Dr Bavitz Handout Part 1 Oral Surgery Course 2008

8/7/2019 Dr Bavitz Handout Part 1 Oral Surgery Course 2008

http://slidepdf.com/reader/full/dr-bavitz-handout-part-1-oral-surgery-course-2008 1/40

BetaBeta--Tricalcium PhosphateTricalcium Phosphate

Brands:Brands:1.1.Synthograft Synthograft

2.2.CerasorbCerasorb3.3.GraftekGraftek



Completely unique and synthetic, GEM 21S® is an innovative combination

of a bioactive protein (highly purified recombinant human platelet derived

growth factor, rhPDGF-BB) and a biocompatible osteoconductive matrix

(beta-tricalcium phosphate, -TCP)GEM 21S® contains 1000x more active growth factor (PDGF) than found in

platelet rich plasma. Compared to bone graft substitute without PDGF

Provides 3x more bone fill at 6 months

Provides a more predictable treatment option even in the most severe cases

Completely unique and synthetic, GEM 21S® is an innovative combination

of a bioactive protein (highly purified recombinant human platelet derived

growth factor, rhPDGF-BB) and a biocompatible osteoconductive matrix

(beta-tricalcium phosphate, -TCP)GEM 21S® contains 1000x more active growth factor (PDGF) than found in

platelet rich plasma. Compared to bone graft substitute without PDGF

Provides 3x more bone fill at 6 months

Provides a more predictable treatment option even in the most severe cases







Sockets with intact buccal and lingual plates Sockets with intact buccal and lingual platesheal well without grafting consider graftingheal well without grafting consider grafting

with resorbable osteoinductive material if with resorbable osteoinductive material if plates compromised and implants plannedplates compromised and implants plannedgrafting with connective tissue if ponticgrafting with connective tissue if pontic

esthetics an issue.esthetics an issue.

Sockets with intact buccal and lingual plates Sockets with intact buccal and lingual platesheal well without grafting consider graftingheal well without grafting consider grafting

with resorbable osteoinductive material if with resorbable osteoinductive material if plates compromised and implants plannedplates compromised and implants plannedgrafting with connective tissue if ponticgrafting with connective tissue if pontic

esthetics an issue.esthetics an issue.



Vital Root Retention Vital Root Retention

Never our first choice, but an optionfor preserving alveolar bone whenperforming full mouth extractions onyoung patients

Teeth must be vital with goodperiodontal health

Similar tooth selection as conventional overdentures, except

elective endodontics not performed

Never our first choice, but an optionfor preserving alveolar bone whenperforming full mouth extractions onyoung patients

Teeth must be vital with goodperiodontal health

Similar tooth selection as conventional overdentures, except

elective endodontics not performed



Vital Root Retention Vital Root Retention

Amputate teeth at crest, then remove2 mm more tooth sub osseous

Consider grafting autogenous bone

over tooth, then close primarily

Ideally, bone grows coronally over avital, asymptomatic root

Depending on rate of alveolarresorption, will help preserve ridge 3-5 years before exposure/extraction

Amputate teeth at crest, then remove2 mm more tooth sub osseous

Consider grafting autogenous bone

over tooth, then close primarily

Ideally, bone grows coronally over avital, asymptomatic root

Depending on rate of alveolarresorption, will help preserve ridge 3-5 years before exposure/extraction



Remove 2 mm toothstructure below bone

2 mm

Suture



New Bone Prosthesis



J Oral Maxillofac Surg. J Oral Maxillofac Surg. 2005 Feb;43(1):72005 Feb;43(1):7--12. A12. Arandomized controlled clinical trial to compare therandomized controlled clinical trial to compare theincidence of injury to the inferior alveolar nerve asincidence of injury to the inferior alveolar nerve asa result of coronectomy and removal of mandibulara result of coronectomy and removal of mandibularthird molars. Renton T, Hankins M, Sproate Cthird molars. Renton T, Hankins M, Sproate C

The length of follow up was about twoThe length of follow up was about two

years, which for the assessment of years, which for the assessment of delayed eruption of the root fragments isdelayed eruption of the root fragments isnot sufficient as this process may continuenot sufficient as this process may continuefor up to 10 years. However, it seems that for up to 10 years. However, it seems that coronectomy reduces the incidence of coronectomy reduces the incidence of injury to the inferior alveolar nerveinjury to the inferior alveolar nervewithout increasing the risk of dry socket orwithout increasing the risk of dry socket or

infection.infection.



