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ePaper created 2017-03-17, 10:24:23 | version 1.38.0
Soft-tissue management for bone augmentation Diferent tissue biotypes react diferently to surgical trauma. For this reason, we have adapted the surgical approach to the biotype (tissue thickness) specific to each patient and the location in the oral cavity. The tissue thickness dictates the way it is manipulated for high-volume augmenta- tion. Thick biotypes can be managed in a conventional manner. However, thin bio- types require new surgical approaches with specific instruments. This course will describe step by step the gain of soft- tissue for tension-free closure even in cases of reduced soft-tissue thickness. The course will define predictable soft-tissue manipulation around implants according to soft-tissue biotype. Learning from our clinical experience in soft-tissue manipulation, we can adapt soft-tissue sur- gery. We need to graft more, to manipulate the soft tissue, to treat each particular case. There is little data in the literature on adapting surgery according to soft-tissue thickness. Most articles describe the same kind of surgery for all cases, with no dis- tinction between biotypes. With this in mind, we have to adjust surgery to the tissue conditions for better soft-tissue clo- sure in cases of grafting and for better esthetics. This means individualized flap design for every tissue type. The next step will be the development of instruments, but more than that, of implant surfaces and biomaterials that address not only the bone but also the soft tissue. Adapting therapy to soft-tissue biotype is changing the way we approach implant dentistry. Soft-tissue management for the esthetic zone Function and esthetics with implant treat- ment depend on case selection, surgical planning and prosthetic reconstruction. Each of these has evolved dramatically over the years. The latest implant designs increasingly help the clinician in achieving these goals in the esthetic zone. Incorrect flap design leads to dramatic failure in this sensitive soft-tissue zone. The course will address the requirements for modern flap design according to the necessary amount of bone and soft-tissue regeneration. Soft-tissue management: Vertical augmentation Vertical bone loss represents a major sur- gical challenge in the implant treatment of the posterior mandible, owing to ana- tomical factors and technical di(cid:3)culties. Proper management of the soft-tissue is crucial for success of any regenerative procedure: A complete and stable closure of the flaps during healing is essential to prevent contamination and infection and allow for undisturbed graft healing and incorporation. This prerequisite can be accomplished only if buccal and lingual flaps are su(cid:3)ciently released, in order to obtain a passive coverage of the augment- ed area, stabilizing it with tension-free sutures. In the posterior mandible in par- ticular, the use of conventional periosteal incisions is not always sufficient for a proper buccal flap passivation, often being limited by anatomical factors. Over time, bone augmentation has moved from highly specialized clinics into the dental o(cid:3)ce. With the help of modern grafting material, the augmentation volume in the dental o(cid:3)ce has increased year by year. However, the main issue remains soft-tissue closure for high- volume augmentation, especially in the posterior mandible and posterior maxilla. We have developed special flap designs and suturing techniques specific to loca- tion to address this ongoing problem of soft-tissue management. The participants will learn about and practice soft-tissue closure according to location. Prosthetic soft-tissue development in implant dentistry The main purpose of this course is to explain, demonstrate and teach soft- tissue development around implants with the help of prosthetic components in fixed, single- and multiple-implant placement. The course will cover abutment design for ideal soft-tissue support, pontic design for esthetic soft-tissue development, emergence profile design for the crown and abutment, diferent wax-up modali- ties, esthetic try-ins for diferent thera- peutic phases, crown margin definition, gingival management with temporaries, and mock-ups. Soft-tissue complications and full-arch restoration With the increasing number of implants being placed in the esthetic zone accord- ing to immediate or delayed protocols, we face soft-tissue complications like reces- sion of the soft-tissue and papillary loss. There are no predictable methods docu- mented in the literature regarding how to increase the soft-tissue height for the papillae or correct recessions around implants. The course will demonstrate individual- ized approaches to correct papillary loss in the esthetic zone using modern flap design techniques. Furthermore, increas- ing soft-tissue thickness and moving the soft tissue coronally after recession around implants through surgery and prosthetic methods will be described. Article Advanced Implant Esthetics issue 2017 — 69