This presentation is focused in the importance of soft tissue grafting techniques around teeth and implants and how to do it in a predictable, modern and a minimally invasive way. We present many different techniques illustrated with clinical cases.
Autogenous tissue is still a gold standard for augmentation procedures. There are great sources of patient's own tissue, often in adjacent areas, that can be utilized. The soft tissue can be moved, flipped, rolled, pediculated - in order to take from the rich sites and give to the poor ones. A novel approach for the wound closure after ridge augmentation and/or implant placement in lateral maxilla will be presented.
Managing aesthetic zone with dental implants is one of the most challenging and demanding treatments in dentistry due to biological limitations. During the lecture the author will systematize how to face each different clinical situation, utilizing different autogenous tissues combined with a micro surgical approach, in order to have the best healing patterns and scar-less surgery.
In 1992, Tarnow's study on the effect of the distance from the contact point to the crestal bone on the presence of interproximal dental papilla gave us a new and ground breaking insight into the management of pink aesthetics. Later Team Atlanta furthered that study, analyzing the different measures between teeth, implants and pontics, giving us an even deeper understanding of how bone height influences in papilla growth. In my understanding, this study was one of the most important in the history of dentistry due to its true crossover between dental surgery and the prosthodontic field, combining aesthetics, oral rehabilitation and oral surgery in treatment planning. Never has interdisciplinary dentistry been more valued. This lecture will go over past and present techniques that can be performed to achieve an optimal aesthetic outcome in the managing of soft tissue.
The main factor for soft and hard tissue healing is the speed and quality of new vascularization. This lecture will present all the positive and negative factors who control the angiogenesis, blood supply, and bone metabolism: -Biological factors as vit. D and cholesterol have to be checked before the surgery -The management of the flaps with sutures is one the main factor for the bone and soft tissue maintenance.. -The soft brushing technique is a new technique which increases the flap without periosteal incision nor bleeding. -Careful Implant placement without too much torque, especially in cortical bone or grafted bone at the re-entry.. -The A-PRF liquid and i-PRF are solutions to reduce the mobility of the granules (sticky bone) with an improvement of angiogenesis The use of growth factors is a stimulation of angiogenesis. The prevention of the negative factors will allow us to achieve the long-term stability.
The expanding role of biologics and minimally invasive surgical protocols is highlighted in this dynamic presentation. The comparison of teeth to implant sites as well as autologous vs. allograft grafts will be discussed. Esthetic Risk Assessment will be introduced and it's use as a a prognostic indicator.
An injury to the tissue instantly stimulates the healing process. To heal properly, we need three elements: scaffolds, cells and growth factors. If one of these three elements are missing there will be no tissue regeneration. Plasma rich in growth factors (Endoret® (PRGF®) technology, enables clinicians to apply autologous growth factors and a fibrin scaffold in a simple, safe and effective method. The Endoret® (PRGF®) stimulates the tissue-building cells to achieve regeneration. An optimal alveolar regeneration is characterized by fast haemostasis, adequate inflammation, stem cell mobilization and differentiation, rapid soft tissue closure of the socket and correct tissue regeneration. The adequate management of the extraction socket will determine the final outcome of implant-supported restorations.
When considering esthetic dental implant therapy, preservation or further enhancement of the available tissue support may provide an improved esthetic outcome with less associated morbidity and treatment duration. Nevertheless, reconstruction of compromised sites due to lost hard and soft tissue volume is often inevitable in the anterior zone. Substantial ridge deficiencies demand more complex grafting procedures with an increased level of invasiveness and subsequent tissue alterations.
Current trends in implant therapy advocate clinical techniques thereby allowing treatment efficiency consisting of condensed clinical procedures, fewer patient appointments, and shortened overall treatment time. Even though there is overwhelming literature to support positive outcomes in regards to implant survival through immediate implant therapy and tooth replacement strategies, esthetics questions still loom, specifically how to handle multiple tooth sites in the esthetic zone. This presentation will address treatment planning strategies with multiple tooth sites incorporating teeth, immediate implants with tooth replacement, and pontics in the esthetic zone. Innovations in implant macro design, to achieve more consistent screw-retained definitive restorations, and devices / strategies in provisional restoration fabrication to save time will be presented.
