Bone & Soft Tissue Regeneration Conference

ABOUT THE COURSE

Factors influence the results in regeneration:

This part of the presentation will dive deep into an unknown territory of new research on the topography of the vertically regenerated bone. There is new evidence showing that when a clinician decides not to use a membrane or if a mis-adapted membrane is utilized, soft tissue fibers like Sharpey’s fibers will grow into the bone graft and may potentially result in bone loss around loaded implants. This presentation will discuss how to prevent and how to treat this type of phenomena that if untreated will result in late biological complications around implants.

Factors such as narrow basal bone before vertical augmentation as well as the importance of the angulation of the distal bony wall will be discussed in detail. The decision making of the so called “pawn sacrifice” will be also included in this part of the course. The change from “baby bone” to the corticalized ridge and the shredding off the so called “smear layer” in the process will be demonstrated. All this important information will make sure that the clinician who will perform vertical ridge augmentation will make the appropriate decisions for long term clinical success.

The mandibular vertical ridge augmentation:

The mandibular ridge augmentation should be an important part to master for every clinician who is performing ridge augmentation. This presentation will focus on the understanding of the surgical anatomy of the floor of the mouth based on several anatomical studies published by the author. The anatomically based modified lingual flap will be described in detail. This technique has been scientifically proven to be the most effective to date.  Flap advancement around the mental nerve is a crucial part of the surgical procedure. This presentation will discuss the details of nerve management in different clinical scenarios such as fibrotic and scar tissue patients. Lingual fixation of the membranes is challenging for many of the colleagues. Newly redesigned fixation tools and the design and use of digital membrane guides will be explained in detail. The digitally re-designed membrane technique will be explained.

Revolutionary “Island” technique for patients with a complete exposure of the mandibular nerve using digitally fabricated nerve guides will be revealed.

This presentation will not only discuss the posterior mandible, but also the extreme atrophy of the anterior mandible.

The Maxillary Vertical Ridge Augmentation:

The anterior maxillary vertical defect is a complex challenge since the vertical defect resulting in a loss of facial support. This results in asymmetrical and unsupported facial appearance that is greatly disturbing to the patient.

Flap design including the position of crestal incision position as well as the extension of the flap greatly depends on the vestibular depth, amount of keratinized tissue available. Minimally invasive flap management using the periosteo-elastic technique is crucial part of better soft tissue healing, but also in the prevention of any infraorbital nerve branch or arterial injuries. Techniques such as the suborbicularis preparation, the periosteoplasty, the papilla shift are going to be demonstrated and explained during high quality video presentations.

Minimally invasive bone harvesting techniques, membrane adaptation and fixation techniques are also going to be demonstrated in conjunction with digital membrane placements. Combination of vertical ridge and sinus augmentation is a frequently needed surgical procedure in the reconstruction of the posterior maxilla. In severely defective cases the clinician must master techniques such as the “Island technique”, the “Atomic bomb design” are essentials for success.

Soft Tissue Reconstruction of the Peri-implant Papillae using the Labial Strip, Iceberg and Garage Soft tissue graft techniques:

For extreme vertical deficiency in an attempt to achieve wound closure and hence graft stability, the buccal mucosa is often broadly released, and this often results in a severe apical translocation of the mucogingival line, loss of vestibule and keratinized mucosa (KM).

The need to graft these large mucosal areas necessitates the harvest of an autograft with enough size and dimension to achieve the desired outcome, and this may lead to significant patient morbidity. Therefore, there was a need for the development of less invasive surgical procedures. Recently, a combination of a strip gingival graft in combination with a collagen matrix was introduced to reconstruct the lost vestibule and keratinized tissue. Further research demonstrated that this regenerated tissue is keratinized. However, any open healing graft that is harvested from the palate will have different color and texture than the neighboring tissue. Therefore, there was a need to further develop a more esthetic grafting technique. A recent clinical study demonstrated that strip gingival graft harvested from the neighboring labial gingiva will result in significantly better tissue color.

In addition to the lack of peri and inter implant papillae can be a significant esthetic and functional problem to the patient. This presentation will demonstrate two novel surgical techniques the Iceberg and the Garage connective tissue grafts to reconstruct the lost papillae.