Dental Surgery, Bone Grafting (Autogenous, Allografts, Zenografts), Soft Tissue Grafting, Emdogain, Gem 24, Resorbable and Non-Resorbable Membranes.
Today dentists are no longer limiting surgery to just the removal of a patient’s tooth or teeth. We have to be aware of what may be replacing that, which was removed. If the patient is considering either an implant or fixed crown and bridge replacement, the dentist must know this choice prior to the extraction surgery. The character and
amount of the patient’s remaining bone now becomes critical since we will need that bone to support either a prosthetic implant screw or a soft tissue ridge to make the fixed bridge more esthetic and cleansable. Any infected tissue also has to be carefully removed and a suitable grafting material and possible membrane support, selected and placed during the surgery. All these steps help ensure that there is adequate bone and soft tissue support for any future implant or fixed bridge. Even if we are just replacing the about to be extracted teeth with a removable denture, a smoother, larger, thicker ridge of good quality bone will only help the removable prosthesis to fit better and for a longer period of time.
There are many ongoing advances in hard and soft tissue regeneration techniques. All have some benefit to protect our natural dentition through out our lifetime but even if we have to resort to the artificial scenario, they will make it more successful and durable, going forward.
Bone grafting, whether we use the patient’s own bone (autogenous grafting) or another person’s bone such as sterilized cadaver bone (allografting) or bovine bone, using sterilized bone from another animal, most often cow bone (zenografting) all end up with the same result, and that is to preserve bone as a support tissue for which ever type of tooth replacement we select.
We also use various resorbable and non-resorbable membranes, which encourage connective tissue growth to support the overlying gum tissue at a height and contour, suitable for the final overlying prosthesis. This is a critical step to ensure a natural and esthetic final result. Also at our disposal are bioactive proteins, such as Emdogain and Gem21, which stimulate and create a matrix to encourage the growth and reapplication of lost support tissues around a patient’s natural teeth. These products now help rectify the damage done by years of advancing periodontal disease (gum disease), but they do not replace the need for controlling the disease with the help of scaling, root planning(deep cleaning) and better oral hygiene.
Scaling, root planning, good oral hygiene and regular dental visits are still essential building blocks to any program to maintain our teeth for a lifetime.