Good afternoon to everybody. It is tough to continue after all of the significant previous speakers. So would like to continue with my second lecture today, which we called anterior pedicle connective tissue graft within palatal flap for immediate incisal implant placement. So I would like just to go to my topic. I would like to speak about medical drawings of the palatal flap and its clinical implementation to show some cases with detailed surgical techniques and videos, followed by the digital prosthodontics workflow as we I revealed recently that I haven’t found in the literature the drawings of this technique. And I’m going to publish and to show how is it beneficial and how is it possible with short Bicon implants. So as we all of you know that we can shorten treatment time to reduce discomfort and preserve the bone and soft tissue if we put implant immediately as we are putting in free flaps also. We are putting here in in the regular dentistry. So immediate implants also can preserve the crestal bone and minimize soft tissue changes in esthetic zone. And now I’m going to to show for the first time, I made some illustrations about this surgical technique where where I would like to stop for for just to describe. Of course, the tooth has to be extracted and gently removed with forceps to preserve already damaged hard and soft tissue if it is damaged or not. And if it is feasible without any laceration of the marginal gingiva. Of course, it is of paramount importance that it is of paramount importance to not to touch the labial aspects of the alveolar socket at all. So not to make any kind of incision at the labial aspect and not to raise the mucoperiosteal flap. So here you can see the tooth extraction, schematic, and the incision commences at the palatal aspect of the alveolar. You can see around in the middle of the marginal gingiva and goes forward up to the projection of the second premolar, and the back cut has to be made, but just through the mucosa. This is the first flap. And you will and with respect to palatal artery, and you can see the the raised flap, just mucosal flap. And then we are going to make the cut here just through the connective tissue, but with respect to the now you you can see the short video here, And you can see the Bicon implant position in the palatal aspect of the alveoli. And somatic drawings for this flap, which is vascularized. What is beneficial as we got the vascularized flap here, and you can see hematically the anterior cut. The anterior cut is finished a little bit. You you we need to to leave a little bit of cuff of connective in order to protect the pedicle and to to to allow nourishment of the flap. And you can see here the stitched. Everything is stitched. And now I also made some from sagittal view, some views. And you can see. So there are two possibilities. The lack of buccal part of the alveolar. And it also can be present. So in the case of the lack of alveolar, it’s simply I just used a free tuber graft, a little bit of a piece of bone, and I stuck just below the mucosa. Of course, with the Bicon. And this is the only implant, if according to my best knowledge, where we can have a bone from autologous bone during the preparation. And we can use this bone like this. And you you you you hear. And in the case of lack of buccal plate, just just make not just even to make a tunnel, just curettage and put the bone below the mucoperiosteum of the labial mucosa. And here everything is stitched. So I’m going now to the cases. And you can see one of my first case. The first case was my mother, but I haven’t put here. And also a good case with the longest follow-up. You can see the preoperative photos, preoperative x-ray, and can see the surgical technique here. So extraction of the tooth very gently. No laceration of the gingiva. And can you put video of tooth to video? Can you play video for me? Please, if you can play video. No? To play video. Yes, I put click but the, okay. But the video is very nice, and I would like to K. Okay. Okay. Okay. Okay. So you can see that the mucosa is preserved, and we have to flip the flap around just to raise. And the periosteum is going to be up in the alveolar. And you can see it is a minimal morbidity at the end. It maybe looks a little bit bloody, But it is vascularized and I’m convinced that we could preserve. You see here also, if you can play the video because there is a implant, Bicon implant insertion in this video. Thank you so much. Yes, and you can also see the moments of the Bicon implant placement, exactly where we explained before in surgical approach. And here is the flap positioned and mucosa, the rest of the mucosal flap is stitched carefully. And you can put temporary Maryland crown, or you will see the complete preserving of gingiva. There’s just four days post operative. And also, if you can play the video, this is after opening of the implant. And complete preservation of the alveolar sulcus. You can see everything is nicely preserved. And this is just, you can see photos. Not any scars to the palatal surface and temporary crown. She’s waiting for definitive crown. This is almost recently made picture and you can see the photos. Another one, lady with also four years follow-up. The pictures before previous speaker mentioned smile line, Pink Esthetic Score, everything. And you can see this is the preoperative and postoperative forty seven months follow-up. The same kind of procedure. And you can see the bone gain during the loading of implants. So you can see the moment of installation of crown. And you can see the bone gain forty seven months after. So I think everything is clear. And also, another guy who has been treated. He’s also colleague of mine who has been treated by colleague of mine who is working at the same department and who has been married his sister. But he changed the, when he saw the Bicon results, I haven’t convinced him to do the Bicon, but just we did the Bicon. And this is the six point five years follow-up with the Bicon. I know that I’m about ten minutes now. And we can see that we can put Bicon just close to the nasopalatine canal. And it looks very stable. And you can see here. So another case also, if I may sum up, whoever knows what I’m talking about will clearly understand that the logic of short implants comes in something logical and something does not need any additional explanation or any additional convincing. So it is there as because it is clear, it is logical, and it is easy, and it leaves no place for error. Thank you very much.
