beta-tricalcium phosphate brands: synthograft
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Beta-Tricalcium Beta-Tricalcium PhosphatePhosphate
BrandsBrands
11SynthograftSynthograft
22CerasorbCerasorb
33GraftekGraftek
Completely unique and synthetic GEM 21Sreg is an innovative combination of a bioactive protein (highly purified recombinant human platelet derived growth factor rhPDGF-BB) and a biocompatible osteoconductive matrix (beta-tricalcium phosphate β-TCP)GEM 21Sreg contains 1000x more active growth factor (PDGF) than found in platelet rich plasma Compared to bone graft substitute without PDGFProvides 3x more bone fill at 6 monthsProvides a more predictable treatment option even in the most severe cases
Completely unique and synthetic GEM 21Sreg is an innovative combination of a bioactive protein (highly purified recombinant human platelet derived growth factor rhPDGF-BB) and a biocompatible osteoconductive matrix (beta-tricalcium phosphate β-TCP)GEM 21Sreg contains 1000x more active growth factor (PDGF) than found in platelet rich plasma Compared to bone graft substitute without PDGFProvides 3x more bone fill at 6 monthsProvides a more predictable treatment option even in the most severe cases
ldquoldquoSockets with intact buccal and lingual Sockets with intact buccal and lingual plates heal well without graftinghellip plates heal well without graftinghellip consider grafting with resorbable consider grafting with resorbable osteoinductive material if plates osteoinductive material if plates compromised and implants plannedrdquo compromised and implants plannedrdquo grafting with connective tissue if pontic grafting with connective tissue if pontic esthetics an issuerdquoesthetics an issuerdquo
ldquoldquoSockets with intact buccal and lingual Sockets with intact buccal and lingual plates heal well without graftinghellip plates heal well without graftinghellip consider grafting with resorbable consider grafting with resorbable osteoinductive material if plates osteoinductive material if plates compromised and implants plannedrdquo compromised and implants plannedrdquo grafting with connective tissue if pontic grafting with connective tissue if pontic esthetics an issuerdquoesthetics an issuerdquo
Vital Root RetentionVital Root RetentionbullNever our first choice but an option for
preserving alveolar bone when performing full mouth extractions on young patients
bullTeeth must be vital with good periodontal health
bullSimilar tooth selection as ldquoconventionalrdquo overdentures except elective endodontics not performed
bullNever our first choice but an option for preserving alveolar bone when performing full mouth extractions on young patients
bullTeeth must be vital with good periodontal health
bullSimilar tooth selection as ldquoconventionalrdquo overdentures except elective endodontics not performed
Vital Root RetentionVital Root RetentionbullAmputate teeth at crest then remove 2
mm more tooth ldquosub osseousrdquo
bullConsider grafting autogenous bone over tooth then close primarily
bullIdeally bone grows coronally over a vital asymptomatic root
bullDepending on rate of alveolar resorption will help preserve ridge 3-5 years before exposureextraction
bullAmputate teeth at crest then remove 2 mm more tooth ldquosub osseousrdquo
bullConsider grafting autogenous bone over tooth then close primarily
bullIdeally bone grows coronally over a vital asymptomatic root
bullDepending on rate of alveolar resorption will help preserve ridge 3-5 years before exposureextraction
Remove 2 mm tooth structure below bone
2 mm
Suture
New Bone Prosthesis
J Oral Maxillofac SurgJ Oral Maxillofac Surg 2005 Feb43(1)7-12 A 2005 Feb43(1)7-12 A randomized controlled clinical trial to randomized controlled clinical trial to compare the incidence of injury to the compare the incidence of injury to the inferior alveolar nerve as a result of inferior alveolar nerve as a result of coronectomy and removal of mandibular third coronectomy and removal of mandibular third molars Renton T Hankins M Sproate Cmolars Renton T Hankins M Sproate C
bull The length of follow up was about two The length of follow up was about two years which for the assessment of years which for the assessment of delayed eruption of the root fragments delayed eruption of the root fragments is not sufficient as this process may is not sufficient as this process may continue for up to 10 years However continue for up to 10 years However it seems that coronectomy reduces the it seems that coronectomy reduces the incidence of injury to the inferior incidence of injury to the inferior alveolar nerve without increasing the alveolar nerve without increasing the risk of dry socket or infection risk of dry socket or infection
J Oral Maxillofac Surg 2004 Dec62(12)1447-52 Coronectomy a technique to protect the inferior alveolar nerve Pogrel MA Lee JS Muff DF
J Oral Maxillofac Surg 2004 Dec62(12)1447-52 Coronectomy a technique to protect the inferior alveolar nerve Pogrel MA Lee JS Muff DF
PURPOSE Damage to the inferior alveolar nerve when extracting lower third molars is often caused by the intimate relationship between the nerve and the roots of the teeth The technique of coronectomy or intentional root retention may minimize this problem
PURPOSE Damage to the inferior alveolar nerve when extracting lower third molars is often caused by the intimate relationship between the nerve and the roots of the teeth The technique of coronectomy or intentional root retention may minimize this problemRESULTS There were no cases of inferior alveolar nerve-involved damage in this study of 41 patients who underwent 50 coronectomies There was 1 case of transient lingual nerve involvement probably from the use of the lingual retractor One patient required subsequent removal of the roots of both lower third molars because of failure to heal and 1 patient required subsequent removal of a root because of subsequent migration to the surface Root migration was noted in approximately 30 of patients over a 6 month period CONCLUSION Coronectomy appears to be a viable technique in those cases where removal of the whole tooth might put the inferior alveolar nerve at considerable risk of damage
RESULTS There were no cases of inferior alveolar nerve-involved damage in this study of 41 patients who underwent 50 coronectomies There was 1 case of transient lingual nerve involvement probably from the use of the lingual retractor One patient required subsequent removal of the roots of both lower third molars because of failure to heal and 1 patient required subsequent removal of a root because of subsequent migration to the surface Root migration was noted in approximately 30 of patients over a 6 month period CONCLUSION Coronectomy appears to be a viable technique in those cases where removal of the whole tooth might put the inferior alveolar nerve at considerable risk of damage
Pre-op (Oral Pre-op (Oral bisphosphonates X bisphosphonates X 5 years)5 years)
Immed Immed PostPost
10 month 10 month postpost
Immediate Implant Placement Following
Extractions
Immediate Implant Placement Following
ExtractionsbullNeed 3-4 mm of solid bone at base
of socket and no active infection
bullSuccess rates ~ to ldquonormalrdquo
bullMost typical sites anterior teeth and 1st premolars
bullAdvantages May reduce loss of labial plate and improve esthetics as well as save time
bullNeed 3-4 mm of solid bone at base of socket and no active infection
bullSuccess rates ~ to ldquonormalrdquo
bullMost typical sites anterior teeth and 1st premolars
bullAdvantages May reduce loss of labial plate and improve esthetics as well as save time
Platelet Rich PlasmaPlatelet Rich PlasmaPlatelet Rich PlasmaPlatelet Rich PlasmabullWhatrsquos HotWhatrsquos Hot
ndash Release various Release various growth factors that growth factors that aid in hemostasis aid in hemostasis and increase rate and increase rate of healing of healing (mitogenesis (mitogenesis angiogenesis) angiogenesis)
bullWhatrsquos HotWhatrsquos Hotndash Release various Release various
growth factors that growth factors that aid in hemostasis aid in hemostasis and increase rate and increase rate of healing of healing (mitogenesis (mitogenesis angiogenesis) angiogenesis)
bullWhatrsquos NotWhatrsquos Notndash CostCostndash Is there any Is there any
difference at 6 difference at 6 weeksweeks
ndash Invasive Invasive borrow 45-borrow 45-90ml of blood90ml of blood
bullWhatrsquos NotWhatrsquos Notndash CostCostndash Is there any Is there any
difference at 6 difference at 6 weeksweeks
ndash Invasive Invasive borrow 45-borrow 45-90ml of blood90ml of blood
Casap et al Immediate Implantation Into Debrided Infected Sockets J Oral Maxillofac Surg 2007
Does placing implants into fresh extraction Does placing implants into fresh extraction sockets preserve bonesockets preserve bone
J Clin Periodontol 2005 Jun32(6)645-52 Ridge alterations following implant placement in fresh extraction sockets an experimental study in the dogArauacutejo MG Sukekava F Wennstroumlm JL Lindhe J
CONCLUSIONS Marked dimensional alterations had occurred in the edentulous ridge after 3 months of healing following the extraction of the distal root of mandibular pre-molars The placement of an The placement of an implant in the fresh extraction site obviously implant in the fresh extraction site obviously failed to prevent the re-modeling that occurred failed to prevent the re-modeling that occurred in the walls of the socketin the walls of the socket The resulting height of the buccal and lingual walls at 3 months was similar at implants and edentulous sites
Most human trials however reveal results Most human trials however reveal results similar to implants place via the ldquoold similar to implants place via the ldquoold schoolrdquo approach even when immediately schoolrdquo approach even when immediately loaded (caution in ldquosoftrdquo bone gt55 YO)loaded (caution in ldquosoftrdquo bone gt55 YO)
Int J Oral Maxillofac Implants 2007 Mar-Apr22(2)187-94 The radiographic bone loss pattern adjacent to immediately placed immediately loaded implantsJaffin R Kolesar M Kumar A Ishikawa S Fiorellini J
J Craniofac Surg 2007 Jul18(4)965-71 Immediate loaded dental implants comparison between fixtures inserted in postextractive and healed bone sitesDegidi M Piattelli A Carinci F
J Periodontol 2007 May78(5)810-5 Vertical crestal bone changes around implants placed into fresh extraction socketsCovani U Cornelini R Barone A
Why ReconstructWhy Reconstruct
bullNot enough bone for implants
bullEnough bone but esthetic result suboptimal
bullPrevent pathologic fracture
bullPoor functionestheticsretention of conventional removable prosthesis
bullNot enough bone for implants
bullEnough bone but esthetic result suboptimal
bullPrevent pathologic fracture
bullPoor functionestheticsretention of conventional removable prosthesis
How Autogenous Bone Grafts
with Implants
How Autogenous Bone Grafts
with Implants
Autogenous Block GraftsAutogenous Block Grafts
bullldquoGold Standardrdquo
bullOsteoinductive and Osteoconductive
bullNo need for membranes
bullHolds form
bullRemodels into 100 high quality bone
bullNo concerns about transmissible diseases
bullldquoGold Standardrdquo
bullOsteoinductive and Osteoconductive
bullNo need for membranes
bullHolds form
bullRemodels into 100 high quality bone
bullNo concerns about transmissible diseases
Autogenous Block Grafts
Autogenous Block Grafts
bullDonor site morbidity
bullQuantity is limited
bullLose 20-30 during healing
bullDonor site morbidity
bullQuantity is limited
bullLose 20-30 during healing
Intra-oral Autogenous Bone Sites
AllogenicAllogenic Block Block GraftGraft
What about membranesWhat about membranes
bullUseful in containing particulate grafts
bullUseful around teethexposed implant threads
bullAdd expense
bull Infection risk
bullUnnecessary with block grafts
bullADA 4266 Resorbable
bullADA 4267 Non-Resorbable
bullUseful in containing particulate grafts
bullUseful around teethexposed implant threads
bullAdd expense
bull Infection risk
bullUnnecessary with block grafts
bullADA 4266 Resorbable
bullADA 4267 Non-Resorbable
Bone Morphogenic Protein (BMP)
Bone Morphogenic Protein (BMP)
bullGrow bone at will
bullPresently two are FDA approved BMP 2 for spinal fusions and BMP 7 for long bone defects
bullStudies show excellent results for socket preservation sinus lifts
bullExpensive ($500000 for a sinus)
bullGrow bone at will
bullPresently two are FDA approved BMP 2 for spinal fusions and BMP 7 for long bone defects
bullStudies show excellent results for socket preservation sinus lifts
bullExpensive ($500000 for a sinus)
FDA Panel Unanimously Recommends Approval of Third Indication For Medtronicrsquos INFUSE Bone Graft Nov 9 2006
FDA Panel Unanimously Recommends Approval of Third Indication For Medtronicrsquos INFUSE Bone Graft Nov 9 2006 INFUSE Bone Graft is recombinant human bone morphogenetic protein-2 (rhBMP-2) applied to an absorbable collagen sponge carrier The purpose of the protein which occurs naturally in the body is to stimulate bone formation It has been previously approved by the FDA for use in certain lumbar spine fusion and tibial fracture repair procedures
INFUSE Bone Graft is recombinant human bone morphogenetic protein-2 (rhBMP-2) applied to an absorbable collagen sponge carrier The purpose of the protein which occurs naturally in the body is to stimulate bone formation It has been previously approved by the FDA for use in certain lumbar spine fusion and tibial fracture repair procedures
Distraction OsteogenesisDistraction
OsteogenesisbullGeneration of bone (and soft
tissue) through distraction of an osseous callus
bullGeneration of bone (and soft tissue) through distraction of an osseous callus
Ann N Y Acad Sci 2006 Apr1068532-42 COX-2 has a critical role during incorporation of structural bone allografts OrsquoKeefe RJ Tiyapatanaputi P Xie C
Ann N Y Acad Sci 2006 Apr1068532-42 COX-2 has a critical role during incorporation of structural bone allografts OrsquoKeefe RJ Tiyapatanaputi P Xie C
Nonsteroidal anti-inflammatory drugs (NSAIDs) which inhibit cyclooxygenase (COX) activity reduce pain and are commonly used in patients with skeletal injury In this article we will also present data to show that selective COX-2 inhibitor delays allograft healing and incorporation These results demonstrated that COX-2 is essential for bone allograft incorporation Furthermore our data support the notion that COX-2-dependent PGE2 produced at the early stage of bone healing is prerequisite for efficient skeletal repair
Nonsteroidal anti-inflammatory drugs (NSAIDs) which inhibit cyclooxygenase (COX) activity reduce pain and are commonly used in patients with skeletal injury In this article we will also present data to show that selective COX-2 inhibitor delays allograft healing and incorporation These results demonstrated that COX-2 is essential for bone allograft incorporation Furthermore our data support the notion that COX-2-dependent PGE2 produced at the early stage of bone healing is prerequisite for efficient skeletal repair
Wise Old Oral Surgeon Wise Old Oral Surgeon Says Beware ofSays Beware of
Wise Old Oral Surgeon Wise Old Oral Surgeon Says Beware ofSays Beware of
bull 3rd molars in function3rd molars in function
bull Lone standing molarsLone standing molars
bull Teeth in bruxers Cl III skeletal patternsTeeth in bruxers Cl III skeletal patterns
bull 3rd molars + post-menopausal women3rd molars + post-menopausal women
bull Prior TMD historyPrior TMD history
bull Prior ldquobadrdquo oral surgery experiencePrior ldquobadrdquo oral surgery experience
bull Distoangular lower 3rds nerve proximityDistoangular lower 3rds nerve proximity
bull 3rd molars in function3rd molars in function
bull Lone standing molarsLone standing molars
bull Teeth in bruxers Cl III skeletal patternsTeeth in bruxers Cl III skeletal patterns
bull 3rd molars + post-menopausal women3rd molars + post-menopausal women
bull Prior TMD historyPrior TMD history
bull Prior ldquobadrdquo oral surgery experiencePrior ldquobadrdquo oral surgery experience
bull Distoangular lower 3rds nerve proximityDistoangular lower 3rds nerve proximity
3rd Molar Surgery ndash Why
3rd Molar Surgery ndash Why
1 Preventtreat pericoronitis (infection)2 Prevent periodontal problems 2nd molar3 Preventtreat caries to 2nd 3rd molar4 Prevent odontogenic cyststumors5 Strengthen mandible possible fx6 Prevent orthodontic relapse7 Treat pain of unknown origin
1 Preventtreat pericoronitis (infection)2 Prevent periodontal problems 2nd molar3 Preventtreat caries to 2nd 3rd molar4 Prevent odontogenic cyststumors5 Strengthen mandible possible fx6 Prevent orthodontic relapse7 Treat pain of unknown origin
Extract 3rds OralSystemic Extract 3rds OralSystemic LinkLink
CLEVELAND April 6 2006 - The first hard evidence has CLEVELAND April 6 2006 - The first hard evidence has been uncovered that bacteria in the mouth may find their been uncovered that bacteria in the mouth may find their way to the uterus causing uterine infections that can lead way to the uterus causing uterine infections that can lead to preterm birth in pregnant womento preterm birth in pregnant women
CLEVELAND April 6 2006 - The first hard evidence has CLEVELAND April 6 2006 - The first hard evidence has been uncovered that bacteria in the mouth may find their been uncovered that bacteria in the mouth may find their way to the uterus causing uterine infections that can lead way to the uterus causing uterine infections that can lead to preterm birth in pregnant womento preterm birth in pregnant women
A newly discovered and as yet unnamed species of the A newly discovered and as yet unnamed species of the bacterium genus bacterium genus BergeyellaBergeyella was found in the mouth was found in the mouth and amniotic fluid of a woman with a uterine infection and amniotic fluid of a woman with a uterine infection who gave birth prematurely (24 weeks) reported who gave birth prematurely (24 weeks) reported microbiologist Yiping W Han PhD of Case Western microbiologist Yiping W Han PhD of Case Western Reserve here Reserve here However the bacterium was not detected in a vaginal However the bacterium was not detected in a vaginal swab as might be expected The finding confirmed swab as might be expected The finding confirmed what some scientists have suspected that intrauterine what some scientists have suspected that intrauterine infections dont always ascend from the genital tract infections dont always ascend from the genital tract but can descend from the oral cavity Dr Han and but can descend from the oral cavity Dr Han and colleagues said in the April issue of the colleagues said in the April issue of the Journal of Journal of Clinical MicrobiologyClinical Microbiology
A newly discovered and as yet unnamed species of the A newly discovered and as yet unnamed species of the bacterium genus bacterium genus BergeyellaBergeyella was found in the mouth was found in the mouth and amniotic fluid of a woman with a uterine infection and amniotic fluid of a woman with a uterine infection who gave birth prematurely (24 weeks) reported who gave birth prematurely (24 weeks) reported microbiologist Yiping W Han PhD of Case Western microbiologist Yiping W Han PhD of Case Western Reserve here Reserve here However the bacterium was not detected in a vaginal However the bacterium was not detected in a vaginal swab as might be expected The finding confirmed swab as might be expected The finding confirmed what some scientists have suspected that intrauterine what some scientists have suspected that intrauterine infections dont always ascend from the genital tract infections dont always ascend from the genital tract but can descend from the oral cavity Dr Han and but can descend from the oral cavity Dr Han and colleagues said in the April issue of the colleagues said in the April issue of the Journal of Journal of Clinical MicrobiologyClinical Microbiology
Journal of Oral and Maxillofacial Journal of Oral and Maxillofacial SurgerySurgery
Volume 65 Issue 3 March 2007 Pages Volume 65 Issue 3 March 2007 Pages 377-383377-383
Progress Report on Third Molar Clinical Trials Progress Report on Third Molar Clinical Trials Raymond P White Jr DDS PhDRaymond P White Jr DDS PhD
1What happens to asymptomatic patients who keep their 1What happens to asymptomatic patients who keep their third molars third molars
2What is the recovery like for those who have them 2What is the recovery like for those who have them removed and what can we do as surgeons to improve removed and what can we do as surgeons to improve post operative outcomespost operative outcomes
3rd Molar Surgery ndash When3rd Molar Surgery ndash WhenbullBefore roots 100 developed
bullAfter roots 13 formed
bullMorbiditycomplications minimized as bone more flexible nerves more pliable and PMH less complicated
bullDonrsquot forget tooth transplanttooth transplant if apex not closed
bullBefore roots 100 developed
bullAfter roots 13 formed
bullMorbiditycomplications minimized as bone more flexible nerves more pliable and PMH less complicated
bullDonrsquot forget tooth transplanttooth transplant if apex not closed
Outcome of tooth transplantation survival and success rates 17-41 years post treatmentCzochrowska EM Stenvik A Bjercke B Zachrisson Am J Orthod Dentofacial Orthop 2002 Feb121(2)110-9The mean age at surgery was 115 years and the mean observation period was 264 264 years (range 17-41 years) Of the 33 teeth transplanted in the 28 patients 3 teeth were lost after 9 10 and 29 years respectively Therefore the 30 teeth in the 25 patients we examined yielded a survival rate of 90 The success rate was 79 because 2 transplants had ankylosed and 2 others failed to fulfill the proposed criteria The patients generally responded very favorably regarding their perception of the treatment Their only hesitation was related to some discomfort during surgery It was concluded that It was concluded that survival and success rates for teeth auto survival and success rates for teeth auto transplanted when the root is partly developed transplanted when the root is partly developed compare favorably in a long-term perspective compare favorably in a long-term perspective with other treatment modalities for with other treatment modalities for substituting missing teethsubstituting missing teeth
Outcome of tooth transplantation survival and success rates 17-41 years post treatmentCzochrowska EM Stenvik A Bjercke B Zachrisson Am J Orthod Dentofacial Orthop 2002 Feb121(2)110-9The mean age at surgery was 115 years and the mean observation period was 264 264 years (range 17-41 years) Of the 33 teeth transplanted in the 28 patients 3 teeth were lost after 9 10 and 29 years respectively Therefore the 30 teeth in the 25 patients we examined yielded a survival rate of 90 The success rate was 79 because 2 transplants had ankylosed and 2 others failed to fulfill the proposed criteria The patients generally responded very favorably regarding their perception of the treatment Their only hesitation was related to some discomfort during surgery It was concluded that It was concluded that survival and success rates for teeth auto survival and success rates for teeth auto transplanted when the root is partly developed transplanted when the root is partly developed compare favorably in a long-term perspective compare favorably in a long-term perspective with other treatment modalities for with other treatment modalities for substituting missing teethsubstituting missing teeth
3rd Molar Surgery ndash When Not
3rd Molar Surgery ndash When Not
bullExtremes of age
bullNo oral communication (full bony)
bullIntimate root-nerve Relationship
bullRisks gt Benefits
bullExtremes of age
bullNo oral communication (full bony)
bullIntimate root-nerve Relationship
bullRisks gt Benefits
3rd Molar Surgery Alternatives
3rd Molar Surgery Alternatives
bullNo Surgery dentist feels risk benefit ratio not favorable or patient refuses ndash document and recommend radiograph q 3-5 years
bullNo Surgery dentist feels risk benefit ratio not favorable or patient refuses ndash document and recommend radiograph q 3-5 years
No High SpeedNo High Speed
bullAir embolus
bullAir emphysema
bullBlow debris into flap
bullBlow bacteria into flap
bullNon-sterile water
bullAir embolus
bullAir emphysema
bullBlow debris into flap
bullBlow bacteria into flap
bullNon-sterile water
Which are trueWhich are true1 Tooth transplants are usually done on
patients 20-302 Average success rate for a tooth
transplant is 20-303 In order to work a transplant must
have endo4 Most transplants will ankylose
A 13 B 24 C 123 D 3 only
E None of the above
1 Tooth transplants are usually done on patients 20-30
2 Average success rate for a tooth transplant is 20-30
3 In order to work a transplant must have endo
4 Most transplants will ankylose
A 13 B 24 C 123 D 3 only
E None of the above
How can I assess the relationship How can I assess the relationship between the 3between the 3rdrd molar root and the molar root and the
inferior alveolar nerveinferior alveolar nerve
- Slide 2
- Slide 3
- Slide 4
- ldquoSockets with intact buccal and lingual plates heal well without graftinghellip consider grafting with resorbable osteoinductive material if plates compromised and implants plannedrdquo grafting with connective tissue if pontic esthetics an issuerdquo
- Vital Root Retention
- Slide 7
- Slide 8
- Slide 9
- J Oral Maxillofac Surg 2005 Feb43(1)7-12 A randomized controlled clinical trial to compare the incidence of injury to the inferior alveolar nerve as a result of coronectomy and removal of mandibular third molars Renton T Hankins M Sproate C
- Slide 11
- Slide 12
- Immediate Implant Placement Following Extractions
- Platelet Rich Plasma
- Slide 15
- Slide 16
- Slide 17
- Why Reconstruct
- How Autogenous Bone Grafts with Implants
- Autogenous Block Grafts
- Slide 21
- Intra-oral Autogenous Bone Sites
- Slide 23
- What about membranes
- Bone Morphogenic Protein (BMP)
- Slide 26
- Distraction Osteogenesis
- Slide 28
- Wise Old Oral Surgeon Says Beware of
- 3rd Molar Surgery ndash Why
- Extract 3rds OralSystemic Link
- Slide 32
- 3rd Molar Surgery ndash When
- 3rd Molar Surgery ndash When Not
- 3rd Molar Surgery Alternatives
- No High Speed
- Slide 38
- Which are true
- Slide 40
-
Completely unique and synthetic GEM 21Sreg is an innovative combination of a bioactive protein (highly purified recombinant human platelet derived growth factor rhPDGF-BB) and a biocompatible osteoconductive matrix (beta-tricalcium phosphate β-TCP)GEM 21Sreg contains 1000x more active growth factor (PDGF) than found in platelet rich plasma Compared to bone graft substitute without PDGFProvides 3x more bone fill at 6 monthsProvides a more predictable treatment option even in the most severe cases
Completely unique and synthetic GEM 21Sreg is an innovative combination of a bioactive protein (highly purified recombinant human platelet derived growth factor rhPDGF-BB) and a biocompatible osteoconductive matrix (beta-tricalcium phosphate β-TCP)GEM 21Sreg contains 1000x more active growth factor (PDGF) than found in platelet rich plasma Compared to bone graft substitute without PDGFProvides 3x more bone fill at 6 monthsProvides a more predictable treatment option even in the most severe cases
ldquoldquoSockets with intact buccal and lingual Sockets with intact buccal and lingual plates heal well without graftinghellip plates heal well without graftinghellip consider grafting with resorbable consider grafting with resorbable osteoinductive material if plates osteoinductive material if plates compromised and implants plannedrdquo compromised and implants plannedrdquo grafting with connective tissue if pontic grafting with connective tissue if pontic esthetics an issuerdquoesthetics an issuerdquo
ldquoldquoSockets with intact buccal and lingual Sockets with intact buccal and lingual plates heal well without graftinghellip plates heal well without graftinghellip consider grafting with resorbable consider grafting with resorbable osteoinductive material if plates osteoinductive material if plates compromised and implants plannedrdquo compromised and implants plannedrdquo grafting with connective tissue if pontic grafting with connective tissue if pontic esthetics an issuerdquoesthetics an issuerdquo
Vital Root RetentionVital Root RetentionbullNever our first choice but an option for
preserving alveolar bone when performing full mouth extractions on young patients
bullTeeth must be vital with good periodontal health
bullSimilar tooth selection as ldquoconventionalrdquo overdentures except elective endodontics not performed
bullNever our first choice but an option for preserving alveolar bone when performing full mouth extractions on young patients
bullTeeth must be vital with good periodontal health
bullSimilar tooth selection as ldquoconventionalrdquo overdentures except elective endodontics not performed
Vital Root RetentionVital Root RetentionbullAmputate teeth at crest then remove 2
mm more tooth ldquosub osseousrdquo
bullConsider grafting autogenous bone over tooth then close primarily
bullIdeally bone grows coronally over a vital asymptomatic root
bullDepending on rate of alveolar resorption will help preserve ridge 3-5 years before exposureextraction
bullAmputate teeth at crest then remove 2 mm more tooth ldquosub osseousrdquo
bullConsider grafting autogenous bone over tooth then close primarily
bullIdeally bone grows coronally over a vital asymptomatic root
bullDepending on rate of alveolar resorption will help preserve ridge 3-5 years before exposureextraction
Remove 2 mm tooth structure below bone
2 mm
Suture
New Bone Prosthesis
J Oral Maxillofac SurgJ Oral Maxillofac Surg 2005 Feb43(1)7-12 A 2005 Feb43(1)7-12 A randomized controlled clinical trial to randomized controlled clinical trial to compare the incidence of injury to the compare the incidence of injury to the inferior alveolar nerve as a result of inferior alveolar nerve as a result of coronectomy and removal of mandibular third coronectomy and removal of mandibular third molars Renton T Hankins M Sproate Cmolars Renton T Hankins M Sproate C
bull The length of follow up was about two The length of follow up was about two years which for the assessment of years which for the assessment of delayed eruption of the root fragments delayed eruption of the root fragments is not sufficient as this process may is not sufficient as this process may continue for up to 10 years However continue for up to 10 years However it seems that coronectomy reduces the it seems that coronectomy reduces the incidence of injury to the inferior incidence of injury to the inferior alveolar nerve without increasing the alveolar nerve without increasing the risk of dry socket or infection risk of dry socket or infection
J Oral Maxillofac Surg 2004 Dec62(12)1447-52 Coronectomy a technique to protect the inferior alveolar nerve Pogrel MA Lee JS Muff DF
J Oral Maxillofac Surg 2004 Dec62(12)1447-52 Coronectomy a technique to protect the inferior alveolar nerve Pogrel MA Lee JS Muff DF
PURPOSE Damage to the inferior alveolar nerve when extracting lower third molars is often caused by the intimate relationship between the nerve and the roots of the teeth The technique of coronectomy or intentional root retention may minimize this problem
PURPOSE Damage to the inferior alveolar nerve when extracting lower third molars is often caused by the intimate relationship between the nerve and the roots of the teeth The technique of coronectomy or intentional root retention may minimize this problemRESULTS There were no cases of inferior alveolar nerve-involved damage in this study of 41 patients who underwent 50 coronectomies There was 1 case of transient lingual nerve involvement probably from the use of the lingual retractor One patient required subsequent removal of the roots of both lower third molars because of failure to heal and 1 patient required subsequent removal of a root because of subsequent migration to the surface Root migration was noted in approximately 30 of patients over a 6 month period CONCLUSION Coronectomy appears to be a viable technique in those cases where removal of the whole tooth might put the inferior alveolar nerve at considerable risk of damage
RESULTS There were no cases of inferior alveolar nerve-involved damage in this study of 41 patients who underwent 50 coronectomies There was 1 case of transient lingual nerve involvement probably from the use of the lingual retractor One patient required subsequent removal of the roots of both lower third molars because of failure to heal and 1 patient required subsequent removal of a root because of subsequent migration to the surface Root migration was noted in approximately 30 of patients over a 6 month period CONCLUSION Coronectomy appears to be a viable technique in those cases where removal of the whole tooth might put the inferior alveolar nerve at considerable risk of damage
Pre-op (Oral Pre-op (Oral bisphosphonates X bisphosphonates X 5 years)5 years)
Immed Immed PostPost
10 month 10 month postpost
Immediate Implant Placement Following
Extractions
Immediate Implant Placement Following
ExtractionsbullNeed 3-4 mm of solid bone at base
of socket and no active infection
bullSuccess rates ~ to ldquonormalrdquo
bullMost typical sites anterior teeth and 1st premolars
bullAdvantages May reduce loss of labial plate and improve esthetics as well as save time
bullNeed 3-4 mm of solid bone at base of socket and no active infection
bullSuccess rates ~ to ldquonormalrdquo
bullMost typical sites anterior teeth and 1st premolars
bullAdvantages May reduce loss of labial plate and improve esthetics as well as save time
Platelet Rich PlasmaPlatelet Rich PlasmaPlatelet Rich PlasmaPlatelet Rich PlasmabullWhatrsquos HotWhatrsquos Hot
ndash Release various Release various growth factors that growth factors that aid in hemostasis aid in hemostasis and increase rate and increase rate of healing of healing (mitogenesis (mitogenesis angiogenesis) angiogenesis)
bullWhatrsquos HotWhatrsquos Hotndash Release various Release various
growth factors that growth factors that aid in hemostasis aid in hemostasis and increase rate and increase rate of healing of healing (mitogenesis (mitogenesis angiogenesis) angiogenesis)
bullWhatrsquos NotWhatrsquos Notndash CostCostndash Is there any Is there any
difference at 6 difference at 6 weeksweeks
ndash Invasive Invasive borrow 45-borrow 45-90ml of blood90ml of blood
bullWhatrsquos NotWhatrsquos Notndash CostCostndash Is there any Is there any
difference at 6 difference at 6 weeksweeks
ndash Invasive Invasive borrow 45-borrow 45-90ml of blood90ml of blood
Casap et al Immediate Implantation Into Debrided Infected Sockets J Oral Maxillofac Surg 2007
Does placing implants into fresh extraction Does placing implants into fresh extraction sockets preserve bonesockets preserve bone
J Clin Periodontol 2005 Jun32(6)645-52 Ridge alterations following implant placement in fresh extraction sockets an experimental study in the dogArauacutejo MG Sukekava F Wennstroumlm JL Lindhe J
CONCLUSIONS Marked dimensional alterations had occurred in the edentulous ridge after 3 months of healing following the extraction of the distal root of mandibular pre-molars The placement of an The placement of an implant in the fresh extraction site obviously implant in the fresh extraction site obviously failed to prevent the re-modeling that occurred failed to prevent the re-modeling that occurred in the walls of the socketin the walls of the socket The resulting height of the buccal and lingual walls at 3 months was similar at implants and edentulous sites
Most human trials however reveal results Most human trials however reveal results similar to implants place via the ldquoold similar to implants place via the ldquoold schoolrdquo approach even when immediately schoolrdquo approach even when immediately loaded (caution in ldquosoftrdquo bone gt55 YO)loaded (caution in ldquosoftrdquo bone gt55 YO)
Int J Oral Maxillofac Implants 2007 Mar-Apr22(2)187-94 The radiographic bone loss pattern adjacent to immediately placed immediately loaded implantsJaffin R Kolesar M Kumar A Ishikawa S Fiorellini J
J Craniofac Surg 2007 Jul18(4)965-71 Immediate loaded dental implants comparison between fixtures inserted in postextractive and healed bone sitesDegidi M Piattelli A Carinci F
J Periodontol 2007 May78(5)810-5 Vertical crestal bone changes around implants placed into fresh extraction socketsCovani U Cornelini R Barone A
Why ReconstructWhy Reconstruct
bullNot enough bone for implants
bullEnough bone but esthetic result suboptimal
bullPrevent pathologic fracture
bullPoor functionestheticsretention of conventional removable prosthesis
bullNot enough bone for implants
bullEnough bone but esthetic result suboptimal
bullPrevent pathologic fracture
bullPoor functionestheticsretention of conventional removable prosthesis
How Autogenous Bone Grafts
with Implants
How Autogenous Bone Grafts
with Implants
Autogenous Block GraftsAutogenous Block Grafts
bullldquoGold Standardrdquo
bullOsteoinductive and Osteoconductive
bullNo need for membranes
bullHolds form
bullRemodels into 100 high quality bone
bullNo concerns about transmissible diseases
bullldquoGold Standardrdquo
bullOsteoinductive and Osteoconductive
bullNo need for membranes
bullHolds form
bullRemodels into 100 high quality bone
bullNo concerns about transmissible diseases
Autogenous Block Grafts
Autogenous Block Grafts
bullDonor site morbidity
bullQuantity is limited
bullLose 20-30 during healing
bullDonor site morbidity
bullQuantity is limited
bullLose 20-30 during healing
Intra-oral Autogenous Bone Sites
AllogenicAllogenic Block Block GraftGraft
What about membranesWhat about membranes
bullUseful in containing particulate grafts
bullUseful around teethexposed implant threads
bullAdd expense
bull Infection risk
bullUnnecessary with block grafts
bullADA 4266 Resorbable
bullADA 4267 Non-Resorbable
bullUseful in containing particulate grafts
bullUseful around teethexposed implant threads
bullAdd expense
bull Infection risk
bullUnnecessary with block grafts
bullADA 4266 Resorbable
bullADA 4267 Non-Resorbable
Bone Morphogenic Protein (BMP)
Bone Morphogenic Protein (BMP)
bullGrow bone at will
bullPresently two are FDA approved BMP 2 for spinal fusions and BMP 7 for long bone defects
bullStudies show excellent results for socket preservation sinus lifts
bullExpensive ($500000 for a sinus)
bullGrow bone at will
bullPresently two are FDA approved BMP 2 for spinal fusions and BMP 7 for long bone defects
bullStudies show excellent results for socket preservation sinus lifts
bullExpensive ($500000 for a sinus)
FDA Panel Unanimously Recommends Approval of Third Indication For Medtronicrsquos INFUSE Bone Graft Nov 9 2006
FDA Panel Unanimously Recommends Approval of Third Indication For Medtronicrsquos INFUSE Bone Graft Nov 9 2006 INFUSE Bone Graft is recombinant human bone morphogenetic protein-2 (rhBMP-2) applied to an absorbable collagen sponge carrier The purpose of the protein which occurs naturally in the body is to stimulate bone formation It has been previously approved by the FDA for use in certain lumbar spine fusion and tibial fracture repair procedures
INFUSE Bone Graft is recombinant human bone morphogenetic protein-2 (rhBMP-2) applied to an absorbable collagen sponge carrier The purpose of the protein which occurs naturally in the body is to stimulate bone formation It has been previously approved by the FDA for use in certain lumbar spine fusion and tibial fracture repair procedures
Distraction OsteogenesisDistraction
OsteogenesisbullGeneration of bone (and soft
tissue) through distraction of an osseous callus
bullGeneration of bone (and soft tissue) through distraction of an osseous callus
Ann N Y Acad Sci 2006 Apr1068532-42 COX-2 has a critical role during incorporation of structural bone allografts OrsquoKeefe RJ Tiyapatanaputi P Xie C
Ann N Y Acad Sci 2006 Apr1068532-42 COX-2 has a critical role during incorporation of structural bone allografts OrsquoKeefe RJ Tiyapatanaputi P Xie C
Nonsteroidal anti-inflammatory drugs (NSAIDs) which inhibit cyclooxygenase (COX) activity reduce pain and are commonly used in patients with skeletal injury In this article we will also present data to show that selective COX-2 inhibitor delays allograft healing and incorporation These results demonstrated that COX-2 is essential for bone allograft incorporation Furthermore our data support the notion that COX-2-dependent PGE2 produced at the early stage of bone healing is prerequisite for efficient skeletal repair
Nonsteroidal anti-inflammatory drugs (NSAIDs) which inhibit cyclooxygenase (COX) activity reduce pain and are commonly used in patients with skeletal injury In this article we will also present data to show that selective COX-2 inhibitor delays allograft healing and incorporation These results demonstrated that COX-2 is essential for bone allograft incorporation Furthermore our data support the notion that COX-2-dependent PGE2 produced at the early stage of bone healing is prerequisite for efficient skeletal repair
Wise Old Oral Surgeon Wise Old Oral Surgeon Says Beware ofSays Beware of
Wise Old Oral Surgeon Wise Old Oral Surgeon Says Beware ofSays Beware of
bull 3rd molars in function3rd molars in function
bull Lone standing molarsLone standing molars
bull Teeth in bruxers Cl III skeletal patternsTeeth in bruxers Cl III skeletal patterns
bull 3rd molars + post-menopausal women3rd molars + post-menopausal women
bull Prior TMD historyPrior TMD history
bull Prior ldquobadrdquo oral surgery experiencePrior ldquobadrdquo oral surgery experience
bull Distoangular lower 3rds nerve proximityDistoangular lower 3rds nerve proximity
bull 3rd molars in function3rd molars in function
bull Lone standing molarsLone standing molars
bull Teeth in bruxers Cl III skeletal patternsTeeth in bruxers Cl III skeletal patterns
bull 3rd molars + post-menopausal women3rd molars + post-menopausal women
bull Prior TMD historyPrior TMD history
bull Prior ldquobadrdquo oral surgery experiencePrior ldquobadrdquo oral surgery experience
bull Distoangular lower 3rds nerve proximityDistoangular lower 3rds nerve proximity
3rd Molar Surgery ndash Why
3rd Molar Surgery ndash Why
1 Preventtreat pericoronitis (infection)2 Prevent periodontal problems 2nd molar3 Preventtreat caries to 2nd 3rd molar4 Prevent odontogenic cyststumors5 Strengthen mandible possible fx6 Prevent orthodontic relapse7 Treat pain of unknown origin
1 Preventtreat pericoronitis (infection)2 Prevent periodontal problems 2nd molar3 Preventtreat caries to 2nd 3rd molar4 Prevent odontogenic cyststumors5 Strengthen mandible possible fx6 Prevent orthodontic relapse7 Treat pain of unknown origin
Extract 3rds OralSystemic Extract 3rds OralSystemic LinkLink
CLEVELAND April 6 2006 - The first hard evidence has CLEVELAND April 6 2006 - The first hard evidence has been uncovered that bacteria in the mouth may find their been uncovered that bacteria in the mouth may find their way to the uterus causing uterine infections that can lead way to the uterus causing uterine infections that can lead to preterm birth in pregnant womento preterm birth in pregnant women
CLEVELAND April 6 2006 - The first hard evidence has CLEVELAND April 6 2006 - The first hard evidence has been uncovered that bacteria in the mouth may find their been uncovered that bacteria in the mouth may find their way to the uterus causing uterine infections that can lead way to the uterus causing uterine infections that can lead to preterm birth in pregnant womento preterm birth in pregnant women
A newly discovered and as yet unnamed species of the A newly discovered and as yet unnamed species of the bacterium genus bacterium genus BergeyellaBergeyella was found in the mouth was found in the mouth and amniotic fluid of a woman with a uterine infection and amniotic fluid of a woman with a uterine infection who gave birth prematurely (24 weeks) reported who gave birth prematurely (24 weeks) reported microbiologist Yiping W Han PhD of Case Western microbiologist Yiping W Han PhD of Case Western Reserve here Reserve here However the bacterium was not detected in a vaginal However the bacterium was not detected in a vaginal swab as might be expected The finding confirmed swab as might be expected The finding confirmed what some scientists have suspected that intrauterine what some scientists have suspected that intrauterine infections dont always ascend from the genital tract infections dont always ascend from the genital tract but can descend from the oral cavity Dr Han and but can descend from the oral cavity Dr Han and colleagues said in the April issue of the colleagues said in the April issue of the Journal of Journal of Clinical MicrobiologyClinical Microbiology
A newly discovered and as yet unnamed species of the A newly discovered and as yet unnamed species of the bacterium genus bacterium genus BergeyellaBergeyella was found in the mouth was found in the mouth and amniotic fluid of a woman with a uterine infection and amniotic fluid of a woman with a uterine infection who gave birth prematurely (24 weeks) reported who gave birth prematurely (24 weeks) reported microbiologist Yiping W Han PhD of Case Western microbiologist Yiping W Han PhD of Case Western Reserve here Reserve here However the bacterium was not detected in a vaginal However the bacterium was not detected in a vaginal swab as might be expected The finding confirmed swab as might be expected The finding confirmed what some scientists have suspected that intrauterine what some scientists have suspected that intrauterine infections dont always ascend from the genital tract infections dont always ascend from the genital tract but can descend from the oral cavity Dr Han and but can descend from the oral cavity Dr Han and colleagues said in the April issue of the colleagues said in the April issue of the Journal of Journal of Clinical MicrobiologyClinical Microbiology
Journal of Oral and Maxillofacial Journal of Oral and Maxillofacial SurgerySurgery
Volume 65 Issue 3 March 2007 Pages Volume 65 Issue 3 March 2007 Pages 377-383377-383
Progress Report on Third Molar Clinical Trials Progress Report on Third Molar Clinical Trials Raymond P White Jr DDS PhDRaymond P White Jr DDS PhD
1What happens to asymptomatic patients who keep their 1What happens to asymptomatic patients who keep their third molars third molars
2What is the recovery like for those who have them 2What is the recovery like for those who have them removed and what can we do as surgeons to improve removed and what can we do as surgeons to improve post operative outcomespost operative outcomes
3rd Molar Surgery ndash When3rd Molar Surgery ndash WhenbullBefore roots 100 developed
bullAfter roots 13 formed
bullMorbiditycomplications minimized as bone more flexible nerves more pliable and PMH less complicated
bullDonrsquot forget tooth transplanttooth transplant if apex not closed
bullBefore roots 100 developed
bullAfter roots 13 formed
bullMorbiditycomplications minimized as bone more flexible nerves more pliable and PMH less complicated
bullDonrsquot forget tooth transplanttooth transplant if apex not closed
Outcome of tooth transplantation survival and success rates 17-41 years post treatmentCzochrowska EM Stenvik A Bjercke B Zachrisson Am J Orthod Dentofacial Orthop 2002 Feb121(2)110-9The mean age at surgery was 115 years and the mean observation period was 264 264 years (range 17-41 years) Of the 33 teeth transplanted in the 28 patients 3 teeth were lost after 9 10 and 29 years respectively Therefore the 30 teeth in the 25 patients we examined yielded a survival rate of 90 The success rate was 79 because 2 transplants had ankylosed and 2 others failed to fulfill the proposed criteria The patients generally responded very favorably regarding their perception of the treatment Their only hesitation was related to some discomfort during surgery It was concluded that It was concluded that survival and success rates for teeth auto survival and success rates for teeth auto transplanted when the root is partly developed transplanted when the root is partly developed compare favorably in a long-term perspective compare favorably in a long-term perspective with other treatment modalities for with other treatment modalities for substituting missing teethsubstituting missing teeth
Outcome of tooth transplantation survival and success rates 17-41 years post treatmentCzochrowska EM Stenvik A Bjercke B Zachrisson Am J Orthod Dentofacial Orthop 2002 Feb121(2)110-9The mean age at surgery was 115 years and the mean observation period was 264 264 years (range 17-41 years) Of the 33 teeth transplanted in the 28 patients 3 teeth were lost after 9 10 and 29 years respectively Therefore the 30 teeth in the 25 patients we examined yielded a survival rate of 90 The success rate was 79 because 2 transplants had ankylosed and 2 others failed to fulfill the proposed criteria The patients generally responded very favorably regarding their perception of the treatment Their only hesitation was related to some discomfort during surgery It was concluded that It was concluded that survival and success rates for teeth auto survival and success rates for teeth auto transplanted when the root is partly developed transplanted when the root is partly developed compare favorably in a long-term perspective compare favorably in a long-term perspective with other treatment modalities for with other treatment modalities for substituting missing teethsubstituting missing teeth
3rd Molar Surgery ndash When Not
3rd Molar Surgery ndash When Not
bullExtremes of age
bullNo oral communication (full bony)
bullIntimate root-nerve Relationship
bullRisks gt Benefits
bullExtremes of age
bullNo oral communication (full bony)
bullIntimate root-nerve Relationship
bullRisks gt Benefits
3rd Molar Surgery Alternatives
3rd Molar Surgery Alternatives
bullNo Surgery dentist feels risk benefit ratio not favorable or patient refuses ndash document and recommend radiograph q 3-5 years
bullNo Surgery dentist feels risk benefit ratio not favorable or patient refuses ndash document and recommend radiograph q 3-5 years
No High SpeedNo High Speed
bullAir embolus
bullAir emphysema
bullBlow debris into flap
bullBlow bacteria into flap
bullNon-sterile water
bullAir embolus
bullAir emphysema
bullBlow debris into flap
bullBlow bacteria into flap
bullNon-sterile water
Which are trueWhich are true1 Tooth transplants are usually done on
patients 20-302 Average success rate for a tooth
transplant is 20-303 In order to work a transplant must
have endo4 Most transplants will ankylose
A 13 B 24 C 123 D 3 only
E None of the above
1 Tooth transplants are usually done on patients 20-30
2 Average success rate for a tooth transplant is 20-30
3 In order to work a transplant must have endo
4 Most transplants will ankylose
A 13 B 24 C 123 D 3 only
E None of the above
How can I assess the relationship How can I assess the relationship between the 3between the 3rdrd molar root and the molar root and the
inferior alveolar nerveinferior alveolar nerve
- Slide 2
- Slide 3
- Slide 4
- ldquoSockets with intact buccal and lingual plates heal well without graftinghellip consider grafting with resorbable osteoinductive material if plates compromised and implants plannedrdquo grafting with connective tissue if pontic esthetics an issuerdquo
- Vital Root Retention
- Slide 7
- Slide 8
- Slide 9
- J Oral Maxillofac Surg 2005 Feb43(1)7-12 A randomized controlled clinical trial to compare the incidence of injury to the inferior alveolar nerve as a result of coronectomy and removal of mandibular third molars Renton T Hankins M Sproate C
- Slide 11
- Slide 12
- Immediate Implant Placement Following Extractions
- Platelet Rich Plasma
- Slide 15
- Slide 16
- Slide 17
- Why Reconstruct
- How Autogenous Bone Grafts with Implants
- Autogenous Block Grafts
- Slide 21
- Intra-oral Autogenous Bone Sites
- Slide 23
- What about membranes
- Bone Morphogenic Protein (BMP)
- Slide 26
- Distraction Osteogenesis
- Slide 28
- Wise Old Oral Surgeon Says Beware of
- 3rd Molar Surgery ndash Why
- Extract 3rds OralSystemic Link
- Slide 32
- 3rd Molar Surgery ndash When
- 3rd Molar Surgery ndash When Not
- 3rd Molar Surgery Alternatives
- No High Speed
- Slide 38
- Which are true
- Slide 40
-
ldquoldquoSockets with intact buccal and lingual Sockets with intact buccal and lingual plates heal well without graftinghellip plates heal well without graftinghellip consider grafting with resorbable consider grafting with resorbable osteoinductive material if plates osteoinductive material if plates compromised and implants plannedrdquo compromised and implants plannedrdquo grafting with connective tissue if pontic grafting with connective tissue if pontic esthetics an issuerdquoesthetics an issuerdquo
ldquoldquoSockets with intact buccal and lingual Sockets with intact buccal and lingual plates heal well without graftinghellip plates heal well without graftinghellip consider grafting with resorbable consider grafting with resorbable osteoinductive material if plates osteoinductive material if plates compromised and implants plannedrdquo compromised and implants plannedrdquo grafting with connective tissue if pontic grafting with connective tissue if pontic esthetics an issuerdquoesthetics an issuerdquo
Vital Root RetentionVital Root RetentionbullNever our first choice but an option for
preserving alveolar bone when performing full mouth extractions on young patients
bullTeeth must be vital with good periodontal health
bullSimilar tooth selection as ldquoconventionalrdquo overdentures except elective endodontics not performed
bullNever our first choice but an option for preserving alveolar bone when performing full mouth extractions on young patients
bullTeeth must be vital with good periodontal health
bullSimilar tooth selection as ldquoconventionalrdquo overdentures except elective endodontics not performed
Vital Root RetentionVital Root RetentionbullAmputate teeth at crest then remove 2
mm more tooth ldquosub osseousrdquo
bullConsider grafting autogenous bone over tooth then close primarily
bullIdeally bone grows coronally over a vital asymptomatic root
bullDepending on rate of alveolar resorption will help preserve ridge 3-5 years before exposureextraction
bullAmputate teeth at crest then remove 2 mm more tooth ldquosub osseousrdquo
bullConsider grafting autogenous bone over tooth then close primarily
bullIdeally bone grows coronally over a vital asymptomatic root
bullDepending on rate of alveolar resorption will help preserve ridge 3-5 years before exposureextraction
Remove 2 mm tooth structure below bone
2 mm
Suture
New Bone Prosthesis
J Oral Maxillofac SurgJ Oral Maxillofac Surg 2005 Feb43(1)7-12 A 2005 Feb43(1)7-12 A randomized controlled clinical trial to randomized controlled clinical trial to compare the incidence of injury to the compare the incidence of injury to the inferior alveolar nerve as a result of inferior alveolar nerve as a result of coronectomy and removal of mandibular third coronectomy and removal of mandibular third molars Renton T Hankins M Sproate Cmolars Renton T Hankins M Sproate C
bull The length of follow up was about two The length of follow up was about two years which for the assessment of years which for the assessment of delayed eruption of the root fragments delayed eruption of the root fragments is not sufficient as this process may is not sufficient as this process may continue for up to 10 years However continue for up to 10 years However it seems that coronectomy reduces the it seems that coronectomy reduces the incidence of injury to the inferior incidence of injury to the inferior alveolar nerve without increasing the alveolar nerve without increasing the risk of dry socket or infection risk of dry socket or infection
J Oral Maxillofac Surg 2004 Dec62(12)1447-52 Coronectomy a technique to protect the inferior alveolar nerve Pogrel MA Lee JS Muff DF
J Oral Maxillofac Surg 2004 Dec62(12)1447-52 Coronectomy a technique to protect the inferior alveolar nerve Pogrel MA Lee JS Muff DF
PURPOSE Damage to the inferior alveolar nerve when extracting lower third molars is often caused by the intimate relationship between the nerve and the roots of the teeth The technique of coronectomy or intentional root retention may minimize this problem
PURPOSE Damage to the inferior alveolar nerve when extracting lower third molars is often caused by the intimate relationship between the nerve and the roots of the teeth The technique of coronectomy or intentional root retention may minimize this problemRESULTS There were no cases of inferior alveolar nerve-involved damage in this study of 41 patients who underwent 50 coronectomies There was 1 case of transient lingual nerve involvement probably from the use of the lingual retractor One patient required subsequent removal of the roots of both lower third molars because of failure to heal and 1 patient required subsequent removal of a root because of subsequent migration to the surface Root migration was noted in approximately 30 of patients over a 6 month period CONCLUSION Coronectomy appears to be a viable technique in those cases where removal of the whole tooth might put the inferior alveolar nerve at considerable risk of damage
RESULTS There were no cases of inferior alveolar nerve-involved damage in this study of 41 patients who underwent 50 coronectomies There was 1 case of transient lingual nerve involvement probably from the use of the lingual retractor One patient required subsequent removal of the roots of both lower third molars because of failure to heal and 1 patient required subsequent removal of a root because of subsequent migration to the surface Root migration was noted in approximately 30 of patients over a 6 month period CONCLUSION Coronectomy appears to be a viable technique in those cases where removal of the whole tooth might put the inferior alveolar nerve at considerable risk of damage
Pre-op (Oral Pre-op (Oral bisphosphonates X bisphosphonates X 5 years)5 years)
Immed Immed PostPost
10 month 10 month postpost
Immediate Implant Placement Following
Extractions
Immediate Implant Placement Following
ExtractionsbullNeed 3-4 mm of solid bone at base
of socket and no active infection
bullSuccess rates ~ to ldquonormalrdquo
bullMost typical sites anterior teeth and 1st premolars
bullAdvantages May reduce loss of labial plate and improve esthetics as well as save time
bullNeed 3-4 mm of solid bone at base of socket and no active infection
bullSuccess rates ~ to ldquonormalrdquo
bullMost typical sites anterior teeth and 1st premolars
bullAdvantages May reduce loss of labial plate and improve esthetics as well as save time
Platelet Rich PlasmaPlatelet Rich PlasmaPlatelet Rich PlasmaPlatelet Rich PlasmabullWhatrsquos HotWhatrsquos Hot
ndash Release various Release various growth factors that growth factors that aid in hemostasis aid in hemostasis and increase rate and increase rate of healing of healing (mitogenesis (mitogenesis angiogenesis) angiogenesis)
bullWhatrsquos HotWhatrsquos Hotndash Release various Release various
growth factors that growth factors that aid in hemostasis aid in hemostasis and increase rate and increase rate of healing of healing (mitogenesis (mitogenesis angiogenesis) angiogenesis)
bullWhatrsquos NotWhatrsquos Notndash CostCostndash Is there any Is there any
difference at 6 difference at 6 weeksweeks
ndash Invasive Invasive borrow 45-borrow 45-90ml of blood90ml of blood
bullWhatrsquos NotWhatrsquos Notndash CostCostndash Is there any Is there any
difference at 6 difference at 6 weeksweeks
ndash Invasive Invasive borrow 45-borrow 45-90ml of blood90ml of blood
Casap et al Immediate Implantation Into Debrided Infected Sockets J Oral Maxillofac Surg 2007
Does placing implants into fresh extraction Does placing implants into fresh extraction sockets preserve bonesockets preserve bone
J Clin Periodontol 2005 Jun32(6)645-52 Ridge alterations following implant placement in fresh extraction sockets an experimental study in the dogArauacutejo MG Sukekava F Wennstroumlm JL Lindhe J
CONCLUSIONS Marked dimensional alterations had occurred in the edentulous ridge after 3 months of healing following the extraction of the distal root of mandibular pre-molars The placement of an The placement of an implant in the fresh extraction site obviously implant in the fresh extraction site obviously failed to prevent the re-modeling that occurred failed to prevent the re-modeling that occurred in the walls of the socketin the walls of the socket The resulting height of the buccal and lingual walls at 3 months was similar at implants and edentulous sites
Most human trials however reveal results Most human trials however reveal results similar to implants place via the ldquoold similar to implants place via the ldquoold schoolrdquo approach even when immediately schoolrdquo approach even when immediately loaded (caution in ldquosoftrdquo bone gt55 YO)loaded (caution in ldquosoftrdquo bone gt55 YO)
Int J Oral Maxillofac Implants 2007 Mar-Apr22(2)187-94 The radiographic bone loss pattern adjacent to immediately placed immediately loaded implantsJaffin R Kolesar M Kumar A Ishikawa S Fiorellini J
J Craniofac Surg 2007 Jul18(4)965-71 Immediate loaded dental implants comparison between fixtures inserted in postextractive and healed bone sitesDegidi M Piattelli A Carinci F
J Periodontol 2007 May78(5)810-5 Vertical crestal bone changes around implants placed into fresh extraction socketsCovani U Cornelini R Barone A
Why ReconstructWhy Reconstruct
bullNot enough bone for implants
bullEnough bone but esthetic result suboptimal
bullPrevent pathologic fracture
bullPoor functionestheticsretention of conventional removable prosthesis
bullNot enough bone for implants
bullEnough bone but esthetic result suboptimal
bullPrevent pathologic fracture
bullPoor functionestheticsretention of conventional removable prosthesis
How Autogenous Bone Grafts
with Implants
How Autogenous Bone Grafts
with Implants
Autogenous Block GraftsAutogenous Block Grafts
bullldquoGold Standardrdquo
bullOsteoinductive and Osteoconductive
bullNo need for membranes
bullHolds form
bullRemodels into 100 high quality bone
bullNo concerns about transmissible diseases
bullldquoGold Standardrdquo
bullOsteoinductive and Osteoconductive
bullNo need for membranes
bullHolds form
bullRemodels into 100 high quality bone
bullNo concerns about transmissible diseases
Autogenous Block Grafts
Autogenous Block Grafts
bullDonor site morbidity
bullQuantity is limited
bullLose 20-30 during healing
bullDonor site morbidity
bullQuantity is limited
bullLose 20-30 during healing
Intra-oral Autogenous Bone Sites
AllogenicAllogenic Block Block GraftGraft
What about membranesWhat about membranes
bullUseful in containing particulate grafts
bullUseful around teethexposed implant threads
bullAdd expense
bull Infection risk
bullUnnecessary with block grafts
bullADA 4266 Resorbable
bullADA 4267 Non-Resorbable
bullUseful in containing particulate grafts
bullUseful around teethexposed implant threads
bullAdd expense
bull Infection risk
bullUnnecessary with block grafts
bullADA 4266 Resorbable
bullADA 4267 Non-Resorbable
Bone Morphogenic Protein (BMP)
Bone Morphogenic Protein (BMP)
bullGrow bone at will
bullPresently two are FDA approved BMP 2 for spinal fusions and BMP 7 for long bone defects
bullStudies show excellent results for socket preservation sinus lifts
bullExpensive ($500000 for a sinus)
bullGrow bone at will
bullPresently two are FDA approved BMP 2 for spinal fusions and BMP 7 for long bone defects
bullStudies show excellent results for socket preservation sinus lifts
bullExpensive ($500000 for a sinus)
FDA Panel Unanimously Recommends Approval of Third Indication For Medtronicrsquos INFUSE Bone Graft Nov 9 2006
FDA Panel Unanimously Recommends Approval of Third Indication For Medtronicrsquos INFUSE Bone Graft Nov 9 2006 INFUSE Bone Graft is recombinant human bone morphogenetic protein-2 (rhBMP-2) applied to an absorbable collagen sponge carrier The purpose of the protein which occurs naturally in the body is to stimulate bone formation It has been previously approved by the FDA for use in certain lumbar spine fusion and tibial fracture repair procedures
INFUSE Bone Graft is recombinant human bone morphogenetic protein-2 (rhBMP-2) applied to an absorbable collagen sponge carrier The purpose of the protein which occurs naturally in the body is to stimulate bone formation It has been previously approved by the FDA for use in certain lumbar spine fusion and tibial fracture repair procedures
Distraction OsteogenesisDistraction
OsteogenesisbullGeneration of bone (and soft
tissue) through distraction of an osseous callus
bullGeneration of bone (and soft tissue) through distraction of an osseous callus
Ann N Y Acad Sci 2006 Apr1068532-42 COX-2 has a critical role during incorporation of structural bone allografts OrsquoKeefe RJ Tiyapatanaputi P Xie C
Ann N Y Acad Sci 2006 Apr1068532-42 COX-2 has a critical role during incorporation of structural bone allografts OrsquoKeefe RJ Tiyapatanaputi P Xie C
Nonsteroidal anti-inflammatory drugs (NSAIDs) which inhibit cyclooxygenase (COX) activity reduce pain and are commonly used in patients with skeletal injury In this article we will also present data to show that selective COX-2 inhibitor delays allograft healing and incorporation These results demonstrated that COX-2 is essential for bone allograft incorporation Furthermore our data support the notion that COX-2-dependent PGE2 produced at the early stage of bone healing is prerequisite for efficient skeletal repair
Nonsteroidal anti-inflammatory drugs (NSAIDs) which inhibit cyclooxygenase (COX) activity reduce pain and are commonly used in patients with skeletal injury In this article we will also present data to show that selective COX-2 inhibitor delays allograft healing and incorporation These results demonstrated that COX-2 is essential for bone allograft incorporation Furthermore our data support the notion that COX-2-dependent PGE2 produced at the early stage of bone healing is prerequisite for efficient skeletal repair
Wise Old Oral Surgeon Wise Old Oral Surgeon Says Beware ofSays Beware of
Wise Old Oral Surgeon Wise Old Oral Surgeon Says Beware ofSays Beware of
bull 3rd molars in function3rd molars in function
bull Lone standing molarsLone standing molars
bull Teeth in bruxers Cl III skeletal patternsTeeth in bruxers Cl III skeletal patterns
bull 3rd molars + post-menopausal women3rd molars + post-menopausal women
bull Prior TMD historyPrior TMD history
bull Prior ldquobadrdquo oral surgery experiencePrior ldquobadrdquo oral surgery experience
bull Distoangular lower 3rds nerve proximityDistoangular lower 3rds nerve proximity
bull 3rd molars in function3rd molars in function
bull Lone standing molarsLone standing molars
bull Teeth in bruxers Cl III skeletal patternsTeeth in bruxers Cl III skeletal patterns
bull 3rd molars + post-menopausal women3rd molars + post-menopausal women
bull Prior TMD historyPrior TMD history
bull Prior ldquobadrdquo oral surgery experiencePrior ldquobadrdquo oral surgery experience
bull Distoangular lower 3rds nerve proximityDistoangular lower 3rds nerve proximity
3rd Molar Surgery ndash Why
3rd Molar Surgery ndash Why
1 Preventtreat pericoronitis (infection)2 Prevent periodontal problems 2nd molar3 Preventtreat caries to 2nd 3rd molar4 Prevent odontogenic cyststumors5 Strengthen mandible possible fx6 Prevent orthodontic relapse7 Treat pain of unknown origin
