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Ridge Preservation (2011)
Ridge Preservation (2011)
Ridge Preservation (2011)
Ridge Preservation (2011)
Ridge Preservation (2011)
Ridge Preservation (2011)
Ridge Preservation (2011)
Ridge Preservation (2011)
Ridge Preservation (2011)
Ridge Preservation (2011)
Ridge Preservation (2011)
Ridge Preservation (2011)
Ridge Preservation (2011)
Ridge Preservation (2011)
Ridge Preservation (2011)
Ridge Preservation (2011)
Ridge Preservation (2011)
Ridge Preservation (2011)
Ridge Preservation (2011)
Ridge Preservation (2011)
Ridge Preservation (2011)
Ridge Preservation (2011)
Ridge Preservation (2011)
Ridge Preservation (2011)
Ridge Preservation (2011)
Ridge Preservation (2011)
Ridge Preservation (2011)
Ridge Preservation (2011)
Ridge Preservation (2011)
Ridge Preservation (2011)
Ridge Preservation (2011)
Ridge Preservation (2011)
Ridge Preservation (2011)
Ridge Preservation (2011)
Ridge Preservation (2011)
Ridge Preservation (2011)
Ridge Preservation (2011)
Ridge Preservation (2011)
Ridge Preservation (2011)
Ridge Preservation (2011)
Ridge Preservation (2011)
Ridge Preservation (2011)
Ridge Preservation (2011)
Ridge Preservation (2011)
Ridge Preservation (2011)
Ridge Preservation (2011)
Ridge Preservation (2011)
Ridge Preservation (2011)
Ridge Preservation (2011)
Ridge Preservation (2011)
Ridge Preservation (2011)
Ridge Preservation (2011)
Ridge Preservation (2011)
Ridge Preservation (2011)
Ridge Preservation (2011)
Ridge Preservation (2011)
Ridge Preservation (2011)
Ridge Preservation (2011)
Ridge Preservation (2011)
Ridge Preservation (2011)
Ridge Preservation (2011)
Ridge Preservation (2011)
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Ridge Preservation (2011)

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Dr. Paul Tompach, with Matt Swenson

Dr. Paul Tompach, with Matt Swenson

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  • 1. Dr. Paul Tompach, DDS, Ph D / Minnesota OMSwith Matt Swenson / DENTSPLY Tulsa
  • 2.  Rationale Graft Material Options ▪ Bone Morphology Changes Following Tooth Extraction  Bone Grafting ▪ Bone Dimensional Changes Following Tooth Extraction ▪ Autograft  General Indications ▪ Allograft ▪ Traumatic Extraction of Tooth ▪ Xenograft ▪ Presence of Root Prominence and Fenestration ▪ Alloplast ▪ Previous Apicoectomy ▪ Root Fracture  Membrane Use ▪ Periodontal Disease ▪ Resorbable Membranes ▪ Dental Abscess ▪ Non-Resorbable Membranes  For Removable Partial Denture ▪ Autogenous Soft Tissue  For Fixed Partial Denture ▪ Allograft Dermal Tissue  For Implant placement  SuturingRidge Preservation Methods Hands-On Grafting with Models  Atraumatic Tooth Extraction  Mixing Graft Material ▪ Periotomes  Placing Graft Material ▪ Elevators  Placing the Membrane ▪ Burs  Suturing  Debridement and Inspection  Selection of Regenerative Materials Postoperative Care Immediate Postoperative Care Follow up Interval When Should I Extract and When Should I Refer the Extraction? Finishing Remarks and Final Key Details
