Mucosal tissue thickness was shown to be the factor having impact on crestal bone stability. Even platform switching of the implant-abutment connection does not reduce crestal bone loss, if soft tissues at the implant placement are thin. 

It is suggested that thin tissues might be thickened during implant placement, thus reducing bone resorption. If bone height is not sufficient, vertical augmentation of the soft tissue is recommended with different materials – autograft, a xenograft or a dermis-derived allograft.  

Further, it is important to preserve bone levels after prosthetic treatment. Recent research has proved that the deeper the position of the margin, the greater amount of residual cement is left undetected. The relation between position of cement excess in the peri-implant sulcus, periodontal status of the patient and severity of peri-implant disease is explained. To avoid cement excess, finished implant restoration with occlusal opening is cemented on titanium base in laboratory and restoration is attached to the implant by an abutment screw.?Zirconium as a material is considered the best for peri-implant soft tissues. However, it’s evident that it must be treated in special manner and polished. 

You will learn: 

• To know the influence of vertical soft tissue thickness on crestal bone stability and be able to diagnose this condition 
• How to augment vertical soft tissues with soft tissue grafts 
• Subcrestal implant placement 
• To learn why polished zirconia is the best option for tissues 
• Understand how titanium base height is important crestal bone stability 
• How to avoid cement-related peri-implantitis 

Development of crestal bone stability. Surgical part
9.00- 13.00

Influence of vertical soft tissues on crestal bone stability. Does platform switch save the bone? Influence of implant placement depth on crestal bone stability. What is the importance of implant-abutment connection stability? Bone remineralization and corticalisation processes in thick tissues. What is the role of bone in “Zero bone loss concepts”? 

Four novel methods to increase vertical soft tissue thickness
a.) subcrestal implant placement
b.) Flattening of the alveolar bone
c.) “Tent pole” technique
d.) Vertical soft tissue thickening 

 13.00-14.00 Lunch 

Maintenance of crestal bone stability. Prosthetic part
14.00-17.00 

How to control cement remnants after cementation. Supragingival margins and individual abutments. Use of rubber-dam for cement prevention. Relation between cement and peri-implant disease. Screw-retained restorations. Use of Ti-base for fabrication of restorations.  

Subgingival prosthetic materials. Zirconia, titanium, ceramics – which is better. Use of ultra-polished zirconia for implant restorations. Composition of peri-implant soft tissues. Supragingival materials. Ceramics, e.max, monolithic Zr – where to use and why?