Osteo Science Foundation 2022 Meeting,
“Regenerative Solutions to Common Problems”

Abstract

You have been referred a 65 female on a bisphosphonate for an extraction and immediate dental implant on #19. What is the best way to proceed? The patient wants to know her risk of medication-related osteonecrosis of the jaws (MRONJ) and what you will do to reduce it? This comprehensive overview of MRONJ will cover this and more. It will review medications that cause MRONJ and which ones are more problematic, along with the frequency and risk of disease. It will review risk and prevention strategies. The staging and current management including the latest research, clinical trials, and future treatment therapies will also be reviewed.

Learning Objectives

1. Understand the etiology and risk of developing MRONJ
2. Understand the risk of MRONJ with different classes of drugs
3. Be aware of future preventative research in the management of MRONJ

Jasjit Dillion, MBBS, DDS, FDSRCS, FACS

Jasjit Kaur Dillon is Professor, Chief, and Program Director of Oral and Maxillofacial Surgery at the University of Washington, Seattle. She obtained her dental degrees from the University of Newcastle Upon Tyne (BDS), the University of California San Francisco (DDS) and her medical degree from St Bartholomew’s School of Medicine, University of London (MBBS). She is a member of the Royal College of Surgeons of England (FDSCRCS), the American College of Surgeons (FACS) and is an examiner for the American Board of OMFS. She has numerous peer reviewed scientific publications, book chapters, lectures nationally and internationally and is the principle investigator on a multi-centered clinical trial on medication related osteonecrosis of the jaw.

Bone Graft Complications

Abstract

Failures and complications associated with bone augmentation can have a devastating effect on the outcome of dental implant treatment. These complications are classified as either early or late. Early complications include wound dehiscence, membrane and graft exposure, and infection, with the most common complication being wound dehiscence. Late complications of bone augmentation are now recognized more frequently and include late resorption, foreign body reaction, late breakdown of grafted sites, lack of keratinized tissue and poor esthetics, as well as implant failure. This clinical presentation will focus on how to identify and avoid potential complications before they arise and how to manage many of the common complications that can occur with bone augmentation procedures. Emphasis will be given to risk assessment, classifications of complications, and treatment of challenging failures.

Learning Objectives

1. Identify patient-related risk factors associated with bone augmentation procedures
2. Identify anatomical-related risk factors associated with bone augmentation procedures
3. Diagnose and treat complications related to bone augmentation surgery

Point/Counterpoint: Vertical Defects in the Esthetic Zone 
Prosthetic or Surgical Solutions?

Bach Le, DDS, MD

Dr. Bach Le completed his specialty training in Oral & Maxillofacial Surgery at Oregon Health Sciences University. He is currently a Clinical Associate Professor of Oral & Maxillofacial Surgery at the USC School of Dentistry. Dr. Le maintains a private practice in Whittier, California. Dr. Le has lectured both nationally and internationally on bone regeneration and dental implant-related surgery and has published extensively in scientific texts and professional journals. Dr. Le is a Diplomate of the American Association of Oral & Maxillofacial Surgeons, the American Dental Society of Anesthesiologist and the International Congress of Oral Implantologists, and holds Fellowship in the International College of Dentists, the American College of Dentists and the International Association of Oral & Maxillofacial Surgeons.

Abstract

There is growing evidence of the importance of both soft and hard tissue dimensions around dental implants in the prevention of short-term and long-term complications. This clinically oriented presentation will focus on the benefits of “phenotype conversion” using autogenous tissue grafts as well as collagen matrices whose usage comes with less patient morbidity. In addition, the use of bone-grafting substitutes to fulfill the “10 Keys for Successful Esthetic-Zone Immediate Implants” will be reviewed as it relates to long-term success. The clinical importance of the buccal gap dimension in the decision process to virtually plan an implant width will be reviewed. Lastly, Dr. Levine will share his conclusions of 4 publications in which he has co-authored with Dr. Mauricio Araujo (University of Maringa, Brazil) on a series of single tooth immediate central incisor implants placed in his private practice with CBCT and clinical analysis at greater than 1-year in function.

