Toronto Conference 2019

A Tribute to the Toronto Conference and its Impact on Global Dentistry

May 4, 2019

University of Toronto Auditorium

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Saturday, May 4

8:30 – 9:00 am – Registration
($50 AO Member / $100 non-AO Member / Students receive complimentary registration)

Featuring these topics and speakers:

Greetings From AO Past President

9:00 – 9:15 am
James Taylor, DMD, MA

Reflections on the 1982 Toronto Conference

9:15 – 9:30 am
George Zarb, BChD, DDS, MS, MSc

The Evolution of our Understanding of Osseointegration

9:30 – 10:00 am
Niloufar Khosravi, PhD

It is now an almost legendary story that, while undertaking animal experiments to study blood flow in bone using titanium chambers, P-I Brånemark was alert to the finding that the chambers were difficult to remove at the end of the experiment. Our early understanding of the phenomenon was pioneered by three groups in Europe led by Brånemark in Gothenburg, Schroeder in Bern, and Straumann in Waldenburg respectively. This started what can reasonably be called a “revolution” in implant dentistry, which spread to North America through the 1982 Toronto Conference organized by George Zarb.

While many definitions of the term “osseointegration” have been published over the last fifty years, the fundamental precept is the functional anchorage of an implant in bone. While this was obvious from Brånemark’s earliest observations, little was known of the mechanisms by which this could be achieved. Thus, although osseointegration is of profound clinical importance in dental and orthopedic implantology, this presentation will focus only on the biological mechanisms that underlie this remarkable healing phenomenon.

Early pioneering attempts to image the structure of the bone/implant interface by electron microscopy were published by Hanson and others in Gothenburg, but preparation techniques were inadequate to maintain the integrity of the interface and detailed knowledge of how bone is initially formed by osteoblasts was simply not available at the time. An important turning point came in the early 90’s with a seminal paper published by Buser and colleagues who showed that the topography of the implant surface had a profound effect on peri-implant healing. These observations were concomitant with those of our own group in Toronto that showed, for the first time, the very earliest matrix secreted by differentiating osteoblasts. Together with an emphasis on the importance of implant surface topography on peri-implant healing, our early biological observations allowed classification of osseointegration into three distinct phases: Osteoconduction or the recruitment and migration of osteogenic cells to the implant surface; Bone Formation and, subsequently, Bone Remodeling. We have shown that it is osteoconduction that is predominantly influenced by implant surface design. However, the question remained; “How do the cells get to the implant surface?”

Our most recent results have shown, using real-time two-photon and confocal intra-vital microscopy that the implant surface has a profound effect on peri-implant angiogenesis. It has been long known that angiogenesis precedes osteogenesis, but we have now shown that implant surface design affects the spatio-temporal organization of peri-implant angiogenesis and that this blood vessel growth is an essential prerequisite to establish the migration pathway of osteogenic cell precursors to the implant surface, which results in contact osteogenesis.

Thus, since Brånemark’s initial findings, our understanding of the mechanisms of osseointegration have significantly evolved. However, important questions still remain, not least of which is “What stimulates the perivascular osteogenic precursors to populate the wound site?” Our continuing understanding of such basic peri-implant biology will inform the future design of implant surfaces with, hopefully, ever improved clinical outcomes in health and disease.

Upon completion of this presentation, participants should be able to: 1) discuss how our knowledge of the basic biology of peri-implant healing has evolved since the first description of osseointegration; 2) explain how, from a biological healing perspective, the most important events in osseointegration precede bone formation; and 3) recognize that implant surface design drives the pattern of blood vessel growth, which is critically important in driving contact osteogenesis.

The Evolution of Bone Grafting for Dental Implants and Today's Realities

10:30 – 11:30 am
Lesley David, DDS

Osseointegration has changed tremendously over the years as have our treatment solutions for patients. With the ability to graft atrophic arches and edentulous spaces, an implant solution may be devised for almost all patients. The evolution of bone grafting will be reviewed along with the various options clinicians have to reconstruct the edentulous predicament. The indications, predictability, and what these surgical endeavors entail will be discussed. In addition, the alternative solutions to bone grafting where possible will also be reviewed and compared to the reconstructive approach.