1 Preventtreat pericoronitis (infection)2 Prevent periodontal problems 2nd molar3 Preventtreat caries to 2nd 3rd molar4 Prevent odontogenic cyststumors5 Strengthen mandible possible fx6 Prevent orthodontic relapse7 Treat pain of unknown origin
Extract 3rds OralSystemic Extract 3rds OralSystemic LinkLink
CLEVELAND April 6 2006 - The first hard evidence has CLEVELAND April 6 2006 - The first hard evidence has been uncovered that bacteria in the mouth may find their been uncovered that bacteria in the mouth may find their way to the uterus causing uterine infections that can lead way to the uterus causing uterine infections that can lead to preterm birth in pregnant womento preterm birth in pregnant women
CLEVELAND April 6 2006 - The first hard evidence has CLEVELAND April 6 2006 - The first hard evidence has been uncovered that bacteria in the mouth may find their been uncovered that bacteria in the mouth may find their way to the uterus causing uterine infections that can lead way to the uterus causing uterine infections that can lead to preterm birth in pregnant womento preterm birth in pregnant women
A newly discovered and as yet unnamed species of the A newly discovered and as yet unnamed species of the bacterium genus bacterium genus BergeyellaBergeyella was found in the mouth was found in the mouth and amniotic fluid of a woman with a uterine infection and amniotic fluid of a woman with a uterine infection who gave birth prematurely (24 weeks) reported who gave birth prematurely (24 weeks) reported microbiologist Yiping W Han PhD of Case Western microbiologist Yiping W Han PhD of Case Western Reserve here Reserve here However the bacterium was not detected in a vaginal However the bacterium was not detected in a vaginal swab as might be expected The finding confirmed swab as might be expected The finding confirmed what some scientists have suspected that intrauterine what some scientists have suspected that intrauterine infections dont always ascend from the genital tract infections dont always ascend from the genital tract but can descend from the oral cavity Dr Han and but can descend from the oral cavity Dr Han and colleagues said in the April issue of the colleagues said in the April issue of the Journal of Journal of Clinical MicrobiologyClinical Microbiology
A newly discovered and as yet unnamed species of the A newly discovered and as yet unnamed species of the bacterium genus bacterium genus BergeyellaBergeyella was found in the mouth was found in the mouth and amniotic fluid of a woman with a uterine infection and amniotic fluid of a woman with a uterine infection who gave birth prematurely (24 weeks) reported who gave birth prematurely (24 weeks) reported microbiologist Yiping W Han PhD of Case Western microbiologist Yiping W Han PhD of Case Western Reserve here Reserve here However the bacterium was not detected in a vaginal However the bacterium was not detected in a vaginal swab as might be expected The finding confirmed swab as might be expected The finding confirmed what some scientists have suspected that intrauterine what some scientists have suspected that intrauterine infections dont always ascend from the genital tract infections dont always ascend from the genital tract but can descend from the oral cavity Dr Han and but can descend from the oral cavity Dr Han and colleagues said in the April issue of the colleagues said in the April issue of the Journal of Journal of Clinical MicrobiologyClinical Microbiology
Journal of Oral and Maxillofacial Journal of Oral and Maxillofacial SurgerySurgery
Volume 65 Issue 3 March 2007 Pages Volume 65 Issue 3 March 2007 Pages 377-383377-383
Progress Report on Third Molar Clinical Trials Progress Report on Third Molar Clinical Trials Raymond P White Jr DDS PhDRaymond P White Jr DDS PhD
1What happens to asymptomatic patients who keep their 1What happens to asymptomatic patients who keep their third molars third molars
2What is the recovery like for those who have them 2What is the recovery like for those who have them removed and what can we do as surgeons to improve removed and what can we do as surgeons to improve post operative outcomespost operative outcomes
3rd Molar Surgery ndash When3rd Molar Surgery ndash WhenbullBefore roots 100 developed
bullAfter roots 13 formed
bullMorbiditycomplications minimized as bone more flexible nerves more pliable and PMH less complicated
bullDonrsquot forget tooth transplanttooth transplant if apex not closed
bullBefore roots 100 developed
bullAfter roots 13 formed
bullMorbiditycomplications minimized as bone more flexible nerves more pliable and PMH less complicated
bullDonrsquot forget tooth transplanttooth transplant if apex not closed
Outcome of tooth transplantation survival and success rates 17-41 years post treatmentCzochrowska EM Stenvik A Bjercke B Zachrisson Am J Orthod Dentofacial Orthop 2002 Feb121(2)110-9The mean age at surgery was 115 years and the mean observation period was 264 264 years (range 17-41 years) Of the 33 teeth transplanted in the 28 patients 3 teeth were lost after 9 10 and 29 years respectively Therefore the 30 teeth in the 25 patients we examined yielded a survival rate of 90 The success rate was 79 because 2 transplants had ankylosed and 2 others failed to fulfill the proposed criteria The patients generally responded very favorably regarding their perception of the treatment Their only hesitation was related to some discomfort during surgery It was concluded that It was concluded that survival and success rates for teeth auto survival and success rates for teeth auto transplanted when the root is partly developed transplanted when the root is partly developed compare favorably in a long-term perspective compare favorably in a long-term perspective with other treatment modalities for with other treatment modalities for substituting missing teethsubstituting missing teeth
Outcome of tooth transplantation survival and success rates 17-41 years post treatmentCzochrowska EM Stenvik A Bjercke B Zachrisson Am J Orthod Dentofacial Orthop 2002 Feb121(2)110-9The mean age at surgery was 115 years and the mean observation period was 264 264 years (range 17-41 years) Of the 33 teeth transplanted in the 28 patients 3 teeth were lost after 9 10 and 29 years respectively Therefore the 30 teeth in the 25 patients we examined yielded a survival rate of 90 The success rate was 79 because 2 transplants had ankylosed and 2 others failed to fulfill the proposed criteria The patients generally responded very favorably regarding their perception of the treatment Their only hesitation was related to some discomfort during surgery It was concluded that It was concluded that survival and success rates for teeth auto survival and success rates for teeth auto transplanted when the root is partly developed transplanted when the root is partly developed compare favorably in a long-term perspective compare favorably in a long-term perspective with other treatment modalities for with other treatment modalities for substituting missing teethsubstituting missing teeth
3rd Molar Surgery ndash When Not
3rd Molar Surgery ndash When Not
bullExtremes of age
bullNo oral communication (full bony)
bullIntimate root-nerve Relationship
bullRisks gt Benefits
bullExtremes of age
bullNo oral communication (full bony)
bullIntimate root-nerve Relationship
bullRisks gt Benefits
3rd Molar Surgery Alternatives
3rd Molar Surgery Alternatives
bullNo Surgery dentist feels risk benefit ratio not favorable or patient refuses ndash document and recommend radiograph q 3-5 years
bullNo Surgery dentist feels risk benefit ratio not favorable or patient refuses ndash document and recommend radiograph q 3-5 years
No High SpeedNo High Speed
bullAir embolus
bullAir emphysema
bullBlow debris into flap
bullBlow bacteria into flap
bullNon-sterile water
bullAir embolus
bullAir emphysema
bullBlow debris into flap
bullBlow bacteria into flap
bullNon-sterile water
Which are trueWhich are true1 Tooth transplants are usually done on
patients 20-302 Average success rate for a tooth
transplant is 20-303 In order to work a transplant must
have endo4 Most transplants will ankylose
A 13 B 24 C 123 D 3 only
E None of the above
1 Tooth transplants are usually done on patients 20-30
2 Average success rate for a tooth transplant is 20-30
3 In order to work a transplant must have endo
4 Most transplants will ankylose
A 13 B 24 C 123 D 3 only
E None of the above
How can I assess the relationship How can I assess the relationship between the 3between the 3rdrd molar root and the molar root and the
inferior alveolar nerveinferior alveolar nerve
- Slide 2
- Slide 3
- Slide 4
- ldquoSockets with intact buccal and lingual plates heal well without graftinghellip consider grafting with resorbable osteoinductive material if plates compromised and implants plannedrdquo grafting with connective tissue if pontic esthetics an issuerdquo
- Vital Root Retention
- Slide 7
- Slide 8
- Slide 9
- J Oral Maxillofac Surg 2005 Feb43(1)7-12 A randomized controlled clinical trial to compare the incidence of injury to the inferior alveolar nerve as a result of coronectomy and removal of mandibular third molars Renton T Hankins M Sproate C
- Slide 11
- Slide 12
- Immediate Implant Placement Following Extractions
- Platelet Rich Plasma
- Slide 15
- Slide 16
- Slide 17
- Why Reconstruct
- How Autogenous Bone Grafts with Implants
- Autogenous Block Grafts
- Slide 21
- Intra-oral Autogenous Bone Sites
- Slide 23
- What about membranes
- Bone Morphogenic Protein (BMP)
- Slide 26
- Distraction Osteogenesis
- Slide 28
- Wise Old Oral Surgeon Says Beware of
- 3rd Molar Surgery ndash Why
- Extract 3rds OralSystemic Link
- Slide 32
- 3rd Molar Surgery ndash When
- 3rd Molar Surgery ndash When Not
- 3rd Molar Surgery Alternatives
- No High Speed
- Slide 38
- Which are true
- Slide 40
-
Vital Root RetentionVital Root RetentionbullNever our first choice but an option for
preserving alveolar bone when performing full mouth extractions on young patients
bullTeeth must be vital with good periodontal health
bullSimilar tooth selection as ldquoconventionalrdquo overdentures except elective endodontics not performed
bullNever our first choice but an option for preserving alveolar bone when performing full mouth extractions on young patients
bullTeeth must be vital with good periodontal health
bullSimilar tooth selection as ldquoconventionalrdquo overdentures except elective endodontics not performed
Vital Root RetentionVital Root RetentionbullAmputate teeth at crest then remove 2
mm more tooth ldquosub osseousrdquo
bullConsider grafting autogenous bone over tooth then close primarily
bullIdeally bone grows coronally over a vital asymptomatic root
bullDepending on rate of alveolar resorption will help preserve ridge 3-5 years before exposureextraction
bullAmputate teeth at crest then remove 2 mm more tooth ldquosub osseousrdquo
bullConsider grafting autogenous bone over tooth then close primarily
bullIdeally bone grows coronally over a vital asymptomatic root
bullDepending on rate of alveolar resorption will help preserve ridge 3-5 years before exposureextraction
Remove 2 mm tooth structure below bone
2 mm
Suture
New Bone Prosthesis
J Oral Maxillofac SurgJ Oral Maxillofac Surg 2005 Feb43(1)7-12 A 2005 Feb43(1)7-12 A randomized controlled clinical trial to randomized controlled clinical trial to compare the incidence of injury to the compare the incidence of injury to the inferior alveolar nerve as a result of inferior alveolar nerve as a result of coronectomy and removal of mandibular third coronectomy and removal of mandibular third molars Renton T Hankins M Sproate Cmolars Renton T Hankins M Sproate C
bull The length of follow up was about two The length of follow up was about two years which for the assessment of years which for the assessment of delayed eruption of the root fragments delayed eruption of the root fragments is not sufficient as this process may is not sufficient as this process may continue for up to 10 years However continue for up to 10 years However it seems that coronectomy reduces the it seems that coronectomy reduces the incidence of injury to the inferior incidence of injury to the inferior alveolar nerve without increasing the alveolar nerve without increasing the risk of dry socket or infection risk of dry socket or infection
J Oral Maxillofac Surg 2004 Dec62(12)1447-52 Coronectomy a technique to protect the inferior alveolar nerve Pogrel MA Lee JS Muff DF
J Oral Maxillofac Surg 2004 Dec62(12)1447-52 Coronectomy a technique to protect the inferior alveolar nerve Pogrel MA Lee JS Muff DF
PURPOSE Damage to the inferior alveolar nerve when extracting lower third molars is often caused by the intimate relationship between the nerve and the roots of the teeth The technique of coronectomy or intentional root retention may minimize this problem
PURPOSE Damage to the inferior alveolar nerve when extracting lower third molars is often caused by the intimate relationship between the nerve and the roots of the teeth The technique of coronectomy or intentional root retention may minimize this problemRESULTS There were no cases of inferior alveolar nerve-involved damage in this study of 41 patients who underwent 50 coronectomies There was 1 case of transient lingual nerve involvement probably from the use of the lingual retractor One patient required subsequent removal of the roots of both lower third molars because of failure to heal and 1 patient required subsequent removal of a root because of subsequent migration to the surface Root migration was noted in approximately 30 of patients over a 6 month period CONCLUSION Coronectomy appears to be a viable technique in those cases where removal of the whole tooth might put the inferior alveolar nerve at considerable risk of damage
RESULTS There were no cases of inferior alveolar nerve-involved damage in this study of 41 patients who underwent 50 coronectomies There was 1 case of transient lingual nerve involvement probably from the use of the lingual retractor One patient required subsequent removal of the roots of both lower third molars because of failure to heal and 1 patient required subsequent removal of a root because of subsequent migration to the surface Root migration was noted in approximately 30 of patients over a 6 month period CONCLUSION Coronectomy appears to be a viable technique in those cases where removal of the whole tooth might put the inferior alveolar nerve at considerable risk of damage
Pre-op (Oral Pre-op (Oral bisphosphonates X bisphosphonates X 5 years)5 years)
Immed Immed PostPost
10 month 10 month postpost
Immediate Implant Placement Following
Extractions
Immediate Implant Placement Following
ExtractionsbullNeed 3-4 mm of solid bone at base
of socket and no active infection
bullSuccess rates ~ to ldquonormalrdquo
bullMost typical sites anterior teeth and 1st premolars
bullAdvantages May reduce loss of labial plate and improve esthetics as well as save time
bullNeed 3-4 mm of solid bone at base of socket and no active infection
bullSuccess rates ~ to ldquonormalrdquo
bullMost typical sites anterior teeth and 1st premolars
bullAdvantages May reduce loss of labial plate and improve esthetics as well as save time
Platelet Rich PlasmaPlatelet Rich PlasmaPlatelet Rich PlasmaPlatelet Rich PlasmabullWhatrsquos HotWhatrsquos Hot
ndash Release various Release various growth factors that growth factors that aid in hemostasis aid in hemostasis and increase rate and increase rate of healing of healing (mitogenesis (mitogenesis angiogenesis) angiogenesis)
bullWhatrsquos HotWhatrsquos Hotndash Release various Release various
growth factors that growth factors that aid in hemostasis aid in hemostasis and increase rate and increase rate of healing of healing (mitogenesis (mitogenesis angiogenesis) angiogenesis)
bullWhatrsquos NotWhatrsquos Notndash CostCostndash Is there any Is there any
difference at 6 difference at 6 weeksweeks
ndash Invasive Invasive borrow 45-borrow 45-90ml of blood90ml of blood
bullWhatrsquos NotWhatrsquos Notndash CostCostndash Is there any Is there any
difference at 6 difference at 6 weeksweeks
ndash Invasive Invasive borrow 45-borrow 45-90ml of blood90ml of blood
Casap et al Immediate Implantation Into Debrided Infected Sockets J Oral Maxillofac Surg 2007
Does placing implants into fresh extraction Does placing implants into fresh extraction sockets preserve bonesockets preserve bone
J Clin Periodontol 2005 Jun32(6)645-52 Ridge alterations following implant placement in fresh extraction sockets an experimental study in the dogArauacutejo MG Sukekava F Wennstroumlm JL Lindhe J
CONCLUSIONS Marked dimensional alterations had occurred in the edentulous ridge after 3 months of healing following the extraction of the distal root of mandibular pre-molars The placement of an The placement of an implant in the fresh extraction site obviously implant in the fresh extraction site obviously failed to prevent the re-modeling that occurred failed to prevent the re-modeling that occurred in the walls of the socketin the walls of the socket The resulting height of the buccal and lingual walls at 3 months was similar at implants and edentulous sites
Most human trials however reveal results Most human trials however reveal results similar to implants place via the ldquoold similar to implants place via the ldquoold schoolrdquo approach even when immediately schoolrdquo approach even when immediately loaded (caution in ldquosoftrdquo bone gt55 YO)loaded (caution in ldquosoftrdquo bone gt55 YO)
Int J Oral Maxillofac Implants 2007 Mar-Apr22(2)187-94 The radiographic bone loss pattern adjacent to immediately placed immediately loaded implantsJaffin R Kolesar M Kumar A Ishikawa S Fiorellini J
J Craniofac Surg 2007 Jul18(4)965-71 Immediate loaded dental implants comparison between fixtures inserted in postextractive and healed bone sitesDegidi M Piattelli A Carinci F
J Periodontol 2007 May78(5)810-5 Vertical crestal bone changes around implants placed into fresh extraction socketsCovani U Cornelini R Barone A
Why ReconstructWhy Reconstruct
bullNot enough bone for implants
bullEnough bone but esthetic result suboptimal
bullPrevent pathologic fracture
bullPoor functionestheticsretention of conventional removable prosthesis
bullNot enough bone for implants
bullEnough bone but esthetic result suboptimal
bullPrevent pathologic fracture
bullPoor functionestheticsretention of conventional removable prosthesis
How Autogenous Bone Grafts
with Implants
How Autogenous Bone Grafts
with Implants
Autogenous Block GraftsAutogenous Block Grafts
bullldquoGold Standardrdquo
bullOsteoinductive and Osteoconductive
bullNo need for membranes
bullHolds form
bullRemodels into 100 high quality bone
bullNo concerns about transmissible diseases
bullldquoGold Standardrdquo
bullOsteoinductive and Osteoconductive
bullNo need for membranes
bullHolds form
bullRemodels into 100 high quality bone
bullNo concerns about transmissible diseases
Autogenous Block Grafts
Autogenous Block Grafts
bullDonor site morbidity
bullQuantity is limited
bullLose 20-30 during healing
bullDonor site morbidity
bullQuantity is limited
bullLose 20-30 during healing
Intra-oral Autogenous Bone Sites
AllogenicAllogenic Block Block GraftGraft
What about membranesWhat about membranes
bullUseful in containing particulate grafts
bullUseful around teethexposed implant threads
bullAdd expense
bull Infection risk
bullUnnecessary with block grafts
bullADA 4266 Resorbable
bullADA 4267 Non-Resorbable
bullUseful in containing particulate grafts
bullUseful around teethexposed implant threads
bullAdd expense
bull Infection risk
bullUnnecessary with block grafts
bullADA 4266 Resorbable
bullADA 4267 Non-Resorbable
Bone Morphogenic Protein (BMP)
Bone Morphogenic Protein (BMP)
bullGrow bone at will
bullPresently two are FDA approved BMP 2 for spinal fusions and BMP 7 for long bone defects
bullStudies show excellent results for socket preservation sinus lifts
bullExpensive ($500000 for a sinus)
bullGrow bone at will
bullPresently two are FDA approved BMP 2 for spinal fusions and BMP 7 for long bone defects
bullStudies show excellent results for socket preservation sinus lifts
bullExpensive ($500000 for a sinus)
FDA Panel Unanimously Recommends Approval of Third Indication For Medtronicrsquos INFUSE Bone Graft Nov 9 2006
FDA Panel Unanimously Recommends Approval of Third Indication For Medtronicrsquos INFUSE Bone Graft Nov 9 2006 INFUSE Bone Graft is recombinant human bone morphogenetic protein-2 (rhBMP-2) applied to an absorbable collagen sponge carrier The purpose of the protein which occurs naturally in the body is to stimulate bone formation It has been previously approved by the FDA for use in certain lumbar spine fusion and tibial fracture repair procedures
INFUSE Bone Graft is recombinant human bone morphogenetic protein-2 (rhBMP-2) applied to an absorbable collagen sponge carrier The purpose of the protein which occurs naturally in the body is to stimulate bone formation It has been previously approved by the FDA for use in certain lumbar spine fusion and tibial fracture repair procedures
Distraction OsteogenesisDistraction
OsteogenesisbullGeneration of bone (and soft
tissue) through distraction of an osseous callus
bullGeneration of bone (and soft tissue) through distraction of an osseous callus
Ann N Y Acad Sci 2006 Apr1068532-42 COX-2 has a critical role during incorporation of structural bone allografts OrsquoKeefe RJ Tiyapatanaputi P Xie C
Ann N Y Acad Sci 2006 Apr1068532-42 COX-2 has a critical role during incorporation of structural bone allografts OrsquoKeefe RJ Tiyapatanaputi P Xie C
Nonsteroidal anti-inflammatory drugs (NSAIDs) which inhibit cyclooxygenase (COX) activity reduce pain and are commonly used in patients with skeletal injury In this article we will also present data to show that selective COX-2 inhibitor delays allograft healing and incorporation These results demonstrated that COX-2 is essential for bone allograft incorporation Furthermore our data support the notion that COX-2-dependent PGE2 produced at the early stage of bone healing is prerequisite for efficient skeletal repair
Nonsteroidal anti-inflammatory drugs (NSAIDs) which inhibit cyclooxygenase (COX) activity reduce pain and are commonly used in patients with skeletal injury In this article we will also present data to show that selective COX-2 inhibitor delays allograft healing and incorporation These results demonstrated that COX-2 is essential for bone allograft incorporation Furthermore our data support the notion that COX-2-dependent PGE2 produced at the early stage of bone healing is prerequisite for efficient skeletal repair
Wise Old Oral Surgeon Wise Old Oral Surgeon Says Beware ofSays Beware of
Wise Old Oral Surgeon Wise Old Oral Surgeon Says Beware ofSays Beware of
bull 3rd molars in function3rd molars in function
bull Lone standing molarsLone standing molars
bull Teeth in bruxers Cl III skeletal patternsTeeth in bruxers Cl III skeletal patterns
bull 3rd molars + post-menopausal women3rd molars + post-menopausal women
bull Prior TMD historyPrior TMD history
bull Prior ldquobadrdquo oral surgery experiencePrior ldquobadrdquo oral surgery experience
bull Distoangular lower 3rds nerve proximityDistoangular lower 3rds nerve proximity
bull 3rd molars in function3rd molars in function
bull Lone standing molarsLone standing molars
bull Teeth in bruxers Cl III skeletal patternsTeeth in bruxers Cl III skeletal patterns
bull 3rd molars + post-menopausal women3rd molars + post-menopausal women
bull Prior TMD historyPrior TMD history
bull Prior ldquobadrdquo oral surgery experiencePrior ldquobadrdquo oral surgery experience
bull Distoangular lower 3rds nerve proximityDistoangular lower 3rds nerve proximity
3rd Molar Surgery ndash Why
3rd Molar Surgery ndash Why
1 Preventtreat pericoronitis (infection)2 Prevent periodontal problems 2nd molar3 Preventtreat caries to 2nd 3rd molar4 Prevent odontogenic cyststumors5 Strengthen mandible possible fx6 Prevent orthodontic relapse7 Treat pain of unknown origin
1 Preventtreat pericoronitis (infection)2 Prevent periodontal problems 2nd molar3 Preventtreat caries to 2nd 3rd molar4 Prevent odontogenic cyststumors5 Strengthen mandible possible fx6 Prevent orthodontic relapse7 Treat pain of unknown origin
Extract 3rds OralSystemic Extract 3rds OralSystemic LinkLink
CLEVELAND April 6 2006 - The first hard evidence has CLEVELAND April 6 2006 - The first hard evidence has been uncovered that bacteria in the mouth may find their been uncovered that bacteria in the mouth may find their way to the uterus causing uterine infections that can lead way to the uterus causing uterine infections that can lead to preterm birth in pregnant womento preterm birth in pregnant women
CLEVELAND April 6 2006 - The first hard evidence has CLEVELAND April 6 2006 - The first hard evidence has been uncovered that bacteria in the mouth may find their been uncovered that bacteria in the mouth may find their way to the uterus causing uterine infections that can lead way to the uterus causing uterine infections that can lead to preterm birth in pregnant womento preterm birth in pregnant women
A newly discovered and as yet unnamed species of the A newly discovered and as yet unnamed species of the bacterium genus bacterium genus BergeyellaBergeyella was found in the mouth was found in the mouth and amniotic fluid of a woman with a uterine infection and amniotic fluid of a woman with a uterine infection who gave birth prematurely (24 weeks) reported who gave birth prematurely (24 weeks) reported microbiologist Yiping W Han PhD of Case Western microbiologist Yiping W Han PhD of Case Western Reserve here Reserve here However the bacterium was not detected in a vaginal However the bacterium was not detected in a vaginal swab as might be expected The finding confirmed swab as might be expected The finding confirmed what some scientists have suspected that intrauterine what some scientists have suspected that intrauterine infections dont always ascend from the genital tract infections dont always ascend from the genital tract but can descend from the oral cavity Dr Han and but can descend from the oral cavity Dr Han and colleagues said in the April issue of the colleagues said in the April issue of the Journal of Journal of Clinical MicrobiologyClinical Microbiology
A newly discovered and as yet unnamed species of the A newly discovered and as yet unnamed species of the bacterium genus bacterium genus BergeyellaBergeyella was found in the mouth was found in the mouth and amniotic fluid of a woman with a uterine infection and amniotic fluid of a woman with a uterine infection who gave birth prematurely (24 weeks) reported who gave birth prematurely (24 weeks) reported microbiologist Yiping W Han PhD of Case Western microbiologist Yiping W Han PhD of Case Western Reserve here Reserve here However the bacterium was not detected in a vaginal However the bacterium was not detected in a vaginal swab as might be expected The finding confirmed swab as might be expected The finding confirmed what some scientists have suspected that intrauterine what some scientists have suspected that intrauterine infections dont always ascend from the genital tract infections dont always ascend from the genital tract but can descend from the oral cavity Dr Han and but can descend from the oral cavity Dr Han and colleagues said in the April issue of the colleagues said in the April issue of the Journal of Journal of Clinical MicrobiologyClinical Microbiology
Journal of Oral and Maxillofacial Journal of Oral and Maxillofacial SurgerySurgery
Volume 65 Issue 3 March 2007 Pages Volume 65 Issue 3 March 2007 Pages 377-383377-383
Progress Report on Third Molar Clinical Trials Progress Report on Third Molar Clinical Trials Raymond P White Jr DDS PhDRaymond P White Jr DDS PhD
1What happens to asymptomatic patients who keep their 1What happens to asymptomatic patients who keep their third molars third molars
2What is the recovery like for those who have them 2What is the recovery like for those who have them removed and what can we do as surgeons to improve removed and what can we do as surgeons to improve post operative outcomespost operative outcomes
3rd Molar Surgery ndash When3rd Molar Surgery ndash WhenbullBefore roots 100 developed
bullAfter roots 13 formed
bullMorbiditycomplications minimized as bone more flexible nerves more pliable and PMH less complicated
bullDonrsquot forget tooth transplanttooth transplant if apex not closed
bullBefore roots 100 developed
bullAfter roots 13 formed
bullMorbiditycomplications minimized as bone more flexible nerves more pliable and PMH less complicated
bullDonrsquot forget tooth transplanttooth transplant if apex not closed
Outcome of tooth transplantation survival and success rates 17-41 years post treatmentCzochrowska EM Stenvik A Bjercke B Zachrisson Am J Orthod Dentofacial Orthop 2002 Feb121(2)110-9The mean age at surgery was 115 years and the mean observation period was 264 264 years (range 17-41 years) Of the 33 teeth transplanted in the 28 patients 3 teeth were lost after 9 10 and 29 years respectively Therefore the 30 teeth in the 25 patients we examined yielded a survival rate of 90 The success rate was 79 because 2 transplants had ankylosed and 2 others failed to fulfill the proposed criteria The patients generally responded very favorably regarding their perception of the treatment Their only hesitation was related to some discomfort during surgery It was concluded that It was concluded that survival and success rates for teeth auto survival and success rates for teeth auto transplanted when the root is partly developed transplanted when the root is partly developed compare favorably in a long-term perspective compare favorably in a long-term perspective with other treatment modalities for with other treatment modalities for substituting missing teethsubstituting missing teeth
Outcome of tooth transplantation survival and success rates 17-41 years post treatmentCzochrowska EM Stenvik A Bjercke B Zachrisson Am J Orthod Dentofacial Orthop 2002 Feb121(2)110-9The mean age at surgery was 115 years and the mean observation period was 264 264 years (range 17-41 years) Of the 33 teeth transplanted in the 28 patients 3 teeth were lost after 9 10 and 29 years respectively Therefore the 30 teeth in the 25 patients we examined yielded a survival rate of 90 The success rate was 79 because 2 transplants had ankylosed and 2 others failed to fulfill the proposed criteria The patients generally responded very favorably regarding their perception of the treatment Their only hesitation was related to some discomfort during surgery It was concluded that It was concluded that survival and success rates for teeth auto survival and success rates for teeth auto transplanted when the root is partly developed transplanted when the root is partly developed compare favorably in a long-term perspective compare favorably in a long-term perspective with other treatment modalities for with other treatment modalities for substituting missing teethsubstituting missing teeth
3rd Molar Surgery ndash When Not
3rd Molar Surgery ndash When Not
bullExtremes of age
bullNo oral communication (full bony)
bullIntimate root-nerve Relationship
bullRisks gt Benefits
bullExtremes of age
bullNo oral communication (full bony)
bullIntimate root-nerve Relationship
bullRisks gt Benefits
3rd Molar Surgery Alternatives
3rd Molar Surgery Alternatives
bullNo Surgery dentist feels risk benefit ratio not favorable or patient refuses ndash document and recommend radiograph q 3-5 years
bullNo Surgery dentist feels risk benefit ratio not favorable or patient refuses ndash document and recommend radiograph q 3-5 years
No High SpeedNo High Speed
bullAir embolus
bullAir emphysema
bullBlow debris into flap
bullBlow bacteria into flap
bullNon-sterile water
bullAir embolus
bullAir emphysema
bullBlow debris into flap
bullBlow bacteria into flap
bullNon-sterile water
Which are trueWhich are true1 Tooth transplants are usually done on
patients 20-302 Average success rate for a tooth
transplant is 20-303 In order to work a transplant must
have endo4 Most transplants will ankylose
A 13 B 24 C 123 D 3 only
E None of the above
1 Tooth transplants are usually done on patients 20-30
2 Average success rate for a tooth transplant is 20-30
3 In order to work a transplant must have endo
4 Most transplants will ankylose
A 13 B 24 C 123 D 3 only
E None of the above
How can I assess the relationship How can I assess the relationship between the 3between the 3rdrd molar root and the molar root and the
inferior alveolar nerveinferior alveolar nerve
- Slide 2
- Slide 3
- Slide 4
- ldquoSockets with intact buccal and lingual plates heal well without graftinghellip consider grafting with resorbable osteoinductive material if plates compromised and implants plannedrdquo grafting with connective tissue if pontic esthetics an issuerdquo
- Vital Root Retention
- Slide 7
- Slide 8
- Slide 9
- J Oral Maxillofac Surg 2005 Feb43(1)7-12 A randomized controlled clinical trial to compare the incidence of injury to the inferior alveolar nerve as a result of coronectomy and removal of mandibular third molars Renton T Hankins M Sproate C
- Slide 11
- Slide 12
- Immediate Implant Placement Following Extractions
- Platelet Rich Plasma
- Slide 15
- Slide 16
- Slide 17
- Why Reconstruct
- How Autogenous Bone Grafts with Implants
- Autogenous Block Grafts
- Slide 21
- Intra-oral Autogenous Bone Sites
- Slide 23
- What about membranes
- Bone Morphogenic Protein (BMP)
- Slide 26
- Distraction Osteogenesis
- Slide 28
- Wise Old Oral Surgeon Says Beware of
- 3rd Molar Surgery ndash Why
- Extract 3rds OralSystemic Link
- Slide 32
- 3rd Molar Surgery ndash When
- 3rd Molar Surgery ndash When Not
- 3rd Molar Surgery Alternatives
- No High Speed
- Slide 38
- Which are true
- Slide 40
-
Vital Root RetentionVital Root RetentionbullAmputate teeth at crest then remove 2
mm more tooth ldquosub osseousrdquo
bullConsider grafting autogenous bone over tooth then close primarily
bullIdeally bone grows coronally over a vital asymptomatic root
bullDepending on rate of alveolar resorption will help preserve ridge 3-5 years before exposureextraction
bullAmputate teeth at crest then remove 2 mm more tooth ldquosub osseousrdquo
bullConsider grafting autogenous bone over tooth then close primarily
bullIdeally bone grows coronally over a vital asymptomatic root
bullDepending on rate of alveolar resorption will help preserve ridge 3-5 years before exposureextraction
Remove 2 mm tooth structure below bone
2 mm
Suture
New Bone Prosthesis
J Oral Maxillofac SurgJ Oral Maxillofac Surg 2005 Feb43(1)7-12 A 2005 Feb43(1)7-12 A randomized controlled clinical trial to randomized controlled clinical trial to compare the incidence of injury to the compare the incidence of injury to the inferior alveolar nerve as a result of inferior alveolar nerve as a result of coronectomy and removal of mandibular third coronectomy and removal of mandibular third molars Renton T Hankins M Sproate Cmolars Renton T Hankins M Sproate C
bull The length of follow up was about two The length of follow up was about two years which for the assessment of years which for the assessment of delayed eruption of the root fragments delayed eruption of the root fragments is not sufficient as this process may is not sufficient as this process may continue for up to 10 years However continue for up to 10 years However it seems that coronectomy reduces the it seems that coronectomy reduces the incidence of injury to the inferior incidence of injury to the inferior alveolar nerve without increasing the alveolar nerve without increasing the risk of dry socket or infection risk of dry socket or infection
J Oral Maxillofac Surg 2004 Dec62(12)1447-52 Coronectomy a technique to protect the inferior alveolar nerve Pogrel MA Lee JS Muff DF
J Oral Maxillofac Surg 2004 Dec62(12)1447-52 Coronectomy a technique to protect the inferior alveolar nerve Pogrel MA Lee JS Muff DF
PURPOSE Damage to the inferior alveolar nerve when extracting lower third molars is often caused by the intimate relationship between the nerve and the roots of the teeth The technique of coronectomy or intentional root retention may minimize this problem
PURPOSE Damage to the inferior alveolar nerve when extracting lower third molars is often caused by the intimate relationship between the nerve and the roots of the teeth The technique of coronectomy or intentional root retention may minimize this problemRESULTS There were no cases of inferior alveolar nerve-involved damage in this study of 41 patients who underwent 50 coronectomies There was 1 case of transient lingual nerve involvement probably from the use of the lingual retractor One patient required subsequent removal of the roots of both lower third molars because of failure to heal and 1 patient required subsequent removal of a root because of subsequent migration to the surface Root migration was noted in approximately 30 of patients over a 6 month period CONCLUSION Coronectomy appears to be a viable technique in those cases where removal of the whole tooth might put the inferior alveolar nerve at considerable risk of damage
RESULTS There were no cases of inferior alveolar nerve-involved damage in this study of 41 patients who underwent 50 coronectomies There was 1 case of transient lingual nerve involvement probably from the use of the lingual retractor One patient required subsequent removal of the roots of both lower third molars because of failure to heal and 1 patient required subsequent removal of a root because of subsequent migration to the surface Root migration was noted in approximately 30 of patients over a 6 month period CONCLUSION Coronectomy appears to be a viable technique in those cases where removal of the whole tooth might put the inferior alveolar nerve at considerable risk of damage
Pre-op (Oral Pre-op (Oral bisphosphonates X bisphosphonates X 5 years)5 years)
Immed Immed PostPost
10 month 10 month postpost
Immediate Implant Placement Following
Extractions
Immediate Implant Placement Following
ExtractionsbullNeed 3-4 mm of solid bone at base
of socket and no active infection
bullSuccess rates ~ to ldquonormalrdquo
bullMost typical sites anterior teeth and 1st premolars
bullAdvantages May reduce loss of labial plate and improve esthetics as well as save time
bullNeed 3-4 mm of solid bone at base of socket and no active infection
bullSuccess rates ~ to ldquonormalrdquo
bullMost typical sites anterior teeth and 1st premolars
bullAdvantages May reduce loss of labial plate and improve esthetics as well as save time
Platelet Rich PlasmaPlatelet Rich PlasmaPlatelet Rich PlasmaPlatelet Rich PlasmabullWhatrsquos HotWhatrsquos Hot
ndash Release various Release various growth factors that growth factors that aid in hemostasis aid in hemostasis and increase rate and increase rate of healing of healing (mitogenesis (mitogenesis angiogenesis) angiogenesis)
bullWhatrsquos HotWhatrsquos Hotndash Release various Release various
growth factors that growth factors that aid in hemostasis aid in hemostasis and increase rate and increase rate of healing of healing (mitogenesis (mitogenesis angiogenesis) angiogenesis)
bullWhatrsquos NotWhatrsquos Notndash CostCostndash Is there any Is there any
difference at 6 difference at 6 weeksweeks
ndash Invasive Invasive borrow 45-borrow 45-90ml of blood90ml of blood
bullWhatrsquos NotWhatrsquos Notndash CostCostndash Is there any Is there any
difference at 6 difference at 6 weeksweeks
ndash Invasive Invasive borrow 45-borrow 45-90ml of blood90ml of blood
Casap et al Immediate Implantation Into Debrided Infected Sockets J Oral Maxillofac Surg 2007
Does placing implants into fresh extraction Does placing implants into fresh extraction sockets preserve bonesockets preserve bone
J Clin Periodontol 2005 Jun32(6)645-52 Ridge alterations following implant placement in fresh extraction sockets an experimental study in the dogArauacutejo MG Sukekava F Wennstroumlm JL Lindhe J
CONCLUSIONS Marked dimensional alterations had occurred in the edentulous ridge after 3 months of healing following the extraction of the distal root of mandibular pre-molars The placement of an The placement of an implant in the fresh extraction site obviously implant in the fresh extraction site obviously failed to prevent the re-modeling that occurred failed to prevent the re-modeling that occurred in the walls of the socketin the walls of the socket The resulting height of the buccal and lingual walls at 3 months was similar at implants and edentulous sites
Most human trials however reveal results Most human trials however reveal results similar to implants place via the ldquoold similar to implants place via the ldquoold schoolrdquo approach even when immediately schoolrdquo approach even when immediately loaded (caution in ldquosoftrdquo bone gt55 YO)loaded (caution in ldquosoftrdquo bone gt55 YO)
Int J Oral Maxillofac Implants 2007 Mar-Apr22(2)187-94 The radiographic bone loss pattern adjacent to immediately placed immediately loaded implantsJaffin R Kolesar M Kumar A Ishikawa S Fiorellini J
J Craniofac Surg 2007 Jul18(4)965-71 Immediate loaded dental implants comparison between fixtures inserted in postextractive and healed bone sitesDegidi M Piattelli A Carinci F
J Periodontol 2007 May78(5)810-5 Vertical crestal bone changes around implants placed into fresh extraction socketsCovani U Cornelini R Barone A
Why ReconstructWhy Reconstruct
bullNot enough bone for implants
bullEnough bone but esthetic result suboptimal
bullPrevent pathologic fracture
bullPoor functionestheticsretention of conventional removable prosthesis
bullNot enough bone for implants
bullEnough bone but esthetic result suboptimal
bullPrevent pathologic fracture
bullPoor functionestheticsretention of conventional removable prosthesis
How Autogenous Bone Grafts
with Implants
How Autogenous Bone Grafts
with Implants
Autogenous Block GraftsAutogenous Block Grafts
bullldquoGold Standardrdquo
bullOsteoinductive and Osteoconductive
bullNo need for membranes
bullHolds form
bullRemodels into 100 high quality bone
bullNo concerns about transmissible diseases
bullldquoGold Standardrdquo
bullOsteoinductive and Osteoconductive
bullNo need for membranes
bullHolds form
bullRemodels into 100 high quality bone
bullNo concerns about transmissible diseases
Autogenous Block Grafts
Autogenous Block Grafts
bullDonor site morbidity
bullQuantity is limited
bullLose 20-30 during healing
bullDonor site morbidity
bullQuantity is limited
bullLose 20-30 during healing
Intra-oral Autogenous Bone Sites
AllogenicAllogenic Block Block GraftGraft
What about membranesWhat about membranes
bullUseful in containing particulate grafts
bullUseful around teethexposed implant threads
bullAdd expense
bull Infection risk
bullUnnecessary with block grafts
bullADA 4266 Resorbable
bullADA 4267 Non-Resorbable
bullUseful in containing particulate grafts
bullUseful around teethexposed implant threads
bullAdd expense
bull Infection risk
bullUnnecessary with block grafts
bullADA 4266 Resorbable
bullADA 4267 Non-Resorbable
Bone Morphogenic Protein (BMP)
Bone Morphogenic Protein (BMP)
bullGrow bone at will
bullPresently two are FDA approved BMP 2 for spinal fusions and BMP 7 for long bone defects
bullStudies show excellent results for socket preservation sinus lifts
bullExpensive ($500000 for a sinus)
bullGrow bone at will
bullPresently two are FDA approved BMP 2 for spinal fusions and BMP 7 for long bone defects
bullStudies show excellent results for socket preservation sinus lifts
bullExpensive ($500000 for a sinus)
FDA Panel Unanimously Recommends Approval of Third Indication For Medtronicrsquos INFUSE Bone Graft Nov 9 2006
FDA Panel Unanimously Recommends Approval of Third Indication For Medtronicrsquos INFUSE Bone Graft Nov 9 2006 INFUSE Bone Graft is recombinant human bone morphogenetic protein-2 (rhBMP-2) applied to an absorbable collagen sponge carrier The purpose of the protein which occurs naturally in the body is to stimulate bone formation It has been previously approved by the FDA for use in certain lumbar spine fusion and tibial fracture repair procedures
INFUSE Bone Graft is recombinant human bone morphogenetic protein-2 (rhBMP-2) applied to an absorbable collagen sponge carrier The purpose of the protein which occurs naturally in the body is to stimulate bone formation It has been previously approved by the FDA for use in certain lumbar spine fusion and tibial fracture repair procedures
Distraction OsteogenesisDistraction
OsteogenesisbullGeneration of bone (and soft
tissue) through distraction of an osseous callus
bullGeneration of bone (and soft tissue) through distraction of an osseous callus
Ann N Y Acad Sci 2006 Apr1068532-42 COX-2 has a critical role during incorporation of structural bone allografts OrsquoKeefe RJ Tiyapatanaputi P Xie C
Ann N Y Acad Sci 2006 Apr1068532-42 COX-2 has a critical role during incorporation of structural bone allografts OrsquoKeefe RJ Tiyapatanaputi P Xie C
Nonsteroidal anti-inflammatory drugs (NSAIDs) which inhibit cyclooxygenase (COX) activity reduce pain and are commonly used in patients with skeletal injury In this article we will also present data to show that selective COX-2 inhibitor delays allograft healing and incorporation These results demonstrated that COX-2 is essential for bone allograft incorporation Furthermore our data support the notion that COX-2-dependent PGE2 produced at the early stage of bone healing is prerequisite for efficient skeletal repair
Nonsteroidal anti-inflammatory drugs (NSAIDs) which inhibit cyclooxygenase (COX) activity reduce pain and are commonly used in patients with skeletal injury In this article we will also present data to show that selective COX-2 inhibitor delays allograft healing and incorporation These results demonstrated that COX-2 is essential for bone allograft incorporation Furthermore our data support the notion that COX-2-dependent PGE2 produced at the early stage of bone healing is prerequisite for efficient skeletal repair
Wise Old Oral Surgeon Wise Old Oral Surgeon Says Beware ofSays Beware of
Wise Old Oral Surgeon Wise Old Oral Surgeon Says Beware ofSays Beware of
bull 3rd molars in function3rd molars in function
bull Lone standing molarsLone standing molars
bull Teeth in bruxers Cl III skeletal patternsTeeth in bruxers Cl III skeletal patterns
bull 3rd molars + post-menopausal women3rd molars + post-menopausal women
bull Prior TMD historyPrior TMD history
bull Prior ldquobadrdquo oral surgery experiencePrior ldquobadrdquo oral surgery experience
bull Distoangular lower 3rds nerve proximityDistoangular lower 3rds nerve proximity
bull 3rd molars in function3rd molars in function
bull Lone standing molarsLone standing molars
bull Teeth in bruxers Cl III skeletal patternsTeeth in bruxers Cl III skeletal patterns
bull 3rd molars + post-menopausal women3rd molars + post-menopausal women
bull Prior TMD historyPrior TMD history
bull Prior ldquobadrdquo oral surgery experiencePrior ldquobadrdquo oral surgery experience
bull Distoangular lower 3rds nerve proximityDistoangular lower 3rds nerve proximity
3rd Molar Surgery ndash Why
3rd Molar Surgery ndash Why
1 Preventtreat pericoronitis (infection)2 Prevent periodontal problems 2nd molar3 Preventtreat caries to 2nd 3rd molar4 Prevent odontogenic cyststumors5 Strengthen mandible possible fx6 Prevent orthodontic relapse7 Treat pain of unknown origin
1 Preventtreat pericoronitis (infection)2 Prevent periodontal problems 2nd molar3 Preventtreat caries to 2nd 3rd molar4 Prevent odontogenic cyststumors5 Strengthen mandible possible fx6 Prevent orthodontic relapse7 Treat pain of unknown origin
Extract 3rds OralSystemic Extract 3rds OralSystemic LinkLink
CLEVELAND April 6 2006 - The first hard evidence has CLEVELAND April 6 2006 - The first hard evidence has been uncovered that bacteria in the mouth may find their been uncovered that bacteria in the mouth may find their way to the uterus causing uterine infections that can lead way to the uterus causing uterine infections that can lead to preterm birth in pregnant womento preterm birth in pregnant women
CLEVELAND April 6 2006 - The first hard evidence has CLEVELAND April 6 2006 - The first hard evidence has been uncovered that bacteria in the mouth may find their been uncovered that bacteria in the mouth may find their way to the uterus causing uterine infections that can lead way to the uterus causing uterine infections that can lead to preterm birth in pregnant womento preterm birth in pregnant women
A newly discovered and as yet unnamed species of the A newly discovered and as yet unnamed species of the bacterium genus bacterium genus BergeyellaBergeyella was found in the mouth was found in the mouth and amniotic fluid of a woman with a uterine infection and amniotic fluid of a woman with a uterine infection who gave birth prematurely (24 weeks) reported who gave birth prematurely (24 weeks) reported microbiologist Yiping W Han PhD of Case Western microbiologist Yiping W Han PhD of Case Western Reserve here Reserve here However the bacterium was not detected in a vaginal However the bacterium was not detected in a vaginal swab as might be expected The finding confirmed swab as might be expected The finding confirmed what some scientists have suspected that intrauterine what some scientists have suspected that intrauterine infections dont always ascend from the genital tract infections dont always ascend from the genital tract but can descend from the oral cavity Dr Han and but can descend from the oral cavity Dr Han and colleagues said in the April issue of the colleagues said in the April issue of the Journal of Journal of Clinical MicrobiologyClinical Microbiology
A newly discovered and as yet unnamed species of the A newly discovered and as yet unnamed species of the bacterium genus bacterium genus BergeyellaBergeyella was found in the mouth was found in the mouth and amniotic fluid of a woman with a uterine infection and amniotic fluid of a woman with a uterine infection who gave birth prematurely (24 weeks) reported who gave birth prematurely (24 weeks) reported microbiologist Yiping W Han PhD of Case Western microbiologist Yiping W Han PhD of Case Western Reserve here Reserve here However the bacterium was not detected in a vaginal However the bacterium was not detected in a vaginal swab as might be expected The finding confirmed swab as might be expected The finding confirmed what some scientists have suspected that intrauterine what some scientists have suspected that intrauterine infections dont always ascend from the genital tract infections dont always ascend from the genital tract but can descend from the oral cavity Dr Han and but can descend from the oral cavity Dr Han and colleagues said in the April issue of the colleagues said in the April issue of the Journal of Journal of Clinical MicrobiologyClinical Microbiology
Journal of Oral and Maxillofacial Journal of Oral and Maxillofacial SurgerySurgery
Volume 65 Issue 3 March 2007 Pages Volume 65 Issue 3 March 2007 Pages 377-383377-383
Progress Report on Third Molar Clinical Trials Progress Report on Third Molar Clinical Trials Raymond P White Jr DDS PhDRaymond P White Jr DDS PhD
1What happens to asymptomatic patients who keep their 1What happens to asymptomatic patients who keep their third molars third molars
2What is the recovery like for those who have them 2What is the recovery like for those who have them removed and what can we do as surgeons to improve removed and what can we do as surgeons to improve post operative outcomespost operative outcomes
3rd Molar Surgery ndash When3rd Molar Surgery ndash WhenbullBefore roots 100 developed
bullAfter roots 13 formed
bullMorbiditycomplications minimized as bone more flexible nerves more pliable and PMH less complicated
bullDonrsquot forget tooth transplanttooth transplant if apex not closed
bullBefore roots 100 developed
bullAfter roots 13 formed
bullMorbiditycomplications minimized as bone more flexible nerves more pliable and PMH less complicated
bullDonrsquot forget tooth transplanttooth transplant if apex not closed
Outcome of tooth transplantation survival and success rates 17-41 years post treatmentCzochrowska EM Stenvik A Bjercke B Zachrisson Am J Orthod Dentofacial Orthop 2002 Feb121(2)110-9The mean age at surgery was 115 years and the mean observation period was 264 264 years (range 17-41 years) Of the 33 teeth transplanted in the 28 patients 3 teeth were lost after 9 10 and 29 years respectively Therefore the 30 teeth in the 25 patients we examined yielded a survival rate of 90 The success rate was 79 because 2 transplants had ankylosed and 2 others failed to fulfill the proposed criteria The patients generally responded very favorably regarding their perception of the treatment Their only hesitation was related to some discomfort during surgery It was concluded that It was concluded that survival and success rates for teeth auto survival and success rates for teeth auto transplanted when the root is partly developed transplanted when the root is partly developed compare favorably in a long-term perspective compare favorably in a long-term perspective with other treatment modalities for with other treatment modalities for substituting missing teethsubstituting missing teeth
Outcome of tooth transplantation survival and success rates 17-41 years post treatmentCzochrowska EM Stenvik A Bjercke B Zachrisson Am J Orthod Dentofacial Orthop 2002 Feb121(2)110-9The mean age at surgery was 115 years and the mean observation period was 264 264 years (range 17-41 years) Of the 33 teeth transplanted in the 28 patients 3 teeth were lost after 9 10 and 29 years respectively Therefore the 30 teeth in the 25 patients we examined yielded a survival rate of 90 The success rate was 79 because 2 transplants had ankylosed and 2 others failed to fulfill the proposed criteria The patients generally responded very favorably regarding their perception of the treatment Their only hesitation was related to some discomfort during surgery It was concluded that It was concluded that survival and success rates for teeth auto survival and success rates for teeth auto transplanted when the root is partly developed transplanted when the root is partly developed compare favorably in a long-term perspective compare favorably in a long-term perspective with other treatment modalities for with other treatment modalities for substituting missing teethsubstituting missing teeth
3rd Molar Surgery ndash When Not
3rd Molar Surgery ndash When Not
bullExtremes of age
bullNo oral communication (full bony)
bullIntimate root-nerve Relationship
bullRisks gt Benefits
bullExtremes of age
bullNo oral communication (full bony)
bullIntimate root-nerve Relationship
bullRisks gt Benefits
3rd Molar Surgery Alternatives
3rd Molar Surgery Alternatives
bullNo Surgery dentist feels risk benefit ratio not favorable or patient refuses ndash document and recommend radiograph q 3-5 years
bullNo Surgery dentist feels risk benefit ratio not favorable or patient refuses ndash document and recommend radiograph q 3-5 years
No High SpeedNo High Speed
bullAir embolus
bullAir emphysema
bullBlow debris into flap
bullBlow bacteria into flap
bullNon-sterile water
bullAir embolus
bullAir emphysema
bullBlow debris into flap
bullBlow bacteria into flap
bullNon-sterile water
Which are trueWhich are true1 Tooth transplants are usually done on
patients 20-302 Average success rate for a tooth
transplant is 20-303 In order to work a transplant must
have endo4 Most transplants will ankylose
A 13 B 24 C 123 D 3 only
E None of the above
1 Tooth transplants are usually done on patients 20-30
2 Average success rate for a tooth transplant is 20-30
3 In order to work a transplant must have endo
4 Most transplants will ankylose
A 13 B 24 C 123 D 3 only
E None of the above
How can I assess the relationship How can I assess the relationship between the 3between the 3rdrd molar root and the molar root and the
inferior alveolar nerveinferior alveolar nerve
- Slide 2
- Slide 3
- Slide 4
- ldquoSockets with intact buccal and lingual plates heal well without graftinghellip consider grafting with resorbable osteoinductive material if plates compromised and implants plannedrdquo grafting with connective tissue if pontic esthetics an issuerdquo
- Vital Root Retention
- Slide 7
- Slide 8
- Slide 9
- J Oral Maxillofac Surg 2005 Feb43(1)7-12 A randomized controlled clinical trial to compare the incidence of injury to the inferior alveolar nerve as a result of coronectomy and removal of mandibular third molars Renton T Hankins M Sproate C
- Slide 11
- Slide 12
- Immediate Implant Placement Following Extractions
- Platelet Rich Plasma
- Slide 15
- Slide 16
- Slide 17
- Why Reconstruct
- How Autogenous Bone Grafts with Implants
- Autogenous Block Grafts
- Slide 21
- Intra-oral Autogenous Bone Sites
- Slide 23
- What about membranes
- Bone Morphogenic Protein (BMP)
- Slide 26
- Distraction Osteogenesis
- Slide 28
- Wise Old Oral Surgeon Says Beware of
- 3rd Molar Surgery ndash Why
- Extract 3rds OralSystemic Link
- Slide 32
- 3rd Molar Surgery ndash When
- 3rd Molar Surgery ndash When Not
- 3rd Molar Surgery Alternatives
- No High Speed
- Slide 38
- Which are true
- Slide 40
-
Remove 2 mm tooth structure below bone
2 mm
Suture
New Bone Prosthesis
J Oral Maxillofac SurgJ Oral Maxillofac Surg 2005 Feb43(1)7-12 A 2005 Feb43(1)7-12 A randomized controlled clinical trial to randomized controlled clinical trial to compare the incidence of injury to the compare the incidence of injury to the inferior alveolar nerve as a result of inferior alveolar nerve as a result of coronectomy and removal of mandibular third coronectomy and removal of mandibular third molars Renton T Hankins M Sproate Cmolars Renton T Hankins M Sproate C
bull The length of follow up was about two The length of follow up was about two years which for the assessment of years which for the assessment of delayed eruption of the root fragments delayed eruption of the root fragments is not sufficient as this process may is not sufficient as this process may continue for up to 10 years However continue for up to 10 years However it seems that coronectomy reduces the it seems that coronectomy reduces the incidence of injury to the inferior incidence of injury to the inferior alveolar nerve without increasing the alveolar nerve without increasing the risk of dry socket or infection risk of dry socket or infection
J Oral Maxillofac Surg 2004 Dec62(12)1447-52 Coronectomy a technique to protect the inferior alveolar nerve Pogrel MA Lee JS Muff DF
J Oral Maxillofac Surg 2004 Dec62(12)1447-52 Coronectomy a technique to protect the inferior alveolar nerve Pogrel MA Lee JS Muff DF
PURPOSE Damage to the inferior alveolar nerve when extracting lower third molars is often caused by the intimate relationship between the nerve and the roots of the teeth The technique of coronectomy or intentional root retention may minimize this problem
PURPOSE Damage to the inferior alveolar nerve when extracting lower third molars is often caused by the intimate relationship between the nerve and the roots of the teeth The technique of coronectomy or intentional root retention may minimize this problemRESULTS There were no cases of inferior alveolar nerve-involved damage in this study of 41 patients who underwent 50 coronectomies There was 1 case of transient lingual nerve involvement probably from the use of the lingual retractor One patient required subsequent removal of the roots of both lower third molars because of failure to heal and 1 patient required subsequent removal of a root because of subsequent migration to the surface Root migration was noted in approximately 30 of patients over a 6 month period CONCLUSION Coronectomy appears to be a viable technique in those cases where removal of the whole tooth might put the inferior alveolar nerve at considerable risk of damage
RESULTS There were no cases of inferior alveolar nerve-involved damage in this study of 41 patients who underwent 50 coronectomies There was 1 case of transient lingual nerve involvement probably from the use of the lingual retractor One patient required subsequent removal of the roots of both lower third molars because of failure to heal and 1 patient required subsequent removal of a root because of subsequent migration to the surface Root migration was noted in approximately 30 of patients over a 6 month period CONCLUSION Coronectomy appears to be a viable technique in those cases where removal of the whole tooth might put the inferior alveolar nerve at considerable risk of damage
Pre-op (Oral Pre-op (Oral bisphosphonates X bisphosphonates X 5 years)5 years)
Immed Immed PostPost
10 month 10 month postpost
Immediate Implant Placement Following
Extractions
Immediate Implant Placement Following
ExtractionsbullNeed 3-4 mm of solid bone at base
of socket and no active infection
bullSuccess rates ~ to ldquonormalrdquo
bullMost typical sites anterior teeth and 1st premolars
bullAdvantages May reduce loss of labial plate and improve esthetics as well as save time
bullNeed 3-4 mm of solid bone at base of socket and no active infection
bullSuccess rates ~ to ldquonormalrdquo
bullMost typical sites anterior teeth and 1st premolars
bullAdvantages May reduce loss of labial plate and improve esthetics as well as save time
Platelet Rich PlasmaPlatelet Rich PlasmaPlatelet Rich PlasmaPlatelet Rich PlasmabullWhatrsquos HotWhatrsquos Hot
ndash Release various Release various growth factors that growth factors that aid in hemostasis aid in hemostasis and increase rate and increase rate of healing of healing (mitogenesis (mitogenesis angiogenesis) angiogenesis)
bullWhatrsquos HotWhatrsquos Hotndash Release various Release various
growth factors that growth factors that aid in hemostasis aid in hemostasis and increase rate and increase rate of healing of healing (mitogenesis (mitogenesis angiogenesis) angiogenesis)
bullWhatrsquos NotWhatrsquos Notndash CostCostndash Is there any Is there any
difference at 6 difference at 6 weeksweeks
ndash Invasive Invasive borrow 45-borrow 45-90ml of blood90ml of blood
bullWhatrsquos NotWhatrsquos Notndash CostCostndash Is there any Is there any
difference at 6 difference at 6 weeksweeks
ndash Invasive Invasive borrow 45-borrow 45-90ml of blood90ml of blood
Casap et al Immediate Implantation Into Debrided Infected Sockets J Oral Maxillofac Surg 2007
Does placing implants into fresh extraction Does placing implants into fresh extraction sockets preserve bonesockets preserve bone
J Clin Periodontol 2005 Jun32(6)645-52 Ridge alterations following implant placement in fresh extraction sockets an experimental study in the dogArauacutejo MG Sukekava F Wennstroumlm JL Lindhe J
CONCLUSIONS Marked dimensional alterations had occurred in the edentulous ridge after 3 months of healing following the extraction of the distal root of mandibular pre-molars The placement of an The placement of an implant in the fresh extraction site obviously implant in the fresh extraction site obviously failed to prevent the re-modeling that occurred failed to prevent the re-modeling that occurred in the walls of the socketin the walls of the socket The resulting height of the buccal and lingual walls at 3 months was similar at implants and edentulous sites
Most human trials however reveal results Most human trials however reveal results similar to implants place via the ldquoold similar to implants place via the ldquoold schoolrdquo approach even when immediately schoolrdquo approach even when immediately loaded (caution in ldquosoftrdquo bone gt55 YO)loaded (caution in ldquosoftrdquo bone gt55 YO)
Int J Oral Maxillofac Implants 2007 Mar-Apr22(2)187-94 The radiographic bone loss pattern adjacent to immediately placed immediately loaded implantsJaffin R Kolesar M Kumar A Ishikawa S Fiorellini J
J Craniofac Surg 2007 Jul18(4)965-71 Immediate loaded dental implants comparison between fixtures inserted in postextractive and healed bone sitesDegidi M Piattelli A Carinci F
J Periodontol 2007 May78(5)810-5 Vertical crestal bone changes around implants placed into fresh extraction socketsCovani U Cornelini R Barone A
Why ReconstructWhy Reconstruct
bullNot enough bone for implants
bullEnough bone but esthetic result suboptimal
bullPrevent pathologic fracture
bullPoor functionestheticsretention of conventional removable prosthesis
bullNot enough bone for implants
bullEnough bone but esthetic result suboptimal
bullPrevent pathologic fracture
bullPoor functionestheticsretention of conventional removable prosthesis
How Autogenous Bone Grafts
with Implants
How Autogenous Bone Grafts
with Implants
Autogenous Block GraftsAutogenous Block Grafts
bullldquoGold Standardrdquo
bullOsteoinductive and Osteoconductive
bullNo need for membranes
bullHolds form
bullRemodels into 100 high quality bone
bullNo concerns about transmissible diseases
bullldquoGold Standardrdquo
bullOsteoinductive and Osteoconductive
bullNo need for membranes
bullHolds form
bullRemodels into 100 high quality bone
bullNo concerns about transmissible diseases
Autogenous Block Grafts
Autogenous Block Grafts
bullDonor site morbidity
bullQuantity is limited
bullLose 20-30 during healing
bullDonor site morbidity
bullQuantity is limited
bullLose 20-30 during healing
Intra-oral Autogenous Bone Sites
AllogenicAllogenic Block Block GraftGraft
What about membranesWhat about membranes
bullUseful in containing particulate grafts
bullUseful around teethexposed implant threads
bullAdd expense
bull Infection risk
bullUnnecessary with block grafts
bullADA 4266 Resorbable
bullADA 4267 Non-Resorbable
bullUseful in containing particulate grafts
bullUseful around teethexposed implant threads
bullAdd expense
bull Infection risk
bullUnnecessary with block grafts
bullADA 4266 Resorbable
bullADA 4267 Non-Resorbable
Bone Morphogenic Protein (BMP)
Bone Morphogenic Protein (BMP)
bullGrow bone at will
bullPresently two are FDA approved BMP 2 for spinal fusions and BMP 7 for long bone defects
bullStudies show excellent results for socket preservation sinus lifts
bullExpensive ($500000 for a sinus)
bullGrow bone at will
bullPresently two are FDA approved BMP 2 for spinal fusions and BMP 7 for long bone defects
bullStudies show excellent results for socket preservation sinus lifts
bullExpensive ($500000 for a sinus)
FDA Panel Unanimously Recommends Approval of Third Indication For Medtronicrsquos INFUSE Bone Graft Nov 9 2006
FDA Panel Unanimously Recommends Approval of Third Indication For Medtronicrsquos INFUSE Bone Graft Nov 9 2006 INFUSE Bone Graft is recombinant human bone morphogenetic protein-2 (rhBMP-2) applied to an absorbable collagen sponge carrier The purpose of the protein which occurs naturally in the body is to stimulate bone formation It has been previously approved by the FDA for use in certain lumbar spine fusion and tibial fracture repair procedures
INFUSE Bone Graft is recombinant human bone morphogenetic protein-2 (rhBMP-2) applied to an absorbable collagen sponge carrier The purpose of the protein which occurs naturally in the body is to stimulate bone formation It has been previously approved by the FDA for use in certain lumbar spine fusion and tibial fracture repair procedures
Distraction OsteogenesisDistraction
OsteogenesisbullGeneration of bone (and soft
tissue) through distraction of an osseous callus
bullGeneration of bone (and soft tissue) through distraction of an osseous callus
Ann N Y Acad Sci 2006 Apr1068532-42 COX-2 has a critical role during incorporation of structural bone allografts OrsquoKeefe RJ Tiyapatanaputi P Xie C
Ann N Y Acad Sci 2006 Apr1068532-42 COX-2 has a critical role during incorporation of structural bone allografts OrsquoKeefe RJ Tiyapatanaputi P Xie C
