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
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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
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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
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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
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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
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what is the gold standard graft?
Autogenous Block Graft
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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
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Autogenous Block Graft DisAdvantages
o Donor site morbidity
o Quantity is limited
o Lose 20-30% during healing
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Membrane Advantages
o Contain particulate grafts
o Useful around teeth/exposed implant threads
19
Membrane DisAdvantages
o Add expense
o Infection risk
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BMP (Bone morphogenetic proteins)
FDA approved types:
1. BMP2 – spinal fusions
2. BMP 7 – long bone defects
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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
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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
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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
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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
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Oral-Antral Communication close via
Obliteration of vestibule OR Palatal approach
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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
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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
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3rd Molar Surgery when NOT to?
o Extremes of age
o No oral communication
o Intimate nerve-root relationship
o Risks outweigh benefits
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