Continued Education is the Key
Transcription
Continued Education is the Key
AZ 6002 Luzern / Fr. 2.50, 1 2.– / Nr. 95 N E U E Saturday, April 24, 2004 Special n Congress Editio LUZERNER ZEITUNG Z E N T R A L S C H W E I Z E R Osteology Foundation wishes you an interesting congress day www.osteology.org T A G E S Z E I T U N G This newspaper is sponsored by WEATHER: Along the mountains, occasional rain is still possible. The Congress Opens EDITORIAL Continued Education is the Key Biotechnology in Daily Practice? At yesterday's opening of the Congress, Scientific Chairman Professor Daniel Buser emphasized how important continued education and training are for the dentist’s practical work. W hy have you come to Lucerne? In the end, the reason has been to help you improve or increase your daily treatment options. You wish to offer your patients reliable treatment methods, attractive and functional implant results with a minimum of pain and discomfort. In his welcoming address, Professor Buser emphasized that, «continued training is the key to achieving highly qualified work as a practicing dentist». And dentists are evidently willing to continue their training and education at the highest level. More than 2000 people from 51 countries are attending the congress. Professor Buser was quite pleased with the avid interest in Osteology. He feels that the large draw is both a success for the Foundation and also evidence of the high level of the scientific program and the speakers. Regenerative implantology has already made great progress. In many situations the need for autogenous bone grafts can be reduced or even eliminated. Bone substitutes and resorbable membranes have made the implantologist’s – and the patient’s – life easier and more comfortable. The surgical hard and soft tissue management has been refined to optimize esthetics. In the future, we will be able to build up missing soft and hard tissue using biotechnology and tissue engineering. The cornerstones are growth factors, cells and matrix technology. Biomaterials function as matrix structures and will play a decisive role in the next ten years. They influence adherence, activaBertrand Piccard (left) in dialogue with the President of the Osteology Foundation, Christoph Hämmerle. PICTURES: SIGI TISCHLER tion and differentiation of cells. Growth factors will probably acceFamous balloon explorer Bertrand speak to the wind – psychology of record-setting balloon adventure. Pic- daily life. He feels that, «even in everyday lerate tissue formation and maturaPiccard, the guest speaker, received re- communication». He illustrated his lec- card drew parallels between experiences life, sometimes you just have to throw tion. And, in very complex situations, cell technology will be used. sounding applause for his talk «How to ture with impressive pictures from his as a balloonist and communication in ballast overboard.» Cells are best in secreting the right proteins at the right time, right place and in the right amount. We Pre-congress Congress just have to make them do it. Professor Christoph Hämmerle, President of the Osteology Foundation, shortly outlined the Foundation’s goal of primarily supporting research projects in the field of bone and tissue regeneration. Professor Hämmerle was likewise most pleased that the Foundation is off to such a good start. He thanked the initiator, Dr. Peter Geistlich, for his generous engagement in the promotion of education and research. Avid Interest in Advanced Techniques for Bone Augmentation The pre-congress workshops on bone regeneration were very popular. The two workshops on advanced techniques for bone augmentation were fully booked out. In his lively presentation, Daniel Buser demonstrated surgical procedures using various cases and videos, plus provided valuable practical tips. Due to the large demand, Massimo Simion and Carlo Maiorana had to carry out their hands-on workshop twice. After the lectures showing study results and cases, dentists could practice vertical block transplant techniques and chin and ramus grafting on pork mandibles. Page 2 Z TOPNEWS SMS senden an 141 TODAY’S TOPICS Neukam / Nevins: Is tissue engineering clinically applicable? (morning) Lang / Sculean: Soft tissue management in esthetic areas. (noon) Buser / Raghoebar: Management of complex bone defects. (afternoon) Extraction Sockets – A Main Topic As far as esthetic sites go, the facial bone plate is a key structure. Its preservation in fresh extraction sockets was intensively discussed during the first congress day. Likewise an important subject was the ideal time point for implant placement after extraction. In a series of high level scientific presentations, the lecturers showed new study results as well as clinically relevant aspects in treating sockets at extraction sites. New techniques to manage deficiencies of soft tissue and to support its healing by using collagen scaffolds or tissue engineering were also presented. The goal of the new concepts