Perspectives on Vertical and Horizontal Augmentation:

The average size of the vertical defect is growing and the age of the patients are decreasing. These extreme vertical defects were not investigated and documented in clinical studies. Can the old principles be applied to these defects?

Is it possible to treat these defects technically and can biology reach up to the expected heights? What will be the outcome after loading?

What happens to the Sausage Technique TM cases after 15 years? What has been changed of the technique in the last decade?

This presentation will update the clinician about techniques that can treat these types of defects. New research related to these defects will be revealed.

Long-term clinical outcomes of vertical and horizontal augmentation will be presented.

Vertical and Horizontal Augmentation utilizing the Sausage Technique TM:

Vertical and horizontal augmentation presents one of the greatest challenges of bone regeneration in implant dentistry. This is primarily due to the difficulty of the surgical procedure and its potential complications.

These complications include postsurgical swelling, bruising, and potential neurosensory disturbances. Minimally invasive flap management that can minimize the chances of these complications will be revealed during this hands-on course. Graft harvesting, membrane fixation for vertical augmentation as well as for the Sausage Technique TM will be practiced.
A step by step approach how to protect the neurovascular bundles such as the mental nerve and to achieve a safe, tension free closure will be learned during this practical course.

Learning objectives:

1. 1. Understand the surgical anatomy of the floor of the mouth
2. 2. Learn the surgical principles of ridge augmentation surgery
3. 3. Learn the tension free closure of the flaps after vertical ridge augmentation
4. 4. Learn soft tissue reconstructions after ridge augmentation

Bone and soft tissue augmentations in the esthetic area: a technique-sensitive procedure

Bone and soft tissue augmentation are necessary to compensate for, or prevent tissue deficits around implants placed in the esthetic region. Lack of bone can either make the placement of implants impossible or it is a limiting factor for an optimal esthetic result. Guided Bone Regeneration is a proven technique for such bone augmentation. When used correctly and with the right materials, the desired result can be achieved with good long-term results. However, the GBR technique is very technique-sensitive. Mistakes which prevent success can be made starting with the incision technique over the membrane adaptation to tension free flap adaptation. But we learned that bone augmentation alone doesn’t give us the perfect tissue volume. Soft tissue augmentation appears to be of enormous importance, particularly for long term success. Depending on the initial situation, various techniques are successful if they are applied correctly. This presentation will discuss the goals of the GBR and soft tissue augmentation techniques, especially in the aesthetic field, as well as which steps in the surgical phase are really essential for success.

Soft tissue autografts from the hard palate – the gold standard for oral soft tissue reconstruction in the spotlight

The application of soft tissue autografts has characterized the last 50 years of clinical periodontology, and till today – more than ever – a variety of soft tissue grafting interventions is carried out with two different targets being pursued: increasing the width of keratinized mucosa and increasing soft tissue volume.

To reduce pain, invasiveness and side effects originating from the donor site at the hard palate, the search for soft tissue substitute materials has become an important field of research and enormous effort has been taken by scientists and clinicians to develop reliable alternatives. However, a solid body of evidence points out, that independent of the clinical indication and independent of the soft tissue substitute material investigated, epithelialized as well as subepithelial connective tissue grafts must be considered as the gold standard materials for oral soft tissue reconstruction to the present day.

Against this background, it must be expected, that more transparency and understanding for the predictably successful application of soft tissue autografts would substantially influence future research and further progress with regard to possible substitute materials will to some extent be dependent on whether or not some fundamental landmark questions can be answered like for instance: what is the true nature of the positive connective tissue graft effect in gingival recession therapy? does it make a difference for the patients, where and how soft tissue autografts are harvested at the hard palate? can varying tissue compositions possibly impact the clinical characteristics of different autografts with regard to re-vascularization, epithelial differentiation and volume stability?

The present presentation will not be able to answer all the aforementioned questions. By presenting available research data and associated clinical observations it can contribute though to a better understanding of the hurdles to take in search for biomaterials that aim to substitute the use of autologous soft tissue grafts in the near future.

Soft tissue augmentation around implants: How far we can go?

Soft tissue augmentation procedures have been demonstrated to be critical for the achievement of the esthetic success of implant therapy. In most of challenging cases soft tissue surgery is performed after bone augmentation to “repair” soft tissue defects caused by or residual after bone surgery. In the presentation the possibility and limits to perform soft tissue augmentation before implant therapy with or without bone reconstruction will be analyzed and described.

Soft tissues management around implants

Part 1 

Soft tissue plastic approaches to increase the height of the keratinized mucosa and / or the thickness of the peri-implant soft tissues can be performed at three different stages: before implant placement, simultaneously with implant placement and after implant placement.

After implant insertion, specially in the mandible, it is frequent to face clinical scenarios in which there is complete absence or a minimal quantity of keratinized tissue, many of the times associated with a reduced depth of the vestibular fornix and a coronal muscle insertion. In these cases,  where there are no esthetic demands, the main objective is  to reconstruct/increase the quantity of keratinized mucosa and deepen the vestibule so as to facilitate the performance of oral hygiene by the patient and at the same time reduce the risk of soft tissue dehiscence . The most appropriate surgical technique to obtain those results is the free gingival graft.

Part 2 

Most of the times soft tissue deficiencies at the buccal aspect of implant-supported crowns are a matter of thickness rather than height. The lack of adequate thickness of the buccal soft tissues can lead to incorrect emergence profiles of the prosthetic crown, which are difficult to maintain from a hygienic point of view; in these cases, the main goal of the plastic surgery is not to increase the height of the keratinized tissues but to augment the thickness of the connective tissue at the level of the peri-implant transmucosal portion. This is achieved with a surgical technique that involves the use of a connective tissue graft covered by a coronally advanced flap.

