Perio-Prosthetic Approach for FP-1 Rehabilitations

Module 1: Introduction and course objectives

In this first introductory video lecture, Dr. Gómez Meda will present the topics that will be covered during this learning experience. From the management of complications to alveolar reconstruction, passing through references to mucogingival surgery and tissue and bone regeneration to the creation of emergence profiles and full-arch rehabilitations with FP-1 prostheses. Dr. Gómez Meda will emphasize from the beginning that the aim of the course is to achieve optimal results by minimizing the number of appointments and to create natural-looking prostheses.

Duration: 9 min

Module 2: Esthetic complications

Scientific research has shown that 7% of complications 5 years after implant surgery are of an aesthetic nature. In the opinion of the course reader, this fact needs to be treated with caution due to the fact that the occurrence of such aesthetic complications makes retreatment of the case necessary, implying a loss of time and money for the clinician and an increase in stress for the patient. The first part of this presentation will focus on strategies to prevent these complications by paying particular attention to orthodontically guided implant placement, also using digital planning SW. Afterwards, it will be shown how nowadays it is possible to achieve optimal results with FP-1 prostheses even in patients with periodontal disease whereas years ago it was necessary to perform an FP-3 prosthesis.

In particular, the following topics will be addressed:

• Implant complications: mechanical, biological, functional and aesthetic
• The prevention of aesthetic complications: recessions, soft tissue collapse, scarring and other traumas around the emergence profile
• The correlation between emergence profile and implant position
• The reconstruction of the papillae in the most predictable way possible

Duration: 1 h 47 min

Module 3: Mucogingival techniques

The focus of this presentation will be on mucogingival surgery techniques applicable to immediate load implant placement. Dr Gómez Meda will focus on root coverage techniques, increasing the proportion of keratinized gingiva around teeth and increasing the volume of soft tissue around implants following regenerative surgery. Various connective graft harvesting techniques will be demonstrated and discussed with commented step-by-step clinical clips.

In particular, the following topics will be addressed:

• What is the correct distance between the contact point and the alveolar ridge?
• Performing epithelial grafts to increase the proportion of keratinized gingiva
• When to perform an epithelial graft?

• Grafts: optimal length, width and quality
• New types of biomaterial available on the market

Duration: 1 h 07 min

Module 4: The advantages of immediate loading implants

In this comprehensive presentation, Dr Gómez Meda will discuss the advantages of immediate loading implants. All key steps will be analysed with the help of several commented clinical clips in step-by-step mode.

In particular, the following topics will be addressed:

• Different timing for implant placement: immediate, delayed, full maturation
• Alveolus reconstruction at the same time as immediate loading
• The insertion of biocollagen
• How to reduce treatment time and morbidity

Duration: 1 h 52 min

Module 5: Socket preservation

Alveolar preservation is necessary to obtain a natural emergence profile and thus a highly aesthetic result even if the patient presents gum recession or bone dehiscence. Dr. Gómez Meda will show how alveolar preservation is necessary in bridges around teeth and implants when the volume of the papillae needs to be preserved and in the case of immediate implant placement when the patient presents a thin cortical. Participants will see how it is never possible to preserve 100% of the alveolar volume because there is always a percentage of bone resorption especially if the patient has a thin phenotype.

In particular, the following topics will be addressed:

• How to predict short- and long-term complications
• The preservation of alveolar volume through mucogingival surgery techniques
• The bone healing process: the timing of mineralisation
• The stabilization of the graft at occlusal level
• The degranulation of the epithelium in the post-extraction alveolus

Duration: 53 min

Module 6: Case planning phase

In this video lecture, participants will discover how to plan their cases appropriately, planning implant and connective graft position. Dr. Gómez Meda will show how to place implants in a digitally guided way, using planning SWs through which he will print out guides to perform the procedures in a minimally invasive way.

In particular, the following topics will be addressed:

• The reconstruction of an emergence profile with temporary composite abutments
• CAD CAM customized healing abutment
• Obtaining an STL file of the surgical guide to be sent to the dental office
• Tissue healing and implant osseointegration

Duration: 1 h 25 min

Module 7: Immediate implants for full-arch rehabilitation

In this presentation, Dr. Gómez Meda will discuss guided implant placement and soft tissue regeneration to achieve a natural-looking emergence profile in order to have natural-looking prostheses. Participants will be able to see through several clinical cases how immediate loading of a full arch is predictable in both the lower and upper arch. The probability of success is high and at the same time the treatment time and morbidity required of the patient is reduced.

The learning curve required to start performing this type of full-arch rehabilitation involves knowledge of the micro- and macroscopic design of the implants, the guided surgery kit and the digital planning SW required to perform digital wax-up and orthodontically guided implant placement.

In particular, the following topics will be covered:

• Immediate load full-arch dentures: functional, economic and psychological advantages
• Mucogingival surgery basics for graft placement
• The combination of mucogingival surgery, digitally guided surgery and immediate loading implant placement
• The placement of immediately loaded implants in inflamed or infected alveolus
• The triple-scan technique: intra- and extraoral temporaries and gingiva

Duration: 2 h 02 min