presented on Friday was, when compared to current treatments, to shorten the overall treatment time and to facilitate the surgical procedure with improved longterm predictability. We believe in the technical feasibility of these new therapies. What we still must work on is the proof of the clinical benefit in relation to costs. The factors and cells must measure up to our current techniques – in efficacy, handling and practicality in daily practice. And the present standard techniques are already quite good. Serious research makes only small steps, but these bring sustained yields. This is why your patients are still waiting for cultivated cells or growth factors to rebuild tissue deficiencies – but we’re working on it, as a company and with the Osteology Foundation. DR. MICHAEL PEETZ, MANAGING DIRECTOR, G E I S T L I C H B I O M AT E R I A L S Page 2 Full concentration at the workshops. SPECIAL CONTENTS Swinging Night Party Osteology Congress 1-4 TV/Radio 60 An unforgettable evening after intensive congress days. Last night, Sibylle Briner, the classical pianist originally from Lucerne, captivated the audience. The fun continued with the «Swinging Night Party» that followed at the Art Deco Hotel Montana. This event was just as impressive, even when a bit livelier, with musical and culinary delicacies, entertainment and dancing . . . . . . . . . . . Page 3 Markt 13 Agenda 62 Wirtschaft 14 Unterwegs 64 Börse 16 Zentralschweiz 32 Inseraterubriken Sport 33 Immobilienmarkt Bund 5 45 Treffpunkt 38 Kultur 46 Todesanzeigen 42 Wetter/Ratgeber 52 Stellenmarkt 47 Dossier 53 Gewusst wo 49 Page 3: Swinging Night Party HEAD 8 OF THE DAY Bio-Gide® Bio-Oss® Christoph Hämmerle Professor Christoph Hämmerle seeks to further promote research projects in the area of bone and tissue regeneration with biological materials. Page 4 the natural choice Manufacturer Geistlich Pharma AG Division Biomaterials Bahnhofstrasse 40 CH - 6110 Wolhusen www.geistlich.com Redaktion: 041 429 51 51, Fax 041 429 51 81, Internet: www.zisch.ch, E-Mail: redaktion@neue-lz.ch, Inserate: 041 227 56 56, Fax 041 227 56 57, Abonnemente: 041 429 53 53, Fax 041 429 53 83 2 OSTEOLOGY CONGRESS Neue Luzerner Zeitung Neue Urner Zeitung Neue Schwyzer Zeitung Neue Obwaldner Zeitung Neue Nidwaldner Zeitung Neue Zuger Zeitung Saturday, April 24, 2004 / Nr. 95 An Unforgettable «Swinging Night Party» at the Hotel Montana What an atmosphere could be felt last night at the Art Deco Hotel Montana! The hotel’s grand rooms and the view over the Lake of Lucerne are legendary and breathtaking. However, the guests at yesterday’s «Osteology Swinging Night Party» were likewise special. They were carried away by the enthralling ambience, diverse entertainment program and the swinging music. The jazz band, «The Montana Swinging Formation», formed the center of the entertainment with their lead singer, Natalie Claude. She made sure the dance evening was an unforgettable event for all and electrified the atmosphere with her broad repertoire – from the Charleston and the Lindy Hop all the way to traditional and I am greatly interested in implantology and periodontology in general. In addition to the opportunity for personal continued education, a congress always provides a good platform for an exciting exchange of ideas with colleagues. MICHAEL SCHWAGROWSKI, ESSEN (GERMANY) So far, my expectations have been completely fulfilled. Friday’s lectures were of a high level. But even in addition to that, the entire infrastructure impresses me. I have never before attended a congress where the conditions have been so good. And this is all the more remarkable because the congress is very well attended with more than 2000 participants. KIRSTEN MOLSTED, COPENHAGEN (DENMARK) What I find particularly useful is, for example, the workshops presented by Professor Buser. These are very practiceoriented. One really benefits the most from the excellent tips that can be used in daily work. ANGELIKA EHLICH-BEUTTER, FELDKIRCH (AUSTRIA) modern jazz. And the «Tickle Toe Hep Cats» dance group brought the 1940s back to life with their show numbers and, in so doing, provided a welcome rest to some hearty pairs of dancers. As always an unforgettable event for the foreign guests was the appearance of the alp horn players. For those who preferred quieter moments, conversation abounded in the famous Whiskey Bar and at the Louis Bar with accompanying piano music. The Montana crew provided the necessary «energy» throughout the evening – they were always present offering new culinary delicacies. We’re not sure when the last guests left the party, but it will certainly remain an unforgettable memory for all. Up to now, I have been quite pleased with the way the congress has progressed. The congress offers an excellent opportunity to update one’s own knowledge. One learns all the news and sees what is happening at the «front.» At congresses, I get many inspirations for my work in the practice. I profit the most from the practical