Nonsteroidal anti-inflammatory drugs (NSAIDs) which inhibit cyclooxygenase (COX) activity reduce pain and are commonly used in patients with skeletal injury In this article we will also present data to show that selective COX-2 inhibitor delays allograft healing and incorporation These results demonstrated that COX-2 is essential for bone allograft incorporation Furthermore our data support the notion that COX-2-dependent PGE2 produced at the early stage of bone healing is prerequisite for efficient skeletal repair
Nonsteroidal anti-inflammatory drugs (NSAIDs) which inhibit cyclooxygenase (COX) activity reduce pain and are commonly used in patients with skeletal injury In this article we will also present data to show that selective COX-2 inhibitor delays allograft healing and incorporation These results demonstrated that COX-2 is essential for bone allograft incorporation Furthermore our data support the notion that COX-2-dependent PGE2 produced at the early stage of bone healing is prerequisite for efficient skeletal repair
Wise Old Oral Surgeon Wise Old Oral Surgeon Says Beware ofSays Beware of
Wise Old Oral Surgeon Wise Old Oral Surgeon Says Beware ofSays Beware of
bull 3rd molars in function3rd molars in function
bull Lone standing molarsLone standing molars
bull Teeth in bruxers Cl III skeletal patternsTeeth in bruxers Cl III skeletal patterns
bull 3rd molars + post-menopausal women3rd molars + post-menopausal women
bull Prior TMD historyPrior TMD history
bull Prior ldquobadrdquo oral surgery experiencePrior ldquobadrdquo oral surgery experience
bull Distoangular lower 3rds nerve proximityDistoangular lower 3rds nerve proximity
bull 3rd molars in function3rd molars in function
bull Lone standing molarsLone standing molars
bull Teeth in bruxers Cl III skeletal patternsTeeth in bruxers Cl III skeletal patterns
bull 3rd molars + post-menopausal women3rd molars + post-menopausal women
bull Prior TMD historyPrior TMD history
bull Prior ldquobadrdquo oral surgery experiencePrior ldquobadrdquo oral surgery experience
bull Distoangular lower 3rds nerve proximityDistoangular lower 3rds nerve proximity
3rd Molar Surgery ndash Why
3rd Molar Surgery ndash Why
1 Preventtreat pericoronitis (infection)2 Prevent periodontal problems 2nd molar3 Preventtreat caries to 2nd 3rd molar4 Prevent odontogenic cyststumors5 Strengthen mandible possible fx6 Prevent orthodontic relapse7 Treat pain of unknown origin
1 Preventtreat pericoronitis (infection)2 Prevent periodontal problems 2nd molar3 Preventtreat caries to 2nd 3rd molar4 Prevent odontogenic cyststumors5 Strengthen mandible possible fx6 Prevent orthodontic relapse7 Treat pain of unknown origin
Extract 3rds OralSystemic Extract 3rds OralSystemic LinkLink
CLEVELAND April 6 2006 - The first hard evidence has CLEVELAND April 6 2006 - The first hard evidence has been uncovered that bacteria in the mouth may find their been uncovered that bacteria in the mouth may find their way to the uterus causing uterine infections that can lead way to the uterus causing uterine infections that can lead to preterm birth in pregnant womento preterm birth in pregnant women
CLEVELAND April 6 2006 - The first hard evidence has CLEVELAND April 6 2006 - The first hard evidence has been uncovered that bacteria in the mouth may find their been uncovered that bacteria in the mouth may find their way to the uterus causing uterine infections that can lead way to the uterus causing uterine infections that can lead to preterm birth in pregnant womento preterm birth in pregnant women
A newly discovered and as yet unnamed species of the A newly discovered and as yet unnamed species of the bacterium genus bacterium genus BergeyellaBergeyella was found in the mouth was found in the mouth and amniotic fluid of a woman with a uterine infection and amniotic fluid of a woman with a uterine infection who gave birth prematurely (24 weeks) reported who gave birth prematurely (24 weeks) reported microbiologist Yiping W Han PhD of Case Western microbiologist Yiping W Han PhD of Case Western Reserve here Reserve here However the bacterium was not detected in a vaginal However the bacterium was not detected in a vaginal swab as might be expected The finding confirmed swab as might be expected The finding confirmed what some scientists have suspected that intrauterine what some scientists have suspected that intrauterine infections dont always ascend from the genital tract infections dont always ascend from the genital tract but can descend from the oral cavity Dr Han and but can descend from the oral cavity Dr Han and colleagues said in the April issue of the colleagues said in the April issue of the Journal of Journal of Clinical MicrobiologyClinical Microbiology
A newly discovered and as yet unnamed species of the A newly discovered and as yet unnamed species of the bacterium genus bacterium genus BergeyellaBergeyella was found in the mouth was found in the mouth and amniotic fluid of a woman with a uterine infection and amniotic fluid of a woman with a uterine infection who gave birth prematurely (24 weeks) reported who gave birth prematurely (24 weeks) reported microbiologist Yiping W Han PhD of Case Western microbiologist Yiping W Han PhD of Case Western Reserve here Reserve here However the bacterium was not detected in a vaginal However the bacterium was not detected in a vaginal swab as might be expected The finding confirmed swab as might be expected The finding confirmed what some scientists have suspected that intrauterine what some scientists have suspected that intrauterine infections dont always ascend from the genital tract infections dont always ascend from the genital tract but can descend from the oral cavity Dr Han and but can descend from the oral cavity Dr Han and colleagues said in the April issue of the colleagues said in the April issue of the Journal of Journal of Clinical MicrobiologyClinical Microbiology
Journal of Oral and Maxillofacial Journal of Oral and Maxillofacial SurgerySurgery
Volume 65 Issue 3 March 2007 Pages Volume 65 Issue 3 March 2007 Pages 377-383377-383
Progress Report on Third Molar Clinical Trials Progress Report on Third Molar Clinical Trials Raymond P White Jr DDS PhDRaymond P White Jr DDS PhD
1What happens to asymptomatic patients who keep their 1What happens to asymptomatic patients who keep their third molars third molars
2What is the recovery like for those who have them 2What is the recovery like for those who have them removed and what can we do as surgeons to improve removed and what can we do as surgeons to improve post operative outcomespost operative outcomes
3rd Molar Surgery ndash When3rd Molar Surgery ndash WhenbullBefore roots 100 developed
bullAfter roots 13 formed
bullMorbiditycomplications minimized as bone more flexible nerves more pliable and PMH less complicated
bullDonrsquot forget tooth transplanttooth transplant if apex not closed
bullBefore roots 100 developed
bullAfter roots 13 formed
bullMorbiditycomplications minimized as bone more flexible nerves more pliable and PMH less complicated
bullDonrsquot forget tooth transplanttooth transplant if apex not closed
Outcome of tooth transplantation survival and success rates 17-41 years post treatmentCzochrowska EM Stenvik A Bjercke B Zachrisson Am J Orthod Dentofacial Orthop 2002 Feb121(2)110-9The mean age at surgery was 115 years and the mean observation period was 264 264 years (range 17-41 years) Of the 33 teeth transplanted in the 28 patients 3 teeth were lost after 9 10 and 29 years respectively Therefore the 30 teeth in the 25 patients we examined yielded a survival rate of 90 The success rate was 79 because 2 transplants had ankylosed and 2 others failed to fulfill the proposed criteria The patients generally responded very favorably regarding their perception of the treatment Their only hesitation was related to some discomfort during surgery It was concluded that It was concluded that survival and success rates for teeth auto survival and success rates for teeth auto transplanted when the root is partly developed transplanted when the root is partly developed compare favorably in a long-term perspective compare favorably in a long-term perspective with other treatment modalities for with other treatment modalities for substituting missing teethsubstituting missing teeth
Outcome of tooth transplantation survival and success rates 17-41 years post treatmentCzochrowska EM Stenvik A Bjercke B Zachrisson Am J Orthod Dentofacial Orthop 2002 Feb121(2)110-9The mean age at surgery was 115 years and the mean observation period was 264 264 years (range 17-41 years) Of the 33 teeth transplanted in the 28 patients 3 teeth were lost after 9 10 and 29 years respectively Therefore the 30 teeth in the 25 patients we examined yielded a survival rate of 90 The success rate was 79 because 2 transplants had ankylosed and 2 others failed to fulfill the proposed criteria The patients generally responded very favorably regarding their perception of the treatment Their only hesitation was related to some discomfort during surgery It was concluded that It was concluded that survival and success rates for teeth auto survival and success rates for teeth auto transplanted when the root is partly developed transplanted when the root is partly developed compare favorably in a long-term perspective compare favorably in a long-term perspective with other treatment modalities for with other treatment modalities for substituting missing teethsubstituting missing teeth
3rd Molar Surgery ndash When Not
3rd Molar Surgery ndash When Not
bullExtremes of age
bullNo oral communication (full bony)
bullIntimate root-nerve Relationship
bullRisks gt Benefits
bullExtremes of age
bullNo oral communication (full bony)
bullIntimate root-nerve Relationship
bullRisks gt Benefits
3rd Molar Surgery Alternatives
3rd Molar Surgery Alternatives
bullNo Surgery dentist feels risk benefit ratio not favorable or patient refuses ndash document and recommend radiograph q 3-5 years
bullNo Surgery dentist feels risk benefit ratio not favorable or patient refuses ndash document and recommend radiograph q 3-5 years
No High SpeedNo High Speed
bullAir embolus
bullAir emphysema
bullBlow debris into flap
bullBlow bacteria into flap
bullNon-sterile water
bullAir embolus
bullAir emphysema
bullBlow debris into flap
bullBlow bacteria into flap
bullNon-sterile water
Which are trueWhich are true1 Tooth transplants are usually done on
patients 20-302 Average success rate for a tooth
transplant is 20-303 In order to work a transplant must
have endo4 Most transplants will ankylose
A 13 B 24 C 123 D 3 only
E None of the above
1 Tooth transplants are usually done on patients 20-30
2 Average success rate for a tooth transplant is 20-30
3 In order to work a transplant must have endo
4 Most transplants will ankylose
A 13 B 24 C 123 D 3 only
E None of the above
How can I assess the relationship How can I assess the relationship between the 3between the 3rdrd molar root and the molar root and the
inferior alveolar nerveinferior alveolar nerve
- Slide 2
- Slide 3
- Slide 4
- ldquoSockets with intact buccal and lingual plates heal well without graftinghellip consider grafting with resorbable osteoinductive material if plates compromised and implants plannedrdquo grafting with connective tissue if pontic esthetics an issuerdquo
- Vital Root Retention
- Slide 7
- Slide 8
- Slide 9
- J Oral Maxillofac Surg 2005 Feb43(1)7-12 A randomized controlled clinical trial to compare the incidence of injury to the inferior alveolar nerve as a result of coronectomy and removal of mandibular third molars Renton T Hankins M Sproate C
- Slide 11
- Slide 12
- Immediate Implant Placement Following Extractions
- Platelet Rich Plasma
- Slide 15
- Slide 16
- Slide 17
- Why Reconstruct
- How Autogenous Bone Grafts with Implants
- Autogenous Block Grafts
- Slide 21
- Intra-oral Autogenous Bone Sites
- Slide 23
- What about membranes
- Bone Morphogenic Protein (BMP)
- Slide 26
- Distraction Osteogenesis
- Slide 28
- Wise Old Oral Surgeon Says Beware of
- 3rd Molar Surgery ndash Why
- Extract 3rds OralSystemic Link
- Slide 32
- 3rd Molar Surgery ndash When
- 3rd Molar Surgery ndash When Not
- 3rd Molar Surgery Alternatives
- No High Speed
- Slide 38
- Which are true
- Slide 40
-
New Bone Prosthesis
J Oral Maxillofac SurgJ Oral Maxillofac Surg 2005 Feb43(1)7-12 A 2005 Feb43(1)7-12 A randomized controlled clinical trial to randomized controlled clinical trial to compare the incidence of injury to the compare the incidence of injury to the inferior alveolar nerve as a result of inferior alveolar nerve as a result of coronectomy and removal of mandibular third coronectomy and removal of mandibular third molars Renton T Hankins M Sproate Cmolars Renton T Hankins M Sproate C
bull The length of follow up was about two The length of follow up was about two years which for the assessment of years which for the assessment of delayed eruption of the root fragments delayed eruption of the root fragments is not sufficient as this process may is not sufficient as this process may continue for up to 10 years However continue for up to 10 years However it seems that coronectomy reduces the it seems that coronectomy reduces the incidence of injury to the inferior incidence of injury to the inferior alveolar nerve without increasing the alveolar nerve without increasing the risk of dry socket or infection risk of dry socket or infection
J Oral Maxillofac Surg 2004 Dec62(12)1447-52 Coronectomy a technique to protect the inferior alveolar nerve Pogrel MA Lee JS Muff DF
J Oral Maxillofac Surg 2004 Dec62(12)1447-52 Coronectomy a technique to protect the inferior alveolar nerve Pogrel MA Lee JS Muff DF
PURPOSE Damage to the inferior alveolar nerve when extracting lower third molars is often caused by the intimate relationship between the nerve and the roots of the teeth The technique of coronectomy or intentional root retention may minimize this problem
PURPOSE Damage to the inferior alveolar nerve when extracting lower third molars is often caused by the intimate relationship between the nerve and the roots of the teeth The technique of coronectomy or intentional root retention may minimize this problemRESULTS There were no cases of inferior alveolar nerve-involved damage in this study of 41 patients who underwent 50 coronectomies There was 1 case of transient lingual nerve involvement probably from the use of the lingual retractor One patient required subsequent removal of the roots of both lower third molars because of failure to heal and 1 patient required subsequent removal of a root because of subsequent migration to the surface Root migration was noted in approximately 30 of patients over a 6 month period CONCLUSION Coronectomy appears to be a viable technique in those cases where removal of the whole tooth might put the inferior alveolar nerve at considerable risk of damage
RESULTS There were no cases of inferior alveolar nerve-involved damage in this study of 41 patients who underwent 50 coronectomies There was 1 case of transient lingual nerve involvement probably from the use of the lingual retractor One patient required subsequent removal of the roots of both lower third molars because of failure to heal and 1 patient required subsequent removal of a root because of subsequent migration to the surface Root migration was noted in approximately 30 of patients over a 6 month period CONCLUSION Coronectomy appears to be a viable technique in those cases where removal of the whole tooth might put the inferior alveolar nerve at considerable risk of damage
Pre-op (Oral Pre-op (Oral bisphosphonates X bisphosphonates X 5 years)5 years)
Immed Immed PostPost
10 month 10 month postpost
Immediate Implant Placement Following
Extractions
Immediate Implant Placement Following
ExtractionsbullNeed 3-4 mm of solid bone at base
of socket and no active infection
bullSuccess rates ~ to ldquonormalrdquo
bullMost typical sites anterior teeth and 1st premolars
bullAdvantages May reduce loss of labial plate and improve esthetics as well as save time
bullNeed 3-4 mm of solid bone at base of socket and no active infection
bullSuccess rates ~ to ldquonormalrdquo
bullMost typical sites anterior teeth and 1st premolars
bullAdvantages May reduce loss of labial plate and improve esthetics as well as save time
Platelet Rich PlasmaPlatelet Rich PlasmaPlatelet Rich PlasmaPlatelet Rich PlasmabullWhatrsquos HotWhatrsquos Hot
ndash Release various Release various growth factors that growth factors that aid in hemostasis aid in hemostasis and increase rate and increase rate of healing of healing (mitogenesis (mitogenesis angiogenesis) angiogenesis)
bullWhatrsquos HotWhatrsquos Hotndash Release various Release various
growth factors that growth factors that aid in hemostasis aid in hemostasis and increase rate and increase rate of healing of healing (mitogenesis (mitogenesis angiogenesis) angiogenesis)
bullWhatrsquos NotWhatrsquos Notndash CostCostndash Is there any Is there any
difference at 6 difference at 6 weeksweeks
ndash Invasive Invasive borrow 45-borrow 45-90ml of blood90ml of blood
bullWhatrsquos NotWhatrsquos Notndash CostCostndash Is there any Is there any
difference at 6 difference at 6 weeksweeks
ndash Invasive Invasive borrow 45-borrow 45-90ml of blood90ml of blood
Casap et al Immediate Implantation Into Debrided Infected Sockets J Oral Maxillofac Surg 2007
Does placing implants into fresh extraction Does placing implants into fresh extraction sockets preserve bonesockets preserve bone
J Clin Periodontol 2005 Jun32(6)645-52 Ridge alterations following implant placement in fresh extraction sockets an experimental study in the dogArauacutejo MG Sukekava F Wennstroumlm JL Lindhe J
CONCLUSIONS Marked dimensional alterations had occurred in the edentulous ridge after 3 months of healing following the extraction of the distal root of mandibular pre-molars The placement of an The placement of an implant in the fresh extraction site obviously implant in the fresh extraction site obviously failed to prevent the re-modeling that occurred failed to prevent the re-modeling that occurred in the walls of the socketin the walls of the socket The resulting height of the buccal and lingual walls at 3 months was similar at implants and edentulous sites
Most human trials however reveal results Most human trials however reveal results similar to implants place via the ldquoold similar to implants place via the ldquoold schoolrdquo approach even when immediately schoolrdquo approach even when immediately loaded (caution in ldquosoftrdquo bone gt55 YO)loaded (caution in ldquosoftrdquo bone gt55 YO)
Int J Oral Maxillofac Implants 2007 Mar-Apr22(2)187-94 The radiographic bone loss pattern adjacent to immediately placed immediately loaded implantsJaffin R Kolesar M Kumar A Ishikawa S Fiorellini J
J Craniofac Surg 2007 Jul18(4)965-71 Immediate loaded dental implants comparison between fixtures inserted in postextractive and healed bone sitesDegidi M Piattelli A Carinci F
J Periodontol 2007 May78(5)810-5 Vertical crestal bone changes around implants placed into fresh extraction socketsCovani U Cornelini R Barone A
Why ReconstructWhy Reconstruct
bullNot enough bone for implants
bullEnough bone but esthetic result suboptimal
bullPrevent pathologic fracture
bullPoor functionestheticsretention of conventional removable prosthesis
bullNot enough bone for implants
bullEnough bone but esthetic result suboptimal
bullPrevent pathologic fracture
bullPoor functionestheticsretention of conventional removable prosthesis
How Autogenous Bone Grafts
with Implants
How Autogenous Bone Grafts
with Implants
Autogenous Block GraftsAutogenous Block Grafts
bullldquoGold Standardrdquo
bullOsteoinductive and Osteoconductive
bullNo need for membranes
bullHolds form
bullRemodels into 100 high quality bone
bullNo concerns about transmissible diseases
bullldquoGold Standardrdquo
bullOsteoinductive and Osteoconductive
bullNo need for membranes
bullHolds form
bullRemodels into 100 high quality bone
bullNo concerns about transmissible diseases
Autogenous Block Grafts
Autogenous Block Grafts
bullDonor site morbidity
bullQuantity is limited
bullLose 20-30 during healing
bullDonor site morbidity
bullQuantity is limited
bullLose 20-30 during healing
Intra-oral Autogenous Bone Sites
AllogenicAllogenic Block Block GraftGraft
What about membranesWhat about membranes
bullUseful in containing particulate grafts
bullUseful around teethexposed implant threads
bullAdd expense
bull Infection risk
bullUnnecessary with block grafts
bullADA 4266 Resorbable
bullADA 4267 Non-Resorbable
bullUseful in containing particulate grafts
bullUseful around teethexposed implant threads
bullAdd expense
bull Infection risk
bullUnnecessary with block grafts
bullADA 4266 Resorbable
bullADA 4267 Non-Resorbable
Bone Morphogenic Protein (BMP)
Bone Morphogenic Protein (BMP)
bullGrow bone at will
bullPresently two are FDA approved BMP 2 for spinal fusions and BMP 7 for long bone defects
bullStudies show excellent results for socket preservation sinus lifts
bullExpensive ($500000 for a sinus)
bullGrow bone at will
bullPresently two are FDA approved BMP 2 for spinal fusions and BMP 7 for long bone defects
bullStudies show excellent results for socket preservation sinus lifts
bullExpensive ($500000 for a sinus)
FDA Panel Unanimously Recommends Approval of Third Indication For Medtronicrsquos INFUSE Bone Graft Nov 9 2006
FDA Panel Unanimously Recommends Approval of Third Indication For Medtronicrsquos INFUSE Bone Graft Nov 9 2006 INFUSE Bone Graft is recombinant human bone morphogenetic protein-2 (rhBMP-2) applied to an absorbable collagen sponge carrier The purpose of the protein which occurs naturally in the body is to stimulate bone formation It has been previously approved by the FDA for use in certain lumbar spine fusion and tibial fracture repair procedures
INFUSE Bone Graft is recombinant human bone morphogenetic protein-2 (rhBMP-2) applied to an absorbable collagen sponge carrier The purpose of the protein which occurs naturally in the body is to stimulate bone formation It has been previously approved by the FDA for use in certain lumbar spine fusion and tibial fracture repair procedures
Distraction OsteogenesisDistraction
OsteogenesisbullGeneration of bone (and soft
tissue) through distraction of an osseous callus
bullGeneration of bone (and soft tissue) through distraction of an osseous callus
Ann N Y Acad Sci 2006 Apr1068532-42 COX-2 has a critical role during incorporation of structural bone allografts OrsquoKeefe RJ Tiyapatanaputi P Xie C
Ann N Y Acad Sci 2006 Apr1068532-42 COX-2 has a critical role during incorporation of structural bone allografts OrsquoKeefe RJ Tiyapatanaputi P Xie C
Nonsteroidal anti-inflammatory drugs (NSAIDs) which inhibit cyclooxygenase (COX) activity reduce pain and are commonly used in patients with skeletal injury In this article we will also present data to show that selective COX-2 inhibitor delays allograft healing and incorporation These results demonstrated that COX-2 is essential for bone allograft incorporation Furthermore our data support the notion that COX-2-dependent PGE2 produced at the early stage of bone healing is prerequisite for efficient skeletal repair
Nonsteroidal anti-inflammatory drugs (NSAIDs) which inhibit cyclooxygenase (COX) activity reduce pain and are commonly used in patients with skeletal injury In this article we will also present data to show that selective COX-2 inhibitor delays allograft healing and incorporation These results demonstrated that COX-2 is essential for bone allograft incorporation Furthermore our data support the notion that COX-2-dependent PGE2 produced at the early stage of bone healing is prerequisite for efficient skeletal repair
Wise Old Oral Surgeon Wise Old Oral Surgeon Says Beware ofSays Beware of
Wise Old Oral Surgeon Wise Old Oral Surgeon Says Beware ofSays Beware of
bull 3rd molars in function3rd molars in function
bull Lone standing molarsLone standing molars
bull Teeth in bruxers Cl III skeletal patternsTeeth in bruxers Cl III skeletal patterns
bull 3rd molars + post-menopausal women3rd molars + post-menopausal women
bull Prior TMD historyPrior TMD history
bull Prior ldquobadrdquo oral surgery experiencePrior ldquobadrdquo oral surgery experience
bull Distoangular lower 3rds nerve proximityDistoangular lower 3rds nerve proximity
bull 3rd molars in function3rd molars in function
bull Lone standing molarsLone standing molars
bull Teeth in bruxers Cl III skeletal patternsTeeth in bruxers Cl III skeletal patterns
bull 3rd molars + post-menopausal women3rd molars + post-menopausal women
bull Prior TMD historyPrior TMD history
bull Prior ldquobadrdquo oral surgery experiencePrior ldquobadrdquo oral surgery experience
bull Distoangular lower 3rds nerve proximityDistoangular lower 3rds nerve proximity
3rd Molar Surgery ndash Why
3rd Molar Surgery ndash Why
1 Preventtreat pericoronitis (infection)2 Prevent periodontal problems 2nd molar3 Preventtreat caries to 2nd 3rd molar4 Prevent odontogenic cyststumors5 Strengthen mandible possible fx6 Prevent orthodontic relapse7 Treat pain of unknown origin
1 Preventtreat pericoronitis (infection)2 Prevent periodontal problems 2nd molar3 Preventtreat caries to 2nd 3rd molar4 Prevent odontogenic cyststumors5 Strengthen mandible possible fx6 Prevent orthodontic relapse7 Treat pain of unknown origin
Extract 3rds OralSystemic Extract 3rds OralSystemic LinkLink
CLEVELAND April 6 2006 - The first hard evidence has CLEVELAND April 6 2006 - The first hard evidence has been uncovered that bacteria in the mouth may find their been uncovered that bacteria in the mouth may find their way to the uterus causing uterine infections that can lead way to the uterus causing uterine infections that can lead to preterm birth in pregnant womento preterm birth in pregnant women
CLEVELAND April 6 2006 - The first hard evidence has CLEVELAND April 6 2006 - The first hard evidence has been uncovered that bacteria in the mouth may find their been uncovered that bacteria in the mouth may find their way to the uterus causing uterine infections that can lead way to the uterus causing uterine infections that can lead to preterm birth in pregnant womento preterm birth in pregnant women
A newly discovered and as yet unnamed species of the A newly discovered and as yet unnamed species of the bacterium genus bacterium genus BergeyellaBergeyella was found in the mouth was found in the mouth and amniotic fluid of a woman with a uterine infection and amniotic fluid of a woman with a uterine infection who gave birth prematurely (24 weeks) reported who gave birth prematurely (24 weeks) reported microbiologist Yiping W Han PhD of Case Western microbiologist Yiping W Han PhD of Case Western Reserve here Reserve here However the bacterium was not detected in a vaginal However the bacterium was not detected in a vaginal swab as might be expected The finding confirmed swab as might be expected The finding confirmed what some scientists have suspected that intrauterine what some scientists have suspected that intrauterine infections dont always ascend from the genital tract infections dont always ascend from the genital tract but can descend from the oral cavity Dr Han and but can descend from the oral cavity Dr Han and colleagues said in the April issue of the colleagues said in the April issue of the Journal of Journal of Clinical MicrobiologyClinical Microbiology
A newly discovered and as yet unnamed species of the A newly discovered and as yet unnamed species of the bacterium genus bacterium genus BergeyellaBergeyella was found in the mouth was found in the mouth and amniotic fluid of a woman with a uterine infection and amniotic fluid of a woman with a uterine infection who gave birth prematurely (24 weeks) reported who gave birth prematurely (24 weeks) reported microbiologist Yiping W Han PhD of Case Western microbiologist Yiping W Han PhD of Case Western Reserve here Reserve here However the bacterium was not detected in a vaginal However the bacterium was not detected in a vaginal swab as might be expected The finding confirmed swab as might be expected The finding confirmed what some scientists have suspected that intrauterine what some scientists have suspected that intrauterine infections dont always ascend from the genital tract infections dont always ascend from the genital tract but can descend from the oral cavity Dr Han and but can descend from the oral cavity Dr Han and colleagues said in the April issue of the colleagues said in the April issue of the Journal of Journal of Clinical MicrobiologyClinical Microbiology
Journal of Oral and Maxillofacial Journal of Oral and Maxillofacial SurgerySurgery
Volume 65 Issue 3 March 2007 Pages Volume 65 Issue 3 March 2007 Pages 377-383377-383
Progress Report on Third Molar Clinical Trials Progress Report on Third Molar Clinical Trials Raymond P White Jr DDS PhDRaymond P White Jr DDS PhD
1What happens to asymptomatic patients who keep their 1What happens to asymptomatic patients who keep their third molars third molars
2What is the recovery like for those who have them 2What is the recovery like for those who have them removed and what can we do as surgeons to improve removed and what can we do as surgeons to improve post operative outcomespost operative outcomes
3rd Molar Surgery ndash When3rd Molar Surgery ndash WhenbullBefore roots 100 developed
bullAfter roots 13 formed
bullMorbiditycomplications minimized as bone more flexible nerves more pliable and PMH less complicated
bullDonrsquot forget tooth transplanttooth transplant if apex not closed
bullBefore roots 100 developed
bullAfter roots 13 formed
bullMorbiditycomplications minimized as bone more flexible nerves more pliable and PMH less complicated
bullDonrsquot forget tooth transplanttooth transplant if apex not closed
Outcome of tooth transplantation survival and success rates 17-41 years post treatmentCzochrowska EM Stenvik A Bjercke B Zachrisson Am J Orthod Dentofacial Orthop 2002 Feb121(2)110-9The mean age at surgery was 115 years and the mean observation period was 264 264 years (range 17-41 years) Of the 33 teeth transplanted in the 28 patients 3 teeth were lost after 9 10 and 29 years respectively Therefore the 30 teeth in the 25 patients we examined yielded a survival rate of 90 The success rate was 79 because 2 transplants had ankylosed and 2 others failed to fulfill the proposed criteria The patients generally responded very favorably regarding their perception of the treatment Their only hesitation was related to some discomfort during surgery It was concluded that It was concluded that survival and success rates for teeth auto survival and success rates for teeth auto transplanted when the root is partly developed transplanted when the root is partly developed compare favorably in a long-term perspective compare favorably in a long-term perspective with other treatment modalities for with other treatment modalities for substituting missing teethsubstituting missing teeth
Outcome of tooth transplantation survival and success rates 17-41 years post treatmentCzochrowska EM Stenvik A Bjercke B Zachrisson Am J Orthod Dentofacial Orthop 2002 Feb121(2)110-9The mean age at surgery was 115 years and the mean observation period was 264 264 years (range 17-41 years) Of the 33 teeth transplanted in the 28 patients 3 teeth were lost after 9 10 and 29 years respectively Therefore the 30 teeth in the 25 patients we examined yielded a survival rate of 90 The success rate was 79 because 2 transplants had ankylosed and 2 others failed to fulfill the proposed criteria The patients generally responded very favorably regarding their perception of the treatment Their only hesitation was related to some discomfort during surgery It was concluded that It was concluded that survival and success rates for teeth auto survival and success rates for teeth auto transplanted when the root is partly developed transplanted when the root is partly developed compare favorably in a long-term perspective compare favorably in a long-term perspective with other treatment modalities for with other treatment modalities for substituting missing teethsubstituting missing teeth
3rd Molar Surgery ndash When Not
3rd Molar Surgery ndash When Not
bullExtremes of age
bullNo oral communication (full bony)
bullIntimate root-nerve Relationship
bullRisks gt Benefits
bullExtremes of age
bullNo oral communication (full bony)
bullIntimate root-nerve Relationship
bullRisks gt Benefits
3rd Molar Surgery Alternatives
3rd Molar Surgery Alternatives
bullNo Surgery dentist feels risk benefit ratio not favorable or patient refuses ndash document and recommend radiograph q 3-5 years
bullNo Surgery dentist feels risk benefit ratio not favorable or patient refuses ndash document and recommend radiograph q 3-5 years
No High SpeedNo High Speed
bullAir embolus
bullAir emphysema
bullBlow debris into flap
bullBlow bacteria into flap
bullNon-sterile water
bullAir embolus
bullAir emphysema
bullBlow debris into flap
bullBlow bacteria into flap
bullNon-sterile water
Which are trueWhich are true1 Tooth transplants are usually done on
patients 20-302 Average success rate for a tooth
transplant is 20-303 In order to work a transplant must
have endo4 Most transplants will ankylose
A 13 B 24 C 123 D 3 only
E None of the above
1 Tooth transplants are usually done on patients 20-30
2 Average success rate for a tooth transplant is 20-30
3 In order to work a transplant must have endo
4 Most transplants will ankylose
A 13 B 24 C 123 D 3 only
E None of the above
How can I assess the relationship How can I assess the relationship between the 3between the 3rdrd molar root and the molar root and the
inferior alveolar nerveinferior alveolar nerve
- Slide 2
- Slide 3
- Slide 4
- ldquoSockets with intact buccal and lingual plates heal well without graftinghellip consider grafting with resorbable osteoinductive material if plates compromised and implants plannedrdquo grafting with connective tissue if pontic esthetics an issuerdquo
- Vital Root Retention
- Slide 7
- Slide 8
- Slide 9
- J Oral Maxillofac Surg 2005 Feb43(1)7-12 A randomized controlled clinical trial to compare the incidence of injury to the inferior alveolar nerve as a result of coronectomy and removal of mandibular third molars Renton T Hankins M Sproate C
- Slide 11
- Slide 12
- Immediate Implant Placement Following Extractions
- Platelet Rich Plasma
- Slide 15
- Slide 16
- Slide 17
- Why Reconstruct
- How Autogenous Bone Grafts with Implants
- Autogenous Block Grafts
- Slide 21
- Intra-oral Autogenous Bone Sites
- Slide 23
- What about membranes
- Bone Morphogenic Protein (BMP)
- Slide 26
- Distraction Osteogenesis
- Slide 28
- Wise Old Oral Surgeon Says Beware of
- 3rd Molar Surgery ndash Why
- Extract 3rds OralSystemic Link
- Slide 32
- 3rd Molar Surgery ndash When
- 3rd Molar Surgery ndash When Not
- 3rd Molar Surgery Alternatives
- No High Speed
- Slide 38
- Which are true
- Slide 40
-
J Oral Maxillofac SurgJ Oral Maxillofac Surg 2005 Feb43(1)7-12 A 2005 Feb43(1)7-12 A randomized controlled clinical trial to randomized controlled clinical trial to compare the incidence of injury to the compare the incidence of injury to the inferior alveolar nerve as a result of inferior alveolar nerve as a result of coronectomy and removal of mandibular third coronectomy and removal of mandibular third molars Renton T Hankins M Sproate Cmolars Renton T Hankins M Sproate C
bull The length of follow up was about two The length of follow up was about two years which for the assessment of years which for the assessment of delayed eruption of the root fragments delayed eruption of the root fragments is not sufficient as this process may is not sufficient as this process may continue for up to 10 years However continue for up to 10 years However it seems that coronectomy reduces the it seems that coronectomy reduces the incidence of injury to the inferior incidence of injury to the inferior alveolar nerve without increasing the alveolar nerve without increasing the risk of dry socket or infection risk of dry socket or infection
J Oral Maxillofac Surg 2004 Dec62(12)1447-52 Coronectomy a technique to protect the inferior alveolar nerve Pogrel MA Lee JS Muff DF
J Oral Maxillofac Surg 2004 Dec62(12)1447-52 Coronectomy a technique to protect the inferior alveolar nerve Pogrel MA Lee JS Muff DF
PURPOSE Damage to the inferior alveolar nerve when extracting lower third molars is often caused by the intimate relationship between the nerve and the roots of the teeth The technique of coronectomy or intentional root retention may minimize this problem
PURPOSE Damage to the inferior alveolar nerve when extracting lower third molars is often caused by the intimate relationship between the nerve and the roots of the teeth The technique of coronectomy or intentional root retention may minimize this problemRESULTS There were no cases of inferior alveolar nerve-involved damage in this study of 41 patients who underwent 50 coronectomies There was 1 case of transient lingual nerve involvement probably from the use of the lingual retractor One patient required subsequent removal of the roots of both lower third molars because of failure to heal and 1 patient required subsequent removal of a root because of subsequent migration to the surface Root migration was noted in approximately 30 of patients over a 6 month period CONCLUSION Coronectomy appears to be a viable technique in those cases where removal of the whole tooth might put the inferior alveolar nerve at considerable risk of damage
RESULTS There were no cases of inferior alveolar nerve-involved damage in this study of 41 patients who underwent 50 coronectomies There was 1 case of transient lingual nerve involvement probably from the use of the lingual retractor One patient required subsequent removal of the roots of both lower third molars because of failure to heal and 1 patient required subsequent removal of a root because of subsequent migration to the surface Root migration was noted in approximately 30 of patients over a 6 month period CONCLUSION Coronectomy appears to be a viable technique in those cases where removal of the whole tooth might put the inferior alveolar nerve at considerable risk of damage
Pre-op (Oral Pre-op (Oral bisphosphonates X bisphosphonates X 5 years)5 years)
Immed Immed PostPost
10 month 10 month postpost
Immediate Implant Placement Following
Extractions
Immediate Implant Placement Following
ExtractionsbullNeed 3-4 mm of solid bone at base
of socket and no active infection
bullSuccess rates ~ to ldquonormalrdquo
bullMost typical sites anterior teeth and 1st premolars
bullAdvantages May reduce loss of labial plate and improve esthetics as well as save time
bullNeed 3-4 mm of solid bone at base of socket and no active infection
bullSuccess rates ~ to ldquonormalrdquo
bullMost typical sites anterior teeth and 1st premolars
bullAdvantages May reduce loss of labial plate and improve esthetics as well as save time
Platelet Rich PlasmaPlatelet Rich PlasmaPlatelet Rich PlasmaPlatelet Rich PlasmabullWhatrsquos HotWhatrsquos Hot
ndash Release various Release various growth factors that growth factors that aid in hemostasis aid in hemostasis and increase rate and increase rate of healing of healing (mitogenesis (mitogenesis angiogenesis) angiogenesis)
bullWhatrsquos HotWhatrsquos Hotndash Release various Release various
growth factors that growth factors that aid in hemostasis aid in hemostasis and increase rate and increase rate of healing of healing (mitogenesis (mitogenesis angiogenesis) angiogenesis)
bullWhatrsquos NotWhatrsquos Notndash CostCostndash Is there any Is there any
difference at 6 difference at 6 weeksweeks
ndash Invasive Invasive borrow 45-borrow 45-90ml of blood90ml of blood
bullWhatrsquos NotWhatrsquos Notndash CostCostndash Is there any Is there any
difference at 6 difference at 6 weeksweeks
ndash Invasive Invasive borrow 45-borrow 45-90ml of blood90ml of blood
Casap et al Immediate Implantation Into Debrided Infected Sockets J Oral Maxillofac Surg 2007
Does placing implants into fresh extraction Does placing implants into fresh extraction sockets preserve bonesockets preserve bone
J Clin Periodontol 2005 Jun32(6)645-52 Ridge alterations following implant placement in fresh extraction sockets an experimental study in the dogArauacutejo MG Sukekava F Wennstroumlm JL Lindhe J
CONCLUSIONS Marked dimensional alterations had occurred in the edentulous ridge after 3 months of healing following the extraction of the distal root of mandibular pre-molars The placement of an The placement of an implant in the fresh extraction site obviously implant in the fresh extraction site obviously failed to prevent the re-modeling that occurred failed to prevent the re-modeling that occurred in the walls of the socketin the walls of the socket The resulting height of the buccal and lingual walls at 3 months was similar at implants and edentulous sites
Most human trials however reveal results Most human trials however reveal results similar to implants place via the ldquoold similar to implants place via the ldquoold schoolrdquo approach even when immediately schoolrdquo approach even when immediately loaded (caution in ldquosoftrdquo bone gt55 YO)loaded (caution in ldquosoftrdquo bone gt55 YO)
Int J Oral Maxillofac Implants 2007 Mar-Apr22(2)187-94 The radiographic bone loss pattern adjacent to immediately placed immediately loaded implantsJaffin R Kolesar M Kumar A Ishikawa S Fiorellini J
J Craniofac Surg 2007 Jul18(4)965-71 Immediate loaded dental implants comparison between fixtures inserted in postextractive and healed bone sitesDegidi M Piattelli A Carinci F
J Periodontol 2007 May78(5)810-5 Vertical crestal bone changes around implants placed into fresh extraction socketsCovani U Cornelini R Barone A
Why ReconstructWhy Reconstruct
bullNot enough bone for implants
bullEnough bone but esthetic result suboptimal
bullPrevent pathologic fracture
bullPoor functionestheticsretention of conventional removable prosthesis
bullNot enough bone for implants
bullEnough bone but esthetic result suboptimal
bullPrevent pathologic fracture
bullPoor functionestheticsretention of conventional removable prosthesis
How Autogenous Bone Grafts
with Implants
How Autogenous Bone Grafts
with Implants
Autogenous Block GraftsAutogenous Block Grafts
bullldquoGold Standardrdquo
bullOsteoinductive and Osteoconductive
bullNo need for membranes
bullHolds form
bullRemodels into 100 high quality bone
bullNo concerns about transmissible diseases
bullldquoGold Standardrdquo
bullOsteoinductive and Osteoconductive
bullNo need for membranes
bullHolds form
bullRemodels into 100 high quality bone
bullNo concerns about transmissible diseases
Autogenous Block Grafts
Autogenous Block Grafts
bullDonor site morbidity
bullQuantity is limited
bullLose 20-30 during healing
bullDonor site morbidity
bullQuantity is limited
bullLose 20-30 during healing
Intra-oral Autogenous Bone Sites
AllogenicAllogenic Block Block GraftGraft
What about membranesWhat about membranes
bullUseful in containing particulate grafts
bullUseful around teethexposed implant threads
bullAdd expense
bull Infection risk
bullUnnecessary with block grafts
bullADA 4266 Resorbable
bullADA 4267 Non-Resorbable
bullUseful in containing particulate grafts
bullUseful around teethexposed implant threads
bullAdd expense
bull Infection risk
bullUnnecessary with block grafts
bullADA 4266 Resorbable
bullADA 4267 Non-Resorbable
Bone Morphogenic Protein (BMP)
Bone Morphogenic Protein (BMP)
bullGrow bone at will
bullPresently two are FDA approved BMP 2 for spinal fusions and BMP 7 for long bone defects
bullStudies show excellent results for socket preservation sinus lifts
bullExpensive ($500000 for a sinus)
bullGrow bone at will
bullPresently two are FDA approved BMP 2 for spinal fusions and BMP 7 for long bone defects
bullStudies show excellent results for socket preservation sinus lifts
bullExpensive ($500000 for a sinus)
FDA Panel Unanimously Recommends Approval of Third Indication For Medtronicrsquos INFUSE Bone Graft Nov 9 2006
FDA Panel Unanimously Recommends Approval of Third Indication For Medtronicrsquos INFUSE Bone Graft Nov 9 2006 INFUSE Bone Graft is recombinant human bone morphogenetic protein-2 (rhBMP-2) applied to an absorbable collagen sponge carrier The purpose of the protein which occurs naturally in the body is to stimulate bone formation It has been previously approved by the FDA for use in certain lumbar spine fusion and tibial fracture repair procedures
INFUSE Bone Graft is recombinant human bone morphogenetic protein-2 (rhBMP-2) applied to an absorbable collagen sponge carrier The purpose of the protein which occurs naturally in the body is to stimulate bone formation It has been previously approved by the FDA for use in certain lumbar spine fusion and tibial fracture repair procedures
Distraction OsteogenesisDistraction
OsteogenesisbullGeneration of bone (and soft
tissue) through distraction of an osseous callus
bullGeneration of bone (and soft tissue) through distraction of an osseous callus
Ann N Y Acad Sci 2006 Apr1068532-42 COX-2 has a critical role during incorporation of structural bone allografts OrsquoKeefe RJ Tiyapatanaputi P Xie C
Ann N Y Acad Sci 2006 Apr1068532-42 COX-2 has a critical role during incorporation of structural bone allografts OrsquoKeefe RJ Tiyapatanaputi P Xie C
Nonsteroidal anti-inflammatory drugs (NSAIDs) which inhibit cyclooxygenase (COX) activity reduce pain and are commonly used in patients with skeletal injury In this article we will also present data to show that selective COX-2 inhibitor delays allograft healing and incorporation These results demonstrated that COX-2 is essential for bone allograft incorporation Furthermore our data support the notion that COX-2-dependent PGE2 produced at the early stage of bone healing is prerequisite for efficient skeletal repair
Nonsteroidal anti-inflammatory drugs (NSAIDs) which inhibit cyclooxygenase (COX) activity reduce pain and are commonly used in patients with skeletal injury In this article we will also present data to show that selective COX-2 inhibitor delays allograft healing and incorporation These results demonstrated that COX-2 is essential for bone allograft incorporation Furthermore our data support the notion that COX-2-dependent PGE2 produced at the early stage of bone healing is prerequisite for efficient skeletal repair
Wise Old Oral Surgeon Wise Old Oral Surgeon Says Beware ofSays Beware of
Wise Old Oral Surgeon Wise Old Oral Surgeon Says Beware ofSays Beware of
bull 3rd molars in function3rd molars in function
bull Lone standing molarsLone standing molars
bull Teeth in bruxers Cl III skeletal patternsTeeth in bruxers Cl III skeletal patterns
bull 3rd molars + post-menopausal women3rd molars + post-menopausal women
bull Prior TMD historyPrior TMD history
bull Prior ldquobadrdquo oral surgery experiencePrior ldquobadrdquo oral surgery experience
bull Distoangular lower 3rds nerve proximityDistoangular lower 3rds nerve proximity
bull 3rd molars in function3rd molars in function
bull Lone standing molarsLone standing molars
bull Teeth in bruxers Cl III skeletal patternsTeeth in bruxers Cl III skeletal patterns
bull 3rd molars + post-menopausal women3rd molars + post-menopausal women
bull Prior TMD historyPrior TMD history
bull Prior ldquobadrdquo oral surgery experiencePrior ldquobadrdquo oral surgery experience
bull Distoangular lower 3rds nerve proximityDistoangular lower 3rds nerve proximity
3rd Molar Surgery ndash Why
3rd Molar Surgery ndash Why
1 Preventtreat pericoronitis (infection)2 Prevent periodontal problems 2nd molar3 Preventtreat caries to 2nd 3rd molar4 Prevent odontogenic cyststumors5 Strengthen mandible possible fx6 Prevent orthodontic relapse7 Treat pain of unknown origin
1 Preventtreat pericoronitis (infection)2 Prevent periodontal problems 2nd molar3 Preventtreat caries to 2nd 3rd molar4 Prevent odontogenic cyststumors5 Strengthen mandible possible fx6 Prevent orthodontic relapse7 Treat pain of unknown origin
Extract 3rds OralSystemic Extract 3rds OralSystemic LinkLink
CLEVELAND April 6 2006 - The first hard evidence has CLEVELAND April 6 2006 - The first hard evidence has been uncovered that bacteria in the mouth may find their been uncovered that bacteria in the mouth may find their way to the uterus causing uterine infections that can lead way to the uterus causing uterine infections that can lead to preterm birth in pregnant womento preterm birth in pregnant women
CLEVELAND April 6 2006 - The first hard evidence has CLEVELAND April 6 2006 - The first hard evidence has been uncovered that bacteria in the mouth may find their been uncovered that bacteria in the mouth may find their way to the uterus causing uterine infections that can lead way to the uterus causing uterine infections that can lead to preterm birth in pregnant womento preterm birth in pregnant women
A newly discovered and as yet unnamed species of the A newly discovered and as yet unnamed species of the bacterium genus bacterium genus BergeyellaBergeyella was found in the mouth was found in the mouth and amniotic fluid of a woman with a uterine infection and amniotic fluid of a woman with a uterine infection who gave birth prematurely (24 weeks) reported who gave birth prematurely (24 weeks) reported microbiologist Yiping W Han PhD of Case Western microbiologist Yiping W Han PhD of Case Western Reserve here Reserve here However the bacterium was not detected in a vaginal However the bacterium was not detected in a vaginal swab as might be expected The finding confirmed swab as might be expected The finding confirmed what some scientists have suspected that intrauterine what some scientists have suspected that intrauterine infections dont always ascend from the genital tract infections dont always ascend from the genital tract but can descend from the oral cavity Dr Han and but can descend from the oral cavity Dr Han and colleagues said in the April issue of the colleagues said in the April issue of the Journal of Journal of Clinical MicrobiologyClinical Microbiology
A newly discovered and as yet unnamed species of the A newly discovered and as yet unnamed species of the bacterium genus bacterium genus BergeyellaBergeyella was found in the mouth was found in the mouth and amniotic fluid of a woman with a uterine infection and amniotic fluid of a woman with a uterine infection who gave birth prematurely (24 weeks) reported who gave birth prematurely (24 weeks) reported microbiologist Yiping W Han PhD of Case Western microbiologist Yiping W Han PhD of Case Western Reserve here Reserve here However the bacterium was not detected in a vaginal However the bacterium was not detected in a vaginal swab as might be expected The finding confirmed swab as might be expected The finding confirmed what some scientists have suspected that intrauterine what some scientists have suspected that intrauterine infections dont always ascend from the genital tract infections dont always ascend from the genital tract but can descend from the oral cavity Dr Han and but can descend from the oral cavity Dr Han and colleagues said in the April issue of the colleagues said in the April issue of the Journal of Journal of Clinical MicrobiologyClinical Microbiology
Journal of Oral and Maxillofacial Journal of Oral and Maxillofacial SurgerySurgery
Volume 65 Issue 3 March 2007 Pages Volume 65 Issue 3 March 2007 Pages 377-383377-383
Progress Report on Third Molar Clinical Trials Progress Report on Third Molar Clinical Trials Raymond P White Jr DDS PhDRaymond P White Jr DDS PhD
1What happens to asymptomatic patients who keep their 1What happens to asymptomatic patients who keep their third molars third molars
2What is the recovery like for those who have them 2What is the recovery like for those who have them removed and what can we do as surgeons to improve removed and what can we do as surgeons to improve post operative outcomespost operative outcomes
3rd Molar Surgery ndash When3rd Molar Surgery ndash WhenbullBefore roots 100 developed
bullAfter roots 13 formed
bullMorbiditycomplications minimized as bone more flexible nerves more pliable and PMH less complicated
bullDonrsquot forget tooth transplanttooth transplant if apex not closed
bullBefore roots 100 developed
bullAfter roots 13 formed
bullMorbiditycomplications minimized as bone more flexible nerves more pliable and PMH less complicated
bullDonrsquot forget tooth transplanttooth transplant if apex not closed
Outcome of tooth transplantation survival and success rates 17-41 years post treatmentCzochrowska EM Stenvik A Bjercke B Zachrisson Am J Orthod Dentofacial Orthop 2002 Feb121(2)110-9The mean age at surgery was 115 years and the mean observation period was 264 264 years (range 17-41 years) Of the 33 teeth transplanted in the 28 patients 3 teeth were lost after 9 10 and 29 years respectively Therefore the 30 teeth in the 25 patients we examined yielded a survival rate of 90 The success rate was 79 because 2 transplants had ankylosed and 2 others failed to fulfill the proposed criteria The patients generally responded very favorably regarding their perception of the treatment Their only hesitation was related to some discomfort during surgery It was concluded that It was concluded that survival and success rates for teeth auto survival and success rates for teeth auto transplanted when the root is partly developed transplanted when the root is partly developed compare favorably in a long-term perspective compare favorably in a long-term perspective with other treatment modalities for with other treatment modalities for substituting missing teethsubstituting missing teeth
Outcome of tooth transplantation survival and success rates 17-41 years post treatmentCzochrowska EM Stenvik A Bjercke B Zachrisson Am J Orthod Dentofacial Orthop 2002 Feb121(2)110-9The mean age at surgery was 115 years and the mean observation period was 264 264 years (range 17-41 years) Of the 33 teeth transplanted in the 28 patients 3 teeth were lost after 9 10 and 29 years respectively Therefore the 30 teeth in the 25 patients we examined yielded a survival rate of 90 The success rate was 79 because 2 transplants had ankylosed and 2 others failed to fulfill the proposed criteria The patients generally responded very favorably regarding their perception of the treatment Their only hesitation was related to some discomfort during surgery It was concluded that It was concluded that survival and success rates for teeth auto survival and success rates for teeth auto transplanted when the root is partly developed transplanted when the root is partly developed compare favorably in a long-term perspective compare favorably in a long-term perspective with other treatment modalities for with other treatment modalities for substituting missing teethsubstituting missing teeth
3rd Molar Surgery ndash When Not
3rd Molar Surgery ndash When Not
bullExtremes of age
bullNo oral communication (full bony)
bullIntimate root-nerve Relationship
bullRisks gt Benefits
bullExtremes of age
bullNo oral communication (full bony)
bullIntimate root-nerve Relationship
bullRisks gt Benefits
3rd Molar Surgery Alternatives
3rd Molar Surgery Alternatives
bullNo Surgery dentist feels risk benefit ratio not favorable or patient refuses ndash document and recommend radiograph q 3-5 years
bullNo Surgery dentist feels risk benefit ratio not favorable or patient refuses ndash document and recommend radiograph q 3-5 years
No High SpeedNo High Speed
bullAir embolus
bullAir emphysema
bullBlow debris into flap
bullBlow bacteria into flap
bullNon-sterile water
bullAir embolus
bullAir emphysema
bullBlow debris into flap
bullBlow bacteria into flap
bullNon-sterile water
Which are trueWhich are true1 Tooth transplants are usually done on
patients 20-302 Average success rate for a tooth
transplant is 20-303 In order to work a transplant must
have endo4 Most transplants will ankylose
A 13 B 24 C 123 D 3 only
E None of the above
1 Tooth transplants are usually done on patients 20-30
2 Average success rate for a tooth transplant is 20-30
3 In order to work a transplant must have endo
4 Most transplants will ankylose
A 13 B 24 C 123 D 3 only
E None of the above
How can I assess the relationship How can I assess the relationship between the 3between the 3rdrd molar root and the molar root and the
inferior alveolar nerveinferior alveolar nerve
- Slide 2
- Slide 3
- Slide 4
- ldquoSockets with intact buccal and lingual plates heal well without graftinghellip consider grafting with resorbable osteoinductive material if plates compromised and implants plannedrdquo grafting with connective tissue if pontic esthetics an issuerdquo
- Vital Root Retention
- Slide 7
- Slide 8
- Slide 9
- J Oral Maxillofac Surg 2005 Feb43(1)7-12 A randomized controlled clinical trial to compare the incidence of injury to the inferior alveolar nerve as a result of coronectomy and removal of mandibular third molars Renton T Hankins M Sproate C
- Slide 11
- Slide 12
- Immediate Implant Placement Following Extractions
- Platelet Rich Plasma
- Slide 15
- Slide 16
- Slide 17
- Why Reconstruct
- How Autogenous Bone Grafts with Implants
- Autogenous Block Grafts
- Slide 21
- Intra-oral Autogenous Bone Sites
- Slide 23
- What about membranes
- Bone Morphogenic Protein (BMP)
- Slide 26
- Distraction Osteogenesis
- Slide 28
- Wise Old Oral Surgeon Says Beware of
- 3rd Molar Surgery ndash Why
- Extract 3rds OralSystemic Link
- Slide 32
- 3rd Molar Surgery ndash When
- 3rd Molar Surgery ndash When Not
- 3rd Molar Surgery Alternatives
- No High Speed
- Slide 38
- Which are true
- Slide 40
-
J Oral Maxillofac Surg 2004 Dec62(12)1447-52 Coronectomy a technique to protect the inferior alveolar nerve Pogrel MA Lee JS Muff DF
J Oral Maxillofac Surg 2004 Dec62(12)1447-52 Coronectomy a technique to protect the inferior alveolar nerve Pogrel MA Lee JS Muff DF
PURPOSE Damage to the inferior alveolar nerve when extracting lower third molars is often caused by the intimate relationship between the nerve and the roots of the teeth The technique of coronectomy or intentional root retention may minimize this problem
PURPOSE Damage to the inferior alveolar nerve when extracting lower third molars is often caused by the intimate relationship between the nerve and the roots of the teeth The technique of coronectomy or intentional root retention may minimize this problemRESULTS There were no cases of inferior alveolar nerve-involved damage in this study of 41 patients who underwent 50 coronectomies There was 1 case of transient lingual nerve involvement probably from the use of the lingual retractor One patient required subsequent removal of the roots of both lower third molars because of failure to heal and 1 patient required subsequent removal of a root because of subsequent migration to the surface Root migration was noted in approximately 30 of patients over a 6 month period CONCLUSION Coronectomy appears to be a viable technique in those cases where removal of the whole tooth might put the inferior alveolar nerve at considerable risk of damage
RESULTS There were no cases of inferior alveolar nerve-involved damage in this study of 41 patients who underwent 50 coronectomies There was 1 case of transient lingual nerve involvement probably from the use of the lingual retractor One patient required subsequent removal of the roots of both lower third molars because of failure to heal and 1 patient required subsequent removal of a root because of subsequent migration to the surface Root migration was noted in approximately 30 of patients over a 6 month period CONCLUSION Coronectomy appears to be a viable technique in those cases where removal of the whole tooth might put the inferior alveolar nerve at considerable risk of damage
Pre-op (Oral Pre-op (Oral bisphosphonates X bisphosphonates X 5 years)5 years)
Immed Immed PostPost
10 month 10 month postpost
Immediate Implant Placement Following
Extractions
Immediate Implant Placement Following
ExtractionsbullNeed 3-4 mm of solid bone at base
of socket and no active infection
bullSuccess rates ~ to ldquonormalrdquo
bullMost typical sites anterior teeth and 1st premolars
bullAdvantages May reduce loss of labial plate and improve esthetics as well as save time
bullNeed 3-4 mm of solid bone at base of socket and no active infection
bullSuccess rates ~ to ldquonormalrdquo
bullMost typical sites anterior teeth and 1st premolars
bullAdvantages May reduce loss of labial plate and improve esthetics as well as save time
Platelet Rich PlasmaPlatelet Rich PlasmaPlatelet Rich PlasmaPlatelet Rich PlasmabullWhatrsquos HotWhatrsquos Hot
ndash Release various Release various growth factors that growth factors that aid in hemostasis aid in hemostasis and increase rate and increase rate of healing of healing (mitogenesis (mitogenesis angiogenesis) angiogenesis)
bullWhatrsquos HotWhatrsquos Hotndash Release various Release various
growth factors that growth factors that aid in hemostasis aid in hemostasis and increase rate and increase rate of healing of healing (mitogenesis (mitogenesis angiogenesis) angiogenesis)
bullWhatrsquos NotWhatrsquos Notndash CostCostndash Is there any Is there any
difference at 6 difference at 6 weeksweeks
ndash Invasive Invasive borrow 45-borrow 45-90ml of blood90ml of blood
bullWhatrsquos NotWhatrsquos Notndash CostCostndash Is there any Is there any
difference at 6 difference at 6 weeksweeks
ndash Invasive Invasive borrow 45-borrow 45-90ml of blood90ml of blood
Casap et al Immediate Implantation Into Debrided Infected Sockets J Oral Maxillofac Surg 2007
Does placing implants into fresh extraction Does placing implants into fresh extraction sockets preserve bonesockets preserve bone
J Clin Periodontol 2005 Jun32(6)645-52 Ridge alterations following implant placement in fresh extraction sockets an experimental study in the dogArauacutejo MG Sukekava F Wennstroumlm JL Lindhe J
CONCLUSIONS Marked dimensional alterations had occurred in the edentulous ridge after 3 months of healing following the extraction of the distal root of mandibular pre-molars The placement of an The placement of an implant in the fresh extraction site obviously implant in the fresh extraction site obviously failed to prevent the re-modeling that occurred failed to prevent the re-modeling that occurred in the walls of the socketin the walls of the socket The resulting height of the buccal and lingual walls at 3 months was similar at implants and edentulous sites
Most human trials however reveal results Most human trials however reveal results similar to implants place via the ldquoold similar to implants place via the ldquoold schoolrdquo approach even when immediately schoolrdquo approach even when immediately loaded (caution in ldquosoftrdquo bone gt55 YO)loaded (caution in ldquosoftrdquo bone gt55 YO)
Int J Oral Maxillofac Implants 2007 Mar-Apr22(2)187-94 The radiographic bone loss pattern adjacent to immediately placed immediately loaded implantsJaffin R Kolesar M Kumar A Ishikawa S Fiorellini J
J Craniofac Surg 2007 Jul18(4)965-71 Immediate loaded dental implants comparison between fixtures inserted in postextractive and healed bone sitesDegidi M Piattelli A Carinci F
J Periodontol 2007 May78(5)810-5 Vertical crestal bone changes around implants placed into fresh extraction socketsCovani U Cornelini R Barone A
Why ReconstructWhy Reconstruct
bullNot enough bone for implants
bullEnough bone but esthetic result suboptimal
bullPrevent pathologic fracture
bullPoor functionestheticsretention of conventional removable prosthesis
bullNot enough bone for implants
bullEnough bone but esthetic result suboptimal
bullPrevent pathologic fracture
bullPoor functionestheticsretention of conventional removable prosthesis
How Autogenous Bone Grafts
with Implants
How Autogenous Bone Grafts
with Implants
Autogenous Block GraftsAutogenous Block Grafts
bullldquoGold Standardrdquo
bullOsteoinductive and Osteoconductive
bullNo need for membranes
bullHolds form
bullRemodels into 100 high quality bone
bullNo concerns about transmissible diseases
bullldquoGold Standardrdquo
bullOsteoinductive and Osteoconductive
bullNo need for membranes
bullHolds form
bullRemodels into 100 high quality bone
bullNo concerns about transmissible diseases
Autogenous Block Grafts
Autogenous Block Grafts
bullDonor site morbidity
bullQuantity is limited
bullLose 20-30 during healing
bullDonor site morbidity
bullQuantity is limited
bullLose 20-30 during healing
Intra-oral Autogenous Bone Sites
AllogenicAllogenic Block Block GraftGraft
What about membranesWhat about membranes
bullUseful in containing particulate grafts
bullUseful around teethexposed implant threads
bullAdd expense
bull Infection risk
bullUnnecessary with block grafts
bullADA 4266 Resorbable
bullADA 4267 Non-Resorbable
bullUseful in containing particulate grafts
bullUseful around teethexposed implant threads
bullAdd expense
bull Infection risk
bullUnnecessary with block grafts
bullADA 4266 Resorbable
bullADA 4267 Non-Resorbable
Bone Morphogenic Protein (BMP)
Bone Morphogenic Protein (BMP)
bullGrow bone at will
bullPresently two are FDA approved BMP 2 for spinal fusions and BMP 7 for long bone defects
bullStudies show excellent results for socket preservation sinus lifts
bullExpensive ($500000 for a sinus)
bullGrow bone at will
bullPresently two are FDA approved BMP 2 for spinal fusions and BMP 7 for long bone defects
bullStudies show excellent results for socket preservation sinus lifts
bullExpensive ($500000 for a sinus)
FDA Panel Unanimously Recommends Approval of Third Indication For Medtronicrsquos INFUSE Bone Graft Nov 9 2006
FDA Panel Unanimously Recommends Approval of Third Indication For Medtronicrsquos INFUSE Bone Graft Nov 9 2006 INFUSE Bone Graft is recombinant human bone morphogenetic protein-2 (rhBMP-2) applied to an absorbable collagen sponge carrier The purpose of the protein which occurs naturally in the body is to stimulate bone formation It has been previously approved by the FDA for use in certain lumbar spine fusion and tibial fracture repair procedures
INFUSE Bone Graft is recombinant human bone morphogenetic protein-2 (rhBMP-2) applied to an absorbable collagen sponge carrier The purpose of the protein which occurs naturally in the body is to stimulate bone formation It has been previously approved by the FDA for use in certain lumbar spine fusion and tibial fracture repair procedures
Distraction OsteogenesisDistraction
OsteogenesisbullGeneration of bone (and soft
tissue) through distraction of an osseous callus
bullGeneration of bone (and soft tissue) through distraction of an osseous callus
Ann N Y Acad Sci 2006 Apr1068532-42 COX-2 has a critical role during incorporation of structural bone allografts OrsquoKeefe RJ Tiyapatanaputi P Xie C
Ann N Y Acad Sci 2006 Apr1068532-42 COX-2 has a critical role during incorporation of structural bone allografts OrsquoKeefe RJ Tiyapatanaputi P Xie C
Nonsteroidal anti-inflammatory drugs (NSAIDs) which inhibit cyclooxygenase (COX) activity reduce pain and are commonly used in patients with skeletal injury In this article we will also present data to show that selective COX-2 inhibitor delays allograft healing and incorporation These results demonstrated that COX-2 is essential for bone allograft incorporation Furthermore our data support the notion that COX-2-dependent PGE2 produced at the early stage of bone healing is prerequisite for efficient skeletal repair
