CE On Demand Course Listing

Peri-implantitis a very important topic and subject of scientific debate. In the early days of implant dentistry, crestal bone loss was not common. Dr Koka discusses the concept of osseosufficiency and whether implants actually "fail" or if failure of implant treatment is rather a host response to a foreign body or to an inappropriate treatment concept. In that sense, the term peri-implantitis as an analogy to periodontitis would be misleading. Implant surface design is scientifically debated as an influencing factor for crestal bone loss and peri-implant tissue reaction. Dr. Koka reviews commonly cited literature data and questions the clinical relevance of animal studies and ligature models for correctly describing peri-implant tissue reaction, and the behavior of current implant designs of main manufacturers. Dr. Koka presents retrospective chart review data from the Mayo Clinic and concludes that TiUnite surfaces protect against higher failure risk of short implants, of implants placed in maxilla and posterior areas, and of implants placed in smokers.

Unique physical, optical, and biologic properties have made zirconia a preferred material for restorative options from single units to full-mouth rehabilitations. For bi-layer restorations with zirconia as a core and framework material, proper selection and application of the respective veneering porcelains are key for success. Over the last years, monolithic full-contour zirconia (FCZ) restorations that do not require hand-layered veneering porcelain have gained tremendous popularity. While the manufacturing of these restorations is simplified through CAD/CAM technologies, there are still many laboratory parameters that determine the ultimate outcomes and clinical success of these restorations. Another factor for long-term success relates to the cementation and bonding of zirconia-based restorations, which differ fundamentally from protocols established for metal alloys and other ceramics. This presentation will give an overview of material, laboratory, manufacturing, and clinical parameters that determine the success of zirconia-based restorations.

The biggest disappointment for patients and practitioners is failure of dental implants. One of the most overlooked parts of implant therapy is hygiene and a robust peri-implant maintenance program. Recognizing early signs of peri-mucositis and resolving the inflammation in its early stages is important for long-term success. A review of the current literature on this topic will be presented. How to implement a hygiene maintenance protocol in your office for the patient with a full-arch prosthesis will be discussed.

In order for a patient to receive a properly placed implant with a functional and esthetically successful restoration, the clinician must be aware of the anatomical limitations of the maxillo-mandibular complex. The goal of this presentation is to provide the clinician with guiding principles for proper assessment and patient selection for implant-based restorations. A review of the regional anatomy of both the maxilla and mandible will assist in developing a structured pre-prosthetic treatment plan for the patient. Finally, an overview of available soft and hard tissue augmentation methodologies will be highlighted to guide the clinician in providing the patient with a functional and esthetically successful outcome.

An unstable soft tissue seal around implants favors an inflammatory reaction that can lead to facial recession, pocket formation and loss of bone support. The more stable and tight the soft tissue seal, the more predictable the outcome of implant rehabilitation. A major criterion influencing this biological interface is the type, quality and thickness of the peri-implant mucosa. How does one optimally preserve the pre-existing keratinized and fibrous mucosa when planning for an implant? What impact does design have? What should be the material composition of the trans-mucosal components, knowing that a cell adhesion is not possible on any material? These questions will be addressed by the lecturers as well as improved methods of respecting the soft tissue interface.

Cone-beam computed tomography (CBCT), in combination with the NobelClinician® software and NobelGuide® surgical templates, offer the dental implant team a new set of planning, surgical, and restorative tools. These technologies aid the restorative, surgical, and dental laboratory team members in the accurate diagnosis, planning, and placement of implants according to a prosthetically driven treatment plan, which is a true multidisciplinary team approach to patient care. This leads to the ultimate goal of improved predictability and patient case outcomes.

Based on over 20 years of clinical experience with immediate implant placement and restoration, Dr. Gelb reviews treatment options and benefits for this protocol in various clinical indications, and gives a glimpse of these procedures from his daily clinical practice. Immediate implant placement and restoration support preservation of the site dimensions, accelerate treatment time and minimize the number of surgical and prosthetic interventions. Immediate restoration seals the extraction socket to retain the clot for regeneration and tissue repair, and provides a platform for esthetic tooth replacement, emergence design and soft tissue management. Dr. Gelb concludes that immediate implant placement and restoration is a fine protocol that has revolutionized implant dentistry, is biologically sound, evidence based and patient preferred.

