Effective Management of an Extraction Site

In this video from the EAO, Dr. Gustavo Avila-Ortiz discusses the key considerations for effective management of an extraction site, including a deep-dive review of all aspects of alveolar ridge preservation.

In this video from the EAO, Dr. Gustavo Avila-Ortiz discusses the key considerations for effective management of an extraction site, including a deep-dive review of all aspects of alveolar ridge preservation.

Main topics include:

  • Minimally traumatic tooth extraction: what is your goal?
  • Assessment of the extraction site, both phenotype and integrity
  • Immediate implant placement: When is it indicated? Is buccal bone thickness a predictor?
  • The choice between alveolar ridge preservation or reconstruction? What materials are are best used in each procedure?

Some key questions that are addressed for alveolar ridge preservation :

  • What are the dimensional changes of the alveolar ridge after tooth extraction and unassisted socket healing? 2
  • What can be done to attenuate alveolar bone remodeling when a tooth is indicated for extraction?
  • What is the effectiveness of  alveolar ridge preservation compared to unassisted socket healing?3

1. Tonetti MS, Jung RE, Avila-Ortiz G, Blanco J, Cosyn J, Fickl S, Figuero E, Goldstein M, Graziani F, Madianos P, Molina A, Nart J, Salvi GE, Sanz-Martin I, Thoma D, Van Assche N, Vignoletti F. Management of the extraction socket and timing of implant placement: Consensus report and clinical recommendations of group 3 of the XV European Workshop in Periodontology. J Clin Periodontol. 2019 Jun;46 Suppl 21:183-194. doi: 10.1111/jcpe.13131. PMID: 31215112.

Four systematic reviews covering the areas of alveolar ridge preservation/bone grafting, immediate early and delayed implant placement and alveolar bone augmentation at the time of implant placement in a healed ridge formed the basis of the deliberations. The level of evidence supporting each consensus statement and its strength was described using a modification of the GRADE tool.

2. Couso-Queiruga E, Stuhr S, Tattan M, Chambrone L, Avila-Ortiz G. Post-extraction dimensional changes: A systematic review and meta-analysis. J Clin Periodontol. 2021 Jan;48(1):126-144. doi: 10.1111/jcpe.13390. Epub 2020 Nov 4. PMID: 33067890.

A variable amount of alveolar bone resorption occurs after unassisted socket healing depending on tooth type.

3. Avila-Ortiz G, Chambrone L, Vignoletti F. Effect of alveolar ridge preservation interventions following tooth extraction: A systematic review and meta-analysis. J Clin Periodontol. 2019 Jun;46 Suppl 21:195-223. doi: 10.1111/jcpe.13057. Erratum in: J Clin Periodontol. 2020 Jan;47(1):129. doi: 10.1111/jcpe.13212. PMID: 30623987.

The aim of this systematic review was to critically analyse the available evidence on the effect of different modalities of alveolar ridge preservation (ARP) as compared to tooth extraction alone in function of relevant clinical, radiographic and patient-centred outcomes.

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