Dentaltown January 2015 - (Page 48)

implantology message board What is the Current Science Behind Socket Grafting to Preserve Ridge Height? To graft or not to graft Dentaltown.com > Message Boards > Implantology almunk Member Since: 12/17/05 Post: 1 of 47 I pull teeth almost every day. I pulled three yesterday. Probably 75 percent of the time, these teeth are never going to be replaced with anything. Socket grafting is an extra step and expense. How often should I be doing it and is there good science now to warrant this extra step? ■ AUG 27 2014 Eric Krause Member Since: 02/19/03 Post: 2 of 47 Dale Rosenbach Member Since: 06/14/07 Post: 3 of 47 Related Message Boards Bad Implant, Bad Graft, Good Graft, Good Implant Good Graft Do You Graft Bone After Wisdom Tooth Ext Like This Case? Graft Bone After I only do it when the patient indicates that they may want an implant down the road. ■ AUG 27 2014 Here's a systematic review from Chen 2009 but it focuses primarily on augmentation with immediate implants. Papers such as Fotek 2009, Crespi 2009, Darby 2009 (a systematic review), and Beck and Mealey 2010, demonstrate that minimally traumatic extraction and socket preservation can maintain ridge dimensions, but there are a lot of confounding variables. The thinner the facial plate (such as in the anterior where the mean thickness is generally recorded 1> as 1mm or less), the more likely it will resorb prior to turnover of the socket clot to osteoid and mineralized bone, but in the posterior, where the facial plate thickness may present as thick as a mean of 1.7-2.2mm thick, there is less of a concern that the plate will resorb prior to the ridge maintaining itself via a socket clot. Based on this, the Tarnowdontists at Columbia favor socket preservation in the anterior, but not so much in the posterior. But we can all see posterior ridges that have not been beaten up by tissue-supported removable prosthesis that are nonetheless deﬁcient enough to require ridge augmentation in either the vertical or even horizontal dimension, and so it's a gamble now to extract a tooth and not preserve it, for patients may return later with a desire to place implants. And so while I don't think we ought to graft every extraction socket, we might be best off engaging patients with this information (whether orally, or with a special informed consent) to force them to consider the potential consequences of not having sites preserved. ■ AUG 27 2014 almunk Member Since: 12/17/05 Post: 4 of 47 Thanks Dale. I extracted a tooth yesterday. Lower 2nd molar, cracked root, almost no bone in furca or around distal root. This tooth sat in a massive hollow. Should I have grafted? I did not. ■ AUG 27 2014 Dale Rosenbach Member Since: 06/14/07 Post: 5 of 47 48 6> It's a great question, and there is no universal answer, just as there is rarely a universal response to be arrived at for anything in dentistry. We don't know how that socket will heal without grafting, and we don't know how it will heal with grafting. So many factors have not been accounted for. If the socket is contiguous with a periradicular volume of granulomatous tissue following weeks, months or years of propogation of pulpal and periapical infection, will the socket that ﬁ lls with blood and eventually turns over into osteoid, woven and ﬁ nally lamellar bone displace this soft tissue? I do not sense that it will. So leaving the soft tissue there is unadvised. Will the site ever be re-entered? Perhaps not. Will the thick and dense plates surrounding the mandibular second molar be sufﬁcient to JANUARY 2015 » dentaltown.com http://www.Dentaltown.com http://www.dentaltown.com/MessageBoard/thread.aspx?a=11&s=2&f=123&t=231062&g=1 http://www.dentaltown.com/MessageBoard/thread.aspx?a=11&s=2&f=173&t=238561&g=1 http://www.dentaltown.com

Table of Contents for the Digital Edition of Dentaltown January 2015

Dentaltown.com Highlights
Howard Speaks: Why Too Much Clinical Dentistry is Bad for Business
Professional Courtesy: Coming Soon: More Denture Patients
Continuing Education
Sleep Apnea Screening and Treatment
Data Encryption: Count the Acronyms
Anterior Tooth Position in Restorative Dentistry: Applying the Chasolen Triad
Poll
Office Visit: Texas Hygienist a Diva of Dings
What is the Current Science Behind Socket Grafting to Preserve Ridge Height?
Pulp Capping: Improving the Prognosis
Industry News
New Products
Should I Extract That Tooth?
Townie Meeting 2015 Preview
Ad Index
Remembering Suzanne Mann
Diagnosis in Endodontics
Quickbooks: Ten Tips to Stay Organized and Efficient
Dentally Incorrect

Dentaltown January 2015