Day 1 – Thursday, 18 May
Pre-symposium Opening “Technological innovation helps the clinic”
Moderators: Juan Blanco & Luca Cordaro
Success factors in the treatment of gingival recession defects
Aesthetic and functional goals require implants placed in prosthetical ideal position and thereby the need to augment a resorbed ridge. A wide variety of techniques, some of which are very invasive are discussed in the community. The goal to proceed as safely, minimally invasively and as cost-intensive as possible often falls by the wayside. The author will evaluate and critical appraise the current literature and evidence and present a simple modified tenting technique as a consequence. He will deepen these results on the basis of clinical cases and long-term data.
- Basics of bone healing
- Comparison of the properties of various bone substitute materials
- Presentation of a simplified method of extensive augmentation
Predictable and high-quality bone regeneration
Guided Surgery – Is it time to move out of the stone age?
This lectures overviews and questions whether the full arch rehabilitation is the panacea for life for edentulous patients. It discusses the rationales for their application and examines new ideas and options available to the implant dentist.
- Does the full arch rehabilitation meet the patients expectations long-term, and has our understanding improved
- How has the full arch rehabilitation process changed in 25 years and is the prognosis more favourable
- Does our modern day technologies minimise peri-implantitis for full arch patients
Fazeela Khan Osborne
After injury or surgical intervention, platelets are natural reservoirs of growth factors and cytokines that play a critical role in healing through the formation, maturation, and repair of soft and hard tissues. Platelet concentrates (PCs) have been used to improve such healing in multiple applications throughout medicine and dentistry since the 1940s. As technology has evolved, the development of second-generation PCs, including leukocyte-rich platelet rich fibrin (L-PRF) have become an integral part of many dental practices due to the lower cost of preparation, the ease and high rate of patient acceptance of autologous materials, and the myriad oral applications for enhancement of hard and soft tissue grafting procedures. This course will seek to review the current understanding of the underlying mechanisms of action of L-PRF as well as the evidence regarding its utility in oral surgical procedures and its capability to improve handling characteristics of graft materials. Further, we will review the step-by-step protocols for L-PRF preparation from venipuncture through insertion into a patient in a variety of clinical scenarios and will provide hands-on practice with these steps to allow dental healthcare practitioners to develop new skills to apply in practice.
- Identify different platelet concentrates (PCs), preparation protocols, and the advantages and disadvantages of these PC for use in oral surgical procedures.
- Describe the effect of PCs on the different cells involved in the regeneration of oral tissues and the evidence of how these impact healing after oral surgical procedures.
- Evaluate the clinical applications for the adjunctive use of PCs to improve oral hard- and soft-tissue regeneration outcomes.
The benefits of L-PRF in oral “regenerative” procedures.
Leucocyte- and platelet-rich fibrin (L-PRF), a 2nd generation platelet concentrate, is an 100% autologous blood derived product, which can be obtained, quickly and at low cost. L-PRF is chair-side produced from peripheral blood, which is immediately centrifuged without any anticoagulants.
L-PRF is rich in fibrin, platelets, and leucocytes (20-fold higher concentration than whole blood) and can be transformed into relatively strong membranes circa 0.5 mm in thickness. These L-PRF membranes releases large amounts of growth factors for a long period (up to 7 days) and possess antibacterial and angiogenic capacity. As such L-PRF membranes offer “significant” and “clinically relevant” advantages in soft- and hard tissue regeneration including ridge preservation, sinus floor augmentation, horizontal/vertical bone augmentation, and osseointegration.
My presentation will give you the support to use this new “concept” without further dilemmas!
