TARRSON FAMILY ENDOWED CHAIR IN PERIODONTICS
UCLA SCHOOL OF DENTISTRY
Presents Presents Dr. E. Barrie Kenney Professor & Chairman Section of Periodontics
E. Barrie Kenney B.D.Sc., D.D.S., M.S., F.R.A.C.D.S. Tarrson Family Endowed Chair in Periodontics. Professor and Chairman ...
 
Dog Socket at 3 month, Normal Healing Closed Flap
<ul><li>DOG SOCKET 3 MONTHS CLOSED FLAP AND POROUS HYDROXY APATITE GRAFT </li></ul>
 
<ul><li>DOG SOCKET 3 MONTHS WITH CLOSED </li></ul><ul><li>FLAP AND GORETEX </li></ul>
 
 
 
Open socket Technique for Extractions <ul><li>Advantages: </li></ul><ul><ul><li>Simplicity </li></ul></ul><ul><ul><li>No c...
Open socket Technique for Extractions <ul><li>Advantages: </li></ul><ul><ul><li>Simplicity </li></ul></ul><ul><ul><li>No c...
 
 
 
 
 
 
 
 
Open socket Technique for Extractions <ul><li>Advantages: </li></ul><ul><ul><li>Simplicity </li></ul></ul><ul><ul><li>No c...
 
 
 
 
 
 
Open Flap Technique -  Biogran plus Capset for sockets  compared to flap alone <ul><li>Influence of Bioactive glass on cha...
<ul><li>16 patients with 2 single rooted tooth extraction </li></ul><ul><li>Sutures placed but no flap closure </li></ul><...
4.00 6.43 Changes in socket fill -1.00 -0.38 Changes in height -3.40 -3.48 Changes in width Controls Biogran + Capset
Open flap Technique for Extractions <ul><li>Advantages: </li></ul><ul><ul><li>Simplicity </li></ul></ul><ul><ul><li>No cha...
<ul><li>Advantages: </li></ul><ul><ul><li>More predictable bone growth </li></ul></ul><ul><ul><li>Better maintenance of ri...
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Surgical Technique for Ridge Preservation Sulcular Incision and Vertical Releasing Incision
Titanium Pins as a Reference Point
Flap Mobilization GTAM Membrane in place
Suturing Technique Water-proof Closure
Results of Clinical Trials of Ridge Maintenance Following Tooth Extraction. <ul><li>A Bone Regenerative Approach to Alveol...
<ul><li>10 patients with 2 single rooted extractions </li></ul><ul><li>Flaps moblized for tight closure </li></ul><ul><li>...
 
 
 
 
 
<ul><li>3 of 10 Goretex sites were exposed during healing. These were removed at 3 months </li></ul>
3 Sites with Exposure of Goretex 4.33 3.66 Changes in socket fill -1.66 -1.00 Changes in height -4.33 -2.00 Changes in wid...
7 Sites with No Exposure of Goretex 2.92 5.43 Changes in socket fill -1.00 -0.28 Changes in height -4.43 -1.71 Changes in ...
3 Sites with Exposure to Goretex <ul><li>Gotetex Control </li></ul><ul><li>Changes in width -2.00mm -4.33mm </li></ul><ul>...
 
 
 
 
 
 
 
 
 
Closed Flap Technique -  Resolut membrane alone compared  to flaps alone <ul><li>Preservation of Alveolar Bone in extracti...
<ul><li>Preservation of Alveolar Bone in Extraction Sockets using Bioabsorbable Membranes. </li></ul><ul><li>Lekovic, V., ...
 
 
3.94 5.81 Changes in socket fill -1.50 -0.38 Changes in height -4.56 -1.31 Changes in width Controls Resolut
RANDOMIZED STUDY EVALUATING RECOMBINANT HUMAN BONE MORPHOGENETIC PROTEIN 2 FOR EXTRACTION SOCKET AUGMENTATION FIORELLINI,J...
CHANGES IN HEIGHT (MM ) NONE  -1,7 PLACEBO -1,0 0.75 BMP  -0.62 1.50 BMP -0,02 CHANGES IN WIDTH 75% SOCKET LENGTH NONE 1.6...
 
 
 
 
 
 
 
Randomized Study  Evaluating Human Bone Morphogenetic Protein-2  for Extraction  Socket Augmentation Fiorelli J P et al J ...
<ul><li>Measured: </li></ul><ul><li>Bone height </li></ul><ul><li>Bone width at  </li></ul><ul><li>25, 50 and 75% socket l...
Bone Density, Biopsies: No significant changes seen, trabecular bone no inflammation Changes at 4 months 2.68mm 2.29mm 1.8...
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
<ul><li>Soft tissue augmentation for pontic esthetics. </li></ul>
 
 
 
 
Closed Flap Techniques –  Goretex alone for sockets  compared to flaps alone <ul><li>A bone regenerative approach to Alveo...
<ul><li>3 of 10 Goretex sites dehisced </li></ul><ul><li>Goretex removed at 3 moths </li></ul><ul><li>7 of 10 sites Gorete...
 
