Regenerative Surgical Therapy in Periodontics is an elective subject and it is taught in the fourth and fifth years of the Degree in Dentistry. It consists of 6 ECTS credits, with a total dedication of 150 hours that are divided into face-to-face classroom hours (71 hours) and non-classroom hours (79 hours).

In Europe, data for total edentulism in the population between 65 and 74 years, ranges from 17% to 36%. Although in Spain this percentage is one of the lowest of Europe, the tooth loss begins early; in fact, only 91% of people aged from 35 to 44 years have more than 20 teeth in their mouths. Tooth loss has important consequences for patients, such as oral and systemic alterations: it reduces masticatory function, alters esthetics, causes discomfort and alters phonation and swallowing, significantly reducing the quality of life of patients.

One of the main causes of tooth loss is periodontal disease. Periodontitis is an inflammatory disease of infectious origin and multifactorial etiology that affects the supporting tissues of the tooth.

Through the subjects of the Degree of Dentistry (Periodontics I and Periodontics II), undergraduate students will acquire the basic knowledge about the supporting structures surrounding the teeth and their substitutes (dental implants), as well as how to establish a diagnosis, a prognosis of the different periodontal and peri-implant pathologies, how to treat them with non-surgical and surgical approaches…

The principles of Guided Tissue Regeneration (GTR) were established in the 1980s and, since then, regenerative procedures around implants and teeth have changed the individual prognosis of teeth affected by advanced periodontal disease and the overall prognosis of the patient's entire dentition.

The objective of this subject is that students acquire the competence and knowledge about the healing of the bone crest after tooth extraction, the prognosis of teeth with / without regenerative treatment, the biological principles of GTR and the main surgical techniques used in both guided tissue regeneration and guided bone regeneration, associated with implantology. Based on this knowledge, the directed, cooperative and autonomous learning of the students will enable them to make decisions aimed at solving simulated clinical cases where regenerative therapies are applied.

Within the subject of Periodontics II, students acquire basic knowledge of periodontal surgical treatment, but it is not possible to develop these regenerative surgical procedures in a comprehensive manner.

Therefore, an elective subject called "REGENERATIVE SURGICAL THERAPY IN PERIODONTICS" will complement the basic compulsory subjects (Periodontics I and Periodontics II), providing students with knowledge to acquire basic skills in regenerative techniques and thus introduce them to a deeper knowledge of periodontal surgical techniques, especially the regenerative ones.

Given its elective nature, it should serve as a support for other subjects that include clinical practices that require knowledge of the clinical and radiographic characteristics of periodontal and peri-implant tissues, both healthy and diseased, such as Periodontics II, Periodontics I, Integrated Adul Practice I and II, Dental Prosthesis III, Dental Pathology and Therapeutics II, and Implantology, among others.

Other recommendations

As new digital tools for teaching are being implemented in this subject, having basic computer skills is recommended, as well as knowledge about presentation softwares (PowerPoint/Keynote) and technical English, since the scientific literature is mostly published in this language.

The competences of the subject are shown in the student guide.



The following are the LO that students will demonstrate at the end of the course, correlated with their respective competences.

LO related to the competences 1 and 4:

LO1. Students will be able to identify key elements of the healing of the bone crest after a tooth extraction.

LO2. Students will be able to know the biological principles of the periodontal regeneration, the periodontal plastic surgery and bone regeneration applied to Implantology.

LO3. Students will be able to know and identify the different surgical techniques used in periodontal regenerative therapy and periodontal plastic surgery, as well as the risk factors associated with them.

LO related to the competences 2, 3 and 4:

LO4. Students will be able to correctly perform the clinical history, as well as the exam of the periodontal and peri-implant tissues.

LO5. Students will be able to consistently analyze the signs and symptoms of simulated clinical cases and, based on scientific evidence, reach a differential and a final diagnosis of periodontal and peri-implant diseases

LO6. Students will be able to correctly identify and request the necessary complementary tests (radiological, serological and microbiological) for establishing the diagnosis and prognosis of periodontal and peri-implant diseases.

LO7. Based on the analysis of the data obtained from the different diagnostic tests, the students will be able to correctly establish an individual and general prognosis of periodontal and peri-implant diseases, as well as a comprehensive treatment plan. Also, students will be able to identify the lesions susceptible to be treated with periodontal regeneration, identifying the risk factors associated with these lesions that will condition the prognosis of the tooth, with or without regenerative treatment, and its impact on the overall prognosis.

LO related to the competence 5:

LO8. Students will be able to correctly perform on patients the periodontal treatment according to their therapeutic needs.

LO related to the competence 6:

LO 9. Students will be able to collaborate on clinical tasks (periodontal chart and radiographic series), to analyze the information about the clinical case and to propose an initial or presumptive diagnosis, a differential diagnosis and a final diagnosis, as well as multidisciplinary and integral treatment plans for the simulated and real cases.

