Extractions Sockets

TARRSON FAMILY ENDOWED CHAIR IN PERIODONTICS

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 Division of Associated Clinical Specialties UCLA School of Dentistry Bone Maintenance After Tooth Extractions

Dog Socket at 3 month, Normal Healing Closed Flap

DOG SOCKET 3 MONTHS CLOSED FLAP AND POROUS HYDROXY APATITE GRAFT

DOG SOCKET 3 MONTHS WITH CLOSED FLAP AND GORETEX

Open socket Technique for Extractions Advantages: Simplicity No change in mucogingival junction _ Can be with or without flap. Disadvantages Increased risk of infection of graft Increased loss of bone width Advantages: More predictable bone growth Better maintenance of ridge width Better hemostasis Disadvantages More complete technique May get change of mucogingival junction - Narrower application Closed flap Technique for Extractions

Open socket Technique for Extractions Advantages: Simplicity No change in mucogingival junction Disadvantages Increased risk of infection of graft Increased loss of bone width WITHOUT FLAP

Open socket Technique for Extractions Advantages: Simplicity No change in mucogingival junction Disadvantages Increased risk of infection of graft Increased loss of bone width WITH FLAP

Open Flap Technique - Biogran plus Capset for sockets compared to flap alone Influence of Bioactive glass on changes in alveolar process dimensions after extraction O. Surg. O Med., O Path., O. Radiol Endo. 2000, 90:581-6 Camargo, P.M., Lekovic, V., Weinlaender, M., Klokkevold, P.R., Kenney, E.B., Dimitrejevic, B. Nedic, M., Jancovic, S., Orsini, M.

16 patients with 2 single rooted tooth extraction Sutures placed but no flap closure Titanium reference pins Re-entry at 6 months

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 Advantages: Simplicity No change in mucogingival junction Disadvantages Increased risk of infection of graft Increased loss of bone width Advantages: More predictable bone growth Better maintenance of ridge width Wider application Disadvantages More complete technique May get change of mucogingival junction Narrower application Closed flap Technique for Extractions

Advantages: More predictable bone growth Better maintenance of ridge width Wider application Disadvantages More complete technique May get change of mucogingival junction Narrower application Closed flap Technique for Extractions

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. A Bone Regenerative Approach to Alveolar Ridge Maintenance Following Tooth Extraction. Report of 10 cases. Lekovic, V., Kenney, E. B., Weinlaender, M., Han, T., Klokkevold, P., Nedic, M., Orsini, M. J. Periodontol 1997 68:563

10 patients with 2 single rooted extractions Flaps moblized for tight closure 6 months re-entry Titanium reference pins Goretex membrances stablized with pins.

3 of 10 Goretex sites were exposed during healing. These were removed at 3 months

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

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

3 Sites with Exposure to Goretex Gotetex Control Changes in width -2.00mm -4.33mm Changes in height -1.00mm -1.66mm Changes in socket fill 3.66mm 4.33mm Goretex Control Changes in width -1.71mm -4.43mm Changes in height -0.28mm -1.00mm Changes in socket fill 5.43mm 2.92mm 7 Pairs of Extractions with no Exposure of Goretex

Closed Flap Technique - Resolut membrane alone compared to flaps alone Preservation of Alveolar Bone in extraction sockets using Bio absorbable membranes Lekovic, V., Camargo, P.M., Klokkevold, P.R., Weinlaender, M., Kenney, E.B., Dimitrejevic, B. Nedic, M.

Preservation of Alveolar Bone in Extraction Sockets using Bioabsorbable Membranes. Lekovic, V., Camargo, P. M., Klokkevold, P. R., Weinlaender, M., Kenney, E. B., Dimteijevic, B., Nedie, C. J. Periodontol 1998 69:1044 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.

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.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

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).

Randomized Study Evaluating Human Bone Morphogenetic Protein-2 for Extraction Socket Augmentation Fiorelli J P et al J Periodont 2005, 76:605 BMP-2 in collagen sponge 80 patients, mean age 47.4 years 95 sockets 0.75mg/ml or 1.50mg/ml CT scan after extraction and at 4 months

Measured: Bone height Bone width at 25, 50 and 75% socket length Bone density using standard density block Flap closed, 4-8 perforations of socket Sockets filled and covered with strip Biopsies at time of implant placement All had 50% or more loss of buccal wall

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

Soft tissue augmentation for pontic esthetics.

Closed Flap Techniques – Goretex alone for sockets compared to flaps alone A bone regenerative approach to Alveolar Ridge maintenace following tooth extraction. Report of 10 cases Lekovic, V., Kenney, E.B., Weinlaender, M., Han, T., Klokkevold, P.R., Nedic, M., Jancovic, S., Orsini,

3 of 10 Goretex sites dehisced Goretex removed at 3 moths 7 of 10 sites Goretex removed at 6 months All Measurements at 6 months

A Bone Regenerative Approach to Alveolar Ridge Maintenance Following Tooth Extraction. Report of 10 cases. Lekovic, V., Kenney, E. B., Weinlaender, M., Han, T., Klokkevold, P., Nedic, M., Orsini, M. J. Periodontol 1997 68:563 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.

16 patients with 2 single rooted extraction 6 months re-entry Titanium reference pins Resolut membrane polyglycolide, polylactide

Resolut Control Changes in width -1.31mm -4.56mm Changes in height -0.38mm -1.50mm Changes in socket fill 5.81mm 3.94mm

Extractions Sockets

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Extractions Sockets