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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. -
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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. -
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. -
Esthetic and Restorative Dentistry - Ceramic Materials
Terry, Douglas A. -
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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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 -
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. -
Fiberglass frameworks in removable prosthodontics
Bücking, Wolfram -
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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 -
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. -
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. -
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.
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Kammaufbau im PA-geschädigten Gebiss
Windisch, PéterGliederung: - Parodontale Regeneration und Alveolarkamm-Augmentation mit Bindegewebstransplantat - Implantatsetzung und Augmentation - Implantatfreilegung und Prothetik Materialliste: Emdogain, Bio-Oss, BioGide, Blockfixierungs-Schraube zum autologen Knochenzylinder, 4/0, 5/0 Nähte, Resolut Membrane, Titan-Pins, autologe Knochenspäne, 2 Replace Groovy Tapered 4, 3X13 mm Implantate -
Recession coverage with connective tissue using the envelope technique at site 13
Ratka-Krüger, PetraList of materials: Periodontometer, handle #6 (Hu-Friedy); Universal probe, handle #6 (Hu-Friedy); Mirror handle #6 (Hu-Friedy); Transfer handle, round; Respiratory, Hirschfeld; Surgical curettes, Prichard; Universal curettes, Younger-Good, handle #6; Universal curette, Indiana University, handle #6; Universal curette, Langer After-Five, handle #6; Tweezers, Gerald; Tweezers, fine; Spatula, fine; Tissue cutter, Super-Cut; Thread cutter, Godman-Fox; Needle holder, Lichtenberg; Needle holder, Castroviejo; Hemostat; Scalpel blades; Tunneling instruments; Gingivectomy meter, Orban, handle #6; Blade holder, Universal 360°; Suture material, polypropylene C6; Suture material, polypropylene C17. -
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.
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BEHAVIOR AND DIFFERENTIATION OF OSTEOBLASTS ON A TITANIUM SURFACE WITH DIFFERENT MICROMETRE-SCALE ROUGHNESS
Objectives: Titanium implants with mean arithmetic roughnesses (Ra) of 1–2µm are associated with improved osseointegration and clinical outcome. However, the procedures used for producing a roughened surface usually change other parameters, such as spatial characteristic skewness and kurtosis, and sub-micrometre and nanoscale roughness. Studies are needed to explore the effect of different surface characteristics on osseointegration and clarify the relationship between Ra and osseointegration. This study aimed to investigate how titanium surfaces with different micrometer-scale roughnesses influenced proliferation, migration and differentiation of osteoblasts in vitro. Methods: Titanium replicas with surface roughnesses (Ra) of approximately 0µm, 1µm, 2µm and 4µm were produced. The surfaces have no significant sub-micrometre or nanoscale roughness and have similar skewness and kurtosis. MG-63 osteoblasts were cultured on the surfaces for up to 5 days and their behavior was investigated using time-lapse microscopy. The speed of cell migration was quantified using specialised software. Gene and protein expression were determined for alkaline phosphatase (ALP), osteocalcin and vascular-endothelial growth factor (VEGF). Results: Cell migration speeds were significantly lower on surfaces with Ra of about 4µm compared to those with lower Ra levels, with no differences between those with Ra in the range 0–2µm. Cell proliferation decreased gradually with increasing Ra. Gene expression of ALP, osteocalcin and VEGF was greater for the 1-µm and 2-µm Ra surfaces than the 0-µm and 4-µm surfaces. These findings were similar for protein expression. ALP and osteocalcin content in the conditioned media were significantly higher for cells grown on the 2-µm Ra surface compared to the 0-µm and 4-µm surfaces. The production of VEGF by cells on the 1-µm and 2-µm surfaces was significantly higher than that of the 0-µm surface. Cells grown on the 2-µm surface produced significantly more VEGF than those on the 4-µm surface. Conclusion: Surfaces with lower and higher roughnesses in this study seem to be suboptimal for osteoblasts. We suggest that decreased cell migration on surfaces with Ra 4µm might be associated with decreased osteoblast differentiation, probably through inhibition of cell-to-cell contact. -
Ethical Considerations for Performing Research in Animals
Laboratory tests have limited value for assessing the safety and effectiveness of new therapies in people. Tests must also be conducted on animals that resemble humans, both biologically and developmentally. We generally acknowledge that certain animals may be caught and sold, kept in captivity, or eaten, but using animals to meet human needs is as an area of huge controversy. This chapter gives a broad perspective on the ethical basis for animal experiments, drawing from the modern “common sense” view and several longstanding philosophical theories. Moral status is considered, alongside integrity, autonomy and dignity of animals, and their ability to reason, to form memories, and to experience pleasure or pain. Smaller animals, such as mice, rats and rabbits are essential for proving a basic principle or concept. Larger animals, such as goats, pigs, sheep, dogs and monkeys, are used more sparingly, not least because of the costs involved in their care; they are necessary because of their greater similarity to humans and thus are more relevant to advancing clinical practice. However, conflicts of interest tend to be larger with animals that are more similar to humans. Primate and dogs tend to evoke our compassion more strongly than rodents or animals we commonly eat. The authors provoke thought on this subject through examples in which the interests of humans are weighed up with those of animals in studies of cosmetics, childhood leukemia and dental defects. -
Ridge Preservation
The alveolar ridge is the bony tissue that surrounds a fully erupted tooth. Its structure may be compromised after extraction of the tooth, but it can be preserved by use of bone substitutes, dental implants and buccal overbuilding with soft tissue grafts. Ridge preservation techniques must be developed in animals before clinical trials in patients can be conducted, and various processes, such as wound healing, can be explored that are not feasible to study in people. Dogs are most commonly used because of their similar tooth types, root structures and fast remodeling time. Several preclinical studies are described in this chapter – mostly using the dog mandible – that compare different experimental conditions, biomaterials, grafts and implants after extraction of teeth. These provide information on the timing and sequence of extraction and grafting procedures, and timepoints for assessing tissue shrinkage and resorption of alveolar bone. Other studies address osseous resorption of flaps, the lack of a periodontal ligament, buccal overbuilding, alveolar plate resorption and inflammatory reactions. Jaw casts, morphometry, histology and high-resolution imaging are used as valid endpoints relating to the alveolar process and socket walls, and the cellular content and mineralization of tissues. The protocols outlined in this chapter will contribute to the accuracy with which preclinical studies predict responses in people.