Strategies for Surgical Success

Presentation Synopsis

Vertical augmentation presents one of the greatest challenges in implant dentistry. This is primarily due to the difficulty of the surgical procedure and its potential complications. The reconstruction of the Vertical Deficiency of the anterior maxilla will be one of the key topics of this presentation. Recently different biological agents as well as growth factors were utilized successfully to reconstruct severely resorbed ridges. However, selection, indication and availability remain a challenge for the clinicians. Selection and clinical application of different growth factors will be discussed in detail such as the use of growth factors for simultaneous GBR and periodontal regeneration of denuded interproximal roots. Research and clinical examples on the Lasagna technique using micro dose of BMP-2 will be also presented. Difference between evidence and clinical experience will be discussed.

For extreme vertical deficiency in an attempt to achieve wound closure and hence graft stability, the buccal mucosa is often broadly released, and this often results in a severe apical translocation of the mucogingival line, loss of vestibule and keratinized mucosa (KM).
The need to graft these large mucosal areas necessitates the harvest of an autograft with enough size and dimension to achieve the desired outcome, and this may lead to significant patient morbidity. Therefore, there was a need for the development of less invasive surgical procedures.

A recent clinical study demonstrated that strip gingival graft harvested from the neighboring labial gingiva will result in significantly better tissue color. In addition to the lack of peri and inter implant papillae can be a significant esthetic and functional problem to the patient. This presentation will demonstrate two novel surgical techniques the Iceberg and the Garage connective tissue grafts to reconstruct the lost papillae.

Learning Objectives

• Identify indications and applications of growth factors and biologics for vertical ridge augmentation and regeneration.
• Evaluate surgical approaches for managing severe vertical deficiencies of the anterior maxilla while minimizing complications and morbidity.
• Apply contemporary soft-tissue grafting techniques to improve keratinized tissue and reconstruct deficient peri-implant papillae.