Efficacy of Ridge Preservation in Esthetic Implant Therapy
Anthony G. Sclar, DMD
This presentation will reveal the important role that use of the "Bio-col" alveolar ridge preservation technique, combined with biologically acceptable prosthetic protocols, have on achieving predictable results when single and multiple adjacent teeth are replaced with dental implant restorations in areas of high esthetic concern. The following topics will be discussed in terms of the effect they have on achieving and maintaining desired esthetic outcomes: the impact that individual case factors including tooth removal technique, socket wall thickness, selection and handling of graft material, management of socket wall defects, timing of implant placement, and the management of peri-implant defects. Furthermore, technique modifications aimed at achieving either maximum osseous regeneration within the extraction socket or limiting the involution of the alveolar ridge that naturally accompanies tooth removal will be presented. Straight forward to complex case studies with long-term clinical and radiographic data will be used to establish the level of efficacy of ridge preservation in esthetic implant therapy.
Objectives: Upon completion of this presentation, participants should be able to 1) discuss the role that ridge preservation plays in achieving predictable outcomes in esthetic implant therapy, 2) describe the impact that individual case factors have on achieving desired esthetic outcomes with ridge preservation, and 3) discuss the preferred treatment outcomes and efficacy of ridge preservation in esthetic implant therapy.
Autogenous Block Grafting
Craig M. Misch, DMD, MDS
In many regards, autogenous bone remains the gold standard for osseous reconstruction. This is especially the case when more severe atrophy or larger bone defects are present. Autogenous bone has several advantages for ridge augmentation including a short healing time, favorable bone quality, low costs, lack of disease transmission and predictability. An emphasis on minimizing donor site morbidity has resulted in greater use of the mandibular ramus over the symphysis for block bone harvest. Larger volume requirements for treating severe atrophy/defects necessitate using the iliac crest. Piezoelectric surgery offers some advantages in bone harvest. Preparation of the recipient site is important to facilitate graft incorporation. Although barrier membranes may not be necessary to minimize graft resorption, the combined use of guided bone regeneration principles with block grafts can expand the area of reconstruction. The use of growth factors can also enhance outcomes with autografts. The short healing requirements of autograft and dense bone quality can reduce treatment lengths and offer the option of immediate implant restoration in many cases.
Objectives: Upon completion of this presentation, participants should be able to 1) discuss the indications and advantages of autogenous block bone grafts for implant site development, 2) identify methods to diminish morbidity associated with block bone harvest, and 3) demonstrate techniques to enhance graft incorporation and minimize complications.
Bone "Manipulation" and the "Periosteal-Bone Flap"
for Horizontal Ridge Reconstruction
Daniel R. Cullum, DDS
Bone manipulation is a minimally invasive approach for correction of the narrow alveolar ridge. Expansion of a vital "bone flap" creates an intra-bony defect for implant placement with the innate healing potential of host bone. The synergy of Cone Beam CT, Piezosurgery(R), modified implant designs and rotary mechanical expenders with modified osteotome techniques have simplified this group of technically demanding procedures. We will discuss the continuum of anatomic and procedural variations in the maxilla and mandible including single stage placement, full thickness flap +/- over-graft, "periosteal bone flap", bone incision design, and expansion techniques. Cone Beam CT imaging is important in the evaluation of horizontal defects for technique selection. Appropriate application of bone manipulation techniques can reduce the time, discomfort and expense of conventional grafting procedures.
Objectives: Upon completion of this presentation, participants should be able to 1) compare bone manipulation to traditional augmentation techniques for single stage implant placement, 2) identify horizontal alveolar deficiences appropriate for implant reconstruction with bone manipulation techniques, and 3) describe the role of periosteal preservation and technique variations between the maxilla and mandible.
Present and Future in Guided Bone Regeneration:
Available Techniques and Future Trends
Massimo Simion, MD, DDS
The prime dictate prerequisite to predict long-term success for osseoinegrated implants is a sufficient volume of healthy bone at recipient sites. However, a sufficient amount of bone volume is frequently lacking as a result of trauma or infectious diseases such as advanced periodontitis. The session addresses different techniques that have been developed to reconstruct deficient alveolar ridges to allow dental implant placement in either a simultaneous or staged approach. Vertical bone loss in partially edentulous patients constitutes a major challenge due to anatomical limitations and technical difficulties. Advances in tissue engineering may offer solutions that resolve bone volume deficits and periodontal defects while at the same time eliminating some of the concerns posed by current techniques. The future is moving towards an era where less invasive treatment regimes are now available to minimize complications and side effects of a surgical procedure, decrease patients' morbidity, increase success rates and decrease technical difficulties. The maturation of tissue engineering and its application to clinical surgical procedures has helped create a new paradigm.
