Don’t expand labial Don’t expand labial plate!plate!

No “Wimpy” No “Wimpy” ForcepsForceps

No Labial ForceNo Labial Force

If must remove bone during extractions, remove:

If must remove bone during extractions, remove:1. Interadicular2. Interdental3. Lingual4. Labial

1. Interadicular2. Interdental3. Lingual4. Labial

If must extract, then remove the smallest amount of the least valuable bone (labial plate in maxilla especially valuable).

If must extract, then remove the smallest amount of the least valuable bone (labial plate in maxilla especially valuable).

Roots Roots TipsTips

Roots Roots TipsTips

““Drill to oblivion ”Drill to oblivion ”

Save (preserve) the buccal and lingual Save (preserve) the buccal and lingual cortical plates by sectioning teeth and cortical plates by sectioning teeth and or removing interdental / interadicular or removing interdental / interadicular

bonebone

Esthetics CountEsthetics Count

Implant Prosthodontics by Dr. Sree KokaImplant Prosthodontics by Dr. Sree Koka

Removing most difficult Removing most difficult tooth last saves bone tooth last saves bone (consider removing (consider removing interdental bone)interdental bone)

Orthodontic Extrusion Saves Orthodontic Extrusion Saves BoneBone

Does grafting at the time of extraction minimize ridge

resorption?

Does grafting at the time of extraction minimize ridge

resorption?

Class 1 Class 1 RecommendationsRecommendations

Class 1 Class 1 RecommendationsRecommendations

•Proven efficacy and effectiveness Proven efficacy and effectiveness supported by 1 or more supported by 1 or more randomized controlled trialsrandomized controlled trials

•Results of trials consistently Results of trials consistently excellentexcellent

• Intervention is safe and definitely Intervention is safe and definitely recommended and usefulrecommended and useful

•Proven efficacy and effectiveness Proven efficacy and effectiveness supported by 1 or more supported by 1 or more randomized controlled trialsrandomized controlled trials

•Results of trials consistently Results of trials consistently excellentexcellent

• Intervention is safe and definitely Intervention is safe and definitely recommended and usefulrecommended and useful

Class 2aClass 2aClass 2aClass 2a

•Multiple studies (prospective, Multiple studies (prospective, retrospective, nonrandomized) retrospective, nonrandomized) with good resultswith good results

•Considered intervention of Considered intervention of choice by majority of prudent choice by majority of prudent dentistsdentists

•Acceptable and usefulAcceptable and useful

•Multiple studies (prospective, Multiple studies (prospective, retrospective, nonrandomized) retrospective, nonrandomized) with good resultswith good results

•Considered intervention of Considered intervention of choice by majority of prudent choice by majority of prudent dentistsdentists

•Acceptable and usefulAcceptable and useful

Class 2b Class 2b Class 2b Class 2b • Fewer studies (Case reports, Fewer studies (Case reports,

intervention done on animals, studies intervention done on animals, studies without controls) generally but not without controls) generally but not always positive always positive

• Considered acceptable safe and Considered acceptable safe and useful… within standard of careuseful… within standard of care

• Considered optional or alternative Considered optional or alternative treatment by most expertstreatment by most experts

• Fewer studies (Case reports, Fewer studies (Case reports, intervention done on animals, studies intervention done on animals, studies without controls) generally but not without controls) generally but not always positive always positive

• Considered acceptable safe and Considered acceptable safe and useful… within standard of careuseful… within standard of care

• Considered optional or alternative Considered optional or alternative treatment by most expertstreatment by most experts

Class 3Class 3Class 3Class 3

•Positive evidence completely Positive evidence completely absent, or studies suggest harmabsent, or studies suggest harm

•Unacceptable, no benefitUnacceptable, no benefit

• Intervention may be worse Intervention may be worse than doing nothing at allthan doing nothing at all

•Positive evidence completely Positive evidence completely absent, or studies suggest harmabsent, or studies suggest harm

•Unacceptable, no benefitUnacceptable, no benefit

• Intervention may be worse Intervention may be worse than doing nothing at allthan doing nothing at all

Class IndeterminateClass IndeterminateClass IndeterminateClass Indeterminate

•Promising, but few studiesPromising, but few studies

•Contradictory resultsContradictory results

•No harm, but benefit No harm, but benefit uncertainuncertain

•““More research needed”More research needed”

•Promising, but few studiesPromising, but few studies

•Contradictory resultsContradictory results

•No harm, but benefit No harm, but benefit uncertainuncertain

•““More research needed”More research needed”Adopted from International

Guidelines 2000 for CPR and ECC

Adopted from International Guidelines 2000 for CPR and

ECC

What graft material?What graft material?What graft material?What graft material?•Fresh warm autogenous boneFresh warm autogenous bone•““Hamburger Helpers” for bone:Hamburger Helpers” for bone:

1.1.Allogenic bone (other humans)Allogenic bone (other humans)2.2.Xenogenic bone (other species)Xenogenic bone (other species)3.3.Alloplastic agents (Bioglass, Ca-Alloplastic agents (Bioglass, Ca-

Sulfate, Methacrylates, Calcium Sulfate, Methacrylates, Calcium Phosphate cements)Phosphate cements)

4.4.““Biologics” BMP,PRPBiologics” BMP,PRP5.5.CombinationsCombinations

Costs? $20.00-$125.00/gram

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

� 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“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,

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 Donor site morbidity’morbidity’