2008 KMU intern reading for GTR

2003/4/10 Tarnow in Taiwan

From biologically-driven ,because biology is never changed 

-- Anatomy of tooth and implant 

-- there is biological width formation below the microgap 1.5-2mm. 

-- probing peri-implant need sliding around the peri-implant sulcus ,not just point probing.

-- Biologic width study --

       COIR 1996;7:212-219 

       JCP 1997;24(8) : 568-572

      JP 1997;68:186-198 

      JP 2000;71:1412-1424 

--Effect of occlusal trauma on implant 

     magnetidue 

     direction 

     frequency 

     duration 

  " all or none" -- microcrack on implant( it's different on tooth) 

HA vs titanium 

  inflammation ----> pH reduction ---> HA dissolution 

       1. sped of integration

      2. percenatge of integartion 

3. failure due to occlusal loading 

4. failure due to peri-implantitis

5. biologic width concerns 

Checklist of implant 

   1. microgap

2. high polished surface

3. machined surface(commercial pure Ti; Ti-Al-Van)

4.Rough surface  (coated (HA,TPS),uncoated (substrated)-acid-etched 

Immediate loading -- crossarch ,rigidly splinting ,>4-implants 

     Implant survival by surface (NYU study) 

        machined 74/104 (survival rates :71.2%)

        rough surface 843/879(survival rates : 96.4%) 

      But,machined surface is highly resistant to peri-implantitis ???

Stephen L. Wheeler : HA (89%)vs TPS(95%)

Need keratinized gingiva ?? 

   JOMI 1996:11:626-633 (HA-coated) -- 

  IJPRD 1991;11:113-125   

Implant in perio compromised P'ts 

    JP 1995;66(2) : 150-157 

Surface topography 

   Sa--average height deviation from the eman plane in um 

   Scx-- average distance between the surface irregularities in spatial direction 

   Sdr -- surface developed ratio ,the ratio between the measured surface and total flat surface

 Fibrin-network develops 

   Davies' study  (Osseotite) 

    distance osteogenesis 

    contact osteogenesis

Each implant system must be judged by its own long-term multi-center study .

Critical factors in implant esthetics --

   3-D implant placement ( buccal : under FGM 3mm; slightly palatally )

  immediate vs delayed socket placement

        1. Height of soft tissue

        2. thickness of soft tissue 

      3. amount of KG 

    Tarnow ,Forum (2000) socket classification  

   be careful of gingival recession 

   PPAD 2001:13

  COIR 1993;4(3):151-157

  JOMI 1999;14:351-360 

Do Site Development before implant installation . 

Do One miracle at One  time.

Guide p't to follow your tx plan,not follow his!!

Incision Design --papillae concern , mid-buccal height concern 

  semi-submerged + smaller diameter healing abutment 

   JOMI 2001:16 

Biologic determinants of esthetic 

   1. adjacent to tooth (JP1992>5mm) 

   2. between tooth and implant (IJPRD 1997;17:327-333;1999;19;21-29) 

 Is the  5mm rule also true for papillae between teeth and implants ??

      IJPRD 2000;20:11-17 

      JP 2001;72:1364-1371 

    3. Between Implants 

       Salama 1998 PPAD 

       Compendium 2001 total tooth replacement 

       JP 2000;71:546-549 ( inter-implant distance <>

       JOMI 2000:15:527-532   

       2002 unpublished paper about "vertical distance"

    4. Pontic design (ovate pontic) 

Golden rules-- Do all sites development before implant placement into the esthetic zone 

KISS principle 

 Based on evidence 

avoid adjacent implants if possible

immediate implant only on ideal cases  

Gingival architecture ,Think Biologically 

 

 

   

11/11/07 Bernard Touati taipei lecture

A biological aproach to implant esthetic tx.

slides in B&W and with video and music 

esthetics

biology

noninvasiveness

digital technology

esthetic implant dentistry --

goals :

simplify surgical procedure and less invasive and max. blood supply

80's anatomically-driven -- biomechanical concerns

90's prosthetically-driven --- emergency profile/shape concerns

2000's biologically-driven --- soft tissue architecture/stability

now

Goal to preserve adequate implant site

rethinking the software

redesigning the hardware

understanding the mucosal seal(peripheral defense)

not biological width --> instead biological space(3D)

Schuphach 2003

--- the weak link of implants ( PDL ,only transspetal fiber)

Gingival recession around implants

( a 1-year longitudinal prospective study. Int J Oral Maxillofac Implants. 2000 Jul-Aug;15(4):527-32. )

-epi .apical migartion + CT inflammation + crestal bone remodeling

Guided implantation is the trend of implantology

( computered based /modeled based )

Curvy abutment (Nobel ) -- an abutment allowing a stable biological space at its level 

anticipate 

immediate biological abutment connection --

1. after lab. customization

2.biocompatible material promotes early fibrin clot and granulation tissue 

3.impair downgrowth of Epi. 

socket preseravtion --

  1.  is the buccal plate intact ?? (partially or totally missing) 

  2.  biotype  

  3. how wide the gap is ?? 