Nonsteroidal anti-inflammatory drugs (NSAIDs) which inhibit cyclooxygenase (COX) activity reduce pain and are commonly used in patients with skeletal injury In this article we will also present data to show that selective COX-2 inhibitor delays allograft healing and incorporation These results demonstrated that COX-2 is essential for bone allograft incorporation Furthermore our data support the notion that COX-2-dependent PGE2 produced at the early stage of bone healing is prerequisite for efficient skeletal repair
Wise Old Oral Surgeon Wise Old Oral Surgeon Says Beware ofSays Beware of
Wise Old Oral Surgeon Wise Old Oral Surgeon Says Beware ofSays Beware of
bull 3rd molars in function3rd molars in function
bull Lone standing molarsLone standing molars
bull Teeth in bruxers Cl III skeletal patternsTeeth in bruxers Cl III skeletal patterns
bull 3rd molars + post-menopausal women3rd molars + post-menopausal women
bull Prior TMD historyPrior TMD history
bull Prior ldquobadrdquo oral surgery experiencePrior ldquobadrdquo oral surgery experience
bull Distoangular lower 3rds nerve proximityDistoangular lower 3rds nerve proximity
bull 3rd molars in function3rd molars in function
bull Lone standing molarsLone standing molars
bull Teeth in bruxers Cl III skeletal patternsTeeth in bruxers Cl III skeletal patterns
bull 3rd molars + post-menopausal women3rd molars + post-menopausal women
bull Prior TMD historyPrior TMD history
bull Prior ldquobadrdquo oral surgery experiencePrior ldquobadrdquo oral surgery experience
bull Distoangular lower 3rds nerve proximityDistoangular lower 3rds nerve proximity
3rd Molar Surgery ndash Why
3rd Molar Surgery ndash Why
1 Preventtreat pericoronitis (infection)2 Prevent periodontal problems 2nd molar3 Preventtreat caries to 2nd 3rd molar4 Prevent odontogenic cyststumors5 Strengthen mandible possible fx6 Prevent orthodontic relapse7 Treat pain of unknown origin
1 Preventtreat pericoronitis (infection)2 Prevent periodontal problems 2nd molar3 Preventtreat caries to 2nd 3rd molar4 Prevent odontogenic cyststumors5 Strengthen mandible possible fx6 Prevent orthodontic relapse7 Treat pain of unknown origin
Extract 3rds OralSystemic Extract 3rds OralSystemic LinkLink
CLEVELAND April 6 2006 - The first hard evidence has CLEVELAND April 6 2006 - The first hard evidence has been uncovered that bacteria in the mouth may find their been uncovered that bacteria in the mouth may find their way to the uterus causing uterine infections that can lead way to the uterus causing uterine infections that can lead to preterm birth in pregnant womento preterm birth in pregnant women
CLEVELAND April 6 2006 - The first hard evidence has CLEVELAND April 6 2006 - The first hard evidence has been uncovered that bacteria in the mouth may find their been uncovered that bacteria in the mouth may find their way to the uterus causing uterine infections that can lead way to the uterus causing uterine infections that can lead to preterm birth in pregnant womento preterm birth in pregnant women
A newly discovered and as yet unnamed species of the A newly discovered and as yet unnamed species of the bacterium genus bacterium genus BergeyellaBergeyella was found in the mouth was found in the mouth and amniotic fluid of a woman with a uterine infection and amniotic fluid of a woman with a uterine infection who gave birth prematurely (24 weeks) reported who gave birth prematurely (24 weeks) reported microbiologist Yiping W Han PhD of Case Western microbiologist Yiping W Han PhD of Case Western Reserve here Reserve here However the bacterium was not detected in a vaginal However the bacterium was not detected in a vaginal swab as might be expected The finding confirmed swab as might be expected The finding confirmed what some scientists have suspected that intrauterine what some scientists have suspected that intrauterine infections dont always ascend from the genital tract infections dont always ascend from the genital tract but can descend from the oral cavity Dr Han and but can descend from the oral cavity Dr Han and colleagues said in the April issue of the colleagues said in the April issue of the Journal of Journal of Clinical MicrobiologyClinical Microbiology
A newly discovered and as yet unnamed species of the A newly discovered and as yet unnamed species of the bacterium genus bacterium genus BergeyellaBergeyella was found in the mouth was found in the mouth and amniotic fluid of a woman with a uterine infection and amniotic fluid of a woman with a uterine infection who gave birth prematurely (24 weeks) reported who gave birth prematurely (24 weeks) reported microbiologist Yiping W Han PhD of Case Western microbiologist Yiping W Han PhD of Case Western Reserve here Reserve here However the bacterium was not detected in a vaginal However the bacterium was not detected in a vaginal swab as might be expected The finding confirmed swab as might be expected The finding confirmed what some scientists have suspected that intrauterine what some scientists have suspected that intrauterine infections dont always ascend from the genital tract infections dont always ascend from the genital tract but can descend from the oral cavity Dr Han and but can descend from the oral cavity Dr Han and colleagues said in the April issue of the colleagues said in the April issue of the Journal of Journal of Clinical MicrobiologyClinical Microbiology
Journal of Oral and Maxillofacial Journal of Oral and Maxillofacial SurgerySurgery
Volume 65 Issue 3 March 2007 Pages Volume 65 Issue 3 March 2007 Pages 377-383377-383
Progress Report on Third Molar Clinical Trials Progress Report on Third Molar Clinical Trials Raymond P White Jr DDS PhDRaymond P White Jr DDS PhD
1What happens to asymptomatic patients who keep their 1What happens to asymptomatic patients who keep their third molars third molars
2What is the recovery like for those who have them 2What is the recovery like for those who have them removed and what can we do as surgeons to improve removed and what can we do as surgeons to improve post operative outcomespost operative outcomes
3rd Molar Surgery ndash When3rd Molar Surgery ndash WhenbullBefore roots 100 developed
bullAfter roots 13 formed
bullMorbiditycomplications minimized as bone more flexible nerves more pliable and PMH less complicated
bullDonrsquot forget tooth transplanttooth transplant if apex not closed
bullBefore roots 100 developed
bullAfter roots 13 formed
bullMorbiditycomplications minimized as bone more flexible nerves more pliable and PMH less complicated
bullDonrsquot forget tooth transplanttooth transplant if apex not closed
Outcome of tooth transplantation survival and success rates 17-41 years post treatmentCzochrowska EM Stenvik A Bjercke B Zachrisson Am J Orthod Dentofacial Orthop 2002 Feb121(2)110-9The mean age at surgery was 115 years and the mean observation period was 264 264 years (range 17-41 years) Of the 33 teeth transplanted in the 28 patients 3 teeth were lost after 9 10 and 29 years respectively Therefore the 30 teeth in the 25 patients we examined yielded a survival rate of 90 The success rate was 79 because 2 transplants had ankylosed and 2 others failed to fulfill the proposed criteria The patients generally responded very favorably regarding their perception of the treatment Their only hesitation was related to some discomfort during surgery It was concluded that It was concluded that survival and success rates for teeth auto survival and success rates for teeth auto transplanted when the root is partly developed transplanted when the root is partly developed compare favorably in a long-term perspective compare favorably in a long-term perspective with other treatment modalities for with other treatment modalities for substituting missing teethsubstituting missing teeth
Outcome of tooth transplantation survival and success rates 17-41 years post treatmentCzochrowska EM Stenvik A Bjercke B Zachrisson Am J Orthod Dentofacial Orthop 2002 Feb121(2)110-9The mean age at surgery was 115 years and the mean observation period was 264 264 years (range 17-41 years) Of the 33 teeth transplanted in the 28 patients 3 teeth were lost after 9 10 and 29 years respectively Therefore the 30 teeth in the 25 patients we examined yielded a survival rate of 90 The success rate was 79 because 2 transplants had ankylosed and 2 others failed to fulfill the proposed criteria The patients generally responded very favorably regarding their perception of the treatment Their only hesitation was related to some discomfort during surgery It was concluded that It was concluded that survival and success rates for teeth auto survival and success rates for teeth auto transplanted when the root is partly developed transplanted when the root is partly developed compare favorably in a long-term perspective compare favorably in a long-term perspective with other treatment modalities for with other treatment modalities for substituting missing teethsubstituting missing teeth
3rd Molar Surgery ndash When Not
3rd Molar Surgery ndash When Not
bullExtremes of age
bullNo oral communication (full bony)
bullIntimate root-nerve Relationship
bullRisks gt Benefits
bullExtremes of age
bullNo oral communication (full bony)
bullIntimate root-nerve Relationship
bullRisks gt Benefits
3rd Molar Surgery Alternatives
3rd Molar Surgery Alternatives
bullNo Surgery dentist feels risk benefit ratio not favorable or patient refuses ndash document and recommend radiograph q 3-5 years
bullNo Surgery dentist feels risk benefit ratio not favorable or patient refuses ndash document and recommend radiograph q 3-5 years
No High SpeedNo High Speed
bullAir embolus
bullAir emphysema
bullBlow debris into flap
bullBlow bacteria into flap
bullNon-sterile water
bullAir embolus
bullAir emphysema
bullBlow debris into flap
bullBlow bacteria into flap
bullNon-sterile water
Which are trueWhich are true1 Tooth transplants are usually done on
patients 20-302 Average success rate for a tooth
transplant is 20-303 In order to work a transplant must
have endo4 Most transplants will ankylose
A 13 B 24 C 123 D 3 only
E None of the above
1 Tooth transplants are usually done on patients 20-30
2 Average success rate for a tooth transplant is 20-30
3 In order to work a transplant must have endo
4 Most transplants will ankylose
A 13 B 24 C 123 D 3 only
E None of the above
How can I assess the relationship How can I assess the relationship between the 3between the 3rdrd molar root and the molar root and the
inferior alveolar nerveinferior alveolar nerve
- Slide 2
- Slide 3
- Slide 4
- ldquoSockets with intact buccal and lingual plates heal well without graftinghellip consider grafting with resorbable osteoinductive material if plates compromised and implants plannedrdquo grafting with connective tissue if pontic esthetics an issuerdquo
- Vital Root Retention
- Slide 7
- Slide 8
- Slide 9
- J Oral Maxillofac Surg 2005 Feb43(1)7-12 A randomized controlled clinical trial to compare the incidence of injury to the inferior alveolar nerve as a result of coronectomy and removal of mandibular third molars Renton T Hankins M Sproate C
- Slide 11
- Slide 12
- Immediate Implant Placement Following Extractions
- Platelet Rich Plasma
- Slide 15
- Slide 16
- Slide 17
- Why Reconstruct
- How Autogenous Bone Grafts with Implants
- Autogenous Block Grafts
- Slide 21
- Intra-oral Autogenous Bone Sites
- Slide 23
- What about membranes
- Bone Morphogenic Protein (BMP)
- Slide 26
- Distraction Osteogenesis
- Slide 28
- Wise Old Oral Surgeon Says Beware of
- 3rd Molar Surgery ndash Why
- Extract 3rds OralSystemic Link
- Slide 32
- 3rd Molar Surgery ndash When
- 3rd Molar Surgery ndash When Not
- 3rd Molar Surgery Alternatives
- No High Speed
- Slide 38
- Which are true
- Slide 40
-
Pre-op (Oral Pre-op (Oral bisphosphonates X bisphosphonates X 5 years)5 years)
Immed Immed PostPost
10 month 10 month postpost
Immediate Implant Placement Following
Extractions
Immediate Implant Placement Following
ExtractionsbullNeed 3-4 mm of solid bone at base
of socket and no active infection
bullSuccess rates ~ to ldquonormalrdquo
bullMost typical sites anterior teeth and 1st premolars
bullAdvantages May reduce loss of labial plate and improve esthetics as well as save time
bullNeed 3-4 mm of solid bone at base of socket and no active infection
bullSuccess rates ~ to ldquonormalrdquo
bullMost typical sites anterior teeth and 1st premolars
bullAdvantages May reduce loss of labial plate and improve esthetics as well as save time
Platelet Rich PlasmaPlatelet Rich PlasmaPlatelet Rich PlasmaPlatelet Rich PlasmabullWhatrsquos HotWhatrsquos Hot
ndash Release various Release various growth factors that growth factors that aid in hemostasis aid in hemostasis and increase rate and increase rate of healing of healing (mitogenesis (mitogenesis angiogenesis) angiogenesis)
bullWhatrsquos HotWhatrsquos Hotndash Release various Release various
growth factors that growth factors that aid in hemostasis aid in hemostasis and increase rate and increase rate of healing of healing (mitogenesis (mitogenesis angiogenesis) angiogenesis)
bullWhatrsquos NotWhatrsquos Notndash CostCostndash Is there any Is there any
difference at 6 difference at 6 weeksweeks
ndash Invasive Invasive borrow 45-borrow 45-90ml of blood90ml of blood
bullWhatrsquos NotWhatrsquos Notndash CostCostndash Is there any Is there any
difference at 6 difference at 6 weeksweeks
ndash Invasive Invasive borrow 45-borrow 45-90ml of blood90ml of blood
Casap et al Immediate Implantation Into Debrided Infected Sockets J Oral Maxillofac Surg 2007
Does placing implants into fresh extraction Does placing implants into fresh extraction sockets preserve bonesockets preserve bone
J Clin Periodontol 2005 Jun32(6)645-52 Ridge alterations following implant placement in fresh extraction sockets an experimental study in the dogArauacutejo MG Sukekava F Wennstroumlm JL Lindhe J
CONCLUSIONS Marked dimensional alterations had occurred in the edentulous ridge after 3 months of healing following the extraction of the distal root of mandibular pre-molars The placement of an The placement of an implant in the fresh extraction site obviously implant in the fresh extraction site obviously failed to prevent the re-modeling that occurred failed to prevent the re-modeling that occurred in the walls of the socketin the walls of the socket The resulting height of the buccal and lingual walls at 3 months was similar at implants and edentulous sites
Most human trials however reveal results Most human trials however reveal results similar to implants place via the ldquoold similar to implants place via the ldquoold schoolrdquo approach even when immediately schoolrdquo approach even when immediately loaded (caution in ldquosoftrdquo bone gt55 YO)loaded (caution in ldquosoftrdquo bone gt55 YO)
Int J Oral Maxillofac Implants 2007 Mar-Apr22(2)187-94 The radiographic bone loss pattern adjacent to immediately placed immediately loaded implantsJaffin R Kolesar M Kumar A Ishikawa S Fiorellini J
J Craniofac Surg 2007 Jul18(4)965-71 Immediate loaded dental implants comparison between fixtures inserted in postextractive and healed bone sitesDegidi M Piattelli A Carinci F
J Periodontol 2007 May78(5)810-5 Vertical crestal bone changes around implants placed into fresh extraction socketsCovani U Cornelini R Barone A
Why ReconstructWhy Reconstruct
bullNot enough bone for implants
bullEnough bone but esthetic result suboptimal
bullPrevent pathologic fracture
bullPoor functionestheticsretention of conventional removable prosthesis
bullNot enough bone for implants
bullEnough bone but esthetic result suboptimal
bullPrevent pathologic fracture
bullPoor functionestheticsretention of conventional removable prosthesis
How Autogenous Bone Grafts
with Implants
How Autogenous Bone Grafts
with Implants
Autogenous Block GraftsAutogenous Block Grafts
bullldquoGold Standardrdquo
bullOsteoinductive and Osteoconductive
bullNo need for membranes
bullHolds form
bullRemodels into 100 high quality bone
bullNo concerns about transmissible diseases
bullldquoGold Standardrdquo
bullOsteoinductive and Osteoconductive
bullNo need for membranes
bullHolds form
bullRemodels into 100 high quality bone
bullNo concerns about transmissible diseases
Autogenous Block Grafts
Autogenous Block Grafts
bullDonor site morbidity
bullQuantity is limited
bullLose 20-30 during healing
bullDonor site morbidity
bullQuantity is limited
bullLose 20-30 during healing
Intra-oral Autogenous Bone Sites
AllogenicAllogenic Block Block GraftGraft
What about membranesWhat about membranes
bullUseful in containing particulate grafts
bullUseful around teethexposed implant threads
bullAdd expense
bull Infection risk
bullUnnecessary with block grafts
bullADA 4266 Resorbable
bullADA 4267 Non-Resorbable
bullUseful in containing particulate grafts
bullUseful around teethexposed implant threads
bullAdd expense
bull Infection risk
bullUnnecessary with block grafts
bullADA 4266 Resorbable
bullADA 4267 Non-Resorbable
Bone Morphogenic Protein (BMP)
Bone Morphogenic Protein (BMP)
bullGrow bone at will
bullPresently two are FDA approved BMP 2 for spinal fusions and BMP 7 for long bone defects
bullStudies show excellent results for socket preservation sinus lifts
bullExpensive ($500000 for a sinus)
bullGrow bone at will
bullPresently two are FDA approved BMP 2 for spinal fusions and BMP 7 for long bone defects
bullStudies show excellent results for socket preservation sinus lifts
bullExpensive ($500000 for a sinus)
FDA Panel Unanimously Recommends Approval of Third Indication For Medtronicrsquos INFUSE Bone Graft Nov 9 2006
FDA Panel Unanimously Recommends Approval of Third Indication For Medtronicrsquos INFUSE Bone Graft Nov 9 2006 INFUSE Bone Graft is recombinant human bone morphogenetic protein-2 (rhBMP-2) applied to an absorbable collagen sponge carrier The purpose of the protein which occurs naturally in the body is to stimulate bone formation It has been previously approved by the FDA for use in certain lumbar spine fusion and tibial fracture repair procedures
INFUSE Bone Graft is recombinant human bone morphogenetic protein-2 (rhBMP-2) applied to an absorbable collagen sponge carrier The purpose of the protein which occurs naturally in the body is to stimulate bone formation It has been previously approved by the FDA for use in certain lumbar spine fusion and tibial fracture repair procedures
Distraction OsteogenesisDistraction
OsteogenesisbullGeneration of bone (and soft
tissue) through distraction of an osseous callus
bullGeneration of bone (and soft tissue) through distraction of an osseous callus
Ann N Y Acad Sci 2006 Apr1068532-42 COX-2 has a critical role during incorporation of structural bone allografts OrsquoKeefe RJ Tiyapatanaputi P Xie C
Ann N Y Acad Sci 2006 Apr1068532-42 COX-2 has a critical role during incorporation of structural bone allografts OrsquoKeefe RJ Tiyapatanaputi P Xie C
Nonsteroidal anti-inflammatory drugs (NSAIDs) which inhibit cyclooxygenase (COX) activity reduce pain and are commonly used in patients with skeletal injury In this article we will also present data to show that selective COX-2 inhibitor delays allograft healing and incorporation These results demonstrated that COX-2 is essential for bone allograft incorporation Furthermore our data support the notion that COX-2-dependent PGE2 produced at the early stage of bone healing is prerequisite for efficient skeletal repair
Nonsteroidal anti-inflammatory drugs (NSAIDs) which inhibit cyclooxygenase (COX) activity reduce pain and are commonly used in patients with skeletal injury In this article we will also present data to show that selective COX-2 inhibitor delays allograft healing and incorporation These results demonstrated that COX-2 is essential for bone allograft incorporation Furthermore our data support the notion that COX-2-dependent PGE2 produced at the early stage of bone healing is prerequisite for efficient skeletal repair
Wise Old Oral Surgeon Wise Old Oral Surgeon Says Beware ofSays Beware of
Wise Old Oral Surgeon Wise Old Oral Surgeon Says Beware ofSays Beware of
bull 3rd molars in function3rd molars in function
bull Lone standing molarsLone standing molars
bull Teeth in bruxers Cl III skeletal patternsTeeth in bruxers Cl III skeletal patterns
bull 3rd molars + post-menopausal women3rd molars + post-menopausal women
bull Prior TMD historyPrior TMD history
bull Prior ldquobadrdquo oral surgery experiencePrior ldquobadrdquo oral surgery experience
bull Distoangular lower 3rds nerve proximityDistoangular lower 3rds nerve proximity
bull 3rd molars in function3rd molars in function
bull Lone standing molarsLone standing molars
bull Teeth in bruxers Cl III skeletal patternsTeeth in bruxers Cl III skeletal patterns
bull 3rd molars + post-menopausal women3rd molars + post-menopausal women
bull Prior TMD historyPrior TMD history
bull Prior ldquobadrdquo oral surgery experiencePrior ldquobadrdquo oral surgery experience
bull Distoangular lower 3rds nerve proximityDistoangular lower 3rds nerve proximity
3rd Molar Surgery ndash Why
3rd Molar Surgery ndash Why
1 Preventtreat pericoronitis (infection)2 Prevent periodontal problems 2nd molar3 Preventtreat caries to 2nd 3rd molar4 Prevent odontogenic cyststumors5 Strengthen mandible possible fx6 Prevent orthodontic relapse7 Treat pain of unknown origin
1 Preventtreat pericoronitis (infection)2 Prevent periodontal problems 2nd molar3 Preventtreat caries to 2nd 3rd molar4 Prevent odontogenic cyststumors5 Strengthen mandible possible fx6 Prevent orthodontic relapse7 Treat pain of unknown origin
Extract 3rds OralSystemic Extract 3rds OralSystemic LinkLink
CLEVELAND April 6 2006 - The first hard evidence has CLEVELAND April 6 2006 - The first hard evidence has been uncovered that bacteria in the mouth may find their been uncovered that bacteria in the mouth may find their way to the uterus causing uterine infections that can lead way to the uterus causing uterine infections that can lead to preterm birth in pregnant womento preterm birth in pregnant women
CLEVELAND April 6 2006 - The first hard evidence has CLEVELAND April 6 2006 - The first hard evidence has been uncovered that bacteria in the mouth may find their been uncovered that bacteria in the mouth may find their way to the uterus causing uterine infections that can lead way to the uterus causing uterine infections that can lead to preterm birth in pregnant womento preterm birth in pregnant women
A newly discovered and as yet unnamed species of the A newly discovered and as yet unnamed species of the bacterium genus bacterium genus BergeyellaBergeyella was found in the mouth was found in the mouth and amniotic fluid of a woman with a uterine infection and amniotic fluid of a woman with a uterine infection who gave birth prematurely (24 weeks) reported who gave birth prematurely (24 weeks) reported microbiologist Yiping W Han PhD of Case Western microbiologist Yiping W Han PhD of Case Western Reserve here Reserve here However the bacterium was not detected in a vaginal However the bacterium was not detected in a vaginal swab as might be expected The finding confirmed swab as might be expected The finding confirmed what some scientists have suspected that intrauterine what some scientists have suspected that intrauterine infections dont always ascend from the genital tract infections dont always ascend from the genital tract but can descend from the oral cavity Dr Han and but can descend from the oral cavity Dr Han and colleagues said in the April issue of the colleagues said in the April issue of the Journal of Journal of Clinical MicrobiologyClinical Microbiology
A newly discovered and as yet unnamed species of the A newly discovered and as yet unnamed species of the bacterium genus bacterium genus BergeyellaBergeyella was found in the mouth was found in the mouth and amniotic fluid of a woman with a uterine infection and amniotic fluid of a woman with a uterine infection who gave birth prematurely (24 weeks) reported who gave birth prematurely (24 weeks) reported microbiologist Yiping W Han PhD of Case Western microbiologist Yiping W Han PhD of Case Western Reserve here Reserve here However the bacterium was not detected in a vaginal However the bacterium was not detected in a vaginal swab as might be expected The finding confirmed swab as might be expected The finding confirmed what some scientists have suspected that intrauterine what some scientists have suspected that intrauterine infections dont always ascend from the genital tract infections dont always ascend from the genital tract but can descend from the oral cavity Dr Han and but can descend from the oral cavity Dr Han and colleagues said in the April issue of the colleagues said in the April issue of the Journal of Journal of Clinical MicrobiologyClinical Microbiology
Journal of Oral and Maxillofacial Journal of Oral and Maxillofacial SurgerySurgery
Volume 65 Issue 3 March 2007 Pages Volume 65 Issue 3 March 2007 Pages 377-383377-383
Progress Report on Third Molar Clinical Trials Progress Report on Third Molar Clinical Trials Raymond P White Jr DDS PhDRaymond P White Jr DDS PhD
1What happens to asymptomatic patients who keep their 1What happens to asymptomatic patients who keep their third molars third molars
2What is the recovery like for those who have them 2What is the recovery like for those who have them removed and what can we do as surgeons to improve removed and what can we do as surgeons to improve post operative outcomespost operative outcomes
3rd Molar Surgery ndash When3rd Molar Surgery ndash WhenbullBefore roots 100 developed
bullAfter roots 13 formed
bullMorbiditycomplications minimized as bone more flexible nerves more pliable and PMH less complicated
bullDonrsquot forget tooth transplanttooth transplant if apex not closed
bullBefore roots 100 developed
bullAfter roots 13 formed
bullMorbiditycomplications minimized as bone more flexible nerves more pliable and PMH less complicated
bullDonrsquot forget tooth transplanttooth transplant if apex not closed
Outcome of tooth transplantation survival and success rates 17-41 years post treatmentCzochrowska EM Stenvik A Bjercke B Zachrisson Am J Orthod Dentofacial Orthop 2002 Feb121(2)110-9The mean age at surgery was 115 years and the mean observation period was 264 264 years (range 17-41 years) Of the 33 teeth transplanted in the 28 patients 3 teeth were lost after 9 10 and 29 years respectively Therefore the 30 teeth in the 25 patients we examined yielded a survival rate of 90 The success rate was 79 because 2 transplants had ankylosed and 2 others failed to fulfill the proposed criteria The patients generally responded very favorably regarding their perception of the treatment Their only hesitation was related to some discomfort during surgery It was concluded that It was concluded that survival and success rates for teeth auto survival and success rates for teeth auto transplanted when the root is partly developed transplanted when the root is partly developed compare favorably in a long-term perspective compare favorably in a long-term perspective with other treatment modalities for with other treatment modalities for substituting missing teethsubstituting missing teeth
Outcome of tooth transplantation survival and success rates 17-41 years post treatmentCzochrowska EM Stenvik A Bjercke B Zachrisson Am J Orthod Dentofacial Orthop 2002 Feb121(2)110-9The mean age at surgery was 115 years and the mean observation period was 264 264 years (range 17-41 years) Of the 33 teeth transplanted in the 28 patients 3 teeth were lost after 9 10 and 29 years respectively Therefore the 30 teeth in the 25 patients we examined yielded a survival rate of 90 The success rate was 79 because 2 transplants had ankylosed and 2 others failed to fulfill the proposed criteria The patients generally responded very favorably regarding their perception of the treatment Their only hesitation was related to some discomfort during surgery It was concluded that It was concluded that survival and success rates for teeth auto survival and success rates for teeth auto transplanted when the root is partly developed transplanted when the root is partly developed compare favorably in a long-term perspective compare favorably in a long-term perspective with other treatment modalities for with other treatment modalities for substituting missing teethsubstituting missing teeth
3rd Molar Surgery ndash When Not
3rd Molar Surgery ndash When Not
bullExtremes of age
bullNo oral communication (full bony)
bullIntimate root-nerve Relationship
bullRisks gt Benefits
bullExtremes of age
bullNo oral communication (full bony)
bullIntimate root-nerve Relationship
bullRisks gt Benefits
3rd Molar Surgery Alternatives
3rd Molar Surgery Alternatives
bullNo Surgery dentist feels risk benefit ratio not favorable or patient refuses ndash document and recommend radiograph q 3-5 years
bullNo Surgery dentist feels risk benefit ratio not favorable or patient refuses ndash document and recommend radiograph q 3-5 years
No High SpeedNo High Speed
bullAir embolus
bullAir emphysema
bullBlow debris into flap
bullBlow bacteria into flap
bullNon-sterile water
bullAir embolus
bullAir emphysema
bullBlow debris into flap
bullBlow bacteria into flap
bullNon-sterile water
Which are trueWhich are true1 Tooth transplants are usually done on
patients 20-302 Average success rate for a tooth
transplant is 20-303 In order to work a transplant must
have endo4 Most transplants will ankylose
A 13 B 24 C 123 D 3 only
E None of the above
1 Tooth transplants are usually done on patients 20-30
2 Average success rate for a tooth transplant is 20-30
3 In order to work a transplant must have endo
4 Most transplants will ankylose
A 13 B 24 C 123 D 3 only
E None of the above
How can I assess the relationship How can I assess the relationship between the 3between the 3rdrd molar root and the molar root and the
inferior alveolar nerveinferior alveolar nerve
- Slide 2
- Slide 3
- Slide 4
- ldquoSockets with intact buccal and lingual plates heal well without graftinghellip consider grafting with resorbable osteoinductive material if plates compromised and implants plannedrdquo grafting with connective tissue if pontic esthetics an issuerdquo
- Vital Root Retention
- Slide 7
- Slide 8
- Slide 9
- J Oral Maxillofac Surg 2005 Feb43(1)7-12 A randomized controlled clinical trial to compare the incidence of injury to the inferior alveolar nerve as a result of coronectomy and removal of mandibular third molars Renton T Hankins M Sproate C
- Slide 11
- Slide 12
- Immediate Implant Placement Following Extractions
- Platelet Rich Plasma
- Slide 15
- Slide 16
- Slide 17
- Why Reconstruct
- How Autogenous Bone Grafts with Implants
- Autogenous Block Grafts
- Slide 21
- Intra-oral Autogenous Bone Sites
- Slide 23
- What about membranes
- Bone Morphogenic Protein (BMP)
- Slide 26
- Distraction Osteogenesis
- Slide 28
- Wise Old Oral Surgeon Says Beware of
- 3rd Molar Surgery ndash Why
- Extract 3rds OralSystemic Link
- Slide 32
- 3rd Molar Surgery ndash When
- 3rd Molar Surgery ndash When Not
- 3rd Molar Surgery Alternatives
- No High Speed
- Slide 38
- Which are true
- Slide 40
-
Immediate Implant Placement Following
Extractions
Immediate Implant Placement Following
ExtractionsbullNeed 3-4 mm of solid bone at base
of socket and no active infection
bullSuccess rates ~ to ldquonormalrdquo
bullMost typical sites anterior teeth and 1st premolars
bullAdvantages May reduce loss of labial plate and improve esthetics as well as save time
bullNeed 3-4 mm of solid bone at base of socket and no active infection
bullSuccess rates ~ to ldquonormalrdquo
bullMost typical sites anterior teeth and 1st premolars
bullAdvantages May reduce loss of labial plate and improve esthetics as well as save time
Platelet Rich PlasmaPlatelet Rich PlasmaPlatelet Rich PlasmaPlatelet Rich PlasmabullWhatrsquos HotWhatrsquos Hot
ndash Release various Release various growth factors that growth factors that aid in hemostasis aid in hemostasis and increase rate and increase rate of healing of healing (mitogenesis (mitogenesis angiogenesis) angiogenesis)
bullWhatrsquos HotWhatrsquos Hotndash Release various Release various
growth factors that growth factors that aid in hemostasis aid in hemostasis and increase rate and increase rate of healing of healing (mitogenesis (mitogenesis angiogenesis) angiogenesis)
bullWhatrsquos NotWhatrsquos Notndash CostCostndash Is there any Is there any
difference at 6 difference at 6 weeksweeks
ndash Invasive Invasive borrow 45-borrow 45-90ml of blood90ml of blood
bullWhatrsquos NotWhatrsquos Notndash CostCostndash Is there any Is there any
difference at 6 difference at 6 weeksweeks
ndash Invasive Invasive borrow 45-borrow 45-90ml of blood90ml of blood
Casap et al Immediate Implantation Into Debrided Infected Sockets J Oral Maxillofac Surg 2007
Does placing implants into fresh extraction Does placing implants into fresh extraction sockets preserve bonesockets preserve bone
J Clin Periodontol 2005 Jun32(6)645-52 Ridge alterations following implant placement in fresh extraction sockets an experimental study in the dogArauacutejo MG Sukekava F Wennstroumlm JL Lindhe J
CONCLUSIONS Marked dimensional alterations had occurred in the edentulous ridge after 3 months of healing following the extraction of the distal root of mandibular pre-molars The placement of an The placement of an implant in the fresh extraction site obviously implant in the fresh extraction site obviously failed to prevent the re-modeling that occurred failed to prevent the re-modeling that occurred in the walls of the socketin the walls of the socket The resulting height of the buccal and lingual walls at 3 months was similar at implants and edentulous sites
Most human trials however reveal results Most human trials however reveal results similar to implants place via the ldquoold similar to implants place via the ldquoold schoolrdquo approach even when immediately schoolrdquo approach even when immediately loaded (caution in ldquosoftrdquo bone gt55 YO)loaded (caution in ldquosoftrdquo bone gt55 YO)
Int J Oral Maxillofac Implants 2007 Mar-Apr22(2)187-94 The radiographic bone loss pattern adjacent to immediately placed immediately loaded implantsJaffin R Kolesar M Kumar A Ishikawa S Fiorellini J
J Craniofac Surg 2007 Jul18(4)965-71 Immediate loaded dental implants comparison between fixtures inserted in postextractive and healed bone sitesDegidi M Piattelli A Carinci F
J Periodontol 2007 May78(5)810-5 Vertical crestal bone changes around implants placed into fresh extraction socketsCovani U Cornelini R Barone A
Why ReconstructWhy Reconstruct
bullNot enough bone for implants
bullEnough bone but esthetic result suboptimal
bullPrevent pathologic fracture
bullPoor functionestheticsretention of conventional removable prosthesis
bullNot enough bone for implants
bullEnough bone but esthetic result suboptimal
bullPrevent pathologic fracture
bullPoor functionestheticsretention of conventional removable prosthesis
How Autogenous Bone Grafts
with Implants
How Autogenous Bone Grafts
with Implants
Autogenous Block GraftsAutogenous Block Grafts
bullldquoGold Standardrdquo
bullOsteoinductive and Osteoconductive
bullNo need for membranes
bullHolds form
bullRemodels into 100 high quality bone
bullNo concerns about transmissible diseases
bullldquoGold Standardrdquo
bullOsteoinductive and Osteoconductive
bullNo need for membranes
bullHolds form
bullRemodels into 100 high quality bone
bullNo concerns about transmissible diseases
Autogenous Block Grafts
Autogenous Block Grafts
bullDonor site morbidity
bullQuantity is limited
bullLose 20-30 during healing
bullDonor site morbidity
bullQuantity is limited
bullLose 20-30 during healing
Intra-oral Autogenous Bone Sites
AllogenicAllogenic Block Block GraftGraft
What about membranesWhat about membranes
bullUseful in containing particulate grafts
bullUseful around teethexposed implant threads
bullAdd expense
bull Infection risk
bullUnnecessary with block grafts
bullADA 4266 Resorbable
bullADA 4267 Non-Resorbable
bullUseful in containing particulate grafts
bullUseful around teethexposed implant threads
bullAdd expense
bull Infection risk
bullUnnecessary with block grafts
bullADA 4266 Resorbable
bullADA 4267 Non-Resorbable
Bone Morphogenic Protein (BMP)
Bone Morphogenic Protein (BMP)
bullGrow bone at will
bullPresently two are FDA approved BMP 2 for spinal fusions and BMP 7 for long bone defects
bullStudies show excellent results for socket preservation sinus lifts
bullExpensive ($500000 for a sinus)
bullGrow bone at will
bullPresently two are FDA approved BMP 2 for spinal fusions and BMP 7 for long bone defects
bullStudies show excellent results for socket preservation sinus lifts
bullExpensive ($500000 for a sinus)
FDA Panel Unanimously Recommends Approval of Third Indication For Medtronicrsquos INFUSE Bone Graft Nov 9 2006
FDA Panel Unanimously Recommends Approval of Third Indication For Medtronicrsquos INFUSE Bone Graft Nov 9 2006 INFUSE Bone Graft is recombinant human bone morphogenetic protein-2 (rhBMP-2) applied to an absorbable collagen sponge carrier The purpose of the protein which occurs naturally in the body is to stimulate bone formation It has been previously approved by the FDA for use in certain lumbar spine fusion and tibial fracture repair procedures
INFUSE Bone Graft is recombinant human bone morphogenetic protein-2 (rhBMP-2) applied to an absorbable collagen sponge carrier The purpose of the protein which occurs naturally in the body is to stimulate bone formation It has been previously approved by the FDA for use in certain lumbar spine fusion and tibial fracture repair procedures
Distraction OsteogenesisDistraction
OsteogenesisbullGeneration of bone (and soft
tissue) through distraction of an osseous callus
bullGeneration of bone (and soft tissue) through distraction of an osseous callus
Ann N Y Acad Sci 2006 Apr1068532-42 COX-2 has a critical role during incorporation of structural bone allografts OrsquoKeefe RJ Tiyapatanaputi P Xie C
Ann N Y Acad Sci 2006 Apr1068532-42 COX-2 has a critical role during incorporation of structural bone allografts OrsquoKeefe RJ Tiyapatanaputi P Xie C
Nonsteroidal anti-inflammatory drugs (NSAIDs) which inhibit cyclooxygenase (COX) activity reduce pain and are commonly used in patients with skeletal injury In this article we will also present data to show that selective COX-2 inhibitor delays allograft healing and incorporation These results demonstrated that COX-2 is essential for bone allograft incorporation Furthermore our data support the notion that COX-2-dependent PGE2 produced at the early stage of bone healing is prerequisite for efficient skeletal repair
Nonsteroidal anti-inflammatory drugs (NSAIDs) which inhibit cyclooxygenase (COX) activity reduce pain and are commonly used in patients with skeletal injury In this article we will also present data to show that selective COX-2 inhibitor delays allograft healing and incorporation These results demonstrated that COX-2 is essential for bone allograft incorporation Furthermore our data support the notion that COX-2-dependent PGE2 produced at the early stage of bone healing is prerequisite for efficient skeletal repair
Wise Old Oral Surgeon Wise Old Oral Surgeon Says Beware ofSays Beware of
Wise Old Oral Surgeon Wise Old Oral Surgeon Says Beware ofSays Beware of
bull 3rd molars in function3rd molars in function
bull Lone standing molarsLone standing molars
bull Teeth in bruxers Cl III skeletal patternsTeeth in bruxers Cl III skeletal patterns
bull 3rd molars + post-menopausal women3rd molars + post-menopausal women
bull Prior TMD historyPrior TMD history
bull Prior ldquobadrdquo oral surgery experiencePrior ldquobadrdquo oral surgery experience
bull Distoangular lower 3rds nerve proximityDistoangular lower 3rds nerve proximity
bull 3rd molars in function3rd molars in function
bull Lone standing molarsLone standing molars
bull Teeth in bruxers Cl III skeletal patternsTeeth in bruxers Cl III skeletal patterns
bull 3rd molars + post-menopausal women3rd molars + post-menopausal women
bull Prior TMD historyPrior TMD history
bull Prior ldquobadrdquo oral surgery experiencePrior ldquobadrdquo oral surgery experience
bull Distoangular lower 3rds nerve proximityDistoangular lower 3rds nerve proximity
3rd Molar Surgery ndash Why
3rd Molar Surgery ndash Why
1 Preventtreat pericoronitis (infection)2 Prevent periodontal problems 2nd molar3 Preventtreat caries to 2nd 3rd molar4 Prevent odontogenic cyststumors5 Strengthen mandible possible fx6 Prevent orthodontic relapse7 Treat pain of unknown origin
1 Preventtreat pericoronitis (infection)2 Prevent periodontal problems 2nd molar3 Preventtreat caries to 2nd 3rd molar4 Prevent odontogenic cyststumors5 Strengthen mandible possible fx6 Prevent orthodontic relapse7 Treat pain of unknown origin
Extract 3rds OralSystemic Extract 3rds OralSystemic LinkLink
CLEVELAND April 6 2006 - The first hard evidence has CLEVELAND April 6 2006 - The first hard evidence has been uncovered that bacteria in the mouth may find their been uncovered that bacteria in the mouth may find their way to the uterus causing uterine infections that can lead way to the uterus causing uterine infections that can lead to preterm birth in pregnant womento preterm birth in pregnant women
CLEVELAND April 6 2006 - The first hard evidence has CLEVELAND April 6 2006 - The first hard evidence has been uncovered that bacteria in the mouth may find their been uncovered that bacteria in the mouth may find their way to the uterus causing uterine infections that can lead way to the uterus causing uterine infections that can lead to preterm birth in pregnant womento preterm birth in pregnant women
A newly discovered and as yet unnamed species of the A newly discovered and as yet unnamed species of the bacterium genus bacterium genus BergeyellaBergeyella was found in the mouth was found in the mouth and amniotic fluid of a woman with a uterine infection and amniotic fluid of a woman with a uterine infection who gave birth prematurely (24 weeks) reported who gave birth prematurely (24 weeks) reported microbiologist Yiping W Han PhD of Case Western microbiologist Yiping W Han PhD of Case Western Reserve here Reserve here However the bacterium was not detected in a vaginal However the bacterium was not detected in a vaginal swab as might be expected The finding confirmed swab as might be expected The finding confirmed what some scientists have suspected that intrauterine what some scientists have suspected that intrauterine infections dont always ascend from the genital tract infections dont always ascend from the genital tract but can descend from the oral cavity Dr Han and but can descend from the oral cavity Dr Han and colleagues said in the April issue of the colleagues said in the April issue of the Journal of Journal of Clinical MicrobiologyClinical Microbiology
A newly discovered and as yet unnamed species of the A newly discovered and as yet unnamed species of the bacterium genus bacterium genus BergeyellaBergeyella was found in the mouth was found in the mouth and amniotic fluid of a woman with a uterine infection and amniotic fluid of a woman with a uterine infection who gave birth prematurely (24 weeks) reported who gave birth prematurely (24 weeks) reported microbiologist Yiping W Han PhD of Case Western microbiologist Yiping W Han PhD of Case Western Reserve here Reserve here However the bacterium was not detected in a vaginal However the bacterium was not detected in a vaginal swab as might be expected The finding confirmed swab as might be expected The finding confirmed what some scientists have suspected that intrauterine what some scientists have suspected that intrauterine infections dont always ascend from the genital tract infections dont always ascend from the genital tract but can descend from the oral cavity Dr Han and but can descend from the oral cavity Dr Han and colleagues said in the April issue of the colleagues said in the April issue of the Journal of Journal of Clinical MicrobiologyClinical Microbiology
Journal of Oral and Maxillofacial Journal of Oral and Maxillofacial SurgerySurgery
Volume 65 Issue 3 March 2007 Pages Volume 65 Issue 3 March 2007 Pages 377-383377-383
Progress Report on Third Molar Clinical Trials Progress Report on Third Molar Clinical Trials Raymond P White Jr DDS PhDRaymond P White Jr DDS PhD
1What happens to asymptomatic patients who keep their 1What happens to asymptomatic patients who keep their third molars third molars
2What is the recovery like for those who have them 2What is the recovery like for those who have them removed and what can we do as surgeons to improve removed and what can we do as surgeons to improve post operative outcomespost operative outcomes
3rd Molar Surgery ndash When3rd Molar Surgery ndash WhenbullBefore roots 100 developed
bullAfter roots 13 formed
bullMorbiditycomplications minimized as bone more flexible nerves more pliable and PMH less complicated
bullDonrsquot forget tooth transplanttooth transplant if apex not closed
bullBefore roots 100 developed
bullAfter roots 13 formed
bullMorbiditycomplications minimized as bone more flexible nerves more pliable and PMH less complicated
bullDonrsquot forget tooth transplanttooth transplant if apex not closed
Outcome of tooth transplantation survival and success rates 17-41 years post treatmentCzochrowska EM Stenvik A Bjercke B Zachrisson Am J Orthod Dentofacial Orthop 2002 Feb121(2)110-9The mean age at surgery was 115 years and the mean observation period was 264 264 years (range 17-41 years) Of the 33 teeth transplanted in the 28 patients 3 teeth were lost after 9 10 and 29 years respectively Therefore the 30 teeth in the 25 patients we examined yielded a survival rate of 90 The success rate was 79 because 2 transplants had ankylosed and 2 others failed to fulfill the proposed criteria The patients generally responded very favorably regarding their perception of the treatment Their only hesitation was related to some discomfort during surgery It was concluded that It was concluded that survival and success rates for teeth auto survival and success rates for teeth auto transplanted when the root is partly developed transplanted when the root is partly developed compare favorably in a long-term perspective compare favorably in a long-term perspective with other treatment modalities for with other treatment modalities for substituting missing teethsubstituting missing teeth
Outcome of tooth transplantation survival and success rates 17-41 years post treatmentCzochrowska EM Stenvik A Bjercke B Zachrisson Am J Orthod Dentofacial Orthop 2002 Feb121(2)110-9The mean age at surgery was 115 years and the mean observation period was 264 264 years (range 17-41 years) Of the 33 teeth transplanted in the 28 patients 3 teeth were lost after 9 10 and 29 years respectively Therefore the 30 teeth in the 25 patients we examined yielded a survival rate of 90 The success rate was 79 because 2 transplants had ankylosed and 2 others failed to fulfill the proposed criteria The patients generally responded very favorably regarding their perception of the treatment Their only hesitation was related to some discomfort during surgery It was concluded that It was concluded that survival and success rates for teeth auto survival and success rates for teeth auto transplanted when the root is partly developed transplanted when the root is partly developed compare favorably in a long-term perspective compare favorably in a long-term perspective with other treatment modalities for with other treatment modalities for substituting missing teethsubstituting missing teeth
3rd Molar Surgery ndash When Not
3rd Molar Surgery ndash When Not
bullExtremes of age
bullNo oral communication (full bony)
bullIntimate root-nerve Relationship
bullRisks gt Benefits
bullExtremes of age
bullNo oral communication (full bony)
bullIntimate root-nerve Relationship
bullRisks gt Benefits
3rd Molar Surgery Alternatives
3rd Molar Surgery Alternatives
bullNo Surgery dentist feels risk benefit ratio not favorable or patient refuses ndash document and recommend radiograph q 3-5 years
bullNo Surgery dentist feels risk benefit ratio not favorable or patient refuses ndash document and recommend radiograph q 3-5 years
No High SpeedNo High Speed
bullAir embolus
bullAir emphysema
bullBlow debris into flap
bullBlow bacteria into flap
bullNon-sterile water
bullAir embolus
bullAir emphysema
bullBlow debris into flap
bullBlow bacteria into flap
bullNon-sterile water
Which are trueWhich are true1 Tooth transplants are usually done on
patients 20-302 Average success rate for a tooth
transplant is 20-303 In order to work a transplant must
have endo4 Most transplants will ankylose
A 13 B 24 C 123 D 3 only
E None of the above
1 Tooth transplants are usually done on patients 20-30
2 Average success rate for a tooth transplant is 20-30
3 In order to work a transplant must have endo
4 Most transplants will ankylose
A 13 B 24 C 123 D 3 only
E None of the above
How can I assess the relationship How can I assess the relationship between the 3between the 3rdrd molar root and the molar root and the
inferior alveolar nerveinferior alveolar nerve
- Slide 2
- Slide 3
- Slide 4
- ldquoSockets with intact buccal and lingual plates heal well without graftinghellip consider grafting with resorbable osteoinductive material if plates compromised and implants plannedrdquo grafting with connective tissue if pontic esthetics an issuerdquo
- Vital Root Retention
- Slide 7
- Slide 8
- Slide 9
- J Oral Maxillofac Surg 2005 Feb43(1)7-12 A randomized controlled clinical trial to compare the incidence of injury to the inferior alveolar nerve as a result of coronectomy and removal of mandibular third molars Renton T Hankins M Sproate C
- Slide 11
- Slide 12
- Immediate Implant Placement Following Extractions
- Platelet Rich Plasma
- Slide 15
- Slide 16
- Slide 17
- Why Reconstruct
- How Autogenous Bone Grafts with Implants
- Autogenous Block Grafts
- Slide 21
- Intra-oral Autogenous Bone Sites
- Slide 23
- What about membranes
- Bone Morphogenic Protein (BMP)
- Slide 26
- Distraction Osteogenesis
- Slide 28
- Wise Old Oral Surgeon Says Beware of
- 3rd Molar Surgery ndash Why
- Extract 3rds OralSystemic Link
- Slide 32
- 3rd Molar Surgery ndash When
- 3rd Molar Surgery ndash When Not
- 3rd Molar Surgery Alternatives
- No High Speed
- Slide 38
- Which are true
- Slide 40
-
Platelet Rich PlasmaPlatelet Rich PlasmaPlatelet Rich PlasmaPlatelet Rich PlasmabullWhatrsquos HotWhatrsquos Hot
ndash Release various Release various growth factors that growth factors that aid in hemostasis aid in hemostasis and increase rate and increase rate of healing of healing (mitogenesis (mitogenesis angiogenesis) angiogenesis)
bullWhatrsquos HotWhatrsquos Hotndash Release various Release various
growth factors that growth factors that aid in hemostasis aid in hemostasis and increase rate and increase rate of healing of healing (mitogenesis (mitogenesis angiogenesis) angiogenesis)
bullWhatrsquos NotWhatrsquos Notndash CostCostndash Is there any Is there any
difference at 6 difference at 6 weeksweeks
ndash Invasive Invasive borrow 45-borrow 45-90ml of blood90ml of blood
bullWhatrsquos NotWhatrsquos Notndash CostCostndash Is there any Is there any
difference at 6 difference at 6 weeksweeks
ndash Invasive Invasive borrow 45-borrow 45-90ml of blood90ml of blood
Casap et al Immediate Implantation Into Debrided Infected Sockets J Oral Maxillofac Surg 2007
Does placing implants into fresh extraction Does placing implants into fresh extraction sockets preserve bonesockets preserve bone
J Clin Periodontol 2005 Jun32(6)645-52 Ridge alterations following implant placement in fresh extraction sockets an experimental study in the dogArauacutejo MG Sukekava F Wennstroumlm JL Lindhe J
CONCLUSIONS Marked dimensional alterations had occurred in the edentulous ridge after 3 months of healing following the extraction of the distal root of mandibular pre-molars The placement of an The placement of an implant in the fresh extraction site obviously implant in the fresh extraction site obviously failed to prevent the re-modeling that occurred failed to prevent the re-modeling that occurred in the walls of the socketin the walls of the socket The resulting height of the buccal and lingual walls at 3 months was similar at implants and edentulous sites
Most human trials however reveal results Most human trials however reveal results similar to implants place via the ldquoold similar to implants place via the ldquoold schoolrdquo approach even when immediately schoolrdquo approach even when immediately loaded (caution in ldquosoftrdquo bone gt55 YO)loaded (caution in ldquosoftrdquo bone gt55 YO)
Int J Oral Maxillofac Implants 2007 Mar-Apr22(2)187-94 The radiographic bone loss pattern adjacent to immediately placed immediately loaded implantsJaffin R Kolesar M Kumar A Ishikawa S Fiorellini J
J Craniofac Surg 2007 Jul18(4)965-71 Immediate loaded dental implants comparison between fixtures inserted in postextractive and healed bone sitesDegidi M Piattelli A Carinci F
J Periodontol 2007 May78(5)810-5 Vertical crestal bone changes around implants placed into fresh extraction socketsCovani U Cornelini R Barone A
Why ReconstructWhy Reconstruct
bullNot enough bone for implants
bullEnough bone but esthetic result suboptimal
bullPrevent pathologic fracture
bullPoor functionestheticsretention of conventional removable prosthesis
bullNot enough bone for implants
bullEnough bone but esthetic result suboptimal
bullPrevent pathologic fracture
bullPoor functionestheticsretention of conventional removable prosthesis
How Autogenous Bone Grafts
with Implants
How Autogenous Bone Grafts
with Implants
Autogenous Block GraftsAutogenous Block Grafts
bullldquoGold Standardrdquo
bullOsteoinductive and Osteoconductive
bullNo need for membranes
bullHolds form
bullRemodels into 100 high quality bone
bullNo concerns about transmissible diseases
bullldquoGold Standardrdquo
bullOsteoinductive and Osteoconductive
bullNo need for membranes
bullHolds form
bullRemodels into 100 high quality bone
bullNo concerns about transmissible diseases
Autogenous Block Grafts
Autogenous Block Grafts
bullDonor site morbidity
bullQuantity is limited
bullLose 20-30 during healing
bullDonor site morbidity
bullQuantity is limited
bullLose 20-30 during healing
Intra-oral Autogenous Bone Sites
AllogenicAllogenic Block Block GraftGraft
What about membranesWhat about membranes
bullUseful in containing particulate grafts
bullUseful around teethexposed implant threads
bullAdd expense
bull Infection risk
bullUnnecessary with block grafts
bullADA 4266 Resorbable
bullADA 4267 Non-Resorbable
bullUseful in containing particulate grafts
bullUseful around teethexposed implant threads
bullAdd expense
bull Infection risk
bullUnnecessary with block grafts
bullADA 4266 Resorbable
bullADA 4267 Non-Resorbable
Bone Morphogenic Protein (BMP)
Bone Morphogenic Protein (BMP)
bullGrow bone at will
bullPresently two are FDA approved BMP 2 for spinal fusions and BMP 7 for long bone defects
bullStudies show excellent results for socket preservation sinus lifts
bullExpensive ($500000 for a sinus)
bullGrow bone at will
bullPresently two are FDA approved BMP 2 for spinal fusions and BMP 7 for long bone defects
bullStudies show excellent results for socket preservation sinus lifts
bullExpensive ($500000 for a sinus)
FDA Panel Unanimously Recommends Approval of Third Indication For Medtronicrsquos INFUSE Bone Graft Nov 9 2006
FDA Panel Unanimously Recommends Approval of Third Indication For Medtronicrsquos INFUSE Bone Graft Nov 9 2006 INFUSE Bone Graft is recombinant human bone morphogenetic protein-2 (rhBMP-2) applied to an absorbable collagen sponge carrier The purpose of the protein which occurs naturally in the body is to stimulate bone formation It has been previously approved by the FDA for use in certain lumbar spine fusion and tibial fracture repair procedures
INFUSE Bone Graft is recombinant human bone morphogenetic protein-2 (rhBMP-2) applied to an absorbable collagen sponge carrier The purpose of the protein which occurs naturally in the body is to stimulate bone formation It has been previously approved by the FDA for use in certain lumbar spine fusion and tibial fracture repair procedures
Distraction OsteogenesisDistraction
OsteogenesisbullGeneration of bone (and soft
tissue) through distraction of an osseous callus
bullGeneration of bone (and soft tissue) through distraction of an osseous callus
Ann N Y Acad Sci 2006 Apr1068532-42 COX-2 has a critical role during incorporation of structural bone allografts OrsquoKeefe RJ Tiyapatanaputi P Xie C
Ann N Y Acad Sci 2006 Apr1068532-42 COX-2 has a critical role during incorporation of structural bone allografts OrsquoKeefe RJ Tiyapatanaputi P Xie C
Nonsteroidal anti-inflammatory drugs (NSAIDs) which inhibit cyclooxygenase (COX) activity reduce pain and are commonly used in patients with skeletal injury In this article we will also present data to show that selective COX-2 inhibitor delays allograft healing and incorporation These results demonstrated that COX-2 is essential for bone allograft incorporation Furthermore our data support the notion that COX-2-dependent PGE2 produced at the early stage of bone healing is prerequisite for efficient skeletal repair
Nonsteroidal anti-inflammatory drugs (NSAIDs) which inhibit cyclooxygenase (COX) activity reduce pain and are commonly used in patients with skeletal injury In this article we will also present data to show that selective COX-2 inhibitor delays allograft healing and incorporation These results demonstrated that COX-2 is essential for bone allograft incorporation Furthermore our data support the notion that COX-2-dependent PGE2 produced at the early stage of bone healing is prerequisite for efficient skeletal repair
Wise Old Oral Surgeon Wise Old Oral Surgeon Says Beware ofSays Beware of
Wise Old Oral Surgeon Wise Old Oral Surgeon Says Beware ofSays Beware of
bull 3rd molars in function3rd molars in function
bull Lone standing molarsLone standing molars
bull Teeth in bruxers Cl III skeletal patternsTeeth in bruxers Cl III skeletal patterns
bull 3rd molars + post-menopausal women3rd molars + post-menopausal women
bull Prior TMD historyPrior TMD history
bull Prior ldquobadrdquo oral surgery experiencePrior ldquobadrdquo oral surgery experience
bull Distoangular lower 3rds nerve proximityDistoangular lower 3rds nerve proximity
bull 3rd molars in function3rd molars in function
bull Lone standing molarsLone standing molars
bull Teeth in bruxers Cl III skeletal patternsTeeth in bruxers Cl III skeletal patterns
bull 3rd molars + post-menopausal women3rd molars + post-menopausal women
bull Prior TMD historyPrior TMD history
bull Prior ldquobadrdquo oral surgery experiencePrior ldquobadrdquo oral surgery experience
bull Distoangular lower 3rds nerve proximityDistoangular lower 3rds nerve proximity
3rd Molar Surgery ndash Why
3rd Molar Surgery ndash Why
1 Preventtreat pericoronitis (infection)2 Prevent periodontal problems 2nd molar3 Preventtreat caries to 2nd 3rd molar4 Prevent odontogenic cyststumors5 Strengthen mandible possible fx6 Prevent orthodontic relapse7 Treat pain of unknown origin
1 Preventtreat pericoronitis (infection)2 Prevent periodontal problems 2nd molar3 Preventtreat caries to 2nd 3rd molar4 Prevent odontogenic cyststumors5 Strengthen mandible possible fx6 Prevent orthodontic relapse7 Treat pain of unknown origin
Extract 3rds OralSystemic Extract 3rds OralSystemic LinkLink
CLEVELAND April 6 2006 - The first hard evidence has CLEVELAND April 6 2006 - The first hard evidence has been uncovered that bacteria in the mouth may find their been uncovered that bacteria in the mouth may find their way to the uterus causing uterine infections that can lead way to the uterus causing uterine infections that can lead to preterm birth in pregnant womento preterm birth in pregnant women
CLEVELAND April 6 2006 - The first hard evidence has CLEVELAND April 6 2006 - The first hard evidence has been uncovered that bacteria in the mouth may find their been uncovered that bacteria in the mouth may find their way to the uterus causing uterine infections that can lead way to the uterus causing uterine infections that can lead to preterm birth in pregnant womento preterm birth in pregnant women
A newly discovered and as yet unnamed species of the A newly discovered and as yet unnamed species of the bacterium genus bacterium genus BergeyellaBergeyella was found in the mouth was found in the mouth and amniotic fluid of a woman with a uterine infection and amniotic fluid of a woman with a uterine infection who gave birth prematurely (24 weeks) reported who gave birth prematurely (24 weeks) reported microbiologist Yiping W Han PhD of Case Western microbiologist Yiping W Han PhD of Case Western Reserve here Reserve here However the bacterium was not detected in a vaginal However the bacterium was not detected in a vaginal swab as might be expected The finding confirmed swab as might be expected The finding confirmed what some scientists have suspected that intrauterine what some scientists have suspected that intrauterine infections dont always ascend from the genital tract infections dont always ascend from the genital tract but can descend from the oral cavity Dr Han and but can descend from the oral cavity Dr Han and colleagues said in the April issue of the colleagues said in the April issue of the Journal of Journal of Clinical MicrobiologyClinical Microbiology
A newly discovered and as yet unnamed species of the A newly discovered and as yet unnamed species of the bacterium genus bacterium genus BergeyellaBergeyella was found in the mouth was found in the mouth and amniotic fluid of a woman with a uterine infection and amniotic fluid of a woman with a uterine infection who gave birth prematurely (24 weeks) reported who gave birth prematurely (24 weeks) reported microbiologist Yiping W Han PhD of Case Western microbiologist Yiping W Han PhD of Case Western Reserve here Reserve here However the bacterium was not detected in a vaginal However the bacterium was not detected in a vaginal swab as might be expected The finding confirmed swab as might be expected The finding confirmed what some scientists have suspected that intrauterine what some scientists have suspected that intrauterine infections dont always ascend from the genital tract infections dont always ascend from the genital tract but can descend from the oral cavity Dr Han and but can descend from the oral cavity Dr Han and colleagues said in the April issue of the colleagues said in the April issue of the Journal of Journal of Clinical MicrobiologyClinical Microbiology
Journal of Oral and Maxillofacial Journal of Oral and Maxillofacial SurgerySurgery
Volume 65 Issue 3 March 2007 Pages Volume 65 Issue 3 March 2007 Pages 377-383377-383
Progress Report on Third Molar Clinical Trials Progress Report on Third Molar Clinical Trials Raymond P White Jr DDS PhDRaymond P White Jr DDS PhD
1What happens to asymptomatic patients who keep their 1What happens to asymptomatic patients who keep their third molars third molars
2What is the recovery like for those who have them 2What is the recovery like for those who have them removed and what can we do as surgeons to improve removed and what can we do as surgeons to improve post operative outcomespost operative outcomes
3rd Molar Surgery ndash When3rd Molar Surgery ndash WhenbullBefore roots 100 developed
bullAfter roots 13 formed
bullMorbiditycomplications minimized as bone more flexible nerves more pliable and PMH less complicated
bullDonrsquot forget tooth transplanttooth transplant if apex not closed
bullBefore roots 100 developed
bullAfter roots 13 formed
bullMorbiditycomplications minimized as bone more flexible nerves more pliable and PMH less complicated
bullDonrsquot forget tooth transplanttooth transplant if apex not closed
Outcome of tooth transplantation survival and success rates 17-41 years post treatmentCzochrowska EM Stenvik A Bjercke B Zachrisson Am J Orthod Dentofacial Orthop 2002 Feb121(2)110-9The mean age at surgery was 115 years and the mean observation period was 264 264 years (range 17-41 years) Of the 33 teeth transplanted in the 28 patients 3 teeth were lost after 9 10 and 29 years respectively Therefore the 30 teeth in the 25 patients we examined yielded a survival rate of 90 The success rate was 79 because 2 transplants had ankylosed and 2 others failed to fulfill the proposed criteria The patients generally responded very favorably regarding their perception of the treatment Their only hesitation was related to some discomfort during surgery It was concluded that It was concluded that survival and success rates for teeth auto survival and success rates for teeth auto transplanted when the root is partly developed transplanted when the root is partly developed compare favorably in a long-term perspective compare favorably in a long-term perspective with other treatment modalities for with other treatment modalities for substituting missing teethsubstituting missing teeth
Outcome of tooth transplantation survival and success rates 17-41 years post treatmentCzochrowska EM Stenvik A Bjercke B Zachrisson Am J Orthod Dentofacial Orthop 2002 Feb121(2)110-9The mean age at surgery was 115 years and the mean observation period was 264 264 years (range 17-41 years) Of the 33 teeth transplanted in the 28 patients 3 teeth were lost after 9 10 and 29 years respectively Therefore the 30 teeth in the 25 patients we examined yielded a survival rate of 90 The success rate was 79 because 2 transplants had ankylosed and 2 others failed to fulfill the proposed criteria The patients generally responded very favorably regarding their perception of the treatment Their only hesitation was related to some discomfort during surgery It was concluded that It was concluded that survival and success rates for teeth auto survival and success rates for teeth auto transplanted when the root is partly developed transplanted when the root is partly developed compare favorably in a long-term perspective compare favorably in a long-term perspective with other treatment modalities for with other treatment modalities for substituting missing teethsubstituting missing teeth
3rd Molar Surgery ndash When Not
3rd Molar Surgery ndash When Not
bullExtremes of age
bullNo oral communication (full bony)
bullIntimate root-nerve Relationship
bullRisks gt Benefits
bullExtremes of age
bullNo oral communication (full bony)
bullIntimate root-nerve Relationship
bullRisks gt Benefits
3rd Molar Surgery Alternatives
3rd Molar Surgery Alternatives
bullNo Surgery dentist feels risk benefit ratio not favorable or patient refuses ndash document and recommend radiograph q 3-5 years
bullNo Surgery dentist feels risk benefit ratio not favorable or patient refuses ndash document and recommend radiograph q 3-5 years
No High SpeedNo High Speed
bullAir embolus
bullAir emphysema
bullBlow debris into flap
bullBlow bacteria into flap
bullNon-sterile water
bullAir embolus
bullAir emphysema
bullBlow debris into flap
bullBlow bacteria into flap
bullNon-sterile water
Which are trueWhich are true1 Tooth transplants are usually done on
patients 20-302 Average success rate for a tooth
transplant is 20-303 In order to work a transplant must
have endo4 Most transplants will ankylose
A 13 B 24 C 123 D 3 only
E None of the above
1 Tooth transplants are usually done on patients 20-30
2 Average success rate for a tooth transplant is 20-30
3 In order to work a transplant must have endo
4 Most transplants will ankylose
A 13 B 24 C 123 D 3 only
E None of the above
How can I assess the relationship How can I assess the relationship between the 3between the 3rdrd molar root and the molar root and the
inferior alveolar nerveinferior alveolar nerve
- Slide 2
- Slide 3
- Slide 4
