Periodontic Specialty Catalog - September 2013 - (Page 28)

BONE GRAFTING BONE GRAFTING ESSENTIALS Bone Grafting Essentials—A Periodontist’s Clinical Perspective by Dr. Karl Zeren, DDS As a periodontist in private practice for more than 30 years, I see patients on a daily basis that can benefit from bone augmentation grafting. Socket grafting, for example, is a routine occurrence in my practice, as is ridge augmentation needed prior to implant placement. I perform these procedures several times a week to optimize the clinical outcomes for my patients and the restorative doctors. Karl Zeren, DDS is a practicing Periodontist from Timonium, MD. One question that is frequently raised is whether or not bone grafting is necessary or beneficial, in particular for extraction sockets. Extensive historical and current research shows that there is a significant risk of substantial loss of alveolar bone both in a horizontal and vertical dimension during the first few months post extraction if a graft is not placed. In my experience, one can anticipate upwards of 30% loss of the buccal plate bone volume within the first few months post extraction, and 1-2 mm of vertical loss. From my perspective, there is no longer any doubt that bone grafting for ridge preservation is a safe, effective, and highly predictable procedure which is supported by research. The range of bone grafting materials currently available is quite extensive, and the need for autogenous bone grafts can and should be limited due to the inherent donor site trauma and a high predictability of success with allografts. The array of allograft materials and barrier membranes that are available provide a rich resource for bone regeneration. For most clinical procedures, my preference is the use of a mineralized cortical bone allograft such as alloOss, frequently coupled with biologic modifiers, also used with a containing barrier membrane such as RCM6. One consideration in using grafting materials is their handling characteristics. If you simply take a particulate material—whether mineralized or demineralized bone; allograft or xenograft—delivery to a graft site can be difficult. When these materials are combined with saline, local anesthetic or a biologic modifier delivery becomes easier. Extraction site regeneration (socket preservation) The most common bone grafting procedure performed in my practice is extraction site regeneration. Based upon the extensive research in this area, I routinely graft extraction sites for every patient except when the patient declines this procedure. Mineralized cortical bone allograft material has been shown to be a good material for grafting sites which are intended for later implant placement. The space maintaining capability of the cortical materials tends to show a more predictable treatment outcome than the cancellous materials, although either material produces a predictable regenerative outcome. Once an extraction socket has been filled with allograft material level to the adjacent crestal bone, a containing barrier is necessary. In the anterior portion of the mouth, a collagen plug such as RCP can be used to seal the socket, and in the molar sites, a collagen barrier membrane tends to produce a more effective result for this environment (Figs. 1–3). The gingival biotype and quantity of tissue available needs to be assessed as one determines the use of one type of barrier versus another. In sites not planned for subsequent implant placement, using a collagen material imbedded with a xenograft such as NuOss tends to minimize the extent of alveolar resorption and assist in the preservation of the alveolar housing (Fig. 4). Figure 1. Site of atraumatic extraction of root, performed after flap elevation Figure 3. Placement of collagen barrier 28 Figure 2. Placement of mineralized cortical bone allograft In situations where there is a poorly contained extraction site where the buccal or lingual walls have been lost, a nonresorbable barrier membrane should be considered. Frequently, the use of titanium reinforcement will assist in both making and maintaining space which is necessary for the regeneration of the alveolar housing. These barrier membranes are also essential to maintain a graft material in the defect. Clinical research strongly supports a closed system when these large uncontained defects are encountered, although some current research utilizing bone proteins suggests this may not always be necessary. Figure 4. Suturing of grafted site To Order: 1-877-460-5900 8am–9pm (et) • To Fax: 1-800-732-7023 24 Hours

Table of Contents for the Digital Edition of Periodontic Specialty Catalog - September 2013

Periodontic Specialty Catalog - September 2013
Table of Contents
Henry Schein Dental Your Trusted Partner
Anesthesia Supplies
Bone Grafting Essentials Article by Dr. Karl Zeren, DDS
Bone Grafting
Educational Products
Emergency Products
Equipment & Technology
Henry Schein Brand
Implants & Accessories
Impression Materials
Infection Control
IV Administration
Patient Aftercare
Periodontal Dressings
Power Scaling
Practice Marketing
Practice Solutions
Rotary Instruments
Software Solutions
Surgical Units & Handpieces
Syringes & Needles
Terms of Sale

Periodontic Specialty Catalog - September 2013