According to Dr Tiziano Testori, Guided surgery in implant dentistry still presents some limitations owing to inherent inaccuracies. (Image: madeinitaly4k/Shutterstock)
This year’s EAO congress is being held jointly by the EAO and two prestigious Italian organisations: the Italian Academy of Osseointegration (IAO) and the Italian Society of Periodontology and Implantology (SIdP). Dr Tiziano Testori was president of the Italian Academy of Osseointegration from 2017 to 2018. In this interview, he talks about the shift towards a more conservative and ethical approach to implantology.
Dr Testori, your lecture at the EAO congress focuses on full-arch guided surgery. What are the key limitations you will be addressing, and why should dental professionals be aware of them? Guided surgery in implant dentistry still presents some limitations owing to inherent inaccuracies. For example, a 2014 study showed positioning discrepancies between the virtually planned and actual implant outcomes.1 Guided implant surgery requires learning and practice, and certain inaccuracies can arise throughout the digital workflow, from data acquisition to placement. Even when the guide is properly prepared, it can still be positioned inaccurately. This highlights how the practice of our profession involves the consideration of small details that, when combined, can make a significant difference.
Dr Tiziano Testori is a distinguished expert in dental implantology and on the roster of international speakers at this year’s EAO congress. (Image: Tiziano Testori)
How do static and dynamic navigation techniques differ, and what factors should influence the choice between them?
The difference between static and dynamic surgery in implantology is not scientifically significant in clinical terms. There is no strong evidence suggesting that static surgery is superior to dynamic surgery or vice versa. While the literature supports both approaches, the choice typically depends on the clinician’s preference. Static surgery remains the most widely used globally, whereas dynamic surgery requires more effort to learn. A clinician needs patience and should ideally perform at least 50 cases to become proficient in dynamic surgery.
For more experienced clinicians, one barrier to dynamic surgery is that they’re accustomed to watching their hands while working rather than looking at a monitor. Both approaches require learning and practice, particularly in planning. In dynamic surgery, however, the preparation of surgical guides is not necessary.
Given your extensive experience, what trends are emerging in the field of osseointegration and implantology that professionals should prepare for? A key trend is the integration of artificial intelligence (AI), which is becoming a reality in cutting-edge facilities. AI assists in the diagnostic phase and is being introduced into routine procedural steps, including automated surgical planning. Advanced planning software today incorporates AI, simplifying the process. More than the planning itself, AI automates steps that previously required manual input, such as clicks, replacing them with voice commands. As software becomes more user-friendly, many clinicians who did not grow up with digital tools will find it easier to adopt these technologies, leading to more accurate implant placement.
“There is no strong evidence suggesting that static surgery is superior to dynamic surgery or vice versa.”
Another significant trend is a medical approach to patient evaluation. This involves assessing individual risk factors to improve success rates and prevent peri-implant disease. For example, we systematically evaluate vitamin D levels, give patients vitamin C supplements to promote tissue healing, and assess oxidative stress. There’s increasing scientific evidence supporting this personalised holistic approach. Our group published the first article on the importance of vitamin D supplementation in implantology ten years ago.2
Why is the decision to retain or extract teeth critical in full-arch restoration, and what advances influence this choice? This question has an ethical aspect. In recent years, there’s been a shift towards a more conservative and ethical approach, moving away from money-driven implantology to patient-centred care. In the past, we’ve seen cases where healthy teeth were extracted to place implants. Doing so is fundamentally wrong and unethical. Patients are becoming more aware of conservative treatment options and understand that periodontal disease can be treated and that implants are meant to replace lost teeth.
Clinicians need to carefully evaluate dental and periodontal parameters before deciding to render a patient edentulous. It’s also essential to consider the patient’s individual response to treatment. In 2016, we published the longevity protocol, which is a computerised assessment to better profile the patient from an implantology perspective.3
Another consideration is that, while we have effective tools to treat periodontal disease, we lack universally agreed-upon treatments for peri-implantitis. This makes it crucial to evaluate the patient thoroughly before deciding to extract teeth.
“Clinicians need to carefully evaluate dental and periodontal parameters before deciding to render a patient edentulous.”
What can attendees expect to gain from your lecture in terms of practical applications for their clinical practice? I hope that attendees will take away important concepts, starting with a well-executed diagnostic phase and a comprehensive patient evaluation. I will also introduce technologies that allow us to be less invasive, which reduces postoperative recovery time. Minimally invasive procedures also involve designing prostheses that are easy for patients to maintain with regular oral hygiene routines. When an implant is correctly placed, the prosthesis will be more accurate and easier to maintain, thereby reducing the risk of peri-implantitis. We have developed the minimally invasive full-arch (MIFA) protocol, which is currently in the preliminary stages of an important clinical study.
Participants learn more about the latest courses and training opportunities offered by EAO. (All images: Robert Strehler)
Participants exchanging ideas among the dynamic atmosphere of EAO-DGI 2024.
Some of the many booths showcasing world-class industry innovations.
Participants engage with ePosters showcasing new clinical and scientific research in implant dentistry.
Italian Dr Luca De Stavola presents on some key aspects of surgical management.
Italian Dr Luca De Stavola presents on some key aspects of surgical management.
More than 4,200 delegates from over 70 countries attended the congress. Here are some enthralled by one of the many presentations on offer.
Congress attendees learn more about implant treatment and digital dentistry at the MegaGen booth.
Next year's EAO congress will be held in glitzy Monaco, the home of the most renowned Formula One race in the world.
Industry leaders make the most of the networking opportunities on offer at the congress.
Participants learn more about Dentsiply Sirona's OSSIX® product line, which offers advanced solutions for guided bone and tissue regeneration.
The congress stimualted extensive, free flowing dialogue among participants. Here are some engaged in discussion about the latest in industry trends.
The aesthetically polished booth from leading Swiss dental implant manufacturer, Nobel Biocare.
Congress attendees learn more about implant, regenerative and esthetic dentistry at the Straumann booth.
Participants keep abreast of daily developments at the conference through the DTI Today publication.
Meisinger Implants shares information about its recent developments in the field of dental implantology with interested visitors.
Editorial note:
Dr Tiziano Testori’s lecture, titled “Minimally invasive full-arch protocol in fully edentulous patients”, is part of the session “Full-arch reconstructions: The surgical approach: When is it time to keep the dentition?”, which will be held on 25 October from 13:45 to 15:00 at the EAO congress. The congress takes place at the Milano Convention Centre. More information about the event can be found here.
References
Testori T, Robiony M, Parenti A, Luongo G, Rosenfeld AL, Ganz SD, Mandelaris GA, Del Fabbro M. Evaluation of accuracy and precision of a new guided surgery system: a multicenter clinical study. Int J Periodontics Restorative Dent. 2014;34 Suppl 3:s59–69. doi: 10.11607/prd.1279.
Choukroun J, Khoury G, Khoury F, Russe P, Testori T, Komiyama Y, Sammartino G, Palacci P, Tunali M, Choukroun E. Two neglected biologic risk factors in bone grafting and implantology: high low-density lipoprotein cholesterol and low serum vitamin D. J Oral Implantol. 2014 Feb;40(1):110–4. doi: 10.1563/aaid-joi-d-13-00062.
Testori T, Clauser C, Deflorian M, Capelli M, Zuffetti F, Fabbro MD. A retrospective analysis of the effectiveness of the longevity protocol for assessing the risk of implant failure. Clin Implant Dent Relat Res. 2016 Dec;18(6):1113–8. doi: 10.1111/cid.12428.
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