<ul><li>A Bone Regenerative Approach to Alveolar Ridge Maintenance Following Tooth Extraction.  Report of 10 cases. </li><...
<ul><li>16 patients with 2 single rooted extraction </li></ul><ul><li>6 months re-entry </li></ul><ul><li>Titanium referen...
<ul><li>Resolut Control </li></ul><ul><li>Changes in width -1.31mm -4.56mm </li></ul><ul><li>Changes in height -0.38mm -1....
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Extractions Sockets

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Extractions Sockets

  1. 1. TARRSON FAMILY ENDOWED CHAIR IN PERIODONTICS
  2. 2. UCLA SCHOOL OF DENTISTRY
  3. 3. Presents Presents Dr. E. Barrie Kenney Professor & Chairman Section of Periodontics
  4. 4. E. Barrie Kenney B.D.Sc., D.D.S., M.S., F.R.A.C.D.S. Tarrson Family Endowed Chair in Periodontics. Professor and Chairman Division of Associated Clinical Specialties UCLA School of Dentistry Bone Maintenance After Tooth Extractions
  5. 6. Dog Socket at 3 month, Normal Healing Closed Flap
  6. 7. <ul><li>DOG SOCKET 3 MONTHS CLOSED FLAP AND POROUS HYDROXY APATITE GRAFT </li></ul>
  7. 9. <ul><li>DOG SOCKET 3 MONTHS WITH CLOSED </li></ul><ul><li>FLAP AND GORETEX </li></ul>
  8. 13. Open socket Technique for Extractions <ul><li>Advantages: </li></ul><ul><ul><li>Simplicity </li></ul></ul><ul><ul><li>No change in mucogingival junction </li></ul></ul><ul><ul><li>_ Can be with or without flap. </li></ul></ul><ul><li>Disadvantages </li></ul><ul><ul><li>Increased risk of infection of graft </li></ul></ul><ul><ul><li>Increased loss of bone width </li></ul></ul><ul><li>Advantages: </li></ul><ul><ul><li>More predictable bone growth </li></ul></ul><ul><ul><li>Better maintenance of ridge width </li></ul></ul><ul><ul><li>Better hemostasis </li></ul></ul><ul><li>Disadvantages </li></ul><ul><ul><li>More complete technique </li></ul></ul><ul><ul><li>May get change of mucogingival junction </li></ul></ul><ul><ul><li>- Narrower application </li></ul></ul>Closed flap Technique for Extractions
  9. 14. Open socket Technique for Extractions <ul><li>Advantages: </li></ul><ul><ul><li>Simplicity </li></ul></ul><ul><ul><li>No change in mucogingival junction </li></ul></ul><ul><li>Disadvantages </li></ul><ul><ul><li>Increased risk of infection of graft </li></ul></ul><ul><ul><li>Increased loss of bone width </li></ul></ul>WITHOUT FLAP
  10. 23. Open socket Technique for Extractions <ul><li>Advantages: </li></ul><ul><ul><li>Simplicity </li></ul></ul><ul><ul><li>No change in mucogingival junction </li></ul></ul><ul><li>Disadvantages </li></ul><ul><ul><li>Increased risk of infection of graft </li></ul></ul><ul><ul><li>Increased loss of bone width </li></ul></ul>WITH FLAP
  11. 30. Open Flap Technique - Biogran plus Capset for sockets compared to flap alone <ul><li>Influence of Bioactive glass on changes in alveolar process dimensions after extraction </li></ul><ul><li>O. Surg. O Med., O Path., O. Radiol Endo. </li></ul><ul><li>2000, 90:581-6 </li></ul><ul><li>Camargo, P.M., Lekovic, V., Weinlaender, M., Klokkevold, P.R., Kenney, E.B., Dimitrejevic, B. Nedic, M., Jancovic, S., Orsini, M. </li></ul>
  12. 31. <ul><li>16 patients with 2 single rooted tooth extraction </li></ul><ul><li>Sutures placed but no flap closure </li></ul><ul><li>Titanium reference pins </li></ul><ul><li>Re-entry at 6 months </li></ul>
  13. 32. 4.00 6.43 Changes in socket fill -1.00 -0.38 Changes in height -3.40 -3.48 Changes in width Controls Biogran + Capset
