LEADING EXPERTS OF SOFT TISSUE REGENERATION
Speakers:
Keynote Speaker: Niklaus P. Lang
Leandro Chambrone, Anton Sculean, Shayan Barootchi, Seiko Min, Jeffrey Ganeles, Homa H. Zadeh, Diego Velásquez and Navid Sharifzadeh
Symposium Lectures: On – Demand Access (for 3 months)
Detailed Program
Keynote Presentation:
Biologic Principles in Periodontal Soft Tissue Regeneration
Treatment of gingival recession may be performed through a variety of techniques and materials. It is important to the performance of any surgical procedure and implantation of any graft material leading to a cascade of events resulting in a series of biologic responses. Wound healing usually begins with an inflammatory phase, which can culminate in either periodontal repair or regeneration. Periodontal repair refers to the mechanism of healing, where reattachment of mucosa to tooth is mediated by either connective tissue and/or long junctional epithelium. On the other hand, regeneration entails restoration of the structures in their original form and function. Understanding the biologic basis of soft tissue regeneration provides clinicians with valuable insights to aid in improving the predictability of therapy.
Evidence-Based Periodontal Soft Tissue Regeneration
Periodontal soft tissue regeneration has long been used for the treatment of gingival recession (GR) and soft tissue phenotype augmentation around natural teeth. During daily practice, clinicians are required to deal with diverse clinical scenarios and to provide the most adequate treatment options for each condition based on the best evidence available, the clinician’s skills and the patients’ desires.
Educational Objectives: At the conclusion of this presentation, participants are expected:
- To discuss the key aspects of the periodontal phenotype involved in the decision-making process of sites requiring soft tissue augmentation.
- To translate evidence-based findings to clinical practice, by presenting treatment approaches to the most common “clinical scenarios” related to gingival recession treatment and soft tissue phenotype modification around natural teeth.
- To identify the influence of the attached gingiva on the long-term stability of results achieved by reconstructive soft tissue procedures.
Anton Sculean, DDS, PhD
The Bernese Concept for Regenerative Plastic-Esthetic Periodontal Surgery.
The use of modified coronally advanced tunnel (MCAT), newly-developed laterally closed tunnel (LCT) or combination of LCT and MCAT in conjunction with connective tissue graft, certain collagen based soft tissue substitutes may result in predictable coverage of single and multiple adjacent gingival recessions. Recently a volume-stable collagen matrix has shown successful outcomes in soft tissue augmentation procedures. This course will provide the biological and clinical rationale on why, when, and how to perform MCAT, LCT or MCAT + LCT to improve the predictability of recession coverage. The indications for applications of a natural collagen matrix and a volume-stable collagen matrix for recession coverage and for tissue augmentation will be presented. Step-by-step clinical cases and surgical videos will illustrate the details of how to perform these surgical techniques, using connective tissue grafts or collagen matrices. Special emphasis will be placed on the details regarding tension-free preparation of the tunnel, suturing techniques for graft fixation and coronal positioning of the soft tissues.
Shayan Barootchi, DMD, MS
Minimally Invasive and Growth Factor-Mediated Root Coverage of Gingival Recessions With the Platelet-Derived Growth Factor
A variety of biomaterials and scaffolding matrices have been investigated as alternatives to the autogenous connective tissue graft for treating gingival recessions, due to inherent drawbacks of palatal tissue harvesting.
In a triple-blinded randomized controlled trial, we recently found evidence that the properties of the novel xenogeneic cross-linked collagen matrix can be further enhanced when incubated with recombinant human platelet-derived growth factor (rhPDGF) in treatment of multiple adjacent gingival recession defects. These “test” sites showed significantly enhanced root coverage outcomes, when compared with the control group that received a “placebo” solution.
The current presentation will include clinical cases and demonstrations of gingival recession treated with this minimally invasive regenerative approach, as well as the results of our recently concluded randomized trial, in particular, 3D volumetric and novel ultrasonographic-evidence of phenotype modification.
The application of such combination therapies of biomaterials and biologic agents can pave the way for contemporary and minimally invasive periodontal regenerative techniques for periodontal root coverage.
If validated against the “gold standard” of autogenous graft, growth factor-mediated root coverage procedures can present a pivotal role in currently-held traditional clinical practice.
