Alveolar Bone Preservation Following Tooth Extraction Flashcards
What are penotromes and piezotromes?
Small instruments which you can place into the PDL and break it for separation
Prevents bone fracture during extraction
Wound healing at the soft tissue level following extraction
first 24 hours = Blood clot or coagulation
1-3 days = Fibrinolysis and proliferation of mesenchymal cells
2-4 days = Replacement of coagulum by granulation tissue
1 week = Vascular network forms
2 weeks = Socket is covered with new CT rich in vessels and inflammatory cells
4-6 weeks = soft tissue becomes keratinized
Wound healing at the hard tissue level following extraction
4-6 weeks = alveolus is filled with woven bone
4-6 months = mineral tissue is reinforced with layers of lamellar bone that is deposited on woven bone
Bone deposition will continue for several months but will not reach the coronal bone level of neighboring bone
What are the resorption patterns that follow an extraction?
Significantly larger resorption in the buccal aspect of the alveolus in both the max and man (it’s thinner, mostly cortical, knife-edged bone)
There is formation of a buccal concavity
Home much bone is lost in the horizontal dimension within the first year?
5-7 mm
When does the most significant bone loss occur following an extraction?
Within 8 weeks after the extraction
How much bone is lost within the first 6 months following an extraction?
40% of height
60% of width
What additional factors may affect the amount of residual bone following tooth extraction
Surgical trauma
Elevation of a flap
Age of the patient
What are the long-term outcomes following a tooth extraction?
Progressive loss of ridge contour, leading to:
- Loss of function
- esthetic problems
- prosthodontic complications
Class I Bone defects
Extraction Socket
Class II and III Bone defects
Dehiscence defects
Class IV Bone defects
Horizontal defects
Class V Bone defects
Vertical defects
Alveolar Ridge Preservation
A guided bone regeneration application at the time of tooth extraction to control bone resorption
Guided Bone Regeneration
A guided tissue regeneration targeting specifically the regeneration of already resorbed bone
What are the indications for an Alveolar Ridge Preservation?
After extractions to preserve the original ridge dimensions and contours when immediate implant placement is not possible
What are the contraindications to Alveolar Ridge Preservation?
Infection
Indicated for immediate implant placement
Soft tissue limitations - esthetic zones, thin biotype
Osteoconductive
Acts as a scaffold
Osteoinductive
Stimulates the proliferation of resident cells
What do autogenous materials permit?
Osteogenesis
Osteoinduction
Osteoconduction
What do Allografts permit?
Osteoconduction
Osteoinduction
What do Xenografts permit?
Osteoconduction
Where can autogenous grafts come from extraorally?
Iliac cancellous bone and marrow
Where can autogenous grafts come from intraorally?
Maxillary tuberosity
Extraction sites
Osseous coagulum
What are the different types of Allogenic grafts?
Frozen iliac bone and marrow
Mineralized freeze-dried bone allograft (FDBA)
Demineralized freeze-dried bone allograft (DFDBA)
FDBA or DFDBA mixed with autogenous bone
What is the role of a barrier in ARP?
Cells which have access to and migrate into a given wound space determine the type of tissue regenerating in that space
It keeps the cells we want in, and cells we don’t want out
What are surgical considerations for a membrane?
Stability of the membrane
Resorption rate/mechanism for resorbable membranes
Wound closure
What are the different barrier types?
Expanded polytetrafluorethylene (ePTFE)
Titanium reinforced ePTFE
Cross-linked bovine collagen barrier
Bioabsorbable polymer formulations
