Zero bone loss concepts – a unique compilation of surgical and prosthetic factors, which are important to develop and maintain crestal bone stability.
Surgical factors start with implant design and biological aspects. Mucosal tissue thickness was shown to be the factor having an impact on crestal bone stability. Even platform switching of the implant-abutment connection does not reduce crestal bone loss if soft tissues at the implant placement are thin. It is suggested that thin tissues might be thickened during implant placement, thus reducing bone resorption. If bone height is not sufficient, vertical augmentation of the soft tissue is recommended with different materials – autograft, a xenograft or a dermis-derived allograft.
Further, it is important to preserve bone levels after prosthetic treatment. Recent research has proved that the deeper the position of the margin, the greater amount of residual cement is left undetected. The relation between the position of cement excess in the peri-implant sulcus, periodontal status of the patient and severity of peri-implant disease is explained. To avoid cement excess, finished implant restoration with the occlusal opening is cemented on titanium base in laboratory and restoration is attached to the implant by an abutment screw. Zirconium as a material is considered the best for peri-implant soft tissues. However, it’s evident that it must be treated in a special manner and polished.
Learning objectives
Keywords: vertical soft tissue thickness; cement remnants; platform switching, implant placement depth.
ZERO BONE LOSS CONCEPTS with DIGITAL AND GUIDED PROTOCOLS
Day 1.
Development of crestal bone stability. Surgical day
9.00- 10.30
Influence of vertical soft tissues on crestal bone stability. Does platform switching save the bone? Influence of implant placement depth on crestal bone stability. What is the importance of implant-abutment connection stability? Bone remineralization and corticalisation processes in thick tissues. What is the role of bone in “Zero bone loss concepts”?
10.30-11.00
Coffee break
11.00-13.00
Four novel methods to increase vertical soft tissue thickness
a.) subcrestal implant placement
b.) Flattening of the alveolar bone
c.) “Tent pole” technique
d.) Vertical soft tissue thickening
13.00-14.00 Lunch
14.30 – 16.30
HANDS ON
1. Practice on pig jaws of vertical soft tissue augmentation with membranes
a.) Incision
b.) Blunt flap release to relief the tension
c.) Preparation of allogenic membrane
d.) Positioning of membrane
e.) Suturing of the membrane with matrix suture for stabilization
2. Subcrestal implant placement
3. Tent pole technique
4. Flattening of the bone
16.30- 17.00
Coffee break
17.00 – 18.00 Questions – answers
Day 2.
Maintenance of crestal bone stability. Prosthetic day
9.00-10.30
How to control cement remnants after cementation. Supragingival margins and individual abutments. The relation between cement and peri-implant disease. Screw-retained restorations. Use of Ti-base for fabrication of restorations. Which cement is most suitable for cementation of Ti-bases?
10.30-11.00
Coffee break
11.00-12.30
Subgingival prosthetic materials. Zirconia, titanium, ceramics – which is better. Use of ultra-polished zirconia for implant restorations. The composition of peri-implant soft tissues. Supragingival materials. Ceramics, e.max, monolithic Zr – where to use and why?
13.00-14.00
Lunch
14.30 – 15.30
HANDS ON
Prosthetic part will focus on implementing special impression method, designed by Dr. Tomas Linkevičius for deeply positioned implants, by using occlusal registration materials to stabilize the transfer.
Passive impression with specially open-tray transfers.
15.30- 16.00
Coffee break
16.00 – 17.00 Questions – answers
Day 3.
Digital, Immediate, and Guided Protocols using Zero Bone Loss Concept
9.00-10.30
Why use the digital workflow? How to bring together CT scans, intraoral scans, and digital wax-ups to plan with Zero Bone Loss Concepts and avoid problems
10.30-11.00
Coffee break
11.00-12.30
Guided Surgery explanation. Understanding the difference in surgical guides, guided drills, incision design, and prosthetically driven implant placement.
13.00-14.00
Lunch
14.30 – 15.30
HANDS ON/LIVE SURGERY
Guided Surgery Hands-on implant placement on models and live patient guided surgery demonstration with Dr. Kyle Stanley
15.30- 16.00
Coffee break
16.00 – 17.00 Questions – answers and final thoughts from the Speakers
