A special way of GBR
The symposium started with a brilliant session on bone augmentation, where Istvan Urban (Hungary) once again showed why he is a reference in vertical and horizontal bone augmentation. He wowed the audience with his “sausage technique”, which might be described as a specific technique in Guided Bone Regeneration (GBR) with a barrier membrane and bone grafting material. He explained his selection criteria for the latter, mentioned the important anatomical landmarks to watch out for and went through the surgical procedures. The very lively discussions with the audience were moderated by Tang Junbo and Ji Ping (both China).
Soft tissue – a game changer
Francesco Cairo (Italy) then shared some of his insights on soft tissue augmentation around natural teeth and implants. Clinical decision-making for the right procedure depends on the number of teeth or implants with gingival recession, the depth of the recession, the width of the remaining keratinised gingiva on the receding root side and the exposure of the root surface. The presence of a periodontal membrane around natural teeth, with a richer blood supply to the soft tissues than implants, allows complex root surface coverage to reposition the gingiva, whereas implants often require bone augmentation prior to soft tissue augmentation. Li Dehua (China) followed with a presentation on peri-implant keratinised tissue gain after bone augmentation. He discussed the significance of peri-implant keratinised mucosa on tissue health and marginal bone level stability and stated that a keratinised mucosa width of less than 2 mm increases patient discomfort, compromises oral hygiene maintenance and increases the risk of peri-implantitis. Surgical techniques using free gingival graft have the best results, but mean more pain and discomfort for the patient.
What, when and how…
Next on stage were Daniel Thoma (Switzerland) and Man Yi (China) with their impressive lectures on how to treat extraction sockets. Daniel Thoma specifically lectured on ridge preservation and the timing of implant placement, whereas Man Yi discussed the question of when grafting might be indicated during immediate implant placement.
The afternoon sessions consisted of case presentations by Istvan Urban and Fan Zheng (China) for bone regeneration, while Daniel Thoma and Zhou Wenjuan (China) each showed their cases for soft tissue regeneration.
Raising complexity under difficult conditions
These sessions were followed by an overview on peri-implantitis, its risk factors and treatment options, given by Daniele Cardaropoli (Italy) and Lai Hongchang (China). Dental plaque is the most common risk factor followed by smoking, iatrogenic factors as well as the lack of sufficient keratinised soft tissue. Cardaropoli later showed some cases illustrating the different treatment options.
The symposium concluded with possibly the most challenging topic, namely bone reconstruction in the aesthetic zone, by Ueli Grunder (Switzerland) and Su Yucheng (China). Grunder emphasised the importance of bone augmentation in the buccal area to ensure the presence of a papilla, which is particularly important in the aesthetic zone. According to him the predictability of the outcome depends on flap design, implant position, GBR technique and flap adaptation.
All in all, despite short-term changes due to the pandemic, it was possible to successfully carry out this high-calibre programme in a combination of face-to face event, live broadcasting and video recording.