Next-Gen Periodontal Regeneration: Interproximal Attachment Rebuild

Lesson 1: Interproximal attachment gain: the challenge for periodontal regeneration

This first lecture provides a definition of interproximal attachment, and highlights the importance of this parameter in the correct periodontal disease stage identification and classification. Different types of interproximal attachment loss are shown, and the anatomic features of the papillae are analyzed to predict the healing potential. The evolution of the biomaterials and techniques involved in periodontal regeneration are explained through a simple, schematic approach, paving the way for the description of the first therapy option: the non-surgical or flap-less approach. Instrumentarium and biomaterial election - based on the tissue phenotype - are covered in the latter part of the lecture through the presentation of several case reports.

Duration: 1 h 10 min

Lesson 2: Papilla treatment: cases with horizontal bone loss and soft tissue deficiency

The second lecture of the Masterclass focuses on papilla treatment in thise cases that show horizontal bone loss and soft tissue deficiency. The discussion delves into the surgical steps to achieve optimal results, and shows whether it is necessary to plan an additional surgery session within our treatment plan.

Duration: 38 min

Lesson 3: Papilla Preservation Technique & Modified Papilla Preservation Technique

The third lecture of the Masterclass provides a contextualisation of the biological rationale behind GTR, and describes two key techniques:

• The Papilla preservation Technique by Takei et al

the Modified Papilla Preservation Technique by Cortellini et al., with non-resorbable and resorbable membranes. These techniques, their advantages and disadvantages, are thoroughly explained through a series of clinical cases.

Duration: 57 min

Lesson 4: Simplified papilla preservation technique

The fourth lecture of the Masterclass focuses on the simplified papilla preservation technique by Cortellini et al. This technique was designed to ensure the right positioning and the correct proximity between a membrane and the flap that covers it. The diagonal incision of the papilla allows to increase the connective tissue interface of the two flaps, a key feature useful both in narrow interproximal spaces, as well as in the molar area where the papillae are too long to guarantee the correct blood supply.

Duration: 27 min

Lesson 5: The Surgical Technique for EMD

This fifth lecture focuses on EMD. Introduced on the market in 1996, EMD is an extract of enamel matrix and contains amelogenins of various molecular weights. Amelogenins are involved in the formation of enamel and periodontal attachment formation during tooth development. The Surgical Technique for EMD - published in 1999 by Rasperini et al. - is described thoroughly.

Duration: 50 min

Lesson 6: Avoiding papilla elevation: MIST and SFA techniques

The sixth lecture of the Masterclass focuses on minimally invasive techniques in periodontal regeneration. The possibility to use a gel rather than a membrane to achieve periodontal tissue regeneration allowed a marked evolution in surgical technique, reducing flap dimension and invasiveness. The Minimally invasive approach by Wachtel et al, and the MIST by Cortellini et al. represent the first examples of this new evolutionary path. The procedure simplification trend did not stop there; with the aim of avoiding papilla elevation, the Single Flap Approach by Trombelli et al. and the evolution of the MIST by Cortellini et al. saw the light; Aslan et al. introduced the Entire Papilla Preservation where the papilla is moved laterally. All these techniques are addressed and described in this lecture.

Duration: 41 min

Lesson 7: Soft Tissue Wall Technique & new perspectives in periodontal regeneration

The seventh lecture describes the Soft Tissue Wall Technique by Rasperini et al., and presents a study on 3D Printed graft (Rasperini et al.) as a future perspective for coronal shift of the interproximal attachment. While some cases require to improve the height of the papilla and contextually reduce pocked depth, all the techniques described so far aim at maintaining the papilla level. This consideration paves the way for a new era in periodontal regeneration technique evolution.

Duration: 1 h 9 min

Lesson 8: Phenotype assessment and mucogingival surgery concepts in modern periodontal regeneration

The eighth lecture describes the importance of the diagnosis of the tissue phenotype. This aspect is mandatory not only in mucogingival surgery, but also in periodontal regeneration. The description provided covers soft tissue management in mucogingival surgery - comprising coronally advanced flap and tunnel technique - and offers a set of indications concerning the use of a connective tissue graft and/or a heterologous matrix. The concept behind this presentation is to transfer the same rationale observed for mucogingival surgery to periodontal regeneration.

Duration: 33 min

Lesson 9: Combined approaches to interproximal attachment gain

The ninth lecture of the Masterclass portrays a series of cases where the interproximal attachment was gained and the tissue phenotype improved simultaneously. It is also shown the application of the VISTA technique, by Homa Zadeh, for the simultaneous treatment of the infrabony component of the defect and of the sorrounding soft tissue, erasing any risk of papilla dehiscence. A case of interdental attachment regeneration, phenotype improvement and furcation involvement resolution completes the lecture.

Duration: 39 min

Lesson 10: Papilla improvement and contextual soft tissue optimization on 21 and 22

The video shows the clinical application of an innovative surgical protocol to create interdental papilla published by Prof. Takanori Suzuki (NYUDC). The recipient site was prepared with a buccal incision apical to the mucogingival junction and to the defective papilla, and a palatal incision, followed by buccolingual tunneling performed with a translingual curette. The missing interproximal papilla received a subepithelial connective tissue graft.

Duration: 52 min

Lesson 11: Entire papilla preservation technique and tunnelling technique for deep infrabony defect correction, gingival recession coverage and soft tissue enhancement on elements 32 and 33

The video shows the clinical application of 2 techniques used in combination to contextually reach 3 goals: deep inrabony defect resolution, gingival recession root coverage and overall soft tissue thickness improvement.

The patient suffers from a severe case of periodontitis and shows thin phenotype characteristics; she has already been treated with non-surgical approaches.

The surgical plan identified allows to minimize the trauma on the tissues, while taking advantage of the sinergic features of the techniques chosen.

Duration: 47 min

Lesson 12: Live Case Discussion

Interactive meeting with Dr. Rasperini to deepen the topics addressed during the Masterclass.

Duration: 1 h 2 min

Lesson 13: First ReLive Case Discussion - 2022 Edition

Interactive meeting with Prof. Rasperini to deepen the topics addressed during the Masterclass.

Duration: 54 min

Lesson 14: ReLIVE Case Discussion 2

Recorded meeting with Prof. Rasperini to deepen the topics addressed during the Masterclass.

Duration: 32 min