MaxiCourse Modules

Historically speaking, Oral Implantology is a relatively new discipline in dentistry.  It demands a multidisciplinary skill set from the clinician.  In this module, we will define the scope of Oral Implantology and introduce participants to the nomenclature commonly used in the classification of edentulous sites.  A systematic approach to quantifying as well as qualifying edentulous sites will set the stage for proper case selection, documentation, and presentation to fulfill the requirements of the AAID Vancouver MaxiCourse.  Proper documentation and informed consent will be emphasized. Continuing on, we will also examine a variety of topics: the surgical operatory set up, asceptic protocol, introduction to the surgical instrumentation, and implant placement protocols.  Participants will receive an overview of dental implants, bone grafting material, and rudimentary grafting techniques.

Presenter: Dr. William Liang

On our first day of lab exercises, participants will:

• Get a feel for bone density through simulation of different densities

• Learn how to utilize an implant motor, hand piece, and various drills for implant placement

• Learn the fundamentals of surgical guide planning and utilize a static guide on a model with implant placement

• Develop an understanding of different sutures materials and build an algorithm for decision-making

• Review the common suturing techniques

• Apply suturing techniques on simulation tissue

SOCIAL EVENT – Complimentary Dinner on Friday evening with Faculty and Classmates

Module Outline

Diagnostic Imaging:

Diagnostic imaging is integral to record keeping as well as effective treatment planning in Oral Implantology. Misinterpretation of this data may lead to poor results, improper diagnosis, and inappropriate treatment planning. Ignorance of existing pathology may result in negligence and harm to the patient. Given the importance of this topic within implant dentistry, we bring in an expert in the field to spend the morning with you, reviewing key concepts and how to integrate the skills sets into your practice and into your preparations for treatment planning.

Following this session, participants will:

• Understand the value and limitations of various imaging techniques
• Be able to use the radiographic imaging appropriately to practice oral implantology in a safe and effective manner
• Be able to distinguish normal from abnormal radiographic appearances and develop a differential diagnosis of the radiographic findings
• Be able to assess the potential risks and complications to surgical procedures in variances to the average radiographic appearance
• Be able to use diagnostic adjuncts to clinically evaluate and overcome shortcomings in various imaging techniques

Presenter: Dr. Dorothy Sonya

The ABC’s:

Various clinical scenarios require an extensive familiarity with the different site preparations, ranging from hard and soft tissue reconstruction to the proper application of diverse implant designs; it also requires an understanding of proper sequencing of the surgical and restorative phases of treatment. This weekend focuses on an exploration of the various components of the implant structure. We will learn about the evolution of root form implant designs, with the most basic designs in the 1930’s leading up to today’s technological advances.

With a thorough understanding of the implant’s components, biomaterials, and design characteristics, we are able to prescribe the proper usage of various implants to specific case applications. We will explore the current principles of platform designs as it pertains to long-term crestal bone maintenance and soft tissue stability.  There will also be an introduction to bone metabolism and wound healing, which forms the basis for bone grafting principles and techniques. Students will also be introduced to the importance of perioplastic techniques in creating long-term, stable aesthetic results.

Learning Objectives

Following this session, participants will:

• Learn about various components of the root form implant and its design and evolution
• Understand the current principles of platform designs and connections as they relate to long-term maintenance and tissue stability
• Understand how implant designs influence placement protocols
• Be able to select the proper implant for the desired prosthetic outcome

Presenter: Dr. William Liang

General Principles of Bone Grafting for the Purpose of Treatment Planning:

Tooth loss is often associated with the loss of bone and overlying soft tissue. In order to replace missing teeth, we need to address the loss of these foundational structures. It is prudent to understand the chain of biological events that take place after a tooth is removed. Proper planning may mitigate loss of bone and soft tissue and set the stage for a better clinical outcome. In this session, we will discuss the effects of bone loss and examine when and how we may prevent bone loss or reconstruct lost tissue. We will examine the pros and cons of various types of biologics and develop an understanding of what the current science supports as clinically achievable modalities.

Learning Objectives

Following this session, participants will:

• Understand the hard and soft tissue consequences of tooth loss
• Understand when it is beneficial to add material into a socket to prevent bone loss following extraction
• Understand biologics and when and what to use under certain clinical conditions and requirements
• Be able to develop an algorithm for the process of extraction through tooth replacement

Presenter: Dr. Peter Balogh

Module Outline

Everything Bone: Physiology, Pathology, & Biomechanics

One of the keys to oral implantology is an understanding of the behaviour of bone when subjected to different biomechanical, physiological, and chemical stresses. In this module, we will look in depth at bone metabolism and physiology and various factors that regulate these processes. We will examine how each of these factors may affect the clinical outcome and how contraindications play a role in various types of procedures.  As well, we will examine how various pharmacological agents can enhance or interfere with bone metabolism.