  • 3. A loss in the volume and size of the alveolar portion of the mandible or maxilla.Volume 75, Issue 5, Pages 512-514 (May 1996)A review of residual ridge resorption and bone density / Esa Klemetti, DDS, PhD (Departmental Dentist)aAbstractResidual ridge resorption is a common and often incapacitating problem, particularly for persons with edentulousmandibles. Several studies suggest a correlation between ridge resorption and osteoporosis. Recent radiologic studiesindicate that the mineral density of the cortex and the bone mass in the mandible are correlated with skeletal bonedensity. Most resorption occurs in the alveolar process, whereas the basal portion remains relatively intact. On the otherhand, radiologic measurements of bone density primarily yield information about the basal portion, where the bone massof the mandible is greatest and functional stresses of mastication may affect bone density. Ironically, radiologicmeasurements may not accurately indicate the effect of osteoporosis on alveolar resorption. Apparently, excessiveocclusal force can also produce extensive atrophy without systemic impact. Not until muscular function decreases doesreal osteoporosis develop in edentulous jaws. Not only does the volume of the ridge decrease, but also the density of thebasal portion decreases as a result of diminished function. This article reviews the literature on residual ridge resorptionand components that may affect the rate of resorption. bone density. Ironically, radiologic measurements may notaccurately indicate the effect of osteoporosis on alveolar resorption. Apparently, excessive occlusal force can also produceextensive atrophy without systemic impact. Not until muscular function decreases does real osteoporosis develop inedentulous jaws. Not only does the volume of the ridge decrease, but also the density of the basal portion decreases as aresult of diminished function. This article reviews the literature on residual ridge resorption and components that mayaffect the rate of resorption.
  • 4. Post ExtractionAlveolar RidgeResorption• Buccal cortex resorbs more than palate• Vertical bone loss of 1.22 MM• Horizontal bone loss of 3.43 MM• Bone loss may continue at a rate of 0.5 MM per year
  • 5. What is Ridge Preservation and Why Offer It?RATIONALE:Following the extraction of teeth, alveolar bone loss may be significant, resulting in great difficulty restoring theedentulous area. The thin buccal cortex of the maxillary alveolus resorbs to a greater degree than the thicker palatalsocket wall. Since the soft tissue drape follows the osseous contour, this alveolar bone remodeling may result in adepressed mucosal profile. The literature reports vertical alveolar bone resorption of 1.12 mm and horizontalresorption of 3.43 mm following the loss of teeth. Further studies show bone loss in extraction sites is accelerated inthe first 6 months, involving as much as a 40% loss of alveolar bone height and a 60% loss of alveolar bone width.Bone loss following tooth extraction may continue at a rate of 0.5 mm per year. This bone resorption results in anarrowing of the alveolar ridge that is often not adequate for restoration. Once bone loss has occurred, a moreinvolved and invasive surgical procedure is required to prepare the alveolus for restoration. Therefore, whenextracting a tooth that is treatment planned for replacement, it is best to immediately provide ridge preservationtreatment to optimize bone fill within the extraction site. This will help maintain the bone height and width andstabilize the marginal soft tissues in anticipation of restoring the area with a high degree of predictability andimproved esthetics.
