Procedure Case description: -Class II furcation defect at teeth 46 and 47 and gingival recessions at teeth 43 and 44 - Root planing using PerioSet - Incision technique - Cleaning furcation defect at tooth 46 - Pref Gel application, rinsing and Emdogain application - Insertion of Bio-Oss into the furcation space with an amalgam plugger after hydration - Condensation of the bone replacement material and application of an absorbable membrane (Bio-Gide) - Atraumatic suture closure using 6/0 Seralene Contents: This video demonstration shows the simultaneous treatment of recessions at teeth 43 and 44 and of class II furcation defects at teeth 46 and 47. After a brief case description, root planning is done using PerioSet. Next, an incision is made and the furcation defects are very carefully cleaned using hand instruments and ultrasonic scalers (Soniflex). The cleaned root surfaces and furcation defects are conditioned with Pref Gel (Straumann) for two minutes. The objective of conditioning is to remove the smear layer, to open the dentine tubules, and to enable surface demineralization. Moreover, this measure serves to optimize the contact between Emdogain and the root surface. After two minutes, the EDTA suspension is removed using physiological saline solution or water spray. Immediately afterwards, Emdogain is applied to the blood and saliva-free root surface. This procedure was also used to treat the furcation defect at tooth 47. Regenerative treatment of tooth 46 was performed since that tooth had a very extensive furcation defect. The defect was filled with Bio-Oss, which was applied using an amalgam plugger. Absorbable Bio-Gide was used for coverage of the furcation entrance. Finally, the wound was closed using loop sutures and single interrupted sutures.

Contents: - Exploration - Incision and Flap Mobilization - Palatal Flap Preservation with Interdental Tissue Preservation - Detoxification and Concrement Removal at 11 - Harvesting of Autogenous Bone Chips from the Spina Nasalis - Conditioning of the Root Surface with EDTA-Gel - Application of Emdogain and Filling of the Bone Defect - Wound Closure Synopsis After Finishing the Initial Treatment for Aggressive Periodontitis, Regenerative Treatment of a Tunnel-Shaped Pocket at Tooth 11 was attempted. Rotation and Crowding of the Buccally Inclined Tooth represented a favorable Etiological Factor. The patient did not wish to receive Orthodontic Treatment to eliminate this Causal Factor after Completion of Primary Treatment. Treatment was therefore limited to the Surgical Regeneration Attempt. The Interdental Space was larger than 3 mm and the Bone Pocket was a mostly Three-Walled Structure, so the Chances of Success were considered to be good. Exploration was first performed to identify the Course of the Defect Margins. Exact knowledge of the Bone Anatomy in all three Planes is essential to successful Incision Planning. A Tunnel-Shaped Defect delimited by Bone in the Region of Tooth 11 with good chances of Periodontal Regeneration was found. A major Challenge of this Procedure is the need to keep the Defect completely covered with Soft Tissue throughout the Healing Process. Cortellini's Papilla Preservation Technique was used for this Purpose. After Incision and Flap Mobilization, it became evident that the Defect only had two Walls in the Coronal Region and that Bone was lacking in the Buccal Region. According to the current Data on Periodontal Regeneration, the Attachment Gain achieved using an Enamel Matrix Protein (Emdogain®) alone can be just as good as that achieved using Emdogain and Bone Graft Material combined. Still, we elected to use a Combination Technique in the Present Case because it provides better Papillary Support. The Graft Material consisted of Autogenous Bone Chips from the Spina Nasalis, which can easily be harvested by Means of the Piezo Technique After gentle Detoxification, the Root Surface was treated with Emdogain. The Defect was then filled with Autogenous Bone Chips and closed by Microsurgical Suture Techniques. Six months after Surgery, Partial Regeneration of the Papilla can be seen.

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.

Outline: - Incision - Flap mobilization - Lateral sinus fenestration - Elevation of the Schneiderian membrane - Implant bed preparation - Bone chip harvesting at the mandibular angle - Filling of sinus lift lumen with autologous bone chips - Implant insertion - Covering the lateral sinus cavity with collagen membrane - Wound closure List of materials - Zeiss Pro Dent microscope with beam splitter and Panasonic 3 CCD camera - Scalpel holder (Ustomed) with Swann-Morton blades 15C and 12D - Narrow rasp (Hu-Friedy) - Micro-vacuum (Luer Lock Suction Tip, American Dental Systems) - Disposable vacuum tube set (Bexamed) - Disposable draping, Lindau (Aescologic) - Piezosurgery with diamond ball (Mectron) - Microforceps (Hu-Friedy) - Excavator (Martin) - Periodontometer, 1-mm gradation (Hu-Friedy) - OsseoSpeed implant set, Dentsply Implants: Marking drill; Twist drill, 2 mm; Depth gauge; Pilot drill, 2/3.2 mm; Twist drill, 3.2 mm; Tapered drill, 3.2/5 mm; OsseoSpeed TX implant, 5.0 × 11 mm; Closure screw, 4.5/5 mm - Columbia curette (Ustomed) - Micross scraper (Meta) - Needle holder (Ustomed) - Langenbeck wound retractor (Ustomed) - Kelly scissors (Ustomed) - Buchanan endodontic hand plugger (American Dental Systems) - Resorbable collagen membrane (Resodont, Resorba) - Ethilon 5-0 FS-3 (Ethicon) - Prolene 6-0 DA-2 (Ethicon)

Contents: - Patient presentation and esthetic analysis - Careful extraction of a non-salvageable tooth - Miniplast splint as a surgical template - Harvesting bone from the implant bed - Placing a CONELOG® implant at site 11 - Obtaining a corticospongeous bone cylinder at site 48 - Alveolar augmentation and reconstruction of the buccal bone lamella - Harvesting a connective-tissue graft - Tunneling the vestibular mucosa, various suturing techniques - Insertion of the provisional restorations - 3 months later: Preparing, impression and arbitrary transfer with a bite fork and facebow, temporary restoration - Master cast, new wax-up, determine the emergence profile - Fabricating a hybrid abutment, Scanning the custom abutment, on-screen crown design - Fabricating a zirconia abutment and a feldspathic ceramic veneer - Conditioning and adhesive attachment of the components, final intraoral check - Try in and adhesive cementation

Outline: - Incision technique/flap mobilization - Bone removal with trephine cutter 6 mm - Bone bed preparation with trephine cutter 5 mm - Fixation of the autologous bone - Membrane adaptation - Introduction of the replacement material - Attachment of the membrane (with nails) - Introduction of a second membrane - Flap mobilization - Flap closure List of materials: - Trephine cutters (Biomet/3i, Palm Beach Gardens, Florida, USA) - Fixation screws (Biomet Microfi xation, Jacksonville, FL, USA) - e-PTFE membrane (Gore-Tex® reinforced, WL Gore, Flagstaff, AZ, USA ) - Mineralized collagen bone replacement material (Bio-Oss® Collagen, Geistlich Pharma AG, Wolhusen, Switzerland) - Collagen membrane (Biogide, Geistlich Pharma, Wolhusen, Switzerland)

Outline: - Incision technique/flap mobilization - Implant insertion - Membrane adaptation - Introduction of the replacement material - Attachment of the membrane - Introduction of the second membrane - Flap mobilization - Flap closure List of materials: Titanium implant (Thommen Medical, Waldenburg, Switzerland); e-PTFE membrane (Gore-Tex® reinforced, WL Gore, Flagstaff, AZ, USA); Mineralized collagen bone replacement material (Bio-Oss® Collagen, Geistlich Pharma, Wolhusen, Switzerland); Collagen membrane (Biogide, Geistlich Pharma, Wolhusen, Switzerland)