3D bioprinting and other novel aspects of tissue engineering
Siddharth Vivek Shanbhag
WISE Happy Hour
Day 2 – Friday, 19 May
Welcome and opening
Luca Cordaro & Mariano Sanz
Session 1 – Treatment planning in the digital era
Katja Nelson & Dehua Li
Digital planning in the esthetic zone
A comprehensive planning and perfect execution of implant dentistry protocols for full arch cases always has been challenging. Minor errors can have detrimental repercussions on the longevity of the work we do. This presentation aims to present a novel classification system for planning of full arch cases. From assessing the available bone, to lip lines and determining the final prosthetic material and design; all this keeping the patients age in sync with the proposed treatment is the need of the hour. The classification is open ended to allow room for all philosophies of implant dentistry from tilted implants to zygoma or pterygoid implants and any grafting protocol in between. It has the bandwidth to allow all the current digital protocols as well as time tested analogue ones, thereby making this a truly patient-centered approach.
- Understand the interplay of factors in the ABCD algorithm and use it for effective treatment planning
- Understand the selection criteria for materials and designing options in modern full arch implant dentistry
- Understand the workflow of Digital Dentistry in full arch implant prosthodontics
Udatta Kher & Ali Tunkiwala
The evolution of Implantology has allowed for new standards to be reached, hard to imagine only a few years ago. Now, new challenge is to treat the patient through a simpler way while maintaining or even improving the high level of treatment quality.
The accurate planning of the clinical case is extremely important in achieving this goal and, during the last few years, the impact of digitalization has hugely improved the way to address the implant treatment.
In fact, computer-guided planning, intra oral scanning and digital tools are the modern keys to optimize the implant positioning in relationship with the bone availability and the ideal prosthetic plan.
Nevertheless, there are few details of the procedure that, even nowadays, are still well managed by using an analog approach.
During this lecture, these details will be taken into account with the purpose to discuss when the complete digital workflow is not the first choice and which are the steps that should be treated from the analog side.
Session 2 – Timing in implant treatment
Post-extraction socket development
For a successful and predictable implant therapy in the esthetic zone we need to know that advantages and disadvantage of delayed versus immediate implant placement.
As a clinician you need to know the long-term prognoses of both treatment modalities, you need to know the limits and chances for the esthetic outcome and you need to know your personal limits in different clinical situations.
Based on complications of esthetic cases you will better understand how to make the right decisions for every individual case and to choose the right timepoint after tooth extraction.
- You will learn the advantages and disadvantages of delayed implants
- You will learn about the long-term outcome of immediate implants versus delayed implants in the esthetic zone
- You will understand how to make the right decisions for every individual case related to immediate versus delayed implant placement
Ronald E. Jung
Minimally invasive procedures keep the vascularization of the alveolus avoiding scars and other esthetic complications. New development in periodontal procedures allow the clinician to reconstruct the hard and soft tissues in predictable ways.
This lecture explains the diagnosis and digital protocol along with the prosthetic and periodontal planification in order to get predictable results with immediate implants in different clinical scenarios.
- To understand the advantages of Immediate Implants
- To reason the importance of Soft tissue management to achieve stable results in the rehabilitation of the esthetic area
- To comprehend how to be more efficient applying digital workflows
Session 3 – Treatment of soft tissue defects: do we have relevant innovation?
Treatment of soft tissue defects: Do we have real innovation?
The role of keratinized mucosa
Dental implants have demonstrated high survival rates in the last decades, however with the ever-increasing attention to esthetics and integration of the restorations that are placed in the patients oral cavity, the pink esthetics have gained relevance. Dental implants, particularly in the anterior zone, are expected to blend within the patients smile and subtle changes in the length of the restoration, color and contour of the soft tissue may be quickly appreciated by the patients. It is for this reason that the prevention and treatment of soft tissue defects around implants has recently gained attention by the scientific community. The keratinized mucosa has been considered to have a protective role in development of peri-implant mucositis and peri-implantitis but also in the development of mucosal dehiscence’s around implants. The objective of this presentation is to elaborate on the role of keratinized mucosa in the development of these conditions and to describe the available surgical techniques used to improve the amount of keratinized mucosa around dental implants.