You have to do good case selection 

Socket classification (Tarnow )

surgical template --reproduce margin 

zirconium abut. ( Glauser IJP 2004 may/june) 

papillae is related to proximal bony support ( Salama  articles) 

it's important to graft CT to counteract the recession process and to get the best esthetic outcome in the long term . (pouch procedure --less invasive) 

implant diameter selection 

  M-D(Esposito 93) implant-tooth >1.5mm 

     3mm deeper under prosthetic Gingival margin 

   B-L ( buccal bone thickness > 2mm) 

reduce bone remodeling

  polished implant neck positioned supra-crestally 

  avoid mucoperiosteal flaps

the tissue is the issue but the bone set the tone

        Atalanta team  

the issue is the soft tissue thickness

     by Tounti  

  

 

after ITI lecture in Taichung

more esthetic consideration
socket preservation concept and timing
more oral presentation skill and practice

implant revisited tour in New york university

Dr Peter Hunt The evolution of implantology
Guideline principles
1. make sure the implant is stable
2. surround in with an osseous coagulum
3. protect the region with soft tissue
an osseous coagulun in a gingival cocoon
Implant design – body +collar
body : Taper design
faster placement
reduced potential for contamination
max. bone-contact
enhanced stability
low stress
collar Now –is critical for supporting
three theories of marginal bone loss
1. developing of the biologic height –periodontal rationale
2. the inadequate implant design concept the argument for microgrooves
3. The microspace –plateform switching
Dr. hunt – best implant is “Camolog”
implant design : summary
8 question
1. plateform size ??
2. 5-yr survival rate
3. mean bone loss around the collar ?
4..How deep does the connection post go down inside the implant ?
5.Rotational slip of the connection?
6.Rotational rupture point??
7.Rototaion component cover the implant plateform ??
8.Potential for developing “emergency profile??

Day 2 in NYU Immediate loading Romanos GE
How do you try to explain “ immediate loading “?
--- Surgery and occlusion loading at the same time
JP 2003 74;74:225
Early loading : final crown <3w>18M)
To wait too long ,bone will disappear
Form follows function.(like gym)
Bone quality is based on Clinical realities, not based on location .
The weakest link—implant-abutment-connection
To confirm no microgap and micromotion between implant-abut. connection
COIR 1996,7,212 : different reaction(astra more resistenat to bact.)
COIR 1998,9,73-79 (astra Less plaque accumulation)
COIR 1997;24;568-572
IMMEDIATE LOADING – ABUT MENT CONNECTION SHOULD POSITIONED FOREEVER
Conclusion
Patient factors:
Surgical factors
Approximately implant selection
Tapered implants with high primary stability
Biomechanical factors

Case of immediate implant into the active infective site

A Case of young female was suffered from fistula over labial side of upper R't central incisor .
We extracted the ill tooth and debride all granulation tissue ,placed implant with little primary stability . Even though there was large bony defect ( 15mmx8mm) ,we still believe it should be work duing to its 3-wall bony defect. We grafted with Bio-Oss and Tuodem membrane over the defect . Keep close follow-up

wo, we finally finished this case with acceptable result on 2007/11/14 .

Short dental implant study

Short Dental Implants in Posterior Partial Edentulism: A Multicenter Retrospective 6-Year Case Series Study
Carl E. Misch et. al.
Methods:
A retrospective evaluation of 273 consecutive posterior partially edentulous patients treated with 745 implants, 7 or 9 mm long, supporting 338 restorations over a 1- to 5-year period was reviewed from four private offices.
Implant survival data were collected relative to stage I to stage II healing, stage II to prosthesis delivery, and prosthesis delivery to as long as 6 years follow-up.
A biomechanical approach to decrease stress to the posterior implants included splinting implants together with no cantilever load, restoring the patient with a mutually protected or canine guidance occlusion, and selecting an implant designed to increase bone-implant contact surface area.
Results:
Of the 745 implants inserted, there were six surgical failures from stage I to stage II healing. All five failures were with a one-stage surgical approach (240 implants). There were two failures from stage II healing to prosthesis delivery. No implants failed after the 338 final implant prostheses were delivered. A 98.9% survival rate was obtained from stage I surgery to prosthetic follow-up.
Conclusions:
Short-length implants may predictably be used to support fixed restorations in the posterior partial edentulism. Methods to decrease biomechanical stress to the bone-implant interface appear appropriate for this treatment.

