John Barton reports back from Trycare’s course in Rome last year.

Last year, as summer turned to autumn, I received an email from Trycare: an invitation to a bone regeneration course in December 2016.

I looked at it a bit sideways as the course was not, as usual, in some godforsaken lodge hotel at a convenient point on the motorway box around Birmingham. It was, in fact, in the eternal city of Rome, with Dr Michele Lopez, sponsored by Osteobiol.

It had all the hallmarks of a good ‘CPD jolly’ in Italy, and with a subject dear to the heart of us all – creating vertical and horizontal alveolar bone using the Khoury shell technique of regenerating the atrophic crestal ridge.

Learning the ropes

The timing of the course on the first Saturday in December was, by my calculations, perfect: I would definitely avoid being at home for putting up Christmas decorations that weekend.

So, on the evening before the course, I boarded the Italian high-speed train – Frecciarossa – in Milan for the journey down to Rome. We whizzed along at 190mph and in two hours and 57 minutes we were there.

Just a five-minute walk from Rome Termini station, Trycare had organised a lovely pre-course dinner at La Matriciana, a wonderful 1920s, Belle Époque style restaurant. I had already taken the precaution of Googling the menu and knew there were going to be great, classic Roman dishes – and there were.

The next morning, 25 delegates from 13 countries all met up again in Dr Lopez’s studio – unassuming from the outside, but immaculate and spacious inside – in the Appio Latino district of Rome, where he practices implant dentistry and implant-retained prosthetics. Strangely, there were no British participants on this Trycare course.

Last year, 1.1 million implants were placed in patients’ mouths in Italy; the UK only managed a piddling 135,000 units in a similarly sized nation. Perhaps we are not taking the Italians – and their strong, high-tech skills in dentistry – as seriously as we should.

The Khoury technique of fixation of the lamina cortical bone and the rationale behind the selection of grafting materials used was clearly explained, with beautiful supporting photographic documentation. What became apparent was that the addition of the game-changing TSV Gel to the ‘cocktail’ of Osteobiol Lamina cortical bone barrier, Gen-Os and membrane means that achieving our dental nirvana and reliably growing crestal bone has become that little bit easier and predictable.

The TSV gel is funny stuff to use: it is kept refrigerated, which keeps it runny, until the moment needed when, added to the hydrophilic Gen-Oss, it mixes together easily; then the viscosity rapidly climbs as it warms up to room temperature, giving excellent handling characteristics and stability to the biomaterials at the graft site under the cortical lamina. But, more importantly, the gel is rich in various forms of collagen acting as a substrate for platelet activation and aggregation. It also attracts stem cells into the site and promotes a more natural osteoclastic remodelling of biomaterials similar to normal physiological bone turnover. All good stuff, and the postoperative photos were excellent; you got the feeling that the photos had not been cherry-picked but that, if you follow the technique, select the correct type of lamina and fill the defect as advised, these are the results that you will get.

Getting hands-on

In the afternoon, after a wonderful seafood risotto lunch (other plates were available) in the local trattoria, we practised placing the new Osteobol Lamina flexible grade cortical bone grafting materials, membranes and pin placement on typodonts – the whole Khoury technique, in fact, but the most interesting thing was to manipulate the new thermosensitive TSV Gel for stabilisation of grafting materials at the site.

During the practical, we were also shown some tricks with titanium fixation pin placement by Dr Lopez. The head of research from Osteobiol was also there, and he announced the interesting fact that they have – in the final phase of CE-marking – a fully resorbable collagen fixation pin system that will be launched sometime next year. This should be a very interesting new product to use, especially in terms of how it will change bone regeneration and implant dentistry.

Playing catch-up

Strangely, and as we know, the UK lags behind other comparable countries for the numbers of implants placed – I am writing about all types of cases, from the slam dunks to the very complex. I feel so few in the UK dental profession ever get going in implant dentistry, placing even just simple implants, as they are put off by the hurdles of complexity set up in their minds by the ‘big boys’ of implant systems, which seem to have a vested interest in keeping implant dentistry a dark art – which it certainly isn’t when looking at the figures in the rest of Europe.

I believe that using the Khoury technique as part of your treatment armamentarium, combined with the full supporting orchestra of biomaterials from Osteobiol, will mean that more implants can be placed as sites become less challenging using this technique.

I’ve done a lot of CPD courses all over the world and this one stood out for its simplicity and elegance. I hope that Trycare runs the course again sometime soon, as I am sure Dr Lopez would be happy to do it. Plus, it can’t hurt to take a trip to Rome with your partner and see the city in all its splendour.

John Barton graduated in 1979. He has worked in private practices from Manchester and Cheshire to Milan and Jeddah (Saudi Arabia). His practice and associates encompass all branches of dentistry and he personally uses Invisalign and implant solutions to get the results that his patients desire.