VISTA for Phenotype Modification Therapy
Prevalence of gingival recession in American adult population is over 50%. There is evidence for high likelihood of progression of untreated gingival recession defects. It is imperative that clinicians are proficient in treating mucogingival deformities.
The Vestibular Incision Subperiosteal Tunnel Access (VISTA) technique introduced by Zadeh in 2011 provides a minimally invasive treatment modality with predictable and esthetic results in correcting various mucogingival deformities. In particular, it is highly effective in phenotype modification therapy, aimed at increasing the gingival thickness.
This lecture will provide latest evidence-based information on the VISTA approach in treating mucogingival deformities around teeth and implants. Importance of phenotype conversion utilizing various graft materials will also be reviewed through clinical cases.
“Recession Regeneration” Treatment for Recession Defects
Gingival recession results from the loss of soft tissue, bone and periodontal ligament. Most root coverage procedures have limitations. Autografts are limited by donor site morbidity and volume. Allografts avoid these problems but heal by repair and long junctional epithelial attachment. Alternatively, coronally positioning flaps in combination with FDBA and pharmaceutically produced PDGF-BB, “Recession Regeneration” covers exposed roots with regenerated periodontal tissues including new cementum, periodontal ligament, bone and gingiva. Additionally, the technique offers off-the shelf convenience, avoids palatal donor sites and provides excellent esthetics. It can also be combined with other periodontal regenerative techniques to enhance outcomes in cases of periodontal defects.
This presentation will provide a brief overview for the technique, evidence for the claims of regeneration, clinical examples of results and a brief overview of an ongoing case series.
Educational Objectives: At the conclusion of this presentation, participants are expected to:
- Understand the biologic principles of “recession regeneration”
- View opportunities to utilize “recession regeneration” to correct significant recession and periodontal defects
- Differentiate between repair of recession compared to regeneration
Paradigm Shift of Concepts in the Treatment of Gingival Recession
In recent years, the concepts in the treatment of gingival recession have undergone a paradigm shift. The initial focus was on increasing band of keratinized tissue, then root coverage. Now, the focus is on phenotype modification therapy (PMT). The other paradigm shift has been the transition from mucogingival surgery, which were mostly resective, to periodontal plastic surgery, which are mostly regenerative and focus more on esthetics and patient experience. Refinements of periodontal plastic surgery have contributed to recognizing the biologic and surgical advantages of vestibular incision subperiosteal tunnel access (VISTA). The VISTA technique allows for maximal thickness gain necessary for phenotype modification, while allowing for optimal esthetics because there are no mucosal incisions of papillae and gingival margins. The present presentation describes the scientific evidence for current strategies utilized in the management of gingival recession and peri-implant mucosal defects.
Educational Objectives: At the conclusion of this presentation, participants should have an understanding of:
- The significance of periodontal and peri-implant mucosal phenotype in long-term stability of tissues.
- Decision making on when phenotype modification therapy is necessary and whether alveolar bone augmentation is needed.
- The adjunctive value of clear aligner orthodontic therapy
- Material selection: connective tissue (palate and tuberosity), acellular dermis allograft, collagen matrix xenograft, platelet-fibrin concentrates, recombinant platelet-derived growth factor.
- Integration of various phases of therapy to optimize outcomes.
Panel Discussion
Keynote Presentation:
Significance of Peri-Implant Mucosal Phenotype
The mucosal phenotype refers to the physical characteristics of peri-implant tissues, such as the thickness of the mucosa and the width of the keratinized tissue. There is ample data to support a critical role for the peri-implant mucosa in the stability of peri-implant tissues. There is also data to support the efficacy of peri-implant mucosal augmentation in promoting peri-implant bone and soft tissue stability. This presentation will review the scientific evidence that relates to the cross-talk between peri-implant mucosa and peri-implant alveolar bone. This information is useful for clinicians to have additional insights about the management of peri-implant tissues.
Evidence-Based Peri-Implant Soft Tissue Regeneration
Peri-implant plastic surgery appears as a translation of the concepts, surgical procedures and main indications developed for the treatment of tooth soft tissue deformities to dental implants. Similar to the concepts established for the treatment planning of gingival tissue, there is a strong need and solid knowledge on the peri-implant tissues behavior (why, when and how to manage them).
Educational Objectives: At the conclusion of this presentation, participants are expected:
- To discuss the key aspects of the peri-implant mucosa: the peri-implant phenotype and its similarities to periodontal soft tissues.
