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Martina Stefanini: Treatment of two adjacent infrabony defects with Straumann® Emdogain®

  In the following case, periodontal regenerative surgery with amelogenins (Emdogain®) produced complete filling of two adjacent vertical, deep and non-contained defects in the lower jaw. Moreover, the results were well maintained in the long term (6 years), as demonstrated clinically and radiologically. The periodontal regenerative treatment changed the prognosis of the lower first molar in a young patient, avoiding extraction and subsequent implant placement. The strict regimen of post-surgical control visits was critical for the successful long-term maintenance of the regenerative results. PRODUCT INFORMATION BY THE MANUFACTURER Straumann® Emdogain® Emdogain® in numbers Straumann® Emdogain® Straumann® Emdogain® (used alone or in combination with bone graft) is arguably the material of choice to treat periodontal defects. Adding Emdogain® to an open flap debridement surgical procedure has demonstrated to yield significantly better clinical results than the procedure alone . Adding Emdogain® to the procedure has also been shown to significantly reduce post-surgical pain and swelling, as well as improve wound healing . Emdogain® in numbers 20 years on the market 2 million patients treated* Over 1000 scientific publications*** Over 600 clinical publications Extremely well tolerated** *based on number of syringes sold globally **based on a global post-surgical complication rate of less than 0.002% *** based on pubmed search for Emdogain or “enamel matrix derivative” PICTURE DOCUMENTATION Fig. 1 stefanini01 Fig. 2 stefanini02 Fig. 3 stefanini03 Fig. 4 stefanini04 Fig. 5 stefanini05 Fig. 6 stefanini06 Fig. 7 stefanini07 Fig. 8 stefanini08 Fig. 9 stefanini09 Fig. 10 stefanini10 Fig. 11 stefanini11 Fig. 12 stefanini12 Fig. 13 stefanini13 Fig. 14 stefanini14 Fig. 15 stefanini15 Fig. 16 stefanini16 Fig. 17 stefanini17 Fig. 18 stefanini18 Fig. 19 stefanini19 INITIAL SITUATION A systemically healthy 33-year-old patient was diagnosed with localized aggressive periodontitis. A pre-operative x-ray (Fig.1) revealed an intra-bony defect in the distal aspect of tooth #46 and on the mesial aspect of tooth #45. Following the initial preparation, a residual 10 mm periodontal pocket was evident distal to tooth #46 and a 7 mm periodontal pocket mesial to tooth #45 (Figs. 2-3). TREATMENT PLANNING After causal therapy, the patient showed a good standard of supragingival plaque control (FMPS and FMBS<15%), and regenerative periodontal surgery with Emdogain® was scheduled. SURGICAL PROCEDURE Following local anesthesia, an envelope-type flap extending from distal #43 to mesial #47 was raised. The supracrestal soft tissue above the angular defects was preserved with the amplified papilla preservation technique between #47 and #46 and with the simplified papilla preservation technique between #45 and #44 (Figs. 4-5). The flap was elevated in a split-full-split approach. The surgical papillae were elevated split thickness, while the central portion of the flap was elevated full thickness until the bony defects were completely exposed. The lingual flap, together with the interdental supracrestal soft tissues, was raised full thickness. The flap elevation was followed by debridement: both bony defects were degranulated, and the root surfaces were planed with ultrasonic and manual instruments. The infrabony defect on #46 was classified as a two-wall defect in the most coronal portion (missing vestibular wall), becoming a three-wall defect in the apical portion. The infrabony defect on #45 was classified as one-wall defect in the most coronal area while, in the apical area, a three-wall defect was evident (Figs. 6-7). The root surfaces were conditioned with EDTA gel 24% for two minutes to remove the smear layer produced by the root planing. After rinsing with saline solution, Emdogain® was applied on the exposed root surface and in the defects (Figs. 8-9).The anatomical papillae between #43 and #44 and between #45 and #4.6 were de-epithelialized, and the buccal flap was moved coronally in order to suture the surgical papilla to the connective tissue of the anatomical papilla with single interrupted sutures. The interdental soft tissues preserved in the area of the infrabony defects (#44-#45 and #46-#47) were sutured by first intention with single interrupted Vicryl 6-0 sutures (Figs. 10-11). The patient was instructed not to brush the treated area. Plaque control was performed with chlorhexidine solution 0.12% three times daily for 15 days. Systemic antibiotic therapy (amoxicillin 1 g twice daily for 7 days) together with anti-inflammatory therapy (ibuprofen 600 mg twice daily for 2 days and subsequently as needed) were prescribed. The sutures were removed after 15 days (Figs. 12-13). CONCLUSION Dr. Martina Stefanini Periodontologist and researcher (with Prof.Giovanni Zucchelli at the University of Bologny, Italy, currently in a Research Fellow position). Level II Master in Periodontology from the University of Siena (Italy). PhD in Medical Sciences from the University of Bologna. Teaching professor at the postgraduate program in Periodontology at the San Raffaele University in Milano, Italy and the Level II Master in Soft Tissue management at the University of Bologna. Active member of the Italian Society of Periodontology. Scientific author and speaker on national and international level. The post Martina Stefanini: Treatment of two adjacent infrabony defects with Straumann® Emdogain® appeared first on STARGET COM.

