Remaining Time

Christian Berger

Christian Berger was born in Kempten/Germany in 1957. Prior to becoming a dentist, he successfully completed the apprenticeship of a dental technician. He studied dentistry at the universities of Heidelberg, Antwerp and London to gain full academic qualification in 1984. In 1989 he received his degree as Dentist of Oral Surgery from the University of Heidelberg’s Department of Oral and Maxillofacial Surgery. Since 1989 he runs his own dental practice in Kempten/Germany. His special interests are focussed on dental surgery, periodontology and aesthetics. Christian Berger was appointed certified expert witness in implantology, oral surgery, periodontology and prosthodontics of the Bavarian Dental Chamber and serves as instructor at their Science and Practice Academy in Munich/Germany. 2002 to 2014 he was vice president of the Bavarian Dental Chamber and in 2006 he was appointed head of the department of postgraduate education thereto. He has been serving as the vice president of the European Dental Association. Since 2005 he is president of the European Association of Dental Implantologists (BDIZ EDI).
Effective December 2014 he is President of the Bavarian Dental Chamber, the largest such institution in Germany with more than 15.000 dental clinicians in Bavaria.
Christian Berger has published books and numerous articles and papers on prosthodontics, implantology and restorative dentistry in national and international journals. He has also been invited as lecturer for various national and international conferences and training programs and at the University of California, Los Angeles (UCLA).
 
Long Term Success in Dentistry

Unlike other dental disciplines, implant therapy is not to start until severe deficits have already been existing: loss of teeth, damage of hard and soft tissue. The lecture will provide an overview of the options on how to avoid risks in an early state and to prevent and manage complications:
  • Risk assessment using the 2012 Cologne ABC Risk Score
  • Classifying bone deficiencies with the 2013 CCARD (Cologne Classification of Alveolar Ridge Defects)
  • Proper prosthetic treatment planning to avoid implant malpositioning / how can complications be avoided caused by inadequate planning?
Today, there is to pay close attention that therapeutic options are not to be judged solely by the dentist’s individual therapeutic spectrum. Without the cooperation between clinician, dental technician and patient neither functional nor aesthetical success can be reached or preserved.
In this respect oral implantology is the top-class discipline related to reconstructing red-white aesthetics. As a matter of fact close-to-nature restorations require teamwork.
For risk assessment the European Consensus Conferences of BDIZ EDI developed the Cologne ABC Risk Score in 2012. The Cologne Risk Score is using a simple ABC system, possibly and attractively visualized in the three colors of the traffic light, clinicians are given the opportunity to rate the planned implant treatment. The Risk Score consists of four partial scores: Medical history, Local findings, Surgical subsection and Restorative subsection. Each of these partial scores is calculated by itself, with the results – like the criteria – expressed in terms of the colours green, yellow and orange, corresponding to A, B and C (“Always” – “Between” – “Complex”). If two or more criteria for a partial score are assessed as yellow (for B, medium risk), the entire partial score is deemed to be B (yellow, medium risk). Similarly, four yellow or two orange criteria result in an overall partial score of C (orange, increased risk). The ABC classification is defined as follows:
• A = “Always“ lowest assessed risk green area
• B = “Between“ medium risk yellow area
• C = “Complex“ increased risk orange area
Red is reserved for cases where the risk assessment shows that treatment at issue may not be recommended which is not the same as being contraindicated.
The overall patient assessment according to the Cologne ABC Risk Score works as follows:
 If all partial scores are green, the patient case as a whole is assessed as low-risk (A for “Always”).
 If at least two of the four partial scores are yellow, the patient case as a whole is assessed as medium-risk (B for “Between”).
 If all partial scores are yellow, the patient case is assessed as increased-risk (C for “Complex”). The same is true if at least two of the four partial scores are orange and yellow.
 
Focusing traumatic bone loss or advanced atrophic bone, hard-tissue augmentation is necessary to reach successful aesthetical oral rehabilitation. For many decades autologous bone augmentation had been considered the gold standard in regenerative surgery – besides distraction osteogenesis. Socket preservation plays an increasing role when extracting the tooth in order to avoid extensive bone resoption of the alveolar ridge, and to keep the buccal bone plate accordingly. Nevertheless, extensive bone defects can not always be avoided expecially after traumatic tooth loss.
The Cologne Classification of Alveolar Ridge Defects (CCARD) classifies volume deficiencies of the alveolar process regardless of their aetiology as vertical, horizontal and combined defects (H, V, C), possibly in conjunction with a sinus area defect (+S). It takes into account the extent of the augmentation needed (1: < 4 mm, 2: 4-8mm, 3: > 8 mm) and the relation of the graft to the surrounding morphology (i: intern, inside the ridge contour vs. e: extern, outside the ridge contour) and makes recommendations on possible treatment approaches based on the current literature. These CCARD-recommendations are intended to serve as a general guideline only, in cases of healthy soft tissue and good general conditions. They can be departed from in exceptional cases (e.g. previous surgery, co-morbidity, compromised bone quality, softtissue deficiencies), based on the Cologne ABC Risk Score, and if the treatment is performed by designated specialists.
Poor prosthetic treatment planning and/or its execution may lead to malpositioning of implants. How can complications be avoided caused by inadequate planning? This lecture will give an overview of treatment planning systems – beginning with three-dimensional diagnostics in oral implantology in combination with new CAD/CAM-systems and new systems to integrate both virtual and prosthetic options. Recommendations for the prevention of damage to adjacent structures will be given. Malpositioning has been reported in the literature as occurring in than 1% of cases (Goodacre, 2003). It should be noted, however, that only malpositioning on a larger scale (with therapeutic consequences) may have been included in the relevant considerations. The literature also suggests that the anterior region, and in particular single-tooth replacements in single-tooth or extended edentulous spaces, present the greatest challenges with regard to the correct three-dimensional positioning of implants. The lecture includes computer-assisted treatment planning as well as surgical navigation systems to describe their benefits from a scientific and clinical point of view. Diligent evaluation of all findings are prerequisite for avoiding numerous potential complication of implant treatment before the fact.
Focusing traumatic bone loss or advanced atrophic bone, hard-tissue augmentation is necessary to reach successful aesthetical oral rehabilitation. For many decades autologous bone augmentation had been considered the gold standard in regenerative surgery – besides distraction osteogenesis. Socket preservation plays an increasing role when extracting the tooth in order to avoid extensive bone resoption of the alveolar ridge, and to keep the buccal bone plate accordingly. Nevertheless, extensive bone defects can not always be avoided expecially after traumatic tooth loss. Literature reports that bone augmentation procedures are still difficult to perform, unpredictable in results and may be associated with complications. Following the Cologne Classification of Alveolar Ridge Defects (CCARD) the different methods of reconstruction possibilities of the alveolar process are showed in combination with the different grafting materials used for augmentation. Each method takes into account the extent of the augmentation needed and the relation of the graft to the surrounding morphology.
Even though survival rate of Implants can be referred to as high, biological and technical complications occur. This means that a remarkable proportion of treatment time has to be accepted by patient, dentist, insurance and society in generell in order to repair and maintain already fixed restorations. Up to now, there are few studies existing over a 10-year-run and more, therefore, little can be said about the data interpretation for several specific fabrication models after this time frame.
On the other hand more and more, patients nowadays will not be treated by one single dentist only but by different specialists. At the same time, there is to pay close attention that therapeutic options are not to be judged solely by the dentist’s individual therapeutic spectrum.