Extraction of Tooth #19 and Ridge Preservation

This case video from Jay B. Reznick, D.M.D., M.D. shows the extraction of tooth #19 followed by ridge preservation grafting. The case involved an 88 year old female, who a week and half prior had lost the PFM crown on tooth #19. Upon examination, her general dentist noticed recurrent decay under the prosthesis, and referred the patient to an endodontist for a root canal. However, in the endodontist’s opinion, the tooth was not restorable and the patient was refered for extraction of the tooth and replacement with a dental implant.

Watch the Video and Leave Your Comments/Questions Below

**Background** Now the dental implants are the standard of care for replacing a missing tooth and especially a single tooth after extraction, we have to modify our technique for how we manage the socket after extraction. Previously, once the tooth was removed we simply curretted out the site and were done. Currently, if we are not going to place the implant immediately upon extraction, we now find ourselves preparing the site for the implant placement a few months down the road. To do this we need to maximize the amount of bone volume that will be available. This is accomplished via ridge preservation grafting. Once the tooth is extracted the ridge resorption begins and by grafting, we minimize the amount of resorption of the ridge so that when we place the implant we will have the maximum amount of bone volume to support the implant in the edentulous space.

11 Comments on Extraction of Tooth #19 and Ridge Preservation

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David Stall
7/29/2016
Excellent video.
Brian
7/29/2016
Agreed, fantastic video.
Jay Reznick
7/29/2016
Thanks. We have another 20 hours of videos on our educational website OnlineOralSurgery.com
Jake Salmond
7/29/2016
Great video. Good lesson
Amit Binderman
8/2/2016
Dr. Reznick, really great video. Beautifully shot and explained. One thing I would raise for your consideration as an additional option in such cases is to have used the two roots for autologous graft. Especially in the case of an elderly patient such as the one treated. The two roots that were extracted would have produced approximately 2cc of autologous graft using the Smart Dentin Grinder device. Any decay is easily eliminated by the protocol and you end up with bacteria free graft within 15 minutes. As you know, autologous dentin graft would undergo ankylosis with the site bone and would promote excellent healing and socket preservation. Again, just another option that is now available to you.
mark barr
8/2/2016
just curious about the necrotic bacterial-ridden radicular pulp tissue within the roots of the abscessed tooth? Would that not infect the socket? or does the Smart Dentin Grinder reduce those litl critters and associated endotoxins to smithereens and render them non-viable?
osseonews
8/2/2016
We have discussed the dentin graft on other posts. Please refer to those for a full discussion and add comments there. Thanks. Below is a list. https://www.osseonews.com/dentin-graft-healing-6-weeks/ https://www.osseonews.com/dentin-graft/ https://www.osseonews.com/bonmaker-using-patients-teeth-make-bone-graft/
Amit Binderman
8/2/2016
Great question. The Smart Dentin Grinder protocol has a step where a "detergient" is used in order to eliminate all bacterial elements. At the same time this substance does not effect the natural GFs and BMPs that naturally exist in dentin and are responsible for the predictable results we are getting. So the dentin graft output is clean and safe.
Dr ATC
8/4/2016
Do you give pain medication on your standard protocol, great video.
Jay Reznick
8/4/2016
I usually have patients take ibuprofen 600mg TID for the first 3 days (unless they cannot take NSAIDs). This keeps them very comfortable most of the time. I also give them a prescription for a back-up pain medication- usually Ultracet.
Dr S B Sethurajan
8/30/2016
Great video

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