  • 6. Rationale• Create Sufficient Bone Volume For Ideal Implant Placement• Minimize Bone Resorption and Soft Tissue Contraction• Decrease Treatment Time If Graft At The Time Of Extraction• Decrease Patient Morbidity and Expense• Grafting Techniques Are Very Predictable• Improve Esthetics
  • 7. General Indications for Ridge Preservation1) Traumatic extraction of a tooth resulting in the loss of bone or fracture of a socket wall2) Presence of a root perforation or fenestration defect3) Previous apicoectomy4) Root fracture involving alveolar bone loss5) Periodontal disease6) Dental abscess with loss of alveolar bone
  • 8. Ridge Preservation For Fixed & Removable Prosthodontics1) Improve force distribution2) Improve mechanical support3) Improve retention4) Maximize pontic site restorability5) Optimize esthetics Photo courtesy of Arta Farahmand, D.D.S / http://www.periodentalimplants.com
  • 9. Ridge Preservation For Dental Implant Placement1) Need alveolar bone to stabilize the implant2) Alveolar bone provides mucosal contour3) Want 1-2 MM of bone surrounding an implant
  • 10. Methods and Types of Ridge PreservationATRAUMATIC TOOTH EXTRACTION:Alveolar ridge preservation begins with atraumatic tooth extraction. Atraumatic tooth extraction minimizes trauma to thehard and soft tissues around the tooth being extracted. Most importantly, the labial/buccal and palatal/lingual bone plates ofthe tooth socket must remain intact. Maintaining a four-wall socket will prevent early collapse of the alveolar ridge.Minimal flap elevation is performed around the neck of the tooth. Periotomes or thin-bladed periosteal elevators are used tosever the periodontal ligament around the neck of the tooth. These instruments are inserted into the periodontal ligamentspace at the line angles, parallel to the root with an application of force apically. The periotome or periosteal elevator createsan access point for a small straight elevator. The elevator is used to widen the periodontal ligament space and mobilize thetooth root being extracted. Once the root has been freed from the socket walls, the root can be removed with a gentle twistingmotion using a forceps.Teeth with a sub gingival coronal fracture or multiple rooted teeth may require sectioning of the remains of the tooth andremoval in sections. For this, we use a straight handpiece with a tungsten carbide tapered fissure bur while avoiding anycontact with the surrounding alveolar bone. Sectioning of the tooth and carefully removing the root fragments greatly reducesthe risk of trauma to the bony tooth socket.
  • 11. What is Ridge Preservation and Why Offer It?DEBRIDEMENT & INSPECTION:Once the tooth has been extracted atraumatically, it is necessary to inspect the site for bony defects and thoroughlydebride the socket walls of soft tissue and debris. We accomplish this using a surgical spoon curette. Thorough use ofthe curette also induces bleeding into the socket which is required for good wound healing. If the extraction site failsto show much bleeding, it may be necessary to use a small round bur to carefully perforate the cortical plate withinthe extraction site. Care must be taken not to fenestrate the bony wall or perforate surrounding structures such asteeth, sinus cavities, or neurovascular canals.
  • 12. What is Ridge Preservation and Why Offer It?SELECTION OF REGENERATIVE MATERIALS:The decision on what graft material is used should be based on biological principles. A graft material should bebiocompatible, have structural stability to maintain the space of the extraction site, support vital bone growth byallowing rapid revascularization and cell migration, be resorbable, be readily available, easy to handle, and costeffective. While many types of graft materials have been advocated to preserve and optimize the amount of bonethat fills in the extraction site, there is no consensus in the literature as to which material is best.
  • 13. Surgical Armamentarium for Traumatic Extraction• Dental Screw Forceps (Circa 1850) These unusual American forceps contain a extendable screw that was held in place by the blades to ease in burrowing into the tooths root during extraction. Photo courtesy of http://www.dentalassistantschools.net
  • 14. Surgical Armamentarium for Maxillary Extraction• Minnesota retractor• #9 periosteal elevator• Small dental spoon curette• #301 small straight dental elevator• #150 maxillary extraction forceps• #4 maxillary molar extraction forceps• #65 maxillary root extraction forceps
  • 15. Surgical Tray Armamentarium for Mandibular Extraction• Minnesota retractor• #9 periosteal elevator• Small dental spoon curette• #301 small straight dental elevator• Ash Mandibular Incisor, Cuspid, and Bicuspid extraction forceps• #23 mandibular molar extraction forceps
  • 16. Methods• Atraumatic tooth extraction.• Debridement and inspection.• Selection of regenerative material.
  • 17. Extraction• Minimal flap elevation.• Periotomes.• Small straight elevator.• Section with handpiece.
  • 18. Debridement• Inspect for bony defects.• Debride with surgical spoon curette.• Round bur if necessary.• Bleeding within extraction site.
