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Bone Spreading, Bone Condensing
Streckbein, RolandContent: Surgical flap creation and elevation; Use of drill template for exact determination of implant position; Implant site creation; Site preparation / tapping; Bone compaction; Insertion of the implants; Impression-taking; Wound closure; Later implant insertion; Dental lab work; Creating the model with laboratory implants; Shaping the bar frame; Adapting the laser welded frame to the model; Manufacturing the tooth replacement, Fitting the bar into the tooth replacement; Finishing work. -
Live surgery Surgical treatment of bone necrosis
Schultze-Mosgau, StefanOutline: - Surgical wound debridement - Sequestrotomy - Preparation of the soft-tissue bed - Plastic, tension-free, saliva-proof wound closure List of materials Basic surgical tool set: - Surgical blade - Preparation scissors - Pair of tweezers - Suture materials -
Periodontal Preserve Therapy (Examples)
Clotten, StefanContent: - Periodontal maintenance therapy for teeth 34 and 35, including the regeneration of a bone defect using bone replacement material, collagen membrane and sutures. - Curettage for treatment of periodontal pockets. - Treatment of gingival pressure sores caused by tight-fitting orthodontic apparatus. - Incision of buccal attachment to relieve gingival pressure for elimination of gingival recession. -
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Fiberglass frameworks in removable prosthodontics
Bücking, Wolfram -
Covering a Recession with a Soft Tissue Transplant
Heinz, Bernd / Jepsen, SörenObjectives: Use of a soft tissue graft for recession coverage at tooth 23 and for gingival augmentation. Content: 1. Incision around tooth 23, intra-sulcular preparation, mobilization of coronal sliding flap, and pre-flap preparation. 2. Root smoothing, reduction of ground cavity with diamond burs from Perioset system. 3. Preparation and harvesting of connective tissue flap from palate, Emdogain application, and wound closure. 4. Placement of interrupted interdental sutures for fixation of connective tissue flap. -
Aesthetic upper anterior implant placement case
Dr. Dominik BüchiDr. Dominik Büchi performed a ridge preservation to keep the soft tissue volume. He then placed an implant 8 weeks later with simultaneous GBR. The final emergence profile was created by a fixed provisional crown. -
Esthetic and Restorative Dentistry - Ceramic Materials
Terry, Douglas A. -
REAL-TIME NAVIGATION: THE BEGINNING OF A NEW ERA IN GUIDED IMPLANT SURGERY
Objectives: To demonstrate that dynamic guided surgery is as predictable as conventional surgery. Methods: Partially edentulous patients requiring a fixed rehabilitation were selected for this pilot study. No specific contraindications were established, and smokers were not excluded. An impression was taken pre-operatively using an irreversible hydrocolloid (Cavex CA37®) to fabricate a diagnostic cast for moulding the surgical stent (NaviStent®). Afterwards, a standard cone-beam CT (CBCT) scan was made with the NaviStent® in place using a Planmeca Promax 3-D Max®. Images were converted into DICOM files and transformed into a 3-D virtual model using the Navident® software. The potential implant locations were planned in a prosthesis-driven way. For preparing the osteotomy, the drilling axis of the handpiece and the twist drills were calibrated. The osteotomies were prepared at low speed using a high level of cooling. The navigation software guided the drilling procedure in real time. Before installing implants, an extra calibration procedure was performed for tracking the implant. The aim of this pilot study was to determine the clinical outcome up to 12 months post-operatively for implants installed using the Navident® guided surgery system. Results: Partially edentulous men (n = 6) and women (n = 7) were included in this pilot study (mean age 52.15 years; range 20–75). Out of these 13 patients, two were current smokers of more than 10 cigarettes per day. Twenty implants were inserted. No mechanical or biological complications occurred during the surgical procedure, and no major complaints were reported, such as hemorrhage, sinus pathology or severe post-operative pain. No implants were lost up to 1 year after insertion, resulting in 100% implant survival. Conclusions: Based on the results of this pilot study, real-time navigation is a promising technique. However, there is not yet enough evidence to show that the method is as safe and predictable as conventional implant surgery. -
Soft Tissue Management in the Aesthetic Zone
Daniel ThomaExpert presenter PD Dr. Daniel Thoma is a Head of Academic Unit at the Clinic for Fixed and Removable Prosthodontics and Dental Material Sciences, University of Zurich, Switzerland. Long-term successful outcomes with implant therapy are based on a number of parameters. Among these, the critical assessment of the peri-implant soft tissues and subsequent therapeutical interventions are considered key factors. -
Short and narrow implants, how far can we go?
