Dal lungotevere ai grandi laghi
Un percorso di crescita professionale e umana
Dr. Nicola Alberto Valente
Roma
17 marzo 2014
UOC Chirurgia
Odontostomatologica e
Riabilitazione Implanto-Protesica
!
• Frequentatore da gennaio 2008
• Tutor da gennaio...
Los Angeles USC 2009
• Certificate of advanced
graduate studies in
Periodontology
!
• Master of Science in
Oral Sciences
MS in Oral Science
• Research Design
• Scientific Writing
• Evidence Based Dentistry
• Biostatistics
• Advanced Statistical...
Certificate in Periodontology
• 40 fully documented cases
• 5 gingivectomy and/or gingivoplasty
• 15 gingival or apically r...
Certificate in Periodontology
• Advanced periodontics clinic
• Hospital practice periodontics
• Supervised teaching in peri...
Certificate in Periodontology
• Advanced periodontics clinic
• Hospital practice periodontics
• Supervised teaching in peri...
Certificate in Periodontology
• Advanced periodontics clinic
• Hospital practice periodontics
• Supervised teaching in peri...
Certificate in Periodontology
• Advanced periodontics clinic
• Hospital practice periodontics
• Supervised teaching in peri...
Certificate in Periodontology
• Advanced periodontics clinic
• Hospital practice periodontics
• Supervised teaching in peri...
PER	
  603	
  Unit	
  C3.	
  	
  The	
  Periodontal	
  Tissues	
  in	
  Disease

January	
  21,	
  	
  2014



	
  

Conne...
Outline
• Introduction
• Basic Concepts of Guided Tissue Regeneration
(GTR)
• Current Concepts of GTR
• Intrabony Defect
•...
• 1. *Aukhil I, Iglhaut J. Periodontal ligament cell kinetics following experimental regenerative procedures. J Clin Perio...
• 13. *Pradeep AR, Pai S, Garg G, Devi P, Shetty SK. A randomized clinical trial of autologous platelet-rich plasma in the...
• 24. Ahmedbeyli C, Dirikan İpçi S, Cakar G, Kuru BE, Yılmaz S. Clinical Evaluation of Coronally Advanced Flap With or Wit...
Postgraduate Treatment Planning
And Case Presentation
PER914
Nicola Alberto Valente DDS
PG Periodontics
11/12/13
HIPAA Declaration
• The informations presented are within the limits of
HIPAA declaration
Personal Data
• Name: E.B.
• Age: 50 years old
• Gender: male
• Race: caucasian
• Marital status: single
• Occupation: rea...
Referral
• Referred from PG prosthodontics for:
• Second stage surgery on implants #12 and #13
• Periodontal evaluation fo...
Chief Complaint
• “I want to have a smile like Julia Roberts”
Medical History
• Major illness:
• ASA:
• Hospitalization & Surgical History:
• Medications:
• Allergies:
None
I
None
None...
Habits
• Smoking: 1 pack of cigarettes a day (trying to quit, he
reports he haven’t been smoking for the last 2 months
and...
Personality And Behavior
• Indifferent (House 1958)
• Apathetic, uninterested and lacks motivation.
Pays no attention to i...
Dental History
• Amalgam fillings: #s 1, 3, 14, 19, 30
• Composite fillings: #s 18, 19., 20, 31
• Endodontic treatments: #18...
Periodontal History
• Osseous recontouring + distal wedge #31 (11/10)
• Open flap debridement + osseous recontouring #18 an...
Physical Examination
• No physical or mental disability was noticed
• Records at initial visit:
• Blood pressure: 147/90 m...
Clinical Examination
• Extra-oral examination:
• No facial asymmetry
• No palpable lymph nodes
• TMJ:
• No deviation detec...
Clinical Examination
Intra-oral examination:
Patient’s tongue, mucosa, floor of the mouth,
hard and soft palate were examin...
Occlusal Analysis
• Severe Class II
• Severe deep bite and over jet
• Anterior guidance: Anterior teeth
• Excursive moveme...
Oral Hygiene
• Plaque control include brushing 2 times/day and no
flossing
• Plaque score is 31,3% (O’Leary et al. 1972)
Periodontal Status
• Gingiva pink with firm consistency and stippling
• Gingival architecture: intermediate (flat/scalloped)...
Periodontal Examination
Maxillary arch
Periodontal charting
Mandibular arch
Diagnosis and Prognosis
• Diagnosis
• Medical: I (ASA)
• Periodontal: Chronic generalized severe periodontitis (AAP)
• Eti...
Treatment Objectives
• Eradicate and change etiologic factors for periodontal disease
• Educate the patient on the causes ...
Treatment Plan
• 2nd stage implant #12 and 13
• Open flap debridement on 1st quadrant
• Open flap debridement + osseous surg...
Treatment Plan
• 2nd stage implant #12 and 13
• Open flap debridement on 1st quadrant
• Open flap debridement + osseous surg...
Treatment Plan
• 2nd stage implant #12 and 13
• Open flap debridement on 1st quadrant
• Open flap debridement + osseous surg...
Treatment Plan
• Increase VDO 1-2mm (PG Pros)
• trial phase: composite restorations, temporary FPD
(implants)
• Re-evaluat...
Treatment Plan
• Increase VDO 1-2mm (PG Pros)
• trial phase: composite restorations, temporary FPD
(implants)
• Re-evaluat...
Treatment Plan
• Increase VDO 1-2mm (PG Pros)
• trial phase: composite restorations, temporary FPD
(implants)
• Re-evaluat...
Treatment Plan
Treatment progress
Crown lengthening should allow to have a tooth structure above the
bone crest of about 3.5-4mm taking i...
Treatment progress
3rd quadrant OFD + OS + crown lengthening #20
Treatment progress
3rd quadrant OFD + OS + crown lengthen...
Treatment progress
3rd quadrant OFD + OS + crown lengthening #20
Treatment progress
3rd quadrant OFD + OS + crown lengthen...
Treatment progress
3rd quadrant OFD + OS + crown lengthening #20
Treatment progress
3rd quadrant OFD + OS + crown lengthen...
Treatment progress
3rd quadrant OFD + OS + crown lengthening #20
Treatment progress
3rd quadrant OFD + OS + crown lengthening #20
Treatment progress
3rd quadrant OFD + OS + crown lengthening #20
4 weeks after surgery
4th quadrant OFD + ORS + crown lengthening #28
and 29
Treatment progress
4th quadrant OFD + ORS + crown lengthening #28
and 29
Treatment progress
Treatment progress
4th quadrant OFD + ORS + crown lengthening #28
and 29
Treatment progress
4th quadrant OFD + ORS + crown lengthening #28
and 29
1 week after surgery
Caso I
• Paziente: DD
• Età: 28
• Sesso: Maschio
• Razza: Ispanico
• Occupazione: Allentown Industries: Heritage Center (w...
