Introducing a new methodology in teaching implant dentistry

1. P
D

2. 1] prosecutor’s verbal opening statement followed by
defendants opening statement.
A brief case report and why this case must be re-
examined for mistakes by the dentist performed the
procedure. Followed by the defendant’s point of view in
a verbal statement why this these mistakes were done
due to circumstances that could not have been avoided.
Case history, how the diagnosis was based upon, what
challenges occurred and what mistakes performed.

3. 1] prosecutor’s verbal opening statement followed by defendants opening statement.
A brief case report and why this case must be re-examined for mistakes by the dentist performed the procedure. Followed by the
defendant’s point of view in a verbal statement why this these mistakes were done due to circumstances that could not have been
avoided. Case history, how the diagnosis was based upon, what challenges occurred and what mistakes performed.
2] prosecutor’s evidence followed by defendant’s evidence. The prosecutor will provide photos and literature in order to bring out
evidence that supports the prosecution’s case. The same with the defendant. Here the defendant should suggest the version of the
facts to that prosecution’s presented during this cross-examination session.
3] Calling all prosecutor’s point of view from jury. Each member of jury could present a literature in order to bring out evidence that
supports the prosecution’s case. Pointing out all other mistakes performed by the dentist.
4] Calling all defendants info from jury. Each member of jury could present a literature in order to bring out evidence that supports the
defendant’s point of view. Jury pointing out possible reason for those steps and all other unique and clever steps performed
5] Closing statements
After all the evidence is presented, the prosecutor and the defender have an opportunity to make closing submissions about why the
dentist should be found not guilty or guilty.
6] Judgment of jury
The jury on each account will have a verdict. Unanimously or not should be announced with details.
7] Sentencing
If found guilty, the sentence for a provincial offence may include what to do to undo the mistake or at least acknowledge the mistake
made in this case.

4. Re-Examination process – cases 1-9
Reference from the literature
Evidence vs.
VERDICT
6
Prosecutor’s
verbal opening
statement
followed by
defendants
opening
statement
30 1 each 1 each 5 1 1 Mints ?
Prosecutor’s
evidence
followed by
defendant’s
evidence.
Jury pointing
out all other
mistakes
performed by
the dentist
Jury pointing
out possible
reason for those
steps and all
other unique
and clever steps
performed by
the dentist
Closing
statements
Judgment of
jury
Sentencing Time

5. 1] prosecutor’s verbal opening statement followed by defendants opening statement.
A brief case report and why this case must be re-examined for mistakes by the dentist performed the procedure. Followed
by the defendant’s point of view in a verbal statement why this these mistakes were done due to circumstances that could
not have been avoided. Case history, how the diagnosis was based upon, what challenges occurred and what mistakes
performed.
2] prosecutor’s evidence followed by defendant’s evidence. The prosecutor will provide photos and literature in order to
bring out evidence that supports the prosecution’s case. The same with the defendant. Here the defendant should suggest
the version of the facts to that prosecution’s presented during this cross-examination session.
3] Calling all prosecutor’s point of view from jury. Each member of jury could present a literature in order to bring out
evidence that supports the prosecution’s case. Pointing out all other mistakes performed by the dentist.
4] Calling all defendants info from jury. Each member of jury could present a literature in order to bring out evidence that
supports the defendant’s point of view. Jury pointing out possible reason for those steps and all other unique and
clever steps performed
5] Closing statements
After all the evidence is presented, the prosecutor and the defender have an opportunity to make closing submissions
about why the dentist should be found not guilty or guilty.
6] Judgment of jury
The jury on each account will have a verdict. Unanimously or not should be announced with details.
7] Sentencing
If found guilty, the sentence for a provincial offence may include what to do to undo the mistake or at least acknowledge

6. Prosecutor

9. Defendant’s point of view

10. EXTREMELY
COMPLEX
CASE TREATED
IN
3 VISITS
I would
reverse all
of the
executive
evidences
that you just
got polluted
with
Defense

11. TIME ?
42 minutes
Single implant in
the anterior
maxillary region
takes 42 minutes,
45-90 minutes
Bone
augmentation
with membrane
2018
Sibert class one
level 3
3
Average number
of visits for this
case is 6, it was
done with 3 visits
only
4 out of 5
Complexity of
implant in the
esthetic region
https://www.augma
bio.com/patient-
info-bone-graft-
dental/
1st Diagnosis
2nd Augmentation
3rd implant
4th uncovery
5th impression
6th restoration
based on: Time required for
implant placement,
Treatment Cost for the
entire procedure, Number of
procedures required for
completing the treatment
and Hounsfield Unit density
in different regions in the
jaws.