Residual cement is considered a main causal risk factor for peri-implant disease. Cement remnants causing microbial activity, immune reaction, allergic response and activation of titanium surface may be the route by which bone is lost around implants. Dr Wadhwani discusses the possible etiology of restorative driven peri-implant disease and the little knowledge that exists in the dental industry about the technical and physical background of cementation techniques and protocols, e.g. how cement flows and how the hydraulic forces developing during cementation procedures can lead to tissue destruction around the implant. By using sophisticated computational fluid dynamics, the attempt is to increase the knowledge and give important insights, identifying the ideal cement application location within the crown lumen, use of adequate amount of cement, influence of speed of crown seating, and explaining how to minimize residual excess cement and the related problems. Cement brands are reviewed and ranked as to their suitability for use with implant-based restorations. A screw-retained design is the easiest alternative—and the screw-retained angulated screw (ASC) abutment increases considerably the options to use screw-retained design in the esthetic zone.

Dr. Scott Maclean demonstrates how to successfully plan posterior implants in the mandibular arch using NobelClinician SmartFusion technology.

To achieve an ideal prosthetic result with dental implants, it takes proper treatment planning. The use of surgical templates helps ensure the correct implant position. Traditional implant placement with conventional surgical templates isrestorative driven, although it does not account for anatomical factors that will make it impossible to place the implant. CAD/CAM surgical templates or guided templates, through the use of surgical planning software, allows for a restorative driven implant placement along with a three dimensional view of the patient’s anatomy. This presentation will discuss the advantages of guided surgery in treating patients with this advancing technology.

This lecture will focus on the dynamics of gingival tissue, and how it responds to immediate, compared to delayed, from a scientific and clinical perspective. The key points for achieving optimal gingival esthetics will be discussed.

The treatment of the fully edentulous patient with computer assisted tomography, computer assisted surgical planning software, and a guided surgical technique using a stereo-lithography surgical template for implant placement has five-year clinical studies reported. Initial issues with esthetics and fit of the prosthesis are concerns. This presentation will discuss the treatment of the fully edentulous arch, treatment factors, and treatment options. At the conclusion of the presentation, a demonstration will be performed treatment planning for the edentulous patient using a surgical planning software program.

This lecture will show you the systematic way to evaluate the treatment planning of edentulous patients, especially the edentulous maxillary patients.

Immediate loading and the biology behind why this concept is now acceptable and predictable will be discussed.

What is the difference between a normal tooth and an implant? What is the critical size? Why do implants avoid resorption, and give us better esthetics? How is it possible to do an extraction, place an implant, augment bone — all in the same day — and have a beautiful esthetic, with no resorption for a full year? Various special implant types will also be discussed.

There are 10 key criteria that are important in implant therapy to achieve optimal soft tissue outcomes. The criteria are divided into 2 areas.

The first area involves the biomaterial elements in therapy, while the second involves procedural issues. The biomaterial elements of implant surface, the implant neck, abutment material, the sub gingival abutment design, and abutment reconnection will be discussed.

The procedural elements covered are implant spacing, implant vertical positioning, bone and soft grafting and provisional management.

This presentation will focus on the 10 key criteria as applied in implant therapy for selected patients.

PART 1: Diagnosis and Treatment Planning, Concepts of Immediate Loading

• Clinical and radiographic evaluation of the patient
• Specific clinical factors which determine the success of treatment
• Restorative space requirements
• Principles of immediate loading (Science and Techniques)

PART 2: Principles of Graftless Solutions and Surgical Protocols

• What is All on 4?
• Principles of All on 4, armamentarium needed.
• Surgical protocols — flap design, implant placement, radiographic evaluation.
• What the surgeon must know prior to placing implants.
• Communication between the restorative dentist and surgeon.

PART 3: Clinical Patient Presentations. Surgical and Prosthetic Protocols for Fabrication of a Full Arch Immediate Load Prosthesis.

• Clinical treatment presentation of a dentate patient.
• Diagnosis, treatment planning and fabrication of the immediate load prosthesis.
• Clinical treatment presentation of an edentulous patient.
• Diagnosis, treatment planning and fabrication of the immediate load prosthesis.

PART 4 — Prosthetic principles and techniques for fabrication of the final prosthesis. Complications and maintenance.

• Fabrication of the final prosthesis from impressions to delivery
• CAD/CAM design of the titanium bar and laboratory procedures involved in fabrication of the final prosthesis
• Commmon complications and how to address them
• Maintenance

Dental implants are placed into the alveolar bone, with the expectation that they become osseointegrated and that the periimplant mucosa will heal to the abutment surface and fulfill the primary functions of the periodontal tissues, which are attachment and protection of the soft tissue and the underlying bone.

This requires that the rather rigid ankylotic-like connection between implant and bone replaces functionally the sophisticated suspension via the periodontal ligament as offered by evolution, and that the structural framework of the periimplant mucosa matches the architecture of the gingiva.