Learning objectives

1. 1. Describe step by step the free gingival graft procedure to increase keratinised mucosa height before or after  implant placement
2. 2. Describe the surgical procedure combining  transmucosal implant placement and simoultaneous submarginal  connective tissue graftor collagen matrix
3. 3. Describe step by step harvesting technique

The Immediate Dentoalveolar Restoration (IDR) is a surgical and prosthetic powerful technique established to broaden indications for immediate loading on individual compromised teeth. It is a technique that allows tissue losses with varied extensions in compromised sockets to be reconstructed in the same surgical session of implant placement and provisional crown installation, reducing the number of interventions and making esthetic aspects predictable. The main focus of the lecture is to present the IDR protocol, which advocates minimally invasive surgery and flapless procedure. Challenging clinical cases in anterior zone in combination with severe bone loss and soft tissue damage will be discussed, and its biological response. This is a new perspective to manage compromised sockets in a simplest and reproducible way.

The main goals of the IDR workshop are to demonstrate improvement of the practitioner’s management of compromised fresh extraction sockets in the esthetic zone; to explain the step-by-step, indications, and advantages of de IDR concept; to describe how to obtain an autogenous bone graft from maxillary tuberosity in the easiest way possible; and to review the management of the graft and complete reconstruction of the alveolar defects. In the IDR workshop the participants will be able to apply all the steps related to the technique on the IDR models specially developed for this course. This is the first introduction in the IDR concept.

Autogenous bone plays fundamental role in supporting new bone formation in critical size defect. Nevertheless, intra-oral bone block harvesting may result a challenging and stressful step for many Clinicians. Digital techniques changed completely the complexity of the free hand approach, indeed, pre-evaluation of the defect anatomy and, consequently, bone block morphology needed to graft the defect is now possible. A computer guided surgery for bone block harvesting helps the Surgeon to harvest the required dimension and shape of the bone block in a safe and stress free approach. The lecture will analyze the planning phase and the surgical steps to manage vertical bone deficiency in the posterior as well as esthetic areas.

The Maxillary Sinus Grafting Procedure is one of the most widely reported surgical procedures in advanced implant dentistry. The treatment techniques have evolved over the years as well as the utilization of graft materials for the modified sinus cavity. Along with all of those publications and changes with technique, a number of complications can also occur during and after the surgical treatment. This presentation will focus on the diagnosis, technique selection and execution as well as the management of complications while treating patients with maxillary sinus graft procedures

This workshop is designed to provide to the participant a deep understanding of the available techniques for the treatment of patients with pneumatized maxillary sinuses. During the workshop, the participant, with the aid of specially designed workshop/models will be able to plan and execute various techniques for accessing the maxillary sinus cavity and manipulating the membrane for the placement of graft materials and/or simultaneous implant placement. A complication simulation will be also practiced to better understand complication solving techniques.

Management of peri-implantitis

Peri-implantitis is a plaque-associated pathological condition characterized by the mucosal inflammation along with progressive loss of supporting bone. Substantial evidence suggests that non-surgical therapy is of limited efficacy in arresting further bone loss, thus indicating the necessity of surgical intervention in the majority of patients diagnosed with peri-implantitis.

Achieving optimal treatment results in diverse clinical situations requires proper knowledge of indications and surgical performance of different surgical treatment modalities. This lecture will cover different surgical peri–implantitis treatment concepts, including reconstructive, resective, and combined surgical therapies, and the decisive factors in determining which surgical technique is most appropriate in different peri-implantitis cases. Important aspects of soft-tissue management and rationale for soft-tissue volume grafting following surgical peri-implantitis treatment, as well as the prognostic factors associated with treatment outcomes will be further discussed.

This hand on course will focus on the flap design, important soft-tissue manipulation aspects and suturing techniques that are of crucial importance in obtaining optimal results in surgical peri-implantitis treatment. The course will also include the demonstration and practice of soft-tissue volume grafting technique at peri-implantitis sites.
The following key aspects will be addressed:

• specific flap designs and suturing techniques for various surgical approaches at peri-implantitis sites
• surgical steps and materials for reconstructive surgical therapy
• soft tissue volume grafting as part of resective, reconstructive and combined procedures in the esthetic zone
• surgical techniques and materials to establish keratinized tissue

Management of peri-implantitis

Peri-implantitis is a plaque-associated pathological condition characterized by the mucosal inflammation along with progressive loss of supporting bone. Substantial evidence suggests that non-surgical therapy is of limited efficacy in arresting further bone loss, thus indicating the necessity of surgical intervention in the majority of patients diagnosed with peri-implantitis.

Achieving optimal treatment results in diverse clinical situations requires proper knowledge of indications and surgical performance of different surgical treatment modalities. This lecture will cover different surgical peri–implantitis treatment concepts, including reconstructive, resective, and combined surgical therapies, and the decisive factors in determining which surgical technique is most appropriate in different peri-implantitis cases. Important aspects of soft-tissue management and rationale for soft-tissue volume grafting following surgical peri-implantitis treatment, as well as the prognostic factors associated with treatment outcomes will be further discussed.

This hand on course will focus on the flap design, important soft-tissue manipulation aspects and suturing techniques that are of crucial importance in obtaining optimal results in surgical peri-implantitis treatment. The course will also include the demonstration and practice of soft-tissue volume grafting technique at peri-implantitis sites.
The following key aspects will be addressed:

• specific flap designs and suturing techniques for various surgical approaches at peri-implantitis sites
• surgical steps and materials for reconstructive surgical therapy
• soft tissue volume grafting as part of resective, reconstructive and combined procedures in the esthetic zone
• surgical techniques and materials to establish keratinized tissue