Augmentation
Workshop
International
Chapter - 4

Surgical key factors for successful implant outcomes in partially edentulous  patients with excellent long term stability

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In this 1-Day Seminar, Prof. Buser will present his current surgical techniques in partially edentulous patients based on more that 35 years of clinical experience with implant surgeries and on numerous preclinical and clinical studies, but also includes the latest developments made in the past 10 years, i.e. with digital implant dentistry and with the new 4th generation Straumann hybrid implants like TLC and TLX. Session 1 will summarize the surgical key-factors to achieve successful implant outcomes with good long-term stability. This includes the utilization of a hybrid implants, such as the new TLC and TLX implants of Straumann, with a micro-rough implant surface in the endosseous portion for optimal osseointegration, whereas the implant has a machined surface in the transcrestal area to minimize the risk to get an exposed micro-rough implant surface in the peri-implant sulcus, since this is a significant risk factors for the development of peri-implantitis during long-term function.

 

Session 2 addresses the selection criteria for post-extraction implant placement. The clinician has three options and all relevant aspects will be presented, when to use Immediate Implant Placement (IIP) with a flapless approach, computer-assisted implant surgery (CAIS), internal defect grafting and immediate restoration free of occlusal contacts. This is a very attractive treatment modality and is used in ideal cases with an intact buccal bone wall. When IIP is not feasible, the concept of Early Implant Placement (EIP) is the next option using a flapless extraction combined with a spontaneous socket healing. This approach is used when the buccal bone wall is very thin or deficient. 4 to 8 weeks later, implant placement is done with an open-flap procedure in a correct 3D position, combined with a simultaneous GBR procedure. This technique will be discussed in full detail in Session 3. The 3rd option is socket grafting for Alveolar Ridge Preservation (ARP). 4 months later, implant placement is done flapless with CAIS. This has become the favorite treatment option in posterior sites in the mandible and in elderly patients to minimize morbidity.

 

In Session 3, all aspects of GBR will be discussed, based on 35+ years of experience. Beginning in Oct 1988, the 1990s represents the development phase of the current surgical technique, which turned into a routine application following the millenium change with fine tuning efforts, most of them based on a much better understanding of the involved tissue biology. For horizontal bone augmentation, which represents the huge majority of cases, we prefer a non-crosslinked collagen membrane (Bio-Gide@), which can be easily applied and doesn’t need a 2nd open flap procedure for membrane removal. Collagen membranes must be supported with appropriate bone fillers to avoid a membrane collapse. We prefer a 2-layer Composite Graft, with locally harvested autogenous bone chips as first layer to cover the exposed implant surface. These bone chips accelerate the formation of bone as demonstrated in more than 10 pre-clinical studies. The 2nd bone filler is a Deproteinzed Bovine Bone Mineral (DBBM; Bio-Oss®) which has a low-substitution rate when osseointegrated in bone, and offers excellent volume stability over time as shown in numerous case reports and clinical studies. In some instances, the membrane is stabilized with membrane tacks to optimize membrane stability. In all instances, a tension-free primary would closure is applied followed by a healing period of 8 weeks, in some cases 12 weeks.

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This Bernese GBR Technique will be demonstrated for single tooth gaps and extended edentulous spaces in the maxilla and in the mandible, including patients outcome with long-term documentation and results of numerous studies with 10 years of follow-up. In addition, the surgical aspects of digital implant dentistry will be shown, when it offers an advantage for the surgical prodecure or for the patients.

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