workshops. As a rule, the lectures tend to be a bit too remote, too scientific for me. They are not geared enough toward the practitioner’s needs. The level of both the lectures as well as of the workshops is very good. Also quite encouraging is the good atmosphere, here at the congress and in the city of Lucerne. My wife and I feel right at home here, and we’re enjoying our stay. HEINZ HOELZL, M E R A N ( I T A LY ) SRIMAN HADINNAPOLA, N O RW I C H ( G R E AT B R I TA I N ) PROFESSOR DAN LUNDGREN, UNIVERSITY OF GÖTEBORG (SWEDEN) Among dentists, there is an increasing trend for specialization. I find that correct. No dentist can offer the entire spectrum of specialty treatments. A congress such as «Osteology» offers the opportunity to receive education and training in a targeted specialty area. The congress gives me the chance to learn new tips and extraordinary talent of the pianist who has won many musical tricks for the practice. This is prizes in her career. Sibylle Briner interpreted works by Gershwin, very helpful. Sibylle Briner Shines at the KKL Last night the Lucerne pianist, Sibylle Briner, enchanted guests at the Culture and Congress Center (KKL) with her delightful tones. The concert was a special experience for the international public: the unique acoustics of Lucerne’s KKL in combination with the Rachmaninov and Bach, with the highest of skill, and for which she received resounding applause. V IVIANNE CHAPPUIS, UNIVERSITY OF BERN (SWITZERLAND) Saturday, April 24, 2004 / Nr. 95 Neue Luzerner Zeitung Neue Urner Zeitung Neue Schwyzer Zeitung Neue Obwaldner Zeitung Neue Nidwaldner Zeitung Neue Zuger Zeitung OSTEOLOGY CONGRESS 3 The first congress day Extraction Sockets and Soft Tissue dominated One of the important conclusions from yesterday’s lectures was that the maintenance of the facial bone wall after tooth extraction is a key for successful esthetics. the bone availability, the shorter the overall treatment time, but the more difficult the soft tissue management may become. Christoph Hämmerle presented a new classification for implantation timing. Whenever possible at esthetic sites, both Hämmerle and Daniel Buser prefer a procedure with implant insertion four to six weeks post-extraction. «Immediate implantation in esthetic sites is unpredictable on a long-term basis», explained Buser. BIRGIT WENZ Tooth extraction can end up being an esthetic disaster if both the buccal bone plate and the gingiva are thin, concluded Jan Lindhe in his clear and excellent presentation. Substantial resorption of the buccal bone plate often take place in the months following tooth extraction. “These dimensional alterations in the bone profile probably occur because of the reduced biological demand on bone function.” Jan Lindhe is currently testing whether implant insertion or placement of Bio-Oss Collagen into the fresh extraction socket can prevent this resorption. Soft tissue reconstruction Stefan Schultze-Mosgau presented new ways to reconstruct missing periimplant gingiva in esthetic areas. The application of two experimental collagen scaffolds onto open soft tissue defects resulted in the formation of new gingiva that was as thick as that achieved with gingival transplants. In a subsequent experiment, human keratinocytes were cultured on these scaffolds to prefabricate soft tissue. Using clinical cases, Schultze-Mosgau demonstrated that this new method of tissue engineering can indeed be used to reconstruct the gingiva. When he mimicked loading during the cell culturing by subjecting the cells to mechanical stress, he could even further improve the results of the in vitro tissue formation. «Collagen membranes can promote soft tissue regeneration. They can initiate the healing process and serve as a Professor Myron Nevins at his lecture, «Ridge preservation after tooth extraction for placement of dental implants». matrix for the in-growth of blood vessels and keratinocytes», related Jürgen Becker. He has tested various collagen membranes with respect to the in vitro response of cells and the tissue reaction after implantation. In comparison to untreated collagen materials, those membranes that were chemically stabilized to prolong resorption time showed reduced cell adhesion and tissue integration. Becker believes that this may be the reason for the frequent, late membrane exposures seen with some of these long-lasting collagen membranes. Implantation Timing The earlier an implant insertion takes place after tooth extraction, the better Ridge Preservation Myron Nevins discussed different strategies for preserving the ridge after extraction of frontal teeth with thin buccal bone walls. Four months after extraction, about half of these patients do not have enough bone left for implant insertion. Either bone morphogenetic protein 2 or «Bio-Oss» could prevent this facial bone loss. However, even with today’s techniques, the occurrence and the extent of bone loss cannot be predicted. «With new results arising from