  14. 33. Open flap Technique for Extractions <ul><li>Advantages: </li></ul><ul><ul><li>Simplicity </li></ul></ul><ul><ul><li>No change in mucogingival junction </li></ul></ul><ul><li>Disadvantages </li></ul><ul><ul><li>Increased risk of infection of graft </li></ul></ul><ul><ul><li>Increased loss of bone width </li></ul></ul><ul><li>Advantages: </li></ul><ul><ul><li>More predictable bone growth </li></ul></ul><ul><ul><li>Better maintenance of ridge width </li></ul></ul><ul><ul><li>Wider application </li></ul></ul><ul><li>Disadvantages </li></ul><ul><ul><li>More complete technique </li></ul></ul><ul><ul><li>May get change of mucogingival junction </li></ul></ul><ul><ul><li>Narrower application </li></ul></ul>Closed flap Technique for Extractions
  15. 34. <ul><li>Advantages: </li></ul><ul><ul><li>More predictable bone growth </li></ul></ul><ul><ul><li>Better maintenance of ridge width </li></ul></ul><ul><ul><li>Wider application </li></ul></ul><ul><li>Disadvantages </li></ul><ul><ul><li>More complete technique </li></ul></ul><ul><ul><li>May get change of mucogingival junction </li></ul></ul><ul><ul><li>Narrower application </li></ul></ul>Closed flap Technique for Extractions
  16. 55. Surgical Technique for Ridge Preservation Sulcular Incision and Vertical Releasing Incision
  17. 56. Titanium Pins as a Reference Point
  18. 57. Flap Mobilization GTAM Membrane in place
  19. 58. Suturing Technique Water-proof Closure
  20. 59. Results of Clinical Trials of Ridge Maintenance Following Tooth Extraction. <ul><li>A Bone Regenerative Approach to Alveolar Ridge Maintenance Following Tooth Extraction. Report of 10 cases. </li></ul><ul><li>Lekovic, V., Kenney, E. B., Weinlaender, M., Han, T., Klokkevold, P., Nedic, M., Orsini, M. </li></ul><ul><li>J. Periodontol 1997 68:563 </li></ul>
  21. 60. <ul><li>10 patients with 2 single rooted extractions </li></ul><ul><li>Flaps moblized for tight closure </li></ul><ul><li>6 months re-entry </li></ul><ul><li>Titanium reference pins </li></ul><ul><li>Goretex membrances stablized with pins. </li></ul>
  22. 66. <ul><li>3 of 10 Goretex sites were exposed during healing. These were removed at 3 months </li></ul>
  23. 67. 3 Sites with Exposure of Goretex 4.33 3.66 Changes in socket fill -1.66 -1.00 Changes in height -4.33 -2.00 Changes in width Control Goretex
  24. 68. 7 Sites with No Exposure of Goretex 2.92 5.43 Changes in socket fill -1.00 -0.28 Changes in height -4.43 -1.71 Changes in width Control Goretex
  25. 69. 3 Sites with Exposure to Goretex <ul><li>Gotetex Control </li></ul><ul><li>Changes in width -2.00mm -4.33mm </li></ul><ul><li>Changes in height -1.00mm -1.66mm </li></ul><ul><li>Changes in socket fill 3.66mm 4.33mm </li></ul><ul><li>Goretex Control </li></ul><ul><li>Changes in width -1.71mm -4.43mm </li></ul><ul><li>Changes in height -0.28mm -1.00mm </li></ul><ul><li>Changes in socket fill 5.43mm 2.92mm </li></ul>7 Pairs of Extractions with no Exposure of Goretex
  26. 79. Closed Flap Technique - Resolut membrane alone compared to flaps alone <ul><li>Preservation of Alveolar Bone in extraction sockets using Bio absorbable membranes </li></ul><ul><li>Lekovic, V., Camargo, P.M., Klokkevold, P.R., Weinlaender, M., Kenney, E.B., Dimitrejevic, B. Nedic, M. </li></ul>
  27. 80. <ul><li>Preservation of Alveolar Bone in Extraction Sockets using Bioabsorbable Membranes. </li></ul><ul><li>Lekovic, V., Camargo, P. M., Klokkevold, P. R., Weinlaender, M., Kenney, E. B., Dimteijevic, B., Nedie, C. </li></ul><ul><li>J. Periodontol 1998 69:1044 </li></ul><ul><li>16 patients with Titanium pins as reference point. Two anterior or premolar extractions with flaps per patient. One site covered with Resolut membrane (gycolide and lactide polymers), other site no regeneration. Flaps mobilized for primary closure. Reentry at six months. </li></ul>
