Implant Surgery Mini-Residency 2009

Faculty
Dennis Perala, DMD, MS
John A. Sorensen, DMD, PhD
                          
Periodontist, Implant Surgeon Course Director
Prosthodontist
2009 Implant Surgery Mini-Residency Course Schedule - 8:00 am – 5:00 pm*
Apr 10       May 8       June 12       Sept 25       Oct 23       Nov 20
Course Goals:  Learn to plan & place implants in your office with confidence! 
This implant surgery mini-residency is aimed at building participant confidence in patient & site assessment, understanding surgical protocols and hand skill development for exodontia, socket preservation, implant placement, & minor grafting.

   

Course Objectives
  • Understand proposed implant site radiographic, anatomic & clinical assessment criteria
  • Understand new concepts of exodontia & maintenance of bone by atruamatic extraction
  • Be knowledgeable on head & neck anatomy relative to implant surgery
  • Understand critical anatomic structures to avoid during surgery
  • Understand drilling protocols
  • Understand implant & abutment selection criteria
  • Understand criteria for implant timing & sequencing protocols:
    • Osseous grafting then implant placement
    • Simultaneous implant placement – osseous grafting
    • Extraction – immediate implant placement
    • Extraction – immediate implant placement – non-functional single tooth provisional restoration
    • Extractions – placement of immediate implants – immediate loading of full arch fixed provisional restoration
  • Understand postoperative patient management, medications, chemotherapeutics, follow-up, complications & trouble shooting
  • Understand provisional restoration modalities, design & fabrication

Session 1  April 10, 2009 8:00am – 6:00pm
Implant Treatment Planning For Single Tooth, Fixed Partially Edentulous, & Completely Edentulous Patients
Instructors:
Dennis G. Perala, DMD, MS
John A. Sorensen, DMD, PhD
A. Lecture - Prosthetically Driven Implant Placement
  • Understand the osseous & soft-tissues healing process post extraction
  • Radiographic evaluation
    • Intraoral radiographs, calibrated digital measurements
    • Panoramic radiographs
    • Cone beam CT radiography – Interpretation, analysis & measurements
      • Simplant, Facilitate & Nobel Guide Virtual surgery and surgical guide design & fabrication
  • Site assessment
  • Understand the indications, contraindications, risks and benefits of both softand hard-tissue grafting procedures
  • Dimensions and anatomic landmarks for fixture placement
  • Predictable Peri-Implant Esthetics
    • Diagnostic aids for esthetic soft tissue results
  • Assess biologic, biomechanical, prosthodontic and esthetic risk factors
  • Contraindications to implant placement and high risk of failure situations
  • Clinical selection criteria for choice of implant design, shape, length, surface treatment and number of stages needed for a given clinical situation
  • Treatment planning & sequencing implant treatment
  • Diagnostic workup
  • Dentist – Surgeon communication
    • Getting the surgeon to place the implants where you need them
  • Surgical guide fabrication
  • Understand & implement selection of single stage vs two-stage vs immediate loading of fixtures
B. Hands-On  - Make radiographic stents and surgical stents to achieve predictable implant placement
  • Study Cast Analysis Model Mapping for Planning Implant Placement
  • Surgical Guide Fabrication Workshop
  • Digital Photography & Image Management (Bring your camera & computer)
    • Clinical Photography
    • Digital Image and  File Management
C. Group Treatment Planning Session on Participants' Patients
  • Bring patients' diagnostic casts, radiographs, charting & photographs
Session 2  May 8, 2009 8:00am – 6:00pm
Exodontia, Socket Preservation, Bone Grafting, Essential Elements of Surgery
Instructors:
Dennis G. Perala, DMD, MS
John A. Sorensen, DMD, PhD
A. Lecture - Dr. Perala
  • Medical Hx
  • Indications/Contraindications for Implant placement
  • Review of relavant head and neck anatomy
  • Vital anatomic structures encountered during soft and hard tissue surgery
  • Exodontia
  • Periotome usage and atraumatic exodontia
  • Preservation of osseous structure during extractions
  • Bone biology, bone healing & physiologic considerations
  • Bone quality classifications I – IV
  • Flap design to allow for primary closure
  • Instrumentation
  • Bone grafting material rationale and selection
    • DFDBA
    • CaS (Calcigen)
    • PRP, Gem 21, or Emdogain
  • Ridge augmentation
    • flap design changes
    • membranes
    • tacks
    • think and plan in the third dimensision for optimal results
  • Connective tissue grafting
    • double blade vs: trap door
    • ideal harvest areas
    • stent for healing 
B. Clinical Session – Exodontia, grafting, socket preservation on participants' patients
  • Ridge augmentation and connective tissue grafting
C. Group Treatment Planning of Next Session Surgery on Participants' Patients
Session 3 June 12, 2009 8:00am – 5:00pm
Implant Placement in Completely Edentulous Patients
Instructors:
Dennis G. Perala, DMD
John A. Sorensen, DMD, PhD
A. Lecture - Dr. Perala – Implant Treatment Planning, Principles & Treatment of Completely Edentulous & Partially Edentulous Removable Patients
  • Radiographic evaluation
    • Cone Beam vs Pano/PA
  • Flap Design changes
  • Flapless approach?
    • harder or easier? – why, why not
  • Hazards: angled roots, mental foramen, sinus
  • How are we gonna restore this?
  • Fixed, removable, access screws, attachments
  • Maxilla angled abutments
  • UCLA options vs  cemented
  • OSSEOSET setup and preparation
  • Implant System step-by-Step
    • Branemark Groovy
    • Replace tapered Groovy
    • NobelActive
  • Healing abutment selection
    • Wide vs normal
    • Height concerns
    • Tightness of healing abutment
    • What happens if it falls off?
    • Sonicare brushes
B. Hands-on Typodont Implant Surgery
  • Flap design
  • Incisions & flap elevation
  • Osteotomy & drill sequencing
  • Implant placement & seating to correct position
  • Grafting
  • Flap closure
  • Suturing
C. Clinical Session    Surgical Implant Placement on Participants' Edentulous Patients
      