- ldquoSockets with intact buccal and lingual plates heal well without graftinghellip consider grafting with resorbable osteoinductive material if plates compromised and implants plannedrdquo grafting with connective tissue if pontic esthetics an issuerdquo
- Vital Root Retention
- Slide 7
- Slide 8
- Slide 9
- J Oral Maxillofac Surg 2005 Feb43(1)7-12 A randomized controlled clinical trial to compare the incidence of injury to the inferior alveolar nerve as a result of coronectomy and removal of mandibular third molars Renton T Hankins M Sproate C
- Slide 11
- Slide 12
- Immediate Implant Placement Following Extractions
- Platelet Rich Plasma
- Slide 15
- Slide 16
- Slide 17
- Why Reconstruct
- How Autogenous Bone Grafts with Implants
- Autogenous Block Grafts
- Slide 21
- Intra-oral Autogenous Bone Sites
- Slide 23
- What about membranes
- Bone Morphogenic Protein (BMP)
- Slide 26
- Distraction Osteogenesis
- Slide 28
- Wise Old Oral Surgeon Says Beware of
- 3rd Molar Surgery ndash Why
- Extract 3rds OralSystemic Link
- Slide 32
- 3rd Molar Surgery ndash When
- 3rd Molar Surgery ndash When Not
- 3rd Molar Surgery Alternatives
- No High Speed
- Slide 38
- Which are true
- Slide 40
-
Casap et al Immediate Implantation Into Debrided Infected Sockets J Oral Maxillofac Surg 2007
Does placing implants into fresh extraction Does placing implants into fresh extraction sockets preserve bonesockets preserve bone
J Clin Periodontol 2005 Jun32(6)645-52 Ridge alterations following implant placement in fresh extraction sockets an experimental study in the dogArauacutejo MG Sukekava F Wennstroumlm JL Lindhe J
CONCLUSIONS Marked dimensional alterations had occurred in the edentulous ridge after 3 months of healing following the extraction of the distal root of mandibular pre-molars The placement of an The placement of an implant in the fresh extraction site obviously implant in the fresh extraction site obviously failed to prevent the re-modeling that occurred failed to prevent the re-modeling that occurred in the walls of the socketin the walls of the socket The resulting height of the buccal and lingual walls at 3 months was similar at implants and edentulous sites
Most human trials however reveal results Most human trials however reveal results similar to implants place via the ldquoold similar to implants place via the ldquoold schoolrdquo approach even when immediately schoolrdquo approach even when immediately loaded (caution in ldquosoftrdquo bone gt55 YO)loaded (caution in ldquosoftrdquo bone gt55 YO)
Int J Oral Maxillofac Implants 2007 Mar-Apr22(2)187-94 The radiographic bone loss pattern adjacent to immediately placed immediately loaded implantsJaffin R Kolesar M Kumar A Ishikawa S Fiorellini J
J Craniofac Surg 2007 Jul18(4)965-71 Immediate loaded dental implants comparison between fixtures inserted in postextractive and healed bone sitesDegidi M Piattelli A Carinci F
J Periodontol 2007 May78(5)810-5 Vertical crestal bone changes around implants placed into fresh extraction socketsCovani U Cornelini R Barone A
Why ReconstructWhy Reconstruct
bullNot enough bone for implants
bullEnough bone but esthetic result suboptimal
bullPrevent pathologic fracture
bullPoor functionestheticsretention of conventional removable prosthesis
bullNot enough bone for implants
bullEnough bone but esthetic result suboptimal
bullPrevent pathologic fracture
bullPoor functionestheticsretention of conventional removable prosthesis
How Autogenous Bone Grafts
with Implants
How Autogenous Bone Grafts
with Implants
Autogenous Block GraftsAutogenous Block Grafts
bullldquoGold Standardrdquo
bullOsteoinductive and Osteoconductive
bullNo need for membranes
bullHolds form
bullRemodels into 100 high quality bone
bullNo concerns about transmissible diseases
bullldquoGold Standardrdquo
bullOsteoinductive and Osteoconductive
bullNo need for membranes
bullHolds form
bullRemodels into 100 high quality bone
bullNo concerns about transmissible diseases
Autogenous Block Grafts
Autogenous Block Grafts
bullDonor site morbidity
bullQuantity is limited
bullLose 20-30 during healing
bullDonor site morbidity
bullQuantity is limited
bullLose 20-30 during healing
Intra-oral Autogenous Bone Sites
AllogenicAllogenic Block Block GraftGraft
What about membranesWhat about membranes
bullUseful in containing particulate grafts
bullUseful around teethexposed implant threads
bullAdd expense
bull Infection risk
bullUnnecessary with block grafts
bullADA 4266 Resorbable
bullADA 4267 Non-Resorbable
bullUseful in containing particulate grafts
bullUseful around teethexposed implant threads
bullAdd expense
bull Infection risk
bullUnnecessary with block grafts
bullADA 4266 Resorbable
bullADA 4267 Non-Resorbable
Bone Morphogenic Protein (BMP)
Bone Morphogenic Protein (BMP)
bullGrow bone at will
bullPresently two are FDA approved BMP 2 for spinal fusions and BMP 7 for long bone defects
bullStudies show excellent results for socket preservation sinus lifts
bullExpensive ($500000 for a sinus)
bullGrow bone at will
bullPresently two are FDA approved BMP 2 for spinal fusions and BMP 7 for long bone defects
bullStudies show excellent results for socket preservation sinus lifts
bullExpensive ($500000 for a sinus)
FDA Panel Unanimously Recommends Approval of Third Indication For Medtronicrsquos INFUSE Bone Graft Nov 9 2006
FDA Panel Unanimously Recommends Approval of Third Indication For Medtronicrsquos INFUSE Bone Graft Nov 9 2006 INFUSE Bone Graft is recombinant human bone morphogenetic protein-2 (rhBMP-2) applied to an absorbable collagen sponge carrier The purpose of the protein which occurs naturally in the body is to stimulate bone formation It has been previously approved by the FDA for use in certain lumbar spine fusion and tibial fracture repair procedures
INFUSE Bone Graft is recombinant human bone morphogenetic protein-2 (rhBMP-2) applied to an absorbable collagen sponge carrier The purpose of the protein which occurs naturally in the body is to stimulate bone formation It has been previously approved by the FDA for use in certain lumbar spine fusion and tibial fracture repair procedures
Distraction OsteogenesisDistraction
OsteogenesisbullGeneration of bone (and soft
tissue) through distraction of an osseous callus
bullGeneration of bone (and soft tissue) through distraction of an osseous callus
Ann N Y Acad Sci 2006 Apr1068532-42 COX-2 has a critical role during incorporation of structural bone allografts OrsquoKeefe RJ Tiyapatanaputi P Xie C
Ann N Y Acad Sci 2006 Apr1068532-42 COX-2 has a critical role during incorporation of structural bone allografts OrsquoKeefe RJ Tiyapatanaputi P Xie C
Nonsteroidal anti-inflammatory drugs (NSAIDs) which inhibit cyclooxygenase (COX) activity reduce pain and are commonly used in patients with skeletal injury In this article we will also present data to show that selective COX-2 inhibitor delays allograft healing and incorporation These results demonstrated that COX-2 is essential for bone allograft incorporation Furthermore our data support the notion that COX-2-dependent PGE2 produced at the early stage of bone healing is prerequisite for efficient skeletal repair
Nonsteroidal anti-inflammatory drugs (NSAIDs) which inhibit cyclooxygenase (COX) activity reduce pain and are commonly used in patients with skeletal injury In this article we will also present data to show that selective COX-2 inhibitor delays allograft healing and incorporation These results demonstrated that COX-2 is essential for bone allograft incorporation Furthermore our data support the notion that COX-2-dependent PGE2 produced at the early stage of bone healing is prerequisite for efficient skeletal repair
Wise Old Oral Surgeon Wise Old Oral Surgeon Says Beware ofSays Beware of
Wise Old Oral Surgeon Wise Old Oral Surgeon Says Beware ofSays Beware of
bull 3rd molars in function3rd molars in function
bull Lone standing molarsLone standing molars
bull Teeth in bruxers Cl III skeletal patternsTeeth in bruxers Cl III skeletal patterns
bull 3rd molars + post-menopausal women3rd molars + post-menopausal women
bull Prior TMD historyPrior TMD history
bull Prior ldquobadrdquo oral surgery experiencePrior ldquobadrdquo oral surgery experience
bull Distoangular lower 3rds nerve proximityDistoangular lower 3rds nerve proximity
bull 3rd molars in function3rd molars in function
bull Lone standing molarsLone standing molars
bull Teeth in bruxers Cl III skeletal patternsTeeth in bruxers Cl III skeletal patterns
bull 3rd molars + post-menopausal women3rd molars + post-menopausal women
bull Prior TMD historyPrior TMD history
bull Prior ldquobadrdquo oral surgery experiencePrior ldquobadrdquo oral surgery experience
bull Distoangular lower 3rds nerve proximityDistoangular lower 3rds nerve proximity
3rd Molar Surgery ndash Why
3rd Molar Surgery ndash Why
1 Preventtreat pericoronitis (infection)2 Prevent periodontal problems 2nd molar3 Preventtreat caries to 2nd 3rd molar4 Prevent odontogenic cyststumors5 Strengthen mandible possible fx6 Prevent orthodontic relapse7 Treat pain of unknown origin
1 Preventtreat pericoronitis (infection)2 Prevent periodontal problems 2nd molar3 Preventtreat caries to 2nd 3rd molar4 Prevent odontogenic cyststumors5 Strengthen mandible possible fx6 Prevent orthodontic relapse7 Treat pain of unknown origin
Extract 3rds OralSystemic Extract 3rds OralSystemic LinkLink
CLEVELAND April 6 2006 - The first hard evidence has CLEVELAND April 6 2006 - The first hard evidence has been uncovered that bacteria in the mouth may find their been uncovered that bacteria in the mouth may find their way to the uterus causing uterine infections that can lead way to the uterus causing uterine infections that can lead to preterm birth in pregnant womento preterm birth in pregnant women
CLEVELAND April 6 2006 - The first hard evidence has CLEVELAND April 6 2006 - The first hard evidence has been uncovered that bacteria in the mouth may find their been uncovered that bacteria in the mouth may find their way to the uterus causing uterine infections that can lead way to the uterus causing uterine infections that can lead to preterm birth in pregnant womento preterm birth in pregnant women
A newly discovered and as yet unnamed species of the A newly discovered and as yet unnamed species of the bacterium genus bacterium genus BergeyellaBergeyella was found in the mouth was found in the mouth and amniotic fluid of a woman with a uterine infection and amniotic fluid of a woman with a uterine infection who gave birth prematurely (24 weeks) reported who gave birth prematurely (24 weeks) reported microbiologist Yiping W Han PhD of Case Western microbiologist Yiping W Han PhD of Case Western Reserve here Reserve here However the bacterium was not detected in a vaginal However the bacterium was not detected in a vaginal swab as might be expected The finding confirmed swab as might be expected The finding confirmed what some scientists have suspected that intrauterine what some scientists have suspected that intrauterine infections dont always ascend from the genital tract infections dont always ascend from the genital tract but can descend from the oral cavity Dr Han and but can descend from the oral cavity Dr Han and colleagues said in the April issue of the colleagues said in the April issue of the Journal of Journal of Clinical MicrobiologyClinical Microbiology
A newly discovered and as yet unnamed species of the A newly discovered and as yet unnamed species of the bacterium genus bacterium genus BergeyellaBergeyella was found in the mouth was found in the mouth and amniotic fluid of a woman with a uterine infection and amniotic fluid of a woman with a uterine infection who gave birth prematurely (24 weeks) reported who gave birth prematurely (24 weeks) reported microbiologist Yiping W Han PhD of Case Western microbiologist Yiping W Han PhD of Case Western Reserve here Reserve here However the bacterium was not detected in a vaginal However the bacterium was not detected in a vaginal swab as might be expected The finding confirmed swab as might be expected The finding confirmed what some scientists have suspected that intrauterine what some scientists have suspected that intrauterine infections dont always ascend from the genital tract infections dont always ascend from the genital tract but can descend from the oral cavity Dr Han and but can descend from the oral cavity Dr Han and colleagues said in the April issue of the colleagues said in the April issue of the Journal of Journal of Clinical MicrobiologyClinical Microbiology
Journal of Oral and Maxillofacial Journal of Oral and Maxillofacial SurgerySurgery
Volume 65 Issue 3 March 2007 Pages Volume 65 Issue 3 March 2007 Pages 377-383377-383
Progress Report on Third Molar Clinical Trials Progress Report on Third Molar Clinical Trials Raymond P White Jr DDS PhDRaymond P White Jr DDS PhD
1What happens to asymptomatic patients who keep their 1What happens to asymptomatic patients who keep their third molars third molars
2What is the recovery like for those who have them 2What is the recovery like for those who have them removed and what can we do as surgeons to improve removed and what can we do as surgeons to improve post operative outcomespost operative outcomes
3rd Molar Surgery ndash When3rd Molar Surgery ndash WhenbullBefore roots 100 developed
bullAfter roots 13 formed
bullMorbiditycomplications minimized as bone more flexible nerves more pliable and PMH less complicated
bullDonrsquot forget tooth transplanttooth transplant if apex not closed
bullBefore roots 100 developed
bullAfter roots 13 formed
bullMorbiditycomplications minimized as bone more flexible nerves more pliable and PMH less complicated
bullDonrsquot forget tooth transplanttooth transplant if apex not closed
Outcome of tooth transplantation survival and success rates 17-41 years post treatmentCzochrowska EM Stenvik A Bjercke B Zachrisson Am J Orthod Dentofacial Orthop 2002 Feb121(2)110-9The mean age at surgery was 115 years and the mean observation period was 264 264 years (range 17-41 years) Of the 33 teeth transplanted in the 28 patients 3 teeth were lost after 9 10 and 29 years respectively Therefore the 30 teeth in the 25 patients we examined yielded a survival rate of 90 The success rate was 79 because 2 transplants had ankylosed and 2 others failed to fulfill the proposed criteria The patients generally responded very favorably regarding their perception of the treatment Their only hesitation was related to some discomfort during surgery It was concluded that It was concluded that survival and success rates for teeth auto survival and success rates for teeth auto transplanted when the root is partly developed transplanted when the root is partly developed compare favorably in a long-term perspective compare favorably in a long-term perspective with other treatment modalities for with other treatment modalities for substituting missing teethsubstituting missing teeth
Outcome of tooth transplantation survival and success rates 17-41 years post treatmentCzochrowska EM Stenvik A Bjercke B Zachrisson Am J Orthod Dentofacial Orthop 2002 Feb121(2)110-9The mean age at surgery was 115 years and the mean observation period was 264 264 years (range 17-41 years) Of the 33 teeth transplanted in the 28 patients 3 teeth were lost after 9 10 and 29 years respectively Therefore the 30 teeth in the 25 patients we examined yielded a survival rate of 90 The success rate was 79 because 2 transplants had ankylosed and 2 others failed to fulfill the proposed criteria The patients generally responded very favorably regarding their perception of the treatment Their only hesitation was related to some discomfort during surgery It was concluded that It was concluded that survival and success rates for teeth auto survival and success rates for teeth auto transplanted when the root is partly developed transplanted when the root is partly developed compare favorably in a long-term perspective compare favorably in a long-term perspective with other treatment modalities for with other treatment modalities for substituting missing teethsubstituting missing teeth
3rd Molar Surgery ndash When Not
3rd Molar Surgery ndash When Not
bullExtremes of age
bullNo oral communication (full bony)
bullIntimate root-nerve Relationship
bullRisks gt Benefits
bullExtremes of age
bullNo oral communication (full bony)
bullIntimate root-nerve Relationship
bullRisks gt Benefits
3rd Molar Surgery Alternatives
3rd Molar Surgery Alternatives
bullNo Surgery dentist feels risk benefit ratio not favorable or patient refuses ndash document and recommend radiograph q 3-5 years
bullNo Surgery dentist feels risk benefit ratio not favorable or patient refuses ndash document and recommend radiograph q 3-5 years
No High SpeedNo High Speed
bullAir embolus
bullAir emphysema
bullBlow debris into flap
bullBlow bacteria into flap
bullNon-sterile water
bullAir embolus
bullAir emphysema
bullBlow debris into flap
bullBlow bacteria into flap
bullNon-sterile water
Which are trueWhich are true1 Tooth transplants are usually done on
patients 20-302 Average success rate for a tooth
transplant is 20-303 In order to work a transplant must
have endo4 Most transplants will ankylose
A 13 B 24 C 123 D 3 only
E None of the above
1 Tooth transplants are usually done on patients 20-30
2 Average success rate for a tooth transplant is 20-30
3 In order to work a transplant must have endo
4 Most transplants will ankylose
A 13 B 24 C 123 D 3 only
E None of the above
How can I assess the relationship How can I assess the relationship between the 3between the 3rdrd molar root and the molar root and the
inferior alveolar nerveinferior alveolar nerve
- Slide 2
- Slide 3
- Slide 4
- ldquoSockets with intact buccal and lingual plates heal well without graftinghellip consider grafting with resorbable osteoinductive material if plates compromised and implants plannedrdquo grafting with connective tissue if pontic esthetics an issuerdquo
- Vital Root Retention
- Slide 7
- Slide 8
- Slide 9
- J Oral Maxillofac Surg 2005 Feb43(1)7-12 A randomized controlled clinical trial to compare the incidence of injury to the inferior alveolar nerve as a result of coronectomy and removal of mandibular third molars Renton T Hankins M Sproate C
- Slide 11
- Slide 12
- Immediate Implant Placement Following Extractions
- Platelet Rich Plasma
- Slide 15
- Slide 16
- Slide 17
- Why Reconstruct
- How Autogenous Bone Grafts with Implants
- Autogenous Block Grafts
- Slide 21
- Intra-oral Autogenous Bone Sites
- Slide 23
- What about membranes
- Bone Morphogenic Protein (BMP)
- Slide 26
- Distraction Osteogenesis
- Slide 28
- Wise Old Oral Surgeon Says Beware of
- 3rd Molar Surgery ndash Why
- Extract 3rds OralSystemic Link
- Slide 32
- 3rd Molar Surgery ndash When
- 3rd Molar Surgery ndash When Not
- 3rd Molar Surgery Alternatives
- No High Speed
- Slide 38
- Which are true
- Slide 40
-
Does placing implants into fresh extraction Does placing implants into fresh extraction sockets preserve bonesockets preserve bone
J Clin Periodontol 2005 Jun32(6)645-52 Ridge alterations following implant placement in fresh extraction sockets an experimental study in the dogArauacutejo MG Sukekava F Wennstroumlm JL Lindhe J
CONCLUSIONS Marked dimensional alterations had occurred in the edentulous ridge after 3 months of healing following the extraction of the distal root of mandibular pre-molars The placement of an The placement of an implant in the fresh extraction site obviously implant in the fresh extraction site obviously failed to prevent the re-modeling that occurred failed to prevent the re-modeling that occurred in the walls of the socketin the walls of the socket The resulting height of the buccal and lingual walls at 3 months was similar at implants and edentulous sites
Most human trials however reveal results Most human trials however reveal results similar to implants place via the ldquoold similar to implants place via the ldquoold schoolrdquo approach even when immediately schoolrdquo approach even when immediately loaded (caution in ldquosoftrdquo bone gt55 YO)loaded (caution in ldquosoftrdquo bone gt55 YO)
Int J Oral Maxillofac Implants 2007 Mar-Apr22(2)187-94 The radiographic bone loss pattern adjacent to immediately placed immediately loaded implantsJaffin R Kolesar M Kumar A Ishikawa S Fiorellini J
J Craniofac Surg 2007 Jul18(4)965-71 Immediate loaded dental implants comparison between fixtures inserted in postextractive and healed bone sitesDegidi M Piattelli A Carinci F
J Periodontol 2007 May78(5)810-5 Vertical crestal bone changes around implants placed into fresh extraction socketsCovani U Cornelini R Barone A
Why ReconstructWhy Reconstruct
bullNot enough bone for implants
bullEnough bone but esthetic result suboptimal
bullPrevent pathologic fracture
bullPoor functionestheticsretention of conventional removable prosthesis
bullNot enough bone for implants
bullEnough bone but esthetic result suboptimal
bullPrevent pathologic fracture
bullPoor functionestheticsretention of conventional removable prosthesis
How Autogenous Bone Grafts
with Implants
How Autogenous Bone Grafts
with Implants
Autogenous Block GraftsAutogenous Block Grafts
bullldquoGold Standardrdquo
bullOsteoinductive and Osteoconductive
bullNo need for membranes
bullHolds form
bullRemodels into 100 high quality bone
bullNo concerns about transmissible diseases
bullldquoGold Standardrdquo
bullOsteoinductive and Osteoconductive
bullNo need for membranes
bullHolds form
bullRemodels into 100 high quality bone
bullNo concerns about transmissible diseases
Autogenous Block Grafts
Autogenous Block Grafts
bullDonor site morbidity
bullQuantity is limited
bullLose 20-30 during healing
bullDonor site morbidity
bullQuantity is limited
bullLose 20-30 during healing
Intra-oral Autogenous Bone Sites
AllogenicAllogenic Block Block GraftGraft
What about membranesWhat about membranes
bullUseful in containing particulate grafts
bullUseful around teethexposed implant threads
bullAdd expense
bull Infection risk
bullUnnecessary with block grafts
bullADA 4266 Resorbable
bullADA 4267 Non-Resorbable
bullUseful in containing particulate grafts
bullUseful around teethexposed implant threads
bullAdd expense
bull Infection risk
bullUnnecessary with block grafts
bullADA 4266 Resorbable
bullADA 4267 Non-Resorbable
Bone Morphogenic Protein (BMP)
Bone Morphogenic Protein (BMP)
bullGrow bone at will
bullPresently two are FDA approved BMP 2 for spinal fusions and BMP 7 for long bone defects
bullStudies show excellent results for socket preservation sinus lifts
bullExpensive ($500000 for a sinus)
bullGrow bone at will
bullPresently two are FDA approved BMP 2 for spinal fusions and BMP 7 for long bone defects
bullStudies show excellent results for socket preservation sinus lifts
bullExpensive ($500000 for a sinus)
FDA Panel Unanimously Recommends Approval of Third Indication For Medtronicrsquos INFUSE Bone Graft Nov 9 2006
FDA Panel Unanimously Recommends Approval of Third Indication For Medtronicrsquos INFUSE Bone Graft Nov 9 2006 INFUSE Bone Graft is recombinant human bone morphogenetic protein-2 (rhBMP-2) applied to an absorbable collagen sponge carrier The purpose of the protein which occurs naturally in the body is to stimulate bone formation It has been previously approved by the FDA for use in certain lumbar spine fusion and tibial fracture repair procedures
INFUSE Bone Graft is recombinant human bone morphogenetic protein-2 (rhBMP-2) applied to an absorbable collagen sponge carrier The purpose of the protein which occurs naturally in the body is to stimulate bone formation It has been previously approved by the FDA for use in certain lumbar spine fusion and tibial fracture repair procedures
Distraction OsteogenesisDistraction
OsteogenesisbullGeneration of bone (and soft
tissue) through distraction of an osseous callus
bullGeneration of bone (and soft tissue) through distraction of an osseous callus
Ann N Y Acad Sci 2006 Apr1068532-42 COX-2 has a critical role during incorporation of structural bone allografts OrsquoKeefe RJ Tiyapatanaputi P Xie C
Ann N Y Acad Sci 2006 Apr1068532-42 COX-2 has a critical role during incorporation of structural bone allografts OrsquoKeefe RJ Tiyapatanaputi P Xie C
Nonsteroidal anti-inflammatory drugs (NSAIDs) which inhibit cyclooxygenase (COX) activity reduce pain and are commonly used in patients with skeletal injury In this article we will also present data to show that selective COX-2 inhibitor delays allograft healing and incorporation These results demonstrated that COX-2 is essential for bone allograft incorporation Furthermore our data support the notion that COX-2-dependent PGE2 produced at the early stage of bone healing is prerequisite for efficient skeletal repair
Nonsteroidal anti-inflammatory drugs (NSAIDs) which inhibit cyclooxygenase (COX) activity reduce pain and are commonly used in patients with skeletal injury In this article we will also present data to show that selective COX-2 inhibitor delays allograft healing and incorporation These results demonstrated that COX-2 is essential for bone allograft incorporation Furthermore our data support the notion that COX-2-dependent PGE2 produced at the early stage of bone healing is prerequisite for efficient skeletal repair
Wise Old Oral Surgeon Wise Old Oral Surgeon Says Beware ofSays Beware of
Wise Old Oral Surgeon Wise Old Oral Surgeon Says Beware ofSays Beware of
bull 3rd molars in function3rd molars in function
bull Lone standing molarsLone standing molars
bull Teeth in bruxers Cl III skeletal patternsTeeth in bruxers Cl III skeletal patterns
bull 3rd molars + post-menopausal women3rd molars + post-menopausal women
bull Prior TMD historyPrior TMD history
bull Prior ldquobadrdquo oral surgery experiencePrior ldquobadrdquo oral surgery experience
bull Distoangular lower 3rds nerve proximityDistoangular lower 3rds nerve proximity
bull 3rd molars in function3rd molars in function
bull Lone standing molarsLone standing molars
bull Teeth in bruxers Cl III skeletal patternsTeeth in bruxers Cl III skeletal patterns
bull 3rd molars + post-menopausal women3rd molars + post-menopausal women
bull Prior TMD historyPrior TMD history
bull Prior ldquobadrdquo oral surgery experiencePrior ldquobadrdquo oral surgery experience
bull Distoangular lower 3rds nerve proximityDistoangular lower 3rds nerve proximity
3rd Molar Surgery ndash Why
3rd Molar Surgery ndash Why
1 Preventtreat pericoronitis (infection)2 Prevent periodontal problems 2nd molar3 Preventtreat caries to 2nd 3rd molar4 Prevent odontogenic cyststumors5 Strengthen mandible possible fx6 Prevent orthodontic relapse7 Treat pain of unknown origin
1 Preventtreat pericoronitis (infection)2 Prevent periodontal problems 2nd molar3 Preventtreat caries to 2nd 3rd molar4 Prevent odontogenic cyststumors5 Strengthen mandible possible fx6 Prevent orthodontic relapse7 Treat pain of unknown origin
Extract 3rds OralSystemic Extract 3rds OralSystemic LinkLink
CLEVELAND April 6 2006 - The first hard evidence has CLEVELAND April 6 2006 - The first hard evidence has been uncovered that bacteria in the mouth may find their been uncovered that bacteria in the mouth may find their way to the uterus causing uterine infections that can lead way to the uterus causing uterine infections that can lead to preterm birth in pregnant womento preterm birth in pregnant women
CLEVELAND April 6 2006 - The first hard evidence has CLEVELAND April 6 2006 - The first hard evidence has been uncovered that bacteria in the mouth may find their been uncovered that bacteria in the mouth may find their way to the uterus causing uterine infections that can lead way to the uterus causing uterine infections that can lead to preterm birth in pregnant womento preterm birth in pregnant women
A newly discovered and as yet unnamed species of the A newly discovered and as yet unnamed species of the bacterium genus bacterium genus BergeyellaBergeyella was found in the mouth was found in the mouth and amniotic fluid of a woman with a uterine infection and amniotic fluid of a woman with a uterine infection who gave birth prematurely (24 weeks) reported who gave birth prematurely (24 weeks) reported microbiologist Yiping W Han PhD of Case Western microbiologist Yiping W Han PhD of Case Western Reserve here Reserve here However the bacterium was not detected in a vaginal However the bacterium was not detected in a vaginal swab as might be expected The finding confirmed swab as might be expected The finding confirmed what some scientists have suspected that intrauterine what some scientists have suspected that intrauterine infections dont always ascend from the genital tract infections dont always ascend from the genital tract but can descend from the oral cavity Dr Han and but can descend from the oral cavity Dr Han and colleagues said in the April issue of the colleagues said in the April issue of the Journal of Journal of Clinical MicrobiologyClinical Microbiology
A newly discovered and as yet unnamed species of the A newly discovered and as yet unnamed species of the bacterium genus bacterium genus BergeyellaBergeyella was found in the mouth was found in the mouth and amniotic fluid of a woman with a uterine infection and amniotic fluid of a woman with a uterine infection who gave birth prematurely (24 weeks) reported who gave birth prematurely (24 weeks) reported microbiologist Yiping W Han PhD of Case Western microbiologist Yiping W Han PhD of Case Western Reserve here Reserve here However the bacterium was not detected in a vaginal However the bacterium was not detected in a vaginal swab as might be expected The finding confirmed swab as might be expected The finding confirmed what some scientists have suspected that intrauterine what some scientists have suspected that intrauterine infections dont always ascend from the genital tract infections dont always ascend from the genital tract but can descend from the oral cavity Dr Han and but can descend from the oral cavity Dr Han and colleagues said in the April issue of the colleagues said in the April issue of the Journal of Journal of Clinical MicrobiologyClinical Microbiology
Journal of Oral and Maxillofacial Journal of Oral and Maxillofacial SurgerySurgery
Volume 65 Issue 3 March 2007 Pages Volume 65 Issue 3 March 2007 Pages 377-383377-383
Progress Report on Third Molar Clinical Trials Progress Report on Third Molar Clinical Trials Raymond P White Jr DDS PhDRaymond P White Jr DDS PhD
1What happens to asymptomatic patients who keep their 1What happens to asymptomatic patients who keep their third molars third molars
2What is the recovery like for those who have them 2What is the recovery like for those who have them removed and what can we do as surgeons to improve removed and what can we do as surgeons to improve post operative outcomespost operative outcomes
3rd Molar Surgery ndash When3rd Molar Surgery ndash WhenbullBefore roots 100 developed
bullAfter roots 13 formed
bullMorbiditycomplications minimized as bone more flexible nerves more pliable and PMH less complicated
bullDonrsquot forget tooth transplanttooth transplant if apex not closed
bullBefore roots 100 developed
bullAfter roots 13 formed
bullMorbiditycomplications minimized as bone more flexible nerves more pliable and PMH less complicated
bullDonrsquot forget tooth transplanttooth transplant if apex not closed
Outcome of tooth transplantation survival and success rates 17-41 years post treatmentCzochrowska EM Stenvik A Bjercke B Zachrisson Am J Orthod Dentofacial Orthop 2002 Feb121(2)110-9The mean age at surgery was 115 years and the mean observation period was 264 264 years (range 17-41 years) Of the 33 teeth transplanted in the 28 patients 3 teeth were lost after 9 10 and 29 years respectively Therefore the 30 teeth in the 25 patients we examined yielded a survival rate of 90 The success rate was 79 because 2 transplants had ankylosed and 2 others failed to fulfill the proposed criteria The patients generally responded very favorably regarding their perception of the treatment Their only hesitation was related to some discomfort during surgery It was concluded that It was concluded that survival and success rates for teeth auto survival and success rates for teeth auto transplanted when the root is partly developed transplanted when the root is partly developed compare favorably in a long-term perspective compare favorably in a long-term perspective with other treatment modalities for with other treatment modalities for substituting missing teethsubstituting missing teeth
Outcome of tooth transplantation survival and success rates 17-41 years post treatmentCzochrowska EM Stenvik A Bjercke B Zachrisson Am J Orthod Dentofacial Orthop 2002 Feb121(2)110-9The mean age at surgery was 115 years and the mean observation period was 264 264 years (range 17-41 years) Of the 33 teeth transplanted in the 28 patients 3 teeth were lost after 9 10 and 29 years respectively Therefore the 30 teeth in the 25 patients we examined yielded a survival rate of 90 The success rate was 79 because 2 transplants had ankylosed and 2 others failed to fulfill the proposed criteria The patients generally responded very favorably regarding their perception of the treatment Their only hesitation was related to some discomfort during surgery It was concluded that It was concluded that survival and success rates for teeth auto survival and success rates for teeth auto transplanted when the root is partly developed transplanted when the root is partly developed compare favorably in a long-term perspective compare favorably in a long-term perspective with other treatment modalities for with other treatment modalities for substituting missing teethsubstituting missing teeth
3rd Molar Surgery ndash When Not
3rd Molar Surgery ndash When Not
bullExtremes of age
bullNo oral communication (full bony)
bullIntimate root-nerve Relationship
bullRisks gt Benefits
bullExtremes of age
bullNo oral communication (full bony)
bullIntimate root-nerve Relationship
bullRisks gt Benefits
3rd Molar Surgery Alternatives
3rd Molar Surgery Alternatives
bullNo Surgery dentist feels risk benefit ratio not favorable or patient refuses ndash document and recommend radiograph q 3-5 years
bullNo Surgery dentist feels risk benefit ratio not favorable or patient refuses ndash document and recommend radiograph q 3-5 years
No High SpeedNo High Speed
bullAir embolus
bullAir emphysema
bullBlow debris into flap
bullBlow bacteria into flap
bullNon-sterile water
bullAir embolus
bullAir emphysema
bullBlow debris into flap
bullBlow bacteria into flap
bullNon-sterile water
Which are trueWhich are true1 Tooth transplants are usually done on
patients 20-302 Average success rate for a tooth
transplant is 20-303 In order to work a transplant must
have endo4 Most transplants will ankylose
A 13 B 24 C 123 D 3 only
E None of the above
1 Tooth transplants are usually done on patients 20-30
2 Average success rate for a tooth transplant is 20-30
3 In order to work a transplant must have endo
4 Most transplants will ankylose
A 13 B 24 C 123 D 3 only
E None of the above
How can I assess the relationship How can I assess the relationship between the 3between the 3rdrd molar root and the molar root and the
inferior alveolar nerveinferior alveolar nerve
- Slide 2
- Slide 3
- Slide 4
- ldquoSockets with intact buccal and lingual plates heal well without graftinghellip consider grafting with resorbable osteoinductive material if plates compromised and implants plannedrdquo grafting with connective tissue if pontic esthetics an issuerdquo
- Vital Root Retention
- Slide 7
- Slide 8
- Slide 9
- J Oral Maxillofac Surg 2005 Feb43(1)7-12 A randomized controlled clinical trial to compare the incidence of injury to the inferior alveolar nerve as a result of coronectomy and removal of mandibular third molars Renton T Hankins M Sproate C
- Slide 11
- Slide 12
- Immediate Implant Placement Following Extractions
- Platelet Rich Plasma
- Slide 15
- Slide 16
- Slide 17
- Why Reconstruct
- How Autogenous Bone Grafts with Implants
- Autogenous Block Grafts
- Slide 21
- Intra-oral Autogenous Bone Sites
- Slide 23
- What about membranes
- Bone Morphogenic Protein (BMP)
- Slide 26
- Distraction Osteogenesis
- Slide 28
- Wise Old Oral Surgeon Says Beware of
- 3rd Molar Surgery ndash Why
- Extract 3rds OralSystemic Link
- Slide 32
- 3rd Molar Surgery ndash When
- 3rd Molar Surgery ndash When Not
- 3rd Molar Surgery Alternatives
- No High Speed
- Slide 38
- Which are true
- Slide 40
-
Most human trials however reveal results Most human trials however reveal results similar to implants place via the ldquoold similar to implants place via the ldquoold schoolrdquo approach even when immediately schoolrdquo approach even when immediately loaded (caution in ldquosoftrdquo bone gt55 YO)loaded (caution in ldquosoftrdquo bone gt55 YO)
Int J Oral Maxillofac Implants 2007 Mar-Apr22(2)187-94 The radiographic bone loss pattern adjacent to immediately placed immediately loaded implantsJaffin R Kolesar M Kumar A Ishikawa S Fiorellini J
J Craniofac Surg 2007 Jul18(4)965-71 Immediate loaded dental implants comparison between fixtures inserted in postextractive and healed bone sitesDegidi M Piattelli A Carinci F
J Periodontol 2007 May78(5)810-5 Vertical crestal bone changes around implants placed into fresh extraction socketsCovani U Cornelini R Barone A
Why ReconstructWhy Reconstruct
bullNot enough bone for implants
bullEnough bone but esthetic result suboptimal
bullPrevent pathologic fracture
bullPoor functionestheticsretention of conventional removable prosthesis
bullNot enough bone for implants
bullEnough bone but esthetic result suboptimal
bullPrevent pathologic fracture
bullPoor functionestheticsretention of conventional removable prosthesis
How Autogenous Bone Grafts
with Implants
How Autogenous Bone Grafts
with Implants
Autogenous Block GraftsAutogenous Block Grafts
bullldquoGold Standardrdquo
bullOsteoinductive and Osteoconductive
bullNo need for membranes
bullHolds form
bullRemodels into 100 high quality bone
bullNo concerns about transmissible diseases
bullldquoGold Standardrdquo
bullOsteoinductive and Osteoconductive
bullNo need for membranes
bullHolds form
bullRemodels into 100 high quality bone
bullNo concerns about transmissible diseases
Autogenous Block Grafts
Autogenous Block Grafts
bullDonor site morbidity
bullQuantity is limited
bullLose 20-30 during healing
bullDonor site morbidity
bullQuantity is limited
bullLose 20-30 during healing
Intra-oral Autogenous Bone Sites
AllogenicAllogenic Block Block GraftGraft
What about membranesWhat about membranes
bullUseful in containing particulate grafts
bullUseful around teethexposed implant threads
bullAdd expense
bull Infection risk
bullUnnecessary with block grafts
bullADA 4266 Resorbable
bullADA 4267 Non-Resorbable
bullUseful in containing particulate grafts
bullUseful around teethexposed implant threads
bullAdd expense
bull Infection risk
bullUnnecessary with block grafts
bullADA 4266 Resorbable
bullADA 4267 Non-Resorbable
Bone Morphogenic Protein (BMP)
Bone Morphogenic Protein (BMP)
bullGrow bone at will
bullPresently two are FDA approved BMP 2 for spinal fusions and BMP 7 for long bone defects
bullStudies show excellent results for socket preservation sinus lifts
bullExpensive ($500000 for a sinus)
bullGrow bone at will
bullPresently two are FDA approved BMP 2 for spinal fusions and BMP 7 for long bone defects
bullStudies show excellent results for socket preservation sinus lifts
bullExpensive ($500000 for a sinus)
FDA Panel Unanimously Recommends Approval of Third Indication For Medtronicrsquos INFUSE Bone Graft Nov 9 2006
FDA Panel Unanimously Recommends Approval of Third Indication For Medtronicrsquos INFUSE Bone Graft Nov 9 2006 INFUSE Bone Graft is recombinant human bone morphogenetic protein-2 (rhBMP-2) applied to an absorbable collagen sponge carrier The purpose of the protein which occurs naturally in the body is to stimulate bone formation It has been previously approved by the FDA for use in certain lumbar spine fusion and tibial fracture repair procedures
INFUSE Bone Graft is recombinant human bone morphogenetic protein-2 (rhBMP-2) applied to an absorbable collagen sponge carrier The purpose of the protein which occurs naturally in the body is to stimulate bone formation It has been previously approved by the FDA for use in certain lumbar spine fusion and tibial fracture repair procedures
Distraction OsteogenesisDistraction
OsteogenesisbullGeneration of bone (and soft
tissue) through distraction of an osseous callus
bullGeneration of bone (and soft tissue) through distraction of an osseous callus
Ann N Y Acad Sci 2006 Apr1068532-42 COX-2 has a critical role during incorporation of structural bone allografts OrsquoKeefe RJ Tiyapatanaputi P Xie C
Ann N Y Acad Sci 2006 Apr1068532-42 COX-2 has a critical role during incorporation of structural bone allografts OrsquoKeefe RJ Tiyapatanaputi P Xie C
Nonsteroidal anti-inflammatory drugs (NSAIDs) which inhibit cyclooxygenase (COX) activity reduce pain and are commonly used in patients with skeletal injury In this article we will also present data to show that selective COX-2 inhibitor delays allograft healing and incorporation These results demonstrated that COX-2 is essential for bone allograft incorporation Furthermore our data support the notion that COX-2-dependent PGE2 produced at the early stage of bone healing is prerequisite for efficient skeletal repair
Nonsteroidal anti-inflammatory drugs (NSAIDs) which inhibit cyclooxygenase (COX) activity reduce pain and are commonly used in patients with skeletal injury In this article we will also present data to show that selective COX-2 inhibitor delays allograft healing and incorporation These results demonstrated that COX-2 is essential for bone allograft incorporation Furthermore our data support the notion that COX-2-dependent PGE2 produced at the early stage of bone healing is prerequisite for efficient skeletal repair
Wise Old Oral Surgeon Wise Old Oral Surgeon Says Beware ofSays Beware of
Wise Old Oral Surgeon Wise Old Oral Surgeon Says Beware ofSays Beware of
bull 3rd molars in function3rd molars in function
bull Lone standing molarsLone standing molars
bull Teeth in bruxers Cl III skeletal patternsTeeth in bruxers Cl III skeletal patterns
bull 3rd molars + post-menopausal women3rd molars + post-menopausal women
bull Prior TMD historyPrior TMD history
bull Prior ldquobadrdquo oral surgery experiencePrior ldquobadrdquo oral surgery experience
bull Distoangular lower 3rds nerve proximityDistoangular lower 3rds nerve proximity
bull 3rd molars in function3rd molars in function
bull Lone standing molarsLone standing molars
bull Teeth in bruxers Cl III skeletal patternsTeeth in bruxers Cl III skeletal patterns
bull 3rd molars + post-menopausal women3rd molars + post-menopausal women
bull Prior TMD historyPrior TMD history
bull Prior ldquobadrdquo oral surgery experiencePrior ldquobadrdquo oral surgery experience
bull Distoangular lower 3rds nerve proximityDistoangular lower 3rds nerve proximity
3rd Molar Surgery ndash Why
3rd Molar Surgery ndash Why
1 Preventtreat pericoronitis (infection)2 Prevent periodontal problems 2nd molar3 Preventtreat caries to 2nd 3rd molar4 Prevent odontogenic cyststumors5 Strengthen mandible possible fx6 Prevent orthodontic relapse7 Treat pain of unknown origin
1 Preventtreat pericoronitis (infection)2 Prevent periodontal problems 2nd molar3 Preventtreat caries to 2nd 3rd molar4 Prevent odontogenic cyststumors5 Strengthen mandible possible fx6 Prevent orthodontic relapse7 Treat pain of unknown origin
Extract 3rds OralSystemic Extract 3rds OralSystemic LinkLink
CLEVELAND April 6 2006 - The first hard evidence has CLEVELAND April 6 2006 - The first hard evidence has been uncovered that bacteria in the mouth may find their been uncovered that bacteria in the mouth may find their way to the uterus causing uterine infections that can lead way to the uterus causing uterine infections that can lead to preterm birth in pregnant womento preterm birth in pregnant women
CLEVELAND April 6 2006 - The first hard evidence has CLEVELAND April 6 2006 - The first hard evidence has been uncovered that bacteria in the mouth may find their been uncovered that bacteria in the mouth may find their way to the uterus causing uterine infections that can lead way to the uterus causing uterine infections that can lead to preterm birth in pregnant womento preterm birth in pregnant women
A newly discovered and as yet unnamed species of the A newly discovered and as yet unnamed species of the bacterium genus bacterium genus BergeyellaBergeyella was found in the mouth was found in the mouth and amniotic fluid of a woman with a uterine infection and amniotic fluid of a woman with a uterine infection who gave birth prematurely (24 weeks) reported who gave birth prematurely (24 weeks) reported microbiologist Yiping W Han PhD of Case Western microbiologist Yiping W Han PhD of Case Western Reserve here Reserve here However the bacterium was not detected in a vaginal However the bacterium was not detected in a vaginal swab as might be expected The finding confirmed swab as might be expected The finding confirmed what some scientists have suspected that intrauterine what some scientists have suspected that intrauterine infections dont always ascend from the genital tract infections dont always ascend from the genital tract but can descend from the oral cavity Dr Han and but can descend from the oral cavity Dr Han and colleagues said in the April issue of the colleagues said in the April issue of the Journal of Journal of Clinical MicrobiologyClinical Microbiology
A newly discovered and as yet unnamed species of the A newly discovered and as yet unnamed species of the bacterium genus bacterium genus BergeyellaBergeyella was found in the mouth was found in the mouth and amniotic fluid of a woman with a uterine infection and amniotic fluid of a woman with a uterine infection who gave birth prematurely (24 weeks) reported who gave birth prematurely (24 weeks) reported microbiologist Yiping W Han PhD of Case Western microbiologist Yiping W Han PhD of Case Western Reserve here Reserve here However the bacterium was not detected in a vaginal However the bacterium was not detected in a vaginal swab as might be expected The finding confirmed swab as might be expected The finding confirmed what some scientists have suspected that intrauterine what some scientists have suspected that intrauterine infections dont always ascend from the genital tract infections dont always ascend from the genital tract but can descend from the oral cavity Dr Han and but can descend from the oral cavity Dr Han and colleagues said in the April issue of the colleagues said in the April issue of the Journal of Journal of Clinical MicrobiologyClinical Microbiology
Journal of Oral and Maxillofacial Journal of Oral and Maxillofacial SurgerySurgery
Volume 65 Issue 3 March 2007 Pages Volume 65 Issue 3 March 2007 Pages 377-383377-383
Progress Report on Third Molar Clinical Trials Progress Report on Third Molar Clinical Trials Raymond P White Jr DDS PhDRaymond P White Jr DDS PhD
1What happens to asymptomatic patients who keep their 1What happens to asymptomatic patients who keep their third molars third molars
2What is the recovery like for those who have them 2What is the recovery like for those who have them removed and what can we do as surgeons to improve removed and what can we do as surgeons to improve post operative outcomespost operative outcomes
3rd Molar Surgery ndash When3rd Molar Surgery ndash WhenbullBefore roots 100 developed
bullAfter roots 13 formed
bullMorbiditycomplications minimized as bone more flexible nerves more pliable and PMH less complicated
bullDonrsquot forget tooth transplanttooth transplant if apex not closed
bullBefore roots 100 developed
bullAfter roots 13 formed
bullMorbiditycomplications minimized as bone more flexible nerves more pliable and PMH less complicated
bullDonrsquot forget tooth transplanttooth transplant if apex not closed
Outcome of tooth transplantation survival and success rates 17-41 years post treatmentCzochrowska EM Stenvik A Bjercke B Zachrisson Am J Orthod Dentofacial Orthop 2002 Feb121(2)110-9The mean age at surgery was 115 years and the mean observation period was 264 264 years (range 17-41 years) Of the 33 teeth transplanted in the 28 patients 3 teeth were lost after 9 10 and 29 years respectively Therefore the 30 teeth in the 25 patients we examined yielded a survival rate of 90 The success rate was 79 because 2 transplants had ankylosed and 2 others failed to fulfill the proposed criteria The patients generally responded very favorably regarding their perception of the treatment Their only hesitation was related to some discomfort during surgery It was concluded that It was concluded that survival and success rates for teeth auto survival and success rates for teeth auto transplanted when the root is partly developed transplanted when the root is partly developed compare favorably in a long-term perspective compare favorably in a long-term perspective with other treatment modalities for with other treatment modalities for substituting missing teethsubstituting missing teeth
Outcome of tooth transplantation survival and success rates 17-41 years post treatmentCzochrowska EM Stenvik A Bjercke B Zachrisson Am J Orthod Dentofacial Orthop 2002 Feb121(2)110-9The mean age at surgery was 115 years and the mean observation period was 264 264 years (range 17-41 years) Of the 33 teeth transplanted in the 28 patients 3 teeth were lost after 9 10 and 29 years respectively Therefore the 30 teeth in the 25 patients we examined yielded a survival rate of 90 The success rate was 79 because 2 transplants had ankylosed and 2 others failed to fulfill the proposed criteria The patients generally responded very favorably regarding their perception of the treatment Their only hesitation was related to some discomfort during surgery It was concluded that It was concluded that survival and success rates for teeth auto survival and success rates for teeth auto transplanted when the root is partly developed transplanted when the root is partly developed compare favorably in a long-term perspective compare favorably in a long-term perspective with other treatment modalities for with other treatment modalities for substituting missing teethsubstituting missing teeth
3rd Molar Surgery ndash When Not
3rd Molar Surgery ndash When Not
bullExtremes of age
bullNo oral communication (full bony)
bullIntimate root-nerve Relationship
bullRisks gt Benefits
bullExtremes of age
bullNo oral communication (full bony)
bullIntimate root-nerve Relationship
bullRisks gt Benefits
3rd Molar Surgery Alternatives
3rd Molar Surgery Alternatives
bullNo Surgery dentist feels risk benefit ratio not favorable or patient refuses ndash document and recommend radiograph q 3-5 years
bullNo Surgery dentist feels risk benefit ratio not favorable or patient refuses ndash document and recommend radiograph q 3-5 years
No High SpeedNo High Speed
bullAir embolus
bullAir emphysema
bullBlow debris into flap
bullBlow bacteria into flap
bullNon-sterile water
bullAir embolus
bullAir emphysema
bullBlow debris into flap
bullBlow bacteria into flap
bullNon-sterile water
Which are trueWhich are true1 Tooth transplants are usually done on
patients 20-302 Average success rate for a tooth
transplant is 20-303 In order to work a transplant must
have endo4 Most transplants will ankylose
A 13 B 24 C 123 D 3 only
E None of the above
1 Tooth transplants are usually done on patients 20-30
2 Average success rate for a tooth transplant is 20-30
3 In order to work a transplant must have endo
4 Most transplants will ankylose
A 13 B 24 C 123 D 3 only
E None of the above
How can I assess the relationship How can I assess the relationship between the 3between the 3rdrd molar root and the molar root and the
inferior alveolar nerveinferior alveolar nerve
- Slide 2
- Slide 3
- Slide 4
- ldquoSockets with intact buccal and lingual plates heal well without graftinghellip consider grafting with resorbable osteoinductive material if plates compromised and implants plannedrdquo grafting with connective tissue if pontic esthetics an issuerdquo
- Vital Root Retention
- Slide 7
- Slide 8
- Slide 9
- J Oral Maxillofac Surg 2005 Feb43(1)7-12 A randomized controlled clinical trial to compare the incidence of injury to the inferior alveolar nerve as a result of coronectomy and removal of mandibular third molars Renton T Hankins M Sproate C
- Slide 11
- Slide 12
- Immediate Implant Placement Following Extractions
- Platelet Rich Plasma
- Slide 15
- Slide 16
- Slide 17
- Why Reconstruct
- How Autogenous Bone Grafts with Implants
- Autogenous Block Grafts
- Slide 21
- Intra-oral Autogenous Bone Sites
- Slide 23
- What about membranes
- Bone Morphogenic Protein (BMP)
- Slide 26
- Distraction Osteogenesis
- Slide 28
- Wise Old Oral Surgeon Says Beware of
- 3rd Molar Surgery ndash Why
- Extract 3rds OralSystemic Link
- Slide 32
- 3rd Molar Surgery ndash When
- 3rd Molar Surgery ndash When Not
- 3rd Molar Surgery Alternatives
- No High Speed
- Slide 38
- Which are true
- Slide 40
-
Why ReconstructWhy Reconstruct
bullNot enough bone for implants
bullEnough bone but esthetic result suboptimal
bullPrevent pathologic fracture
bullPoor functionestheticsretention of conventional removable prosthesis
bullNot enough bone for implants
bullEnough bone but esthetic result suboptimal
bullPrevent pathologic fracture
bullPoor functionestheticsretention of conventional removable prosthesis
How Autogenous Bone Grafts
with Implants
How Autogenous Bone Grafts
with Implants
Autogenous Block GraftsAutogenous Block Grafts
bullldquoGold Standardrdquo
bullOsteoinductive and Osteoconductive
bullNo need for membranes
bullHolds form
bullRemodels into 100 high quality bone
bullNo concerns about transmissible diseases
bullldquoGold Standardrdquo
bullOsteoinductive and Osteoconductive
bullNo need for membranes
bullHolds form
bullRemodels into 100 high quality bone
bullNo concerns about transmissible diseases
Autogenous Block Grafts
Autogenous Block Grafts
bullDonor site morbidity
bullQuantity is limited
bullLose 20-30 during healing
bullDonor site morbidity
bullQuantity is limited
bullLose 20-30 during healing
Intra-oral Autogenous Bone Sites
AllogenicAllogenic Block Block GraftGraft
What about membranesWhat about membranes
bullUseful in containing particulate grafts
bullUseful around teethexposed implant threads
bullAdd expense
bull Infection risk
bullUnnecessary with block grafts
bullADA 4266 Resorbable
bullADA 4267 Non-Resorbable
bullUseful in containing particulate grafts
bullUseful around teethexposed implant threads
bullAdd expense
bull Infection risk
bullUnnecessary with block grafts
bullADA 4266 Resorbable
bullADA 4267 Non-Resorbable
Bone Morphogenic Protein (BMP)
Bone Morphogenic Protein (BMP)
bullGrow bone at will
bullPresently two are FDA approved BMP 2 for spinal fusions and BMP 7 for long bone defects
bullStudies show excellent results for socket preservation sinus lifts
bullExpensive ($500000 for a sinus)
bullGrow bone at will
bullPresently two are FDA approved BMP 2 for spinal fusions and BMP 7 for long bone defects
bullStudies show excellent results for socket preservation sinus lifts
bullExpensive ($500000 for a sinus)
FDA Panel Unanimously Recommends Approval of Third Indication For Medtronicrsquos INFUSE Bone Graft Nov 9 2006
FDA Panel Unanimously Recommends Approval of Third Indication For Medtronicrsquos INFUSE Bone Graft Nov 9 2006 INFUSE Bone Graft is recombinant human bone morphogenetic protein-2 (rhBMP-2) applied to an absorbable collagen sponge carrier The purpose of the protein which occurs naturally in the body is to stimulate bone formation It has been previously approved by the FDA for use in certain lumbar spine fusion and tibial fracture repair procedures
INFUSE Bone Graft is recombinant human bone morphogenetic protein-2 (rhBMP-2) applied to an absorbable collagen sponge carrier The purpose of the protein which occurs naturally in the body is to stimulate bone formation It has been previously approved by the FDA for use in certain lumbar spine fusion and tibial fracture repair procedures
Distraction OsteogenesisDistraction
OsteogenesisbullGeneration of bone (and soft
tissue) through distraction of an osseous callus
bullGeneration of bone (and soft tissue) through distraction of an osseous callus
Ann N Y Acad Sci 2006 Apr1068532-42 COX-2 has a critical role during incorporation of structural bone allografts OrsquoKeefe RJ Tiyapatanaputi P Xie C
Ann N Y Acad Sci 2006 Apr1068532-42 COX-2 has a critical role during incorporation of structural bone allografts OrsquoKeefe RJ Tiyapatanaputi P Xie C
Nonsteroidal anti-inflammatory drugs (NSAIDs) which inhibit cyclooxygenase (COX) activity reduce pain and are commonly used in patients with skeletal injury In this article we will also present data to show that selective COX-2 inhibitor delays allograft healing and incorporation These results demonstrated that COX-2 is essential for bone allograft incorporation Furthermore our data support the notion that COX-2-dependent PGE2 produced at the early stage of bone healing is prerequisite for efficient skeletal repair
Nonsteroidal anti-inflammatory drugs (NSAIDs) which inhibit cyclooxygenase (COX) activity reduce pain and are commonly used in patients with skeletal injury In this article we will also present data to show that selective COX-2 inhibitor delays allograft healing and incorporation These results demonstrated that COX-2 is essential for bone allograft incorporation Furthermore our data support the notion that COX-2-dependent PGE2 produced at the early stage of bone healing is prerequisite for efficient skeletal repair
Wise Old Oral Surgeon Wise Old Oral Surgeon Says Beware ofSays Beware of
Wise Old Oral Surgeon Wise Old Oral Surgeon Says Beware ofSays Beware of
bull 3rd molars in function3rd molars in function
bull Lone standing molarsLone standing molars
bull Teeth in bruxers Cl III skeletal patternsTeeth in bruxers Cl III skeletal patterns
bull 3rd molars + post-menopausal women3rd molars + post-menopausal women
bull Prior TMD historyPrior TMD history
bull Prior ldquobadrdquo oral surgery experiencePrior ldquobadrdquo oral surgery experience
bull Distoangular lower 3rds nerve proximityDistoangular lower 3rds nerve proximity
bull 3rd molars in function3rd molars in function
bull Lone standing molarsLone standing molars
bull Teeth in bruxers Cl III skeletal patternsTeeth in bruxers Cl III skeletal patterns
bull 3rd molars + post-menopausal women3rd molars + post-menopausal women
bull Prior TMD historyPrior TMD history
bull Prior ldquobadrdquo oral surgery experiencePrior ldquobadrdquo oral surgery experience
bull Distoangular lower 3rds nerve proximityDistoangular lower 3rds nerve proximity
3rd Molar Surgery ndash Why
3rd Molar Surgery ndash Why
1 Preventtreat pericoronitis (infection)2 Prevent periodontal problems 2nd molar3 Preventtreat caries to 2nd 3rd molar4 Prevent odontogenic cyststumors5 Strengthen mandible possible fx6 Prevent orthodontic relapse7 Treat pain of unknown origin
1 Preventtreat pericoronitis (infection)2 Prevent periodontal problems 2nd molar3 Preventtreat caries to 2nd 3rd molar4 Prevent odontogenic cyststumors5 Strengthen mandible possible fx6 Prevent orthodontic relapse7 Treat pain of unknown origin
Extract 3rds OralSystemic Extract 3rds OralSystemic LinkLink
CLEVELAND April 6 2006 - The first hard evidence has CLEVELAND April 6 2006 - The first hard evidence has been uncovered that bacteria in the mouth may find their been uncovered that bacteria in the mouth may find their way to the uterus causing uterine infections that can lead way to the uterus causing uterine infections that can lead to preterm birth in pregnant womento preterm birth in pregnant women
CLEVELAND April 6 2006 - The first hard evidence has CLEVELAND April 6 2006 - The first hard evidence has been uncovered that bacteria in the mouth may find their been uncovered that bacteria in the mouth may find their way to the uterus causing uterine infections that can lead way to the uterus causing uterine infections that can lead to preterm birth in pregnant womento preterm birth in pregnant women
A newly discovered and as yet unnamed species of the A newly discovered and as yet unnamed species of the bacterium genus bacterium genus BergeyellaBergeyella was found in the mouth was found in the mouth and amniotic fluid of a woman with a uterine infection and amniotic fluid of a woman with a uterine infection who gave birth prematurely (24 weeks) reported who gave birth prematurely (24 weeks) reported microbiologist Yiping W Han PhD of Case Western microbiologist Yiping W Han PhD of Case Western Reserve here Reserve here However the bacterium was not detected in a vaginal However the bacterium was not detected in a vaginal swab as might be expected The finding confirmed swab as might be expected The finding confirmed what some scientists have suspected that intrauterine what some scientists have suspected that intrauterine infections dont always ascend from the genital tract infections dont always ascend from the genital tract but can descend from the oral cavity Dr Han and but can descend from the oral cavity Dr Han and colleagues said in the April issue of the colleagues said in the April issue of the Journal of Journal of Clinical MicrobiologyClinical Microbiology
A newly discovered and as yet unnamed species of the A newly discovered and as yet unnamed species of the bacterium genus bacterium genus BergeyellaBergeyella was found in the mouth was found in the mouth and amniotic fluid of a woman with a uterine infection and amniotic fluid of a woman with a uterine infection who gave birth prematurely (24 weeks) reported who gave birth prematurely (24 weeks) reported microbiologist Yiping W Han PhD of Case Western microbiologist Yiping W Han PhD of Case Western Reserve here Reserve here However the bacterium was not detected in a vaginal However the bacterium was not detected in a vaginal swab as might be expected The finding confirmed swab as might be expected The finding confirmed what some scientists have suspected that intrauterine what some scientists have suspected that intrauterine infections dont always ascend from the genital tract infections dont always ascend from the genital tract but can descend from the oral cavity Dr Han and but can descend from the oral cavity Dr Han and colleagues said in the April issue of the colleagues said in the April issue of the Journal of Journal of Clinical MicrobiologyClinical Microbiology
Journal of Oral and Maxillofacial Journal of Oral and Maxillofacial SurgerySurgery
Volume 65 Issue 3 March 2007 Pages Volume 65 Issue 3 March 2007 Pages 377-383377-383
Progress Report on Third Molar Clinical Trials Progress Report on Third Molar Clinical Trials Raymond P White Jr DDS PhDRaymond P White Jr DDS PhD
1What happens to asymptomatic patients who keep their 1What happens to asymptomatic patients who keep their third molars third molars
2What is the recovery like for those who have them 2What is the recovery like for those who have them removed and what can we do as surgeons to improve removed and what can we do as surgeons to improve post operative outcomespost operative outcomes
3rd Molar Surgery ndash When3rd Molar Surgery ndash WhenbullBefore roots 100 developed
bullAfter roots 13 formed
bullMorbiditycomplications minimized as bone more flexible nerves more pliable and PMH less complicated
bullDonrsquot forget tooth transplanttooth transplant if apex not closed
bullBefore roots 100 developed
bullAfter roots 13 formed
bullMorbiditycomplications minimized as bone more flexible nerves more pliable and PMH less complicated
bullDonrsquot forget tooth transplanttooth transplant if apex not closed
Outcome of tooth transplantation survival and success rates 17-41 years post treatmentCzochrowska EM Stenvik A Bjercke B Zachrisson Am J Orthod Dentofacial Orthop 2002 Feb121(2)110-9The mean age at surgery was 115 years and the mean observation period was 264 264 years (range 17-41 years) Of the 33 teeth transplanted in the 28 patients 3 teeth were lost after 9 10 and 29 years respectively Therefore the 30 teeth in the 25 patients we examined yielded a survival rate of 90 The success rate was 79 because 2 transplants had ankylosed and 2 others failed to fulfill the proposed criteria The patients generally responded very favorably regarding their perception of the treatment Their only hesitation was related to some discomfort during surgery It was concluded that It was concluded that survival and success rates for teeth auto survival and success rates for teeth auto transplanted when the root is partly developed transplanted when the root is partly developed compare favorably in a long-term perspective compare favorably in a long-term perspective with other treatment modalities for with other treatment modalities for substituting missing teethsubstituting missing teeth
Outcome of tooth transplantation survival and success rates 17-41 years post treatmentCzochrowska EM Stenvik A Bjercke B Zachrisson Am J Orthod Dentofacial Orthop 2002 Feb121(2)110-9The mean age at surgery was 115 years and the mean observation period was 264 264 years (range 17-41 years) Of the 33 teeth transplanted in the 28 patients 3 teeth were lost after 9 10 and 29 years respectively Therefore the 30 teeth in the 25 patients we examined yielded a survival rate of 90 The success rate was 79 because 2 transplants had ankylosed and 2 others failed to fulfill the proposed criteria The patients generally responded very favorably regarding their perception of the treatment Their only hesitation was related to some discomfort during surgery It was concluded that It was concluded that survival and success rates for teeth auto survival and success rates for teeth auto transplanted when the root is partly developed transplanted when the root is partly developed compare favorably in a long-term perspective compare favorably in a long-term perspective with other treatment modalities for with other treatment modalities for substituting missing teethsubstituting missing teeth
3rd Molar Surgery ndash When Not
3rd Molar Surgery ndash When Not
bullExtremes of age
bullNo oral communication (full bony)
bullIntimate root-nerve Relationship
bullRisks gt Benefits
bullExtremes of age
bullNo oral communication (full bony)
bullIntimate root-nerve Relationship
bullRisks gt Benefits
3rd Molar Surgery Alternatives
3rd Molar Surgery Alternatives
bullNo Surgery dentist feels risk benefit ratio not favorable or patient refuses ndash document and recommend radiograph q 3-5 years
bullNo Surgery dentist feels risk benefit ratio not favorable or patient refuses ndash document and recommend radiograph q 3-5 years
No High SpeedNo High Speed
bullAir embolus
bullAir emphysema
bullBlow debris into flap
bullBlow bacteria into flap
bullNon-sterile water
bullAir embolus
bullAir emphysema
bullBlow debris into flap
bullBlow bacteria into flap
bullNon-sterile water
Which are trueWhich are true1 Tooth transplants are usually done on
patients 20-302 Average success rate for a tooth
transplant is 20-303 In order to work a transplant must
have endo4 Most transplants will ankylose
A 13 B 24 C 123 D 3 only
E None of the above
1 Tooth transplants are usually done on patients 20-30
2 Average success rate for a tooth transplant is 20-30
3 In order to work a transplant must have endo
4 Most transplants will ankylose
A 13 B 24 C 123 D 3 only
E None of the above
How can I assess the relationship How can I assess the relationship between the 3between the 3rdrd molar root and the molar root and the