Bone Augmentation & Vascular Enhancement Concepts: It's Time to Make it Simple!
The purpose of this presentation is to make the participant think biology first and not mechanic first. A biological thinking will dramatically simplify vertical and/or horizontal bone augmentation procedures. We will also be introducing a new approach for the simplification of soft tissue handling: the Soft Brushing Technique, that will allow the coronal advancement of both buccal and lingual flaps, but also the palatal flap without the need for periosteal releasing incisions.
mIVAN* Technique is a nice abbreviation for complicated terminus: " Modified Interpositional Augmentation Neogenesis". It is basically simultaneous hard and soft tissue augmentation utilizing pediculated connective tissue graft. It works for Socket type 2 and 3 and ridges with horizontal atrophy. Combined with Partial Extraction Therapy, mIVAN technique is a nice treatment choice for the teeth with recessions.
The Bernotti V-Y Flap, it's a coronally advanced flap technique with a "V-Y'' flap design, which consist in a microsurgery technique with or without connective tissue graft, that will improve mucosal biotype and keratinized band in a predictable way for isolated mucosal recession, dehiscence and translucent tissue, at teeth or implants sites.
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.
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.
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). This lecture teaches step-by-step how to be successful with implant prosthetics from single tooth, partially edentulous to full arch reconstruction.
Soft tissue improvement and prosthetic management in the aesthetic zone.
The restorative dentist is facing many challenges along the aesthetic road. One of the hardest steps is to harmonize the gingival appearance with the white smile. The soft tissue improvement around teeth and implants is really important for the long term outcome. That is why most of today's courses and lectures are focusing on this topic. The presenter will describe some clinical situations where the muco-gingival surgery payed a big role in the final aesthetic result.
The Esthetic Reconstructive TRIAD: "GBR, GTR and Tissue Molding"
Implant dentistry in the esthetic zone is highly challenging. In recent years there are several studies, well defined approaches available on how to achieve pleasing outcomes. We must understand the biology of extraction sites and different treatment options for preserving or even reconstructing bony structures for predictable implant placement. This clinical and evidence based presentation will emphasize the importance of proper 3-dimensional implant placement, show different bone preservation techniques i.e P.E.T. (Partial Extraction Therapy) and how soft tissue grafting can effect the final end result. However we must admit that not only surgery but prosthetic skills have a major influence on our work. Implant placement must be determined with the prosthetic plan in mind! On the other hand abutment design, platform shifting concept as tissue molding "tools" and screw retained solutions will be high-lighted with lots of case presentations.
Dental implant esthetics can be challenging, but these challenges are magnified when a patient has had multiple failed implant and bone grafting surgeries. This video demonstrates the treatment of one such case. This is a surgical video demonstrating the VIP-CT (Vascularized Interpositional Connective Tissue) graft. While multiple treatment options exist, this start-to-finish video highlights the patient's initial presentation, the surgical technique, and the final outcome at 2 years.
Every esthetic case is a challenge. As clinicians we need to understand and combine different treatment modalities and materials to achieve outstanding esthetic and functional results. This clinical case will demonstrate the importance of the little details, and how they influence the final result. We'll go step by step thought the analyze, planning surgical and prosthetic procedures with focus on the key points that I find to be crucial.
One of the biggest challenges that we dentists have are those cases that require a multidisciplinary approach which traditionally were managed using invasive and long term treatments. Nowadays, and depending on the case, the contemporary dentist can offer minimally invasive treatments which allow us to modify the shape of the hard and soft tissues. The combination of surgical lip repositioning with periodontal plastic surgery yields highly effective results in the treatment of gummy smiles. During patient examination it is important to establish the etiology responsible for the excessive gingival display. The combined technique can be considered as an alternative option to more invasive procedures. The prognosis is acceptable and the patient realizes that the esthetic problem has been minimized.
The "Advanced" PRF (A-PRF) and "Injectable" PRF (I-PRF) protocols were designed with this new concept. Indications are numerous in all medical fields where we need regeneration: bone, cartilage, skin etc... However, the use of growth factors is not a guarantee of long term stability, as they are active only at the beginning of the process. Numerous rules of tissue engineering have to be applied to maintain the regenerated bone through an adequate blood supply: this lecture is an enlightenment on the biological and mechanical conditions for long term stability of the bone: "grafted bone" or "bone around implants".
