The National Osteology Symposium in Paris started with a workshop morning with different topics around hard and soft tissue regeneration. Philippe Doucet (France) and Frédéric Duffau (France) first gave an overview on the ever-popular topic of peri-implantitis, where they stressed the importance of diagnosis. Later, various treatment options based on different initial situations were put into practice with the participants. Other workshops worth mentioning were the one by Pierre Marin and Antoine Popelut as well as the one by Philippe Russe (all France) on complex vertical bone augmentations using customized 3D printed mesh and guided surgery. Complex clinical cases were presented to illustrate the crucial points of the procedure. Surgical tips and recommendations from these experts were highly appreciated by the audience.
The afternoon of this highly scientific congress started with short statements on the Osteology Foundation from Sofia Aroca (France), Georges Khoury (France) and Frank Renouard (France).
State of the Artists on preventive tissue regeneration
Two authorities on the field of preventive tissue regeneration then opened the afternoon sessions with state-of-the-art lectures: Massimo De Sanctis (Italy) emphasized the technique of modified coronally advanced flap surgery (MCAF) for the treatment of multiple gingival recessions. According to him this technique has proven to work best for this indication. Anton Sculean pointed out that to achieve periodontal regeneration, the focus must be on the periodontal ligament cells and not on the bone. According to Sculean, further studies with new collagen matrices will show additional perspectives in reconstructive/regenerative periodontal surgery. He kept the attention of the audience until the end and led over to the highlight of the day, a live surgery by Bernard Schweitz (France) who performed a multiple recession coverage, using the standard of care technique and following the MCAF by De Sanctis: a connective tissue graft under a coronally advanced flap which was prepared following the De Sanctis technique.
Female leaders take surgery to the next level
The next day started with a phenomenal session on peri-implant tissue management with three female speakers who happen to be the current who’s who in this field. Anne Benhamou (France) opened the session by showing the main parameters for a successful immediate single implant placement in the esthetic zone, mentioning guided bone regeneration plus connective tissue grafting as the new gold standard. The use of the latter is a major benefit in the aesthetic zone for long-term soft tissue stability. Her recommendation to acquire knowledge about benefits and limitations of digital planning as well as guided implant placement technologies, drew a roadmap for those not yet familiar with digital procedures.
The session was continued by Tali Chackartchi (Israel) who talked specifically about the anatomy and the implant position as original risk factors of peri-implant lesions. She strongly recommended starting with the end in mind, and this is where digital planning comes in handy again. Respecting the safety zone allows vascularization of the bone as well as soft tissue and, when there is not enough space for an implant, GBR should be performed before starting the digital planning.
Third and last speaker of this session was Ausra Ramanauskaite (Germany) who pointed out the challenges of infectious and inflammatory peri-implant defect management. Guided bone regeneration with a collagen membrane is her treatment recommendation, and simultaneous soft tissue grafting may be effective especially in the esthetic area.
Isabelle Kleinfinger (France) then conducted a live surgery where she did a premolar extraction followed by immediate implant placement. A connective tissue graft harvested from the tuberosity covered the implant neck and protected the augmented area. Hélène Arnal (France) performed a second live surgery showing implant placement in the esthetic zone in a healed site with vertical and horizontal bony defect. Arnal’s treatment concept was a vertical and horizontal augmentation with a form-stable non-resorbable membrane and a mixture of autogenous and xenogenous bone grafting material.
The day was rounded off with a brilliant session on "aiming for excellence". Vivianne Chappuis (Switzerland) referred to studies showing that physiological growth factors are of great benefit for regeneration, Martina Stefanini (Italy) emphasized the need of healthy, well vascularized papillae to treat recession defects around implants and Frank Zastrow (Germany) underlined how rarely he resorts to bone substitutes and mainly works with autogenous bone.
Learning tissue engineering from the best
The following and last day of the Osteology Paris started with a session on tissue engineering. Shahram Ghanaati (Germany) showed that platelet rich fibrin, used as a scaffold to support the regeneration of bone and soft tissue, has proven to be effective in preserving the ridge following tooth extraction. For a long-term ridge preservation, he recommends a mixture of PRF and a slow resorbing bone graft material (hybrid graft).
Ronald Younes (Lebanon) presented his concept of “Hybrid Bone Regeneration” where a xenograft is mixed with an allograft and PRF, and then combined with a 3D-printed customized titanium mesh to treat severe bone defects.
Philippe Russe and Pierre Marin then shared the stage to give a presentation on the use of CAD CAM and custom 3D printed titanium mesh for complex vertical augmentations. The results of a series of an impressive sixty cases with four years of follow-up were presented.
Human factors to confound predictable outcomes
The so called “Ooooops” session that many had been waiting for did not disappoint the audience. Emmanuelle Ettegui (France), Brenda Mertens (France) and Nora Alno (France) were asked to go back in their memories and talk about cases that went simply wrong. The main concern of Frank Renouard, who moderated this session, was not the problem solving but rather how to analyse which parameters had led to the mistakes in the first place. This session brought back the audience’s awareness to the importance of a meticulous surgery planning including checklists and pre-op briefings with the clinical staff.
This event was a double success - on the one hand thanks to the undisputed scientific quality and on the other hand due to the extraordinary appeal of such a live event in the current context. More will hopefully follow.
A big thank you to the chairs, speakers and the local organizers who made this event a great success.