  • 19. Graft Materials• Biocompatibility.• Structural stability.• Support vital bone growth.• Resorbable.• Readily available.• Cost effective. Photo courtesy of http://www.mtf.org/
  • 20. Graft Material OptionsBONE GRAFTING:Bone graft materials include autogenous bone (from self), allograft (non-self human bone), xenograft (animal bone),and alloplastic (synthetic) materials.Autogenous bone can be harvested from neighboring sites in the jaws. Bone can be scraped or shaved with a bur,collected with a rongeur forceps or collected as a block from the mandibular symphysis or ramus/body region.However, harvesting autogenous bone is associated with significant morbidity related to the donor surgical site.Complications associated with the donor sites include pain, swelling, hematoma, infection, and sensory disturbance.As a result of the shortcomings associated with harvesting autogenous bone, many substitute materials have beendeveloped. Allografts are harvested from human cadavers and treated in bone banks using a variety of methods.These different processing methods result in different mineralized, freeze-dried, solvent-dehydrated ordemineralized states with or without carriers of different molecules. Rigorous screening of donors along with carefulprocessing has greatly reduced the risk of disease transmission associated with the use of osseous allografts. The useof allograft materials eliminates donor site morbidity and the materials can be stored in the office for convenient use.
  • 21. Graft Material OptionsBONE GRAFTING (CONTINUED):Allografts can be further divided into mineralized and demineralized forms. Solvent-dehydrated mineralized bonehas been advocated for use in alveolar ridge preservation because it is osteoconductive (serves as a scaffold for boneforming cells), it supports bone ingrowth, and it will resorb and be replaced within a relatively short period of time.The cellular reaction to allogenic bone processed using solvent dehydration is very favorable. Primary periostealosteoblast adhesion readily occurs and early remodeling begins by 4 weeks post implantation. By 8-12 weeks, amature bone marrow is present and by 26 weeks, human mineralized solvent-dehydrated bone is completelyresorbed.Demineralized bone allografts are prepared at a tissue bank by processing the bone with hydrochloric acid. Thistreatment may expose biologically active proteins which may help stimulate new bone formation. However, there isevidence that freeze-dried demineralized bone allografts are capable of less bone induction and less new boneformation, resulting in decreased bone strength.
  • 22. Graft Material OptionsBONE GRAFTING (CONCLUDED):Xenografts are mostly derived from bovine sources and are processed by a variety of methods to provide apredominantly deproteinized mineralized bone matrix. The structure of these materials facilitates osteoconduction,angiogenesis, and new bone formation. Although these materials facilitate new bone generation, it is still unknownwhether they completely resorb. Nonetheless, these materials are widely used for alveolar ridge preservation.Alloplasts are synthetic grafting materials that provide scaffolding for new bone formation. Many syntheticmaterials are available including bioactive glasses, glass ionomers, aluminum oxide, calcium sulfate, calciumphosphate, and synthetic hydroxyappatite. These materials do not evoke an immune response when implanted, andthey do not carry the risk of disease transmission. However, they differ in their rates of resorption, contain nointrinsic growth factors, and have different porosities making vascular ingrowth and bone formation less predictable.
  • 23. Methods• Autogenous. Same• Allograft. Autogenous Human• Xenograft.• Alloplast. Human To Allograft Human Animal To Xenograft Human Synthetic Alloplast To Human
  • 24. Autogenous• Tissue or cells recovered from an individual and transplanted back into that same individual.• Scrape or shave jaws w/bur.• Harvest w/rongeur forceps.• Block graft from symphysis or ramus.• Significant morbidity.
  • 25. Allograft• Tissue or cells recovered from one individual and intended for transplantation into another individual of the same species.• Harvest from human cadavers.• Processed to remove antigens.• No donor site morbidity.• Mineralized and Demineralized
  • 26. Mineralized• Solvent dehydrated.• Osteoconductive.• Support bone growth.• Fully resorbable.
