Surgical Protocol: Immediate or Socket Graft

Fri, 12/17/2010 - 05:51 — keyslelomomma

What is the best approach to extraction site and site preservation?
Is it better to extract the tooth, place an implant and bone graft at that visit or is it better to extract the tooth, place a bone graft and membrane and wait for the graft to osseointegrate and then go back in and place the implant?
In cases where I need to extract and place a graft and wait, which graft material is best to use in a situation like that?
Which membrane should I use in a situation where I will be grafting a socket and will not be able to get a tension free primary closure?

Comments

Fri, 01/07/2011 - 13:38 — bgryfe

Exo to graft or not to graft

I find that if the socket is dry and with a poor blood flow, the graft has only a 50:50 chance of 75% or better bone level success. Even with using a #6 or #8 round bur to try and get some bleeding if it stays fairly dry, for some reason the integration is never as good as with a socket that is rich with blood and plasma. Tried PRP for a while and it didn't make much difference if the socket was already dry. In these cases if at all possible I place the implant immediately. I've placed them into palatal root sockets and mesial or distal sockets in molars as well and have been very succesful this way. I do like to place Bio-Oss or just about any of the xenografts or human denatured grafts with about the same success. Don't really notice that much difference as far as success with most sinus grafts as far as type of material I use. Back in the 80's and 90's I used to use Peri-Glass and even this worked well. Some of these implants are going on 20 years now in spite of what most speakers condemn as a material that never really integrates, but natural bone does form around the stuff and holds the implants well.

Sun, 01/09/2011 - 09:40 — shazlovely

Bleeding in the socket key to bone fill

Bgryfe you are correct, blood flow is key to bone fill in the socket I will frequently score the bone to stimulate blood flow in the socket.

Sun, 01/09/2011 - 09:52 — Mike Hollister DMD

Immediate or socket graft: Depends

If you have plenty of apical bone and can stabilize the implant I have no problem with an immediate implant.

Otherwise if the site is compromised I would graft with FDBA and calcium sulfate and wait 3-4 months.

Thu, 01/13/2011 - 19:48 — Dr. Wentkel

Graft the Socket: I use FDBA and MIS Bone bond Calcium sulfate

I think its best to graft and delay placement. Much more predictable. I use FDBA from CK Dental and Calcium Sulfate from MIS Bone Bond.

Sun, 01/16/2011 - 10:02 — Richard Hughes DDS

Graft the socket.

I agree with Dr. Wentkel. It is better to graft and develop a site that is easier and safer to implant. One can avoid a whole lot of problems by taking this approach.