J Oral Maxillofac Surg. 2004 Dec;62(12):1447-52.Coronectomy: a technique to protect the inferior alveolarnerve. Pogrel M A, Lee JS , Muff DF.

J Oral Maxillofac Surg . 2004 Dec;62(12):1447-52.Coro nect o my: a techniqu e t o pro tect the inferior alveolar ner ve. Pogr el M A, Lee JS , M uff DF.

PURPOSE: Da mag e t o the i nf erior al veolar ner ve when ext rac t i ng lo wer thir d molar s i s of ten cau sed by the i nt i ma te r ela t io nshi p between thener ve a nd the roo ts of the teeth. The tec hni qu e of coro nec t o my, or i ntent io nal roo t r etent io n, ma y mi ni mize thi s pro bl em.

PURPOSE: Da mag e t o the i nf erior al veolar ner ve when ext rac t i ng lo wer thir d molar s i s of ten cau sed by the i nt i ma te r ela t io nshi p between thener ve a nd the roo ts of the teeth. The tec hni qu e of coro nec t o my, or i ntent io nal roo t r etent io n, ma y mi ni mize thi s pro bl em.

RESULTS: Ther e wer e no ca ses of i nf erior al veolar ner ve-i nvol vedda mag e i n thi s st u dy of 41 pa t i ents who u nder went 50 coro nec t o mi es.Ther e wa s 1 ca se of t ra nsi ent li ngual ner ve i nvol vement, pro ba bl y fro mthe u se of the li ngual r et rac t or . One pa t i ent r equir ed su bsequ ent r emo val of the roo ts of bo th lo wer thir d molar s becau se of failur e t o

heal , a nd 1 pa t i ent r equir ed su bsequ ent r emo val of a roo t becau se of su bsequ ent migra t io n t o the surfac e. Roo t migra t io n wa s no ted i na ppro xi ma tel y 30% of pa t i ents o ver a 6 mo nth perio d.CONCLUSION: Coro nec t o my a ppear s t o be a via bl e tec hni qu e i n tho seca ses wher e r emo val of the whol e t oo th mig ht pu t the i nf erior al veolar ner ve a t co nsi dera bl e ri sk of da mag e.

RESULTS: Ther e wer e no ca ses of i nf erior al veolar ner ve-i nvol vedda mag e i n thi s st u dy of 41 pa t i ents who u nder went 50 coro nec t o mi es.Ther e wa s 1 ca se of t ra nsi ent li ngual ner ve i nvol vement, pro ba bl y fro mthe u se of the li ngual r et rac t or . One pa t i ent r equir ed su bsequ ent r emo val of the roo ts of bo th lo wer thir d molar s becau se of failur e t o

heal , a nd 1 pa t i ent r equir ed su bsequ ent r emo val of a roo t becau se of su bsequ ent migra t io n t o the surfac e. Roo t migra t io n wa s no ted i na ppro xi ma tel y 30% of pa t i ents o ver a 6 mo nth perio d.CONCLUSION: Coro nec t o my a ppear s t o be a via bl e tec hni qu e i n tho seca ses wher e r emo val of the whol e t oo th mig ht pu t the i nf erior al veolar ner ve a t co nsi dera bl e ri sk of da mag e.



PrePre--op (Oralop (Oral

bisphosphonates X 5bisphosphonates X 5years)years)

Immed Post Immed Post

10 month post 10 month post



Immediate Implant Placement

Following Extractions

Immediate Implant Placement

Following Extractions Need 3-4 mm of solid bone at base of

socket, and no active infection

Success rates ~ to normal

Most typical sites: anterior teeth and1st premolars

Advantages? May reduce loss of labialplate and improve esthetics, as well assave time

Need 3-4 mm of solid bone at base of socket, and no active infection

Success rates ~ to normal

Most typical sites: anterior teeth and1st premolars

Advantages? May reduce loss of labialplate and improve esthetics, as well assave time



Platelet Rich PlasmaPlatelet Rich PlasmaPlatelet Rich PlasmaPlatelet Rich PlasmaWhats HotWhats Hot

Release variousRelease variousgrowth factors that growth factors that aid in hemostasisaid in hemostasisand increase rateand increase rate

of healingof healing(mitogenesis,(mitogenesis,angiogenesis)angiogenesis)

Whats HotWhats Hot

Release variousRelease variousgrowth factors that growth factors that aid in hemostasisaid in hemostasisand increase rateand increase rate

of healingof healing(mitogenesis,(mitogenesis,angiogenesis)angiogenesis)

Whats NotWhats Not

Cost Cost

Is there anyIs there anydifference at 6difference at 6weeks?weeks?

