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Don’t expand labial plate! No “Wimpy” Forceps No Labial Force If must remove bone during extractions, remove: 1. 2. 3. 4. Interadicular Interdental Lingual Labial If must extract, then remove the smallest amount of the least valuable bone (labial plate in maxilla especially valuable). Roots Tips “Drill to oblivion ” Save (preserve) the buccal and lingual cortical plates by sectioning teeth and or removing interdental / interadicular bone Esthetics Count Implant Prosthodontics by Dr. Sree Koka Removing most difficult tooth last saves bone (consider removing interdental bone) Orthodontic Extrusion Saves Bone Does grafting at the time of extraction minimize ridge resorption? Class 1 Recommendations • Proven efficacy and effectiveness supported by 1 or more randomized controlled trials • Results of trials consistently excellent • Intervention is safe and definitely recommended and useful Class 2a • Multiple studies (prospective, retrospective, nonrandomized) with good results • Considered intervention of choice by majority of prudent dentists • Acceptable and useful Class 2b • Fewer studies (Case reports, intervention done on animals, studies without controls) generally but not always positive • Considered acceptable safe and useful… within standard of care • Considered optional or alternative treatment by most experts Class 3 • Positive evidence completely absent, or studies suggest harm • Unacceptable, no benefit • Intervention may be worse than doing nothing at all Class Indeterminate • Promising, but few studies • Contradictory results • No harm, but benefit uncertain • “More research needed” Adopted from International Guidelines 2000 for CPR and ECC What graft material? • Fresh warm autogenous bone • “Hamburger Helpers” for bone: 1. Allogenic bone (other humans) 2. Xenogenic bone (other species) 3. Alloplastic agents (Bioglass, Ca-Sulfate, Methacrylates, Calcium Phosphate cements) 4. “Biologics” BMP,PRP 5. Combinations Costs? $20.00-$125.00/gram ALLOGRAFT CONSENT (Check if applicable and if checked consent signature must be completed): Use of donated bone or tissue products if applicable, has been explained to me and I understand that there are risks associated with implanting these types of products. These risks include reactions, infections such as hepatitis and AIDS. These risks, although extremely rare, can be serious ands possibly fatal. Alternatives to allograft use have been explained to me and include but are not limited to . I CONSENT to use of donated bone/tissue if determined by my physician Patient Signature I DO NOT CONSENT to use of donated bone/tissue Patient Signature “Socket Preservation”… ADA 7953 Int J Periodontics Restorative Dent. 2006 Feb;26(1):19-29. A study of the fate of the buccal wall of extraction sockets of teeth with prominent roots. Nevins M, Camelo M, De Paoli S, Friedland B, Schenk RK, What do I use? Autogenous bone mixed with a resorbable alloplast ‘Donor site morbidity’