LO related to the competence 7:

LO10. Students will be able to analyze, in an autonomous and collaborative way, the most important scientific information in the field of periodontics, for its implementation in the resolution of specific cases in this area (periodontal regenerative procedures), identifying which surgical treatment is the most indicated and the risk factors that might condition the success of such procedure.

LO related to the competence 8:

LO 11. Students will be able to use an appropriate academic terminology and a writing style adapted to the different situations (patients, other professional dentists…).

LO 12. Students will be able to use an appropriate terminology and an oral language tailored to the different scenarios that can arise between the patient and the professional dentist.

Theorical Lessons:

Lesson 1.- The edentulous ridge: from the alveolar process to total edentulism. Intraalveolar and extraalveolar changes after tooth extraction. (2 hours)

Lesson 2.- Healing of the wound after periodontal surgery. Healing of the soft and hard tissues surrounding dental implants. (2 hours)

Lesson 3.- Prognostic factors related to the patient, the defect and the tooth in periodontal regeneration. (1 hour)

Lesson 4.- The surgical approach and the importance of the suture in periodontal healing focusing on regeneration. (1 hour)

Lesson 5.- Principles and biologic development of the guided tissue regeneration (GTR). Indications considering the scientific evidence. (2 hours)

Lesson 6.- Membranes and biomaterials in GTR. (1 hour)

Lesson 7.- Biologically active periodontal regeneration: a different approach, Where is the limit? (1 hour)

Lesson 8.- Clinical strategies for periodontal regeneration. Decision making. (2 hours)

Lesson 9.- Mucogingival therapy: Periodontal Plastic Surgery (4 hours)

Lesson 10.- Ridge augmentation procedures associated to implant installation: (2 hours)

o Biologic principles of Guided Bone Regeneration (GBR)

o Membranes and graft biomaterials

o Alveolar preservation

o Ridge aumentation in thickness and height

Lesson 11.-Treatment of the atrophic posterior maxilla (2 hours)

Practical contents:

1.- Clinical seminars: 15 hours of clinical seminars, in which simulated clinical cases will be solved through active methodologies (case-problem), in small groups and with the whole group.

2.-Laboratory Practices (LP) (Hands-on in a simulation model)

· LP1.- Preparation of the surgical field. Microsurgical instruments (1 hour)

· LP2.- Suturing techniques in periodontics: (2 hours).Presentation of different suturing techniques

· LP3.- GTR/ amelogenin techniques on angular defects around teeth (typodont). (3 hours)

· LP4.- Sinus lift. (2 hours)

· LP5.- GBR in bone defects surrounding dental implants. (2 hours)

· LP6.- Mucogingival surgery techniques in a simulation model (typodont /animal model). (2 hours)

3.- Clinical practices (24 hours)

Students will attend as observers to the surgical procedures performed in the Dental Clinic Service of the UPV/EHU by students of the MFP in Periodontics and MFP in Osseointegration and Oral Rehabilitation.

LO1, 2, 3, 4 and 5: The acquisition of LO1, LO2 and LO3 will be achieved through master classes to the entire group, where the conceptual contents of the subject will be explicity explained. All the concepts of this subject will be explicitly explained, and the fundamental concepts will be treated interactively. To complete these LO1, 2 and 3, the students will study them them through self-learning (LO10), through basic and deepening bibliography, completing activities in the virtual classroom (eGela) ) and consolidating knowledge through personalized tutoring.



LO 4,5,6,7,9,10,11 and 12: They will be developed through seminars and LP. Seminars will be held in double sessions using a methodology based on clinical cases and case problems and students will be divided into small cooperative groups.



LO 4,5,6,7,9,10,11 and 12: They will be developed through seminars and LP. They will be developed in simulated models in small groups supervised by the tutoring teacher.



LO 4, 5, 6, 7, 8, 9,10, 11 and 12: They will be developed through clinical practices at the Dental Service of the UPV/EHU in small groups supervised by the tutoring teacher.



Virtual classrooms (eGela) will be used as a complement to face-to-face teaching.

• Continuous Assessment System
• Final Assessment System
• Tools and qualification percentages:
  • Realization of Practical Work (exercises, cases or problems) (%): 40
  • Team projects (problem solving, project design)) (%): 20
  • Exhibition of works, readings ... (%): 30
  • Portfolio (%): 10

General aspects of evaluation (continuous and final) applicable to all types of evaluation:



1.-Attendance and completion of practical content: Attendance is mandatory, and all practical content must be independently developed and passed, since it allows achieving 90% of the LO of the subject. Thus, non-attendance cannot exceed the limits settled in the regulations and must be duly justified. (UPV/EHU student regulations, November 2016 resolution, (https://www.ehu.eus/documents/3026289/3106907/Reglamento_Alumnado_UPV_EHU.pdf)

2.-Final evaluation (requirements): If a student refuses the continuous evaluation and requests a single final test, he/she must confirm his/her attendance in advance (at least 3 weeks before the test). If failing to do so, or not showing up the day of the exam will automatically result in failing the subject in both the ordinary and the extraordinary call.