quality of dental implants

You have to think more than before
Besides the clinical documentation ( basic requirements)
--Represented locally and consulted easily
-- Deliver products timely
-- Ethical and professional reputation
-- Training
-- Ease of use
--Flexibility
-- Stock inventory
-- Engineering design
--Costs ---money and time
review from Int. J Prostho 2004
Discussion by Heti peri-implant reading club

My Nordic review tour--stockholm city tour

Stockholm – The Capital of Scandinavia
There are many reasons why Stockholm is the natural Capital of Scandinavia. One is that Stockholm is positioned at the heart of the region, and enjoys the benefits of a world-class transport infrastructure. Another is that Stockholm is the largest city in the largest country in Scandinavia.
It is also where you find the most multinational companies, the largest stock market and, not least, the most visitors. People come to Stockholm for the food, the design and the music. Stockholm also offers a unique range of galleries and museums, and every year the eyes of the world are on Stockholm when the Nobel Prizes are awarded.

regeneration of intrabony defect : EDTA ?

Effect of EDTA Root Conditioning on the Healing of Intrabony Defects Treated With an Enamel Matrix Protein Derivative JP 2006, Vol. 77, No. 7, Pages 1167-1172

The purpose of this study was to determine the effect of root conditioning on the healing of intrabony defects treated with EMD.
Methods: Twenty-four patients, each of whom exhibited one deep intrabony defect, were randomly treated with either open flap debridement (OFD) followed by root surface conditioning with EDTA and application of EMD (OFD + EDTA + EMD) or with OFD and application of EMD only (OFD + EMD). The following parameters were recorded at baseline and at 1 year: plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing depth (PD), and clinical attachment level (CAL).
Results: No differences in any of the investigated parameters were observed at baseline between the two groups. Healing was uneventful in all patients. At 1 year after therapy, the OFD + EDTA + EMD group showed a reduction in mean PD from 9.3 ± 1.3 mm to 4.0 ± 0.9 mm (P <0.001), color="#ffff00">There were no significant differences in any of the investigated parameters between the two groups.
Conclusion: In intrabony defects, regenerative surgery including OFD + EDTA + EMD failed to show statistically significant differences in terms of PD reduction and CAL gain compared to treatment with OFD + EMD.

root resection therapy

A case of molar furcation involved G3
Treatment with root resection of DL root and bone grafting into the the extracted socket .

Establish your own brand

Brand is personality ,not product or logo ,which is feeling about you for customers.
"品牌"的意義:是企業要強化自己最值得驕傲的特質,並且向外溝通這種特質.最終, 品牌的建立靠的不是廣告, 而是企業對自己承諾扎扎實實的表現 .

預知下半年景氣

指標一 美元
指標二 人民幣匯率
指標三 利率
指標四 債券市場
指標五 通貨膨脹
指標六 房地產市場
指標七 就業市場
指標八 資本財 , 耐久財銷售
指標九 零售銷售
指標十 大宗商品 原物料行情
亞洲股匯後市仍然看好
www.CW.com.tw

Vertical dimension elevation with implant therapy in post-radiotheraphy NPC patient

A case who was gum impinged bite had been received radiotherapy because of NPC .
We elevated his vertical dimension and reconstructed occlusion with implant.

The origin of Astra implant design

Biomechanical aspects --
Original from " Galileo G (1638) --- Bone size is directly correlated with body weight and activity
Von Meyer H. & C.Culmann(1867) --- There are direct relationship between the structure of cancellous of the bone and direction of loading . The bone structure is similar to the architecture design .
Wolff's law (1892) --- The law of bone transformation
The first one who combined the above two findings .
A bone .. develpos the structure best suited to resist the force acting upon it.
Wolff's law applies to pro tennis players
Humeral cortical thickness on playing side is greater by 34.9% on men and 28.4% on women compared with control side . ( Jones HH et al 1977 Bone Joint Surg Am 204-208)
Wolff's law applies to astronauts
A device delivering a mechanical impluse intended to mimic the heel strike transient
(Goodship et al 1998 Acta Astronaut 65-75)

