Regenerative Procedures for Implant Site Optimization: Establishing the Perio-Implant Interface
Emerging concepts in implant dentistry have allowed bone preservation to become a reality, thus reducing the need for extensive augmentation procedures. Nevertheless, clinicians are still confronted with atrophic defects that require complex regenerative strategies for dental implant rehabilitation. This presentation will focus on some of the essential elements for a predictable regenerative protocol in implant site development.
A discussion will include the use of defect topography as a guide in choosing a suitable augmentation technique. Several considerations that allow for tension free wound closure will be reviewed. Furthermore, an evidence based approach in graft material selection will be presented.
Clinical cases will then be reviewed, to demonstrate how to integrate the presented principles into daily clinical practice.
A Complete 3D Strategy to Esthetic Cross Arch Restorations: Guide Surgery & Soft Tissue Interface Management with CAD-CAM Restorations
I will highlight the benefits achievable through the use of guided planning, guided laboratory procedures and guided surgeries, while maintaining the fundamental principles of osseointegration. My ten years of scientifically proven experience and clinical follow-up in guided surgery and CAD/CAM biomimetic restorations will be shared with the audience to support clinical protocols as well as practical tips and tricks with case studies demonstrating each clinical scenario. New surgical and prosthetic improvements and novel proof-of-concept techniques to enhance the natural soft tissue integration will be presented. Viewers will also broaden their knowledge of hard and soft tissue surgical management through the guided surgery, discovering the latest implant designs and prosthetic interfaces designed to achieve an ideal soft tissue seal and bone level over time.
The Dual Zone Approach to Tooth Replacement in the Esthetic Zone
Improvements in implant designs have helped advance successful immediate anterior implant placement into fresh extraction sockets. Clinical techniques described in this presentation will enable practitioners to achieve predictable esthetic success using a method that limits the amount of buccal contour change of the extraction site ridge and potentially enhances the thickness of the peri-implant soft tissues coronal to the implant-abutment interface. This approach involves atraumatic tooth removal without flap elevation, and placing a bone graft into the residual gap around an immediate fresh-socket anterior implant with a screw-retained provisional restoration acting as a prosthetic socket seal device. Long term follow up and evidence from scientific literature to support this concept will be described.
Plastic-Esthetic Periodontal and Implant Surgery: A Microsurgical Approach - Part 1
This 2 part presentation is a comprehensive overview of the principles, indications, and clinical techniques of plastic-esthetic periodontal and implant microsurgery, focusing especially on minimal soft tissue trauma and maximally perfect wound closure. Microsurgery provides clinically relevant advantages over conventional macro-surgical concepts for regenerative and plastic-esthetic periodontal surgery, especially in the all-important esthetic zone. The microsurgical principles and procedures presented will described using high resolution multimedia.
Human Palatal and Tuberosity Mucosa as Donor Sites for Ridge Augmentation
Since different clinical outcomes of periodontal bilaminar surgeries using the
palate or the maxillary tuberosity as connective tissue (CT) donor sites have
been observed, tissues grafted with CT from the palate or the tuberosity 1
year after surgical procedures for ridge augmentation were compared with
nongrafted tissues by using morphologic and molecular methods. Collagen
content and matrix metalloproteinases 1 and 2 expression were similar in
tissues and cultured fibroblasts from the palate and tuberosity, although with
interindividual differences. In contrast, differences in collagen cross-linking
and maturation in the tuberosity fibroblasts were observed, suggesting a
possible role in determining hyperplastic responses in some patients.
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.
Vertical Ridge Augmentation and Soft Tissue Reconstruction of the Anterior Atrophic Maxillae: A Case Series
Severe vertical ridge deficiency in the anterior maxilla represents one of the most challenging clinical scenarios in the bone regeneration arena. As such, a combination of vertical bone augmentation using various biomaterials and soft tissue manipulation is needed to obtain successful outcomes. The present case series described a novel approach to overcome vertical deficiencies in the anterior atrophied maxillae by using a mixture of autologous and anorganic bovine bone. Soft tissue manipulation including, but not limited to, free soft tissue graft was used to overcome the drawbacks of vertical bone augmentation (eg, loss of vestibular depth and keratinized mucosa). By combining soft and hard tissue grafts, optimum esthetic and long-term implant prosthesis stability can be achieved and sustained.
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 Provisionalization: A Critical Aspect in Tissue Care and Esthetics-Part 2
The management of the hopeless tooth or an edentulous span in the Estheitc Zone is amongst the most clinically demanding procedures in tooth replacement do to the demands of tissue preservation and patient management during the healing phase. As important as the implant surgical process in these areas is the role of the immediate provisional restoration. Tissue support, emergence profile and The provisional restoration phase of implant therapy has become one of the most critical steps in immediate or delayed placement for several reasons including the following...
Connective Tissue Graft Harvesting Techniques - Part 1
In this presentation, Prof. Giovanni Zucchelli develops a critical comparison between the different CTG harvesting techniques, and shows the correct management of this kind of graft as well as its use in coronally advanced flap surgical technique for the treatment of gingival recessions.
Crowns and Bridges