Preface

Chapter 7 **The Role of Hydrophilic Sandblasted Titanium and Laser Microgrooved Zirconia Surfaces in Dental Implant**

**Section 4 Non Autogenous Grafting Healing Pattern 169**

Chapter 9 **Biodegradation of Injectable Calcium Phosphate Bone Cements: A Dental Perspective 171**

Chapter 8 **The Effects of Surface Roughening Techniques on Surface and Electrochemical Properties of Ti Implants 153**

Youssef Al Jabbari, Wolf Dieter Mueller, Abdulaziz Al-Rasheed and

**Treatment 129** Aleksa Markovic

**VI** Contents

Spiros Zinelis

Volkan Arısan

Dental implantology is a dynamic science that is evolving very fast. The current era of tech‐ nology and social media has added more pressure to reach a superior quality in health care and cosmetics. As every aspect in life, a lot of challenges stood up to the mission. As a sur‐ geon dealing with dental implants and facial reconstruction, almost on a daily basis, the challenging vibes are always there especially after a long consultation visit of a severely compromised case requiring multistep rehabilitation, ended up by receiving a shy patient's wish stating, "I can't wait for 6 months or so to complete the whole process". I honestly to‐ tally agree with the patient's wish, and I do feel that the science of dental implant has a lot to provide to our clients. And that is raising the question of "how can we make it better and faster" to meet every patient's expectation and social obligations at the current era of the twenty-first century.

Occasionally, practitioners in the field will try to be as idealistic as possible in all aspects of care, and usually that means more preparation, more surgical reconstruction, and hence more time on patients cost, however, such is considered totally unrealistic. Hence, the art of customizing a specific rehabilitation plan can be the secret to solve the predicament depend‐ ing on science, tools, manpower, and the technology that can provide that plan.

To be able to do so, it is of prime importance to understand how wide is this specialty. It requires a lot of knowledge about the basics of healing biology, including bone, graft, soft tissue, and adding an external metallic or ceramic material into them and hoping for the complex to be in a stable well-being for lifetime. It can be as simple as placing a single im‐ plant in a well-prepared site and can get much more complicated once dealing with compro‐ mised sites or compromised health, such as trying to treat sick elderlies with significant tissue deficiency. A lot of texts have discussed the basics and beyond; however, still more are needed to keep up to the best expectations and outcomes in this comprehensive dental implant science.

When the clinical expertise is put together with evolving research and technology to im‐ prove the service, that is when updates in the field can be applicable. Hence, the book *"Den‐ tal Implantology and Biomaterial"* has gathered a special group of unique scientists from more than 10 countries, including Germany, Greece, Italy, Iran, Malaysia, Saudi Arabia, Serbia, Spain, Sweden, and Turkey, who discussed "hot" clinically applied correlated research top‐ ics in a single book to enrich the idea of a "focused updates" toward dental implantology, linking the involved specialties with scientific tips and tricks in the field. Clinicians, post‐ graduate residents, researchers, and students can find this book stimulating to improve their practice and initiate more research ideas in the subject. The beauty is about reducing the gap between the laboratory science and the clinical application, and that is what forms the main value of the book.

*"Dental Implantology and Biomaterial"* started with an introductory chapter discussing the clinically applied dental implant practice through a direct link to the main factors of success and failure. The chapter will discuss exciting challenging cases, technical maneuvers, and showing some complications. This chapter will be the door to discuss some solutions through current research topics that are modifying implant surfaces and improving the im‐ plant biological seal in relation with the soft tissue envelop, improving the implant surface, narrowing the diameter, or using a white implant surface material that can present valid solutions in demanding locations in the oral cavity such as the cosmetically challenging an‐ terior maxilla.

Every implantologist will be dealing with the shortcomings of alveolar bone deficiency in different shapes and forms, in horizontal or/and vertical dimension. Although it is well known that autogenous grafting is usually the best, it might not be applicable based on the clinical scenario or patient's preference and hence, discussing an alternative such as nonau‐ togenous calcium phosphate biodegradable products is useful. All the former can be com‐ promised if the "bacterial load" factor is not considered in managing such cases and hence the relation and the application of antibiotics are thoroughly discussed as well.