Ignacio Sanz Martin
To be functionally useful, oral implants have to pierce the gingiva and enter the oral cavity, thus establishing a transmucosal connection between the external environment and the inner parts of the body. Still, the major goal is to obtain long-term peri-implant health based on stable soft tissue dimensions. Thus, periodontal plastic microsurgical soft tissue grafting procedures are increasingly performed in conjunction with dental implants. From a biological point of view the gain of keratinized mucosa and soft tissue thickness is associated with stable peri-implant health. From an esthetic point of view, increased soft tissue thickness (thick peri-implant phenotype) may decrease the risk of recessions and loss of papilla-like tissue. Since almost 50 years the connective tissue graft is used for periodontal indications (Edel 1974). Hundreds of studies were published and made this technique to the Golden Standard. Nowadays new biotechnological materials enter the dental field to replace the subepithelial connective tissue transplant in order to avoid the donor harvesting surgery. The lecture checks wether there are still advantages for CTGs and which modifications in microsurgical techniques surpass those of biotechnological matrices.
S. Marcus Beschnidt
Treatment of soft tissue defects at dental implants is still a great challenge for the clinician. A number of factors such as position of the implant within the bony envelope, presence or absence of supporting bone, recession depth and width, and thickness of the soft tissues may limit the management of soft tissues and consequently impair the outcomes. Emerging evidence indicates that by having a correct indication, the modified coronally advanced tunnel (MCAT), the laterally closed tunnel (LCT) or the very recently described combination of MCAT and LCT in conjunction with connective tissue grafts, certain collagen based soft tissue grafts alone or combined with biologics may result in predictable outcomes and long-term stability.
Xenogeneic three-dimensional (3D) collagen matrices may represent an alternative to autologous soft tissue grafts in periodontology and implant dentistry. In a series of experiments, we have investigated the adsorption and release of growth factors from four 3D collagen-based matrices and the migratory, proliferative, wound healing, and differentiation potential of primary human oral fibroblasts (hOF), primary human periodontal ligament cells (hPDL) as well as two osteoprogenitor cell lines in response to four clinically used matrices.
Among the evaluated matrices, a newly introduced hydrated acellular dermal matrix (HADM) has consistently been shwon to exhibit stronger positive effects on the oral cellular behavior. Furthermore, new data strongly support the biofunctionalization of the 3D matrices as a potential treatment modality for soft tissue and bone defects in the clinical setting.
The aims of the presentation are
- To outline the indications and contraindications for correction of soft tissue defects at dental implants.
- To present the biologic rationale and the clinical indication for using soft tissue replacement materials for the correction of soft tissue defects at dental implants.
Session 4 – CAD/CAM implant supported restoration – are they a must?
The dental world is changing and making the right decision for our patient gets more and ore complex nowadays. Especially the digital workflow goes far beyond intraoral scanning and CAD/CAM of dental restorations. Especially in the field of implantology, digital planning and full digital processes are possible, however still have limiting factors. The fast development in technology and the range of uncountable material-options for all treatment steps make it difficult for dentists and technician to keep an overview.
The lecture will give an overview of current technological possibilities, workflow and material options and dares to bridge the gap between scientific background and clinical application in daily routine. Starting at impression taking – over individual gingiva formers to implant supported restorations.
In short – which workflow, which material make sense and what are the parameters that matter to be successful because the knowledge makes the difference!
Jan Frederik Güth
The one abutment one time concept presents biological advantages. In this lecture, the literature background and the practical aspects of this concept will be introduced and discussed.
For worfklow efficiency purpuses, and thanks to the possibilities the Ti-base components and the digital workflow offer, the one crown one time concept was developed. The approach of the Geneva Team of Fixed Prosthodontics to this evolved concept will be presented, reviewing its advantages, limitations, and tips and tricks for its application in the clinics.
Participants’ learning objectives
- Literature background of The One Abutment One Time concept.
- Advantages, limitations and application of The One Crown One Time concept.