inferior alveolar nerveinferior alveolar nerve
- Slide 2
- Slide 3
- Slide 4
- ldquoSockets with intact buccal and lingual plates heal well without graftinghellip consider grafting with resorbable osteoinductive material if plates compromised and implants plannedrdquo grafting with connective tissue if pontic esthetics an issuerdquo
- Vital Root Retention
- Slide 7
- Slide 8
- Slide 9
- J Oral Maxillofac Surg 2005 Feb43(1)7-12 A randomized controlled clinical trial to compare the incidence of injury to the inferior alveolar nerve as a result of coronectomy and removal of mandibular third molars Renton T Hankins M Sproate C
- Slide 11
- Slide 12
- Immediate Implant Placement Following Extractions
- Platelet Rich Plasma
- Slide 15
- Slide 16
- Slide 17
- Why Reconstruct
- How Autogenous Bone Grafts with Implants
- Autogenous Block Grafts
- Slide 21
- Intra-oral Autogenous Bone Sites
- Slide 23
- What about membranes
- Bone Morphogenic Protein (BMP)
- Slide 26
- Distraction Osteogenesis
- Slide 28
- Wise Old Oral Surgeon Says Beware of
- 3rd Molar Surgery ndash Why
- Extract 3rds OralSystemic Link
- Slide 32
- 3rd Molar Surgery ndash When
- 3rd Molar Surgery ndash When Not
- 3rd Molar Surgery Alternatives
- No High Speed
- Slide 38
- Which are true
- Slide 40
-
How Autogenous Bone Grafts
with Implants
How Autogenous Bone Grafts
with Implants
Autogenous Block GraftsAutogenous Block Grafts
bullldquoGold Standardrdquo
bullOsteoinductive and Osteoconductive
bullNo need for membranes
bullHolds form
bullRemodels into 100 high quality bone
bullNo concerns about transmissible diseases
bullldquoGold Standardrdquo
bullOsteoinductive and Osteoconductive
bullNo need for membranes
bullHolds form
bullRemodels into 100 high quality bone
bullNo concerns about transmissible diseases
Autogenous Block Grafts
Autogenous Block Grafts
bullDonor site morbidity
bullQuantity is limited
bullLose 20-30 during healing
bullDonor site morbidity
bullQuantity is limited
bullLose 20-30 during healing
Intra-oral Autogenous Bone Sites
AllogenicAllogenic Block Block GraftGraft
What about membranesWhat about membranes
bullUseful in containing particulate grafts
bullUseful around teethexposed implant threads
bullAdd expense
bull Infection risk
bullUnnecessary with block grafts
bullADA 4266 Resorbable
bullADA 4267 Non-Resorbable
bullUseful in containing particulate grafts
bullUseful around teethexposed implant threads
bullAdd expense
bull Infection risk
bullUnnecessary with block grafts
bullADA 4266 Resorbable
bullADA 4267 Non-Resorbable
Bone Morphogenic Protein (BMP)
Bone Morphogenic Protein (BMP)
bullGrow bone at will
bullPresently two are FDA approved BMP 2 for spinal fusions and BMP 7 for long bone defects
bullStudies show excellent results for socket preservation sinus lifts
bullExpensive ($500000 for a sinus)
bullGrow bone at will
bullPresently two are FDA approved BMP 2 for spinal fusions and BMP 7 for long bone defects
bullStudies show excellent results for socket preservation sinus lifts
bullExpensive ($500000 for a sinus)
FDA Panel Unanimously Recommends Approval of Third Indication For Medtronicrsquos INFUSE Bone Graft Nov 9 2006
FDA Panel Unanimously Recommends Approval of Third Indication For Medtronicrsquos INFUSE Bone Graft Nov 9 2006 INFUSE Bone Graft is recombinant human bone morphogenetic protein-2 (rhBMP-2) applied to an absorbable collagen sponge carrier The purpose of the protein which occurs naturally in the body is to stimulate bone formation It has been previously approved by the FDA for use in certain lumbar spine fusion and tibial fracture repair procedures
INFUSE Bone Graft is recombinant human bone morphogenetic protein-2 (rhBMP-2) applied to an absorbable collagen sponge carrier The purpose of the protein which occurs naturally in the body is to stimulate bone formation It has been previously approved by the FDA for use in certain lumbar spine fusion and tibial fracture repair procedures
Distraction OsteogenesisDistraction
OsteogenesisbullGeneration of bone (and soft
tissue) through distraction of an osseous callus
bullGeneration of bone (and soft tissue) through distraction of an osseous callus
Ann N Y Acad Sci 2006 Apr1068532-42 COX-2 has a critical role during incorporation of structural bone allografts OrsquoKeefe RJ Tiyapatanaputi P Xie C
Ann N Y Acad Sci 2006 Apr1068532-42 COX-2 has a critical role during incorporation of structural bone allografts OrsquoKeefe RJ Tiyapatanaputi P Xie C
Nonsteroidal anti-inflammatory drugs (NSAIDs) which inhibit cyclooxygenase (COX) activity reduce pain and are commonly used in patients with skeletal injury In this article we will also present data to show that selective COX-2 inhibitor delays allograft healing and incorporation These results demonstrated that COX-2 is essential for bone allograft incorporation Furthermore our data support the notion that COX-2-dependent PGE2 produced at the early stage of bone healing is prerequisite for efficient skeletal repair
Nonsteroidal anti-inflammatory drugs (NSAIDs) which inhibit cyclooxygenase (COX) activity reduce pain and are commonly used in patients with skeletal injury In this article we will also present data to show that selective COX-2 inhibitor delays allograft healing and incorporation These results demonstrated that COX-2 is essential for bone allograft incorporation Furthermore our data support the notion that COX-2-dependent PGE2 produced at the early stage of bone healing is prerequisite for efficient skeletal repair
Wise Old Oral Surgeon Wise Old Oral Surgeon Says Beware ofSays Beware of
Wise Old Oral Surgeon Wise Old Oral Surgeon Says Beware ofSays Beware of
bull 3rd molars in function3rd molars in function
bull Lone standing molarsLone standing molars
bull Teeth in bruxers Cl III skeletal patternsTeeth in bruxers Cl III skeletal patterns
bull 3rd molars + post-menopausal women3rd molars + post-menopausal women
bull Prior TMD historyPrior TMD history
bull Prior ldquobadrdquo oral surgery experiencePrior ldquobadrdquo oral surgery experience
bull Distoangular lower 3rds nerve proximityDistoangular lower 3rds nerve proximity
bull 3rd molars in function3rd molars in function
bull Lone standing molarsLone standing molars
bull Teeth in bruxers Cl III skeletal patternsTeeth in bruxers Cl III skeletal patterns
bull 3rd molars + post-menopausal women3rd molars + post-menopausal women
bull Prior TMD historyPrior TMD history
bull Prior ldquobadrdquo oral surgery experiencePrior ldquobadrdquo oral surgery experience
bull Distoangular lower 3rds nerve proximityDistoangular lower 3rds nerve proximity
3rd Molar Surgery ndash Why
3rd Molar Surgery ndash Why
1 Preventtreat pericoronitis (infection)2 Prevent periodontal problems 2nd molar3 Preventtreat caries to 2nd 3rd molar4 Prevent odontogenic cyststumors5 Strengthen mandible possible fx6 Prevent orthodontic relapse7 Treat pain of unknown origin
1 Preventtreat pericoronitis (infection)2 Prevent periodontal problems 2nd molar3 Preventtreat caries to 2nd 3rd molar4 Prevent odontogenic cyststumors5 Strengthen mandible possible fx6 Prevent orthodontic relapse7 Treat pain of unknown origin
Extract 3rds OralSystemic Extract 3rds OralSystemic LinkLink
CLEVELAND April 6 2006 - The first hard evidence has CLEVELAND April 6 2006 - The first hard evidence has been uncovered that bacteria in the mouth may find their been uncovered that bacteria in the mouth may find their way to the uterus causing uterine infections that can lead way to the uterus causing uterine infections that can lead to preterm birth in pregnant womento preterm birth in pregnant women
CLEVELAND April 6 2006 - The first hard evidence has CLEVELAND April 6 2006 - The first hard evidence has been uncovered that bacteria in the mouth may find their been uncovered that bacteria in the mouth may find their way to the uterus causing uterine infections that can lead way to the uterus causing uterine infections that can lead to preterm birth in pregnant womento preterm birth in pregnant women
A newly discovered and as yet unnamed species of the A newly discovered and as yet unnamed species of the bacterium genus bacterium genus BergeyellaBergeyella was found in the mouth was found in the mouth and amniotic fluid of a woman with a uterine infection and amniotic fluid of a woman with a uterine infection who gave birth prematurely (24 weeks) reported who gave birth prematurely (24 weeks) reported microbiologist Yiping W Han PhD of Case Western microbiologist Yiping W Han PhD of Case Western Reserve here Reserve here However the bacterium was not detected in a vaginal However the bacterium was not detected in a vaginal swab as might be expected The finding confirmed swab as might be expected The finding confirmed what some scientists have suspected that intrauterine what some scientists have suspected that intrauterine infections dont always ascend from the genital tract infections dont always ascend from the genital tract but can descend from the oral cavity Dr Han and but can descend from the oral cavity Dr Han and colleagues said in the April issue of the colleagues said in the April issue of the Journal of Journal of Clinical MicrobiologyClinical Microbiology
A newly discovered and as yet unnamed species of the A newly discovered and as yet unnamed species of the bacterium genus bacterium genus BergeyellaBergeyella was found in the mouth was found in the mouth and amniotic fluid of a woman with a uterine infection and amniotic fluid of a woman with a uterine infection who gave birth prematurely (24 weeks) reported who gave birth prematurely (24 weeks) reported microbiologist Yiping W Han PhD of Case Western microbiologist Yiping W Han PhD of Case Western Reserve here Reserve here However the bacterium was not detected in a vaginal However the bacterium was not detected in a vaginal swab as might be expected The finding confirmed swab as might be expected The finding confirmed what some scientists have suspected that intrauterine what some scientists have suspected that intrauterine infections dont always ascend from the genital tract infections dont always ascend from the genital tract but can descend from the oral cavity Dr Han and but can descend from the oral cavity Dr Han and colleagues said in the April issue of the colleagues said in the April issue of the Journal of Journal of Clinical MicrobiologyClinical Microbiology
Journal of Oral and Maxillofacial Journal of Oral and Maxillofacial SurgerySurgery
Volume 65 Issue 3 March 2007 Pages Volume 65 Issue 3 March 2007 Pages 377-383377-383
Progress Report on Third Molar Clinical Trials Progress Report on Third Molar Clinical Trials Raymond P White Jr DDS PhDRaymond P White Jr DDS PhD
1What happens to asymptomatic patients who keep their 1What happens to asymptomatic patients who keep their third molars third molars
2What is the recovery like for those who have them 2What is the recovery like for those who have them removed and what can we do as surgeons to improve removed and what can we do as surgeons to improve post operative outcomespost operative outcomes
3rd Molar Surgery ndash When3rd Molar Surgery ndash WhenbullBefore roots 100 developed
bullAfter roots 13 formed
bullMorbiditycomplications minimized as bone more flexible nerves more pliable and PMH less complicated
bullDonrsquot forget tooth transplanttooth transplant if apex not closed
bullBefore roots 100 developed
bullAfter roots 13 formed
bullMorbiditycomplications minimized as bone more flexible nerves more pliable and PMH less complicated
bullDonrsquot forget tooth transplanttooth transplant if apex not closed
Outcome of tooth transplantation survival and success rates 17-41 years post treatmentCzochrowska EM Stenvik A Bjercke B Zachrisson Am J Orthod Dentofacial Orthop 2002 Feb121(2)110-9The mean age at surgery was 115 years and the mean observation period was 264 264 years (range 17-41 years) Of the 33 teeth transplanted in the 28 patients 3 teeth were lost after 9 10 and 29 years respectively Therefore the 30 teeth in the 25 patients we examined yielded a survival rate of 90 The success rate was 79 because 2 transplants had ankylosed and 2 others failed to fulfill the proposed criteria The patients generally responded very favorably regarding their perception of the treatment Their only hesitation was related to some discomfort during surgery It was concluded that It was concluded that survival and success rates for teeth auto survival and success rates for teeth auto transplanted when the root is partly developed transplanted when the root is partly developed compare favorably in a long-term perspective compare favorably in a long-term perspective with other treatment modalities for with other treatment modalities for substituting missing teethsubstituting missing teeth
Outcome of tooth transplantation survival and success rates 17-41 years post treatmentCzochrowska EM Stenvik A Bjercke B Zachrisson Am J Orthod Dentofacial Orthop 2002 Feb121(2)110-9The mean age at surgery was 115 years and the mean observation period was 264 264 years (range 17-41 years) Of the 33 teeth transplanted in the 28 patients 3 teeth were lost after 9 10 and 29 years respectively Therefore the 30 teeth in the 25 patients we examined yielded a survival rate of 90 The success rate was 79 because 2 transplants had ankylosed and 2 others failed to fulfill the proposed criteria The patients generally responded very favorably regarding their perception of the treatment Their only hesitation was related to some discomfort during surgery It was concluded that It was concluded that survival and success rates for teeth auto survival and success rates for teeth auto transplanted when the root is partly developed transplanted when the root is partly developed compare favorably in a long-term perspective compare favorably in a long-term perspective with other treatment modalities for with other treatment modalities for substituting missing teethsubstituting missing teeth
3rd Molar Surgery ndash When Not
3rd Molar Surgery ndash When Not
bullExtremes of age
bullNo oral communication (full bony)
bullIntimate root-nerve Relationship
bullRisks gt Benefits
bullExtremes of age
bullNo oral communication (full bony)
bullIntimate root-nerve Relationship
bullRisks gt Benefits
3rd Molar Surgery Alternatives
3rd Molar Surgery Alternatives
bullNo Surgery dentist feels risk benefit ratio not favorable or patient refuses ndash document and recommend radiograph q 3-5 years
bullNo Surgery dentist feels risk benefit ratio not favorable or patient refuses ndash document and recommend radiograph q 3-5 years
No High SpeedNo High Speed
bullAir embolus
bullAir emphysema
bullBlow debris into flap
bullBlow bacteria into flap
bullNon-sterile water
bullAir embolus
bullAir emphysema
bullBlow debris into flap
bullBlow bacteria into flap
bullNon-sterile water
Which are trueWhich are true1 Tooth transplants are usually done on
patients 20-302 Average success rate for a tooth
transplant is 20-303 In order to work a transplant must
have endo4 Most transplants will ankylose
A 13 B 24 C 123 D 3 only
E None of the above
1 Tooth transplants are usually done on patients 20-30
2 Average success rate for a tooth transplant is 20-30
3 In order to work a transplant must have endo
4 Most transplants will ankylose
A 13 B 24 C 123 D 3 only
E None of the above
How can I assess the relationship How can I assess the relationship between the 3between the 3rdrd molar root and the molar root and the
inferior alveolar nerveinferior alveolar nerve
- Slide 2
- Slide 3
- Slide 4
- ldquoSockets with intact buccal and lingual plates heal well without graftinghellip consider grafting with resorbable osteoinductive material if plates compromised and implants plannedrdquo grafting with connective tissue if pontic esthetics an issuerdquo
- Vital Root Retention
- Slide 7
- Slide 8
- Slide 9
- J Oral Maxillofac Surg 2005 Feb43(1)7-12 A randomized controlled clinical trial to compare the incidence of injury to the inferior alveolar nerve as a result of coronectomy and removal of mandibular third molars Renton T Hankins M Sproate C
- Slide 11
- Slide 12
- Immediate Implant Placement Following Extractions
- Platelet Rich Plasma
- Slide 15
- Slide 16
- Slide 17
- Why Reconstruct
- How Autogenous Bone Grafts with Implants
- Autogenous Block Grafts
- Slide 21
- Intra-oral Autogenous Bone Sites
- Slide 23
- What about membranes
- Bone Morphogenic Protein (BMP)
- Slide 26
- Distraction Osteogenesis
- Slide 28
- Wise Old Oral Surgeon Says Beware of
- 3rd Molar Surgery ndash Why
- Extract 3rds OralSystemic Link
- Slide 32
- 3rd Molar Surgery ndash When
- 3rd Molar Surgery ndash When Not
- 3rd Molar Surgery Alternatives
- No High Speed
- Slide 38
- Which are true
- Slide 40
-
Autogenous Block GraftsAutogenous Block Grafts
bullldquoGold Standardrdquo
bullOsteoinductive and Osteoconductive
bullNo need for membranes
bullHolds form
bullRemodels into 100 high quality bone
bullNo concerns about transmissible diseases
bullldquoGold Standardrdquo
bullOsteoinductive and Osteoconductive
bullNo need for membranes
bullHolds form
bullRemodels into 100 high quality bone
bullNo concerns about transmissible diseases
Autogenous Block Grafts
Autogenous Block Grafts
bullDonor site morbidity
bullQuantity is limited
bullLose 20-30 during healing
bullDonor site morbidity
bullQuantity is limited
bullLose 20-30 during healing
Intra-oral Autogenous Bone Sites
AllogenicAllogenic Block Block GraftGraft
What about membranesWhat about membranes
bullUseful in containing particulate grafts
bullUseful around teethexposed implant threads
bullAdd expense
bull Infection risk
bullUnnecessary with block grafts
bullADA 4266 Resorbable
bullADA 4267 Non-Resorbable
bullUseful in containing particulate grafts
bullUseful around teethexposed implant threads
bullAdd expense
bull Infection risk
bullUnnecessary with block grafts
bullADA 4266 Resorbable
bullADA 4267 Non-Resorbable
Bone Morphogenic Protein (BMP)
Bone Morphogenic Protein (BMP)
bullGrow bone at will
bullPresently two are FDA approved BMP 2 for spinal fusions and BMP 7 for long bone defects
bullStudies show excellent results for socket preservation sinus lifts
bullExpensive ($500000 for a sinus)
bullGrow bone at will
bullPresently two are FDA approved BMP 2 for spinal fusions and BMP 7 for long bone defects
bullStudies show excellent results for socket preservation sinus lifts
bullExpensive ($500000 for a sinus)
FDA Panel Unanimously Recommends Approval of Third Indication For Medtronicrsquos INFUSE Bone Graft Nov 9 2006
FDA Panel Unanimously Recommends Approval of Third Indication For Medtronicrsquos INFUSE Bone Graft Nov 9 2006 INFUSE Bone Graft is recombinant human bone morphogenetic protein-2 (rhBMP-2) applied to an absorbable collagen sponge carrier The purpose of the protein which occurs naturally in the body is to stimulate bone formation It has been previously approved by the FDA for use in certain lumbar spine fusion and tibial fracture repair procedures
INFUSE Bone Graft is recombinant human bone morphogenetic protein-2 (rhBMP-2) applied to an absorbable collagen sponge carrier The purpose of the protein which occurs naturally in the body is to stimulate bone formation It has been previously approved by the FDA for use in certain lumbar spine fusion and tibial fracture repair procedures
Distraction OsteogenesisDistraction
OsteogenesisbullGeneration of bone (and soft
tissue) through distraction of an osseous callus
bullGeneration of bone (and soft tissue) through distraction of an osseous callus
Ann N Y Acad Sci 2006 Apr1068532-42 COX-2 has a critical role during incorporation of structural bone allografts OrsquoKeefe RJ Tiyapatanaputi P Xie C
Ann N Y Acad Sci 2006 Apr1068532-42 COX-2 has a critical role during incorporation of structural bone allografts OrsquoKeefe RJ Tiyapatanaputi P Xie C
Nonsteroidal anti-inflammatory drugs (NSAIDs) which inhibit cyclooxygenase (COX) activity reduce pain and are commonly used in patients with skeletal injury In this article we will also present data to show that selective COX-2 inhibitor delays allograft healing and incorporation These results demonstrated that COX-2 is essential for bone allograft incorporation Furthermore our data support the notion that COX-2-dependent PGE2 produced at the early stage of bone healing is prerequisite for efficient skeletal repair
Nonsteroidal anti-inflammatory drugs (NSAIDs) which inhibit cyclooxygenase (COX) activity reduce pain and are commonly used in patients with skeletal injury In this article we will also present data to show that selective COX-2 inhibitor delays allograft healing and incorporation These results demonstrated that COX-2 is essential for bone allograft incorporation Furthermore our data support the notion that COX-2-dependent PGE2 produced at the early stage of bone healing is prerequisite for efficient skeletal repair
Wise Old Oral Surgeon Wise Old Oral Surgeon Says Beware ofSays Beware of
Wise Old Oral Surgeon Wise Old Oral Surgeon Says Beware ofSays Beware of
bull 3rd molars in function3rd molars in function
bull Lone standing molarsLone standing molars
bull Teeth in bruxers Cl III skeletal patternsTeeth in bruxers Cl III skeletal patterns
bull 3rd molars + post-menopausal women3rd molars + post-menopausal women
bull Prior TMD historyPrior TMD history
bull Prior ldquobadrdquo oral surgery experiencePrior ldquobadrdquo oral surgery experience
bull Distoangular lower 3rds nerve proximityDistoangular lower 3rds nerve proximity
bull 3rd molars in function3rd molars in function
bull Lone standing molarsLone standing molars
bull Teeth in bruxers Cl III skeletal patternsTeeth in bruxers Cl III skeletal patterns
bull 3rd molars + post-menopausal women3rd molars + post-menopausal women
bull Prior TMD historyPrior TMD history
bull Prior ldquobadrdquo oral surgery experiencePrior ldquobadrdquo oral surgery experience
bull Distoangular lower 3rds nerve proximityDistoangular lower 3rds nerve proximity
3rd Molar Surgery ndash Why
3rd Molar Surgery ndash Why
1 Preventtreat pericoronitis (infection)2 Prevent periodontal problems 2nd molar3 Preventtreat caries to 2nd 3rd molar4 Prevent odontogenic cyststumors5 Strengthen mandible possible fx6 Prevent orthodontic relapse7 Treat pain of unknown origin
1 Preventtreat pericoronitis (infection)2 Prevent periodontal problems 2nd molar3 Preventtreat caries to 2nd 3rd molar4 Prevent odontogenic cyststumors5 Strengthen mandible possible fx6 Prevent orthodontic relapse7 Treat pain of unknown origin
Extract 3rds OralSystemic Extract 3rds OralSystemic LinkLink
CLEVELAND April 6 2006 - The first hard evidence has CLEVELAND April 6 2006 - The first hard evidence has been uncovered that bacteria in the mouth may find their been uncovered that bacteria in the mouth may find their way to the uterus causing uterine infections that can lead way to the uterus causing uterine infections that can lead to preterm birth in pregnant womento preterm birth in pregnant women
CLEVELAND April 6 2006 - The first hard evidence has CLEVELAND April 6 2006 - The first hard evidence has been uncovered that bacteria in the mouth may find their been uncovered that bacteria in the mouth may find their way to the uterus causing uterine infections that can lead way to the uterus causing uterine infections that can lead to preterm birth in pregnant womento preterm birth in pregnant women
A newly discovered and as yet unnamed species of the A newly discovered and as yet unnamed species of the bacterium genus bacterium genus BergeyellaBergeyella was found in the mouth was found in the mouth and amniotic fluid of a woman with a uterine infection and amniotic fluid of a woman with a uterine infection who gave birth prematurely (24 weeks) reported who gave birth prematurely (24 weeks) reported microbiologist Yiping W Han PhD of Case Western microbiologist Yiping W Han PhD of Case Western Reserve here Reserve here However the bacterium was not detected in a vaginal However the bacterium was not detected in a vaginal swab as might be expected The finding confirmed swab as might be expected The finding confirmed what some scientists have suspected that intrauterine what some scientists have suspected that intrauterine infections dont always ascend from the genital tract infections dont always ascend from the genital tract but can descend from the oral cavity Dr Han and but can descend from the oral cavity Dr Han and colleagues said in the April issue of the colleagues said in the April issue of the Journal of Journal of Clinical MicrobiologyClinical Microbiology
A newly discovered and as yet unnamed species of the A newly discovered and as yet unnamed species of the bacterium genus bacterium genus BergeyellaBergeyella was found in the mouth was found in the mouth and amniotic fluid of a woman with a uterine infection and amniotic fluid of a woman with a uterine infection who gave birth prematurely (24 weeks) reported who gave birth prematurely (24 weeks) reported microbiologist Yiping W Han PhD of Case Western microbiologist Yiping W Han PhD of Case Western Reserve here Reserve here However the bacterium was not detected in a vaginal However the bacterium was not detected in a vaginal swab as might be expected The finding confirmed swab as might be expected The finding confirmed what some scientists have suspected that intrauterine what some scientists have suspected that intrauterine infections dont always ascend from the genital tract infections dont always ascend from the genital tract but can descend from the oral cavity Dr Han and but can descend from the oral cavity Dr Han and colleagues said in the April issue of the colleagues said in the April issue of the Journal of Journal of Clinical MicrobiologyClinical Microbiology
Journal of Oral and Maxillofacial Journal of Oral and Maxillofacial SurgerySurgery
Volume 65 Issue 3 March 2007 Pages Volume 65 Issue 3 March 2007 Pages 377-383377-383
Progress Report on Third Molar Clinical Trials Progress Report on Third Molar Clinical Trials Raymond P White Jr DDS PhDRaymond P White Jr DDS PhD
1What happens to asymptomatic patients who keep their 1What happens to asymptomatic patients who keep their third molars third molars
2What is the recovery like for those who have them 2What is the recovery like for those who have them removed and what can we do as surgeons to improve removed and what can we do as surgeons to improve post operative outcomespost operative outcomes
3rd Molar Surgery ndash When3rd Molar Surgery ndash WhenbullBefore roots 100 developed
bullAfter roots 13 formed
bullMorbiditycomplications minimized as bone more flexible nerves more pliable and PMH less complicated
bullDonrsquot forget tooth transplanttooth transplant if apex not closed
bullBefore roots 100 developed
bullAfter roots 13 formed
bullMorbiditycomplications minimized as bone more flexible nerves more pliable and PMH less complicated
bullDonrsquot forget tooth transplanttooth transplant if apex not closed
Outcome of tooth transplantation survival and success rates 17-41 years post treatmentCzochrowska EM Stenvik A Bjercke B Zachrisson Am J Orthod Dentofacial Orthop 2002 Feb121(2)110-9The mean age at surgery was 115 years and the mean observation period was 264 264 years (range 17-41 years) Of the 33 teeth transplanted in the 28 patients 3 teeth were lost after 9 10 and 29 years respectively Therefore the 30 teeth in the 25 patients we examined yielded a survival rate of 90 The success rate was 79 because 2 transplants had ankylosed and 2 others failed to fulfill the proposed criteria The patients generally responded very favorably regarding their perception of the treatment Their only hesitation was related to some discomfort during surgery It was concluded that It was concluded that survival and success rates for teeth auto survival and success rates for teeth auto transplanted when the root is partly developed transplanted when the root is partly developed compare favorably in a long-term perspective compare favorably in a long-term perspective with other treatment modalities for with other treatment modalities for substituting missing teethsubstituting missing teeth
Outcome of tooth transplantation survival and success rates 17-41 years post treatmentCzochrowska EM Stenvik A Bjercke B Zachrisson Am J Orthod Dentofacial Orthop 2002 Feb121(2)110-9The mean age at surgery was 115 years and the mean observation period was 264 264 years (range 17-41 years) Of the 33 teeth transplanted in the 28 patients 3 teeth were lost after 9 10 and 29 years respectively Therefore the 30 teeth in the 25 patients we examined yielded a survival rate of 90 The success rate was 79 because 2 transplants had ankylosed and 2 others failed to fulfill the proposed criteria The patients generally responded very favorably regarding their perception of the treatment Their only hesitation was related to some discomfort during surgery It was concluded that It was concluded that survival and success rates for teeth auto survival and success rates for teeth auto transplanted when the root is partly developed transplanted when the root is partly developed compare favorably in a long-term perspective compare favorably in a long-term perspective with other treatment modalities for with other treatment modalities for substituting missing teethsubstituting missing teeth
3rd Molar Surgery ndash When Not
3rd Molar Surgery ndash When Not
bullExtremes of age
bullNo oral communication (full bony)
bullIntimate root-nerve Relationship
bullRisks gt Benefits
bullExtremes of age
bullNo oral communication (full bony)
bullIntimate root-nerve Relationship
bullRisks gt Benefits
3rd Molar Surgery Alternatives
3rd Molar Surgery Alternatives
bullNo Surgery dentist feels risk benefit ratio not favorable or patient refuses ndash document and recommend radiograph q 3-5 years
bullNo Surgery dentist feels risk benefit ratio not favorable or patient refuses ndash document and recommend radiograph q 3-5 years
No High SpeedNo High Speed
bullAir embolus
bullAir emphysema
bullBlow debris into flap
bullBlow bacteria into flap
bullNon-sterile water
bullAir embolus
bullAir emphysema
bullBlow debris into flap
bullBlow bacteria into flap
bullNon-sterile water
Which are trueWhich are true1 Tooth transplants are usually done on
patients 20-302 Average success rate for a tooth
transplant is 20-303 In order to work a transplant must
have endo4 Most transplants will ankylose
A 13 B 24 C 123 D 3 only
E None of the above
1 Tooth transplants are usually done on patients 20-30
2 Average success rate for a tooth transplant is 20-30
3 In order to work a transplant must have endo
4 Most transplants will ankylose
A 13 B 24 C 123 D 3 only
E None of the above
How can I assess the relationship How can I assess the relationship between the 3between the 3rdrd molar root and the molar root and the
inferior alveolar nerveinferior alveolar nerve
- Slide 2
- Slide 3
- Slide 4
- ldquoSockets with intact buccal and lingual plates heal well without graftinghellip consider grafting with resorbable osteoinductive material if plates compromised and implants plannedrdquo grafting with connective tissue if pontic esthetics an issuerdquo
- Vital Root Retention
- Slide 7
- Slide 8
- Slide 9
- J Oral Maxillofac Surg 2005 Feb43(1)7-12 A randomized controlled clinical trial to compare the incidence of injury to the inferior alveolar nerve as a result of coronectomy and removal of mandibular third molars Renton T Hankins M Sproate C
- Slide 11
- Slide 12
- Immediate Implant Placement Following Extractions
- Platelet Rich Plasma
- Slide 15
- Slide 16
- Slide 17
- Why Reconstruct
- How Autogenous Bone Grafts with Implants
- Autogenous Block Grafts
- Slide 21
- Intra-oral Autogenous Bone Sites
- Slide 23
- What about membranes
- Bone Morphogenic Protein (BMP)
- Slide 26
- Distraction Osteogenesis
- Slide 28
- Wise Old Oral Surgeon Says Beware of
- 3rd Molar Surgery ndash Why
- Extract 3rds OralSystemic Link
- Slide 32
- 3rd Molar Surgery ndash When
- 3rd Molar Surgery ndash When Not
- 3rd Molar Surgery Alternatives
- No High Speed
- Slide 38
- Which are true
- Slide 40
-
Autogenous Block Grafts
Autogenous Block Grafts
bullDonor site morbidity
bullQuantity is limited
bullLose 20-30 during healing
bullDonor site morbidity
bullQuantity is limited
bullLose 20-30 during healing
Intra-oral Autogenous Bone Sites
AllogenicAllogenic Block Block GraftGraft
What about membranesWhat about membranes
bullUseful in containing particulate grafts
bullUseful around teethexposed implant threads
bullAdd expense
bull Infection risk
bullUnnecessary with block grafts
bullADA 4266 Resorbable
bullADA 4267 Non-Resorbable
bullUseful in containing particulate grafts
bullUseful around teethexposed implant threads
bullAdd expense
bull Infection risk
bullUnnecessary with block grafts
bullADA 4266 Resorbable
bullADA 4267 Non-Resorbable
Bone Morphogenic Protein (BMP)
Bone Morphogenic Protein (BMP)
bullGrow bone at will
bullPresently two are FDA approved BMP 2 for spinal fusions and BMP 7 for long bone defects
bullStudies show excellent results for socket preservation sinus lifts
bullExpensive ($500000 for a sinus)
bullGrow bone at will
bullPresently two are FDA approved BMP 2 for spinal fusions and BMP 7 for long bone defects
bullStudies show excellent results for socket preservation sinus lifts
bullExpensive ($500000 for a sinus)
FDA Panel Unanimously Recommends Approval of Third Indication For Medtronicrsquos INFUSE Bone Graft Nov 9 2006
FDA Panel Unanimously Recommends Approval of Third Indication For Medtronicrsquos INFUSE Bone Graft Nov 9 2006 INFUSE Bone Graft is recombinant human bone morphogenetic protein-2 (rhBMP-2) applied to an absorbable collagen sponge carrier The purpose of the protein which occurs naturally in the body is to stimulate bone formation It has been previously approved by the FDA for use in certain lumbar spine fusion and tibial fracture repair procedures
INFUSE Bone Graft is recombinant human bone morphogenetic protein-2 (rhBMP-2) applied to an absorbable collagen sponge carrier The purpose of the protein which occurs naturally in the body is to stimulate bone formation It has been previously approved by the FDA for use in certain lumbar spine fusion and tibial fracture repair procedures
Distraction OsteogenesisDistraction
OsteogenesisbullGeneration of bone (and soft
tissue) through distraction of an osseous callus
bullGeneration of bone (and soft tissue) through distraction of an osseous callus
Ann N Y Acad Sci 2006 Apr1068532-42 COX-2 has a critical role during incorporation of structural bone allografts OrsquoKeefe RJ Tiyapatanaputi P Xie C
Ann N Y Acad Sci 2006 Apr1068532-42 COX-2 has a critical role during incorporation of structural bone allografts OrsquoKeefe RJ Tiyapatanaputi P Xie C
Nonsteroidal anti-inflammatory drugs (NSAIDs) which inhibit cyclooxygenase (COX) activity reduce pain and are commonly used in patients with skeletal injury In this article we will also present data to show that selective COX-2 inhibitor delays allograft healing and incorporation These results demonstrated that COX-2 is essential for bone allograft incorporation Furthermore our data support the notion that COX-2-dependent PGE2 produced at the early stage of bone healing is prerequisite for efficient skeletal repair
Nonsteroidal anti-inflammatory drugs (NSAIDs) which inhibit cyclooxygenase (COX) activity reduce pain and are commonly used in patients with skeletal injury In this article we will also present data to show that selective COX-2 inhibitor delays allograft healing and incorporation These results demonstrated that COX-2 is essential for bone allograft incorporation Furthermore our data support the notion that COX-2-dependent PGE2 produced at the early stage of bone healing is prerequisite for efficient skeletal repair
Wise Old Oral Surgeon Wise Old Oral Surgeon Says Beware ofSays Beware of
Wise Old Oral Surgeon Wise Old Oral Surgeon Says Beware ofSays Beware of
bull 3rd molars in function3rd molars in function
bull Lone standing molarsLone standing molars
bull Teeth in bruxers Cl III skeletal patternsTeeth in bruxers Cl III skeletal patterns
bull 3rd molars + post-menopausal women3rd molars + post-menopausal women
bull Prior TMD historyPrior TMD history
bull Prior ldquobadrdquo oral surgery experiencePrior ldquobadrdquo oral surgery experience
bull Distoangular lower 3rds nerve proximityDistoangular lower 3rds nerve proximity
bull 3rd molars in function3rd molars in function
bull Lone standing molarsLone standing molars
bull Teeth in bruxers Cl III skeletal patternsTeeth in bruxers Cl III skeletal patterns
bull 3rd molars + post-menopausal women3rd molars + post-menopausal women
bull Prior TMD historyPrior TMD history
bull Prior ldquobadrdquo oral surgery experiencePrior ldquobadrdquo oral surgery experience
bull Distoangular lower 3rds nerve proximityDistoangular lower 3rds nerve proximity
3rd Molar Surgery ndash Why
3rd Molar Surgery ndash Why
1 Preventtreat pericoronitis (infection)2 Prevent periodontal problems 2nd molar3 Preventtreat caries to 2nd 3rd molar4 Prevent odontogenic cyststumors5 Strengthen mandible possible fx6 Prevent orthodontic relapse7 Treat pain of unknown origin
1 Preventtreat pericoronitis (infection)2 Prevent periodontal problems 2nd molar3 Preventtreat caries to 2nd 3rd molar4 Prevent odontogenic cyststumors5 Strengthen mandible possible fx6 Prevent orthodontic relapse7 Treat pain of unknown origin
Extract 3rds OralSystemic Extract 3rds OralSystemic LinkLink
CLEVELAND April 6 2006 - The first hard evidence has CLEVELAND April 6 2006 - The first hard evidence has been uncovered that bacteria in the mouth may find their been uncovered that bacteria in the mouth may find their way to the uterus causing uterine infections that can lead way to the uterus causing uterine infections that can lead to preterm birth in pregnant womento preterm birth in pregnant women
CLEVELAND April 6 2006 - The first hard evidence has CLEVELAND April 6 2006 - The first hard evidence has been uncovered that bacteria in the mouth may find their been uncovered that bacteria in the mouth may find their way to the uterus causing uterine infections that can lead way to the uterus causing uterine infections that can lead to preterm birth in pregnant womento preterm birth in pregnant women
A newly discovered and as yet unnamed species of the A newly discovered and as yet unnamed species of the bacterium genus bacterium genus BergeyellaBergeyella was found in the mouth was found in the mouth and amniotic fluid of a woman with a uterine infection and amniotic fluid of a woman with a uterine infection who gave birth prematurely (24 weeks) reported who gave birth prematurely (24 weeks) reported microbiologist Yiping W Han PhD of Case Western microbiologist Yiping W Han PhD of Case Western Reserve here Reserve here However the bacterium was not detected in a vaginal However the bacterium was not detected in a vaginal swab as might be expected The finding confirmed swab as might be expected The finding confirmed what some scientists have suspected that intrauterine what some scientists have suspected that intrauterine infections dont always ascend from the genital tract infections dont always ascend from the genital tract but can descend from the oral cavity Dr Han and but can descend from the oral cavity Dr Han and colleagues said in the April issue of the colleagues said in the April issue of the Journal of Journal of Clinical MicrobiologyClinical Microbiology
A newly discovered and as yet unnamed species of the A newly discovered and as yet unnamed species of the bacterium genus bacterium genus BergeyellaBergeyella was found in the mouth was found in the mouth and amniotic fluid of a woman with a uterine infection and amniotic fluid of a woman with a uterine infection who gave birth prematurely (24 weeks) reported who gave birth prematurely (24 weeks) reported microbiologist Yiping W Han PhD of Case Western microbiologist Yiping W Han PhD of Case Western Reserve here Reserve here However the bacterium was not detected in a vaginal However the bacterium was not detected in a vaginal swab as might be expected The finding confirmed swab as might be expected The finding confirmed what some scientists have suspected that intrauterine what some scientists have suspected that intrauterine infections dont always ascend from the genital tract infections dont always ascend from the genital tract but can descend from the oral cavity Dr Han and but can descend from the oral cavity Dr Han and colleagues said in the April issue of the colleagues said in the April issue of the Journal of Journal of Clinical MicrobiologyClinical Microbiology
Journal of Oral and Maxillofacial Journal of Oral and Maxillofacial SurgerySurgery
Volume 65 Issue 3 March 2007 Pages Volume 65 Issue 3 March 2007 Pages 377-383377-383
Progress Report on Third Molar Clinical Trials Progress Report on Third Molar Clinical Trials Raymond P White Jr DDS PhDRaymond P White Jr DDS PhD
1What happens to asymptomatic patients who keep their 1What happens to asymptomatic patients who keep their third molars third molars
2What is the recovery like for those who have them 2What is the recovery like for those who have them removed and what can we do as surgeons to improve removed and what can we do as surgeons to improve post operative outcomespost operative outcomes
3rd Molar Surgery ndash When3rd Molar Surgery ndash WhenbullBefore roots 100 developed
bullAfter roots 13 formed
bullMorbiditycomplications minimized as bone more flexible nerves more pliable and PMH less complicated
bullDonrsquot forget tooth transplanttooth transplant if apex not closed
bullBefore roots 100 developed
bullAfter roots 13 formed
bullMorbiditycomplications minimized as bone more flexible nerves more pliable and PMH less complicated
bullDonrsquot forget tooth transplanttooth transplant if apex not closed
Outcome of tooth transplantation survival and success rates 17-41 years post treatmentCzochrowska EM Stenvik A Bjercke B Zachrisson Am J Orthod Dentofacial Orthop 2002 Feb121(2)110-9The mean age at surgery was 115 years and the mean observation period was 264 264 years (range 17-41 years) Of the 33 teeth transplanted in the 28 patients 3 teeth were lost after 9 10 and 29 years respectively Therefore the 30 teeth in the 25 patients we examined yielded a survival rate of 90 The success rate was 79 because 2 transplants had ankylosed and 2 others failed to fulfill the proposed criteria The patients generally responded very favorably regarding their perception of the treatment Their only hesitation was related to some discomfort during surgery It was concluded that It was concluded that survival and success rates for teeth auto survival and success rates for teeth auto transplanted when the root is partly developed transplanted when the root is partly developed compare favorably in a long-term perspective compare favorably in a long-term perspective with other treatment modalities for with other treatment modalities for substituting missing teethsubstituting missing teeth
Outcome of tooth transplantation survival and success rates 17-41 years post treatmentCzochrowska EM Stenvik A Bjercke B Zachrisson Am J Orthod Dentofacial Orthop 2002 Feb121(2)110-9The mean age at surgery was 115 years and the mean observation period was 264 264 years (range 17-41 years) Of the 33 teeth transplanted in the 28 patients 3 teeth were lost after 9 10 and 29 years respectively Therefore the 30 teeth in the 25 patients we examined yielded a survival rate of 90 The success rate was 79 because 2 transplants had ankylosed and 2 others failed to fulfill the proposed criteria The patients generally responded very favorably regarding their perception of the treatment Their only hesitation was related to some discomfort during surgery It was concluded that It was concluded that survival and success rates for teeth auto survival and success rates for teeth auto transplanted when the root is partly developed transplanted when the root is partly developed compare favorably in a long-term perspective compare favorably in a long-term perspective with other treatment modalities for with other treatment modalities for substituting missing teethsubstituting missing teeth
3rd Molar Surgery ndash When Not
3rd Molar Surgery ndash When Not
bullExtremes of age
bullNo oral communication (full bony)
bullIntimate root-nerve Relationship
bullRisks gt Benefits
bullExtremes of age
bullNo oral communication (full bony)
bullIntimate root-nerve Relationship
bullRisks gt Benefits
3rd Molar Surgery Alternatives
3rd Molar Surgery Alternatives
bullNo Surgery dentist feels risk benefit ratio not favorable or patient refuses ndash document and recommend radiograph q 3-5 years
bullNo Surgery dentist feels risk benefit ratio not favorable or patient refuses ndash document and recommend radiograph q 3-5 years
No High SpeedNo High Speed
bullAir embolus
bullAir emphysema
bullBlow debris into flap
bullBlow bacteria into flap
bullNon-sterile water
bullAir embolus
bullAir emphysema
bullBlow debris into flap
bullBlow bacteria into flap
bullNon-sterile water
Which are trueWhich are true1 Tooth transplants are usually done on
patients 20-302 Average success rate for a tooth
transplant is 20-303 In order to work a transplant must
have endo4 Most transplants will ankylose
A 13 B 24 C 123 D 3 only
E None of the above
1 Tooth transplants are usually done on patients 20-30
2 Average success rate for a tooth transplant is 20-30
3 In order to work a transplant must have endo
4 Most transplants will ankylose
A 13 B 24 C 123 D 3 only
E None of the above
How can I assess the relationship How can I assess the relationship between the 3between the 3rdrd molar root and the molar root and the
inferior alveolar nerveinferior alveolar nerve
- Slide 2
- Slide 3
- Slide 4
- ldquoSockets with intact buccal and lingual plates heal well without graftinghellip consider grafting with resorbable osteoinductive material if plates compromised and implants plannedrdquo grafting with connective tissue if pontic esthetics an issuerdquo
- Vital Root Retention
- Slide 7
- Slide 8
- Slide 9
- J Oral Maxillofac Surg 2005 Feb43(1)7-12 A randomized controlled clinical trial to compare the incidence of injury to the inferior alveolar nerve as a result of coronectomy and removal of mandibular third molars Renton T Hankins M Sproate C
- Slide 11
- Slide 12
- Immediate Implant Placement Following Extractions
- Platelet Rich Plasma
- Slide 15
- Slide 16
- Slide 17
- Why Reconstruct
- How Autogenous Bone Grafts with Implants
- Autogenous Block Grafts
- Slide 21
- Intra-oral Autogenous Bone Sites
- Slide 23
- What about membranes
- Bone Morphogenic Protein (BMP)
- Slide 26
- Distraction Osteogenesis
- Slide 28
- Wise Old Oral Surgeon Says Beware of
- 3rd Molar Surgery ndash Why
- Extract 3rds OralSystemic Link
- Slide 32
- 3rd Molar Surgery ndash When
- 3rd Molar Surgery ndash When Not
- 3rd Molar Surgery Alternatives
- No High Speed
- Slide 38
- Which are true
- Slide 40
-
Intra-oral Autogenous Bone Sites
AllogenicAllogenic Block Block GraftGraft
What about membranesWhat about membranes
bullUseful in containing particulate grafts
bullUseful around teethexposed implant threads
bullAdd expense
bull Infection risk
bullUnnecessary with block grafts
bullADA 4266 Resorbable
bullADA 4267 Non-Resorbable
bullUseful in containing particulate grafts
bullUseful around teethexposed implant threads
bullAdd expense
bull Infection risk
bullUnnecessary with block grafts
bullADA 4266 Resorbable
bullADA 4267 Non-Resorbable
Bone Morphogenic Protein (BMP)
Bone Morphogenic Protein (BMP)
bullGrow bone at will
bullPresently two are FDA approved BMP 2 for spinal fusions and BMP 7 for long bone defects
bullStudies show excellent results for socket preservation sinus lifts
bullExpensive ($500000 for a sinus)
bullGrow bone at will
bullPresently two are FDA approved BMP 2 for spinal fusions and BMP 7 for long bone defects
bullStudies show excellent results for socket preservation sinus lifts
bullExpensive ($500000 for a sinus)
FDA Panel Unanimously Recommends Approval of Third Indication For Medtronicrsquos INFUSE Bone Graft Nov 9 2006
FDA Panel Unanimously Recommends Approval of Third Indication For Medtronicrsquos INFUSE Bone Graft Nov 9 2006 INFUSE Bone Graft is recombinant human bone morphogenetic protein-2 (rhBMP-2) applied to an absorbable collagen sponge carrier The purpose of the protein which occurs naturally in the body is to stimulate bone formation It has been previously approved by the FDA for use in certain lumbar spine fusion and tibial fracture repair procedures
INFUSE Bone Graft is recombinant human bone morphogenetic protein-2 (rhBMP-2) applied to an absorbable collagen sponge carrier The purpose of the protein which occurs naturally in the body is to stimulate bone formation It has been previously approved by the FDA for use in certain lumbar spine fusion and tibial fracture repair procedures
Distraction OsteogenesisDistraction
OsteogenesisbullGeneration of bone (and soft
tissue) through distraction of an osseous callus
bullGeneration of bone (and soft tissue) through distraction of an osseous callus
Ann N Y Acad Sci 2006 Apr1068532-42 COX-2 has a critical role during incorporation of structural bone allografts OrsquoKeefe RJ Tiyapatanaputi P Xie C
Ann N Y Acad Sci 2006 Apr1068532-42 COX-2 has a critical role during incorporation of structural bone allografts OrsquoKeefe RJ Tiyapatanaputi P Xie C
Nonsteroidal anti-inflammatory drugs (NSAIDs) which inhibit cyclooxygenase (COX) activity reduce pain and are commonly used in patients with skeletal injury In this article we will also present data to show that selective COX-2 inhibitor delays allograft healing and incorporation These results demonstrated that COX-2 is essential for bone allograft incorporation Furthermore our data support the notion that COX-2-dependent PGE2 produced at the early stage of bone healing is prerequisite for efficient skeletal repair
Nonsteroidal anti-inflammatory drugs (NSAIDs) which inhibit cyclooxygenase (COX) activity reduce pain and are commonly used in patients with skeletal injury In this article we will also present data to show that selective COX-2 inhibitor delays allograft healing and incorporation These results demonstrated that COX-2 is essential for bone allograft incorporation Furthermore our data support the notion that COX-2-dependent PGE2 produced at the early stage of bone healing is prerequisite for efficient skeletal repair
Wise Old Oral Surgeon Wise Old Oral Surgeon Says Beware ofSays Beware of
Wise Old Oral Surgeon Wise Old Oral Surgeon Says Beware ofSays Beware of
bull 3rd molars in function3rd molars in function
bull Lone standing molarsLone standing molars
bull Teeth in bruxers Cl III skeletal patternsTeeth in bruxers Cl III skeletal patterns
bull 3rd molars + post-menopausal women3rd molars + post-menopausal women
bull Prior TMD historyPrior TMD history
bull Prior ldquobadrdquo oral surgery experiencePrior ldquobadrdquo oral surgery experience
bull Distoangular lower 3rds nerve proximityDistoangular lower 3rds nerve proximity
bull 3rd molars in function3rd molars in function
bull Lone standing molarsLone standing molars
bull Teeth in bruxers Cl III skeletal patternsTeeth in bruxers Cl III skeletal patterns
bull 3rd molars + post-menopausal women3rd molars + post-menopausal women
bull Prior TMD historyPrior TMD history
bull Prior ldquobadrdquo oral surgery experiencePrior ldquobadrdquo oral surgery experience
bull Distoangular lower 3rds nerve proximityDistoangular lower 3rds nerve proximity
3rd Molar Surgery ndash Why
3rd Molar Surgery ndash Why
1 Preventtreat pericoronitis (infection)2 Prevent periodontal problems 2nd molar3 Preventtreat caries to 2nd 3rd molar4 Prevent odontogenic cyststumors5 Strengthen mandible possible fx6 Prevent orthodontic relapse7 Treat pain of unknown origin
1 Preventtreat pericoronitis (infection)2 Prevent periodontal problems 2nd molar3 Preventtreat caries to 2nd 3rd molar4 Prevent odontogenic cyststumors5 Strengthen mandible possible fx6 Prevent orthodontic relapse7 Treat pain of unknown origin
Extract 3rds OralSystemic Extract 3rds OralSystemic LinkLink
CLEVELAND April 6 2006 - The first hard evidence has CLEVELAND April 6 2006 - The first hard evidence has been uncovered that bacteria in the mouth may find their been uncovered that bacteria in the mouth may find their way to the uterus causing uterine infections that can lead way to the uterus causing uterine infections that can lead to preterm birth in pregnant womento preterm birth in pregnant women
CLEVELAND April 6 2006 - The first hard evidence has CLEVELAND April 6 2006 - The first hard evidence has been uncovered that bacteria in the mouth may find their been uncovered that bacteria in the mouth may find their way to the uterus causing uterine infections that can lead way to the uterus causing uterine infections that can lead to preterm birth in pregnant womento preterm birth in pregnant women
A newly discovered and as yet unnamed species of the A newly discovered and as yet unnamed species of the bacterium genus bacterium genus BergeyellaBergeyella was found in the mouth was found in the mouth and amniotic fluid of a woman with a uterine infection and amniotic fluid of a woman with a uterine infection who gave birth prematurely (24 weeks) reported who gave birth prematurely (24 weeks) reported microbiologist Yiping W Han PhD of Case Western microbiologist Yiping W Han PhD of Case Western Reserve here Reserve here However the bacterium was not detected in a vaginal However the bacterium was not detected in a vaginal swab as might be expected The finding confirmed swab as might be expected The finding confirmed what some scientists have suspected that intrauterine what some scientists have suspected that intrauterine infections dont always ascend from the genital tract infections dont always ascend from the genital tract but can descend from the oral cavity Dr Han and but can descend from the oral cavity Dr Han and colleagues said in the April issue of the colleagues said in the April issue of the Journal of Journal of Clinical MicrobiologyClinical Microbiology
A newly discovered and as yet unnamed species of the A newly discovered and as yet unnamed species of the bacterium genus bacterium genus BergeyellaBergeyella was found in the mouth was found in the mouth and amniotic fluid of a woman with a uterine infection and amniotic fluid of a woman with a uterine infection who gave birth prematurely (24 weeks) reported who gave birth prematurely (24 weeks) reported microbiologist Yiping W Han PhD of Case Western microbiologist Yiping W Han PhD of Case Western Reserve here Reserve here However the bacterium was not detected in a vaginal However the bacterium was not detected in a vaginal swab as might be expected The finding confirmed swab as might be expected The finding confirmed what some scientists have suspected that intrauterine what some scientists have suspected that intrauterine infections dont always ascend from the genital tract infections dont always ascend from the genital tract but can descend from the oral cavity Dr Han and but can descend from the oral cavity Dr Han and colleagues said in the April issue of the colleagues said in the April issue of the Journal of Journal of Clinical MicrobiologyClinical Microbiology
Journal of Oral and Maxillofacial Journal of Oral and Maxillofacial SurgerySurgery
Volume 65 Issue 3 March 2007 Pages Volume 65 Issue 3 March 2007 Pages 377-383377-383
Progress Report on Third Molar Clinical Trials Progress Report on Third Molar Clinical Trials Raymond P White Jr DDS PhDRaymond P White Jr DDS PhD
1What happens to asymptomatic patients who keep their 1What happens to asymptomatic patients who keep their third molars third molars
2What is the recovery like for those who have them 2What is the recovery like for those who have them removed and what can we do as surgeons to improve removed and what can we do as surgeons to improve post operative outcomespost operative outcomes
3rd Molar Surgery ndash When3rd Molar Surgery ndash WhenbullBefore roots 100 developed
bullAfter roots 13 formed
bullMorbiditycomplications minimized as bone more flexible nerves more pliable and PMH less complicated
bullDonrsquot forget tooth transplanttooth transplant if apex not closed
bullBefore roots 100 developed
bullAfter roots 13 formed
bullMorbiditycomplications minimized as bone more flexible nerves more pliable and PMH less complicated
bullDonrsquot forget tooth transplanttooth transplant if apex not closed
Outcome of tooth transplantation survival and success rates 17-41 years post treatmentCzochrowska EM Stenvik A Bjercke B Zachrisson Am J Orthod Dentofacial Orthop 2002 Feb121(2)110-9The mean age at surgery was 115 years and the mean observation period was 264 264 years (range 17-41 years) Of the 33 teeth transplanted in the 28 patients 3 teeth were lost after 9 10 and 29 years respectively Therefore the 30 teeth in the 25 patients we examined yielded a survival rate of 90 The success rate was 79 because 2 transplants had ankylosed and 2 others failed to fulfill the proposed criteria The patients generally responded very favorably regarding their perception of the treatment Their only hesitation was related to some discomfort during surgery It was concluded that It was concluded that survival and success rates for teeth auto survival and success rates for teeth auto transplanted when the root is partly developed transplanted when the root is partly developed compare favorably in a long-term perspective compare favorably in a long-term perspective with other treatment modalities for with other treatment modalities for substituting missing teethsubstituting missing teeth
Outcome of tooth transplantation survival and success rates 17-41 years post treatmentCzochrowska EM Stenvik A Bjercke B Zachrisson Am J Orthod Dentofacial Orthop 2002 Feb121(2)110-9The mean age at surgery was 115 years and the mean observation period was 264 264 years (range 17-41 years) Of the 33 teeth transplanted in the 28 patients 3 teeth were lost after 9 10 and 29 years respectively Therefore the 30 teeth in the 25 patients we examined yielded a survival rate of 90 The success rate was 79 because 2 transplants had ankylosed and 2 others failed to fulfill the proposed criteria The patients generally responded very favorably regarding their perception of the treatment Their only hesitation was related to some discomfort during surgery It was concluded that It was concluded that survival and success rates for teeth auto survival and success rates for teeth auto transplanted when the root is partly developed transplanted when the root is partly developed compare favorably in a long-term perspective compare favorably in a long-term perspective with other treatment modalities for with other treatment modalities for substituting missing teethsubstituting missing teeth
3rd Molar Surgery ndash When Not
3rd Molar Surgery ndash When Not
bullExtremes of age
bullNo oral communication (full bony)
bullIntimate root-nerve Relationship
bullRisks gt Benefits
bullExtremes of age
bullNo oral communication (full bony)
bullIntimate root-nerve Relationship
bullRisks gt Benefits
3rd Molar Surgery Alternatives
3rd Molar Surgery Alternatives
bullNo Surgery dentist feels risk benefit ratio not favorable or patient refuses ndash document and recommend radiograph q 3-5 years
bullNo Surgery dentist feels risk benefit ratio not favorable or patient refuses ndash document and recommend radiograph q 3-5 years
No High SpeedNo High Speed
bullAir embolus
bullAir emphysema
bullBlow debris into flap
bullBlow bacteria into flap
bullNon-sterile water
bullAir embolus
bullAir emphysema
bullBlow debris into flap
bullBlow bacteria into flap
bullNon-sterile water
Which are trueWhich are true1 Tooth transplants are usually done on
patients 20-302 Average success rate for a tooth
transplant is 20-303 In order to work a transplant must
have endo4 Most transplants will ankylose
A 13 B 24 C 123 D 3 only
E None of the above
1 Tooth transplants are usually done on patients 20-30
2 Average success rate for a tooth transplant is 20-30
3 In order to work a transplant must have endo
4 Most transplants will ankylose
A 13 B 24 C 123 D 3 only
E None of the above
How can I assess the relationship How can I assess the relationship between the 3between the 3rdrd molar root and the molar root and the
inferior alveolar nerveinferior alveolar nerve
- Slide 2
- Slide 3
- Slide 4
- ldquoSockets with intact buccal and lingual plates heal well without graftinghellip consider grafting with resorbable osteoinductive material if plates compromised and implants plannedrdquo grafting with connective tissue if pontic esthetics an issuerdquo
- Vital Root Retention
- Slide 7
- Slide 8
- Slide 9
- J Oral Maxillofac Surg 2005 Feb43(1)7-12 A randomized controlled clinical trial to compare the incidence of injury to the inferior alveolar nerve as a result of coronectomy and removal of mandibular third molars Renton T Hankins M Sproate C
- Slide 11
- Slide 12
- Immediate Implant Placement Following Extractions
- Platelet Rich Plasma
- Slide 15
- Slide 16
- Slide 17
- Why Reconstruct
- How Autogenous Bone Grafts with Implants
- Autogenous Block Grafts
- Slide 21
- Intra-oral Autogenous Bone Sites
- Slide 23
- What about membranes
- Bone Morphogenic Protein (BMP)
- Slide 26
- Distraction Osteogenesis
- Slide 28
- Wise Old Oral Surgeon Says Beware of
- 3rd Molar Surgery ndash Why
- Extract 3rds OralSystemic Link
- Slide 32
- 3rd Molar Surgery ndash When
- 3rd Molar Surgery ndash When Not
- 3rd Molar Surgery Alternatives
- No High Speed
- Slide 38
- Which are true
- Slide 40
-
AllogenicAllogenic Block Block GraftGraft
What about membranesWhat about membranes
bullUseful in containing particulate grafts
bullUseful around teethexposed implant threads
bullAdd expense
bull Infection risk
bullUnnecessary with block grafts
bullADA 4266 Resorbable
bullADA 4267 Non-Resorbable
bullUseful in containing particulate grafts
bullUseful around teethexposed implant threads
bullAdd expense
bull Infection risk
bullUnnecessary with block grafts
bullADA 4266 Resorbable
bullADA 4267 Non-Resorbable
Bone Morphogenic Protein (BMP)
Bone Morphogenic Protein (BMP)
bullGrow bone at will
bullPresently two are FDA approved BMP 2 for spinal fusions and BMP 7 for long bone defects
bullStudies show excellent results for socket preservation sinus lifts
bullExpensive ($500000 for a sinus)
bullGrow bone at will
bullPresently two are FDA approved BMP 2 for spinal fusions and BMP 7 for long bone defects
bullStudies show excellent results for socket preservation sinus lifts
bullExpensive ($500000 for a sinus)
FDA Panel Unanimously Recommends Approval of Third Indication For Medtronicrsquos INFUSE Bone Graft Nov 9 2006
FDA Panel Unanimously Recommends Approval of Third Indication For Medtronicrsquos INFUSE Bone Graft Nov 9 2006 INFUSE Bone Graft is recombinant human bone morphogenetic protein-2 (rhBMP-2) applied to an absorbable collagen sponge carrier The purpose of the protein which occurs naturally in the body is to stimulate bone formation It has been previously approved by the FDA for use in certain lumbar spine fusion and tibial fracture repair procedures
INFUSE Bone Graft is recombinant human bone morphogenetic protein-2 (rhBMP-2) applied to an absorbable collagen sponge carrier The purpose of the protein which occurs naturally in the body is to stimulate bone formation It has been previously approved by the FDA for use in certain lumbar spine fusion and tibial fracture repair procedures
Distraction OsteogenesisDistraction
OsteogenesisbullGeneration of bone (and soft
tissue) through distraction of an osseous callus
bullGeneration of bone (and soft tissue) through distraction of an osseous callus
Ann N Y Acad Sci 2006 Apr1068532-42 COX-2 has a critical role during incorporation of structural bone allografts OrsquoKeefe RJ Tiyapatanaputi P Xie C
Ann N Y Acad Sci 2006 Apr1068532-42 COX-2 has a critical role during incorporation of structural bone allografts OrsquoKeefe RJ Tiyapatanaputi P Xie C
Nonsteroidal anti-inflammatory drugs (NSAIDs) which inhibit cyclooxygenase (COX) activity reduce pain and are commonly used in patients with skeletal injury In this article we will also present data to show that selective COX-2 inhibitor delays allograft healing and incorporation These results demonstrated that COX-2 is essential for bone allograft incorporation Furthermore our data support the notion that COX-2-dependent PGE2 produced at the early stage of bone healing is prerequisite for efficient skeletal repair
Nonsteroidal anti-inflammatory drugs (NSAIDs) which inhibit cyclooxygenase (COX) activity reduce pain and are commonly used in patients with skeletal injury In this article we will also present data to show that selective COX-2 inhibitor delays allograft healing and incorporation These results demonstrated that COX-2 is essential for bone allograft incorporation Furthermore our data support the notion that COX-2-dependent PGE2 produced at the early stage of bone healing is prerequisite for efficient skeletal repair
Wise Old Oral Surgeon Wise Old Oral Surgeon Says Beware ofSays Beware of
Wise Old Oral Surgeon Wise Old Oral Surgeon Says Beware ofSays Beware of
bull 3rd molars in function3rd molars in function
bull Lone standing molarsLone standing molars
bull Teeth in bruxers Cl III skeletal patternsTeeth in bruxers Cl III skeletal patterns
bull 3rd molars + post-menopausal women3rd molars + post-menopausal women
bull Prior TMD historyPrior TMD history
bull Prior ldquobadrdquo oral surgery experiencePrior ldquobadrdquo oral surgery experience
bull Distoangular lower 3rds nerve proximityDistoangular lower 3rds nerve proximity
bull 3rd molars in function3rd molars in function
bull Lone standing molarsLone standing molars
bull Teeth in bruxers Cl III skeletal patternsTeeth in bruxers Cl III skeletal patterns
bull 3rd molars + post-menopausal women3rd molars + post-menopausal women
bull Prior TMD historyPrior TMD history
bull Prior ldquobadrdquo oral surgery experiencePrior ldquobadrdquo oral surgery experience
bull Distoangular lower 3rds nerve proximityDistoangular lower 3rds nerve proximity
3rd Molar Surgery ndash Why
3rd Molar Surgery ndash Why
1 Preventtreat pericoronitis (infection)2 Prevent periodontal problems 2nd molar3 Preventtreat caries to 2nd 3rd molar4 Prevent odontogenic cyststumors5 Strengthen mandible possible fx6 Prevent orthodontic relapse7 Treat pain of unknown origin
1 Preventtreat pericoronitis (infection)2 Prevent periodontal problems 2nd molar3 Preventtreat caries to 2nd 3rd molar4 Prevent odontogenic cyststumors5 Strengthen mandible possible fx6 Prevent orthodontic relapse7 Treat pain of unknown origin
Extract 3rds OralSystemic Extract 3rds OralSystemic LinkLink
CLEVELAND April 6 2006 - The first hard evidence has CLEVELAND April 6 2006 - The first hard evidence has been uncovered that bacteria in the mouth may find their been uncovered that bacteria in the mouth may find their way to the uterus causing uterine infections that can lead way to the uterus causing uterine infections that can lead to preterm birth in pregnant womento preterm birth in pregnant women
CLEVELAND April 6 2006 - The first hard evidence has CLEVELAND April 6 2006 - The first hard evidence has been uncovered that bacteria in the mouth may find their been uncovered that bacteria in the mouth may find their way to the uterus causing uterine infections that can lead way to the uterus causing uterine infections that can lead to preterm birth in pregnant womento preterm birth in pregnant women