Invasive, borrowInvasive, borrow4545--90ml of blood90ml of blood

Whats NotWhats Not

Cost Cost

Is there anyIs there anydifference at 6difference at 6weeks?weeks?

Invasive, borrowInvasive, borrow4545--90ml of blood90ml of blood



C asap et al . Immediat e Implantation I nto Debrid ed I nf ect ed Sock ets . J O ral M a xillofac Surg 2007.



Does placing implants into fresh extraction Does placin g implants into fresh ex traction sock ets pr es erv e bon e? sock ets pr es erv e bon e?

J Clin Periodontol. 2005 Jun;32(6):645-52.Ri dge alt erations f ollowin g implant plac ement in f r esh ex traction sock ets : an ex perimental st udy in the dog. Araú jo MG, Suk ekava F, Wennström JL, Lin dhe J.

CO NCLUSIONS: Marked dimensional alterations had occurredin the edentulous ridge after 3 months of healing following theextraction of the distal root of mandibular pre-molars. TheTheplac ement of an implant in the f r esh ex traction sit eplac ement of an implant in the f r esh ex traction sit e

obviousl y f ail ed to pr ev ent the r eobviousl y f ail ed to pr ev ent the r e--modelin g that modelin g that occ urr ed in the walls of the sock et .occ urr ed in the walls of the sock et . The resulting height of the buccal and lingual walls at 3 months was similar at

implants and edentulous sites.



Most human trials howev er, r ev eal r esults similar Most human trials howev er, r ev eal r esults similar to implants plac e via the old school approach, to implants plac e via the old school approach, ev en when immediat ely load ed (caution in sof t ev en when immediat ely load ed (caution in sof t

bon e, >55 Y/O)bon e, >55 Y/O)

Int J Oral Maxillofac Implants. 2007 Mar- Apr;22(2):187-94.The radiographic bon e loss patt ern ad jac ent to immediat ely plac ed, immediat ely load ed implants .Jaff in R, Kol esar M, Kumar A, Ishi kawa S , Fior ellini J.

J Craniofac Surg. 2007 Jul;18(4):965-71.Immediat e load ed d ental implants : comparison between f i x tur es ins ert ed in post ex tractiv e and heal ed bon e sit es .Degidi M, Piatt elli A, Carinci F.

J Periodontol. 2007 May;78(5):810-5. Vertical cr estal bon e changes around implants plac ed into f r esh ex traction soc kets .Covani U, Corn elini R, Baron e A



Why Reconstruct? Why Reconstruct?

Not enough bone for implants

Enough bone, but esthetic result suboptimal

Prevent pathologic fracture

Poor function/esthetics/retention of conventional removable prosthesis

Not enough bone for implants

Enough bone, but esthetic result suboptimal

Prevent pathologic fracture

Poor function/esthetics/retention of conventional removable prosthesis



How? Autogenous Bone Grafts

with Implants

How? Autogenous Bone Grafts

with Implants



Autogenous Block Grafts Autogenous Block Grafts

Gold Standard

Osteoinductive and Osteoconductive No need for membranes

Holds form

Remodels into 100% high quality bone

No concerns about transmissible diseases

Gold Standard

Osteoinductive and Osteoconductive No need for membranes

Holds form

Remodels into 100% high quality bone

No concerns about transmissible diseases



Autogenous Block Grafts Autogenous Block Grafts

Donor site morbidity

Quantity is limited

Lose 20-30% during healing

Donor site morbidity

Quantity is limited

Lose 20-30% during healing



Intra-oral Autogenous Bone Sites



Allogenic Allogenic Block Graf t Block Graf t



What about membranes? What about membranes?

Useful in containing particulate grafts

Useful around teeth/exposed implant

threads Add expense

Infection risk

Unnecessary with block grafts AD A 4266 Resorbable

AD A 4267 Non-Resorbable

Useful in containing particulate grafts

Useful around teeth/exposed implant

threads Add expense

Infection risk

Unnecessary with block grafts AD A 4266 Resorbable

AD A 4267 Non-Resorbable



Bone Morphogenic Protein

(BMP)

Bone Morphogenic Protein

(BMP)

Grow bone at will?