studies, we will have new options for treating fresh extraction sockets.» Important aspects of soft tissue in extraction sites were highlighted by Wilfried Wagner. «Preservation of the ridge and guided soft tissue regeneration will be important issues in our future treatment concepts», stated Wagner. Peri-implantitis «Tissue loss due to peri-implantitis may continue to progress, even after the bacterial infection has been eliminated», explained Tord Berglundh. He found that the extent of bone resorption is more pronounced around implants with rough surfaces compared to turned surfaces. However, Klaus Lang reported that the re-osseointegration of rough implant surfaces is more pronounced than that of turned surfaces. Karl-Ludwig Ackermann rounded off the first congress day by presenting his extensive clinical experience with bone augmentation procedures. Many useful tips and tricks for daily practice. Workshop participants concentrate on the porcine mandible. Workshops Contouring Results in Optimal Crest Volume The workshops of Buser and Maiorana together with Simion highlighted the practical aspects of advanced bone augmentation procedures. Daniel Buser favors early implant placement and simultaneous bone regeneration. He performs tooth extractions 6 to 8 weeks before implant insertion. At the time of implantation, the bone defect is filled with autogenous bone chips. The slowly resorbing bone substitute, Bio-Oss, is used to contour the crest since it maintains the augmented volume. Buser uses a collagen membrane (Bio-Gide) to cover the defect. The reopening takes place 6 to 12 weeks later. «With this procedure, we have less difficulties in implant bed preparation and a reduced risk of facial bone resorption», said Buser. With his cases, he demonstrated that soft tissue reaching sufficient height and convexity can be achieved, as can optimal emergence profiles. However, for complex situations, he prefers a staged approach using block grafts contoured with Bio-Oss and a non-resorbable membrane. «We want to simplify this demanding procedure by using the collagen membranes here as well, and are currently testing them in a clinical study.» Dentists could practice advanced surgical techniques for bone augmentation in the workshop of Massimo Simion and Carlo Maiorana. The speakers demonstrated how to use autogenous bone blocks, how to contour the ridge morphology with Bio-Oss and how to optimize soft tissue management. A Warm Welcome at the Rosengart Museum «I warmly welcome you to my home!» With these gracious words, the patroness and art collector, Angela Rosengart, received speakers and guests of the Osteology Congress on Thursday evening at the Rosengart Museum in Lucerne. The collection of Angela Rosengart is unique and of inestimable value. Two years ago, she opened her art treasures to the public. The guests of «Osteology» could appreciate the great honor of being personally received by the hostess. During the museum tour, they could admire the exquisite paintings. The Rosengart Museum boasts works by Picasso, Cezanne, Klee, Monet, Kandinsky and Miro, in addition to many others. Angela Rosengart was a personal friend of Picasso. «I felt Picasso’s eyes burning into me,» was how Angela Rosengart described the feeling she had when Picasso was drawing her portrait. Her father, a famous art dealer and friend of Picasso’s, was a frequent visitor to the studios of Matisse, Chagall, Braque and Picasso. He also knew and was a friend to many painters of the classical modernist period. Today, the Rosengart Museum enjoys an international reputation. It belongs to the absolute highlights of Lucerne. A visit to the museum can be highly recommended to all participants. Mayor Urs W. Studer proudly presents the «Rathaus». Reception at the city hall of Lucerne Lucerne is the Home of «Osteology» Two years ago, the art collector and patroness, Angela Rosengart, opened up her collection to the public. She personally led the guests of Osteology through her museum. In honor of the opening of the Symposium, representatives of the Osteology Foundation as well as speakers and invited guests of the congress were received in the «Rathaus» (city hall) and warmly welcomed to Lucerne by the mayor, Urs W. Studer. Michael Peetz, Managing Director of Geistlich Biomaterials, thanked him for his warm hospita- lity. He emphasized that, «Lucerne is not only the home of Geistlich Biomaterials, but also of the Osteology Foundation. It was therefore important for us to bring this congress to Lucerne.» The President of the Foundation, Professor Christoph Hämmerle, expressed his confidence that the congress would be a resounding success. In his short address at the reception, Professor Hämmerle explicitly recognized the efforts of Dr. Peter Geistlich in connection with the establishment of the Foundation. «The Foundation seeks to, and will, continue to develop this enthusiasm even further. The Foundation shall become a platform for the exchange of all forms of ideas and scientific erudition.» 