Webinar course Gianfranco Carnevale: Soft tissue management. Crown lengthening. Root separation and resection

During the seminar the students will go through an analysis of the fundamental importance of this step of the decision tree for the treatment of a periodontitis case.They will evaluate all the aspects of the treated cases which need to be analyzed and, with the help of the available evidence, they will select the appropriate decision for each phase organizing the sequence of events and the sequence of the appointments for the front desk.

The soft tissue management both around teeth and around implants follows the same biological and wound healing rules. It will be described how to perform many types of flap with much emphasis given to the accomplishment of the partial thickness flap also in implant surgery. The students will learn the procedures to preserve and increase the gingiva present in the surgical site through various easy and predictable technical approaches.

In esthetic zones post-extractive or post traumatic deformities of edentulous ridges can cause a severe visual and psychological problem. Recession of the marginal buccal gingiva can cause root sensitivity, difficulty in performing a good home care, and mostly in upper frontal areas uncomfortable esthetical problems. The students will learn to control the etiological causes and the better surgical approach to obtain a stable and predictable result.

The marginal supracrestal anatomy and biology will be analyzed in detail. The importance of “biologic width” will be discussed and challenged. The surgical technique of osseous resective surgery to perform crown lengthening will be described to the students and the expected healing will be debated. the students will learn different technical approaches used in tooth fractures, in prosthetic and operative reconstructions and will understand the timing of the wound healing in the different treatment situations.

The position of the most apical inter-dental portion of the alveolar crest is classically used in osseous resective surgery (ORS) to establish the amount of the inter-proximal and buccal/lingual bone resection. Supracrestal fibres connected to the root cementum are always present coronal to the alveolar crest both in healthy and diseased sites.

The students will learn a surgical approach, supported by strong evidence, that combines the classical method of osseous resection with the gingival fibre retention technique. A description of the surgical procedure in four steps will be provided (flap design, marginal soft tissue removal and fibre retention, ORS, suture of the flap). The proposed and clinically long-term controlled technique shifts the bottom of the defect in a more coronal position at the level of the connective tissue fibre attachment, establishing a significantly more conservative supporting bone resection.

The position of the most apical inter-dental portion of the alveolar crest is classically used in osseous resective surgery (ORS) to establish the amount of the inter-proximal and buccal/lingual bone resection. Supracrestal fibres connected to the root cementum are always present coronal to the alveolar crest both in healthy and diseased sites.

The students will learn a surgical approach, supported by strong evidence, that combines the classical method of osseous resection with the gingival fibre retention technique. A description of the surgical procedure in four steps will be provided (flap design, marginal soft tissue removal and fibre retention, ORS, suture of the flap). The proposed and clinically long-term controlled technique shifts the bottom of the defect in a more coronal position at the level of the connective tissue fibre attachment, establishing a significantly more conservative supporting bone resection.

Before deciding the treatment of an interradicular defect of an upper or lower molar a dentist has to be very familiar with the anatomy of the tooth, both in the coronal and in the radicular area. It is so because the knowledge of the anatomy will be very helpful in the process of decision-making. Many different scenarios will be presented and evaluated in order to teach the students the correct decision for different clinical situations. The students will learn a protocol to perform root separation and/or resection which, if followed step by step, will help them in obtaining predictable and stable long-term results.

Before deciding the treatment of an interradicular defect of an upper or lower molar a dentist has to be very familiar with the anatomy of the tooth, both in the coronal and in the radicular area. It is so because the knowledge of the anatomy will be very helpful in the process of decision-making. Many different scenarios will be presented and evaluated in order to teach the students the correct decision for different clinical situations. The students will learn a protocol to perform root separation and/or resection which, if followed step by step, will help them in obtaining predictable and stable long-term results.

In order to perform implant and periodontal surgery in the same operating session it is absolutely necessary that the same surgical approach can be suitable for both procedures. The soft tissue management is performed through split and split-fool flaps while regenerative procedures and sinus lift, if needed, can be easily done through a split-crestal and a crestal approach without the adjunct of any material. The students will analyze, throughout a vast number of cases, the many practical advantages of performing a combined approach; one for all, the less quantity of surgical sessions and time which also means less stress, discomfort and medication for the patient.

A complex prosthetic case is very often a severe periodontitis case and one that needs a multidisciplinary treatment. Treatment plan and definition of the sequence of therapeutic events play, of course, a fundamental role in approaching this type of patient. The understanding of patient expectations is as important as planning the case. The dentist has to explain the real possibilities of the planned treatment in order to be sure that the final treatment will satisfy the expectations of the patient. Cases will be described and analyzed step by step describing why and how the various phases were performed from the first visit, revaluation, to the cementation of the final prosthetic rehabilitation.