A WEEKEND GRAFTING IN ROME
BY DR JOHN BARTON , INTERNATIONAL HEALTH CENTRE – MILAN
A s last Summer was turning into Autumn , one lunchtime I was doing my email when an invitation from Trycare of Bradford for a bone regeneration course in December arrived . I looked at it a bit sideways as the course was not , as usual , in some god forsaken lodge hotel at a convenient point on the motorway box round Birmingham , but was in fact in the eternal city of Rome , with Dr Michele Lopez , sponsored by OsteoBiol , presenting the course . This had all the hallmarks of a good weekend CPD jolly in Italy , and with a subject dear to the heart of us all - creating vertical and horizontal alveolar bone using the Khoury shell technique of regenerating the atrophic crestal ridge . The timing of the course on the first Saturday in December was , by my calculations , perfect : I would definitely avoid being at home for one of the two days of putting up Christmas decorations that weekend ( and in the other scenario management would not want to miss out on a trip to Rome ). So the evening before the course I boarded the Italian high speed train , “ La Frecciarossa ”, in Milan for the journey down to Rome . We whizzed along at 190 mph and in two hours and fifty seven minutes we were there . Just five minutes ’ walk from Rome Termini station , Trycare had organised a lovely pre-course dinner at “ La Matriciana ”, a wonderful 1920 ’ s ristorante of the belle epoque style that they just aren ’ t making anymore . I had already taken the precaution of Googling the menu on their site and knew it was going to be just great classic Roman dishes and it was . The next morning the twenty five delegates from thirteen countries all met up again in the , unassuming from the outside but immaculate and spacious inside , studio of Michele Lopez in the Appio Latino district of Rome , where he practises implantology and implant retained prosthetics . Strangely there were no British participants on this Trycare course .
I feel that as a nation and professionally we don ’ t take the Italians seriously , we think of their love of “ la dolce vita ” and their “ bella figura ” and that they make the most fun but scary cars to drive around the Italian lakes . But there is more to them than this , they have a very strong hi-tech dental materials sector with companies like Tecnoss , and a dental profession that knows a whole lot
more about implantology than we like to give them credit for , and Michele is one of those guys . Last year in Italy , 1.1 million implants were placed in patients ’ mouths ; the U . K . only managed 135,000 units in a similarly sized nation . Strange , but I digress .
The presentation of the Khoury technique of fixation of the lamina cortical bone and the rationale behind the selection of grafting materials used was clearly explained and the supporting photographic documentation was beautiful . What , though , became apparent was that the addition of the game changing TSV gel to the cocktail of OsteoBiol Lamina cortical bone barrier , GenOss and membrane means that achieving our dental nirvana and reliably growing crestal bone just became that little bit easier and predictable . The TSV gel is funny stuff to use : it is kept refrigerated which keeps it runny , till the moment needed when , added to the hydrophilic Gen-Oss , it mixes together easily ; then the viscosity rapidly climbs as it warms up to room temperature , giving excellent handling characteristics and excellent stability to the biomaterials at the graft site under the cortical lamina . But , more importantly , the gel is rich in various forms of collagen acting as a substrate for platelet activation and aggregation . It also attracts stem cells into the site and promotes a more natural osteoclastic remodeling of biomaterials similar to normal physiological bone turnover . All good stuff and the post operative photos were excellent : you got the feeling that the photos had not been cherry picked but that , if you follow the technique , select the correct type of lamina and fill the defect as advised , these are the results you will get .
In the afternoon , after a wonderful seafood risotto lunch ( other plates were available ) in the local trattoria , we practised on typodonts the placement of the new OsteoBiol “ Lamina ” flexible grade cortical bone grafting materials , membranes and pin placement ; in fact the whole Khoury technique , but the most interesting thing was to manipulate the new thermosensitive TSV gel for stabilization of grafting materials at the site . During the practical we were also shown some tricks with titanium fixation pin placement by Michele . The head of research from OsteoBiol was also there and he announced the interesting fact that they have now in the final phase of “ CE ” marking , a fully resorbable collagen fixation pin system that will be launched sometime next year : this should be a very interesting new product to use that we can only now think around the edges about how it will change bone regeneration and implant dentistry .
Strangely , as we know , the U . K . lags behind other comparable countries for the numbers of implants placed and in this respect I am writing about all types of cases from the slam dunks to the very complex . I feel so few in the U . K . dental profession ever get going in implantology , placing even just simple implants , as they are put off by the hurdles of complexity set up in their minds by the big boys of implant systems who seem to have a vested interest in keeping implantology as a dark art which , in the rest of Europe by looking at the placement figures , it clearly isn ’ t . I believe that , using the Khoury technique as part of your treatment armentarium , combined with the full supporting orchestra of bio-materials from OsteoBiol , that more implants will be placed as more sites become less challenging using this technique . I ’ ve done a lot of CPD courses all over the world and this one stood out for its simplicity and elegance . I do hope that Trycare run the course again sometime soon as I am sure Michele Lopez would be happy to do it , the price was reasonable and there is a budget airline departing from somewhere near to you that can take you and your partner to the eternal city for some great weekend CPD in the wonderful city of Rome in all it ’ s splendour .
Dental Practice Magazine
75