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
Open socket Techniquefor Extractions
• Advantages:– Simplicity– No change in mucogingival junction
• Disadvantages– Increased risk of infection of graft– Increased loss of bone width
WITHOUT FLAP
Open socket Techniquefor 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
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:– 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 Techniquefor 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 Techniquefor Extractions
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
Changes in width -2.00 -4.33
Changes in height -1.00 -1.66
Changes in socket fill 3.66 4.33
7 Sites with No Exposure of Goretex
Goretex Control
Changes in width -1.71 -4.43
Changes in height -0.28 -1.00
Changes in socket fill 5.43 2.92
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
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.
Resolut Controls
Changes in width -1.31 -4.56
Changes in height -0.38 -1.50
Changes in socket fill 5.81 3.94
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.
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
ResolutControl
Changes in width -1.31mm -4.56mm
Changes in height -0.38mm -1.50mm
Changes in socket fill 5.81mm 3.94mm
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