Table of Contents
Message from Graham Blackbeard
Founder and Managing Director
Message from Graham
Welcome to the February issue of “Southern Implants In Focus“
In spite of the pandemic we have been blessed with growth, and my thanks go to you, our customers, who trust us to partner with you in providing effective patient treatment.
We are getting to grips with the new regulatory environment (MDR) and thank all of those that have published or contributed data, for the various levels of clinical performance assessment that we need. Record keeping and documenting follow-ups have become more important than ever before.
We continue to engineer our products to increase your efficiency and provide longevity of your treatments. We thank you for the input you give us, and we will strive to provide products and service of an exemplary level.
The dental literature shows significant improvements in the quality of life of edentulous patients who have two conventional dental implants placed in their lower jaw to retain their lower dentures. These implants can be life changing for the older edentulous patient.
In the past they were seen as useful, but they were inconsistent at best. With Southern’s high strength titanium, these implants offer a more predictable, long-term solution. The ILZ implant is introduced in this newsletter, and they will also be discussed at SICON 2022 in the Overdenture Forum on Sunday afternoon.
SICON 2022 will take place in Pretoria, South Africa in March, and we look forward to welcoming those that are able to attend and interact with their colleagues. It is at these events that we receive direction and are energized to advance to the next level.
Advancing the management of atrophic ridges with a new mini dental implant
Although the edentulous population is reducing, those patients that do become edentulous do so later in life, with significantly resorbed ridges. These elderly patients often have an impaired ability to adapt to new dentures and are unable to comply with oral hygiene requirements. This affects their ability to eat a healthy diet.
Historically, the placement of two mini dental implants (MDIs) to retain dentures was seen as a potential solution for these edentulous patients, but they failed to fulfil their potential.
The surgical procedure was certainly less invasive, but the strength of these early MDIs were inconsistent, with many fractures reported. Older MDIs were made of a titanium alloy, which does not integrate as well as pure titanium does. MDIs could still be a solution and have proved themselves to improve quality of life for this group of patients. Being able to place these flapless, also has the benefit of less pain after the procedure.
The dental literature has many publications showing significant improvements in the quality of life of edentulous patients who have two conventional dental implants placed in their lower jaw to retain their lower dentures.
Prof Craig Barclay from the University of Manchester, with the Southern Implants engineering team, developed a new site-specific mini-implant for these cases.
The new implant design features:
- 2.4 mm diameter fixture
- Apical taper implant with a 1.8 mm stud attachment
- Type IV titanium, cold worked for withstanding functional loads
- Sandblasted surface in clinical use for over 20 years (first clinical use in 1997) and proven to encourage osseointegration
- Titanium ensures similar integration and longevity as conventional implants
- CE approved in 2015
- A hexagonal collar allows for greater strength underneath the ball abutment
- >3 mm in height negates the need for pick-up copings during restoration (analogue can be accurately located with an impression of the implant head, therefore less componentry)
- Reduced sharp edges of the implant neck facilitates soft tissue adaptation
- Wider stud diameter (1.8 mm) enables standard Rhein attachment (no ‘o’ ring)
- A Co-Axis® option to accommodate the lingually inclined ridge.
A two year review of a the first 21 patients with ILZ placed by the same operator was recently completed.1 60 MDIs in a cohort of 21 patients with highly atrophic and complex cases were reviewed. The review indicated that the new MDIs developed by Southern and Prof Barclay had improved survival compared to the old versions. There were four implant failures in total in this group of patients, all in class V mandibles and within 12 weeks of placement; confounding factors compromised survival of the 4 failed implants; 90% of the MDIs were in the anterior mandible (2 MDIs per mandible).
Suggestions for placement:
- Precision drill assists in more precise piercing of the underlying bone in flapless placement (atrophic bone can be sharply convex in shape).
- Drill osteotomy to full depth with a 2mm pilot drill – this will prep the osteotomy apex without compromising primary stability as its in dense cortical bone (NOTE: earlier MDIs advocated 50-60% of desired length and hand-torque to full length, however this makes for difficult seating).
- The final 4 mm in an atrophic ridge often involves the lower cortex of the mandible
- MDI requires an osteotomy to penetrate the cortical bone
- Type 1 bone (almost entirely homogenous compact bone) overheats easily and has reduced blood supply, therefore drilling slowly is advised.
1. Mini Dental Implants in the Management of The Atrophic Maxilla and Mandible: A New Implant Design and Preliminary Results (Barclay CW, Jawad S, Foster E. European Journal of Prosthodontics and Restorative Dentistry (2018) 26, 190–196)
Congratulations Dr. Hattingh
Congratulations to Dr. Andre Hattingh, on the completion and successful defence of his PhD thesis at Ghent University.
