Maryland AGD AE and Socket Grafting. Advanced Implant Mentoring Rob D Orazio, DDS. Day 1 Morning 1

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3 advancedimplantmentoring.com Page3

4 7:30am 8:00am Continental Breakfast & Registration 8:00am 9:30am Lecture- Effects of Tooth Loss on Bone -Site Preservation and Augmentation 9:30am 9:45am Break 9:45am 11:30 Lecture-Atraumatic Extractions and Instrumentation 11:30pm Noon Lunch Noon 1:15pm Hands On: Preservation & Site Augmentation 1:15pm 1:30pm Break 1:30pm 3:00pm Lecture- Soft Tissue Management - Site Preservation and Dental Implants 3:00pm 4:00 pm Question & Answer session Course Evaluations and CE Validation Page4

5 Cancellous, Trabecular, Medullary, Spongy Cortical Plate Page5

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7 Poor Performing Prostheses Consequences Natural teeth exhibit a biting force of 450 pounds per square inch (psi) Dentures exhibit a maximum biting force of 50 psi 15 year old dentures exhibit as little as 5 psi 28% of denture wearers take medication for gastrointestinal disorders 50% of denture wearers avoid some types of foods due to an inability to chew them Anatomic Esthetic Consequences Collapsed vertical dimension appears Prognathic appearance develops Loss of muscle tone causing sagging lip structure Smile line concavities under pontics Only 35% of patients wear their distal extension partial denture after 10 years 20% of patients wear only one prosthesis at a time 7% of patients don t wear their full or partial dentures at all! This poor performance leads to a decreased quality of life Page7

8 The literature shows that edentulism leads to a decreased quality of life Nutrition Psychological Comfort Communication Employment Appearance BONE LOSS Bone Loss Over Time B o n e V o l u m e A B C-w C-h D Time in Years Page8

9 Consumer awareness surveys conducted from 1999 through 2002 concluded that 63% of patients who refused bone grafting and implant treatment options would have accepted had they simply known about bone resorption and the fact that bone grafting and dental implants prevents bone loss from occurring. Neil Park DDS CDA White Paper Tooth loss reduces bone DENSITY and bone VOLUME This is what the public knows as BONE RESORPTION Maxillary and mandibular bone structure progressively weakens as the teeth are lost Vascularity of bone is altered with less cancellous (trabecular) bone being present Healing times will vary due to the volume and density changes Mechanical stresses may increase due to bone loss Phonetics and function may vary due to bone loss Page9

10 Misch Classification For common nomenclature Assesses the density of the Trabecular Bone Assesses the ratio of Cortical/Trabecular Bone Also known as Bone Type Type I D-I Type II D-II Type III D-III Type IV D- IV Page10

11 Note The thin buccal cortical plates from the 1st bicuspid to the central incisors. Page11

12 Within 6 months Class A Class D 1 year 4 yrs 10 yrs Class B Class B-wClass C 12 yrs 20+yrs Class C-h Diameters 3.25, 4.0, 5.0,6.0 8,10,12,14, 16mm lengths LABIAL PLATE BONE LOSS Page12

13 Within 6 months 1 year 4 yrs 10 yrs 12 yrs 20+yrs 550 BITE POUNDS 540 PER SQUARE POUN INCHDS PER SQUAR E INCH 4/8/ Dental Implant Institute Page13

14 MODERATE BONE LOSS 50 POUNDS PER SQUARE INCH 4/8/ Dental Implant Institute YEAR BONE LOSS--CAUSE--DENTURES 37 TO 25 POUNDS PER SQUARE INCH 4/8/ Dental Implant Institute Page14

15 SEVERE BONE LOSS--DENTAL CRIPPLE Page15

16 3 Divisions Oral Mucosa All layers above the periosteum Periosteum Bone Masticatory mucosa..i.e attached gingiva Keratinized stratified squamous epithelium Tongue dorsum, hard palate, attached gingiva Collagen fiber rich, deep rete pegs Lining mucosa (i.e. buccal ) Non keratinized stratified squamous epithelium Almost everywhere else in the oral cavity Elastic fibers Specialized mucosa Taste buds Page16

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