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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. -
Fiberglass frameworks in removable prosthodontics
Bücking, Wolfram -
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. -
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. -
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. -
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. -
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 -
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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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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. -
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 -
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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Cell-to-Cell Communication: Periodontal Regeneration
Stadlinger, Bernd / Terheyden, HendrikUnlike bone, which undergoes remodeling by resorption followed by bone apposition, teeth are not subject to physiological remodeling. They are remarkably resistant to physiological remodeling processes. The reason for this is found in the periodontium and cementum. The mechanisms that take effect in this area and the effectiveness of the periodontal system - consisting of gingiva, alveolar bone, periodontium and cementum - after injuries will be visualized in the new scientific 3D film, "Periodontal Regeneration".The visualization of these complex processes is of great interest for academic teaching as well as for the clinician and general practitioner as the cellular interactions are presented in the context of four phases. For the first time scanning electron microscopic images of real cells will be visualized allowing the comparison of their characteristics with computer animated simulations. DVD 1: Expert Version approx. 14 minutes DVD 2: Public Version approx. 13 minutes Outline: - Cementum formation - Orthodontic tooth movement - Trauma and periodontitis - Periodontal regeneration -
Esthetic and Restorative Dentistry - Dental Photography
Terry, Douglas A. -
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LONG-TERM OUTCOMES OF PERIODONTAL REGENERATION USING A COLLAGEN-ENRICHED, BOVINE-DERIVED XENOGRAFT IN A LARGE COHORT
Objectives: To evaluate the 5-year clinical outcome of regenerative periodontal therapy (RPT) using minimally invasive surgery and a collagen-enriched bovine-derived xenograft (1), and to identify predictors for gains in clinical attachment level (CAL) and vertical radiographic bone (RB) (2). Methods: Subjects were 95 non-smoking patients, with up to 25% full-mouth plaque and bleeding presenting at least 6 months after initial periodontal therapy with more than one isolated interdental infrabony defect. They were treated consecutively by the same clinician with combined surgery and xenograft. Clinical and radiographic data were collected before surgery, and after 1 year and 5 years. Results: Eighty-four patients (39 men, 45 women, mean age 53 years) were available for follow-up after 1 year and demonstrated a mean probing depth (PD) of 7.8mm, a CAL of 10.0mm and a defect depth of 5.2mm before surgery. Thirteen patients dropped out between year 1 and year 5. At 5 years, mean PD reduction was 3.3mm (SD 2.2 ), CAL gain was 3.0mm (SD 2.1) and RB gain was 57% (SD 38). Of these, 45% showed ≥4.0mm CAL gain, and 24% were considered failures (≤ 1.0mm CAL gain), 48% showed considerable RB gain (≥75%).The only predictor for CAL gain included sites that were always plaque-free during aftercare (p= 0.003). Predictors for RB gain included patient compliance (p=0.001) and sites that were always plaque-free during aftercare (p=0.010). Conclusions: Regenerative periodontal therapy using minimally invasive surgery and a collagen-enriched bovine-derived xenograft demonstrated favourable clinical and radiographic outcomes after 5 years. Oral hygiene and patient compliance had a significant impact in the long term. -
STEM CELL BONE ALLOGRAFTS IN MAXILLARY SINUS AND RIDGE AUGMENTATION – REPORT OF A CASE
Objectives: To evaluate the use of an allograft cellular matrix containing live stem cells for maxillary sinus and ridge augmentations. Methods: Maxillary sinus and ridge augmentations were performed using an allograft cellular matrix containing live stem cells. The post-operative results were evaluated by CT scans and peri-apical radiographs. Sinus augmentation was evaluated after 10 weeks. Radiographic bone tomography was similar to that of the native bone and the ridge augmentation resulted in a vertical ridge augmentation of 3–4mm. The cellular matrix was supplied by Brockton, MA and processed by AlloSource, Centennial, CO. Results: Following healing and approximately 10 weeks following surgery, an additional CT scan was taken. This showed that the native and augmented bone was of an adequate width for supporting an implant. Radiography revealed that the augmented bone had a similar texture to native bone, indicating formation of mature bone. The scan also revealed downward growth of the bone in a vertical direction, overlapping the crest of the native pre-maxillary bone. This was not attempted during the surgical procedure, and was a particular cause for concern. Conclusions: This use of allograft mesenchymal stem cells has been shown to be a reliable method for ridge augmentation, especially in the vertical direction in areas of severe ridge atrophy. Further studies are needed to support this finding in a more guided manner, especially for vertical ridge augmentation. -
Choice of abutment
Dr. Stefan HolstWhen restoring implants with fixed crown and bridgework, the clinician faces a variety of implant abutments to choose from: Abutments made of different materials (metal or ceramics) and fabricated with different techniques (cast or CAD/CAM abutments). In this module, these treatment options are discussed in detail, including their esthetic, mechanical and biological impact and long-term performance.





