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Video Details
即時インプラント治療でのリッジプリザベーションと造成 Part1

Description:
In part 1 of this lecture series, Dr. Robert Horowitz utilizes clinical research and clinical cases to outline successful approaches to extraction site enhancement and implant placement. What to utilize for grafting? when to place the implant? what are the costs? and how to combine various techniques? are some of the questions that are answered.

Date Added:
3/19/2009

Author(s):

Robert  A. Horowitz, DDS Robert A. Horowitz, DDS
Dr. Robert A. Horowitz graduated from Columbia University School of Dental and Oral Surgery in 1982 having concentrated in periodontics and fixed prosthodontics. After...
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Online Videos / Surgery / Bone Grafting / Ridge Preservation and Augmentation In Immediate Implant Therapy Part 1




Questions & Comments
Long Nguyen - (9/2/2016 1:38 PM)

Very interesting lecture. Where is part two? Please post it on soon. Thanks

Maurice Salama - (11/28/2013 9:22 AM)

Robert; This lecture is still worth viewing even after the past few years. Well thought out and good to go back in time and see what the thought were at those times and how things change. Would love to hear how your views may have changed. Dr. Salama

Maurice Salama - (11/27/2012 4:38 PM)

Robert; This lecture is still worth viewing even after the past few years. Well thought out and good to go back in time and see what the thought were at those times and how things change. Would love to hear how your views may have changed. Dr. Salama

Robert Horowitz - (6/29/2009 7:45 PM)

As I prepare to do part 2 of the series on socket therapy, I'll try to give some of my thoughts into your question. The question of cost of regenerating in an extraction socket is in terms of dollars, bone and/or soft tissue loss or regeneration on adjacent teeth and time. We know from my own work as well as that of Drs. Sottosanti and Anson about the simple, predictable use of calcium sulfate and demineralized, freeze-dried bone for socket regeneration. They are able to maintain the calcium sulfate barrier in place more effectively than others. Over their same mix of DFDBA/CS, I use non-expanded PTFE barriers. The advantage of their technique is that there is no disruption of the interdental gingival fibers. Additionally, calcium sulfate will enable epithelialization over the top of the barrier. Other materials, pure-phase beta TCP have also been shown to be fully resorbable and replaced by vital bone in the time frame desired for implant placement, 4 - 6 months after extraction. When the socket has sufficient bone remaining, a PTFE barrier alone can be used over a blood clot with similar results. All of these techniques enable vital bone formation and the following of healing with conventional dental radiography. The use of other materials that don't lose their radio-opacity over time have been shown in animal studies to delay healing and not to allow the surgeon or restorative dentist to estimate the level of socket healing.
Growth factors - There's an alphabet city of them out there. PRF, PRGF, BMP, VEGF. Of all of these, the most expensive and best studied so far is BMP. Can we improve our predictability of socket regeneration by the use of close to $1000 worth of material as compared to DFDBA/CS? Those studies remain to and NEED to be done. There are many concerns about BMP - dosing, swelling, containment,... SO, there's no magic bullet, but many ways to skin the cat WITH biologic analysis of the results out there.

Bob Horowitz

henry salama - (4/14/2009 3:12 PM)

Ashwath,
A well reasoned and presented perspective. However, you left out the decision making process itself from your a,b, c list of considerations in achieving "targetted and/or desirable final results". Unfortunately, "cost" is often a factor that must be considered for most practitioners and practices. Just look at how many practitioners still choose to TP 3-unit bridges rather than an implant, even in an ideal extraction site environment. While I believe most practitioners are truly desirous of achieving this "targetted and/or desirable final results", right or wrong, limited insurance benefits, lab fees, sharing revenue with the surgeon etc... are all factors that often creep into the decision making process.
If on the other hand, a therapeutic protocol or technique is both clinically beneficial and cost effective, from a practice management perspective, then more practitioners may more readily include it in their TP considerations. Today, extraction site preservation is cost effective because most dental insurances include benefits for ridge augmentation techniques, material delivery systems are easier to use and the techniques that Dr. Horowitz outlined are more predictable and have less complications requiring fewer follow-ups.

Ashwath Gowda - (4/11/2009 10:02 PM)

You are mentioning "cost for the dentist" in preserving ridge or reconstructing a resorbed alveolar ridge... you are also implying that cost(dentist's costs) as one of the considerations in achieving "targetted and/or desirable final results"...this, with reference to the materials/supplies(grafting materials)
Comment: Let's suppose that, there exists a "magic material" (it does not exist as of to-day)costing several thousands of dollars, and it always produces nothing but the "desired results" under suitable surgicle technique and clinical approach...
don't you think that, either you and or I will be the first ones to present it to our patients? You would have produced the first such clical slide by now!... in other words, as of to-day,
A. Required knowledge (of available materials), B. Clinical/surgical skills and C. Experience/expertise of individual operator/s is entirely responsible for the final results... not the "costs" of materials including labour!
Please respond, amgdds@hotmail.com

Maurice Salama - (3/24/2009 1:55 PM)

Would love to hear from some members about how they choose to manage extraction sites?
What grafting products? Immediate or delayed implant placement? Any membranes or bioactive modifiers?

Maurice Salama - (3/21/2009 2:33 PM)

Just watched the video by Dr. Horowritz on extraction site management. Outstanding job and very educational. It maybe the best buccal shelf harvest educational video I've ever seen. Dr. Pikos does a great job describing the key issues involved in this procedure. Take a look.

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