From Resective to Regenerative: Interdental Attachment & Papilla Reconstruction

Lesson 1: Redefining the concept of hopeless tooth

In this first video lecture, Prof. Rasperini will redefine the concept of hopeless tooth by introducing a paradigm shift in the management of periodontal disease.

Participants will deepen the importance of focusing on preserving natural dentition and re-evaluating tooth extractions.

The lesson delves into the diagnosis and classification of periodontitis, highlighting the critical issue of interdental attachment loss rather than the traditional focus on pocket depth.

Treatment goals will be discussed and, thanks to several clinical videos, Prof. Rasperini will show how to achieve infection control, reduce plaque levels and slow or stop the progression of periodontal disease also managing residual pocket depths.

In particlar, this lecture covers the following topics:

• A new definition of success in Periodontology
• The management of severely compromised teeth
• How to treat and re-evaluate teeth before considering extraction
• Diagnosis and classification of perimplantitis
• How to identify the disease by observing the interproximal attachment loss
• Treatment goals, phases and the complete data collection

Duration: 56 min · Presented by: Giulio Rasperini, Emilia Kazarian

Lesson 2: The challenge of the interproximal attachment gain

This video lesson explores a transformative shift in periodontal regeneration, moving beyond a sole focus on intrabony defects to emphasize the importance of interproximal attachment.

The discussion delves into the challenges of gaining interproximal attachment and traces the evolution of techniques and biomaterials designed to address complex periodontal conditions.

Prof. Rasperini will provide participants an overview of regenerative procedures over time, highlighting foundational studies in guided tissue regeneration and the essential elements for successful wound repair.

The lesson examines the causes of papilla loss and outlines the clinical parameters to consider, such as papilla height, width, phenotype, and keratinization.

The evolution of techniques and biomaterials is explored, showcasing how advancements have enabled the simultaneous treatment of infrabony and soft tissue defects.

A detailed comparison between Emdogain and membranes underscores Emdogain’s advantages, including fewer complications and comparable surgical outcomes, supported by 25 years of follow-up data.

In particlar, this lecture covers the following topics:

• The challenge of interproximal attachment gain and the evolution of techniques and biomaterials
• Guided tissue regeneration key studies over time
• Basic elements for wound repair
• Which is the cause of papilla missing?

Duration: 1 h 10 min · Presented by: Giulio Rasperini, Emilia Kazarian

Lesson 3: Advancements in regenerative materials and approaches

In this video lecture, Prof. Rasperini explores how advancements in regenerative materials and approaches have enhanced clinical outcomes and minimized complications.

Membrane-related complications are also discussed, providing insights into their impact on regenerative procedures.

Practical strategies for managing papilla loss in cases of intrabony defects are presented, with techniques tailored to specific phenotypes. For thick phenotypes, approaches such as the Soft Tissue Wall Technique and CA+EPPT are examined.

For thin phenotypes, solutions include Soft Tissue Wall combined with Connective Tissue (CT), Connective Tissue Wall, CA+EPPT, and AICAST.

This lesson provides a comprehensive overview of state-of-the-art techniques and biomaterials, providing clinicians with the knowledge to optimize periodontal regeneration outcomes while addressing diverse clinical challenges.

In particlar, this lecture covers the following topics:

• The simultaneous treatment of both infrabony and tissue defects
• How to manage membrane complications
• A comparison between the use of Emdogain and membranes
• What to do in case of papilla loss, thin phenotype and infrabony defect?

What to do in case of papilla loss, thick phenotype and infrabony defect?

Duration: 1 h 02 min · Presented by: Giulio Rasperini, Emilia Kazarian

Lesson 4: Papilla loss and intrabony defect treatment possibilities

This video lecture provides a historical overview of the treatment options for cases involving papilla loss and intrabony defects, tracing the evolution of techniques and approaches in periodontal therapy.

Special attention is given to the Tunnel Technique, designed to manage deep attachment loss in challenging cases where pockets are present, but the papilla is absent.

The importance of respecting soft tissues throughout the treatment process will be emphasized and participants will understand when to prescribe antibiotics and how to simultaneously treat intrabony and soft tissue defects.

