Dr. Rolf Ewers - April 24, 2009

American Dental Implant Association
The Miami Implant Update
April 24, 2009
Dr. Rolf Ewers
Bone Forming Materials to Enhance Missing Bone

· Oral Surgeon from University of Vienna and has CMF Institute Vienna
· MAJOR facial surgeries
o 21 hour surgery example on lady from Romania
o Full facial reconstruction of gentleman where accessory nerve was preserved: skydive
· Bone replacement material (BRM) vs Bone forming Material (BFM)
· BFM vs. Foreign Body Material
o FBM – Bio-Oss never resorbs… even after 7, 14 yrs
o FBM – Interpore after 26 yrs… still there
· PAR
o Porosity
o Absorption
o Resorption
· Must be biocompatible
· Algisorb
o Very porous
o Histomorphology
§ Hydrolytic alteration of the scaffold
§ Creeping substitution by new bone
§ Even see nuclei in the tubules of Algisorb
o Copies nature
§ More elegant than cadaver
· Augmentation techniques
o Bone quality
§ Class I – Revascularized bone: Never resorbed, can maybe add in BMP
§ Class II – Distracted bone (vascularized)
§ Class III – Pedicled inlay bone (not vascularized)
§ Class IVa – Autogenous Onlay bone (not vascularized)
§ Class IVb – Augmented allograft (not vascularized)*
· *The one they are always trying to sell is 5th
o Never extracts tooth w/o filling the root
o Need to place a membrane to prevent mesenchymal cells from inving bon e graft
· What is best membrane?
o 1. Thin cortical bone,
o 2. Titanium membrane
o 3. E-PTFE membrane
o 4. Slowly resorbing membrane
· Algisorb – after 7 months, the histomorphology is 23% newly formed bone and 33% algisorb
· Algiorb with PRP – after 7 mo 31% newly formed bone and 21% residual algisorb
o The PRP is activating the osteoclasts
· Johansson et al 2001
o Algisorb has 14% replacement versus 30% with iliac crest
· Only a 4.4% failure with algisorb and maxillary sinus lifts
· The Bow Tie Book
o Oral and Implant Surgery Dunsche, Ewers, Filippi
o By Quintesscence
· Future
o Rehumanization of resorbable material
o Bioactivating of the bone forming material
o PAR – Porosity, Absorption, Resorption
o Autogenous stem cell products
· Tenting
o BMP2 with good scaffolding and bone (just implants sticking out)
· It’s not the bone, it’s the SOFT TISSUE coverage
o That’s how you get true success of bone grafts