4 OSTEOLOGY CONGRESS Neue Luzerner Zeitung Neue Urner Zeitung Neue Schwyzer Zeitung Neue Obwaldner Zeitung Neue Nidwaldner Zeitung Neue Zuger Zeitung Congress Osteology Symposium Sold Out Regeneration of bone and tissue is gaining increasing interest in implant dentistry and periodontology. Prof. Daniel Buser, University Berne and Scientific Chairman of the Symposium, explains why. surgical techniques and the right products. These questions need to be discussed at conferences such as this in Lucerne. What are the main, unresolved questions in bone regeneration discussed here in Lucerne? Prof. Buser: The implant surgeon can predictably achieve satisfying, functional results in horizontal bone defects with bone grafts and bone substitutes combined with barrier membranes. We still have limitations in treatment outcomes in more complex, vertical bone defects. We are aiming at simplifying the surgical procedures, making them more user-friendly and less demanding for the patients. INTERVIEW BY BIRGIT WENZ Prof. Buser, how many people are attending this congress? Prof. Buser: We have over 2000 registered participants from 51 countries. We have reached the maximum capacity of this congress center. We have twice as many participants as at the last Osteology Symposium in Barcelona, where 1000 attended. Did you expect so many participants? Prof. Buser: It became clear in February, since the congress was already sold out at that time, and we had to organize a video transmission. But when we were planning the congress, we anticipated about 1200 people. The number of 2000 completely exceeds our expectations. What are the reasons for the large interest in this symposium? Prof. Buser: The main reason is that regeneration currently is a major item of interest. The Osteology Symposium is the only large, international congress focusing on this subject. And the Symposium is known for its high level Professor Daniel Buser (rigth) together with the initiants of the Osteology Foundation, Dr. Peter Geistlich, and Dr. Michael Peetz, Managing Director, Geistlich Biomaterials. programs and beautiful congress locations. The fact that the independent and scientific Osteology Foundation has organized the congress for the first time makes it even more interesting. ce. Furthermore the number of implant placements is constantly increasing. Simultaneously, the number of cases needing regenerative procedures is increasing, too. But regeneration has been known for more than a decade now. Prof. Buser: This is true from a scientific point of view. Regenerative procedures using barrier membranes have been developed in the mid-eighties for periodontology and shortly afterwards for implant patients. But only since the past few years can regeneration be called a standard method in daily practi- What are today’s problems and questions in regenerative procedures? Prof. Buser: Today, more and more patients want an optimal result in red and white aesthetics. To achieve an ideal and long-lasting soft tissue appearance, sufficient bone volume in crest width and height is required. This volume is often lacking and needs to be regenerated or augmented with appropriate Do participants find these answers here in Lucerne? Prof. Buser: Osteology in Lucerne brings us one step forward. During these three days, the clinicians see new aspects and techniques in extraction socket treatment and aesthetically oriented surgery, which they can apply in their daily work. We will take a look into the near future to see the potential of tissue engineering and growth factors. Why will people come to future Osteology Congresses? Prof. Buser: The high standard of the scientific program and the balance between practically relevant questions and application oriented research will be highly attractive also in the future. The Foundation will soon set the next date and location. Saturday, April 24, 2004 / Nr. 95 TE Used for Cartilage Defects Tissue Engineering is discussed as a future new treatment method in dentistry. Cell therapy is already being used clinically for treating cartilage defects. One of the first established applications of Tissue Engineering (TE) is «autologous chondrocyte transplantation» for cartilage defects in the knee. Among the few companies offering this treatment is Geistlich Biomaterials, Wolhusen, in alliance with a German cell culturing company. Cartilage cells are harvested and cultivated for six weeks, then implanted into the defect and covered by a collagen membrane (Chondro-Gide, Geistlich). The efficacy of this application has been demonstrated in long-term clinical studies spanning more than 10 years. Since the results of this treatment are superior to conventional therapies, health insurance companies in several countries will soon reimburse costs. However, the high rates of about 5,000 – 6,000 Euros will limit its broad use. These costs arise mainly from the complexity of human cell culturing, the strict quality control