  • 27. Cellular Reaction to Mineralized Allogenic Bone.1) Hydrophilic for osteoblast adhesion.2) Early remodeling by 4 weeks.3) Mature bone marrow by 8-12 weeks.4) Complete resorption by 26 weeks.5) On average site ready for implant at 4 months.
  • 28. Demineralized• Processed w/ hydrochloric acid.• May expose biologically active protiens.• Osteoinductive (MTF).• Less new bone formation.• Decreased bone strength.
  • 29. Cellular Reaction to Demineralized Allogenic Bone.1) Freeze drying can diminish osteoinductivity.2) New bone formation in 4 weeks.3) New bone formation less predictable.4) Variable bone formation among bone banks.5) On average site ready for implant at 4 months. Photo courtesy of http://www.ckdental.net
  • 30. Xenograft• Bovine sources.• Deproteinized, mineralzied bone matrix• Osteconductive.• Incomplete resorption.
  • 31. Cellular Reaction to Xenograft Bone.1) Minimal immune response.2) Early revascularization.3) Osteoblast ingress and adhesion4) Slow resorption (15-30 months).5) On average site ready for implant at 4-6 months. Photos courtesy of MICHAEL S. BLOCK, D.M.D., ISRAEL FINGER, D.D.S. and ROBERT LYTLE, D.D.S.
  • 32. Alloplast• Bioactive Glasses.• Glass Ionomers.• Aluminum Oxide.• Calcium Sulfate.• Calcium Phosphate.• Synthetic Hydxyapatite. 1) Non-immunogenic. 2) Varying Resorption Times. 3) No Growth Factors. 4) Varying Porosities. Photos courtesy of http://www.acesurgical.com
  • 33. Cellular Reaction to Alloplast Bone.1) Osteblasts bind quickly.2) Collagen production.3) Bone proteins produced.4) Simultaneous osteoconduction. Photos courtesy of http://www.tulsadentalspecialties.com
  • 34. Membrane UseMEMBRANE USEBoth resorbable and nonresorbable membranes have been used in conjunction with bone grafts to preserve alveolarridge dimensions following tooth extraction. The purpose of the membrane is to assist with containment of the bonegraft particles within the extraction site. The barrier membrane contains the graft material while soft tissue healingtakes place over the extraction site.Early membranes were nonresorbable Gortex membranes made of expanded polytetrafluoroethelyene (e-PTFE).This is a biocompatible Teflon material that is soft and easy to manipulate, trim, and secure to the surgical site. Atitanium-reinforced e-PTFE was introduced about 15 years ago to resist the forces of the mucosal tissues that causemembrane collapse. The disadvantages of nonresorbable membranes are that they require a second surgicalprocedure to remove the membrane and they result in a high incidence of flap sloughing and membrane exposure.The exposure of nonresorbable membranes to the oral environment during healing often leads to infection whichcompromises alveolar bone volume retention.
