In 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.

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Objectives: The objective was to simplify the regenerative procedure using a minimally invasive technique. Ridge preservation at the time of the patient’s tooth avulsion was not possible because of acute infection. Surgery was performed using biomaterials during the early post-extractive healing process. The "early build-up technique", as used in healthy patients, was chosen to reduce comorbidity risks in a single high-risk patient.
Methods: A 69-year-old woman had been treated with oral alendronate 70 mg weekly since 2001 because of a vertebral fracture caused by osteoporosis. She had experienced in anamnesis breast neoplasm in 2000 (and recurrence in 2015) and myocardial infarction for which she had a triple bypass in 2007 and angioplasty in 2014. The patient attended the clinic for chronic periodontitis and the tooth 4.7 was extracted because of recurrent periodontal abscesses. Before the extraction, cone beam computed tomography (CBCT) allowed evaluation of cortical wall thickness around the mobile mesial inclined 4.7 from the most significant eight cross sections (CS), and 16-mm mesiodistal bone assessment. The edentulous area 4.6 was partially included in the evaluation. Photographs were taken and periodontal probing performed 2 months after extraction of 4.7. The surgical protocol involved flapless avulsion of the tooth in October 2011 and the flap procedure 2 months later (December 2011). The early alveolar build-up was performed using bovine-derived xenograft and collagen matrix. The surgical design was restricted to keratinised gingiva 4.6–4.7. The intra-alveolar connective tissue of the thick vestibular flap was preserved and rotated on the second layer of the matrix to protect the wound. The exposed surface of the matrix resembled geometrically a post-extract alveolus and flap suture was performed without periosteal-releasing incisions to guide soft tissue proliferation (GGP; guided gingival proliferation).
Results: No complications were reported after surgery. The exposed matrix surface was part of the GGP procedure. As in healthy patients, the exposed biomaterial surface was sealed after 4 weeks. The gain in keratinised gingiva was 2mm. The hard tissue outcome was detected by 16-mm mesiodistal CBCT changes before the extraction and after surgery. Before the extraction, the bone crest width in the distal area 4.7 was 6 mm in two cross-sections and 8–9 mm in three mesial cross sections (area missing 4.6). Near the roots in 4.7 in three central cross-sections, there was only 1 mm of lingual cortical wall with fenestration defects (1 CS) and vestibular bone was largely absent (>50%). The alveolar cavity was partially retentive. After lateral ridge regeneration the bone crest width was 10–12 mm in seven cross-sections, with the greatest linear horizontal bone gain (of 10 mm) in four central cross-sections. The lingual osseous fenestration was healed. Overall the lingual bone plate height in distal area 4.7 was decreased by 1–2 mm (three distal cross-sections), with no differences in central and mesial areas (five sections). The vestibular cortical wall height was 2–5 mm greater in the central and distal area 4.7 (six cross-sections), with no differences in the mesial area (two cross-sections). The vertical distance between bone crest and alveolar nerve level was 8–9 mm in all cross sections, without residual defect area. After 4 years of follow-up the 4.7 site is in a stable condition according to ortopantomography and photographs.
Conclusions: In healthy patients, this surgical augmentation of horizontal alveolar bone and keratinised gingiva is problem-free, and was shown to be the case also in this high-risk patient, in whom implant surgery is contraindicated because of comorbid conditions and uncontrolled periodontitis. In healthy patients, implant insertion is possible 6–12 months after bone augmentation. The choice of the GGP protocol for this alendronate-treated patient was associated with fewer risks than surgery with primary intention healing of the wound. Further clinical trials should be conducted on the GGP protocol, and may show that covering bone substitutes with collagen matrix exposed during the early post-extractive wound healing process is a surgical step instead of a complication of the GBR procedure.

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.

Objectives: Dimensional changes occur in the alveolar ridge after tooth loss, due to bone resorption. Bioactive ceramic scaffolds are available for bone alveolar augmentation, but their mechanical properties are still an issue during implantation. The aim of this study was to characterize the mechanical properties of synthesized β-TCP hybrid scaffolds coated with bioabsorbable collagen or PDLLA.
Methods: β-TCP powder was obtained by reactive milling. Scaffolds were produced by the replica method from polyurethane foam patterns. Type I collagen or poly (D,L- lactic acid) (PDLLA) were used to coat the scaffolds by dip coating. The hybrid scaffolds were then divided into four groups: non-coated (GA); double immersion in collagen type I (GB); double immersion in PDLLA (GC); and ten immersions in PDLLA (GD). Samples were characterized by compressive tests, x-ray diffraction and scanning electron microscopy with energy dispersive x-ray analysis (SEM/EDS). Statistical analysis was performed by two-way ANOVA(p
Results: Chemical and microscopic analyses revealed proper morphology of powder particles and scaffolds with or without polymeric coatings. Hybrid scaffolds of PDLLA had higher compressive strength (0.11 MPa ± 0.054) (p
Conclusion: β-TCP scaffolds synthesised by the replica method showed proper morphology and size of interconnected pores. The PDLLA scaffold-coating method increased mechanical strength of the porous ceramic material, showing desirable properties such as high compressive strength, biocompatibility and osteoconductivity. These properties are essential in alveolar preservation procedures for resisting compression from soft tissues and occlusal stress from mastication.

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.