Connective Tissue Graft Using Alloderm
Lee H. Silverstein, DDS, MS, FACD, FICD
New Surgical Protocol to Create Interimplant Papilla: The Preliminary Results of a Case Series
The aim of this study was to introduce a new surgical technique to regenerate the papilla adjacent to multiple or single implants using a novel instrument and a new incision design. A total of 10 consecutively treated patients with maxillary anterior implant-supported provisional restorations and missing interproximal papillae received a subepithelial connective tissue graft. The receipient site was prepared with a buccal incision apical to the mucoginigival unction and to the defective papilla, and a palatal incision, followed by buccolingual tunneling performed with a translingual curette. An average improvement in papilla index score from 0.8 to 2.4 was found after an average follow-up period of 16.3 months. This case series demonstrated that interimplant papilla regeneration can be successful over a period of 11-30 months postloading. Long-term prospective studies on tissue stability and esthetic outcomes are needed to corroborate the finding in this study.
Aesthetic Crown Lengthening
The rationale for crown lengthening procedures has progressively become more aesthetic-driven due to the increasing popularity of smile enhancement therapy. Although the biologic requirements are similar to the functionally oriented exposure of sound tooth structure, aesthetic expectations require an increased emphasis on the appropriate diagnosis of the hard and soft tissue relationships, as well as the definitive restorative parameters to be achieved. The development of a clinically relevant aesthetic blueprint and attendant surgical guide is of paramount importance for the achievement of successful outcomes.
Labial Bone Thickness in Area of Anterior Maxillary Implants Associated with Crestal Labial Soft Tissue Thickness
Soft tissue problems (ie, gingival recessions) are common in implantology and are often associated with thin soft tissue biotypes or buccally placed implants. Goaslind described 2 types of biotypes commonly found in the natural dentition: thick and thin. It has been suggested that thicker soft tissue biotypes are associated with less tissue recession, higher crestal bone levels, and better aesthetics. A thin tissue biotype has been shown to be more prone to tissue recession. Gingival recession is always associated with alveolar bone dehiscences. Furthermore, there is evidence that thick soft tissue may be protective against crestal bone loss (ie, tissue thickness of ,2.5 mm resulted in crestal bone loss of 1.45 mm vs. thicker tissues had 0.26 mm). This protective effect occurred, despite the supracrestal position of the implant-abutment interface.
Immediate Implant Provisionalization: A Critical Aspect in Tissue Care and Esthetics-Part 2
A step-by-step protocol will be presented in how to fabricate the proper screw-retained provisional restoration from the fabrication of the acrylic shell to managing and capturing the proper supportive subgingival contour.
The Evolving Role of Soft Tissue Enhancement in Esthetic Reconstructive Dentistry
Soft tissue grafting techniques, new regenerative materials and bioactivators will be highlighted. The expanding role of allograft materials (Perioderm), platelet rich in growth factors (PRGF, PRF), and when to utilize them will be suggested. The ability of these combined protocols to alter the soft tissue profile around natural teeth, implants, and dentulous ridges, will be reviewed as to its critical role in "Complete Esthetics".
Papilla Preservation and Regeneration in Reconstructive Therapy
Dr. Thomas Han outlines the clinical decision making rational for choosing a specific surgical technique for diverse papilla regenerative challenges in the anterior region.
From Extraction to Prosthetic Restoration: Considerations for the Esthetic Zone
This webinar will highlight surgical and restorative techniques to accomplish predictable outcomes in the esthetic zone with implant therapy. Treatment modalities will be demonstrated with high quality photography and case series discussion. Surgical modalities presented will include ridge preservation, the current evidence on the use of growth factors such as PRP and hr-PDGF bb. Also timing of implant placement as well as soft and hard tissue augmentation will be discussed. Special emphasis will be placed on immediate provisionalization of implants to accomplish optimal peri-implant mucosa architecture. Techniques to transfer provisional emergence profile to the final restoration will be presented.
Acellular Dermal Grafts in the Correction of Gingival Recession: Discovering the Possibilities
In this presentation, follow the evolution of root coverage surgery from autogenous grafts to the more contemporary alternatives of today.
Prosthetic Soft Tissue Development From Single to Full Arch Reconstruction
In addition to surgical intervention is the creation of the specific emergence profile that is essential in the aesthetic zone. The emergence profile composed of 2 parts, the abutment and the subgingival part of the crown. The shape of abutment can be individually shaped so that it gives natural appearance and varies individually (depending on the depth, angulation and diameter of the implant). Sometimes it even dictates the implant position. From a surgical perspective, soft tissue height, position and thickness need to be diagnosed and corrected when needed. From the prosthetic point of view, the emergence profile has to be created to mimic the natural appearance and maintained over time in respect to the biological changes. The course teaches step by step how to be successful with implant prosthetics from single tooth, partially edentulous to full arch reconstruction.
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