Vertical and Horizontal Augmentation Revisited:
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 Revisited:
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.
Dr. Kan completed training from Loma Linda University School of Dentistry. He is a Professor and maintains a private practice. He is on the Editorial board for several journals and has published over 100 reference articles and chapters.
Regenerating esthetics vertical tissue defects is always challenging. While it is possible to regenerate bone vertically, the critical final few millimeters where the gingiva meets the prosthesis often do not emulate gingival architecture with a natural scallop.
This often leads to long crowns with flat gingival architecture or crowns with artificial gingiva.This presentation will explore the science and limitations in management of esthetics partially edentulous vertical tissue defects for the critical final 4-5 mm where the gingiva meets the tooth/restoration.
Single Immediate implant placement and provisionalization with Connective Tissue Grafts
This model based hands-on session will familiarized the participants with single immediate implant placement and provisionalization (IIPP) in the Esthetic zone. In additional, various techniques for harvesting the connective tissue grafts and how to apply for IIPP will be discussed and demonstrated.
Dr. Pierpaolo Cortellini received his MD from the University of Florence (Italy) in 1980, and his DDS in 1984 from the University of Siena (Italy). Dr Cortellini is the founder of research non profit entities ATRO (Firenze IT) and ERGOPerio (Berne CH). He is Past President of the Italian Society of Periodontology and of the European Federation of Periodontology. Promoter and Coordinator of six “National Educational Projects” from SIdP, he was Scientific Chairman of Europerio 6 and of the 1st EFP Master Clinic. He runs a multidisciplinary private practice in Florence (Italy). Dr. Cortellini is involved in clinical research in periodontology since 1982, with special emphasis to periodontal regeneration, aesthetics, and diagnosis. Dr. Cortellini lectures extensively on a national and international level; he is referee of the main scientific journals in the field of periodontology, and is the author of more than 140 original publications in scientific journals.
Periodontal Regeneration in teeth Severely Compromised by Intrabony Defects and / or Furcations
Compromised teeth, molars in particular, represent a formidable clinical challenge, as they are lost or extracted with high frequency. Advances in regeneration of periodontal intrabony defects and the parallel development of newer biomaterials and novel surgical techniques have significantly changed the prognosis of single rooted teeth with increasingly complex defects. Similar significant clinical improvements can be achieved by applying periodontal regeneration to complex intrabony defects combined with furcation involvement in both maxillary and mandibular molars. Molars are characterized by the presence of deep pockets and by a pattern of periodontal breakdown that involves both apical and inter-radicular spread of attachment and bone loss. Deep pockets at molars are frequently associated with a combination of horizontal furcation defects, craters and intrabony defects at one or more of the roots. Application of periodontal regeneration to furcated molars has been an area of active investigation. The benefits include improvement in vertical clinical attachment levels, decrease in probing pocket depths, and improvements in horizontal and vertical furcation involvement. These surrogate outcomes also translated into excellent tooth retention observed during the follow-up period.
Dr. William Giannobile is the Najjar Endowed Professor & Chair of the Department of Periodontics and Oral Medicine at the University of Michigan School of Dentistry. He is also a Professor of Biomedical Engineering at the College of Engineering. He received his DDS and MS in Oral Biology from the University of Missouri. He later received his Certificate in Periodontology and Doctor of Medical Sciences in Oral Biology from Harvard University. He completed postdoctoral training in Molecular Biology at the Dana-Farber Cancer Institute and Harvard Medical School. Dr. Giannobile previously served as a faculty member at Harvard and the Forsyth Institute. He has served as a Visiting Professor at the University of Genoa Medical School Biotechnology Institute and in the Department of Periodontology at the Eastman Dental Institute, University College London.
Dr. Giannobile’s continuously funded research program from the National Institutes of Health over the past 25 years has focused on oral and periodontal regenerative medicine, tissue engineering and personalized medicine. Dr. Giannobile currently serves as the Editor-in-Chief for the Journal of Dental Research, the official journal of the International Association for Dental Research. He is a past-president of the American Academy of Periodontology Foundation and President of the Osteology Foundation. He is a Fellow of the American Association for the Advancement of Science (AAAS) and a Fellow of the International College of Dentists. He currently serves as the Co-Principal Investigator of the NIH-funded Michigan-Pittsburgh-Wyss Regenerative Medicine Resource Center that focuses on the translation of regenerative technologies to the clinical arena. Dr. Giannobile is a diplomate of the American Board of Periodontology and participates in a practice limited to periodontics and implant dentistry in Ann Arbor, Michigan.
Regenerative Medicine for Periodontal and Implant Reconstruction:
The Future is Now!
Repair of alveolar bone defects caused by periodontal and peri-implant tissue destruction is a major goal of oral reconstructive therapy. The field of regenerative medicine combines advances in materials science and biology to repair tissues and organs. Bone tissue engineering has been achieved with limited success by the utilization of barrier membranes, space fillers, and block grafting techniques. The use of biologics such as growth factors have entered into the clinical arena to offer another tool to treat periodontal lesions. This presentation will review emerging therapies in the areas of materials science, 3D printing, growth factor biology and cell therapies. Results from preclinical and clinical trials will be presented using stem cells, 3D printing and growth factors. The presentation will conclude with a future perspective on the use of novel biomimetic approaches such biomimetic scaffolding materials with the potential of accelerating dental implant osseointegration and periodontal tissue repair.
In 2006 and 2008 is the winner of The AAP Foundation-E Bud Tarrson Research Award in Oral Plastic Surgery
Single tooth replacement: the crucial role of soft tissues
Do the loss of buccal bone after tooth extraction represent an esthetic or functional limitation to implant installation? Do we really need bone to prevent bone resorption or regenerate buccal bone in order to achieve the best esthetic outcome? Can we functionally and esthetically compensate for the loss of buccal bone with soft tissue augmentation procedure only?
