Introduction
Summary
Different Management Applications
Summary
Successful early alveolar ridge augmentation procedures may reduce, or eliminate, the need for future ridge augmentation
- The objectives of an atraumatic extraction technique, as well as ridge and site preservation will lead to a functional and esthetic prosthetic result in the long term and enables the patient to be treated in a shorter time with fewer surgical procedures.
(1) Using barrier membranes alone:
The authors suggested that treatment of extraction sockets with membranes is valuable in preserving alveolar bone in extraction sockets and preventing alveolar ridge defects.
- Multiple bone graft regimens and techniques have been suggested to minimize alveolar ridge atrophy and to evaluate new bone growth within extraction sockets.
- Generally, these procedures are primarily aimed at preserving the current bone level and hopefully regenerating new bone.
- As oral health improves, more people are retaining their teeth and patient expectations are increasing. Increasingly, implants are used to replace missing teeth.
- Irrespective of the method used for tooth replacement, preserving the ridge and soft tissue at extraction sites is important for both function and esthetics.
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Summary
Different Management Applications
Introduction
Materials used for Socket Preservation
Diagnosis
Classification
Loss of alveolar bone may be attributed to a variety of factors, such as endodontic pathology, periodontitis, facial trauma and aggressive moves during extractions.
Most extractions are done with no regard for maintaining the alveolar ridge.
(2) Using bone graft with/without barrier membrane::
Bone graft materials have been used to augment bony defects adjacent to dental implants and to repair chronic extraction socket defects, with and without the use of barrier membranes.
When combined with barrier membranes, bone graft materials have also shown to prevent collapse of the barrier membrane.
- Functionally, removable dentures require the maximum possible bone and soft tissue support for ease of chewing, speaking and denture retention, where ridge preservation avoids excessive loss of alveolar support and the need for bulky dentures, the latter being cumbersome and unaesthetic.
- Type II sockets are the most difficult to diagnose.
- The largest group of aesthetic problems comes from improper treatment of Type II because of the post-treatment tissue recession that may occur.
- Many different procedures have been suggested to treat sockets of this type.
Tarnow D. P., 2007 Classified sockets into 3 types:
- Type I Socket
- Type II Socket
- Type III Socket
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Diagnosis
Introduction
Summary
Classification
Materials used for Socket Preservation
- Type III sockets are very difficult to treat and require soft tissue augmentation with additional grafts of connective tissues, or connective tissue and bone.
The facial soft tissue and buccal plate of bone are at normal levels in relation to the cementoenamel junction of the pre-extracted tooth and remain intact post-extraction.
- In the case of fixed prostheses, the pontics will be shallower, there will be less recession and bone loss around the abutment teeth, and it will be easier to maintain periodontal health if the ridge is preserved.
Barrier Membranes can be classified to:
Resorbable Membrane.
Non-resorbable Membrane.
(requires a secondary surgery)
Tooth extraction results in alveolar bone loss as a result of resorption of the edentulous ridge.
An average of 40% to 60% of original height and width is expected to be lost after tooth extraction.
This can negatively influence bone volume that is needed for future dental implant placement.
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Diagnosis
Summary
Materials used for Socket Preservation
Outline
Classification
Materials used for Socket Preservation
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- Autografts are considered to be the ideal material for bone grafting procedures because it possesses osteogenic, osteoinductive and osteoconductive properties.
- Type I sockets are the easiest and most predictable to treat.
- Most of the cases seen demonstrating excellent aesthetics are Type I sockets.
- Introduction
- Classification
- Diagnosis
- Different Management Applications
- Materials used for Socket Preservation
- Increasingly for implants either with immediate or delayed placement, if the bony support is poor, or if the soft tissue was severely damaged, then the soft tissue contours and dimensions will also be esthetically displeasing.
- Since ridge and soft tissue preservation leaves a soft tissue contour that is more natural, the result will also be more pleasing esthetically.
The facial soft tissue is present but
the buccal plate is partially missing following extraction of the tooth.
However, they do increase the risk of additional pain, infection and donor site morbidity because an additional surgical procedure is necessary for harvesting.
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Diagnosis
Socket Preservation
Materials used for Socket Preservation
Classification
References
Biology of Bone Grafts
- The key factor determining the quality of the socket following extraction is the presence or absence of the buccal hard and soft tissues.
- This is done by both clinical and radiographical evaluation.
- Socket Diagnosis should be done prior to extraction.
Bone healing and subsequent new bone formation after grafting take place through osteogenesis, osteoinduction, and/or osteoconduction.
The facial soft tissue and the buccal plate of bone are both markedly reduced after tooth extraction.
- Osteogenic grafts supply viable osteoblasts that form new bone.
- Osteoinductive grafts stimulate pluripotential mesenchymal cells to differentiate into osteoblasts that can form new bone.
- Osteoconductive grafts act as a lattice for cell growth, permitting osteoblasts from the wound margins to infiltrate the defect and migrate across the graft.
- Tarnow, D.P., Elian, N., Choo, S., Froum, S. & Smith, R. B. 2007. A Simplified Socket Classification and Repair Technique, Pract Proced Aesthet Dent, 19(2), 99-104.
- Wang, H., Kiyonobu, K. & Rodrigo, F. 2004. Socket Augmentation: Rationale and Technique. Implant Dentistry. 13(4), 286–296.
- Wang, H.L. & Al-Shammari, K. F. 2002.Guided tissue regeneration-based root coverage utilizing collagen membranes: technique and case reports. Quintessence Int. 33, 715–721.
- Feinberg, S. E. & Fonseca, R. J. 1986. Reconstructive Preprosthetic Oral and Maxillofacial Surgery, 1st ed. Philadelphia: WB Saunders.
- Gonshor A. 2006, Continuing Education Recognition Program (CERP) by the Academy of Dental Therapeutics and Stomatology, Extraction Site and Ridge Preservation.
- Irinakis, T. 2006. Rationale for Socket Preservation after Extraction of a Single-Rooted Tooth when Planning for Future Implant Placement. J Can Dent Association. 72(10), 917–22.
- Lekovic ,V., Camargo, P. M., Klokkevold, P.R. 1998. Preservation of alveolar bone in extraction sockets using bio-absorbable membranes. J Periodontol. 69, 1044–1049.
Prepared By:
Dr.Bander K Al-Moharib
Supervised By:
Dr.Osamah M Al-Mugeiren, PG Perio R3
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