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Dr. Benic also answered the remaining questions that he didn't manage to responde to during the live webcast.
Q: What kind of bone density is required to place implants in the posterior maxilla?
A: The main question is: how do you quantify bone density? There is no clear evidence on the correlation between bone density and implant success. the bone quality needs to be adequate to permit the primary implant stability.
Q: If you remove a tooth, and you were planning to do Summer's technique to lift the membrane but you caused a perforation into the sinus from the extraction, would you:
1) suture the tissue and wait for the sinus membrane to close by itself,
2) would you use Collaplug or Collatape and leave it alone, or
3) would you place the Collatape, and continue with Summer's sinus lift and socket bone graft?
A: I would choose first option. Suture the tissue and wait for the sinus membrane to close by itself.
Q: When would you do a frenectonomy to protect your implant? When assessing the peri-implant?
A: When assessing the peri-implant soft tissue one important parameter is the presence of attached keratinized mucosa. In cases without attached mucosa around the implant it may be advantageous to surgically create the attached mucosa. In such a case frenectomy may be combined with increase of attached mucosa.
Q: Do you place implants in patients with chronic periodontitis?
A: No. The presence of untreated periodontitis is considered a contraindication for implant placement.
Q: Can we place single piece implants in the posterior region?
A: Yes. However, care should be taken to avoid overload of one-piece implants during the healing phase.
Q: In what situations do you:
- use or not use tapered or straight implants
- flap or flapless implant placement ?
A: For the first question I would recommend you to look at my lecture: „Implant surgery part ll“
Flapless procedure can be performed in cases with sufficient amount of bone to avoid peri-implant bone defects and by using guided surgery.
Q: What suture material do you prefer?
A: Suture materials
- For macrosurgical purposes, mattress sutures: nonresorbable, monofil, ePTFE (expanded polytetrafluoroethylene) (e.g. Gore-Tex CV-5)
- For microsurgical purposes, interrupted sutures: non-resorbable, monofil, Polyamide (e.g. Dafilon 6-0)
- Non-resorbable sutures are preferable because of higher tissue compatibility and less inflammatory tissue reactions than resorbable materials
- monofil materials are preferable because of less bacteria adherence and capillarity (wick effect: microorganisms and fluid)
In the Dental Campus „Soft Tissue Management Course“ you can find an inventory list for instruments and materials that are used for implant surgery.
Q: How would you fabricate your provisional restoration to contour the tissue?
Q: When do you use piezosurgery method?
A: For sinus floor elevation through lateral window technique and for harvesting of autogenous bone blocks.
Q: What are your thoughts on performing a connective tissue graft around already functioning implants to help increasing the thickness of mucosa to improve esthetic outcomes?
A: This is a challenging procedure. Whenever possible remove the implant. Supported crown prior to surgical intervention. A tunnel technique with a connected tissue graft is the preferred approach.
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