Management of Extraction Sites: Scientific Evidence and Clinical Translation

COURSE DESCRIPTION
Dental extraction is commonly indicated when teeth cannot be restored or maintained in acceptable conditions compatible with long-term health, function and/or esthetics. The absence of a tooth in its alveolus triggers a cascade of biologic events that typically result in a variable dimensional reduction of the alveolar process. Severe alveolar ridge atrophy may have a considerable impact on tooth replacement therapy, particularly when an implant-supported restoration is planned. Hence, adequate management of the extraction site and subsequent implant therapy represent a major component of contemporary dental practice. Following tooth loss, successful implant therapy is based on a thorough understanding of the biological and structural properties of the tissues that support implant fixtures and their corresponding prosthetic elements.

This didactic session is aimed at reviewing the healing dynamics that typically follow tooth extraction and different conventional and therapeutic strategies to minimize the negative impact of tooth loss for adequate restorative-driven dental implant planning (either immediate or delayed) based on current evidence. Additionally, this presentation will provide a thorough overview on the essential characteristics of the periodontal and peri-implant tissues, the different components of the peri-implant phenotype, the properties and indications of different biomaterials (e.g., membranes, barriers, matrices, bone graft materials and biologics) and basic clinical guidelines pertaining to proper case selection and treatment planning, including surgical and restorative considerations, with an emphasis on relevant scientific evidence pertaining to proper implant placement in the esthetic zone. Clinical examples will be presented to illustrate emerging concepts and technical tips on these topics.

EDUCATIONAL OBJECTIVES

• Review the sequence of biological events that take place after tooth extraction, and how the result of these processes may affect future implant placement and restorative therapy
• Discuss the role that some critical factors may play in the healing dynamics following tooth extraction
• Understand the rationale and scientific evidence supporting different treatment options available for the management of the extraction site, as well as their indications and limitations