12. 1] prosecutor’s verbal opening statement followed by defendants opening statement.
A brief case report and why this case must be re-examined for mistakes by the dentist performed the procedure. Followed
by the defendant’s point of view in a verbal statement why this these mistakes were done due to circumstances that could
not have been avoided. Case history, how the diagnosis was based upon, what challenges occurred and what mistakes
performed.
2] prosecutor’s evidence followed by defendant’s evidence. The prosecutor will provide photos and literature in order to
bring out evidence that supports the prosecution’s case. The same with the defendant. Here the defendant should suggest
the version of the facts to that prosecution’s presented during this cross-examination session.
3] Calling all prosecutor’s point of view from jury. Each member of jury could present a literature in order to bring out
evidence that supports the prosecution’s case. Pointing out all other mistakes performed by the dentist.
4] Calling all defendants info from jury. Each member of jury could present a literature in order to bring out evidence that
supports the defendant’s point of view. Jury pointing out possible reason for those steps and all other unique and
clever steps performed
5] Closing statements
After all the evidence is presented, the prosecutor and the defender have an opportunity to make closing submissions
about why the dentist should be found not guilty or guilty.
6] Judgment of jury
The jury on each account will have a verdict. Unanimously or not should be announced with details.
7] Sentencing
If found guilty, the sentence for a provincial offence may include what to do to undo the mistake or at least acknowledge

14. “Whether the patient’s first visit is with the
surgeon or the restorative doctor, a full
evaluation of patient needs, wants, and
desires must be undertaken.1–4,8–10,22
Before a commitment to treatment is made,
diagnostic material must be evaluated by
the entire team. A medical and dental
evaluation, as well as pertinent history,
appropriate radiographic studies, mounted
diagnostic models, and a generalized
evaluation of the team and patient’s goals
must be analyzed”.1–6,8,9,30
“Provisional prosthetic fabrication for patients begins with the initial
examination. The mounted diagnostic models act as the base from, which the
provisionals will be fabricated. Selection of a shade should be made at this
visit”.

15. Using Papillae-
Sparing Incisions
in the Esthetic
Zone to Restore
Form and Function
Gary Greenstein, DDS, MS;
Dennis Tarnow, DDS
Vertical incisions wrongly placed !!!

16. Vertical incisions wrongly placed !!!

17. Vertical incisions left a permanent scar !
Vertical incisions wrongly placed !!!

18. For implants placed 1 mm below the bone crest, no hard tissue remodeling was observed. For implants
placed 2 or 3 mm below the bone level, a slight remodeling occurred, even though the implant neck was
never exposed. It can be assumed that the conical connection as technical factor may help to achieve and
maintain marginal bone level stability,
but if the implant is placed too deeply in the bone, a bone remodeling will occur. This result is in
agreement with a recent multicenter prospective clinical study showing a statistically significant positive
correlation between the depth of implant insertion and early MBL
Tomasi, C.; Tessarolo, F.; Caola, I.; Piccoli, F.; Wennstrom, J.L.;
Nollo, G.; Berglundh, T. Early healing of peri-implant mucosa in man.
J. Clin. Periodontol. 2016, 43, 816–824.

19. “Tissue-level and non-platform-switched implants typically are not placed below the
bone level (subcrestal) (Figure 3).22 Placement of such implants below the bone
level is not recommended, as the bone will remodel leading to crestal bone loss in a
saucerization pattern.11 This occurs in tissue-level implants because the smooth
collar of the implant is not roughened for osseointegration. In non-platform-switched
implants, subsequent placement of the abutment below bone level leads to
remodeling circumferentially to accommodate biological width development ”
Compendium September 2020 Volume 41, Issue 8
Implant Restorations: Establishing a Proper Emergence Profile
Mark Bishara,

20. “Implant malposition in the oro-facial dimension and
particularly being too far facially inclined in the maxilla,
may be the most common operator related risk factor
(anecdotal). These implants potentially can have an
increased incidence of biological complications such
as bone loss, implant loss, esthetic and prosthetic
complications and may not be restorable”.
Risk Factors In Implant Dentistry: Unrestorable Implants, August 6, 2019, by Murray Arlin