SIBASE – Southern Implants Ti-Base
Southern Implants’ CAB, DB, CIA and Cosmetic Abutments are renowned for their individual functionality and variety of features. Each abutment offers clinicians numerous variations to allow prosthesis designs to be accomplished at the desired emergence profile due to the choice of an ideal chimney height.
However, Southern Implants aims to stay dedicated to our commitment to excellence and innovation by combining the best features of previous ranges to form a ground-breaking new abutment that enables clinicians to overcome everyday challenges in implant dentistry.
Southern Implants’ SI-BASE Abutments have been designed through the optimisation of each of these individual features to create an abutment which allows clinicians to decide on the chimney height and collar height simultaneously without having to forfeit any benefit. SI-BASE Abutments will be available for every implant diameter across all implant ranges.
SI-BASE Abutments have a tall chimney with a number of height indicators, allowing for the abutment chimney to be customised to the desired height. There are three collar heights (1.5 mm, 3 mm and 5 mm) available to the customer with two restoration platform diameter sizes per implant diameter. This allows for a subtle emergence profile, user choice and versatility.
SI-BASE Abutments will be available in the second half of 2022.
INVERTA® extended range
The INVERTA® Implant represents the latest breakthrough technology from Southern Implants and is designed for optimizing aesthetics in maxillary anterior extraction socket sites. INVERTA® helps clinicians achieve optimized aesthetics for their patients with its innovative Body-Shift Design by allowing more space for bone growth and health.
As part of our continued efforts to better serve our customers and build the INVERTA® range, Southern Implants is proud to announce a range expansion to the INVERTA® range. Additions of larger diameter INVERTA® implant (Ø5.0mm coronal – Ø6.0mm maximum diameter) for use in the canine and molar sites have been added by customer requests to the Deep Conical range. Shorter, 8mm lengths, have also been added to the Ø3.5/Ø4.5 and Ø4.0/Ø5.0 Deep Conical range. The External Hex range has also seen a range expansion with the addition of a larger diameter INVERTA® implant (Ø5.2mm coronal – Ø6.0mm maximum diameter) along with a 12° Co-Axis® variant available due to customer demand.
We look forward to hearing your feedback regarding these range extensions. As we continue to grow and innovate, we expect further developments to the INVERTA® range available soon with narrow variations in the pipeline!
SIGUIDED: Accessible Digital Dentistry
Guided implant surgery has the advantage of helping the implant surgeon place implants precisely and accurately. Many surgeons prefer not to use guides at all, while for others it is a useful tool in their arsenal.
One of the main drawbacks of guided implant surgery is the initial cost of investing in specialized surgical equipment and planning software, as well as the time needed for training. It is essential to know and understand not only the software required to do the planning, but also know and understand the surgical system and implants that the clinician is planning to use. Especially at the start of the guided journey, the time spent in learning the software and planning cases may exceed that of the actual surgery time. However, as with any technology, the cost of the equipment will come down, and more and more clinicians will become familiar with the software and processes.
The Southern Implants SIREAL guided system was launched in 2020, revolutionising the tooling necessary to enter the guided surgery market. Instead of various tools, Southern’s “Cannon” turns your existing surgical kit into a guided kit. Read more about SIREAL here and here.
SIGuided sevice is currently available in AUSTRALIA, UK and soon to be launched in South Africa.
SIGuided service has been developed to improve the experience of guided surgery and to simplify the process – clients can upload their scans and photographs, and a planner will then design and submit a plan for approval. After approval the guide is 3D printed, and the guide, implants and any components that may be required for the case are all sent together to the clinician in one box.
The benefits to the clinician are that the time intensive planning process is outsourced, and implants and component can be ordered on a case-by-case basis.
The SIGuided process can be summarised as follows:
- Upload order form and scans.
- Planning of the case.
- Printing of the guide.
- Packing and dispatch of the guide and all the components required for the case.
This SIGuided case was provided by Dr Michael Tang, from Kalyani Dental Lounge in Glasgow.
Key speakers include Profs Dale Howes, PO Ostman, Drs Nicholas Egbert, Petros Yuvanoglu, Costa Nicolopoulos, Howard Gluckman, Stephen Chu, Greg Boyes-Varley, Riz Syed, Chris Butterworth, Craig Barclay and many more, addressing a wide array of topics.
