Content: In the maxillary incisor region, a sinus floor augmentation to enlarge the vertical bone supply may be indicated for a vertically reduced local bone height of less than 5 to 7 mm before procedures to rehabilitate masticatory function with an implant-bearing tooth replacement. For a single-sided deposit osteoplasty, the quantity of autogenous bone from the chin region is usually sufficient. The operative procedure of a single-sided lateral sinus floor augmentation is demonstrated with particulate spongious bone and alternatively with an autogenous block graft. The video also shows the operative method for a crestal sinus floor augmentation with the aid of the endoscopically controlled condensation technique. The advantages and disadvantages of the individual procedures are highlighted. In addition, the technique for harvesting chin bone transplants in different case examples is shown. Outline: - Operative technique for lateral sinus floor augmentation with autogenous particulate spongious bone - Operative technique for lateral sinus floor augmentation with autogenous block grafts - Crestal, endoscopically controlled sinus floor augmentation with condensation technique - Techniques for harvesting chin bone grafts - Range of indication for sinus floor augmentation - Lateral sinus floor augmentation - Operative technique of crestal, endoscopically controlled sinus floor augmentation - Operative technique of autogenous chin bone removal

Content: In adolescence, the exposure and orthodontic classification of retained teeth, especially canines and premolars, represents a useful therapy measure. Techniques for surgically exposing vestibularly and palatally retained teeth are demonstrated using the tubed pedicle flap technique. Because epithelialized mucous membrane is covered in the tubed pedicle flap technique, a renewed growth of the exposed tooth is prevented and a classification of the tooth with orthodontic appliances under sight control is enabled. Depending on the retention form, the extent of movement, and the patient's age, exposure may no longer be possible under some circumstances, indicating the need for operative removal of the retained canine or premolar. Preoperative localization methods, vestibular and palatal operative access paths, and surgical techniques for atraumatic removal are demonstrated. Operative techniques for the atraumatic removal of retained maxillary third molars also are shown. For the gentle removal of retained maxillary third molars, it is very important to record their topographic positional relationship to the maxillary sinus and to select the cutting direction and most suitable osteotomy technique. Outline: - Techniques for exposing maxillary canines or premolars for orthodontic classification - Operative removal of retained maxillary canines - Operative removal of retained maxillary third molars

Procedure: - Incision - Flap Design - Removal of the granulation tissue - Application of the PrefGel on the root surface - Application of the Enamel -Matrix -Protein (Emdogain) - Suture (Offset-Suture) - Identical procedure on the opposite side (1st quadrant) Materials: Retractor Micro Surgical Scalpel Handle Mini Scalpel Blades 4 x Gracey Curettes Periosteal Trombelli Periosteal Prichard Microsurgical Needle Holder Castroviejo Scissors Tweezers Microsurgical Tweezers Gore Tex CV-5 Sutures Gore Tex CV-6 Sutures Emdogain 0,7 ml PrefGel

Procedure - Indications and preoperative planning - Incision technique and osteotomy - Placement of distraction apparatus - Wound closure and postoperative regimen Materials: V2-Alveolar distractor, Medartis (Switzerland) 2,0mm Screws for Osteosynthesis, Medartis (Switzerland) Vicryl Suture, Ethilon (USA)

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.

Procedure: - Introduction: History -Taking, Examination, Diagnosis, Etiology, Prognosis for Individual Teeth - Four - Phase Treatment Sequence - Modified Papilla Preservation Technique(MPPT) - Simplified Papilla Preservation Technique (SPPT) - Findings 6 months after Surgery Synopsis The Modified and Simplified Papilla Preservation Techniques for conservation of interproximal papillary tissue were designed to provide access to deep and narrow bony defects to enable regenerative periodontal treatment. The Modified Papilla Preservation Technique (MPPT) was designed to ensure tension-free primary closure via barrier membranes in patients with small interdental spaces. The Simplified Papilla Preservation Technique(SPPT) is used to gain access to narrow interdental spaces ( < 2mm) and to deep defects in the lateral tooth region. Apart from preserving primary wound closure in the interdental space, the two techniques also serve to keep the membrane from collapsing into the bony defect. Both MPPT and SPPT employ special suture techniques to ensure tension-free primary closure of the interdental space. This video clip also serves to demonstrate that the two techniques of interproximal tissue preservation can also be used for periodontal interventions without regenerative measures.

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.

Overview: - 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.

This case is an excellent demonstration of the use of the minimally invasive access flap technique for treatment of (chronic) periodontitis in an esthetically critical zone. The access flap was used in conjunction with enamel matrix proteins for regenerative therapy.,