In addition, we will be introduced to some of the bone regenerative theories. We will also touch on some of the craniofacial bone pathology that may be encountered while dealing with dental implant treatment; when working with patients during the screening process, it is important to be able to recognize and handle such cases.

Learning Objectives

Following this module, participants will:

• Understand the concept of osseointegration and soft tissue healing
• Be able to critically evaluate the various components and features of different root form designs
• Be able to rationalize their choice of dental implants based on their understanding of the biomechanical, physiological, and microbiological factors affecting the process of osseointegration
• Be familiar with the various biomechanical, physiological, and chemical stressors of bone growth and maintenance
• Be able to examine and recognize normal bone as opposed to bone with potential pathology
• Be knowledgeable of the current understanding of bisphosphonates and its relationship with bone metabolism
• Be familiar with the microscopic and macroscopic structure of bone and its implications for bone manipulation and grafting procedures
• Be aware of the embryological origins of various types of bone and its effect on the lifetime behaviour of the organ

Presenter: Dr. Charles Shuler

The History & Evolution of Modern Implantology: Lessons learned from the 20th century pioneers

This presentation will review the various types of implants that were designed by pioneers including those from the AAID who made a difference in their patients’ lives by providing stable fixed prosthesis. The thought process that went behind many of the current concepts will be discussed and the merits of the innovations will be compared to what was practiced five decades ago. It would be interesting to note that many of the theories and techniques that we call as state of the art today were in fact discarded by the early pioneers.

Learning Objectives

Following this module, participants will:

• Understand the various type of implants that were in development in the 20^th century and what stood the test of time
• Know the rationale behind the evolution of some of the implant designs in use today
• Be able to identify some of the older implants that were utilized in North American and Europe so that one can plan some restorative options in the event some successful cases come to their practices.
• Be able to plan simpler and more predictable options for some extremely challenging cases.

Choosing between a single tooth implant and a 3 unit FPD – What works and what doesn’t

Restorative options of a missing single tooth implant in the esthetic zone can sometimes be challenging and we are faced with a dilemma as to when one should choose an implant vs. a conventional fpd.  Despite the rising success rates of dental implants, we sometimes find the need to revisit conventional options in certain cases. This presentation will help the participants create objective criteria to decide when one option is preferred over the other.

Learning Objectives

Following this module, participants will:

• Be able to create a matrix with objective scale to establish some parameters for restorative options.
• Be able to prognosticate the outcomes for better case presentations
• Understand the importance of co factors that can influence long term outcomes of the implant and FPD options
• Be able to create contingency plans in the event a desirable outcome is not expected

Presenter: Dr. Shankar Iyer

The Sinus & NIRISAB

Many of the concepts of contemporary implant dentistry were developed long ago by our speaker, Dr. Hilt Tatum. In this module, we will introduce the concept of Natural Implant Restoration in Stable Alveolar Bone [NIRISAB]. Issues such as establishing and maintaining long-term bone stability around dental implants, the effects of the micro-gap implant connection, and the principles of dental alveolar reconstruction have been thoughtfully developed throughout Dr. Tatum’s career and through many years of clinical experience.

In addition to the above, we will also thoroughly explore the concept of sinus augmentation, as pioneered by Dr. Tatum, and its continued superiority in its application to contemporary implant dentistry.

Module Outline

Block Grafting

The session will concentrate on a single missing tooth site in the anterior maxillae that needs augmentation prior to implant placement. A didactic lecture first, 3-4 hours long, and then a hands-on course, 2 hours long, that includes anatomically correct models with soft tissue. The participants will perform the incision, flap, site preparation, block preparation and block fixation and pericardial membrane placement and then the incision closure. Each participant will share a drill/motor to use, the proper tools and instruments, the actual block and membranes that they would use in the surgery on a patient, a screw kit with the appropriate screws, and the proper suture to use.

