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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 -
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. -
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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 -
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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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. -
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. -
Esthetic and Restorative Dentistry - Ceramic Materials
Terry, Douglas A. -
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. -
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. -
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. -
Fiberglass frameworks in removable prosthodontics
Bücking, Wolfram -
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Sofortbelastung eines zahnlosen Unterkiefers mit einem okklusal verschraubten, festsitzenden Zahnersatz - Der komplette Fall
Yüksel, OrcanGliederung: - Erläuterung der Sofortbelastung im Zahnlosen Unterkiefer und des Ledermann Konzeptes - Chirurgisches Vorgehen der Implantation mit den XIVE® TG Implantaten - Bissregistrierung und Abdrucknahme - Präsentation der prothetischen Komponenten - Anprobe und passives Verkleben im Mund der Mesiostruktur - Eingliederung Inhalt: Die Extraktion der Zähne in einem teilbezahnten Unterkiefer mit gleichzeitiger Implantation von 6 XIVE® TG Implantaten wird vorgestellt. In Anlehnung an das bewährte Ledermann Konzept, der Sofortbelastung wird in diesem besonderen Fall die Versorgung im Mund des Patienten mit einer Mesiostruktur spannungsfrei primär verblockt. Auf diesem Gerüst wird eine occlusal verschraubte brückenähnliche Totalprothese mit Kunststoffzähnen eingegliedert. Die Versorgung ist bedingt durch den Zahnarzt abnehmbar und daher für den Patienten festsitzend. Das einfache aber äußerst passgenaue und schnelle Verfahren mit minimalem Aufwand an erforderlichen Implantatteilen ist der Inhalt dieses Beitrages. -
Microsurgical Removal of a Foreign Body from the Mandibular Canal
Schultze-Mosgau, StefanOverview: - Access and incision: Creation of a vestibular pedicled mucoperiosteal flap via a gingival margin incision while preserving the papilla - Removal of vestibular bone in the region of tooth 46 using a microsurgical instrument - Exposure of the neurovascular bundle - Removal of the foreign body - Re-adaptation of the mucoperiosteal flap - Wound closure with atraumatic suture material Contents: Female patient with an indication for microsurgical foreign body removal (removal of a fractured root canal instrument from a previous endodontic treatment of tooth 46) using a surgical microscope. The foreign body extends from the apex into the mandibular canal. -
Implantatplastik Regio 34
Schwarz, FrankChirugisch-resektive Therapie einer fortgeschrittenen Periimplantitis mittels Implantatplastik im Bereich der vestibulär exponierten Titananteile.
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A systematic review of implant supported maxillary overdentures after a mean observation period of at least 1 year
Slot W, Raghoebar GM, Vissink A, Huddleston Slater JJ, Meijer HJAAbstract Aim: The aim of the present systematic review of implant-supported maxillary overdentures was to assess the survival of implants, survival of maxillary overdentures and the condition of surrounding hard and soft tissues after a mean observation period of at least 1 year. Material and methods: MEDLINE (1950–August 2009), EMBASE (1966–August 2009) and CENTRAL (1800–August 2009) were searched to identify eligible studies. Two reviewers independently assessed the articles. Results: Out of 147 primarily selected articles, 31 studies fulfilled the inclusion criteria. A meta-analysis showed an implant survival rate (SR) of 98.2% per year in case of six implants and a bar anchorage. In case of four implants and a bar anchorage, the implant SR was 96.3% per person. In case of four implants and a ball anchorage, the implant SR was 95.2% per year. Conclusion: In all three treatment options, the SR of the implants is more than 95%. The studies included reveal that a maxillary overdenture supported by six dental implants, which are connected with a bar, is the most successful treatment regarding survival of both the implants and overdenture. Second in line is the treatment option with four implants and a bar. The treatment option with four or less implants and a ball attachment system is the least successful. -
BEHAVIOR AND DIFFERENTIATION OF OSTEOBLASTS ON A TITANIUM SURFACE WITH DIFFERENT MICROMETRE-SCALE ROUGHNESS
Objectives: Titanium implants with mean arithmetic roughnesses (Ra) of 1–2µm are associated with improved osseointegration and clinical outcome. However, the procedures used for producing a roughened surface usually change other parameters, such as spatial characteristic skewness and kurtosis, and sub-micrometre and nanoscale roughness. Studies are needed to explore the effect of different surface characteristics on osseointegration and clarify the relationship between Ra and osseointegration. This study aimed to investigate how titanium surfaces with different micrometer-scale roughnesses influenced proliferation, migration and differentiation of osteoblasts in vitro. Methods: Titanium replicas with surface roughnesses (Ra) of approximately 0µm, 1µm, 2µm and 4µm were produced. The surfaces have no significant sub-micrometre or nanoscale roughness and have similar skewness and kurtosis. MG-63 osteoblasts were cultured on the surfaces for up to 5 days and their behavior was investigated using time-lapse microscopy. The speed of cell migration was quantified using specialised software. Gene and protein expression were determined for alkaline phosphatase (ALP), osteocalcin and vascular-endothelial growth factor (VEGF). Results: Cell migration speeds were significantly lower on surfaces with Ra of about 4µm compared to those with lower Ra levels, with no differences between those with Ra in the range 0–2µm. Cell proliferation decreased gradually with increasing Ra. Gene expression of ALP, osteocalcin and VEGF was greater for the 1-µm and 2-µm Ra surfaces than the 0-µm and 4-µm surfaces. These findings were similar for protein expression. ALP and osteocalcin content in the conditioned media were significantly higher for cells grown on the 2-µm Ra surface compared to the 0-µm and 4-µm surfaces. The production of VEGF by cells on the 1-µm and 2-µm surfaces was significantly higher than that of the 0-µm surface. Cells grown on the 2-µm surface produced significantly more VEGF than those on the 4-µm surface. Conclusion: Surfaces with lower and higher roughnesses in this study seem to be suboptimal for osteoblasts. We suggest that decreased cell migration on surfaces with Ra 4µm might be associated with decreased osteoblast differentiation, probably through inhibition of cell-to-cell contact. -
Restauration mit Komposit-Schichttechnik im Frontzahnbereich/OK
Dietschi, DidierMorphologische Missbildungen wie zapfenförmige Seitenzähne sind häufige Anomalien, die restaurativ zu behandeln sind. Mit minimalinvasiven dentalchirurgischen Techniken, die zunehmend an Popularität in der ästhetischen Zahnmedizin gewinnen, ist eine idealästhetische Korrektur weitgehend oder gänzlich ohne Gewebsverlust möglich. Dieses Video zeigt die Rekonstruktion von zwei lateralen Schneidezähnen mit direktem Kompositaufbau gefolgt von einer sogenannten "natürlichen Beschichtung" mit Applikation von einzelnen Dentin- und Schmelzschichten, um die natürliche Zahnanatomie nachzuahmen. Alle Schritte zur Wiederherstellung des Zahns werden bis ins Detail erklärt, inklusive Farbauswahl, Anlegen des Kofferdamms, Klebeverfahren sowie Finishing und Polishing der Dentin- und Schmelzschichten. Durch die Einhaltung einer präzisen und sorgfältigen Operationstechnik erzielt man ein zuverlässiges Ergebnis mit einem völlig natürlich aussehenden Zahnersatz.