Saturday, 15 November 2014

#TubulesLive Event: Ridge Preservation with Professor Nikos Donos


This week's #TubulesLive Event was with Professor Nikos Donos about Ridge Preservation. 




It is important when assessing patients for implant work you inform them there may be a need for bone or soft tissue grafts so they can make a fully informed decision about treatment. 
This episode of #TubulesLive has taught me what options are out there in terms of grafting materials and which cases may require them.

Here I will summarise learning points from the event:

  • It is important to plan the loss of a tooth in depth by assessing the amount of bone and soft tissue present to support either an implant or a prosthesis. 
  • The ALVEOLAR PROCESS is the maxillary or mandibular bone that supports teeth, roots and unerupted tooth buds. 
  • The process of healing after tooth extraction typically follows:
                 0-3 days          Inflammation and formation of blood clot in the socket
                 4-7 days          Fibroplasia and the formation of granulation tissue
                 7-30 days        Mineralisation and the formation of woven bone
                 30 + days        Remodelling and formation of lamellar bone
  • The most abundant tissue present in bone healing is connective tissue
  • Studies show that there is significant resorption of buccal bone following extractions (since buccal bone is thinner than lingual/palatal bone), and two thirds of this resorption occurs in the 1st month following extraction
  • Alveolar atrophy can be caused by functional factors (e,g, loading of a prosthesis), inflammatory factors (e.g. traumatic extractions, periodontal problems) and systemic and anatomical factors (e.g. age, nutrition)
  • Options for implant placement:
             1. Extract and wait: 6-8 weeks (Type I), 12-16 weeks (Type II), more than 6 months (Type III)
             2. Extract and immediate placement of implant (Type IV)
             3. Extract and alveolar ridge preservation techniques (ARP)
  • ARP techniques include: grafting, guided tissue regeneration (GTR), sponges/plugs, soft tissue sealing, growth factors, systemic medications or a combination of any of these. 
  • Some studies have shown that there is a reduction in the loss of alveolar ridge width and height following extractions with ARP compared to unassisted healing.
  • 100% ARP is unpredictable and you cannot prevent resorption after extractions
  • There is currently no significant difference between ARP techniques in systematic reviews 
  • There are lots of different products on the market to use in grafting procedures e.g. BioOss (which is demineralised bovine bone mineral i.e. DBBM, and collagen) and synthetics (which are usually hydroxyapatite and tricalcium silicates or phosphates)
  • Implant placement can be done with a flap or flaplessly
  • Whilst flapless techniques have the advantage of having no periosteal disruption, raising a flap will allow for better access and assessment and primary closure of the guided bone regeneration
  • On animal studies, flaps have been shown to lead to less horizontal bone loss, whilst the flapless technique leads to more keratinised tissue and less discomfort for the patient.
  • Soft tissue sealing can be carried out with synthetic grafts or with free gingival grafts which are sutured on top of the socket
  • Whilst at the moment there is no clinical evidence supporting soft tissue sealing, it has been suggested that there may be an increase in the amount of keratinised tissue on the buccal side to support an implant

In summary, whilst alveolar ridge preservation may not be needed in all patients, for example where there is an active endodontic abscess associated with a tooth, ARP can be useful in a lot of cases to help preserve tissues in order to support an implant and give a good aesthetic result.

I hope you have found these notes useful. The next #TubulesLive event will be in the new year, on the 22nd January with Dr Alan Sidi: Sinus Augmentation for Dental Implants.


I hope to see you there! Please leave your thoughts about ridge preservation and dental implants in the section below!


To see my other posts about previous #TubulesLive events see here



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