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.,

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: - Minimally invasive, atraumatic extraction of an anterior tooth - Buccal soft tissue augmentation using a modified tunneling technique - Socket preservation technique for conservation of the extraction socket - Provisional restoration and closure using modified suspension sutures Materials Checklist: Tunneling Knife® (Dr. Zuhr), No. 1 / No. 2 Keydent Microblade SR Geistlich Bio-Oss® Spongiosa, particle size 0.25 - 1 mm Geistlich Bio-Gide® membrane, 25 x 25 mm Seralene Blue 7/0 DS-15, 0.5 m sutures CV-5 Gore-Tex sutures

Contents: - Incisions using a microsurgical scalpel - Reflecting a buccal flap - Preparing papillary flaps using a microsurgical scalpel - Lifting off of the papillary flaps using a papillary elevator - Removing the granulation tissue using an ultrasound scaler - Cleaning the dental roots using manual instruments - Trying to dental root - Applying Emdogain - Mixing Bio-Oss and Emdogain - Introducing the Bio-Oss into both bone defects - Microsurgical suturing Materials Checklist: Cheek retractor Microsurgical scalpel blade holder Microsurgical scalpel blade Soniflex tips Bone rest Castroviejo microsurgical needle holder Suturing scissors Dental tweezers Microsurgical tweezers Monofilament suturing material 6/0 Seralene Pref gel Emdogain Bio-Oss

Contents: - Blood sampling - Platelet separation activation - Introduction of bone replacement material - Access flap and curettage - Introduction of PRGF and bone replacement material - Plastic suture Materials Checklist: All materials required for producing PRGF (BTI Germany) Bone replacement materials Geistlich Biomaterials Surgical instruments, Aesculap Suture materials, Ethicon

Contents: - Implant planning and positioning - Preparation - Drilling and thread-cutting - Implant insertion - Wound closure Synopsis: The implant position is determined using a drill guide/x-ray template (regions 34-32-42-44). A Peeso drill is inserted in the drill guide and used to mark the position in the mucoperiosteum. An incision is made, and the mucoperiosteum is displaced. The implant insertion sites are prepared by using a 2 mm twist drill, 2/3 mm pilot drill, 3 mm and 3/5 mm twist drills. This is followed by counter-drilling and thread-cutting. The implants were loaded at 40-50 N. The wound is then closed using GORE-TEX® suture material.