The rotated palatal pedicle flap was first described in 1999 and has become an essential tool in our box of tricks for implant and soft tissue and bone augmentation surgery. It is a vascularized pedicle graft that helps us achieve excellent soft tissue bulk, increased amounts of attached gingiva and awesome soft tissue contours. It is also important in double flap closure for passive flap closure and many many more treatment options. This webinar will detail the exact techniques to allow you to carry out this excellent grafting procedure as well as many tips and tricks for simplifying and demystifying this technique.
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.
Although new restorative materials have improved predictability and outcomes, hard and soft tissue management plays a fundamental role when working in aesthetic areas. To achieve ideal results, preservation of the natural hard and soft tissue architecture is the primary clinical objective. This new proposed AGE protocol illustrates the importance of hard and soft tissue management when working in esthetic and highly compromised areas. This protocol and schematic approach was developed to help the surgical practitioner visualize and divide the problem into a predictable step-by-step workflow.
In dental esthetics the regeneration of a compromised papilla , remains the most complex aspect of any reconstructive endeavor. The original 5mm Rule was found to exist only for a papilla bordered by 2 teeth and was expanded into a classification of 6 Types dependent on alternative adjacent support.e. implants or pontics.
In this short lecture a harvesting of free and pediculated connective tissue graft from the palate in one incision technique is presented. One incision technique as described by Huerzeler and Allen is a minimal invasive technique that results in wound healing by primary intention and therefore causes minimal postoperative discomfort. Through pictures and animations this technique is shown step by step. This presentation also deals with a wound healing and possible complications.
Dr. Maurice Salama describes briefly the first ever Dentalxp Clinical Masters Week Program where 6 courses were performed in 7 days at the Dentalxp Teaching Center in Atlanta, GA to help provide global members the skills, tools and techniques to perform better and more predictable dentistry to their patients.
This video post outlines the sequential treatment of a reconstruction requiring posterior crown lengthening to optimize the esthetic periodontal-restorative interface.
The demand for creating esthetic restorations has become a consistent theme in dental literature and in daily clinical practice. Surgical concepts that are emphasized as important to the esthetic outcome include resective procedures to change bone volume and levels, as well as additive procedures such as tissue grafting to alter the biotype and volume around teeth and implants. Predominately with implant treatment, today's surgical and restorative strategies play an important role in post-extractive tissue guidance, mandating precise surgical techniques, and emphasizing cooperation and coordination between the surgical and restorative team members. This webinar will explore some of the complications of treatment, underscoring the responsibility of the surgical and restorative teams to critically assess emerging treatment concepts, materials and techniques.
What Tissue Changes Can We Expect with Anterior Implant Therapy?
Minimizing soft tissue changes following anterior implant therapy is one of the holy grails in implant dentistry. Gingival recession will not only impact the patient's esthetics, the difficulties in correcting such problem create further challenges to the clinicians. This presentation will focus on how much soft tissue changes can be expected following implant in the esthetic zone. Discussion will be made as to the etiology of gingival recession and what we can do to prevent it from happening.
In this surgical video, a modified roll technique is utilized for labial augmentation of an anterior implant at the time of uncovering. Incision design, de-epithelialization, tunnel flap on labial and suturing is described. Post-op results are included.
Soft tissue deficiencies around implants impact esthetics and often lead to escalating problems. Early recognition and intervention with minimally invasive soft tissue surgery reduces the risk of undesirable sequellae associated with conventional surgical approaches around implants. The application of a minimally invasive soft tissue grafting method will be shown for treatment of soft tissue problems around implants and the indications for use of this technique will be outlined.
This case demonstrates some digital tools that our dental team uses to provide as much as information as possible to the lab technician in order to achieve an acceptable result.
The Immediate Dentoalveolar Restoration technique has been used for over 7 years, allowing the reconstruction of tissue losses in the same surgical session of dental extraction, implant placement and provisional crown installation, minimizing the treatment time and morbidity of the procedures.
