Interpositional Bone Grafts to Treat the Posterior Atrophic Mandible
This presentation analyzes the interpositional bone graft or inlay technique, discussing the reconstructive surgical approach. Horizontal osteotomy with the interposition of bone in the form of a “sandwich” involves raising a coronal osteotomized segment of the mandible, which is still attached to the lingual periosteum, and interpositioning a block bone graft. This technique guarantees a dual vascular supply to the inlay graft from the lingual periosteum and from the residual bone; it also allows optimum use of the native basal bone, which should be less prone to resorption. The advantages and disadvantages of the inlay technique are compared with other commonly used augmentation techniques in the management of posterior mandibular atrophies.
Achieving Stable Esthetic Results with Implant Supported Restorations
We will discuss basic concept regarding immediate implant placement and guided bone regeneration procedure related to the esthetic zone before focusing on the soft tissue management. We will describe the prosthetic procedures which are performed before, during and after the surgical procedures. Provisional restorations, impression techniques, prosthetic profiles and restorative materials will be presented. The purpose of the presentation is to provide a check list that will guide the clinician developing a proper analysis and diagnosis for the successful esthetic result with implant supported restoration.
Predictable Posterior Implant Placement in Extraction Sites
Many techniques have been published to preserve the ridge from buccal-lingual collapse. In this presentation, we will overview the literature and see some cases to explain which is one of the most predictable protocols
for immediate extraction and immediate implant placement in posterior areas according to the latest studies.
We will also show the benefits of using growth factors as an agglutinant and protective component for our graft in non cooperative patients.
An Evidenced-Based Approach to Extraction Site Management
Once a decision is made to extract a tooth, clinicians have a decision to make; delayed management – i.e. extract and wait, immediate implant placement or a staged approach – i.e. graft and wait. This presentation discusses the evidenced based decision making process for this endeavor. Emphasis is placed on classification of extraction sites and risk assessment as a guide to customizing the treatment protocol for the clinician as well as the patient.
Reconstruction of a Single-Tooth Traumatic Defect in the Anterior Maxilla Using the Khoury Bone Plate Graft
Trauma to teeth and the dentoalveolar process may result in a ridge defect that precludes straightforward implant
therapy of the patient. Typically bone and soft tissue augmentation of the area would first be needed to adequately
prepare the tissues for the implant and its restoration..Grafting of the site is substantially more difficult in cases where
the ridge also lacks adequate height, and techniques to recreate a bony envelope to apply guided bone regeneration
may be required. Moreover, defects in the anterior aesthetic zone that require both bone and soft tissue grafting and
a restoration that harmonizes the adjacent pink and white aesthetics may be an even more significant challenge to
the restorative team. Hereafter a case of trauma to an anterior maxillary tooth that saw destruction of the ridge is
presented, with the defect reconstructed to accommodate a functional and aesthetically pleasing implant supported
The Pontic-Shield: Partial Extraction Therapy for Implant Dentistry
Augmentive ridge preservation techniques aim to manage the postextraction ridge. The partial extraction of teeth may better preserve the ridge form by maintaining the bundle bone-periodontal tissues and preserve the ridge beneath dentures or fixed prostheses. The socket-shield technique entails preparing a tooth root section simultaneous to immediate implant placement and has demonstrated histologic and clinical results contributory to esthetic implant treatment. A retrospective 10-patient case series treating 14 partial extraction sites demonstrates how a modification of the socket-shield technique can successfully develop pontic sites and preserve the ridge.
Immediate Implant Placement into Extraction Sockets with Labial Plate Dehiscence Defects: A Clinical Case Series
To measure the buccal plate reconstruction of extraction sockets with labial plate dehiscence defects using a bone
allograft in combination with an absorbable collagen membrane and a custom-healing abutment at the time of tooth
removal. Implants placed into sockets with labial plate dehiscence defects demonstrated radiographic reformation of the labial plate dehiscence defect at 6 to 9 months post-treatment. The net gain in labial plate on CBCT in L1 and L2 was 3.0 mm, where 0 mm existed at pre-treatment. The minimum amount of labial plate thickness of 2.0 mm was achieved in all treated sites, evaluated radiographically at 6-9 months post-operatively, in a single
procedure, without flap elevation and maintaining the gingival architecture and satisfactory esthetics.
The Socket-Shield Technique: First Histological, Clinical, and Volumetrical Observations after Separation of the Buccal Tooth Segment – A Pilot Study
The “socket-shield technique” has shown its potential in preserving buccal tissues. However, front teeth often
have to be extracted due to vertical fractures in buccolingual direction. It has not yet been investigated if the socket-shield
technique can only be used with intact roots or also works with a modified shield design referring to vertical fracture lines.
The aim of this study was to assess histologically, clinically, and volumetrically the effect of separating the
remaining buccal root segment in two pieces before immediate implant placement.
Vertical or Shoulderless Preparations in Contemporary Prosthodontics
Tooth preparations without a defined finish line have been termed in several different ways, such as knife edge, feather edge, or shoulderless.
From a biological standpoint, preserving a maximum amount of sound tooth structure, as it is done in vertical preparations, might also offer a more conservative alternative to a horizontal margin design in other clinical conditions such as endodontically treated teeth, vital teeth in young individual, teeth affected by caries at the cervical third. Vertical margins on zirconia crowns have been tested in vitro and clinical reports have been published. A re-evaluation of possible advantages and shortcomings of vertical preparation design in contemporary prosthodontics will be presented in light of recently published literature.
Bone Reconstruction: A New Algorithm for the Implantologist
Bone augmentation is often required to place an adequate number of dental implants in ideal positions for prosthetic support. In addition to biomechanical demands bone augmentation can also provide proper ridge contour for improved esthetic outcomes. Disadvantages of bone augmentation techniques include increase morbidity, surgical time, costs and treatment length. As such a trend has develop towards treatment approaches that avoid bone grafting including shorter and narrower implants, angled implants and/or fewer implants for prosthetic support. This presentation will look at various bone augmentation techniques, methods to minimize the morbidity of bone grafting and guide clinicians on implant rehabilitation with grafting versus non-grafting approaches.
A Defined Algorithm for Regenerative Success Part 2
These presentations will focus open the above concepts but prioritize the diagnostic phase and surgical common denominators required for a successful regenerative outcome. Flap design, space maintenance, bone and membrane selections and tension free closure provides the template for all the new age materials and technologies to be successful in clinical practice.
Crowns and Bridges