As timing is always a prime topic of discussion with almost every patient seeking implant rehabilitation, the feasibility to put implants in full function is a point of continuous re‐ search. Although a lot of studies are using the primary stability path as an indicator for re‐ habilitation, it should be carefully approached. Improving the implant surface characters and using an objective method to check secondary stability such as the resonance frequency analysis is presented. However, the long-term relation with the soft tissue envelope is anoth‐ er challenge that should be linked with the success of the treatment provided.

It makes all the contributing authors and myself as an editor and contributor, proud to share an experience that I prefer calling "focused and diverse" in the wide field of "dental implan‐ tology". I hope that it can be a uniquely excellent reference to clinicians, trainees, and re‐ searchers in the field.

As life goes, missions will evolve surrounded by challenges that might help pursuing them or letting them go. Although, I am a big believer in positive and negative energy impacts; as an oral maxillofacial surgeon, I do believe as well in the power of utilizing those energies to the best paths ever. It does imitate a surgical challenge in the theatre that would urge cutting through, camouflaging, or just excising. Therefore, a positive surrounding will definitely boost up the energy, whereas a negative one should be forced with a spirit of refocusing and that is what a real training in oral maxillofacial surgery is all about and that is what we should be training our younger trainees to pursue for the future of education and health care. Hence, I am pleased to acknowledge all my friends, teachers, peers and colleagues whom I was lucky to have around in my life. Their presence has been always pleasant and supportive to me on the personal as well as the professional level; *"You've been always an 'energy boost', God bless you all."* My family members: "thank you dear Father Ahmad Jawad, mother Fatma, wife Najiah, and lovely children, for keeping up with my busy schedule and me."

*King Abdulaziz University, Faculty of Dentistry:* All the faculty, administration, and staff with special gratitude to dear colleagues, teachers, and friends:

between the laboratory science and the clinical application, and that is what forms the main

*"Dental Implantology and Biomaterial"* started with an introductory chapter discussing the clinically applied dental implant practice through a direct link to the main factors of success and failure. The chapter will discuss exciting challenging cases, technical maneuvers, and showing some complications. This chapter will be the door to discuss some solutions through current research topics that are modifying implant surfaces and improving the im‐ plant biological seal in relation with the soft tissue envelop, improving the implant surface, narrowing the diameter, or using a white implant surface material that can present valid solutions in demanding locations in the oral cavity such as the cosmetically challenging an‐

Every implantologist will be dealing with the shortcomings of alveolar bone deficiency in different shapes and forms, in horizontal or/and vertical dimension. Although it is well known that autogenous grafting is usually the best, it might not be applicable based on the clinical scenario or patient's preference and hence, discussing an alternative such as nonau‐ togenous calcium phosphate biodegradable products is useful. All the former can be com‐ promised if the "bacterial load" factor is not considered in managing such cases and hence

As timing is always a prime topic of discussion with almost every patient seeking implant rehabilitation, the feasibility to put implants in full function is a point of continuous re‐ search. Although a lot of studies are using the primary stability path as an indicator for re‐ habilitation, it should be carefully approached. Improving the implant surface characters and using an objective method to check secondary stability such as the resonance frequency analysis is presented. However, the long-term relation with the soft tissue envelope is anoth‐

It makes all the contributing authors and myself as an editor and contributor, proud to share an experience that I prefer calling "focused and diverse" in the wide field of "dental implan‐ tology". I hope that it can be a uniquely excellent reference to clinicians, trainees, and re‐

