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Flashcards in maozsfjbvpaw midterm Deck (36)
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1

Ideal Graft Material (5)

• Confirmed via biopsy

• Osteoinductive
o Turns on patients bone growing cells
o Ex. BMP (but v expensive)

• Osteoconductive
o Grows onto bone
o Ex. Cow bone

• Caution
o Infection or disease transmission
o Mad cow disease via prions
o Can use HIV bone because pt undergoes purifying process

• C-Graft
o Derived from calcified marine algae
o 15+ years of clinical success
o Successful bone regeneratin, porosity, absorption, resorption

2

When to Graft

When to Graft
• Thin labial plate
• Missing labial plate
• DO NOT graft if buccal plate is solid and 3 mm

3

Risk of chin bone graft

teeth because apex is
disturbed

4

BTP? brands?

Beta Tricalcium Phosphate

1) synthograft
2) cerasorb
3) graftek

5

what is Beta Tricalcium Phosphate?

o Completely resorbed without any residue
o Replaced by natural, vital bone
o Process takes about 3-24 months depending on type of bone
(desmal/chondral)

6

What is GEM 21S?

o Combo of bioactive protein (highly purified recombinant
human platelet derived growth factor) and biocompatible
osteoconductive matrix
o Has 1000x more growth factor than in platelet rich plasma
o Provides 3x more bone fill at 6 mo
o Provides a more predictable treatment option even in severe cases

7

Demineralized Freeze Dried Bone Allograft (DFDBA)

• Cadaver bone that has gone thru gamma radiation
• From accredited tissue banks
• Most popular at school

8

Vital Root Retention indication?

o NEVER OUR FIRST CHOICE
o Option for preserving alveolar bone for FMTE in young
patients
o Teeth must be vital with good perio health

9

Vital Root Retention Procedure

o Amputate tooth at crest
o Remove 2 mm more (sub-osseous)
o New bone grows over top of vital, asymptomatic root
o Can graft autogenous bone over tooth

**lasts 3-5 years

10

Coronectomy

• Indications -When roots of 3M are close to lingual nerve or IAN

• Results -Does not increase the risk of dry socket or infection

11

Immediate Implant Placement Following Extractions
1) requirments
2) sites
3) advatages

1) 3-4 mm SOLID bone at base of socket; No active infection

2) anterior teetha nd 1 PM

3) Success rates ~ normal; MAY reduce loss of labial plate; MAY improve esthetics; MAY save time

12

Platelet Rich Plasma Advantages

o Release growth factors that aid in hemostasis
o Increase rate of healing (mitogenesis, angiogenesis)

13

Platelet Rich Plasma DisAdvantages

o Cost
o Heals faster NOT better
o Invasive, borrow 45-90mL of blood

14

Indications for alveolar bone reconstruction?

When bone is taken from iliac crest or ribs (autogenous)

o Not enough bone for implant
o Enough bone but suboptimal esthetics
o Prevents pathologic fracture
o Poor function/esthetics/retention of conventional removable
prosthesis

15

what is the gold standard graft?

Autogenous Block Graft

16

Autogenous Block Graft Advantages

o Osteoinductive AND osteoconductive
o No need for membranes
o Holds form
o Remodels into 100% high quality bone
o No concerns about transmissible diseases

17

Autogenous Block Graft DisAdvantages

o Donor site morbidity
o Quantity is limited
o Lose 20-30% during healing

18

Membrane Advantages

o Contain particulate grafts
o Useful around teeth/exposed implant threads

19

Membrane DisAdvantages

o Add expense
o Infection risk

20

BMP (Bone morphogenetic proteins)

FDA approved types:
1. BMP2 – spinal fusions
2. BMP 7 – long bone defects

21

Decoronation

• In younger patients
• Remove crown of akylosed teeth and endo treat
• Kid wears flipper for many years

22

Distraction Osteogenesis used for?

Hemifacial microsomia and Pierre Roban Syndrome

23

Distraction Osteogenesis

• Generation of bone (and soft tissue) through “distraction” of
osseous callus

• Done by orthodontists via rapid palatal expansion

• The procedure was first proposed by Bernhard von Langenbeck in
1869, but the first publication of

24

NSAIDS Role

Inhibit COX activity and Reduce pain

25

NSAIDS Problems

1) Selective COX-2 inhibitors delay allograft healing and incorporation
2) COX-2 is essential for allografts à COX-2 dependent prostaglandins aid in skeletal repair at early stage of healing

26

Oral-Antral Communication GOAL

Prevent fistula from forming (epithelial lined tract from one part of the body to another – a chronic, healed, defect)

27

Oral-Antral Communication Classification

0-2 mm : No specific treatment

3-5 mm : Close socket (3-0 Silk)

> 5 mm : Obtain primary closure-advance flap

28

Oral-Antral Communication Preventative Measures

1. No smoking
2. Use amoxicillin or afrin nasal spray to prevent infection
3. OBTAIN PRIMARY CLOSURE THAT DAY
4. Don’t blow nose

29

Oral-Antral Communication close via

Obliteration of vestibule OR Palatal approach

30

Root Tip in Sinus

Will always have an O-A communication – treat accordingly
* <5 mm and unifected = usually not a problem, leave it
* DO NOT enlarge hole in attempt to retrieve !!
* Try saline irrigation and suction
* >5 mm and infected = Caldwell Luc

31

BEWARE OF 3rd MOLARS

• 3rd molars in function
• 3rd molars in post-menopausal women
• Lone standing molars
• Teeth in bruxers ( class 3 skeletal patterns)
• Prior TMD history
• Prior “bad” oral surgery experience
• Distoangular 3rds (nerve proximity)

32

3rd Molar Surgery Why?

o Prevent/treat pericoronitis (infection)
o Prevent periodontal problems 2nd molar
o Prevent/treat caries to 2nd 3rd molar
o Prevent odontogenic cysts/tumors
o Strengthen mandible and decrease possible Fx
o Prevent ortho relapse (crock of shit)
o Treat pain of unknown origin – do diagnostic nerve block with Marcaine

33

3rd Molar Surgery When?

o Before roots are 100% developed
o After roots are 1/3 formed
o Can do a tooth transplant if apex is open!!

34

3rd Molar Surgery classification

o Mesio-angle impaction = most common
o Vertical impaction
o Horizontal impaction = most dangerous
o Disto-angle impaction = least common

35

3rd Molar Surgery when NOT to?

o Extremes of age
o No oral communication
o Intimate nerve-root relationship
o Risks outweigh benefits

36

IAN Damage

0.5-1% = permanent damage
5-7% temporary damage
IF root touching nerve = 30% damage