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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. -
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. -
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. -
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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 -
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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 -
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. -
Fiberglass frameworks in removable prosthodontics
Bücking, Wolfram -
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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. -
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. -
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Esthetic and Restorative Dentistry - Ceramic Materials
Terry, Douglas A. -
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.
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Treatment of the Edentulous Mandible with an Immediately Loaded Screw-retained Fixed Restoration - The entire case
Yüksel, OrcanProcedure: - Presentation of procedure for immediate implant loading in the edentulous mandible according to the Ledermann concept - Surgical implantation of XIVE® TG implants - Bite registration and impression-taking - Presentation of prosthetic components - Fitting and passive fixation of the mesostructure in the mouth - Integration procedure Contents: This video demonstrates the extraction of teeth in a partially dentate mandible followed by immediate loading of six XIVE® TG implants. Following the Ledermann immediate loading concept, a mesostructure will be used for tension-free primary interlock in this special case. Bridge-like lower full dentures with plastic teeth will then be inserted on this frame and retained with an occlusal screw. Since the dentures can only be removed by the dentist, they are \fixed\ as far as the patient is concerned. This simple and quickly produced yet extremely well-fitting restoration, which requires only minimal time and effort for the implant components, is the subject of this contribution. -
Regenerative Procedures for Optimized Esthetics at Tooth 11
Schlee, MarkusContents: - Exploration - Incision and Flap Mobilization - Palatal Flap Preservation with Interdental Tissue Preservation - Detoxification and Concrement Removal at 11 - Harvesting of Autogenous Bone Chips from the Spina Nasalis - Conditioning of the Root Surface with EDTA-Gel - Application of Emdogain and Filling of the Bone Defect - Wound Closure Synopsis After Finishing the Initial Treatment for Aggressive Periodontitis, Regenerative Treatment of a Tunnel-Shaped Pocket at Tooth 11 was attempted. Rotation and Crowding of the Buccally Inclined Tooth represented a favorable Etiological Factor. The patient did not wish to receive Orthodontic Treatment to eliminate this Causal Factor after Completion of Primary Treatment. Treatment was therefore limited to the Surgical Regeneration Attempt. The Interdental Space was larger than 3 mm and the Bone Pocket was a mostly Three-Walled Structure, so the Chances of Success were considered to be good. Exploration was first performed to identify the Course of the Defect Margins. Exact knowledge of the Bone Anatomy in all three Planes is essential to successful Incision Planning. A Tunnel-Shaped Defect delimited by Bone in the Region of Tooth 11 with good chances of Periodontal Regeneration was found. A major Challenge of this Procedure is the need to keep the Defect completely covered with Soft Tissue throughout the Healing Process. Cortellini's Papilla Preservation Technique was used for this Purpose. After Incision and Flap Mobilization, it became evident that the Defect only had two Walls in the Coronal Region and that Bone was lacking in the Buccal Region. According to the current Data on Periodontal Regeneration, the Attachment Gain achieved using an Enamel Matrix Protein (Emdogain®) alone can be just as good as that achieved using Emdogain and Bone Graft Material combined. Still, we elected to use a Combination Technique in the Present Case because it provides better Papillary Support. The Graft Material consisted of Autogenous Bone Chips from the Spina Nasalis, which can easily be harvested by Means of the Piezo Technique After gentle Detoxification, the Root Surface was treated with Emdogain. The Defect was then filled with Autogenous Bone Chips and closed by Microsurgical Suture Techniques. Six months after Surgery, Partial Regeneration of the Papilla can be seen. -
Restoration of Anterior Teeth with Porcelain laminate Veneers
Bastek, Siegfried / Fiechter, PaulContent: Preparation of teeth; Composite build-up for larger lesions; Smoothing of preparation surfaces; Placement of retraction cords; Impression-taking with A-silicone; Placement of temporary; Preparation of model; Preparation of laminate veneers; Final adhesive bonding of laminate veneers.
