Gratis Inhalte
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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: - Incision around tooth 23, intra-sulcular preparation, mobilization of coronal sliding flap, and pre-flap preparation. - Root smoothing, reduction of ground cavity with diamond burs from Perioset system. - Preparation and harvesting of connective tissue flap from palate, Emdogain application, and wound closure. - Placement of interrupted interdental sutures for fixation of connective tissue flap. -
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. -
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. -
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. -
Fiberglass frameworks in removable prosthodontics
Bücking, Wolfram -
Live surgery Surgical treatment of bone necrosis
Schultze-Mosgau, Stefan -
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. -
Esthetic and Restorative Dentistry - Ceramic Materials
Terry, Douglas A. -
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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. -
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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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. -
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.
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The Carnevale Technique: Hemisection/Trisection of Molars with Furcation Involvement
Hürzeler, Markus B.Procedure - Apical Flap Repositioning - Trisection of the Upper Molar - Extraction of the Distobuccal Root - Tangential Preparation of the Abutment Teeth - Temporary Relining Contents Molars with furcation involvement have a shorter long-term prognosis for tooth retention than single-rooted teeth. Apart from replacing these teeth with implants, they can also be treated by hemisection or trisection with the goal of eliminating furcation and creating single-root conditions. Studies on the long-term stability of teeth treated by hemisection / trisection show mixed results. Some investigators have found failure rates of up to 40 percent. In Gianfranco Carnevale's group, on the other hand, success rates of more than 90 percent have been reported for a 10-year follow-up period. Pretreatment: Initial work on the abutment teeth, which had grade II-III furcation involvement, was done six to eight weeks after conservative periodontal therapy in preparation for placement of the long-term temporary. Preparation was done tangentially, up to the bone level, to spare as much dental hard tissue as possible while eliminating all recesses and root concavities. A metal-reinforced long-term temporary was used to splint the prepared teeth. Endodontic treatment of the affected teeth was subsequently performed. Surgical procedure: Apical displacement of the gingiva around the involved teeth was done before incision. A mucosal flap was created on the buccal and palatal sides. Trisection of the teeth was then performed. After dissecting and excising the distobuccal root, intraoperative preparation of the abutment teeth was carried out. Temporary relining was another important step, the objective of which was to splint the root and to prevent tilting. Further treatment: Impressions for the definitive restoration were made six months postoperative. The restoration margins of the tangential preparation were defined using a master model. The definitive reconstruction had fine metal margins. -
Placement of Two Endosseous Implants in the 11 - 21 Region
Hildebrand, DetlefProcedure: - Incision - Flap Design - Application of the template - Implant Placement - Suture - Application of the provisionary Materials: Camlog RootLine Implants, Ø 4,3mm, 13 mm length, E-Woo Picasso Trio: Digital Panoramic, Cephalometric and Dental CT (3in1). -
Multiple recession coverage using a modified tunnelling procedure
Zuhr, OttoOverview - Incision technique - Flap creation - Transplant fixation - Suture closure Contents: This video demonstrates the coverage of multiple recessions by means of a modified tunneling technique characterized by the use of a minimally invasive, atraumatic procedure without the creation of vertical incisions.
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SHORT LIFE OF AN IMPLANT-FIXED PROSTHESIS AND PATIENT SATISFACTION
Objectives: An intercalary defect or free-end defect of a few teeth can be treated with an implant prosthetic. This report introduces an implant treatment with a fixed superstructure delivered to a maxillary edentulous patient who could not accept a removable denture because of a severe gagging reaction, with maintenance of the implant prosthesis for 10 years. Methods: A sixty-one-year-old man complained of a functional disorder with an old, poorly maintained complete denture in 2006. He had been struggling with gagging for a long time. Conventional protocols involve preparing a complete but temporary removable denture was required to determine the occlusal plane and alignment of the artificial teeth, but the patient did not want this. Therefore, we decided to install four implants and prepare a provisional fixed bridge to determine the occlusal indices. Following CT analysis, the implants were manually installed at the lateral incisor and second molar regions bilaterally in one surgical operation. Five months later, further surgery was performed to connect multiunit abutments to the implants. A prosthetic impression was taken at the multiunit abutment level, and a biteplate was used to obtain the occlusal plane and ideal 3-dimensional position of the superstructure. After making adjustments to the provisional superstructure, a final one-piece Pt-Au bridge with a hybrid ceramics–resin coating was delivered. All operations were carried under intravenous sedation. Results: The patient’s maxillary alveolar