Diagnosi
Armitage GC. Periodontal diagnoses and classification of periodontal diseases. Periodontol
2000. 2004;34:9-21.
Par...
Parodontite aggressiva localizzata
• Insorgenza circum-puberale
• Robusta risposta anticorpale sierica agli agenti
infetti...
• Caratteristiche primarie
• Eccetto per la presenza della patologia parodontale i
pazienti sono altrimenti in buona salut...
Terapia
• Scaling sopragingivale (familiarizzazione del paziente mentalmente disabile)
• SRP 1° e 2° quadrante con anestet...
• Rivalutazione a 7 settimane da inizio tx sistemica: ulteriori
miglioramenti, mutamento generalizzato delle tasche da pro...
• Rivalutazione a 7 settimane da inizio tx sistemica: ulteriori
miglioramenti, mutamento generalizzato delle tasche da pro...
• Rivalutazione a 7 settimane da inizio tx sistemica: ulteriori
miglioramenti, mutamento generalizzato delle tasche da pro...
• Rivalutazione a 7 settimane da inizio tx sistemica: ulteriori
miglioramenti, mutamento generalizzato delle tasche da pro...
pre tx
post tx
• Rivalutazione dopo chx 0,12%: controllo della placca
migliorato, nessun BOP residuo. Tessuti parodontali
relativi a 1.1 ...
Caso II
• Paziente: AR
• Età: 65
• Sesso: Maschio
• Razza: Caucasico
• Occupazione: Insegnante in pensione
• Riferito da: ...
Diagnosi
Armitage GC. Periodontal diagnoses and classification of periodontal diseases. Periodontol
2000. 2004;34:9-21.
Par...
Stambaugh RV, Dragoo M, Smith DM, Carasali L. The limits of subgingival scaling. Int J Periodontics
Restorative Dent. 1981...
Ramfjord SP, Nissle RR. The modified widman flap. J Periodontol. 1974 Aug;45(8):601-7.
Ramfjord SP, Nissle RR. The modified widman flap. J Periodontol. 1974 Aug;45(8):601-7.
1 mese post OFD
1 anno post OFD
Caso III
• Paziente: LS
• Età: 45
• Sesso: Femmina
• Razza: Caucasica
• Occupazione: Receptionist in una palestra
• Riferi...
Takei HH, Han TJ, Carranza FA Jr, Kenney EB, Lekovic V. Flap technique for periodontal bone implants.
Papilla preservation...
Takei HH, Han TJ, Carranza FA Jr, Kenney EB, Lekovic V. Flap technique for periodontal bone implants.
Papilla preservation...
Caso IV
• Paziente: LA
• Età: 46
• Sesso: Femmina
• Razza: Caucasica
• Occupazione: Insegnante di italiano e spagnolo
• Ri...
Perdita di attacco interprossimale - coronale alla MGJ
CAL interprossimale > CAL buccal
Miller class III copertura radicol...
Perdita di attacco interprossimale - coronale alla MGJ
CAL interprossimale > CAL buccal
Miller class III copertura radicol...
Perdita di attacco interprossimale - coronale alla MGJ
CAL interprossimale > CAL buccal
Miller class III copertura radicol...
Perdita di attacco interprossimale - coronale alla MGJ
CAL interprossimale > CAL buccal
Miller class III copertura radicol...
3 settimane post-op
7 mesi post-op
7 mesi post-op
7 mesi post-op
Caso V
• Paziente: PM
• Età: 36
• Sesso: Femmina
• Razza: Caucasica
• Occupazione: Casalinga
• Riferito da: Clinica pre-do...
No perdita di attacco interprossimale - coronale alla MGJ
Miller class I copertura radicolare totale
Miller, P.D. A classi...
No perdita di attacco interprossimale - coronale alla MGJ
Miller class I copertura radicolare totale
Miller, P.D. A classi...
Zuhr O, Rebele SF, Schneider D, Jung RE, Hürzeler MB. Tunnel technique with connective tissue
graft versus coronally advan...
Implant Center
Post-estrattivo in posizione 1.5
da dente deciduo ritenuto per
agenesia premolare
Dente deciduo ritenuto e
agenesia premolare 1.5
Straumann
Bone Level - SLA
4.1mm RC x 12mm
Kutkut A, Andreana S, Monaco E. Esthetic consideration for alveolar socket preservation prior to
implant placement: descri...
Kutkut A, Andreana S, Monaco E. Esthetic consideration for alveolar socket preservation prior to
implant placement: descri...
Kutkut A, Andreana S, Monaco E. Esthetic consideration for alveolar socket preservation prior to
implant placement: descri...
Kutkut A, Andreana S, Monaco E. Esthetic consideration for alveolar socket preservation prior to
implant placement: descri...
1 settimana post-op
Barone A, Toti P, Piattelli A, Iezzi G, Derchi G, Covani U. Extraction socket healing in humans after ...
3 settimane post-op
3 mesi post-op
3 mesi post-op
4 mesi post-op
4 mesi post-op
16 mesi
16 mesi
16 mesi
16 mesi
Posizionamento implantare 3.5-3.6 con
socket preservation 3.5 e espansione di
cresta con osso di cadavere irradiato e
solf...
Referral
Extraction and socket preservation of #20
Ridge augmentation
Implant placement #19 and #20
Prima visita
6 mesi dopo socket
preservation
ridge augmentation
Kutkut A, Andreana S. Medical-Grade Calcium Sulfate Hemihydrate in Clinical Implant Dentistry: A Review...
ridge augmentation
Kutkut A, Andreana S. Medical-Grade Calcium Sulfate Hemihydrate in Clinical Implant Dentistry: A Review...
ridge augmentation
Kutkut A, Andreana S. Medical-Grade Calcium Sulfate Hemihydrate in Clinical Implant Dentistry: A Review...
ridge augmentation
Kutkut A, Andreana S. Medical-Grade Calcium Sulfate Hemihydrate in Clinical Implant Dentistry: A Review...
ridge augmentation
Kutkut A, Andreana S. Medical-Grade Calcium Sulfate Hemihydrate in Clinical Implant Dentistry: A Review...
ridge augmentation
Kutkut A, Andreana S. Medical-Grade Calcium Sulfate Hemihydrate in Clinical Implant Dentistry: A Review...
ridge augmentation
Kutkut A, Andreana S. Medical-Grade Calcium Sulfate Hemihydrate in Clinical Implant Dentistry: A Review...
• Rocky Mountain Tissue Bank Irradiated bone
• Dentogen Calcium Sulphate, 1g
• ACE conFORM Collagen Membrane 20mm x 30mm
•...
2 settimane post-op
2 settimane post-op
3 settimane post-op
3 settimane post-op
3 settimane post-op
Posizionamento impianti
Cornelini R, Cangini F, Covani U, Andreana S. Simultaneous implant placement and vertical ridge
au...