21. The practitioner has the options of freehand,
partially guided, and fully guided implant
placement surgery. Guided surgery results in
more accurate results than freehand surgery.
Computerized treatment planning and guided
surgery provides improved accuracy,
predictability and patient care.Dec. 10, 2019
Guided Implantology: The SMART Guide
December 10, 2019
by Mark Antal

22. Subgingival Supragingival
Sub-crestal ?
Risk Factors In Implant Dentistry: Unrestorable Implants, August 6, 2019, by Murray Arlin

25. A screw joint has been
defined as two parts that are
held together by a screw. (3)
Applied torque to a screw
within a joint develops a force
within the screw called
preload. (4) Preload is
developed when torque
applied to the screw places
the shank of the screw in
tension. The subsequent
elastic recovery of the screw
is transferred to the two
separate components, pulling
them together, thus creating a
clamping force. If the elastic
recovery of the screw is
exceeded (overtightening or
excessive forces on the joint),
the screw will either fracture
or loosen.
Etiology, prevention, and treatment of screw loosening
and fracture
Prosthodontist Andrew Mackie

26. Clearly, this is not a problem with
screw-retained prosthesis because no
cement is used. In fact, peri-implant
soft tissue responses seemed to be
more favorable with screw-retained
restorations compared with cement retained
restorations.
Peri-Implant Tissue Inflammation:
Residual cement is a common complication of cement-retained prostheses.
The shape of the abutment and crown margin must follow the soft tissue
margin to prevent cement margins that are too deep. Soft tissue inflammation
and bone loss can occur when residual cement is left.
Screw- Versus Cement-Retained Implant Restorations: Current Concepts Angie Lee et al,

27. Accusations Evidence
Investigation of the TRUTH

28. ?
?

29. “… titanium implant surgery usually takes about 1-2
hours for each implant being placed”.
https://www.google.com/search?q=is+2+hou
rs+to+place+1+dental+implant+too+long?&s
ource=lmns&bih=595&biw=1278&safe=strict
&hl=en&sa=X&ved=2ahUKEwjazIeAlsLwAh
VXB50JHYXWCY4Q_AUoAHoECAEQAA
“A majority of patients have an innate fear of the surgical
phase”.

31. ?
Less than
1mm
difference

32. “Regardless of membrane type or graft
material, successful GBR hinges on 4 key
properties outlined by the “PASS” principle:
primary wound closure, angiogenesis,
stability, and space maintenance”.
Flap Designs for Flap Advancement
During Implant Therapy: A Systematic
Review Alexandra B. Plonka
Wang HL, Boyapati L. “PASS”
principles for predictable bone
regeneration. Implant Dent. 2006;15:8–
17

33. “Regardless of membrane type or graft
material, successful GBR hinges on 4 key
properties outlined by the “PASS” principle:
primary wound closure, angiogenesis,
stability, and space maintenance”.
Flap Designs for Flap Advancement
During Implant Therapy: A Systematic
Review Alexandra B. Plonka
Wang HL, Boyapati L. “PASS”
principles for predictable bone
regeneration. Implant Dent. 2006;15:8–
17
Considerations for Incision and Flap Design With Implant
Therapy in the Esthetic Zone Lance Hill Hutchens,

34. According to a recent meta-analysis,
there are no relevant differences in
bone loss between implants placed
at subcrestal and equicrestal levels.
Palacios-Garzón, N.; Velasco-Ortega, E.; López-López, J. Bone Loss
in Implants Placed at Subcrestal and Crestal Level: A Systematic
Review and Meta-Analysis. Materials 2019, 12, 154

35. There was
no other
choice?

36. Conclusion: These results suggest tooth-borne, single-
implant cases performed later in the practitioner’s
experience are most appropriate for freehand placement,
whereas guided surgery should be considered to improve
accuracy for multiple-implant cases in edentulous or
partially edentulous sites.
(Implant Dent
2017;26:500–509)

37. “Based on comparative studies,
evaluating implants with comparable
design but different surface
roughness, it can be concluded that
average peri-implant bone loss
around the moderately rough and
minimally rough surfaces is less than
around rough surfaces”.
2017 Feb;73(1):218-227.
Implant surface roughness and patient factors on long-term peri-
implant bone loss, Hugo De Bruyn
If the company provided this abutment and the lab
tampers with the connection it will get weaker and
unsmooth surface touching bone could cause
periimplantitis.