The context of an understanding of the elicited host site interfacial healing response will be reiterated for the time period immediately following implant placement up to long-term behavior. The role of the implant’s surface and its macro-, and microscopic design features for osseointegration will be elucidated and the clinical implications explained.

In particular, the biodynamics of the cascade of early wound healing beginning with the first interactions between modified rough implant surfaces, over inflammatory and proliferating phase up to the final osseointegration, will be demonstrated and summarized in an animation video.

There are still many aspects of periimplant healing that need to be elucidated, but we can state that we understand today the principal healing patterns leading to osseointegration. There still is room for improvement. There still is room to understand the benefit of new implant coatings, of improved implant designs and of new implant materials. There is no doubt at all that the hitherto exciting story about osseointegration will continue!

Why would you want to use ridge expansion? Ridge expansion allows us, through varying techniques, to make cuts in the bone, to bend the bone, and to create a 4-wall bony defect that we can place a tapered implant into with viable bone surrounding it. It allows us to restore a more natural arch form, increase vestibular depth, and help to place implants in a more restorative-driven position.

Ridge expansion allows us to have unique healing vs. grafting “turn-over”, and it allows us to have special clinical applications that we can’t achieve with any other technique. It shortens the healing interval and reduces pain. For our patients it is a very minimally invasive approach. However, these techniques have a steeper learning curve and require special instrumentation to complete.

This lecture will show you how ridge expansion can enhance your practice and your patient care.

The purpose of this two-part series on “Restoration of ‘Failing Teeth’ with Implants in the Aesthetic Zone” is to help you predictably achieve highly esthetic outcomes that restore function and stand the test of time. This lecture will present the sound biological principles that can help you approach the treatment of challenging cases where your patient has a seriously compromised dentition. Surgical and prosthetic considerations will be discussed. Is the tooth maintainable? Is it more predictable to maintain the compromised tooth or extract and place an implant? We should always try to save the tooth if possible, but determining this requires analysis of the patient: How old is the patient? What is the tooth’s dental history? What is the structural integrity of the tooth? What is the periodontal status? What are the functional demands? This lecture will present and discuss the key elements that we must consider when thinking about implants in the esthetic zone.

This introductory lecture will take you on a journey to see how NobelActive can help you through various cases ranging from simple to complex. First you will learn about the design, biologics, and features of the NobelActive implant. We will show you how to utilize NobelActive in cases where there is a severe defect in the molar area after extraction where there is only 1mm, and what you can do in cases where you want to preserve the papilla between two implants. You will be shown the benefits of being able to change direction when placing NobelActive, and when it is best to do this. We will present hard cases: one involving severe atrophy in the maxilla, and another involving two missing congenital laterals in a limited spacing where a 3mm is utilized. You will learn how to best utilize NobelActive in All-on-4 and All-on-6 cases with fixation. We will also present a case where there is a failed implant and how we successfully replace it with immediate loading of a NobelActive.

In this presentation Dr. Edmond Bedrossian follows up on his previous lecture ‘A systematic surgical and restorative plan for treatment of the Edentulous Patient with a Fixed Prosthesis’ (catalog #141-00). He will begin by highlighting the differences between the tooth-only defect patient, and the composite defect patient. He will step through 4 different cases, explaining each step that is necessary for a predictable outcome.

Dr. Bedrossian will discuss the interarch space as well as the indications for alveolaplasty: economic, technical, and esthetic.

In this presentation, Dr. Sanda Moldovan will discuss nutrition as it applies to patient outcomes.

After years of study and experience as both a periodontist and nutritionist, Dr. Moldovan has seen the connection between nutrition and clinical results.

We have a global epidemic of obesity today. Over 30% of US adults are obese. What does that mean for us as practitioners? We know that these patients are not going to heal well. They are going to have a lot of inflammation, pain, and excessive swelling. This presentation will discuss how to deal with these patients.

Dr. Moldovan will discuss what is important in bone healing and soft tissue healing, and what nutritional support options are available for maximizing these processes.

This 30-minute video presentation by Dr. Paul Homoly will reveal some things that you can bring to your practice immediately to help your patients accept complete care.

Dr. Homoly will tackle the term “chief complaint” (a term we dentists use all the time when consulting with our patients). He will explain why this term may not be working for you, and he will show you how you can replace this term with four other “chiefs”: “Chief Condition”, “Chief Disability”, “Chief Benefit”, and “Chief Fit Issue”. He will explain each of these new terms and demonstrate how they can help your patients say “yes”.

Biological Potential of Hard and Soft Tissues — From Bone Resorption to Planned Implant Therapy to Predictable Gingival Esthetics

Immediate Tooth Replacement of Failing Tooth #11

Tissue and Bone Defect Restoration