Nothing is good as what nature gave us. As implant dentists, we can easily adopt a God complex, believing that we have the power to restore the mouth beyond the imaginable.
In reality, we work hard to achieve what was originally present in terms of function and aesthetics. Respecting the foundations of healthy hard and soft tissue and maintaining these where possible will lead us to better and more predictable long-term results.
A number of factors play a role in ridge preservation including patient selection (history, treatment planning), anatomy, biology of healing, extraction technique and sequelae, and use of grafting materials. I have found that the most predictable results are gained by combining an atraumatic extraction technique and ridge preservation at the time of extraction. In terms of the extraction, I opt to lift a flap, section multi-rooted teeth, and remove as little buccal and furcation bone as possible. Understanding of the physiology of bony healing is paramount. In cases where the bone is well vascularised and the roots were short or narrow, there should be a sufficient bony framework for healing. However, when the bone is poorly vascularised, the defect is large, or there is infection, the area is susceptible to necrosis and collapse. In these cases, I preventatively place bony granules to preserve the ridge as much as possible.
In cases where the ridge is not preserved or bony defects occur, ridge augmentation by means of grafting is required. Ridge augmentation serves three major objectives – function, aesthetics and prognosis. Functionally, we hope to create a volume of vital bone that will support the dental implant. Aesthetically, there needs to be sufficient bone to support the soft tissue. In terms of prognosis, we must establish an adequate volume of bone coronally. As a practitioner, I have had many years of success using the botiss system – bone and tissue regeneration biomaterials. These products have been developed over many years to suit a variety of surgical scenarios. For me, the Botiss system has provided ease of use along with a reassurance that I am delivering materials that are reliable and predictable. By creating a strong healthy foundation, I am confident that this system gives me the best opportunity for long-term dental implant success.
The Northumberland Institute of Dental Medicine
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