Don

1
Dont expand labial plate!
No Wimpy Forceps No Labial Force
2
If must remove bone during extractions, remove

• Interadicular
• Interdental
• Lingual
• Labial

3
If must extract, then remove the smallest amount
of the least valuable bone (labial plate in
maxilla especially valuable).
4
Roots Tips
Think Bone Preservation
5
Drill to oblivion
6
Save (preserve) the buccal and lingual cortical
plates by sectioning teeth and or removing
interdental / interadicular bone
7
Esthetics Count
8
Implant Prosthodontics by Dr. Sree Koka
9
Removing most difficult tooth last saves bone
(consider removing interdental bone)
10
Orthodontic Extrusion Saves Bone
11
Does grafting at the time of extraction minimize
ridge resorption?
12
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

13
Class 2a

• Multiple studies (prospective, retrospective,
  nonrandomized) with good results
• Considered intervention of choice by majority of
  prudent dentists
• Acceptable and useful

14
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

grafting sockets
15
Class 3

• Positive evidence completely absent, or studies
  suggest harm
• Unacceptable, no benefit
• Intervention may be worse than doing nothing at
  all

16
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
17
What graft material?

• Fresh warm autogenous bone
• Hamburger Helpers for bone
• Allogenic bone (other humans)
• Xenogenic bone (other species)
• Alloplastic agents (Bioglass, Ca-Sulfate,
  Methacrylates, Calcium Phosphate cements)
• Biologics BMP,PRP
• Combinations

18
Costs? 20.00-125.00/gram
19

• 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

20
Socket Preservation ADA 7953
Int J Periodontics Restorative Dent. 2006
Feb26(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,
21
What do I use? Autogenous bone mixed with a
resorbable alloplast
Donor site morbidity