Posizionamento impianti
Cornelini R, Cangini F, Covani U, Andreana S. Simultaneous implant placement and vertical ridge
au...
Posizionamento impianti
Cornelini R, Cangini F, Covani U, Andreana S. Simultaneous implant placement and vertical ridge
au...
Posizionamento impianti
Cornelini R, Cangini F, Covani U, Andreana S. Simultaneous implant placement and vertical ridge
au...
Posizionamento impianti
Cornelini R, Cangini F, Covani U, Andreana S. Simultaneous implant placement and vertical ridge
au...
Posizionamento impianti
Cornelini R, Cangini F, Covani U, Andreana S. Simultaneous implant placement and vertical ridge
au...
Posizionamento impianti
Cornelini R, Cangini F, Covani U, Andreana S. Simultaneous implant placement and vertical ridge
au...
Posizionamento impianti
Cornelini R, Cangini F, Covani U, Andreana S. Simultaneous implant placement and vertical ridge
au...
• Straumann SLA BL RC 4.8mm x 10mm (#19)
• Straumann SLA BL RC 4.1mm x 10mm (#20)
• Alloss Cortico/Cancellous Particulate
...
2 weeks after
Controllo a 2 mesi
Controllo a 2 mesi
Controllo a 2 mesi
2nd stage
4 febbraio 2014
2nd stage
Posizionamento implantare 2.4-2.5
con espansione di cresta
con osso equino e solfato di calcio
follow up 1 settimana
2nd stage
2nd stage
2 settimane dopo
Osteonecrosi post-implantare da terapia
bifosfonati IV pregressa
-
Rigenerazione con rhPDGF e Solfato di Calcio
follow up a 9 mesi
Nevins M, Giannobile WV, McGuire MK, Kao RT, Mellonig JT, Hinrichs JE, McAllister BS, Murphy KS, McClai...
follow up a 9 mesi
Nevins M, Giannobile WV, McGuire MK, Kao RT, Mellonig JT, Hinrichs JE, McAllister BS, Murphy KS, McClai...
follow up a 9 mesi
Nevins M, Giannobile WV, McGuire MK, Kao RT, Mellonig JT, Hinrichs JE, McAllister BS, Murphy KS, McClai...
Grazie
navalente
navalentedds@gmail.com
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
ARCOI presentation - Rome, march 2014
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ARCOI presentation - Rome, march 2014

  1. 1. Dal lungotevere ai grandi laghi Un percorso di crescita professionale e umana Dr. Nicola Alberto Valente Roma 17 marzo 2014
  2. 2. UOC Chirurgia Odontostomatologica e Riabilitazione Implanto-Protesica ! • Frequentatore da gennaio 2008 • Tutor da gennaio 2010
  3. 3. Los Angeles USC 2009
  4. 4. • Certificate of advanced graduate studies in Periodontology ! • Master of Science in Oral Sciences
  5. 5. MS in Oral Science • Research Design • Scientific Writing • Evidence Based Dentistry • Biostatistics • Advanced Statistical Concepts • Hard Tissue Engineering • Dynamics of Bone • …
  6. 6. Certificate in Periodontology • 40 fully documented cases • 5 gingivectomy and/or gingivoplasty • 15 gingival or apically repositioned flap • 10 clinical crown lenghtening • 15 periodontal surgical ossous recontouring • 10 bone replacement grafts • 5 guided tissue regenerations • 5 lateral sliding flaps or free gingival graft • 5 subepithelial connective tissue grafts • 8 distal or proximal wedge procedures • 2 provisional splinting, extracoronal or intracoronal • 125 subgingival scaling and root planing • 5 localized delivery of chemotherapeutics agents • 2 root amputation or hemisection • 20 periodontal maintenance • 10 periodontal maintenance (supervision of hygienist) • 7 surgical placement of implant body • 3 sinus graft/ramus graft/chin graft • 3 in-service exams • Comprehensive qualifying examination • Oral examination • Recertification every 6 years
  7. 7. Certificate in Periodontology • Advanced periodontics clinic • Hospital practice periodontics • Supervised teaching in periodontics
  8. 8. Certificate in Periodontology • Advanced periodontics clinic • Hospital practice periodontics • Supervised teaching in periodontics • Critical analysis of literature in Periodontics (Journal Club)
  9. 9. Certificate in Periodontology • Advanced periodontics clinic • Hospital practice periodontics • Supervised teaching in periodontics • Critical analysis of literature in Periodontics (Journal Club) • Seminars in periodontal biology
  10. 10. Certificate in Periodontology • Advanced periodontics clinic • Hospital practice periodontics • Supervised teaching in periodontics • Critical analysis of literature in Periodontics (Journal Club) • Seminars in periodontal biology • Postgraduate treatment planning (Perio/Pros)
  11. 11. Certificate in Periodontology • Advanced periodontics clinic • Hospital practice periodontics • Supervised teaching in periodontics • Critical analysis of literature in Periodontics (Journal Club) • Seminars in periodontal biology • Postgraduate treatment planning (Perio/Pros) • […]
  12. 12. PER  603  Unit  C3.    The  Periodontal  Tissues  in  Disease
 January  21,    2014
 
  
 Connective  Tissue  Regeneration   and  Mucogingival  Surgery
 Dr.  Nicola  Alberto  Valente   Supervisor:  Dr.  Joseph  J  Zambon
  13. 13. Outline • Introduction • Basic Concepts of Guided Tissue Regeneration (GTR) • Current Concepts of GTR • Intrabony Defect • GTR and Furcation Therapy • Membranes • Enamel Matrix Derivative (Emdogain) • Connective Tissue Graft and GTR • Alternatives to the Use of Connective Tissue Graft • Implant and GTR
  14. 14. • 1. *Aukhil I, Iglhaut J. Periodontal ligament cell kinetics following experimental regenerative procedures. J Clin Periodontol. 1988 Jul;15(6): 374-82. (Nicola) • 2. *Jepsen S, Eberhard J, Herrera D, Needleman I. A systematic review of guided tissue regeneration for periodontal furcation defects. What is the effect of guided tissue regeneration compared with surgical debridement in the treatment of furcation defects? J Clin Periodontol. 2002;29 Suppl 3:103-16; discussion 160-2. Review. (Nicola) • 3. *Wang HL, Greenwell H, Fiorellini J, Giannobile W, Offenbacher S, Salkin L, Townsend C, Sheridan P, Genco RJ; Research, Science and Therapy Committee. Periodontal regeneration (position paper) . J Periodontol. 