Christoph Hämmerle, José NartIn this webinar moderated by Prof Ronald Jung and Dr. Adrián Guerrero the expert presenters Prof. Christoph Hämmerle and Dr. José Nart discuss about the importance and benefits of using short and narrow implants. -
Implantation with Simultaneous Augmentation
Grunder, UeliProcedure: - Case evaluation - Incision technique - Implant placement - Membrane adjustment and fixation - Introduction of replacement material - Flap mobilization - Suture technique Contents: Implantation was desired for replacement of a missing upper canine tooth and the adjacent lateral incisor tooth. The initial case evaluation revealed a relatively narrow gap between these two teeth in addition to extensive hard and soft-tissue defects. We selected an incision technique that made it possible to do the augmentation work yet subsequently achieve a tension-free flap closure. Since the bony defect was large while the available space was limited, we had to go for the best possible compromise in regard to implant insertion. After the implants had been inserted, augmentation was carried out using a non-absorbable, titanium-reinforced membrane, bone replacement material, and an absorbable membrane. Extreme flap mobilization was needed to achieve flap closure. An optimal suture technique was used to complete the surgery. -
Cell-to-Cell Communication - Inflammatory Reactions
Stadlinger, Bernd / Terheyden, HendrikVisualizing the invisible while experiencing a fascination with science is the great challenge that Cell-to-Cell Communication, representing an all-new genre, has set out to meet. A spectacularly sophisticated computer animation in HD quality depicts the highly complex processes of intercellular interaction during an inflammatory periodontal reaction complete with the messenger molecules implicated. The various cell types constitute the main cast of the film, using a finely tuned communication process in their quest to destroy the bacterial invaders, with messenger molecules as supporting cast. A stunning didactic and dramatic experience! Outline: - Biofilm - Gingivitis and the Innate Immune Defense - Periodontitis and the Adaptive Immune Defense - Cleaning and Regeneration
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Abdeckung einer Rezession mittels Bindegewebstransplantat
Heinz, Bernd / Jepsen, SörenZielsetzung: Rezessionsdeckung an Zahn 23 und Verstärkung der Gingiva durch ein Bindegewebstransplantat. Inhalt: 1. Schnittführung in regio 23, intrasulkuläre Präparation, Mobilisation der Koronalverschiebelappen, Präparation eines Vorflap. 2. Wurzelglättung, Reduktion der Grundkavität mit Diamanten aus dem Perioset-System. 3. Präparation und Entnahme des Bindegwebstransplantats aus dem Palatinum, Applikation von Emdogain und Wundverschluss. 4. Fixierung und Vernähen des Bindegewebstransplantats durch interdentale Knopfnähte. -
Prosthetic Planning and Prosthetically Guided Minimally Invasive Implantation
Rammelsberg, Peter / Hassel, AlexanderContents: - Considerations for prosthetic treatment planning (PowerPoint) - Production of the drill guide according to prosthetic specifications (PowerPoint) - Surgical procedure (film) - Flapless surgery - Access preparation - Pilot drilling using the drill guide - Preparation of the implant site - Internal sinus lift - Implantation Materials Checklist: Pilot drill; Alignment pin, depth gauge Straight osteotome for bone condensation (Ø 3.5 mm); Larger drills to enlarge the osteotmy; Round burs; Osteotome, angled, for sinus lift (Ø 4.2 mm); Ratchet, adaptor for ratchet (short); Holding key for transmission, SCS screwdriver (short); STRAUMANN Standard Plus RN implant (Ø 4.1 mm, L: 12 mm) and healing abutment (2 mm); STRAUMANN Standard Plus WN implant (Ø 4.8 mm, length 12 mm) and healing abutment (3 mm); Scalpel blade (15c) and scalpel blade holder (Martin); Two dental mirrors and dental forceps; Surgical forceps; Anatomical forceps; Probe; Periodontal probe; Sharp spoon; Sterile compresses (Hu Friedy); Isotonic sodium chloride solution, 0.9% (Braun).
