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science & practice 17 AEEDC Dubai 2016 able risk of injury to the nerve, therefore intentional retention of parts of the tooth was proposed via a planned procedure introduced around20yearsagocalledcoronec- tomy. This is the removal of the crown of a tooth, leaving the root in situ. It is merely adopted to avoid orminimisedamagetotheIDN.The rate of complications after coronec- tomy is comparable to that ob- served after surgical extraction, ex- cept with a significantly low inci- dence of injury to the IDN. It should be noted that both sec- tioningandcoronectomycanbeper- formed with a shorter incision, as the amount of bone removal re- quired is minimal, thus minimising the postoperative morbidity. How- ever, it cannot be performed in all cases in which the LM3 is close to theIDCandiscertainlycontra-indi- cated when the LM3 is decayed or its roots are associated with a pathology and should be con- sidered with caution in severely inclined mesio-angular and hori- zontal impaction cases. The author doesnotrecommenddistalbonere- moval or retraction of the lingual flapwiththeintentionofprotecting the lingual nerve, as these may in- crease the risk of damaging the lin- gualnerve.Itshouldbeemphasised that incision may not extend be- yond the distobuccal aspect of the tooth. Theotherimportantaspectofthe dental extraction procedure is the future replacement of the tooth to be extracted. The current trend of tooth replacement for both func- tional and aesthetic reasons is the placement of dental implants. The successofthistreatmentlargelyde- pends on the availability of healthy bone in sufficient volume. There- fore, it is crucial for the dental prac- titionernottocompromisethealve- olar bone during extraction of the teeth. Changes in the alveolar bone ridge after an extraction are in- evitable. After all dental extrac- tions,boneheightandwidthalways undergo dimensional changes. Bonedoesnotregenerateabovethe levelofthealveolarcrest,thatis,its heightwillnotincreaseduringheal- ing. The buccal plate tends to shrink,shiftingthecrestofthealve- olarridgelingually,andoftenforms a concavity. Such changes are pro- portionaltotheamountoftraumato the soft and hard tissue during the extraction. An additional unfavourable change that may take place is the slow remodelling of the bone formed to fill up the extraction socket owing to lack of functional stimulation. The presence of poorly remodelledalveolarbonemaycom- promise the stability and function ofthefutureimplant.Furthermore, studies show that the stripping and elevation of mucoperiosteal tissue produce a higher number of osteo- clasts within the alveolar ridge and hence greater resorption and shrinkage are seen after the classi- calsurgicalorthetraumaticextrac- tion of teeth. The preservation of alveolar bone for future implant placement may be achieved by avoiding unnecessary bone removal and stripping of the periosteum during surgery, as well as performing a surgical alveolar bone preserva- tion procedure. Bone removal can be largely avoided or minimised through modification of the tradi- tional extraction technique. The first such modification is the use of dentalperiotomesandluxatomesto gently strip the periodontal liga- ment fibres and widen the socket without causing cracks or fracture of the cortical plates, as commonly encounteredwhenusingdentalfor- cepsorthebulkyelevators.Theuse of such gentle instruments also eliminates the need for elevation of mucoperiosteal tissue. However, it should be noted that the safe use of these instruments requires ade- quate training and should be en- couraged during undergraduate clinics. Clot stabilisation through light packing of the socket with col- lagenspongesmayhelptominimise clot dislodgment, as well as acceler- atethehealingprocessandbonere- generation. The second strategy is the alveo- lar bone preservation procedure. This includes packing the extrac- tion socket with different fillers, such as osteoinductive or osteocon- ductive materials, like autogenous, natural or synthetic bone grafting materials that support the alveolar socket walls, thus preventing their collapseandshrinkage.Itshouldbe noted that this intervention can only slow down the post-extraction changes to improve the success of the dental implant, but cannot stop them altogether. Finally, post-extraction care should include an explanation ofthehealingprocessandpotential symptoms encountered after such procedures. The prescription of medications should be limited to non-steroidal anti-inflammatory drugs in most cases and imprudent useofantibioticsorsocketdressing should be avoided. STRIVING FOR CLINICAL EXCELLENCE Featured Speakers APRIL 8 - 10, 2016 Suntec Singapore Convention & Exhibition Centre Online Registration Now Open! IDEM Singapore 2016’s conference theme is built upon the common goal of all dentists – both general and specialist: Striving for Clinical Excellence. Look forward to world-class clinicians, researchers and educators discussing contemporary issues in the field of dentistry. Ms. Cindy Tantarica Tel: +65 6500 6721 Fax: +65 6294 8403 Ms. Cindy Tantarica Tel: +65 6500 6721 Fax: +65 6294 8403 Endorsed By Singapore Dental Association Co-organizer Held In In Co-operation With Supported By Walter Dias, Germany Clinical Excellence in Aesthetic Restorations - Hybrid and Indirect Techniques Using Smart Composites Elif Keser, Turkey PiezocisionTM for Rapid Orthodontic Therapy: A Multi-disciplinary Team Approach Hien Ngo, Kuwait Chairperson of the Full Day Symposium: Towards the Post-Amalgam Era Pre-Register and Meet Over 500 Exhibitors! Join the IDEM Singapore Trade Fair to meet over 500 internationally recognized manufacturers, distributors and traders. With exhibitors showcasing their latest products and services on levels 4 and 6, your visit will be packed with opportunities to strike new deals and re-enforce existing partnerships. Dental Tribune Study Club in Cooperation with IDEM Singapore Visit the Dental Tribune Study Club in the exhibition hall on level 6 to attend free live lectures on the latest in dental technology and procedure. Widen your networking possibilities and assess new products and techniques. Information on Study Club lectures will be avaliable online closer to the event. Sign up as an exhibition visitor online today to guarantee your complimentary entry. AD Tel: +6565006721 Fax: +6562948403 Tel: +6565006721 Fax: +6562948403

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