Demystifying the art of implant placement

09 July 2024
Venceslav Stankov is an expert in periodontics, implantology, and microsurgery.

The Dentist speaks to Venceslav Stankov about the importance of a multidisciplinary team.  

Venceslav Stankov is among the World's Top 100 Doctors in Dentistry, according to the Global Summit Institute.  He is a recognised expert in periodontics, implantology, and microsurgery, renowned for his innovative approach to gum and soft tissue restoration around dental implants and in treating periodontal diseases.  

Tell us about your professional background

My parents were both dentists and it was a ‘no brainer’ to follow their steps from an early age. I initially chose prosthodontics but soon realised that I couldn’t do prosthodontics without implant treatments. The early collaboration with surgeons did not give me results I was truly happy with, which prompted me to place implants myself. I was lucky to work with one of the most eminent dental implantologists in the world, Henry Salama, to learn about periodontics and periodontal-prosthesis. After graduating in my home city, I also obtained masters degrees from six universities.

What is the importance of working with a multidisciplinary team in oral implantology?

We all have our limitations.  If we need to involve orthodontics or complex prosthetic planning, for example, I cannot possibly be the best in all these disciplines. Working with specialists augments my vision, not only with regards to the treatment itself, but in every aspect of the planning to achieve the vision.

Would you expand on your Synergy team?

The Synergy team is a group we created with four dentists from Bulgaria. I head up the team and partner Ivaylo Pashov is a specialist in oral surgery, implantology and periodontal surgery. Ivaylo was three times awarded with the prestigious award ‘Best young implantologist’ of the American brand BioHorizons - in 2020, 2022 and 2023. 

Kalin Marinov is a specialist in aesthetic dentistry and mucogingival/implant surgery. Lately Kalin completed a two-year master program in ’Soft-tissue management around teeth and implants’ under the leadership of Giovani Zucchelli in Bologna University, Italy. 

Bozhidar Nastanliev, the youngest of the team contributes with his triple passions for periodontal surgery, implant dentistry and aesthetics. 

I am also part of an international team that includes David Norré (Belgium), Florin Cofar (Romania), and Eric van Dooren (Belgium). Florin specialises in complex aesthetic rehabilitation and minimally invasive procedures. Eric is an active member of the European Academy of Aesthetic Dentistry and lectures nationally and internationally, mainly on aesthetics, implants, and aesthetic periodontal surgery. I involve them in cases, and their feedback is the best and fastest way for me to grow and improve outcomes.  I also try and visit the best teams in the world for the same reason.

Does the 360-degree implantology concept offer the best scenario for your team?

Yes, absolutely.  The 360-degree approach is a very logical and effective concept. We incorporate the knowledge coming from a prosthetic approach, from prosthodontics, biology, and the implant system itself. These four elements need to work synergistically to lead to the best outcome.

With the prosthetic approach, you have a design, you use the component and then you put the implant in the bone. Another approach is to start from the bone to assess its availability, quality and quantity, followed by an evaluation of the soft tissue quality and quantity, which will guide your implant placement plan and the component best suited for it. And, of course, if you go with the biological perspective, you need a four millimetre implant, and the component should not be more than 30 degrees to the emergence profile.

The 360-degree implantology concept is about combining these three ways of thinking and making them work together and not one against each other. This is a simplified process and exactly what we need to demystify the art of implant placement.

How has oral implantology evolved regarding workflows and protocols in the last seven to 10 years?

In the past, we focused much more on the bone and implant position in the bone. However, we came to the realisation that the soft tissue was far more important. The implant designs we are working with allow for a deeper placement, resulting in more bone and less need for augmentation.  

I am pleased to say that implantology is becoming much more predictable, much more gentle and much more comfortable for the patients. This also means that the waiting period for integration ranges between three to four months without the additional six months of bone augmentation - making it far more acceptable for both the clinician and patient.

What attracted you to the Bredent system?

I have worked with the most popular systems on the market but the fact that Bredent offers different types of implants and component designs is really ideal for me.   The company offers a platform match (BlueSky) and a conical connection and platform switch (CopaSky).  The BlueSky implants are very strong and useful for the areas where you have a lot of stress and load like single molars, big teeth and jaws.

For premolar, canines and central incisors, I like CopaSky. The platform switch system allows for much less bone augmentation and focuses on the soft tissue.  Bredent also collaborates with clinicians and really makes a point of working together on the components. They are not a huge company and it has the benefit of reacting fast. I need to count on a company that gives me reliable support without any delays, and Bredent provides that for me. They are like a family, and we speak openly with each other.

What should clinicians consider when choosing a dental implant system, both in terms of design and other important aspects?

I would say that the most important thing is component selection. Even when a current implant system gives you satisfactory results, there is no guarantee that the switch to digital will work as its components might not have matched this, however Bredent has a very good digital component. 

What has been your experience with implant placement at the equicrestal and subcrestal level?

We carried out a lot of studies ourselves and were sadly unable to publish some of them because every implant was placed equicrestal and lost bone. We now believe that the best position for the implant is subcrestal; with the Bredent system the BlueSky is placed slightly subcrestally and CopaSky, one millimetre subcrestal.

Why is the microstructured backtaper on the CopaSky implants so important?

Losing bone around the implant can be normal. However, if there is a problem, you will not know it in advance. So when I see a very good bone response on my X-rays, I am very encouraged. I would not comment saying it is relevant or important, it is a matter of preference. If the bone outcome is perfect then you know it is perfect, and that makes me sleep better! 

How do the prosthetic components of the CopaSky give the clinician a winning edge in terms of immediate restoration, soft tissue management and digital workflow?

The major benefit of the CopaSky prosthetic components is that they are thin and strong at the same time. There is a special conical design of the screw that allows for better titanium fitness.  This provides more space for soft tissue, aesthetics and biology. Bredent has a variety of digital components and I enjoy the fact there are many height options for the titanium base and uni-cone abutments. We are faced with a number of different situations every day, and this versatility makes my life a lot easier.

What do you understand about the platform switch, zero bone loss, and bone growth concept?

The easiest way to achieve a zero bone loss outcome is to work with the platform switch and the platform switch implant, however that may not be sufficient. It needs to be a platform switch and the components need to have a very narrow emergence profile, less than 30 degrees and this is what we have with the copaSKY system. As you have an implant that can go deeper, you end up with a very nice titanium base and a thin emergence profile. This makes the process for retaining the bone where it was before much easier.  We assume that if the bone is not lost, it is better for the patient because then we have more stable tissue, the surface of the implant is in the bone and not in the tissue so it is less likely to be contaminated. As a result we have the beauty of more stable and more predictable results.

What are the conditions necessary for bone growth concept with CopaSky?

The implant should be at least 4mm deep in relation to the soft tissue and the profile of the restoration should be less than 30mm. Then everything needs to be perfectly clean to be able to insert a component.

What are your future projects?

I am working on a book involving bredent implants with the ambition to make implantology more accessible with simplified protocols. This should be published in 2025, and we hope it will improve dentists’ lives when it comes to implant placement.