Procedure: - Introduction: History -Taking, Examination, Diagnosis, Etiology, Prognosis for Individual Teeth - Four - Phase Treatment Sequence - Modified Papilla Preservation Technique(MPPT) - Simplified Papilla Preservation Technique (SPPT) - Findings 6 months after Surgery Synopsis The Modified and Simplified Papilla Preservation Techniques for conservation of interproximal papillary tissue were designed to provide access to deep and narrow bony defects to enable regenerative periodontal treatment. The Modified Papilla Preservation Technique (MPPT) was designed to ensure tension-free primary closure via barrier membranes in patients with small interdental spaces. The Simplified Papilla Preservation Technique(SPPT) is used to gain access to narrow interdental spaces ( < 2mm) and to deep defects in the lateral tooth region. Apart from preserving primary wound closure in the interdental space, the two techniques also serve to keep the membrane from collapsing into the bony defect. Both MPPT and SPPT employ special suture techniques to ensure tension-free primary closure of the interdental space. This video clip also serves to demonstrate that the two techniques of interproximal tissue preservation can also be used for periodontal interventions without regenerative measures.

Objectives: Severe injuries or biological dysfunction of the periodontal ligament may lead to ankylosis. Osseointegrated implant and ankylosed teeth are very similar, both with the potential for complete immobility. Ankylosis and osseointegration affect dentoalveolar development during growth, and lead to infraposition and aesthetic problems. Relocation of malpositioned ankylosed teeth or implants to correct positions requires surgery. The aim of this study was to evaluate the orthodontic bone-stretching procedure. Methods: A cohort of patients presented with implants in the wrong position (n = 4) or an ankylosed tooth in infraclusion (n = 14). Orthodontic treatment was conducted for dysmorphosis correction, excluding ankylosed teeth or implants. Before surgery, dental CTs were taken to evaluate the positions of adjacent teeth for surgical planning. Under local anesthesia, a full-thickness flap was reclined and two vertical deep corticotomies were performed using piezosurgery (Piezotome 2 SatelecRTM) on either side of the ankylosed tooth or implant. Then the two vertical cuts were connected by making a third cut, subapical to the apex. Immediately after the surgical procedure, orthodontic traction was applied and reactivated every two weeks. Calipers were used to take comparative measures with adjacent teeth during activation of the bone-stretching device. The quantity and speed of the movement were evaluated. At the end of the treatment, control cone-beam CT (CBCT) was performed, and MeshlabRTM software and movements in three dimensions were assessed by CBCT merging. Results: After a period of 3–9 months, each ankylosed tooth or implant had been moved. At the end of the treatment, they were correctly repositioned. In one case in which root resorptions were important, the movement was stopped by a tooth fracture. The analysis showed that the movement began after a minimal period of three weeks and continued until the end of the traction. The duration of treatment depended more on the distance between the incisal edge and the occlusal plane than on traction strength. Repositioning with vertical movement was more difficult than with palatal or vestibular movements and may require second surgery. The control did not demonstrate periodontal pathology after orthodontic bone-stretching. The control CBCT showed tooth or implant repositioning occurred with no problems. Osseointegration was stable for implants. CBCT merging to show bone movement revealed that the implant or ankylosed tooth moved with the neighbouring bone at the same time and in the same direction. The bone-stretching movement led to vertical bone augmentation. While the maxilla developed in a vertical direction, the ankylosed teeth remained more or less in infraocclusion. The individual growth pattern and progression of infraposition varied with age and sex of the patient. Slight over-treatment might compensate for this. Conclusion: The orthodontic bone-stretching technique seems to be viable for relocating ankylosed teeth and implants from a wrong position, but orthodontic preparation is essential and is associated with adequate soft tissue management. Bone-stretching movement led to a vertical bone augmentation. The results with ankylosed teeth and implants may not be stable over time and continuous growth of the patient must be considered when planning treatment. In the future, this technique may enable relocalisation of implants in the wrong position, however more long-term prospective clinical trials are needed to confirm its effectiveness.

The 13 participants of the intensive course came from 10 countries from all-over the world to gain deeper insights into histology in oral bone regeneration. The Expert Module of the Osteology Research Academy comprises 13 hours of practical (in the laboratory) and 7 hours of theoretical advanced training on the following topics: Pre-clinical and clinical studies in bone regeneration MicroCT, histomorphometry and digital image analysis Bone anatomy, histology, physiology and bone pathophysiology Hard tissue sample preparation Data presentation: from the raw picture to the figure Asked about their experiences during the course the participants gave the following feedback: The professionalism and enthusiasm of all people involved, and the course have been an excellent steppingstone for someone like me who has been out of the research field since my postgraduate studies. Steven Soukoulis, Australia An inspiring course with great content that will be applicable for my future research. Monica Misawa, Brazil In very much enjoyed the workshops, tips and tricks for future projects and the 1:1 discussion with the experts. Dominic Ho, Hong Kong The next Expert Module will take place 7-9. November 2016 in Vienna. Further information For the third time the Osteology Foundation has organised the Osteology Research Academy Expert Module in Kiel. The course on Hard Tissue Research was held in collaboration with the Department of Maxillofacial Surgery at the University of Kiel.