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COMPARISON OF DIFFERENT BONE SUBSTITUTES BASED ON A LITERATURE REVIEW
Objectives: Many procedures require the use of bone grafts to replace or recover the volume of bone that has been resorbed. Many configurations of dental implants exist, along with bone autografts, bone allograft, alloplastic bone substitutes and bone xenograft, to recreate physiological occlusion, and aesthetic and masticatory function. We aimed to investigate whether autogenous bone is still the gold standard for treating patients. Methods: We performed an electronic literature search of the PubMed[tm] database using search terms “substitute bone materials”, “bone grafts”, “bone autografts”, “alloplastic bone”, “bone allograft” and “bone xenograft”. We identified between 100 and 200 research papers and reviews, from which the abstract was read to select 70 (excluding all those that did were not dentistry-related). Qualitative assessment was performed on publications that clearly met the following inclusion criteria: recent papers, published in the last 8 years, related to the terms listed above. Results: The individual healing profile of a given bone substitute with respect to osteogenic potential and substitution rate must be considered when selecting adjunctive grafting materials for bone regeneration procedures. Bone replacement materials could be classified into xenografts, or. substances or other natural hydroxyapatite and biocompatible substances. Allograft materials belong to the same species, but do not contain living cells. Alloplastic materials are synthetic materials used instead of real bone. Autograft bone can be obtained from various intraoral and extraoral sites, such as iliac crest, cranial vault, and tibia of the patient. Different case reports reported the use of different bone substitutes. In one study, standardised mandibular defects in mini-pigs were filled with nanocrystalline hydroxyapatite (HA-SiO), deproteinised bovine bone mineral (DBBM), biphasic calcium phosphate (BCP) with a 60/40% HA/β-TCP (tricalcium phosphate) (BCP 60/40) ratio, or particulate autogenous bone for histological and histomorphometric analysis. At 2 and 8 weeks, the percentages of fillers in the test groups were DBBM 35.65%, HA-SiO 34.47%, and BCP 60/40 23.64%. It was significantly higher than autogenous bone and was substituted more quickly, producing more new bone (17.1% ). These findings suggest that the osteogenic potential of HA-SiO and BCP is inferior to that of autogenous bone. However, if a low substitution rate is desired to stabilise volume, as in the aesthetic zone, then HA-SiO and DBBM may be preferable. Conclusion: Despite the increasing number of available bone substitutes in the last years, bone autografts remain the gold standard. They are osteogenic, osteoinductive and osteoconductive, and the newer ones have a regulatory action. -
EVALUATION OF OSTEOGENIC POTENTIAL IN STRO-1-POSITIVE HUMAN TOOTH-GERM DERIVED MESENCHYMAL STEM CELLS (hTGSCs)
Objectives: The objective of this study was compare the osteogenic differentiation potential and mineralisation of STRO-1-positive selected mesenchymal stem cells derived from human tooth germ (hTGSCs) with a heterogeneous hTGSC population, and to determine whether a minor cell subpopulation is more committed to osteogenic differentiation. Methods: Human TGSCs were isolated from dental follicle and apical papilla tissues of impacted tooth germs of third molars from volunteers aged 13–20 years. Cells were expanded and characterised by flow cytometric analysis with CD34, CD45, CD105, CD90, CD44, CD14 and CD117 antigens. Following surface-antigen profiling, STRO-1 antigen, defining a mesenchymal stem cell subpopulation, was used for cell selection with flourescence-activated cell sorting (FACS). Three cell populations (STRO-1 positive, STRO-1 negative, and unsorted) were tested for their ability to differentiate towards osteoblast-like phenotype in osteogenic medium and standard culture medium. Cultures were analysed for cell proliferation (MTS assay and protein assay) and alkaline phosphotase (ALP) activity on days 1, 4, 7, 14 and 21; calcium deposition and gene expression of runx2, osteocalcin and osteonectin with real-time polymerase chain reaction (RT-PCR) on