The italian version of the video surgery, received 35,000 views on YouTube. Given the great interest, I think it’s appropriate to show the second surgery I performed last week.

The bone regeneration was very successful and properly restored the volumes.

After placing the implants, to further increase the tissue volume and achieve a correct prosthetic emergence in the end, I performed a connective tissue graft secured with a technique that I think you’ll find interesting.

Now I’ll leave you to the video. Remember to log in to YouTube to watch it, as it is a surgical content restricted by the platform.

Let me know what you think!

See you soon,

Federico

L'articolo [VIDEO] RESULTS OF A BONE REGENERATION DONE SIX MONTHS AGO. LET’S SEE WHAT HAS FORMED UNDER THERE. sembra essere il primo su Mastering Dentistry.

My response was:

‘If you wait to have 4/5 mm of crestal bone, you will never perform a trans-sinus implant!’

The technique we are discussing is meant to address cases of extreme atrophy before moving on to reconstructive or zygomatic techniques, so it’s very difficult to think that there are cases with 5 millimeters of bone in the premolar area… In fact, such cases wouldn’t be atrophic but simple cases accessible to everyone.

On social media, I keep seeing cases being published that, even if sometimes well managed prosthetically, are extremely simple in terms of the surgical component. Sometimes, they even stem from the massive extraction of teeth that were absolutely maintainable and recoverable.

On the other hand, I see very few (actually almost none) real cases. The ones I encounter daily in my practice, with jaws destroyed by decades of dentures or, increasingly, by advanced and undiagnosed peri-implantitis.

My concern is that these cases aren’t being published because colleagues actually don’t treat them, considering them too complex.

For years, I have been trying to help colleagues understand that even cases deemed very complex are, in fact, manageable by most surgeons, and I strive to teach them how to do it.

Today, with this video, I want to answer that question.

‘How many millimeters of crestal bone are needed for a trans-sinus implant?’…

There is no rule. Even zero if you’re skilled enough… check out the video of this case!”

The previous prosthetic situation is this, and I promise that I will soon publish the prosthetic solution for the case as well.

But for now, let’s see how I placed these implants.

See you soon.

Now I’ll let you watch the video. Make sure you’re logged into YouTube, otherwise, you won’t be able to see it due to the age restriction.

P.S. If you don’t see the video preview, click on this YouTube link.

L'articolo [VIDEO] HOW MUCH CRESTAL BONE IS NEEDED TO PLACE A TRANSNASAL IMPLANT? sembra essere il primo su Mastering Dentistry.

To respond to this statement, I had shown a rather extreme case of trans-sinus implantology in which the bone at the crestal level, meaning in the coronal part of the implant, was practically zero.

Today, however, I want to show you a standard case, one that you might encounter when you start using this technique.

I have been using trans-sinus implants for a few years, and they allow me to solve cases that used to require sinus lifts or zygomatic implants.

This technique now allows me to resolve cases of moderate atrophy in an extremely simple and fast way, so I encourage you to explore it further because you will definitely gain great advantages from it.

The case you see, in which I will show you the insertion of just one of the two trans-sinus implants, was managed surgically in just a few minutes, about twenty.

Often I see cases on the web or observe cases sent to me by colleagues asking for advice, which demonstrate how little awareness there still is regarding full arch rehabilitations.

Ideas are unclear, and there are conflicting opinions, so those who then have to apply the techniques mix them all together and end up with results that are often far from satisfactory.

This leads colleagues, especially younger ones, to lack confidence in their results or skills, thus making it difficult for them to effectively propose these treatments to their patients.

If you want to improve your confidence, clear your head of the many misconceptions you’ve been told, and learn how to properly plan all full arch rehabilitation cases, I invite you topurchase our online course, which you can find here.

Now I’ll say goodbye and leave you with the video.

Remember to log in to YouTube, as it is a surgical video and has been censored.

See you soon!

L'articolo [VIDEO] STANDARD CASE OF TRANS-SINUS IMPLANTS. THE BEST VIDEO IN THE WORLD… sembra essere il primo su Mastering Dentistry.

Since they gave me one to try, I decided to make a video to show how it’s used. I haven’t been able to observe the healing or regeneration yet, but of course, in four months, I’ll make a video where we’ll look at the re-entry and the quality of the regenerated bone.

As always, no matter what material is used, it’s essential to adhere to all the principles of Guided Bone Regeneration (GBR).

The material sold by this company is never the solution to your regeneration problems:

 
• Are your flaps opening? Don’t look for a magical material, you need to improve your surgery!!

 
• Are your grafts getting infected? Don’t look for a magical material, you need to improve your surgery!!

 
• Do you find jelly instead of bone upon reopening? Don’t look for a magical material, you need to improve your surgery!!

I realize that this message may not be democratic because those with two left hands will never achieve the goal, regardless of the material used, but unfortunately, that’s the way it is .

However, I’m sure that at least you have one right hand, and this video can give you great insights into the most important technical and biological aspects.