2005 Sep;76(9):1601-22. (Nicola) • 4. Hannu Larjava, Yi Yang, Edward Putnins, Jyrki Heino, Lari Häkkinen. Biological agents and cell therapies in periodontal regeneration Endodontic Topics 2012 26(1): 18-40 (Hania) • 5. Carreira AC, Lojudice FH, Halcsik E, Navarro RD, Sogayar MC, Granjeiro JMBone Morphogenetic Proteins: Facts, Challenges, and Future Perspectives. J Dent Res. 2014 Jan 3. [Epub ahead of print] (Hania) • 6. Lee CH, Hajibendeh J, Takahiro S, Fan A, Shang P, Mao J. 3D Printed Multiphase Scaffolds for Regeneration of Periodontium Complex. Tissue Eng Part A. 2013 Dec 2. [Epub ahead of print] (Hania) • 7. *Prichard JP. The diagnosis and management of vertical bony defects. J Periodontol 1983;54:29-35. (Gabriela) • 8. *Aichelmann-Reidy ME, Reynolds MA. Predictability of clinical outcomes following regenerative therapy in intrabony defects. J Periodontol. 2008 Mar;79(3):387-93. (Gabriela) • 9. *Stavropoulos A, Karring T. Guided tissue regeneration combined with a deproteinized bovine bone mineral (Bio-Oss) in the treatment of intrabony periodontal defects: 6-year results from a randomized-controlled clinical trial. J Clin Periodontol. 2010 Feb;37(2):200-10. (Gabriela) • 10. *Anderegg C, Martin S, Gray J, Mellonig J, Gher M. Clinical evaluation of the use of decalcified freeze-dried bone allograft with guided tissue regeneration in the treatment of molar furcation invasions. J Periodontol 1991;62:264-268. (Reham) • 11. *Pontoriero R, Lindhe J. Guided tissue regeneration in the treatment of degree II furcations in maxillary molars. J Clin Periodontol. 1995 Oct;22(10):756-63. (Reham) • 12. *Pontoriero R, Lindhe J Guided tissue regeneration in the treatment of degree III furcation defects in maxillary molars. J Clin Periodontol. 1995 Oct;22(10):810-2. (Reham)
  15. 15. • 13. *Pradeep AR, Pai S, Garg G, Devi P, Shetty SK. A randomized clinical trial of autologous platelet-rich plasma in the treatment of mandibular degree II furcation defects. J Clin Periodontol. 2009 Jul;36(7):581-8. (Wael) • 14. *Yukna C.N. and Yukna RA: Multi-center evaluation of bioabsorbable collagen membrane for guided tissue regeneration in human class II furcation. J. Periodontol 1996; 67: 650-657. (Ammar) • 15. *Lindfors LT, Tervonen EA, Sándor GK, Ylikontiola LP. Guided bone regeneration using a titanium-reinforced ePTFE membrane and particulate autogenous bone: the effect of smoking and membrane exposure. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010 Jun; 109(6):825-30. Epub 2010 Apr 9. (Ammar) • 16. Bottino MC, Thomas V, Schmidt G, Vohra YK, Chu TM, Kowolik MJ, Janowski GM. Recent advances in the development of GTR/GBR membranes for periodontal regeneration--a materials perspective. Dent Mater. 2012 Jul;28(7):703-21 (Ammar) • 17. *Donos N, Glavind L, Karring T, Sculean A. Clinical evaluation of an enamel matrix derivative in the treatment of mandibular degree II furcation involvement: a 36-month case series. Int J Periodontics Restorative Dent. 2003 Oct;23(5):507-12. (Wael) • 18. *Sculean A, Windisch P, Szendröi-Kiss D, Horváth A, Rosta P, Becker J, Gera I, Schwarz F. Clinical and histologic evaluation of an enamel matrix derivative combined with a biphasic calcium phosphate for the treatment of human intrabony periodontal defects. J Periodontol. 2008 Oct;79(10):1991-9. (Wael) • 19. *Nickles K, Ratka-Krüger P, Neukranz E, Raetzke P, Eickholz P. Ten-year results after connective tissue grafts and guided tissue regeneration for root coverage. J Periodontol. 2010 Jun;81(6):827-36. (Amal) • 20. Zucchelli G, Mounssif I, Mazzotti C, Stefanini M, Marzadori M, Petracci E, Montebugnoli L. Coronally advanced flap with and without connective tissue graft for the treatment of multiple gingival recessions. A comparative short and long term controlled randomized clinical trial. J Clin Periodontol. 2013 Dec 30. doi: 10.1111/jcpe.12224. [Epub ahead of print] (Amal) • 21. Kahn S, Rodrigues WJ, Barceleiro Mde O. Periodontal Plastic Microsurgery in the Treatment of Deep Gingival Recession after Orthodontic Movement Case Rep Dent. 2013;2013:851413. doi: 10.1155/2013/851413. Epub 2013 Nov 7. (Amal) • 22. Zuhr O, Rebele SF, Schneider D, Jung RE, Hürzeler MB. Tunnel technique with connective tissue graft versus coronally advanced flap with enamel matrix derivative for root coverage: a RCT using 3D digital measuring methods. Part I. Clinical and patient-centred outcomes. J Clin Periodontol. 2013 Oct 4. doi: 10.1111/jcpe.12178. [Epub ahead of print] (Hytham) • 23. Rotenberg SA, Tatakis DN. Dimensional Changes During Early Healing Following a Subepithelial Connective Tissue Graft Procedure. J Periodontol. 2013 Nov 11. [Epub ahead of print] (Hytham)
  16. 16. • 24. Ahmedbeyli C, Dirikan İpçi S, Cakar G, Kuru BE, Yılmaz S. Clinical Evaluation of Coronally Advanced Flap With or Without Acellular Dermal Matrix Graft on Complete Defect Coverage for the Treatment of Multiple Gingival Recessions with Thin Tissue Biotype. J Clin Periodontol. 2013 Dec 4. doi: 10.1111/jcpe.12211. [Epub ahead of print] (Hytham) • 25. *El Helow K, El Askary Ael S. Regenerative barriers in immediate implant placement: a literature review. Implant Dent. 2008 Sep; 17(3):360-71. Review. (Sri) • 26. *Benić GI, Jung RE, Siegenthaler DW, Hämmerle CH. Clinical and radiographic comparison of implants in regenerated or native bone: 5-year results. Clin Oral Implants Res. 2009 May;20(5):507-13. Epub 2009 Mar 3. (Sri) • 27. *Jung RE, Windisch SI, Eggenschwiler AM, Thoma DS, Weber FE, Hämmerle CH. A randomized-controlled clinical trial evaluating clinical and radiological outcomes after 3 and 5 years of dental implants placed in bone regenerated by means of GBR techniques with or without the addition of BMP-2. Clin Oral Implants Res. 2009 Jul;20(7):660-6. Epub 2009 Mar 27.(Sri)
  17. 17. Postgraduate Treatment Planning And Case Presentation PER914 Nicola Alberto Valente DDS PG Periodontics 11/12/13
  18. 18. HIPAA Declaration • The informations presented are within the limits of HIPAA declaration
  19. 19. Personal Data • Name: E.B. • Age: 50 years old • Gender: male • Race: caucasian • Marital status: single • Occupation: real estate
  20. 20. Referral • Referred from PG prosthodontics for: • Second stage surgery on implants #12 and #13 • Periodontal evaluation for deep pockets • Crown lengthening on #22, #28, #29
  21. 21. Chief Complaint • “I want to have a smile like Julia Roberts”