Learning Objectives

1. Recognize and apply the benefits to your practice of the “10 Keys for Successful Esthetic-Zone Immediate Implants” as it relates to the diagnostic, surgical, and prosthetic phases 
2. The importance of soft and hard tissue augmentation for usage in both esthetic and non-esthetic areas for long-term success from single tooth to full arch 
3. Describe the indications and benefits for the use of a new volume-stable collagen matrix to augment soft tissue thickness around dental implants and its important role in “phenotype conversion” 
4. To understand the recent documented evidence supporting the usage of “phenotype conversion” around dental implants including a series of clinical studies to be published by Dr. Levine and his clinical research group 

Robert A. Levine DDS, FCPP, FISPPS

Abstract

Reconstruction of the maxillofacial region poses many challenges and continues to be one of the most difficult tasks of an oral and maxillofacial surgeon.  In the past few decades, a focus on improving patient form and functionality has driven advancements in the field.  With the advent of free microvascular tissue transfer, patients requiring large hard and soft tissue reconstruction have had improved results that what was acceptable in the past. In addition, our application of computer aided design and manufacturing has made predictable functional reconstruction even more attainable. Even with these recent advancements our pursuit for perfection has yet to be realized as we explore new methods to solve an age-old problem.

Learning Objectives

1. Review of principles for maxillofacial reconstruction.
2. Free tissue reconstruction techniques.
3. Use of computer aided surgical design and 3D printing in reconstruction.
4. Future directions in facial reconstruction.

Nicholas Makhoul, DMD, MD

Dr. Makhoul is an academic clinician-scientist at McGill University with a specialization in maxillofacial reconstructive surgery. His research interests include tissue engineering composite vascularized flap for complex facial reconstruction as well as outcomes studies in patients undergoing complex maxillofacial surgery. Dr. Makhoul also heads the Maxillofacial surgery unit at McGill University and has an active clinical practice in a broad field of  Oral and Maxillofacial Surgery.

Abstract

Today’s, point of care in-situ tissue engineering can reconstruct large continuity defects of the mandible and cystic defects as well as regenerate sufficient bone to place dental implants with ridge augmentation procedures!

The components of predictable in-situ tissue engineering have been shown to be cells, a signal, i.e., rhBMP-2/ACS, and a matrix, i.e., cancellous allogeneic bone +/or fibrin, fibronectin, vitronectin. As defects become larger and the tissue bed becomes more compromised with scar, radiation, or poor vascularity, a greater number of osteoprogenitor cells/stem cells is required. Three existing bone marrow harvesters have shown the ability to regenerative bone in jaws to varying degrees. One system uses a straight trocar to remove 60 ml of a bone marrow aspirate which is centrifuged to a 10 ml concentrate. Another system uses a straight to trocar to harvest 10 ml of a bone marrow aspirate without the need to centrifuge. A third system uses a flex metric design to harvest 10 ml or more, if required, also without centrifugation and has shown superiority in stem cell yield, applicability to the office, better safety and reduced cost. Data on these three systems will be compared as well as outcomes in bone regeneration.

Learning Objectives

1. The attendee will learn where the largest number of stem cells and osteoprogenitor cells reside in the donor sites of the tibia, anterior ilium, and posterior ilium
2. The attendee will learn of appropriate markers for stem cells as well as the counts in CFU-f’s to look for to assess stem cell yield
3. The attendee will be able to assess and know the difference in bone marrow aspiration devices related to a need or not need for a centrifuge, a straight needle versus a flexible needle, and the value of aspirate upon removal of the needle or going forward

Robert E. Marx, DDS

Abstract

Learning Objectives

1. Discuss the fundamental science behind tissue-engineering with a focus on cutting-edge strategies for bone and nerve regeneration

2. Review clinical strategies for bone and nerve regeneration to optimize patient outcomes

3. Review surgical technique and management of complications

James C. Melville, DDS, FACS

James C. Melville, DDS, FACS, is an Associate Professor in the Department of Oral and Maxillofacial Surgery at the University of Texas Health Science Center at Houston UTHealth and specializes in Oral, Head & Neck Oncology and Microvascular Reconstructive Surgery. He graduated from the University of Michigan School of Dentistry in Ann Arbor, Michigan, in 2005 and completed a General Practice Residency at the University of California San Francisco in 2006. He completed a residency in oral and maxillofacial surgery in 2012, followed by fellowships in oral, head, and neck oncology and microvascular reconstructive surgery at the University of Miami/Jackson Memorial Hospital. He was appointed to the UTH OMFS internship director in 2017.

