Numerous conservative” rescue ” of the tooth by re-treating the system of its channels with all available means is exhausted, and the doctor recognizes that he is powerless in this situation and the tooth will have to be removed…. We discussed earlier why this is necessary. Now let’s go to the next stage, and denote the following: “Qualified tooth extraction is the initial stage to their effective replacement.”
Restoration of tooth bone tissue
When removing a tooth, a qualified dentist has already discussed with the patient the further treatment plan, and knows how it will replace the missing tooth. A significant part of dentists, surgeons, and General practitioners, acting on classical methods, immediately after tooth extraction, compress the edges of the hole in order to reduce the wound surface and improve tissue healing, as well as smoothing or biting the sharp edges of the hole (preventing the formation of sharp bone protrusions — ” exostoses»)
In clinics specializing in periodontics and implantology, in addition to the classic approach to the hole of the removed tooth, there is an approach to “prevention of bone atrophy after removal”. The implantologist who performs tooth extraction will not only try to do it as atraumatic as possible, but will also examine the hole completely for the presence of periodontal defects, and if they are detected, will combine such removal with the substitution of a bone substitute in order to prevent atrophy and restore the volume of bone tissue. And this procedure is performed with the help of bone substitutes of various origins.
Curettage of the well after tooth extraction
The process of bone atrophy at the site of the removed tooth proceeds dynamically for the first 2-3 months, reaching 40%-60% by the end of the third year due to insufficient load on this section of the alveolar process. In the future, the process of atrophy is kept at the level of 1-3% per year in the absence of adverse factors.
The method of replacing the hole defect is as follows. After tooth extraction, the doctor performs a thorough curettage of the hole (clearing the hole of soft tissues and tissues of inflammatory origin). Then the bone substitute is mixed with the blood obtained from the hole, placed in the hole. After that, the bone substitute is covered with an insulating membrane, and the hole is sutured tightly. In 3-4 months after such manipulation, the well is ready for implant placement.
As we found out earlier, there are several types of bone substitutes:
- alloplasts are synthetic drugs. ChronOS and BioResorb are the most widely distributed in Russia
- xenotransplants are preparations of animal origin. The most widespread in the world of them – BioOss
- allografts are preparations of human origin, for example, Tutogen, Osteograft.
The membranes used in the above-described manipulations can be of two types: absorbable (for example, BioGide) and non-absorbable (for example, GorTex)/ Absorbable membranes do not require further removal, as non-absorbable, but the second can be used for large bone defects. Both types of membranes should be covered with tightly sewn mucosa. The divergence of the wound edges above the membranes is associated with such an unfavorable phenomenon for implantation as Smoking, and is an urgent signal to contact your doctor. This is due to the fact that the absorbable membrane when the seams diverge under the influence of saliva can dissolve within 1-2 days, and the non – absorbable membrane can contaminate (collect, glue) on its surface microorganisms from saliva, which will not allow the graft material to turn into bone. Therefore, in the first case, it is necessary to carry out medical treatment of the wound, and in the second — to remove such a membrane. In both cases, the amount of bone being restored will be reduced due to the impact of adverse factors on the wound. Thus, failure to follow the rules of postoperative wound care can lead to obtaining smaller volumes of bone than planned during the intervention.
Complete closure of the wound during manipulations to preserve or restore bone volume is associated with a shortage of soft tissues. Therefore, the doctor should think over the plan of his manipulations with soft tissues, think about what he will make incisions, so that the wound can later be tightly sutured. Sometimes it is difficult to carry out such a movement of tissues, in such cases, you can use a non-absorbable Cytoplast membrane, which can be removed from the wound after 3 weeks without suturing it tightly.