local drug therapy in periodontal disease

Several local drug delivery systems employed as monotherapies improved periodontal health and provided results that were not statistically significantly different than attained with scaling and root planing (SRP) alone. In contrast,many local drug delivery devices when used as adjuncts to SRP provided a statistically significant enhancement of parameters commonly used to monitor periodontal status. However,meanimprovements with respect to probing depth reduction or gainof clinical attachment were often limited to tenths of millimeters.Several devices also achieved specific criteria that canbe used to identify clinically significant findings (e.g., numberof sites with probing depth reduction ‡2 mm). However, there are conflicting datawith respect to the ability of local drug deliveryto enhance results of SRP at deep probing sites, and there is limited information relative to its capability to inhibit disease progression or enhance osseous repair in infrabony defects. Conclusion: The decision to use local drug delivery during active treatment or maintenance should be based upon clinical findings, responses to therapy recorded in the literature, desired clinical outcomes, and the patient’s dental and medical history. J Periodontol 2006;77:565-578.

LIFECORE advanced implant course in Hualien

I am going to attending 3-day course for "implant instructor training course " in Hualien .
http://www.parkview-hotel.com

Nordic learning tour (I)

A wonderful and fantastic tour in Sweden and accompanied with my mentor,黃啟洲 醫師 .
The mentor open my eyes and my mind that no longer restricted in the limited world.

股市人生

胡立陽先生故事 : 我有一次到英國探望一個朋友，這個朋友養了大約 200 頭羊，他的羊每次參加比賽都得冠軍。他除了可以精準的叫出每一隻羊的名字和特徵外，還能告訴我哪隻羊心情好、哪隻羊好像不太舒服。對我來說每一隻羊都是一樣的，我並不能看出其中的分別。我看股票就好像他看羊一樣，鎖定一籃子的股票後，就開始像養羊一樣，觀察這些股票的一舉一動，其他股票我都不看，我在華爾街時就是這樣連看 3 - 5 年，對我來說這些股票都是有生命的，甚至會覺得這些股票每天都會跟我說話，它如果狀況不好我一定看的出來。今天跌了 0.5 元對別人意義可能不大，但是對我來說卻是非同小可，可能就代表一個千載難逢的買點。現在的投資人太博愛了，每支股票都想看，哪支漲看哪支，這樣是絕對無法獲利的。
如同一個醫生不可能什麼疾病都會看， 一定有其專精的項目 ；只做專精的相關部份， 其他則轉往其它的醫師， 才能為病患的健康做最好的把關 ．

immediate implant

A case of young adult female p't complained about " uneven incisal edge of ant. false tooth"
Via X-ray examination,we found the perforation site over the middle third of the canal . So we suggest ext. it and place implant and temporay restoration for esthetic consideration .


A Randomized controlled clinical study tell us about the effect of flapless implant surgery on soft tissue profile : Twenty-four patients with a missing tooth in the premaxillary region were randomly assigned to one of two groups(12 each): immediate loading (IL) or delayed loading (DL) (loadingafter 4 months). No significant differenceswere detected between groups at each time and over time inthe other clinical parameters, PD, mBI, mPI, and WKM (P >0.05).
Conclusions: The results of this study indicate that creeping attachment(i.e., soft tissue recovery) might occur within 2 months after IL. The study suggests that flapless implant surgery providesesthetic soft tissue results in single-tooth implants either immediately or delayed loaded. J Periodontol 2006;77:874-882

sinus graft

The female patient had recieved sinus grafting simultaneously implantation over R't side of posterior max. Because there is septum in the sinus, I used the combination techinque of lateral window (medial) and osteotome technique to place Bio-Oss graft and implant .