  • 35. Membrane UseMEMBRANE USE (CONTINUED):Resorbable membranes were initially made of glycolide and lactide polymers. These membranes are easily formed tothe desired shape and they are slowly resorbed. However, they do not tolerate intraoral exposure very well.Exposure of glycolide/lactide polymer membranes often leads to multiple debridement procedures and significantgraft loss. More recently, resorbable membranes began to be made from human or bovine collagen. The collagen iscross-linked to control the amount of time it remains stable and functional. These membranes are slowly resorbed orare integrated into the adjacent soft tissues. The resorbable collagen membranes are very hydrophilic which greatlyenhances their handling ability and leads to their ease of use. They are very effective at preventing soft tissueingrowth and they are not particularly susceptible to infection if they become exposed. The disadvantage ofresorbable membranes is that they do not provide much structural support and they lack the ability to create andhold space. For alveolar ridge preservation, we most commonly use a resorbable collagen membrane with a shortresorption time because epithelialization takes place within the first 2-3 weeks following tooth extraction. Theresorbable collagen material is placed over the bone graft to cover the extraction site. There is no need for primaryclosure with a coronally advanced flap which minimizes esthetic disfigurement. If the buccal wall is thin or not intact,
  • 36. Membrane UseMEMBRANE USE (CONTINUED):a guided bone regeneration technique is required using a resorbable collagen membrane to contain the bone graft.These membranes stay in place and keep the wound covered for extended periods of time and they function bestunder primary closure of the soft tissue.Autogenous tissues can also be used to cover a ridge preserving bone graft. These include autogenous free gingivalgrafts, free connective tissue grafts, and rotated or advanced flaps. Free gingival grafts are obtained with a punchbiopsy technique from the palate. They provide an increased amount of keratinized mucosa at the recipient site.Subepithelial connective tissue grafts harvested from the palate have been used to cover bone grafted extractionsites. This approach has been advocated in cases with gingival recession or a lack of attached gingiva. Pedicle flapsfrom the palate have been described for coverage of grafted extraction sites. This technique is useful for changingthe gingival thickness at the extraction site. The disadvantages of using autogenous palatal tissue grafts include painduring donor site healing be secondary intention and the potential for significant bleeding due to the proximity ofthe greater palatine vessels.
  • 37. Membrane UseMEMBRANE USE (CONCLUDED):Acellular dermal matrix allografts have also been used as a form of barrier membrane for alveolar ridge preservation.In addition to containing the bone graft material and allowing for organization of the blood clot, the dermal allograftmay also serve to increase the keratinized mucosa at the extraction site.Suturing:Once the membrane is placed over the graft site, the gingival margins are approximated to the membrane using aresorbable suture material. Horizontal mattress sutures are often combined with interrupted sutures to hold thewound edges together.
  • 38. Methods• Contain bone graft particles.• Exclude soft tissues.• Non-Resorbable.• Resorbable. Photos courtesy of http://www.acesurgical.com
  • 39. Non-Resorbable• Expanded Polytetrafluoroethelyene (e-PTFE)• Easy to handle.• Titanium reinforced.• Require removal.• Exposure is a problem. Photos courtesy of http://www.acesurgical.com
  • 40. Resorbable Glycolide & Lactide Polymer Membranes1) Easy to handle.2) Resorbs slowly3) Exposure is a problem.
  • 41. Resorbable Collagen Membranes1) Human or bovine collagen.2) Collagen cross-linking determines resorption time.3) Hydrophilic.4) Not as susceptible to infection.5) Does not promote structural support.
  • 42. Resorbable Collagen Membranes1) Collaplug.2) Biogrand.3) Osseoshield.
  • 43. Autogenous Tissue• Free gingival graft.• Subepithelial connective tissue graft.• Pedical flaps.
  • 44. Acellular Dermal Matrix Membranes1) Contain bone graft.2) Organize blood clot.3) Increase keratinized tissue. Photos courtesy of Dr. David Wong @ http://www.tulsainstitute.com
  • 45. PerioDerm by MTFPERIODERM IS MINIMALLY PROCESSED:Each PerioDerm Acellular Dermis graft is aseptically processed and packaged in Class 10 (certified) clean rooms at MTF’sstate-of-the-art dermis processing facility.PerioDerm Acellular Dermis undergoes a three-phase process that gently cleans, decellularizes and disinfects withoutcrosslinking or compromising the integrity of the dermal matrix. This proprietary process renders PerioDerm sterile perUnited States Pharmacopeia Standard 71 (USP 71).Step 1. Sodium Chloride: PerioDerm Acellular Dermis is soaked in a sodium chloride solution that promotes plasmolysis,removing the epidermis and disrupting cells while leaving the extracellular matrix intact.Step 2. Triton: PerioDerm Acellular Dermis is washed in Triton, a mild detergent that removes cellular debris to reducesurgical site inflammation and rejection.Step 3. Disinfection: The PerioDerm disinfection process provides a 6.0 log* (nearly a million-fold) reduction in microbiallevels, including bacteria, fungi, spores, mold, yeast, and a 4-6 log* reduction of viral load, minimizing diseasetransmission and cross contamination.