3.-Evaluation system of preference and minimum requirements for passing the subject: Whenever possible, a continuous evaluation will be carried out. In order to pass the subject, the theoretical and practical contents must be passed independently.

4.-Plagiarism: No copy or imitation of the work done by third parties may be presented as one's own. Students must know how to cite and use references. The suspicion of plagiarism may cause turning down the work and, consequently, failing the subject.



Evaluation with 100% face-to-face teaching:

The evaluation will consist of:

1.- Continuous evaluation. 60% of the final result.

Continuous evaluation of the student’s participation and resolution of the clinical cases presented in the seminars, as well as attendance to the laboratory and clinical practices, with an active participation.

2.- Individual final evaluation. 40% of the final result.

It will consist of a final oral test or lecture on the part of the course not evaluated in the continuous evaluation, on theoretical aspects or clinical cases developed in the lectures and seminars, including the presentation of papers or readings.



Final evaluation:



The evaluation will consist of:

1.-Continuous evaluation: 30% of the final result. Continuous evaluation of the student’s participation and resolution of the clinical cases presented in the seminars, as well as attendance to the laboratory and clinical practices, with an active participation.



2.- Individual final exam: 70% of the final result. It will consist of a final oral test on the part of the course not evaluated in the continuous evaluation, by means of a oral exam about the theoretical aspects or clinical cases developed in the lectures and seminars, including the presentation of papers or readings. In order to pass the subject, a minimum of 7 points over 10 must be obtained in the oral test, in order to add this result to the rest of the evaluation.



If, for epidemiological reasons, a face-to-face evaluation would NOT be possible, a final assessment will be made according to such conditions.



Evaluation of semi-face-to-face education derived from the aforementioned epidemiological situation:

Continuous evaluation of all the face-to-face and the telematic teaching activities, considering the general evaluation criteria.

All sessions and assignments proposed by the faculty as a substitute for classroom teaching will be mandatory and will be part of the evaluation of the course.

Since attendance to seminars and clinical practices is mandatory, those students who, despite having attended them and having a positive evaluation, fail the course in the ordinary exams, will keep the positive evaluation of the practical contents and will only have to take a single theoretical test.

The criteria mentioned in the ordinary call are also maintained regarding the epidemiological situation derived from the current pandemic.



To refuse both ordinary and extraordinary calls, it will be enough not attending the exam.

Clinical pyjamas and clinical cap.
Specific material to be established by the Dental Clinic Service.
Device with Internet connection: laptop/tablet/mobile phone
Educational materials

Basic bibliography

Basic bibliography

o Aguirre-Zorzano L.A., Estefanía-Fresco R., García-De-La-Fuente AM (2017). Diagnóstico periodontal: conceptos básicos. EHU-OCW.https://ocw.ehu.eus/course/view.php?id=433;

o Aguirre-Zorzano, L.A., Estefanía-Fresco R., Fernández Jiménez A., García-De la Fuente A.M.(2022) Enfermedad periodontal y periimplantaria: nuevas claves diagnósticas [2022/10][cas]. ISSN 2255-2316 https://ocw.ehu.eus/course/view.php?id=585

o Amine et al. (2019). Periodontal root coverage. An Evidence-Based Guide to Prognosis and Treatment.Springer.

https://link.springer.com/book/10.1007/978-3-030-20091-6

o Berglundh et al.(2021) Lindhe´s Clinical Periodontology and Implant Dentistry. 7th edition, ed. Wiley Blackwell, Munksgaard.

o Chambrone, L (2015). Evidence-Based Periodontal and Peri-Implant Plastic Surgery: A Clinical. Roadmap from Function to Aesthetics” Editorial Springer. http://link.springer.com/book/10.1007/978-3-319-13975-3.

o Chambrone, L., Ortiz, G. A., & Valenzuela, S. G. (2022). Tissues: Critical Issues in Periodontal and Implant-Related Plastic and Reconstructive Surgery. Quintessence Publishing Company, Incorporated.

o Nares(2020). Advances in Periodontal Surgery. Springer. https://link.springer.com/book/10.1007/978-3-030-12310-9

o Rateitschack KH, Rateitschack Pluss EM, Wolf HF. Atlas de Periodoncia.2ª Ed Salvat. Barcelona 1991.

o Younes et al. (2015). Sinus Grafting Techniques.A Step-by-Step Guide.https://link.springer.com/book/10.1007/978-3-319-11448-4

o Zuhr O. & Hürzeler M.(2012).Plastic-Esthetic Periodontal and Implant Surgery. A microsurgical aproach. Quintessence Publishing.