Articles related bone grafts in different sitations

Bone Physiology
1.Factors That Modulate the Effects of Bone Morphogenetic Protein-Induced Periodontal Regeneration: A Critical Review
King.G.N. J Periodontol 2002;73:925-936
2.Mediators of Periodontal Osseous Destruction and Remodeling: Principles and Implications for Diagnosis and Therapy
Mcauley.L.K. J Periodontol 2002;73:1377-1391
3.Calcium nutrition and metabolism Felix
Bronner.F. Dent Clin N Am 47 (2003) 209-224
4.Mesenchymal Stem Cells and Their Involvement in Bone Remodeling Repair, and Regeneration
Heersche.J.N.M. 17-23
5.Biology of Bone Healing: Its Impact on Clinical Therapy
Hollinger.J.O. 17-53
Bone Graft Review
1.Bone Grafting Materials for Dental Applications: A practical Guide
Gross.J.S. Compendium/October 1997;1013-1036
2.A thorough physicochemical characterization of 14 calcium phosphate-based bone substitution materials in comparison to natural bone
Tadic.D. Biomaterials 25 (2004) 987-994
3.Bone Grafting and its Essential Role in Implant Dentistry
Rissolo.A.R. Volume 42‧umber 1‧January 1998:91-116
4.Bone Grafts and Growth and Differentiation Factors for Regenerative Therapy: A Review
Rose.L.F. Pract Proced Aesthet Dent 2001;13(9):725-734
5.A systematic review of graft materials and biological agents for periodontal intraosseous defects
Trombelli.L. J Clin Periodontol 2002;29(suppl. 3): 117-135
6.The Efficacy of Bone Replacement Grafts in the Treatment of Periodontal Osseous Defects. A Systematic Review
Reynolds.M.A. Ann Periodontol 2003;8:227-265
7.The Critical Size Defect as an Experimental Model for Craniomandibulofacial Nonunions
Schmitz.J.P. Clinical Orthopaedics and Related Reearch Number 205 April, 1986;299-308
8.Relationship Between the Radiographic Periodontal Defect Angle and healing After Treatment
Steffensen.B. J. Periodontol. May 1989;248-254
9.Radiographic Defect Depth and Width for prognosis and Description of Periodontal Healing of Infrabony Defects
Klein.F. J Periodontol 2001;72:1639-1646
10.Particle Size of periodontal Bone Grafting Materials
Zanert.D.J. Accepted for publication 18 October 1983;406-409
11.Bone Regeneration Using an Open Flap procedure: Utilization of Periodontal ligament, Bone and Periosteum
Pollack.R.P. “The International Journal of Periodontics and Restorative Dentistry” 4/1982;59-69
Demineralized Freeze-Dried Bone Allograft
1.Histologic Evaluation of New Attachment in Human Intrabony Defects
A Literature Review
Bowers.G.M. Accepted for publication 14 December 1981;509-514
2.Clinical Evaluation of localized Periodontosis Defects Treated with Freeze-Dried Bone Allografts Combined with local and Systemic Tetracyclines
Yukna.R.A. “The International Journal of Periodontics and Restorative Dentistry” 5/1982;9-21
3.Dectalcified Freeze-Dried Bone Allograft as an Implant Material in Human Periodontal Defects
Mellonig.J.T. “The International Journal of Periodontics and Restorative Dentistry”6/1984;41-55
4.Histologic Evaluation of New Attachment in Humans
A Preliminary Report
Bowers.G.M. Accepted for publication 19 November 1984;381-395
5. Histologic Evaluation of New Attachment Apparatus Formation in Humans
Part IIBowers.G.M. Journal of Periodontology , 1989;60:675-682
6.Histologic Evaluation of New Attachment Apparatus Formation in Humans
Part IIIBowers.G.M. Journal of Periodontology , 1989;60:683-693
7.Effect of Various Graft Materials with Tetracycline in Localized Juvenile Periodontitis
Evans.G.H. J Periodontol 1989;60;491-497
8.Ability of Commercial Demineralized Freeze-Dried Bone Allograft to Induce New Bone Formation
Schwartz.Z. J Periodontol 1996;67:918-926
9.A Clinical Evaluation of Demineralized Freeze-Dried Bone Allograft in Combination with Tetracycline in the Treatment of periodontal Osseous Defects
Masters.L.B. J Periodontol 1996;67:770-781
10.Effect(s) of the Demineralization Process on the Osteoinductivity of Demineralized Bone Matrix
Zhang.M. J Periodontol 1997;68:1085-1092
11.Ability of Commercial Demineralized Freeze-Dried Bone Allograft to Induce New Bone Formation is Dependent on Donor Age But Not Gender
Schwartz.Z. J Periodontol 1998;69:470-478
12.The Use of a New Allograft material for Osseous Reconstruction Associated With Dental Implants
Babbush.C.A. Implant Dentistry/ Volume 7, Number 3 1998;205-210
13.Contemporary Grafting Material for Use in Dnetal Implantology
Dental Implantology Update June 1998
14.Supracrestal Bone Regeneration: A Pilot Study
Kassolis.J.D. Int J Periodontics Restorative Dent 1999;19:131-139
15.Collagen and a Thermally Reversible Poloxamer Deliver Demineralied Bone Matrix(DBM) and Biologically Active Proteins to Sites of Bone Regeneration
Coulson.R. Proceedings from Portland bone Symposium 1999 p.619-637
16.GBR in Human Extraction Sockets and Ridge Defects Prior to Implant Placement: Clinical Results and Histologic Evidence of Osteoblastic and Osteoclastic Activities in DFDBA
Brugnami.F. Int J Periodontics Restorative Dent 1999;19:259-267
17.The Use of Demineralized Freeze-Dried Bone-Glycoprotein Matrix Grafts in Treating Baboon Periodontal Infrabony Defects
Blumenthal.N.M Int J Periodontics Restorative Dent 2000;20:61-69
18.Tissue Banking of Bone Allografts Used in Periodontal Regeneration
J Periodontol 2001;72:834-838
19.Is There a Role for DFDBA in Periodontal Regenerative Therapy?
Grest Editorlal J Periodontol September 1996;946-948
20.”Pacific Coast Tissue Bank” Dental Allograft Material
Synthetic Graft
1.Comparison of Porous Bone Mineral and Biologically Active Glass in critical-Sized Defects
Schmitt.J.M. J Periodontol 1997;68:1043-1053
2.Clinical Use of a bioactive Glass Particulate in the treatment of Human Osseous Defects
Shapoff.C.A. Compendium/April 1997:352-363
3.Clinical Evaluation of Bioactive Glass in the Treatment of Periodontal osseous Defects in Humans
Lovelace.T.B. J Pweiosonrol 1998;69:1027-1035
4.Fixture Modification and Osseous Regeneration of The “Ailing/Failing” Implant
Evasic.R. journal of Oral Implantology Vol. XXV/No. Two/1999:135-137
5.Human Histologic Evaluation of Bioactive Ceramic in the Treatment of Periodontal osseous Defects
Nevins.M.L. Int J Periodontics Restorative Dent 2000;20:459-467
6.Clinical Application of Bioactive Glass In the Treatment Of Periodontal Defects in Asian Patients
Wang.K.C. Unicare Research January 2001;1-7
8.UNIGRAFT
9.FISIOGRAFT