  22. 22. Medical History • Major illness: • ASA: • Hospitalization & Surgical History: • Medications: • Allergies: None I None None No
  23. 23. Habits • Smoking: 1 pack of cigarettes a day (trying to quit, he reports he haven’t been smoking for the last 2 months and just started smoking again) • Alcohol consumption: once or twice per week • Recreational drugs: 2 pot per week (1 per day reported in a 2009 medical assessment) • Parafunctional habits: Clenching
  24. 24. Personality And Behavior • Indifferent (House 1958) • Apathetic, uninterested and lacks motivation. Pays no attention to instructions, not enough cooperative
  25. 25. Dental History • Amalgam fillings: #s 1, 3, 14, 19, 30 • Composite fillings: #s 18, 19., 20, 31 • Endodontic treatments: #18 • Missing teeth: #s 2, 4, 5, 12, 13, 15, 16, 17, 20, 32 • Fractured teeth: #s 3, 30 • 4 implants (#s 4, 5, 12, 13) placed in march 2012 and never loaded (2nd stage only on 4 and 5)
  26. 26. Periodontal History • Osseous recontouring + distal wedge #31 (11/10) • Open flap debridement + osseous recontouring #18 and 19 (4/11) • Open flap debridement + osseous recontouring #14 (6/11) • No Perio maintenance reported in chart between last surgery and implants placement in march 2012 • No Perio maintenance reported in chart after implant placement
  27. 27. Physical Examination • No physical or mental disability was noticed • Records at initial visit: • Blood pressure: 147/90 mmHg • Pulse: 73 bpm • Weight: 200 lbs • Height: 6’ 4’’ • BMI: 24.3 (Normal weight)
  28. 28. Clinical Examination • Extra-oral examination: • No facial asymmetry • No palpable lymph nodes • TMJ: • No deviation detected upon opening • Asymptomatic TMJ and masticatory muscles • Mouth opening within normal range • Head and neck: no abnormalities or pathology observed
  29. 29. Clinical Examination Intra-oral examination: Patient’s tongue, mucosa, floor of the mouth, hard and soft palate were examined and no pathology was found.
  30. 30. Occlusal Analysis • Severe Class II • Severe deep bite and over jet • Anterior guidance: Anterior teeth • Excursive movements: Right side: balancing side interference Left Side: no interference • Working side contacts: Left and right group function • Protrusive assessment: No interference • Fremitus: No • Plane of occlusion: Irregular • Esthetic deficit: wear, overeruption and spacing of anterior teeth, missing upper premolars
  31. 31. Oral Hygiene • Plaque control include brushing 2 times/day and no flossing • Plaque score is 31,3% (O’Leary et al. 1972)
  32. 32. Periodontal Status • Gingiva pink with firm consistency and stippling • Gingival architecture: intermediate (flat/scalloped) • Slight recessions on upper canines and molars • Adequate amount of keratinized gingiva • Generalized horizontal bone loss, localized vertical on #1 • Widening of PDL on #8, over eruption of #8 and 9 • Good vestibular depth except for #4 and 5
  33. 33. Periodontal Examination
  34. 34. Maxillary arch
  35. 35. Periodontal charting
  36. 36. Mandibular arch
  37. 37. Diagnosis and Prognosis • Diagnosis • Medical: I (ASA) • Periodontal: Chronic generalized severe periodontitis (AAP) • Etiology • Primary: Plaque due to poor oral hygiene • Secondary: Defective restorations Risk factors: smoke • Prognosis (McGuire & Nunn 1996) • Overall: Fair • #1, 19, 30, 31: Poor • Long term prognosis (Kwok & Caton 2007) • Favorable
  38. 38. Treatment Objectives • Eradicate and change etiologic factors for periodontal disease • Educate the patient on the causes and prevention of periodontal disease • Improve oral hygiene and plaque control • Reduce plaque and calculus to below disease threshold (SRP) • Surgically reduce the deep periodontal pockets • Re-establish esthetics and functions • Schedule regular periodontal maintenance recalls for monitoring and preventive care
  39. 39. Treatment Plan • 2nd stage implant #12 and 13 • Open flap debridement on 1st quadrant • Open flap debridement + osseous surgery on 3rd quadrant • Open flap debridement + osseous surgery on 4th quadrant • Crown lengthening on #20, 28 and 29 • OHI, education, motivation • Scaling and root planing, recontouring defective restoration
  40. 40. Treatment Plan • 2nd stage implant #12 and 13 • Open flap debridement on 1st quadrant • Open flap debridement + osseous surgery on 3rd quadrant • Open flap debridement + osseous surgery on 4th quadrant • Crown lengthening on #20, 28 and 29 • OHI, education, motivation • Scaling and root planing, recontouring defective restoration
  41. 41. Treatment Plan • 2nd stage implant #12 and 13 • Open flap debridement on 1st quadrant • Open flap debridement + osseous surgery on 3rd quadrant • Open flap debridement + osseous surgery on 4th quadrant • Crown lengthening on #20, 28 and 29 • OHI, education, motivation • Scaling and root planing, recontouring defective restoration
  42. 42. Treatment Plan • Increase VDO 1-2mm (PG Pros) • trial phase: composite restorations, temporary FPD (implants) • Re-evaluation after 6-8 weeks • Final restorations: single crowns up to the canines, veneers on #7-10, 23-26 • Restore implant #4, 5, 12, 13 • Night guard • Maintenance every 3 months
  43. 43. Treatment Plan • Increase VDO 1-2mm (PG Pros) • trial phase: composite restorations, temporary FPD (implants) • Re-evaluation after 6-8 weeks • Final restorations: single crowns up to the canines, veneers on #7-10, 23-26 • Restore implant #4, 5, 12, 13 • Night guard • Maintenance every 3 months
  44. 44. Treatment Plan • Increase VDO 1-2mm (PG Pros) • trial phase: composite restorations, temporary FPD (implants) • Re-evaluation after 6-8 weeks • Final restorations: single crowns up to the canines, veneers on #7-10, 23-26 • Restore implant #4, 5, 12, 13 • Night guard • Maintenance every 3 months
  45. 45. Treatment Plan
  46. 46. Treatment progress Crown lengthening should allow to have a tooth structure above the bone crest of about 3.5-4mm taking into account the biological width which is 2.04mm (Gargiulo 1961) + 1.5 mm for the ferrule. Anyway, since a rebound of about 1-2mm is expected (Wagenberg 1989), 4-5mm of tooth structure above the crest is recommended.
