2. Background Atraumatic Extraction technique Hands on 1: Atraumatic extraction technique Biomaterials “ Closed” Socket preservation Hands on 2: Socket preservation “ Open” Socket preservation and Ridge augmentation Hands on 3: Ridge augmentation Implant treatment options Summary and conclusions Today’s Plan
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5. Socket preservation Ridge preservation Ridge augmentation Guided bone regeneration Site preparation Immediate implant placement Delayed implant placement Root submergence
6. Background Socket preservation after tooth extraction can maintain the alveolar ridge dimensions The whole idea of this is to perform a series of straightforward procedures at the time of extraction that will result in a better site for dental implants, pontics or dentures .....especially for implant therapy where this can allow for aesthetic implant therapy without the need for extensive grafting later on
7. Anatomy Buccal bone - bundle bone poor blood supply thin absent Gingival biotype - thick thin scalloped normal
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9. Bone Resorption Extraction of teeth results in resorption of the alveolar process in both a vertical and horizontal direction Different rates of resorption around the mouth More loss of height and width buccally Complicates implant therapy for patients Aesthetic result may be compromised
12. Does placement of an immediate implant prevent this bone loss? 4 weeks 12 weeks
13. Treatment Strategies Ultimate goal is to preserve as much of the alveolar ridge as possible and prevent resorption of the buccal plate in particular Biomaterials can help prevent this resorption 1. At extraction time - graft materials - graft materials + implant - implant - nothing 2. Wait 4 weeks or 12 weeks - graft materials + implant
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15. “ Important to identify the probable and possible short, medium and long term treatment plan prior to treatment planning the extraction socket effectively”
16. Treatment Strategies XLA - 4-6 weeks - Implant placement XLA - 12 weeks - Implant placement XLA + Bone graft - 6-9 months - Implant placement Bone grafting materials need 6-9 months to allow for enough graft replacement and new bone formation - Depends on size of defect and presence of bony walls providing blood supply Collagen materials do not delay implant placement
21. 1. Pericision Size 15, 15c or 12 blade Separating supracrestal periodontal attachment apparatus Incision can extend into PDL
22. 2. Elevation Periotomes, other... Used mainly mesially and distally avoiding damage or fracture to buccal plate
23. 3. Forceps Delivery Root separation if required Appropriate extraction forceps Modify delivery technique Delivery of all roots......
24. 4. Socket Degranulation !! Often overlooked Remove all soft tissue remnants Bone files, spoon excavators, other Care of maxillary sinus and ID Canal
36. Type 1 Bovine Collagen Cross linked Zero memory Hydrate 4-6 months resorption Similar to BioGide - Natural collagen - Resorbs quicker
37. Longer resorption times 6-8 months Elastic memory + rigidity Largely removes the need to use non-resorbable membranes - Gortex, EPTFE
38. Bone Grafts Autogenous - Your own bone Allograft - Other human bone Xenograft - Animal bone Alloplast - Synthetic bone substitute Donor site availability Resorption rates Moral issues
39. Bovine bone Porous mineralised bone matrix No organic component Very similar to BioOss Particle size 0.2-0.5 microns 1.0-2.0 microns Generally use the smaller size except for sinus grafting
65. Implant Timing Options Type 1: Immediate implant placement Type 2: Early delayed implant placement Type 3: Late delayed implant placement Type 4: Healed ridge
72. Orthodontic Extrusion Consider extrusion of teeth with vertical bone defects Even teeth that are due for extraction Predictable method of vertical augmentation Aesthetic demand Sectional fixed appliance 3-6 months active treatment followed by 3 months retention
So the whole idea behind this is to prevent situations like this arising, we see these types of resorptive defects commonly and they can be avoided by utilising a few different procedures at the time of extraction to prevent the need for extensive grafting in the future, make doing aesthetic implant dentistry more achievable But also not just the procedures that are available to us now with the increasing advances in biomaterials, but also treatment strategies, and knowing at the time of extraction where this site is headed, be it for an immediate implant, for an implant in the near future, as a pontic site or also for a denture
bundle bone supported by the PDL less mineralised buccal wall is less than 0.5 in 50% and still less than 1mm in 80 %
1 Week - initial connective tissue matrix, blood clot, 2 Week - large amounts of woven bone in lateral and apical areas of socket 4 Week - dominated by newly formed woven bone bundle bone of buccal crest has resorbed, with some replacement by woven bone position of buccal crest compared to palatal wall
8 Week - socket entrance sealed by hard tissue ridge 12 Weeks -