Objectives: Distraction osteogenesis is based on the separation of two vital bone segments and careful distraction after initial formation of callus. A callus between a titanium surface and surrounding bone (“jumping gap regeneration“) might also be eligible for expansion, providing a significantly less-invasive method of distraction osteogenesis. The aim of this pilot study was to evaluate the elevation of a thin HA-coated titanium plate and subsequent callus distraction beneath the titanium. Methods: After gaining approval of the local ethics committee of the University Hospital of Cologne and authorisation by the Federal Institute for Drugs and Medical Devices (BfArM, Bonn, Germany), 10 healthy patients with a vertical bone defect of the posterior maxilla or mandible (two bilateral) were consecutively enrolled. Mucoperiosteal flap elevation was performed, and HA-coated titanium plates (Bonehill Type Zä/® prototypes 14x7mm or 18x8 mm) were inserted 1–2mm away from the underlying bone, by fixing to adjacent teeth using individual bridges. Soft tissue was thickened up beneath the periosteum using a 1-mm collagen matrix (Mucodermä/®) and closed using single mattress sutures. The callus-forming phase was 7–10 days. Membranes were then elevated 0.70mm per day until the desired individual augmentation heights of 4–8 mm were reached. After 4–8 months‘ consolidation, the titanium plates were removed and bone core biopsies harvested in preparation of the implant bed. Conventional radiographs were taken at baseline, after plate insertion, and after the healing periods. Results: Initial healing was uneventful in all cases, with 8 of 12 augmented areas showing sufficient vertical bone formation at the end of the consolidation period. Implants were placed as planned, and histological evaluation showed excellent bone formation with physiological microarchitecture of the bone trephines. One site showed complete reduction of the initially achieved augmentation height based on insufficient retention; in other cases there were trauma-related soft tissue perforations with subsequent removal. In the successful cases, radiographs taken after 4-months‘ consolidation showed initial mineralisation of augmented areas, with increasing radiodensity up to 8 months. At implant uncovering, bone levels were stable radiologically and clinically in both vertical and horizontal dimensions. Conclusions: Given the limitations of this pilot study, we conclude that this novel technique of distraction osteogenesis using HA-coated titanium plates in distance to the underlying bone leads to predictable vertical bone regeneration; this is a proof of concept. It also offers a minimally invasive alternative for vertical ridge augmentation in severely resorbed jaws. A trial based on parallel inclusion of a higher number of patients in a multicentre setting using a device with an internal distraction mechanism, has now begun yielding data on new applications.

The preservation of teeth is one of the most important topics for Professor Friedrich W. Neukam at the International Osteology Symposium 2016. We spoke to him in his role as the symposiums chairman on what this implies exactly and what the other important questions are which will be dealt with in Monaco in April 2016. Professor Neukam, the scientific programme of the International Osteology Symposium 2016 in Monaco will be held under the motto Learning the WHY and HOW in regenerative therapy. What are the contents that bring this motto to life? Friedrich Neukam:in our daily practice routines we need to examine all our procedures which we have applied for years - and quite successfully as we believe. The reason being, that our knowledge has changed rapidly within the space of only a few years. That is also one of the objectives of the Osteology Symposium in Monaco 2016: we want to question things and want to give dental practitioners a bench mark by reviewing known techniques in regenerative therapy, while at the same time posing the question of what is the protocol most suited to achieve a predictable treatment objective. Of course, a further objective is to present the current state of knowledge and the latest research results in the regeneration of oral tissue, to discuss these and to demonstrate their clinical implementation for dental practitioners. The programme covers a broad spectrum of topics in oral regeneration. Which are the most important for you? Friedrich Neukam:the long-term success of regenerative measures, be it to preserve teeth or for implants in healthy oral hard and soft tissue conditions. Teeth for a lifetime is a very important subject for me, to achieve the dream of preserving teeth for a lifetime if at all possible, and, of course, this also applies to implants. What are the options that techniques for bone regeneration and soft tissue regeneration offer us here in the various indications, be it in the posterior or the anterior regions - while ensuring a long-term aesthetic outcome. Of