Specific material from scientific journals of the specialty:



o Supplement to Journal of Periodontology: (2015). Proceedings of the 2014 AAP Regeneration Workshop – Enhancing Periodontal Health Through Regenerative Approaches.

o Periodontology 2000: volume 68, 73,77



o Aguirre-Zorzano, L. A., García-De La Fuente, A. M., Estefanía-Fresco, R., & Marichalar-Mendía, X. (2017). Complications of harvesting a connective tissue graft from the palate. A retrospective study and description of a new technique. Journal of clinical and experimental dentistry, 9(12), e1439–e1445. https://doi.org/10.4317/jced.54337

o Bjarni et al.(2014):” Sinus floor elevation utilizing the transalveolar approach” Periodontology 2000, Vol. 66, 2014, 59–71. | DOI: 10.1111/prd.12043

o Fernández-Jiménez, A., García-De-La-Fuente, A. M., Estefanía-Fresco, R., Marichalar-Mendia, X., Aguirre-Urizar, J. M., & Aguirre-Zorzano, L. A. (2021). Complete root coverage in the treatment of Miller class III or RT2 gingival recessions: a systematic review and meta-analysis. BMC oral health, 21(1), 145. https://doi.org/10.1186/s12903-021-01494-3

o Fernández-Jiménez, A., Estefanía-Fresco, R., García-De-La-Fuente, A. M., Marichalar-Mendia, X., Aguirre-Urizar, J. M., & Aguirre-Zorzano, L. A. (2023). Comparative study of the modified VISTA technique (m-VISTA) versus the coronally advanced flap (CAF) in the treatment of multiple Miller class III/RT2 recessions: a randomized clinical trial. Clinical oral investigations, 27(2), 505–517. https://doi.org/10.1007/s00784-022-04746-w

o Fernández-Jiménez, A., García-De-La-Fuente, A. M., Marichalar-Mendia, X., Aguirre-Zorzano, L. A., & Estefanía-Fresco, R. (2023). Treatment of deep single RT2 and RT3 antero-mandibular gingival recessions with a combination of surgical techniques: A case series study. Journal of esthetic and restorative dentistry : official publication of the American Academy of Esthetic Dentistry ... [et al.], 10.1111/jerd.13120.

o Sculean et al. (2008). Regeneration of periodontal tissues: combinations of barrier membranes and grafting materials–biological foundation and preclinical evidence: a systematic review. Journal of clinical periodontology, 35, 106-116.

o Susin & Wikesjö (2013). Regenerative periodontal therapy: 30 years of lessons learned and unlearned”. Periodontol 2000., Jun;62(1):232-42. doi: 10.1111/prd.12003. http://onlinelibrary.wiley.com/doi/10.1111/prd.12003/epdf



Learning material in video (EHUTB) in Spanish:

o Aguirre-Zorzano LA, Estefanía-Fresco R, Fernández-Jiménez A, García-De-La-Fuente A M.(2018).Implantes dentales: carga inmediata y provisionalización. Aguirre-Zorzano LA, Estefanía-Fresco R, Fernández-Jiménez A, García-De-La-Fuente A M. (2018).Implantes dentales: implantes dentales e injerto de tejido conectivo.

o Aguirre-Zorzano LA, Estefanía-Fresco R, Fernández-Jiménez A, García-De-La-Fuente A M.(2018)Terapia quirúrgica: elevación de seno maxilar e implantes dentales en la misma sesión”.

o Fernández-Jiménez A, Estefanía-Fresco R, , García-De-La-Fuente A M., Aguirre-Zorzano LA (2021)Técnica VISTA modificada (m-VISTA) en el tratamiento de recesiones gingivales múltiples clases III de Miller/RT2

In-depth bibliography

Scientific journals (in English)
o Clinical Oral Implant Research
o Journal Clinical of Periodontology
o Journal of Periodontology
...
Database:
o PubMed
o Isi Web Of Knowlegde
o Scopus

Journals

-Periodoncia Clínica (“Periodoncia y Osteointegración” sustituye a la revista Periodoncia y Osteointegración) http://www.sepa.es/web_update/periodoncia-clinica-presentacion/
-Periodoncia y Osteointegracion http://www.sepa.es/web_update/po-home

Web addresses

Sociedad Española de Periodoncia (SEPA): https://www.sepa.es/;
European Federation of Periodontology (EFP): https://www.efp.org/;
American Academy of Periodontology (AAP): https://www.perio.org/