days 7, 14 and 21. Mineralisation and cell phenotype were further screened with Von Kossa staining and confocal microscopy on days 7, 14 and 21. Statistical analysis was made with SPSS Statistics 22[tm]. Kruskal Wallis and Mann–Whitney U tests were applied and a p value of Results: Flow cytometry analysis of passage 3 (p3) hTGSCs showed positivity for CD44, CD90 and CD105, and negativity for CD14, CD45, CD34 and CD117. A total of 11% of p3 hTGSCs were sorted as STRO-1-positive and 24% as STRO-1-negative. In STRO-1-positive cells, osteogenic groups showed significantly higher calcium content than the controls on days 7, 14 and 21. In STRO-1-negative and unsorted cells, the osteogenic groups showed significantly higher calcium content on days 14 and 21 compared to controls. Calcium deposition was not significantly different in osteogenic cell groups in on days 7, 14 and 21. Calcium content seemed to increase in all cell groups from day 7 to day 21. In osteogenic groups, ALP activity of unsorted cells was significantly higher than that of STRO-1-positive and STRO-1-negative groups on days 7, 14 and 21, suggesting a faster rate of osteogenic differentiation in this group, whereas there was no statistical difference between groups on day 21. Activity of ALP was lowest in all groups on day 7 and increased on days 14 and 21. Osteocalcin was expressed in all groups, with no significant difference between them. Osteonectin was highly and significantly expressed in all osteogenic groups on day 7, which is consistent with the findings for ALP and calcium deposition, suggesting that mineralisation was initiated on day 7. Runx2 was downregulated from day 7 to 14. There were no significant differences in the expression of late and early markers of mineralisation in all osteogenic cell groups. Conclusion: Human TGSCs are a novel stem cell source without ethical issues that can be obtained from routine dental treatments. These results suggest they have a high capacityfor osteogenic differentiation. Selecting groups based on STRO-1 negativity or positivity offers no advantages over unsorted cells, but other osteogenic markers might be allow selection of more sensitive osteogenic subpopulations from hTGSCs. -
SINUS FLOOR AUGMENTATION AFTER ENDOSCOPIC SINUS SURGERY (ESS) FOR THE TREATMENT OF CHRONIC MAXILLARY SINUSITIS—A CASE SERIES
Objectives: The aim of this study was to evaluate maxillary sinus health in patients who underwent sinus floor augmentation for implant placement after endoscopic sinus surgery (ESS) for the treatment of chronic maxillary sinusitis. Methods: In this series, ESS was performed on four patients with chronic maxillary sinusitis before sinus floor augmentation. A two-stage sinus floor augmentation was performed using deproteinised bovine bone graft and non-cross-linked collagen membrane, 3 months later. Root-form dental implants were placed after 5 months of healing. Cone-beam CT (CBCT) images were taken before ESS, before and after sinus augmentation, and 3 years postoperatively. Sinus membrane thickness and ostium patency were evaluated during the observation period. Marginal bone loss for each dental implant was analysed by CBCT scanning and implant success was evaluated. All patients were rehabilitated with implant-supported fixed restorations. Results: All dental implants were placed in the grafted sinuses and the success rate was 100%. Sinusitis did not recur during the 3-year follow-up period. The ostiomeatal complex was not stenosed after ESS throughout the observation period, however the sinus membranes of two patients were thick and almost filled the sinus cavity before sinus floor augmentation. Corticosteroids were administered for 3 weeks to decrease the membrane thickness. Additive CBCT images confirmed membrane changes in these patients. On completion of medical therapy, sinus floor augmentations could be performed. Conclusion: ESS therapy before sinus augmentation is a reliable and predictable technique for achieving and maintaining the normal physiological environment of the maxillary sinus, after which dental implants can be safely placed in augmented sinus floor sites. CBCT scanning at regular intervals is recommended after ESS treatment for monitoring sinus membrane inflammation and ostium patency.