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THE EFFECT OF BIOENGINEERED MUSSEL GLUE AS A bone morphogenetic protein (BMP)-2 CARRIER FOR BONE REGENERATION
Objectives: Recombinant human (rh)BMP-2 is known to induce bone formation by stimulating osteoblast differentiation. Mussel adhesive proteins (MAPs) secreted from mussels have been suggested as suitable adhesives for tissue engineering and medicine. In this study, rMAP was used to immobilise rhBMP-2 on a titanium mesh (Ti-mesh) surface, and the osteoinductivity of the BMP-2/rMAP on Ti-mesh surfaces was investigated in vitro and in vivo. Methods: (i) Expression and purification of rMAP: Hybrid rMAP was expressed in Escherichia coli and the proteins were harvested for purification after centrifugation. The rMAP was extracted using 25% (vol/vol) acetic acid, and endotoxin was removed by sequential purification. The purity of rMAP was assessed by 12% (wt/vol) sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE). (ii) BMP-2 immobilisation using rMAP on Ti-mesh surfaces: For in vitro analysis, surfaces were coated with 50µg/cm2 of rMAP solution after removing all organic molecules from the Ti-mesh surface. To immobilise BMP-2 on Ti-mesh surfaces, rMAP solution was mixed with 50µg/mL of rhBMP-2 in sodium bicarbonate (pH 0.8), and coated on the mesh surfaces as described previously. (iii) Animal surgery for in vivo bone regeneration ability assays: Each kind of Ti-mesh surface was tested on male Sprague-Dawley rats (n = 6) weighing 250–300g. The rat calvaria were exposed through skin and periosteum incisions using a #15 surgical blade, and circular bone defects were punched using a 8-mm diameter trephine drill under saline irrigation. Two short screws were used to fix each Ti-mesh (prepared just before surgery) over the defect. (iv) Radiographic and histological assessment was made of in vivo bone regeneration. (v) In vitro cell attachment and proliferation assays were performed. (vi) In vitro osteoblast differentiation assays included phenotypic differentiation assays and osteogenic gene expression analysis. Results: Through micro-CT analysis and histological evaluation, the BMP-2/rMAP-coated titanium surfaces displayed improved new bone formation in the rat calvarial defect model compared to rMAP-coated and uncoated surfaces. In addition, cellular behaviours (e.g. adhesion and proliferation) of mouse pre-osteoblast MC3T3-E1 cells were significantly increased on Ti-mesh surfaces coated with BMP-2/rMAP and rMAP. The BMP-2/rMAP-coated surface showed the highest degree of osteogenic differentiation. Messenger RNA expression of osteogenic differentiation marker genes was upregulated in MC3T-E1 cells on BMP-2/rMAP-coated Ti-mesh surfaces. Conclusions: Recombinant MAP is a promising biomaterial for BMP-2 immobilisation on titanium surfaces and guided bone regeneration with enhanced osteoinductivity -
Immediate Function with NoblePerfect Implants
Nölken, RobertProcedure: - Extraction of upper front teeth not suitable for preservation - Immediate loading of four NobelPerfectTM implants - Intraoperative registration of implant position - Flap-free Vestibular Bone Augmentation - Connective Tissue Graft for Periodontal Regeneration - Immediate Loading of temporary implants on the day of surgery - Definitive restoration 6 months later Materials: NobelPerfect Groovy Implants RP and NP; NobelPerfect Temporary Abutments RP and NP; NobelPerfect Implant Replicas RP and WP; Ribbond, Bondable Reinforcement Ribbon; Ethilon 5-0 FS3 Suture Material; Astra Bonetrap Bone Collector. -
Single Tooth Replacementwith Implants in the Esthetic Region
Yüksel, OrcanProcedure: Delayed loading of dental implants in the esthetic zone of the maxilla. Guided bone regeneration (GBR) for compensatory augmentation with subsequent exposure after healing. Contents: Soft and hard tissue loss leads to esthetic problems, even in patients with successful implant osseointegration. Delayed loading of dental implants in the esthetic zone is frequently indicated in dental practice, for example, in patients with congenital absence of the lateral incisors. Dental implants can solve this problem. Depending on the extent of hard tissue loss, it may be necessary to perform guided bone regeneration (GBR) in order to achieve better esthetic results. Depending on the degree of atrophy, GBR may be performed before or simultaneous with implantation. Correct implant placement is essential to achieving the end goal: an esthetically pleasing and natural result. In this film and in the presentation, we will demonstrate in detail the procedure for placing implants in this esthetically sensitive region. In addition, we will demonstrate a method of impression-taking that provides dental laboratories a better foundation for achieving excellent esthetic results.