Let me know what you think!

See you soon!

L'articolo “[VIDEO] GUIDED BONE REGENERATION WITH A NEW RESORBABLE MAGNESIUM MEMBRANE… LET’S TRY IT!” sembra essere il primo su Mastering Dentistry.

and I had to perform the surgery blind .

Well, actually it wasn’t really blind, because I could see the alveolar crest and its shape, and I knew that under the soft tissue layer was the bone, with the same shape but a bit smaller… ‘not such a big deal’ when you think about it .

However, let’s start from the beginning: there are some cases of edentulism, quite rare to be honest, for which a flapless approach is definitely indicated. The characteristics of these cases are:

• A bone that is thick enough to allow implants to be placed within the bone structure without having to search for an adequate thickness by means of a partial osteotomy.

• A regular crest that allows one to make a totally convex prosthesis in its part in contact with the soft tissue and, consequently, adequately cleanable.

• Enough bone to place standard length implants in a standard position (I think it is obvious, and requires no explanation, that transinusal or zygomatic implants require a flap approach…).

• An appropriate amount of keratinized tissue, within which prosthetic connections can emerge.

All these conditions are necessary. In the absence of even one of them, a flapless approach will lead to a low-quality result. Moreover, I don’t give a damn if you can’t lift a flap, that is no justification for doing low quality work to patients. Either you learn how to lift flaps or you limit yourself to fillings, very simple

However, as I said, there are some rare cases where a flapless approach is possible and can lead to an excellent result. Something I will never understand is the role of a digital surgical guide in these cases that, given the above conditions, are absolutely obvious and trivial to treat ‘blindly’. Everything ends up in doing the same surgery you did on the plastic model at the basic AO4 course organised by any implant company. Nothing more and nothing less.

I know that some of those reading are getting very pissed off because they do a lot of guided implantology and maybe even base their marketing and training on it or have business relationships with companies that produce the related material. However, I won’t say I’m sorry, because I really don’t care. I find this trend useless and uneducational for the youth. But as you know, I am very humble , so I don’t exclude that I am absolutely wrong… it is possible that guided implantology is absolutely useful and you are right. I have not found this usefulness so far, but who knows… never say never!

Now I’ll leave you to the video, but first I’ll show you the fixed prosthesis delivered 4 hours after the ‘surgery’ (inverted commas are a must)…

See you soon!

L'articolo Check out the video!!! I did a full-arch guided rehab too…. sembra essere il primo su Mastering Dentistry.

It’s all about the trend, and if you’re not rocking a bunch of zygomatic implants, you’re not making waves. Once it was about showing off the big car, today the long implant.

The big issue, though, is that most of these cases don’t actually need zygomatic implants. If you check out the panoramic shots, often, you can see that the bone is more than enough, sometimes even for a standard AO4.

Sure, sometimes there’s a bone shortage, but many of the cases I come across could still be handled with a strategy that, in my opinion (when applicable), is better than the zygomatic approach. First off, it’s more manageable for your average implantologist, and secondly, the complications are way fewer in terms of quantity and much simpler to handle.

The strategy I’m talking about involves using trans-sinus implants.

I mainly deal with atrophic cases, and I gotta tell you, the use of zygomatic implants in my clinical practice is almost non-existent, even though I’ve never turned down any case. I rarely find the indication to use them, to be honest.

On the flip side, trans-sinus implants are my go-to, and they let me tackle a whole bunch of severe atrophy cases relatively easily.

I won’t bore you with the technical details, which I break down in the video below. To check it out, you have to be logged into YouTube.

Let me know your thoughts!

See you soon.

L'articolo Short educational video on trans-sinus implants sembra essere il primo su Mastering Dentistry.

This will be the real barrier that will protect our patient’s implants in the long term, especially if they are surrounded by regenerated bone in a risky area such as the posterior mandible.

In my opinion, soft tissue reconstruction is far more important than hard tissue reconstruction.

Having an implant with two or three coils outside the bone but nice gingival tissue is far better than having an implant immersed in reconstructed bone but without nice marginal gingival tissue. Obviously, having both is the best!!!

So let’s see how we can schematize the reconstruction of the keratinized tissue in a posterior mandibular reconstructed site in three steps, which we can carry out at the same time as uncovering the implants placed 3 months earlier…

The third step is to suture the graft. It will be crucial at this point to immobilize the graft. Indeed, it’s hard to imagine microscopic vessels being able to connect with each other if the two surfaces are moving reciprocally.

Let’s see the procedure on video… as YouTube censors violent images, you will have to be logged in with your YouTube account to see it.

Read the first part here

Read the second part here

L'articolo Free gingival graft technique in the posterior mandible. Chapter 3: Graft suturing sembra essere il primo su Mastering Dentistry.

This will be the real barrier that will protect our patient’s implants in the long term, especially if they are surrounded by regenerated bone in a risky area such as the posterior mandible.