In this very technical and scientific presentation, Dr. Joseph Choukroun, a physician and researcher from France, describes the benefits of Platelet Rich Fibrin (PRF) in wound healing. He emphasizes the effect of PRF on the two essential factors of wound healing which are new vessels and cells in surgical sites like extraction sockets, sinus augmentation and more.
The "Semilunar" Graft Technique in Periodontal Plastic Surgery: Revision and Retreatment of Anterior Recession Defects.
In this lecture and video based Case Report, a patient with multiple recession defects in the Maxillary Anterior Region who was first treated with Tunnel Approach and ACDM grafts reveals breakdown of the result at 3 years in the area of the Maxillary Left Central Incisor with further recession and erosion of the root. The Semi-Lunar Approach is highlighted as a minimally invasive microsurgical approach to this situation. Incision design, instrumentation and suturing are highlighted. Post-op results are displayed.
The "Modified Tunnel" technique is a method of esthetic connective tissue grafting that protects the interdental papillae. First published in 1999, this lateral tunnel approach uses vertical incisions on both sides of the treatment area. These vertical incisions facilitate placement and positioning of the graft over the root surfaces without the need to disturb the interdental papillae. This technique is very useful in esthetic areas and those that involve several teeth. An acellular dermal connective tissue allograft is an excellent choice of graft material to use with this technique.
The video presented will show clinical long term evidence of its importance along with different techniques to achieve long term results.
In order to reconstruct the lost periodontal tissues different kinds of graft materials have been used, including auto-grafts, allografts and xenografts and also Polypeptide growth factors in combination with guided tissue regeneration (GTR).In this presentation Dr Omid Moghaddas will present the concepts of using connective tissue and PRGF in treatment of intrabony defects and also review the literature on this topic.
oft tissue grafting is rapidly playing a larger role in restorative, esthetic, and reconstructive dentistry. While conventional grafting techniques have several limitations, newer grafting materials and techniques make it easier for patients to say "yes" to the treatment they truly need and desire. In this webinar, Dr. Wong will perform a step-by-step demonstration using Perioderm to correct multiple gingival recession defects. Soft tissue allografts are quickly becoming a "game changer" in dentistry, making optimum dentistry more than an ideal... it's a reality.
Dr. Alvarez show us an easy and simple way by using the 3inOne concept, to face the definitive impression and cementation process without loosing all the good results during the extraction, implant placement and provisionalisations.
Harvesting, placement and stabilization of autogenous connective tissue grafts.
This video presentation displays a step by step review of the clinical surgical process from incision, to bed prep, all the way through to final suturing and stabilization.
Dr. Michael Gelb elaborates on the nuances of treating sleep disorders in the dental practice. Utilizing the EndoPat-2000 to measure the health or dysfunction of the endothelium, Dr. Gelb ascertains an important risk factor in cardiovascular disease.
Dr. Rogerio Zambonato outlines new perspectives on dento-facial esthetic paradigms that aim at bringing into equilibrium function, health and comfort along with the alignment of dento-facial parameters of beauty.
Dr. Thomas Han outlines the clinical decision making rational for choosing a specific surgical technique for diverse papilla regenerative challenges in the anterior region.
Dr. Mehraban describes advanced but simplified techniques and technologies available to enhance root coverage and zone of attached gingiva.
Dr. Michael Sonick demonstrates the utilization of AlloDerm Regenerative Tissue Matrix to thicken and enhance the zone of keratinized gingiva in the lower anterior region.
Dr. Ernesto Lee outlines the biologic, surgical and esthetic parameters that must be adhered to successfully achieve esthetic crown lengthening.
Dr. Miguel Stanley discusses the reconstruction of large post-extraction defects within the esthetic zone involving both bone and soft tissue deficiencies.
Dr. Paul Weigl discusses the very important relationship that exists between Abutment Connection, micro-movement and Soft tissue Wellness in implant therapy.
Dr. Silverstein discusses the steps to successful esthetic crown lengthening.
The use of a natural plant extract to enhance healing.
Case presentations & management of failure at the implant site.
A surgcal slideshow with Dr. Maurice Salama.