Digitally Supported Guided Bone and Soft Tissue Regeneration

Istvan Urban

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.
Guided Bone Regeneration (GBR) has become one of the most well accepted and least invasive surgical techniques in the past decades.
Patients are presenting today for larger defects than the past. This is due to defects created by peri-implantitis, bone graft failures, accidents and tumors. Recently, more patients with larger defects are seeking for regenerative therapy because of more favorable results and the acceptance of the dental profession.
To make regeneration easier and more predictable digital planning and tool creation, such as the Master Guide for assisting lingual membrane fixation, correct graft dimension and optimal implant positioning into the regenerated bone has been developed. This will be discussed in detail.
The reconstruction of the vertical and horizontal Deficiency of different regions will be one of the key topics of this presentation. The detailed surgical anatomy of the floor of the mouth, the Modified Lingual Flap as well as the technique for protecting the mental and infraorbital nerves will be presented in details.
To achieve wound closure and graft stability in advanced deficiency, the buccal mucosa is often widely released, which can severely shift the mucogingival line apically and lead to 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. Recently, a combination of a strip gingival graft in combination with a collagen matrix was introduced to reconstruct the lost vestibule and keratinized tissue. Further research demonstrated that this regenerated tissue is keratinized. However, any open healing graft that is harvested from the palate will have different color and texture than the neighboring tissue. Therefore, there was a need to further develop a more esthetic grafting technique. 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.
Different regions such as anterior, posterior maxillary as well as mandibular soft tissue reconstructions will be discussed in a detail.
These procedures are simple, repeatable, and biologically sound. These techniques are less invasive, not overcomplicated – they are simple treatment strategies with lower complication rates and more predictability in the final outcome.