  47. 47. Treatment progress 3rd quadrant OFD + OS + crown lengthening #20 Treatment progress 3rd quadrant OFD + OS + crown lengthening #20
  48. 48. Treatment progress 3rd quadrant OFD + OS + crown lengthening #20 Treatment progress 3rd quadrant OFD + OS + crown lengthening #20
  49. 49. Treatment progress 3rd quadrant OFD + OS + crown lengthening #20 Treatment progress 3rd quadrant OFD + OS + crown lengthening #20
  50. 50. Treatment progress 3rd quadrant OFD + OS + crown lengthening #20
  51. 51. Treatment progress 3rd quadrant OFD + OS + crown lengthening #20
  52. 52. Treatment progress 3rd quadrant OFD + OS + crown lengthening #20 4 weeks after surgery
  53. 53. 4th quadrant OFD + ORS + crown lengthening #28 and 29 Treatment progress
  54. 54. 4th quadrant OFD + ORS + crown lengthening #28 and 29 Treatment progress
  55. 55. Treatment progress 4th quadrant OFD + ORS + crown lengthening #28 and 29
  56. 56. Treatment progress 4th quadrant OFD + ORS + crown lengthening #28 and 29 1 week after surgery
  57. 57. Caso I • Paziente: DD • Età: 28 • Sesso: Maschio • Razza: Ispanico • Occupazione: Allentown Industries: Heritage Center (work program for people with disabilities) • Riferito da: UB pediatric dentistry for periodontal disease • Chief complaint: preoccupato della mobilità dei due centrali superiori (il flaring è cominciato circa 2 anni fa) • Storia medica: Autismo - Ipertensione - Obesità
  58. 58. Diagnosi Armitage GC. Periodontal diagnoses and classification of periodontal diseases. Periodontol 2000. 2004;34:9-21. Parodontite Aggressiva Localizzata
  59. 59. Parodontite aggressiva localizzata • Insorgenza circum-puberale • Robusta risposta anticorpale sierica agli agenti infettivi: il sierotipo anticorpale dominante è IgG2. • Presentazione localizzata a primi molari e incisivi • Infiammazione gengivale, edema, sanguinamento, formazione di tasche. Parameter on aggressive periodontitis. American Academy of Periodontology. J Periodontol. 2000 May;71(5 Suppl):867-9
  60. 60. • Caratteristiche primarie • Eccetto per la presenza della patologia parodontale i pazienti sono altrimenti in buona salute. • Rapida perdita di attacco e distruzione ossea. • Aggregazione familiare Zambon JJ. Actinobacillus actinomycetemcomitans in human periodontal disease. J Clin Periodontol. 1985 Jan;12(1):1-20 American Academy of Periodontology (1999). Consensus report: Aggressive Periodontitis". Ann. Periodontol.
  61. 61. Terapia • Scaling sopragingivale (familiarizzazione del paziente mentalmente disabile) • SRP 1° e 2° quadrante con anestetico gel intrasulculare (Oraqix) • SRP 3° e 4° quadrante con anestetico gel intrasulculare (Oraqix) • Rivalutazione a 1 mese: nessun miglioramento significativo. Prescritta terapia sistemica con Amoxicillina+Metronidazolo 250mg+250mg TID per 10 giorni. • Rivalutazione a 3 settimane dall’inizio della terapia sistemica, miglioramenti già visibili in termini di PD e BOP (sanguinamento non rilevato in nessun sito) OHI has been reinforced. Rivalutazione in un mese. Zambon JJ, Christersson LA, Genco RJ. Diagnosis and treatment of localized juvenile periodontitis. J Am Dent Assoc. 1986 Aug;113(2):295-9. Van Winkelhoff, A.J., et al.Metronidazole plus amoxycilin in the treatment of Actinobacillus actinomycetemcomitans associated periodontitis. J. Clin. Periodontol, 1989; 16: 128-31.
  62. 62. • Rivalutazione a 7 settimane da inizio tx sistemica: ulteriori miglioramenti, mutamento generalizzato delle tasche da profondità severe a range fisiologici e stabilizzazione delle mobilità (eccetto 1.1). Controllo domiciliare della placca da migliorare, prescritta CHX 0,12% BID per un mese. Rivalutazione in 5 settimane.
  63. 63. • Rivalutazione a 7 settimane da inizio tx sistemica: ulteriori miglioramenti, mutamento generalizzato delle tasche da profondità severe a range fisiologici e stabilizzazione delle mobilità (eccetto 1.1). Controllo domiciliare della placca da migliorare, prescritta CHX 0,12% BID per un mese. Rivalutazione in 5 settimane.
  64. 64. • Rivalutazione a 7 settimane da inizio tx sistemica: ulteriori miglioramenti, mutamento generalizzato delle tasche da profondità severe a range fisiologici e stabilizzazione delle mobilità (eccetto 1.1). Controllo domiciliare della placca da migliorare, prescritta CHX 0,12% BID per un mese. Rivalutazione in 5 settimane.
  65. 65. • Rivalutazione a 7 settimane da inizio tx sistemica: ulteriori miglioramenti, mutamento generalizzato delle tasche da profondità severe a range fisiologici e stabilizzazione delle mobilità (eccetto 1.1). Controllo domiciliare della placca da migliorare, prescritta CHX 0,12% BID per un mese. Rivalutazione in 5 settimane.
  66. 66. pre tx post tx
  67. 67. • Rivalutazione dopo chx 0,12%: controllo della placca migliorato, nessun BOP residuo. Tessuti parodontali relativi a 1.1 sono ancora interessati da patologia parodontale (infiammazione, perdita ossea, tasca) dopo consultazione con protesista si decide per estrazione e realizzazione di PPR. Il paziente passa in fase di mantenimento con cadenza trimestrale.
  68. 68. Caso II • Paziente: AR • Età: 65 • Sesso: Maschio • Razza: Caucasico • Occupazione: Insegnante in pensione • Riferito da: Clinica pre-doc per cure parodontali • Chief complaint: nessuno • Storia medica: Broncopneumopatia cronica istruttiva - enfisema - disordine ossessivo compulsivo - ipertrofia prostatica
  69. 69. Diagnosi Armitage GC. Periodontal diagnoses and classification of periodontal diseases. Periodontol 2000. 2004;34:9-21. Parodontite Cronica Severa Generalizzata
  70. 70. Stambaugh RV, Dragoo M, Smith DM, Carasali L. The limits of subgingival scaling. Int J Periodontics Restorative Dent. 1981;1(5):30-41. Kaldahl WB1, Kalkwarf KL, Patil KD, Dyer JK, Bates RE Jr. Evaluation of four modalities of periodontal therapy. Mean probing depth, probing attachment level and recession changes. J Periodontol. 1988 Dec;59(12):783-93.
  71. 71. Ramfjord SP, Nissle RR. The modified widman flap. J Periodontol. 1974 Aug;45(8):601-7.
  72. 72. Ramfjord SP, Nissle RR. The modified widman flap. J Periodontol. 1974 Aug;45(8):601-7.