Cristina Zarauz & João Pitta
Digital workflow or analog approach?
Science Slam – Award ceremony
Dolce Vita Night
Day 3 – Saturday, 20 May
Session 5 – Young OR Foundation Researchers
High vs low insertion torque-primary stability and crestal bone changes
In vivo precision of intraoral scanners
Fracture behaviour of lithium-disilicate crowns retained on two-piece screw-retained zirconia implants
Effect of different peri-implantitis treatments on implant surface properties and cytocompatibility. An in vitro study
Root coverage of non-carious cervical lesions with dermal matrix. What is the difference?
Marilia Bianchini Lemos Reis
OR Foundation Research Award
Session 6 – Can we influence bone and soft tissue healing around implants?
This lecture aims to examine the current concept of using soft tissue graft to manage implant-related dehiscence defects. The significance of keratinized mucosa and tissue thickness on peri-implant health will be examined, as well as various methods regenerating attached keratinized tissue and increasing thickness of peri-implant mucosa. Additionally, the durability of these procedures will be thoroughly discussed.
- Understand the concept of peri-implant phenotype and its relevance to both health and esthetic outcome with dental implants
- Learn how to perform various soft tissue grafting procedures around dental implants
- Understanding the durability of these grafting procedures
For an ideal implant-supported restoration, the surgical phase should be planned in advance and the implant should be placed according to well/known recommended three-dimensional parameters. This should leave enough space from the head of the implant, to the cervical part of the tooth’s anatomy, to be able to sculpt the provisional restoration according to the anatomy, height and soft tissue volume of the patient’s adjacent teeth. Soft tissue aesthetics should be modelled during the provisional phase of the treatment, bearing in mind that critical or subcritical contour changes have important clinical implications. During this lecture, concepts for ideal emergence profile during the provisional phase will be discussed and reviewed in order to optimice the esthetic result.
- How to plan and execute an ideal emergence profile in an immediate implant placement procedure.
- Review concepts of critical and subcritical contour for sculpting periimplant soft tissues.
- Define the value of immediate provisionalization after osseointragration and soft tissue maturation.
Today the demand from dental implants include osseotintegration, prosthetic stability and aesthetic Different implant design has shown to influence osseointegration to bone by primary stability and secondary bone growth ,The height of soft tissue adhesion ,maintenance of bone is also influenced by implant design. The lecture will provide the rational on the dependence of implant success and osseointegration by implant design ,Newly formed bone and soft tissue can be also influenced by different implant manufacturing aspects Also after osteointegration how implant are designed or used can help to maintain bone or promote periimplantitis. Implant success does not depend upon just one factor; it is an accumulation of implant design characteristics which are important in load transfer and maintaining implant success.
Implant selection depends upon case to case, but it should be understood that one sole factor will not account for success and different factors might have an effect on the outcome of implant therapy.
Session 7 – Do digital technologies really help the implant surgeon?
Implant dentistry continues to evolve and one of the most efficient and modern treatment strategies is immediate loading. This lecture will illustrate novel full digital approaches like the Simplified Digital Protocol (SDP) and the Minimally Invasive Full Arch Protocol (MIFA). These innovative protocols will allow the clinicians to deliver the final prosthesis in a very cost-effective and efficient way.
- Identify the step-by-step surgical /prosthetic procedures in treating fully edentulous and partially edentulous patients
- Apply the Simplified Digital Protocol (SDP) or MIFA Protocol in your clinical practice as a routine
- Understand how to improve the practice by means of efficient procedures
Digitalization and advanced technologies are constantly incorporated in implant dentistry. Mainly, computer supported implant planning and guided surgery.
It is well established that implant insulation using guides will enable a more precise outcome. However, to master these advanced tools and reach an accurate result, we must have a comprehensive understanding of the digital workflow to control process errors.