Our exceptional topics include:
- Career-spanning experience solving implant complications
- Measurable effects of the Southern Implants workflows on private practice efficiency
- Combining the MSc Implant surface with implantoplasty for peri-implantitis treatments
- Deciding which abutment is right for your case
- The dermal apron technique: an alternative in thin biotypes
- Passive abutments and digital workflow: interim results of an RCT using MSc implants
- Debunking common myths about treating posterior jaws
- Co-Axis® implants a decade later: long-term real-world patient outcomes
- Implant disasters and how to treat them
- The SiBase concept: design rationale and clinical experience from the co-developer
- How Southern Implants makes a clinical difference in failures, complications and revisions
- Bone regeneration using a novel design titanium mesh membrane
- A decade of experience with Zygomatic implants and related prosthetics
- Partial extraction therapy using Inverta®
- Prosthodontic perspectives and new abutment designs
In addition to this exciting academic programme, a guided factory tour of the Southern Implants factory is also available. Anyone who has ever joined one of these was blown away by the precision, attention to detail, and passion of the Southern Implants team.
Expert Exchange Forums will allow delegates to rub shoulders and discuss key points with a panel of world-renowned clinicians in these focused exchange sessions. Forums include:
- Oncology Expert Exchange Forum
- Overdentures Expert Exchange Forum
- Inverta® Expert Exchange Forum
- Accelerated Treatment Expert Exchange Forum
Get in touch with your local Southern Implants team who will have all the latest information in our rapidly changing environment, or email firstname.lastname@example.org.
Research – Zygomatic treatments
In spite of the disruptions to practice caused by the coronavirus pandemic, our doctors continued to produce world-class research from their globally renowned institutions – and zygomatic treatments were the focus.
In particular, the group led by Dr Carlos Aparicio of Spain continued to forge ahead with research on the Zygomatic Anatomy Guided Approach (ZAGA), which he first proposed in 2011 to classify the five most common zygomatic morphology types and their distinct surgical approaches (1).
In 2021 he and co-authors published a paper further elucidating the classification system according to three main zones of the zygomatic implant trajectory: the “Zygomatic Implant Critical Zone (ZICZ)”, the “Antrostomy Zone”, and the “Anchor Zone” (2). A thorough understanding of the function and vulnerabilities of each zone should, in the authors’ opinion, dramatically reduce risks of oral-sinus or oral-nasal fistula, soft tissue dehiscence and fracture of the zygoma, while maximising implant primary stability and optimising the emergence location of the implant head.
The paper describes in detail parameters concerning pre-operative assessment, 3D planning and even legal considerations, and is a must-read for maxillofacial surgeons of all levels of experience. Southern Implants offers a range of zygomatic implants including the traditional Zygomatic, machined-surface Oncology, and narrow-diameter ZYGAN and ZYGEX, all of which have distinctive characteristics to best suit the patient’s unique anatomical structure.
An independent methodological cadaver study by Dr Vosselman and colleagues from the University of Groningen described a 3D workflow for Southern Implants Oncology implants (3). The implants were used in single-procedure prosthetic obturation following Brown Class IIb maxillectomy and intended for immediate loading.
Using this 3D workflow with Southern Implants zygomatic drills, non-engaging cylinders and custom polyamide printed guides resulted in a fractional mean emergence point deviation of 1.03 ± 0.85 mm, mean zygoma entry point deviation of 1.20 ± 0.62 mm, and implant angle deviation of 2.97 ± 1.44°.
The unification of 3D surgical and prosthetic plans resulted in an extremely accurate placement and a technique that will reduce number of surgical sessions and prosthetic interventions, which is of particular importance in patients requiring adjuvant radiotherapy. The study will be repeated in actual maxillectomy patients shortly, and will be of great interest to any clinician hoping to use digital and guided methods in zygomatic surgery.
1. Aparicio C. A proposed classification for zygomatic implant patient based on the zygoma anatomy guided approach (ZAGA): a cross-sectional survey. Eur J Oral Implantol. 2011;4(3):269–75.
2. Aparicio C, López-Píriz R, Peñarrocha M. Preoperative Evaluation and Treatment Planning. Zygomatic Implant Critical Zone (ZICZ) Location. Atlas of the Oral and Maxillofacial Surgery Clinics of North America. 2021 Sep 1;29(2):185–202.
3. Vosselman N, Glas HH, de Visscher S a. HJ, Kraeima J, Merema BJ, Reintsema H, et al. Immediate implant-retained prosthetic obturation after maxillectomy based on zygomatic implant placement by 3D-guided surgery: a cadaver study. Int J Implant Dent. 2021 Jun 14;7(1):54.
