Download Don`t expand labial plate!

Don’t expand labial plate!
No “Wimpy” Forceps
No Labial Force
If must remove bone during
extractions, remove:
1.
2.
3.
4.
Interadicular
Interdental
Lingual
Labial
If must extract, then remove
the smallest amount of the least
valuable bone (labial plate in
maxilla especially valuable).
Roots
Tips
“Drill to oblivion ”
Save (preserve) the buccal and lingual
cortical plates by sectioning teeth and or
removing interdental / interadicular bone
Esthetics Count
Implant Prosthodontics by Dr. Sree Koka
Removing most difficult tooth
last saves bone (consider
removing interdental bone)
Orthodontic Extrusion Saves Bone
Does grafting at the time of
extraction minimize ridge
resorption?
Class 1 Recommendations
• Proven efficacy and effectiveness
supported by 1 or more randomized
controlled trials
• Results of trials consistently excellent
• Intervention is safe and definitely
recommended and useful
Class 2a
• Multiple studies (prospective,
retrospective, nonrandomized)
with good results
• Considered intervention of choice
by majority of prudent dentists
• Acceptable and useful
Class 2b
• Fewer studies (Case reports, intervention
done on animals, studies without controls)
generally but not always positive
• Considered acceptable safe and useful…
within standard of care
• Considered optional or alternative
treatment by most experts
Class 3
• Positive evidence completely absent,
or studies suggest harm
• Unacceptable, no benefit
• Intervention may be worse
than doing nothing at all
Class Indeterminate
• Promising, but few studies
• Contradictory results
• No harm, but benefit uncertain
• “More research needed”
Adopted from International
Guidelines 2000 for CPR and ECC
What graft material?
• Fresh warm autogenous bone
• “Hamburger Helpers” for bone:
1. Allogenic bone (other humans)
2. Xenogenic bone (other species)
3. Alloplastic agents (Bioglass, Ca-Sulfate,
Methacrylates, Calcium Phosphate
cements)
4. “Biologics” BMP,PRP
5. Combinations
Costs? $20.00-$125.00/gram
 ALLOGRAFT CONSENT (Check if applicable and if checked
consent signature must be completed):
Use of donated bone or tissue products if applicable, has been
explained to me and I understand that there are risks associated with
implanting these types of products. These risks include reactions,
infections such as hepatitis and AIDS. These risks, although extremely
rare, can be serious ands possibly fatal. Alternatives to allograft use
have been explained to me and include but are not limited to
.
 I CONSENT to use of donated bone/tissue if determined by my
physician
Patient Signature
 I DO NOT CONSENT to use of donated bone/tissue
Patient Signature
“Socket Preservation”… ADA 7953
Int J Periodontics Restorative Dent.
2006 Feb;26(1):19-29. A study of the
fate of the buccal wall of extraction
sockets of teeth with prominent roots.
Nevins M, Camelo M, De Paoli S,
Friedland B, Schenk RK,
What do I use? Autogenous
bone mixed with a resorbable
alloplast
‘Donor site morbidity’