Failure and Success in Periodontal and Peri-Implant Soft Tissue Surgery

In this first video lecture of the course, the focus of the lecturer will be on the strategies to avoid medical errors and to prevent complications’ occurrence. Thanks to this lecture, participants will understand that complications can occur in three different treatment phases: pre, intra and post-surgery. Here, the pre-surgical phase will be analysed, highlighting those strategies that must necessarily be implemented in order to minimize the risk of complications and errors; the patient’s medical and pharmacological history, diagnosis and prognosis, analysis of systemic diseases and local factors will be discussed in detail.

According to Prof. Giovanni Zucchelli, intra-operative complications are the most stressful for the surgeon as they require an immediate management. Participants will have the opportunity to learn the most frequent and complex complications including intra-operative bleeding, nerves damages and perforations. Usually, these complications are caused by a lack of skills on the surgeon’s side but several techniques, to be put into practice during the preliminary planning phase, will be shown to prevent them. A special focus will be paid to the management of excessive bleeding, a phenomenon that is not particularly dangerous for the patient but that represents a great obstacle for the operator, and to the palatal graft retrieval phase, a crucial step that can cause serious problems if not performed according to the due standard protocol, and to the management of intra-operative perforations, for which a table will be provided containing the anatomical parameters that impact on the complexity of the surgery.

Perforations are the most frequent complications in mucogingival surgery and in this video lecture, several clinical clips will be shown as examples to clarify to the participants which are the most delicate steps in which the risk of perforation increases significantly; the execution of the deep split thickness and the detachment of the muscular insertion from the periosteum in primis. Participants will be able to deepen their knowledge about the clinical protocol to be followed when realizing that a perforation has occurred. In the final part of the video lecture, Prof. Zucchelli will show a clinical video through which he will illustrate to participants the possible perforation caused by the detachment of well-adherent muscle structures that cause fragility to the mucosa.

This video lecture focuses on the prevention of intra-operative complications related to damage to nerve structures, paying particular attention to the inferior alveolar nerve in the chin area and the infra-orbital nerve. Prof. Giovanni Zucchelli will comment in a step-by-step mode a clinical video showing the treatment of a multiple gingival recession in the lower arch.

Thanks to this presentation, participants will deepen their knowledge about a wide range of post-surgical complications that may happen immediately after the treatment’s finalization such as pain, bruising, swelling and early bleeding. In the second part of the lecture, on the other hand, a specific focus will be placed on delayed post-surgical complications such as flap dehiscence, scars appearance, partial root coverage, hypersensitivity and exostosis.

In this video lecture participants will observe a clinical clip thanks to which Prof. Zucchelli will show how to face an exposed palatine root went into necrosis. The treatment protocol to cover the recession with an enveloped palatal flap will be shown, then Follow-Up at 3 months will be discussed and participants will notice the complete healing of the palatal tissue.

Prof. Zucchelli will discuss soft tissue management complications in mucogingival surgery. Several clinical case will be shown and participants will see how peri-implant soft tissue dehiscences appearance and they will have the chance to discover the rationale behind the correct operative treatment, based on the proper peri-implant papillary dimension and implant position.

This lecture’s focus will be on misplaced implants management with particular attention paid to too apical placed implant and too coronal one. Participants, helped by several clinical clips, will discover how to treat misplaced implants with loss of papilla in both mesial and distal direction.

A misplaced graft could lead to the gingival exposure of the entire grafted part, causing an unesthetic texture between the soft tissue and the exposed portion of the graft. In this comprehensive video lecture, the reasons leading to such exposure will be discussed; the graft might have been disepithelized incorrectly or the clinician might have made mistakes during the drilling phase.

Prof. Zucchelli’s mucogingival approach will be shown in this video lecture and participants will notice that this technique is based on the coronally displacement of the envelope flap and the placement of the connective graft which allows the overcoming of the limitations traditionally associated with post-extractive implants.

This learning experience ends with an Hands-On on a pig jaw that will allow participants to observe the palatal graft incision protocol. Every treatment phase will be discussed by Prof. Zucchelli in a high didactic and detailed way. Participants will appreciate the design phases of the distal and mesial junctions, disepithelization and the subsequent suturing