Presently two are FD A approved,BMP 2 for spinal fusions, and BMP7 for long bone defects

Studies show excellent results forsocket preservation, sinus lifts

Expensive ($5000.00 for a sinus)

Grow bone at will?

Presently two are FD A approved,BMP 2 for spinal fusions, and BMP7 for long bone defects

Studies show excellent results forsocket preservation, sinus lifts

Expensive ($5000.00 for a sinus)



FDA Panel Unanimously Recommends Approval of ThirdIndication For Medtronics INFUSE Bone Graft Nov. 9, 2006.FDA Panel Unanimously Recommends Approval of ThirdIndication For Medtronics INFUSE Bone Graft Nov. 9, 2006.

INFUSE Bone Graft is recombinant human bonemorphogenetic protein-2 (rhBMP-2) applied to anabsorbable collagen sponge carrier. The purpose of theprotein, which occurs naturally in the body, is to stimulatebone formation. It has been previously approved by the FD A

for use in certain lumbar spine fusion and tibial fracture repairprocedures.

INFUSE Bone Graft is recombinant human bonemorphogenetic protein-2 (rhBMP-2) applied to anabsorbable collagen sponge carrier. The purpose of theprotein, which occurs naturally in the body, is to stimulatebone formation. It has been previously approved by the FD A

for use in certain lumbar spine fusion and tibial fracture repairprocedures.



Distraction OsteogenesisDistraction Osteogenesis

Generation of bone (and soft tissue)through distraction of an osseous callus

Generation of bone (and soft tissue)through distraction of an osseous callus



Ann N Y Acad S ci . 2006 Apr;1068:532-42. COX-2 has a c ri tical role d uring inc orporati on of struc tural bon eallografts. OKeefe RJ, Ti yapatanaputi P, Xi e C

Ann N Y Acad S ci . 2006 Apr;1068:532-42. COX-2 has a c ri tical role d uring inc orporati on of struc tural bon eallografts. OKeefe RJ, Ti yapatanaputi P, Xi e C

Nonsteroidal anti-inflammatory drugs (NS AIDs), whichinhibit cyclooxygenase (COX) activity, reduce pain and

are commonly used in patients with skeletal injury.Inthis article we will also present data to show that

selective COX-2 inhibitor delays allograft healing andincorporation. These results demonstrated that COX-2

is essential for bone allograft incorporation.Furthermore, our data support the notion that COX-2-dependent PGE2 produced at the early stage of bonehealing is prerequisite for efficient skeletal repair.

Nonsteroidal anti-inflammatory drugs (NS AIDs), whichinhibit cyclooxygenase (COX) activity, reduce pain and

are commonly used in patients with skeletal injury.Inthis article we will also present data to show that

selective COX-2 inhibitor delays allograft healing andincorporation. These results demonstrated that COX-2

is essential for bone allograft incorporation.Furthermore, our data support the notion that COX-2-dependent PGE2 produced at the early stage of bonehealing is prerequisite for efficient skeletal repair.



Wise Old Oral Surgeon SaysWise Old Oral Surgeon Says

Beware of:Beware of:

Wise Old Oral Surgeon SaysWise Old Oral Surgeon Says

Beware of:Beware of: 3rd molars in function3rd molars in function

Lone standing molarsLone standing molars Teeth in bruxers/ Cl. III skeletal patternsTeeth in bruxers/ Cl. III skeletal patterns

3rd molars + post 3rd molars + post--menopausal womenmenopausal women

Prior TMD historyPrior TMD history Prior bad oral surgery experiencePrior bad oral surgery experience

Distoangular lower 3rds/ nerve proximityDistoangular lower 3rds/ nerve proximity

3rd molars in function3rd molars in function

Lone standing molarsLone standing molars Teeth in bruxers/ Cl. III skeletal patternsTeeth in bruxers/ Cl. III skeletal patterns

3rd molars + post 3rd molars + post--menopausal womenmenopausal women

Prior TMD historyPrior TMD history Prior bad oral surgery experiencePrior bad oral surgery experience

Distoangular lower 3rds/ nerve proximityDistoangular lower 3rds/ nerve proximity



3rd Molar Surgery Why? 3rd Molar Surgery Why?

