This video demonstrates the use of the VPI Cervico system/concept for the selection of the proper gingival cervical profile, the accurate placement of an implant in relation to the desired custom gingival cervical profile and the development and recording of the selected custom gingival emergence and Cervical profile after implant osseointegration.

This a complicated sinus graft case where extraction of a palatally impacted tooth was performed at the same time with the sinus lift procedure. 7 months later 2 implants were placed and they were immediately loaded. 16 months post loading both implants are clinically and radiographically successful.

Dr.Vergoullis

DENTAL IMPLANTS IN THE ESTHETIC ZONE

DENTAL IMPLANTS IN THE ESTHETIC ZONE IN COMBINATION WITH CROWN LENGTHENING PROCEDURE POST ORTHODONTIC TREATMENT

POINTS OF INTEREST:

1. PATIENT WAS REFFERED FOR IMPLANT PLACEMENT BUT DURING CONSULTATION APPOINTMENT SHE WAS INFORMED FOR THE AESTHETIC ADVANTAGES OF PERFORMING A  CROWN LENGTHENING PROCEDURE OF THE CENTRAL INCISORS AND THE PATIENT AGREED ON PROCEEDING WITH A COMBINED IMPLANT PLACEMENT AND CROWN LENGTHENING APPROACH

2. THERE WAS PLENTY OF BONE FACIALLY BUT THERE WAS BONE MISSING PALATALLY. THIS IS USUALLY SEEN IN CERTAIN CASES POST ORTHODONTIC TREATMENT. IN THESE CASES IT IS IMPORTANT TO CONSIDER THE LINGUAL SIDE OF THE FINAL PROSTHESIS WHEN DECIDING ON IMPLANT POSITION

3. #12 SITE SHOWED SOME IRRITATION DUE TO GRAFT EXFOLIATION FACIALLY, WHICH IS CONSISTENT WITH PRESENCE OF THINNER SOFT TISSUE IN THE AREA. A CTG AT TIME OF GRAFTING OR AT UNCOVERY COULD PREVENT SUCH ISSUES.

IOANNIS

Bilateral Sinus graft & GBR with tenting screw Vs laminate block graft

This is a case where we performed a bilateral sinus graft and simultaneous ridge width augmentation. On both sides we utilised the bony window as a source of graft. On the right side the window broke upon use of the bony screw, so we crashed it in small pieces and we utilised the screw as a tenting screw and performed GBR. On the left side we utilised the window as a laminate graft.
Unfortunately our piezotome was broken at the time, so we had to use a high speed hand piece with a diamond bur, which made the process uneasy. I am looking forward to hearing your thoughts about the efficiency of these two different approaches.
Best,
Ioannis

Implant maintenance

This is a case of immediate extraction, implant placement and loading performed 8 years ago. We show in the video the protocol of maintenance we utilise.
1. Pocket depth probing and bleeding on probing recordings
2. Cleaning of implants with inserts with silicone tip
3. Cleaning of the prosthesis with regular cavitron inserts

Cosmetic crown lengthening with new prosthetic restorations

The patient was referred in our clinic by the GP for aesthetic crown lengthening of the maxillary anterior teeth, in order to improve the teeth proportions and re-establish bilateral symmetry.
Post crown lengthening composite resin was placed over the newly exposed root surfaces in order to support the gingival in there new position.
12 weeks post-op a new set of temporary prostheses were placed and the tissue was allowed to mature for an additional month before final restorations were placed.

Surgery: Ioannis Vergoullis, DDS, MS
Prosthetics: Claudia Stamatidou, DDS
Lab: TDK

Esthetic rehabilitation of the maxillary anterior teeth

The patient was referred to our clinic for esthetic evaluation of the maxillary anterior teeth. 

The teeth were in malposition in the arch. They also had uneven gingival margins as well as inadequate crown proportions. 

We recommended orthodontic treatment for proper teeth alignment. Followed by cosmetic crown lengthening for establishment of adequate crown proportions. Finally, prosthetic rehabilitation with full ceramic veneers and crowns.

