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implants - international magazine of oral implantology International Edition

I industry report Fig. 8_Solid, healthy bone must be reached to allow the normal regeneration of bone. When infection or necrosis remain throughout the socket and adjacent bone, with or without condensing osteitis, healing will rarely ever be completed. Figs. 9 & 10_The hole is filled with a synthetic graft material (Synthograft) after elimination of fibrous marrow and disinfection of the cavity. bonethatalliswell,andnonewbonegrowthisneeded. Bone cells thus do not start new growth and then mi- gratethroughabarriernaturallydesignedtolimitsuch growth.Thejawbonedeterminesthatiftheligamentis stillthere,thetoothmustbethereaswell. Since the periodontal ligament does not extend to theupperedgeoftheextractionsite,newbonegrowth activitywillnotbeinhibitedatthetopofthesocket,and a characteristic thin cap of bone will eventually extend over the extraction hole. Larger cavitations often have only a cap of gingival tissue over them. Even the thin overlying cap of bone does not form in these cases. In routine dental extraction, portions of the periodontal ligament will sometimes be more strongly attached to thetooththantheboneandberemovedalongwiththe tooth.Whenpartiallyremovedinthisfashion,thehap- hazardabsenceoftheligamentwillpermitequallyhap- hazard growth of bone, resulting in the wide variety of cavitationshapesandsizes(Fig.2). _Treatment Surgeryisoftennecessarytocleanoutacavitational site properly and thoroughly, for there is no other way to remove dead bone. The key to bone healing and re- generation is the removal of the necrotic tissue. If the necrotictissueisnotthoroughlyremoved,thenecrosis will spread and cause further destruction to the bone, nerves and blood vessels. This kills teeth in the process, for they are cut off from their blood supply. Once the necrotic tissue has been cleaned out, healing can then takeplaceandnewbonecellswillfillinthecavitations. Neither antibiotic injections into the bone nor laser treatments will stop the progressive necrosis if not all debris has been thoroughly curetted out of the cavita- tion. Thenexttreatmentstepisabonegraftingprocedure tofillthecleanedanddisinfectedcavity.Ifthecavitation is limited to 5–6 mm in diameter, a plateau press fitted rootformimplantcanbeplacedintothegraftingmate- rial immediately. Otherwise, the implant will be placed in a larger grafted area after three months of healing (Figs.3a&b). _Clinical implications The following case is representative of many other casesIhaveencounteredduring25yearsofclinicalex- perienceinnumerousclinicsinvariouscountries.A52- year-old female patient came to the practice with 19 missingteethinboththemaxillaeandthemandible.The second premolars and first molars had been extracted between five and 12 years ago, after incorrect en- dodontictreatment.Shenotedthatthemolarshadhad abscesses and the premolars had fractured a few years afterthepoorendodontictreatment. Thetreatmentplanwastoinsertfourshortimplants toreplacethesecondpremolarsandfirstmolarsofthe mandible. The dental panoramic tomogram showed a circularformationof5–6mmindiametermesialtothe second molar root on the right side of the mandible 22 I implants1_2014 Fig. 7 Fig. 8 Fig. 9 Fig. 10