Content: With a maxillary sinus recess reaching far into the alveolar process of the maxilla, the maxillary sinus can sometimes be opened when maxillary incisors are extracted. An oro-antral communication is determined by a nose-blowing test or by sounding out of the alveolus with blunt probes. After an inflamed, cystic, or tumorous maxillary sinus illness has been excluded, an oro-antral communication should be closed immediately with plastic surgery within the first 24 hours after extraction to prevent the germ-free maxillary sinus from being contaminated. Plastic covering by plastic surgery using a cheek flap with vestibular stem is demonstrated. After a mucoperiosteal flap with vestibular stem has been formed, the flap is lengthened by slitting the periosteum so that a tension-free sealing of the opened maxillary sinus will be possible without endangering the flap's blood flow at the same time. Outline: - Diagnostics of an oro-antral communication - Exclusion of inflammatory, cystic, or tumorous maxillary sinus illnesses - Cheek flap plastic surgery for plastic covering of an oro-antral communication: - Cutting direction for the formation of a mucoperiosteal flap with vestibular stem; - De-epithelalization of wound margins; - Mobilization of the flap by slitting the periosteum; - Periosteal holding stitches for tension; - free closure of the oro-antral communication; - Stitching technique for saliva-proof wound closure. - Demonstration of buccal flap plastic surgery - Demonstration of bridge flap plastic surgery - Demonstration of palatal flap plastic surgery - Postoperative reaction measures

Procedure: Theoretical Part: - Adult male with a deep and broad intraosseous bone defect located on tooth #13 - The indication for modified papilla preservation in the scope of regenerative therapy was established based on the width of the diastema - Regenerative periodontal therapy with Emdogain and a Bio-Oss® cancellous bone graft - Emdogain is applied to the root surface to stimulate regeneration of periodontal structures - To prevent graft collapse and to minimize the risk of development of too large a recession in this esthetically important region, the defect was filled with Bio-Oss® cancellous bone material Practical Part: - The papilla preservation technique was performed using microsurgical instruments - The root surface area was conditioned with 24% EDTA for ca. 2 minutes - Emdogain was applied to the root surface - The defect was filled with the Emdogain/Bio-Oss® mixture - The wound was closed with two mattress sutures one horizontal mattress suture to secure the graft in place, and a second modified vertical mattress suture to tightly close the papilla - A 5-0 suture was used for the horizontal mattress suture, and a 6-0 monofilament was used for the vertical mattress suture - Postoperative care entailed rinsing the wound twice daily for 4 weeks with 0.2% chlorhexidine and ibuprofen analgesia on the first few days after surgery Contents: The patient's jaw displayed a generalized loss of clinical attachment and alveolar bone. His general history was unremarkable; the patient was a non-smoker. Microbiological tests showed large numbers of Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis. The diagnosis was "generalized aggressive periodontitis". After four months of initial therapy consisting of antibiotic combination therapy (amoxicillin + metronidazole), intraoral radiographs showed a deep and wide intraosseous bone defect located mesial and palatal to tooth #13. To preserve this strategically important tooth we opted to perform regenerative therapy with Emdogain and Bio-Oss cancellous bone material. Ten months after regenerative periodontal therapy, the probing depth had decreased by 7 mm, and 5-6 mm of clinical attachment had been gained. At this time, the probing depth was 2-3 mm and intraoral radiographs showed near-complete filling of the osseous defect.

Nothing but positive feedback could be heard after the very successful symposium jointly organized by the Osteology Foundation, the AAP, and the AAP Foundation. It took place as part of the pre-programme of the AAP Annual Meeting, which was held in Orlando, Florida in November this year. With an audience of more than 500, the Symposium exceed all expectations. All seats were taken, and some late-comers even had to stand. Joan Otomo-Corgell, President of the AAP, opened the symposium, and particular welcomed over 130 third-year periodontics residents who had received scholarships from the AAP Foundation to attend the symposium. Theprogrammecovered a broad range of topics in periodontal treatment and research, exploring the current concepts and alternatives in bone regeneration, outlining the use of scaffolds and biological mediators to improve the outcomes of bone regenerative therapies, and explaining the clinical guidelines associated with current concepts and alternatives in soft tissue augmentation and periodontal regeneration. The symposium with national and international speakers also included discussion of using soft tissue substitutes to improve the outlines of soft tissue regenerative therapies. Mariano Sanzfrom Spain, current President of the Osteology Foundation (OF), andWilliam V. Giannobile(USA), Board Member of the OF, were among the presenters, as well asPamela K. McClain(USA), also Board Member of the OF and past-president of the AAP.David M. Kim(USA) andRodrigo Neiva(USA), both members of theOF Expert Council, gave presentations as well. A great addition to the programme was the presentation byMartha Somerman, Director of the National Institute of Dental and Craniofacial Research (NIDCR), who spoke about research opportunities in regenerative medicine. The organizers and everybody involved were extremely excited about the success of the symposium, and representatives of the two Foundations as well as the AAP announced to continue the collaboration, since it is a great partnership for success. More than 500 participants attended the joint symposium by the Osteology Foundation, the AAP and the AAP Foundation in Orlando, Florida, on 14 November 2015. The outstanding programme with national and international speakers focused on current technologies for hard and soft tissue oral regeneration.