  73. 73. 1 mese post OFD
  74. 74. 1 anno post OFD
  75. 75. Caso III • Paziente: LS • Età: 45 • Sesso: Femmina • Razza: Caucasica • Occupazione: Receptionist in una palestra • Riferito da: Clinica pre-doc per tasca profonda elemento 347 • Chief complaint: “sono consapevole e preoccupata dei miei problemi alle gengive” • Storia medica: Nessuna patologia rilevante dichiarata
  76. 76. Takei HH, Han TJ, Carranza FA Jr, Kenney EB, Lekovic V. Flap technique for periodontal bone implants. Papilla preservation technique. J Periodontol. 1985 Apr;56(4):204-10.
  77. 77. Takei HH, Han TJ, Carranza FA Jr, Kenney EB, Lekovic V. Flap technique for periodontal bone implants. Papilla preservation technique. J Periodontol. 1985 Apr;56(4):204-10.
  78. 78. Caso IV • Paziente: LA • Età: 46 • Sesso: Femmina • Razza: Caucasica • Occupazione: Insegnante di italiano e spagnolo • Riferito da: Screening per valutazione parodontale • Chief complaint: “I miei denti d’avanti si muovono” • Storia medica: Nessuna patologia rilevante dichiarata
  79. 79. Perdita di attacco interprossimale - coronale alla MGJ CAL interprossimale > CAL buccal Miller class III copertura radicolare parziale Miller, P.D. A classification of marginal tissue recession.  Int J Perio Rest Dent 5: 9-13, 1985 Zucchelli G, Testori T, De Sanctis M. Clinical and anatomical factors limiting treatment outcomes of gingival recession: A new method to predetermine the line of root coverage. J Periodontol 2006;77:714-721.
  80. 80. Perdita di attacco interprossimale - coronale alla MGJ CAL interprossimale > CAL buccal Miller class III copertura radicolare parziale Miller, P.D. A classification of marginal tissue recession.  Int J Perio Rest Dent 5: 9-13, 1985 Zucchelli G, Testori T, De Sanctis M. Clinical and anatomical factors limiting treatment outcomes of gingival recession: A new method to predetermine the line of root coverage. J Periodontol 2006;77:714-721.
  81. 81. Perdita di attacco interprossimale - coronale alla MGJ CAL interprossimale > CAL buccal Miller class III copertura radicolare parziale Miller, P.D. A classification of marginal tissue recession.  Int J Perio Rest Dent 5: 9-13, 1985 Zucchelli G, Testori T, De Sanctis M. Clinical and anatomical factors limiting treatment outcomes of gingival recession: A new method to predetermine the line of root coverage. J Periodontol 2006;77:714-721.
  82. 82. Perdita di attacco interprossimale - coronale alla MGJ CAL interprossimale > CAL buccal Miller class III copertura radicolare parziale Miller, P.D. A classification of marginal tissue recession.  Int J Perio Rest Dent 5: 9-13, 1985 Zucchelli G, Testori T, De Sanctis M. Clinical and anatomical factors limiting treatment outcomes of gingival recession: A new method to predetermine the line of root coverage. J Periodontol 2006;77:714-721.
  83. 83. 3 settimane post-op
  84. 84. 7 mesi post-op
  85. 85. 7 mesi post-op
  86. 86. 7 mesi post-op
  87. 87. Caso V • Paziente: PM • Età: 36 • Sesso: Femmina • Razza: Caucasica • Occupazione: Casalinga • Riferito da: Clinica pre-doc per recessioni multiple • Chief complaint: “Le mie gengive sono sensibili” • Storia medica: Nessuna patologia rilevante dichiarata
  88. 88. No perdita di attacco interprossimale - coronale alla MGJ Miller class I copertura radicolare totale Miller, P.D. A classification of marginal tissue recession.  Int J Perio Rest Dent 5: 9-13, 1985
  89. 89. No perdita di attacco interprossimale - coronale alla MGJ Miller class I copertura radicolare totale Miller, P.D. A classification of marginal tissue recession.  Int J Perio Rest Dent 5: 9-13, 1985
  90. 90. Zuhr O, Rebele SF, Schneider D, Jung RE, Hürzeler MB. Tunnel technique with connective tissue graft versus coronally advanced flap with enamel matrix derivative for root coverage: a RCT using 3D digital measuring methods. Part I. Clinical and patient-centred outcomes. J Clin Periodontol. 2013 Oct 4. [Epub ahead of print]
  91. 91. Implant Center
  92. 92. Post-estrattivo in posizione 1.5 da dente deciduo ritenuto per agenesia premolare
  93. 93. Dente deciduo ritenuto e agenesia premolare 1.5
  94. 94. Straumann Bone Level - SLA 4.1mm RC x 12mm
  95. 95. Kutkut A, Andreana S, Monaco E. Esthetic consideration for alveolar socket preservation prior to implant placement: description of a technique and 80-case series report. Gen Dent. 2012 Nov-Dec; 60(6):e398-403..
  96. 96. Kutkut A, Andreana S, Monaco E. Esthetic consideration for alveolar socket preservation prior to implant placement: description of a technique and 80-case series report. Gen Dent. 2012 Nov-Dec; 60(6):e398-403..
  97. 97. Kutkut A, Andreana S, Monaco E. Esthetic consideration for alveolar socket preservation prior to implant placement: description of a technique and 80-case series report. Gen Dent. 2012 Nov-Dec; 60(6):e398-403..
  98. 98. Kutkut A, Andreana S, Monaco E. Esthetic consideration for alveolar socket preservation prior to implant placement: description of a technique and 80-case series report. Gen Dent. 2012 Nov-Dec; 60(6):e398-403..
  99. 99. 1 settimana post-op Barone A, Toti P, Piattelli A, Iezzi G, Derchi G, Covani U. Extraction socket healing in humans after ridge preservation techniques: comparison between flapless and flapped procedures in a randomized clinical trial. J Periodontol. 2014 Jan;85(1):14-23.
