Edentulous site enhancement: a regenerative approach to the management of edentulous areas. Part 2: Peri-implant tissues.

The appearance and long-term stability of peri-implant bone, mucosa, and gingiva determine the success of implant-supported prostheses from both the esthetic and functional standpoints. Any surgical or prosthetic technique that takes into consideration only some variables, or that only intervenes in a limited phase of treatment, is a potential source of a partially successful and/or unpredictable clinical outcome. This article describes the underlying principles and surgical-prosthetic procedures of a systematic regenerative approach, edentulous site enhancement (ESE).

Edentulous site enhancement: a regenerative approach for the management of edentulous areas. Part 1. Pontic areas.

The successful esthetic integration of a prosthesis is dependent on the anatomic site in which the restoration is inserted. Edentulous site enhancement is a regenerative approach based on the following: (1) anatomic evidence that the morphology of soft tissues is dependent on the underlying support (bone, roots, implants) but also significantly influenced by overlying structures (fixed or removable prostheses); (2) histologic evidence of the remarkable regenerative capacity of the newly formed tissue that develops during healing by secondary intention; (3) clinical evidence that it is possible to guide the formation of this new regenerative tissue by creating a support with proper morphology and a highly polished surface; (4) observations that positive pressure exerted by alimentary bolus and negative pressure produced by deglutition affect the growth of this tissue healing by second intention; and (5) the application of appropriate oral hygiene techniques to guide tissue healing and maintain its integrity. The edentulous site enhancement approach is simple, practical, and predictable and offers minimal postoperative complications.

Morphogenic bone splitting: description of an original technique and its application in esthetically significant areas.

Purpose: This article presents a regenerative technique, morphogenic bone splitting (MBS), which overcomes the limitations associated with expansion techniques described to date.

Materials And Methods: The authors propose a method whereby the bone-mucosa-gingival complex (BMGC) is displaced in its entirety, establishing a new focus for a secondary hinge located in the coronal reaches of the osteotomy. Depending on clinical needs, this approach modifies or eliminates the facially inclined hinge displacement characteristic of ridge expansion techniques.