  • 46. Postoperative CareIMMEDIATE POST OPERATIVE CARE:Patients are routinely prescribed penicillin or a penicillin derivative for prophylaxis during the first 10 postoperativedays. Patients also receive postoperative analgesics. They are instructed to consume a soft diet with no vigorousoral rinsing or spitting until epithelialization is complete. Patients may wear a flipper or an Essix type temporaryrestoration with an atraumatic or ovate pontic.FOLLOW UP INTERVAL:Patients are recalled at 2 weeks, 6 weeks, and 3 months following a ridge preservation bone graft procedure toassess healing. A radiograph is taken at 3 months to evaluate the bone fill within the grafted extraction site. Ideally,the dental implant is placed 4 months after the tooth extraction and ridge preservation bone graft.
  • 47. Suturing Membranes1) Approxiimate gingiva to membrane.2) Resorbable suture.3) Horizontal mattress.4) Interrupted sutures.
  • 48. 1_4-Corner: start DF 2_4-Corner: across to ML 3_4-Corner: over to MF in/over out/in 4_4-Corner: across to DL 5A_4-Corner: tie on facial 5B_4-Corner benefits: holds membrane & papilla
  • 49. Hands-On• Reflecting Tissue• Mixing Graft Material “• Placing Graft Material• Placing the Membrane• Suturing Knowledge is of no value “ unless you put it into practice. -Heber J. Grant
  • 50. Postoperative CareIMMEDIATE POST OPERATIVE CARE:Patients are routinely prescribed penicillin or a penicillin derivative for prophylaxis during the first 10 postoperativedays. Patients also receive postoperative analgesics. They are instructed to consume a soft diet with no vigorousoral rinsing or spitting until epithelialization is complete. Patients may wear a flipper or an Essix type temporaryrestoration with an atraumatic or ovate pontic.FOLLOW UP INTERVAL:Patients are recalled at 2 weeks, 6 weeks, and 3 months following a ridge preservation bone graft procedure toassess healing. A radiograph is taken at 3 months to evaluate the bone fill within the grafted extraction site. Ideally,the dental implant is placed 4 months after the tooth extraction and ridge preservation bone graft.
  • 51. Post-Op Care• Antibiotics.• Analgesics.• Soft Diet.• Oral Home Care.• Temporary Restoration.
  • 52. Follow Up Interval1) Patient recalled at two weeks, six weeks, and three months.2) Radiograph at three months.3) Implant placement at four months.
  • 53. When Should I Extract and When Should I Consider Refering?• Consider the ease or difficulty of the extraction. Is it a single or multiroot tooth, does the tooth have a history of endodontic treatment with the possibility of a compromised buccal bone plate?• Evaluate whether extensive bone loss is likely to be present at the time of the extraction. This may be the case due to periodontal disease, developmental defects, traumatic injury, root canal failure, dental abscess, or fractured roots.• Examine the area for fenestration or dehiscence defects by bone sounding with a periodontal probe. Dehiscence or fenestration defects may require guided bone regeneration techniques to resolve.• Loss of a bony wall resulting in less than a four-wall defect may require guided bone regeneration techniques.• A history of dentoalveolar trauma can result in ankylosis or fusion of the tooth root surface to the alveolar bone. This may require a more extensive surgical procedure to extract the tooth and graft the area.• Highly esthetic cases may require more experience and expertise.• Placement of an immediate dental implant may be possible. This often requires advanced bone grafting techniques and membrane use in conjunction with immediate implant placement.
