This lecture will discuss soft tissue components of the peri-implant phenotype and the biologic classification of soft tissue graft materials from clinical perspectives to highlighting the characteristics and predictability of soft-tissue graft materials in different clinical scenarios. 

The principles, selections, procedures and technique notes of managing peri-implant phenotype modification via soft-tissue grafts and flaps in a less invasive but more predictable ways to increase soft tissue volume, augment keratinized tissue, improve implant esthetics, etc will be demonstrated to not only achieve long term stability but also avoid implant complications for the next generation of practice.

The era of digital dentistry has exploded in the last 20 years and has fundamentally changed our profession. However, it has also come at a price which questions our biologic compass as treatment has become heavily predicated on computer-guided expectations compared to decision making based on surgical experience and core treatment planning principles. From each full volume CBCT scan, a historical picture of growth and development can be gleaned, influencing our decision making. To that end, each treatment plan we put forth and the materials we choose to alter or influence bone can have consequences on the healing dynamics, the esthetic/biologic outcomes realized and, ultimately, our successes in creating sustainable conditions. The digital era has not only provided better diagnostic capabilities to assess and plan, but has given us expanded planning modalities to design more personalized surgical therapies when complex bone construction efforts are needed. This presentation will provide a historical background of guided implant technology, review current digital therapies and provide a look into the future where artificial intelligence may change the paradigm even further.

To achieve predictable and optimal outcomes, contemporary multidisciplinary treatment in periodontal patients should aim to achieve not only functional stability but also aesthetic harmony. The sequelae of periodontitis represent a complex therapeutic challenge. Among them, tooth replacement in the anterior zone with dental implants implies careful diagnosis and treatment planning in the context of interdisciplinary dentistry. In this lecture, protocols to facilitate the execution of interdisciplinary treatment plans to rehabilitate the aesthetic zone in patients with a history of periodontitis will be  presented, with a special focus on minimally invasive techniques.

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.

Soft tissue grafting has emerged as a valuable technique to address these complications and enhance the esthetic and functional outcomes of dental implants. This presentation reviews the current literature on the management of peri-implant deformities using mainly soft tissue grafting techniques. A treatment-driven classification will be presented, consisting of three different levels of complexity. Clinical recommendations pertaining to the prosthetic and surgical management of each type of peri-implant marginal mucosal defect will be illustrated with practical examples, facilitating decision-making processes in daily practice.

This presentation will focus on the selection of regenerative approaches in the treatment of peri-implant defects. Open versus closed healing approaches using different graft materials and growth factors will be demonstrated. Surface decontamination is an essential part of the success of this therapy and implant macro as well micro design plays an important role of the success.
 

Non-confined, vertical defects around peri-implantitis involved implants are considered to be the most challenging. This presentation will also discuss surgical approaches treating these demanding defects around implants. A decision tree of techniques selection based on defect type when treating peri-implantitis will be presented.

Many of the peri-implantitis lesions treated today are complex in their bone morphology as the remaining walls surrounding the affected dental implant are not always circumferential i.e. clot/graft containing in their configuration. Moreover, the disease process may also leave portions of the implant body supracrestal to any remaining lesion. This is due to a variety of factors including the position of the dental implant. In those areas where regenerative treatment is not possible, it may be best to decontaminate the surface with implantoplasty and manage the remaining lesion through resection. The goal is to establish heath with cleansability. On the other hand, there may be a number of combination lesions where a hybrid approach i.e. regeneration with resection should be provided. This lecture will explore the reasons and benefits to using implantoplasty as a monotherapy as well as in combination with regeneration.

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. However, it has been demonstrated that successful clinical outcomes can be predictably achievable when strict protocols are followed. The detailed understanding of clinical anatomy should guide the clinician when managing the soft tissue flaps in an attempt to securely close the flaps to achieve optimal healing environment of the graft. Graft immobilizations, the optimal use of graft materials are essential in achieving bone formation even in a distance from the bony walls. This presentation will summarize the essential steps of ridge augmentation and gives an insight how a clinician can learn these demanding procedures.

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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, especially in the mandible, it is common to face clinical scenarios in which there is complete absence or a minimal quantity of keratinized tissue, as many times this is 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 time, 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 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.

This workshop is designed to help dentists manage peri-implantitis with higher predictability, less trauma and therefore increase both the dentist’s confidence and patient’s acceptance when dealing with peri-implantitis. Participants will learn the principles and techniques to provide more predictability and less trauma for their patients in the management of peri-implantitis.

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 post-surgical 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 how  to achieve a safe, tension-free closure will be discussed during this practical course.

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The role of digital technologies in dental implant therapy has rapidly expanded over the last 15 years. CBCT imaging for implant planning is now an industry norm. The use of surgical guides, however, continues to lag significantly behind. Recent changes in software accessibility and 3D printing remove many of the obstacles hindering wider adoption. Join us as we discuss the latest developments in guided implant surgery with a focus on in-house management of the process. 

For natural appearance of implant-supported prostheses placed in aesthetic areas, the preservation and/or reconstruction of the tissue volume is crucial in many instances. Soft tissue, bone, or combined augmentation may be attempted to reduce alveolar ridge defects and enhance the alveolar contour at the edentulous segment. However, while adequate tissue volume around anterior implants is a key to aesthetic success, proper management of the provisional and definitive restoration are of paramount importance to obtain optimal esthetic results.

In this hands-on session, fundamental concepts for subgingival abutment design and the role of the critical and subcritical contour to sculpt the peri-implant soft tissues, including the mucosal margin level, architecture and color, will be described step-by-step.

Treating the biologic complications of peri-implant mucositis and peri-implantitis has remained a conundrum for clinicians. As the use of lasers in dentistry has continued to expand in both acceptance and application, employing them for managing these two conditions has been one approach to gaining greater predictability and success.  This lecture will update the audience on scientific evidence for laser use for both peri-implant mucositis and peri-implantitis. Clinical cases will also be provided showcasing why different lasers are being employed by practitioners as an integral part for managing implant biologic complications.

Restoration of the dental implant represents a clear challenge for the dentist. Not only immediate, such as what type of connection, cement or screw retained, the material to use, but also how to best implement the tools we use such as torque wrenches. Beyond the initial restoration goes the challenge of maintain the site- evaluating for disease- what tests to use and how useful they are. Then comes contact point issues, which are known to open during normal aging and the sequalae that comes with these tooth movements (food impaction, caries screw loosening, periimplant disease, material fracture..) This lecture will discuss how research has helped answer some of these clinically relevant questions along with advice on how to manage the problems we all have for best practice.

In dentistry, we live in a constantly changing environment. New workflows, materials, techniques and products inundate our lives on nearly a daily basis. In this presentation,

we will examine the most current concepts and controversies in the diagnostic, surgical, and restorative aspects of implant dentistry in order to simplify and streamline their application into your daily practice.