Beautiful Soft Tissue Around Anterior Implants

Category: Surgery

Instructor(s): Ricardo Kern

Course structure: Lessons: 18 lessons | Duration: 17 h 14 min

Course overview

In this series, Ricardo teaches you how to get perfect gingival cosmetics, his combination of periodontal surgery skill and understanding of prosthodontics is extraordinary. Lecture is divided into 18 parts.

Throughout these videos Ricardo shows you how to combine:
- Prosthodontics
- Digital Planning
- Transferring that to your study casts in the lab
- Communication with the lab
- Soft tissue surgery
- Perfect cosmetic outcome

Curriculum

Part 1

• Lesson program:
• Understanding the biology and anatomy of soft tissue
• Multiunit implants with temporaries
• Time without the patient to digital plan
• Digital planning
• Correct photographs needed and how to take them
• Correct placement of smile design lines
• Zenith point
• Smile curvature
• Tooth measurements and percentages
• Planning clinical cases
• Cementoenamel junction

Part 2

• Lesson program:
• Live cases reviewed
• Removing exostosis
• Crown lengthening- bone contouring to follow soft tissue design desired
• Crown lengthening and correct measurements for accurate results
• Different scalpel handling techniques for different biotypes.
• Bone removal for different biotypes.
• How far to raise a gingival flap.
• Suturing
• Changing the muscular position
• Alternative ways to perform crown lengthening

Part 3

• Lesson program:
• Approaching different biotypes (tissue)
• Types of suturing and why
• Correct steps for gum contouring
• Alternative treatment options for longer/ shorter treatment times
• Thin and thick bone biotypes
• Case review
• Understanding the root/ implant/ temporary to graft correctly
• Gingival impression index
• Working with the technician
• Giving your technician as much detail as you have
• Viewing a cast and information from the technicians’ point of view
• Treatment planning cases
• How to design your horizontal and vertical lines for smile design

Part 4

• Lesson program:
• Smile planning - getting precise measurements
• Smile lines- the three lines needed to create a smile
• Symmetry in a smile - different treatment options
• Creating harmony between the smile and the face; and smile and the lips
• Placing all-on-four implants with immediate temporisation (surgery video)
• Taking impressions for full arch/ all-on-four implants
• Making a gingival impression index

Part 5

• Lesson program:
• Cases- full UPR clearance; implant placement; temporaries
• Time blocks for implant placements and realigning temporaries
• Making your temporary with modifications to replicate the final work
• Taking impressions of implants/ soft tissue contour
• The temporary is a prototype
• Giving the technician precise impressions to replicate prototype
• Treatment planning difficult cases with several issues apparent
• Making implant temporaries using acrylic resin
• Soft tissue grafts
• Soft tissue thicknesses; nourishment to survive over different materials/ surfaces
• Where to run your blade when raising a flap
• Where to start your incision and why
• Suturing your connective tissue
• Placing your temporary over your soft tissue graft

Part 6

• Lesson program:
• Soft tissue modification and implant index impressions
• Building up a papilla
• Planning to plan a case
• Single implant placement procedure
• Emergence Profile

Part 7

• Lesson program:
• Single implant placement and temporary abutment
• Soft tissue of the socket
• Bone loss around the implant
• Bone crest behaviour in different biotype
• Creating the environment to shape biological width
• Reviewing older cases of extraction/ implant/ no graft
• The importance of shaping a temporary properly
• What is the Critical or Sealing zone?
• Forming your emergence profile

Part 8

• Lesson program:
• Harvesting connective tissue
• Free gingival graft surgery video
• Blood flow on the palate
• Practicing on Pigs heads
• How to de-epithelialize
• Leaving epithelium on the graft
• Tuberosity harvesting technique

Part 9

• Lesson program:
• Intrasulcular incisions
• Harvesting connective tissue
• Trap door technique
• Video demonstration of graft
• How to store a graft after harvesting
• Deciding on a graft site
• Different graft techniques/ areas depending on where you are going to use it
• How to block grayness from a tooth root
• How to use tunneling instruments correctly
• How to tunnel your graft into position
• Anchorage point when suturing your graft

Part 10

• Lesson program:
• Clinical case of tunnelling: tunnelling instruments need to be delicate, measure out size of grafting after you have done the tunnelling, trim connective tissue prior to starting any sutures, using a different technique to a receding area
• Clinical cases
• Pinhole Technique
• VISTA access

Part 11

• Lesson program:
• Roll flap for posterior not anterior
• How to approach for a soft tissue graft
• Incisions go toward the bone contouring
• Contour over the Frenum
• Checking the pull of the tissue
• Always need to contour
• Prepare the contour

Part 12

• Lesson program:
• Rebuilding papilla with implant placement and soft tissue grafting
• Suturing
• Post-op follow up and grafting discussion
• Temporary emergence profile and implant loading
• Socket sealing and grafting
• Implant placement and grafting following extraction
• Inserting temporary and post-op follow up
• Emergence Profile

Part 13

• Lesson program:
• If you approach the roll flap correctly you can fix a lot of different cases
• Promote the incision
• Mechanical support
• Dremel tool
• Raising a full thickness flap
• Closing the flap
• Harvest extra connective tissue
• Crestal sinus lift
• Healing abutments
• Sutures
• Bone graft

Part 14

• Lesson program:
• Shape and size of graft
• Placing the graft
• Covering exposed root
• Protocol for cleaning root
• Pediculated graft
• Simple approach
• Shaping to implant with little keratinocyte tissue
• Apically reposition the keratinocyte area
• Workflow to create prosthesis
• Apically reposition the keratinocyte area
• Mistakes

Part 15

• Lesson program:
• Techniques and applying the right one to the patients situation
• How to treat a soft tissue defect while keeping an existing implant (placed by previous professional)
• Making the wrong surgical decision for a patient
• Using the “Tunnelling” technique
• How to design and cover roots
• How to treat teeth with different levels of recession
• Working with an orthodontic case
• Free gingival graft, split in 2, to cover whole arch
• Perforations of the bone to encourage inflammatory response for orthodontic movement
• Extraction and single implant
• Making the temporary using existing veneer

Part 16

• Lesson program:
• Bundle Bone
• Shield Technique
• Extraction Technique
• Partial Extraction Therapy
• Emergence profile
• Making temporary
• Ceramic crown
• Implant Planning
• Temporisation

Part 17

• Lesson program:
• Soft tissue management
• Implant maxillary lateral incisor
• Managing a defect
• Implant removal
• Grafting the defect
• Suturing
• Temporisation management
• Graft harvesting
• Guide Surgery

Part 18

• Lesson program:
• Shaping soft tissue around temporaries
• Crown lengthening
• Soft tissue contouring
• Composite restorations
• Temporary crown adjustment for impression
• Smile Curvature
• Adjusting temporary
• Insertion of implant crown
• Cleaning implant crown