A newly discovered and as yet unnamed species of the A newly discovered and as yet unnamed species of the bacterium genus bacterium genus BergeyellaBergeyella was found in the mouth was found in the mouth and amniotic fluid of a woman with a uterine infection and amniotic fluid of a woman with a uterine infection who gave birth prematurely (24 weeks) reported who gave birth prematurely (24 weeks) reported microbiologist Yiping W Han PhD of Case Western microbiologist Yiping W Han PhD of Case Western Reserve here Reserve here However the bacterium was not detected in a vaginal However the bacterium was not detected in a vaginal swab as might be expected The finding confirmed swab as might be expected The finding confirmed what some scientists have suspected that intrauterine what some scientists have suspected that intrauterine infections dont always ascend from the genital tract infections dont always ascend from the genital tract but can descend from the oral cavity Dr Han and but can descend from the oral cavity Dr Han and colleagues said in the April issue of the colleagues said in the April issue of the Journal of Journal of Clinical MicrobiologyClinical Microbiology
A newly discovered and as yet unnamed species of the A newly discovered and as yet unnamed species of the bacterium genus bacterium genus BergeyellaBergeyella was found in the mouth was found in the mouth and amniotic fluid of a woman with a uterine infection and amniotic fluid of a woman with a uterine infection who gave birth prematurely (24 weeks) reported who gave birth prematurely (24 weeks) reported microbiologist Yiping W Han PhD of Case Western microbiologist Yiping W Han PhD of Case Western Reserve here Reserve here However the bacterium was not detected in a vaginal However the bacterium was not detected in a vaginal swab as might be expected The finding confirmed swab as might be expected The finding confirmed what some scientists have suspected that intrauterine what some scientists have suspected that intrauterine infections dont always ascend from the genital tract infections dont always ascend from the genital tract but can descend from the oral cavity Dr Han and but can descend from the oral cavity Dr Han and colleagues said in the April issue of the colleagues said in the April issue of the Journal of Journal of Clinical MicrobiologyClinical Microbiology
Journal of Oral and Maxillofacial Journal of Oral and Maxillofacial SurgerySurgery
Volume 65 Issue 3 March 2007 Pages Volume 65 Issue 3 March 2007 Pages 377-383377-383
Progress Report on Third Molar Clinical Trials Progress Report on Third Molar Clinical Trials Raymond P White Jr DDS PhDRaymond P White Jr DDS PhD
1What happens to asymptomatic patients who keep their 1What happens to asymptomatic patients who keep their third molars third molars
2What is the recovery like for those who have them 2What is the recovery like for those who have them removed and what can we do as surgeons to improve removed and what can we do as surgeons to improve post operative outcomespost operative outcomes
3rd Molar Surgery ndash When3rd Molar Surgery ndash WhenbullBefore roots 100 developed
bullAfter roots 13 formed
bullMorbiditycomplications minimized as bone more flexible nerves more pliable and PMH less complicated
bullDonrsquot forget tooth transplanttooth transplant if apex not closed
bullBefore roots 100 developed
bullAfter roots 13 formed
bullMorbiditycomplications minimized as bone more flexible nerves more pliable and PMH less complicated
bullDonrsquot forget tooth transplanttooth transplant if apex not closed
Outcome of tooth transplantation survival and success rates 17-41 years post treatmentCzochrowska EM Stenvik A Bjercke B Zachrisson Am J Orthod Dentofacial Orthop 2002 Feb121(2)110-9The mean age at surgery was 115 years and the mean observation period was 264 264 years (range 17-41 years) Of the 33 teeth transplanted in the 28 patients 3 teeth were lost after 9 10 and 29 years respectively Therefore the 30 teeth in the 25 patients we examined yielded a survival rate of 90 The success rate was 79 because 2 transplants had ankylosed and 2 others failed to fulfill the proposed criteria The patients generally responded very favorably regarding their perception of the treatment Their only hesitation was related to some discomfort during surgery It was concluded that It was concluded that survival and success rates for teeth auto survival and success rates for teeth auto transplanted when the root is partly developed transplanted when the root is partly developed compare favorably in a long-term perspective compare favorably in a long-term perspective with other treatment modalities for with other treatment modalities for substituting missing teethsubstituting missing teeth
Outcome of tooth transplantation survival and success rates 17-41 years post treatmentCzochrowska EM Stenvik A Bjercke B Zachrisson Am J Orthod Dentofacial Orthop 2002 Feb121(2)110-9The mean age at surgery was 115 years and the mean observation period was 264 264 years (range 17-41 years) Of the 33 teeth transplanted in the 28 patients 3 teeth were lost after 9 10 and 29 years respectively Therefore the 30 teeth in the 25 patients we examined yielded a survival rate of 90 The success rate was 79 because 2 transplants had ankylosed and 2 others failed to fulfill the proposed criteria The patients generally responded very favorably regarding their perception of the treatment Their only hesitation was related to some discomfort during surgery It was concluded that It was concluded that survival and success rates for teeth auto survival and success rates for teeth auto transplanted when the root is partly developed transplanted when the root is partly developed compare favorably in a long-term perspective compare favorably in a long-term perspective with other treatment modalities for with other treatment modalities for substituting missing teethsubstituting missing teeth
3rd Molar Surgery ndash When Not
3rd Molar Surgery ndash When Not
bullExtremes of age
bullNo oral communication (full bony)
bullIntimate root-nerve Relationship
bullRisks gt Benefits
bullExtremes of age
bullNo oral communication (full bony)
bullIntimate root-nerve Relationship
bullRisks gt Benefits
3rd Molar Surgery Alternatives
3rd Molar Surgery Alternatives
bullNo Surgery dentist feels risk benefit ratio not favorable or patient refuses ndash document and recommend radiograph q 3-5 years
bullNo Surgery dentist feels risk benefit ratio not favorable or patient refuses ndash document and recommend radiograph q 3-5 years
No High SpeedNo High Speed
bullAir embolus
bullAir emphysema
bullBlow debris into flap
bullBlow bacteria into flap
bullNon-sterile water
bullAir embolus
bullAir emphysema
bullBlow debris into flap
bullBlow bacteria into flap
bullNon-sterile water
Which are trueWhich are true1 Tooth transplants are usually done on
patients 20-302 Average success rate for a tooth
transplant is 20-303 In order to work a transplant must
have endo4 Most transplants will ankylose
A 13 B 24 C 123 D 3 only
E None of the above
1 Tooth transplants are usually done on patients 20-30
2 Average success rate for a tooth transplant is 20-30
3 In order to work a transplant must have endo
4 Most transplants will ankylose
A 13 B 24 C 123 D 3 only
E None of the above
How can I assess the relationship How can I assess the relationship between the 3between the 3rdrd molar root and the molar root and the
inferior alveolar nerveinferior alveolar nerve
- Slide 2
- Slide 3
- Slide 4
- ldquoSockets with intact buccal and lingual plates heal well without graftinghellip consider grafting with resorbable osteoinductive material if plates compromised and implants plannedrdquo grafting with connective tissue if pontic esthetics an issuerdquo
- Vital Root Retention
- Slide 7
- Slide 8
- Slide 9
- J Oral Maxillofac Surg 2005 Feb43(1)7-12 A randomized controlled clinical trial to compare the incidence of injury to the inferior alveolar nerve as a result of coronectomy and removal of mandibular third molars Renton T Hankins M Sproate C
- Slide 11
- Slide 12
- Immediate Implant Placement Following Extractions
- Platelet Rich Plasma
- Slide 15
- Slide 16
- Slide 17
- Why Reconstruct
- How Autogenous Bone Grafts with Implants
- Autogenous Block Grafts
- Slide 21
- Intra-oral Autogenous Bone Sites
- Slide 23
- What about membranes
- Bone Morphogenic Protein (BMP)
- Slide 26
- Distraction Osteogenesis
- Slide 28
- Wise Old Oral Surgeon Says Beware of
- 3rd Molar Surgery ndash Why
- Extract 3rds OralSystemic Link
- Slide 32
- 3rd Molar Surgery ndash When
- 3rd Molar Surgery ndash When Not
- 3rd Molar Surgery Alternatives
- No High Speed
- Slide 38
- Which are true
- Slide 40
-
What about membranesWhat about membranes
bullUseful in containing particulate grafts
bullUseful around teethexposed implant threads
bullAdd expense
bull Infection risk
bullUnnecessary with block grafts
bullADA 4266 Resorbable
bullADA 4267 Non-Resorbable
bullUseful in containing particulate grafts
bullUseful around teethexposed implant threads
bullAdd expense
bull Infection risk
bullUnnecessary with block grafts
bullADA 4266 Resorbable
bullADA 4267 Non-Resorbable
Bone Morphogenic Protein (BMP)
Bone Morphogenic Protein (BMP)
bullGrow bone at will
bullPresently two are FDA approved BMP 2 for spinal fusions and BMP 7 for long bone defects
bullStudies show excellent results for socket preservation sinus lifts
bullExpensive ($500000 for a sinus)
bullGrow bone at will
bullPresently two are FDA approved BMP 2 for spinal fusions and BMP 7 for long bone defects
bullStudies show excellent results for socket preservation sinus lifts
bullExpensive ($500000 for a sinus)
FDA Panel Unanimously Recommends Approval of Third Indication For Medtronicrsquos INFUSE Bone Graft Nov 9 2006
FDA Panel Unanimously Recommends Approval of Third Indication For Medtronicrsquos INFUSE Bone Graft Nov 9 2006 INFUSE Bone Graft is recombinant human bone morphogenetic protein-2 (rhBMP-2) applied to an absorbable collagen sponge carrier The purpose of the protein which occurs naturally in the body is to stimulate bone formation It has been previously approved by the FDA for use in certain lumbar spine fusion and tibial fracture repair procedures
INFUSE Bone Graft is recombinant human bone morphogenetic protein-2 (rhBMP-2) applied to an absorbable collagen sponge carrier The purpose of the protein which occurs naturally in the body is to stimulate bone formation It has been previously approved by the FDA for use in certain lumbar spine fusion and tibial fracture repair procedures
Distraction OsteogenesisDistraction
OsteogenesisbullGeneration of bone (and soft
tissue) through distraction of an osseous callus
bullGeneration of bone (and soft tissue) through distraction of an osseous callus
Ann N Y Acad Sci 2006 Apr1068532-42 COX-2 has a critical role during incorporation of structural bone allografts OrsquoKeefe RJ Tiyapatanaputi P Xie C
Ann N Y Acad Sci 2006 Apr1068532-42 COX-2 has a critical role during incorporation of structural bone allografts OrsquoKeefe RJ Tiyapatanaputi P Xie C
Nonsteroidal anti-inflammatory drugs (NSAIDs) which inhibit cyclooxygenase (COX) activity reduce pain and are commonly used in patients with skeletal injury In this article we will also present data to show that selective COX-2 inhibitor delays allograft healing and incorporation These results demonstrated that COX-2 is essential for bone allograft incorporation Furthermore our data support the notion that COX-2-dependent PGE2 produced at the early stage of bone healing is prerequisite for efficient skeletal repair
Nonsteroidal anti-inflammatory drugs (NSAIDs) which inhibit cyclooxygenase (COX) activity reduce pain and are commonly used in patients with skeletal injury In this article we will also present data to show that selective COX-2 inhibitor delays allograft healing and incorporation These results demonstrated that COX-2 is essential for bone allograft incorporation Furthermore our data support the notion that COX-2-dependent PGE2 produced at the early stage of bone healing is prerequisite for efficient skeletal repair
Wise Old Oral Surgeon Wise Old Oral Surgeon Says Beware ofSays Beware of
Wise Old Oral Surgeon Wise Old Oral Surgeon Says Beware ofSays Beware of
bull 3rd molars in function3rd molars in function
bull Lone standing molarsLone standing molars
bull Teeth in bruxers Cl III skeletal patternsTeeth in bruxers Cl III skeletal patterns
bull 3rd molars + post-menopausal women3rd molars + post-menopausal women
bull Prior TMD historyPrior TMD history
bull Prior ldquobadrdquo oral surgery experiencePrior ldquobadrdquo oral surgery experience
bull Distoangular lower 3rds nerve proximityDistoangular lower 3rds nerve proximity
bull 3rd molars in function3rd molars in function
bull Lone standing molarsLone standing molars
bull Teeth in bruxers Cl III skeletal patternsTeeth in bruxers Cl III skeletal patterns
bull 3rd molars + post-menopausal women3rd molars + post-menopausal women
bull Prior TMD historyPrior TMD history
bull Prior ldquobadrdquo oral surgery experiencePrior ldquobadrdquo oral surgery experience
bull Distoangular lower 3rds nerve proximityDistoangular lower 3rds nerve proximity
3rd Molar Surgery ndash Why
3rd Molar Surgery ndash Why
1 Preventtreat pericoronitis (infection)2 Prevent periodontal problems 2nd molar3 Preventtreat caries to 2nd 3rd molar4 Prevent odontogenic cyststumors5 Strengthen mandible possible fx6 Prevent orthodontic relapse7 Treat pain of unknown origin
1 Preventtreat pericoronitis (infection)2 Prevent periodontal problems 2nd molar3 Preventtreat caries to 2nd 3rd molar4 Prevent odontogenic cyststumors5 Strengthen mandible possible fx6 Prevent orthodontic relapse7 Treat pain of unknown origin
Extract 3rds OralSystemic Extract 3rds OralSystemic LinkLink
CLEVELAND April 6 2006 - The first hard evidence has CLEVELAND April 6 2006 - The first hard evidence has been uncovered that bacteria in the mouth may find their been uncovered that bacteria in the mouth may find their way to the uterus causing uterine infections that can lead way to the uterus causing uterine infections that can lead to preterm birth in pregnant womento preterm birth in pregnant women
CLEVELAND April 6 2006 - The first hard evidence has CLEVELAND April 6 2006 - The first hard evidence has been uncovered that bacteria in the mouth may find their been uncovered that bacteria in the mouth may find their way to the uterus causing uterine infections that can lead way to the uterus causing uterine infections that can lead to preterm birth in pregnant womento preterm birth in pregnant women
A newly discovered and as yet unnamed species of the A newly discovered and as yet unnamed species of the bacterium genus bacterium genus BergeyellaBergeyella was found in the mouth was found in the mouth and amniotic fluid of a woman with a uterine infection and amniotic fluid of a woman with a uterine infection who gave birth prematurely (24 weeks) reported who gave birth prematurely (24 weeks) reported microbiologist Yiping W Han PhD of Case Western microbiologist Yiping W Han PhD of Case Western Reserve here Reserve here However the bacterium was not detected in a vaginal However the bacterium was not detected in a vaginal swab as might be expected The finding confirmed swab as might be expected The finding confirmed what some scientists have suspected that intrauterine what some scientists have suspected that intrauterine infections dont always ascend from the genital tract infections dont always ascend from the genital tract but can descend from the oral cavity Dr Han and but can descend from the oral cavity Dr Han and colleagues said in the April issue of the colleagues said in the April issue of the Journal of Journal of Clinical MicrobiologyClinical Microbiology
A newly discovered and as yet unnamed species of the A newly discovered and as yet unnamed species of the bacterium genus bacterium genus BergeyellaBergeyella was found in the mouth was found in the mouth and amniotic fluid of a woman with a uterine infection and amniotic fluid of a woman with a uterine infection who gave birth prematurely (24 weeks) reported who gave birth prematurely (24 weeks) reported microbiologist Yiping W Han PhD of Case Western microbiologist Yiping W Han PhD of Case Western Reserve here Reserve here However the bacterium was not detected in a vaginal However the bacterium was not detected in a vaginal swab as might be expected The finding confirmed swab as might be expected The finding confirmed what some scientists have suspected that intrauterine what some scientists have suspected that intrauterine infections dont always ascend from the genital tract infections dont always ascend from the genital tract but can descend from the oral cavity Dr Han and but can descend from the oral cavity Dr Han and colleagues said in the April issue of the colleagues said in the April issue of the Journal of Journal of Clinical MicrobiologyClinical Microbiology
Journal of Oral and Maxillofacial Journal of Oral and Maxillofacial SurgerySurgery
Volume 65 Issue 3 March 2007 Pages Volume 65 Issue 3 March 2007 Pages 377-383377-383
Progress Report on Third Molar Clinical Trials Progress Report on Third Molar Clinical Trials Raymond P White Jr DDS PhDRaymond P White Jr DDS PhD
1What happens to asymptomatic patients who keep their 1What happens to asymptomatic patients who keep their third molars third molars
2What is the recovery like for those who have them 2What is the recovery like for those who have them removed and what can we do as surgeons to improve removed and what can we do as surgeons to improve post operative outcomespost operative outcomes
3rd Molar Surgery ndash When3rd Molar Surgery ndash WhenbullBefore roots 100 developed
bullAfter roots 13 formed
bullMorbiditycomplications minimized as bone more flexible nerves more pliable and PMH less complicated
bullDonrsquot forget tooth transplanttooth transplant if apex not closed
bullBefore roots 100 developed
bullAfter roots 13 formed
bullMorbiditycomplications minimized as bone more flexible nerves more pliable and PMH less complicated
bullDonrsquot forget tooth transplanttooth transplant if apex not closed
Outcome of tooth transplantation survival and success rates 17-41 years post treatmentCzochrowska EM Stenvik A Bjercke B Zachrisson Am J Orthod Dentofacial Orthop 2002 Feb121(2)110-9The mean age at surgery was 115 years and the mean observation period was 264 264 years (range 17-41 years) Of the 33 teeth transplanted in the 28 patients 3 teeth were lost after 9 10 and 29 years respectively Therefore the 30 teeth in the 25 patients we examined yielded a survival rate of 90 The success rate was 79 because 2 transplants had ankylosed and 2 others failed to fulfill the proposed criteria The patients generally responded very favorably regarding their perception of the treatment Their only hesitation was related to some discomfort during surgery It was concluded that It was concluded that survival and success rates for teeth auto survival and success rates for teeth auto transplanted when the root is partly developed transplanted when the root is partly developed compare favorably in a long-term perspective compare favorably in a long-term perspective with other treatment modalities for with other treatment modalities for substituting missing teethsubstituting missing teeth
Outcome of tooth transplantation survival and success rates 17-41 years post treatmentCzochrowska EM Stenvik A Bjercke B Zachrisson Am J Orthod Dentofacial Orthop 2002 Feb121(2)110-9The mean age at surgery was 115 years and the mean observation period was 264 264 years (range 17-41 years) Of the 33 teeth transplanted in the 28 patients 3 teeth were lost after 9 10 and 29 years respectively Therefore the 30 teeth in the 25 patients we examined yielded a survival rate of 90 The success rate was 79 because 2 transplants had ankylosed and 2 others failed to fulfill the proposed criteria The patients generally responded very favorably regarding their perception of the treatment Their only hesitation was related to some discomfort during surgery It was concluded that It was concluded that survival and success rates for teeth auto survival and success rates for teeth auto transplanted when the root is partly developed transplanted when the root is partly developed compare favorably in a long-term perspective compare favorably in a long-term perspective with other treatment modalities for with other treatment modalities for substituting missing teethsubstituting missing teeth
3rd Molar Surgery ndash When Not
3rd Molar Surgery ndash When Not
bullExtremes of age
bullNo oral communication (full bony)
bullIntimate root-nerve Relationship
bullRisks gt Benefits
bullExtremes of age
bullNo oral communication (full bony)
bullIntimate root-nerve Relationship
bullRisks gt Benefits
3rd Molar Surgery Alternatives
3rd Molar Surgery Alternatives
bullNo Surgery dentist feels risk benefit ratio not favorable or patient refuses ndash document and recommend radiograph q 3-5 years
bullNo Surgery dentist feels risk benefit ratio not favorable or patient refuses ndash document and recommend radiograph q 3-5 years
No High SpeedNo High Speed
bullAir embolus
bullAir emphysema
bullBlow debris into flap
bullBlow bacteria into flap
bullNon-sterile water
bullAir embolus
bullAir emphysema
bullBlow debris into flap
bullBlow bacteria into flap
bullNon-sterile water
Which are trueWhich are true1 Tooth transplants are usually done on
patients 20-302 Average success rate for a tooth
transplant is 20-303 In order to work a transplant must
have endo4 Most transplants will ankylose
A 13 B 24 C 123 D 3 only
E None of the above
1 Tooth transplants are usually done on patients 20-30
2 Average success rate for a tooth transplant is 20-30
3 In order to work a transplant must have endo
4 Most transplants will ankylose
A 13 B 24 C 123 D 3 only
E None of the above
How can I assess the relationship How can I assess the relationship between the 3between the 3rdrd molar root and the molar root and the
inferior alveolar nerveinferior alveolar nerve
- Slide 2
- Slide 3
- Slide 4
- ldquoSockets with intact buccal and lingual plates heal well without graftinghellip consider grafting with resorbable osteoinductive material if plates compromised and implants plannedrdquo grafting with connective tissue if pontic esthetics an issuerdquo
- Vital Root Retention
- Slide 7
- Slide 8
- Slide 9
- J Oral Maxillofac Surg 2005 Feb43(1)7-12 A randomized controlled clinical trial to compare the incidence of injury to the inferior alveolar nerve as a result of coronectomy and removal of mandibular third molars Renton T Hankins M Sproate C
- Slide 11
- Slide 12
- Immediate Implant Placement Following Extractions
- Platelet Rich Plasma
- Slide 15
- Slide 16
- Slide 17
- Why Reconstruct
- How Autogenous Bone Grafts with Implants
- Autogenous Block Grafts
- Slide 21
- Intra-oral Autogenous Bone Sites
- Slide 23
- What about membranes
- Bone Morphogenic Protein (BMP)
- Slide 26
- Distraction Osteogenesis
- Slide 28
- Wise Old Oral Surgeon Says Beware of
- 3rd Molar Surgery ndash Why
- Extract 3rds OralSystemic Link
- Slide 32
- 3rd Molar Surgery ndash When
- 3rd Molar Surgery ndash When Not
- 3rd Molar Surgery Alternatives
- No High Speed
- Slide 38
- Which are true
- Slide 40
-
Bone Morphogenic Protein (BMP)
Bone Morphogenic Protein (BMP)
bullGrow bone at will
bullPresently two are FDA approved BMP 2 for spinal fusions and BMP 7 for long bone defects
bullStudies show excellent results for socket preservation sinus lifts
bullExpensive ($500000 for a sinus)
bullGrow bone at will
bullPresently two are FDA approved BMP 2 for spinal fusions and BMP 7 for long bone defects
bullStudies show excellent results for socket preservation sinus lifts
bullExpensive ($500000 for a sinus)
FDA Panel Unanimously Recommends Approval of Third Indication For Medtronicrsquos INFUSE Bone Graft Nov 9 2006
FDA Panel Unanimously Recommends Approval of Third Indication For Medtronicrsquos INFUSE Bone Graft Nov 9 2006 INFUSE Bone Graft is recombinant human bone morphogenetic protein-2 (rhBMP-2) applied to an absorbable collagen sponge carrier The purpose of the protein which occurs naturally in the body is to stimulate bone formation It has been previously approved by the FDA for use in certain lumbar spine fusion and tibial fracture repair procedures
INFUSE Bone Graft is recombinant human bone morphogenetic protein-2 (rhBMP-2) applied to an absorbable collagen sponge carrier The purpose of the protein which occurs naturally in the body is to stimulate bone formation It has been previously approved by the FDA for use in certain lumbar spine fusion and tibial fracture repair procedures
Distraction OsteogenesisDistraction
OsteogenesisbullGeneration of bone (and soft
tissue) through distraction of an osseous callus
bullGeneration of bone (and soft tissue) through distraction of an osseous callus
Ann N Y Acad Sci 2006 Apr1068532-42 COX-2 has a critical role during incorporation of structural bone allografts OrsquoKeefe RJ Tiyapatanaputi P Xie C
Ann N Y Acad Sci 2006 Apr1068532-42 COX-2 has a critical role during incorporation of structural bone allografts OrsquoKeefe RJ Tiyapatanaputi P Xie C
Nonsteroidal anti-inflammatory drugs (NSAIDs) which inhibit cyclooxygenase (COX) activity reduce pain and are commonly used in patients with skeletal injury In this article we will also present data to show that selective COX-2 inhibitor delays allograft healing and incorporation These results demonstrated that COX-2 is essential for bone allograft incorporation Furthermore our data support the notion that COX-2-dependent PGE2 produced at the early stage of bone healing is prerequisite for efficient skeletal repair
Nonsteroidal anti-inflammatory drugs (NSAIDs) which inhibit cyclooxygenase (COX) activity reduce pain and are commonly used in patients with skeletal injury In this article we will also present data to show that selective COX-2 inhibitor delays allograft healing and incorporation These results demonstrated that COX-2 is essential for bone allograft incorporation Furthermore our data support the notion that COX-2-dependent PGE2 produced at the early stage of bone healing is prerequisite for efficient skeletal repair
Wise Old Oral Surgeon Wise Old Oral Surgeon Says Beware ofSays Beware of
Wise Old Oral Surgeon Wise Old Oral Surgeon Says Beware ofSays Beware of
bull 3rd molars in function3rd molars in function
bull Lone standing molarsLone standing molars
bull Teeth in bruxers Cl III skeletal patternsTeeth in bruxers Cl III skeletal patterns
bull 3rd molars + post-menopausal women3rd molars + post-menopausal women
bull Prior TMD historyPrior TMD history
bull Prior ldquobadrdquo oral surgery experiencePrior ldquobadrdquo oral surgery experience
bull Distoangular lower 3rds nerve proximityDistoangular lower 3rds nerve proximity
bull 3rd molars in function3rd molars in function
bull Lone standing molarsLone standing molars
bull Teeth in bruxers Cl III skeletal patternsTeeth in bruxers Cl III skeletal patterns
bull 3rd molars + post-menopausal women3rd molars + post-menopausal women
bull Prior TMD historyPrior TMD history
bull Prior ldquobadrdquo oral surgery experiencePrior ldquobadrdquo oral surgery experience
bull Distoangular lower 3rds nerve proximityDistoangular lower 3rds nerve proximity
3rd Molar Surgery ndash Why
3rd Molar Surgery ndash Why
1 Preventtreat pericoronitis (infection)2 Prevent periodontal problems 2nd molar3 Preventtreat caries to 2nd 3rd molar4 Prevent odontogenic cyststumors5 Strengthen mandible possible fx6 Prevent orthodontic relapse7 Treat pain of unknown origin
1 Preventtreat pericoronitis (infection)2 Prevent periodontal problems 2nd molar3 Preventtreat caries to 2nd 3rd molar4 Prevent odontogenic cyststumors5 Strengthen mandible possible fx6 Prevent orthodontic relapse7 Treat pain of unknown origin
Extract 3rds OralSystemic Extract 3rds OralSystemic LinkLink
CLEVELAND April 6 2006 - The first hard evidence has CLEVELAND April 6 2006 - The first hard evidence has been uncovered that bacteria in the mouth may find their been uncovered that bacteria in the mouth may find their way to the uterus causing uterine infections that can lead way to the uterus causing uterine infections that can lead to preterm birth in pregnant womento preterm birth in pregnant women
CLEVELAND April 6 2006 - The first hard evidence has CLEVELAND April 6 2006 - The first hard evidence has been uncovered that bacteria in the mouth may find their been uncovered that bacteria in the mouth may find their way to the uterus causing uterine infections that can lead way to the uterus causing uterine infections that can lead to preterm birth in pregnant womento preterm birth in pregnant women
A newly discovered and as yet unnamed species of the A newly discovered and as yet unnamed species of the bacterium genus bacterium genus BergeyellaBergeyella was found in the mouth was found in the mouth and amniotic fluid of a woman with a uterine infection and amniotic fluid of a woman with a uterine infection who gave birth prematurely (24 weeks) reported who gave birth prematurely (24 weeks) reported microbiologist Yiping W Han PhD of Case Western microbiologist Yiping W Han PhD of Case Western Reserve here Reserve here However the bacterium was not detected in a vaginal However the bacterium was not detected in a vaginal swab as might be expected The finding confirmed swab as might be expected The finding confirmed what some scientists have suspected that intrauterine what some scientists have suspected that intrauterine infections dont always ascend from the genital tract infections dont always ascend from the genital tract but can descend from the oral cavity Dr Han and but can descend from the oral cavity Dr Han and colleagues said in the April issue of the colleagues said in the April issue of the Journal of Journal of Clinical MicrobiologyClinical Microbiology
A newly discovered and as yet unnamed species of the A newly discovered and as yet unnamed species of the bacterium genus bacterium genus BergeyellaBergeyella was found in the mouth was found in the mouth and amniotic fluid of a woman with a uterine infection and amniotic fluid of a woman with a uterine infection who gave birth prematurely (24 weeks) reported who gave birth prematurely (24 weeks) reported microbiologist Yiping W Han PhD of Case Western microbiologist Yiping W Han PhD of Case Western Reserve here Reserve here However the bacterium was not detected in a vaginal However the bacterium was not detected in a vaginal swab as might be expected The finding confirmed swab as might be expected The finding confirmed what some scientists have suspected that intrauterine what some scientists have suspected that intrauterine infections dont always ascend from the genital tract infections dont always ascend from the genital tract but can descend from the oral cavity Dr Han and but can descend from the oral cavity Dr Han and colleagues said in the April issue of the colleagues said in the April issue of the Journal of Journal of Clinical MicrobiologyClinical Microbiology
Journal of Oral and Maxillofacial Journal of Oral and Maxillofacial SurgerySurgery
Volume 65 Issue 3 March 2007 Pages Volume 65 Issue 3 March 2007 Pages 377-383377-383
Progress Report on Third Molar Clinical Trials Progress Report on Third Molar Clinical Trials Raymond P White Jr DDS PhDRaymond P White Jr DDS PhD
1What happens to asymptomatic patients who keep their 1What happens to asymptomatic patients who keep their third molars third molars
2What is the recovery like for those who have them 2What is the recovery like for those who have them removed and what can we do as surgeons to improve removed and what can we do as surgeons to improve post operative outcomespost operative outcomes
3rd Molar Surgery ndash When3rd Molar Surgery ndash WhenbullBefore roots 100 developed
bullAfter roots 13 formed
bullMorbiditycomplications minimized as bone more flexible nerves more pliable and PMH less complicated
bullDonrsquot forget tooth transplanttooth transplant if apex not closed
bullBefore roots 100 developed
bullAfter roots 13 formed
bullMorbiditycomplications minimized as bone more flexible nerves more pliable and PMH less complicated
bullDonrsquot forget tooth transplanttooth transplant if apex not closed
Outcome of tooth transplantation survival and success rates 17-41 years post treatmentCzochrowska EM Stenvik A Bjercke B Zachrisson Am J Orthod Dentofacial Orthop 2002 Feb121(2)110-9The mean age at surgery was 115 years and the mean observation period was 264 264 years (range 17-41 years) Of the 33 teeth transplanted in the 28 patients 3 teeth were lost after 9 10 and 29 years respectively Therefore the 30 teeth in the 25 patients we examined yielded a survival rate of 90 The success rate was 79 because 2 transplants had ankylosed and 2 others failed to fulfill the proposed criteria The patients generally responded very favorably regarding their perception of the treatment Their only hesitation was related to some discomfort during surgery It was concluded that It was concluded that survival and success rates for teeth auto survival and success rates for teeth auto transplanted when the root is partly developed transplanted when the root is partly developed compare favorably in a long-term perspective compare favorably in a long-term perspective with other treatment modalities for with other treatment modalities for substituting missing teethsubstituting missing teeth
Outcome of tooth transplantation survival and success rates 17-41 years post treatmentCzochrowska EM Stenvik A Bjercke B Zachrisson Am J Orthod Dentofacial Orthop 2002 Feb121(2)110-9The mean age at surgery was 115 years and the mean observation period was 264 264 years (range 17-41 years) Of the 33 teeth transplanted in the 28 patients 3 teeth were lost after 9 10 and 29 years respectively Therefore the 30 teeth in the 25 patients we examined yielded a survival rate of 90 The success rate was 79 because 2 transplants had ankylosed and 2 others failed to fulfill the proposed criteria The patients generally responded very favorably regarding their perception of the treatment Their only hesitation was related to some discomfort during surgery It was concluded that It was concluded that survival and success rates for teeth auto survival and success rates for teeth auto transplanted when the root is partly developed transplanted when the root is partly developed compare favorably in a long-term perspective compare favorably in a long-term perspective with other treatment modalities for with other treatment modalities for substituting missing teethsubstituting missing teeth
3rd Molar Surgery ndash When Not
3rd Molar Surgery ndash When Not
bullExtremes of age
bullNo oral communication (full bony)
bullIntimate root-nerve Relationship
bullRisks gt Benefits
bullExtremes of age
bullNo oral communication (full bony)
bullIntimate root-nerve Relationship
bullRisks gt Benefits
3rd Molar Surgery Alternatives
3rd Molar Surgery Alternatives
bullNo Surgery dentist feels risk benefit ratio not favorable or patient refuses ndash document and recommend radiograph q 3-5 years
bullNo Surgery dentist feels risk benefit ratio not favorable or patient refuses ndash document and recommend radiograph q 3-5 years
No High SpeedNo High Speed
bullAir embolus
bullAir emphysema
bullBlow debris into flap
bullBlow bacteria into flap
bullNon-sterile water
bullAir embolus
bullAir emphysema
bullBlow debris into flap
bullBlow bacteria into flap
bullNon-sterile water
Which are trueWhich are true1 Tooth transplants are usually done on
patients 20-302 Average success rate for a tooth
transplant is 20-303 In order to work a transplant must
have endo4 Most transplants will ankylose
A 13 B 24 C 123 D 3 only
E None of the above
1 Tooth transplants are usually done on patients 20-30
2 Average success rate for a tooth transplant is 20-30
3 In order to work a transplant must have endo
4 Most transplants will ankylose
A 13 B 24 C 123 D 3 only
E None of the above
How can I assess the relationship How can I assess the relationship between the 3between the 3rdrd molar root and the molar root and the
inferior alveolar nerveinferior alveolar nerve
- Slide 2
- Slide 3
- Slide 4
- ldquoSockets with intact buccal and lingual plates heal well without graftinghellip consider grafting with resorbable osteoinductive material if plates compromised and implants plannedrdquo grafting with connective tissue if pontic esthetics an issuerdquo
- Vital Root Retention
- Slide 7
- Slide 8
- Slide 9
- J Oral Maxillofac Surg 2005 Feb43(1)7-12 A randomized controlled clinical trial to compare the incidence of injury to the inferior alveolar nerve as a result of coronectomy and removal of mandibular third molars Renton T Hankins M Sproate C
- Slide 11
- Slide 12
- Immediate Implant Placement Following Extractions
- Platelet Rich Plasma
- Slide 15
- Slide 16
- Slide 17
- Why Reconstruct
- How Autogenous Bone Grafts with Implants
- Autogenous Block Grafts
- Slide 21
- Intra-oral Autogenous Bone Sites
- Slide 23
- What about membranes
- Bone Morphogenic Protein (BMP)
- Slide 26
- Distraction Osteogenesis
- Slide 28
- Wise Old Oral Surgeon Says Beware of
- 3rd Molar Surgery ndash Why
- Extract 3rds OralSystemic Link
- Slide 32
- 3rd Molar Surgery ndash When
- 3rd Molar Surgery ndash When Not
- 3rd Molar Surgery Alternatives
- No High Speed
- Slide 38
- Which are true
- Slide 40
-
FDA Panel Unanimously Recommends Approval of Third Indication For Medtronicrsquos INFUSE Bone Graft Nov 9 2006
FDA Panel Unanimously Recommends Approval of Third Indication For Medtronicrsquos INFUSE Bone Graft Nov 9 2006 INFUSE Bone Graft is recombinant human bone morphogenetic protein-2 (rhBMP-2) applied to an absorbable collagen sponge carrier The purpose of the protein which occurs naturally in the body is to stimulate bone formation It has been previously approved by the FDA for use in certain lumbar spine fusion and tibial fracture repair procedures
INFUSE Bone Graft is recombinant human bone morphogenetic protein-2 (rhBMP-2) applied to an absorbable collagen sponge carrier The purpose of the protein which occurs naturally in the body is to stimulate bone formation It has been previously approved by the FDA for use in certain lumbar spine fusion and tibial fracture repair procedures
Distraction OsteogenesisDistraction
OsteogenesisbullGeneration of bone (and soft
tissue) through distraction of an osseous callus
bullGeneration of bone (and soft tissue) through distraction of an osseous callus
Ann N Y Acad Sci 2006 Apr1068532-42 COX-2 has a critical role during incorporation of structural bone allografts OrsquoKeefe RJ Tiyapatanaputi P Xie C
Ann N Y Acad Sci 2006 Apr1068532-42 COX-2 has a critical role during incorporation of structural bone allografts OrsquoKeefe RJ Tiyapatanaputi P Xie C
Nonsteroidal anti-inflammatory drugs (NSAIDs) which inhibit cyclooxygenase (COX) activity reduce pain and are commonly used in patients with skeletal injury In this article we will also present data to show that selective COX-2 inhibitor delays allograft healing and incorporation These results demonstrated that COX-2 is essential for bone allograft incorporation Furthermore our data support the notion that COX-2-dependent PGE2 produced at the early stage of bone healing is prerequisite for efficient skeletal repair
Nonsteroidal anti-inflammatory drugs (NSAIDs) which inhibit cyclooxygenase (COX) activity reduce pain and are commonly used in patients with skeletal injury In this article we will also present data to show that selective COX-2 inhibitor delays allograft healing and incorporation These results demonstrated that COX-2 is essential for bone allograft incorporation Furthermore our data support the notion that COX-2-dependent PGE2 produced at the early stage of bone healing is prerequisite for efficient skeletal repair
Wise Old Oral Surgeon Wise Old Oral Surgeon Says Beware ofSays Beware of
Wise Old Oral Surgeon Wise Old Oral Surgeon Says Beware ofSays Beware of
bull 3rd molars in function3rd molars in function
bull Lone standing molarsLone standing molars
bull Teeth in bruxers Cl III skeletal patternsTeeth in bruxers Cl III skeletal patterns
bull 3rd molars + post-menopausal women3rd molars + post-menopausal women
bull Prior TMD historyPrior TMD history
bull Prior ldquobadrdquo oral surgery experiencePrior ldquobadrdquo oral surgery experience
bull Distoangular lower 3rds nerve proximityDistoangular lower 3rds nerve proximity
bull 3rd molars in function3rd molars in function
bull Lone standing molarsLone standing molars
bull Teeth in bruxers Cl III skeletal patternsTeeth in bruxers Cl III skeletal patterns
bull 3rd molars + post-menopausal women3rd molars + post-menopausal women
bull Prior TMD historyPrior TMD history
bull Prior ldquobadrdquo oral surgery experiencePrior ldquobadrdquo oral surgery experience
bull Distoangular lower 3rds nerve proximityDistoangular lower 3rds nerve proximity
3rd Molar Surgery ndash Why
3rd Molar Surgery ndash Why
1 Preventtreat pericoronitis (infection)2 Prevent periodontal problems 2nd molar3 Preventtreat caries to 2nd 3rd molar4 Prevent odontogenic cyststumors5 Strengthen mandible possible fx6 Prevent orthodontic relapse7 Treat pain of unknown origin
1 Preventtreat pericoronitis (infection)2 Prevent periodontal problems 2nd molar3 Preventtreat caries to 2nd 3rd molar4 Prevent odontogenic cyststumors5 Strengthen mandible possible fx6 Prevent orthodontic relapse7 Treat pain of unknown origin
Extract 3rds OralSystemic Extract 3rds OralSystemic LinkLink
CLEVELAND April 6 2006 - The first hard evidence has CLEVELAND April 6 2006 - The first hard evidence has been uncovered that bacteria in the mouth may find their been uncovered that bacteria in the mouth may find their way to the uterus causing uterine infections that can lead way to the uterus causing uterine infections that can lead to preterm birth in pregnant womento preterm birth in pregnant women
CLEVELAND April 6 2006 - The first hard evidence has CLEVELAND April 6 2006 - The first hard evidence has been uncovered that bacteria in the mouth may find their been uncovered that bacteria in the mouth may find their way to the uterus causing uterine infections that can lead way to the uterus causing uterine infections that can lead to preterm birth in pregnant womento preterm birth in pregnant women
A newly discovered and as yet unnamed species of the A newly discovered and as yet unnamed species of the bacterium genus bacterium genus BergeyellaBergeyella was found in the mouth was found in the mouth and amniotic fluid of a woman with a uterine infection and amniotic fluid of a woman with a uterine infection who gave birth prematurely (24 weeks) reported who gave birth prematurely (24 weeks) reported microbiologist Yiping W Han PhD of Case Western microbiologist Yiping W Han PhD of Case Western Reserve here Reserve here However the bacterium was not detected in a vaginal However the bacterium was not detected in a vaginal swab as might be expected The finding confirmed swab as might be expected The finding confirmed what some scientists have suspected that intrauterine what some scientists have suspected that intrauterine infections dont always ascend from the genital tract infections dont always ascend from the genital tract but can descend from the oral cavity Dr Han and but can descend from the oral cavity Dr Han and colleagues said in the April issue of the colleagues said in the April issue of the Journal of Journal of Clinical MicrobiologyClinical Microbiology
A newly discovered and as yet unnamed species of the A newly discovered and as yet unnamed species of the bacterium genus bacterium genus BergeyellaBergeyella was found in the mouth was found in the mouth and amniotic fluid of a woman with a uterine infection and amniotic fluid of a woman with a uterine infection who gave birth prematurely (24 weeks) reported who gave birth prematurely (24 weeks) reported microbiologist Yiping W Han PhD of Case Western microbiologist Yiping W Han PhD of Case Western Reserve here Reserve here However the bacterium was not detected in a vaginal However the bacterium was not detected in a vaginal swab as might be expected The finding confirmed swab as might be expected The finding confirmed what some scientists have suspected that intrauterine what some scientists have suspected that intrauterine infections dont always ascend from the genital tract infections dont always ascend from the genital tract but can descend from the oral cavity Dr Han and but can descend from the oral cavity Dr Han and colleagues said in the April issue of the colleagues said in the April issue of the Journal of Journal of Clinical MicrobiologyClinical Microbiology
Journal of Oral and Maxillofacial Journal of Oral and Maxillofacial SurgerySurgery
Volume 65 Issue 3 March 2007 Pages Volume 65 Issue 3 March 2007 Pages 377-383377-383
Progress Report on Third Molar Clinical Trials Progress Report on Third Molar Clinical Trials Raymond P White Jr DDS PhDRaymond P White Jr DDS PhD
1What happens to asymptomatic patients who keep their 1What happens to asymptomatic patients who keep their third molars third molars
2What is the recovery like for those who have them 2What is the recovery like for those who have them removed and what can we do as surgeons to improve removed and what can we do as surgeons to improve post operative outcomespost operative outcomes
3rd Molar Surgery ndash When3rd Molar Surgery ndash WhenbullBefore roots 100 developed
bullAfter roots 13 formed
bullMorbiditycomplications minimized as bone more flexible nerves more pliable and PMH less complicated
bullDonrsquot forget tooth transplanttooth transplant if apex not closed
bullBefore roots 100 developed
bullAfter roots 13 formed
bullMorbiditycomplications minimized as bone more flexible nerves more pliable and PMH less complicated
bullDonrsquot forget tooth transplanttooth transplant if apex not closed
Outcome of tooth transplantation survival and success rates 17-41 years post treatmentCzochrowska EM Stenvik A Bjercke B Zachrisson Am J Orthod Dentofacial Orthop 2002 Feb121(2)110-9The mean age at surgery was 115 years and the mean observation period was 264 264 years (range 17-41 years) Of the 33 teeth transplanted in the 28 patients 3 teeth were lost after 9 10 and 29 years respectively Therefore the 30 teeth in the 25 patients we examined yielded a survival rate of 90 The success rate was 79 because 2 transplants had ankylosed and 2 others failed to fulfill the proposed criteria The patients generally responded very favorably regarding their perception of the treatment Their only hesitation was related to some discomfort during surgery It was concluded that It was concluded that survival and success rates for teeth auto survival and success rates for teeth auto transplanted when the root is partly developed transplanted when the root is partly developed compare favorably in a long-term perspective compare favorably in a long-term perspective with other treatment modalities for with other treatment modalities for substituting missing teethsubstituting missing teeth
Outcome of tooth transplantation survival and success rates 17-41 years post treatmentCzochrowska EM Stenvik A Bjercke B Zachrisson Am J Orthod Dentofacial Orthop 2002 Feb121(2)110-9The mean age at surgery was 115 years and the mean observation period was 264 264 years (range 17-41 years) Of the 33 teeth transplanted in the 28 patients 3 teeth were lost after 9 10 and 29 years respectively Therefore the 30 teeth in the 25 patients we examined yielded a survival rate of 90 The success rate was 79 because 2 transplants had ankylosed and 2 others failed to fulfill the proposed criteria The patients generally responded very favorably regarding their perception of the treatment Their only hesitation was related to some discomfort during surgery It was concluded that It was concluded that survival and success rates for teeth auto survival and success rates for teeth auto transplanted when the root is partly developed transplanted when the root is partly developed compare favorably in a long-term perspective compare favorably in a long-term perspective with other treatment modalities for with other treatment modalities for substituting missing teethsubstituting missing teeth
3rd Molar Surgery ndash When Not
3rd Molar Surgery ndash When Not
bullExtremes of age
bullNo oral communication (full bony)
bullIntimate root-nerve Relationship
bullRisks gt Benefits
bullExtremes of age
bullNo oral communication (full bony)
bullIntimate root-nerve Relationship
bullRisks gt Benefits
3rd Molar Surgery Alternatives
3rd Molar Surgery Alternatives
bullNo Surgery dentist feels risk benefit ratio not favorable or patient refuses ndash document and recommend radiograph q 3-5 years
bullNo Surgery dentist feels risk benefit ratio not favorable or patient refuses ndash document and recommend radiograph q 3-5 years
No High SpeedNo High Speed
bullAir embolus
bullAir emphysema
bullBlow debris into flap
bullBlow bacteria into flap
bullNon-sterile water
bullAir embolus
bullAir emphysema
bullBlow debris into flap
bullBlow bacteria into flap
bullNon-sterile water
Which are trueWhich are true1 Tooth transplants are usually done on
patients 20-302 Average success rate for a tooth
transplant is 20-303 In order to work a transplant must
have endo4 Most transplants will ankylose
A 13 B 24 C 123 D 3 only
E None of the above
1 Tooth transplants are usually done on patients 20-30
2 Average success rate for a tooth transplant is 20-30
3 In order to work a transplant must have endo
4 Most transplants will ankylose
A 13 B 24 C 123 D 3 only
E None of the above
How can I assess the relationship How can I assess the relationship between the 3between the 3rdrd molar root and the molar root and the
inferior alveolar nerveinferior alveolar nerve
- Slide 2
- Slide 3
- Slide 4
- ldquoSockets with intact buccal and lingual plates heal well without graftinghellip consider grafting with resorbable osteoinductive material if plates compromised and implants plannedrdquo grafting with connective tissue if pontic esthetics an issuerdquo
- Vital Root Retention
- Slide 7
- Slide 8
- Slide 9
- J Oral Maxillofac Surg 2005 Feb43(1)7-12 A randomized controlled clinical trial to compare the incidence of injury to the inferior alveolar nerve as a result of coronectomy and removal of mandibular third molars Renton T Hankins M Sproate C
- Slide 11
- Slide 12
- Immediate Implant Placement Following Extractions
- Platelet Rich Plasma
- Slide 15
- Slide 16
- Slide 17
- Why Reconstruct
- How Autogenous Bone Grafts with Implants
- Autogenous Block Grafts
- Slide 21
- Intra-oral Autogenous Bone Sites
- Slide 23
- What about membranes
- Bone Morphogenic Protein (BMP)
- Slide 26
- Distraction Osteogenesis
- Slide 28
- Wise Old Oral Surgeon Says Beware of
- 3rd Molar Surgery ndash Why
- Extract 3rds OralSystemic Link
- Slide 32
- 3rd Molar Surgery ndash When
- 3rd Molar Surgery ndash When Not
- 3rd Molar Surgery Alternatives
- No High Speed
- Slide 38
- Which are true
- Slide 40
-
Distraction OsteogenesisDistraction
OsteogenesisbullGeneration of bone (and soft
tissue) through distraction of an osseous callus
bullGeneration of bone (and soft tissue) through distraction of an osseous callus
Ann N Y Acad Sci 2006 Apr1068532-42 COX-2 has a critical role during incorporation of structural bone allografts OrsquoKeefe RJ Tiyapatanaputi P Xie C
Ann N Y Acad Sci 2006 Apr1068532-42 COX-2 has a critical role during incorporation of structural bone allografts OrsquoKeefe RJ Tiyapatanaputi P Xie C
Nonsteroidal anti-inflammatory drugs (NSAIDs) which inhibit cyclooxygenase (COX) activity reduce pain and are commonly used in patients with skeletal injury In this article we will also present data to show that selective COX-2 inhibitor delays allograft healing and incorporation These results demonstrated that COX-2 is essential for bone allograft incorporation Furthermore our data support the notion that COX-2-dependent PGE2 produced at the early stage of bone healing is prerequisite for efficient skeletal repair
Nonsteroidal anti-inflammatory drugs (NSAIDs) which inhibit cyclooxygenase (COX) activity reduce pain and are commonly used in patients with skeletal injury In this article we will also present data to show that selective COX-2 inhibitor delays allograft healing and incorporation These results demonstrated that COX-2 is essential for bone allograft incorporation Furthermore our data support the notion that COX-2-dependent PGE2 produced at the early stage of bone healing is prerequisite for efficient skeletal repair
Wise Old Oral Surgeon Wise Old Oral Surgeon Says Beware ofSays Beware of
Wise Old Oral Surgeon Wise Old Oral Surgeon Says Beware ofSays Beware of
bull 3rd molars in function3rd molars in function
bull Lone standing molarsLone standing molars
bull Teeth in bruxers Cl III skeletal patternsTeeth in bruxers Cl III skeletal patterns
bull 3rd molars + post-menopausal women3rd molars + post-menopausal women
bull Prior TMD historyPrior TMD history
bull Prior ldquobadrdquo oral surgery experiencePrior ldquobadrdquo oral surgery experience
bull Distoangular lower 3rds nerve proximityDistoangular lower 3rds nerve proximity
bull 3rd molars in function3rd molars in function
bull Lone standing molarsLone standing molars
bull Teeth in bruxers Cl III skeletal patternsTeeth in bruxers Cl III skeletal patterns
bull 3rd molars + post-menopausal women3rd molars + post-menopausal women
bull Prior TMD historyPrior TMD history
bull Prior ldquobadrdquo oral surgery experiencePrior ldquobadrdquo oral surgery experience
bull Distoangular lower 3rds nerve proximityDistoangular lower 3rds nerve proximity
3rd Molar Surgery ndash Why
3rd Molar Surgery ndash Why
1 Preventtreat pericoronitis (infection)2 Prevent periodontal problems 2nd molar3 Preventtreat caries to 2nd 3rd molar4 Prevent odontogenic cyststumors5 Strengthen mandible possible fx6 Prevent orthodontic relapse7 Treat pain of unknown origin
1 Preventtreat pericoronitis (infection)2 Prevent periodontal problems 2nd molar3 Preventtreat caries to 2nd 3rd molar4 Prevent odontogenic cyststumors5 Strengthen mandible possible fx6 Prevent orthodontic relapse7 Treat pain of unknown origin
Extract 3rds OralSystemic Extract 3rds OralSystemic LinkLink
CLEVELAND April 6 2006 - The first hard evidence has CLEVELAND April 6 2006 - The first hard evidence has been uncovered that bacteria in the mouth may find their been uncovered that bacteria in the mouth may find their way to the uterus causing uterine infections that can lead way to the uterus causing uterine infections that can lead to preterm birth in pregnant womento preterm birth in pregnant women
CLEVELAND April 6 2006 - The first hard evidence has CLEVELAND April 6 2006 - The first hard evidence has been uncovered that bacteria in the mouth may find their been uncovered that bacteria in the mouth may find their way to the uterus causing uterine infections that can lead way to the uterus causing uterine infections that can lead to preterm birth in pregnant womento preterm birth in pregnant women
A newly discovered and as yet unnamed species of the A newly discovered and as yet unnamed species of the bacterium genus bacterium genus BergeyellaBergeyella was found in the mouth was found in the mouth and amniotic fluid of a woman with a uterine infection and amniotic fluid of a woman with a uterine infection who gave birth prematurely (24 weeks) reported who gave birth prematurely (24 weeks) reported microbiologist Yiping W Han PhD of Case Western microbiologist Yiping W Han PhD of Case Western Reserve here Reserve here However the bacterium was not detected in a vaginal However the bacterium was not detected in a vaginal swab as might be expected The finding confirmed swab as might be expected The finding confirmed what some scientists have suspected that intrauterine what some scientists have suspected that intrauterine infections dont always ascend from the genital tract infections dont always ascend from the genital tract but can descend from the oral cavity Dr Han and but can descend from the oral cavity Dr Han and colleagues said in the April issue of the colleagues said in the April issue of the Journal of Journal of Clinical MicrobiologyClinical Microbiology
A newly discovered and as yet unnamed species of the A newly discovered and as yet unnamed species of the bacterium genus bacterium genus BergeyellaBergeyella was found in the mouth was found in the mouth and amniotic fluid of a woman with a uterine infection and amniotic fluid of a woman with a uterine infection who gave birth prematurely (24 weeks) reported who gave birth prematurely (24 weeks) reported microbiologist Yiping W Han PhD of Case Western microbiologist Yiping W Han PhD of Case Western Reserve here Reserve here However the bacterium was not detected in a vaginal However the bacterium was not detected in a vaginal swab as might be expected The finding confirmed swab as might be expected The finding confirmed what some scientists have suspected that intrauterine what some scientists have suspected that intrauterine infections dont always ascend from the genital tract infections dont always ascend from the genital tract but can descend from the oral cavity Dr Han and but can descend from the oral cavity Dr Han and colleagues said in the April issue of the colleagues said in the April issue of the Journal of Journal of Clinical MicrobiologyClinical Microbiology
Journal of Oral and Maxillofacial Journal of Oral and Maxillofacial SurgerySurgery
Volume 65 Issue 3 March 2007 Pages Volume 65 Issue 3 March 2007 Pages 377-383377-383
Progress Report on Third Molar Clinical Trials Progress Report on Third Molar Clinical Trials Raymond P White Jr DDS PhDRaymond P White Jr DDS PhD
1What happens to asymptomatic patients who keep their 1What happens to asymptomatic patients who keep their third molars third molars
2What is the recovery like for those who have them 2What is the recovery like for those who have them removed and what can we do as surgeons to improve removed and what can we do as surgeons to improve post operative outcomespost operative outcomes
3rd Molar Surgery ndash When3rd Molar Surgery ndash WhenbullBefore roots 100 developed
bullAfter roots 13 formed
bullMorbiditycomplications minimized as bone more flexible nerves more pliable and PMH less complicated
bullDonrsquot forget tooth transplanttooth transplant if apex not closed
bullBefore roots 100 developed
bullAfter roots 13 formed
bullMorbiditycomplications minimized as bone more flexible nerves more pliable and PMH less complicated
bullDonrsquot forget tooth transplanttooth transplant if apex not closed
Outcome of tooth transplantation survival and success rates 17-41 years post treatmentCzochrowska EM Stenvik A Bjercke B Zachrisson Am J Orthod Dentofacial Orthop 2002 Feb121(2)110-9The mean age at surgery was 115 years and the mean observation period was 264 264 years (range 17-41 years) Of the 33 teeth transplanted in the 28 patients 3 teeth were lost after 9 10 and 29 years respectively Therefore the 30 teeth in the 25 patients we examined yielded a survival rate of 90 The success rate was 79 because 2 transplants had ankylosed and 2 others failed to fulfill the proposed criteria The patients generally responded very favorably regarding their perception of the treatment Their only hesitation was related to some discomfort during surgery It was concluded that It was concluded that survival and success rates for teeth auto survival and success rates for teeth auto transplanted when the root is partly developed transplanted when the root is partly developed compare favorably in a long-term perspective compare favorably in a long-term perspective with other treatment modalities for with other treatment modalities for substituting missing teethsubstituting missing teeth
Outcome of tooth transplantation survival and success rates 17-41 years post treatmentCzochrowska EM Stenvik A Bjercke B Zachrisson Am J Orthod Dentofacial Orthop 2002 Feb121(2)110-9The mean age at surgery was 115 years and the mean observation period was 264 264 years (range 17-41 years) Of the 33 teeth transplanted in the 28 patients 3 teeth were lost after 9 10 and 29 years respectively Therefore the 30 teeth in the 25 patients we examined yielded a survival rate of 90 The success rate was 79 because 2 transplants had ankylosed and 2 others failed to fulfill the proposed criteria The patients generally responded very favorably regarding their perception of the treatment Their only hesitation was related to some discomfort during surgery It was concluded that It was concluded that survival and success rates for teeth auto survival and success rates for teeth auto transplanted when the root is partly developed transplanted when the root is partly developed compare favorably in a long-term perspective compare favorably in a long-term perspective with other treatment modalities for with other treatment modalities for substituting missing teethsubstituting missing teeth
3rd Molar Surgery ndash When Not
3rd Molar Surgery ndash When Not
bullExtremes of age
bullNo oral communication (full bony)
bullIntimate root-nerve Relationship
bullRisks gt Benefits
bullExtremes of age
bullNo oral communication (full bony)
bullIntimate root-nerve Relationship
bullRisks gt Benefits
3rd Molar Surgery Alternatives
3rd Molar Surgery Alternatives
bullNo Surgery dentist feels risk benefit ratio not favorable or patient refuses ndash document and recommend radiograph q 3-5 years
bullNo Surgery dentist feels risk benefit ratio not favorable or patient refuses ndash document and recommend radiograph q 3-5 years
No High SpeedNo High Speed
bullAir embolus
bullAir emphysema
bullBlow debris into flap
bullBlow bacteria into flap
bullNon-sterile water
bullAir embolus
bullAir emphysema
bullBlow debris into flap
bullBlow bacteria into flap
bullNon-sterile water
Which are trueWhich are true1 Tooth transplants are usually done on
patients 20-302 Average success rate for a tooth
transplant is 20-303 In order to work a transplant must
have endo4 Most transplants will ankylose
A 13 B 24 C 123 D 3 only
E None of the above
1 Tooth transplants are usually done on patients 20-30
2 Average success rate for a tooth transplant is 20-30
3 In order to work a transplant must have endo
4 Most transplants will ankylose
A 13 B 24 C 123 D 3 only
E None of the above
How can I assess the relationship How can I assess the relationship between the 3between the 3rdrd molar root and the molar root and the
inferior alveolar nerveinferior alveolar nerve
- Slide 2
- Slide 3
- Slide 4
- ldquoSockets with intact buccal and lingual plates heal well without graftinghellip consider grafting with resorbable osteoinductive material if plates compromised and implants plannedrdquo grafting with connective tissue if pontic esthetics an issuerdquo
- Vital Root Retention
- Slide 7
- Slide 8
- Slide 9
- J Oral Maxillofac Surg 2005 Feb43(1)7-12 A randomized controlled clinical trial to compare the incidence of injury to the inferior alveolar nerve as a result of coronectomy and removal of mandibular third molars Renton T Hankins M Sproate C
- Slide 11
- Slide 12
- Immediate Implant Placement Following Extractions
- Platelet Rich Plasma
- Slide 15
- Slide 16
- Slide 17
- Why Reconstruct
- How Autogenous Bone Grafts with Implants
- Autogenous Block Grafts
- Slide 21
- Intra-oral Autogenous Bone Sites
- Slide 23
- What about membranes
- Bone Morphogenic Protein (BMP)
- Slide 26
- Distraction Osteogenesis
- Slide 28
- Wise Old Oral Surgeon Says Beware of
- 3rd Molar Surgery ndash Why
- Extract 3rds OralSystemic Link
- Slide 32
- 3rd Molar Surgery ndash When
- 3rd Molar Surgery ndash When Not
- 3rd Molar Surgery Alternatives
- No High Speed
- Slide 38
- Which are true
- Slide 40
-
Ann N Y Acad Sci 2006 Apr1068532-42 COX-2 has a critical role during incorporation of structural bone allografts OrsquoKeefe RJ Tiyapatanaputi P Xie C
Ann N Y Acad Sci 2006 Apr1068532-42 COX-2 has a critical role during incorporation of structural bone allografts OrsquoKeefe RJ Tiyapatanaputi P Xie C
Nonsteroidal anti-inflammatory drugs (NSAIDs) which inhibit cyclooxygenase (COX) activity reduce pain and are commonly used in patients with skeletal injury In this article we will also present data to show that selective COX-2 inhibitor delays allograft healing and incorporation These results demonstrated that COX-2 is essential for bone allograft incorporation Furthermore our data support the notion that COX-2-dependent PGE2 produced at the early stage of bone healing is prerequisite for efficient skeletal repair
Nonsteroidal anti-inflammatory drugs (NSAIDs) which inhibit cyclooxygenase (COX) activity reduce pain and are commonly used in patients with skeletal injury In this article we will also present data to show that selective COX-2 inhibitor delays allograft healing and incorporation These results demonstrated that COX-2 is essential for bone allograft incorporation Furthermore our data support the notion that COX-2-dependent PGE2 produced at the early stage of bone healing is prerequisite for efficient skeletal repair
Wise Old Oral Surgeon Wise Old Oral Surgeon Says Beware ofSays Beware of
Wise Old Oral Surgeon Wise Old Oral Surgeon Says Beware ofSays Beware of
bull 3rd molars in function3rd molars in function
bull Lone standing molarsLone standing molars
bull Teeth in bruxers Cl III skeletal patternsTeeth in bruxers Cl III skeletal patterns
bull 3rd molars + post-menopausal women3rd molars + post-menopausal women
bull Prior TMD historyPrior TMD history
bull Prior ldquobadrdquo oral surgery experiencePrior ldquobadrdquo oral surgery experience
bull Distoangular lower 3rds nerve proximityDistoangular lower 3rds nerve proximity
bull 3rd molars in function3rd molars in function
bull Lone standing molarsLone standing molars
bull Teeth in bruxers Cl III skeletal patternsTeeth in bruxers Cl III skeletal patterns
bull 3rd molars + post-menopausal women3rd molars + post-menopausal women
bull Prior TMD historyPrior TMD history
bull Prior ldquobadrdquo oral surgery experiencePrior ldquobadrdquo oral surgery experience
bull Distoangular lower 3rds nerve proximityDistoangular lower 3rds nerve proximity
3rd Molar Surgery ndash Why
3rd Molar Surgery ndash Why
1 Preventtreat pericoronitis (infection)2 Prevent periodontal problems 2nd molar3 Preventtreat caries to 2nd 3rd molar4 Prevent odontogenic cyststumors5 Strengthen mandible possible fx6 Prevent orthodontic relapse7 Treat pain of unknown origin
1 Preventtreat pericoronitis (infection)2 Prevent periodontal problems 2nd molar3 Preventtreat caries to 2nd 3rd molar4 Prevent odontogenic cyststumors5 Strengthen mandible possible fx6 Prevent orthodontic relapse7 Treat pain of unknown origin
Extract 3rds OralSystemic Extract 3rds OralSystemic LinkLink
CLEVELAND April 6 2006 - The first hard evidence has CLEVELAND April 6 2006 - The first hard evidence has been uncovered that bacteria in the mouth may find their been uncovered that bacteria in the mouth may find their way to the uterus causing uterine infections that can lead way to the uterus causing uterine infections that can lead to preterm birth in pregnant womento preterm birth in pregnant women
CLEVELAND April 6 2006 - The first hard evidence has CLEVELAND April 6 2006 - The first hard evidence has been uncovered that bacteria in the mouth may find their been uncovered that bacteria in the mouth may find their way to the uterus causing uterine infections that can lead way to the uterus causing uterine infections that can lead to preterm birth in pregnant womento preterm birth in pregnant women