As life goes, missions will evolve surrounded by challenges that might help pursuing them or letting them go. Although, I am a big believer in positive and negative energy impacts; as an oral maxillofacial surgeon, I do believe as well in the power of utilizing those energies to the best paths ever. It does imitate a surgical challenge in the theatre that would urge cutting through, camouflaging, or just excising. Therefore, a positive surrounding will definitely boost up the energy, whereas a negative one should be forced with a spirit of refocusing and that is what a real training in oral maxillofacial surgery is all about and that is what we should be training our younger trainees to pursue for the future of education and health care. Hence, I am pleased to acknowledge all my friends, teachers, peers and colleagues whom I was lucky to have around in my life. Their presence has been always pleasant and supportive to me on the personal as well as the professional level; *"You've been always an 'energy boost', God bless you all."* My family members: "thank you dear Father Ahmad Jawad, mother Fatma, wife Najiah, and lovely children, for keeping up with my busy schedule and

the relation and the application of antibiotics are thoroughly discussed as well.

er challenge that should be linked with the success of the treatment provided.

value of the book.

VIII Preface

terior maxilla.

searchers in the field.

me."

Abdulghani Mira, Motaz Ghulman, Ali Alghamdi, Yaser Alkhiari, Fahad Alsulaimani, Ali Habib, Zuhair Al Morshed, Ahmad Alyamani, Amr Bayoumi, Ahmad Jan, Maisa Alsubaie, Basem Jamal, Mohammad Alghamdi, Mohammad Shah, Wael Elias, Hosam Baeshen, Moath Attar, Samar Alagi, Abeer Alnowaiser, Mohammad Khalil, Ibrahim Yamani, Lina Ashi, Ab‐ dulElah Binmahfoz, Osama Qutob, Loai Alsofi, Mohammad Huwait, Khalid Merdad, Dina Altayeb and Ayman Johar

And a special gratitude to the following personnel at the administration section: Mr. Fouad Abdulmajed, Abboud Mohammad, Khalid Alshehri, Rajallah Alsulami, and Farid Alzahra‐ ni.

*McGill University:* Timothy Head (RIP), Jocelyn Feine, Richard Emery, Michele Elhakim, Antoine Chehadi, Deborah Iera, Julia Pompura, Paul Allison, Mark Shenouda, Alex Dostie, Aldo Camarda, and Dennis Kalloyannis.

*The Saudi Board of Oral and Maxillofacial Surgery (The Saudi Commission of Health spe‐ cialties):* Colleagues and friends whom I had an honored chance to operate, educate, and research with: Abdulla Al-Etel, Mohammad Alkindi, Khalid Almutairi, Abdulrahman Alo‐ saimi, Abdulsalam Aljabbab, Sulaiman Alruwaili, Raed Shata, Fahad Aljayar, Bader Aljan‐ dan, Emtenan Abdulmajed, and Ebtesam Aljerb.

*King Khalid University:* Ibrahim Alshahrani, Mohammad Alfarsi, Yousef Algarni, Saad Al‐ qahtani, Adel Mostafa, Ashraf Gebreel, Abdulnaser Sulaiman, Khalid Bdair, Zahir Kota, Kamran Bokhari, Abdulbagi Mostafa, and Ghatafan Alnohaily (RIP), and Mohammad Dal‐ lak.

*Dentalia Specialty Clinic:* Ahmad Halawani, Wassim Saati, Zainab Saati, Jowdat Jamuld‐ din, Nada Jamaluddin, Hasan Shaikh, Hasan Kathiri, Ahmad Hani, Wahid Mohammad, and the amazing coordinators: Rana Anjum, Hanan Beyan, Mohammad Saafan, Rawan Almalki, Morooj Masriya, Eman Tolba, and Moneera Alsulaimani

And finally, I would like to acknowledge the support of the InTech publishing agency mem‐ bers: Ana Simcic, Romina Rovan, Iva Lipovic, and Ana Pantar. Thank you for being patient and supportive throughout the project.

#### **Mazen Ahmad Almasri, BDS, MSc, FRCD(C), Dipl. ABOMS**

Consultant of Oral Maxillofacial Surgery/Reconstruction and Implantology Assistant Professor, Department of Oral Maxillofacial Surgery Faculty of Dentistry, King AbdulAziz University Jeddah, Saudi Arabia

**Implant Clinical Managemet - Expectations and Reality**

**Chapter 1**