1. Prevent/treat pericoronitis (infection)

2. Prevent periodontal problems 2nd molar

3. Prevent/treat caries to 2nd / 3rd molar

4. Prevent odontogenic cysts/tumors

5. Strengthen mandible, possible fx

6. Prevent orthodontic relapse?

7. Treat pain of unknown origin

1. Prevent/treat pericoronitis (infection)

2. Prevent periodontal problems 2nd molar

3. Prevent/treat caries to 2nd / 3rd molar

4. Prevent odontogenic cysts/tumors

5. Strengthen mandible, possible fx

6. Prevent orthodontic relapse?

7. Treat pain of unknown origin



Extract 3rds: Oral/Systemic Link? Extract 3rds: Oral/Systemic Link?

CLE VELAND, April 6, 2006CLE VELAND, April 6, 2006 -- The first hard evidence has beenThe first hard evidence has been

uncovered that bacteria in the mouth may find their way to theuncovered that bacteria in the mouth may find their way to theuterus, causing uterine infections that can lead to preterm birth inuterus, causing uterine infections that can lead to preterm birth inpregnant women.pregnant women.

CLE VELAND, April 6, 2006CLE VELAND, April 6, 2006 -- The first hard evidence has beenThe first hard evidence has been

uncovered that bacteria in the mouth may find their way to theuncovered that bacteria in the mouth may find their way to theuterus, causing uterine infections that can lead to preterm birth inuterus, causing uterine infections that can lead to preterm birth inpregnant women.pregnant women.

A newly discovered and as yet unnamed species of the A newly discovered and as yet unnamed species of thebacterium genusbacterium genus BergeyellaBergeyella was found in the mouth andwas found in the mouth andamniotic fluid of a woman with a uterine infection who gaveamniotic fluid of a woman with a uterine infection who gavebirth prematurely (24 weeks), reported microbiologist Yiping W.birth prematurely (24 weeks), reported microbiologist Yiping W.Han, Ph.D., of Case Western Reserve here.Han, Ph.D., of Case Western Reserve here.However, the bacterium was not detected in a vaginal swab, asHowever, the bacterium was not detected in a vaginal swab, as

might be expected. The finding confirmed what some scientistsmight be expected. The finding confirmed what some scientistshave suspected, that intrauterine infections don't alwayshave suspected, that intrauterine infections don't always"ascend" from the genital tract but can "descend" from the oral"ascend" from the genital tract but can "descend" from the oralcavity, Dr. Han and colleagues said in the April issue of thecavity, Dr. Han and colleagues said in the April issue of the J ournal of Clinical Microbiology J ournal of Clinical Microbiology..

A newly discovered and as yet unnamed species of the A newly discovered and as yet unnamed species of thebacterium genusbacterium genus BergeyellaBergeyella was found in the mouth andwas found in the mouth andamniotic fluid of a woman with a uterine infection who gaveamniotic fluid of a woman with a uterine infection who gavebirth prematurely (24 weeks), reported microbiologist Yiping W.birth prematurely (24 weeks), reported microbiologist Yiping W.Han, Ph.D., of Case Western Reserve here.Han, Ph.D., of Case Western Reserve here.However, the bacterium was not detected in a vaginal swab, asHowever, the bacterium was not detected in a vaginal swab, as

might be expected. The finding confirmed what some scientistsmight be expected. The finding confirmed what some scientistshave suspected, that intrauterine infections don't alwayshave suspected, that intrauterine infections don't always"ascend" from the genital tract but can "descend" from the oral"ascend" from the genital tract but can "descend" from the oralcavity, Dr. Han and colleagues said in the April issue of thecavity, Dr. Han and colleagues said in the April issue of the J ournal of Clinical Microbiology J ournal of Clinical Microbiology..



Journal of Oral and Maxillofacial SurgeryJournal of Oral and Maxillofacial Surgery Volume 65, Issue 3 Volume 65, Issue 3, March 2007, Pages 377, March 2007, Pages 377--383383

Progress Report on Third Molar Clinical TrialsProgress Report on Third Molar Clinical Trials

Raymond P. White, Jr DDS, PhDRaymond P. White, Jr DDS, PhD

1.What happens to asymptomatic patients who keep their third1.What happens to asymptomatic patients who keep their thirdmolars?molars?

2.What is the recovery like for those who have them removed,2.What is the recovery like for those who have them removed,and what can we do as surgeons to improve post operativeand what can we do as surgeons to improve post operativeoutcomes?outcomes?



