In 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.

Outline: - 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

Dr. 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.

Expert 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.

Visualizing 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

Content: 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.

Objectives: 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.

Procedure: - 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.

Content: - 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.

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.

Gliederung - Instrumente und Planung - Inzision - Spaltlappenpräparation - Entnahme Bindegewebstransplantat - Naht am Gaumen - Einbringen und Naht des Transplantats - Mikrochirurgische Naht Inhalt: Mikrochirurgischer Eingriff zur Deckung zweier benachbarter freiliegender Wurzeloberflächen. Step by Step wird ein koronal verschobener Spaltlappen mit subepithelialem Bindegewebstransplantat gezeigt. Die Entnahme des Bindegewebes am Gaumen erfolgt nur mittels einer horizontalen Inzision. Ein sehr präziser mikrochirurgischer Nahtverschluss ist der Schlüssel zum perfekten ästhetischen Ergebnis.

Contents: - Implant planning and positioning - Preparation - Drilling and thread-cutting - Implant insertion - Wound closure Synopsis: The implant position is determined using a drill guide/x-ray template (regions 34-32-42-44). A Peeso drill is inserted in the drill guide and used to mark the position in the mucoperiosteum. An incision is made, and the mucoperiosteum is displaced. The implant insertion sites are prepared by using a 2 mm twist drill, 2/3 mm pilot drill, 3 mm and 3/5 mm twist drills. This is followed by counter-drilling and thread-cutting. The implants were loaded at 40-50 N. The wound is then closed using GORE-TEX® suture material.

Procedure: - 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.