Dr. Melville was awarded the Faculty Educator Development Award (FEDA) in 2019 by the American Association of Oral & Maxillofacial Surgeons (AAOMS). An award given to promising young academic surgeons. He was awarded the AAOMS Advocacy Challenge Coin by the AAOMS Board of Trustees and AAOMS Committee on Government Affairs in 2020. AAOMS designed its own Challenge Coin to recognize oral and maxillofacial surgeons who have made significant advocacy contributions on behalf of the Association. The AAOMS Challenge Coin is awarded to those elite few who transcend the efforts of their colleagues to further the specialty through advocacy. Dr. Melville will serve as the Vice-President of Oral & Maxillofacial Section of the International Dental Association of Researchers (IADR) starting in July 2021.

Dr. Melville is a diplomate of the American Board of Oral and Maxillofacial Surgery and a fellow of the American Association of Oral and Maxillofacial Surgeons, the American Academy of Craniomaxillofacial Surgeons, American College of Oral & Maxillofacial Surgeons and the American College of Surgeons.

He has written a Springer textbook on maxillofacial reconstruction and contributed to 18 chapters in textbooks concerning oral and maxillofacial surgery, oncology, maxillofacial reconstruction, microvascular reconstruction, and tissue engineering. In addition, he is the author of more than 30 articles in peer-reviewed journals. He is a reviewer for the Journal of Oral and Maxillofacial Surgery (JOMS), Triple OOOO Journal, Journal of Cranio-Maxillofacial Surgery, Journal of Tissue Engineering, Journal of Biomedical Materials Research, Experimental Dermatology and of Journal of American Dental Association (JADA).

Abstract

Learning Objectives

Upon completion of this presentation, participants should be able to:

1. Explain the objectives of soft tissue augmentation.
2. Compare various techniques and how they differ from the gold standard.
3. Discuss the advantages of alternative therapy.

Michael K. McGuire

Dr. McGuire is the primary author of over fifty scientific articles and textbook chapters, an unparalleled achievement for someone in full-time private practice. He serves on the editorial board of multiple publications and is the founder and chairman of the McGuire Institute, a not-for-profit practice-based clinical research network.

An eminent speaker, having given over 200 continuing education programs, Dr. McGuire has lectured for both national and international audiences. His research has received the American Academy of Periodontology’s highest recognition for excellence, four times earning the Robinson Regeneration Award and twice the Clinical Research Award. He is also the recipient of the Academy’s prestigious Master Clinician Award and the Academy’s highest honor, the Gold Medal Award. In 2015 he received the William J. Gies Periodontology Award for his distinguished achievement in periodontology.

Dr. McGuire is past Chairman of the American Board of Periodontology. He has served as president of numerous dental organizations, including the American Academy of Periodontology and the American Academy of Periodontology Foundation. He is a voting member of the FDA Dental Products Devices Panel. Emory University recognized Dr. McGuire with its Distinguished Alumnus Award in 2009.

Abstract

Learning Objectives

1. Discuss the methods for vertical bone augmentation in the anterior maxilla
2. Understand the limitations of augmentation and implant replacement of multiple missing teeth in the esthetic zone
3. Discuss surgical approaches to prepare the anterior maxilla for the prosthetic solution to defect management

Criag M. Misch, DDS, MDS

Dr. Craig Misch received certificates in postgraduate Prosthodontics and Oral Implantology, as well as a Master of Dental Science from University of Pittsburgh. Thereafter he became Co-Director of the University of Pittsburgh Oral Implantology Center. Dr. Misch then completed specialty training in Oral and Maxillofacial Surgery in Pittsburgh and is board certified by the American Board of Oral and Maxillofacial Surgery as well as the American Board of Oral Implantology/Implant Dentistry.  Dr. Misch practices as a dual specialist in Sarasota, Florida. He is a Clinical Associate Professor at the Universities of Florida, Alabama, Pennsylvania, and Michigan in the departments of periodontics and prosthodontics. Dr. Misch serves as  Editor in Chief of The International Journal of Oral Implantology and is on the editorial boards of the Journal of Oral Implantology and the International Journal of Periodontics and Restorative Dentistry. He has been a featured speaker for numerous organizations and has published extensively with over 50 publications and 20 textbook chapters.