Angel Moreno: All-Records-in-One® for immediate loading – a novel technique for manufacturing a full-arch, fixed, implant-supported provisional restoration in the surgical office (Straumann® Bone Level Tapered Implant)

  This case report presents an immediate-loading procedure as an innovative application for the newly described “All-Records-in-One®” impression technique*. This method allows us to fabricate a temporary implant-supported restoration for an edentulous patient in a quick, accurate and comfortable manner for both patients and clinicians. As the procedure is entirely prosthodontically driven, it is highly accurate and has a low incidence of occlusal corrections, thereby substantially reducing the average patient´s chair time. PRODUCT INFORMATION BY THE MANUFACTURER The Straumann® Bone Level Tapered Implant offers excellent primary stability in soft bone and fresh extraction sockets. The tapered form adequately compresses the underprepared osteotomy. It also allows to effecively master your patient’s limited anatomy such as facial undercut, converging root tips, concave jaw structure or narrow atrophied ridges. Building on the clinically proven features of the Straumann® Bone Level Implant, the BLT introduces the powerful combination of Roxolid®, SLActive®, Bone Control Design™, CrossFit® connection, prosthetic diversity, plus a tapered implant body. MORE? All about the STRAUMANN® BONE LEVEL TAPERED IMPLANT on STARGET at a glance. Click here PICTURE DOCUMENTATION Fig. 1 moreno01 Fig. 2 moreno02 Fig. 3 moreno03 Fig. 4 moreno04 Fig. 5 moreno05 Fig. 6 moreno06 Fig. 8 moreno08 Fig. 9 moreno09 Fig. 10 moreno10 Fig. 11 moreno11 Fig. 12 moreno12 Fig. 13 moreno13 Fig. 14 moreno14 Fig. 15 moreno15 Fig. 16 moreno16 Fig. 17 moreno17 Fig. 18 moreno18 Fig. 19 moreno19 Fig. 20 moreno20 Fig. 21 moreno21 Fig. 22 moreno22 INITIAL SITUATION An edentulous healthy 58-year-old non-smoking male, wearing maxillary and mandibular complete dentures presented at our dental office. He complained about their instability and unsatisfactory appearance (Fig. 1). He also reported pain and frequent pressure ulcers caused by the instability of the mandibular denture (Fig. 2) and also by the lack of keratinized tissue. We assessed viable bone from a panoramic radiograph and CBCT scan (Fig. 3), and the patient was offered several treatment options, including fixed, full arch implant-supported restorations in both maxilla and mandible, and also a free gingival procedure to increase the quality of the tissue, which was refused by the patient. For financial reasons, the patient chose a conventional complete denture in the upper jaw and a full-arch, screw-retained hybrid prosthesis in the lower jaw. TREATMENT PLANNING An immediate-loading option was discussed and fully explained to the patient. Once the patient agreed to have the treatment, we made two diagnostic wax-ups for the upper and lower jaws and tried them in the patient´s mouth to check esthetics, vertical dimension and centric relation records. After clinically assessing the esthetics and functional records, we fabricated a definitive complete denture in the upper jaw and a temporary acrylic complete denture in the lower jaw. SURGICAL PROCEDURE The patient received a prophylactic dose of 2g amoxicillin plus clavulanic acid one hour before the surgery. Also, an anti-inflammatory drug (ibuprofen) was prescribed for the day of the surgery and, only if necessary, after the procedure. The surgery was carried out under local anesthesia. A full-thickness flap was raised, and the residual bone was reduced in order to obtain a proper prosthetic space for the restoration and an adequate implant bed (Fig. 4). Five Straumann® Bone Level Tapered (BLT) implants were placed between the mental foramina (Fig. 5) according to the manufacturer´s instructions. All implants displayed a high degree of primary stability, requiring a ≥ 30Ncm torque as tested with a torque-control device. PROSTHETIC PROCEDURE Five Straumann® RC screw-retained abutments were tightened to 35 Ncm over each implant. The height of the abutments was clinically chosen according to the peri-implant mucosa and the 3D position of the implants (Fig. 6). Next, protective RC caps were tightened to the RC screw-retained abutments with 10 Ncm. At this point, the temporary prosthesis, now used as a prosthetic template, was placed in the patient´s mouth (Fig. 7). We then mixed and placed some silicone putty in the prosthetic stent window, and made an impression of the cap shapes at the same time as a centric occlusal record was taken against the upper definitive denture (Figs. 8,9). The silicone putty was removed, and an incision of about 1-2 mm was made (Fig. 10). Separating agent was applied over the silicone putty and was again placed in the prosthetic stent (Fig. 11). Polyvinyl siloxane material was poured (Fig. 12), and an impression was taken while asking the patient to close his mouth, taking care to keep the interocclusal centric record we just performed in the wax-up try-in. Once the impression material had set, we removed the impression (Fig. 13) and cut the entire thickness of the polyvinyl siloxane material corresponding to the mark of each protective cap (Fig. 14). Since we had already applied separating agent before, we were able to again remove the silicone putty material without breaking the impression (Fig. 15). We removed the RC protective caps, and titanium copings were placed over the RC screw-retained abutments and tightened to 15 Ncm. Finally, the prosthetic stent was again placed in the patient´s mouth over each titanium coping (Fig. 16) and autopolymerizing acrylic resin with a medium consistency was poured into the space (Fig. 17). Before this material set completely, we had to check that the occlusal centric relation record was maintained at all times. We waited for about 7 or 8 minutes until the acrylic material had set completely and, finally, we removed it from the patient´s mouth (Fig. 18). FINAL RESULT Once we had removed the unfinished temporary hybrid prosthesis from the patient´s mouth, about 30-35 minutes from the beginning, we had two options: finish it in the surgical office or send it to the lab. In both situations the patient can stay in the waiting room or go for a walk during the process, since his presence is not required. In most cases, and taking account of profitability and our own and the patient´s convenience, the prosthesis is finished by the lab. In his lab the technician pours autopolymerizing acrylic resin to fill any gaps (Fig. 19), trims the prosthesis cantilevers and polishes it in order to obtain the final temporary hybrid prosthesis (Figs. 20,21). Finally, the full-arch, fixed, implant-supported provisional restoration is placed in the patient´s mouth. Fig. 22 shows the clinical situation immediately after placement of the temporary prosthesis as we received it from the lab, about one hour later. Only minor occlusal corrections were needed. Postoperative x-ray control confirmed the correct positioning and fit between the implants and the temporary implant-supported hybrid prosthesis. * “All-Records-in-One®” is a trademark of Createch, Mendaro (Guipúzcoa), Spain. Angel Moreno Lucendo DDS Cofounder of Createch Medical (Spain). Basic and clinical research in digital implant dentistry and implant prosthetics. Private practice limited to implant dentistry and oral rehabilitation. Lecturer at international level. CLINICAL REVIEW The clinical facts behind the Straumann® Bone Level Tapered Implant. Click here BROCHURE Download the Straumann® Bone Level Tapered Implant brochure. Click here The post Angel Moreno: All-Records-in-One® for immediate loading – a novel technique for manufacturing a full-arch, fixed, implant-supported provisional restoration in the surgical office (Straumann® Bone Level Tapered Implant) appeared first on STARGET COM.

