Two-Part Hands-On Workshop: How to Achieve Optimal Aesthetic Results:

Part 1: Tooth extraction inevitably leads to a rapid loss of bone and soft-tissue volume and resorption of the bone crest. These changes result in unfavourable ridge anatomy that jeopardises dental implant and restorative treatment. If the scientific knowledge of how extraction sockets heal is properly applied, there is an increased possibility of achieving optimal aesthetic &...

The Alternative to Connective Tissue Grafts
Soft-tissue grafting procedures are considered an integral part of implant dentistry, with various techniques and materials applied at different time-points. Although autogenous transplants are still
widely used and are still considered the gold-standard, they are associated with major disadvantages and most prominently the associated morbidity. Therefore, more recently, collagen-based...

The Osteology Foundation promotes research, education and collaboration between universities and industry in the field of oral and maxillofacial tissue regeneration. The objective is to make new techniques and products available to practitioners quicker and with greater goal orientation. True to its motto “2020 Vision for Regeneration”, the Osteology Foundation aims to bridge the gap between scientific progress and clinical practice, as well as...

Theoretical background:
• Advanced ridge defects present one of the greatest challenges of bone regeneration in implant dentistry
• There are several techniques available to reconstruct these deficiencies
• The Sausage Technique presents one of the least invasive technique that provides good bone support for implants long-term
• Re-establishment of the vestibule and keratinised tissue after vertical and horizontal augmentation
• The use of a strip gingival graft in combination with a collagen matrix to reconstruct the aforementioned soft tissue

Hands-on workshop – techniques presented:
• Learn the surgical principles of ridge augmentation surgery using the Sausage Technique
• Learn membrane placement, membrane stretch and fixation techniques
• Learn the three steps of flap advancement techniques to achieve tension free closure
• Learn how to protect the mental nerve from injury
• Learn the double layer suture technique to achieve a safe soft-tissue adaptation after ridge augmentation
• Learn how to harvest a strip gingival graft whilst minimising the morbidity traditionally associated with autogenous soft tissue graft harvesting
• Learn how create a Modified Apically Positioned Flap (MAPF), along with suturing techniques to secure both the strip gingival graft, as well as the collagen matrix

Theoretical background:
• Is guided bone regeneration a safe therapy and what is known about long-term results?
• New innovative clinical approaches will be demonstrated to solve the problem of hard- and soft tissue volume stability
• Are there reliable off-the-shelf solutions that will bring us to the next level of soft tissue regeneration
Hands-on workshop – techniques presented:
• New surgical techniques for simultaneous GBR and Implant placement using stabilized graft materials (L-shape technique)
• Handling of the GBR materials
• Stabilizing graft materials
• Handling and management of the soft tissues
Model: pig jaw

Different reconstructive procedures are nowadays available to allow for implant placement in severely atrophic partially or totally edentulous ridges, such as GBR with particulate grafts with resorbable or non-resorbable membranes or autogenous bone block grafts. These procedures are both reliable, but sometimes time-consuming and very technically demanding in terms of adaptation and fixation of the grafts, both particulate or in blocks.

Recently, customized, CAD/CAM titanium meshes are available on the market with the aim of offering results similar to those obtained with the traditional reconstructive procedures, whilst also allowing for the relevant simplification of the surgical procedure.

The production of these Ti-Meshes is in fact performed on personalized 3-D models obtained by CBCTs of the atrophic area of each patient, allowing an extreme precision and simplification of the adaptation of the mesh to the defect to be reconstructed.

The aim of this workshop is to teach all participants how to perform all of the surgical steps of the reconstructive procedure of partially edentulous jaws with customized Ti-Meshes with the aid of both didactic (including detailed slides & procedural videos) and hands-on (using both animal (pig jaw) and synthetic models) sessions.
LEARNING OBJECTIVES
1. How to optimize pre-operative planning of a clinical case in need of reconstruction of an atrophic edentulous ridge with a customized Ti-Mesh;
2. How to optimize incision lines of soft tissues to access the defect;
3. How to choose the grafting materials for guided bone regeneration (GBR) with Ti- meshes;
4. How to harvest bone chips with bone scrapers from intra-oral sites (mandibular ramus; hands-on exercises using an animal (pig jaw) model );
5. How to optimize the combination of autogenous bone chips with bovine bone mineral for GBR (hands-on exercises using a synthetic model simulating an edentulous area of the jaw);
6. How to adapt the preformed Ti-Mesh to the defect and how to stabilize it with titanium screws (hands-on exercises using a synthetic model simulating an edentulous area of the jaw);
7. How to optimize the use of collagen membranes over the Ti- Meshes prior to soft-tissue closure;
8. How to release mucoperiosteal flaps to obtain a water-tight and tension-free suture (hands-on exercises using an animal (pig jaw) model).

New insights into structural anatomy of the oral mucosa and the biological processes support the hypothesis that control of flap tension is crucial for optimal wound healing. On the other side, there is evidence in the literature that clinicians cannot control flap tension without training of their psychomotor and visual-spatial skills, especially when tensions are low.

It is the goal of the present hands-on course to evaluate the variability of applied flap tensions of the individual trainee and to present bench models how to practice the control of flap tension. Additionally, based on clinical situations, we will show the participants how biomaterials can help to increase wound stability and influence the tensions applied on wound margins.

The course is focused on skills training in mucosal surgery and on selection of the biomaterials based on clinical models.

Hands-on training (contents)
- flap design and mobilisation
- training of visual-spatial skills
- control of flap tension in wound closure
- suturing – techniques and training of hand precision and bi-manual coordination
- introduction into periodontal keyhole surgery