Lunch with the Masters

With peri-implantitis on the rise, laser therapy for implant surface detoxification is becoming more demanding than ever! This session aims to bridge the knowledge gap between fundamentals and clinical applications of lasers used to treat periimplantitis. This presentation will include the surgical management involving hard and soft peri-implant tissues as well as the appropriate follow up cases to ensure treatment outcomes. 
 

Peri-implant diseases are emerging with tenacious complications. The etiology is unclear with unpredictable treatment outcomes. Millions of patients with dental implants are haunted and threatened by these diseases. Through clinical practices and experiences with the operating microscope, we have this unique opportunity to evaluate the etiologic factors and perform precise tissue management under higher magnification and with micro-instruments. The modified microsurgical treatment protocol has led to favorable preliminary outcomes. Minimally invasive soft tissue management, implant surface decontamination, and biomaterial stabilization might have contributed to these positive regenerative outcomes. Non-invasive and point-of-care ultrasound imaging of peri-implant tissues of diseased implants provides not only anatomical information important for clinical decision making but also functional information possibly related to wound healing and prognosis. Bony defect topography, soft tissue dimensions and quality can be evaluated on ultrasound. Quantitative tissue perfusion analysis from ultrasound could shed light on understanding of regenerative wound healing of treated implants. The quality of socket healing that may relate to implant prognosis and longevity could be evaluated by ultrasound, based on our recent study. This presentation will cover fundamentals about the use of the operating microscope for managing peri-implant diseases and new findings from ultrasound research on peri-implant diseases.

Peri-implantitis is characterized by inflammation and infection around dental implants, which can lead to implant failure if left untreated. An imbalance or shift in the composition of the oral microbiome and its interactions with the host mucosal mediators can disrupt the equilibrium between beneficial and harmful micro-organisms. The lecture sheds light on the alterations in this peri-implant environment using microbiomics, transcriptomics, imaging, and validating findings with targeted quantification approaches. 

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As the patient ages, it is possible that dental implant fixtures that are well-integrated and healthy can be restored two or even three (or more) times over several decades. The modern restorative or prosthodontic clinician must be able to efficiently and effectively integrate existing dental implant fixtures into new treatment plans so as to avoid unnecessary surgery or cost to the patient. To do this, a strong understanding of abutment and prosthetic design is necessary. We will review cases and principles for removing existing implant prosthetics and re-restoring dental implants, and treatment planning for new dental implants to be useful for future work. 

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This presentation will cover mucogingival surgery to oral plastic surgery and the tidal wave of soft tissue grafting and optimal flap reposition/rotation management. The clinical major differences of oral plastic surgery between natural teeth and dental implants will be discussed as well as the challenge of soft tissue augmentation around dental implant phenotype modifications. Is there any more predictable and less invasive approach and what does it take?