In particlar, this lecture covers the following topics:

• Deep attachment loss and no papilla: Tunnel Technique
• The proper healing time before undergoing surgery
• The treatment of infrabony defects with simplified approaches
• The simultaneous treatment of both infrabony and soft tissue defects

Duration: 22 min · Presented by: Giulio Rasperini, Emilia Kazarian

Lesson 5: Periodontitis: the sixth most common disease in humanity

This video lecture focuses on periodontitis, the sixth most common disease worldwide, affecting over 50% of the population.

Dr. Kazarian emphasizes the critical importance of early diagnosis, explaining that interproximal attachment loss evaluation is the only reliable method for early detection, as radiographic imaging and CBCT are insufficient.

The role of normal probing in the initial assessment is also highlighted, alongside an overview of sulcus, junctional epithelium, and ligament morphology in a healthy periodontium.

The progression from periodontal health to disease is explored, starting with plaque accumulation and gingivitis and the differences between gingivitis and periodontitis are clearly outlined.

Participants will understand how treatment begins with non-surgical therapy, focusing on reducing inflammation without invasive procedures or addressing gingival recessions.

Clinical pathways following non-surgical treatment are presented as well as the factors critical for surgical success in periodontal regeneration, such as flap and clot stability, defect access, and primary intention healing.

In particlar, this lecture covers the following topics:

• How to early diagnose periodontal diseases?
• Clinical options after non-surgical treatment
• Factor of surgical success in periodontal regeneration
• Gingivitis VS Perimplantitis
• Non-surgical initial therapy to remove the inflammation

Duration: 59 min · Presented by: Giulio Rasperini, Emilia Kazarian

Lesson 6: Gingival papilla reconstruction

This video lesson explores the revolutionary shift in periodontology, moving from resective techniques, once the gold standard, to advanced regenerative procedures.

A highlight of the lesson is the 3D Tunneling Technique, demonstrated through clinical videos. This technique, performed from the buccal, lingual, and interdental sites, is designed to move interdental tissues coronally and maintain them without tension—making it the only reliable method for papilla reconstruction in the lower jaw.

The session also includes an overview of the specialized instruments used for buccal and lingual tunneling and the precise positioning of grafts.

The functional and aesthetic implications of gingival recession and papilla loss are discussed, including black triangles, gingival asymmetry, food impaction, phonetic challenges, and increased plaque accumulation, all of which heighten the risk of periodontal issues.

In particlar, this lecture covers the following topics:

• How to regenerate tissue by moving it coronally while addressing buccal exposure
• Interproximal tissue regeneration and clinical attachment level improvement
• Functional and aesthetic implications of gingival recession and papilla loss3D Tunnelling Technique surgical protocol and proper instrumentation

Duration: 55 min · Presented by: Giulio Rasperini, Emilia Kazarian

Lesson 7: Advancing Periodontology: Regenerative Techniques for Gingival and Papilla Reconstruction

This comprehensive video lesson delves into the evolution of periodontal treatment, focusing on cutting-edge methods to regenerate and thicken gingival tissue, address buccal exposure, and restore interproximal tissue—the most challenging area to regenerate.

A highlight of this lesson is the introduction to 3D Tunnelling, a revolutionary technique that enables the coronal movement of interdental tissues while maintaining stability and tension-free results.

In particlar, this lecture covers the following topics:

• Predictable outcomes for recession types (RT1, RT2) and challenges in RT3The impact of papilla loss on aesthetics and function (black triangles, asymmetry, plaque accumulation)3D Tunnelling: a technique to move and stabilize interdental tissues coronally, restoring papillae, especially in the lower jaw
• Clinical videos demonstrating instrumentation, graft positioning, and tailored approaches for different phenotypes

Duration: 32 min · Presented by: Giulio Rasperini, Emilia Kazarian

Lesson 8: ReLIVE Surgery: 3D Tunnelling Technique

The channel concludes with a ReLIVE Surgery that provides a detailed, step-by-step demonstration of the 3D Tunneling Technique, offering a comprehensive understanding of its application in papilla reconstruction.

Duration: 1 h 27 min · Presented by: Giulio Rasperini, Emilia Kazarian