Learning Objectives

Following this session, participants will have / be able to:

• Diagnose the need to augment a ridge and determine the criteria
• A review of the different methods to do a ridge augmentation
• Medication protocols pre and post op, including antibiotics, steroids, mouth rinses and pain meds
• Incision and flap designs for a variety of missing teeth.
• Why use block and particulate allografts
• Why and how to use pericardium allograft for the membrane covering the block
• How to prepare the recipient site.
• How to prepare the block and fix the block with a screw(s).
• The appropriate suture to use and how to close the flap.
• Determine when the grafted site is ready for implant placement

Hands-On Workshops

Having spent three modules absorbing the theoretical side of implant dentistry, our fourth module turns to practical application. On our second lab exercises day, participants will:

• Further examine the concept of guided surgery and its application in implant dentistry
• Learn to manipulate CBCT software in conjunction with surgical guide software to design a guide
• Practice guided surgery by placing multiple implants on simulation models
• Learn techniques in flap reflection, surgical tie-backs, CT grafting, and autogenous bone harvesting
• Implement those techniques on simulation bone and tissue

Saturday / Sunday

Dental implant procedures require that the surgeon work in parts of the jaw that are outside the scope of everyday dentistry. Implantology often involves working in vital structures and surgical spaces that must be recognized and understood before working in these areas. Violation of these structures may create serious immediate or long-term consequences to the patient.

This program provides a systematic review of the anatomical structures, and participants will learn how to apply that knowledge in the surgical setting. The program is developed with a combination of modular lectures [November, recorded videos, and December mornings] and cadaver dissection in the surgical anatomy lab to reinforce the learning. By the completion of this session, dentists can approach their surgery with confidence in knowing how to provide treatment in a safe manner.

The distinguishing feature of this program is the emphasis and reinforcement of practical application of surgical anatomy.

Saturday and Sunday will include various hands-on cadaver exercises.

Learning Objectives

Following this session, participants will:

• Be able to identify surgical spaces and vital structures, and the clinical significance of both
• Be able to identify these structures in the Anatomy Lab and aware of the clinical consequences of intruding into these structures
• More confidently be able to apply various local anesthetic techniques
• Be familiar with bone, anatomy, physiology, and local growth factors
• Be introduced to evidence-based management of atrophied jaw bones
• Understand the spread of infection, emergency treatment of complications, and emergencies in the dental office
• Be knowledgeable of the surgical anatomy of the submandibular region of interest to implantologists
• Be familiar with the surgical anatomy of the mandible and maxilla as organs

Presenter: Dr. Mohamed Sharawy & Dr. William Liang

SOCIAL EVENT – Complimentary Dinner on Saturday evening with Faculty and Classmates

This module of the MaxiCourse is open to dentists not participating in the full program. Follow this LINK for more information. Limited availability.

Halfway through the year, our fifth module turns again to practical application with our first Live Surgery Module.

Understanding current minimally invasive gingival grafts options for teeth and implants: when and why are they used and how do we decide on which technique is appropriate?

This course will set the stage to better understand today’s treatment alternatives to manage gingival recession around teeth and to enhance both gingival volume/level around dental implants. The goal of these presentations is to educate the participant on current autogenous graft protocols and to better understand when allografts can be used predictability.

Learning Objectives

• A review of the literature relating to the differing protocols
• Methods to document recession and tissue volume stability
• Anticipating treatment outcomes based on today’s classification systems
• Understand the appropriate language used to describe the soft tissues around teeth and implants
• Guidelines for selection of autogenous vs. allograft materials
• A review of surgical techniques: donor site preparation and management when autogenous tissue is selected, recipient site preparation, graft handling and graft/flap stabilization
• Essential instrument requirements will be reviewed
• Post-surgical care and follow-ups
• Video review of the CTG and dermal-ARC protocol

 

Peri-implant diseases and conditions that are commonly encountered and that need to be identified and managed by the entire dental team

In the afternoon module, we will look at a comprehensive overview of dental implant treatment complications. The etiology, prevention and management of peri-implant mucositis and peri-implantitis, and esthetic challenges will be presented. Treatment possibilities to reduce these complications will be discussed, with emphasis on understanding the entire team’s role in risk management.

Learning Objectives

Following this session, participants will:

• Understand the clinical characteristics of a healthy peri-implant site and the clinical methods and instruments that are indicated to assess this. Understand what you and your team must document to assess health and changes to disease states.
• Recognize a change from health to mucositis, how it should be recorded and what predisposes implants to this.
• Recognize the clinical characteristics of peri-implantitis and the major risk indicators for this problem.
• Identify the main factors associated with hard and soft tissue deficiencies at sites to be treated with implants.
• Understand the current treatment concepts being used to manage the various disease and deficiencies in implant sites. Understand the outcomes of disease management efforts.

Presenter: Dr. Sonia Leziy

• Understand how and when to load a dental implant 
• Be familiar with criteria for evaluating soft tissue adequacy around an implant
• Recognize developments or preservation of the implant/tooth emergence profile
• Understand the current science supporting immediate implant placement
• Understand the contraindications to immediate implant placement
• Learn basic perioplastic techniques to enhance outcomes
• Be familiar with key research articles in the field of oral implantology