Walter van Loo, Director of Proscan, our distributor in Belgium and the Netherlands, recently retired. Walter and partner Guy Mullens opened the Proscan doors 20 years ago in 2002, with the distribution of Southern Implants one of their offerings.
Proscan was at the forefront of digital dentistry. The operational side of the Proscan business is now in the capable hands of Karen and Gert Mullens, with some input from their father and co-founder of Proscan, Guy Mullens. Walter says that: “I am really proud that Guy and I laid the foundations for digital dentistry not only in Belgium but also outside of it.
Actually, we are digital dinosaurs – when we bought our first digital scanners in 2002, digital aspects of dentistry were not nearly as common as they are today. Today, the contribution of digital dentistry is totally enmeshed within digital processes.”
Happy retirement, Walter!
It is with great sadness that we announce the passing of one of our dedicated members of the Southern Family, Lauranda Gisela Breytenbach. She moved on to a better world on the 6th of January 2022 after a short but severe fight with cancer.
Lauranda had dedicated 17 years of her life to Southern, and had become highly respected by regulators around the world, due to her extensive knowledge and experience. Her thirst for knowledge and exemplary work ethic led to her being one of the most respected individuals in her field.
Her lust for life led to adventure upon adventure. No destination was too far, no mountain was unreachable and no “do not go beyond this point” was ever adhered to. She showed us the larger world out there through her love of photography, she always brought pieces of the world back to us and sometimes when we were good, she even took us with her.
Lauranda will always be remembered for her patient nature and big heart. She believed that women should have every opportunity to achieve anything they set their minds to, and was an avid contributor to the Dignity Dreams foundation.
She was patient, she was kind, she was loved and she shall forever be missed…
Atrophic Maxilla course UK
Due to demand after the first UK Atrophic Maxilla course, a second was held at Mar Hall, Glasgow.
The course comprised two days in the relaxed company of a panel of authorities, immersed in the topics of bone regeneration, atrophic maxilla full arch treatment approaches, anterior aesthetics and immediate molar treatments with site-specific implants.
Lectures and hands-on opportunities focused Co-Axis®, Nazalus, Zygomatic, pterygoid sites, and MAX implants.
The faculty are all leaders in their fields – Prof Dale Howes, Drs Stavros Eleftheriou, Andre Hattingh, Dominic O’Hooley, Greg Boyes-Varley, Riz Syed, Rudi Mukherjee and Andrew Fish.
Zygomatic meeting France
Southern Implants France kicked off their face-to-face meetings with a Zygomatic meeting in October 2021. Speakers included Bruno Courtois, Ludovic Denglos, Jean Baptiste Verdino, Harmik Minassian, Luarence Evrard, Sepehr Zerrine, Rahael Bonnet and Samama Mickael.
Southern Implants North America hosted it’s second Envision Education Program December 9-12, 2021 in beautiful Delray Beach, Florida. The event entitled “Expert Forum on Optimizing Practice Outcomes” featured renowned clinicians speaking about their evolving practices and how site-specific implant dentistry is playing a pivotal role in their success.
Education opportunities abounded during Envision 2022 with two-days of hands-on workshops followed by a full day general session. The workshops were a hit with sold out attendance for the Site-Specific Immediate Implants – Posterior and Anterior workshop led by Drs. Lyssova and Chu, as well as the Less Invasive Full-arch Rehabilitation workshop led by Drs. Egbert and Tahmasebi. Envision 2022 culminated a lineup of world-class clinicians during the full day general session.
The first half of the day clinicians shared their experiences with immediate anterior workflows and treating the severely atrophic maxilla These were presented point/counterpoint debate style allowing Drs. Baumgarten and Chu, Tahmasebi and Tuminelli to share their unique perspectives and providing attendees with a well-rounded view of different protocols. Drs. Egbert and Morris then shared how using site-specific treatment protocols in their practices has led to maximizing efficiencies while also providing better outcomes for their patients. The program concluded with our very own Graham Blackbeard sharing what new technologies are on the horizon.
Thank you to all the attendees and educators who made this unique education experience possible.
|21-23 March||SICON 2022, Pretoria, South Africa|
|26-28 May||UK: ADI Team Congress, Manchester|
|15-18 June||Europerio, Copenhagen, Denmark|
|29 September – 1 October||EAO (European Association for Osseointegration). Geneva, Switserland|
|14 – 15 October||SAVE THE DATE: Southern Implants Europe Conference|