  28. 83. 3.94 5.81 Changes in socket fill -1.50 -0.38 Changes in height -4.56 -1.31 Changes in width Controls Resolut
  29. 84. RANDOMIZED STUDY EVALUATING RECOMBINANT HUMAN BONE MORPHOGENETIC PROTEIN 2 FOR EXTRACTION SOCKET AUGMENTATION FIORELLINI,J.T. ET AL J. PERIODONT.2005 76: 605 80 PATIENTS CAT SCANS OF SOCKETS GOT 0.75 OR 1.5 MG/ML BMP OR PLACEBO COLLAGEN SPONGE OR NO TREATMENT EVALUATED AT 4 MONTHS 50% BONE LOSS ON BUCCAL
  30. 85. CHANGES IN HEIGHT (MM ) NONE -1,7 PLACEBO -1,0 0.75 BMP -0.62 1.50 BMP -0,02 CHANGES IN WIDTH 75% SOCKET LENGTH NONE 1.65 PLACEBO 1.82 0.75 BMP 2.29 1.75 BMP 2.68 (MM).
  31. 93. Randomized Study Evaluating Human Bone Morphogenetic Protein-2 for Extraction Socket Augmentation Fiorelli J P et al J Periodont 2005, 76:605 <ul><li>BMP-2 in collagen sponge </li></ul><ul><li>80 patients, mean age 47.4 years </li></ul><ul><li>95 sockets </li></ul><ul><li>0.75mg/ml or 1.50mg/ml </li></ul><ul><li>CT scan after extraction and at 4 months </li></ul>
  32. 94. <ul><li>Measured: </li></ul><ul><li>Bone height </li></ul><ul><li>Bone width at </li></ul><ul><li>25, 50 and 75% socket length </li></ul><ul><li>Bone density using </li></ul><ul><li>standard density block </li></ul><ul><li>Flap closed, 4-8 perforations of socket </li></ul><ul><li>Sockets filled and covered with strip </li></ul><ul><li>Biopsies at time of implant placement </li></ul><ul><li>All had 50% or more loss of buccal wall </li></ul>
  33. 95. Bone Density, Biopsies: No significant changes seen, trabecular bone no inflammation Changes at 4 months 2.68mm 2.29mm 1.82mm Changes in width 75% length, i.e., apical end 86% 55% 59% Implant placed with no augmentation 3.27mm 1.76mm 0.82mm Changes in width 25% length, i.e., coronal end -0.02mm -0.62mm -1.00mm Changes in height N=21 N=22 N=17 1.50mg/ml 0.75mg/ml Control
  34. 123. <ul><li>Soft tissue augmentation for pontic esthetics. </li></ul>
  35. 128. Closed Flap Techniques – Goretex alone for sockets compared to flaps alone <ul><li>A bone regenerative approach to Alveolar Ridge maintenace following tooth extraction. </li></ul><ul><li>Report of 10 cases </li></ul><ul><li>Lekovic, V., Kenney, E.B., Weinlaender, M., Han, T., </li></ul><ul><li>Klokkevold, P.R., Nedic, M., Jancovic, S., Orsini, </li></ul>
  36. 129. <ul><li>3 of 10 Goretex sites dehisced </li></ul><ul><li>Goretex removed at 3 moths </li></ul><ul><li>7 of 10 sites Goretex removed at 6 months </li></ul><ul><li>All Measurements at 6 months </li></ul>
  37. 131. <ul><li>A Bone Regenerative Approach to Alveolar Ridge Maintenance Following Tooth Extraction. Report of 10 cases. </li></ul><ul><li>Lekovic, V., Kenney, E. B., Weinlaender, M., Han, T., Klokkevold, P., Nedic, M., Orsini, M. </li></ul><ul><li>J. Periodontol 1997 68:563 </li></ul>10 patients with anterior teeth extractions with flaps, Titanium pins as reference points. Took Impressions of exposed sockets. One socket covered with Goretex (PTFE) membrane, other socket no regenerative procedure. Flaps mobilized and tight closure. Reentry at six months.
  38. 132. <ul><li>16 patients with 2 single rooted extraction </li></ul><ul><li>6 months re-entry </li></ul><ul><li>Titanium reference pins </li></ul><ul><li>Resolut membrane polyglycolide, polylactide </li></ul>
  39. 133. <ul><li>Resolut Control </li></ul><ul><li>Changes in width -1.31mm -4.56mm </li></ul><ul><li>Changes in height -0.38mm -1.50mm </li></ul><ul><li>Changes in socket fill 5.81mm 3.94mm </li></ul>
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