3rd Molar Surgery When? 3rd Molar Surgery When?

Before roots 100% developed

After roots: 1/3 formed

Morbidity/complications minimizedas bone more flexible, nerves morepliable, and PMH less complicated

Dont forget tooth transplanttooth transplant if apex not closed

Before roots 100% developed

After roots: 1/3 formed

Morbidity/complications minimizedas bone more flexible, nerves morepliable, and PMH less complicated

Dont forget tooth transplanttooth transplant if apex not closed



Outcome of tooth transplantation: survival andsuccess rates 17-41 y ears post treatment.

Czochrowska EM, Stenvik A, Bjercke B,Zachrisson. Am J Orthod D entofacial Orthop. 2002Feb;121(2):110-9.

The mean age at surgery was 11.5 years, and the meanobservation period was 26.426.4 years (range, 17-41 years). Of the 33 teeth transplanted in the 28 patients, 3 teeth were

lost after 9, 10, and 29 years, respectively. Therefore, the30 teeth in the 25 patients we examined yielded a survivalrate of 90%. The success rate was 79% because 2transplants had ankylosed, and 2 others failed to fulfill theproposed criteria. The patients generally responded very

favorably regarding their perception of the treatment. Theironly hesitation was related to some discomfort duringsurgery. It was concluded that survival and successIt was concluded that survival and successrates for teeth auto transplanted when the root isrates for teeth auto transplanted when the root ispartly developed compare favorably in a longpartly developed compare favorably in a long--termtermperspective with other treatment modalities forperspective with other treatment modalities for

substituting missing teeth.substituting missing teeth.

Outcome of tooth transplantation: survival andsuccess rates 17-41 y ears post treatment.

Czochrowska EM, Stenvik A, Bjercke B,Zachrisson. Am J Orthod D entofacial Orthop. 2002Feb;121(2):110-9.

The mean age at surgery was 11.5 years, and the meanobservation period was 26.426.4 years (range, 17-41 years). Of the 33 teeth transplanted in the 28 patients, 3 teeth were

lost after 9, 10, and 29 years, respectively. Therefore, the30 teeth in the 25 patients we examined yielded a survivalrate of 90%. The success rate was 79% because 2transplants had ankylosed, and 2 others failed to fulfill theproposed criteria. The patients generally responded very

favorably regarding their perception of the treatment. Theironly hesitation was related to some discomfort duringsurgery. It was concluded that survival and successIt was concluded that survival and successrates for teeth auto transplanted when the root isrates for teeth auto transplanted when the root ispartly developed compare favorably in a longpartly developed compare favorably in a long--termtermperspective with other treatment modalities forperspective with other treatment modalities for

substituting missing teeth.substituting missing teeth.



3rd Molar Surgery When Not3rd Molar Surgery When Not

Extremes of age

No oral

communication(full bony)

Intimate root-nerve

Relationship Risks > Benefits

Extremes of age

No oral

communication(full bony)

Intimate root-nerve

Relationship Risks > Benefits



3rd Molar Surgery Alternatives? 3rd Molar Surgery Alternatives?

No Surgery: dentist feels risk: benefit ratio not favorable or patient refuses document and recommend radiograph q3-5 years

No Surgery: dentist feels risk: benefit ratio not favorable or patient refuses document and recommend radiograph q3-5 years



No High SpeedNo High Speed

Air embolus

Air emphysema

Blow debris into flap Blow bacteria into flap

Non-sterile water

Air embolus

Air emphysema

Blow debris into flap Blow bacteria into flap

Non-sterile water





Which are true? Which are true?

1. Tooth transplants are usually doneon patients 20-30

2. Average success rate for a tooth

transplant is 20-30%3. In order to work, a transplant must

have endo

4. Most transplants will ankylose

A. 1,3 B. 2,4 C. 1,2,3 D. 3 only

E. None of the above

1. Tooth transplants are usually doneon patients 20-30

2. Average success rate for a tooth

transplant is 20-30%3. In order to work, a transplant must

have endo

4. Most transplants will ankylose

A. 1,3 B. 2,4 C. 1,2,3 D. 3 only

E. None of the above



How can I assess the relationship between theHow can I assess the relationship between the33rdrd molar root and the inferior alveolar nerve?molar root and the inferior alveolar nerve?

Documents

Dr Bavitz Handout Part 1 Oral Surgery Course 2008