James G Wilson (USA), president of the AAP, opened the Symposium with a welcome note from the AAP and William Giannobile took over the introduction of the Osteology Foundation and its mission. Diego Velasquez (USA) gave attendees an overview of the AAP Foundation and emphasised that this was the third collaboration of all three organisations.
Hard and soft tissue management around teeth…
Giulio Rasperini (Italy), whose lecture had to be recorded as he couldn’t be present on site, started with his presentation on managing soft tissue complications around teeth. He presented two recession coverage cases by a coronally advanced flap (CAF), a connective tissue graft (CTG), as well as a collagen matrix, and explained that fremitus on teeth was the reason why recession coverage in these cases did not work on all teeth and should therefore be checked before treatment. According to him, the prognostic factors for complete root coverage are interproximal attachment loss, flap thickness, flap tension, final position of the gingival margin and non-carious cervical lesions (NCCL). Finally, the soft tissue phenotype is also an important factor for the success rate, accounting for 80% in thick phenotypes but only 25% in thin ones. Based on this, Rasperini recommends the use of a CTG only for recession coverage in thin phenotypes, deep recessions, lower jaws and NCCL without keratinised tissue. He ended his presentation with an overview on soft tissue management techniques from the 80s to the most recent VISTA technique by Homa Zadeh.
Next on stage was Hom-Lay Wang (USA), who gave a presentation on hard tissue management around teeth. Wang, who counts 650 publications in his track record, began his presentation by emphasising that prevention is always better than treatment. He reminded the audience of the principles in guided tissue regeneration (GTR), that being the PASS principles: primary wound closure, angiogenesis, space and wound stability, as well as the six Ds for guided regeneration (GR): degranulate, de-plaque, detoxify, decorticate, de-epithelise, de-tension. Another recommendation was to avoid chlorhexidine during the first two weeks, as it not only kills bacteria but also the cells that should migrate into the defect. To cover defects, he advocated flexible collagen membranes with their better attachment and therefore superior seclusion. For furcation treatment, he uses a bone filler, a membrane and CAF. Wang finished his presentation by reminding everyone that preserving the teeth is the best peri-implantitis prevention.
… and implants
Wang was followed by Martina Stefanini (Italy), who gave a lecture on soft tissue management around implants. Complete dehiscence coverage around implants as well as the repositioning of the soft tissue margin of the implant-supported crown is the final treatment objective, she declared. Different classes of defects and treatment approaches for each class were illustrated with impressive cases. She showed several treatment options: CAF in addition to CTG, a combined prosthodontic and periodontal treatment, or a submerged procedure where the implant heals under the closed flap. The choice of the treatment thereby depends on the category of the defect.
Gustavo Avila Ortiz (USA) closed the symposium with a presentation on hard tissue complications around implants. He divided the complications into two categories: biological and prosthetic ones. The first one affects the peri-implant tissues and doesn’t necessarily result in prosthetic complications, but the latter very often leads to biological complications according to Avila Ortiz. He then showed an overview of salvageable and non-salvageable implant conditions and went on with clinical cases illustrating the different scenarios. Non-salvageable conditions for him were cases with lack of osseointegration, some cases of peri-implantitis, unfavourable and non-restorable implant positions as well as implant fractures. On the other hand, he would save an implant in case of non-progressive marginal bone loss, peri-implant marginal mucosa defects and some cases of peri-implantitis.
Foundations on a joint path
The very successful Regeneration Symposium also provided a good stepping stone for the following day’s leadership team meeting between the Osteology Foundation and the AAP Foundation. Both organisations expressed their mutual appreciation and encouragement for further cooperation, and especially emphasised the benefit for residents. It was agreed to continue the fruitful collaboration with different activities over the coming years.
Recognition at the highest level
Another highlight of the meeting was that two Osteology Foundation Board members, Pamela K. McClain and Istvan Urban (Hungary), received the AAP Master Clinician Award. The award recognises members who have practised and demonstrated consistent clinical excellence in periodontics and have willingly and unselfishly shared that clinical experience with members of the profession. Because the Annual Meeting in 2020 was held online, both awards were presented together in Miami Beach.
Time for networking
The Osteology Foundation’s networking event on the last day of the congress offered invited participants another opportunity to exchange ideas with colleagues and speakers. 280 participants used this opportunity after the last AAP Congress was held virtually, and the pleasure of seeing each other again was great among everybody.