D. Group Treatment Planning of Next Session Surgery on Participants' Patients
  • Bring patients' diagnostic casts, radiographs, charting & photographs
Session 4 September 25, 2009 8:30am – 5:00pm
Extractions & Single Immediate Implant Placement
Instructors:
Dennis G. Perala, DMD, MS
John A. Sorensen, DMD, PhD
A.  Lecture
  • Ideal patients for immediate implant placement
  • Indications/contraindications for immediate placement
  • Infection present/cystic tissue/defect we have to deal with
  • Site selection
  • Periotome usage and atraumatic exodontia
  • Tricks of extraction to preserve buccal bone
  • Full flap or keep the papilla intact?
  • Starter drill location and techniques
  • How much surface area in NEW bone?
    • Will this hold?
    • Did you achieve sufficient torque and stability for an immediate temporary?
  • Drill Sequence
    • What steps do we skip from normal?
  • Fixture selection and tapered vs straight
  • Immediate abutment and how to alter if needed
  • Defect filling with graft
  • Emdogain
  • Soft tissue concerns
  • Modifications of immediate abutment sheath
  • Abutment & temporary prosthesis materials selection
  • Principles of immediate implant & immediate temporary crown placement
  • Techniques for rapid & efficient temporary crown fabrication
B. Clinical Session - Extractions, Implant Placement, Grafting, Immediate Provisionalization on Participants' Patients
  • Primarily anterior & premolar immediate procedures
  • Variety of surgical treatments base on patients' needs
C. Group Treatment Planning of Next Session Surgery on Participants' Patients
Session 5 October 23, 2009 8:00am – 5:30pm
Implant Placement In The Maxillary Sinus Areas
Lecture & Implant Surgery Session
Instructors:
Dennis G. Perala, DMD, MS
John A. Sorensen, DMD, PhD
A. Lecture
  • Anatomy of the sinus
    • Membrane, spikes, septa, pathology
  • Bone quality and quantity
  • Sinus Lift
    • Healing and delayed placement
    • BioOSS
    • Gem21
    • Mectron piezotome
  • Osteotome
    • Single site and small amount of push up
    • Greater the distance of elevation, the greater risk of perforation
  • Sinus Bump – OFFSET osteotome
    • How much bone is needed?
    • How far can we push up? 
  • Anitbiotic selection for sinus
    • Biaxin or Augmentin
  • Complications
B. Clinical Session - Sinus bump & Implant Placement, Grafting on Participants' Patients
  • Primarily anterior & premolar immediate procedures
  • Variety of surgical treatments base on patients' needs
C. Group Treatment Planning of Next Session Surgery on Participants' Patient

  
Session 6 November 20, 2009 8:00am – 5:00pm
Principles of Full Arch Implant Placement & Immediate Fixed Provisionalization
Lecture & Implant Surgery Session
Instructors:
Dennis G. Perala, DMD, MS
John A. Sorensen, DMD, PhD
A. Lecture - Steps in the delivery of fixed implant prostheses
  • Prosthodontic Implant Treatment Planning, Principles & Treatment of Completely Edentulous & Partially Edentulous Removable Patients
  • Complete denture concepts – You can't place the implants if you don't know where the teeth are supposed to be
  • Occlusion for edentulous & dentate patients
  • Cone beam CT assisted treatment planning
    • how do we transfer this data to the patient's mouth?
  • Treatment options for the completely edentulous patient
  • Ostectomy- The often overlooked key to success with full arch implant supported prostheses
  • Sequencing treatment- From extractions to temporary denture to definitive prosthesis
  • Process & design principles for conversion of complete denture to provisional fixed prosthesis
  • Special considerations and torque requirements
  • Bone grafting and managing defects all over the place.
  • Tissue closure
  • Abutment selection due to immediate cross-arch stabilization needs
    • Who do we sleep and why?
B. Video of Patient Treatment - Drs. Perala & Sorensen
  • Surgery - Extractions and Immediate Implant Placement
  • Prosthodontics – Conversion & delivery of Immediate Provisional Full-arch Fixed Prosthesis
C. Clinical Session - All surgical procedures on participants' patients

6:00 Cocktail party
 
7:30 Graduation dinner

Compliments of PDI
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