regulations as well as the demanding logistics. For dental applications TE has to prove its superiority to standard therapies – in efficacy, speed or burden on the patient. Such advantages have to be related to costs. However, the more cell transplantations are performed, the less a single treatment might become. B . W. Foundation Advertisement Osteology Foundation Supports Projects on Tissue Regeneration ® Bio-Gide ® Bio-Oss The newly-founded Osteology Foundation supports research projects in the field of bone and tissue regeneration. Prof. Christoph Hämmerle, University of Zurich, President of the Foundation, explains its function. Why does the Foundation focus on biological materials? Prof. Hämmerle: Within the past ten years, it has been shown that natural products possess a good capacity for bone and soft tissue regeneration. They have also been found to be suitable carriers for growth factors and cells in Natural products posses a good capacity for bone and soft tissue regeneration. INTERVIEW BY BIRGIT WENZ the leading system 1 2 1, 2 European Dental Bone Substitutes and Membranes, Klaricon 2003 European Markets for Dental Bone Graft Subitutes, Millennium Research Group, 2002 Manufacturer Geistlich Pharma AG Division Biomaterials Bahnhofstrasse 40 CH - 6110 Wolhusen www.geistlich.com Professor Hämmerle, how would you characterize the Osteology Foundation? Prof. Hämmerle: The Osteology Foundation will specifically promote applied research. While basic research is relevant to understanding biological mechanisms, applied research aims to develop new treatment options. This is usually achieved with new products and improved clinical procedures. Universities test new methods and define treatment standards. Industry has the technology and experience for product development. Osteology will support the collaboration between universities and the industry, with an exclusive focus on regeneration. PROFESSOR CHRISTOPH HÄMMERLE the field of tissue engineering. We believe they will play a relevant role in future therapeutic concepts. Professor Christoph Hämmerle, President of the Osteology Foundation. decides on the topics of discussion. There are two committees, Science and Education. The Committee Science is responsible for supporting research projects. The Committee Education organizes international and national Osteology Symposia. The administrative office of Osteology is in Lucerne and provides information throughout the year. How will Osteology support this collaboration? Prof. Hämmerle: On one hand, with financial support of research projects in What type of projects will be funded? applied research, Prof. Hämmerle: and on the other, Osteology will supwith continued port scientific studeducation about new The Osteology ies in the field of treatment methods. regeneration with Foundation creates a platThis will primarily biological materials. take place at nationform for research and The studies must al and international innovation. pertain to new and osteology congresPROFESSOR clinically relevant ses. Both the studies CHRISTOPH HÄMMERLE questions of interand continued est, both for univereducation will accelsities and industry. erate developments and shorten the time required to bring Results should be published in international, peer-reviewed scientific new techniques into clinical practice. journals. Once every year, in autumn, the members of the Scientific CommitHow is the Foundation organized? Prof. Hämmerle: The Foundation tee evaluate grant applications. The best projects will be funded. The Board is governed by a board of eleven members. The Executive Management details on application and the evaluatiCommitte as part of the Board, organ- on process can be found under izes the yearly board meetings and www.osteology.org. How does Osteology benefit science? Prof. Hämmerle: In the foundation the members of the board will discuss questions in regenerative applied research with the industry. This will exert an important influence on the new development of projects. During the first board meeting held in January 2004, new research fields and treatment concepts for bone and tissue regeneration were discussed. This meeting triggered new ideas and important thought-provoking impulses. What will be the main topics of interest for the Foundation in the near future? Prof. Hämmerle: New treatment concepts with growth factors or cells will continue to play an important role in the discussions of the Foundation Board. Various research groups have already reported on promising results with these techniques. But there are still open questions regarding the benefit for clinical practice, especially when the overall effort and costs are considered. Relevant advantages of these new techniques may be the reduction of the total treatment time and decreasing the burden for the patient by allowing to replace autogenous bone transplants in complex defects. Applied research has to define the indications and work out the surgical procedures.