ridge had been resorbed vertically and horizontally and the buccal side was considerably compromised. For a long time, he had been unable to make continuous use of the complete denture, which covered the palate widely and elicited gagging. Dental CT revealed insufficient bone volume for vertical implant placement, thus a bone graft was required; however, no donor site was identified for posterior augmentation by sinus floor elevation. Therefore, bilateral posterior implants were placed and tilted along the mesial wall of the sinus cavities, to acquire initial stabilisation at 20 N/cm. Two anterior implants were also angled labially to establish the class I occlusion. The initial stability was 25 N/cm. Bilateral mandibular posterior recovery with dental implants and the occlusal plane and vertical dimension were determined by the Willis face method. The patient felt nauseous with the provisional bridge, thus the posterior parts of the bridge were not well maintained, although the patient insisted on continuing with it. Five years later, the patient noticed more frequent bleeding from the peri-implant crevicules. With the pa.ent’s understanding, we decided to remove the whole implants . Conclusion: Multiple tooth defects are often not suited to fixed prostheses on implants because occlusal or functional recovery can be difficult, with restricted implant positions and angulations in absorbed, compromised alveolar ridges and gingival recession. It was difficult for our patient to travel long distances to the hospital at the stated periods, particularly after the onset of respiratory disease, so it informed consent needed to address the predictable insufficiency of the prosthesis, and the increased risk of peri-implantitis. In reality, the patient was satisfied and had no complaints for 10-years, demonstrating that implants can restore function, aesthetics and quality of life, even if they have a relatively short life. -
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CONSERVATION OF BONE ADAPTIVE OPPORTUNITIES DURING ORAL OSTEOPLASTIC SURGICAL INTERVENTION
Objectives: From analysis of the literature, the absence of epithelial proliferation and adaptive capacity dice determines the ability of tissues to regenerate. When planning a clinical experiment, we suggested the presence of gap (≥ 8.0mm) between the implant and the bone in the area of the implant platform (factor of epithelial proliferation). The aim of this study was to evaluate the efficiency of the rooting implant method in terms of preserving alveolar bone volume. Methods: Sixty patients were studied in 2013–2016 (male–female ratio 1:2; mean age 43 ± 5 years). Various parameters were explored using specialist devices such as a physiodispenser. The implant position was determined using a Navigator YUK-MTM (patent number UА 85876), and bone architecture was visualised using modified radiovisiographs with cadmium–zinc–tellurium single-crystal filters. Implants with an internal connection of depth 3.5mm and length 10.0mm were used. Patients were divided into two groups. The treatment group (n = 30) underwent root implant surgery, with the application of bone thickening gel-like material on the back of the circular platform implant. When rooting compression of this layer reached a thickness of 0.5mm as displayed on the navigational device, the operation was stopped. The back implant surface and surrounding area were covered with a 10.0-mm nanostructured membrane. The control group (n = 30) underwent standard dental implantation. Surgery was carried out by a single operator under standardised conditions, and all patients were examined by a standard procedure. The degree of vertical bone resorption after 6 and 12 months was used to indicate bone atrophy. Results: After 6 months, the treatment group gave unexpected result: in sixteen cases, there was vertical restoration of bone tissue in the near-implant area. In nine, excess bone tissue, freeing the cap implant, was removed. In ten cases, the initial bone level was preserved at the near-implant area. Changes in gums and problems with subsequent prosthetics occurred significantly less often. In four cases, bone was resorbed approximately 1.5mm from the lingual and vestibular sides of the alveolar crest. After 12 months, the patients in the treatment group showed no bone loss. In 22 patients in the control group (73%), X-ray and visual examination revealed varying degrees of proliferation of soft-tissue defect in the area of the periosteum (which can be affected by watering), whereby defects covered the implants irregularly. Radiovisiographic images of both groups revealed 46 cases with wedge-shaped defects filled with gingival tissue (the fine bone structure was not visible using standard methods). The navigation device gave an accuracy of implant positioning 2.0 ± 0.5 minutes (at a deviation of less than 25 arcminutes) and 1.0±0.5 minutes (at a deviation of less than 5 minutes). Linear positioning accuracy was 0.50 ± 0.05mm (at the implant moving up to 10mm). Conclusion: It is possible to predict the impact of pathogenic factors in dental implantation and safely achieve prosthetic restoration of anatomical structures for patients and their organs. Bone regenerative capacity is preserved and bone remodelling is stabilised in the area of the periosteum. The proposed method of visualising thin bone structure makes it possible to assess the impact of surgery on the size and nature of the defect, and predict reparative capabilities and the effectiveness of rehabilitation. The clinical potential of this medical navigation includes dentistry and medical robotic systems. This study opened up further possibilities for optimising the surgical process, predicting the impact of pathogenic factors in dental implants, and eliminating it.