Reconstructive procedures in periodontology aim at regenerating the lost periodontal supporting tissues which have been lost following periodontal disease. During the last decades, several treatment modalities including the use of bone grafting materials, barrier membranes, enamel matrix derivative (EMD), some types of growth factors or various combinations thereof, have been shown to promote periodontal regeneration (i.e. formation of cementum, periodontal ligament, alveolar bone and gingiva) to a varying extent.

In recent years, a better understanding of the biology, combined with improved surgical techniques yielded to clinical concepts enabling predictable treatment outcomes in intrabony, furcation, and also recession-type defects. In carefully selected patients and defects, in conjunction with a strict pre -and postoperative infection control, reconstructive periodontal surgery may lead to substantial regeneration of hard and soft tissues and clinical benefits evidenced by probing depth reduction, gain of clinical attachment, defect fill and improved esthetic outcomes. Moreover, longitudinal studies have also provided evidence for long-term stability of the clinical outcomes, thus pointing to the clinical relevance of these concepts in improving tooth prognosis. Very recently, new formulations of EMD such as Osteogain combined with various types of bone grafting materials or collagen matrices have been shown to positively influence periodontal wound healing/regeneration.

In the last years, the use of innovative surgical techniques such as the Modified Coronally Advanced Tunnel (MCAT) or the Laterally Moved Tunnel (LMT) combined with connective tissue grafts or collagen matrices with or without EMD have been proven as predictable methods for obtaining predictable coverage of single and multiple gingival recessions, latest data indicating long-term (up to 10 years) stability of the results. In certain, well selected, cases the MCAT has been also successfully used to correct soft tissue defects around dental
implants.

The present course will provide the scientific background for a biologically driven philosophy in reconstructive periodontal surgery while presentations of clinical cases and of surgical videos will demonstrate the step-by- step procedure of these concepts in various clinical scenarios.

 

 

This presentation will review the contemporary interdisciplinary concepts in management of the aesthetic zone and the contemporary surgical and prosthetic concepts in management of implants in the aesthetic zone with a view to achieving optimum long-term aesthetics and stability.

 

Furthermore, the aesthetic rehabilitation of the periodontally and structurally compromised dentition and inadequate or failed implant treatment in the aesthetic zone remains a challenge despite the numerous advances in the treatment of periodontitis, regenerative and dental implant therapies. With this in mind, novel ‘out of the box’ approaches for aesthetic rehabilitation of complex aesthetic & restorative dilemmas will be presented.

 

Participants will :

- Learn the key principles for the treatment planning and management (both surgical & prosthetic) of implant restorations in the aesthetic zone

- Gain an understanding of the biology of the peri-implant tissues, the post-extraction site and the application of this knowledge to clinical decision-making.

- Learn the principles of bone and soft tissue management around implants, as well as how to manage bone and soft tissue defects in post-extraction sites and peri-implant defects

- Learn to manage both delayed and immediate implants

- Learn the benefit of interdisciplinary case management

- Strategies for aesthetic rehabilitation of complex aesthetic & restorative dilemmas will be presented and discussed

- Review a systematic approach to case management in complex cases

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. Patient selection, patient preparation for surgery, precise surgical techniques and postoperative management are the key factors in reducing the rate of bone graft complications.

 

To predictably achieve successful bone augmentation angiogenesis, clot stability and space maintenance should be employed. In an attempt to achieve wound closure and hence graft stability, the buccal mucosa are often broadly released, and this often results in a severe apical translocation of the mucogingival line, loss of vestibule and keratinized mucosa (KM).

 

Mandibular vertical ridge augmentation will be discussed. The detailed surgical anatomy of the floor of the mouth, the Modified Lingual Flap as well as the technique for protecting the mental nerve will be presented in details.

Recent research of the SAUSAGE TECHNIQUE^TM as well as minimally invasive soft tissue reconstruction will be presented.

 

Utilizing these procedures may lessen the need of harvested autogenous bone and may generally lead to decreased morbidity and therefore increased patient comfort and satisfaction associated with these regenerative procedures.