Alveolar Bone Preservation Following Tooth Extraction

Question 1

What are penotromes and piezotromes?

Answer 1

Small instruments which you can place into the PDL and break it for separation
Prevents bone fracture during extraction

Question 2

Wound healing at the soft tissue level following extraction

Answer 2

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

Question 3

Wound healing at the hard tissue level following extraction

Answer 3

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

Question 4

What are the resorption patterns that follow an extraction?

Answer 4

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

Question 5

Home much bone is lost in the horizontal dimension within the first year?

Answer 5

5-7 mm

Question 6

When does the most significant bone loss occur following an extraction?

Answer 6

Within 8 weeks after the extraction

Question 7

How much bone is lost within the first 6 months following an extraction?

Answer 7

40% of height

60% of width

Question 8

What additional factors may affect the amount of residual bone following tooth extraction

Answer 8

Surgical trauma
Elevation of a flap
Age of the patient

Question 9

What are the long-term outcomes following a tooth extraction?

Answer 9

Progressive loss of ridge contour, leading to:

• Loss of function
• esthetic problems
• prosthodontic complications

Question 10

Class I Bone defects

Answer 10

Extraction Socket

Question 11

Class II and III Bone defects

Answer 11

Dehiscence defects

Question 12

Class IV Bone defects

Answer 12

Horizontal defects

Question 13

Class V Bone defects

Answer 13

Vertical defects

Question 14

Alveolar Ridge Preservation

Answer 14

A guided bone regeneration application at the time of tooth extraction to control bone resorption

Question 15

Guided Bone Regeneration

Answer 15

A guided tissue regeneration targeting specifically the regeneration of already resorbed bone

Question 16

What are the indications for an Alveolar Ridge Preservation?

Answer 16

After extractions to preserve the original ridge dimensions and contours when immediate implant placement is not possible

Question 17

What are the contraindications to Alveolar Ridge Preservation?

Answer 17

Infection
Indicated for immediate implant placement
Soft tissue limitations - esthetic zones, thin biotype

Question 18

Osteoconductive

Answer 18

Acts as a scaffold

Question 19

Osteoinductive

Answer 19

Stimulates the proliferation of resident cells

Question 20

What do autogenous materials permit?

Answer 20

Osteogenesis
Osteoinduction
Osteoconduction

Question 21

What do Allografts permit?

Answer 21

Osteoconduction

Osteoinduction

Question 22

What do Xenografts permit?

Answer 22

Osteoconduction

Question 23

Where can autogenous grafts come from extraorally?

Answer 23

Iliac cancellous bone and marrow

Question 24

Where can autogenous grafts come from intraorally?

Answer 24

Maxillary tuberosity
Extraction sites
Osseous coagulum

Question 25

What are the different types of Allogenic grafts?

Answer 25

Frozen iliac bone and marrow
Mineralized freeze-dried bone allograft (FDBA)
Demineralized freeze-dried bone allograft (DFDBA)
FDBA or DFDBA mixed with autogenous bone

Question 26

What is the role of a barrier in ARP?

Answer 26

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

Question 27

What are surgical considerations for a membrane?

Answer 27

Stability of the membrane
Resorption rate/mechanism for resorbable membranes
Wound closure

Question 28

What are the different barrier types?

Answer 28

Expanded polytetrafluorethylene (ePTFE)
Titanium reinforced ePTFE
Cross-linked bovine collagen barrier
Bioabsorbable polymer formulations