Astra OsseoSpeed™ 5.0 Straight

OsseoSpeed™ 5.0 Straight

The 5.0 Straight is here
Maxillary molar region
Mandibular molar region
Extraction sites
Our new 5.0 mm straight implant complements the Astra Tech range of MicroThread™– OsseoSpeed™ implants. The entire implant from the apex to the neck is 5.0 mm wide, providing extended bone-to-implant contact for optimal primary stability.Improved primary stability
The new 5.0 mm straight implant is designed for challenging situations where improved primary stability is desired. What’s more, it features the original Conical Seal Design™ abutment connection, the original MicroThread™ implant neck and the unique OsseoSpeed™ surface. They work together to ensure maintained marginal bone levels over time.

大前研一

未來臺灣創新的致勝關鍵
如何讓顧客願意付四倍價錢來買的東西,其中的關鍵就是創新
1. Strategic degree of freedom (SDF) --- What is customers really looking for ??
2. Arbitrage -運用套利
3.The new combination -- 老東西 新組合
4.Maximize the marginal contribution of the fixed cost -- 固定成本的貢獻極大化
5.Expand the digital continent
6.Fast forward -- 快轉時鐘 ,遇見未來
改變不是一夜就發生 環顧四周 其實會有一些指標的
7.Utilize the under utilized --- 挖掘出未被利用的部分
8. Real-time online case study -- 要假想自己如果是他 如何下決策
9. What does this all mean? -- Stop to thinking 不要一直埋頭苦幹
10. 培養構想力 --- 構想力是超越願景、超越概念的一種做法。你要贏過你的競爭者，而且這種構想只存在於人的心裡，你沒有辦法透過腦力激盪來做成這個構想。
　　　不要所有事情都依賴機器 ，未來，個人的重要性會超過企業與國家，未來創造利潤的來源也是個人　　　　　　　　　　　　　　
　　　　　　　　　　　　　　　　　　　originated from www.CW.com.tw

Cortical bone collector
1.ready to use
2.minmally invasive
3.useful
4.versatile
5.convenient

Ridge augmentaion with titanium mesh and bio-oss bone graft over 11 area

前牙美觀處理(anterior teeth esthetic management )
1. disease control
2. smile line
3. tooth shape
4. biotype of periodontium
5. crown -root ratio after management ( ortho or op.)
6. prosthetic design
case : peri-ortho tx. and soft tissue graft over 22 labial area