Soft tissue management around teeth and implants - a microsurgical concept

DAY 1

9.00 am – 10.00 am

Lecture

Microsurgical principles

The concept of microsurgery has shown incredible growth in recent years. It allows the clinician to perform very atraumatic and precise surgery not only due to magnification aids but also by using smaller instruments and finer suture materials. But are there additional benefits clínically measurable? Does the use of microsurgical principles and procedures provide relevant advantages over conventional concepts for plastic esthetic periodontal surgery such as improved wound healing? Is there a benefit in natural appearance, harmonious transitions between tissue structures, and the absence of scarring in the esthetic zone? In the first lecture, these essential parameters of a successful treatment outcome will be discussed and an overview of innovation and evidence of the dental microsurgical concept is given.

10.30 am – 12.30 pm

Hands-on

Microsurgical flap preparation & suturing (rubber dam, aubergine), socket seal augmentation (pig jaw)
After the introductory lecture on microsurgery, the participants will get to know and work with the new microsurgical instruments & sutures. They will get familiar with them during suturing exercises on the rubber dam, flap preparations on the aubergine and the first augmentation exercise with a socket seal in the pig jaw.

13.30 pm – 15.00 pm

Lecture

Soft tissue graft harvesting, substitutes & augmentation procedures

Soft tissue replacement grafts have become an essential component to increase tissue volume in plastic periodontal and implant surgery. Autogenous subepithelial connective tissue grafts are more and more applied in aesthetic indications like soft tissue thickening, recession treatment, ridge preservation, soft tissue ridge augmentation and papilla re-construction. For the clínical performance of connective tissue graft harvesting and transplantation, a deep understanding of the anatomy at the donor sites and a profound knowledge of tissue integration and re-vascularization processes are required. The available donor sites are the anterior and posterior palate including the maxillary tuberosity, providing grafts of a different geometric shape and histologic composition. The selective clínical application of different grafts depends on the amount of required tissue, the indication and the personal preference of the treating surgeon. One of the main future challenges is to compare the efficacy and long-term stability of soft tissue autografts and their prospective substitutes. Although standardized recommendations regarding treatment choice and execution can hardly be given, guidelines for predictable and successful treatment outcomes can be provided based on clínical experience and the available scientific data. The aim of this lecture is to discuss the advantages and shortfalls of different donor sites, substitute materials and harvesting techniques as well as the execution of soft tissue augmentation procedures.

15.30 pm – 19.00 pm

Hands-on

Autograft harvesting from the posterior palate & recession coverage with coronally advanced flap (pig jaw)
In this hands-on exercise on the pig jaw, the participants will learn to harvest connective tissue from the posterior part of the palate and to use this graft for recession coverage. To exercise the flap prepation and suturing techniques introduced before in a more realistic situation, a recession coverage with a coronally advanced flap will be done in the pig jaw.

DAY 2

9.00 am – 10.00 am

Lecture

Tunneling technique for augmentation & recession coverage

The long-standing experience in recession coverage procedures has led to a learning curve in clínical performance and decision making, which can now be applied in other indications of periodontal and implant surgery in the patients’ interest. Incision-free tunneling techniques originally described only for surgical coverage of gingival recessions can now successfully be used also for socket preservation after tooth extraction, alveolar ridge augmentation in conjunction with fixed partial dentures, soft tissue management in immediate and delayed implant procedures and recession coverage around implants. Based on clínical case examples, the therapeutic indications, the predictability, the limits and the long-term prognosis of the tunneling techniques in plastic-aesthetic periodontal and implant surgery will be illustrated and the advantages of an incision-free approach will be pointed out.

10.30 am – 12.30 pm

Hands-on

Recession coverage with tunneling technique after autograft harvesting from the anterior palate (pig jaw)
In this hands-on exercise, the course participants will learn to perform a tunneling flap for recession coverage, a technique which can also be used in other indications like implant uncoverage and augmentation procedures. The use of special tunneling instruments will be trained and the participants will acquire the knowledge and get a feeling for their appropriate application. Besides, the autograft harvesting from the anterior palate will be exercised.

13.30 pm – 15.00 pm

Lecture

Contemporary strategies for healthy peri-implant tissues

The peri-implant soft tissue plays an important role not only from an aesthetic point of view, but also has an important biological significance. Under optimal conditions, it has a protective effect on the underlying structures. Besides the production of a natural appearance, the creation of these conditions today represents one of the largest challenges in implant surgery and can be achieved by the creation of the correct thickness and quality of the peri-implant mucosa. Of at least the same importance like microsurgical materials is the selection of the correct flap design. To make the right decisions in this context, the indications, advantages and limitations of soft tissue management around implants will be addressed in this lecture. Based on the experience in plastic-aesthetic periodontal surgery, the theoretical and practical basis of highly innovative strategies is presented and discussed in detail. The participants will acquire a basic knowledge of a biologically and aesthetically oriented implant therapy, which is associated with predictability and long-term stability of healthy peri-implant tissues.

15.30 pm – 19.00 pm

Hands-on

Free gingival grafts around implants (pig jaw)

The treatment with free gingival grafts is performed more often again since implants are used in dentistry. In many clínical situations, the width of the keratinized gingiva around implants is insufficient and this often leads to unhealthy situations. To improve the peri-implant soft tissue condition, a free gingival graft is a very predictable way to recreate a sufficient width of the keratinized and attached gingiva. Being one of the most challenging procedures, placing a free gingival graft is also a very good exercise to apply all principles about microsurgical soft tissue handling learned in this course.