Marcelo Nunes - (1/5/2015 8:04 PM)

excelent lecture and explanation. thank you!

Charles Schwimer - (11/8/2014 10:32 AM)

Howie and Henry excellent discussion! 2mm of vital bone will promote soft tissue stability, but what conditions need to be satisfied to to achieve and MAINTAIN 2mm of vital bone? What is the critical "jump distance" between bundle bone of the adjacent teeth and the remaining basal bone in the extraction site that will provide for bone stability over time? In addition, what role does soft tissue height and thickness play in a closed /submerged implant environment vs an open / functional implant environment? Any thoughts? Chuck

henry salama - (11/6/2014 12:38 PM)

Bashar, raising a full thickness flap traumatizes the periosteal blood supply and certainly will have a more negative effect on the labial plate than a "flapless" approach. However, when facing a labial plate of 1mm thickness or less, even a flapless approach in combination with atraumatic extraction will still result in significant ridge alteration unless other means such as bone and/or soft tissue grafting etc. are utilized. Therefore, as clinicians, we have to design our therapy in such a way as to minimize these ridge alterations. I hope I answered your question. Regards

Bashar imran - (11/6/2014 10:36 AM)

Thank you Dr.Henry for your presentation , my question is : does Atraumatic extraction without reflecting a flap would affect the 1mm thickness of labial plate of bone or not ?

saadou khalaf - (11/4/2014 11:03 PM)

great presentation and great discussion thank you very much

Howard Gluckman - (11/4/2014 2:02 PM)

Henry thanks for the feedback. I totally agree with all and I think the science confirms it to most degrees. The tissue issue I think has to do with the concavity of the abutment and the crown which is allowing thicker infill. Unfortunately it does not extrapolate into more stability in the short term and we are still seeing the same +/- 1mm recession on the buccal plate. We also did a number of other measurements which will share with you once I have it. Mostly they confirm what is known I believe.

henry salama - (11/4/2014 12:46 PM)

Howie, as to your second observation of thicker tissue 1 year post-op. Very interesting and definitely worth following up. My inquiry and interest would be related to asking what would have influenced that thickening: a) whether the sites were grafted?, b) whether placing the implants more palatally along with flatter or concave emergence profiles of the abutments/restoration creates more room for soft tissue to be thickened? and c) whether the tissue thickness should also be measured at 3 & 5mm apical to the gingival margin or a reference point on an adjacent tooth. Either way, I think you're collecting some very useful data to look at & correlate to clinical decision making. Well done Howie.

henry salama - (11/4/2014 12:35 PM)

Howie, great comments and observations. First, as to thickness of the labial plate. I agree, and as I mentioned in the review, I believe its more important to END with 2 mm than to BEGIN with a 2mm labial plate of bone. Its not unreasonable, however, to assume that Kan & Ferrer would be correct in their observations. I also believe that starting with a thicker labial plate would a) have a better chance of a greater percentage of the original labial plate surviving the extraction process, b) Therefore, protecting your grafted socket gap longer and better and c) support the attached component of the gingival tissue longer & better as well. That being said, the literature tells us that the chances of having an original pre-operative labial plate of 2mm is roughly only about 4-5% of potential extraction sites.

Howard Gluckman - (11/3/2014 1:21 PM)

Mo I have some interesting data that may prove the complete opposite of what Chu and Tarnow are saying. I have 1 year follow up data on about 20 cases that I have not yet correlated the data. I have measured tissue thickness changes over the year after dimmed implant placement. I must check the data but if I remember correctly the tissue actually gets thicker. we measure 2mm below the gingival margin at placement and then 1 your follow up. may be some interesting stuff to write up when I look at all the data.