This is a good implant case to learn from.   I placed these dental implants back in 2008 and they were later restored. 

Implants: Learning from Past Mistakes

osseoseal over graft 1

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osseoseal over graft 8

A Flexible Collagen Membrane, is a great option for GBR when looking to contour and “seal” off particulate bone graft in a self-containing defect. 

Using a Flexible Porcine Collagen Membrane over a Graft

immediate implant 1

immediate implant 2

It seems as though most folks are still opting to utilize a staged approach when replacing molars, especially maxillary molars. But, immediate implants for maxillary molars might be more predictable.

Immediate Implant for Maxillary Molar

flapless pre-op

flapless post-op

This short video demonstrates flapless implant surgery  on the upper posterior, providing a detailed step by step demonstration along with a few key tips.

Flapless Implant Surgery on Upper Posterior

DALI Acellular Dermis (ADM) is a great option for buccal contour augmentation around implants at the time of placement. Depending on the buccal bone thickness, it can be used with or without a bone graft.

Improving Buccal Contour Augmentation

In this video from the EAO, Dr. Gustavo Avila-Ortiz discusses the key considerations for effective management of an extraction site, including a deep-dive review of all aspects of alveolar ridge preservation.

Effective Management of an Extraction Site

In this video from the EAO, Dr. Ausra Ramanauskaite discusses current concepts for treating peri-implant mucositis and peri-implantitis, including a review of adjunctive therapies, non-surgical treatment, and surgical approaches.

Peri-implant Disease: Review of Current Treatment Options and Concepts

Soft Tissue 1

Soft Tissue 2

Soft Tissue 3

Soft Tissue 4

Soft tissue defects in dental treatments can vary widely, requiring different approaches depending on the specific circumstances.

Soft Tissue Defects: CTG and Dermis

Angled Abutment to for Screw-Retained Bridge 1

Angled Abutment to for Screw-Retained Bridge 2

Angled Abutment to for Screw-Retained Bridge 3

Angled Abutment to for Screw-Retained Bridge 4

The facial angulation of # 10 precluded a standard screw-retained option, but we still didn't opt for  a cement-retained option.

Angled Abutment for Screw-Retained Bridge

GBR Photo 1

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GBR Photo 3

GBR Photo 4

GBR Photo 5

GBR Photo 6

GBR Photo 7

How predictable is it to graft the defect around this implant at the time of placement? The major factors I considered in this case were the presence of the implant within the bony housing and the quality of the soft tissue.

Grafting around implant at time of placement: predictable?

dali flex tissue

dali flex xray

Following 6 weeks of healing, after using the DALI Flex Graft, we see nice healing and an obvious increase in the facial contour.

DALI Flex Graft: An Alternative Solution for Defects

DALI Flex Graft for Buccal Augmentation 1

DALI Flex Graft for Buccal Augmentation 2

DALI Flex Graft for Buccal Augmentation 3

DALI Flex Graft for Buccal Augmentation 4

DALI Flex Graft for Buccal Augmentation 5

DALI Flex Graft for Buccal Augmentation 6

DALI Flex Graft for Buccal Augmentation 7

DALI Flex Graft for Buccal Augmentation 8

Following a GBR at the time of implant placement, a buccal ridge deficiency persisted. Instead of using graft particulate, we decided to use a flexible cortical sheet.

DALI Flex Graft for Buccal Augmentation

GBR  One Visit 1

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GBR  One Visit 9

GBR  One Visit 10

What some clinicians may view as a situation requiring a separate GBR procedure prior to implant placement, can often times be treated with implant placement in one surgical visit. This case will demonstrate this one-visit approach.

Turn Two Surgeries into One

2 Implants or One Surgical

2 Implants or One Restore

When replacing two adjacent mandibular incisors, we have the choice to place two implants vs. one implant with a cantilever.

Two Implants or One?

VIP Graft 1

VIP Graft 2

VIP Graft 3

VIP Graft 4

VIP Graft 5

VIP Graft 6

VIP Graft 7

VIP Graft 8

When this patient presented for treatment of hopeless #9, the degree of recession present was the major challenge. Due to the lack of tissue present, a bone regeneration procedure would be extremely challenging.

Pedicle Graft for a Challenging Recession

Tension Relief 1

Tension Relief 2

Tension Relief 3

Tension Relief 4

Tension Relief 5

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Tension Relief 7

When performing extensive GBR, we want to insure the primary closure of the flap margins over the graft and membrane. 

Tension- Relief for Primary Closure

Tissue Contour 1

Tissue Contour 2

Tissue Contour 3

Tissue Contour 4

There are many factors that dictate the peri implant tissue contours and papilla fill. These include: bone levels, distance to the contact point, adequate tissue thickness, and a properly designed/contoured restoration. 

Tissue Contour: Have Some Patience 

oral-antral communication 1

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oral-antral communication 3

oral-antral communication 4

We should take advantage of the surgical uncovery appointment to re-establish vestibular depth and provide a wide zone of keratinized tissue on both sides of the implants.

