads usingautogenous bone in the form of bone chips collected with BoneTrap.AIM:Bone chips were collected with BoneTrapduring drilling of implant sites in patients (n 21) with 4–14exposed implant threads either as a result of marginal dehiscencedefects or buccal fenestrations. Bone were subsequently packed tocover exposed threads at implant installation.M AT E R I A L S & M E T H O D S :Evaluation after 6-months follow-up revealed 81%–82%coverage with good quality bone at the defects.R E S U LT S :By collecting bone chips with BoneTrap it is possibleto achieve substantial amounts of bone regeneration on exposedimplant threads in a safe and reliable way.CONCLUSION:The defect covered with good quality bone at second-stage surgery6 months later.INSIGHT #3:27

Believing that a well-informed patient is a prerequisite to successful implant treatMia Jensen, DDSClinical Information Manager, DentalAstra Tech ABment, Astra Tech has produced a new set of patient information material. The32-page brochure covers the possibilities afforded by implants, how treatment iscarried out and what to expect. A folder containing a summary of this informationhas been prepared for the waiting room, together with a stand fitting both brochureand folder. Both the brochure and the folder can offer a possibility for brandingwith the dentist or clinic logo.Inform Your Patientand Promote Your ClinicIndividualized treatmentare addressed and, by introducing aglossary at the end, the information onwhich can be wall-mounted or placedon a table to make an informative anddental implant treatment is bothcomplete and understandable. Theattractive addition to the waiting room.brochure is intended to be handed outby the dentist to patients seriouslyAll material is translated into severallanguages such as French, Italian,considering or about to undergoimplant treatment.Spanish, Finnish, Norwegian, Danish,Swedish, Japanese and others to meetThe brochure contains interviews withfive patients and explains the features,functions and advantages of implanttreatment with the Astra Tech DentalImplant System. Treatments such assingle tooth, partial restorations andfull bridges, as well as implantsupported dentures are described inthe fully illustrated text. Photographsall patients’ needs.Promotion possibilityAstra Tech also offer the unique possibility of promoting the individualIf you are interested in ordering,please contact your local Astra Techdentist or clinic with space on the backcover of the printed materialrepresentative.that can be used for individuallabeling by the dentist, if the esthetically pleasing outcome.Treatment is introduced in a stepby-step scheme presenting both onestage and two-stage treatment. Thechoice of treatment option depends onthe clinical situation but the flexibilityof the Astra Tech Dental ImplantSystem permits the best individualsolution possible for the patient.There is also a section left blank forpersonal questions or for individualadvice from the treating dentist. In thesection with questions and answers,Q & A, many of the patient’s concerns8I NSIGHT #3:2To increase interest in and raiseawareness of dental implanttreatment, Astra Tech offer aneight-page folder intended forthe waiting room and henceis accessible to all patients.The folder is based on thebrochure and presents theoptions and benefits ofdental implant treatment ina more general way.The folder and brochurecan be presented on asmart Plexiglas stand

Single Tooth Implants– A Five Year Prospective StudyThis study by RM Palmer, PJ Palmer and BJ Smith has recentlybeen published in Clinical Oral Implants Research, 2000:11.The most important clinical findings are outlined below.C L I N I C A L RES EA RC HPJ Palmer, BBS, MSc, MRD, RCSGuy’s, Kings and St Thomas’sHospital School of Medicine andDentistry, LondonSingle tooth implants have been in usefor many years but there are few prospective studies in the dental literature.The Astra Tech Fixture ST constitutesa considerable change of philosophy inthat it was specifically designed as asingle tooth replacement from the outsetin an effort to make thi

The Astra Tech Insight is published and distributed world-wide by Astra Tech AB, P.O. Box 14, S-431 21 Mölndal, Sweden. Astra Tech is a company in the AstraZeneca Group. Editor-in-chief Mia Jensen, DDS Clinical Information Manager, Astra Tech AB Associate editor Anders Holmén, DDS Me

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