38. “The depth of implant placement is
dependent on whether the
replacement is in the anterior or
posterior zone.17 In the anterior zone
typically the goal is to place the
platform 3 mm to 4 mm below the
cementoenamel junction (CEJ) of
adjacent teeth.18 This allows for
adequate room for emergence profile
for esthetic purposes”.
Compendium September 2020 Volume 41, Issue 8
Implant Restorations: Establishing a Proper Emergence Profile
Mark Bishara,

39. “In general, for single-unit partially
edentulous patients, closed
tray and open tray impression
copings can be used
interchangeably”.
Int J Oral Maxillofac Implants. 2014 Jul-Aug;29(4):836-45. doi:
10.11607/jomi.3625. Accuracy of implant impressions for
partially and completely edentulous patients: a systematic
review. Papaspyridakos P, Chen CJ, Gallucci GO, Doukoudakis A,
Weber HP, Chronopoulos V.

40. 2%–10% of the torque value is lost
due to the settling effect.
Winkler S. et al.Implant screw
mechanics and the settling effect:
Overview. J Oral Implantol.
2003;29(5):242–245.

41. “The differences in implant survival
rates between screw- or cement retained
prostheses were evaluated in
a systematic review.31 No differences
were found between the two types of
prosthesis in terms of implant survival
or success rates. In regards to prosthesis
success rates (72 months),
cement-retained prostheses demonstrated
a 93.2% success, compared
with 83.4% with screw-retained prostheses,
although the results did not
reach a level of statistical significance
(P 0.05)”.
Screw- Versus Cement-
Retained Implant
Restorations: Current
Concepts Angie Lee et al,

42. 1-2mm error in guided
surgery is expected, can you
imagine 2mm error in this
osteotomy.
0.6mm error in CBCT is
normal.
Hand free and visualize/
place the implant is the
safest way.

44. 1] prosecutor’s verbal opening statement followed by defendants opening statement.
A brief case report and why this case must be re-examined for mistakes by the dentist performed the procedure. Followed
by the defendant’s point of view in a verbal statement why this these mistakes were done due to circumstances that could
not have been avoided. Case history, how the diagnosis was based upon, what challenges occurred and what mistakes
performed.
2] prosecutor’s evidence followed by defendant’s evidence. The prosecutor will provide photos and literature in order to
bring out evidence that supports the prosecution’s case. The same with the defendant. Here the defendant should suggest
the version of the facts to that prosecution’s presented during this cross-examination session.
3] Calling all prosecutor’s point of view from jury. Each member of jury could present a literature in order to bring out
evidence that supports the prosecution’s case. Pointing out all other mistakes performed by the dentist.
4] Calling all defendants info from jury. Each member of jury could present a literature in order to bring out evidence that
supports the defendant’s point of view. Jury pointing out possible reason for those steps and all other unique and
clever steps performed
5] Closing statements
After all the evidence is presented, the prosecutor and the defender have an opportunity to make closing submissions
about why the dentist should be found not guilty or guilty.
6] Judgment of jury
The jury on each account will have a verdict. Unanimously or not should be announced with details.
7] Sentencing
If found guilty, the sentence for a provincial offence may include what to do to undo the mistake or at least acknowledge

45. 1] prosecutor’s verbal opening statement followed by defendants opening statement.
A brief case report and why this case must be re-examined for mistakes by the dentist performed the procedure. Followed
by the defendant’s point of view in a verbal statement why this these mistakes were done due to circumstances that could
not have been avoided. Case history, how the diagnosis was based upon, what challenges occurred and what mistakes
performed.
2] prosecutor’s evidence followed by defendant’s evidence. The prosecutor will provide photos and literature in order to
bring out evidence that supports the prosecution’s case. The same with the defendant. Here the defendant should suggest
the version of the facts to that prosecution’s presented during this cross-examination session.
3] Calling all prosecutor’s point of view from jury. Each member of jury could present a literature in order to bring out
evidence that supports the prosecution’s case. Pointing out all other mistakes performed by the dentist.
4] Calling all defendants info from jury. Each member of jury could present a literature in order to bring out evidence that
supports the defendant’s point of view. Jury pointing out possible reason for those steps and all other unique and
clever steps performed
5] Closing statements
After all the evidence is presented, the prosecutor and the defender have an opportunity to make closing submissions
about why the dentist should be found not guilty or guilty.
6] Judgment of jury
The jury on each account will have a verdict. Unanimously or not should be announced with details.
7] Sentencing
If found guilty, the sentence for a provincial offence may include what to do to undo the mistake or at least acknowledge

