4.2 Clinical Concept
Extraction planning
Background information
Myron Nevins:
«Maxillary anterior teeth with prominent roots have thin buccal bone plates. In such situations there is a higher risk for resorption of these buccal plates in the first months after
tooth extraction. At time of implantation complex bone and soft tissue augmentation procedures are then required to achieve acceptable functional and esthetic results. Therefore
our goal is to preserve the buccal bone plate and prevent its resorption after extraction.»
Insufficient soft tissue
Soft tissue evaluation
Case with massive loss of
hard and soft tissue.
Soft tissue grafting needs
to be performed prima-
2. Aims of the therapy
> Preservation of the buccal bone plate, so that there is an optimal situation regarding hard and
soft tissue during the following implantation procedure.
Sufficient soft tissue
Insufficient bone walls:
thin or missing
3. Concept Prof. Myron Nevins
Soft tissue grafting
Aveolar ridge evaluation
Sufficient bone walls
> Preservation of thin buccal bone plates after extraction of teeth with prominent roots by placing Bio-Oss® granules in the sockets.
Socket grafting with Bio-Oss® to prevent bone resorption
Filling in of Bio-Oss® prevents resorption of the buccal bone plate
Spontaneous healing
Sockets with thin buccal walls are filled with Bio-Oss®.
Fig A CT-Scan after filling Bio-Oss® into the
fresh extraction socket. Fig B CT-Scan 60
days later. The bone contour has been maintained.
Bone wall resorption
Situation after tooth extraction (left). Within a clinical study, control sockets were left untreated, while test sockets were filled with Bio-Oss® (middle). Complete, primary wound
closure (right). Study Nevins et al. Case by Raffaele Cavalcanti.
Fig A
Fig B
4. Surgical Procedure / Clinical Aspects
Sufficient bone walls
4.1 Clinical problem: Bone resorption
Case of a patient with severe pocket formation (left). Without any treatment the buccal
bone wall was lost completely after tooth extraction (right).
Prominent roots have very thin buccal bone plates which often resorb after extraction
Fenestration
or dehiscence
Implant placement
Bone augmentation necessary,
often with block graft
No fenestration or
dehiscence
Fig 3a
Fig 1 Cadaver model of prominent roots
Fig 2 CT-Scan of a patient 28 days after extraction of 4 prominent roots: Thin buccal
bone plates resorb and are hardly visible
anymore.
2
Fig 3b
Fig 3a CT-Scan of a patient after extraction of teeth
with prominent roots. Fig 3b CT-Scan of the same
patient 60 days later: The buccal plate is lost and this
will result in a compromised implant position.
Guided bone
regeneration
o.k.
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