From Bern out into the world

First Osteology-EFP Virtual Live Surgery From Bern out into the world

Drs. Sonya Sharma and Heike Fania | Osteology Foundation

Broadcasted live from Bern, over 1000 attendees from more than 80 countries attended the first Virtual Live Surgery Day organised jointly by the Osteology Foundation and the European Federation of Periodontology (EFP). The event consisted of two sessions, one on recession coverage, the other on peri-implantitis treatment. First session: recession coverage

After the welcome and introduction by the two presidents, William Giannobile for the Osteology Foundation and Lior Shapira for the EFP, the session started with the keynote lecture by Martina Stefanini. She talked about “recession coverage in the mandible: possibilities and limits”.

Stefanini explained that recession coverage treatment in the mandible is often complex due to the unfavourable anatomical condition. It is influenced by several factors, e.g. tooth position, vestibulum depth and tissue phenotype. The Vertically Coronally Advanced Flap (VCAF) and the Laterally Closed Tunnel (LCT) are two new procedures that can obtain complete root coverage, increased vestibular depth, soft tissue depth, decreased morbidity of the harvest area and aesthetics. Stefanini said that compared to the traditional techniques, the CAF Difficulty Score across different parameters is high for the VCAF, but the surgical technique itself is more difficult.

After Stefanini’s lecture, Mariano Sanz as moderator, introduced the patient. Anton Sculean performed the surgery on a thin phenotype patient with an RT2 (Miller’s class III) recession in region 41. The treatment aimed to improve oral hygiene, alleviate the pain and improve aesthetics. The technique used to treat this recession was the LCT or the Modified Coronally Advanced Tunnel (MCAT) in conjunction with a palatal subepithelial connective tissue graft (CTG). The LCT has advantages in a thin phenotype with limited or no attached gingiva. Tension-free mobilisation of soft tissue can be obtained without any incision on the papilla or the flap to optimise wound stability.

The procedure started with mechanical debridement of the root followed by an intrasulcular incision in the depth of the recession to enable the tunnel. Following this, detachment of the periosteum and frenulum was performed. A 1 mm CTG was harvested from of the palate, stabilised over the recession area and closed with mattress sutures.

Lots of questions arrived from the audience during the surgery, which were addressed live and in the panel discussion following the surgery. Whilst Sculean was finishing the surgery, the panel discussion started with Martina Stefanini, Andreas Stavropoulos and Giovanni Salvi. One of the topics discussed was that verticality is restored with both VCAF and LCT. Stefanini said that it is immediate in VCAF, whereas verticality is restored after some time in LCT.

Stavropoulos pointed out that compared to the maxilla, the mandible has a shallow vestibule and shorter alveolar ridge, which leads to a less stabilised wound. Hence, the techniques need to be adapted accordingly. When Sculean joined the panel, he highlighted the fact that 80% of young patients develop recession post orthodontic treatment because activation of the retainers during orthodontic treatment pushes the teeth both labially and lingually. His recommendation was CBCT to check if enough bone is present both labially and lingually as part of the pre-treatment planning phase.

Second session: treatment of peri-implantitis

The session which was moderated by Giovanni Salvi, started with a lecture by Frank Schwarz on surgical techniques for peri-implantitis treatment. He explained that selection of the approach depends on the category of the defect. He also recommended a non-reconstructive approach for implants with a machined surface, a reconstructive approach for class 1 defects with four walls present, and a combined approach for the more challenging cases. He explained that the combined approach consists of open flap debridement, implantoplasty and the application of a bone filler material.

Regarding decontamination protocols, Schwarz highlighted that there is no scientific evidence that favours any decontamination protocol. Therefore, he recommends keeping it simple. The most important factor for successful treatment is the implant surface. Furthermore, he also explained the importance of concomitant soft

“Lots of questions arrived from the audience during the surgery, which were addressed live and in the panel discussion following the surgery.”

tissue volume grafting (CTG or collagen matrix) to compensate for the insufficient thickness of the mucosa and to overcome soft tissue recession postoperatively.

Salvi then introduced the patient of the second live surgery, which was performed by Andreas Stavropoulos: a systemically and periodontally healthy 34-year-old female patient with congenitally missing teeth 12 and 22 replaced by implants. Due to peri-implantitis on implant region 12, the cemented crown was removed one month ago and replaced with a temporary bridge to allow mucosal healing. A mesial defect with an infrabony component was visible in the radiograph. Buccal bone dehiscence was present. After opening the flap, the surface was cleaned with an air polishing device and implantoplasty was performed on the buccal side of the implant. The soft tissue situation was fragile in the central position over the implant and very difficult to manage. After implantoplasty, he harvested autologous bone chips locally to fill the defect and covered it with a collagen membrane cut into shape to cover the defect.

Mariano Sanz, Anton Sculean and Frank Schwarz joined Giovanni Salvi for the panel discussion after the live surgery. Andreas Stavropoulos also joined once he had finished the surgery. One of the topics discussed was whether implants should be placed at all in high-risk patients because of a periodontitis history. Sculean said yes and that also in those patients, predictable results can be achieved. However, he advised that an implant should never be placed in a periodontally compromised patient before systemic periodontal therapy has been completed, and only if the amount of bone and soft tissues is sufficient for implant placement and prosthetic planning. It requires a comprehensive treatment approach.

When asked which factors minimise peri-implantitis, Sculean explained that prosthetics play an essential role to allow cleaning; also, the position of the implant, sufficient bone around the implant, the amount of attached mucosa and the thickness of the mucosa.

Thank you very much to all the speakers, the attendees and the EFP to make this exceptional event happen.

OSTEOLOGY-EFP VIRTUAL LIVE SURGERY DAY //////////////////////////////////////////////////////////// 17 JUNE 2021

After panel discussion

Mariano Sanz on the stage

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