A newly discovered and as yet unnamed species of the A newly discovered and as yet unnamed species of the bacterium genus bacterium genus BergeyellaBergeyella was found in the mouth was found in the mouth and amniotic fluid of a woman with a uterine infection and amniotic fluid of a woman with a uterine infection who gave birth prematurely (24 weeks) reported who gave birth prematurely (24 weeks) reported microbiologist Yiping W Han PhD of Case Western microbiologist Yiping W Han PhD of Case Western Reserve here Reserve here However the bacterium was not detected in a vaginal However the bacterium was not detected in a vaginal swab as might be expected The finding confirmed swab as might be expected The finding confirmed what some scientists have suspected that intrauterine what some scientists have suspected that intrauterine infections dont always ascend from the genital tract infections dont always ascend from the genital tract but can descend from the oral cavity Dr Han and but can descend from the oral cavity Dr Han and colleagues said in the April issue of the colleagues said in the April issue of the Journal of Journal of Clinical MicrobiologyClinical Microbiology
A newly discovered and as yet unnamed species of the A newly discovered and as yet unnamed species of the bacterium genus bacterium genus BergeyellaBergeyella was found in the mouth was found in the mouth and amniotic fluid of a woman with a uterine infection and amniotic fluid of a woman with a uterine infection who gave birth prematurely (24 weeks) reported who gave birth prematurely (24 weeks) reported microbiologist Yiping W Han PhD of Case Western microbiologist Yiping W Han PhD of Case Western Reserve here Reserve here However the bacterium was not detected in a vaginal However the bacterium was not detected in a vaginal swab as might be expected The finding confirmed swab as might be expected The finding confirmed what some scientists have suspected that intrauterine what some scientists have suspected that intrauterine infections dont always ascend from the genital tract infections dont always ascend from the genital tract but can descend from the oral cavity Dr Han and but can descend from the oral cavity Dr Han and colleagues said in the April issue of the colleagues said in the April issue of the Journal of Journal of Clinical MicrobiologyClinical Microbiology
Journal of Oral and Maxillofacial Journal of Oral and Maxillofacial SurgerySurgery
Volume 65 Issue 3 March 2007 Pages Volume 65 Issue 3 March 2007 Pages 377-383377-383
Progress Report on Third Molar Clinical Trials Progress Report on Third Molar Clinical Trials Raymond P White Jr DDS PhDRaymond P White Jr DDS PhD
1What happens to asymptomatic patients who keep their 1What happens to asymptomatic patients who keep their third molars third molars
2What is the recovery like for those who have them 2What is the recovery like for those who have them removed and what can we do as surgeons to improve removed and what can we do as surgeons to improve post operative outcomespost operative outcomes
3rd Molar Surgery ndash When3rd Molar Surgery ndash WhenbullBefore roots 100 developed
bullAfter roots 13 formed
bullMorbiditycomplications minimized as bone more flexible nerves more pliable and PMH less complicated
bullDonrsquot forget tooth transplanttooth transplant if apex not closed
bullBefore roots 100 developed
bullAfter roots 13 formed
bullMorbiditycomplications minimized as bone more flexible nerves more pliable and PMH less complicated
bullDonrsquot forget tooth transplanttooth transplant if apex not closed
Outcome of tooth transplantation survival and success rates 17-41 years post treatmentCzochrowska EM Stenvik A Bjercke B Zachrisson Am J Orthod Dentofacial Orthop 2002 Feb121(2)110-9The mean age at surgery was 115 years and the mean observation period was 264 264 years (range 17-41 years) Of the 33 teeth transplanted in the 28 patients 3 teeth were lost after 9 10 and 29 years respectively Therefore the 30 teeth in the 25 patients we examined yielded a survival rate of 90 The success rate was 79 because 2 transplants had ankylosed and 2 others failed to fulfill the proposed criteria The patients generally responded very favorably regarding their perception of the treatment Their only hesitation was related to some discomfort during surgery It was concluded that It was concluded that survival and success rates for teeth auto survival and success rates for teeth auto transplanted when the root is partly developed transplanted when the root is partly developed compare favorably in a long-term perspective compare favorably in a long-term perspective with other treatment modalities for with other treatment modalities for substituting missing teethsubstituting missing teeth
Outcome of tooth transplantation survival and success rates 17-41 years post treatmentCzochrowska EM Stenvik A Bjercke B Zachrisson Am J Orthod Dentofacial Orthop 2002 Feb121(2)110-9The mean age at surgery was 115 years and the mean observation period was 264 264 years (range 17-41 years) Of the 33 teeth transplanted in the 28 patients 3 teeth were lost after 9 10 and 29 years respectively Therefore the 30 teeth in the 25 patients we examined yielded a survival rate of 90 The success rate was 79 because 2 transplants had ankylosed and 2 others failed to fulfill the proposed criteria The patients generally responded very favorably regarding their perception of the treatment Their only hesitation was related to some discomfort during surgery It was concluded that It was concluded that survival and success rates for teeth auto survival and success rates for teeth auto transplanted when the root is partly developed transplanted when the root is partly developed compare favorably in a long-term perspective compare favorably in a long-term perspective with other treatment modalities for with other treatment modalities for substituting missing teethsubstituting missing teeth
3rd Molar Surgery ndash When Not
3rd Molar Surgery ndash When Not
bullExtremes of age
bullNo oral communication (full bony)
bullIntimate root-nerve Relationship
bullRisks gt Benefits
bullExtremes of age
bullNo oral communication (full bony)
bullIntimate root-nerve Relationship
bullRisks gt Benefits
3rd Molar Surgery Alternatives
3rd Molar Surgery Alternatives
bullNo Surgery dentist feels risk benefit ratio not favorable or patient refuses ndash document and recommend radiograph q 3-5 years
bullNo Surgery dentist feels risk benefit ratio not favorable or patient refuses ndash document and recommend radiograph q 3-5 years
No High SpeedNo High Speed
bullAir embolus
bullAir emphysema
bullBlow debris into flap
bullBlow bacteria into flap
bullNon-sterile water
bullAir embolus
bullAir emphysema
bullBlow debris into flap
bullBlow bacteria into flap
bullNon-sterile water
Which are trueWhich are true1 Tooth transplants are usually done on
patients 20-302 Average success rate for a tooth
transplant is 20-303 In order to work a transplant must
have endo4 Most transplants will ankylose
A 13 B 24 C 123 D 3 only
E None of the above
1 Tooth transplants are usually done on patients 20-30
2 Average success rate for a tooth transplant is 20-30
3 In order to work a transplant must have endo
4 Most transplants will ankylose
A 13 B 24 C 123 D 3 only
E None of the above
How can I assess the relationship How can I assess the relationship between the 3between the 3rdrd molar root and the molar root and the
inferior alveolar nerveinferior alveolar nerve
- Slide 2
- Slide 3
- Slide 4
- ldquoSockets with intact buccal and lingual plates heal well without graftinghellip consider grafting with resorbable osteoinductive material if plates compromised and implants plannedrdquo grafting with connective tissue if pontic esthetics an issuerdquo
- Vital Root Retention
- Slide 7
- Slide 8
- Slide 9
- J Oral Maxillofac Surg 2005 Feb43(1)7-12 A randomized controlled clinical trial to compare the incidence of injury to the inferior alveolar nerve as a result of coronectomy and removal of mandibular third molars Renton T Hankins M Sproate C
- Slide 11
- Slide 12
- Immediate Implant Placement Following Extractions
- Platelet Rich Plasma
- Slide 15
- Slide 16
- Slide 17
- Why Reconstruct
- How Autogenous Bone Grafts with Implants
- Autogenous Block Grafts
- Slide 21
- Intra-oral Autogenous Bone Sites
- Slide 23
- What about membranes
- Bone Morphogenic Protein (BMP)
- Slide 26
- Distraction Osteogenesis
- Slide 28
- Wise Old Oral Surgeon Says Beware of
- 3rd Molar Surgery ndash Why
- Extract 3rds OralSystemic Link
- Slide 32
- 3rd Molar Surgery ndash When
- 3rd Molar Surgery ndash When Not
- 3rd Molar Surgery Alternatives
- No High Speed
- Slide 38
- Which are true
- Slide 40
-
Wise Old Oral Surgeon Wise Old Oral Surgeon Says Beware ofSays Beware of
Wise Old Oral Surgeon Wise Old Oral Surgeon Says Beware ofSays Beware of
bull 3rd molars in function3rd molars in function
bull Lone standing molarsLone standing molars
bull Teeth in bruxers Cl III skeletal patternsTeeth in bruxers Cl III skeletal patterns
bull 3rd molars + post-menopausal women3rd molars + post-menopausal women
bull Prior TMD historyPrior TMD history
bull Prior ldquobadrdquo oral surgery experiencePrior ldquobadrdquo oral surgery experience
bull Distoangular lower 3rds nerve proximityDistoangular lower 3rds nerve proximity
bull 3rd molars in function3rd molars in function
bull Lone standing molarsLone standing molars
bull Teeth in bruxers Cl III skeletal patternsTeeth in bruxers Cl III skeletal patterns
bull 3rd molars + post-menopausal women3rd molars + post-menopausal women
bull Prior TMD historyPrior TMD history
bull Prior ldquobadrdquo oral surgery experiencePrior ldquobadrdquo oral surgery experience
bull Distoangular lower 3rds nerve proximityDistoangular lower 3rds nerve proximity
3rd Molar Surgery ndash Why
3rd Molar Surgery ndash Why
1 Preventtreat pericoronitis (infection)2 Prevent periodontal problems 2nd molar3 Preventtreat caries to 2nd 3rd molar4 Prevent odontogenic cyststumors5 Strengthen mandible possible fx6 Prevent orthodontic relapse7 Treat pain of unknown origin
1 Preventtreat pericoronitis (infection)2 Prevent periodontal problems 2nd molar3 Preventtreat caries to 2nd 3rd molar4 Prevent odontogenic cyststumors5 Strengthen mandible possible fx6 Prevent orthodontic relapse7 Treat pain of unknown origin
Extract 3rds OralSystemic Extract 3rds OralSystemic LinkLink
CLEVELAND April 6 2006 - The first hard evidence has CLEVELAND April 6 2006 - The first hard evidence has been uncovered that bacteria in the mouth may find their been uncovered that bacteria in the mouth may find their way to the uterus causing uterine infections that can lead way to the uterus causing uterine infections that can lead to preterm birth in pregnant womento preterm birth in pregnant women
CLEVELAND April 6 2006 - The first hard evidence has CLEVELAND April 6 2006 - The first hard evidence has been uncovered that bacteria in the mouth may find their been uncovered that bacteria in the mouth may find their way to the uterus causing uterine infections that can lead way to the uterus causing uterine infections that can lead to preterm birth in pregnant womento preterm birth in pregnant women
A newly discovered and as yet unnamed species of the A newly discovered and as yet unnamed species of the bacterium genus bacterium genus BergeyellaBergeyella was found in the mouth was found in the mouth and amniotic fluid of a woman with a uterine infection and amniotic fluid of a woman with a uterine infection who gave birth prematurely (24 weeks) reported who gave birth prematurely (24 weeks) reported microbiologist Yiping W Han PhD of Case Western microbiologist Yiping W Han PhD of Case Western Reserve here Reserve here However the bacterium was not detected in a vaginal However the bacterium was not detected in a vaginal swab as might be expected The finding confirmed swab as might be expected The finding confirmed what some scientists have suspected that intrauterine what some scientists have suspected that intrauterine infections dont always ascend from the genital tract infections dont always ascend from the genital tract but can descend from the oral cavity Dr Han and but can descend from the oral cavity Dr Han and colleagues said in the April issue of the colleagues said in the April issue of the Journal of Journal of Clinical MicrobiologyClinical Microbiology
A newly discovered and as yet unnamed species of the A newly discovered and as yet unnamed species of the bacterium genus bacterium genus BergeyellaBergeyella was found in the mouth was found in the mouth and amniotic fluid of a woman with a uterine infection and amniotic fluid of a woman with a uterine infection who gave birth prematurely (24 weeks) reported who gave birth prematurely (24 weeks) reported microbiologist Yiping W Han PhD of Case Western microbiologist Yiping W Han PhD of Case Western Reserve here Reserve here However the bacterium was not detected in a vaginal However the bacterium was not detected in a vaginal swab as might be expected The finding confirmed swab as might be expected The finding confirmed what some scientists have suspected that intrauterine what some scientists have suspected that intrauterine infections dont always ascend from the genital tract infections dont always ascend from the genital tract but can descend from the oral cavity Dr Han and but can descend from the oral cavity Dr Han and colleagues said in the April issue of the colleagues said in the April issue of the Journal of Journal of Clinical MicrobiologyClinical Microbiology
Journal of Oral and Maxillofacial Journal of Oral and Maxillofacial SurgerySurgery
Volume 65 Issue 3 March 2007 Pages Volume 65 Issue 3 March 2007 Pages 377-383377-383
Progress Report on Third Molar Clinical Trials Progress Report on Third Molar Clinical Trials Raymond P White Jr DDS PhDRaymond P White Jr DDS PhD
1What happens to asymptomatic patients who keep their 1What happens to asymptomatic patients who keep their third molars third molars
2What is the recovery like for those who have them 2What is the recovery like for those who have them removed and what can we do as surgeons to improve removed and what can we do as surgeons to improve post operative outcomespost operative outcomes
3rd Molar Surgery ndash When3rd Molar Surgery ndash WhenbullBefore roots 100 developed
bullAfter roots 13 formed
bullMorbiditycomplications minimized as bone more flexible nerves more pliable and PMH less complicated
bullDonrsquot forget tooth transplanttooth transplant if apex not closed
bullBefore roots 100 developed
bullAfter roots 13 formed
bullMorbiditycomplications minimized as bone more flexible nerves more pliable and PMH less complicated
bullDonrsquot forget tooth transplanttooth transplant if apex not closed
Outcome of tooth transplantation survival and success rates 17-41 years post treatmentCzochrowska EM Stenvik A Bjercke B Zachrisson Am J Orthod Dentofacial Orthop 2002 Feb121(2)110-9The mean age at surgery was 115 years and the mean observation period was 264 264 years (range 17-41 years) Of the 33 teeth transplanted in the 28 patients 3 teeth were lost after 9 10 and 29 years respectively Therefore the 30 teeth in the 25 patients we examined yielded a survival rate of 90 The success rate was 79 because 2 transplants had ankylosed and 2 others failed to fulfill the proposed criteria The patients generally responded very favorably regarding their perception of the treatment Their only hesitation was related to some discomfort during surgery It was concluded that It was concluded that survival and success rates for teeth auto survival and success rates for teeth auto transplanted when the root is partly developed transplanted when the root is partly developed compare favorably in a long-term perspective compare favorably in a long-term perspective with other treatment modalities for with other treatment modalities for substituting missing teethsubstituting missing teeth
Outcome of tooth transplantation survival and success rates 17-41 years post treatmentCzochrowska EM Stenvik A Bjercke B Zachrisson Am J Orthod Dentofacial Orthop 2002 Feb121(2)110-9The mean age at surgery was 115 years and the mean observation period was 264 264 years (range 17-41 years) Of the 33 teeth transplanted in the 28 patients 3 teeth were lost after 9 10 and 29 years respectively Therefore the 30 teeth in the 25 patients we examined yielded a survival rate of 90 The success rate was 79 because 2 transplants had ankylosed and 2 others failed to fulfill the proposed criteria The patients generally responded very favorably regarding their perception of the treatment Their only hesitation was related to some discomfort during surgery It was concluded that It was concluded that survival and success rates for teeth auto survival and success rates for teeth auto transplanted when the root is partly developed transplanted when the root is partly developed compare favorably in a long-term perspective compare favorably in a long-term perspective with other treatment modalities for with other treatment modalities for substituting missing teethsubstituting missing teeth
3rd Molar Surgery ndash When Not
3rd Molar Surgery ndash When Not
bullExtremes of age
bullNo oral communication (full bony)
bullIntimate root-nerve Relationship
bullRisks gt Benefits
bullExtremes of age
bullNo oral communication (full bony)
bullIntimate root-nerve Relationship
bullRisks gt Benefits
3rd Molar Surgery Alternatives
3rd Molar Surgery Alternatives
bullNo Surgery dentist feels risk benefit ratio not favorable or patient refuses ndash document and recommend radiograph q 3-5 years
bullNo Surgery dentist feels risk benefit ratio not favorable or patient refuses ndash document and recommend radiograph q 3-5 years
No High SpeedNo High Speed
bullAir embolus
bullAir emphysema
bullBlow debris into flap
bullBlow bacteria into flap
bullNon-sterile water
bullAir embolus
bullAir emphysema
bullBlow debris into flap
bullBlow bacteria into flap
bullNon-sterile water
Which are trueWhich are true1 Tooth transplants are usually done on
patients 20-302 Average success rate for a tooth
transplant is 20-303 In order to work a transplant must
have endo4 Most transplants will ankylose
A 13 B 24 C 123 D 3 only
E None of the above
1 Tooth transplants are usually done on patients 20-30
2 Average success rate for a tooth transplant is 20-30
3 In order to work a transplant must have endo
4 Most transplants will ankylose
A 13 B 24 C 123 D 3 only
E None of the above
How can I assess the relationship How can I assess the relationship between the 3between the 3rdrd molar root and the molar root and the
inferior alveolar nerveinferior alveolar nerve
- Slide 2
- Slide 3
- Slide 4
- ldquoSockets with intact buccal and lingual plates heal well without graftinghellip consider grafting with resorbable osteoinductive material if plates compromised and implants plannedrdquo grafting with connective tissue if pontic esthetics an issuerdquo
- Vital Root Retention
- Slide 7
- Slide 8
- Slide 9
- J Oral Maxillofac Surg 2005 Feb43(1)7-12 A randomized controlled clinical trial to compare the incidence of injury to the inferior alveolar nerve as a result of coronectomy and removal of mandibular third molars Renton T Hankins M Sproate C
- Slide 11
- Slide 12
- Immediate Implant Placement Following Extractions
- Platelet Rich Plasma
- Slide 15
- Slide 16
- Slide 17
- Why Reconstruct
- How Autogenous Bone Grafts with Implants
- Autogenous Block Grafts
- Slide 21
- Intra-oral Autogenous Bone Sites
- Slide 23
- What about membranes
- Bone Morphogenic Protein (BMP)
- Slide 26
- Distraction Osteogenesis
- Slide 28
- Wise Old Oral Surgeon Says Beware of
- 3rd Molar Surgery ndash Why
- Extract 3rds OralSystemic Link
- Slide 32
- 3rd Molar Surgery ndash When
- 3rd Molar Surgery ndash When Not
- 3rd Molar Surgery Alternatives
- No High Speed
- Slide 38
- Which are true
- Slide 40
-
3rd Molar Surgery ndash Why
3rd Molar Surgery ndash Why
1 Preventtreat pericoronitis (infection)2 Prevent periodontal problems 2nd molar3 Preventtreat caries to 2nd 3rd molar4 Prevent odontogenic cyststumors5 Strengthen mandible possible fx6 Prevent orthodontic relapse7 Treat pain of unknown origin
1 Preventtreat pericoronitis (infection)2 Prevent periodontal problems 2nd molar3 Preventtreat caries to 2nd 3rd molar4 Prevent odontogenic cyststumors5 Strengthen mandible possible fx6 Prevent orthodontic relapse7 Treat pain of unknown origin
Extract 3rds OralSystemic Extract 3rds OralSystemic LinkLink
CLEVELAND April 6 2006 - The first hard evidence has CLEVELAND April 6 2006 - The first hard evidence has been uncovered that bacteria in the mouth may find their been uncovered that bacteria in the mouth may find their way to the uterus causing uterine infections that can lead way to the uterus causing uterine infections that can lead to preterm birth in pregnant womento preterm birth in pregnant women
CLEVELAND April 6 2006 - The first hard evidence has CLEVELAND April 6 2006 - The first hard evidence has been uncovered that bacteria in the mouth may find their been uncovered that bacteria in the mouth may find their way to the uterus causing uterine infections that can lead way to the uterus causing uterine infections that can lead to preterm birth in pregnant womento preterm birth in pregnant women
A newly discovered and as yet unnamed species of the A newly discovered and as yet unnamed species of the bacterium genus bacterium genus BergeyellaBergeyella was found in the mouth was found in the mouth and amniotic fluid of a woman with a uterine infection and amniotic fluid of a woman with a uterine infection who gave birth prematurely (24 weeks) reported who gave birth prematurely (24 weeks) reported microbiologist Yiping W Han PhD of Case Western microbiologist Yiping W Han PhD of Case Western Reserve here Reserve here However the bacterium was not detected in a vaginal However the bacterium was not detected in a vaginal swab as might be expected The finding confirmed swab as might be expected The finding confirmed what some scientists have suspected that intrauterine what some scientists have suspected that intrauterine infections dont always ascend from the genital tract infections dont always ascend from the genital tract but can descend from the oral cavity Dr Han and but can descend from the oral cavity Dr Han and colleagues said in the April issue of the colleagues said in the April issue of the Journal of Journal of Clinical MicrobiologyClinical Microbiology
A newly discovered and as yet unnamed species of the A newly discovered and as yet unnamed species of the bacterium genus bacterium genus BergeyellaBergeyella was found in the mouth was found in the mouth and amniotic fluid of a woman with a uterine infection and amniotic fluid of a woman with a uterine infection who gave birth prematurely (24 weeks) reported who gave birth prematurely (24 weeks) reported microbiologist Yiping W Han PhD of Case Western microbiologist Yiping W Han PhD of Case Western Reserve here Reserve here However the bacterium was not detected in a vaginal However the bacterium was not detected in a vaginal swab as might be expected The finding confirmed swab as might be expected The finding confirmed what some scientists have suspected that intrauterine what some scientists have suspected that intrauterine infections dont always ascend from the genital tract infections dont always ascend from the genital tract but can descend from the oral cavity Dr Han and but can descend from the oral cavity Dr Han and colleagues said in the April issue of the colleagues said in the April issue of the Journal of Journal of Clinical MicrobiologyClinical Microbiology
Journal of Oral and Maxillofacial Journal of Oral and Maxillofacial SurgerySurgery
Volume 65 Issue 3 March 2007 Pages Volume 65 Issue 3 March 2007 Pages 377-383377-383
Progress Report on Third Molar Clinical Trials Progress Report on Third Molar Clinical Trials Raymond P White Jr DDS PhDRaymond P White Jr DDS PhD
1What happens to asymptomatic patients who keep their 1What happens to asymptomatic patients who keep their third molars third molars
2What is the recovery like for those who have them 2What is the recovery like for those who have them removed and what can we do as surgeons to improve removed and what can we do as surgeons to improve post operative outcomespost operative outcomes
3rd Molar Surgery ndash When3rd Molar Surgery ndash WhenbullBefore roots 100 developed
bullAfter roots 13 formed
bullMorbiditycomplications minimized as bone more flexible nerves more pliable and PMH less complicated
bullDonrsquot forget tooth transplanttooth transplant if apex not closed
bullBefore roots 100 developed
bullAfter roots 13 formed
bullMorbiditycomplications minimized as bone more flexible nerves more pliable and PMH less complicated
bullDonrsquot forget tooth transplanttooth transplant if apex not closed
Outcome of tooth transplantation survival and success rates 17-41 years post treatmentCzochrowska EM Stenvik A Bjercke B Zachrisson Am J Orthod Dentofacial Orthop 2002 Feb121(2)110-9The mean age at surgery was 115 years and the mean observation period was 264 264 years (range 17-41 years) Of the 33 teeth transplanted in the 28 patients 3 teeth were lost after 9 10 and 29 years respectively Therefore the 30 teeth in the 25 patients we examined yielded a survival rate of 90 The success rate was 79 because 2 transplants had ankylosed and 2 others failed to fulfill the proposed criteria The patients generally responded very favorably regarding their perception of the treatment Their only hesitation was related to some discomfort during surgery It was concluded that It was concluded that survival and success rates for teeth auto survival and success rates for teeth auto transplanted when the root is partly developed transplanted when the root is partly developed compare favorably in a long-term perspective compare favorably in a long-term perspective with other treatment modalities for with other treatment modalities for substituting missing teethsubstituting missing teeth
Outcome of tooth transplantation survival and success rates 17-41 years post treatmentCzochrowska EM Stenvik A Bjercke B Zachrisson Am J Orthod Dentofacial Orthop 2002 Feb121(2)110-9The mean age at surgery was 115 years and the mean observation period was 264 264 years (range 17-41 years) Of the 33 teeth transplanted in the 28 patients 3 teeth were lost after 9 10 and 29 years respectively Therefore the 30 teeth in the 25 patients we examined yielded a survival rate of 90 The success rate was 79 because 2 transplants had ankylosed and 2 others failed to fulfill the proposed criteria The patients generally responded very favorably regarding their perception of the treatment Their only hesitation was related to some discomfort during surgery It was concluded that It was concluded that survival and success rates for teeth auto survival and success rates for teeth auto transplanted when the root is partly developed transplanted when the root is partly developed compare favorably in a long-term perspective compare favorably in a long-term perspective with other treatment modalities for with other treatment modalities for substituting missing teethsubstituting missing teeth
3rd Molar Surgery ndash When Not
3rd Molar Surgery ndash When Not
bullExtremes of age
bullNo oral communication (full bony)
bullIntimate root-nerve Relationship
bullRisks gt Benefits
bullExtremes of age
bullNo oral communication (full bony)
bullIntimate root-nerve Relationship
bullRisks gt Benefits
3rd Molar Surgery Alternatives
3rd Molar Surgery Alternatives
bullNo Surgery dentist feels risk benefit ratio not favorable or patient refuses ndash document and recommend radiograph q 3-5 years
bullNo Surgery dentist feels risk benefit ratio not favorable or patient refuses ndash document and recommend radiograph q 3-5 years
No High SpeedNo High Speed
bullAir embolus
bullAir emphysema
bullBlow debris into flap
bullBlow bacteria into flap
bullNon-sterile water
bullAir embolus
bullAir emphysema
bullBlow debris into flap
bullBlow bacteria into flap
bullNon-sterile water
Which are trueWhich are true1 Tooth transplants are usually done on
patients 20-302 Average success rate for a tooth
transplant is 20-303 In order to work a transplant must
have endo4 Most transplants will ankylose
A 13 B 24 C 123 D 3 only
E None of the above
1 Tooth transplants are usually done on patients 20-30
2 Average success rate for a tooth transplant is 20-30
3 In order to work a transplant must have endo
4 Most transplants will ankylose
A 13 B 24 C 123 D 3 only
E None of the above
How can I assess the relationship How can I assess the relationship between the 3between the 3rdrd molar root and the molar root and the
inferior alveolar nerveinferior alveolar nerve
- Slide 2
- Slide 3
- Slide 4
- ldquoSockets with intact buccal and lingual plates heal well without graftinghellip consider grafting with resorbable osteoinductive material if plates compromised and implants plannedrdquo grafting with connective tissue if pontic esthetics an issuerdquo
- Vital Root Retention
- Slide 7
- Slide 8
- Slide 9
- J Oral Maxillofac Surg 2005 Feb43(1)7-12 A randomized controlled clinical trial to compare the incidence of injury to the inferior alveolar nerve as a result of coronectomy and removal of mandibular third molars Renton T Hankins M Sproate C
- Slide 11
- Slide 12
- Immediate Implant Placement Following Extractions
- Platelet Rich Plasma
- Slide 15
- Slide 16
- Slide 17
- Why Reconstruct
- How Autogenous Bone Grafts with Implants
- Autogenous Block Grafts
- Slide 21
- Intra-oral Autogenous Bone Sites
- Slide 23
- What about membranes
- Bone Morphogenic Protein (BMP)
- Slide 26
- Distraction Osteogenesis
- Slide 28
- Wise Old Oral Surgeon Says Beware of
- 3rd Molar Surgery ndash Why
- Extract 3rds OralSystemic Link
- Slide 32
- 3rd Molar Surgery ndash When
- 3rd Molar Surgery ndash When Not
- 3rd Molar Surgery Alternatives
- No High Speed
- Slide 38
- Which are true
- Slide 40
-
Extract 3rds OralSystemic Extract 3rds OralSystemic LinkLink
CLEVELAND April 6 2006 - The first hard evidence has CLEVELAND April 6 2006 - The first hard evidence has been uncovered that bacteria in the mouth may find their been uncovered that bacteria in the mouth may find their way to the uterus causing uterine infections that can lead way to the uterus causing uterine infections that can lead to preterm birth in pregnant womento preterm birth in pregnant women
CLEVELAND April 6 2006 - The first hard evidence has CLEVELAND April 6 2006 - The first hard evidence has been uncovered that bacteria in the mouth may find their been uncovered that bacteria in the mouth may find their way to the uterus causing uterine infections that can lead way to the uterus causing uterine infections that can lead to preterm birth in pregnant womento preterm birth in pregnant women
A newly discovered and as yet unnamed species of the A newly discovered and as yet unnamed species of the bacterium genus bacterium genus BergeyellaBergeyella was found in the mouth was found in the mouth and amniotic fluid of a woman with a uterine infection and amniotic fluid of a woman with a uterine infection who gave birth prematurely (24 weeks) reported who gave birth prematurely (24 weeks) reported microbiologist Yiping W Han PhD of Case Western microbiologist Yiping W Han PhD of Case Western Reserve here Reserve here However the bacterium was not detected in a vaginal However the bacterium was not detected in a vaginal swab as might be expected The finding confirmed swab as might be expected The finding confirmed what some scientists have suspected that intrauterine what some scientists have suspected that intrauterine infections dont always ascend from the genital tract infections dont always ascend from the genital tract but can descend from the oral cavity Dr Han and but can descend from the oral cavity Dr Han and colleagues said in the April issue of the colleagues said in the April issue of the Journal of Journal of Clinical MicrobiologyClinical Microbiology
A newly discovered and as yet unnamed species of the A newly discovered and as yet unnamed species of the bacterium genus bacterium genus BergeyellaBergeyella was found in the mouth was found in the mouth and amniotic fluid of a woman with a uterine infection and amniotic fluid of a woman with a uterine infection who gave birth prematurely (24 weeks) reported who gave birth prematurely (24 weeks) reported microbiologist Yiping W Han PhD of Case Western microbiologist Yiping W Han PhD of Case Western Reserve here Reserve here However the bacterium was not detected in a vaginal However the bacterium was not detected in a vaginal swab as might be expected The finding confirmed swab as might be expected The finding confirmed what some scientists have suspected that intrauterine what some scientists have suspected that intrauterine infections dont always ascend from the genital tract infections dont always ascend from the genital tract but can descend from the oral cavity Dr Han and but can descend from the oral cavity Dr Han and colleagues said in the April issue of the colleagues said in the April issue of the Journal of Journal of Clinical MicrobiologyClinical Microbiology
Journal of Oral and Maxillofacial Journal of Oral and Maxillofacial SurgerySurgery
Volume 65 Issue 3 March 2007 Pages Volume 65 Issue 3 March 2007 Pages 377-383377-383
Progress Report on Third Molar Clinical Trials Progress Report on Third Molar Clinical Trials Raymond P White Jr DDS PhDRaymond P White Jr DDS PhD
1What happens to asymptomatic patients who keep their 1What happens to asymptomatic patients who keep their third molars third molars
2What is the recovery like for those who have them 2What is the recovery like for those who have them removed and what can we do as surgeons to improve removed and what can we do as surgeons to improve post operative outcomespost operative outcomes
3rd Molar Surgery ndash When3rd Molar Surgery ndash WhenbullBefore roots 100 developed
bullAfter roots 13 formed
bullMorbiditycomplications minimized as bone more flexible nerves more pliable and PMH less complicated
bullDonrsquot forget tooth transplanttooth transplant if apex not closed
bullBefore roots 100 developed
bullAfter roots 13 formed
bullMorbiditycomplications minimized as bone more flexible nerves more pliable and PMH less complicated
bullDonrsquot forget tooth transplanttooth transplant if apex not closed
Outcome of tooth transplantation survival and success rates 17-41 years post treatmentCzochrowska EM Stenvik A Bjercke B Zachrisson Am J Orthod Dentofacial Orthop 2002 Feb121(2)110-9The mean age at surgery was 115 years and the mean observation period was 264 264 years (range 17-41 years) Of the 33 teeth transplanted in the 28 patients 3 teeth were lost after 9 10 and 29 years respectively Therefore the 30 teeth in the 25 patients we examined yielded a survival rate of 90 The success rate was 79 because 2 transplants had ankylosed and 2 others failed to fulfill the proposed criteria The patients generally responded very favorably regarding their perception of the treatment Their only hesitation was related to some discomfort during surgery It was concluded that It was concluded that survival and success rates for teeth auto survival and success rates for teeth auto transplanted when the root is partly developed transplanted when the root is partly developed compare favorably in a long-term perspective compare favorably in a long-term perspective with other treatment modalities for with other treatment modalities for substituting missing teethsubstituting missing teeth
Outcome of tooth transplantation survival and success rates 17-41 years post treatmentCzochrowska EM Stenvik A Bjercke B Zachrisson Am J Orthod Dentofacial Orthop 2002 Feb121(2)110-9The mean age at surgery was 115 years and the mean observation period was 264 264 years (range 17-41 years) Of the 33 teeth transplanted in the 28 patients 3 teeth were lost after 9 10 and 29 years respectively Therefore the 30 teeth in the 25 patients we examined yielded a survival rate of 90 The success rate was 79 because 2 transplants had ankylosed and 2 others failed to fulfill the proposed criteria The patients generally responded very favorably regarding their perception of the treatment Their only hesitation was related to some discomfort during surgery It was concluded that It was concluded that survival and success rates for teeth auto survival and success rates for teeth auto transplanted when the root is partly developed transplanted when the root is partly developed compare favorably in a long-term perspective compare favorably in a long-term perspective with other treatment modalities for with other treatment modalities for substituting missing teethsubstituting missing teeth
3rd Molar Surgery ndash When Not
3rd Molar Surgery ndash When Not
bullExtremes of age
bullNo oral communication (full bony)
bullIntimate root-nerve Relationship
bullRisks gt Benefits
bullExtremes of age
bullNo oral communication (full bony)
bullIntimate root-nerve Relationship
bullRisks gt Benefits
3rd Molar Surgery Alternatives
3rd Molar Surgery Alternatives
bullNo Surgery dentist feels risk benefit ratio not favorable or patient refuses ndash document and recommend radiograph q 3-5 years
bullNo Surgery dentist feels risk benefit ratio not favorable or patient refuses ndash document and recommend radiograph q 3-5 years
No High SpeedNo High Speed
bullAir embolus
bullAir emphysema
bullBlow debris into flap
bullBlow bacteria into flap
bullNon-sterile water
bullAir embolus
bullAir emphysema
bullBlow debris into flap
bullBlow bacteria into flap
bullNon-sterile water
Which are trueWhich are true1 Tooth transplants are usually done on
patients 20-302 Average success rate for a tooth
transplant is 20-303 In order to work a transplant must
have endo4 Most transplants will ankylose
A 13 B 24 C 123 D 3 only
E None of the above
1 Tooth transplants are usually done on patients 20-30
2 Average success rate for a tooth transplant is 20-30
3 In order to work a transplant must have endo
4 Most transplants will ankylose
A 13 B 24 C 123 D 3 only
E None of the above
How can I assess the relationship How can I assess the relationship between the 3between the 3rdrd molar root and the molar root and the
inferior alveolar nerveinferior alveolar nerve
- Slide 2
- Slide 3
- Slide 4
- ldquoSockets with intact buccal and lingual plates heal well without graftinghellip consider grafting with resorbable osteoinductive material if plates compromised and implants plannedrdquo grafting with connective tissue if pontic esthetics an issuerdquo
- Vital Root Retention
- Slide 7
- Slide 8
- Slide 9
- J Oral Maxillofac Surg 2005 Feb43(1)7-12 A randomized controlled clinical trial to compare the incidence of injury to the inferior alveolar nerve as a result of coronectomy and removal of mandibular third molars Renton T Hankins M Sproate C
- Slide 11
- Slide 12
- Immediate Implant Placement Following Extractions
- Platelet Rich Plasma
- Slide 15
- Slide 16
- Slide 17
- Why Reconstruct
- How Autogenous Bone Grafts with Implants
- Autogenous Block Grafts
- Slide 21
- Intra-oral Autogenous Bone Sites
- Slide 23
- What about membranes
- Bone Morphogenic Protein (BMP)
- Slide 26
- Distraction Osteogenesis
- Slide 28
- Wise Old Oral Surgeon Says Beware of
- 3rd Molar Surgery ndash Why
- Extract 3rds OralSystemic Link
- Slide 32
- 3rd Molar Surgery ndash When
- 3rd Molar Surgery ndash When Not
- 3rd Molar Surgery Alternatives
- No High Speed
- Slide 38
- Which are true
- Slide 40
-
Journal of Oral and Maxillofacial Journal of Oral and Maxillofacial SurgerySurgery
Volume 65 Issue 3 March 2007 Pages Volume 65 Issue 3 March 2007 Pages 377-383377-383
Progress Report on Third Molar Clinical Trials Progress Report on Third Molar Clinical Trials Raymond P White Jr DDS PhDRaymond P White Jr DDS PhD
1What happens to asymptomatic patients who keep their 1What happens to asymptomatic patients who keep their third molars third molars
2What is the recovery like for those who have them 2What is the recovery like for those who have them removed and what can we do as surgeons to improve removed and what can we do as surgeons to improve post operative outcomespost operative outcomes
3rd Molar Surgery ndash When3rd Molar Surgery ndash WhenbullBefore roots 100 developed
bullAfter roots 13 formed
bullMorbiditycomplications minimized as bone more flexible nerves more pliable and PMH less complicated
bullDonrsquot forget tooth transplanttooth transplant if apex not closed
bullBefore roots 100 developed
bullAfter roots 13 formed
bullMorbiditycomplications minimized as bone more flexible nerves more pliable and PMH less complicated
bullDonrsquot forget tooth transplanttooth transplant if apex not closed
Outcome of tooth transplantation survival and success rates 17-41 years post treatmentCzochrowska EM Stenvik A Bjercke B Zachrisson Am J Orthod Dentofacial Orthop 2002 Feb121(2)110-9The mean age at surgery was 115 years and the mean observation period was 264 264 years (range 17-41 years) Of the 33 teeth transplanted in the 28 patients 3 teeth were lost after 9 10 and 29 years respectively Therefore the 30 teeth in the 25 patients we examined yielded a survival rate of 90 The success rate was 79 because 2 transplants had ankylosed and 2 others failed to fulfill the proposed criteria The patients generally responded very favorably regarding their perception of the treatment Their only hesitation was related to some discomfort during surgery It was concluded that It was concluded that survival and success rates for teeth auto survival and success rates for teeth auto transplanted when the root is partly developed transplanted when the root is partly developed compare favorably in a long-term perspective compare favorably in a long-term perspective with other treatment modalities for with other treatment modalities for substituting missing teethsubstituting missing teeth
Outcome of tooth transplantation survival and success rates 17-41 years post treatmentCzochrowska EM Stenvik A Bjercke B Zachrisson Am J Orthod Dentofacial Orthop 2002 Feb121(2)110-9The mean age at surgery was 115 years and the mean observation period was 264 264 years (range 17-41 years) Of the 33 teeth transplanted in the 28 patients 3 teeth were lost after 9 10 and 29 years respectively Therefore the 30 teeth in the 25 patients we examined yielded a survival rate of 90 The success rate was 79 because 2 transplants had ankylosed and 2 others failed to fulfill the proposed criteria The patients generally responded very favorably regarding their perception of the treatment Their only hesitation was related to some discomfort during surgery It was concluded that It was concluded that survival and success rates for teeth auto survival and success rates for teeth auto transplanted when the root is partly developed transplanted when the root is partly developed compare favorably in a long-term perspective compare favorably in a long-term perspective with other treatment modalities for with other treatment modalities for substituting missing teethsubstituting missing teeth
3rd Molar Surgery ndash When Not
3rd Molar Surgery ndash When Not
bullExtremes of age
bullNo oral communication (full bony)
bullIntimate root-nerve Relationship
bullRisks gt Benefits
bullExtremes of age
bullNo oral communication (full bony)
bullIntimate root-nerve Relationship
bullRisks gt Benefits
3rd Molar Surgery Alternatives
3rd Molar Surgery Alternatives
bullNo Surgery dentist feels risk benefit ratio not favorable or patient refuses ndash document and recommend radiograph q 3-5 years
bullNo Surgery dentist feels risk benefit ratio not favorable or patient refuses ndash document and recommend radiograph q 3-5 years
No High SpeedNo High Speed
bullAir embolus
bullAir emphysema
bullBlow debris into flap
bullBlow bacteria into flap
bullNon-sterile water
bullAir embolus
bullAir emphysema
bullBlow debris into flap
bullBlow bacteria into flap
bullNon-sterile water
Which are trueWhich are true1 Tooth transplants are usually done on
patients 20-302 Average success rate for a tooth
transplant is 20-303 In order to work a transplant must
have endo4 Most transplants will ankylose
A 13 B 24 C 123 D 3 only
E None of the above
1 Tooth transplants are usually done on patients 20-30
2 Average success rate for a tooth transplant is 20-30
3 In order to work a transplant must have endo
4 Most transplants will ankylose
A 13 B 24 C 123 D 3 only
E None of the above
How can I assess the relationship How can I assess the relationship between the 3between the 3rdrd molar root and the molar root and the
inferior alveolar nerveinferior alveolar nerve
- Slide 2
- Slide 3
- Slide 4
- ldquoSockets with intact buccal and lingual plates heal well without graftinghellip consider grafting with resorbable osteoinductive material if plates compromised and implants plannedrdquo grafting with connective tissue if pontic esthetics an issuerdquo
- Vital Root Retention
- Slide 7
- Slide 8
- Slide 9
- J Oral Maxillofac Surg 2005 Feb43(1)7-12 A randomized controlled clinical trial to compare the incidence of injury to the inferior alveolar nerve as a result of coronectomy and removal of mandibular third molars Renton T Hankins M Sproate C
- Slide 11
- Slide 12
- Immediate Implant Placement Following Extractions
- Platelet Rich Plasma
- Slide 15
- Slide 16
- Slide 17
- Why Reconstruct
- How Autogenous Bone Grafts with Implants
- Autogenous Block Grafts
- Slide 21
- Intra-oral Autogenous Bone Sites
- Slide 23
- What about membranes
- Bone Morphogenic Protein (BMP)
- Slide 26
- Distraction Osteogenesis
- Slide 28
- Wise Old Oral Surgeon Says Beware of
- 3rd Molar Surgery ndash Why
- Extract 3rds OralSystemic Link
- Slide 32
- 3rd Molar Surgery ndash When
- 3rd Molar Surgery ndash When Not
- 3rd Molar Surgery Alternatives
- No High Speed
- Slide 38
- Which are true
- Slide 40
-
3rd Molar Surgery ndash When3rd Molar Surgery ndash WhenbullBefore roots 100 developed
bullAfter roots 13 formed
bullMorbiditycomplications minimized as bone more flexible nerves more pliable and PMH less complicated
bullDonrsquot forget tooth transplanttooth transplant if apex not closed
bullBefore roots 100 developed
bullAfter roots 13 formed
bullMorbiditycomplications minimized as bone more flexible nerves more pliable and PMH less complicated
bullDonrsquot forget tooth transplanttooth transplant if apex not closed
Outcome of tooth transplantation survival and success rates 17-41 years post treatmentCzochrowska EM Stenvik A Bjercke B Zachrisson Am J Orthod Dentofacial Orthop 2002 Feb121(2)110-9The mean age at surgery was 115 years and the mean observation period was 264 264 years (range 17-41 years) Of the 33 teeth transplanted in the 28 patients 3 teeth were lost after 9 10 and 29 years respectively Therefore the 30 teeth in the 25 patients we examined yielded a survival rate of 90 The success rate was 79 because 2 transplants had ankylosed and 2 others failed to fulfill the proposed criteria The patients generally responded very favorably regarding their perception of the treatment Their only hesitation was related to some discomfort during surgery It was concluded that It was concluded that survival and success rates for teeth auto survival and success rates for teeth auto transplanted when the root is partly developed transplanted when the root is partly developed compare favorably in a long-term perspective compare favorably in a long-term perspective with other treatment modalities for with other treatment modalities for substituting missing teethsubstituting missing teeth
Outcome of tooth transplantation survival and success rates 17-41 years post treatmentCzochrowska EM Stenvik A Bjercke B Zachrisson Am J Orthod Dentofacial Orthop 2002 Feb121(2)110-9The mean age at surgery was 115 years and the mean observation period was 264 264 years (range 17-41 years) Of the 33 teeth transplanted in the 28 patients 3 teeth were lost after 9 10 and 29 years respectively Therefore the 30 teeth in the 25 patients we examined yielded a survival rate of 90 The success rate was 79 because 2 transplants had ankylosed and 2 others failed to fulfill the proposed criteria The patients generally responded very favorably regarding their perception of the treatment Their only hesitation was related to some discomfort during surgery It was concluded that It was concluded that survival and success rates for teeth auto survival and success rates for teeth auto transplanted when the root is partly developed transplanted when the root is partly developed compare favorably in a long-term perspective compare favorably in a long-term perspective with other treatment modalities for with other treatment modalities for substituting missing teethsubstituting missing teeth
3rd Molar Surgery ndash When Not
3rd Molar Surgery ndash When Not
bullExtremes of age
bullNo oral communication (full bony)
bullIntimate root-nerve Relationship
bullRisks gt Benefits
bullExtremes of age
bullNo oral communication (full bony)
bullIntimate root-nerve Relationship
bullRisks gt Benefits
3rd Molar Surgery Alternatives
3rd Molar Surgery Alternatives
bullNo Surgery dentist feels risk benefit ratio not favorable or patient refuses ndash document and recommend radiograph q 3-5 years
bullNo Surgery dentist feels risk benefit ratio not favorable or patient refuses ndash document and recommend radiograph q 3-5 years
No High SpeedNo High Speed
bullAir embolus
bullAir emphysema
bullBlow debris into flap
bullBlow bacteria into flap
bullNon-sterile water
bullAir embolus
bullAir emphysema
bullBlow debris into flap
bullBlow bacteria into flap
bullNon-sterile water
Which are trueWhich are true1 Tooth transplants are usually done on
patients 20-302 Average success rate for a tooth
transplant is 20-303 In order to work a transplant must
have endo4 Most transplants will ankylose
A 13 B 24 C 123 D 3 only
E None of the above
1 Tooth transplants are usually done on patients 20-30
2 Average success rate for a tooth transplant is 20-30
3 In order to work a transplant must have endo
4 Most transplants will ankylose
A 13 B 24 C 123 D 3 only
E None of the above
How can I assess the relationship How can I assess the relationship between the 3between the 3rdrd molar root and the molar root and the
inferior alveolar nerveinferior alveolar nerve
- Slide 2
- Slide 3
- Slide 4
- ldquoSockets with intact buccal and lingual plates heal well without graftinghellip consider grafting with resorbable osteoinductive material if plates compromised and implants plannedrdquo grafting with connective tissue if pontic esthetics an issuerdquo
- Vital Root Retention
- Slide 7
- Slide 8
- Slide 9
- J Oral Maxillofac Surg 2005 Feb43(1)7-12 A randomized controlled clinical trial to compare the incidence of injury to the inferior alveolar nerve as a result of coronectomy and removal of mandibular third molars Renton T Hankins M Sproate C
- Slide 11
- Slide 12
- Immediate Implant Placement Following Extractions
- Platelet Rich Plasma
- Slide 15
- Slide 16
- Slide 17
- Why Reconstruct
- How Autogenous Bone Grafts with Implants
- Autogenous Block Grafts
- Slide 21
- Intra-oral Autogenous Bone Sites
- Slide 23
- What about membranes
- Bone Morphogenic Protein (BMP)
- Slide 26
- Distraction Osteogenesis
- Slide 28
- Wise Old Oral Surgeon Says Beware of
- 3rd Molar Surgery ndash Why
- Extract 3rds OralSystemic Link
- Slide 32
- 3rd Molar Surgery ndash When
- 3rd Molar Surgery ndash When Not
- 3rd Molar Surgery Alternatives
- No High Speed
- Slide 38
- Which are true
- Slide 40
-
Outcome of tooth transplantation survival and success rates 17-41 years post treatmentCzochrowska EM Stenvik A Bjercke B Zachrisson Am J Orthod Dentofacial Orthop 2002 Feb121(2)110-9The mean age at surgery was 115 years and the mean observation period was 264 264 years (range 17-41 years) Of the 33 teeth transplanted in the 28 patients 3 teeth were lost after 9 10 and 29 years respectively Therefore the 30 teeth in the 25 patients we examined yielded a survival rate of 90 The success rate was 79 because 2 transplants had ankylosed and 2 others failed to fulfill the proposed criteria The patients generally responded very favorably regarding their perception of the treatment Their only hesitation was related to some discomfort during surgery It was concluded that It was concluded that survival and success rates for teeth auto survival and success rates for teeth auto transplanted when the root is partly developed transplanted when the root is partly developed compare favorably in a long-term perspective compare favorably in a long-term perspective with other treatment modalities for with other treatment modalities for substituting missing teethsubstituting missing teeth
Outcome of tooth transplantation survival and success rates 17-41 years post treatmentCzochrowska EM Stenvik A Bjercke B Zachrisson Am J Orthod Dentofacial Orthop 2002 Feb121(2)110-9The mean age at surgery was 115 years and the mean observation period was 264 264 years (range 17-41 years) Of the 33 teeth transplanted in the 28 patients 3 teeth were lost after 9 10 and 29 years respectively Therefore the 30 teeth in the 25 patients we examined yielded a survival rate of 90 The success rate was 79 because 2 transplants had ankylosed and 2 others failed to fulfill the proposed criteria The patients generally responded very favorably regarding their perception of the treatment Their only hesitation was related to some discomfort during surgery It was concluded that It was concluded that survival and success rates for teeth auto survival and success rates for teeth auto transplanted when the root is partly developed transplanted when the root is partly developed compare favorably in a long-term perspective compare favorably in a long-term perspective with other treatment modalities for with other treatment modalities for substituting missing teethsubstituting missing teeth
3rd Molar Surgery ndash When Not
3rd Molar Surgery ndash When Not
bullExtremes of age
bullNo oral communication (full bony)
bullIntimate root-nerve Relationship
bullRisks gt Benefits
bullExtremes of age
bullNo oral communication (full bony)
bullIntimate root-nerve Relationship
bullRisks gt Benefits
3rd Molar Surgery Alternatives
3rd Molar Surgery Alternatives
bullNo Surgery dentist feels risk benefit ratio not favorable or patient refuses ndash document and recommend radiograph q 3-5 years
bullNo Surgery dentist feels risk benefit ratio not favorable or patient refuses ndash document and recommend radiograph q 3-5 years
No High SpeedNo High Speed
bullAir embolus
bullAir emphysema
bullBlow debris into flap
bullBlow bacteria into flap
bullNon-sterile water
bullAir embolus
bullAir emphysema
bullBlow debris into flap
bullBlow bacteria into flap
bullNon-sterile water
Which are trueWhich are true1 Tooth transplants are usually done on
patients 20-302 Average success rate for a tooth
transplant is 20-303 In order to work a transplant must
have endo4 Most transplants will ankylose
A 13 B 24 C 123 D 3 only
E None of the above
1 Tooth transplants are usually done on patients 20-30
2 Average success rate for a tooth transplant is 20-30
3 In order to work a transplant must have endo
4 Most transplants will ankylose
A 13 B 24 C 123 D 3 only
E None of the above
How can I assess the relationship How can I assess the relationship between the 3between the 3rdrd molar root and the molar root and the
inferior alveolar nerveinferior alveolar nerve
- Slide 2
- Slide 3
- Slide 4
- ldquoSockets with intact buccal and lingual plates heal well without graftinghellip consider grafting with resorbable osteoinductive material if plates compromised and implants plannedrdquo grafting with connective tissue if pontic esthetics an issuerdquo
- Vital Root Retention
- Slide 7
- Slide 8
- Slide 9
- J Oral Maxillofac Surg 2005 Feb43(1)7-12 A randomized controlled clinical trial to compare the incidence of injury to the inferior alveolar nerve as a result of coronectomy and removal of mandibular third molars Renton T Hankins M Sproate C
- Slide 11
- Slide 12
- Immediate Implant Placement Following Extractions
- Platelet Rich Plasma
- Slide 15
- Slide 16
- Slide 17
- Why Reconstruct
- How Autogenous Bone Grafts with Implants
- Autogenous Block Grafts
- Slide 21
- Intra-oral Autogenous Bone Sites
- Slide 23
- What about membranes
- Bone Morphogenic Protein (BMP)
- Slide 26
- Distraction Osteogenesis
- Slide 28
- Wise Old Oral Surgeon Says Beware of
- 3rd Molar Surgery ndash Why
- Extract 3rds OralSystemic Link
- Slide 32
- 3rd Molar Surgery ndash When
- 3rd Molar Surgery ndash When Not
- 3rd Molar Surgery Alternatives
- No High Speed
- Slide 38
- Which are true
- Slide 40
-
3rd Molar Surgery ndash When Not
3rd Molar Surgery ndash When Not
bullExtremes of age
bullNo oral communication (full bony)
bullIntimate root-nerve Relationship
bullRisks gt Benefits
bullExtremes of age
bullNo oral communication (full bony)
bullIntimate root-nerve Relationship
bullRisks gt Benefits
3rd Molar Surgery Alternatives
3rd Molar Surgery Alternatives
bullNo Surgery dentist feels risk benefit ratio not favorable or patient refuses ndash document and recommend radiograph q 3-5 years
bullNo Surgery dentist feels risk benefit ratio not favorable or patient refuses ndash document and recommend radiograph q 3-5 years
No High SpeedNo High Speed
bullAir embolus
bullAir emphysema
bullBlow debris into flap
bullBlow bacteria into flap
bullNon-sterile water
bullAir embolus
bullAir emphysema
bullBlow debris into flap
bullBlow bacteria into flap
bullNon-sterile water
Which are trueWhich are true1 Tooth transplants are usually done on
patients 20-302 Average success rate for a tooth
transplant is 20-303 In order to work a transplant must
have endo4 Most transplants will ankylose
A 13 B 24 C 123 D 3 only
E None of the above
1 Tooth transplants are usually done on patients 20-30
2 Average success rate for a tooth transplant is 20-30
3 In order to work a transplant must have endo
4 Most transplants will ankylose
A 13 B 24 C 123 D 3 only
E None of the above
How can I assess the relationship How can I assess the relationship between the 3between the 3rdrd molar root and the molar root and the
inferior alveolar nerveinferior alveolar nerve
- Slide 2
- Slide 3
- Slide 4
- ldquoSockets with intact buccal and lingual plates heal well without graftinghellip consider grafting with resorbable osteoinductive material if plates compromised and implants plannedrdquo grafting with connective tissue if pontic esthetics an issuerdquo
- Vital Root Retention
- Slide 7
- Slide 8
- Slide 9
- J Oral Maxillofac Surg 2005 Feb43(1)7-12 A randomized controlled clinical trial to compare the incidence of injury to the inferior alveolar nerve as a result of coronectomy and removal of mandibular third molars Renton T Hankins M Sproate C
- Slide 11
- Slide 12
- Immediate Implant Placement Following Extractions
- Platelet Rich Plasma
- Slide 15
- Slide 16
- Slide 17
- Why Reconstruct
- How Autogenous Bone Grafts with Implants
- Autogenous Block Grafts
- Slide 21
- Intra-oral Autogenous Bone Sites
- Slide 23
- What about membranes
- Bone Morphogenic Protein (BMP)
- Slide 26
- Distraction Osteogenesis
- Slide 28
- Wise Old Oral Surgeon Says Beware of
- 3rd Molar Surgery ndash Why
- Extract 3rds OralSystemic Link
- Slide 32
- 3rd Molar Surgery ndash When
- 3rd Molar Surgery ndash When Not
- 3rd Molar Surgery Alternatives
- No High Speed
- Slide 38
- Which are true
- Slide 40
-
3rd Molar Surgery Alternatives
3rd Molar Surgery Alternatives
bullNo Surgery dentist feels risk benefit ratio not favorable or patient refuses ndash document and recommend radiograph q 3-5 years
bullNo Surgery dentist feels risk benefit ratio not favorable or patient refuses ndash document and recommend radiograph q 3-5 years
No High SpeedNo High Speed
bullAir embolus
bullAir emphysema
bullBlow debris into flap
bullBlow bacteria into flap
bullNon-sterile water
bullAir embolus
bullAir emphysema
bullBlow debris into flap
bullBlow bacteria into flap
bullNon-sterile water
Which are trueWhich are true1 Tooth transplants are usually done on
patients 20-302 Average success rate for a tooth
transplant is 20-303 In order to work a transplant must
have endo4 Most transplants will ankylose
A 13 B 24 C 123 D 3 only
E None of the above
1 Tooth transplants are usually done on patients 20-30
2 Average success rate for a tooth transplant is 20-30
3 In order to work a transplant must have endo
4 Most transplants will ankylose
A 13 B 24 C 123 D 3 only
E None of the above
How can I assess the relationship How can I assess the relationship between the 3between the 3rdrd molar root and the molar root and the
inferior alveolar nerveinferior alveolar nerve
- Slide 2
- Slide 3
- Slide 4
- ldquoSockets with intact buccal and lingual plates heal well without graftinghellip consider grafting with resorbable osteoinductive material if plates compromised and implants plannedrdquo grafting with connective tissue if pontic esthetics an issuerdquo
- Vital Root Retention
- Slide 7
- Slide 8
- Slide 9
- J Oral Maxillofac Surg 2005 Feb43(1)7-12 A randomized controlled clinical trial to compare the incidence of injury to the inferior alveolar nerve as a result of coronectomy and removal of mandibular third molars Renton T Hankins M Sproate C
- Slide 11
- Slide 12
- Immediate Implant Placement Following Extractions
- Platelet Rich Plasma
- Slide 15
- Slide 16
- Slide 17
- Why Reconstruct
- How Autogenous Bone Grafts with Implants
- Autogenous Block Grafts
- Slide 21
- Intra-oral Autogenous Bone Sites
- Slide 23
- What about membranes
- Bone Morphogenic Protein (BMP)
- Slide 26
- Distraction Osteogenesis
- Slide 28
- Wise Old Oral Surgeon Says Beware of
- 3rd Molar Surgery ndash Why
- Extract 3rds OralSystemic Link
- Slide 32
- 3rd Molar Surgery ndash When
- 3rd Molar Surgery ndash When Not
- 3rd Molar Surgery Alternatives
- No High Speed
- Slide 38
- Which are true
- Slide 40
-
No High SpeedNo High Speed
bullAir embolus
bullAir emphysema
bullBlow debris into flap
bullBlow bacteria into flap
bullNon-sterile water
bullAir embolus
bullAir emphysema
bullBlow debris into flap
bullBlow bacteria into flap
bullNon-sterile water
Which are trueWhich are true1 Tooth transplants are usually done on
patients 20-302 Average success rate for a tooth
transplant is 20-303 In order to work a transplant must
have endo4 Most transplants will ankylose
A 13 B 24 C 123 D 3 only
E None of the above
1 Tooth transplants are usually done on patients 20-30
2 Average success rate for a tooth transplant is 20-30
3 In order to work a transplant must have endo
4 Most transplants will ankylose
A 13 B 24 C 123 D 3 only
E None of the above
How can I assess the relationship How can I assess the relationship between the 3between the 3rdrd molar root and the molar root and the
inferior alveolar nerveinferior alveolar nerve
- Slide 2
- Slide 3
- Slide 4
- ldquoSockets with intact buccal and lingual plates heal well without graftinghellip consider grafting with resorbable osteoinductive material if plates compromised and implants plannedrdquo grafting with connective tissue if pontic esthetics an issuerdquo
- Vital Root Retention
- Slide 7
- Slide 8
- Slide 9
- J Oral Maxillofac Surg 2005 Feb43(1)7-12 A randomized controlled clinical trial to compare the incidence of injury to the inferior alveolar nerve as a result of coronectomy and removal of mandibular third molars Renton T Hankins M Sproate C
- Slide 11
- Slide 12
- Immediate Implant Placement Following Extractions
- Platelet Rich Plasma
- Slide 15
- Slide 16
- Slide 17
- Why Reconstruct
- How Autogenous Bone Grafts with Implants
- Autogenous Block Grafts
- Slide 21
- Intra-oral Autogenous Bone Sites
- Slide 23
- What about membranes
- Bone Morphogenic Protein (BMP)
- Slide 26
- Distraction Osteogenesis
- Slide 28
- Wise Old Oral Surgeon Says Beware of
- 3rd Molar Surgery ndash Why
- Extract 3rds OralSystemic Link
- Slide 32
- 3rd Molar Surgery ndash When
- 3rd Molar Surgery ndash When Not
- 3rd Molar Surgery Alternatives
- No High Speed
- Slide 38
- Which are true
- Slide 40
-
Which are trueWhich are true1 Tooth transplants are usually done on
patients 20-302 Average success rate for a tooth
transplant is 20-303 In order to work a transplant must
have endo4 Most transplants will ankylose
A 13 B 24 C 123 D 3 only
E None of the above
1 Tooth transplants are usually done on patients 20-30
2 Average success rate for a tooth transplant is 20-30
3 In order to work a transplant must have endo
4 Most transplants will ankylose
A 13 B 24 C 123 D 3 only
E None of the above
How can I assess the relationship How can I assess the relationship between the 3between the 3rdrd molar root and the molar root and the
inferior alveolar nerveinferior alveolar nerve
- Slide 2
- Slide 3
- Slide 4
- ldquoSockets with intact buccal and lingual plates heal well without graftinghellip consider grafting with resorbable osteoinductive material if plates compromised and implants plannedrdquo grafting with connective tissue if pontic esthetics an issuerdquo
- Vital Root Retention
- Slide 7
- Slide 8
- Slide 9
- J Oral Maxillofac Surg 2005 Feb43(1)7-12 A randomized controlled clinical trial to compare the incidence of injury to the inferior alveolar nerve as a result of coronectomy and removal of mandibular third molars Renton T Hankins M Sproate C
- Slide 11
- Slide 12
- Immediate Implant Placement Following Extractions
- Platelet Rich Plasma
- Slide 15
- Slide 16
- Slide 17
- Why Reconstruct
- How Autogenous Bone Grafts with Implants
- Autogenous Block Grafts
- Slide 21
- Intra-oral Autogenous Bone Sites
- Slide 23
- What about membranes
- Bone Morphogenic Protein (BMP)
- Slide 26
- Distraction Osteogenesis
- Slide 28
- Wise Old Oral Surgeon Says Beware of
- 3rd Molar Surgery ndash Why
- Extract 3rds OralSystemic Link
- Slide 32
- 3rd Molar Surgery ndash When
- 3rd Molar Surgery ndash When Not
- 3rd Molar Surgery Alternatives
- No High Speed
- Slide 38
- Which are true
- Slide 40
-
How can I assess the relationship How can I assess the relationship between the 3between the 3rdrd molar root and the molar root and the
inferior alveolar nerveinferior alveolar nerve
- Slide 2
- Slide 3
- Slide 4
- ldquoSockets with intact buccal and lingual plates heal well without graftinghellip consider grafting with resorbable osteoinductive material if plates compromised and implants plannedrdquo grafting with connective tissue if pontic esthetics an issuerdquo
- Vital Root Retention
- Slide 7
- Slide 8
- Slide 9
- J Oral Maxillofac Surg 2005 Feb43(1)7-12 A randomized controlled clinical trial to compare the incidence of injury to the inferior alveolar nerve as a result of coronectomy and removal of mandibular third molars Renton T Hankins M Sproate C
- Slide 11
- Slide 12
- Immediate Implant Placement Following Extractions
- Platelet Rich Plasma
- Slide 15
- Slide 16
- Slide 17
- Why Reconstruct
- How Autogenous Bone Grafts with Implants
- Autogenous Block Grafts
- Slide 21
- Intra-oral Autogenous Bone Sites
- Slide 23
- What about membranes
- Bone Morphogenic Protein (BMP)
- Slide 26
- Distraction Osteogenesis
- Slide 28
- Wise Old Oral Surgeon Says Beware of
- 3rd Molar Surgery ndash Why
- Extract 3rds OralSystemic Link
- Slide 32
- 3rd Molar Surgery ndash When
- 3rd Molar Surgery ndash When Not
- 3rd Molar Surgery Alternatives
- No High Speed
- Slide 38
- Which are true
- Slide 40
-