In this presentation, the digital workflow for dynamic and static guided implant placement will be introduced and challenged. Highlighting potential errors, alongside suggestions for amendments to prevent it.
- Indicate the value of computer supported implant planning and guided surgery as a standard of care.
- Understand the inherent risk the digital tools present us with.
- Critically review of possible process errors in the workflow of dynamic and static guided surgery.
Challenging situations in dental impantology are not only defined by limited bone quantity but also by general medical aspects of patient health. In recent years the development of planning systems has helped us to visualize and discuss different therapy options and guide patients in decision making. The digitalization process also allows to plan bone augmentation procedures with respect to the later implant position. Thus, nowadays “back ward planning” now includes also the augmentation (or use of implants with smaller dimensions). In the first step the selection of the most appropriate augmentation technique is facilitated. Also 3D planning of individual Ti meshes or customized bone blocks is possible. 3D models can be sterilized and used during the operation. The lecture will focus on scientific and practical aspects of this interplay between digital planning and complex reconstruction procedures.
- Understand the use of the digital workflow with integration of augmentation procedures.
- Select appropriate augmentation procedure based on “digital facts”.
- Understand the development and future options of augmentation procedures based on the digital work flow.
Session 8 – Hard tissue augmentation with the conventional approach
The long-term success of bone reconstruction depends of a precise diagnostic, atraumatic surgery, the amount of vascularisation and vitality of the grafted area, correct implant position as well as a systematic soft tissue augmentation. Autogenous bone grafts harvested from the mandible, and used following the split bone block (SBB) technique are offering many possibilities for intra operative facilities leading to a high vascular support of the grafted area which is important for 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. 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.
- Minimal invasive bone augmentation: the “carrot technique”
- Split bone block technique and biological concept
- Vertical 3D bone augmentation: the “Box technique”
- Technique of pedicle connective tissue flap.
Dental implants are a successful and predictable treatment option for missing teeth, where most patients and clinicians seek this treatment to replace missing teeth. Favorable implant outcomes depend greatly on adequate bone and soft tissue for restoratively-driven implant placement, long-term function, and optimal esthetics. For the practicing clinician, predictability of grafting techniques and materials is extremely important where they must understand indications, advantages, disadvantages, risks, and complications. For many years, autogenous bone grafts have been the “gold standard” for bone grafting procedures. Is this still the case in 2023? When are block bone grafts indicated, and should all clinicians be able to offer these techniques to their patients? What is the role of allogenic, xenogenic, or synthetic block grafts? Or, have particulate grafts replaced block grafts entirely? This presentation will update the practicing clinician on advances in block bone grafting techniques and technologies, as well as their advantages, complications, and limitations.
- This presentation will discuss indications, advantages, and complications of block bone grafting to facilitate implant placement.
- This presentation will familiarize the participant with the various types of block bone grafting materials.
Dental implants are the treatment of choice in the majority of the edentulism. A significant lack of bone volume, in the alveolar ridge, compromises the final prosthetic restorations from an aesthetic as well as functional point of view. Therefore, ridge bone augmentation is one of the critical surgical approaches to obtain a successful result. Currently there are several possibilities to deal with this technique, being guided bone regeneration (GBR) one of the most scientifically approved to be used in daily practice. This procedure can be managed simultaneously or in a staged approach in relation to the implant installation. Both options can be effective for repairing bone defects and improving the chances of a successful dental implant procedure. The decision on which approach to use will depend on the specific needs and circumstances of the local anatomy of the defect.
In this conference we will update the scientific evidence of this “conventional” technique, showing several cases in different clinical scenarios with a long-term follow-up.
- The attendees will be able to differentiate the diverse bony defects to select the simultaneous or staged approach.
- The attendees will be familiarized with the different flaps (soft tissue management) to obtain an optimal bone regeneration.
- The attendees will have knowledge of the different biomaterials (grafts and membranes)
End of Congress
Oral Reconstruction Foundation
Phone: +41 61 565 41 51
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