Abstract

Learning Objectives

1. Understand the bone physiology regarding its regeneration processes and capacities
2. Assess the different available bone substitutes and surgical techniques
3. Avoid complications by strictly following physiologically based surgical augmentation principles

Robert Sader, MD, DDS, PhD

Prof. Dr.mult. Robert Sader has received his training in OMF-Surgery at Technical University Munich. After working at University Hospital Basel, in 2004 he was appointed as professor, director, and chair of Oral, Cranio-Maxillofacial and Facial Plastic Surgery at Goethe-University Frankfurt. His department offers the whole spectrum from dentoalveolar and septic surgery, dental implantology, traumatology, orthognatics, TMJ surgery, oncology, plastic-reconstructive, and craniofacial surgery. In Frankfurt he is as well medical director and CEO of the University Dental Institute “Carolinum”. Since 2009 he is president of the German Academy of Aesthetic Dentistry and the Frankfurt Dental Association founded in 1863. Moreover, he is Executive Board Member of the International Foundation of Cleft Lip and Palate, Educational Board Member of the Osteo Science Foundation and the International Association of Oral and Maxillofacial Surgery and General Secretary elect of the International Federation of Esthetic Dentistry. Since 2018 he is the President of the Oral Reconstruction Foundation.

Abstract

Previous studies have indicated that surgical treatment of peri-implantitis with concomitant placement of a bone filler is associated with clinical and radiographic improvements on both short- and long-term periods. However, the available evidence also suggests, that the effectiveness of regenerative treatment approaches is influenced by several factors, such as the type and configuration of the defect and implant surface characteristics, as well as the method of surface decontamination.

Learning Objectives

1. Surgical techniques and materials for regenerative therapy of peri-implantitis associated defects
2. Various decontamination protocols
3. Combination procedures for advanced defects (resective/regenerative)
4. The indication for soft tissue volume grafting
5. Indication based flap and suturing techniques

Frank Schwarz, DMD

Frank Schwarz is Professor and Chairman of the Department of Oral Surgery and Implantology at the Centre for Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University Frankfurt, Germany. He serves as an Associate Editor for the Journal of Clinical Periodontology and Editorial Board Member for Clinical Oral Implants Research. He is past President of the German Association of Oral Implantology (DGI), Executive Board Member of the Osteology Foundation and was awarded the André Schröder Research Prize in 2007, the Miller Research Prize in 2012, and the Jan Lindhe Award in 2017.

Abstract

First conceptualized by W.T. Green in the 1970s, the advent of tissue engineering was a significant milestone in the field of medicine and surgery. What started as proof-of-concept studies in preclinical models has transitioned to clinically applicable regenerative strategies for maxillofacial reconstruction in patients. Tissue-engineered bone grafts have made the reconstruction of defects of the oral and maxillofacial region predictable and reliable without the need for harvesting autogenous bone. At the same time, the use of allogeneic nerve has revolutionized nerve repair and changed the concept of sensory recovery after trauma and ablation. The focus of this session will be on the two fields where the most significant advancements have occurred, craniofacial bone and sensory nerves. Multiple long-term clinical studies have demonstrated tissue-engineered bone grafts and allogeneic nerve reconstruction are equivalent or even superior to autogenous grafts.

The “bench” part of this session will introduce and discuss the science regarding bone and nerve repair and regeneration. Emphasis will be placed on state-of-the-art science regarding growth factors, autogenous bone substitutes, and allogeneic grafts.

The “bedside” session will focus on key concepts for the successful clinical application of tissue engineering science to bone and nerve repair. This session will briefly discuss preoperative workup, preparation, and procedural options for patients with tumors, post-resection defects, and traumatic defects. Focus areas will include surgical technique, postoperative care, and the management of complications.

Learning Objectives

1. Discuss the science behind bone grafts, tissue-engineering graft, Allogeneic Nerve regeneration

2. Review surgical techniques to optimize bone and nerve regeneration and patient outcomes

3. Review Surgical Technique and Management of Complications

Simon Young, DDS, MD, PhD

Dr. Young is a board-certified Oral and Maxillofacial Surgeon with an interest in the treatment and reconstruction of craniomaxillofacial trauma and pathology. He has broad experience in the fields of polymer synthesis, polymer characterization, growth factor delivery, in vivo models and characterization of bone and neovascularization. His research efforts include the synthesis and characterization of implantable materials designed to elicit in situ cell recruitment and programming. One aspect of this work includes the use of materials able to simultaneously deliver multiple growth factors with distinct release profiles, for the promotion of bone regeneration in the craniomaxillofacial complex.

Abstract

Puhan He, DMD 

Abstract

Matthew Dailey, DDS, MD