- To assess the rationale and potential clinical and esthetic improvements related to peri-implant soft tissue regenerations and augmentation.
- To present the most common clinical scenarios and where to use or not to use peri-implant soft tissue phenotype modification approaches.
Anton Sculean, DDS, PhD
The Bernese Concept for Regenerative Plastic-Esthetic Periodontal Surgery.
The use of modified coronally advanced tunnel (MCAT), newly-developed laterally closed tunnel (LCT) or combination of LCT and MCAT in conjunction with connective tissue graft, certain collagen based soft tissue substitutes may result in predictable coverage of single and multiple adjacent gingival recessions. Recently a volume-stable collagen matrix has shown successful outcomes in soft tissue augmentation procedures. This course will provide the biological and clinical rationale on why, when, and how to perform MCAT, LCT or MCAT + LCT to improve the predictability of recession coverage. The indications for applications of a natural collagen matrix and a volume-stable collagen matrix for recession coverage and for tissue augmentation will be presented. Step-by-step clinical cases and surgical videos will illustrate the details of how to perform these surgical techniques, using connective tissue grafts or collagen matrices. Special emphasis will be placed on the details regarding tension-free preparation of the tunnel, suturing techniques for graft fixation and coronal positioning of the soft tissues.
Diego Velásquez, DDS, MS
Biomechanical Aspects of Soft Tissue Management: A Microsurgical Approach
Mucogingival surgical procedures are geared towards correcting or eliminating anatomical, developmental, or traumatic tissue aberrations and deformities affecting the gingiva, the alveolar mucosa or both.
Whether addressing the natural dentition or dental implants, emerging evidence is supporting the critical importance of precise and delicate tissue manipulation under enhanced magnification and illumination tools. Biomechanical principles associated with flap design and suturing techniques are intimately related to adequate wound healing and successful outcomes in mucogingival therapy.
Educational Objectives:
- Visualize the biomechanical befits of precise soft tissue management afforded by the microsurgical approach.
- Understand the different bio-textiles and biomaterials available for performing microsurgical procedures in periodontal and dental implant related therapy.
- Become knowledgeable about the specifically designed microsurgical armamentarium that facilitates performing tasks under the operating microscope.
Soft Tissue Augmentation for Correction of Challenging Esthetic Problems in Implant Therapy
Synopsis: From the early days of the discovery of dental implants, there has been a substantial paradigm shift from utilizing the implants in the edentulous ridges to rehabilitation of the most complex cases in the esthetic zone. With increasing number of implants placed in the esthetic zone, there is a rising number of complications associated with this treatment protocol. There has been a need for documentation of esthetic complications as well as defining the risk factors. Despite all the benefits of this treatment modality, the clinicians could be aware of all the disadvantages correspondingly.
Objectives: This presentation will describe the importance of the soft tissue complex around dental implants, as well as illustrate the different surgical techniques to enhance the soft tissue barrier at the implant sites for long term health, function and esthetics.
This presentation will consist of different clinical scenarios the value of different techniques for specific indication. From the old-fashioned free gingival graft and laterally positioned flap to newer coronally advanced flaps, VISTA technique and the advantageous usages of vascularized grafts, this case presentation will illustrate how challenging cases, such as severe soft tissue deficiencies, esthetic complications and mal-positioned implants, may be managed with these surgical interventions.
Peri-Implant Mucosa for Health and Esthetics
Mucosal augmentation may be utilized for a variety of situations, including to provide a stable supracrestal peri-implant attachment, to prevent or correct mucosal dehiscence, to facilitate oral hygiene and create proper contour for implant restorations for optimal esthetics. Today, the clinician’s toolbox may contain a variety of techniques and material, including autogenous tissues, soft tissue substitutes that mimic extra-cellular matrix and biologics, which may be instrumental for different scenarios.
Educational Objectives: At the conclusion of this presentation, participants should have an understanding of:
- The significance of peri-implant phenotype in long-term stability of tissues.
- Decision making on the necessity of phenotype modification therapy.
- The significance of vestibule and vestibular extension techniques.
Followed by Panel Discussion
Tuition
- $595.00 (Will have on-demand access to view the videos for 3 months)
CE Units
- 14.5 hours CE units will be awarded after successful completion of exam following the course.