The finalist teams of the Excellence in Prosthodontics Award

  Choose your favorite finalist team. Online vote will be open until Sunday, March 19 (11:59 PM GMT). Vote Now Dr. Pascal Magne will award the winning team that will be announced during the IX AIOP Mediterranean Meeting held April 7-8, 2017, in Riccione (Italy). FIRST PRIZE: Straumann® CARES® Intraoral Scanner: A collaboration between: AIOP (Italian Academy of Prosthetic Dentistry) APS (American Prosthodontic Society) JPD (The Journal of Prosthetic Dentistry) ZERODONTO (Free Blog of Dentistry) powered by Straumann The post The finalist teams of the Excellence in Prosthodontics Award appeared first on STARGET COM.

Straumann at IDS 2017: Rocking dentistry like never before!

  March 21-25 2017: More than ever before, Straumann will surprise dentistry at the International Dental Show in Cologne, Germany, by presenting a horn of plenty of innovations, product novelties and services that will shake up the market. Virtual Reality worlds plus a breathtaking show during IDS will rock you to the core. Visit our IDS campaign websites for more information and be there when Straumann raises the roof of the Cologne exhibition hall! Hands in the air for Virtual Reality & Live Rock sessions! Let yourself be  transported to a world of Virtual Reality, with surprising perspectives on groundbreaking innovations. Put on the VR glasses and experience an unparalleled video and audio experience combining information, science and virtual reality. Then let yourself be entertained by live rock sessions and the classic Straumann booth party – every evening during IDS! Who will be the winner of the Straumann® Rock Guitar? This extraordinary piece of art has been handbuilt by one of the most talented guitar makers with original Straumann® parts. Who has submitted the most impressive performance and gained the hearts of the audience? On Friday, March 24 at 17:00 you will find out when we officially hand over the guitar to the winner! The post Straumann at IDS 2017: Rocking dentistry like never before! appeared first on STARGET COM.


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