Soft tissues management around implants
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.
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.
1. Describe step by step the free gingival graft procedure to increase keratinised mucosa height before or after implant placement
2. Describe the surgical procedure combining transmucosal implant placement and simoultaneous submarginal connective tissue graft or collagen matrix
3. Describe step by step harvesting technique
Born in Lebanon
1978: DMD, St. Joseph University, Beirut.
1978-1979: Department of Oral and Maxillofacial Surgery of the University of Freiburg, Germany.
1979-1994: Assistant Professor and later Associate Professor at the Dep. of Oral and Maxillofacial Surgery of the University of Muenster, Germany
1984: Diploma in Oral Surgery and Doctorate in Medical Dentistry.
1988: Habilitation and senior surgeon at the dep. of Oral and Maxillofacial Surgery of the University of Muenster
1994: Professor at the University of Muenster
Chairman and Director of the Privatklinik Schloss Schellenstein, Olsberg, Germany.
Professor at the Dep. of Oral and Maxillofacial Surgery of the University of Muenster.
Member of editorial board of several international journals.
Chairman of the examination comity for Oral Surgery.
Board member of the German society of Oral surgery
Several Prices (e.g. Pioneers in Dentistry 2016 AUB, W. Laney Award 2017 American A. Osseointegration) and Patents. Author of 3 bestseller Textbooks translated in to more than 10 languages.
More than 125 Publications and 1000 Lectures / Courses worldwide.
Augmentation of Severe Bony Defects with Intra Oral Bone Grafts: Biological Approach and Long Term Results
Autogenous Bone graft is still the gold standard for the reconstruction of severe atrophy of the maxilla or the mandible. Two & 3 dimensional bony defects need for the reconstruction special surgical procedures with autogenous bone grafts to assure at long term an acceptable functional and esthetical result. Biomaterials have here their limitation and are for such reconstruction until today not an alternative due to their poor regeneration potential.
Autogenous bone graft harvested from intraoral sites, especially the retromolar area of the mandible, and used following the split bone block (SBB) technique is offering many possibilities for intra operative facilities and stable long term results. Splitting the thick cortical block to 2 or 3 thin blocks is augmenting the number of blocks allowing the reconstruction of larger atrophic crest and giving a better adaptation to the recipient site with individual determination of the width and the volume of the grafted area. Filling the space and gaps between the thin block and the remaining crest with particulate bone chips is reducing the time needed for revascularization of the graft improving its vitality compared to the original thick block. Long term studies are confirming that Implants inserted in this augmented area presented similar osseointegration as implants placed in non grafted bone.
This presentation describes practical aspects and results of those techniques that make possible long-term esthetic and functional implant restorations:
Rino Burkhardt graduated from the University of Zurich and received his doctorate from the Medical Faculty of the same University. He is an EFP (European Federation of Periodontology) certified specialist in periodontology and received his Masters degree from the Medical Faculty of the University of Berne (MAS in Periodontology).
In 2004 he won a prize from the European Federation of Periodontology for his research in microsurgery. Since 1996 he runs a private clinic in Zurich, limited to periodontology and implantology. He is a senior lecturer at the University of Zurich and honorary professor at the University of Hong Kong. Currently, he is the president of the Swiss Society of Implantology and vice president of the Clinical Research Foundation for the Promotion of Oral Health.
Passive wound closure in mucosal surgery - revisited
Since decades, the tenet of passive wound closure is described as a key factor for uneventful healing. New insights into structural anatomy of the oral mucosa and the biological processes support the hypothesis that tension is needed for optimal healing.
It is the goal of the presentation to shed light on the mechanosensing of connective tissue cells and the mechanisms how minimally-invasive approaches can regulate healing patterns. Additionally, the critical factors that should be controlled by the surgeons are discussed and presented by clinical cases.
Received his MD degree (1981), DDS degree (1984). Specialty in Orthodontics (1986) from University of Milan, Italy.
Fellowship at the Division of Oral Maxillo-Facial Surgery (Head: Robert E. Marx, DDS), School of Medicine, University of Miami, Miami FL (2000).
Head of the Section of Implant Dentistry and Oral Rehabilitation, Department of Biomedical, Surgical and Dental Science (Chairman: prof. L. Francetti), IRCCS, Galeazzi Institute, Milan, Italy.
Adjunct Clinical Associate Professor, Department of Periodontics and Oral Medicine, The University of Michigan, School of Dentistry, Ann Arbor, Michigan 48109-1078.
Founder and Scientific Director. Lake Como Institute (LCI) Implant Advanced Training Center, Como, Italy.
Past-President (2017-2018) of the Italian Academy of Osseointegration (IAO).
Member of the Editorial Board of IJOMI, EJOI, IJPRD, Quintessence Publishing.
Author of 123 peer-reviewed publications indexed in Pub Med.
Author of three books in Implantology edited by Quintessence Publishing.
Minimally invasive treatment of the atrophic maxilla: a revisited clinical vision after 30 years or research and clinical experience
Maxillary sinus elevation surgery has evolved during the last 25 years to a point where it is considered the most successful augmentation procedure performed today and the survival rate of implants placed in these grafts is as high or higher than that of implants placed in the non-grafted posterior maxilla. The sinus elevation procedure is still evolving due to the development of new surgical techniques and new biomimetic technologies, however, there is still no unanimous consensus on when to adopt the lateral/crestal approach or alternative treatments like short, transinus and tilted implants. This lecture will address both evidence-based and the latest state-of-the-art techniques.