  100. 100. 3 settimane post-op
  101. 101. 3 mesi post-op
  102. 102. 3 mesi post-op
  103. 103. 4 mesi post-op
  104. 104. 4 mesi post-op
  105. 105. 16 mesi
  106. 106. 16 mesi
  107. 107. 16 mesi
  108. 108. 16 mesi
  109. 109. Posizionamento implantare 3.5-3.6 con socket preservation 3.5 e espansione di cresta con osso di cadavere irradiato e solfato di calcio
  110. 110. Referral Extraction and socket preservation of #20 Ridge augmentation Implant placement #19 and #20
  111. 111. Prima visita
  112. 112. 6 mesi dopo socket preservation
  113. 113. ridge augmentation Kutkut A, Andreana S. Medical-Grade Calcium Sulfate Hemihydrate in Clinical Implant Dentistry: A Review Journal of Long-Term Effects of Medical Implants, 20(4): 295–301 (2010)
  114. 114. ridge augmentation Kutkut A, Andreana S. Medical-Grade Calcium Sulfate Hemihydrate in Clinical Implant Dentistry: A Review Journal of Long-Term Effects of Medical Implants, 20(4): 295–301 (2010)
  115. 115. ridge augmentation Kutkut A, Andreana S. Medical-Grade Calcium Sulfate Hemihydrate in Clinical Implant Dentistry: A Review Journal of Long-Term Effects of Medical Implants, 20(4): 295–301 (2010)
  116. 116. ridge augmentation Kutkut A, Andreana S. Medical-Grade Calcium Sulfate Hemihydrate in Clinical Implant Dentistry: A Review Journal of Long-Term Effects of Medical Implants, 20(4): 295–301 (2010)
  117. 117. ridge augmentation Kutkut A, Andreana S. Medical-Grade Calcium Sulfate Hemihydrate in Clinical Implant Dentistry: A Review Journal of Long-Term Effects of Medical Implants, 20(4): 295–301 (2010)
  118. 118. ridge augmentation Kutkut A, Andreana S. Medical-Grade Calcium Sulfate Hemihydrate in Clinical Implant Dentistry: A Review Journal of Long-Term Effects of Medical Implants, 20(4): 295–301 (2010)
  119. 119. ridge augmentation Kutkut A, Andreana S. Medical-Grade Calcium Sulfate Hemihydrate in Clinical Implant Dentistry: A Review Journal of Long-Term Effects of Medical Implants, 20(4): 295–301 (2010)
  120. 120. • Rocky Mountain Tissue Bank Irradiated bone • Dentogen Calcium Sulphate, 1g • ACE conFORM Collagen Membrane 20mm x 30mm • Cytoplast PTFE 3-0
  121. 121. 2 settimane post-op
  122. 122. 2 settimane post-op
  123. 123. 3 settimane post-op
  124. 124. 3 settimane post-op
  125. 125. 3 settimane post-op
  126. 126. Posizionamento impianti Cornelini R, Cangini F, Covani U, Andreana S. Simultaneous implant placement and vertical ridge augmentation with a titanium-reinforced membrane: a case report. Int J Oral Maxillofac Implants. 2000 Nov- Dec;15(6):883-8.
  127. 127. Posizionamento impianti Cornelini R, Cangini F, Covani U, Andreana S. Simultaneous implant placement and vertical ridge augmentation with a titanium-reinforced membrane: a case report. Int J Oral Maxillofac Implants. 2000 Nov- Dec;15(6):883-8.
  128. 128. Posizionamento impianti Cornelini R, Cangini F, Covani U, Andreana S. Simultaneous implant placement and vertical ridge augmentation with a titanium-reinforced membrane: a case report. Int J Oral Maxillofac Implants. 2000 Nov- Dec;15(6):883-8.
  129. 129. Posizionamento impianti Cornelini R, Cangini F, Covani U, Andreana S. Simultaneous implant placement and vertical ridge augmentation with a titanium-reinforced membrane: a case report. Int J Oral Maxillofac Implants. 2000 Nov- Dec;15(6):883-8.
  130. 130. Posizionamento impianti Cornelini R, Cangini F, Covani U, Andreana S. Simultaneous implant placement and vertical ridge augmentation with a titanium-reinforced membrane: a case report. Int J Oral Maxillofac Implants. 2000 Nov- Dec;15(6):883-8.
  131. 131. Posizionamento impianti Cornelini R, Cangini F, Covani U, Andreana S. Simultaneous implant placement and vertical ridge augmentation with a titanium-reinforced membrane: a case report. Int J Oral Maxillofac Implants. 2000 Nov- Dec;15(6):883-8.
  132. 132. Posizionamento impianti Cornelini R, Cangini F, Covani U, Andreana S. Simultaneous implant placement and vertical ridge augmentation with a titanium-reinforced membrane: a case report. Int J Oral Maxillofac Implants. 2000 Nov- Dec;15(6):883-8.
  133. 133. Posizionamento impianti Cornelini R, Cangini F, Covani U, Andreana S. Simultaneous implant placement and vertical ridge augmentation with a titanium-reinforced membrane: a case report. Int J Oral Maxillofac Implants. 2000 Nov- Dec;15(6):883-8.
  134. 134. • Straumann SLA BL RC 4.8mm x 10mm (#19) • Straumann SLA BL RC 4.1mm x 10mm (#20) • Alloss Cortico/Cancellous Particulate • Dentogen Calcium Sulphate • ACE conFORM Collagen Membrane 15mm x 20mm • Cytoplast PTFE 3-0
  135. 135. 2 weeks after
  136. 136. Controllo a 2 mesi
  137. 137. Controllo a 2 mesi
  138. 138. Controllo a 2 mesi
  139. 139. 2nd stage
  140. 140. 4 febbraio 2014 2nd stage
  141. 141. Posizionamento implantare 2.4-2.5 con espansione di cresta con osso equino e solfato di calcio
  142. 142. follow up 1 settimana
  143. 143. 2nd stage
  144. 144. 2nd stage 2 settimane dopo
  145. 145. Osteonecrosi post-implantare da terapia bifosfonati IV pregressa - Rigenerazione con rhPDGF e Solfato di Calcio
  146. 146. follow up a 9 mesi Nevins M, Giannobile WV, McGuire MK, Kao RT, Mellonig JT, Hinrichs JE, McAllister BS, Murphy KS, McClain PK, Nevins ML, Paquette DW, Han TJ, Reddy MS, Lavin PT, Genco RJ, Lynch SE. Platelet-derived growth factor stimulates bone fill and rate of attachment level gain: results of a large multicenter randomized controlled trial. J Periodontol. 2005 Dec; 76(12): 2205-15.
  147. 147. follow up a 9 mesi Nevins M, Giannobile WV, McGuire MK, Kao RT, Mellonig JT, Hinrichs JE, McAllister BS, Murphy KS, McClain PK, Nevins ML, Paquette DW, Han TJ, Reddy MS, Lavin PT, Genco RJ, Lynch SE. Platelet-derived growth factor stimulates bone fill and rate of attachment level gain: results of a large multicenter randomized controlled trial. J Periodontol. 2005 Dec; 76(12): 2205-15.
  148. 148. follow up a 9 mesi Nevins M, Giannobile WV, McGuire MK, Kao RT, Mellonig JT, Hinrichs JE, McAllister BS, Murphy KS, McClain PK, Nevins ML, Paquette DW, Han TJ, Reddy MS, Lavin PT, Genco RJ, Lynch SE. Platelet-derived growth factor stimulates bone fill and rate of attachment level gain: results of a large multicenter randomized controlled trial. J Periodontol. 2005 Dec; 76(12): 2205-15.
  149. 149. Grazie navalente navalentedds@gmail.com

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