In my opinion, soft tissue reconstruction is far more important than hard tissue reconstruction.

Having an implant with two or three coils outside the bone but nice gingival tissue is far better than having an implant immersed in reconstructed bone but without nice marginal gingival tissue. Obviously, having both is the best!!!

So let’s see how we can schematize the reconstruction of the keratinized tissue in a posterior mandibular reconstructed site in three steps, which we can carry out at the same time as uncovering the implants placed 3 months earlier…

The second step is to take a flap of connective epithelium tissue from the palate.

Obviously, looking for keratinized tissue where this has often disappeared either due to previous resorption or due to subsequent bone regeneration procedures, we will have to take tissue from a well-keratinized area and the palate is definitely the best donor site.

When I need only connective tissue, I always use the tuber maxillae, but if we need an extensive connective epithelium flap, we will hardly find a sufficiently extended tuber.

Let’s see the procedure on video… as YouTube censors violent images, you will have to be logged in with your YouTube account to see it.

Read the first part here

Read the third part here

L'articolo Free gingival graft technique in the posterior mandible. Chapter 2: Graft harvesting. sembra essere il primo su Mastering Dentistry.

This will be the real barrier that will protect our patient’s implants in the long term, especially if they are surrounded by regenerated bone in a risky area such as the posterior mandible.

In my opinion, soft tissue reconstruction is far more important than hard tissue reconstruction.

Having an implant with two or three coils outside the bone but nice gingival tissue is far better than having an implant immersed in reconstructed bone but without nice marginal gingival tissue. Obviously, having both is the best!!!

So let’s see how we can schematize the reconstruction of the keratinized tissue in a posterior mandibular reconstructed site in three steps, which we can carry out at the same time as uncovering the implants placed 3 months earlier…

The first step is to create a bleeding recipient site that can accommodate our graft.

Since we are going to graft a free flap, it will take all its vascularity from the underlying tissue.

Let’s see the procedure on video… as YouTube censors violent images, you will have to be logged in with your YouTube account to see it.

Read the second part here

Read the third part here

L'articolo [video] Free gingival graft technique in the posterior mandible. Chapter 1: Preparation of the recipient site sembra essere il primo su Mastering Dentistry.

The question was whether, in my opinion, fixed rehabilitation on implants could be performed. This article, and especially the video that follows, are intended to be my suggestions to that colleague and anyone else who might find them useful.

We will talk about the treatment of this patient of mine, treated five years ago, which seems to me very similar to that of the colleague.

In the meantime, I would like to make a comment on a topic that is very important to me but which I know is still very controversial in the dental community: standardization.

Fortunately, most colleagues are beginning to accept that operative (in this case surgical) procedures and techniques should be standardized and based on the best available scientific evidence.

Since the evidence in the literature, on long-standing topics such as implantology, is usually unambiguous and there are position statements and indications from scientific associations on various topics, these should be used to define one’s own operative protocols.

Discover the course "Simplification in full arch rehabilitation".

To give an example, back in 2012 the EAO stated that there seems to be no reason to place more than 4 or 6 implants in the rehabilitation of an arch and that treatment with 4 implants was, even then, a well-documented solution… ergo there is no reason to place more than 4 implants. Therefore, the rehabilitation of an edentulous jaw will be an all-on-4, always and in any case… unless there are absolute contraindications to implantology, which also include, of course, economic insolvency.

As you can see, however, in the space of one paragraph we have gone from clinical and operational indications to a DECISION-MAKING protocol, put another way, to a DECISION-MAKING STANDARDIZATION, and it is precisely this that many colleagues still cannot accept.

They want to evaluate, consider, assume, and balance… a thousand factors whose influence on treatment success, however, is not reflected in the scientific literature.

Therefore, they want to know the thickness of the bone (which is obvious in such a case), the age of the patient, the years spent with dentures, and even his dexterity… I wouldn’t be surprised if someone also went to assess the morphotype of the skull, the chewing cycles, the posture of the back, or the support of the soles of the feet on the floor .

Sorry but this has no influence on the optimal treatment, which remains: four straight intraforaminal implants with 12 teeth screwed on top.

The doctor must understand that mistakes are right around the corner, especially in stressful situations, and standardization is the best way to minimize human error.

Now that you know how I feel about (almost) all the edentulous jaws in the world, I think it’s time to take a look at my surgery from 5 years ago, which someone might find useful… and you know what? Today, 5 years later, I would have done exactly the same movements… in the same order!

The same thing happens in hospitals and high-level surgery rooms where, for some 15 years now, standardized guidelines indicated by checklists and flow charts have been followed, thanks to the work of enlightened colleagues such as Pronovost and Gawande.

Well, actually, thinking about it, I would have changed two small things, because remember that STANDARDIZATION does not mean immobilism but continuous refinement of procedures based on new evidence.

See you soon!

L'articolo [Video] Surgical treatment of an atrophic mandible sembra essere il primo su Mastering Dentistry.