particular importance to me, is the question of which decision and treatment avenues we follow if extraction of a tooth proves necessary. Because then there are a number of options available. We need to consider the various treatment options, which is why I am looking forward to the interactive discussion on Decision making after tooth extraction. The discussion round includes experts with many years of clinical experience who will be presenting the use of regenerative techniques for preserving hard and soft tissues. You have just mentioned the topic Teeth for a lifetime. What exactly are the questions relating to this part of the programme? Friedrich Neukam:Well, as already mentioned briefly, I believe it is the wish of everyone to keep their teeth for a lifetime if possible. For me, the questions of periodontal treatment and regenerative therapy options are at the forefront here. However, what I truly look forward to, is how the HOW will be presented. For me this also means that one must receive clear information on when these measures are not effective, and I think that a crucial question will be answered: which is, when do we need to extract teeth in order to enable other treatment, such as regenerative techniques but also implant restorations in the local tissues. A major poster exhibition will also be held as part of the Osteology Monaco event, together with the Research Forum where current research results will be presented. What, in your opinion, are the most important topics which have so far been covered in research? Friedrich Neukam:if we look at the regenerative options available today, then pre-clinical research results, and of course, also clinical studies, relating to bone preservation after tooth extraction as well as the preservation and reconstruction of the soft tissue are of prime importance to me as they have a major influence on our clinical treatment modalities. If your colleagues ask you why they should participate in next years Osteology Monaco, what would you tell them? Friedrich Neukam:first of all I would not focus on the casino in Monaco, but rather I believe, that the Osteology Foundation and the international Osteology Symposium in Monaco have become the standard - a standard worldwide for regenerative measures in the oral cavity. This is where experts from across the globe meet to take positions on current topics, research results as well as clinical questions. In other words, this is a highly attractive forum with a programme which is also devoted to entirely practical aspects, namely, the WHY and the HOW in regenerative therapy. Thank you for the interview Professor Neukam. More information and registration on www.osteology-monaco.org #OsteologyMonaco

Gliederung: Theoretischer Teil: - Männlicher Patient: tiefer und breiter intraossärer Knochendefekt am Zahn 13 - Indikation für die Modified Papilla Preservation Technique im Rahmen der regenerativen Therapie durch die Breite des Diastema gegeben - Regenerative Parodontaltherapie mit: Emdogain (Regeneration parodontaler Strukturen); Bio-Oss Spongiosa (Verhinderung Lappenkollaps und Minimierung der Entstehung einer zu starken Rezession) Praktischer Teil: - Durchführung der Papilla Preservation Technique mit mikrochirurgischem Intrumentarium - Konditionierung der Wurzeloberfläche mit 24% igem EDTA für ca. 2 min - Entferung der EDTA Reste durch Spülung mit steriler Kochsalzlösung - Applikation von Emdogain auf die Wurzeloberfläche - Auffüllung des Defektes mit einem Gemisch aus Emdogain und Bio-Oss - Nahtverschluss mit zwei Matratzennähten (horizontal gekreuzte sowie vertikal modifizierte Matratzennaht) - Nahtmaterial: - 5-0 für die horizontale Matratzennaht; - 6-0 Monofilament für die vertikale Matratzennaht - Die postoperative Nachsorge umfasste Spülungen mit 0,2% Chlorhexidin (2 x Tägl. für 4 Wochen) und Gabe von Ibuprofen in den ersten Tagen post operationem. Inhalt: Der männliche Patient zeigte einen generalisierten Verlust von klinischem Attachment und Alveolarknochen. Die allgemeine Anamnese war unauffälig, der Patient war Nichtraucher. Die mikrobiologische Untersuchung zeigte hohe Zahlen von Actinobacillus actinomycetemcomitans und Porphyromonas gingivalis. Die Diagnose lautete: "generalisierte aggressive Parodontitis". Vier Monate nach Durchführung der Initialtherapie unter gleichzeitiger Gabe von Antibiotika (Amoxicillin + Metronidazol), zeigte die intraorale Röntgenaufnahme einen tiefen und breiten intraossären Knochendefekt, lokalisiert mesial und palatinal am Zahn 13. Um den Erhalt dieses strategisch wichtigen Zahnes zu gewährleisten, wurde eine regenerative Therapie mit Emdogain und Bio-Oss Spongiosa durchgeführt. Zehn Monate nach Durchführung der regenerativen Parodontaltherapie zeigte sich eine Reduktion der Sondierungstiefe um 7 mm und einen Gewinn an klinischem Attachment von 5-6 mm. Die Sondierungsiefe zu diesem Zeitpunkt war 2-3 mm und das intraorale Röntgenbild zeigte eine fast vollständige Auffüllung des Knochendefekts.