46. 1] prosecutor’s verbal opening statement followed by defendants opening statement.
A brief case report and why this case must be re-examined for mistakes by the dentist performed the procedure. Followed
by the defendant’s point of view in a verbal statement why this these mistakes were done due to circumstances that could
not have been avoided. Case history, how the diagnosis was based upon, what challenges occurred and what mistakes
performed.
2] prosecutor’s evidence followed by defendant’s evidence. The prosecutor will provide photos and literature in order to
bring out evidence that supports the prosecution’s case. The same with the defendant. Here the defendant should suggest
the version of the facts to that prosecution’s presented during this cross-examination session.
3] Calling all prosecutor’s point of view from jury. Each member of jury could present a literature in order to bring out
evidence that supports the prosecution’s case. Pointing out all other mistakes performed by the dentist.
4] Calling all defendants info from jury. Each member of jury could present a literature in order to bring out evidence that
supports the defendant’s point of view. Jury pointing out possible reason for those steps and all other unique and clever
steps performed
5] Closing statements
After all the evidence is presented, the prosecutor and the defender have an opportunity to make closing submissions
about why the dentist should be found not guilty or guilty.
6] Judgment of jury
The jury on each account will have a verdict. Unanimously or not should be announced with details.
7] Sentencing
If found guilty, the sentence for a provincial offence may include what to do to undo the mistake or at least acknowledge

47. 1] prosecutor’s verbal opening statement followed by defendants opening statement.
A brief case report and why this case must be re-examined for mistakes by the dentist performed the procedure. Followed
by the defendant’s point of view in a verbal statement why this these mistakes were done due to circumstances that could
not have been avoided. Case history, how the diagnosis was based upon, what challenges occurred and what mistakes
performed.
2] prosecutor’s evidence followed by defendant’s evidence. The prosecutor will provide photos and literature in order to
bring out evidence that supports the prosecution’s case. The same with the defendant. Here the defendant should suggest
the version of the facts to that prosecution’s presented during this cross-examination session.
3] Calling all prosecutor’s point of view from jury. Each member of jury could present a literature in order to bring out
evidence that supports the prosecution’s case. Pointing out all other mistakes performed by the dentist.
4] Calling all defendants info from jury. Each member of jury could present a literature in order to bring out evidence that
supports the defendant’s point of view. Jury pointing out possible reason for those steps and all other unique and
clever steps performed
5] Closing statements
After all the evidence is presented, the prosecutor and the defender have an opportunity to make closing submissions
about why the dentist should be found not guilty or guilty.
6] Judgment of jury
The jury on each account will have a verdict. Unanimously or not should be announced with details.
7] Sentencing
If found guilty, the sentence for a provincial offence may include what to do to undo the mistake or at least acknowledge

48. 1] prosecutor’s verbal opening statement followed by defendants opening statement.
A brief case report and why this case must be re-examined for mistakes by the dentist performed the procedure. Followed
by the defendant’s point of view in a verbal statement why this these mistakes were done due to circumstances that could
not have been avoided. Case history, how the diagnosis was based upon, what challenges occurred and what mistakes
performed.
2] prosecutor’s evidence followed by defendant’s evidence. The prosecutor will provide photos and literature in order to
bring out evidence that supports the prosecution’s case. The same with the defendant. Here the defendant should suggest
the version of the facts to that prosecution’s presented during this cross-examination session.
3] Calling all prosecutor’s point of view from jury. Each member of jury could present a literature in order to bring out
evidence that supports the prosecution’s case. Pointing out all other mistakes performed by the dentist.
4] Calling all defendants info from jury. Each member of jury could present a literature in order to bring out evidence that
supports the defendant’s point of view. Jury pointing out possible reason for those steps and all other unique and
clever steps performed
5] Closing statements
After all the evidence is presented, the prosecutor and the defender have an opportunity to make closing submissions
about why the dentist should be found not guilty or guilty.
6] Judgment of jury
The jury on each account will have a verdict. Unanimously or not should be announced with details.
7] Sentencing
If found guilty, the sentence for a provincial offence may include what to do to undo the mistake or at least acknowledge

49. END OF THIS SESSION