Extractions Sockets

TARRSON FAMILY ENDOWED CHAIR IN PERIODONTICS

UCLA SCHOOL OF DENTISTRY

PresentsPresentsDr. E. Barrie KenneyProfessor & ChairmanSection 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 CLOSEDFLAP AND GORETEX

Open socket Techniquefor 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 Techniquefor Extractions


• Advantages:– Simplicity– No change in mucogingival junction


WITHOUT FLAP




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

Biogran + Capset Controls

Changes in width -3.48 -3.40

Changes in height -0.38 -1.00

Changes in socket fill 6.43 4.00

Open flap Techniquefor Extractions



• Advantages:– More predictable bone growth– Better maintenance of ridge width– Wider application


junction– Narrower application


• Advantages:– More predictable bone growth– Better maintenance of ridge width– Wider application


junction– Narrower application


Surgical Technique for Ridge Preservation

Sulcular Incision and Vertical Releasing Incision

Titanium Pinsas 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

Goretex Control




7 Sites with No Exposure of Goretex

Goretex Control




3 Sites with Exposure to Goretex

GotetexControl

Changes in width -2.00mm -4.33mm

Changes in height -1.00mm -1.66mm

Changes in socket fill 3.66mm 4.33mm

GoretexControl




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.


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.

Resolut Controls




RANDOMIZED STUDY EVALUATING RECOMBINANT HUMAN BONE MORPHOGENETIC PROTEIN 2 FOR EXTRACTION SOCKET

AUGMENTATIONFIORELLINI,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 TREATMENTEVALUATED 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 alJ 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 changesseen, trabecular boneno inflammation Control 0.75mg/ml 1.50mg/ml

N=17 N=22 N=21

Changes in height -1.00mm -0.62mm -0.02mm

Changes in width 25% length, i.e., coronal end 0.82mm 1.76mm 3.27mm

Changes in width 75% length, i.e., apical end 1.82mm 2.29mm 2.68mm

Implant placed with no augmentation 59% 55% 86%

Changes at 4 months

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 casesLekovic, 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.


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

ResolutControl




Education

Extractions Sockets