Objectives: Upon completion of this presentation, participants should be able to 1) identify the correct clinical indications and pre-requisites for a successful vertical ridge augmentation therapy, including the analysis of the patient and its overall characteristics and the anatomical parameters of the area of interest, 2) discuss the history and overall development of techniques over the past decades, 3) identify the rationale in applying the tissue engineering principles to the therapeutic options, and 4) describe the endpoints of a successful "state of the art" surgical technique.
Hard Tissue Biologics
Alan S. Herford, MD, DDS
Many grafting options are available and each is associated with unique advantages as well as disadvantages. Protein-signaled grafting provides clinicians with another option for regenerating bone prior to implant placement. An overview of types of hard tissue biologics will be presented and the role of recombinant human bone morphogenic protein (rhBMP-2) will be highlighted. This presentation will review the mechanism of action of rhBMP-2 as well as indications and contraindications for its use. Both approved and off-label use of this growth factor will be discussed including maxillary sinus lifts, localized alveolar defects, as well as aveolar clefts, manibulary continuity defects, and extensive alveolar defects. Emphasis will be placed on specific surgical techniques that can provide predictable bone augmentation using hard tissue biologics.
Objectives: Upon completion of this presentation, participants should be able to 1) demonstrate the use of rhBMP-2 including mechanisms of action and identify possible advantages of its use, 2) identify the limitations of rhBMP-2 and what surgical techniques can optimize its success, and 3) describe a treatment phase that includes the use of growth factors.
Soft Tissue Biologics
Michael K. McGuire, DDS
This program will explore new solutions employing live cell delivery systems and growth factors to resolve soft tissue problems around teeth and implants. Novel new materials and techniques to treat soft tissue defects will be presented.
Objectives: Upon completion of this presentation, participants should be able to 1) discuss how and why these new materials may level the playing field, 2) describe how they can rewrite the rules of regeneration, and 3) identify the differences between tissue replacement grafts and bioactive grafts.
Connective Tissue Grafts at Time of Implant Placement
and/or Second Stage
Kirk L. Pasquinelli, DDS
In the esthetic zone, the soft tissue form, appearance and volume around an implant can make the difference between a restoration that is perceived as esthetically pleasing or as an eyesore. This presentation will describe the soft tissue anatomy around implants, the surgical procedures to improve the appearance of these tissues, and how implant restorations influence this tissue. Diagnosis and treatment of soft tissue deficiencies via restorative, surgical and orthodontic approaches will be explained through a review of several cases. The participant will gain an understanding of the relationship of bone and soft tissue to implants and implant restorations as well as how to manipulate the soft tissues in order to improve esthetic implant outcomes.
Objectives: Upon completion of this presentation, participants should be able to 1) understand the anatomical relationship between bone and soft tissues surrounding implants and how it affects esthetics, 2) describe when tissue augmentation procedures will be necessary to improve esthetic outcomes with implants, 3) know a variety of techniques to enhance the esthetic outcomes of implant supported restorations.
Rebuilding the Inter-Implant Papilla
Patrick Palacci, DDS
Peri-implant tissue surgery has two goals: to allow the implant to pierce the mucosa and to create a favorable soft tissue anatomy resulting in a perimucosal contour matching healthy gingival architecture. To reach these goals, the surgical technique should be based on biological principles - the blood supply to the involved hard and soft tissue should be maintained to allow the formation of a proper tissue barrier. This technique results in harmonious soft tissue architecture adjacent to implant-supported prostheses, provided that the implants are properly positioned. This, in turn, results in a better outcome in terms of esthetics, phonetics, and oral hygiene. The surgical papilla regeneration technique predictably creates better initial conditions for mucosal soft tissue to form a perimucosal contour matching healthy gingival architecture. However, peri-implant soft tissue, as well as gingival tissue, needs to be supported by hard tissue. It follows that a predictable treatment outcome depends not only on proper hard tissue support of the perimucosal soft tissue but also on proper implant positioning. Improper implant placement jeopardizes the stability to create papillae.
Objectives: Upon completion of this presentation, participants should be able to 1) identify the cases which can successfully be treated in terms of papillae reconstruction, 2) discuss the different sequences of treatment for each specific case, and 3) describe how to predictably recreate papillae life formation and avoid complications.