  • 54. When to Consider Referring.1) Difficult extraction.  Multi-root tooth, with diverging or converging roots.  H/O endodontic treatment.2) Extensive bone loss caused by: • Periodontal disease. • Developmenta; defect. • H/O trauma. • RCT failure. • Dental abscess. • Root fracture.
  • 55. When to Consider Referring.3) Fenestration.4) Complete loss of a bony wall.5) Dentoalveolar trauma.6) Esthetic cases.7) Immediate implant placement.
  • 56. Musculoskeletal Transplant Foundation (MTF).WHY CHOOSE MTF?MTF is a non-profit charitable trust, founded by surgeons for surgeons. Driven by our Medical Board of Directors andMedical Board of Trustees, our mission is to provide surgeons with high-quality, safe allograft to treat a wide range ofclinical applications.We maintain some of the most stringent donor criteria in the industry, and we reject more donors every year than any othertissue bank in the country. At MTF, we believe that safety and quality of the tissue begins with the level of donors youaccept. Since our inception in 1987, with over 3 million grafts distributed, MTF maintains an unrivaled safety record.Finally, MTF places great value on education, research, science and all of those who make our mission possible on a dailybasis. From the selfless gift of the donor family, to the conscientious and respectful recovery partners, to our employeesand the surgeons and patients we serve.REASONS FOR CHOOSING MTF: • No Tissue Bank Has a Better Safety Record. Period. From the procurement of tissue to processing and storage, to a surgeon’s use of an allograft in a recipient’s surgery, the highest safety standards are observed at all times. • MTF is guided in all aspects of our business by surgeons on our Board of Directors and Medical Board of Trustees, never by shareholders.
  • 57. Musculoskeletal Transplant Foundation (MTF).REASONS FOR CHOOSING MTF (CONTINUED): • MTF does not work with any for-profit tissue recovery agencies. We believe that non-profit control of recovery and distribution are at the heart of ensuring ethical stewardship of the donated gift. • MTF employs an Audit Team whose sole purpose is to audit our recovery partners on a regular basis and ensure compliance. • MTF rejects more donors every year than any other tissue bank because these donors do not meet our strict acceptance criteria. • MTF only uses nurses to perform all of our social and medical history screening. • MTF employs the latest technologies in donor testing such as serological and Nucleic Acid Testing (NAT) to screen out HIV, Hepatitis B and C. • MTF donors are only released to processing after all charts and records are carefully reviewed by one of our Medical Directors who are all physicians with infectious disease or pathology backgrounds.
  • 58. Musculoskeletal Transplant Foundation (MTF).REASONS FOR CHOOSING MTF (CONCLUDED): • MTF employs the use of antibiotic soaks, surfactant treatments, and ethanol soaks in processing tissue. All processing steps are validated and performed in Class 10 Clean Rooms to ensure sterility. • MTF performs final sterility tests on all tissue before it is released to physicians for use. • MTF employs the TissueTrace® system to ensure traceability of all tissue to the hospital and patient.
  • 59. Dr. Tompach received his Dental Degree from the University of Minnesota and completed his residency in oral and maxillofacial surgery at the University of Iowa. He is a fellow of the American Association of Oral and Maxillofacial Surgeons and a Board Certified Diplomate of the American Board Course Instructor:Dr. Paul Tompach, DDS, Ph D of Oral and Maxillofacial Surgeons. He is a member of the Minnesota Society of Oral and Maxillofacial Surgeons, the American Dental Association, and the Minnesota Dental Association. His interests include all aspects of oral surgery with an emphasis in dental implants and bone grafting. Dr. Tompach can be reached directly at ptompach@comcast.net or 952-925-2525. His group’s website is http://www.mnoral.com Matt Swenson’s (DENTSPLY Tulsa & Your Dental Edge) mission is to provide an unbiased, centralized resource for dental professionals who want to learn more, do more, and be more in their practices. Matt can be reached directly at 612-381-7068 or matt@yourdentaledge.com. Matt’s dental blog can be found at http://yourdentaledge.com

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