The patient declined ortho treatment. Patient understood that esthetic results may be compromised without ortho treatment and more invasive teeth preparation might be needed.

Diagnostic wax-up was performed and a direct mock-up was done in the patient mouth. 

Based on the mock-up, cosmetic crown lengthening was performed. 

Final restorations were cemented 3 months later.

At 6 months follow up, stable results are appreciated.

Surgery: Ioannis Vergoullis, DDS, MS

Restorative treatment: Marieta Kalogirou, DDS

Immediate replacement of a primary canine with an implant

Patient presented to our clinic for removal of a long standing primary upper right canine (#53) and to be replaced with a dental implant. Clinically, the tooth to be extracted presents with class 3 mobility. 

Patient is a mild smoker (<10 cig/day) without any other contributing factors in the medical history.

We proceeded with the extraction of the primary tooth. The socket was thoroughly derided and difinfected with diamond burs and rinsing with a mixture of TTC solution and saline. 

A Legacy3 3.7x11 implant was immediately placed following the appropriate position within the existent socket.  A high insertion torque was obtained. An impression was taken and a 2 stage protocol was utilized due to the smoking habit of the patient. 

Uncovery of the implant was performed 3 months later.  A temporary crown was placed at this time in order to guide soft tissue profile during healing. 

1 month later, a final screw retained crown was placed by the GP. 

At 1 year post-implant placement, soft and hard tissues seem favorable. However, patient's interproximal oral hygiene was fair and thus mild gingival inflammation is evident on the mesial papillae. 

Oral hygiene was reinforced and an appropiate maintenance schedule was discussed with the patient to ensure gingival health around the implant.

SOCKET GRAFT WITH CYTOPLAST MEMBRANE

Patient presented in our clinic for extraction of tooth # 36 and dental implant replacement after it was diagnosed non-restorable by the patient's dentist.

Treatment plan:

- Extraction of #36 and socket graft

- Dental implant placement 3-4 months later

- Restoration of the dental implant 2-3 months later.

Upon extraction and thorough disinfection of the socket, a facial dehiscence ranging from 8-11mm was identified. Also, a 4mm deep 4-wall defect was found on mesial of tooth #37.

The #36 socket and the periodontal defect on #37 were grafted with a mixture of FDBA and tetracycline and covered with a cytoplast membrane. The membrane was left exposed. Oral hygiene instructions to the patient involved chlorhexidine gel 0.2% application 3 times per day for 7 weeks until the membrane was removed.

A Legacy3 5.2x10mm dental implant was then placed 4 months later presenting high initial stability. After 1 year post-op, good bone stability around the implant can be observed. Also, the defect on medial of #37 responded favorably as it can be observed clinically and radiographically. 

The technique used in this particular case could be utilized in posterior sites with a thick soft tissue and where large amount of bone augmentation is required. Patients medical history should be clear so proper healing could be expected. It is not recommended for patients with potentially impaired healing like diabetics and smokers.

Sinus graft complications & management

The following clinical case shows several minor complications and management during different dental implant surgical stages. 

This is the case of a  28 years old healthy male who came to our clinic for dental implant rehabilitation of the posterior left maxillary area. After clinical and radiographic evaluation, the need for vertical and horizontal ridge bone augmentation was determined. Vertical augmentation was treatment planned to be obtained through lateral window sinus lift surgery accompanied by horizontal ridge augmentation using particulate bone grafting material and membrane. 

Two dental implants were placed 8 months post sinus lift surgery. During the osteotomy for the molar site implant, a small membrane perforation was identified, managed and controlled through the osteotomy site. Dental implants were placed and primary stability was obtained for both. 

Upon dental implant uncovery, 3 months after surgical placement,  bone loss was found on the molar site implant. We reduced the exposed implant threads with Implant-plasty using a fine diamond bur and a layer of HA xenograft bone grafting material was used to graft the facial aspect of the implant. 

The 3 year follow up X-ray shows good bone stability around the implants.

Ioannis