Addressing an Oral-Antral Communication

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Implant Uncovery: Ensuring Healthy Peri-Implant Tissues

GBR Defect 1

GBR Defect 2

GBR Defect DALI

GBR Defect Osseoseal

GBR Defect result

Even when there is an extensive amount of bone loss around teeth planned for extraction, we can still employ immediate placement provided we follow biological and surgical principles that have been described in the literature.

GBR for Extensive Defect Around Implants

implant site

DALI Mineralized Cortical Cancellous Bone

Osseoseal membrane

DALI Amnion membrane

Site after

Healing

In more challenging cases of bone regeneration, sometimes you need something extra to help facilitate healing. Recently, I have been reaching for Amnion Chorion membranes, which are rich in growth factors.

Facilitate Healing in Bone Regeneration with Amnion-Chorion Membranes

site

with implant

dermis placement

results

In some cases, a dermis soft tissue substitute is sometimes better than elevating an extensive flap to facilitate graft and membrane placement. 

Improving Emergence Profile with DALI Dermis

osseoseal implant

osseoseal implant place

osseoseal implant with bone

osseoseal implant instrument

osseoseal implant final

osseoseal implant suture

A few colleagues have asked me about my placement technique for the OsseoSeal membrane. An easy way to apply the membrane is as follows...

Placement Technique for OsseoSeal Collagen Membrane

In this short video case, Dr. Gober, demonstrates one way of avoiding the need for a lateral sinus lift via the placement of an additional implant.

Alternative to Lateral Sinus Lift

In this video, we review two cases where autogenous free gingival grafts were performed, and provide several key clinical tips to ensure the success of this grafting technique. 

Autogenous Free Gingival Graft around Dental Implants

Missing #27

Failed Implant Site

Implant Placement

Grafting of Site

Placement of Dali Membrane

Implant Uncovery

Before and After DALI Amnion at failed site

This video case demonstrates the use of a DALI amnion-chorion membrane in combination with a porcine collagen membrane for guided bone regeneration in a previously failed site. 

Improving GBR with an Amnion Chorion Membrane: Dual Layer Technique

blood supply for graft

Learn about cortical perforations and why they are often critical for predictable bone regeneration.

Cortical Perforations in Guided Bone Regeneration

dali-dermis-membrane

This video demonstrates the use of DALI acellular dermis as a substitute for a standard membrane in a case of contour augmentation.

DALI Acellular Dermis as a Membrane Substitute

Maxillary Molar Extraction Technique decoronation

Maxillary Molar Extraction Technique section

This short video reviews two cases to demonstrate a Maxillary Molar Extraction Technique using Decoronation and Sectioning.

Maxillary Molar Extraction Technique: Decoronation and Sectioning

Oro-antral communication suspected

Oro-antral communication revealed

Oro-antral communication technique

Oro-antral communication suturing

Oro-antral communication healing

Oro-antral communication before and after

This short video presents a case of Oro-Antral Communication following extraction, providing several tips and techniques for managing this difficult situation.

Post Extraction Oro-Antral Communication Closure

radiograph following repair of fenestration defects

flap design in repair of fenestration defects

membrane choice for repair fenestration defects

marginal gingiva for repair fenestration defects

Learn and review a key point about incision and flap design when repairing fenestration defects.

Incision and Flap Design when Repairing Fenestration Defects

Suturing in the mandible

Learn why a mid-crestal incision is the incision of choice around dental implants in the mandible.

Suturing Tips Around Dental Implants in the Mandible

Tension Free Closure Knot

Tension Free Closure Suture

Tension Free Closure Technique

This video reviews some suturing techniques that can help you achieve primary closure.

Suturing for Tension-Free Primary Wound Closure

This case of severe bone defects, demonstrates some key principles of successful GBR, including the need to stay within the confines of the alveolar housing.

Bone Regeneration of Extensive Socket Defects with Immediate Implant Placement

This case presented with 2 challenges: the presence of a unique odontoma, and secondly the presence of a periapical radiolucency above #12.

Trusting the Process: Removal of Odontoma, GBR, and Placement of Keystone Paltop Implants

Fenestration Defect

DALI Bone

OsseoSeal Membrane

This video discusses the regeneration of fenestration defects at the time of extraction and immediate implant placement. Specifically, the video shows the benefits of using a flexible porcine collagen membrane, like OsseoSeal, in the treatment of these cases.

Regenerating Fenestration Defects during Extraction and Implant Placement

Keratinized Tissue

Dali Dermis

This video demonstrates the use of DALI Acellular Dermis for soft tissue grafting in a root coverage case.

DALI Dermis for Soft Tissue Grafting

gober-osseoseal-contour

This short video from Dr. Gober demonstrates the use of the OsseoSeal collagen membrane for buccal contour augmentation.

Membrane Adaptability: Using OsseoSeal for Buccal Contour Augmentation

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