Upon completion of this presentation, participants should be able to:
1) describe what constitutes the “ideal” bone graft for various edentulous scenarios; 2) list the indications for bone grafting and various options; and 3) discuss alternatives to bone grafting.

Peri-Implant Soft Tissue: Where Biology Meets Technology

Noon – 1:00 pm
Carlo Ercoli, DDS

Peri-implant soft tissue are the ultimate areas where biology meets technology. It is in this anatomical and functional area that health is maintained or disease could potentially be initiated with short and long term effect on the prognosis of the dental implant and surrounding hard and soft tissues. This interface is where implant and prosthetic restoration design, materials chemistry and micro-nano-characteristics, and hard and soft phenotype interact and become relevant for long-term biomimetic behavior of our restorations. This presentation will review the relevant diagnostic elements and therapeutic interventions that affect the health and esthetics of soft tissue around dental implants.

Upon completion of this presentation, participants should be able to: 1) indicate the relevant known anatomical, functional and prosthetic material characteristics affecting peri-implant tissues; 2) predict how soft tissue characteristics and relevant grafting procedures may affect site preparation, before, during and after implant placement; and 3) explain how the ultimate long-term prognosis of our implant prostheses rests on an adequate understanding of the known biologic behaviors of the tissues surrounding our restorations and on a humble appreciation of what remains to be elucidated.

The Evolution of Prosthodontic Dental Implant Management From 1982 to the Present

1:00 – 2:00 pm
Izchak Barzilay, DDS, MS

The beginnings of predictable North American dental implant treatment started with the 1982 Implant conference in Toronto. The conference (under the guidance of Professor George Zarb) spread the word that implants do work when done correctly. At the time, the Nobelpharma implants (later the Nobel Biocare implants) took center stage with the external hex pure titanium implant in one diameter (3.75mm) with standard abutments (4mm tall being the shortest) and prescribed denture tooth and acrylic restoration supported by metal (the Toronto Hybrid Design). This held well for several years at which time other companies started marketing other designs that affected both surgical and prosthetic treatments. The marketplace developed into what it is today……a multi company, multi fixtured, multi connection, multi design, multi strategy market.

This presentation will review the evolution of Prosthetic componentry and Prosthetic design over the past 35 years. Use of abutments, screws, cements, ceramics, acrylics, composites, impression materials, CAD/CAM methods will be reviewed so that we can see where we came from and future concepts will be presented with the vision of what we can expect in the next 35 years.

Upon completion of this presentation, participants should be able to: 1) describe the changes in prosthodontic componentry; 2) explain why changes have been made over the years; 3) critically evaluate which changes are needed and which changes are marketing hype; and 4) analyze a photograph and identify older components and know how to maintain them.

Closing Remarks

2:30 – 2:45 pm
James Taylor, DMD, MA

Registration Fees

Registration Fees - Meeting is Open to Members and Non-Members

REGISTRATION FEES

AO Members, Univ. of Toronto Faculty, Allied Staff – $50 (USD)
Non-AO Member Dentists – $100 (USD)
Students – Complimentary

Earn 4.75 ADA-CERP credits

Description of ADA-CERP

Continuing Education Credit

The Academy of Osseointegration is an ADA CERP Recognized Provider. ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply an acceptance of credit hours by boards of dentistry. Concerns or complaints about a CE provider may be directed to the provider or to the Commission for Continuing Education Provider Recognition at ada.org/cerp.

This continuing education activity has been planned and implemented in accordance with the standards of ADA Continuing Education Recognition Program (CERP). The Academy of Osseointegration designates this activity for 4.75 continuing education credits. Credit is awarded and based on actual number of contact hours, excluding breaks, meals and registration periods. Attendees may claim fewer hours in accordance with their actual attendance. (CE credits are earned by attending all scientific sessions except for the Corporate Forums.) The current term of acceptance extends from 5/1/2018 – 6/30/2022.

The formal continuing education program for the Academy of Osseointegration is accepted by the Academy of General Dentistry (Recognition #145608) for Fellowship/Mastership credit.

The Academy of Osseointegration is also a recognized continuing education provider for the Dental Board of California (RP 3090).